Rhino-orbital mucormycosis is a life-threatening opportunistic fungal infection, which affects mainly immunocompromised hosts. It is commonly caused by ubiquitous fungi belonging to the order Mucorales, family Mucoraceae, which is also commonly known as the black fungus among the general population. The prevalence of mucormycosis (approximately 0.14 cases/1000 population) in India is about 80 times higher than in other developed countries. Despite aggressive treatment with surgical debridement and timely antifungal administration, the overall mortality rate is high. COVID 19 pandemic has led to an increase in the incidence of rhino-orbital mucormycosis. A multidisciplinary approach with early diagnosis and timely treatment with good control of glycemic levels, judicious use of steroids, and addressing immune status of patients helps in reducing the mortality and aids in improving survival rates of mucormycosis patients.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 has had health implications of unprecedented magnitude. The second wave of the pandemic hit India with a tremendous rise in the number of patients requiring care not only for the viral inflammatory disease but also for secondary infections. Nearly 6–7 new patients of rhino-orbito-cerebral mucormycosis with active or resolved COVID-19 infection are reporting daily at a tertiary institute in Northern India. This another battle against an epidemic of mucormycosis, within an already established ongoing war of COVID-19 pandemic has aroused a need to understand the causal factors and implement effective prevention and control programs. The authors performed a thorough literature review in PubMed to understand the correlation between the two diseases. This review summarizes the plausible risk factors, and environmental determinants of mucormycosis in COVID-19, that are of particular importance to public health professionals.

We have previously described the design and development of a questionnaire. It is important to establish the validity of a questionnaire before it is administered to a population. A series of inter-related tests are required to determine the validity of a questionnaire. Questionnaires pass through an iterative process that includes the development of items, testing of the validity, revision of items, revision of the conceptual basis of the test, retesting, and repetition of the process till the questionnaire is finalized. The process of validation of a questionnaire continues if the questionnaire is in use. In this manuscript, we briefly describe the conceptual basis of the different methods that are used to establish the validity of questionnaires and item retention and exclusion.

Purpose: To study the ocular morbidity exclusively due to the usage of handheld digital devices (HHDD). Materials and Methods: It is a population-based cross-sectional study using survey method. A questionnaire was prepared, and face validity was established. Pilot study with 25 participants was used to validate the questionnaire. Data were collected from 534 participants and data of 207 participants were excluded from the analysis based on the exclusion criteria. Thus, data of 327 participants were considered for the analysis purpose. Data set was divided into two depending on whether the participant used HHDD for 2 h on a day or more. Then these two groups were compared regarding the ocular morbidities. Data were analyzed using SPSS 26.0 version. Results: Out of 327 participants, 181 participants (55.4%) were males and 146 participants (44.6%) were female. Eye strain (P = 0.0252), Neck pain (P = 0.0006) and Watering of eyes (P = 0.0069) had statistically significant association with the usage of HHDD. Participants who use HHDD for more than 2 h/day were at 1.95 times of higher risk and participants with continuous usage of HHDD for >2 h/day were at 1.86 times higher risk of getting ocular morbidities than others. In HHDD users asthenopic symptoms were more compared to ocular surface-related problems. Conclusion: This study demonstrates that the long and continuous usage of HHDD has a significant association with ocular morbidity. Further studies are needed to analyze and ascertain whether the existing treatment algorithm and ocular ergonomics for computer users are enough for individual or combined usage of HHDD.

