A narrative review on the role of technology and nutrients in ocular health

The COVID-19 pandemic has led to a revolution in the education sector. The continuous use of gadgets for learning and entertainment has aroused a keen interest in eye health and the role of foods and nutrients in improving eye health. This study aims to identify and summarize various eye disorders and parameters that are involved in ocular health. Methods: A detailed search of related literature has been carried out with the help of authenticated search engines like Pubmed and Google scholar to review the major deleterious eye problems that persist, and the aetiology of the disorders. Though ocular health is determined by several parameters like socio economic factors, genetic determinants, gender, race, life style and nutrition, diet seems to be a significant lifestyle element that pose to have longstanding effects on ocular health. This study concludes that, it is not an individual nutrient or non-nutrient that impacts eye health, rather a holistic nutritional approach renders more efficacy on vision. It is emphasized that a proper advocacy of foods and nutrients, wise means of technology usage can help to overcome the deleterious effects of deficiencies on eyes.

The renin-angiotensin system in the eye

The renin–angiotensin system is major endocrine, paracrine, and autocrine system that has a notorious role in regulating hemodynamics and electrolyte balance, thus controlling blood pressure. Nonetheless, the functions of RAS are multiple and continue to expand, as its receptors, enzymes, and peptides have been identified in different organs/tissues, implying novel local effects of RAS and participation in the pathogenesis of different diseases in multiple organs, including the eyes. Vascularized, fibrous, and nervous structures of the eyes and their fluids express several RAS components including angiotensinogen, prorenin, renin, (P)RR, ACE, Ang II, AT1R, AT2R, ACE2, Ang 1-7, and Mas. Additionally, abundant RAS hormones are present in intraocular tissues implicating local production. Ocular RAS functions seem to be diverse;first, RAS is proposed to modulate aqueous humor biosynthesis and drainage, consequently regulating IOP. Exacerbation of ACE/ Ang II/ AT1R actions is observed in glaucoma, and blockage of this axis with ACEIs and ARBs is a feature that can be explored to reduce IOP and treat glaucoma. Second, impairment of RAS with exacerbation of ACE/ Ang II/ AT1R and depletion of ACE2/ Ang 1-7/ Mas culminate in an angiogenic, inflammatory, proliferative, and oxidative phenotype, which is tightly related to retinal vascular disorders such as diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. Indeed, treatments blocking ACE/ Ang II/ AT1R or enhancing ACE2/ Ang 1-7/ Mas are reported to be beneficial to prevent or restrain the progression of these diseases. Finally, clinical manifestations of COVID-19 include ocular disorders such as conjunctivitis, dry eyes, eye pain, discharge, and blurred vision. ACE2 expression in ocular tissues may define ophthalmic susceptibility to SARS-CoV-2 infection. Moreover, SARS-CoV-2 entry mechanisms may cause depletion of ACE2 biological effects, which can contribute to RAS dysregulation and the ocular disorders observed in COVID-19. This chapter focuses on reviewing the components and functions of the ocular RAS, its implications for eye homeostasis, and the potential of RAS as a therapeutic target to treat ocular disorders, including glaucoma, diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. © 2023 Elsevier Inc. All rights reserved.

Increasing hand-hygiene compliance in clinical settings using a baby-eyes sticker

This double-blind field study tested the effectiveness of a baby-eyes image in promoting healthcare workers' hand-hygiene compliance in a hospital setting. Adults are inclined to take care of babies and aspire to be their role models;therefore, they should wash their hands thoroughly when being watched by babies. Participants were healthcare workers from the obstetrical and neonatology units of a women's hospital in Hangzhou. We recorded and coded 3,360 hours and 10,325 hand-hygiene events over a five-week period—from 16 October to 20 November 2018. Three types of stickers, depicting baby eyes, adult eyes, or flowers, were placed above handwashing basins to compare hand-hygiene behavior between the three conditions. Each condition continued for one week, and experimenters interchanged the stickers in each unit to control for the location and sequence effects. Participants in the baby-eyes condition (72.9%) were more likely to use sanitizer than those in the flowers condition (69.4%;χ2 = 9.74, p < .01, φc = 0.034). Moreover, participants in the baby-eyes condition were more likely to use sanitizer than those in the adult-eyes condition (70.8%);however, the difference only trended towards significance (χ2 = 2.38, p = .066, φc = 0.023). The mean handwashing time between the three conditions was significant (Welch's F(2, 3488.436) = 3.50, p < .05, η2 = 0.001). Washing time in the baby-eyes condition (17.41 ± 12.02) was significantly longer than in the adult-eyes condition (16.36 ± 11.47;p < .05). The presence of a baby-eyes image promoted hand-hygiene compliance in the hospital environment. This finding can be adopted to change public health behaviors. It also holds theoretical implications that enhance our understanding of how being monitored by children can enhance responsible behaviors.

