Screen Time Among Medical and Nursing Students and Its Correlation With Sleep Quality and Attention Span: A Cross-Sectional Study.

BACKGROUND:  Screen time is increasing among students and is also known to affect their lifestyle and health. The study investigated the correlation of screen time with sleep quality and attention span. METHODS: A cross-sectional study was conducted among undergraduate medical and nursing students in November 2021. A total of 192 students were selected randomly and investigated using a structured questionnaire. Sleep behavior was assessed using the Pittsburg Sleep Quality Index. Screen time and attention span were measured for each participant. The screen time data was reported as the median with an IQR. Pearson's correlation was performed to assess the correlation between screen time and sleep behavior and screen time and attention span. RESULTS:  The median screen time for 28 days was 260 (192.2-326.7) hours, and the median non-academic screen time was 250.0 (172.3-328.0) hours. Subjective sleep quality was good among 163 (84.9%) of the study participants. Global sleep quality was poor among 91 (42.2%) participants. The median score of the digit span forward was 6.00 (IQR: 5.00-7.00), and the median score of the digit span backward was 5.00 (IQR: 4.00-6.00). The global sleep score had a strong positive correlation with screen time, with a Pearson's correlation coefficient of 0.86. Forward and backward attention spans were not correlated with sleep scores, with correlation coefficients of 0.037 and 0.071, respectively. CONCLUSION:  Screen time is increasing significantly among medical and nursing undergraduate students, and their sleep is also getting affected. Emphasis should be given to the balance between digitalization and health.

Detecting glaucoma from multi-modal data using probabilistic deep learning.

Objective: To assess the accuracy of probabilistic deep learning models to discriminate normal eyes and eyes with glaucoma from fundus photographs and visual fields. Design: Algorithm development for discriminating normal and glaucoma eyes using data from multicenter, cross-sectional, case-control study. Subjects and participants: Fundus photograph and visual field data from 1,655 eyes of 929 normal and glaucoma subjects to develop and test deep learning models and an independent group of 196 eyes of 98 normal and glaucoma patients to validate deep learning models. Main outcome measures: Accuracy and area under the receiver-operating characteristic curve (AUC). Methods: Fundus photographs and OCT images were carefully examined by clinicians to identify glaucomatous optic neuropathy (GON). When GON was detected by the reader, the finding was further evaluated by another clinician. Three probabilistic deep convolutional neural network (CNN) models were developed using 1,655 fundus photographs, 1,655 visual fields, and 1,655 pairs of fundus photographs and visual fields collected from Compass instruments. Deep learning models were trained and tested using 80% of fundus photographs and visual fields for training set and 20% of the data for testing set. Models were further validated using an independent validation dataset. The performance of the probabilistic deep learning model was compared with that of the corresponding deterministic CNN model. Results: The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and combined modalities using development dataset were 0.90 (95% confidence interval: 0.89-0.92), 0.89 (0.88-0.91), and 0.94 (0.92-0.96), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using the independent validation dataset were 0.94 (0.92-0.95), 0.98 (0.98-0.99), and 0.98 (0.98-0.99), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using an early glaucoma subset were 0.90 (0.88,0.91), 0.74 (0.73,0.75), 0.91 (0.89,0.93), respectively. Eyes that were misclassified had significantly higher uncertainty in likelihood of diagnosis compared to eyes that were classified correctly. The uncertainty level of the correctly classified eyes is much lower in the combined model compared to the model based on visual fields only. The AUCs of the deterministic CNN model using fundus images, visual field, and combined modalities based on the development dataset were 0.87 (0.85,0.90), 0.88 (0.84,0.91), and 0.91 (0.89,0.94), and the AUCs based on the independent validation dataset were 0.91 (0.89,0.93), 0.97 (0.95,0.99), and 0.97 (0.96,0.99), respectively, while the AUCs based on an early glaucoma subset were 0.88 (0.86,0.91), 0.75 (0.73,0.77), and 0.92 (0.89,0.95), respectively. Conclusion and relevance: Probabilistic deep learning models can detect glaucoma from multi-modal data with high accuracy. Our findings suggest that models based on combined visual field and fundus photograph modalities detects glaucoma with higher accuracy. While probabilistic and deterministic CNN models provided similar performance, probabilistic models generate certainty level of the outcome thus providing another level of confidence in decision making.

