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Jiménez-García M, Segura-Calvo FJ, Puzo M, Castro-Alonso FJ. Biometric description of 34 589 eyes undergoing cataract surgery: sex differences. J Cataract Refract Surg 2024; 50:668-675. [PMID: 38446495 DOI: 10.1097/j.jcrs.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To describe gender differences in the biometric parameters of a large sample of patients with cataract. Cataract surgery has evolved from a vision restoration to a refractive procedure, and population-based studies are vital to optimize normative databases and postsurgical outcomes. SETTING Miguel Servet University Hospital, Zaragoza, Spain. DESIGN Retrospective single-center observational study. METHODS The study included 34 589 eyes (20 004 patients with cataract). Biometric data were obtained from IOL Master 700 and Pentacam HR. Linear mixed models were used to account for intereye correlation. HofferQST formula was used to calculate the hypothetical distribution of intraocular lens (IOL) power (arbitrary lens; A = 119.2). RESULTS Most biometric variables showed significant differences between sexes ( P < .0001), such as 0.53 mm shorter eyes found in females, of which 0.16 mm are explained by shorter aqueous depth. Steeper anterior keratometries (∼0.75 diopter [D]) were found in women, to end up in no difference on anterior astigmatism magnitude, but different orientation ( P < .0001). The distribution of IOL power differed between sexes ( P < .001), with the interquartile range shifting 1 D toward more powerful lenses in women and odds ratio (power >26 D) = 2.26, P < .0001 (Fisher). CONCLUSIONS Large sample size studies provide smaller margin of error, higher power, and controlled risk of reporting false (negative or positive) findings. Highly significant differences between sexes in ocular biometry were found; this supports the idea that including sex as a parameter in IOL calculation should be explored and may improve results. In addition, the distribution of IOL powers was provided, which may be useful for manufacturers and hospital stock planning.
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Affiliation(s)
- Marta Jiménez-García
- From the GIMSO, Institute for Health Research Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain (Jiménez-García, Segura-Calvo, Puzo, Castro-Alonso); UFR, Department of Ophthalmology, University Hospital Miguel Servet, Zaragoza, Spain (Jiménez-García, Segura-Calvo, Puzo, Castro-Alonso); ARCCA, Department of Ophthalmology, Hospital Nuestra Señora de Gracia, Zaragoza, Spain (Jiménez-García, Segura-Calvo, Puzo, Castro-Alonso); Surgery Department, Ophthalmology Area, University of Zaragoza, Zaragoza, Spain (Segura-Calvo); Department of Ophthalmology, Alcañiz Hospital, Alcañiz (Teruel), Spain (Puzo, Castro-Alonso)
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Bian L, Ma B, Sun Z, Li W, Liu Y, Qin R, Chen J, Ma Y, Zhao L, Qi H. Prevalence data for total corneal astigmatism in cataract patients. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06488-9. [PMID: 38613688 DOI: 10.1007/s00417-024-06488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE To report the prevalence data for total corneal astigmatism (TCA) in cataract patients. METHODS The authors retrospectively collected and analyzed the preoperative biometric data of the patients who underwent cataract surgery in the Department of Ophthalmology, Peking University Third Hospital, from January 2019 to May 2023. RESULTS The mean age of the 10817 patients was 71 ± 10 years; the male/female ratio was 4653/6164. The mean TCA obtained by the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany), the Abulafia-Koch (AK) formula, and the Barrett toric calculator was 1.11 ± 0.81 diopter (D), 1.13 ± 0.75 D, and 1.12 ± 0.74 D respectively, which was significantly greater than the mean standard keratometric (K) astigmatism (0.99 ± 0.75 D) obtained by IOLMaster 700. Against-the-rule (ATR) astigmatism was dominant in all the TCA measurements, and its proportion increased with age. TCA measurements by different methods exhibit high variability, with a total of 1574 (8.9%) data sets from 1016 (9.4%) patients showing a difference larger than 0.5 D in at least one pair of TCA measurements. CONCLUSION The use of TCA rather than K astigmatism significantly influenced the choice of intraocular lenses (IOLs) as more patients would be candidates for toric IOLs. It was essential to carefully compare and select TCA obtained with multiple methods for optimal postoperative visual quality.
