Publications by authors named "Rohit Saxena"

215 Publications

Ethambutol toxicity: Expert panel consensus for the primary prevention, diagnosis and management of ethambutol-induced optic neuropathy.

Indian J Ophthalmol 2021 Dec;69(12):3734-3739

Directorate General of Health Services, Government of India, New Delhi, India.

Ethambutol use may lead to permanent vision loss by inducing a dose- and duration-dependent optic neuropathy. This has been of concern to ophthalmologists and physicians both; however, ethambutol continues to be used because of its anti-mycobacterial action with relative systemic safety. Recently, the guidelines of the Revised National Tuberculosis Control Programme of India have been revised to allow for fixed dose and longer duration of ethambutol use; this is likely to result in an increase in vision-threatening adverse effects. Taking cognizance of this, neuro-ophthalmologists, infectious disease specialists, and scientists met under the aegis of the Indian Neuro-Ophthalmology Society to deliberate on prevention, early diagnosis, and management of ethambutol-related toxic optic neuropathy. The recommendations made by the expert group focus on early suspicion of ethambutol toxicity through screening at the physician's office and opportunistic screening by the ophthalmologist. Further, they focus on an early diagnosis through identification of specific clinical biomarkers and on management in way of early stoppage of the drug and supportive therapy. This statement also describes the mechanism of reporting a case of toxic optic neuropathy through the Pharmacovigilance Programme of India and emphasizes the need for spreading awareness regarding vision-threatening adverse effects among patients and healthcare workers.
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http://dx.doi.org/10.4103/ijo.IJO_3746_20DOI Listing
December 2021

Lifestyle modification in school-going children before and after COVID-19 lockdown.

Indian J Ophthalmol 2021 12;69(12):3623-3629

Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To evaluate the impact of COVID-19 lockdown restrictions on lifestyle of school-going children.

Methods: This was a questionnaire-based prospective study of 1237 school children aged 9-14 years enrolled from various private and government schools across Delhi in October-December 2020. These children were being followed-up over the previous 2 years (before pandemic) with details of their lifestyle like near/outdoor/reading activities using a questionnaire as a part of another study. The data during the COVID-19 lockdown was collected by telephonic interview. This was compared to similar information collected from this cohort in the pre-Covid period in 2019 when the students had a regular physical school curriculum.

Results: A significant decline was noted in time spent on outdoor activity (from 8.5 hours/week in pre-COVID-19 time to 1.6 hours/week during COVID-19 lockdown; P < 0.001) and doing homework offline (from 15.3 hour/week to 14 hours/week; P < 0.001). A significant increase was noted in screen time spent on digital devices (from 6.2 hours/week to 19.8 hours/week; P<0.001), and watching television (from 12.2 hours/week to 13.4 hours/week; P < 0.001). The rise in the digital on-screen time was significantly more in boys (P < 0.001) and in students from private schools (P < 0.001). The rise in the duration of watching television was significantly more in girls than boys (P < 0.05).

Conclusion: COVID-19 lockdown has markedly impacted the lifestyle of school children by significantly decreasing the outdoor activity and increasing the screen time, thereby pre-disposing them to ocular ill-health and myopia. This necessitates the adoption of guidelines for promoting healthy digital habits in children.
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http://dx.doi.org/10.4103/ijo.IJO_2096_21DOI Listing
December 2021

The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project "Fixing the missing link": Prevalence data from West Bengal.

Indian J Ophthalmol 2021 Nov;69(11):3103-3109

Senior Optometrist, Trenetralaya, Kolkata, West Bengal, India.

Purpose: The aim of this study was to determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in rural and urban West Bengal (WB).

Methods: Patients were screened in the physician's clinic by a team of ophthalmologist, optometrist and counsellor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera.

Results: A total of 1553 subjects were screened over 39 camps across 14 districts of WB over 17 months. The prevalence of DR was 21.51%, with a significant difference between rural (26.55%) and urban (13.89%) areas (P < 0.01). No significant difference with gender was seen (P = 0.99). Presence and grade of DR were related to age, loss of vision, diabetic age, diabetic control, awareness of diabetic blindness and last eye checkup.

Conclusion: This study provides the first major prevalence data from WB, and gives valuable insight regarding modifiable risk factors for DR. It is also the first DR study in India to be conducted in the physician's clinic. The study results emphasise the need to "fix the missing link" between ophthalmologists and treating physicians to win the battle against DR.
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http://dx.doi.org/10.4103/ijo.IJO_3322_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725092PMC
November 2021

Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects.

Front Neurosci 2021 6;15:745355. Epub 2021 Oct 6.

Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Standard automated perimetry (SAP) is the gold standard for evaluating the presence of visual field defects (VFDs). Nevertheless, it has requirements such as prolonged attention, stable fixation, and a need for a motor response that limit application in various patient groups. Therefore, a novel approach using eye movements (EMs) - as a complementary technique to SAP - was developed and tested in clinical settings by our group. However, the original method uses a screen-based eye-tracker which still requires participants to keep their chin and head stable. Virtual reality (VR) has shown much promise in ophthalmic diagnostics - especially in terms of freedom of head movement and precise control over experimental settings, besides being portable. In this study, we set out to see if patients can be screened for VFDs based on their EM in a VR-based framework and if they are comparable to the screen-based eyetracker. Moreover, we wanted to know if this framework can provide an effective and enjoyable user experience (UX) compared to our previous approach and the conventional SAP. Therefore, we first modified our method and implemented it on a VR head-mounted device with built-in eye tracking. Subsequently, 15 controls naïve to SAP, 15 patients with a neuro-ophthalmological disorder, and 15 glaucoma patients performed three tasks in a counterbalanced manner: (1) a visual tracking task on the VR headset while their EM was recorded, (2) the preceding tracking task but on a conventional screen-based eye tracker, and (3) SAP. We then quantified the spatio-temporal properties (STP) of the EM of each group using a cross-correlogram analysis. Finally, we evaluated the human-computer interaction (HCI) aspects of the participants in the three methods using a user-experience questionnaire. We find that: (1) the VR framework can distinguish the participants according to their oculomotor characteristics; (2) the STP of the VR framework are similar to those from the screen-based eye tracker; and (3) participants from all the groups found the VR-screening test to be the most attractive. Thus, we conclude that the EM-based approach implemented in VR can be a user-friendly and portable companion to complement existing perimetric techniques in ophthalmic clinics.
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http://dx.doi.org/10.3389/fnins.2021.745355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526798PMC
October 2021

Prevalence of myopia and its risk factors in rural school children in North India: the North India myopia rural study (NIM-R Study).

Eye (Lond) 2021 Oct 13. Epub 2021 Oct 13.

Department of Community Ophthalmology, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Background: To assess the prevalence of myopia and its risk factors in rural school children.

Methods: Children in classes 4-7 of eight randomly selected schools (five government and three private) in rural Haryana, with unaided vision <6/9.5 were screened, their cycloplegic refraction is done, myopes were identified. A questionnaire-based assessment of risk factors was done for myopes and compared with 10% of randomly selected children with normal vision (controls). The prevalence of myopia and its association with risk factors were assessed.

Results: Children screened were 1486 (89.5% coverage). The mean age of children was 11.2 ± 1.5 years with 861 (57.9%) boys. Prevalence of myopia was 6.4% (95% Confidence intervals [CI]: 5.2%, 7.8%). Prevalence was higher among private schools (10.1%) compared to government schools (1.4%) (p < 0.001), and among girls 7.2% (45/625) compared to boys 5.8% (50/861) (p = 0.2786). The mean spherical equivalent refractive error was -1.61D ± 1.32D. The prevalence of high myopia was 1.1% (1/95). There was a 75% unmet need for spectacles. Studying in private school was positively associated with myopia as per our multivariate analysis (p = 0.016). An inverse association was found for time spent outdoors (p = 0.009). Watching television, indoor time, screen time, age, or gender were not found to be statistically significant as risk factors.

Conclusion: The prevalence of myopia is increasing among children of rural areas, especially those in private schools with a strong inverse association with time spent outdoors. Regular screening, lifestyle modification and awareness about modifiable risk factors are essential.
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http://dx.doi.org/10.1038/s41433-021-01797-3DOI Listing
October 2021

Simulation of complex strabismus surgical procedures on goat eyes.

Eur J Ophthalmol 2021 Sep 8:11206721211045190. Epub 2021 Sep 8.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Purpose: To describe the possibility of complex strabismus surgical simulation on goat eyes.

Methods: The goat eyes were procured from local slaughterhouse with retained extra ocular muscle tissues. The obtained eyes were inspected for globe integrity, muscle quality, muscle length, and the surrounding teno-conjunctival layers. The included eyes were then segregated for surgical simulation based on their insertion and orientation (as oblique or recti), and they were mounted on a mannequin head, with a fixation suture at free end to simulate the resting tension. Additionally, as per necessary, extra muscles were also transplanted along desired sites to simulate human extra ocular muscle anatomy.

Results: The inferior oblique, superior oblique, and all other four recti were successfully simulated in varying proportions in more than 50 eyes. Primarily, by simulating the lateral rectus, inferior rectus, and the inferior oblique muscle, staged weakening procedures of inferior oblique were successfully practiced (Fink's recession, Park's recession, Elliot and Nankin procedure, total anterior positioning, and antero-nasal trans-position or Stager's procedure). Similarly, by simulating superior rectus, inferior rectus, lateral rectus, and the medial rectus muscles, half width transposition, full width transposition, and other complex procedures were practiced (Knapp's procedure, augmented Knapp's, Nishida's procedure, Faden operation, and Y splitting procedure). Furthermore, by simulating superior oblique and the superior rectus muscles, superior oblique tuck, posterior tenectomy, loop tenotomy, and Harada Ito procedures were successfully practiced.

Conclusions: On goat eyes, the complex strabismus surgical procedures can be successfully simulated and practiced after re-organizing the existing muscles in different patterns.
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http://dx.doi.org/10.1177/11206721211045190DOI Listing
September 2021

Optical coherence tomography angiography in amblyopia: A critical update on current understandings and future perspectives.

