Goldmann Applanation Tonometry: Using a Red-Free Filter for Mass Screening

Letter/No abstrac

Goldmann Applanation Tonometry: Using a Red-Free Filter for Mass Screening

Letter/No abstrac

Sensitivity and Specificity of Swedish Interactive Threshold Algorithm and Standard Full Threshold Perimetry in Primary Open-angle Glaucoma

Perimetry is one of the mainstays in glaucoma diagnosis and treatment. Various strategies offer different accuracies in glaucoma testing. Our aim was to determine and compare the diagnostic sensitivity and specificity of Swedish Interactive Threshold Algorithm (SITA) Fast and Standard Full Threshold (SFT) strategies of the Humphrey Field Analyzer (HFA) in identifying patients with visual field defect in glaucoma disease. This prospective observational case series study was conducted in a university-based eye hospital. A total of 37 eyes of 20 patients with glaucoma were evaluated using the central 30-2 program and both the SITA Fast and SFT strategies. Both strategies were performed for each strategy in each session and for four times in a 2-week period. Data were analyzed using the Student’s t-test, analysis of variance, and chi-square test. The SITA Fast and SFT strategies had similar sensitivity of 93.3%. The specificity of SITA Fast and SFT strategies was 57.4% and 71.4% respectively. The mean duration of SFT tests was 14.6 minutes, and that of SITA Fast tests was 5.45 minutes (a statistically significant 62.5% reduction). In gray scale plots, visual field defect was less deep in SITA Fast than in SFT; however, more points had significant defect (p < 0.5% and p < 1%) in pattern deviation plots in SITA Fast than in SFT; these differences were not clinically significant. In conclusion, the SITA Fast strategy showed higher sensitivity for detection of glaucoma compared to the SFT strategy, yet with reduced specificity; however, the shorter test duration makes it a more acceptable choice in many clinical situations, especially for children, elderly, and those with musculoskeletal diseases

Long-term Outcomes of Collagen Crosslinking for Early Keratoconus

Purpose: To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods: Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery. Results: The patients’ mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P < 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow-up (P = 0.92). No considerable difference was found between the post- and preoperative mean objective cylinder values (P = 0.34). The mean subjective cylinder value changed significantly from –4.05 ± 1.85 D preoperatively to –3.1 ± 1.42 D at the final follow-up (P < 0.05). The mean central corneal thickness was 496.97 ± 45.95 μm preoperatively and this value was stable at nine-year follow-up (P = 0.183). No significant difference was found between the pre- and postoperative mean maximum and mean minimum corneal curvature values (P = 0.429 and P = 0.248, respectively). There were no significant postoperative complications. Conclusion: Corneal crosslinking in early keratoconus seems to be a safe procedure that can effectively stabilize UCVA, BSCVA, subjective SE and CCT, while improving objective spherical equivalent

Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose: To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs). Methods: In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items. Results: The mean patients’ age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001). Conclusion: Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision

Fourier Analysis of Keratometric Data in Epithelium Removal versus Epithelial Disruption Corneal Cross-linking

Purpose: To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes. Methods: In this double-masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period. Results: Patients’ mean age was 23.3 ± 3.6 years. The preoperative thickness of the thinnest point was 459.20 ± 37.40 μm and 455.80 ± 32.70 μm in the epithelium removal and epithelial-disruption CXL groups, respectively (P = ?). The corresponding figures were 433.50 ± 33.50 μm and 451.90 ± 39.70 μm, respectively, six months after the treatment (P = 0.0001). The irregularity component was 0.030 ± 0.016 μm in the epithelium-removal group and 0.028 ± 0.011 μm in the epithelium-disruption group preoperatively (P = ?). This measurement was 0.031 ± 0.016 μm and 0.024 ± 0.009 μm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P > 0.05). Conclusion: This study shows that epithelium-disruption CXL is superior to epithelium removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques within the six-month follow-up period