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Affiliation(s)
- Linbo Bian
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Baikai Ma
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Zhengze Sun
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Wenlong Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Yiyun Liu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Rui Qin
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Jiawei Chen
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Yunke Ma
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Lu Zhao
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China
| | - Hong Qi
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China.
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Saidi NA, Abdul Karim NS, Ismail A, Raja Othman RNF, Kasah NHA, Yaakub A, Ngoo QZ. Does the Difference in Axial Length Affect the Refractive Outcome? Malays J Med Sci 2024; 31:71-75. [PMID: 38456112 PMCID: PMC10917597 DOI: 10.21315/mjms2024.31.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 03/09/2024] Open
Abstract
Background The purpose of this study is to compare axial length (AL) and the refractive outcome after phacoemulsification surgery from 2014 to 2019 at Hospital Sultanah Nur Zahirah, Terengganu, Malaysia. Method This was a retrospective record review of all cataract patients who met the inclusion criteria and underwent uneventful superior wound phacoemulsification with nontoric intraocular lens (IOL) by a single surgeon from 2014 to 2019. Using optical biometry or immersion technique, the preoperative AL determined solely via the Sanders, Retzlaff and Kraff 2 (SRK2) formula was selected. The postoperative spherical equivalent (SE) at 6 weeks-12 weeks was retrieved. Using Statistical Package for the Social Sciences version 24.0, the mean differences between targeted and actual postoperative SE were analysed based on the AL. Result In this study, 490 eyes of 472 patients aged 25 years old-88 years old (mean age 65.72 years old [SD 8.83]) were involved. There were 162 eyes (33%) in Group A (< 23 mm), 189 eyes (39%) in Group B (23.01 mm-24.0 mm) and 139 eyes (28%) in Group C (> 24.0 mm). The mean AL was 23.63 mm (SD 1.19). The mean differences between the targeted and actual postoperative SE were: -0.09 D (SD 0.60) in Group A, -0.07 D (SD 0.53) in Group B and -0.16 D (SD 0.52) in Group C. No significant difference was found between these groups (P = 0.327). Conclusion There was no significant difference in the refractive outcome using the SRK2 formula in different ALs after phacoemulsification surgery. Hence, there is no reason to modify or adjust the targeted SE based on AL.
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Affiliation(s)
- Noor Amalina Saidi
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nur Syahirah Abdul Karim
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Adawiyah Ismail
- Department of Ophthalmology Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | | | | | - Azhany Yaakub
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Qi Zhe Ngoo
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Narang R, Agarwal A. Refractive cataract surgery. Curr Opin Ophthalmol 2024; 35:23-27. [PMID: 37962881 DOI: 10.1097/icu.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. RECENT FINDINGS With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism. SUMMARY Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
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Affiliation(s)
- Rhea Narang
- SMT. NHL Medical College, Ahmedabad, Gujarat
| | - Ashvin Agarwal
- Dr Agarwal's Eye Hospital & Research Centre, Chennai, Tamil Nadu, India
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Romano V, Madrid-Costa D, Alfonso JF, Alio J, Allan B, Angunawela R, Auffarth G, Carones F, Khoramnia R, Moore J, Nanavaty MA, Savini G, Pagano L, Romano MR, Virgili G, Fernández-Vega-Cueto L. Recommendation for Presbyopia-Correcting Intraocular Lenses: A Delphi Consensus Statement by the ESASO Study Group. Am J Ophthalmol 2023; 253:169-180. [PMID: 37236521 DOI: 10.1016/j.ajo.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE To establish consensus among experts in lens and refractive surgery to guide general ophthalmologists on issues related to presbyopia-correcting intraocular lenses (IOLs). DESIGN A modified Delphi method to reach a consensus among experts. METHODS A steering committee formulated 105 relevant items grouped into four sections (preoperative considerations, IOL selection, intraoperative considerations, and postoperative considerations). The consensus was defined as ≥ 70% of experts agreeing with the evaluation of a statement. RESULTS Ten experts participated and completed all rounds of questionnaires (100% response rate). Of 68 items considered in the preoperative considerations, consensus was achieved in 48 (70.6%). There was a lack of consensus over IOL selection, the experts only agreed on the importance of the patient's habits for the optical IOL design selection. Of the 14 considerations related to intraoperative issues, the experts reached a consensus on 10 (71.4%). The postoperative considerations section reached the highest consensus in 10 items of 13 (76.9%). CONCLUSIONS Key recommendations for a diffractive multifocal IOL were a potential postoperative visual acuity > 0.5, a keratometry between 40-45 diopters, a pupil >2.8 mm under photopic conditions and <6.0 mm under scotopic conditions, a root mean square of higher order corneal aberrations <0.5 µm for 6-mm pupil size, while monofocal or non-diffractive IOLs should be considered for patients with coexisting eye disorders. A lack of agreement was found in the issues related to the IOL selection.
