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Background/aimsThe COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness.MethodsThere were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation—follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes.ResultsIn phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations.ConclusionThe face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.
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CLINICAL RELEVANCE: Vision-related problems can be part of longstanding sequelae after COVID-19 and hamper the return to work and daily activities. Knowledge about symptoms, visual, and oculomotor dysfunctions is however scarce, particularly for non-hospitalised patients. Clinically applicable tools are needed as support in the assessment and determination of intervention needs. BACKGROUND: The purpose of this study was to evaluate vision-related symptoms, assess visual and oculomotor function, and to test the clinical assessment of saccadic eye movements and sensitivity to visual motion in non-hospitalised post-COVID-19 outpatients. The patients (n = 38) in this observational cohort study were recruited from a post-COVID-19 clinic and had been referred for neurocognitive assessment. METHODS: Patients who reported vision-related symptoms reading problems and intolerance to movement in the environment were examined. A structured symptom assessment and a comprehensive vision examination were undertaken, and saccadic eye movements and visual motion sensitivity were assessed. RESULTS: High symptom scores (26-60%) and prevalence of visual function impairments were observed. An increased symptom score when reading was associated with less efficient saccadic eye movement behaviour (p < 0.001) and binocular dysfunction (p = 0.029). Patients with severe symptoms in visually busy places scored significantly higher on the Visual Motion Sensitivity Clinical Test Protocol (p = 0.029). CONCLUSION: Vision-related symptoms and impairments were prevalent in the study group. The Developmental Eye Movement Test and the Visual Motion Sensitivity Clinical Test Protocol showed promise for clinical assessment of saccadic performance and sensitivity to movement in the environment. Further study will be required to explore the utility of these tools.
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Introduction: As a part of prophecy by WHO nearly half of the population of Globe will be facing problem of refractive errors by 2050. In India by the mid of this century these diseases will flourish in Indian continent with frightening velocity. Amblyopia is one of the basic reason for refractive errors in childhood with maximum global prevalence of 4.7% averaging 2% school going children. "Amblyopia" is a disorder in retinal image foundation because of decline in the value of central, adjusted vision which most commonly happens during first decade of life. Hence we have undertaken the present study to know the status of amblyopic status in school going children during and in Post Covid sessions. Methodology: In this hospital-based observational cross-sectional study we examined (optometry, retinoscopy along with Auto-refractometer) 639 school going students from our tertiary care institutes who were facing problem in their vision. Results and discussion: Amongst the participants during COVID period 331 (52.73%) were girls and 308 (48.2%) were boys learning in different classes having refractive errors. Out of these total participants 27 students were found to have amblyopia. Affecting a greater number of females that is 16 (4.8%) and 11 boys (3.5%) of the total participating population. While in post covid period out of 437 boys students 3.4% were having amblyopia with statistical significant difference between the two groups depicting more number of boys having amblyopia during COVID period. Refractive errors are mostly caused by prolonged focusing on the screen, that children should take a break from the screen every half an hour to avoid possible eye problems. Conclusion(s): We conclude that if detection of amblyopia is possible in earlier phases of life then nationwide campaign or programme should be initiated and implemented for prevention of mortality of vision.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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This report describes a case of a newly diagnosed 49-year-old HIV patient, who presented with decreased visual acuity and retinal lesions characterized by ischemia at the level of the deep retinal capillary plexus, documented with optical coherence tomography (OCT), OCT angiography, fluorescein angiography, and visual fields testing. These lesions closely resembled the morphologic and clinical characteristics of late paracentral acute middle maculopathy. The presence of these lesions suggests that HIV microangiopathy can potentially affect both superficial and deep retinal capillary plexuses.
