Past Issues - Vol. 18, No. 4, October – December 2022

Al-Shifa Journal of Ophthalmology

Editorial: Navigating the Challenges of Healthcare Waste Management in Ophthalmology - Lessons to Learn
Wajid Ali Khan

Air Puff Tonometer Versus Goldmann Applanation Tonometer in Glaucomatous Eyes: Comparative Evaluation Conducted At Rawal Institute Of Health Sciences
Erum Yousafzai, Afia Matloob Rana, Waseem Akhter

Objective: This study aims to determine the suitability of the Air-puff tonometer as a reliable alternative to the Goldmann applanation tonometer for measuring Intraocular Pressure (IOP).
Methodology: A cross-sectional study was conducted at the Outpatient Department (OPD) of Ophthalmology, Rawal Institute of Health Sciences, Islamabad, from April 2022 to September 2022. It involved 100 patients (200 eyes) aged above 20 years with suspected raised IOP. Both genders were included in the study. IOP measurements were obtained using the Air-puff tonometer and Goldmann Applanation Tonometer (GAT) mounted on the Slit-lamp. Three measurements were obtained with each instrument on both eyes within 15 minutes, and the average was used for analysis. Data analysis was performed using SPSS version 22.
Results: Among the total 100 patients, the mean age was 44.19 years. The mean IOP was 17.108 mmHg with the Air-puff tonometer and 15.873 mmHg with the Goldmann applanation tonometer. The difference between the instruments was < 2mmHg in 131 eyes and >2-3mmHg in 69 eyes. The Mean Difference (Air-puff – Goldmann) for these 200 eyes was 1.234mmHg (<2mmHg), with a standard deviation of 1.713.
Conclusion: The study concludes that while the Air-puff tonometer lacks correspondence to the Goldmann tonometer at high or low pressures, it measures IOP that closely corresponds to the Goldmann tonometer, particularly within 10-20mmHg intervals and moderately within 20-30mmHg. The Air-puff tends to overestimate low IOP and underestimate high IOP.

Comparison of the Accuracy of Phone Applications With Snellen Chart In Determining Visual Acuity
Rehan Naqaish, Amena Masrur, Sidra Naseem, Fatima Amjad, Anum Badar, Mishal Batool

Objective: To correlate the visual acuity assessment as tested by smartphone application with standard Snellen visual acuity.
Methodology: A total of 136 individuals were included in this analytical cross-sectional survey conducted at Shifa Foundation Community Health Center, Islamabad between January 2022 and September 2022. Snellen’s visual acuity was assessed using a standard Snellen’s visual acuity chart, while the Paxos checkup by DigiSight technologies was used to assess visual acuity on smart phone using one appropriately color calibrated I-phone 7 device. Visual acuity from each assessment was noted in the decimal format. Data was analyzed through SPSS v 23.
Results: A total of 88 males and 48 females were included in the study (n=136). The mean visual acuity of right and left eyes as assessed with Snellen’s chart were 0.88±0.2 and 0.86±0.22, respectively. The mean visual acuity for right and left eyes as assessed by Paxos checkup were 0.84±0.19 and 0.86±0.21, respectively. There was positive correlation was present in both eyes. The Pearson’s correlation for right eyes was r = 0.66 and significant at p = 0.001, while the correlation for left eyes was r = 0.71 and significant at p = 0.001. Conclusions: There is a strong correlation between Snellen’s visual acuity assessment and assessment of visual acuity by the smartphone application. This makes the latter a viable strategy for screening at places where taking a Snellen’s chart might not be feasible.