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Affiliation(s)
- Vito Romano
- From Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (V.R.).
| | - David Madrid-Costa
- Faculty of Optics and Optometry, Universidad Complutense de Madrid, Spain (D.M.-C.)
| | - Jose F Alfonso
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain (J.F.A., L.F.-V.-C.)
| | - Jorge Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, Alicante, Spain (J.A.)
| | - Bruce Allan
- The Refractive Surgery Service, Moorfields Eye Hospital, London, United Kingdom (B.A.)
| | | | - Gerd Auffarth
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany (G.A.)
| | | | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), University Eye Clinic Heidelberg, Heidelberg, Germany (R.K.)
| | | | | | | | - Luca Pagano
- Royal Liverpool University Hospital, Liverpool, United Kingdom (L.P.)
| | - Mario R Romano
- Eye Unit, Department of Biomedical science, Humanitas University, Milan, Italy (M.R.R.)
| | - Gianni Virgili
- Eye clinic, AOU Careggi Teaching Hospital, University of Florence, Florence, Italy (G.V.); Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Prediction accuracy of intraoperative aberrometry compared with preoperative biometry formulae for intraocular lens power selection. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:2-10. [PMID: 34303640 DOI: 10.1016/j.jcjo.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/19/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the accuracy of intraoperative wavefront aberrometry to preoperative biometry formulae for predicting intraocular lens power. DESIGN Retrospective, consecutive case series. PARTICIPANTS Eyes undergoing cataract extraction with at least 1 month of follow-up after surgery at an ambulatory surgical centre in Toronto. METHODS Consecutive sample of 228 cataract extractions with monofocal, trifocal, or toric intraocular lens implantation from November 1, 2017, to December 31, 2019. The spherical equivalent was predicted preoperatively with Barrett Universal II, Hill-Radial Basis Function (RBF), SRK/T, Holladay I, Holladay II, Haigis, and HofferQ using biometry measurements and intraoperatively with wavefront aberrometry. The primary outcomes were mean prediction error and proportion of eyes with a spherical equivalent within 0.5 D of the refractive target at postoperative month 1. RESULTS The analysis included 159 eyes with 52% females and a mean age of 69.4 years. Formulae with the lowest mean prediction error were Hill-RBF (0.32 D ± 0.02 D), Barrett Universal II (0.32 D ± 0.02 D), intraoperative aberrometry (0.32 D ± 0.02 D), SRK/T (0.33 D ± 0.02 D), Holladay II (0.34 D ± 0.03 D), Holladay I (0.35 D ± 0.02 D), Haigis (0.37 D ± 0.02 D), and HofferQ (0.42 D ± 0.02 D). There were no statistically significant differences between intraoperative aberrometry and the preoperative formulae. Formulae with the highest proportion of eyes within 0.5 D of the refractive target were intraoperative aberrometry (82%), Barrett Universal II (81%), Hill-RBF (80%), SRK/T (77%), Holladay II (76%), Holladay I (75%), Haigis (71%), and HofferQ (70%). CONCLUSIONS Intraoperative aberrometry and modern preoperative biometry formulae are equally effective at reaching the refractive target. In normal eyes, intraoperative aberrometry does not appear to provide any additional benefit to modern prediction formulae.
