Naren shetty - Academia.edu (original) (raw)

Papers by Naren shetty

Phakic intraocular lens: Getting the right size

Indian Journal of Ophthalmology

Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are u... more Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are unable to get refractive correction through laser platforms due to high refractive error or certain corneal contraindications. Phakic IOL's (PIOL) have their own set of complications and challenges, the most important being getting the sizing right. This paper attempts to solve the problem of accurate sizing of PIOL's. Parameters needed for calculating the ideal size of PIOL's have been studied in a step by step manner using all possible tools depending upon the availability and preference of the surgeon. The pros and cons of using a particular tool for measurements have been highlighted along with illustrative case examples to help surgeons who are starting PIOL implantation surgery.

Annals of the Academy of Medicine, Singapore

DF) is endemic in India and Singapore, and also causes frequent epidemics. Dengue virus belongs t... more DF) is endemic in India and Singapore, and also causes frequent epidemics. Dengue virus belongs to the Flavivirus genus of the family Flaviviridae and its members include the 4 antigenically related serotypes of dengue virus (DENV 1-4). It is transmitted to humans through the bite of infected female Aedes aegypti mosquitoes, and is characterised by an acute onset of fever associated with symptoms of malaise, headache, muscle aches, retro-orbital pain, joint pain, abdominal discomfort, rash and bleeding diathesis. Thrombocytopaenia, a major feature of DF, results from decreased platelet production from bone marrow suppression or increased platelet destruction. Prophylactic platelet transfusion is a common practice to prevent clinical bleeding in adults with dengue and thrombocytopaenia. However, transfusion of blood products may be detrimental to patients given the risks of fluid overload, transmission of infectious diseases and transfusion reactions. Ocular findings associated with DF are subconjunctival haemorrhage, vitreous haemorrhage, retinal haemorrhage, cotton wool spots, central and branch retinal artery occlusion, central scotoma, papilloedema, optic neuropathy, retinal vasculitis, retinitis, retinal pigment epithelium mottling, foveolitis, choroidal effusion, exudative retinal detachment, anterior uveitis, endogenous endophthalmitis and panophthalmitis. Panophthalmitis is a rare complication, with only 7 cases reported following platelet transfusion in DF in the literature. We report 5 cases of unusual complication of DF causing panophthalmitis, leading to rapidly progressive and painful visual loss shortly after receiving platelet transfusion. These 5 cases were referred from 5 different centres to our tertiary eye centre for ocular evaluation. As we are not aware of the prevailing practices in those centres, we are unable to comment on the rationale for platelet transfusion. These 5 cases occurred over a 6-month period from July to December 2019. Table summarises these 5 cases. Platelets are vulnerable to bacterial growth as they are stored at room temperature for up to 5 days, whereas other blood components are refrigerated or frozen. Gram-positive bacteria (e.g. Staphylococcus

Repeatability of biometry measured by three devices and its impact on predicted intraocular lens power

Journal of Cataract and Refractive Surgery

PURPOSE To compare the repeatability of ocular biometry measured with the Lenstar LS 900, IOLMast... more PURPOSE To compare the repeatability of ocular biometry measured with the Lenstar LS 900, IOLMaster 700 and Anterion, and its impact on predicted intraocular lens (IOL) power SETTING:: Tertiary eye-care facility in South India. DESIGN Prospective, observational and cross-sectional. METHODS Eyes diagnosed with cataract had three consecutive scans on each biometers. The repeatability was assessed using the within-subject standard deviation (Sw), test-retest repeatability (TRT) and coefficient of variation (COV). The agreement was evaluated with the intraclass correlation (ICC). The IOL power was calculated with the Barrett Universal II formula. RESULTS The study comprised of 127 eyes of 76 patients. The repeatability of all parameters for a given device were excellent (ICC > 0.9, low COV and Sw). The agreement of the parameters between the biometers was very good (range from 0.93 to 0.99). The predicted IOL power differed statistically between the devices (p<0.05) but the difference was clinically insignificant between the three biometers (ICC > 0.99 for repeat calculation of IOL power). CONCLUSIONS All the biometers included in the study had good to excellent repeatability of biometry parameters. The agreement of the predicted IOL power was excellent between the three optical biometers.