Purpose: The aim of this study was to study the central corneal thickness (CCT), anterior chamber depth (ACD), and axial length (AL) in patients with type II diabetes mellitus and compare it with healthy controls. Methods: A hospital-based nonrandomized prospective comparative study was conducted on 50 type II diabetics and 50 healthy controls. Complete ophthalmic examination was performed. CCT was measured using an ultrasound pachymeter, ACD, and AL was measured using an optical biometer. Statistical comparisons were done between the cases and controls. Results: The mean CCT in diabetic group was significantly higher (531.00 ± 33.42 μm) compared to control group (505.70 ± 32.19 μm) (P < 0.001) The mean ACD in diabetics (3.19 ± 0.35 mm) was significantly lesser compared to healthy control (3.78 ± 0.10 mm) (P < 0.001). CCT and ACD values between subgroups of diabetics such as duration of diabetes, grade of retinopathy, HBA1C values were statistically not significant (P > 0.05). AL s were comparable between the two groups. Conclusion: Patients with type 2 diabetes mellitus in our study had a thicker CCT and shallow anterior chamber regardless of retinopathy status, duration of diabetes mellitus, glycemic control.

Purpose: The purpose of the study is to evaluate the microbiological safety profile of multidoses of bevacizumab (Avastin) from a single-use vial in a real-life scenario. Methods: In a prospective interventional study, a total of 12 sequential vials of bevacizumab (Avastin) were used for this study. After using each vial for multipuncture, multidoses of intravitreal injections for 1 month, leftover bevacizumab in the vial was again stored in the refrigerator at 4°C. All the vials were sent for microbiological evaluation using Gram staining, potassium hydroxide mount, blood agar, MacConkey agar, and brain–heart infusion broth cultures; both at the opening of each vial and after utilization of 12^th vial. Patients receiving intravitreal injections from these vials for various ophthalmic indications were followed up at least 3 months postprocedure for clinical evidence of infection. The Microbiology Laboratory is standardized, especially for ophthalmology specimens, and the media, blood agar and MacConkey, agar were prepared in-house, whereas brain–heart infusion broth is commercial media (HiMedia). Results: All the 12 used vials' microbiological evaluation when evaluated at the opening of vials and 13^th month of the study period showed no bacterial or fungal elements. None of the patients who received intravitreal injections from these vials developed clinically detectable ocular infection or inflammation. Conclusion: This study suggests that the contents of multiple-dose bevacizumab (Avastin) vials remain sterile over a period of 1 year without any microbial contamination if proper refrigeration and aseptic precautions are maintained. Multipuncture, multidose Avastin vial utilization with due aseptic precautions and storage shows reliable microbiological safety both in vitro and in vivo over 1 year period.

Objectives: (1) To identify the patterns of visual field defects in patients with primary open-angle glaucoma (POAG) in advanced stage. (2) To identify macular split in patients with POAG in advanced stage. Materials and Methods: A cross-sectional study of 180 eyes of 160 patients within a period of 1 year was conducted. All patients with advanced POAG according to the modified Hodapp–Parrish–Anderson criteria were included in the study. A detailed examination including best-corrected visual acuity, color vision, gonioscopy, fundus examination, intraocular pressure measurement, visual field analysis using Humphrey field analyzer, and macular program was done. Results: Of the total 180 eyes, 7.2% had 0.8 cup, 67.8% had 0.9 cup, and 25% had glaucomatous optic atrophy. In the 30-2 program, 11.7% eyes had superior arcuate scotoma, 13.9% had inferior arcuate scotoma, 27.8% had double arcuate scotoma, and 46.7% had severely depressed field. In the 10–2 program, 22.8% had normal field, 26.1% had scotomas not involving fixation, and 51.1% had scotomas involving fixation. In the macular program, 63.3% had normal result, 18.3% had macular threat, and 18.3% had macular split. Conclusions: The most common field defect in the 30–2 program was severely depressed field. The most common defect in the 10–2 program was scotomas involving fixation. The macular program was normal in a majority of patients.