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Lukewich MK, Murtaza F, Somani S, Tam ES, Chiu HH. Comparison of Barrett Toric Calculations Using Measured and Predicted Posterior Corneal Astigmatism in Cataract Surgery Patients. Clin Ophthalmol 2022; 16:1739-1751. [PMID: 35673350 PMCID: PMC9167600 DOI: 10.2147/opth.s351011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark K Lukewich
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sohel Somani
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Eric S Tam
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Correspondence: Hannah H Chiu, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +1 416 292-0330, Fax +1 416 292-0331, Email
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Turner JM, Purslow C, Murphy PJ. Comparison of Javal-Schiøtz keratometer, Orbscan IIz and Pentacam topographers in evaluating anterior corneal topography. Clin Exp Optom 2022:1-8. [PMID: 35614035 DOI: 10.1080/08164622.2022.2067470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CLINICAL RELEVANCE Inter-instrument variation in anterior corneal shape (ACS) measurement has a consequence for ocular clinical practice. BACKGROUND To consider inter-instrument variability in keratometry measurements across the ACS and to explore instrument protocols for determining ACS keratometric analogues (KAs). METHODS Mean keratometry/KAs of the right eye were recorded using Javal-Schiøtz keratometer (J-S), Orbscan IIz and Pentacam from 124 subjects (78 females; mean ± SD age: 24.71 ± 6.61 years). Mean radii of curvature were obtained for 1-mm wide annular zones extending up to 6 mm (horizontally) and 4 mm (vertically) from the apex for Orbscan and Pentacam. Zonal mean radius of curvature was calculated by averaging keratometry values for all measured points within the zone. RESULTS KA (mean ± SD): Horizontal: Orbscan (7.80 ± 0.31 mm) and J-S (7.82 ± 0.29 mm) were not significantly different (p = 0.072). Pentacam (7.86 ± 0.29 mm) was significantly flatter than J-S (p < 0.001) and Orbscan (p < 0.001). Vertical: Orbscan (7.64 ± 0.31 mm) was significantly steeper than J-S (7.67 ± 0.29 mm, p < 0.005) and Pentacam (7.70 ± 0.29 mm, p < 0.001). Pentacam was significantly flatter than J-S (p < 0.001) and significant flatter than Orbscan across the entire profile (1-4 mm zones horizontal and vertical, p < 0.001). LoAs (CI): J-S/Orbscan: ±0.75 mm (0.05-0.18); J-S/Pentacam: ±0.72 mm (0.01-0.12); Pentacam/Orbscan: ±0.16 mm (0.04-0.08). There was a +0.03 mm positive bias for Orbscan compared to J-S, +0.06 mm positive bias for Orbscan compared to Pentacam and -0.03 mm negative bias for Pentacam compared to J-S. CONCLUSIONS Algorithms used by Orbscan and Pentacam to solve the peripheral paraxial ray problem produce significantly different KAs. Instrument-specific KAs cannot be used inter-changeably between instruments. Differences in KA between instruments are not significant for ocular surgery, but may influence rigid contact lens fitting. Pentacam measures flatter than Orbscan and J-S.
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Affiliation(s)
- Jennifer M Turner
- Division of Optometry, Department of Health and Wellbeing, University of the West of England, Bristol, UK.,School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Christine Purslow
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Paul J Murphy
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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Deng Y, Shi Y, Wen C. TRIM3 Inhibits H 2O 2-Induced Apoptosis in Human Lens Epithelial Cells by Decreasing p53 via Ubiquitination. Curr Eye Res 2022; 47:747-752. [PMID: 35317686 DOI: 10.1080/02713683.2022.2040538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Cataract is a leading visual disease characterized by enhanced oxidative stress and increased apoptosis of human lens epithelial cells (HLECs). TRIM3 is a tumor suppressor in many cancers. However, its role in cataract remains unknown. In this study, we aimed to explore the role of TRIM3 in H2O2-injured HLECs and the underlying mechanisms involved. METHODS HLECs were treated with different H2O2 concentrations to induce apoptosis. A lentivirus was designed to overexpress TRIM3 and p53, and TRIM3 knockdown was prepared. A P53 inhibitor, PFTα, was used to knockdown p53. Cell viability and apoptosis were detected by CCK-8 and flow cytometric analyses, respectively. TRIM3, p53, Bcl2, and Bax expression levels were determined by qRT-qPCR and western blotting. RESULTS It was found that H2O2-treated HLECs had markedly decreased cell viability and TRIM3 expression. TRIM3 overexpression attenuated the H2O2-induced HLEC apoptosis, while TRIM3 knockdown promoted it. P53, a downstream target of TRIM3, was found to be negatively regulated by TRIM3 via ubiquitination in HLECs. Furthermore, p53 overexpression abolished the effect of TRIM3 overexpression on H2O2-induced HLEC apoptosis, while PFTα alleviated the TRIM3 knockdown-mediated HLEC apoptosis. CONCLUSION This study demonstrates that TRIM3 inhibited the H2O2-induced apoptosis of HLECs by decreasing p53 via ubiquitination.