Eur J Ophthalmol 2021 Sep 2:11206721211042554. Epub 2021 Sep 2.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Optical coherence tomography angiography (OCTA) is a non-invasive tool to assess the retino-choroidal vasculature in vivo. It tracks the red blood cell movement and maps the vasculature in quick succession. In routine, diabetic retinopathy, age related macular degeneration, central serous chorioretinopathy, and others are commonly being studied to unveil its clinic role. On the other hand, amblyopia is a condition where the visual acuity is subnormal due to non-organic causes in the eye. But the OCTA studies till now have shown variable changes along retino-choroidal vasculature. Hence, to comprehend the existing literature knowledge, a systematic literature search was carried out and the original works describing novel findings in amblyopic eyes on OCTA were included. Upon detailed assessment, firstly, the disturbed vasculature along superficial retinal plexus, deeper retinal plexus, and choroidal plexus were evident in most untreated amblyopic eyes. However, such changes were not uniform, which is due to noted heterogenic patient profile, small sample size, biometric biases, non-uniform algorithms, and other factors. And to note, even in presence of such diverse changes, almost all the authors stated a plausible explanation for their notable changes. Secondly, the utility of OCTA in identifying vascular changes with standard treatments and segregation of visual beneficiaries from non-beneficiaries were possible. Hence, to conclude, OCTA is a valuable tool which can provide valuable useful insights into the amblyopic eyes during pre and post treatment periods. However, to gather more concrete evidence for clinical benefits, systematic, homogenous, and better structured clinical studies are mandated.
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http://dx.doi.org/10.1177/11206721211042554DOI Listing
September 2021

Clinical Role of Swept Source Anterior Segment Optical Coherence Tomography in Strabismus Re-Operation with Lost Surgical Details.

Clin Ophthalmol 2021 25;15:3581-3591. Epub 2021 Aug 25.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Background: To characterize the diagnostic role of swept source anterior segment optical coherence tomography (SS-ASOCT) in strabismus re-operations with lost surgical details.

Methods: Patients presenting to our outpatient services for strabismus care from February 2020 to March 15th 2021 were systematically evaluated. Those willing to undergo re-operation were included in the study. A total of 30 patients were identified and out of this a total of 10 eyes of 10 patients with lost surgical details were finally included in the study. Demographic details, preoperative deviation, ocular findings, orthoptic measurements, detailed SS-ASOCT findings, intraoperative measurements, and post-operative outcomes were recorded.

Results: The mean age of 10 patients was 23.7±5.75 years. Seven were male and three were female. The mean pre-operative SS-ASOCT measured distance from angle to insertion was 8.90±1.85 mm and the mean intraoperative distance was 9.12±2.14 mm. A mean difference of 0.21±1.31 mm was noted, and this difference was statistically insignificant (paired test, p = 0.57). In addition, SS-ASOCT unraveled novel signs to differentiate operated eyes from the un-operated eyes, and recessed muscle from the resected muscle.

Conclusion: In strabismus re-operation with lost surgical details, the pre-operative SS-ASOCT can provide reliable muscle details with respect to its type of surgery and amount surgery.
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http://dx.doi.org/10.2147/OPTH.S328215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403674PMC
August 2021

Reply.

Ophthalmology 2021 12 23;128(12):e215-e217. Epub 2021 Aug 23.

Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

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http://dx.doi.org/10.1016/j.ophtha.2021.07.011DOI Listing
December 2021

Role of spectral domain optical coherence tomography in the diagnosis and prognosis of papilledema.

Indian J Ophthalmol 2021 Sep;69(9):2372-2377

Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India.

Purpose: The study of papilledema with a novel noninvasive technique such as spectral domain-optical coherence tomography (SD-OCT) provides minute and detailed cross-sectional changes thus giving an insight into the application of biomechanical principles and pathophysiology of disc edema.

Methods: We measured average retinal nerve fiber layer (RNFL) thickness and the retinal pigment epithelium/Bruch's membrane (RPE/BM) angle at the temporal and nasal borders of the neural canal opening (NCO) in 30 eyes with papilledema, 30 eyes with papillitis, and 80 control eyes. The inward angulation was considered as positive and the outward as negative. Follow-up was done at 1, 2, 3, and 6 months. The main outcome measures are the average RNFL thickness and the RPE/BM angle.

Results: 29 eyes (96.6%) with papilledema had a positive RPE/BM angle (+8.11 ± 3.13). 29 eyes (96.6%) with papillitis had a negative RPE/BM angle (-1.04 ± 3.27). On follow-up at 1 month, both RNFL thickness (P = 0.01) and RPE-BM angle (P = 0.001) reduced significantly in eyes with papilledema; in eyes with papillitis, there was a significant reduction in the RNFL thickness (P = 0.02), but not in the RPE-BM angle (P > 0.05). RNFL thickness in papilledema cases normalized at 3 months whereas RPE/BM normalized at 6 months of follow-up. To detect papilledema, OCT has a sensitivity of 96.66% and specificity of 99.09% on both nasal and temporal sides.

Conclusion: After appropriate treatment, the RPE/BM angle in papilledema decreased much later than the RNFL thickness. Hence, the RPE/BM angle in papilledema (positive) can be used to differentiate it from papillitis (negative) and also to monitor the activity of the disease.
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http://dx.doi.org/10.4103/ijo.IJO_3269_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544041PMC
September 2021

Approach to optic neuritis: An update.

