Ocular associations in hyperlipidaemia: A rural hospital based study

The incidence of hypercholesterolemia is ever increasing as the co morbid conditions such as diabetes mellitus, hypertension, stressful life is on a rise. Ocular conditions associated with hypercholesterolemia are issues which are minimally discussed. : This prospective cross-sectional study was conducted from January 2019 to June 2019. Complete eye examination was performed including visual acuity examination, refraction, tear film evaluation, slit lamp examination, measurement of intraocular pressure using rebound tonometer, gonioscopy, direct and indirect ophthalmoscopy Total of 81 patients were examined, out of which males were 55, females were 26. Most common ocular finding was Xanthoma and Xanthelasma in 61(70%) patients. Arcus juvenalis was noted in 12 (14.63%), Lipid keratopathy in 23(29.26%). Other comorbidities associated were Hypertensive Retinopathy, diabetic retinopathy, Pre senile cataract, Primary open angle Glaucoma, Branch retinal vein occlusion which has indirect causal relationship. Along with systemic workup, Hypercholesterolemia also warrants a routine detailed ocular examination even if the patient is asymptomatic. This aids in early diagnosis and management of the co-existing ocular morbidities.

Effect of Pterygium Removal Combined with Conjunctival Autograft on Corneal Parameters in Swept-Source Imaging

Background: Both pterygium ingrowth and excision determine alterations in corneal topography. The aim of this study was to evaluate the influence of pterygium removal combined with conjunctival autografts in addition to the use of human fibrin tissue glue on changes in corneal parameters as measured by 3-D swept-source anterior segment optical coherence tomography (AS-OCT) imaging. Methods: Sixteen eyes (16 patients) with pterygium that qualified for surgical treatment were enrolled in this study. Eye examination, slit lamp, and 3-D AS-OCT (CASIA 2) assessment were performed before the surgery and 7 days, 1 month, and 6 months after pterygium excision. Topographic parameters of both anterior and posterior surfaces of the cornea were analysed at each follow-up visit. Results: The gradual decrease in total astigmatism power from preoperative median 2.75 (6.15) D to 1.2 (1.1) D at 6-month follow-up (p = 0.034) was noted from the day 7 visit. Values were strongly influenced by variations of anterior cornea astigmatism. In contrast, a gradual total HOA reduction at the 1-month (from median 0.79 (1.3) D to 0.44 (0.27) D; p = 0.038) and at 6-month visits (0.25 (0.09); p = 0.001) was observed. Similarly, values were strongly influenced by variations of the anterior. Additionally, total average keratometry values increased from preoperative 44.05 (2.25) D to 44.6 (1.9) (p = 0.043) 1 month after the surgery. Conclusions: Significant steepening of the anterior cornea and a reduction in both astigmatism and HOA were observed after pterygium excision. The anterior corneal surface was an essential component of the total postoperative corneal topography values. Three-dimensional swept-source AS-OCT imaging seems to be a valuable tool for monitoring both the progression of the disease and postoperative effects in pterygium eyes.

Refraction in the Pediatric Eye Examination

Accurate determination of refractive error is one of the most critical components of a pediatric eye examination. According to the National Eye Institute, refractive errors are the most common causes of correctable reduced vision in children. Children with uncorrected refractive error are more likely to have developmental delays, visual-related academic problems, and poor social skills or interactions. In addition to difficulty seeing, uncorrected refractive errors can contribute to developmental deficits of accommodation, binocular vision, and certain forms of strabismus, amblyopia, and perceptual function. The author provides the clinician an in-depth guide on how to determine the refractive error in pediatric patients. The chapter focuses on the specific techniques, advantages and disadvantages, equipment required, and step-by-step procedures for performing retinoscopy, objective refraction, and subjective refraction on children.

Case History for the Pediatric Eye Examination

The art of taking a patient's case history is essential for a solid understanding of pertinent details before proceeding with an examination. While establishing rapport with the patient, the clinician should ask questions about birth history, developmental history, educational and social history. Active listening skills and flexibility of the provider are useful tools for an effective start to the examination. This chapter reviews categories of questions needed for optimization of case history for the pediatric patient. This includes questions focused on specific age categories, including infants and toddlers, preschoolers, elementary-aged children, and adolescents. The chapter author provides clinical pearls for a more efficient and effective exam, including a section on assisting children with special needs.

Diagnostic Agents in the Pediatric Eye Examination

In this chapter, the author reviews the most common topical ophthalmic drops for diagnostic use in a pediatric eye exam. Topical diagnostic agents have become an integral part of an ocular health examination even in infants and young children. Topical local anesthetics are commonly used for eye procedures such as tonometry, gonioscopy, and minor office procedures. The proper use of mydriatic drugs allows clinicians to identify and diagnose various ocular abnormalities that might otherwise go undetected. Cycloplegic refraction is a reliable procedure to determine the true refractive status of patients with accommodative esotropia, pseudomyopia, and latent hyperopia. Cycloplegic refraction is also useful in non-communicative or uncooperative patients and when a functional vision problem is suspected such as when visual acuities do not correlate with symptoms or clinical expecteds. Many times, diagnostic drops can help a clinician be more confident of the patient's clinical findings.