Background and Objective of the Study: The COVID-19 pandemic has increased the use of online platforms for education. This may lead to digital eye strain (DES) in the student community. The objective of this study was to assess the pattern of digital device use, the prevalence of DES symptoms and assess the awareness of DES among undergraduate medical students. Materials and Methods: This was a cross-sectional study and was conducted among undergraduate medical students of a medical college in Kerala using a structured, self-administered online questionnaire. Results: Two-hundred and twenty-seven students responded to this questionnaire. Of these respondents, 90.3% (205 students) reported experiencing the ocular and extra-ocular symptoms of DES. Neck pain, headache, and watering of eyes were the most frequent symptoms. Continuous use of devices without breaks, the predominant activity on devices, the presence of refractive errors, and inappropriate control of glare on digital devices had a statistically significant association with DES. Although 79.4% of students were aware that using digital devices can cause eye strain, <20% were aware of the ideal distance for viewing digital screens and the 20-20-20 rule of taking breaks in-between screen time. Conclusion: Undergraduate medical students reported a high prevalence of DES during the COVID-19 college shutdown. Lack of timely breaks and inappropriate control of glare from monitors were associated with DES symptoms. Only a few students were aware of the ergonomic measures to be adopted during device use. Educating undergraduate medical students about DES is essential to curb this rising problem.

Purpose: This study aims to analyze the clinical profile of patients who presented with visual symptoms after the onset of anti-tubercular therapy (ATT) on daily fixed drug combination and to quantify optic nerve damage in these patients using optical coherence tomography as an objective tool. Study Design and Methodology: This was a cross-sectional observational study of 20 patients who presented with visual symptoms following treatment with daily regime ATT. History was recorded, and detailed ophthalmological evaluation was done, including optic nerve head-retinal nerve fiber layer (ONH-RNFL) analysis using spectral-domain optical coherence tomography (SD-OCT). Data were analyzed with PSPP software. Results: Patients received ethambutol (EMB) at a mean daily dose of 17.61 ± 1.73 mg/kg/day. Of the 40 eyes analyzed, color vision was defective in 35 eyes and contrast sensitivity was reduced in 27 eyes. Mean ONH-RNFL thickness values were 110.8 ± 26.5 μm; 103.7 ± 24.4 μm; 72.6 ± 18 μm; 63.9 ± 13.2 μm; in the inferior, superior, nasal, and temporal quadrants, respectively. Females had more RNFL loss than males. Age, weight, and contrast sensitivity had a positive correlation and log mar vision had a negative correlation with RNFL thickness. Duration of EMB therapy, cumulative dose, and indication for ATT influenced ONH-RNFL thickness. History of renal disease, alcoholism, and smoking were risk factors for RNFL loss. There was a median delay of 21 days in reporting after the development of visual symptoms. Conclusions: Our study population received EMB at a daily dose of >15 mg/kg/day. ONH-RNFL thickness was reduced on SD-OCT. RNFL thickness helps to quantify the role of various risk factors in EMB toxicity, making it a useful tool for objective assessment. Patient education and active screening for the detection of early toxicity are needed to reduce visual impairment and blindness.

Purpose: Diabetic retinopathy (DR) remains a leading cause of vision loss in the adult population. The purpose of our study was to analyze and co-relate diabetic retinopathy-related micro-vascular changes using Optical Coherence Tomography Angiography (OCTA) in various stages of diabetic retinopathy. Methods: One hundred and twenty eyes of diabetic patients were categorized into three groups of forty each. Group-A included eyes without retinopathy, Group-B included eyes with Non-Proliferative Diabetic Retinopathy and Group-C included eyes with proliferative DR. Apart from complete ocular examination, foveal avascular zone parameters were analyzed using OCTA. Results: Statistically significant differences were found concerning vascular density and perfusion density between eyes with DR when compared to eyes without DR (P>0.001). 9 Vascular density (VD) significantly decreases in eyes with the progressive stage of DR. Foveal avascular zone showed a significant increase in area, perimeter, and circularity in the eyes with PDR compared to other groups. Conclusion: FAZ metrics showed significant changes proportional to diabetic retinopathy stages. Vascular density and perfusion density parameter analysis by OCTA could be used as early biomarkers in predicting the risk of diabetic retinopathy progression.

