Comparabilidad del autorrefractómetro portátil Retinomax K-plus 3 en modo rápido versus autorrefractómetro de sobremesa en modo estándar / Comparability of the Retinomax K-plus 3 handheld autorefractometer in quick mode versus on-table autorefractometer in standard mode

I ntroducción Este estudio analiza la comparabilidad de las medidas tomadas por un autorefractómetro portátil Retinomax K-plus 3 en modo Quick (rápido) y un autorrefractómetro de sobremesa Topcon KR-800 en modo estándar sobre la población pediátrica, y establece su correlación. Método Es un estudio comparativo retrospectivo. Se midieron las variables potencia dióptrica esférica (SPH), potencia dióptrica cilíndrica (CYL), ángulo del eje cilíndrico (AX) y equivalente esférico (SE) con el Retinomax en modo Quick y con el Topcon en modo estándar. Cada paciente fue evaluado en condiciones ciclopléjicas y no ciclopléjicas por ambos autorefractómetros. Se realizó la prueba t de Student entre ambos instrumentos para SPH, CYL y SE. Se calculó el coeficiente de correlación de Pearson y se representó la dispersión mediante gráficas de Bland-Altman, evaluándose también el subgrupo de pacientes menores de 4 años. Se realizó un análisis descriptivo de los porcentajes de medidas que diferían. Resultados Incluyó 98 ojos de 49 sujetos (rango de edad: 3-16 años). Los datos de SPH sin cicloplejia son prácticamente idénticos, mientras que con cicloplejia hay un sesgo hipermetrópico de +0,5 dioptrías medidas con Retinomax. Los resultados de CYL son muy similares con y sin cicloplejia. Existe una gran correlación de Pearson para ambos instrumentos (>0,91) y un bajo grado de dispersión en los gráficos de Bland-Altman bajo cicloplejia. Conclusión Los datos del Retinomax fueron consistentes con los obtenidos por el Topcon. El Retinomax es un instrumento útil para detectar errores de refracción en niños de entre 3 y 16 años (AU)

Introduction This study analyzes the comparability of measurements taken by a Retinomax K-plus 3 handheld autorefractometer in quick mode and a Topcon KR-800 on-table autorefractometer in standard mode on the pediatric population, and establishes their correlation. Methods It is a retrospective comparative study. Spherical diopter power (SPH), cylindrical diopter power (CYL), angle of cylindrical axis (AX), and spherical equivalent (SE) were measured with the Retinomax in quick mode and with the Topcon in standard mode. Each patient was evaluated in cycloplegic and non-cycloplegic conditions by both autorefractometers. Student's t-test was performed between the two instruments for SPH, CYL, and SE. The Pearson correlation coefficient was calculated and the dispersion was represented using Bland-Altman graphs, also evaluating the subgroup of patients under 4 years of age. A descriptive analysis of the percentages of measures that differed was performed. Results It included 98 eyes of 49 subjects (age range: 3-16 years). The data for HPS without cycloplegia are virtually identical, whereas with cycloplegia there is a hyperopic bias of +0.5 diopters measured with Retinomax. CYL results are very similar with and without cycloplegia. There is a high Pearson correlation for both instruments (>0.91) and a low degree of dispersion in the Bland-Altman plots under cycloplegia. Conclusion The Retinomax data were consistent with those obtained by Topcon. The Retinomax is a useful instrument for detecting refractive errors in children between 3 and 16 years of age (AU)

Corneal biomechanics and glaucoma beyond the bidirectional impact of intraocular pressure and corneal deformation response / Biomecânica corneana e glaucoma além do impacto bididirecional da pressão intraocular e da resposta da deformação corneana

ABSTRACT The purpose of this study was to highlight the impact of biomechanical corneal response in available in vivo tonometry methods for glaucoma management. Systematic review of non-contact air-puff tonometers that analyzes the corneal deformation response, with special focus on the investigation of the correlation of derived parameters with intraocular pressure measurements. The two actual and commercially available in vivo corneal tonometers provide promising information about biomechanical characteristics of the cornea and its relation to glaucoma, allowing the development of new protocols to evaluate, diagnose, and manage this disease.