Detection of Some Causes of Feline Eye Infections in Baghdad City.

The current study aimed to determine the causes associated with ocular infection in cats received at Baghdad veterinary hospital from March 2020 to April 2021. Forty cats (22 females and 18 males) were examined at a small animal clinic in Baghdad veterinary hospital from March 2020 to April 2021. The cats suffered from severe eyes infection (inflammation, lacrimation, redness and other ocular signs). On the other hand, ten healthy cats were examined and prepared for bacterial isolation as a control group. For bacterial isolation, sterile cotton swabs with transport medium were taken gently from the corneal and conjunctiva area of infected eyes. The swabs were placed in an ice box within 24 hours for laboratory culture. Sterile swabs with transport media were used in our study; swabs passed directly on the inferior conjunctival sac of the compromised eye avoiding contact with eyelashes and skin of eyelids. All swabs were inoculated on the following media (5% Sheep blood agar, MacConkey agar and Nutrient agar) at 37ºC for 24 to 48 h.ImmunoChromatoGraphy assay (ICG) of FCV on samples. The results showed that 50%of Mixed bacterial and FCV were the significant cause of isolates; also, it showed that S. aureus was the most bacterial cause of eye infection; young females were mostly infected in February. In conclusion, the wide distribution of ocular infections in cats is due to different causes, especially with bacteria, including Staphylococcus spp. and virus (FCV). The seasonal variation between months plays a significant factor in the spreading of eye infections in the feline.

Post-acute sequelae of SARS-CoV-2 Delta variant infection: a report of three cases in a single family

Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that has resulted in global pandemic and crisis in health care system. Several studies have focused only on hospitalized patients with 30 to 90 days after one cycle of illness but post-acute sequelae of COVID-19 existing even after a year remains unclear. Moreover, long-term sequelae in outpatients have not been documented and henceforth myriad clinical sequelae in long haulers continue to evolve. In this study, we report three cases represents a single family presenting several post-acute sequelae one after the other extending beyond one year of recovery. To our knowledge such a case series has not been reported in earlier studies. Herein, we present the sequelae in various organs namely neuropsychiatric (tinnitus, anxiety, depression, insomnia, and posttraumatic stress disorder, cognitive decline), cardiovascular (tachycardia, bradycardia), gastrointestinal (appendicitis) and Dermatologic (erythematous rash and acne) besides ophthalmic manifestations (conjunctivitis and dry eyes) in Long-COVID-19 and recommend management strategies.

A hospital based observational study of clinical spectrum and outcome of mucormycosis during the COVID pandemic

Background : Mucormycosis is a life threatening fungal disease caused by the filamentous fungi mucormycetes. Though a known entity for decades, it began to manifest in an unprecedented manner in the COVID scenario specially with the second wave in India. The objectives were to describe the demographic characteristics, clinical presentations, risk factors, therapy and in-hospital mortality of patients with Mucormycosis. Material and Methods : We conducted a retrospective observational study for a period of six months from March 2021 to August 2021. The data was collected for cases of mucormycosis from multiple centres all over West Bengal and analysed. All consecutive individuals with confirmed mucormycosis were enrolled in this study. The data documenting demographic particulars, presentation, predisposing factors and comorbiditieswere recorded in a pre validated case report form Details of investigation recording site and extent of disease, therapeutic intervention and outcome was mentioned . Statistical analysis was done using SPSS 21.0 for MS-Windows. Results : The total number of cases from March to August 2021 was 263 . There were 171 males and 92 females and the mean age of occurrence was 50.8+or-0.4 years .In West Bengal clusters of cases were being reported most commonly from the districts of North 24 Parganas, Kolkata, Jalpaiguri, Darjeeling and Hooghly. Some cases admitted here hailed from outside states like Bihar, Jharkhand, Odisha and Assam. The majority of the cases 74.22% (196)were COVID Associated Mucormycosis (CAM) while only 25.78% were non COVID associated. Diabetes mellitus was associated in 78.7% and history of prolonged steroid therapy in 57.4% of cases. We encountered rhino orbital mucormycosis in 99.24% of cases and cerebral involvement in 47.3%. They were treated with Amphotericin B deoxycholate along with endoscopic debridement. The most common side effects of Amphotericin B Deoxycholate were hypokalemia (93%), hypomagnesemia (32%) and AKI (74%) of the cases . The number of patients discharged was 16.7% and 10 left against medical advice (LAMA) . In hospital deaths were recorded to be 26.7%. Cause of death was commonly -AKI, septic shock and multiorgan failure . Conclusion : Prevention is better than cure of this devastating disease which is difficult todiagnose and treat . Awareness about mucormycosis and careful clinical evaluation of post-COVID patients is mandatory in this era in order to rapidly diagnose and treat mucormycosis.