Background: Silicone oil (SO) is an important adjunct for internal tamponade, especially in eyes with proliferative vitreoretinopathy, diabetic tractional retinal detachments, and traumatic retinal detachments. SO has been associated with complications, such as cataract, keratopathy, and glaucoma. Secondary glaucoma has been reported to occur at any time in the postoperative period with a wide range of intraocular pressures (IOPs) and vision loss. Aim: The aim of this study is to assess the incidence and clinical profile of SO-induced ocular hypertension (SOIOH) at our institution, after pars plana vitrectomy (PPV) and silicone oil tamponade (SOT) in patient requiring the procedure. Materials and Methods: This is a prospective study of patients who attended Minto Ophthalmic Hospital, Regional Institute of Ophthalmology, Bengaluru from November 2017 to October 2020 who were requiring SOT for various vitreoretinal pathology. Preoperative complete ophthalmic evaluation was done, starting from visual acuity recording using Snellen's chart, slit-lamp examination, IOP measurement using Goldmann's applanation tonometry, gonioscopy, and dilated fundus examination. A standard three-port PPV with SO injection was performed. SOIOH was defined as IOP >21 mmHg after a period of 3 weeks postoperative, which required either medical or surgical therapy. Patients who developed SOIOH were compared to those who did not develop SOIOH (SOIOH free group), in terms of age, length of SOT, presence of retained SO in anterior chamber and angle, and IOP outcomes. Results: Among 26 patients who met our inclusion criteria were evaluated. Among them, 19 (73%) were male and 7 (27%) were female. The mean average age of all the patients was 36.88 (standard deviation [SD] 17.53) ranging from 10 years to 63 years. The mean average IOP of all patients preoperatively was 13.77 mm of hg (SD 3.45 mm of hg). It increased postoperatively showing a mean average postoperative IOP of all patients as 26.08 mm of hg (SD 11.2 mm of hg). The mean overall increase in IOP postoperatively was 12.31 mm of hg (P = 0.001). The mean average preoperative IOP was 12.2 mm of hg and mean postoperative IOP was 15.4 mm of hg in the SOIOH free group, with a mean average IOP spike postoperatively was 3.2 mm of hg (P = 0.061). In the SIOH group, the postoperatively average IOP spike was 15.75 mm Hg with values ranging from 14.75 mm hg preoperative to 30.5 mm hg postoperative (P = 0.001). Interpretation and Conclusions: Patients who underwent PPV with SOT should be followed up for longer period and those who have retained SO in anterior chamber or angles should be followed up more frequently as chances of development of SOIOH is more in them as proved by this study.

Introduction: Intracameral injection of preservative-free lidocaine is used as an alternative to reduce the potential disadvantages of common mydriatics in cataract surgery. Aims and Objectives: The aim is to evaluate pupil dilation by an intracameral injection of lidocaine during phacoemulsification cataract surgery and compare the results with those using conventional topical mydriatics. Methods: A prospective cohort study was conducted in 60 consecutive patients undergoing phacoemulsification cataract surgery under topical anesthesia at Government Medical College, Kannur from July 2018 to December 2019. Patients were allocated to intracameral lidocaine or topical mydriatics for dilation of the pupil before phacoemulsification. Results: The preoperative pupil size was similar in intracameral lidocaine (2.90 ± 0.3 mm) and topical mydriatic (2.81 ± 0.4 mm) groups. Pupil dilation was slightly more in the topical mydriatic group (7.31 ± 1.0 mm) compared to the intracameral lidocaine group (6.96 ± 1.0 mm). The pupil size at the end of the surgery was nearly similar in both groups. Mean duration of the surgery was similar in both the groups. Both the groups had 27 patients who maintained dilation till the end of the surgery. The difference between the groups was not statistically significant and a post hoc power analysis showed the need for studies with a larger sample size. Conclusion: This study shows that injection of 0.2–0.3 ml of preservative-free lidocaine 1% intracamerally provides persistent, stable, satisfactory pupil dilation comparable to that of topical mydriatics, for safe phacoemulsification, and intraocular lens implantation. However, studies with a larger sample size are needed to confirm that both interventions perform similarly.