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Affiliation(s)
- Yingying Deng
- Department of Ophtalmology, Shanghai Eighth People Hospital, Shanghai, China
| | - Yuhua Shi
- Department of Ophtalmology, Shanghai Eighth People Hospital, Shanghai, China
| | - Chenting Wen
- Department of Ophtalmology, Shanghai Eighth People Hospital, Shanghai, China
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Langenbucher A, Schrecker J, Eppig T, Schröder S, Cayless A, Schwemm M, Nagy Z, Szentmáry N. Ratio of torus and equivalent power to refractive cylinder and spherical equivalent in phakic lenses - a Monte-Carlo simulation study. Acta Ophthalmol 2022; 100:58-67. [PMID: 34018315 DOI: 10.1111/aos.14902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spherical and astigmatic powers for phakic intraocular lenses are frequently calculated using fixed ratios of phakic lens refractive power to refractive spherical equivalent, and of phakic lens astigmatism to refractive cylinder. In this study, a Monte-Carlo simulation based on biometric data was used to investigate how variations in biometrics affect these ratios, in order to improve the calculation of implantable lens parameters. METHODS A data set of over sixteen thousand biometric measurements including axial length, phakic anterior chamber depth, and corneal equivalent and astigmatic power was used to construct a multidimensional probability density distribution. From this, we determined the axial position of the implanted lens and estimated the refractive spherical equivalent and refractive cylinder. A generic data model resampled the density distributions and interactions between variables, and the implantable lens power was determined using vergence propagation. RESULTS 50 000 artificial data sets were used to calculate the phakic lens spherical equivalent and astigmatism required for emmetropization, and to determine the corresponding ratios for these two values. The spherical ratio ranged from 1.0640 to 1.3723 and the astigmatic ratio from 1.0501 to 1.4340. Both ratios are unaffected by the corneal spherical / astigmatic powers, or the refractive cylinder, but show strong correlation with the refractive spherical equivalent, mild correlation with the lens axial position, and moderate negative correlation with axial length. As a simplification, these ratios could be modelled using a bi-variable linear regression based on the first two of these factors. CONCLUSION Fixed spherical and astigmatic ratios should not be used when selecting high refractive power phakic IOLs as their variation can result in refractive errors of up to ±0.3 D for a 8 D lens. Both ratios can be estimated with clinically acceptable precision using a linear regression based on the refractive spherical equivalent and the axial position.
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Affiliation(s)
- Achim Langenbucher
- Department of Experimental Ophthalmology Saarland University Homburg Germany
| | - Jens Schrecker
- Department of Ophthalmology Rudolf‐Virchow‐Clinics Glauchau Germany
| | - Timo Eppig
- Department of Experimental Ophthalmology Saarland University Homburg Germany
| | - Simon Schröder
- Department of Experimental Ophthalmology Saarland University Homburg Germany
| | - Alan Cayless
- School of Physical Sciences The Open University Milton Keynes UK
| | - Michael Schwemm
- Department of Experimental Ophthalmology Saarland University Homburg Germany
| | - Zoltán Nagy
- Department of Ophthalmology Semmelweis‐University Budapest Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology Semmelweis‐University Budapest Hungary
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Abdolalizadeh P, Ghiasian L, Hadavandkhani A, Eshaghi A, Hadi Y, Nadjafi-Semnani F. Comparing pentacam HR screening indices in different normal corneal thicknesses among refractive surgery candidates. J Curr Ophthalmol 2022; 34:200-207. [PMID: 36147272 PMCID: PMC9487003 DOI: 10.4103/joco.joco_249_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose: To compare Pentacam indices in normal eyes with different corneal thicknesses. Methods: It is a retrospective observational study. Ninety-six normal eyes of 96 patients who were referred for refractive surgery in a tertiary university-based hospital from October 2015 to April 2019 were recruited consecutively. Corneal keratometry as well as Pentacam's software Belin-Ambrósio Enhanced Ectasia Display (BAD) parameters including pachymetry progression indices (PPIs), maximum Ambrosio's relational thickness (ART-max), corneal elevations, normalized deviations, BAD total deviation value (BAD-D), and anterior surface indices were measured by Pentacam HR (Type 70900). The included were classified as thin (26 eyes), average (45 eyes), and thick (25 eyes) corneas with the thinnest point thickness of ≤496 μm, 497–595 μm, and ≥596 μm, respectively. The specificities of all parameters were calculated based on routine cut-off values. Results: The refraction, keratometry, and elevations were not different (P > 0.05). All PPIs (minimum, average, and maximum) of thick corneas were significantly lower than average and thin corneas (P < 0.001). ART-max increased by thickening of the cornea (P < 0.001). BAD-D score and normalized indices of pachymetric parameters decreased with the increase of thickness (P < 0.001), while specificities of all indices increased with corneal thickening. More than 96% of thick corneas were classified as normal PPI-max (24/25), ART-max (25/25), and BAD-D (25/25), while nearly <54% of thin corneas (14/26 for PPI-max, 9/26 for ART-max, and 12/26 for BAD-D) were normal. Conclusions: The pachymetry-related indices and BAD-D were different among normal corneas with various thicknesses. The specificities of PPIs, ART-max, and BAD-D of thin corneas were lower than in thick corneas.