Detection of mitotic HEp-2 cell images: role of feature representation and classification framework under class skew.

We propose and analyze a framework to detect and identify the mitotic type staining patterns among different non-mitotic (interphase) patterns on HEp-2 cell substrate specimen images. This is considered as a principal task in computer-aided diagnosis (CAD) of the autoimmune disorders. Due to the rare appearance of mitotic patterns in whole slide/specimen images, the sample skew between mitotic and non-mitotic patterns is an important consideration.We suggest to apply some effective samples skew balancing strategies for the task of classification between mitotic v/s interphase patterns. Another aspect of this study is to consider the morphology and texture-based differences between both the classes that can be incorporated through effective morphology and texture-based descriptors, including the Gabor and LM (Leung-Malik) filter banks and also through some contemporary filter banks derived from convolutional neural networks (CNN).The proposed framework is evaluated on a public dataset and we demonstrate good performance (0.99 or 1 Matthews correlation coefficient (MCC) in many cases), across various experiments. The study also presents a comparison between hand-engineered and CNN-based feature representation, along with the comparisons with state-of-the-art approaches. Hence, the framework proves to be a good solution for the mentioned skewed classification problem.

Artificial Intelligence Efficiently Identifies Regional Differences in the Progression of Tomographic Parameters of Keratoconic Corneas.

PURPOSE: To develop an artificial intelligence (AI) model to effectively assess local versus global progression of keratoconus using multiple tomographic parameters. METHODS: This was a retrospective review of medical records of patients diagnosed as having keratoconus. A total of 1,884 Pentacam (Oculus Optikgeräte GmbH) scans of 366 eyes (296 patients) were analyzed. Based on an increase in maximum anterior curvature (Kmax), the eyes were classified as actual "progression" and "no progression." The corresponding changes in other Pentacam parameters were incorporated to train and cross-validate (five-fold) the AI models. Three AI models were trained (an increase in Kmax by A = 0.75 diopters [D], B = 1.00 D, and C = 1.25 D). The area under the curve (AUC), sensitivity, specificity, and classification accuracy, along with other metrics, were evaluated. RESULTS: The AUC, sensitivity, specificity, and classification accuracy were 0.90, 85%, 82%, and 83%, respectively, for Model A; 0.91, 86%, 82%, and 88%, respectively, for Model B; and 0.93, 89%, 81%, and 91%, respectively, for Model C. All models also predicted that 60% to 62% of the actual progression eyes had concomitant progression-associated changes in the other Pentacam parameters (global progression). However, there was discordance between increase in Kmax and concomitant associated changes in the other parameters in 38.8% to 40% of the eyes (local progression). CONCLUSIONS: The AI models identified the eyes where the increase in Kmax and corresponding progression-associated changes in the other parameters were in agreement. These eyes may require corneal cross-linking earlier than the rest. [J Refract Surg. 2021;37(4):240-248.].

Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers.

Keratoconus (KC) is a progressive ectatic corneal disorder. There are multiple topographic devices and their varied indices used for diagnosis, detecting progression, and deciding management. It is important to understand the repeatablility, intra- test variabililty, and comparability amongst various topographic devices. The Scheimpflug camera-based devices, such as the Pentacam (Oculus, Wetzlar, Germany), Galilei (Ziemer, Biel, Switzerland), and Sirius (Costruzione Strumenti Oftalmici, Florence, Italy) are known to assist in the detection of early keratoconus and subclinical keratoconus. This article reviews the various Scheimpflug camera-based devices in depth, addressing their different indices, diagnostic accuracy, repeatability, and agreement and identifying the strongest parameter of each device. It will guide the practicing clinician by giving practical tips for decision making in the diagnosis and management of keratoconus.