RESUMO O objetivo deste estudo é destacar o impacto da resposta biomecânica corneana em métodos de tonometria in vivo disponíveis para o manejo do glaucoma. Trata-se de revisão sistemática de tonômetros de ar que analisa a resposta à deformação corneana, com foco especial na investigação da correlação dos parâmetros derivados com as medições da pressão intraocular. Os dois tonômetros mais recentes e comercialmente disponíveis fornecem informações promissoras sobre as características biomecânicas da córnea e sua relação com o glaucoma, permitindo o desenvolvimento de novos protocolos para avaliar, diagnosticar e controlar a doença.

Handheld fundus camera performance, image quality and outcomes of diabetic retinopathy grading in a pilot screening study.

PURPOSE: To compare the performance and image quality of the handheld fundus camera to standard table-top fundus cameras in diabetic retinopathy (DR) screening. The reliability and diagnostic accuracy of DR grading performed by an ophthalmologist and a photographer reader were evaluated. MATERIALS AND METHODS: 157 patients with diabetes, attending screening or follow-up of DR, were evaluated by fundus photographs taken in mydriasis by Optomed Aurora and Canon or Zeiss Visucam fundus cameras. The image quality and the severity of DR were evaluated independently by an ophthalmologist and experienced photographer. The sensitivity, specificity and reliability of the assessments were determined. RESULTS: 1884 fundus images from 314 eyes were analysed. In 53% of all eyes, DR was not present. 10% had mild non-proliferative diabetic retinopathy (NPDR), 16% moderate NPDR, 6% severe NPDR and 16% proliferative diabetic retinopathy (PDR). The DR grading outcomes by Aurora highly equalled to those of Canon or Zeiss (κ = 0.93, 95% CI 0.91 to 0.94), and there was almost perfect agreement in grading between the ophthalmologist and photographer (κ = 0.96, 95% CI 0.95 to 0.97). The image quality of Aurora was sufficient for reliable assessment according to both graders in 84-88% of the cases. CONCLUSION: The Optomed Aurora fundus camera seems appropriate for DR screening. The sufficient image quality and high diagnostic accuracy for DR grading are supportive for a less expensive and easily transportable screening system for DR. Immediate image grading carried out by a photographer would further improve and speed up the screening process in all settings.

Bulbar Redness and Dry Eye Disease: Comparison of a Validated Subjective Grading Scale and an Objective Automated Method.

SIGNIFICANCE: In this study, assessments of conjunctival redness were performed to evaluate whether patients with or without dry eye disease (DED) could be discriminated based on this measure. Our findings suggest that subjectively grading redness by quadrant, as opposed to automated en face measurements, may be more suitable for this purpose. PURPOSE: This study aimed to quantify bulbar redness using the validated bulbar redness (VBR) grading scale and an automated objective method (Oculus Keratograph 5M; K5M) in participants with DED and non-DED controls. METHODS: Participants with DED (Ocular Surface Disease Index score ≥20 and Oxford scale corneal staining ≥2) and controls (Ocular Surface Disease Index score ≤10 and corneal staining ≤1) attended two study visits. In part 1A of visit 1, baseline bulbar redness was graded with the VBR scale in each conjunctival quadrant of both eyes, followed by automated measurements of temporal and nasal redness with the K5M. This was immediately followed by part 1B, during which a topical vasoconstrictor was instilled into both eyes. Redness assessments were repeated 5 and 30 minutes after instillation with both instruments. Participants returned 14 days later for visit 2, where the same assessments as for visit 1A were repeated. RESULTS: Seventy-four participants (50 DED and 24 controls) completed the study. There were statistically significant differences in redness between the DED and control groups when assessed with the VBR scale (14/16 comparisons; all, P < .05), whereas no significant differences in K5M-derived redness between the DED and non-DED groups were found at any location or time point. Both subjective and objective instruments detected statistically significant reductions in redness 5 and 30 minutes after instillation of the vasoconstrictor (all, P < .01). CONCLUSIONS: Although both subjective and objective instruments were sensitive to detecting changes in redness induced by vasoconstriction, statistically significant differences in redness between DED and control groups were only found using the VBR scale.

Influence of Artificial Tears on Keratometric Measurements in Cataract Patients.