Indian Journal of Ophthalmology

Purpose: To evaluate the relation of the tear film on the quality of vision comparing parameters ... more Purpose: To evaluate the relation of the tear film on the quality of vision comparing parameters in normal patients to those having dry eye disease. Methods: 50 normal and 50 eyes with dry eye disease (DED) were included in the study. Patients were screened for dry eye with Schirmer's test, tear break up time, ocular surface staining, and assessment of meibomian gland disease. Their quality of vision was assessed using the Optical quality analysis system (OQAS). The results of dry eye evaluation were correlated with the parameters on the OQAS especially the mean objective scatter index (OSI). Results: Patients with dry eye and unstable tear film were found to have a significantly worse quality of vision and optical scatter (P < 0.05). They were also noted to have fluctuation of vision between blinks. Conclusion: Tear film optics can have an important bearing on the quality of vision and quality of life. A detailed assessment preoperatively will help improve surgical outcomes and patient satisfaction.

Traumatic dislocation of an implantable phakic contact lens

Indian Journal of Ophthalmology

Ocular trauma can range from trivial to significant, with varying implications on the visual acui... more Ocular trauma can range from trivial to significant, with varying implications on the visual acuity and prognosis. A 32-year-old woman presented with complaints of blurring of vision following blunt ocular trauma with a previous history of having undergone implantable phakic contact lens (IPCL V2.0) implantation 2 years back. The corrected distance visual acuity (CDVA) was 20/20 in the right eye and 20/30 in the left eye. Slit-lamp examination revealed a prolapse of inferonasal IPCL footplate into the anterior chamber with pupillary entrapment. No corneal endothelial touch was noted. Immediate repositioning of the IPCL was performed and the patient regained a CDVA of 20/20 in the left eye, postoperatively. Traumatic dislocation of IPCL is a rare occurrence, which can be successfully managed by prompt surgery, thus avoiding further complications like corneal endothelial decompensation.

ABCD: A new classification for keratoconus

Indian Journal of Ophthalmology

Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more mo... more 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.

Screening corneal epithelial gene expression patterns for predicting post PRK (Photorefractive keratectomy) corneal haze

Investigative Ophthalmology & Visual Science, 2015

Aim To report the clinical features, investigations, management, and outcome in typical cases of ... more Aim To report the clinical features, investigations, management, and outcome in typical cases of Vogt-Koyanagi-Harada Syndrome (VKH) in a tertiary eye care center in South India. Materials and methods Retrospective interventional case series of VKH patients. Results Seventy-one eyes of 36 patients (age range 12-68 years) were included. Anatomical diagnoses were posterior uveitis (15 eyes) and pan uveitis (56 eyes). The classification of the cases with regard to VKH disease was as follows: six eyes were classified as complete, 41 eyes as incomplete, and 24 eyes as probable VKH disease. Commonest extraocular manifestation noted in 25 cases was headache. The more common ocular presentations were disc hyperemia (40 eyes) and exudative retinal detachment in the posterior pole (46 eyes) and in the retinal periphery (24 eyes). All patients were managed on systemic steroids. Systemic immunosuppressive therapy was given in 21 cases. Majority of the participants had good visual outcome. Concl...

Clinical profile and error of inclusion and exclusion in schools for the blind in Bangalore and a review of literature

Purpose: To determine the causes of severe visual impairment and blindness in children in schools... more Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in the city of Bangalore, Karnataka and to determine the error of inclusion and exclusion from these schools. Methods: This was a cross-sectional study. Children in four schools for the blind were subjected to a detailed ophthalmic evaluation. The World Health Organization Program for Prevention of Blindness low-vision form was used to collect data. To know the educational background of children with visual disability of 40% or more (best-corrected visual acuity of ≤6/24 in the better eye), not in schools for the blind, we collected data by telephonic conversation after procuring their phone numbers from our low-vision clinic. Results: One-hundred-seventy-eight children were examined. The major site of anomaly causing blindness in 31% of children was optic nerve, followed by retina (24%), cornea (23%), and whole globe (22%). Avoidable blindness was 35.42%. Thirteen percent...