Indian J Ophthalmol 2021 Sep;69(9):2266-2276

Neuro-ophthalmology and Strabismus Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Over the past few years, there has been remarkable development in the area of optic neuritis. The discovery of new antibodies has improved our understanding of the pathology of the disease. Antiaquaporin4 antibodies and antimyelin oligodendrocytes antibodies are now considered as distinct entities of optic neuritis with their specific clinical presentation, neuroimaging characteristics, treatment options, and course of the disease. Similarly, there has been a substantial change in the treatment of optic neuritis which was earlier limited to steroids and interferons. The development of new immunosuppressant drugs and monoclonal antibodies has reduced the relapses and improved the prognosis of optic neuritis as well as an associated systemic disease. This review article tends to provide an update on the approach and management of optic neuritis.
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http://dx.doi.org/10.4103/ijo.IJO_3415_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8544067PMC
September 2021

Structural and white matter changes associated with duration of Braille education in early and late blind children.

Vis Neurosci 2021 08 24;38:E011. Epub 2021 Aug 24.

Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, India.

In early (EB) and late blind (LB) children, vision deprivation produces cross-modal plasticity in the visual cortex. The progression of structural- and tract-based spatial statistics changes in the visual cortex in EB and LB, as well as their impact on global cognition, have yet to be investigated. The purpose of this study was to determine the cortical thickness (CT), gyrification index (GI), and white matter (WM) integrity in EB and LB children, as well as their association to the duration of blindness and education. Structural and diffusion tensor imaging data were acquired in a 3T magnetic resonance imaging in EB and LB children (n = 40 each) and 30 sighted controls (SCs) and processed using CAT12 toolbox and FSL software. Two sample t-test was used for group analyses with P < 0.05 (false discovery rate-corrected). Increased CT in visual, sensory-motor, and auditory areas, and GI in bilateral visual cortex was observed in EB children. In LB children, the right visual cortex, anterior-cingulate, sensorimotor, and auditory areas showed increased GI. Structural- and tract-based spatial statistics changes were observed in anterior visual pathway, thalamo-cortical, and corticospinal tracts, and were correlated with education onset and global cognition in EB children. Reduced impairment in WM, increased CT and GI and its correlation with global cognitive functions in visually impaired children suggests cross-modal plasticity due to adaptive compensatory mechanism (as compared to SCs). Reduced CT and increased FA in thalamo-cortical areas in EB suggest synaptic pruning and alteration in WM integrity. In the visual cortical pathway, higher education and the development of blindness modify the morphology of brain areas and influence the probabilistic tractography in EB rather than LB.
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http://dx.doi.org/10.1017/S0952523821000080DOI Listing
August 2021

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19.

Indian J Ophthalmol 2021 Aug;69(8):2196-2201

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis.

Methods: An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed.

Results: Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care.

Conclusion: COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.
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http://dx.doi.org/10.4103/ijo.IJO_1116_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482930PMC
August 2021

Subcritical water pretreatment for agave bagasse fractionation from tequila production and enzymatic susceptibility.

Bioresour Technol 2021 Oct 14;338:125536. Epub 2021 Jul 14.

Biorefinery Group, Food Research Department, Faculty of Chemistry Sciences, Autonomous University of Coahuila, Saltillo, Coahuila 25280, Mexico. Electronic address:

This work focuses on the effect of subcritical water pretreatment conditions on agave bagasse chemical composition, biomass fractionation, and enzymatic hydrolysis obtained from the different tequila production processes. The pretreatment was carried out in a batch pressurized reactor within an isothermal regime. The operational conditions for subcritical water pretreatment were (150-190 °C) and (10-50 min). The best operational conditions were selected, based on the increased cellulose content (>50%) in the pretreated solid phase. The conditions for 190 °C for 50 and 30 min of pretreated agave bagasse solids were chosen for enzymatic hydrolysis susceptibility (15 FPU/g of the substrate). The maximum conversion yield (cellulose to glucose) during enzymatic hydrolysis achieved was up to 61.62% (5.86 g/L) in industrial bagasse at 72 h and initial saccharification rate was 0.34 g/(L*h) at 12 h. This study indicates that the agave bagasse is a promising raw material in the development of second-generation biorefineries.
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http://dx.doi.org/10.1016/j.biortech.2021.125536DOI Listing
October 2021

Management of amblyopia in pediatric patients: Current insights.

Eye (Lond) 2022 Jan 7;36(1):44-56. Epub 2021 Jul 7.

Department of Neuroophthalmology and Strabismus, Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Amblyopia is a cause of significant ocular morbidity in pediatric population and may lead to visual impairment in future life. It is caused due to formed visual deprivation or abnormal binocular interactions. Several risk factors in pediatric age group may lead to this disease. Author groups have tried managing different types of amblyopia, like anisometropic amblyopia, strabismic amblyopia and combined mechanism amblyopia, with optical correction, occlusion therapy, penalization, binocular therapy and surgery. We review historical and current management strategies of different types of amblyopia affecting children and outcomes in terms of visual acuity, binocularity and ocular deviation, highlighting evidence from recent studies. Literature searches were performed through Pubmed. Risk factors for amblyopia need to be identified in pediatric population as early in life as possible and managed accordingly, as visual outcomes in amblyopia are best if treated at the earliest. Although, monocular therapies like occlusion or penalization have been shown to be quite beneficial over the years, newer concepts related to binocular vision therapy are still evolving.
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http://dx.doi.org/10.1038/s41433-021-01669-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727565PMC
January 2022

Clinical Features, Gender Differences, Disease Course, and Outcome in Neuromyelitis Optica Spectrum Disorder.

Ann Indian Acad Neurol 2021 Mar-Apr;24(2):186-191. Epub 2020 Jan 6.

Department of Neuroimaging and Interventional Neuroradiology, All India institute of Medical Sciences, New Delhi, India.