Background: This is a prospective study which aims: To compare the preoperative and postoperative corneal astigmatism in patients undergoing pterygium excision by conjunctival autograft technique using autologous blood. To determine the correlation of pterygium length with preoperative and postoperative corneal astigmatism and thus ascertain an early indication for pterygium surgery. Materials and methods: 75 patients with primary pterygia were evaluated after dividing them into three groups based on length, Grade A - < 2mm, Grade B - 2 – 4mm and Grade C - > 4mm. Preoperative and postoperative corneal astigmatism were compared between the three groups using autorefraction and keratometer readings. Postoperative astigmatism was recorded on three visits – day 7, day 28 and third month. Statistical analysis: Statistical Package for Social Sciences (SPSS) version 19.0 for windows was used. Spearman's rank order (χ) was calculated to observe correlation of pterygium length with the preoperative and postoperative corneal astigmatism. A p-value < 0.05 was considered statistically significant. Results: The mean length of the pterygium was 2.77 ± 0.12mm. Majority had with – the – rule astigmatism (64%). Postoperatively mean uncorrected visual acuity (UCVA) increased significantly from 0.533 ± 0.03 to 0.78 ± 0.03 (P < 0.0001). Preoperative mean keratometric astigmatism of 2.55 ± 0.36D significantly decreased to 1.213 ± 0.20D postoperatively (r = 0.89, P < 0.0001). A positive correlation between the length of pterygium and both preoperative (χ = 0.68, P < 0.001) and postoperative (χ = 0.53, P < 0.001) corneal astigmatism was observed. Conclusion: The increase in the length of pterygium significantly correlated with the degree of preoperative corneal astigmatism. The evidence of significant improvement in visual acuity and decrease in pterygium induced corneal astigmatism was observed three months postoperatively by conjunctival autograft technique with autologous blood. Hence, pterygium induced corneal astigmatism of length > 2mm is an early indication for surgical intervention.

To describe a new technique of performing capsulotomy with phacoemulsification probe in cataracts with extensive capsular fibrosis. After making two side ports and a 2.2-mm temporal limbal incision, the phaco probe is inserted into the eye. An initial cut is made on the fibrosed anterior capsule with the phacotip. Subsequent cuts are made in the same plane to create a central opening which is of 5–5.5 mm size. This opening is quite stable as it is surrounded by fibrous tissue. Phacoemulsification and intra-ocular lens implantation can be safely done through this opening without damaging the integrity of the capsular opening. We have performed phacocapsulectomy in four such cases. All of them gained best-corrected visual acquity better than 20/40 at 3 months of follow-up. Creating a capsular opening in a cataract with extensive anterior capsular fibrosis is always challenging. Phacocapsulectomy can be a very useful method in dealing such cases.

We describe a case of posttraumatic vertical diplopia and Horner's syndrome (HS). The patient presented 2 weeks post road traffic accident with acute onset double vision more in left gaze and right tilt. The left eye had mild ptosis. The apparent elevation deficit in the left eye in levoelevation was misinterpreted as left eye superior rectus paresis instead of right eye inferior oblique overaction and thus mimicked superior division third nerve palsy in the left eye. Anisocoria was more in the dark. Computerized tomography of the brain and orbit was normal. Magnetic resonance imaging of the cervical spine showed left C6–C7 nerve root avulsion. A diagnosis of right fourth nerve palsy with left eye HS secondary to brachial plexus injury was made. We could not find a previous description of fourth nerve palsy with contralateral HS following trauma in the literature.

