Artificial intelligence (AI) and machine learning (ML) have entered several avenues of modern life, and health care is just one of them. Ophthalmology is a field with a lot of imaging and measurable data, thus ideal for application of AI and ML. Many of these are still in research stage, but show promising results. The ophthalmic diseases where AI is being used are diabetic retinopathy, glaucoma, age-related macular degeneration, retinopathy of prematurity, retinal vascular occlusions, keratoconus, cataract, refractive errors, retinal detachment, squint, and ocular cancers. It is also useful for intraocular lens power calculation, planning squint surgeries, and planning intravitreal antivascular endothelial growth factor injections. In addition, AI can detect cognitive impairment, dementia, Alzheimer's disease, stroke risk, and so on from fundus photographs and optical coherence tomography. We will surely see many more innovations in this rapidly growing field.

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Ophthalmology is a very visual science; therefore, visualizing the eye and its pathology in good clarity is essential for a diagnosis. Over the past several years, smartphones have evolved to replace several gadgets in our daily life, including cameras. In ophthalmology, they have been very useful to take good quality photographs through slit lamp, gross photographs and also fundus photos using low-cost smartphone fundus cameras. In this article, we elaborate on the techniques, tips, and tricks to obtain excellent smartphone ophthalmic photographs and videos with a mid-level smartphone camera. We teach how to take diffuse and slit photographs, with and without an adapter, in addition, how to take Gonioscopy, specular microscopy, and fundus via 90D. These photos and videos can also be edited on the smartphone itself and used for case discussion, second opinion, teaching, presentations, and publications.

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The first iPhone was released in 2007 and the first Android phone in 2008. Ten years later, smartphones are becoming ubiquitous. They now have more advanced sensors, cameras and more processing power, which have allowed several innovative apps to be made, which were not possible a few years ago. These apps will change the way we interact with patients and with clinical data, provide affordable and advanced testing, enhance the way we learn, and hopefully improve doctor–patient interactions. However, most of these apps are made without professional input and needvalidation before use. We try to review the current landscape of Smartphone Apps in Ophthalmology.

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The technology of three-dimensional (3D) printing has evolved over the past few years with cumulative improvements in the resolution, accuracy, cost-effectiveness, and speed of this highly customizable manufacturing process. Ophthalmologists have designed multiple 3D printed smartphone based fundus cameras with some of the designs available as open-source for all to download and 3D-print. Now, the technology has been used for anything from eyewear and medical devices to printing of live cells and tissues like an artificial cornea. It also has uses in education and surgical planning. The author had the opportunity to work with a 3D printer and make some of these models. The future is bright for innovations in this field as we are only beginning to understand the capabilities of this technology.

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Aim: The aim of this study was to evaluate the safety and efficacy of biosimilar intravitreal ranibizumab (Razumab) for the treatment of chorioretinal vascular diseases such as diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), and macular edema secondary to retinal vein occlusions (RVOs). Methods: A prospective analysis was performed on consented patients with DME (Group 1), nAMD (Group 2), and macular edema secondary to RVO (Group 3). All patients received Razumab at baseline. Snellen visual acuity assessment, anterior segment and fundus evaluation, fundus photo, and optical coherence tomography imaging were done at days 0, 1, 7, and 30, respectively. The International Society for Clinical Electrophysiology of Vision standard electroretinography (ERG) was performed at baseline and day 30 (23 eyes who could afford the investigation). Primary and secondary outcome measures were safety parameters that included signs of clinical and ERG toxicity and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT), respectively. Results: One hundred and twenty-three eyes of 95 patients received biosimilar intravitreal ranibizumab injection between November 2015 and April 2016. No serious drug-related ocular or systemic adverse events were identified. Mean pretreatment BCVA was 0.67 ± 0.41 logMAR with CMT 345.90 ± 128.84 μm and postinjection BCVA at day 30 was 0.57 ± 0.37 logMAR with CMT reducing to 287.66 ± 90.28 μm, indicating statistical significance (P = 0.001 and P< 0.0001, respectively) for all groups. Conclusion: The biosimilar intravitreal ranibizumab for DME, nAMD, and macular edema secondary to RVO was tolerated over a month with improvements in BCVA and CMT without detectable ocular and systemic toxicity. While the long-term safety and efficacy remain unknown, these short-term results suggest that biosimilar ranibizumab could become a safe, low-cost therapy for macular diseases.