Frequency of Dry Eye Diseases among Children During the COVID-19 Pandemic in Pakistan

Objective: To assess the frequency of dry eye among children during the COVID-19 pandemic. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Hafeez Hospital, Islamabad Pakistan, from Mar to Aug 2021. Methodology: Children aged 7-15 years reporting to the PNS Hafeez Hospital, OPD were included in the study. A proforma was used to record the demographics and screen time of the children. In addition, an ophthalmic examination was conducted to assess the dry eye status of the children using the Schirmer-II test. Results: Seventy-three children participated in the study. Their mean age was 11.08±2.42 years. There were 40(54.8%) boys and 33 (45.2%) girls. These children had a mean daily screen time of 7.23±2.77hours. Children with dry eye had a greater amount of screen time (8.75±2.11hours) as compared to those with normal tear function (6.05±2.66 hours;p<0.001). In addition, the screen time of children with dry eyes was significantly greater than those with normal tear functions (p=0.001). Conclusion: Children with dry eyes were reported to have more screen time and more online classes than their counterparts with normal tear functions. Authorities should consider resuming face-to-face sessions for all school children.

The effect of body indexes on presence of ocular symptoms in COVID-19 patients

Background: During the COVID-19 pandemic, the presence of ocular symptoms was common in COVID-19 patients, which can cause secondary complications in the treatment of ocular diseases. On the other hand, obesity can cause secondary symptoms in infectious diseases by impairing the function of the immune system, which indicates the relationship between involvement of different tissues and dysfunction of the cellular immune system. The aim of this study was to investigate the relationship between body indexes (i.e., age, height, weight, and BMI) and the presence of ocular symptoms in patients with COVID-19. Methods: In this cross-sectional study (from March 2021 to May 2021), ocular symptoms (including blurred vision, epiphora, photophobia, discharge and exudate, redness, pain, and itching of the eyes) and body indexes (age, height, weight and BMI) were evaluated in 108 patients with COVID-19, who were referred to Ayatollah Rouhani hospital, Babol, Iran. The independent t-test and Kruskal-Wallis statistical tests were used to examine the data relationship in SPSS software. Results: The results showed that the mean body weight in COVID-19 patients with blurred vision was significantly higher than COVID-19 patients without blurred vision (P=0.003, t=-3.056). The mean height of COVID-19 patients with epiphora was significantly lower than the mean height of COVID-19 patients without epiphora (P=0.018, t=2.398). Also, the BMI of COVID-19 patients with epiphora was 30.00 +or-4.07 kg/m2, while the BMI of COVID-19 patients without epiphora was 27.68+or-4.42 kg/m2 (P=0.047, t=0.026). In COVID-19 patients with at least one ocular symptom, height was significantly lower than heigh of COVID-19 patients without any ocular symptoms (P=0.001, t=3.397). Conclusion: Our results indicate the essential role of obesity in the occurrence of eye symptoms in COVID-19 patients. In this study, it was found that blurred vision, epiphora and the presence of at least one eye symptom in COVID-19 patients were significantly associated with the upward trend of BMI (as an index of obesity).