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an astrocytopathy with a predilection for the optic nerve, spinal cord, and brainstem. In this ambispective study, we evaluate clinical characteristics, responses to therapy, and disability outcomes in patients with NMOSD.

Methods: Patients diagnosed as NMOSD and following up for at least 1 year at a tertiary care center in India were recruited. Patient data were collected ambispectively from January 2012 until December 2018.

Results: A total of 106 patients (29M/77F) with NMOSD were evaluated. The mean age of onset was 29 (±11.6) years. About 77 patients (72.64%) were positive for the AQP4 antibody. Age of onset was higher for those presenting with an opticospinal syndrome (34.2 years) as compared to either isolated longitudinally extensive transverse myelitis (LETM) (30 years) or optic neuritis (ON) (25.3 years). The most common syndrome at onset was LETM in 57 patients (53.77%) followed by ON in 31 patients (29.24%). Azathioprine was the most common immunotherapy (83.96%) prescribed followed by rituximab (7.54%) and mycophenolate mofetil (1.88%). There was a significant decrease in the number of relapses post-azathioprine ( < 0.001). Out of 67 patients with ON, 21 (31.34%) had complete recovery while 17 (25.37%) patients had a severe deficit at a 3-month follow-up. Out of 92 patients with a motor deficit, 49 (53.26%) patients had a partial motor deficit at a 6-month follow-up. The severe visual deficit at baseline and female gender predicted poor visual and motor recovery, respectively.

Conclusion: This is the largest descriptive study on patients with NMOSD from India. Relapse rates were similar irrespective of the clinical presentation, age, gender, and disease course. Treatment with immunosuppressive treatment significantly affected the disease course.
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http://dx.doi.org/10.4103/aian.AIAN_334_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232474PMC
January 2020

Evaluation of Memory and Language Network in Children and Adolescents with Visual Impairment: A Combined Functional Connectivity and Voxel-based Morphometry Study.

Neuroophthalmology 2021 3;45(3):147-161. Epub 2021 Feb 3.

Centre for Linguistics, School of Language, Literature and Culture Studies, Jawaharlal Nehru University, New Delhi, India.

Functional network changes associated with Braille reading are different in early blind (EB) and late blind (LB) participants. The objectives were to study the functional connectivity (of memory and language areas based on blood oxygen level-dependent [BOLD] mapping) and structural changes in EB and LB children and adolescents. A total of 110 participants (all right-handed) were recruited in two age groups of 6-12 years (children) and 13-19 years (adolescents) consisting of EB (n = 20), LB (n = 20), and sighted controls (SC, n = 15) in each group. Group differences were estimated between children and adolescent groups. Structural changes in visual cortex and medial temporal area, increased BOLD activations and altered functional connectivity in the primary visual cortex, inferior frontal gyrus, middle temporal gyrus, and hippocampus during Braille reading task were observed in adolescents as compared with children blind groups (pFDR corrected <0.05). Functional results were positively correlated with duration of Braille reading and age at onset in EB and LB groups (p ≤ 0.01). Visual, language, and learning memory networks were different in adolescents and children of both EB and LB groups, and also between EB and LB groups suggesting cross-modal plasticity. The functional and structural results revealed education dependent cross-modal plasticity in visually impaired participants. Memory and language network were affected more in the LB group than the EB group, and more in children than adolescents.
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http://dx.doi.org/10.1080/01658107.2020.1855452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210866PMC
February 2021

Near work, screen time, outdoor time and myopia in schoolchildren in the Sunflower Myopia AEEC Consortium.

Acta Ophthalmol 2021 Jun 17. Epub 2021 Jun 17.

Singapore Eye Research Institute, Singapore, Singapore.

Purpose: To examine the association between near work, screen time including TV and outdoor time with myopia in children from the Sunflower Myopia Asian Eye Epidemiology Consortium (AEEC).

Methods: We analysed AEEC cross-sectional data (12 241 children) on risk factors (near work, screen time including TV and outdoor time) and myopia of six population-based studies (China, Hong Kong and Singapore). Cycloplegic refraction and axial length (AL) measurements were included. Risk factors were determined using questionnaires. Data were pooled from each study, and multivariable regression analysis was performed to evaluate the associations between risks factors and myopia, spherical equivalent (SE) and AL.

Results: Among the included children, 52.1% were boys, 98.1% were Chinese and 69.7% lived in urban areas. Mean±standard deviation (SD) for age was 8.8 ± 2.9 years, for SE was -0.14 ± 1.8 D and for AL was 23.3 ± 1.1 mm. Myopia prevalence was 30.6%. In multivariate analysis, more reading and writing (OR = 1.17; 95% CI, 1.11-1.24), more total near work (OR = 1.05; 95% CI, 1.02-1.09) and less outdoor time (OR = 0.82, 95% CI, 0.75-0.88) were associated with myopia (p's < 0.05). These factors were similarly associated with SE and AL (p's < 0.05), except for total near work and AL (p = 0.15). Screen time including TV was not significantly associated with myopia (p = 0.49), SE (p = 0.49) or AL (p = 0.83).

Conclusion: In this study, increased reading and writing and decreased outdoor time were associated with myopia. Screen time may be a surrogate factor of near work or outdoor time, but further research is needed to assess its role as an independent risk factor for myopia.
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http://dx.doi.org/10.1111/aos.14942DOI Listing
June 2021

Neuro-ophthalmic manifestations of tuberculosis.

