SWOT analysis of ortho-K practice in India.

PURPOSE: Orthokeratology (ortho-K) has been well established as a methodology for myopia correction and control its progression. A SWOT analysis serves as a strategic planning tool for intervention hence the purpose of this study to establish and implement ortho-K practice in India. METHOD: The study was conducted between December 2020 and June 2021. A prospective questionnaire-based study was conducted to elicit the responses in the SWOT study. Based on focus group discussion a set of five statements under strengths, weaknesses, opportunities and threats were identified. These were closed ended questions were based on a 5-point likert scale. The Content Validation Index (CVI) was computed for each item taking those answers relevant with a score of three and four on the Likert scale and omitting those with a score of one and two on the Likert scale as non-relevant. RESULTS: Strengths: 'Ortho-K is an excellent option for myopia control' was agreed by more than 50% of respondents. 67% of respondents agreed that advanced topographers has made ortho-K lens fitting easier. Weakness: More than 60% agreed that Ortho-K practice involves investment in instrumentation like topographers and trial lenses. 50% agreed that due to multiple follow up patients may be lost to follow up. OPPORTUNITY: 'Pandemic has necessitated the need for optometrists to explore myopia control options such as ortho-K' was agreed by more than 50%. Threats: 'Reluctance from adults and parents to try overnight contact lenses for myopia correction/control' was agreed by more than 50% of respondents. 62% agreed that atropine is perceived as an effective myopia control option by majority of the Indian ophthalmologists. CONCLUSION: Ortho-K as an emerging modality for Myopia management in India through SWOT analysis, allows practitioners as well as CL industry to approach Ortho-K appropriately with novel designs and practice patterns that suits the market needs.

Impact of Scleral Lens Front Surface Eccentricity on Visual Acuity, Contrast Sensitivity, and Higher-Order Aberrations in Eyes With Keratoconus.

PURPOSE: To investigate the effect of front surface eccentricity (FSE) of scleral lenses (SLs) on corrected distance visual acuity (CDVA), contrast sensitivity (CS), and higher-order aberrations (HOAs) in keratoconic eyes. METHODS: Fifteen keratoconic eyes fitted with BostonSight SCLERAL lenses of different eccentricity values (FSE0=0, FSE1=0.30, and FSE2=0.60). CDVA, CS, and HOAs were measured at baseline and after 30 min of SL wear. CDVA and CS were measured with the Early Treatment Diabetic Retinopathy Study and Pelli-Robson chart, respectively, and iTrace aberrometer was used to evaluate the HOAs. RESULTS: Baseline CDVA was 0.30±0.29, which significantly improved to 0.10±0.11, 0.05±0.06, and 0.05±0.08 logMAR with FSE0, FSE1, and FSE2, respectively ( P <0.05). The post hoc showed no significant difference between eccentricities. Baseline CS was 1.19±0.47, which improved to 1.54±0.12, 1.59±0.10, and 1.60±0.11 with FSE0, FSE1, and FSE2, respectively ( P <0.01), but post hoc showed no significant difference between eccentricities. A statistically significant reduction was found in HOAs when compared with baseline ( P <0.01). Comparison between eccentricities showed a significant difference only between FSE0 and FSE1 for RMS coma ( P =0.01) and RMS spherical aberrations ( P =0.004) where FSE1 showed better performance in reducing HOAs compared with FSE0. HO-RMS, RMS secondary astigmatism, and RMS trefoil showed no significant difference between eccentricities, but FSE1 and FSE2 performed superior to FSE0. CONCLUSION: BostonSight SCLERAL lenses with varying eccentricities corrected a significant amount of HOAs and improved CDVA and CS in keratoconus patients. Practitioners should be aware of this distinct feature of SLs and use it as needed to improve visual performance.

Results of the School Children Ocular Biometry and Refractive Error Study in South India.