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Kolačko Š, Predović J, Kokot A, Bosnar D, Brzović-Šarić V, Šarić B, Balog S, Milanovic K, Ivastinovic D. Do Gender, Age, Body Mass and Height Influence Eye Biometrical Properties in Young Adults? A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111719. [PMID: 34770229 PMCID: PMC8582935 DOI: 10.3390/ijerph182111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Do gender, age, body mass and height influence eye biometrical properties in young adults? METHODS A total of 155 eyes (92 female, 63 male) of healthy subjects between the ages of 18 and 39 years were included in the study. The subjects' gender and age were recorded, and their body mass, height and biometrical properties of the eyes were measured. RESULTS The male subjects had significantly thicker and flatter corneas and lower minimal rim-to-disk ratios than the female subjects did. In both genders, age showed strong, negative correlations with anterior chamber depth and pupil diameter and a positive correlation with lens thickness. We also found significant, negative correlations between body height and mass with keratometry measurements, negative correlations between body height and optic disk rim area and rim volume, and positive correlations between body mass and axial length in both genders. CONCLUSIONS Biometric eye parameters differ among people. In addition to age and gender, which are usually taken into consideration when interpreting ocular biometry findings, we strongly suggest that body height and mass should be also routinely considered when interpreting eye biometry data, as these factors have an impact on ocular biometry.
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Affiliation(s)
- Štefanija Kolačko
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jurica Predović
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Ophthalmology and Optometry, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence: (J.P.); (A.K.)
| | - Antonio Kokot
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
- Correspondence: (J.P.); (A.K.)
| | - Damir Bosnar
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
- Department of Ophthalmology and Optometry, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Ophthalmology and Optometry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vlatka Brzović-Šarić
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
| | - Borna Šarić
- University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (Š.K.); (D.B.); (V.B.-Š.); (B.Š.)
| | - Slaven Balog
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
- Dr. Balog Ophthalmology Clinic, 31000 Osijek, Croatia
| | - Kristina Milanovic
- Department of Anatomy and Neuroscience, Faculty of medicine, University of Josip Juraj Strossmayer, 31000 Osijek, Croatia; (S.B.); (K.M.)
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University of Graz, 8036 Graz, Austria;
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Koo EH, Paranjpe V, Feuer WJ, Persad PJ, Donaldson KE. Refractive Outcomes in Fuchs' Endothelial Corneal Dystrophy: Conventional and Femtosecond Laser-Assisted Cataract Surgery. Clin Ophthalmol 2021; 15:3419-3429. [PMID: 34408397 PMCID: PMC8367218 DOI: 10.2147/opth.s309869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the refractive outcomes of eyes with Fuchs’ endothelial corneal dystrophy (FECD) following phacoemulsification. Methods This is a retrospective chart review of patients with FECD who underwent phacoemulsification. Manifest refraction at the early postoperative period (1–6 weeks) and late postoperative period (3–12 months) was collected. The spherical equivalent (SE) and variance of SE from target in diopters (D) were analyzed. Results A total of 219 eyes from 175 FECD patients (73 FLACS, 146 conventional phacoemulsification) were included. In the early postoperative period, when comparing variance from intended target, 62% (n=126) had a SE variance of ≤0.5 D, 22% (n=44) >0.5 D and ≤1 D, and 17% (n=34) >1 D. In the late postoperative period, 62% (n=85) had a SE variance of ≤0.5 D, 19% (n=26) >0.5 D and ≤1 D, and 20% (n=27) >1 D. There was no difference in the variance of SE comparing FLACS versus conventional phacoemulsification in either the early postoperative period (p=0.78) or the late postoperative period (p=0.29). Conclusion Patients with mild-to-moderate FECD had favorable refractive outcomes with phacoemulsification. There was no difference in refractive outcomes in eyes with FECD between the group that underwent FLACS versus the group that underwent conventional phacoemulsification.