Challenges in the management of retinoblastoma during nationwide lockdown: an observational study from a retinoblastoma center in South India

Introduction: The nationwide lockdown due to coronavirus disease 2019 led to travel restrictions resulting in a delay in diagnosis, treatment, and follow-up of children with retinoblastoma (RB). Objectives: We audited the impact and challenges of lockdown among RB children over 1-year period (May 2020-2021). Materials and Methods: It is a cross-sectional study of 104 children with RB, who presented within the 1-year study period. The demographic details, clinical presentations, and outcome of treatment due to lockdown were studied. Results: Of the 152 eyes of 104 children, unilateral RB was observed in 52% and bilateral in 48%, in which four children had metastatic disease and one child had trilateral RB. International classification groups D (n: = 64 eyes, 42%) and E (n: = 38 eyes, 25%) were in majority. Almost, half of the children (n: = 53, 51%) underwent enucleation. Overall, the vision was preserved in 32% of the children and globe preservation in 49% of children. Eleven children (10.5%) succumbed due to disease progression. But, only five children were affected with severe acute respiratory syndrome coronavirus 2 infection. The majority of children (n: = 72, 69%) had to travel more than or equal to 1,000 km for treatment. About 57% (n: = 60) patients were newly diagnosed during the lockdown period and due to the travel restrictions, they had a mean delay of 2.2 months (range: 0-15 months) in starting treatment and 27% (n: = 29) of children on treatment had an interruption of treatment. Conclusion: Multidisciplinary team management with strategies to support the RB families during locked down crisis is essential to continue care without interruptions.

Ocular manifestations of COVID-19 infection

The eyes, which were not previously the subject of investigation, have emerged as one of the more intriguing aspect of COVID-19 infection. The probable pathways for SARS-CoV-2 infection through the eyes are either through the tear film and draining tear ducts leading to the upper respiratory tract and gastrointestinal tract, or through the conjunctiva into limbal superficial cells into the inner eye, where distribution via the blood or nervous system appears to be possible. Virus pathogenesis through tear and conjunctiva has been established in animal models of several coronavirus eye diseases, and preliminary research have shown that SARS-CoV-2 may do the same in humans. Given that COVID-19 cases have reached pandemic proportions and are on the rise, it is vital to recognize the illness's ocular manifestations and avert potentially vision-threatening effects. Coronaviruses may be transmitted between animals and humans through evolution, therefore investigating them in animal models could be crucial in the future to discover further elements of ocular involvement. It is recommended that health care and individual personnel take steps to avoid infection and limit viral transmission. More study is needed to understand the transmission pathways and the alternatives for COVID-19 prevention and therapy disseminated through the ocular surfaces for prompt recovery of the patients.

COVID-19-Related Burning Eye Syndrome and Burning Mouth Syndrome: A Systematic Review and Meta-analysis.

BACKGROUND: Previous research highlights burning eye syndrome (BES) and burning mouth syndrome (BMS) as chronic complications of COVID-19 infection. The aim of this systematic review and meta-analysis is to establish the prevalence of COVID-19-related BES and COVID-19-related BMS and describe their phenomenology. METHODOLOGY: A literature search in the PubMed database was performed, and seven papers (five on BES and two on BMS) were eligible to be included in this systematic review and meta-analysis. RESULTS: The pooled prevalence of COVID-19-related BES was 9.9% (95% CI 3.4-25.4%). The frequency of COVID-19-related BMS is only reported in isolated cases and ranges from 4% in mild-to-moderate cases to 15% in severe, hospitalized cases, with female patients being mostly affected. COVID-19 severity is a potential risk factor for both BES and BMS. Neither syndrome occurs in isolation. COVID-19-related BES usually appears within the first week post-infection, persisting up to 9 weeks later. COVID-19-related BMS occurs during and after initial infection, and may also persist as a chronic disease. CONCLUSIONS: Both BES and BMS are neuropathic COVID-19 infection complications, still under-studied and under-investigated, despite the fact that both are prevalent. Both COVID-19-related BES and COVID-19-related BMS could potentially be initial long COVID syndrome manifestations, and further research should be carried out in this field.

Microglia activation and neuronal alterations in retinas from COVID-19 patients: correlation with clinical parameters.