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As ophthalmologists, we often come across visually impaired persons (VIPs) whose poor vision we cannot improve. They would benefit with low-vision aids (LVA), but most are reluctant to use them. The visually impaired find it difficult to use advanced technology, as it is often not designed with them in mind. When the world switched from phones with keyboards to full-screen touchscreens, VIPs found it difficult without the tactile feedback of physical keyboard buttons. However, in recent years, there have been numerous innovative apps to assist people with low vision, to not only navigate their smartphone but also their environment and daily life. Programmers have made the use of the high-resolution cameras, gyroscope sensor, vibration feedback, and audio feedback to convert smartphones into LVA, often for free and with no additional hardware. The authors review some of the smartphone apps available for those with low vision. These apps can bring a certain level of independence and self-confidence in these people who are otherwise often dependent on others.

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Blepharoptosis, or ptosis of the eyelid, refers to drooping of the upper eyelid that usually results from a congenital or acquired abnormality of the muscles that elevate the eyelid. Ptosis may be the presenting sign or symptom of a serious neurologic disease. Regardless of the etiology, when ptosis obstructs vision, it is disabling. The appropriate management requires recognition of the underlying cause. This review article highlights the various aspects of ptosis evaluation and management.

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Purpose: The aim of this study is to evaluate the reasons for delayed presentation, lens-induced glaucoma (LIG) incidence, intra- and post-operative course and visual outcome among patients with hypermature cataract in Kanchipuram district. Materials and Methods: A prospective interview-based study was undertaken among 304 patients with hypermature over 3 years in the Ophthalmology department of a medical College located in Kanchipuram. Presence of LIG was noted. After small incision cataract surgery, intra- and post-operative complications, final best-corrected visual acuity (BCVA) at 6 weeks were noted and compared with delayed presentation using Chi-square test. Results: Good visual acuity in the other eye was the reason for delayed presentation in 160 (52.6%) patients. Poor post-operative visual acuity was associated with delayed presentation (r = −0.203, n = 304 and P < 0.012). LIG was seen in 30 (10%) patients and 26 (8.5%) of these were pseudophakic in the fellow eye. 8 (2.6%) patients had zonular dehiscence. Difficulty in doing rhexis (156 patients), corneal edema (62 patients), and inferior subluxation of posterior chamber intraocular lens (12 patients) were the most common intraoperative, early and late postoperative complications. Final BCVA of 6/12 or better was seen in 282 patients. Conclusion: Hypermature cataract and LIG are still seen in rural and suburban India and are more likely to develop in patients having good visual acuity in the fellow eye following previous cataract surgery. As delayed presentation is associated with poor postoperative outcome, it is important to educate the community about the need for early surgery.

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Necessity and opportunity in the form of rapidly advancing technology has made affordable innovations possible at a fast pace in ophthalmology. This article tries to cover a few of the recent frugal innovations which have a clinical potential for ophthalmologists.

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Aim: The aim of this study was to analyze the endothelial cell count and morphology of the endothelial cell of donor corneas using Eye Bank Specular Microscope (EBSM). Materials and Methods: Eye bank data of 100 donor corneas procured and processed between January 2016 and December 2017, at an eye bank associated with a medical college hospital were retrospectively analyzed. Endothelial cell density (ECD), coefficient of variance (CV), and percentage age of hexagonality (6A) of donor cornea were compared across different age groups, gender, and phakic status of the donor tissue. Results: The mean age of the donors was 63.53 ± 19.92 (range 15–92 years). The mean ECD of the donor cornea was 2708.93 ± 271.52 cells/mm²; the average CV was 28.37 ± 6.3; and the average percentages of hexagonal cells were 63.85%. The cell count was significantly greater in the age group of <20 years when compared to rest of the age groups. There were no significant differences between the age groups on CV and 6A. The ECD of the male donors (66%) was more than that of female donors (34%). The ECD of the phakic donors was significantly more than that of pseudophakic (PP) and aphakic (AP) donors. Conclusion: ECD is significantly greater in younger age group as compared to older age groups; however, there are no significant differences in CV and 6A. The ECD of the phakic donors was more than that of PP and AP donors. Endothelial cell analysis by EBSM alters the final grading of tissues and its subsequent utilization for corneal transplantation with good prognosis for graft survival.