Association of Low Visual Acuity and Head Injury among the Undergraduate Students of Bingham University, Karu, Nigeria

A laboratory-based cross-sectional study was conducted among Bingham University undergraduate students, Karu, to investigate the proportion of visual acuity (VA) among the students. The study aimed at investigating an association between head injury with low VA of students whose parent’s use medicated eye glasses. A total of 262 undergraduate students participated in the study. A predesigned, pre-tested, self-administered questionnaire was filled by the students. Eye examination using the optotype Snellen E Chart followed and the VA of the right (VARE) and left eyes (VALE) were tested separately. A regression and correlation model was used to assess the relationship between head injury and low VA. Head injury at one point of time in their life was strongly associated with low VA for both eyes (VARE, r = 0.524, R2 = 0.274, p = 0.040; VALE, r = 0.0.531, R2 = 0.282 p = 0.010). Parents’ use of medicated eye glasses was also associated with low VA of students (VARE p = 0.009; VALE p < 0.001). Our results showed that students that had any form of head injury at any point in their life either as a child, teenager or an adult, were more likely to have low VA. However, the educational status of parents, anthropometric parameters and ethnicity had no association with low VA. We conclude that any form of head injury, at any point in one’s life, and parent’s use of eye glasses are risk factors for low VA.

Pregabalin as a probable cause of central serous chorioretinopathy: Two case reports

Pregabalin is commonly used for the treatment of neuropathic pain and is attributed to adverse effects of peripheral vasodilation and peripheral edema. Central serous chorioretinopathy (CSCR) is characterized by choroidal fluid leaks from choroidal vessels under the retina, causing focal retinal detachment with macular vision loss. Herein, we report two cases admitted to our clinic with vision loss while under pregabalin treatment. Upon eye examination, both patients were diagnosed with acute CSCR. Pregabalin treatment was discontinued upon the diagnosis of CSCR. We consider that the use of pregabalin in the presented two cases may be the causal effect of the CSCR diagnosis, as pathophysiology of CSCR is in parallel with the edema-related adverse effects of pregabalin.

Connecting Patient and Provider Burnout to Eye Exam Frequency among Latinx Older Adults with Diabetes Mellitus

Among Latinx older adults, our current understanding of barriers to eye exam often fails to consider the impact of patient and provider burnout which can decrease treatment adherence and recommendation receptivity in this group. The purpose of this study was to examine correlates of eye exam frequency among Latinx older adults in South Los Angeles and explore associations reflecting patient and/or provider burnout. Data analysis was informed by the Secret Self-Management Loop and the Burnout Dyad conceptual models. This secondary analysis used data collected from a convenience sample of non-institutionalized Latinx adults 55+ in South LA (n=165) and used multinomial regression analysis. Outcome variable is recency of eye exam, independent variables are self-reported health, including diabetes mellitus diagnosis, and either patient or provider burnout (that are functions of grouped demographic or quality of care variables). Variables associated with Provider Burnout, appear to represent a larger influence on eye examination frequency then variables associated with Patient Burnout, with the most influential factor being provider recommendation. A surprising finding was the number of participants who had never received this recommendation from a provider (21%). One-third (32%) of participants with diabetes mellitus had not had an eye examination within 12 months and almost one-fifth (13%) of participants with diabetes who had received this recommendation had not received the exam. Further exploration is needed to support a better understanding of how both patient and provider burnout impacts adherence to eye examination and other preventive care recommendations for diabetes mellitus among Latinx older adults.

Acute retinal necrosis with exudative retinal detachment in a child

Acute retinal necrosis (ARN) is a rare ocular emergency caused mainly by viral entities. ARN may be caused by Herpes zoster virus (HZV) and Herpes simplex virus (HSV), both HSV-1 and HSV-2. ARN mostly present in 20–60 years old immunocompetent adults. A 7-year-old girl presented to the eye clinic with complaints of left eye redness noted by her mother for 2–3 days. On examination with indirect ophthalmoscopy, no hypopyon was seen in either eye. In the left eye fundus view was hazy. Ultrasound B-scan performed showed exudative retinal detachment. PCR of ocular fluid was positive for HSV-1 DNA. The patient was started on topical steroids and antibiotics and systemic antivirals. In addition, she also received intravitreal ganciclovir 4 mg/0.1 mL three times under general anaesthesia. At her last follow-up, 3 years from her presentation, her right eye examination was within normal limits, and left eye showed thick vitreous bands with a posterior vitreous detachment, and left inferotemporal retinal scarring.

Retinal autofluorescence findings after COVID-19

The main purpose of this study was to investigate the presence of retinal autofluorescence findings in COVID-19 patients. Observational study conducted in São Paulo in 2020. Demographic, medical history, and concomitant events, as well as medications used, hospitalization details, and laboratory test results, were obtained. Patients underwent eye examination and multimodal imaging, including color, red-free, autofluorescence fundus photography and optical coherence tomography. Eighteen patients had autofluorescence findings (6 females; average age 54 years, range 31 to 86 years; 26 eyes). Hyper-autofluorescence findings were present in 6 patients, Hypo-autofluorescence in 14 patients, and 6 patients had mixed pattern lesions. Retinal autofluorescence abnormalities were present in COVID-19 patients and may be secondary to primary or secondary changes caused by the SARS-CoV-2.