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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 11 | Issue 1
Page Nos. 1-33

Online since Thursday, October 10, 2019

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REVIEW ARTICLE  

Strategies in myopia prevention and management p. 1
Yazan Sultan Gammoh
DOI:10.4103/sjopthal.sjopthal_12_19  
It has been estimated that more than half of the population residing in the Eastern Mediterranean region (EMR) will have myopia by 2050. With recent evidence from the EMR revealing that myopia is becoming more prevalent in children and presenting at a younger age than seen before, it is of importance to investigate the strategies employed in myopia control. Various intervention strategies have been investigated in the last few years including optical, pharmacological, and environmental modification methods. Spectacle-based strategies including use of bifocal lenses and progressive addition lenses (PALs) have been shown to be the least successful in reducing the progression of myopia. However, the use of such lenses provides better myopia control than prescribing single-vision lenses or under-correcting, which may increase myopia progression. Since many practitioners in the region are only allowed to prescribe and fit spectacles, the use of bifocals and PALs should not be neglected. Multifocal contact lenses and orthokeratology have proven to be successful clinically in the management of myopia. However, cost and limited availability of these lenses in the region are barriers for the use of these lenses by EMR practitioners. Use of atropine has been shown to be effective in controlling myopia progression. With the limited scope of practice regarding the use of diagnostic drugs by optometrists, there is need for advocating to allow optometrists to use ocular diagnostics such as atropine. In addition, limited availability of low-dose atropine limits the use of atropine as a myopia control strategy. It has been shown that spending more time outdoors acts as a preventive mechanism against the development of myopia. With evidence from studies on children from the region indicating more near work and reduced outdoor time as risk factors for myopia, it is imperative to educate parents and teachers for the need to increase time outdoors.
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ORIGINAL ARTICLES Top