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Background: The novel coronavirus pneumonia has attracted considerable attention from the international community. With the spread of outbreaks around the world, the WHO characterized COVID-19 as a pandemic.Methods: Relevant studies in PubMed were searched from January 1, 2020 to April 12, 2020, using the following search strategy: ("novel coronavirus pneumonia” OR "severe acute respiratory syndrome coronavirus 2” OR "coronavirus disease 2019” OR "COVID-19” OR "novel coronavirus neumonia”) AND ("ophthalmology” OR "ophthalmologist” OR "eye” OR "conjunctiva” OR "conjunctivitis” OR "corneal” OR "keratitis”).Results: SARS-CoV-2 can spread through aerosol and is detected in tears of patients with COVID-19 infection. Notably, some infected patients had conjunctivitis, and conjunctivitis was the first symptom in some patients later diagnosed to have COVID-19 infection. This would increase the risk for ophthalmologists through inpatient consultations or regular clinical practice. When dealing with seemingly regular ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be reduced.Conclusion: Ophthalmologists must continuously update their knowledge regarding COVID-19 and take effective measures to prevent COVID-19 transmission.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19.Methods: We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: "eye,” "ophthalmologic,” "ocular,” "vision,” "conjunctivitis,” "severe acute respiratory syndrome coronavirus 2,” "SARS-CoV-2,” "corona,” "2019-nCoV,” "COVID19,” and "COVID.” The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review.Results: A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis.Conclusions: Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.
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Myopia is a prevalent yet confusingocular disorder. Myopia,formerlyconsidered abenignrefractivecondition, is nowassociatedwithanincreasedriskofdevelopingseveraloculardisorders,evenatmodestlevels.Myopiaisaglobalproblemthatexpe rts have documented. Despite the fact that the specific cause of myopia remains a mystery, it appears to be a combinationof genetic and environmental factors, making the prevention and treatment of the condition difficult and highly personalised.Myopia can have a positive impact on both the quality of life and the health of the eyes if it is prevented. Progressive additionlenses (PAL), topical atropine, ortho-k (orthokeratology) lenses and multifocal contact lenses are some of the most commoncontrol options currently available. Myopia has gained prominence in optometry studies as a result of its high prevalence. It ismore common for children to suffer from problems, such as extreme myopia and myopic macular degeneration, if they begindevelopingmyopiaatanearlyage.Thepurposeofthisstudywillbetoconductaninquiryintotheepidemiologyandriskfactorsfor myopiainschool-agedchildren(aged 6-19years)aroundtheworld.Copyright © 2022, Anka Publishers. All rights reserved.
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The zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its resultant human coronavirus disease (COVID-19) recently appeared as a global health threat that can cause severe respiratory infection and terminal respiratory distress. By the first week of April, more than 1.3 million people had been globally infected and more than 70,000 had lost their lives to this contagious virus. Clinical manifestations occur shortly after exposure, or a few days later. There is controversy regarding the transmission of the virus through the tear and conjunctiva;however, there are reports that the ocular surface might be a potential target for COVID-19. The ease of transmission of this virus at close proximity presents a risk to eyecare workers. Several recommendations have been issued by local and national organizations to address the issue of safe ophthalmic practice during the ongoing COVID-19 pandemic. These guidelines have numerous similarities;however, subtle differences exist. The purpose of this paper was to discuss measures, with a specific focus on standard precautions, to prevent further dissemination of COVID-19 at Eye Clinics. We have proposed procedures to triage suspected cases of COVID-19, considering emergency conditions.
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Background: To report the posterior segment (uvea and retinal) manifestations and imaging characteristics of eyes of patients with and after coronavirus disease 2019 (COVID-19).Methods: We searched the PubMed/MEDLINE database to identify relevant articles using the following search terms: COVID-19, SARS-CoV-2, retina, uvea, optic nerve, retinal findings, posterior segment manifestations, and endophthalmitis. Articles published from December 1, 2019, to May 30, 2021, and indexed in PubMed/MEDLINE were screened.Results: For the purpose of this review, we included clinical features of 26 case reports and 8 case series. The posterior segment manifestations reported included cotton wool spots, retinal hemorrhages, central serous retinopathy, papillophlebitis, optic neuritis, panuveitis, multifocal retinitis, necrotizing retinitis, central retinal artery/vein occlusion, and Purtschner like retinopathy. In this review, we have also included optical coherence tomography angiography (OCTA) features that have been described in COVID-19 patients with pneumonia.Conclusions: COVID-19 patients can experience uveo-retinal manifestations even after recovery. These patients, even if asymptomatic for eye symptoms, should undergo an eye evaluation to rule out posterior segment involvement. OCTA performed in these patients revealed microvascular changes in the superficial and deep retinal plexuses. Some of these patients may require anticoagulant or antiplatelet therapy.
