Optometry

Posterior amorphous corneal dystrophy (PACD) is classically characterised by bilaterally thin and flat central corneas with a deep, stromal sheet-like opacity. The epithelium, Bowman's layer, and anterior stroma are usually normal in PACD. Here, we report a case that had bilaterally anterior oval amorphous corneal opacities, which is different from the typical presentation of PACD. Corneal stromalysis occurred in them with progression to descemetocele unilaterally.

Dear Editor,
Face masks have become mandatory in everyone’s life.[1] Despite being designed to completely cover the patient’s nose and mouth [Fig. 1], there seems to be an innate urge among most of the Indian patients to pull down their masks before ophthalmic chin rest examination and investigations, as a sign of respect to the doctor or due to a feeling of not being heard when spoken.

Rhino-orbital-cerebral mucormycosis (ROCM) is a fatal infection, causing a threat to vision and life. [1] Fungal infections secondary to COVID-19 have shown doubling of mortality (35%-66%) with a delay of 6 days of treatment initiation. [1,2] Diagnosis of mucor is based on-direct microscopy of KOH mount, culture, serology, polymerase chain reaction (PCR), histopathological/microbiological confirmation of intraoperative surgical debridement tissue via functional endoscopic sinus surgery (FESS), and orbital exenteration. Surgical debridement helps in reducing disease burden and drug penetration, arrests disease spread, and provides intraoperative samples for histopathology/microbiological examination. [3,4] Smartphone-based intraocular lens microscope (IOLSCOPE) is an innovative point-of-care (POC) diagnostic device that helps in detecting fungal hyphae. It is a do-it-yourself device that uses four 30-D adhered intraocular lenses attached to the smartphone camera that can be used as a microscope. [5]

We report a case series of three patients, presenting with the ciliopathic disorder of Bardet–Biedl syndrome, highlighting the need for fundus auto-fluorescence (FAF) and infrared reflectance (IRR) imaging in them, with additional gonadal photographs which are poorly reported in literature.

There is a spurt in the number of ophthalmology webinars during the pandemic period giving the participants the luxury to pick and choose the webinars that they wish to
attend. On the flip side, there are many pedagogical and technical issues which need to be addressed, to increase the attentive interest of the participants. In this manuscript,
we propose the usage of the novel green mat technology in ophthalmology webinars with minimal cost and high productivity.

Scleral flap tears during trabeculectomy are difficult to repair in a predictable fashion. Donor scleral flap reinforcements are commonly preferred for managing trabeculectomy flaprelated over-filtration, leading to shallow anterior chamber (AC). Due to the advent of COVID-19 lockdown, especially in the initial phases, eye banking activities almost came to a standstill, with almost no corneal and/or scleral tissue retrievals. Hence, in this manuscript we have presented a mini case series with follow-up of two of our cases; where Gore-Tex (e-polytetrafluoroethylene) implant was used as an alternative to scleral patch graft, for managing trabeculectomy flaprelated over-filtration, with their pros and cons. Though Gore-Tex implant stability in both cases were contentious, it still served the purpose of managing the flap-related over-filtration and subsequent shallow AC.

Anti-glaucoma medications (AGM) become an integral part of every person's life, from the day he or she is diagnosed with glaucoma. It is well documented that non-compliance towards glaucoma eye drop medications could result in unnecessary changes to medications or listing for more invasive procedures, thus increasing risk to the patient and costs to the healthcare establishment. Also, glaucoma patients having lower compliance rates are at a higher risk of developing irreversible vision loss due to glaucoma, than patients with strict compliance. So far, there are many studies published, focusing on AGM compliance behavior among illiterate and rural glaucoma patients in India. Hence in this manuscript, we have presented the review of literature on compliance behaviour, among the literate glaucoma patients from an urban background; and proposed various novel and innovative, cost-effective strategies with augmented reality, real-time moving images, and eye drops reminding mobile applications to strengthen the literate glaucoma patient's understanding of their disease process and give them a timely reminder about AGM usage.

Augmented reality (AR) has come a long way from a science-fiction concept to a science-based reality. AR is a view of the real, physical world in which the elements are enhanced by computer-generated inputs. AR is available on mobile handsets, which constitutes an essential e-learning platform. Today, AR is a real technology and not a science-fiction concept. The use of an e-ophthalmology platform with AR will pave the pathway for new-age gameful pedagogy. In this manuscript, we present a newly innovated AR program named "Eye MG AR" to simplify ophthalmic concept learning and to serve as a new-age immersive 3D pedagogical tool for gameful learning.

A 35-year-old vegetarian female presented with severe headache and left-sided hemifacial spasm to the ophthalmic outpatient department. Her best-corrected visual acuity was 20/20 in both eyes (OU). Fundus evaluation with TrueColor Confocal scanner (Eidon, iCare, Finland) revealed central serous chorioretinopathy (CSCR) in OD not involving the fovea [Figure 1a], in an otherwise apparently normal posterior pole in OU [Figure 1a and b]. But on infrared (IR) imaging with swept-source optical coherence tomography (SS-OCT) with enhanced depth imaging (EDI) (Spectralis, Heidelberg Engineering, Germany), generalized pigment mottling of the posterior pole was revealed in OU [Figure 1c and d], despite the color fundus appearing apparently normal in OU. Color vision testing using Ishihara plates appeared normal. Visual fields showed areas of generalized depression [Figure 2]. Complete history taking, systemic, and hematological evaluation were normal, except for Vitamin B12 deficiency (serum level <50 ng/L). History of mental stress, usage of steroids, and insomnia was ruled out after physician and psychiatric evaluation. The patient has a balanced vegetarian diet intake, with no obvious signs of loss of appetite, malnourishment, and A 35-year-old female presented with severe headache and left-sided hemifacial spasm to the ophthalmic outpatient department. Ocular examination revealed normal visual acuity and color vision, with a presumably normal posterior pole in OU, except for parafoveal central serous chorioretinopathy (CSCR) in OD. Infrared imaging of both fundi revealed generalized retinal pigment epithelial (RPE) mottling, despite the color fundus appearing apparently normal in OU. Complete history taking, systemic workup, and hematological workup was performed and was normal, except for severe Vitamin B12 deficiency. Visual evoked potential was performed and showed delayed latency in OU, diagnosing subclinical demyelinating optic neuropathy. The patient was then started on methylcobalamin 1500 mcg and was reviewed. Signs resolved completely at 1 month follow-up. RPE disturbance (due to severe Vitamin B12 deficiency) may be a possible indirect contributor for CSCR. Hence, Vitamin B12 deficiency manifesting as bilateral optic neuropathy with extensive RPE mottling should be closely monitored for the evolution of CSCR.

