Assessment of quality of life in glaucoma patients in a tertiary care center in Eastern India.

Purpose: The aim of this study is to assess the quality of life (QOL) in glaucoma patients and find out the sociodemographic factors predicting QOL. Methods: A cross-sectional study was conducted in a tertiary care center from August 2021 to February 2022. Subjects diagnosed with glaucoma for at least 6 months were enrolled. After taking informed consent, demographic details and detailed history were collected for all patients. Comprehensive eye examination (visual acuity, intraocular pressure, gonioscopy, fundoscopy, visual field assessment, ocular coherence tomogram assessment) was done for all and they were asked to fill the WHOQOL-BREF questionnaire. Data were collected and analyzed using SPSS 21. Results: One hundred and ninety-nine patients were recruited. Mean age of participants was 57.99 ± 10.76 years. Based on various domains and subgroups, QOL values were significant with respect to income (P = 0.016). Gender-wise QOL in females was lower than that of males with respect to all the domains (P = 0.001). While marital status affected both environmental and social domain, literacy affected only the social domain. A variation in intraocular pressure affected the QOL in the psychological domain. QOL was not significantly associated with the severity of the disease. Gender was the most predominant predictor out of all sociodemographic factors. Conclusion: Chronic diseases affect the QOL of individuals in many ways. Glaucoma being a chronic disease hampers patients' vision irreversibly and by extension the various physical, social, and psychological aspects of the patient's life as well. Hence, knowledge of the change in QOL it brings about can help plan the treatment, counseling, and management of these patients.

Challenges in managing glaucoma-related morbidity due to lockdown in a developing country.

Objective: The aim of this study was to assess the ocular morbidity due to delayed presentation in glaucoma patients because of COVID lockdown. Methodology: This was a retrospective study of 15 cases presented to us between October 2020 and February 2021. Cause of glaucoma in our study group was either primary angle closure, pseudoexfoliation, lens-induced glaucoma, or neovascular glaucoma. The cause of delayed presentation was identified and patients were treated with antiglaucoma medications, Nd-Yag laser, and surgery as per the standard treatment protocol. Results: With both medical and surgical intervention, some useful vision was restored in five cases while in rest it was not salvageable. The vision in the affected eye ranged from 6/60 in Snellen's chart to perception of light and projection of rays positive. Better results were achieved in angle, closure, and lens-induced glaucoma cases as compared to neovascular glaucoma cases. Conclusion: The time of presentation in such cases is as important as the etiopathogenesis. We are left with limited treatment options if the presentation is late. The lockdown ended but it unraveled quite a few instances of disease presentation which were totally preventable under normal circumstances. Introspection on finding out newer and proactive methods to reach people suffering from such irreversible but preventable diseases is the need of the day especially when preventable but irreversible diseases like glaucoma are considered.

Structural changes in retina (Retinal nerve fiber layer) following mild traumatic brain injury and its association with development of visual field defects.

BACKGROUND: Mild traumatic brain injury (mTBI)is the most common form of traumatic brain injury accounting for 70-80% of all brain injuries annually. There is increasing evidence that long lasting morphological and functional consequence can be present in visual system following mTBI. Among all the visual manifestation, awareness of Visual field defects is important because it may compromise the social, personal or professional life of any individual. Retinal structural changes such as thinning of Retinal nerve fiber layer (RFNL)captured using optical coherence tomography have emerged as a possible biomarker in many neurological diseases however very little is known in cases with mTBI OBJECTIVE: (I) To demonstrate the structural changes/morphological changes in retina if any following mTBI. (II) Whether the structural changes in retina have any association with the development of Visual field deficits leading to Visual function impairment following mTBI (III) Clinical relevance of structural changes in retina as a possible biomarker for visual function impairment due to visual field deficits. MATERIALS AND METHODS: Our study included 60 patients with mTBI who fulfilled the inclusion criteria. All patients underwent a detailed ophthalmic evaluation with special focus on temporal recording of Retinal nerve layer thickness using SD- Optical Coherence Tomography and Visual field (Visual field Index) by Humphrey Automated Field Analyser. RESULTS: 30% of eyes had significant thinning of RFNL (> 30% of the base line thickness) at 6 months following mTBI. Visual function impairment due to visual field deficits (VFI < 80%) at 6 months was seen in 40% of the eyes. The structural changes and visual function impairment peaked at 6 months' post injury. A strong Association was noted between RFNL thinning and manifestation of Visual field deficits (VFI < 80%) leading to visual function impairment (P < 0.001). The Correlation Co-efficient between thinning of RFNL and Visual field deficits had a positive correlation(p < 0.001). CONCLUSION: This novel study has demonstrated that visual functional impairment due to Visual field deficits is a real possibility following mTBI. Monitoring of retinal parameter such as thinning of Retinal nerve fiber layer, using Optical coherence tomography, can be a biomarker for early detection or development of visual field defects in mTBI.

Angle Closure with Patent Laser Peripheral Iridotomy - An Unusual Complication.

A 41-year-old female presented with diminished vision in both eyes with recurrent episodes of pain, redness, and watering. With a provisional diagnosis of primary angle-closure glaucoma in the left eye and primary angle closure in the right eye, anti-glaucoma medications were started in the left eye and laser peripheral iridotomy was done in both eyes. Follow-up showed patent iridotomy in both eyes and dilated fundoscopy revealed total cupping in the left eye. Next day, the patient had angle closure in the right eye. On medical management, symptoms subsided but intraocular pressure (IOP) was still raised. Right eye trabeculectomy with cataract surgery was done. Vision was restored to 6/9 with IOP of 12 mmHg after 2 weeks. The event was considered to be precipitated because of plateau iris configuration which is an anatomical variant of angle in angle-closure patients. This proves patent laser iridotomy is not always a ticket to dilatation and one should be aware of all possible complications.

The Onset and Recovery Timeline of Visual Photosensitivity Following Mild Traumatic Brain Injury with Special Focus on Habitual Digital Device Screens Users.

PRIMARY OBJECTIVE: Visual photosensitivity following mild traumatic brain injury (mTBI) can cause mild discomfort to significant pain and can affect a person's ability to lead a regular life and perform normal activities. The purpose of the present study is twofold: (1) To determine the recovery pattern of visual photosensitivity following mTBI and (2) to find out whether the onset of visual photosensitivity and its recovery pattern is any different among habitual screen users (HSU) (chronic exposure to digital device screens). MATERIALS AND METHODS: This study was a hospital-based prospective, analytical, observational study. The study period was from July 2017 to March 2019. All the mTBI patients with visual photosensitivity who fulfilled the inclusion Criteria were followed up for 1 year to capture their recovery profile. RESULTS: In 60% of the patients, the time of appearance of visual photosensitivity was at around 3 month's post-mTBI. Nearly 66.6% of patients suffering from visual photosensitivity following mTBI recovered within 3 months following the onset of their symptoms. The symptoms of visual photosensitivity appeared earlier among the HSU as compared to nonscreen users (P = 0.0039). The recovery from the symptoms of visual photosensitivity following mTBI is delayed in HSU (P = 0.0028). The patients in whom the symptoms of visual photosensitivity persisted beyond a year were predominantly HSU (P = 0.0062). CONCLUSIONS: The present study has given a new insight on the timeline of recovery for the patients with visual photosensitivity following mTBI. To the best of our knowledge, this is the only study which has shown how chronic exposure to blue light from digital device screens can affect the recovery of visual symptoms such as visual photosensitivity following mTBI.