Advanced epithelial mapping for refractive surgery.

One of the leading challenges in refractive surgery today is the presence of underlying subclinical early-stage keratoconus (KC), which can lead to iatrogenic post laser in situ keratomileusis ectasia. Timely detection of this condition could aid the refractive surgeons in better decision-making. This includes being able to defer refractive surgery in subclinical cases as well as providing treatment for the same in the form of appropriate corneal collagen crosslinking treatments. Corneal topography is considered the gold standard for the diagnosis of corneal ectatic disorders. However, there is a likelihood that topographers are overlooking certain subclinical cases. The corneal epithelium is known to remodel, which may mask underlying stromal irregularities. Imaging and analyzing corneal epithelium and stroma independently will undoubtedly open newer avenues to supplement our understanding of postrefractive surgery outcomes and KC. This review encapsulates the various Optical coherence tomography-based epithelial mapping devices particularly RTVue (Optovue, Fremont, USA) and MS-39 (Costruzione Strumenti Oftalmici, Florence, Italy) in terms of their utility in these conditions. It will help guide the clinician on how including an epithelial mapping in clinical practice can aid in diagnosis, management, and interpretation of outcomes both for refractive surgery as well as KC.

ABCD: A new classification for keratoconus.

Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more modern staging system. The new Belin ABCD keratoconus staging system incorporates anterior and posterior curvature centered on the thinnest point of the cornea, thinnest pachymetry values and distance visual acuity in grades from 0-4. By including posterior curvature and thickness measurements based on the thinnest point, as opposed to apical, the new staging system better reflects anatomical changes seen in keratoconus and other ectatic diseases.

Integrating binocular vision assessment in refractive surgery work-up: Proposition and protocol.

Refractive surgeries are one of most commonly performed surgeries for correcting visual impairment due to refractive errors. With the increase in demand for refractive surgeries, there is an enormous strain on the operating surgeon for delivering ideal outcomes i.e 20/20 visual acuity. Regression, under-correction and ectasia are the most dreaded complications post-refractive correction, for the surgeon as well as the patient. They have significant effects on the quantity of the vision and most importantly on the quality of life of the patient. With the advent of digital era and jobs requiring the eyes being glued to the screen for hours there has been a surge in the patients presenting with complaints of asthenopia, glare, halos, and difficulty in focusing; pointing towards diagnosis of non-strabismic binocular vision anomalies (NSBVA). NSBVA in a postrefractive surgery patient may masquerade as regression or under-correction. However, timely diagnosis of NSBVA in such patients would prevent the greater harm caused by wrongful re-correction. Home- and office-based vision therapy results in improvement in visual acuity in a large majority of these patients. This preferred practice pattern intends to guide the refractive surgeons to diagnose and treat the postrefractive surgery NSBVA following a case-based and algorithmic approach. It also emphasizes the inclusion of the binocular vision assessment as a part of the pre-operative workup for patients undergoing refractive procedures.

Preferred practice patterns for photorefractive keratectomy surgery.

Over the past two decades, excimer laser-based refractive surgery procedures have been successfully established for their safety and satisfactory visual outcomes. Surface ablation procedures or photorefractive keratectomy (PRK) are practised commonly for the correction of refractive errors including myopia, astigmatism and hyperopia. Satisfactory visual outcomes are achieved in majority of cases, although a very small percentage have issues related to corneal haze, regression, and its associated visual disturbances. To ensure optimal outcomes and to minimize complications, certain keys to success have been designed on the basis of the current review of literature on surface ablation procedures.

Algorithmic approach to diagnosis and management of post-refractive surgery dry eye disease.