Cycloplegic Effects on the Cylindrical Components of the Refraction

It is important to predict which astigmatic patients require separate refraction for near vision. This study compared cylindrical components changes by cyclopentolate 1% for the low and high amount of astigmatism. The right eyes of 1014 healthy individuals (307 males and 707 females) with cylindrical refractive power more than −0.5 diopter on autorefractometer were selected. Both male and female patients in the age range of 17–45 years were refracted before and after cycloplegia, using 1% cyclopentolate. All volunteers were classified into 2 subgroups including the lower astigmatism group (−2.25 to −0.50) and the higher astigmatic group (−2.50 to over). Alpines’ method was used to compare the effect of cycloplegic drop on cylindrical power. The mean age in the lower astigmatism group (29.58; 95% CI: 29.18 to 29.99 years) was not significantly different from the higher astigmatic group (29.85; 95% CI: 29.07 to 30.62) and there were no significant differences in gender between these two groups (P=0.54). Differences between wet and dry refraction in J0 (−0.03; 95% CI:−0.06 to −0.008) and J45 (−0.03; 95% CI:−0.06 to −0.01) were significant only in the higher astigmatic group. Axis changes by the cycloplegic drop in the lower astigmatism group were 3.51 (CI: 3.22 to 3.81) and axis changes by the cycloplegic drop in the higher astigmatism group were 2.21 (CI: 1.73 to 2.49). In patients with a lower amount of astigmatism (−2.25 to −0.50), additional near subjective refraction could be done for precise determination of axis and in patients with a higher amount of astigmatism (−2.50 to over), near subjective refraction might be done for precise determination of power

Common Causes of Visual Impairment Among Sixth Grade Students in Boyer Ahmad city

Background: In line with the implementation of primary health care, Knowing the factors causing visual impairment is very helpful among children and students among population of each district. That's why in this study, we intend to study common causes of visual impairment in sixth grade elementary students in Boyer Ahmad city and we compared the results with similar studies. Materials and Methods: 1850 of 4427 sixth grade elementary students selected by Cluster sampling method in 2016-17 and they examined by linear snellen chart in the respective schools in 6 meters distance. Abnormal individuals were referred to specialized centers of Ophthalmology to determine the cause of decreased vision and they examined completely by an ophthalmologist. Results: In the initial screening, of 1850 people examined, 168 students (9.1%) known abnormal based on basic view of 0.8 and they were referred to specialized clinic for specialist examination. of these, 95 students reffered to ophthalmologist. In specialist examination, 70 students (8.3% of total examined patients) were visually impaired which the most important were Refractive Errors(3.84%), Amblyopia(2.3%) and Strabismus(0.19%). 38% of amblyopia was refractive errors. Of total number referred to an ophthalmologist, 26.3% of people were malingering which including 2.35% of general population.   Conclusion: Refractive errors was known as the most common cause of visual impairment and Amblyopia in the study group. As for to diagnosis simplicity and treatment of refractive errors we can dramatically reduced the prevalence of amblyopia and we also can reduce the incidence of malingering through cultural measures by the Broadcasting of Province

Candida albicans endophthalmitis following penetrating keratoplasty: A case report

Endophthalmitis is one of the most serious complications of intraocular surgeries, and Candida albicans constitutes the majority of cases of post penetrating keratoplasty (PK) endophthalmitis. The presenting case is a 21-year-old woman with known case of advanced keratoconus and vernal keratoconjunctivitis who underwent PK, and developed recalcitrant anterior uveitis and subsequent whitish lesion on the superonasal of the lens. She was on topical steroids with possible impression of Uretts Zavalia syndrome versus phacoantigenic uveitis following traumatic cataract up to the 50th day of post operation that manifested symptoms of frank endophthalmitis; and underwent deep vitrectomy, lensectomy, localized iridectomy and irrigation with diluted Imipenem and Amphotericin-B. Microbiologic study of a vitreous sample revealed growth of Candida albicans, however optisol culture was negative and donor rim was not evaluated. One week later, intravitreal Amphotericin-B was administered. The patient remained aphakic with clear graft in the 6th month follow up. Due to great correlation of positive donor rim culture with fungal endophthalmitis and the devastating effect of delayed diagnosis, routine donor rim culture is recommended, to aid us in earlier diagnosis in the presence of nonspecific early signs of fungal endophthalmitis