Capillary hemangioma occurs in 1%–2% of neonates and in 10%–12% of infants within 1st year of life. They may present as a cutaneous, subcutaneous, or orbital lesion. The most common sites are eyelid or brow, with a predilection for the upper eyelid. We hereby report a case of a 1-year-old female child presenting in our outpatient department with swelling over the left eyebrow since birth gradually increasing in size. The lesion was firm in consistency, slightly mobile, nontender, superior orbital margin nonpalpable. Based on imaging, a diagnosis of dermoid cyst was made, but on excision, there was an absence of capsule surrounding it with positivity for human glucose transport protein 1 (GLUT1) on histopathology changing the diagnosis to hemangioma.

Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, seasonal disorder which mostly affects young males. Shield ulcer is an uncommon manifestation of severe form of VKC, seen in 3%–11% of VKC patients, which adversely affects vision. The purpose of this case report is to bring to light that proper timely management can improve visual acuity. A 15-year-old male presented with a complaint of severe itching, with foreign body sensation and redness in BE since 1 week. It was associated with blurring of vision in LE since 2 days. He had history of similar episodes since the past 7 years, usually exacerbating in spring for which he was advised topical steroids and lubricating drops. On examination, RE showed papillae in both upper and lower tarsal conjunctiva. LE showed lid edema, giant cobblestone appearance of papillae in upper and lower tarsal conjunctiva, and a fluorescein stained positive epithelial defect of 3 mm × 4 mm which had elevated plaque containing mucus and debris was noted in the central cornea. He was diagnosed with bilateral VKC with Grade 3 shield ulcer in LE. He was started on topical steroid 4 times and lubricating drops in BE along with topical tacrolimus 0.03% BD in LE. No improvement was noted after 3 days. Margin and base of ulcer with 1 mm of clear margin was scraped and bandage contact lens was put on the 3^rd day of starting treatment. On 1 week follow-up of scraping, healing margin was noted with best-corrected visual acuity (BCVA) of 6/60. After 1 month, the BCVA improved to 6/18, and at 3-month follow–up, it improved to 6/9. Shield ulcer, although rare, is an incapacitating vision threatening manifestation of VKC. Timely management of the same is essential to ensure full recovery without any permanent ocular damage. Conservative management should always be considered before surgical treatment in all cases. Various studies are being carried to study the efficacy of immunosuppressive agents especially tacrolimus in treating shield ulcer. Here, we found out that timely instillation of tacrolimus can lead to prompt recovery with significant visual rehabilitation.

Torpedo maculopathy is an uncommon, often isolated retinal finding reported in literature. We report a case of torpedo maculopathy with nystagmus and abnormal electroretinogram findings with an abnormal mutation in a child. This case highlights the need for a detailed evaluation including electrophysiology and genetic testing in this retinal pathology.

Primary vitreous cysts are rare ocular manifestations. Often, they do not cause any visual disturbances. Vitreous cysts can be congenital or acquired. Here, we report the case of a 60-year-old male patient who presented to our outpatient department with a complaint of a bubble-like floater in his right eye which remained fixed despite movement of eyeballs. He had this visual disturbance for the past 20 years. The size and appearance of floater remained constant all these years. Aided visual acuity was 20/20 in both the eyes. Fundus examination showed the presence of a single transparent nonmobile cyst in the vitreous cavity of the right eye. Left eye fundus was normal. Right eye B-scan showed a nonmobile vitreous cyst abutting the optic nerve. The patient tested negative for Echinococcus and cysticercosis. As it was a primary vitreous cyst and the patient was asymptomatic, we decided to keep the patient under regular follow-up.

It is well documented that systemic antimicrobials can cause ocular side effects. This becomes especially relevant in multidrug therapy where more than one drug can cause similar ocular side effect. We describe a case of progressive decrease in vision associated with linezolid therapy in a 17-year-old female patient, on treatment with the second-line anti-tuberculous drugs including linezolid, for multiple drug-resistant tuberculosis presented to us with painless progressive decrease in vision in both eyes. Color vision was defective and fundus examination revealed optic disc edema in both eyes. Since the patient was not on ethambutol and gave a history of peripheral neuropathy, linezolid-induced toxic optic neuropathy was suspected and linezolid dechallenge was done. Discontinuation of linezolid treatment resulted in marked improvement in visual acuity. Our report emphasizes the need for early detection of ocular side effects and how monitoring of visual function is imperative in patients on long-term linezolid treatment.