Eye (Lond) 2022 Jan 14;36(1):15-28. Epub 2021 Jun 14.

Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Neuro-ophthalmic features are a known association in tuberculosis, especially common in central nervous system tuberculosis (CNS-TB). They are mostly the result of the visual pathway and/or ocular motor and other cranial nerve involvement. Furthermore, toxic optic neuropathy and paradoxical response to anti-tubercular drugs (ATT) are also not uncommon. The etiopathogenesis is by the complex interplay of various factors like exudates, vasculitis, arachnoiditis, presence of tuberculomas, hydrocephalus, brain infarcts and/or immune-mediated reaction. The entity often poses a diagnostic dilemma for the ophthalmologists/neuro-ophthalmologists and may lead to irreversible vision loss. The presence of neuro-ophthalmic features not only affect the visual outcome but are also predictors of systemic morbidity of the disease. Therefore, understanding and knowledge about this entity are necessary for the comprehensive management of the disease. While various forms of TB including CNS-TB have been well-dealt with in literature, little is discussed specifically about the neuro-ophthalmic manifestations of tuberculosis. Therefore, the purpose of this review is to highlight current understanding of the types of neuro-ophthalmic involvement in tuberculosis, its etiopathogenesis, diagnosis and management.
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http://dx.doi.org/10.1038/s41433-021-01619-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727585PMC
January 2022

A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India.

Indian J Ophthalmol 2021 06;69(6):1381-1387

Head, Cornea Services, RP Center, AIIMS, New Delhi, India.

Purpose: This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India.

Methods: This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3-15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination.

Results: Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand.

Conclusion: Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed.
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http://dx.doi.org/10.4103/ijo.IJO_2408_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302266PMC
June 2021

Eye-Movement-Based Assessment of the Perceptual Consequences of Glaucomatous and Neuro-Ophthalmological Visual Field Defects.

Transl Vis Sci Technol 2021 02;10(2)

Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, The Netherlands.

Purpose: Assessing the presence of visual field defects (VFD) through procedures such as perimetry is an essential aspect of the management and diagnosis of ocular disorders. However, even the latest perimetric methods have shortcomings-a high cognitive demand and requiring prolonged stable fixation and feedback through a button response. Consequently, an approach using eye movements (EM)-as a natural response-has been proposed as an alternate way to evaluate the presence of VFD. This approach has given good results for computer-simulated VFD. However, its use in patients is not well documented yet. Here we use this new approach to quantify the spatiotemporal properties (STP) of EM of various patients suffering from glaucoma and neuro-ophthalmological VFD and controls.

Methods: In total, 15 glaucoma patients, 37 patients with a neuro-ophthalmological disorder, and 21 controls performed a visual tracking task while their EM were being recorded. Subsequently, the STP of EM were quantified using a cross-correlogram analysis. Decision trees were used to identify the relevant STP and classify the populations.

Results: We achieved a classification accuracy of 94.5% (TPR/sensitivity = 96%, TNR/specificity = 90%) between patients and controls. Individually, the algorithm achieved an accuracy of 86.3% (TPR for neuro-ophthalmology [97%], glaucoma [60%], and controls [86%]). The STP of EM were highly similar across two different control cohorts.

Conclusions: In an ocular tracking task, patients with VFD due to different underlying pathology make EM with distinctive STP. These properties are interpretable based on different clinical characteristics of patients and can be used for patient classification.

Translational Relevance: Our EM-based screening tool may complement existing perimetric techniques in clinical practice.
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http://dx.doi.org/10.1167/tvst.10.2.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873497PMC
February 2021

Comparative evaluation of Octopus semi-automated kinetic perimeter with Humphrey and Goldmann perimeters in neuro-ophthalmic disorders.

Indian J Ophthalmol 2021 04;69(4):918-922

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: The aim of this study was to compare the performance of Octopus 900(OVF) kinetic module with Goldmann perimeter (GVF) and Humphrey 750i (HVF) perimeters in neuro-ophthalmic disorders.

Methods: During this prospective observational cross-sectional study, 17 patients (26 eyes) with neuro-ophthalmic disorders underwent visual field examination on the three perimeters. Field defects on OVF were matched with HVF and GVF for the number of quadrants involved. An unmasked observer, and a masked observer (unaware of the clinical diagnosis) were made to separately diagnose the type of field defects on all three fields for the same patient. The pattern of field defect on OVF was compared with GVF and HVF field defects for both observers.

Results: When OVF was compared with HVF and GVF, 88% eyes correctly matched for normal or abnormal visual fields, while quadrant-matching was 80% and 89% respectively. For the unmasked observer, the pattern of field defects on OVF was similar to HVF and GVF in 58% and 65% eyes respectively while for a masked observer, it was 54% and 62%. Central and paracentral scotomas showed unmatched fields when OVF was compared with HVF and GVF. When these patients were excluded, sensitivity of OVF increased to 95%.

Conclusion: Clinical correlation aids in better characterisation of a field defect. All 3 perimeters are concurrent in the pattern of field defects for non-central defects. However, the default protocol on OVF may not be enough to demarcate the central and para-central scotomas. Development of a customised protocol for the assessment of central and centrocecal field defects increases the accuracy of OVF.
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http://dx.doi.org/10.4103/ijo.IJO_1266_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012927PMC
April 2021

Myopia, Melatonin and Conjunctival Ultraviolet Autofluorescence: A Comparative Cross-sectional Study in Indian Myopes.