BACKGROUND: Different ocular alterations have been described in patients with coronavirus disease 2019 (COVID-19). Our aim was to determine whether COVID-19 affected retinal cells and establish correlations with clinical parameters. METHODS: Retinal sections and flat-mount retinas from human donors with COVID-19 (n = 16) and controls (n = 15) were immunostained. The location of angiotensin-converting enzyme 2 (ACE2) and the morphology of microglial cells, Müller cells, astrocytes, and photoreceptors were analyzed by confocal microscopy. Microglial quantification and the area occupied by them were measured. Correlations among retinal and clinical parameters were calculated. RESULTS: ACE2 was mainly located in the Müller cells, outer segment of cones and retinal pigment epithelium. Cell bodies of Müller cells in COVID-19 group showed greater staining of ACE2 and cellular retinaldehyde-binding protein (CRALBP). The 81.3% of COVID-19 patients presented disorganization of honeycomb-like pattern formed by Müller cells. Gliosis was detected in 56.3% of COVID-19 patients compared to controls (40%) as well as epiretinal membranes (ERMs) or astrocytes protruding (50%). Activated or ameboid-shape microglia was the main sign in the COVID-19 group (93.8%). Microglial migration towards the vessels was greater in the COVID-19 retinas (P < 0.05) and the area occupied by microglia was also reduced (P < 0.01) compared to control group. Cone degeneration was more severe in the COVID-19 group. Duration of the disease, age and respiratory failure were the most relevant clinical data in relation with retinal degeneration. CONCLUSIONS: The retinas of patients with COVID-19 exhibit glial activation and neuronal alterations, mostly related to the inflammation, hypoxic conditions, and age.

A Deep Learning Approach to Predict Chronological Age.

Recently, researchers have turned their focus to predicting the age of people since numerous applications depend on facial recognition approaches. In the medical field, Alzheimer's disease mainly depends on patients' ages. Multiple methods have been implemented and developed to predict age. However, these approaches lack accuracy because every image has unique features, such as shape, pose, and scale. In Saudi Arabia, Vision 2030, concerning the quality of life, is one of the twelve initiatives that were launched recently. The health sector has gained increasing attention as the government has introduced age-based policies to improve the health of its elderly residents. These residents are urgently advised to vaccinate against COVID-19 based on their age. In this paper, proposing a practical, consistent, and trustworthy method to predict age is presented. This method uses the color intensity of eyes and a Convolutional Neural Network (CNN) to predict age in real time based on the ensemble of CNN. A segmentation algorithm is engaged since the approach takes its input from a video stream or an image. This algorithm extracts data from one of the essential parts of the face: the eyes. This part is also informative. Several experiments have been conducted on MATLAB to verify and validate results and relative errors. A Kaggle website dataset is utilized for ages 4 to 59. This dataset includes over 270,000 images, and its size is roughly 2 GB. Consequently, the proposed approach produces ±8.69 years of Mean Square Error (MSE) for the predicted ages. Lastly, a comparative evaluation of relevant studies and the presented algorithm in terms of accuracy, MSE, and Mean Absolute Error (MAE) is also provided. This evaluation shows that the approach developed in the current study outperforms all considered performance metrics since its accuracy is 97.29%. This study found that the color intensity of eyes is highly effective in predicting age, given the high accuracy and acceptable MSE and MAE results. This indicates that it is helpful to utilize this methodology in real-life applications.

Frequency of Dry Eye Diseases among Children During the COVID-19 Pandemic in Pakistan

Objective: To assess the frequency of dry eye among children during the COVID-19 pandemic. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Hafeez Hospital, Islamabad Pakistan, from Mar to Aug 2021. Methodology: Children aged 7-15 years reporting to the PNS Hafeez Hospital, OPD were included in the study. A proforma was used to record the demographics and screen time of the children. In addition, an ophthalmic examination was conducted to assess the dry eye status of the children using the Schirmer-II test. Results: Seventy-three children participated in the study. Their mean age was 11.08±2.42 years. There were 40(54.8%) boys and 33 (45.2%) girls. These children had a mean daily screen time of 7.23±2.77hours. Children with dry eye had a greater amount of screen time (8.75±2.11hours) as compared to those with normal tear function (6.05±2.66 hours;p<0.001). In addition, the screen time of children with dry eyes was significantly greater than those with normal tear functions (p=0.001). Conclusion: Children with dry eyes were reported to have more screen time and more online classes than their counterparts with normal tear functions. Authorities should consider resuming face-to-face sessions for all school children. © 2022, Army Medical College. All rights reserved.