Purpose To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular ... more Purpose To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular lens (IOL), AcrySof® IQ PanOptix® (TFNT00), in an Indian population. Patients and Methods This prospective, multicenter, observational, single-arm, post-marketing study included 67 patients undergoing cataract surgery with bilateral implantation of TFNT00 across five Indian sites. Postoperative outcomes were assessed at 3 months after second eye surgery. Effectiveness outcomes included: mean binocular and monocular visual acuity (VA) at distance (4 m), intermediate (60 cm), and near (40 cm); binocular defocus curve; manifest refraction; and subjective symptom questionnaire evaluation. Safety outcomes included the rate of ocular adverse events and mesopic contrast sensitivity. Results Mean binocular and monocular distance-corrected and uncorrected VAs of 0.1 logMAR or better (approximately 20/25 Snellen) were achieved at distance, intermediate, and near. Overall, ≥70% of patients achieved...

A review of meibography for a refractive surgeon

Indian Journal of Ophthalmology

Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a... more Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a cosmetic correction. The expectations associated with such a surgery are enormous and one has to anticipate all possible complications and side-effects that come with the procedure and prepare accordingly. The most common amongst these is post-refractive surgery dry eye of which Meibomian gland dysfunction is a commonly associated cause. We present an understanding of various diagnostic imaging modalities that can be used for evaluating meibomian glands which can also serve as a visual aid for patient understanding. We also describe various common conditions which can silently cause changes in the gland architecture and function which are to be considered and evaluated for.

Changes in the interaction of ophthalmologists and ophthalmic industry during and after COVID-19 lockdown: A perspective

Indian Journal of Ophthalmology

Indian Journal of Ophthalmology

COVID-19 pandemic has put health on focus and the corona crisis will work as a catalyst for the g... more COVID-19 pandemic has put health on focus and the corona crisis will work as a catalyst for the governments and health policy workers in India (and globally) to invest more budgets in healthcare to deal with such pandemic. For government official and policy makers in India, it is time to take health of 1.3 billon people seriously by allocating more gross domestic product (GDP) in health, hygiene and hospitals (introducing new facility and upgrading the existing govt. run hospitals) and by appointing new doctors and healthcare workers to improve doctor-population and population-hospital beds ratio, so we strengthen our ability to fight with such pandemic in future. All India Ophthalmology Society (AIOS), Indian Journal of Ophthalmology, Young Ophthalmologist Society of India (YOSI) doing commendable work. All members of ophthalmic fraternity need to stay united, help, support and guide each other during this difficult time. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Quantitative High-speed Assessment of Droplet and Aerosol From an Eye After Impact With an Air-puff Amid COVID-19 Scenario

Journal of Glaucoma

Purpose: To quantify aerosol and droplets generated during noncontact tonometry (NCT) and assess ... more Purpose: To quantify aerosol and droplets generated during noncontact tonometry (NCT) and assess the spread distance of the same. Methodology: This was an experimental study on healthy human volunteers (n=8 eyes). In an experimental setup, NCT was performed on eyes (n=8) of human volunteers under normal settings, with a single and 2 drops of lubricant. High-speed shadowgraphy, frontal lighting technique, and fluorescein analysis were used to detect the possible generation of any droplets and aerosols. Mathematical computation of the spread of the droplets was then performed. Results: In a natural setting, there was no droplet or aerosol production. Minimal splatter along with droplet ejection was observed when 1 drop of lubricant was used before NCT. When 2 drops of lubricant were instilled, a significant amount of fluid ejection in the form of a sheet that broke up into multiple droplets was observed. Some of these droplets traversed back to the tonometer. Droplets ranging from 100 to 500 µm in diameter were measured. Conclusions: There was no droplet generation during NCT performed in a natural setting. However, NCT should be avoided in conditions with high-tear volume (natural or artificial) as it would lead to droplet spread and tactile contamination.

Epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases of refractive error in pediatric population visiting a tertiary eye care center

Journal of Clinical Ophthalmology and Research

Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refracti... more Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases in children visiting a tertiary care eye center in southern India. Materials and Methods: This prospective study was conducted on 367 children, ≤15 years of age, with significant refractive error who visited our tertiary eye care hospital over a period of 1 year. Every child underwent detailed ocular examination. Significant refractive error was defined as myopia of ≥−0.75 diopter (D), hypermetropia of more than +2 D, and astigmatism of more than 0.75 D. Descriptive statistics were computed for better and the worse eye. Statistical tests were applied between the worse and better eyes using Chi-square test. Results: A total of 367 children (38.8%) were diagnosed for the first time of having refractive error. Only 146 (39.8%) children presented with visual complaints. With respect to the vision in the worse eye, 65.9% (n = 240) had moderately subnormal vision. There was no statistically significant difference (P = 0.057) between age distribution and visual acuity in the worse eye. Two hundred and thirty-eight children (64.9%) had significant astigmatism as compared to 161 myopic (43.9%) children. There was a statistically significant difference between reasons of visit and different age groups. Conclusions: Astigmatism was the most prevalent refractive error and uncorrected astigmatism the most significant amblyogenic factor. Since majority of children, especially in the younger age group, present with nonvisual complaints, involvement of pediatricians and parents will help us to reduce morbidity due to uncorrected refractive error and amblyopia.

International Journal Of Community Medicine And Public Health

Background: Refractive errors are the second most common reason of blindness in India after catar... more Background: Refractive errors are the second most common reason of blindness in India after cataract. It accounts for 33.3% of cases of childhood blindness. The purpose of this study was to estimate the prevalence of refractive error and related visual impairment in children visiting a tertiary care eye center in Southern India.Methods: This was hospital-based descriptive study. Children <15 years of age with significant refractive error were included in the study. They were examined for visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment and fundus. Significant refractive error was defined as myopia ≥-0.75D, hypermetropia >+2D and astigmatism >0.75D. Descriptive statistics with frequency, mean±Standard deviation were computed for better and the worse eye. Statistical tests were applied between the worse and better eye using Chi square test.Results: A total of 946 children were scr...

Scientific Reports

Molecular factors altered in corneas that develop haze post refractive surgery have been describe... more Molecular factors altered in corneas that develop haze post refractive surgery have been described, but pre-existing factors that predispose clinically normal corneas to aberrant fibrosis post surgery and the role of the corneal epithelium remains unknown. We analyzed the global gene expression in epithelium collected intraoperatively from subjects undergoing photorefractive keratectomy. Subjects were grouped into those that developed haze 12 months post surgery (n = 6 eyes; haze predisposed) and those that did not develop haze in a similar follow up duration (n = 11 eyes; controls). Ontological analysis of 1100 upregulated and 1780 downregulated genes in the haze predisposed group revealed alterations in pathways associated with inflammation, wnt signaling, oxidative stress, nerve functions and extra cellular matrix remodeling. Novel factors such as PREX1, WNT3A, SOX17, GABRA1and PXDN were found to be significantly altered in haze predisposed subjects and those with active haze(n =...

Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK

Journal of Refractive Surgery

PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during a... more PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].