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Prisms are used in diagnosis and Therapy of Ophthalmic disorders. Prismotherapy provides symptomatic relief not only in many kinds of squints, but also in non strabismic conditions like convergence insufficiency, nystagmus, heminopia etc. One of the most important therapeutic skill we have acquire in this direction, is the localisation of such clinical needs and the timely use of the wonderful therapeutic functions of prisms for the relief of such conditions. Thin Fresnel prisms are now more used in clinical practice.

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Retinal vein occlusion is commonly seen in the elderly.This article aims to comprehensively discuss the etiology,classification,risk factors and latest modalities of management of this condition.

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Cystoid macular edema is a complication of uveitis which can lead to severe visual impairment if left untreated. Uveitic macular edema occurs when the balance between the water entering the eye and pumped out of the eye is altered thus losing equilibrium in the physiologic function of the retina. Edema has a negative impact on visual recovery in patients with uveitis and may continue to exist despite control of uveitis. This delayed resolution of edema observed clinically and by imaging is most frequent following intermediate uveitis, birdshot retinochoroidopathy, sarcoid uveitis, panuveitis, and iridocyclitis associated with human leukocyte antigen B27. Literature about management of uveitic macular edema is limited, and no consensus has been reached with regard to management protocol. Several treatment options exist including corticosteroids, nonsteroidal anti-inflammatory drugs, immunomodulatory agents, implants, and surgery. These therapies can be administered through various routes such as oral, topical, periocular, or intravitreal injections. A response to treatment is seen as decrease in macular thickness and improvement in visual acuity.

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Optical coherence tomography (OCT), widely used in the management of macular disorders and glaucoma, has proved its usefulness in many neurophthalmic disorders. OCT can quantify the retinal nerve fiber layer thickness and ganglion cell layer thickness and provides an idea about the neuronal integrity of the anterior visual pathway, which cannot be picked up by routine fundoscopy. Here, we are discussing some neurophthalmic and neurologic diseases where OCT can contribute to the diagnosis, disease monitoring and can provide prognostic information.

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Background and Purpose: The prevalence of myopia has been increasing steadily, and studies on the relationship between myopia and central corneal thickness (CCT) have shown conflicting results. The purpose of this study was to investigate the relationship between myopia and CCT in a hospital based population from South India. Materials and Methods: This prospective, cross-sectional study was carried out from a tertiary care institution in South India between January 2017 and June 2018. One hundred and ninety-four myopic individuals between 11 and 40 years of age with spherical equivalent (SE) ranging from -0.5 to -6 Diopters after cycloplegic refraction were enrolled in the study. CCT was measured in both eyes of each patient using Tomey EM-3000 noncontact specular microscope (Tomey Corporation, Nagoya, Japan). The relation between CCT and myopia was analyzed using Pearson's correlation coefficient. Statistical significance was set at P < 0.05. Results: A total of 388 eyes were analyzed. 50% (n=97) of study participants were females. The mean age of the study participants was 25.47 ± 7.25 years (range: 12–40 years). The mean SE was −-2.79±1.34 D (range: -0.5 to -6.0 D). The mean CCT was 540.53 ± 56.16 μm (range: 441–664 μm). No significant association was observed between CCT and age or gender of the study participants (P = 0.706 and 0.550, respectively). No correlation was observed between mean CCT and SE (Pearson, r = 0.095,P = 0.062). Conclusion: There was no correlation between CCT and degree of myopia. These data contribute to the ongoing discussion on the structural alterations in ocular coats and susceptibility to glaucoma in myopia.