PURPOSE: To assess the influence of artificial tears of different viscosity on K-readings prior to cataract surgery. DESIGN: Prospective randomized crossover, before-and-after clinical study. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION: A total of 123 eyes of 80 patients prior to cataract surgery were assigned to 2 groups based on normal and dry eyes. INTERVENTION: Two native baseline keratometries were followed by instillation of either high- or low-viscosity eye drops. Keratometry was repeated 30 seconds, 2 minutes, and 5 minutes after instillation. MAIN OUTCOME MEASURES: Influence of eye drops of different viscosity in normal and dry eyes on short time K-readings. RESULTS: Repeatability between native baseline measurements was high (standard deviation = 0.02 mm in normal and in dry eyes). In normal and dry eyes, a statistically significant increase in measurement variability after instillation of both low-viscosity and high-viscosity eye drops was observed (P < .01). Measurement variability was most pronounced between baseline measurement and 30 seconds and diminished over time. Variability of K-readings appeared higher in dry eyes compared with normal eyes. Astigmatism changed more than 0.5 diopters in 13.2% of normal eyes and 34.4% in dry eyes using eye drops of high viscosity. CONCLUSION: Tear film-stabilizing eye drops prior to keratometry measurements influenced K-readings significantly, especially in dry eyes. A time period of more than 5 minutes should be allowed to pass after instillation of eye drops. The higher the viscosity of the eye drops, the stronger the influence and the longer its persistence.

Red reflex technique training simulator in newborns / Simulador para o treinamento da técnica do reflexo vermelho em recém-nascidos

Abstract: Introduction: The Red Reflex Test (RRT) consists of visualizing the reflection that light causes in the retina when it passes through the pupil. It is a screening test for pathologies that can lead to blindness, which still have great social and economic impact on families and the government. Teaching through simulators allows students and health professionals to acquire and improve their clinical skills. Objective: The aim of the study is to develop a low-cost dummy, 3D printed and based on the Arduino platform, for the training of the red reflex technique (RRT) in newborns and evaluate its educational effectiveness. Method: A RRT dummy was presented to 7 expert judges: 6 pediatricians and 1 ophthalmologist to evaluate its applicability in medical learning. For this purpose, they used a 14-item Likert scale of 5 points. Subsequently, 40 individuals participated in a course: 33 medical students, 5 pediatric residents, a nurse and a general physician. The participants were randomly assigned to two groups: control (CG) and experimental (EG) group. Each group consisted of 20 participants. The EG went through 4 stages: 1) theoretical background; 2) handling of the simulator; 3) simulated clinical practice and; 4) evaluation in real-life patients. Whereas the CG went through the following teaching methodological processes: 1) theoretical background; 2) direct training in real-life patients and; 4) practical evaluation in a real-life patient. After each respective group intervention, both groups were assessed on their learning in 40 newborns at Santa Casa de Misericórdia do Pará Foundation in Belém, state of Pará, Brazil. Results: At the judges' evaluation regarding the simulator positive items (design, similarity, interest, relevance, content, memorization, didactics, previous reminiscence, comprehension and application), 49.2% answered 'strongly agree' and 44.4%, 'agree'. Regarding the negative questions (difficulty in understanding, information overload, abstraction, difficulty in handling and clarity of operation), 40.0% answered 'strongly disagree', and 57.1%, 'disagree'. The judges were 94.9% favorable to the use of the simulator in medical education. However, comparing the two groups of students, regarding the time of exam, the results showed no statistically significant difference (p-value = 0.29). Conclusions: The dummy showed its applicability for the learning of RRT, with the advantage of being able to perform the exam without having to disturb a real-life patient.