Journal of Biophotonics

The purpose was to determine the optimum negative spherical aberration induction required to impr... more The purpose was to determine the optimum negative spherical aberration induction required to improve near and intermediate visual acuity (VA) of presbyopic eyes. A total of 174 normal and diabetic (no retinopathy) presbyopic eyes (age ≥ 40) were measured with Visual adaptive optics simulator (Voptica, Spain). First, baseline uncorrected VA and aberrations were measured. VA at This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Phakic intraocular lens: Getting the right size

Indian Journal of Ophthalmology

Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are u... more Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are unable to get refractive correction through laser platforms due to high refractive error or certain corneal contraindications. Phakic IOL's (PIOL) have their own set of complications and challenges, the most important being getting the sizing right. This paper attempts to solve the problem of accurate sizing of PIOL's. Parameters needed for calculating the ideal size of PIOL's have been studied in a step by step manner using all possible tools depending upon the availability and preference of the surgeon. The pros and cons of using a particular tool for measurements have been highlighted along with illustrative case examples to help surgeons who are starting PIOL implantation surgery.

Annals of the Academy of Medicine, Singapore

DF) is endemic in India and Singapore, and also causes frequent epidemics. Dengue virus belongs t... more DF) is endemic in India and Singapore, and also causes frequent epidemics. Dengue virus belongs to the Flavivirus genus of the family Flaviviridae and its members include the 4 antigenically related serotypes of dengue virus (DENV 1-4). It is transmitted to humans through the bite of infected female Aedes aegypti mosquitoes, and is characterised by an acute onset of fever associated with symptoms of malaise, headache, muscle aches, retro-orbital pain, joint pain, abdominal discomfort, rash and bleeding diathesis. Thrombocytopaenia, a major feature of DF, results from decreased platelet production from bone marrow suppression or increased platelet destruction. Prophylactic platelet transfusion is a common practice to prevent clinical bleeding in adults with dengue and thrombocytopaenia. However, transfusion of blood products may be detrimental to patients given the risks of fluid overload, transmission of infectious diseases and transfusion reactions. Ocular findings associated with DF are subconjunctival haemorrhage, vitreous haemorrhage, retinal haemorrhage, cotton wool spots, central and branch retinal artery occlusion, central scotoma, papilloedema, optic neuropathy, retinal vasculitis, retinitis, retinal pigment epithelium mottling, foveolitis, choroidal effusion, exudative retinal detachment, anterior uveitis, endogenous endophthalmitis and panophthalmitis. Panophthalmitis is a rare complication, with only 7 cases reported following platelet transfusion in DF in the literature. We report 5 cases of unusual complication of DF causing panophthalmitis, leading to rapidly progressive and painful visual loss shortly after receiving platelet transfusion. These 5 cases were referred from 5 different centres to our tertiary eye centre for ocular evaluation. As we are not aware of the prevailing practices in those centres, we are unable to comment on the rationale for platelet transfusion. These 5 cases occurred over a 6-month period from July to December 2019. Table summarises these 5 cases. Platelets are vulnerable to bacterial growth as they are stored at room temperature for up to 5 days, whereas other blood components are refrigerated or frozen. Gram-positive bacteria (e.g. Staphylococcus

Repeatability of biometry measured by three devices and its impact on predicted intraocular lens power

Journal of Cataract and Refractive Surgery

PURPOSE To compare the repeatability of ocular biometry measured with the Lenstar LS 900, IOLMast... more PURPOSE To compare the repeatability of ocular biometry measured with the Lenstar LS 900, IOLMaster 700 and Anterion, and its impact on predicted intraocular lens (IOL) power SETTING:: Tertiary eye-care facility in South India. DESIGN Prospective, observational and cross-sectional. METHODS Eyes diagnosed with cataract had three consecutive scans on each biometers. The repeatability was assessed using the within-subject standard deviation (Sw), test-retest repeatability (TRT) and coefficient of variation (COV). The agreement was evaluated with the intraclass correlation (ICC). The IOL power was calculated with the Barrett Universal II formula. RESULTS The study comprised of 127 eyes of 76 patients. The repeatability of all parameters for a given device were excellent (ICC > 0.9, low COV and Sw). The agreement of the parameters between the biometers was very good (range from 0.93 to 0.99). The predicted IOL power differed statistically between the devices (p<0.05) but the difference was clinically insignificant between the three biometers (ICC > 0.99 for repeat calculation of IOL power). CONCLUSIONS All the biometers included in the study had good to excellent repeatability of biometry parameters. The agreement of the predicted IOL power was excellent between the three optical biometers.

