Determination of Refractive Error Using Direct Ophthalmoscopy in Children.

Purpose: Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test. Patients and Methods: This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed. Results: The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021). Conclusion: The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.

Cháksu: A glaucoma specific fundus image database.

We introduce Cháksu-a retinal fundus image database for the evaluation of computer-assisted glaucoma prescreening techniques. The database contains 1345 color fundus images acquired using three brands of commercially available fundus cameras. Each image is provided with the outlines for the optic disc (OD) and optic cup (OC) using smooth closed contours and a decision of normal versus glaucomatous by five expert ophthalmologists. In addition, segmentation ground-truths of the OD and OC are provided by fusing the expert annotations using the mean, median, majority, and Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm. The performance indices show that the ground-truth agreement with the experts is the best with STAPLE algorithm, followed by majority, median, and mean. The vertical, horizontal, and area cup-to-disc ratios are provided based on the expert annotations. Image-wise glaucoma decisions are also provided based on majority voting among the experts. Cháksu is the largest Indian-ethnicity-specific fundus image database with expert annotations and would aid in the development of artificial intelligence based glaucoma diagnostics.

Central retinal vein occlusion secondary to varicella zoster retinal vasculitis in an immunocompetent individual during the COVID-19 pandemic - A case report.

We report the occurrence of unilateral central retinal vein occlusion (CRVO) in a young yoga enthusiast who presented amidst the COVID-19 pandemic. Subtle signs of uveitis when systemically investigated revealed a multitude of causes, but ocular fluid polymerase chain reaction was positive for varicella zoster virus (VZV). The prompt initiation of antivirals resulted in a good visual outcome. Our case describes the rare presentation of VZV retinal vasculitis as CRVO in a young healthy individual and highlights the importance of early antiviral therapy for favorable outcomes.

Smartphone-Acquired Image Photogrammetry for Detection of Shallow Anterior Chamber.

PURPOSE: This study aimed to explore the role of smartphone imaging of the eye using two perspectives - anterior and temporal - in the detection of a shallow anterior chamber (AC). The AC depth (ACD) of an eye can be used as a surrogate marker for identification of eyes at risk of developing angle-closure disease. METHODS: A prospective observational study was conducted at a university teaching hospital in South India. Each eye was photographed with a smartphone using the two perspectives, followed by quantitative measurement of ACD using optical biometry. The percentage of nasal iris illuminated was measured from the image acquired using the flashlight method (anterior perspective), whereas pupil position relative to the cornea was measured from the image acquired using the temporal perpendicular method (temporal perspective). The receiver-operating characteristic curve and area under the curve (AUC) were studied for both perspectives independently for overall predictive accuracy in detection of shallow AC (ACD <2.7 mm, obtained by IOL Master). RESULTS: A total of 275 eyes were examined, of which 77 (28%) had an ACD <2.7 mm. The accuracy of detection of shallow AC was found to be 95.2% for both perspectives when used alone or in combination. AUC of the anterior perspective was 0.99 (95% CI 0.982-0.997). The AUC for the temporal perspective was 0.993 (95% CI 0.988-0.999). CONCLUSION: Smartphone-acquired image photogrammetry of an eye with anterior and temporal perspectives independently and in combination provided accuracy nearing 95% in the detection of shallow AC (ACD <2.7 mm). REGISTRATION: This trial was registered with the Clinical Trial Registry of India (CTRI/2018/09/015867, September 28, 2018).

Leptospiral uveitis in coastal Karnataka: A case report.

We report a case of a young male from Udupi, Karnataka, presenting with features of bilateral non-granulomatous anterior uveitis with mild vitritis. There was a history of fever and myalgia a month before ocular features, which was partially treated. He also gave a history of being actively involved in the flood relief work in the district, before the onset of fever. This prompted an evaluation of leptospirosis, which came positive. The possibility of leptospira uveitis needs to be considered, especially in cases of non-granulomatous uveitis after floods in areas endemic for leptospirosis, which may otherwise be wrongly labeled idiopathic.

The association between diabetic retinopathy and periodontal disease.

PURPOSE: The purpose of the study was to study the association between diabetic retinopathy (DR) and periodontal disease (PD) in a South Indian cohort. METHODS: This was a cross-sectional, observational, interdisciplinary hospital-based study wherein patients with diabetes mellitus visiting the ophthalmology department of a university teaching hospital in coastal Karnataka, south India, during the study period, were screened independently for retinopathy by an ophthalmologist and PD by a periodontal surgeon. All the patients were above 18 years of age and did not have juvenile or gestational diabetes. A total of 213 patients consented to participate in the study. The data were analyzed for association using the Chi-square test. RESULTS: There was a statistically significant association between the presence of DR and PD (P = 0.02). The increasing severity of DR was associated with an increase in the components of PD including plaque index (P < 0.001) and gingival index (P < 0.001). CONCLUSION: There is a significant association between DR and PD. The awareness of this association can aid in the screening of potentially sight-threatening retinopathy in diabetics presenting to the dental clinic with PD.

Ocular toxoplasmosis associated with scleritis.

We report an atypical presentation of Toxoplasma retinochoroiditis with associated scleritis in a young and immunocompetent patient. The diagnosis was done on the basis of Polymerase chain reaction of vitreous sample, and the clinical response to specific treatment. This case highlights the unusual presentation of ocular toxoplasmosis as scleritis.