Resumo: Introdução: O Teste do Reflexo Vermelho (TRV) consiste em visualizar o reflexo que a luz causa na retina ao passar pela pupila. Dessa forma, o TRV tria patologias que levam à cegueira e pode reduzir o impacto social e econômico das famílias e do governo. O ensino por meio de simuladores permite que estudantes e profissionais de saúde adquiram e melhorem as habilidades clínicas. Objetivos: Este estudo teve como objetivos desenvolver um manequim de baixo custo, impresso em 3D e baseado na plataforma Arduino, para o treinamento do TRV em recém-nascidos e avaliar a eficácia educacional desse exame. Métodos: Um manequim do TRV foi apresentado a sete juízes especialistas - seis pediatras e um oftalmologista - que avaliaram a aplicabilidade do teste na aprendizagem médica. Para isso, utilizaram a escala Likert de 14 itens de 5 pontos. Posteriormente, 40 participantes participaram de um curso: 33 estudantes de Medicina, cinco residentes em pediatria, uma enfermeira e um médico generalista. Dividiram-se aleatoriamente os participantes em dois grupos: controle (GC) e experimental (GE). Cada grupo foi composto por 20 participantes. Submeteu-se o GC ao ensino convencional em pacientes reais. O GE passou por quatro etapas: 1. fundamentação teórica, 2. manipulação do simulador, 3. prática clínica simulada e 4. avaliação nos pacientes reais. No GC, adotaram-se os seguintes passos: 1. fundamentação teórica, 2. treinamento direto em pacientes reais e 3. avaliação em pacientes reais. Após a intervenção de cada grupo, os dois grupos foram avaliados quanto à aprendizagem em 40 recém-nascidos da Fundação Santa Casa de Misericórdia do Pará, em Belém, no Pará. Resultados: Na avaliação dos juízes em relação aos itens positivos para o simulador (design, similaridade, interesse, relevância, conteúdo, memorização, didática, reminiscência anterior, compreensão e aplicação), 49,2% afirmaram que concordavam fortemente e 44,4% mencionaram apenas que concordavam. Nas questões negativas (dificuldade de entendimento, sobrecarga de informação, abstração, dificuldade de manuseio e clareza de operação), 40,0% discordaram fortemente e 57,1% discordaram. Os juízes concordaram em 94,9% a favor do uso do simulador na educação médica. Porém, comparando os dois grupos de estudantes, em relação ao tempo de exame, os resultados não mostraram diferença estatisticamente significante (p = 0,29). Conclusão: O manequim mostrou aplicabilidade na aprendizagem do TRV, com a vantagem de realizar o exame sem que o paciente real fosse incomodado.

Anisocoria assessment in subjects with dark irides - Custom-built infrared screening device vs. millimeter ruler / Evaluación de anisocoria en sujetos con iris oscuros - Dispositivo de cribado mediante infrarrojos hecho a medida vs regla milimetrada

PURPOSE: Detection of anisocoria in those with dark irides is difficult, and failure to detect anisocoria can have dire consequences. Whether infrared pupillometry and gross measurement would yield different prevalence rates for anisocoria in those with dark irides is unknown. We compared the frequency of anisocoria in healthy adults with dark irides assessed with mm ruler versus infrared pupillometry. METHODS: Pupil diameters in light (L) and dark (D) conditions were obtained to identify anisocoria in 59 human subjects with dark irides using two techniques. To avoid bias, gross measurements (S) with ruler were taken first. Pupils were imaged under infrared illumination mounted in a spectacle frame with mm tape attached. Adobe Photoshop was used to measure pupil sizes on the digital images (O). RESULTS: Proportions of anisocoria by group were SL .034, OL .130, SD 0.00, OD .135. Fisher's exact test showed that anisocoria in dim light was more frequent with the infrared photo technique. Exact binomial probability testing showed that the anisocoria in SL and SD conditions was not different from an expected proportion of 5%; whereas anisocoria in OL condition was not different from an expected proportion of 20%, and anisocoria in OD condition was not different from expected proportions of 10, 15, and 20%. CONCLUSIONS: In people with dark irides, ruler measurements of pupil size underestimate the frequency of anisoria in dim lighting conditions compared to the use of infrared pupillometry. Whether detection rates of pathologic anisocoria differ with measurement technique remain to be explored

OBJETIVO: La detección de anisocoria en los sujetos con iris oscuros es difícil, y la falta de detección puede tener consecuencias nefastas. Se desconoce si la pupilometría de infrarrojos y la medición en bruto arrojarían diferentes tasas de prevalencia de anisocoria en los sujetos con iris oscuros. Comparamos la frecuencia de anisocoria en adultos sanos con iris oscuros, valorados con regla en mm versus pupilometría de infrarrojos. MÉTODOS: Se obtuvieron los diámetros de la pupila en los iris claros (L) y oscuros (D) para identificar la anisocoria en 59 sujetos con iris oscuros, utilizando dos técnicas. Para evitar sesgos, se realizaron en primer lugar las medidas brutas (S) con la regla. Las pupilas se fotografiaron mediante un sistema de iluminación de infrarrojos montado en gafas con cinta en mm anexa. Se utilizó Adobe Photoshop para medir los tamaños de las pupilas en las imágenes digitales (O). RESULTADOS: Las proporciones de anisocoria por grupo fueron SL 0,034, OL 0,130, SD 0, OD 0,135. La prueba exacta de Fisher reflejó que la anisocoria con luz tenue era más frecuente con la técnica de fotografías de infrarrojos. La prueba de probabilidad binómica exacta reflejó que la anisocoria en las situaciones de SL y SD no era diferente a la proporción prevista del 5%, mientras que la anisocoria en la situación OL no era diferente a la proporción prevista del 20%, y la anisocoria en la situación OD no era diferente a las proporciones previstas del 10, 15, y 20%. CONCLUSIONES: En las personas con iris oscuros, las mediciones del tamaño de la pupila realizadas con regla subestimaron la frecuencia de anisocoria con luz tenue, en comparación con el uso de pupilometría de infrarrojos. Queda por explorar si las tasas de detección de anisocoria patológica difieren con la técnica de medición