Curr Eye Res 2021 10 9;46(10):1474-1481. Epub 2021 Mar 9.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

: To explore the role of outdoor light exposure by estimating ocular sun exposure measured by Conjunctival Ultraviolet Autofluorescence (CUVAF) imaging and serum melatonin levels in myopes and non-myopes.: Age and sex matched emmetropes and myopes (60 each) aged 10-25 years participated. Those with a history of ocular surgery or any ocular or systemic co-morbidity were excluded. Socio-demographic parameters, sun exposure questionnaires, indoor and outdoor activity profile, morning serum melatonin levels, sleep pattern, degree of myopia, ocular biometry and area of CUVAF on ultraviolet photography were noted and analyzed.: Mean age of myopes (18 ± 4.5 years) and emmetropes (18.5 ± 4 years) was similar ( = .523). Serum melatonin levels were significantly higher ( = .001) among myopes (89.45 pg/ml) as compared to emmetropes (52.83 pg/ml). Lifetime sun exposure was significantly lower in myopes than emmetropes ( = .0003). Area of CUVAF was inversely related to degree of myopia ( < .0001). Day time sleepiness was greater in myopes (51.7%) than emmetropes (15%) ( < .0001). There was a positive correlation between serum melatonin levels and axial length among myopes (correlation coefficient = 0.27; = .03). Age and gender had no association with serum melatonin levels.: This study demonstrates an inverse relationship between serum melatonin levels and degree of CUVAF in myopes. A novel link between serum melatonin, axial length and outdoor sun exposure is highlighted in the current study.
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http://dx.doi.org/10.1080/02713683.2021.1894580DOI Listing
October 2021

Effect of induced anisometropia on stereopsis and surgical tasks in a simulated environment.

Indian J Ophthalmol 2021 03;69(3):568-572

Department of Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To quantitatively correlate the loss of stereopsis by induced anisometropia with its effect on tasks that require binocular vision and stereopsis, such as ophthalmic surgery in a simulated environment.

Methods: Thirty-nine ophthalmic residents with best-corrected visual acuity of 20/20 or better OU, with normal binocular vision and stereopsis, were recruited for the study. Anisometropia was induced using spherical and cylindrical trial lenses from +1D to +5D in a trial frame. The residents performed an anterior chamber navigation exercise on the EYESi simulator and the surgical score at baseline and for each level of induced anisometropia was noted. Near stereopsis was assessed by the Randot test and TNO test at baseline and for each level of induced anisometropia.

Results: Stereoacuity on the Randot test and TNO test were 30 (95% CI, 25.9-34.1) and 44.4 (95% CI, 28.5-60.3) arcseconds, respectively which reduced to 65.5 (95% CI, 48.7-82.3) and 75.9 (95% CI, 15.5-136.3) arcseconds at anisometropia of +1D Sph (P < 0.001) and 380 (95% CI, 309.9-450.1) and 1922.1 (95% CI, 1582.5-2261.7) arcseconds for +5D Sph, respectively for the two tests, (P < 0.001). The corresponding surgical score reduced from 93.8 (95% CI, 91.1-96.7) to 87.5 (95% CI, 79.2-95.8, P < 0.001) for 1 DSph and 55.97 (95% CI, 38.3-73.7, P < 0.001) for 5DSph. There was a strong negative correlation between stereopsis scores and surgical task scores (Spearman's rho -0.86, P value <0.001) Similar changes were seen for anisometropia induced with cylindrical powers.

Conclusion: Induced anisometropia is associated with a significant diminution in surgical task scores in a simulated environment and this is correlated with the deterioration in stereoacuity. Assessment of stereopsis may be included as a regular part of the screening procedure for ophthalmic trainee residents.
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http://dx.doi.org/10.4103/ijo.IJO_1540_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942079PMC
March 2021

Visual Cortex Alterations in Early and Late Blind Subjects During Tactile Perception.

Perception 2021 Mar 16;50(3):249-265. Epub 2021 Feb 16.

28730All India Institute of Medical Sciences, India.

Involvement of visual cortex varies during tactile perception tasks in early blind (EB) and late blind (LB) human subjects. This study explored differences in sensory motor networks associated with tactile task in EB and LB subjects and between children and adolescents. A total of 40 EB subjects, 40 LB subjects, and 30 sighted controls were recruited in two subgroups: children (6-12 years) and adolescents (13-19 years). Data were acquired using a 3T MR scanner. Analyses of blood oxygen level dependent (BOLD), functional connectivity (FC), correlation, and post hoc test for multiple comparisons were carried out. Difference in BOLD activity was observed in EB and LB groups in visual cortex during tactile perception, with increased FC of visual with dorsal attention and sensory motor networks in EB. EB adolescents exhibited increased connectivity with default mode and salience networks when compared with LB. Functional results correlated with duration of training, suggestive of better performance in EB. Alteration in sensory and visual networks in EB and LB correlated with duration of tactile training. Age of onset of blindness has an effect in cross-modal reorganization of visual cortex in EB and multimodal in LB in children and adolescents.
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http://dx.doi.org/10.1177/0301006621991953DOI Listing
March 2021

Atropine for the Treatment of Childhood Myopia in India: Multicentric Randomized Trial.