Indian Journal of Ophthalmology

Purpose: To evaluate the relation of the tear film on the quality of vision comparing parameters ... more Purpose: To evaluate the relation of the tear film on the quality of vision comparing parameters in normal patients to those having dry eye disease. Methods: 50 normal and 50 eyes with dry eye disease (DED) were included in the study. Patients were screened for dry eye with Schirmer's test, tear break up time, ocular surface staining, and assessment of meibomian gland disease. Their quality of vision was assessed using the Optical quality analysis system (OQAS). The results of dry eye evaluation were correlated with the parameters on the OQAS especially the mean objective scatter index (OSI). Results: Patients with dry eye and unstable tear film were found to have a significantly worse quality of vision and optical scatter (P < 0.05). They were also noted to have fluctuation of vision between blinks. Conclusion: Tear film optics can have an important bearing on the quality of vision and quality of life. A detailed assessment preoperatively will help improve surgical outcomes and patient satisfaction.

Traumatic dislocation of an implantable phakic contact lens

Indian Journal of Ophthalmology

Ocular trauma can range from trivial to significant, with varying implications on the visual acui... more Ocular trauma can range from trivial to significant, with varying implications on the visual acuity and prognosis. A 32-year-old woman presented with complaints of blurring of vision following blunt ocular trauma with a previous history of having undergone implantable phakic contact lens (IPCL V2.0) implantation 2 years back. The corrected distance visual acuity (CDVA) was 20/20 in the right eye and 20/30 in the left eye. Slit-lamp examination revealed a prolapse of inferonasal IPCL footplate into the anterior chamber with pupillary entrapment. No corneal endothelial touch was noted. Immediate repositioning of the IPCL was performed and the patient regained a CDVA of 20/20 in the left eye, postoperatively. Traumatic dislocation of IPCL is a rare occurrence, which can be successfully managed by prompt surgery, thus avoiding further complications like corneal endothelial decompensation.

ABCD: A new classification for keratoconus

Indian Journal of Ophthalmology

Recent advances in the diagnosis and treatment of ectatic corneal disease have mandated a more mo... more 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.

Screening corneal epithelial gene expression patterns for predicting post PRK (Photorefractive keratectomy) corneal haze

Investigative Ophthalmology & Visual Science, 2015

Aim To report the clinical features, investigations, management, and outcome in typical cases of ... more Aim To report the clinical features, investigations, management, and outcome in typical cases of Vogt-Koyanagi-Harada Syndrome (VKH) in a tertiary eye care center in South India. Materials and methods Retrospective interventional case series of VKH patients. Results Seventy-one eyes of 36 patients (age range 12-68 years) were included. Anatomical diagnoses were posterior uveitis (15 eyes) and pan uveitis (56 eyes). The classification of the cases with regard to VKH disease was as follows: six eyes were classified as complete, 41 eyes as incomplete, and 24 eyes as probable VKH disease. Commonest extraocular manifestation noted in 25 cases was headache. The more common ocular presentations were disc hyperemia (40 eyes) and exudative retinal detachment in the posterior pole (46 eyes) and in the retinal periphery (24 eyes). All patients were managed on systemic steroids. Systemic immunosuppressive therapy was given in 21 cases. Majority of the participants had good visual outcome. Concl...

Clinical profile and error of inclusion and exclusion in schools for the blind in Bangalore and a review of literature

Purpose: To determine the causes of severe visual impairment and blindness in children in schools... more Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in the city of Bangalore, Karnataka and to determine the error of inclusion and exclusion from these schools. Methods: This was a cross-sectional study. Children in four schools for the blind were subjected to a detailed ophthalmic evaluation. The World Health Organization Program for Prevention of Blindness low-vision form was used to collect data. To know the educational background of children with visual disability of 40% or more (best-corrected visual acuity of ≤6/24 in the better eye), not in schools for the blind, we collected data by telephonic conversation after procuring their phone numbers from our low-vision clinic. Results: One-hundred-seventy-eight children were examined. The major site of anomaly causing blindness in 31% of children was optic nerve, followed by retina (24%), cornea (23%), and whole globe (22%). Avoidable blindness was 35.42%. Thirteen percent...