Dry eye disease (DED) is a condition that is fast reaching epidemic proportions around the world. Dry eye post-refractive surgery is the leading cause of iatrogenically induced DED. The wide variety of presentations and the disparity between signs and symptoms in many patients make this a very challenging aspect of our clinical practice. There has been a paradigm shift in the way we approach and treat this condition. The International Dry eye workshop has added new knowledge and focus to our management of dry eye. A wide range of newer diagnostic modalities are available for the diagnosis of DED. Dry eye is one of the most common side effects of refractive surgery and can have a bearing the patient's perception of surgical outcomes as well. A thorough understanding of the possible underlying etiopathologies of this disease and the difference in etiopathogenesis of postrefractive dry eye is essential for optimal outcomes. It is important to approach each case in a unique fashion and customize the therapy to the patient presentation. This review article compiles all these aspects of management of dry eye in general, and postrefractive surgery dry eye in particular; from the ones commonly practiced in the clinic to the newer modalities of therapy with insights into the disease from a more practical point of view.

Customized laser vision correction for irregular cornea post-refractive surgery.

Ablation-related complications following the refractive procedures are a major challenge for a refractive surgeon, considering the elective nature of the procedure. The use of topography-guided customized ablation has revolutionized the management of irregular corneas postrefractive surgery. This preferred practice highlights various hurdles encountered while managing cases of decentered ablation, small ablation zones, and planning a cataract surgery in patients with irregular corneas. It will give insight to the refractive surgeon on the planning of corneal regularization on various modern-day refractive platforms available, such as the WaveLight® EX-500 (Alcon Laboratories, Inc., Fort Worth, TX, USA), Schwind Amaris 1050 (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany), and Technolas Teneo 317 model 2 excimer laser (Bausch & Lomb, Rochester, NY, USA). The algorithmic approach outlined will enable the refractive surgeon to choose between the wavefront optomized and the topography-guided ablations.

Epithelial remodelling masquerading as keratoconus progression: An interesting case report.

A 25-year-old male patient presented with chief complaints of itching in both eyes (OU) for the past one month. Detailed ophthalmic examination showed best-corrected visual acuity of 6/6 OU. On slit-lamp examination of the left eye, Vogt's striae were documented and rest of the anterior segment was normal OU. Pentacam-HR and ASOCT confirmed the diagnosis of keratoconus. The patient was started on Trehalose containing preparation for both eyes. On follow-up visit at 8 months, progression was documented on Pentacam-HR. MS-39 showed epithelial remodeling, but no stromal or posterior elevation, indicative of a pseudo-progression. Corneal epithelial remodeling post topical trehalose containing eye drops application has been very sparsely reported in literature. It is an important differential to consider when faced with a situation of a likely progression of keratoconus, especially to differentiate true from pseudo-progression.

Effectiveness of GAN-based Synthetic Samples Generation of Minority Patterns in HEp-2 Cell Images.

In this paper, we present a framework to address the augmentation of images for the rare and minor appearance of mitotic type staining patterns, for Human Epithelium Type2 (HEp-2) cell images. The identification of mitotic patterns among non-mitotic/interphase patterns is important in the process of diagnosis of various autoimmune disorders. This task leads to a pattern classification problem between mitotic v/s interphase. However, among the two classes, typically, the number of mitotic cells are relatively very less. Thus, in this work, we propose to generate synthetic mitotic samples, which can be used to augment the number of mitotic samples and balance the samples of mitotic and interphase patterns in classification paradigm. An effective feature representation is used, to validate the usefulness of the synthetic samples in classification task, along with a subjective validation done by a medical expert. The results demonstrate that the approach of generating and mingling synthetic samples with existing training data works well and yields good performance, with 0.98 balanced class accuracy (BcA) in one case, over a public dataset, i.e., UQ-SNP I3A Task-3 mitotic cell identification dataset.

Potentially blinding adverse drug reaction to peribulbar lignocaine anesthesia: A rare case report.