Ophthalmology 2021 09 2;128(9):1367-1369. Epub 2021 Feb 2.

Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

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http://dx.doi.org/10.1016/j.ophtha.2021.01.026DOI Listing
September 2021

Ethambutol Optic Neuropathy: Vigilance and Screening, the Keys to Prevent Blindness with the Revised Anti-tuberculous Therapy Regimen.

J Assoc Physicians India 2021 Feb;69(2):54-57

Indian Neuro-Ophthalmology Society Research Group (INOSRG): Ambika Selvakumar, Ankur Sinha, Digvijay Singh, Hemalini Sawant, Jaspreet Sukhija, Jawahar Lal Goyal, Jenil Seth, Jitendra Jethani, Jyoti Matalia, Kumudini Sharma, Mahesh Kumar, Meenakshi Dhar, Murlidhar R, Naveen Jaikumar, Nishant Kumar, Padmavathy Maharajan, Pradeep Agarwal, Rashmin Gandhi, Ravinder Battu, Rohit Saxena, Satya Karna, Shikha Bassi, Soveetha Rath, Sujata Guha, Sumit Monga, Swati Phuljhele, V Krishna, Varshini Shankar, Vimal Fudnawala, Vimla Menon, Virender Sachdeva.

There has been change in the guidelines for the management of tuberculosis in India. The new guidelines advocate the daily use of Ethambutol for both intensive and continuation phase of the treatment. This may be a matter of concern as increased cumulative dose may lead to increase in incidence of toxic optic neuropathy due to ethambutol. Indian Neuro-Ophthalmology Society has taken cognizance of the issue and has come-up with guidelines for prevention and early detection of the toxic optic neuropathy.
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February 2021

Unusual case of elevator deficit: looking beyond the extraocular muscles.

BMJ Case Rep 2021 Jan 15;14(1). Epub 2021 Jan 15.

Ophthalmology, All India Institute of Medical Sciences, New Delhi, India

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http://dx.doi.org/10.1136/bcr-2020-239344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813358PMC
January 2021

An Ophthalmologist's Insight Into The Viral Pandemics.

J Optom 2022 Jan-Mar;15(1):35-43. Epub 2021 Jan 6.

Department of Ophthalmology, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address:

In recent past, major pandemics and epidemics have occurred due to the emergence and resurgence of the novel strains of viruses like Influenza [HINI-A "Spanish Flu", H1N1-Novel A "Swine flu"], Corona [Middle East Respiratory Syndrome (MERS), Severe acute respiratory syndrome (SARS-CoV-1, SARS-CoV-2)] and Ebola virus [Ebola virus disease]. These infectious diseases may have several ocular manifestations and rarely might be the presenting symptom of the underlying disease. The eyes can act as a portal of entry and/or route of viral transmission for these pathogens. Therefore, an ophthalmologist/optometrist needs to act with ample preparedness and responsibility. Establishing a standard of care in ophthalmic practice by modifying the conventional examination techniques and adopting tele-ophthalmology model to triage the patients can control the community spread of the disease. This article aims to elucidate the ocular manifestations in these pandemics and measures that should be adopted in ophthalmic practice to prevent the disease transmission.
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http://dx.doi.org/10.1016/j.optom.2020.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045749PMC
December 2021

Pediatric Keratoconus: Topographic, Biomechanical and Aberrometric Characteristics.

Am J Ophthalmol 2021 05 29;225:69-75. Epub 2020 Dec 29.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India.

Purpose: This study sought to evaluate the demographic profile, clinical features, topographic features, and biomechanical and aberrometric characteristics in pediatric keratoconus (KC).

Design: Cross-sectional study.

Methods: Pediatric KC cases <18 years of age were evaluated at a tertiary hospital. Main outcome measurements were demographic profile, clinical features, visual acuity, corneal topography, aberrometry, and biomechanical and confocal microscopy findings.

Results: A total of 116 eyes of 62 consecutive patients were recruited with a mean ± age of 14.7 ± 2.77 years (range: 8-18 years); 46 of 62 (88%) were males; 57 of 62 cases (92%) had bilateral disease; 53 of 116 eyes (46%) had progressive KC; and 9 of 116 eyes (8%) had acute hydrops. Systemic associations were found in 6 of 62 patients (9.7%) and ocular associations in 77 of 116 eyes (66.3%); 68 of 116 eyes (58.6%) had associated vernal keratoconjunctivitis (VKC). Among eyes with VKC, 29 of 68 eyes (46%) were in stage IV KC, versus 25% of eyes with no VKC (P = .004). The mean ± SD refractive spherical equivalent was -4.72 ± 3.32 diopters (D), and refractive astigmatism was 3.69 ± 3.09 D. The mean values of maximum keratometry, thinnest pachymetry, and corneal higher-order aberrations were 60.89 ± 10.9 D, 396.05 ± 95.03 μm, and 1.18 ± 1.2 μm, respectively. Values of corneal hysteresis and corneal resistance factor correlated with the stage of KC (r = -0.26; P = .007).

Conclusions: Pediatric KC was commonly associated with VKC in this cohort. Eyes with VKC had more severe KC than those without VKC. Nearly half of the patients presented with progressive disease. Corneal biomechanical changes correlated well with stage of KC in this pediatric age group.
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http://dx.doi.org/10.1016/j.ajo.2020.12.020DOI Listing
May 2021
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