Ophthalmology Pakistan

Artificial Intelligence and Diabetic Retinopathy:The Future is Here

Muhammad Moin Yaqin — 2024-06-30

The currently available AI tools can help in Diabetic retinopathy screening in a cost effective manner, round the clock availability to the internist, and prompt referrals can help control the disease burden.

Retinal Nerve Fiber Layer Thickness in Recently Diagnosed Primary Open Angle Glaucoma

Sundas Gul — 2024-06-30

Objective: To determine the frequency and pattern of retinal nerve fiber layer thinning in recently diagnosed primary open-angle glaucoma (POAG).

Methods: This Cross-sectional study was carried out at the Ophthalmology Department, Hayatabad Medical Complex Peshawar from 1^st May 2021 to 31^st March 2022. Patients with a history of POAG were included in the study and subjected to assessment of visual acuity, IOP (with GAT) and Global retinal nerve fiber thickness (G-RNFL) through OCT. RNFL thickness was further stratified by age and gender to explore effect modification, employing ANOVA for age group comparisons, and t-tests for RNFL thinning, with a significance level set at p < 0.05.

Results: A total of 136 patients with a history of POAG were recruited. The mean age of the study sample was 54.5 + 13.6 years. There were 66.9% males and 33.1% females. The mean duration of POAG was 239.2 + 106.1 days. The mean BCVA was 0.696 + 0.7 and IOP was 18.9 + 9.1 mmHg. The Retinal nerve fiber thickness (RNFL) was 65.4 + 22.2 microns and 50.7% had their right eye with worse involvement.

Conclusion: Global retinal nerve fiber thickness is a significant prognostic factor for POAG.

Comparative Effectiveness of different therapies for Convergence Insufficiency

Sara Sonum — 2024-06-30

Purpose: This study aimed to determine the effectiveness of different treatment options such as brock string, dot card, jump convergence and pencil push-up exercises for convergence insufficiency (CI).

Methodology: After ethical approval, this quasi experimental study was conducted at District Head Quarter (DHQ) Bhakkar, Thel University Bhakkar, schools and collages of Bhakkar and district Layyah by selecting 140 patients presenting with symptomatic convergence insufficiency through non-probability convenient sampling. After informed consent, Positive Fusional Vergence (PFV), CI Symptom Survey (CISS) and near point of convergence (NPC) were measured. Then randomly divide into four groups of 35 patients by non-probability purposive sampling. Each group received one of the chosen therapy for 3 consecutive months. All patients were examined and self-structure proforma was filled as baseline data on each follow-up of therapy. Data was analyzed by IBM SPSS version 23.

Results: After completion of three month of treatment, near point of convergence improved from mean 13.343 ±.219 to 8.757±.194; CI 95%: p<0.001 respectively in brock string, mean 13.486 ±.197 to 7.729 ±.169; CI 95%: p<0.001 in dot card exercise, in jump convergence mean 13.614 ±.214 to 9.057, ±.170; CI 95%: p<0.001 improvement of NPC occur and in pencil push-up 13.243 ±.208 to 8.329 ±.143; CI 95%: p<0.001.

Conclusion: The dot card is most effective treatment to perform at home for CI, effective for achieving clinically significant improvements in signs and symptoms associated with CI in young adults.

Implication of Orthoptic scoring system for the management of Orbital Floor Blowout Fracture

Ayesha Kanwal — 2024-06-30

OBJECTIVES: To introduce an orthoptic scoring system that can be implicated for decision-making about the management of patients with orbital floor blowout fractures and to assess the significance of orthoptics as a decisive element in the treatment of patients with orbital floor blowout fracture (OFBF).

METHOD: The Ethical Review Board of the College of Ophthalmology and Allied Vision Sciences (1479, 23), Mayo Hospital, Lahore, has approved this study. A comprehensive prospective cohort study was done on 44 Mayo Hospital, Lahore patients using a self-designed proforma. The duration of the study was from September to November, 2023. Forty-four participants were included with an age limit of 15-80 years. Complete orthoptic evaluation and review of medical records were done on each participant individually. All factors (diplopia, extraocular muscles movement, ecchymosis and others) included in this orthoptic scoring system were numbered according to individual patients' conditions. Descriptive data analysis was done by using SPSS Version 25.00. A p-value of ≤ 0.05 was used to define the significance threshold.