Witnessing the spectacle/eye goggles in the eye: An investigative optical coherence tomography analysis of macula in advanced diabetic eye disease Case 1 A 79-year-old male presented with defective vision in both eyes (OU) for the past 6 months. On examination, the best-corrected visual acuity (BCVA) was perception of light in right eye (OD) and 20/200 in left eye (OS). History taking revealed uncontrolled diabetic status for the past 10 years. The anterior segment OU was normal. The fundus examination revealed advanced diabetic eye disease OU with vitreous hemorrhage, subhyaloid hemorrhage, vitreomacular traction (VMT), and tractional retinal detachment (TRD); in the structural form of spectacle in optical coherence tomography (OCT) of OS macula [Fig. 1]. Trans pars plana vitrectomy (PPV), VMT release, membrane peeling, fluid air exchange, and silicone oil tamponade were planned for OU. [1,2] Case 2 A 73-year-old female presented with defective vision OD for the past 9 months. On examination, BCVA was hand movements positive (HM+) in OD and 20/200 in OS. There was a history of uncontrolled diabetes mellitus for the past 8 years. The anterior segment OU was normal. The fundus examination revealed advanced diabetic eye disease OU with epiretinal membrane, panretinal photocoagulation (PRP) laser marks, extensive fibrovascular proliferation, VMT, and TRD; in the structural form of eye goggles in OCT of OD macula [Fig. 2]. Trans PPV, VMT release, membrane peeling, fluid air exchange, and silicone oil tamponade were planned for OU. [1,2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patient(s) understand that his/her/their names and initials will not be published and due efforts will be made to conceal his/her/their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

To our knowledge, assessment of striate keratopathy (SK) is subjectively done with slit-lamp bio-microscopic examination, which is the most common practice. In this manuscript, we have reported the role of objective scheimpflug imaging modality, in decoding the healing and repair process of SK, post prolonged cataract surgery. The quantitative and qualitative framing of this pathology with hyperreflective and hyporeflective hot spots (optical blooming) has never been reported in the literature before. In addition to the imaging of the cascadic events of SK in default colour, the role of digital calipers in the measurement of corneal thickness in SK (in inverse colour) is also highlighted. This manuscript throws light on the unique features of scheimpflug imaging technology, for the possible consideration of it as a routine post-operative investigation in patients undergoing prolonged or complicated cataract surgery, in quantifying their SK.

The field of augmented reality (AR) and three-dimensional (3D) printing are rapidly growing with many new potential applications in medical education and pedagogy. In this chapter, we have used 3D AR and 3D printed models of the cerebral arterial circulatory system, created by us to simplify concept learning. Various cerebral circulation diseases pertaining to ophthalmology can be explained in detail for immersive learning, with the help of various 3D models, for structures such as the circle of Willis, cavernous sinus, various cranial nerves, cerebrum, cerebellum and the eye. These models not only help in cognitive understanding of cerebral circulation diseases but also aid in diagnosing them with better conviction. Ophthalmologists, sometimes being the first responder, have a vigilant role to play with a heightened awareness of these cerebral arterial circulation diseases, which are not only vision-threatening but life-threatening too. This chapter summarizes the construction and holistic application of these 3D ophthalmology-related arterial cerebral circulation models in AR and 3D printing.

A 10-year-old male child presented with blunt force injury to his right eye (OD), with best-corrected visual acuity of 20/200. Posterior segment evaluation showed vitreous hemorrhage, Berlin's edema, and choroidal rupture anterior to the equator, parallel to the ora serrata, associated with subretinal hemorrhages. In this manuscript, we have reported a rare traumatic manifestation of multiple direct choroidal ruptures in a child. According to our knowledge, this has never been reported in the literature before. This manuscript also highlights the importance of vigilant optical coherence tomography (macula) follow-up in such scenarios, despite the choroidal rupture not involving the macular region.

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Practical sessions facilitate teaching, critical thinking, and coping skills, especially among medical students and professionals. Currently, in ophthalmology, virtual and augmented reality are employed for surgical training by using three-dimensional (3D) eyeball models. These 3D models when printed can be used not only for surgical training but also in teaching ophthalmic residents and fellows for concept learning through tactile 3D puzzle assembly. 3D printing is perfectly suited for the creation of complex bespoke items in a cost-effective manner, making it ideal for rapid prototyping. Puzzle making, when combined with 3D printing can evolve into a different level of learning in the field of ophthalmology. Though various 3D eyeball models are currently available, complex structures such as the cerebral venous system and the circle of Willis have never been 3D printed and presented as 3D puzzles for assembling and learning. According to our knowledge, this concept of ophthalmic pedagogy has never been reported. In this manuscript, we discuss in detail the 3D models created by us (patent pending), for printing into multiple puzzle pieces for effective tactile learning by cognitive assembling.