Effect of nutritional-deficiency anemia on peripapillary retinal nerve fiber layer: A North Indian study.

PURPOSE: The purpose of this study was to evaluate the effect of nutritional-deficiency anemia (NDA) on peripapillary retinal nerve fiber layer thickness (PPRNFLT) using spectral-domain optical coherence tomography and to determine any correlation arising thereof. This was a single-center, cross-sectional, observational study. MATERIALS AND METHODS: A total 115 eyes of 115 NDA patients (50 of each with iron-deficiency anemia [IDA] and Vitamin B12-deficiency anemia [BDA], and 15 with folic acid-deficiency anemia [FDA]) aged 18-65 years were compared with a total 100 eyes of 50 age- and sex-matched healthy controls. All subjects underwent comprehensive clinical, ophthalmic, and hematological evaluation, followed by PPRNFLT assessment for the mean total, superior, inferior, nasal, and temporal quadrants. RESULTS: PPRNFLT for the mean total and all four quadrants in IDA patients, for the mean total, inferior, nasal, and temporal quadrants in BDA patients, and for the mean total, inferior, and nasal quadrants, in FDA patients, was significantly lower as compared to the controls (P < 0.05). The mean total PPRNFLT of all NDA patients correlated significantly (P < 0.05) with their relevant hematological parameters with Pearson's coefficient (r) value of 0.613, 0.610, 0.336, 0.295, 0.337, 0.374, and - 0.509, respectively, for serum haemoglobin (Hb), iron, ferritin, mean corpuscular volume (MCV), mean cell hemoglobin, mean corpuscular hemoglobin concentration, and total iron binding capacity in IDA; 0.310, 0.435, and - 0.386, respectively, for serum Hb%, Vitamin B12, and MCV in BDA; and 0.557, 0.358, and - 0.294 for Hb%, folate, and MCV, respectively, in FDA cases. Mean total retinal nerve fiber layer thinning of all NDA patients showed progression with the increasing severity grades of anemia, except in very severe BDA where an inverse relationship was documented. CONCLUSION: Our study revealed that PPRNFLT is significantly thinner in all NDA patients (total and all four quadrants in IDA; total, inferior, nasal, and temporal in BDA; and total, inferior, and nasal in FDA) correlating well with their relevant hematological parameters. Early detection of this may be crucial in preventing potential blinding sequelae and differentiating glaucomatous and other neuro-ophthalmic disorders.

Effect of vitamin B12 deficiency anemia on peripapillary retinal nerve fiber layer.

AIM: To evaluate the effect of vitamin B12 deficiency anemia (BDA) on peripapillary retinal nerve fiber layer thickness (RNFLT) using spectral domain optical coherence tomography (SD-OCT), and to determine any correlation arising thereof. METHODS: In this cross-sectional observational study, 99 eyes of 50 BDA patients of age 18-65y were compared with 100 eyes of 50 healthy control subjects. All subjects underwent comprehensive clinical, ophthalmic, and hematological evaluation, followed by peripapillary RNFLT assessment using SD-OCT. RESULTS: The mean total, inferior, nasal, and temporal RNFLT were significantly lower in BDA group as compared to control group (P<0.05). The mean total, inferior and nasal RNFLT correlated significantly (P<0.05) with serum Hb%, B12 and mean corpuscular volume (MCV) level (r=0.310, 0.435, -0.386 for total; r=0.932, 0.481, -0.513 for inferior; r=0.344, 0.254, -0.233 for nasal; respectively), while temporal and superior RNFLT quadrant did not show any correlation with any of the hematological parameters (r=0.144, 0.167, -0.096; r=0.111, 0.070, -0.099; respectively). The mean total RNFLT showed progressive thinning at par with the progression of anemia, except in very severe BDA, where an inverse relationship was documented. CONCLUSION: The mean total, inferior, nasal, and temporal peripapillary RNFLT was significantly thinner in BDA patients. Peripapillary RNFLT thinning seemed to proceed at par with the progression of severity of anemia, except in very sever grade. Early assessment of peripapillary RNFLT may be crucial in BDA patients to prevent potential blinding sequelae. Peripapillary RNFLT thinning in BDA patients should be considered in the differential diagnosis of other non-glaucomatous optic neuropathies, as well.

Impact of ophthalmic webinars on the resident's learning experience during COVID-19 pandemic: An insight into its present and future prospects.

PURPOSE: To analyze the impact of ophthalmic webinars on the resident's learning experience during the COVID-19 pandemic (CP). METHODS: This cross-sectional nationwide study was carried out for 1 month during CP and included a total of 382 ophthalmic residents. A questionnaire was sent through various social media platforms. RESULTS: Residents expressed a decline in their clinical exposure (74%; 220), thesis work (58%; 218), and acquisition of the knowledge and skills (42.5%; 161) during CP. Benefits of webinars as perceived by the residents included gain in additional knowledge (77%; 286), feedback on queries (56%; 209), access to multiple speakers (50%; 191), and topics (30%; 110). Nearly 75% (291) of residents endorsed webinars as good to the very good academic tool, and 54% (202) preferred to continue attending webinars in the post-CP phase. However, connectivity/download/data issues (54%; 200) followed by loss of personal touch (53%; 188), lengthy or irrelevant topic (37%; 134), and poor transmission quality (33%; 121) were major deterrents against the webinar. CONCLUSION: The current study generated overall mixed responses from the ophthalmic postgraduate residents in favor of webinars. In the present format, webinars bear enormous potentials to supplement the traditional learning tools by providing uninterrupted learning experiences. However, they are still limited by their pedagogical and technical issues.

ToRCH-screening in pediatric cataract revisited: A North Indian tertiary care centre study.

Purpose: To analyze and report ToRCH-serology screening profile (Toxoplasma gondii [TOX], rubella [RV], cytomegalovirus [CMV], and herpes simplex virus [HSV-I/II]) in pediatric cataract. Methods: In this prospective analytical study, 1,026 consecutive children were screened, of which 46 children with clinically diagnosed congenital (n = 26) and developmental cataract (n = 20) were included. Post-traumatic and familial cataracts were excluded. Sera of all children were tested both qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner. Results: Overall, IgM/IgG-seropositivity against ≥1 ToRCH agent was reported in 91.3% (42/46) children. IgM (±IgG) positivity against ≥1 ToRCH agent was reported in 26.08% (12/46) children (nine congenital and three developmental cataract; P = 0.18), which included 8.7% (4/46) children reported positive against ≥2 agents. Finally, 13% (6/46) children were reported to be sero-clinical-positive (three were infants and three were> 1 year age, P = 0.55; five congenital and one developmental cataract, P = 0.21). Either alone or combined, RV attributed to the majority (50%; 6/12) of the IgM (±IgG) and sero-clinical-positive (50%; 3/6) children. None of the children were HSV-II IgM-positive. Laboratory-confirmed congenital rubella syndrome was reported in 4.3% (2/46) children. One sero-clinical-positive infant with rare coexisting bilateral persistent fetal vasculature was also reported. IgG-alone positivity was reported highest with CMV in 67.4% (31/46) children, whereas 43.4% (20/46) children were found nonimmune to RV. Conclusion: The current study emphasizes the need to interpret ToRCH-screening in pediatric cataract with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize the diagnostic errors. Clinicians should remain vigilant regarding sero-clinical-positivity in older children too who might pose a threat to the spread of infection.