Peribulbar lignocaine anesthesia is commonly used in ophthalmic surgeries. It rarely causes any severe allergic reaction. A 63-year-old male presented with complicated pseudophakia. He underwent successful vitrectomy under local anesthesia. He later presented with acute-onset proptosis, orbital swelling, and extraocular movement restriction. He was afebrile with normal blood workup and radiological investigations and gave a similar past history. The patient was treated successfully with intravenous medications but two months later developed optic atrophy. An adverse reaction to lignocaine appears to be the most probable cause. Early detection and prompt management of this condition may avert a potentially grave visual outcome. Literature review shows that this case is one of its kinds to report this potentially blinding complication of peribulbar lignocaine anesthesia.

All India Ophthalmological Society - Preferred practice in refractive surgery during the COVID-19 pandemic.

Coronavirus pandemic has strained the healthcare system with mortality and morbidity. A number of elective surgeries have come to standstill due to lockdown and movement restrictions. Refractive surgery being a purely elective procedure and quite a fresh subset of ophthalmology, there is a lack of unanimity as to what precautions should be followed to resume the practice of same. This article attempts to highlight simple guidelines in accordance with an expert panel, which can be followed by all those involved directly or indirectly in refractive surgery services while addressing safety of doctors, supporting staff as well as patients as a primary concern.

Potential ocular and systemic COVID-19 prophylaxis approaches for healthcare professionals.

The COVID-19 pandemic has brought with it, innumerable challenges in healthcare, both through the direct burden of morbidity and mortality of the disease, and also by the curtailing of other essential albeit less emergency medical services to reduce the risk of community spread. Reports from around the world are showing mounting number of cases even in healthcare professionals spite of usage of adequate personal protective equipment. There are a number of factors which could account for this, be it the affinity of the virus to the respiratory and other mucosa or to patient risk factors for developing severe forms of the disease. In view of the growing need for resuming other medical services, it is essential to find newer ways to protect ourselves better, whether by systemic or topical mucosal prophylaxis with various medications or lifestyle changes promoting wellbeing and immunity. This article discusses additional prophylactic measures including drug repurposing or new indication paradigms to render protection. Certain medications such as chloroquine, trehalose, antihistaminics, and interferons used topically for various ocular conditions with reasonably good safety records are known to have anti-viral properties. Hence, can be harnessed in preventing SARS-CoV-2 attachment, entry, and/or replication in host cells. Similarly, use of hypertonic saline for nasal and oral mucosa and dietary changes are possible methods of improving our resistance. These additional prophylactic measures can be cautiously explored by healthcare professionals to protect themselves and their patients.

Multimodal imaging in an idiopathic spontaneously absorbed cataractous lens: A rare case report.

PURPOSE: To report an unusual and rare case of idiopathic spontaneous absorption of the cataractous lens and its multimodal imaging features. METHODS: A 56-year-old female presented with a complaint of diminution of vision in both eyes (OU). Slit lamp examination of the right eye (OD) revealed Morgagnian cataract with a normal anterior segment. Slit lamp examination of the left eye (OS) revealed absorbed cataractous lens with intact lens capsule with clear visual axis. Fundus examination OS was unremarkable. No history of trauma, past ocular surgery or any ocular or systemic disease. Ultrasonography B-scan OU was unremarkable. Her blood examination was normal. Anterior segment optical coherence tomography showed increased anterior chamber depth OS. It also showed Morgagnian cataractous lens with nucleus in the bag OD and absorbed cataractous lens with thin adhered capsular bag OS. Scheimpflug imaging also showed decreased densitometry OS. She underwent successful phacoemulsification in OD with in-the-bag placement of intraocular lens. For OS with absorbed lens, she underwent phacoemulsification with anterior circular curvilinear capsulorhexis using a capsulotomy forceps. The cortical matter in the bag area was aspirated with implantation of intraocular lens in the ciliary sulcus over the intact capsule rim. RESULTS: The patient underwent phacoemulsification with anterior continuous curvilinear capsulorhexis with intraocular lens placement in the ciliary sulcus OS. CONCLUSIONS: This case is first of its kind in the literature. The role of ultrasound B-scan, anterior segment optical coherence tomography, and Scheimpflug imaging in the preoperative evaluation of capsulolenticular status and subsequent successful management is discussed.