RESULTS: Out of the 44 patients, 15.9% of patients were recommended for conservative treatment, surgery was deemed as a viable option for 29.5% of patients, and surgery was considered necessary for 54.5% of patients with an orbital floor blowout fracture. All the factors included in orthoptic scoring system were evaluated significant (p-value=0.00)

CONCLUSION: The orthoptic scoring system has the potential to serve as a valuable diagnostic tool in the management of patients with orbital floor blowout fractures. The study suggests that a comprehensive orthoptic evaluation is necessary to determine the optimal treatment for patients with orbital floor blowout fractures.

Association of Severity of Diabetic Retinopathy with HbA1c Level.

Muhammad Asif — 2024-06-30

Objective: To compare the association of the severity of Diabetic Retinopathy with the level of HbA1c.

Methodology:

This cross-sectional study was conducted at Pak International Medical College and Hospital Peshawar from March (2019) to June (2019) after approval of ethical review board. Using consecutive sampling technique, total of 106 patients with Diabetic Mellitus type -2 were enrolled in the study who presented to out patient department of ophthalmology, Pak International Medical College and Hospital, Peshawar. Non diabetic patients and those who did not give consent to participate were excluded. After informed consent, full ophthalmologic examination was carried out for each patient. Diabetic retinopathy was graded as 0-5. No diabetic changes were labeled as Grade-0, and mild to moderate NPDR were included in Grade-1, CSME with NPDR as Grade 2, PDR as Grade 3, Advanced DR (VIT HE+ RD) was labeled as Grade 4, and nerve Palsy, CRAO, CRVO was labeled as Grade-5. Frequency and percentages were calculated for categorical data while mean, maximum, minimum, and standard deviation for continuous data via SPSS version- 27. One way ANOVA was applied to check for significance. P value less than 0.05 was considered significant.

Results

Out of the 106 participants, 44 were male (41.50%) and 62 were female (58.50%). Among participants, Grade -2 (HbA1c range 8-12) comprised the highest percentage of patients at 44.3%, followed by Grade-1 (HbA1c range 5-8) with 35.8%, and Grade -3 (HbA1c range 12-15) with 19.8%. This suggests that as HbA1c values increase, the severity of DMR tends to escalate, emphasizing the critical role of glycemic control in managing diabetic complications affecting the retina.

Conclusion

As the HbA1c level increases the severity of diabetic retinopathy increases.

Refractive Errors in Thalassemia Patients

Sibgha Naseem — 2024-06-30

Purpose: The objective of this study was to evaluate the frequency of refractive error among thalassemia patients.

METHOD: This cross sectional study was performed in duration of six months at Sir Ganga Ram hospital from July, 2023 to August, 2023. A total of hundred (n=100) thalassemia patients, were included in this study between the age range of 17 to 30 years. All subjects with thalassemia were previously diagnosed. Objective refraction was accomplished with Auto-Refractometer (Axis), and vision was examined with Snellen chart/Log Mar chart. SPSS version 26 was used to analyze the results. Chi-Square test was applied to find the significance of data. P-value <0.05 was considered as significant.

Results: The mean age of participants was 21.28±3.39 years. In the right eye of thalassemia patients, the result showed that 51% were emmetropic, 11% had hyperopia, 1% had hyperopic astigmatism, 20% had myopia, and 17% had myopic astigmatism. In the left eyes of patients, 52% were emmetropic, 10% had hyperopia, 2% had hyperopic astigmatism, 18% had myopic astigmatism, and 18% had myopia. P-value was 0.043.

Conclusion: The cross sectional study results conclude that patient’s vision may not be significantly affected by thalassemia. Thalassemia patients were more effected with Myopia. While hyperopic astigmatism was least effected.