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Background: The limited accessibility of in-person optometry services during the coronavirus disease 2019 highlighted the need for teleoptometry but no data exists to substantiate the foregoing in Trinidad & Tobago (T&T). The study assessed the knowledge, attitude and perception (KAP) of optometrists toward teleoptometry in T&T. Methods: This cross-sectional study utilized a convenient sampling technique to administer a structured, web-based survey to all registered optometrists in T&T between March and June 2021. Information on demographics and KAP of teleoptometry were collected. Descriptive statistics (mean, percentages, and standard deviations) were used to describe the characteristics of respondents. The mean scores for the main outcomes (KAP) were compared between the categorical groups of the demographic variables, using a one-way analysis of variance. A P-value of less than 0.05 was considered statistically significant. Results: Of the 116 registered optometrists in T&T, 63 responded to the survey (response rate, 54.3%), and were mostly women (44, 69.8%), aged 21-30 years (42, 66.7%), worked in urban regions (41, 65.1%), and half of them (32, 50.8%) had practiced optometry for five or more years. More than two-thirds of the optometrists (76.4%) reported that they had never provided teleoptometry services, and only a few (2, 3.2%) had training on teleoptometry. The percentage mean scores for knowledge were significantly lower than attitude (38.5 ± 17.9% vs 78.2 ± 29.9%; P = 0.002) and perception (46.2 ± 11.4%; P < 0.001) scores, all of which were significantly lower among self-employed than employed optometrists (P < 0.02, for all three variables). While men and non-professional computer users had higher mean scores for attitude than women (3.03 [95%CI: 2.14, 3.93] vs 2.31 [95%CI: 1.41, 3.21], P = 0.037) and professional users (3.15 [95%CI: 2.07, 4.24] vs 2.18 [95%CI: 1.12, 3.24], P = 0.001), knowledge and perception scores varied significantly with practitioners' years of experience (P = 0.042) and age (P = 0.041), respectively. Conclusion: The findings of the study suggest that although there was limited knowledge of teleoptometry among the participants, particularly the self-employed and the less experienced optometrists, most of them had good attitudes and perceptions toward teleoptometry. To fill the identified knowledge gap, there is a need for teleoptometry training among optometrists in T&T.
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Purpose: To report three older male individuals, all homoplasmic for m.14484 T > C mutation in the ND6 gene, presenting onset of vision loss weeks‐months after covid vaccination. None reported a history of covid‐19 infection.Methods: All clinical data was extracted and reported here as a Case Series.Results: A 68 years old man (A) had a 3rd dose of BioNTech/Pfizer COVID‐19 vaccination on 1st Nov 2021. 10 days later his vision was 6/6 OD and 6/60 OS. By Dec 2021 VA was 6/36 OD and 6/60 OS. His nephew lost vision age of 18 years with LHON. In March 2022, visual acuities were HM OD and HM OS. In May 2022 visual acuity was HM OD, PL OS. He started on idebenone 300 mg tds.A 55 years old man (B) had a 1st dose Astra Zeneca COVID‐19 vaccination in mid Feb 2021. 12 days later, March 2021 he developed a Bell's Palsy and sensory neuropathy at the top of his legs, feet and upper arms, with difficulty walking. MRI showed enhanced optic nerves and enhanced lesions at C2. In April 2021, he lost vision in his right eye, followed by left eye in June 2021. By September 2021 vision was CF BEs. He started on idebenone 300 mg po tds. In May 2022 he was LogMAR @ 2 m 1.34 OD and MH OS.A 72 years old man (C) had his 2nd dose of BioNTech/Pfizer COVID‐19 vaccination in April 2021. In Sept 2021 he reported loss of vision in both eyes but could not date onset. He was the maternal cousin of individual B. In May 2022 vision was 3/60 OD CF OS. He started on idebenone 300 mg po tds.Conclusions: Adverse ocular events related to COVID‐19 vaccines are remarkable rare. There are >20 published case reports (~89 patients) of adverse ocular events within 28 days of COVID‐19 vaccination, with all three vaccines (Pfizer, AstraZeneca and Moderna). Reports incl. conjunctivitis, facial and abducens nerve palsy, CSR, uveitis, MEWDS, VKH, Graves' Disease, endothelial graft rejection, AAION and AZOOR. The role of vaccination in subsequent vision loss in those with underlying mitochondrial mutation is not clear.
