Current Issues - Vol. 19, No. 1, January – March 2023

Al-Shifa Journal of Ophthalmology

Editorial: The Revolutionary Impact of Artificial Intelligence on Advancing Glaucoma Care
Mahmood Ali

The Impact of Asynchronous Learning on Cognitive Performance in the Delivery of Undergraduate Ophthalmology Curriculum
Amena Masrur, Ali Tayyab, Hassan Naveed Ismail

Objective: To determine the impact of asynchronous learning on student performance in the delivery of undergraduate ophthalmology curriculum.
Methods: Randomized controlled crossover study was conducted in the Department of Ophthalmology, Islamabad Medical & Dental College between January 2020 to November 2021. A total of 110 4th year medical students of the Islamabad Medical and Dental College (class of 2021) rotating in the ophthalmology clerkship were recruited in the study. Curricular content in the ophthalmology clerkship is organized into 5 themes, each one representing a specific pattern of patient presentation. Each of the 10 clerkship groups rotating in the ophthalmology department were instructed asynchronously (on line for 2 weeks after which they rotated in the clinic for face-to-face sessions for another 2 weeks.) At the end of each 2-week rotation, the students’ performance was assessed via a 70 MCQ paper and their performance in each of the components of asynchronous learning was compared.
Results: A total of 110 (40 male and 70 female) students were recruited in the study. The mean students’ score for the themes delivered on line was 34.5 (±14.7) versus 41.96 (±16.5) for those taught via face-to-face sessions. This result is statistically significant (P =0.000, t= 5.079, d=109). Students who did well on line, also scored better in the themes delivered face to face. (Pearson’s correlation 0.55, p=0.000). Comparing genders, female students did better in the assessment for the themes taught on campus (42.95 ±14.18 vs 39.46 ±15.70) while male students did better in the assessment of themes taught on-line. (38.11 ±15.40 vs 34.90 ±16.70). These results, however, were not statistically significant.
Conclusion: Students tend to do better when taught on-campus, with online learning having a negative impact on their performance.

Risk Factors for Posterior Capsular Opacification after Cataract Surgery in Dera Ismail Khan, Pakistan
Muhammad Kamran Khalid, Muhammad Shoaib Khan, Maria Shafiq, Muhammad Irfanullah Kakar

Objective: To determine Demographic (Gender, Age, Address, and Place of surgery) and Clinical (Laterality, Procedure of surgery and Type of IOL) variables as risk factors for development of PCO in our location.
Materials & Methods: This was a cross-sectional comparative study conducted at the department of Ophthalmology, Gomal Medical College, Dera Ismail Khan, Pakistan from January 2021 to March 2021. The sample consisted of consecutive patients of Nd:YAG laser procedures during this period at Eye Unit, DHQ Teaching Hospital Dera Ismail Khan, Pakistan. A total of 160 patients with PCO undergoing Nd:YAG laser procedures were included in the study during this period. Demographic (Gender, Age, Address, and Place of surgery) and Clinical (Laterality, Procedure of surgery and Type of IOL) variables were compared with development of PCO (Duration from surgery) using Chi-square test and p-value <0.05 was taken statistically significant.
Results: Among the demographic variables, age of the patients <15 years was statistically significant (p<0.05) risk factor for the development of early PCO (<12 months), whereas gender, urban or rural address and place of surgery in public or private setup were not statistically significant risk factors for development of early PCO (p>0.05). Whereas among the clinical variables, ECCE procedure of surgery and PMMA type of IOL were statistically significant (p<0.05) risk factors for the development of early PCO (<12 months), and laterality i.e. right or left eye was not a statistically significant risk factors for development of early PCO (p>0.05).
Conclusions: Age of the patient <15 years, ECCE procedure of surgery and PMMA type of IOL are significant risk factors for development of early PCO in our setup.

Presentation of Pediatric Ocular Trauma to the Ophthalmology Unit of a Tertiary Care Hospital
Mubashir Rehman, Adnan Ahmad, Afrasyab, Zakir Hussain, Jawad Humayun, Irfan Aslam Khattak

Purpose: To determine the frequency of presentation of pediatric ocular trauma presented to emergency department of ophthalmology unit of a tertiary care hospital.
Material and methods: Patients were selected from emergency and outdoor patient department. Detailed ocular examination including visual acuity, extra ocular movements, adnexal examination, slit lamp examination of conjunctiva, cornea, anterior segment and posterior segment examination was carried out. Digital Xray orbit (Antero Posterior and Lateral view) was carried out to rule out intra ocular, intra orbital foreign body and orbital fractures.
Results: Total number of patients involve in this study were 101. Eighty one were male and 20 were female. Patient age ranges from 1 year to 16 years with mean age ± SD = 12 ± 2. Most of the patients were in age group 11-16 years(55%) and most frequent ocular trauma was open globe injury in 69.3% patients. There was statistically significant difference among age groups in type of Ocular trauma, open globe injury being the most common one in age group 11-16 years (P value = 0.0032).
Conclusion: In pediatric age group most common injury following ocular trauma is open globe injury followed by closed globe injury, chemical injury, thermal injury, orbital wall fracture and eyelid & lacrimal laceration. Majority of eye injuries in pediatric age group are preventable and this cause of visual disability can be greatly reduced by implementation of safety precautions such as keeping sharp objects out of children reach.