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Purpose: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. Identification of risk factors is essential for its early detection and management. Aim: The aim of this study was to analyze the incidence and risk factors of Retinopathy of Prematurity in preterm babies admitted in neonatal care unit over the period of one year. Materials and Methods: A clinical retrospective study was done among 259 preterm babies referred to our department from October 2014 to September 2015 for screening of ROP. Fundus examination with indirect ophthalmoscope (IDO) was done. Babies with manifestation of ROP were followed-up for progression and managed appropriately. Results: One hundred and forty-two (54.8%) babies were found to have ROP at various stages. In very low birth weight (VLBW) babies (<1000 g; n = 40), 34 (85%) had ROP, out of which 19 (55.9%) had significant disease. Among LBW neonates (<1500 g; n = 165), 108 (65.45%) had ROP, out of which 37 (34.3%) had significant disease (P < 0.05). In neonates less than 28 weeks (n = 33), 25 (75.8%) had ROP, out of which 14 (56%) had significant disease. Out of the 103 babies who had RDS, 61 (59.2%) babies developed ROP, out of which 20 (32.8%) had significant disease. Conclusion: Prematurity and LBW were found to be independent risk factors in development of ROP in neonates.

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Background: Creating awareness regarding eye donation is the prime factor responsible for promoting voluntary pledging and donation of eyes. Planning awareness campaigns is determined by the prevalence of dearth of understanding of eye donation. Aims and Objectives: To assess the awareness and perception among eye care seekers toward eye donation. Material and Methods: A cross-sectional study was conducted among patients attending ophthalmology outpatient department seeking eye care, using a predesigned, pretested, semistructured, selfadministered questionnaire. Results: The study group included 250 participants. The male to female ratio was 1:1. A total of 94.4% participants had heard about eye donation. A total of 71.7% were willing to donate their eyes; 90.3% had not pledged their eyes; 63.7% were ready to implement eye donation as a family custom. Willingness, consent, and wish to make eye donation as a family custom was more among males (P = 0.049), graduates (P = 0.013), Christians (P = 0.019), those who were aware of the subject (P = 0.00), and who were single (P = 0.00). Only 7.6% had faced discouragement from the society or kith and kin when pledging of eye was considered. A total of 66.1% knew about the existence of a registered eye bank in the institute. Nobility was the main motivation (87.7%). A total of 61.8% felt that donated eye can give vision to the needy. Conclusion: This study revealed that eye care seekers were well aware of eye donation with a favorable attitude towards it; most of them were inclined to pledge their eyes. Counseling of this receptive group and identifying interested candidates among them as volunteers for eye donation is helpful in promoting eye donation among the community.

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Purpose: The purpose of this study is to compare the incidence of retinopathy of prematurity (ROP) in small-for-gestational-age (SGA) infants with appropriate-for-gestational-age (AGA) infants. Materials and Methods: A hospital-based prospective descriptive study was conducted on all cases of preterm babies <34 weeks of gestation and/or <1500 g of birth weight admitted in a tertiary care center, who were sent for ROP screening. Babies were divided into two groups using Lubchenco growth chart. Group 1 consisted of all AGA preterm babies. Group 2 consisted of SGA preterm babies. Screening and staging of ROP were done. Babies were managed appropriately. Data were entered and analyzed. Results: Out of the 300 babies examined, 67 babies were SGA and rest 233 were AGA. The overall incidence of ROP was 29% and it was increased in SGA group to 40% compared to AGA group, which was 25.8%. SGA had a significant association with ROP. Other significant factors were oxygen delivery, mechanical ventilation, sepsis, respiratory distress syndrome, surfactant, apnea, blood transfusions, and acidosis. Maternal factors such as oligohydramnios, premature rupture of membranes, and preeclampsia were also associated with ROP significantly. On multivariate analysis, apnea, blood transfusion, low partial pressure of oxygen, lower gestational age, and maternal gestational diabetes mellitus were independent risk factors. Conclusion: The incidence of ROP is higher in SGA compared to AGA. Being small for gestation is a risk factor for developing ROP.

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Aim: The aim of this study is to analyze the factors responsible for delay in surgical treatment among adults with strabismus. Materials and Methods: A validated questionnaire-based study on fifty adult strabismic patients, enrolled through simple random sampling, who underwent surgical correction of strabismus at the strabismus clinic of a tertiary care eye hospital. Results: A total of fifty patients in the age group 18– 45 years, including 28 males (56%) and 22 females (44%) were studied. 24% were students, 22% were professionals, 18% were skilled laborers, and 18% were homemakers. Strabismus had significant psychological impact on the quality of life of the patient and 50% suffered from low self-esteem attributable to squint 32% reported peer pressure and bullying. Lack of awareness about surgery (32%), fear of surgery (24%), and nonaffordability were the most common reasons reported by patients for delayed the surgical correction. The reasons for seeking surgical treatment in adulthood were for improving self-esteem and quality of life (32%) and due to pressure from family and friends (24%). Conclusion: Social factors predominate as obstacles for timely correction of strabismus. Economic factors and lack of awareness among medical communities also contribute toward delay in treatment.