Agreement analysis / Análisis de concordancia

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Reply to: "Agreement analysis" / Respuesta a: "Análisis de concordancia"

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Melanin concentration and depolarization metrics measurement by polarization-sensitive optical coherence tomography.

Imaging of melanin in the eye is important as the melanin is structurally associated with some ocular diseases, such as age-related macular degeneration. Although optical coherence tomography (OCT) cannot distinguish tissues containing the melanin from other tissues intrinsically, polarization-sensitive OCT (PS-OCT) can detect the melanin through spatial depolarization of the backscattered light from the melanin granules. Entropy is one of the depolarization metrics that can be used to detect malanin granules in PS-OCT and valuable quantitative information on ocular tissue abnormalities can be retrived by correlating entropy with the melanin concentration. In this study, we investigate a relationship between the melanin concentration and some depolarization metrics including the entropy, and show that the entropy is linearly proportional to the melanin concentration in double logarithmic scale when noise bias is corrected for the entropy. In addition, we also confirm that the entropy does not depend on the incident state of polarization using the experimental data, which is one of important attributes that depolarization metrics should have. The dependence on the incident state of polarization is also analyzed for other depolarization metrics.

Use of 'U-shaped tool for follow up of corneal ulcer cases in the COVID-19 pandemic.

To describe a smartphone-based telemedicine tool for monitoring of corneal ulcer size during the corona pandemic, a simple "U"-shaped tool was constructed using three Schirmer's strips that were provided to the patients with small to medium-sized corneal ulcers. The patient and the attendant were trained to use this simple U-shaped tool at home and send digital images to the treating ophthalmologist, to monitor the course of the ulcer. The tool was used in five eyes of five patients with active microbial keratitis. Patients were followed up regularly with the use of telemedicine facility every 48 h for an average duration of 7.6 days (range 6-9 days). In all the five eyes, assessment of the serial images with U-shaped tool showed decrease in size of corneal ulcer, which corroborated with subjective improvement in symptoms. Hence, the novel "'U'-shaped tool" may provide an effective measure in following-up of corneal ulcer patients in times of the COVID-19 pandemic, obviating frequent hospital visits and risk of contracting COVID.

Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases.

BACKGROUND: A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases. METHODS: A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists. RESULTS: A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera. CONCLUSION: This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.

Smartphone-Based Fundus Imaging-Where Are We Now?

With the advent of smartphone-based fundus imaging (SBFI), a low-cost alternative to conventional digital fundus photography has become available. SBFI allows for a mobile fundus examination, is applicable both with and without pupil dilation, comes with built-in connectivity and post-processing capabilities, and is relatively easy to master. Furthermore, it is delegable to paramedical staff/technicians and, hence, suitable for telemedicine. Against this background a variety of SBFI applications have become available including screening for diabetic retinopathy, glaucoma, and retinopathy of prematurity and its applications in emergency medicine and pediatrics. In addition, SBFI is convenient for teaching purposes and might serve as a surrogate for direct ophthalmoscopy. First wide-field montage techniques are available and the combination of SBFI with machine learning algorithms for image analyses is promising. In conclusion, SBFI has the potential to make fundus examinations and screenings for patients particularly in low- and middle-income settings more accessible and, therefore, aid tackling the burden of diabetic retinopathy, glaucoma, and retinopathy of prematurity screening. However, image quality for SBFI varies substantially and a reference standard for grading appears prudent. In addition, there is a strong need for comparison of different SBFI approaches in terms of applicability to disease screening and cost-effectiveness.