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Affiliation(s)
- Ellen H Koo
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Vikram Paranjpe
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - William J Feuer
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Patrice J Persad
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Kendall E Donaldson
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
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Corneal aberrations measured with a high-resolution Scheimpflug tomographer: repeatability and reproducibility. J Cataract Refract Surg 2021; 46:581-590. [PMID: 32050208 DOI: 10.1097/j.jcrs.0000000000000084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the precision of elevation and wavefront aberration measurements with the Pentacam HR (Oculus Optikgeräte GmbH). SETTING Flinders University, Australia. DESIGN Instrument evaluation study. METHODS A randomly selected eye of 100 participants was scanned twice with the Pentacam HR by 1 observer on the 3 measurement modes: 25-picture, 50-picture, and cornea fine. A second observer performed 2 scans on the same random eye with the 25-picture mode. Repeatability and reproducibility were assessed using the within-subject SD (Sw) statistic from a 1-way analysis of variance. RESULTS From the 100 scanned eyes, the higher-order aberration root mean square (RMS) repeatability limit for both elevation and wavefront, and anterior and posterior measurements was 0.03 μm for all 3 measurement modes. Anterior, posterior, and total corneal wavefront Zernike terms were highly precise, with most Zernike terms displaying a repeatability limit of 0.03 μm. The least repeatable measurement was the posterior elevation Zernike term with the 25-picture scan (repeatability limit 1.50 μm). The cornea fine measurement mode provided the most precise measurements. Reproducibility limits (second observer) were similar to repeatability limits with the 25-picture scan mode. CONCLUSIONS The Pentacam HR provided highly precise aberration outputs. The most precise measurements are achievable with the cornea fine measurement mode and wavefront aberrations. One should be cognizant of posterior elevation aberration precision, particularly for lower radial order and higher azimuthal frequency terms. Accounting for tilt and misalignment of aberrations, all RMS and Zernike aberrations were extremely precise (repeatability and reproducibility limit less than 0.000001 μm).
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Can İ, Takmaz T, Özdamar A, Kamış Ü, Aydın Akova Y, Arslan OŞ, Baykara M, Devranoğlu K, Günenç Ü, Mutlu FM, Özcan AA, Taşındı E. Evaluation of the Cataract Surgery 2018 Survey in Terms of Achieving Refractive Cataract Surgery Targets. Turk J Ophthalmol 2021; 51:7-18. [PMID: 33631897 PMCID: PMC7931655 DOI: 10.4274/tjo.galenos.2020.46020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are. Materials and Methods A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria. Results Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%. Conclusion It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery.