Purpose To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular ... more Purpose To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular lens (IOL), AcrySof® IQ PanOptix® (TFNT00), in an Indian population. Patients and Methods This prospective, multicenter, observational, single-arm, post-marketing study included 67 patients undergoing cataract surgery with bilateral implantation of TFNT00 across five Indian sites. Postoperative outcomes were assessed at 3 months after second eye surgery. Effectiveness outcomes included: mean binocular and monocular visual acuity (VA) at distance (4 m), intermediate (60 cm), and near (40 cm); binocular defocus curve; manifest refraction; and subjective symptom questionnaire evaluation. Safety outcomes included the rate of ocular adverse events and mesopic contrast sensitivity. Results Mean binocular and monocular distance-corrected and uncorrected VAs of 0.1 logMAR or better (approximately 20/25 Snellen) were achieved at distance, intermediate, and near. Overall, ≥70% of patients achieved...

A review of meibography for a refractive surgeon

Indian Journal of Ophthalmology

Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a... more Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a cosmetic correction. The expectations associated with such a surgery are enormous and one has to anticipate all possible complications and side-effects that come with the procedure and prepare accordingly. The most common amongst these is post-refractive surgery dry eye of which Meibomian gland dysfunction is a commonly associated cause. We present an understanding of various diagnostic imaging modalities that can be used for evaluating meibomian glands which can also serve as a visual aid for patient understanding. We also describe various common conditions which can silently cause changes in the gland architecture and function which are to be considered and evaluated for.

Changes in the interaction of ophthalmologists and ophthalmic industry during and after COVID-19 lockdown: A perspective

Indian Journal of Ophthalmology

Indian Journal of Ophthalmology

COVID-19 pandemic has put health on focus and the corona crisis will work as a catalyst for the g... more COVID-19 pandemic has put health on focus and the corona crisis will work as a catalyst for the governments and health policy workers in India (and globally) to invest more budgets in healthcare to deal with such pandemic. For government official and policy makers in India, it is time to take health of 1.3 billon people seriously by allocating more gross domestic product (GDP) in health, hygiene and hospitals (introducing new facility and upgrading the existing govt. run hospitals) and by appointing new doctors and healthcare workers to improve doctor-population and population-hospital beds ratio, so we strengthen our ability to fight with such pandemic in future. All India Ophthalmology Society (AIOS), Indian Journal of Ophthalmology, Young Ophthalmologist Society of India (YOSI) doing commendable work. All members of ophthalmic fraternity need to stay united, help, support and guide each other during this difficult time. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Quantitative High-speed Assessment of Droplet and Aerosol From an Eye After Impact With an Air-puff Amid COVID-19 Scenario

Journal of Glaucoma

Purpose: To quantify aerosol and droplets generated during noncontact tonometry (NCT) and assess ... more Purpose: To quantify aerosol and droplets generated during noncontact tonometry (NCT) and assess the spread distance of the same. Methodology: This was an experimental study on healthy human volunteers (n=8 eyes). In an experimental setup, NCT was performed on eyes (n=8) of human volunteers under normal settings, with a single and 2 drops of lubricant. High-speed shadowgraphy, frontal lighting technique, and fluorescein analysis were used to detect the possible generation of any droplets and aerosols. Mathematical computation of the spread of the droplets was then performed. Results: In a natural setting, there was no droplet or aerosol production. Minimal splatter along with droplet ejection was observed when 1 drop of lubricant was used before NCT. When 2 drops of lubricant were instilled, a significant amount of fluid ejection in the form of a sheet that broke up into multiple droplets was observed. Some of these droplets traversed back to the tonometer. Droplets ranging from 100 to 500 µm in diameter were measured. Conclusions: There was no droplet generation during NCT performed in a natural setting. However, NCT should be avoided in conditions with high-tear volume (natural or artificial) as it would lead to droplet spread and tactile contamination.

Epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases of refractive error in pediatric population visiting a tertiary eye care center

Journal of Clinical Ophthalmology and Research

Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refracti... more Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases in children visiting a tertiary care eye center in southern India. Materials and Methods: This prospective study was conducted on 367 children, ≤15 years of age, with significant refractive error who visited our tertiary eye care hospital over a period of 1 year. Every child underwent detailed ocular examination. Significant refractive error was defined as myopia of ≥−0.75 diopter (D), hypermetropia of more than +2 D, and astigmatism of more than 0.75 D. Descriptive statistics were computed for better and the worse eye. Statistical tests were applied between the worse and better eyes using Chi-square test. Results: A total of 367 children (38.8%) were diagnosed for the first time of having refractive error. Only 146 (39.8%) children presented with visual complaints. With respect to the vision in the worse eye, 65.9% (n = 240) had moderately subnormal vision. There was no statistically significant difference (P = 0.057) between age distribution and visual acuity in the worse eye. Two hundred and thirty-eight children (64.9%) had significant astigmatism as compared to 161 myopic (43.9%) children. There was a statistically significant difference between reasons of visit and different age groups. Conclusions: Astigmatism was the most prevalent refractive error and uncorrected astigmatism the most significant amblyogenic factor. Since majority of children, especially in the younger age group, present with nonvisual complaints, involvement of pediatricians and parents will help us to reduce morbidity due to uncorrected refractive error and amblyopia.

International Journal Of Community Medicine And Public Health

Background: Refractive errors are the second most common reason of blindness in India after catar... more Background: Refractive errors are the second most common reason of blindness in India after cataract. It accounts for 33.3% of cases of childhood blindness. The purpose of this study was to estimate the prevalence of refractive error and related visual impairment in children visiting a tertiary care eye center in Southern India.Methods: This was hospital-based descriptive study. Children <15 years of age with significant refractive error were included in the study. They were examined for visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment and fundus. Significant refractive error was defined as myopia ≥-0.75D, hypermetropia >+2D and astigmatism >0.75D. Descriptive statistics with frequency, mean±Standard deviation were computed for better and the worse eye. Statistical tests were applied between the worse and better eye using Chi square test.Results: A total of 946 children were scr...

Scientific Reports

Molecular factors altered in corneas that develop haze post refractive surgery have been describe... more Molecular factors altered in corneas that develop haze post refractive surgery have been described, but pre-existing factors that predispose clinically normal corneas to aberrant fibrosis post surgery and the role of the corneal epithelium remains unknown. We analyzed the global gene expression in epithelium collected intraoperatively from subjects undergoing photorefractive keratectomy. Subjects were grouped into those that developed haze 12 months post surgery (n = 6 eyes; haze predisposed) and those that did not develop haze in a similar follow up duration (n = 11 eyes; controls). Ontological analysis of 1100 upregulated and 1780 downregulated genes in the haze predisposed group revealed alterations in pathways associated with inflammation, wnt signaling, oxidative stress, nerve functions and extra cellular matrix remodeling. Novel factors such as PREX1, WNT3A, SOX17, GABRA1and PXDN were found to be significantly altered in haze predisposed subjects and those with active haze(n =...

Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK

Journal of Refractive Surgery

PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during a... more PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].

Journal of Biophotonics

The purpose was to determine the optimum negative spherical aberration induction required to impr... more The purpose was to determine the optimum negative spherical aberration induction required to improve near and intermediate visual acuity (VA) of presbyopic eyes. A total of 174 normal and diabetic (no retinopathy) presbyopic eyes (age ≥ 40) were measured with Visual adaptive optics simulator (Voptica, Spain). First, baseline uncorrected VA and aberrations were measured. VA at This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.