To Study the Efficacy of Combination of Brinzolamide 1%/Brimonidine 0.2% (Fixed Combination) in Patients of Primary Open-angle Glaucoma, Who Were Already on Treatment on Topical Drugs (AGT)
Sidrah Riaz, Norin Iftikhar Bano, Muhammad Tariq Khan, Tariq Mehmood Qureshi, Umair Tariq Mirza, Amna Iftikhar Arshad

Objective: To evaluate the IOP lowering efficacy of combination of Brinzolamide 1% and Brimonidine 0.2% in the treatment of primary open-angle glaucoma (POAG) who were already using one or more topical anti-glaucoma drops (AGT).
Methods: The Prospective therapeutic trial study was conducted at Al Ehsan Welfare Eye Hospital from 2019 to 2020. All patients with POAG with age above 40 years and insufficient IOP control, using either with one or two topical anti-glaucoma drugs (not combination) were enrolled in the study and were followed for 6 months regarding IOP control, after shifting patients on the combination of AGT drops. A detailed history was taken from all enrolled patients and clinical examination was performed. Applanation tonometry by Goldman applanation tonometer, gonioscopy and cup disc ratio were documented. Patients used topical combination eye drop (Brinzolamide 1% and Brimonidine 0.2%) used at 8am ± 30 minutes and 8pm ± 30 minutes (12 hourly) in both eyes. Follow-up was done at 1 week, 2 weeks, 4 weeks, 3 months and 6 months. Follow-up visits included IOP measurement and documentation of any side effects noted by patients. Mean IOP lowering and safety profile of BBFC at 6 months follow-up was noted. One sample t-test was performed to see the significance of results.
Results: IOP lowering effect of BBFC (brinzolamide and brimonidine fixed combination) was observed in all 31 patients from baseline IOP. The most common ocular adverse effect was conjunctival hyperemia followed by blurred vision.
Conclusion: Brinzolamide and brimonidine fixed combination, used twice daily, is safe with minimal side effects. It is effective treatment option for patients with POAG in whom IOP is not controlled with mono-therapy and in whom beta-blockers or prostaglandin analogues are contraindicated.

Retinopathy of Prematurity: Estimated Burden at Ayub Teaching Hospital
Danish Zafar, Muhammad Sharjeel, Muhammad Sohail Arshad, Muhammad Kamran Khalid, Asif Mehmood Orakzai

Background: Retinopathy of prematurity (ROP) is a growing concern in Pakistan, leading to childhood blindness in over 50,000 cases worldwide annually. ROP contributes to 15-35% of childhood blindness in middle-income countries. While improved neonatal care has reduced infant mortality rates, the risk of ROP has significantly increased.
Objective: This study aims to estimate the disease burden of ROP within our setting to facilitate the establishment of an effective screening and rehabilitation program.
Methods: Cross-sectional study with retrospective data collection was carried out. We retrospectively examined records of preterm patients admitted to the NICU at Ayub Teaching Hospital from November 2022 to April 2023. We assessed the number of monthly admissions, discharges, and mortalities. Categorical variables were expressed in terms of frequency and percentages.
Results: Between November 2022 and April 2023, 540 preterm babies were admitted to the NICU at Ayub Teaching Hospital. Out of these, 315 were discharged, while 225 expired during this six-month period. The average mortality rate during this time was 41.6%. The highest admission rate (268) was observed in the weight range of 1 kg to 1.5 kg. 172 preterm babies had a gestational age of 32 to 33 weeks, with a mortality rate of 32%. Assuming an ROP incidence of 21.4%, it is estimated that 115 out of the 540 patients could develop ROP. The confidence interval for an incidence of 20% ranged from 16.7 to 23.3, and for an incidence of 32%, it ranged from 28 to 35.9.
Conclusion: ROP is a preventable cause of childhood blindness. A well-established screening program is crucial to reduce the disease burden on society. It requires proper screening, skilled personnel, and financial resources. Addressing this emerging epidemic is essential for a brighter future.