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Affiliation(s)
| | - Tamer Takmaz
- Ankara City Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Akif Özdamar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | | | | | - Osman Şevki Arslan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Mehmet Baykara
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
| | | | - Üzeyir Günenç
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Fatih Mehmet Mutlu
- University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Turkey
| | - Altan Atakan Özcan
- Çukurova University Faculty of Medicine, Department of Ophthalmology, Adana, Turkey
| | - Emrullah Taşındı
- Okan University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Kane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology 2020; 128:e94-e114. [PMID: 32798526 DOI: 10.1016/j.ophtha.2020.08.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022] Open
Abstract
The refractive outcome of cataract surgery is influenced by the choice of intraocular lens (IOL) power formula and the accuracy of the various devices used to measure the eye (including intraoperative aberrometry [IA]). This review aimed to cover the breadth of literature over the previous 10 years, focusing on 3 main questions: (1) What IOL power formulas currently are available and which is the most accurate? (2) What biometry devices are available, do the measurements they obtain differ from one another, and will this cause a clinically significant change in IOL power selection? and (3) Does IA improve refractive outcomes? A literature review was performed by searching the PubMed database for articles on each of these topics that identified 1313 articles, of which 166 were included in the review. For IOL power formulas, the Kane formula was the most accurate formula over the entire axial length (AL) spectrum and in both the short eye (AL, ≤22.0 mm) and long eye (AL, ≥26.0 mm) subgroups. Other formulas that performed well in the short-eye subgroup were the Olsen (4-factor), Haigis, and Hill-radial basis function (RBF) 1.0. In the long-eye group, the other formulas that performed well included the Barrett Universal II (BUII), Olsen (4-factor), or Holladay 1 with Wang-Koch adjustment. All biometry devices delivered highly reproducible measurements, and most comparative studies showed little difference in the average measures for all the biometric variables between devices. The differences seen resulted in minimal clinically significant effects on IOL power selection. The main difference found between devices was the ability to measure successfully through dense cataracts, with swept-source OCT-based machines performing better than partial coherence interferometry and optical low-coherence reflectometry devices. Intraoperative aberrometry generally improved outcomes for spherical and toric IOLs in eyes both with and without prior refractive surgery when the BUII and Hill-RBF, Barrett toric calculator, or Barrett True-K formulas were not used. When they were used, IA did not result in better outcomes.
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Affiliation(s)
- Jack X Kane
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - David F Chang
- University of California, San Francisco, San Francisco, California
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Yong JJ, Hatch KM. Intraoperative Aberrometry for IOL Selection. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Natung T, Shullai W, Nongrum B, Thangkhiew L, Baruah P, Phiamphu ML. Ocular biometry characteristics and corneal astigmatisms in cataract surgery candidates at a tertiary care center in North-East India. Indian J Ophthalmol 2019; 67:1417-1423. [PMID: 31436184 PMCID: PMC6727703 DOI: 10.4103/ijo.ijo_1353_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study is to determine the ocular biometry characteristics and corneal astigmatisms using partial coherence laser interferometry in patients aged 40 years or above undergoing cataract surgery in a medical college in North-East India. Methods In a hospital-based cross-sectional study, ocular biometry characteristics such as axial length (AL), anterior chamber depth (ACD), white-to-white (WTW) diameter, corneal power (K), and corneal astigmatisms (D) of consecutive eligible cataract patients in a medical college in North-East India between January 2015 and December 2017 were determined using the intraocular lens (IOL) master. Height and weight were also measured. Results A cross-sectional study evaluated ocular biometry characteristics of 641 eyes in 641 eligible patients. The mean age was 64.04 ± 10.81 years. The mean AL, ACD, WTW, corneal power, IOL power, and body mass index (BMI) were 23.34 ± 1.12 mm, 3.12 ± 0.39 mm, 11.92 ± 0.54 mm, 44.41 ± 1.50 diopter (D), 20.53 ± 2.79 D, and 26.12 ± 4.32, respectively. Against-the-rule, with-the-rule, and oblique astigmatisms were 48.4%, 33.2%, and 18.4%, respectively. Corneal astigmatism of ≥1 D was found in 292 eyes (45.55%) and >1.5 D in 182 eyes (28.39%). AL had statistically significant correlation with ACD, WTW, K, IOL power, height and weight but not with age. By multivariate analysis, AL was found to be associated with ACD, WTW, K and IOL power (P ≤ 0.05). The mean AL was negatively correlated with the mean K (R-square 0.138). Conclusion This study is likely to provide the initial normative data for ocular biometry values in Indian adults 40 years or above, because such data is lacking in Indians using the IOL master. This will also help ophthalmologists in planning and improving the quality of surgical outcomes in phacoemulsification and phacorefractive surgeries by choosing the appropriate IOL and incision location.
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Affiliation(s)
- Tanie Natung
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
| | - Wakaru Shullai
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
| | - Benjamin Nongrum
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
| | - Lanalyn Thangkhiew
- Department of Ophthalmology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
| | - Prasenjit Baruah
- Department of Optometry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
| | - Mary L Phiamphu
- Department of Optometry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, P.O. Mawdiangdiang, Shillong, Meghalaya, India
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