Medical legal validity of the use of the anomaloscope in the dyschromatopsia of aspiring civil and military aircraft pilots.

Color blindness is a condition of altered color perception, scientifically defined as "dyschromatopsia". Color blindness affects 8% of the world population. Color blindness is caused by an alteration of the cones that influences the vision of the color self (red, green, blue). A comparative study was conducted in dischromatopsic subjects identified during the course of the ordinary investigations directed towards the civil aero-navigating personnel by the Ophthalmology Department of the Air Force, between March 2019 and January 2020, at "Aldo Di Loreto" Institute of Aeronautical and Space Medicine of Rome. 10 subjects aged 20 to 50, with dyschromatopsia found at Ishihara's pseudoisochromatic tables, were submitted to Oculus HMC-Anomaloscope with a manual execution program and then a CAD test. Thus, in 2 out of 10 cases of dyschromatopsia, the Anomaloscope would have guided the medical judgement, while the CAD test would have oriented towards a judgment of full fitness despite the same lack of chromatic sensitivity however, underlined by both tests. In conclusion, the CAD test confirmed a highly sensitive and specific method of determining the presence and depth of the chromatic perception deficit but also the method was able to prevent the unjust refusal of certain air navigation activities to the aspirant staff.

Evaluación y tratamiento del glaucoma durante las 24 horas del día. ¿Dónde estamos y hacia dónde vamos? / Evaluation and treatment of glaucoma 24hours a day. Where are we and where are we going?

El manejo actual del glaucoma implica de forma general tratamiento tópico médico, tratamiento láser y cirugía con el objetivo de controlar las cifras de presión intraocular, y evitar así la progresión de la enfermedad. A pesar de que el seguimiento de los pacientes con glaucoma suele realizarse con tomas de medidas de presión intraocular esporádicas y aisladas, la literatura ya indica que quizá esta no es la mejor forma de manejar esta enfermedad. Este artículo revisa la importancia de la monitorización de la presión intraocular durante las 24 horas del día basándose en estudios y publicaciones que existen al respecto hasta la fecha. De forma crítica se repasa la metodología de estas publicaciones, y la necesidad de estudiar más en detalle los cambios de presión intraocular en los diferentes tipos de glaucoma y con las diferentes terapias que usamos en glaucoma para optimizar el manejo de la enfermedad

Current management of glaucoma generally involves medical, laser, or surgical treatment in order to achieve an intraocular pressure (IOP) control which is commensurate with either stability or delayed progression of the disease. Although the follow-up of glaucoma patients is usually carried out with sporadic and isolated intraocular pressure measurements, the literature already indicates that this might not the best option to manage glaucoma patients. This article reviews the importance of 24 hours intraocular pressure monitoring based on studies and publications that exist in this regard to date. A critical review on the methodology of these publications has been conducted. The need is stressed for further studies on the intraocular pressure patterns in different types of glaucoma, as well as the pattern with different therapies used in glaucoma aimed at optimising the management of the disease

A Comparison of Lower Eyelid Retraction in Normal Individuals with Positive versus Negative Orbital Vector.

PURPOSE: The present study aimed to compare lower eyelid retraction (LER) in individuals with a positive orbital vector with that of individuals with a negative orbital vector. MATERIALS AND METHODS: This cross-sectional study was conducted on 123 normal individuals including 64 men and 59 women aged 20-80 years. After the individuals underwent Hertel exophthalmometry, two side-view and front-view photos were taken using a camera. The orbital vector angle and the extent of scleral show were then measured in millimeter, using the Photoshop software. Eventually, the recorded data were analyzed through statistical software. RESULTS: The findings of this study showed that LER has a significant correlation with orbital vector angle and the extent of proptosis (P < 0.05). The mean value of orbital vector angle in individuals without LER was 9.76°, while this figure was calculated to be - 13.65° in individuals with LER. The mean protrusion value based on Hertel exophthalmometry was 14.08 mm in individuals without LER and 16.27 mm in individuals with LER. The extent of scleral show had a significant correlation with proptosis and orbital vector angle (P = 0.01), with a mean value of - 0.41 mm in individuals without LER and 0.94 mm in participants with LER. CONCLUSIONS: The prevalence of LER and scleral show is positively correlated with the extent of proptosis and negatively correlated with orbital vector angle.