Role of inheritance and causes of childhood blindness: A multicenter study in Sudan p. 8
Abdelaziz Mohamed Elmadina, Nuha Mohamed Fath Elrahman, Muhammad Ijaz Ahmad, Manzoor Ahmad Qureshi, Mohamed El Hassan Elawad, Abrar Ahmad Bhatti
DOI:10.4103/sjopthal.sjopthal_10_19  
Aim: This study aims to study the causes of childhood blindness (CB), the impact of consanguineous marriage, and the role of inheritance. Methods: This was a cross-sectional observational study conducted in Khartoum State at Sudanese National Association of the Blinds, Alnoor Institute and Umbada Center for the Blinds. Individuals whose visual acuity was 3/60 or less were registered as blind since birth were included in the study.Demographic data and history, Snellen, visual acuity test, both subjective and objective refraction, and a questionnaire were used to assess the family history of blindness and parents' relationship. Results: Infantile blindness was found greater (75.8%) in Sudanese male than females (24.2%) population; (χ2 = 32.03, P = 0.000). Most of the participants' age (62.5%) was <5 years (χ2 = 7.5, P = 0.006) and ranged between 8 and 42 with a mean of 23.1 ± 8.1-year-old. The most frequent causes of infantile blindness were found to be congenital cataract (28.3%), corneal abnormalities (28.3%), optic nerve defects (27.5%) followed by retinal abnormalities (5.83%) and structural abnormalities (3.33%); however, 6.67% of the participants were without obvious ocular anatomical defects (χ2 = 56.5, P = 0.000). Most of the participants (69.2%) showed a positive family history of blindness (χ2 = 17.63, P = 0.000) and in 92.6% of the participants, the parents were related to each other (71.7% had 1st degree cousins; 9.2% 2nd degree cousins; 11.7% far relationship, (χ2 = 139.8, P = 0.000).Inherited factors were found in 65% of participants who were born blind (49.2% autosomal recessive, 5% autosomal dominant, 10.8% Xlinked whereas 35% were isolated cases, (χ2 = 61.67, P = 0.000). Conclusion: Most of the causes of CB are avoidable or preventable. Structured strategies should be developed for screening, referring, and early diagnosis with genetic analysis awareness among communities.Inherited disorders are still counted as significant causes among CB group. Raising health risks of consanguineous marriage might well help in avoidance of such blindness. However, screening, early detection, and rehabilitation programs will reduce the harm of such causes in children.
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Dry eye disease and tear dysfunction in patients with type 2 diabetes: A hospital-based study from South India p. 14
K Divya, N Dhivya, M Raaja Ganesh, D Sundar
DOI:10.4103/sjopthal.sjopthal_4_19  
Purpose: Diabetics are more prone to dry eye disease (DED) and tear film dysfunction. The aim of this study was to assess the frequency of DED and tear film abnormalities in patients with type 2 diabetes compared to healthy controls. Materials and Methods: This was a hospital-based prospective case-control study. One hundred patients with type 2 diabetes and 100 healthy controls were enrolled by consecutive sampling. All study participants completed the Ocular Surface Disease Index (OSDI) questionnaire to score dry eye symptoms. Tear film breakup time (TFBUT), ocular surface staining with fluorescein and Schirmer's test were performed, and results were analyzed. Student's t-test was applied for comparisons between groups. Correlation between variables was detected using Pearson's correlation coefficient. Statistical significance was set at P < 0.05. Results: Dry eye was encountered in 54 among the 100 diabetic patients studied. Age and sex of diabetic patients were not found to affect the dry eye status. Longer duration of diabetes was significantly associated with DED (P = 0.03). Significant differences in OSDI scores, TFBUT, fluorescein staining, and Schirmer's test values were observed between the study groups (P < 0.001). An increased level of glycosylated hemoglobin was significantly associated with abnormal tear function tests. Conclusion: Patients with longer duration of diabetes and poor glycemic control are more predisposed to have abnormalities of the tear film and DED. Apart from conventional therapies, optimal glycemic control should be an important consideration in the management of tear dysfunction in diabetic patients.
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Retinal nerve fiber layer and visual field changes in patients undergoing trabeculectomy at Sub-Himalayan Region p. 19
Yashpal Sharma, Vinod Sharma, Kalpana Sharma, ML Pandey
DOI:10.4103/sjopthal.sjopthal_5_19  
Introduction: Glaucoma constitutes a group of multifactorial optic neuropathies with changes in intrapapillary and parapapillary regions of optic nerve head and retinal nerve fiber layer (RNFL). Optical coherence tomography (OCT) measurement of peripapillary RNFL thickness may be the best among the currently available digital imaging instruments for detecting and tracking optic nerve damage in glaucoma. Objective: Analyzing changes in RNFL and visual field (VF) before and after trabeculectomy. Materials and Methods: The RNFL measurement using Topcon 3D OCT and VF assessment with Octopus 900 perimeter of 27 patients undergoing trabeculectomy were done at 1 week preoperatively and 1 week, 1 month, and 3 months postoperatively. Results: All the four RNFL quadrants showed improvement in thickness which was either numerically or statistically significant. In the VF analysis, the mean sensitivity (MS) was 8.73 ± 4.5493 at 1 week preoperatively. The mean value for MS at 3rd month was 9.859 ± 5.5606 (P = 0.043). Statistically significant improvement was observed at 3rd month postoperatively. The mean deviation observed within 1 week preoperative period was 19.044 ± 4.6111. The mean value was 18.26 ± 5.164 (P = 0.003) at 1 month. The mean value came equal to 17.926 ± 5.4928 (P = 0.012) at 3rd month. Statistically significant improvement was observed postoperative follow-up period. Conclusion: The vision in patients of primary open angle glaucoma can be restored through early detection of glaucoma by OCT and perimetry. As there is improvement in RNFL thickness and global indices of VF in patients undergoing trabeculectomy, further visual deterioration can be avoided.
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A study for the assessment of central corneal thickness and visual field defects in patients of primary open-angle glaucoma p. 25
Richa Dhiman, Gaurav Sharma, Mandeep Tomar, Mitasha Singh
DOI:10.4103/sjopthal.sjopthal_7_19  
Purpose: The aim of this study is to assess the central corneal thickness (CCT) and visual field (VF) changes in patients of primary open-angle glaucoma (POAG) and the influence of CCT on glaucomatous damage in glaucoma clinic of Dr. R. P. G. M. C Kangra at Tanda. Materials and Methods: This cross-sectional study conducted on 103 eyes of 58 patients of POAG- >40 years. All patients underwent a complete eye examination including Goldmann applanation tonometry, CCT measurement through ultrasonic pachymeter, stereoscopic disc photography, retinal nerve fiber layer (RNFL) photography, and automated perimetry. Correlation of CCT with age, gender, intraocular pressure (IOP), advanced glaucoma intervention study (AGIS) score, VF parameters (mean deviation, pattern standard deviation [PSD]), vertical cup-disc ratio, average RNFL, and number of antiglaucoma medications was analyzed. The patients were divided into two groups – thin and thick CCT taking a reference range of 529 μm derived from a previous study done in same area with larger sample size. Pearson correlation was used for correlation coefficient and a value of P < 0.05 was considered statistically significant. Results: Thin CCT was significantly correlated with IOP (r = 0.28, P = 0.004). Thin CCT was also significantly associated with worsened PSD of VF (r = 0.25, P = 0.02). The mean AGIS score was more (8.07 ± 5.52) in patients with thin CCT (<529 μm) in comparison (5.96 ± 6.10) to patients with thick CCT (>529 μm) which was statistically significant (P < 0.05). Conclusion: CCT is a significant risk factor for glaucomatous VF loss. Patients with thinner CCT are more likely to have advanced VF defects in comparison to patients with thick CCT.
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CASE REPORT Top

Partial Descemet's membrane detachment with clear cornea after 3 Years post uneventful phacoemulsification p. 31
Amr Mounir, Engy Mohamed Mostafa
DOI:10.4103/sjopthal.sjopthal_11_19  
In this report, we presented a 67-year-old male patient complaining of discomfort and slight eye redness for 1 week in the right eye. His surgical history was notable for uneventful phacoemulsification with a posterior chamber intraocular lens implantation in this eye 3 years earlier. Slit-lamp examination of the same eye revealed an area of localized partial Descemet's membrane detachment (DMD) in the right eye. The detached membrane was rolled and wrinkled with no associated stromal edema with clear corneal stroma. Anterior segment optical coherence tomography showed incomplete detachment with no associated increase in the corneal thickness in areas overlying detached and attached DM. The decision was to proceed with conservative treatment with monthly follow-up. After 6 months, the condition remained stable with no change in size of the DMD or in the corneal clarity.
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