Smoking Behaviour and Dry Eye Symptoms among Uitm Puncak Alam Students during Covid 19

Introduction: The pandemic of COVID-19 has impacted the economy and psychological health, especially during the implementation of a movement control order. The implementation has raised adverse behaviour such as smoking and drinking to deal with psychological stress and anxiety. This study has investigated the pattern of smoking behaviour and the relationship between smoking behaviour and dry eye symptoms among smokers during the COVID 19 pandemic. Methods: The Smoking Behavior and Dry Eye Symptoms (OSDI) questionnaires were used in the study with the value for Cronbach α was 0.676. The adapted questionnaires were distributed online to 377 smokers who studied at UiTM Puncak Alam. The collected data were analyzed demographically, and the significant value was set at p<0.05 using the Pearson test. Results: The average intake of cigarettes was between six to ten cigarettes per day. During COVID-19, 54.1% of the participants responded to an increase in the frequency of cigarettes per day. 17.2% of the participants had severe dry eyes due to smoking activity. The Pearson test showed a significant correlation between dry eyes symptoms and smoking behaviour p <0.05. Conclusion: During Covid 19, the prevalence of dry eye symptoms has increased among smokers, and it is linked to poor ocular surface health due to the changes in smoking behaviour and tobacco intake. This behaviour might commit to an unhealthy lifestyle that can reduce the quality of life. © 2022 UPM Press. All rights reserved.

A community-led outreach programme to improve eye care service delivery in Sri Lanka. (Special Issue: Community engagement in eye care: working with and for communities.)

According to the most recent national census on blindness, nearly 100,000 persons in Sri Lanka over the age of 40 are thought to be blind from untreated cataracts. Due to the COVID-19 epidemic and the fact that more than 80% of the population lives in rural areas, access to eye care is currently limited. The Association of Community Ophthalmologists of Sri Lanka (SLACO) has been providing free outreach eye care visits on a regular basis in rural regions for the past five to six years in an effort to solve the issue. These visits primarily serve to provide patients with free reading glasses and referrals for complimentary cataract surgery. SLACO members volunteer their services without payment. After registration, individuals had their eyes tested and their distance and near visual acuity were measured. As walk-in patients were accepted, the community ophthalmologist from SLACO assessed 143 patients and gave 120 of them near-vision glasses. 43 patients with operable cataracts had pre-operative evaluations (ECG, fasting blood sugar, and blood pressure check) that day. Because there was a two-year waiting list for the three closest government eye units, SLACO arranged for them to be sent to a charity eye hospital in Colombo.

Conjunctival Swabs Reveal Higher Detection Rate Compared to Schirmer Strips for SARS-CoV-2 RNA Detection in Tears of Hospitalized COVID-19 Patients.

Purpose: To determine the prevalence of SARS-CoV-2 in tear samples and to investigate whether it correlates with ocular findings and patients' prognosis in Brazil. Methods: Tears were collected using Schirmer strips (SS) and conjunctival swabs (CS) from patients hospitalized with laboratory-confirmed SARS-CoV-2 infection. Samples were analyzed using qRT-PCR. Demographic and clinical data, ocular symptoms, and Schirmer tests (ST) were collected from patients. Charlson Comorbidity Index (CCI) was used to rate comorbidities, and patients were monitored until hospital discharge or death. Results: There were 61 hospitalized patients, 33 of which were diagnosed with COVID-19. Within the confirmed COVID-19 patients, SARS-CoV-2 was detected in 18.2% (n = 6) of CS and 12.1% (n = 4) of SS samples. Subjective and objective parameters for dry eye syndrome (e.g., ST COVID-19: 8.3 ± 6.4mm, non-COVID-19: 8.9 ± 6.6mm, p > 0.05) were comparable between COVID-19 (n = 33) and non-COVID-19 patients (n = 28). Among the 16 COVID-19 patients exhibiting ocular symptoms, only tearing was reported significantly more frequently when tear samples were positive for SARS-CoV-2 (p < 0.05). Strikingly, patients whose tears tested positive for SARS-CoV-2 had significantly inferior CCI (pos.: 34.0 ± 31.8%, neg.: 67.6 ± 36.4%, p < 0.05) and higher mortality rates (pos.: 50.0%, neg.: 7.4%, p < 0.01). Conclusions: SARS-CoV-2 was detected with a prevalence of 18.2% on the ocular surface. Decreased CCI and increased mortality rate in the positive tear group suggests that viral detection may relate to prognosis and highlight the need of personal protective measures for healthcare professionals. Most of the patients, regardless of COVID-19 diagnosis, had low tear production and eye discomfort, possibly pointing to the need for artificial tear use during hospitalization.