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Aim: The aim of this study is to evaluate the accuracy of the anterior segment optical coherence tomography (AS-OCT) in measuring the distance from the limbus to the insertion of primary and previously operated horizontal rectus muscles. Materials and Methods: This was prospective observational study; we did AS-OCT preoperatively and measured the distance from angle of anterior chamber to muscle insertion using the caliper tool provided in the software. We calculated limbus-insertion distance by adding 1 mm to the angle-insertion distance. We compared this value with intraoperative measurement obtained with surgical caliper. Results: Totally 35 muscles were evaluated, including 12 previously operated muscles. 88.6% of the measurements were within the 1 mm difference considered clinically acceptable. Bland– Altman plots showed good agreement between the two methods. Conclusions: AS-OCT can image the horizontal rectus muscle insertions well and provide good reliability and accuracy in measurement of the limbus-insertion distance.

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Fortification means to intensify or strengthen the medication, to achieve adequate drug concentration. Fortified antimicrobials are not commercially available, thus should be, prepared of optimal constitution in a sterile pharmaceutical dispensary. This article provides guidelines on topical fortified therapy dosage concentration and methodology of preparation of drugs for patients with infectious keratitis. Acquaintance on fortified antimicrobial medication, its appropriate usage and timely intervention will help us to treat most of the resistant microbial keratitis and prevent the need for surgical intervention.

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The management of total eyelid avulsion is an arduous task with unpredictable functional and cosmetic result. We present a case of total lower eyelid avulsion in a 6 year old child following injury with bicycle. The reconstruction was done within 6 hours of injury. Retrieval of tissue from the incident site and its preservation permitted us to use it as a composite autograft. The child has recovered well with minor sequelae.

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Aurolab aqueous drainage implant is a nonvalved tube implant used to treat refractory glaucoma. Although implanting the device could be surgically more demanding than certain other drainage devices, the author aims to describe the techniques which enable him to perform the surgery safely and efficiently.

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Objective: The objective was to study the incidence and risk factors predisposing to retinopathy of prematurity (ROP) and to assess the outcome after laser photocoagulation. Design: This was a retrospective cohort observational study. Materials and Methods: Infants admitted to a Neonatal Intensive Care Unit of 12 referral hospitals in Kerala between May 2015 and June 2016 were followed up till retinal vascularization completes. Preterm infants with birth weight <1700 g and gestation >34 weeks were screened for ROP at 4 weeks after birth or 31–33 postconceptional age, whichever was later. Infants with birth weight >1700 g and gestation >35 weeks were screened only on neonatologist's discretion. All infants were screened according to the Indian guidelines of type 1 and 2 ROP. We treated both eyes of all infants showing threshold ROP. Statistical analysis was done using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: The incidence of ROP in 622 infants screened was 158 (25.4%), of which threshold ROP was seen in 61 (9.80%). No ROP was found in infants weighing >2000 g or with a gestational age >36 weeks. Risk factors predisposing to ROP were hours on ventilator, hemoglobin%, oxygen therapy, and number of blood transfusions, which were more significant in infants with type 1 or threshold ROP than type 2 ROP. Out of 97 infants with type 2 ROP, we saw stage 1 in 31 (30.92%), stage 2 in 59 (60.82%), and stage 3 in 7 (7.21%) infants. 61 (9.80%) infants with threshold ROP were treated with laser photocoagulation. Aggressive posterior ROP or rush disease was seen in 29 (47.54%) of 61 infants with type 1 ROP. Only 2 (3.27%) infants showed falciform fold over macula and 1 (1.63%) infant was blind due to retinal detachment. Conclusion: One-fourth of the infants showed ROP, of which one-tenth needed laser photocoagulation, the outcome of which was good. Risk factors predisposing to ROP were low hemoglobin, high oxygen therapy, increased number of blood transfusions, and hours of ventilator.

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