Comparing Posterior Capsule Opacification Incidence: Rigid Polymethyl Methacrylate vs. Foldable Acrylic Intraocular Lenses in Cataract Surgery
Mohammad Alam

Objectives: This comparative study aimed to determine the incidence of posterior capsule opacification following cataract surgery using Acrylic foldable intraocular lenses versus Polymethyl methacrylate rigid intraocular lenses.
Methodology: This study, conducted at the Department of Ophthalmology in DHQ Teaching Hospital Kohat and the Eye Care Centre Kohat, spanned from January 2018 to December 2020. Two patient groups with age-related cataracts were carefully selected after obtaining informed consent. Group A (200 patients) underwent Phacoemulsification surgery with foldable acrylic intraocular lenses, while Group B (200 patients) underwent small incision manual cataract surgery with rigid polymethyl methacrylate intraocular lenses. Follow-up assessments occurred at intervals between 6 months and 2 years. In Group A, 132 patients (66%) completed follow-up, and in Group B, 119 patients (59.5%) completed follow-up, with subsequent assessment for Posterior Capsule Opacification (PCO).
Results: In Group A, 11 patients (8.33%) exhibited Posterior Capsule Opacification, whereas in Group B, 31 patients (26.05%) displayed this condition.
Conclusion: The incidence of Posterior Capsule Opacification was found to be significantly lower in patients who received foldable acrylic intraocular lenses compared to those with Polymethyl methacrylate intraocular lenses.

Assessment Of Low Vision Aids For Low Vision Patients
Mubashir Rehman, Ihteraz Afzal, Adnan Ahmad, Irfan Aslam Khattak, Mohammad Farhan, Maria Saleem

Purpose: To evaluate assessment of low vision aids for low vision patients.
Methodology: All patients with VA less than 6/18 in the better eye after medical or surgical treatment and / or best available correction were included in the study. Low vision devices including telescopes stand magnifiers, hand magnifiers and closed-circuit television (CCTV) were used during the low vision assessment. Specific type and design of low vision device was selected to meet the activities according to the specific and professional needs of each case.
Results: Total number of patients included in this study were 126, in which 65.07% were males and 34.93% were females. About 58.74 % patients were improved to WHO category I (6/18 or better) with low vision devices, 23.81 % patients improved to category II, 9.52 % improved to category III and 7.93 % to category IV. Considering near VA, with low vision devices, about 75.50 % improved to category I (1M or better), while 20.74 % improved to WHO category II (<1M to 3.2M) and 3.76 % to category III (<3.2M).
Conclusion: Low vision aids if selected according to the needs of low vision patients are useful tools to help low vision patients in terms of some improvement in vision to carry out some specific daily works and are an effective means of providing visual rehabilitation.

Effect Of Prophylactic Use Of Fixed Combination Of Topical Dorzolamide And Timolol On Intraocular Pressure Spike After Intravitreal Bevacizumab
Ameera Jamil, Kanwal Zareen Abbasi, Maria Zubair, Seher Umer, Fuad Ahmad Khan Niazi

Background: Intravitreal injections are common in ophthalmology practice and rapidly increasing with new indications. This study aims to identify the rise in the intraocular pressure following intravitreal Anti VEGF bevacizumab.
Objective: To evaluate mean changes in IOP among patients given intravitreal bevacizumab injection with topical dorzolamide and timolol fixed combination prophylaxis as compare to controls.
Methodology: It was a randomized control trial, conducted at ophthalmology department, Rawalpindi medical university and allied hospitals from March 2021 to December 2021. Patients were divided in two groups by lottery method. Group A was control group in which only intraocular pressure was measured before and after administration of intravitreal bevacizumab. While in Group B, cases given topical dorzolamide and timolol fixed combination prophylaxis before intravitreal anti VEGF bevacizumab were included. IOP in both groups was measured before and immediately after the procedure in supine position by hand held Perkin’s tonometer. IOP was repeated immediately after injection, at 30 min and 60 min in both groups.
Results: Mean Intraocular pressure in Group-A before injection was 14.1+3.04 and in Group-B was 13.57+3.78 with p value 0.49. At 0 minute, it was 32.73+7.31 in Group A and 24.4+3.42 in Group B, p value was 0.0001. At 30 minutes, it was reduced to 22.57+5.38 in Group-A and 16.93+3.88 in Group-B, p value was 0.0001. At 60 minutes, IOP was 17.67+2.47 in Group-A and 14.9+3.30 in Group-B, p value was 0.001.
Conclusion: Mean changes in IOP in patients having intravitreal bevacizumab injection, with topical dorzolamide and timolol fixed combination prophylaxis, was significantly lower when compared to controls.