Ocular Therapeutics for Optometry in Africa

While optometrists should not abandon their traditional strengths such as the provision of spectacle lenses and contact lens practice, there is an urgent need to improve access to more affordable and qualitatively satisfactory eye and vision care for not only relatively uncomplicated ocular refractive services but also regarding various ophthalmic disorders such as ocular surface disorders, milder and often self-limiting ophthalmic infections and glaucoma. The same weaknesses in the satisfactory provision of more comprehensive eye care in South Africa also extend to other parts of Africa where eye care services (including also low or partial vision and contact lenses for conditions such as keratoconus) are frequently constrained and patients with relatively minor but sometimes more serious eye problems are largely underserved because of inadequate utilisation of existing infrastructure and personnel or, in many cases, severe lack of necessary infrastructure and personnel in ophthalmology and optometry. [...]to the readers of the journal and everyone else involved in whatever capacity with the journal, all the very best and hopefully 2023 will bring many good things as we emerge from the shadow of the COVID-19 pandemic!

Teleophthalmology case study: Sankara Nethralaya, India

Both current and new patients at Sankara Nethralaya Eye Hospital can use free community-based teleophthalmology services as well as paid online services, even if they do not have personal internet access. The first eye hospital in India to use teleophthalmology to offer primary eye treatment to patients in remote communities was Chennai's Sankara Nethralaya Eye Hospital in 2003. This free service provides thorough eye exams as well as screening for cataracts and diabetic retinopathy utilizing a satellite link put on the roof of a mobile eye care van. It quickly became apparent that more people not simply those in rural areas would need teleophthalmology services with the COVID-19 pandemic's arrival in 2020. The Indian government's practice guidelines for telemedicine, which it released at the start of the COVID-19 pandemic offered a framework for the control and expansion of teleconsultation services in the nation. Sankara Nethralaya set up three new teleophthalmology access points for new patients, current patients, and patients who do not have access to the internet but can visit an optical store in response to this and in addition to its current service in rural areas. A patient can consult an ophthalmologist directly from home using this paradigm, which uses not many resources. An electronic medical records system, teleconsultation capabilities (audio/video calling), and a payment portal are necessities for the hospital. After their eligibility has been verified at the hospital, clients who are unable to pay can receive free teleophthalmology services. Patients utilizing this model must have a smartphone and an internet connection (mobile internet or otherwise). Patients without smartphones are unable to share medical records or photographs, but they can still seek advise from doctors by making audio calls and sending short messages (SMS), as well as visiting an optical store that is affiliated with the hospital, if one is close. Teleconsultations are useful for pre-operative counseling, second opinions, evaluating uploaded patient records, and monitoring post-operative patients. Orthoptic, contact lens, poor vision, rehabilitation, and genetic counseling services can all be provided via teleconsultations. The quality management staff will be able to provide better services by gathering patient input after each teleconsultation and responding quickly to complaints.

Communication technology for eye care

If equity of access is a priority, communication technology has the ability to significantly increase access to eye health care. Digital technologies are a part of everyday life and, when used in the healthcare industry, have the potential to significantly enhance people's health. The World Health Assembly's adoption of the Global Strategy on Digital Health in 2020 encourages the development of digital health services to enhance health outcomes. There is also growing agreement that more people will be able to take advantage of universal health coverage thanks to the use of cutting-edge digital breakthroughs and technologies. Big data, artificial intelligence, genomics, wearable technology, and communication technologies are all included under the general phrase "digital health." The emphasis in this issue is mostly on communication technologies, including telehealth, telemedicine, and teleconsultations (often known as "mHealth"). These have evolved into essential resources for providing healthcare, in part as a result of the COVID-19 pandemic's pressures. Communication technology has a lot of promise to contribute to the provision of high-quality, reasonably priced healthcare. But there are difficulties. As our article on advances in refractive error shows, new technology can be expensive and as a result, must be well adapted to the demands of the community where it will be utilized as well as of adequate quality to justify the financial investment made. Existing disparities in communities' access to technology, infrastructure, and education present another significant obstacle. If we want to prevent escalating currently present health imbalances, we must use technology in a manner that is appropriate, equitable, and ethical. When adding communication, they should focus on factors like inadequate internet connectivity, low digital literacy, and lack of access to broadband internet and smartphones, often known as "digital determinants of health." As a result, this issue's papers offer recommendations for creating inclusive and accessible teleophthalmology services for persons with disabilities, limited digital literacy, and those without internet access, while safeguarding patient data and privacy. This article also talk about the use of artificial intelligence (AI) in eye care and the necessity for fair AI service development.