Neuromyelitis optica (NMO) is a rare autoimmune disease affecting nerves of the eyes and central nervous system. Etiology of NMO is yet to be completely defined. The purpose of this report is to bring to light one such unique case of NMO.

Ischemic optic neuropathy is a very rare but well-known complication following hemodialysis in patients with chronic kidney disease, It can be potentially blinding when involving both optic nerves and there is no effective established treatment available so far. If involvement of one eye is detected earlier, a multidisciplinary approach and efforts directed at controlling risk factors such as anemia and hypotension will go a long way in preventing the involvement of other eye in young individuals. We report a case of posterior ischemic optic neuropathy in the right eye with recovery of vision but persistent color vision deficit with recent-onset nonarteritic anterior ischemic optic neuropathy in the left eye, which has not been reported so far.

In this case series, we describe four members of a family with the phenotype of superficial variant of granular corneal dystrophy (GCD). The complete description of cases, clinical photographs, anterior segment optical coherence tomography and discussion of treatment outcome have been highlighted. The common symptom for which the patients sought medical attention was blurring of vision. Typical corneal lesions were fluffy, white, too numerous to count, and in the most superficial part of corneal stroma. In all cases, the lesions recurred in spite of the different modes of the initial treatment. The recurrent lesions were also abundant but superficial in location and were managed successfully. Based on anterior segment optical coherence tomography and clinical findings, we thus describe a superficial variant of GCD occuring in three generations of a family with onset before 6 years of age and which recurred even after the best of clearance.

Conventionally, fundus camera is the only source for taking retinal images. With the advent of smartphones, fundus photography has become more portable, simpler, cheaper, and easier. Various techniques of fundus imaging with smartphones were put forth in the last decade. Senior ophthalmologists always prefer using a direct ophthalmoscope (DO) for viewing the fundus. DO has the advantage of viewing magnified images giving no scope in missing findings. We illustrate the use of a smartphone and a DO in recording patient's facial details, distant direct ophthalmoscopy apart from taking images of normal/pathological lesions of the optic disc, vessels, and retina in the form of a videograph or photograph. This technique is extremely useful for training purposes, bedside-imaging as in intensive care unit/wards, in remote areas such as camps, creating patient awareness, counseling, monitoring the progression, documentation, sharing, and cross consultation. These advantages are being utilized in our institute since 2014.

Visual acuity is the sum of qualitative and quantitative factors. A combination of both determines the final visual acuity. The quality of vision (QoV) can be easily assessed by documenting objectively the higher-order aberrations or by using subjective questionnaires available. The QoV is an integration of varied optical and neural factors. Similarly, the quantity of vision is documented by measuring uncorrected and best-corrected distance visual acuities. Optical aberrations are defect in a lens or a mirror prevents light rays from being focused at a single point and results in a distorted or blurred image. Moreover, they are the departure of the performance of an optical system from the predictions of paraxial optics. The QoV is primarily affected by both higher- and lower-order optical aberration. Aberrometers are the most vital instruments used for estimating optical aberrations so that a more comprehensive understanding of optical error can be quantified and corrected. A variety of aberrometers with different principles are available, such as Ray Tracing, Hartmann-Shack, Tscherning, and automatic retinoscopy. In this review, our prime focuses on Ray Tracing aberrometer, iTrace. This review will help all the ophthalmologists including residents and fellows learn the principle, features, and clinical applications of iTrace. The system integrates corneal topography with wavefront aberrometry, which has the unique feature of revealing the internal aberrations of the eye by subtracting the corneal aberrations from total aberration. It is the investigation of choice in the today's era considering patient satisfaction and visual outcomes, postpremium intraocular lens implantations.