Objectives: Axial length (AL) is an important contributor to refraction, and growth curves are gaining importance in the prediction of myopia. This study aimed to profile the distribution of ocular biometry parameters and to identify correlates of spherical equivalent refraction (SE) among school children in South India. Materials and Methods: The School Children Ocular Biometry and Refractive Error study was conducted as part of a school screening program in southern India. The enrolled children underwent tests that included vison check, refraction, binocular vision assessment, and biometry measurements. Results: The study included 1382 children whose mean (standard deviation [SD]) age was 10.18 (2.88) years (range: 5-16 years). The sample was divided into 4 groups (grades 1-2, grades 3-5, grades 6-9, and grade 10) based on significant differences in right AL (p<0.001). The mean (SD) AL (range: 20.33-27.27 mm) among the four groups was 22.50 (0.64) mm, 22.88 (0.69) mm, 23.30 (0.82) mm, and 23.58 (0.87) mm, respectively. The mean SE (range: +1.86 to -6.56 D) was 0.08 (0.65 D) in class 1 and decreased with increasing grade to -0.39 (1.20 D) in grade 10. There was a significant difference in all biometry parameters between boys and girls (p<0.001). Age, AL, and mean corneal curvature were the main predictors of SE. Conclusion: This study provides a profile of ocular biometry parameters among school children in South India for comparison against profiles from other regions across the country. The study data will form a reference for future studies assessing myopia in this ethnicity.

Masking the Red Reflex of Flash Photography With Prosthetic Lenses.

ABSTRACT: The purpose of this case report was to represent the clinical expertise in managing with a patient with visible red fundal reflex on flash photography and its management with a soft prosthetic contact lens (PCL). This unique case report discussed a 31-year-old man complaining of visible red reflex in right eye while taking photographs with flashlight. Ocular history revealed that he is status post intraocular lens implantation and strabismus surgery followed by a nonpenetrating injury with a stick in the right eye 20 years back. The middilated, slow, tonic pupil was making the fundal glow more prominent in bright flashlight. Because cosmesis was the main concern, various types of PCL trials were used. Finally, the red reflex was concealed with a type-D, gray, transparent, iris tinted PCL. Thus, PCL enhanced the aesthetic appearance and created a positive impact on the patient's quality of life and should be considered and prescribed in similar patients.

Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses.

PURPOSE: To investigate the effect of varying the fluid reservoir (FR) thickness of scleral lenses (SL) on corrected distance visual acuity (CDVA), contrast sensitivity (CS) and higher-order aberrations (HOAs) in keratoconic eyes. METHODS: Forty eyes with keratoconus were fitted with a diagnostic Boston Sight SL having three different FR thicknesses. CDVA, CS and HOAs were measured before and after 30 min of lens wear. An i-Trace aberrometer and anterior segment optical coherence tomography (AS-OCT) were used to measure HOAs and FR thickness, respectively. RESULTS: Statistically significant improvements in CDVA and CS were seen with different FR thickness lenses (p < 0.01). Baseline CDVA (0.22 ± 0.15) improved to 0.03 ± 0.06, 0.04 ± 0.07 and 0.07 ± 0.08 with low, standard and high FR lenses, respectively. Post-hoc testing showed better CDVA with low (p = 0.006) and standard FR (p = 0.009) lenses compared to high FR lenses. Before lens wear, CS was 1.27 ± 0.27, which improved to 1.67 ± 0.11, 1.73 ± 0.12 and 1.66 ± 0.89 with low, standard and high FR lenses, respectively. Lenses with standard FR showed better CS compared with those having low (p = 0.009) and high FRs (p < 0.001). A statistically significant reduction of higher order-root mean square aberrations (HO-RMS), coma, spherical aberration, secondary astigmatism and trefoil were found with all FR thickness lenses compared to baseline (p < 0.01). No significant difference was noted between lenses (p = 0.01). All three lenses corrected almost equal amount of HOAs. A moderate positive correlation was observed between CDVA and HO-RMS (r = 0.61, p < 0.001) for low FR lenses. CONCLUSIONS: BostonSight SCLERALs were found to be very effective in improving vision, CS and reducing HOAs in keratoconus. Lenses with varying FR thickness showed equal effectiveness in visual performance and reducing HOAs. FR thickness should be considered an important factor to provide better vision and CS by minimising HOAs, as well as to maintain the normal physiology of eyes with keratoconus.