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Since the spread of coronavirus pandemic caused by the SARS‐CoV‐2 virus, several measures were implemented worldwide to try to stop the pandemic and minimize its impact on healthcare.Ophthalmologists are one of the most exposed specialists to airborne particles due to their close proximity to patients' faces during the examination.Therefore during the pandemic, all non‐essential procedures and appointments were cancelled or postponed, and new approaches to virtual clinics were explored.This presentation will discuss the impact of Covid related delayed care in patients with glaucoma and how the implementation of virtual and diagnostic clinics had on reducing long waiting list and streamlining patient's care .
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Purpose: To describe the demographics and clinical characteristics of anterior scleritis associated with uveitis in a referral center in Tunisia.Methods: The charts of twenty patients (20 eyes) diagnosed with sclero‐uveitis at Fattouma Bourguiba University Hospital, Monastir, Tunisia, presented between January 2015 and April 2022, were retrospectively reviewed. Detailed ophthalmic examination and fundus photography were performed in all patients. Mean follow‐up period was 28.4 months. Patients with keratitis or posterior scleritis were excluded.Results: There were eight women and 12 males patients with a mean age of 34.8 years. All patients presented with ocular pain. Mean initial best‐corrected visual acuity (BCVA) was 20/80 (range, 20/2000–20/25).There was an associated anterior uveitis in 80% of cases and panuveitis in 20%. Clinical findings at presentation included nodular scleritis in five eyes (25%) and scleromalacia perforans in four eyes (20%). Idiopathic sclero‐uveitis accounted for almost 55%. Identified causes of sclerouveitis included rheumatoid arthritis in four eyes (20%), tuberculosis in three eyes (15%), granulomatosis with polyangiitis in two eyes (10%), sarcoidosis in one eye (5%) and then one case after mRNA 1273 vaccine (5%). Ocular complications included pupillary seclusion in 25% of cases and vision loss in 10% of patients. Mean final BCVA was 20/100 (range, 20/4000–20/32). Treatment modalities of non‐infectious scleritis included indomethacine in 14 patients (82.3%), systemic corticosteroid in seven patients (41.1%) and immunosuppressant or biological agent in five patients (29.4%).Conclusions: Our results provide useful information about the patterns and etiologies of sclerouveitis. The leading causes of sclerouveitis include mainly rheumatoid arthritis and tuberculosis. An infectious cause should be always ruled out.
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Purpose: The SARS‐CoV‐2 pandemic has affected all countries in the world and is still ongoing. Although respiratory symptoms are the main manifestation of acute infection, there is also increasing evidence that neurological and vascular symptoms occur, and it is unknown whether residuals remain after patients have recovered. We therefore set out to investigate whether ocular vascular alterations remain after patients have recovered.Methods: Patients that had recovered from COVID‐19 infection within the last 6 months before inclusion and healthy age‐ and sex‐matched controls were recruited. Main inclusion criteria for patients were confirmed positive PCR test for SARS‐CoV‐2 in the medical history and positive testing for SARS‐CoV‐2 seroprevalence while controls had no history of COVID‐19 infection. Arteriovenous (AV) difference in oxygen saturation was calculated out of retinal arterial and venous oxygen saturation, which were measured with a commercially available Dynamic Vessel Analyser (DVA, Imedos, Germany). Retinal vessel diameters and arteriovenous ratio (AVR) were assessed using the same device. In addition, mean blur rate in the tissue area of the optic nerve head (MT) was quantified using laser speckle flowgraphy (LSFG, Nidek, Japan).Results: 29 patients that had recovered from moderate to severe COVID‐19 requiring hospitalization (mean age 35 ± 17 years) and 11 control subjects (mean age 36 ± 12 years) were included in the present study. No differences between groups regarding sex or concomitant diseases in the medical history were found. Body mass index (BMI) was significantly higher in patients that had recovered from COVID‐19 (27.5 ± 5.6 vs. 24.5 ± 2.8 m2/kg, p = 0.036). AVR as well as AV difference in oxygen saturation was significantly lower in patients compared to healthy controls (p = 0.021 for AVR and p = 0.023 for AV difference in oxygen saturation). MT in the optic nerve head also was significantly lower in patients (23.4 ± 10.1 a.u.) than in control subjects (47.3 ± 26.6 a.u., p < 0.001).Conclusions: The results of this study imply that retinal metabolism is still altered in patients after recovering from COVID‐19 infection. Longitudinal studies are required to investigate whether these changes in retinal vessels as well as optic nerve head blood flow are temporary or remain.
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PURPOSE: Optometry education strives to develop competencies required for reflective practice in its pupils. The forced changes in academia during COVID-19 pandemic, rapid switching to online methods imposed serious challenges on the training of reflective skills. We hypothesize that the synchronous online sessions of case-based reflections are effective in imparting training for reflective practice in optometry students. METHODS: A prospective study was done with planned, synchronous, online, small group workshops for case-based reflections through the second year of optometry program during 'introduction to patient care' course. The reflective competencies were measured with a modified Groningen Reflection Ability Scale (GRAS) at the beginning and towards conclusion. Data was analysed with Mann-Whitney one tail test and qualitative thematic methods. RESULTS: Total of 104 students participated in the study. The aggregate score showed significant improvement (p<0.05) in students' reflective ability. A rising trend was seen in each component namely self-reflection, empathetic and communication reflections. DISCUSSIONS: The results demonstrate that the reflective skills can be developed using virtual patient experiences, case-based reflective practices conducted in synchronous small group workshops in online mode. Students perceived it as useful activity in developing themselves as healthcare professionals.
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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!
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Purpose : Congress passed the CARES Act (Coronavirus Aid, Relief, and Economic Security) Provider Relief Fund to help healthcare providers recoup lost revenue during the pandemic. We aimed to determine how much of this federal aid was provided to ophthalmology and optometry practices, and whether the amount of aid received varied based on practice size. Methods : We used the Centers for Medicare and Medicaid Services (CMS) Physician Compare National Database to identify medical practices that provide eye care. We used practice names to link this database to the Health and Human Services (HHS) Provider Relief Fund (PRF) database to determine how much aid each practice received through the CARES Act. Results : We identified 2,625 optometry or ophthalmology practices that received funding through the CARES Act Provider Relief Fund that were not hospital-owned or affiliated with multi-specialty practices. Large practices with more than 10 clinicians accounted for only 268 of the 2,625 practices in our sample, but received nearly half of all funding ($182 million). Per-practitioner funding varied based on practice size (p=0.047), but differences in per-practitioner funds were not significant after adjusting for practice specialty (ophthalmology, optometry, or both). We also found that retina specific practices tended to receive more than their counterparts. Conclusions : This study demonstrates a relatively uniform distribution of per capita funds when adjusted for ophthalmologists, optometrists, and mixed-practices regardless of practice size. This policy demonstrates how federal aid is distributed to independent ophthalmology practices, and that smaller practices which are at higher risk may need larger per capita payments to remain viable during times of economic stress.