Journal of Ophthalmic and Vision Research
Year:2015 | Volume:10 | Issue:4|Papers Count:28

We recently developed a prototype online program for training residents and fellows about retinopathy of prematurity (ROP). We were motivated by the lack of adequate training in this important area. Since ROP is a rapidly progressive disease that can result in blindness, adequate and efficient knowledge regarding ROP should be expected of retina and pediatric ophthalmology fellows and at least available to all ophthalmology residents. Although for teaching purposes it might be best for all training in ROP to take place in the NICU, this is not practical because of constraints in time and resources as well as the safety of affected infants. Fortunately, high quality wide-angle images of the fundus can now be readily obtained for teaching and telemedicine.

Purpose: To evaluate corneal changes after collagen crosslinking (CXL) therapy for keratoconus (KCN) using the Galilei dual Scheimpflug analyzer.Methods: This prospective, nonrandomized clinical study included 35 eyes of 32 keratoconus patients who had undergone CXL. The eyes were saturated with riboflavin solution and were subjected for 30 minutes to ultraviolet-A (UV-A) light with irradiance of 3 mW/cm2. Effectiveness of the treatment was assessed by measuring uncorrected visual acuity (UCVA), best‑corrected visual acuity (BCVA), manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations by the Galilei dual Scheimpflug analyzer. Prior to treatment and 8 months after therapy, Scheimpflug analysis was performed using the Galilei system. The four sets of data including keratometry values, pachymetry, elevation parameters and surface indices were statistically analyzed and compared.Results: Mean patient age was 22.3±3.8 years and mean postoperative follow‑up was 8.1±3.2 months. There was a significant increase in UCVA (0.54±0.35 Log MAR preoperatively to 0.49±0.34 LogMAR postoperatively, P=0.01) and BCVA (0.21±0.19 Log MAR preoperatively to 0.16±0.17 LogMAR postoperatively, P=0.01). Mean cycloplegic spherical equivalent refractive error was -4.13±2.65 Diopter (D) preoperatively and -4.67±2.96 D postoperatively (P<0.001). During the follow-up period, no significant difference was observed in pachymetric and elevation data postoperatively.Conclusion: Corneal stabilization could be achieved by collagen crosslinking therapy for keratoconus in terms of corneal thickness, keratometry values, elevation parameters and surface indices.

Purpose: To evaluate the effect of donor and eye bank characteristics on graft rating and clinical outcomes after penetrating keratoplasty (PK) for keratoconus.Methods: This retrospective interventional case series included 252 keratoconic eyes which underwent PK. Donor data included age and sex, cause of death, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density (ECD) and morphology, and graft rating. Postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency. Multivariate regression analysis assessed correlations between donor and eye bank characteristics and graft quality, and postoperative outcomes.Results: Mean recipient and donor age was 29.7±10.0 and 26.2±8.8 years, respectively and mean follow-up period was 66.7±38.5 months. Death-to-preservation time was significantly associated with the presence of graft epithelial sloughing (P=0.005) and stromal cloudiness (P<0.001). Donor age significantly influenced ECD (P=0.02), mean cell area (P=0.04), and hexagonality (P=0.01). The presence of epithelial defects on postoperative day 1 correlated significantly with death-to-preservation time (P=0.004). Graft stromal edema on postoperative day 1 was significantly associated with graft epithelial sloughing (P<0.001). Postoperative visual and refractive outcomes, complications, and graft survival were not correlated with any donor or eye bank factors.Conclusion: Donor and eye bank variables affected the quality of donor corneas and early postoperative course. However, their long term effect on clinical outcomes, complications, and graft survival were insignificant.

Purpose: To compare distant and near visual function after cataract surgery with implantation of Crystalens HD or Tek-Clear as accommodating intraocular lenses (IOLs), versus SA60AT as a standard IOL.Methods: The study included 62 eyes of 58 patients divided into three groups using three different IOLs: Crystalens HD (Bausch and Lomb, NY, USA), Tek-Clear (Tekia, CA, USA) and SA60AT (Alcon, TX, USA) were implanted in 23, 14 and 25 eyes, respectively. Corrected distant visual acuity (CDVA), uncorrected and distance corrected near visual acuities (UCNVA and DCNVA), near point of accommodation (NPA), spectacle freedom and patient satisfaction were assessed six months postoperatively and compared between the three groups.Results: After 6 months, all patients showed significant improvement in CDVA with no significant difference among the study groups. However, UCNVA and DCNVA were significantly better in patients implanted with accommodating IOLs. NPA was closest in the Crystalens HD group, followed by Tek-Clear and monofocal SA60AT (P<0.001). Patients with accommodating IOLs were more likely to become spectacle free and satisfied with their near vision as compared to subjects receiving a monofocal IOL.Conclusions: Accommodating IOLs (Crystalens HD and Tek-Clear) effectively reduce the necessity for spectacles after cataract surgery.

Purpose: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery.Methods: This retrospective cohort study included data of 1, 632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded.Best corrected visual acuities were compared before and after the operation.Results: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes.Conclusion: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes.

Purpose: To evaluate the safety and efficacy of phacoemulsification for management of post‑filtering ocular hypotony.Methods: This prospective interventional case series study recruited 21 consecutive patients with an established diagnosis of ocular hypotony with or without maculopathy. Clear corneal incision phacoemulsification was done for all patients. Nineteen cases that completed a follow-up of at least 6 months were considered for final analysis.Results: Mean baseline intraocular pressure (IOP) was 2.95±1.43 mm Hg, which increased to 8.84 ± 4.67 mm Hg at 6 months (P<0.001). Hypotony was resolved in 13 cases (68%) at 6 months while 6 cases (32%) showed persistent hypotony at this time point. Postoperative IOP change at all follow-up time points was not correlated with patient age, time interval between filtering surgery and phacoemulsification, baseline IOP, baseline anterior chamber depth and IOP on the first postoperative day. Three cases (16%) showed filtering bleb failure with dramatic IOP rise around the first postoperative month and required glaucoma medication for IOP control. No significant intra- or postoperative complications were noted.Conclusion: Cataract surgery alone seems promising in resolving hypotony in patients with post‑filtering ocular hypotony, and can be considered as an effective treatment modality before proceeding to more complicated procedures.

Purpose: To compare trabeculectomy with mitomycin-C (MMC) application before versus after scleral flap dissection in terms of corneal endothelial cell loss and surgical outcomes.Methods: In this double blind clinical trial, patients were randomized to MMC 0.02% application before (group A) or after (group B) scleral flap dissection. The main outcome measure was corneal endothelial cell density; secondary outcome measures included IOP, glaucoma medications, success rates (IOP£21 and ≤18 mmHg, defined as criterion 1 and 2, respectively) and complications.Results: Overall, 99 eyes of 99 subjects including 72 male and 27 female subjects were operated and followed for at least 6 months. The study groups were comparable in terms of baseline variables. Outcomes of surgery were similar at six months in terms of IOP (11.8±5.8 vs.11.7±5.5 mmHg, P=0.88) and number of medications (0.2 ±0.6 vs 0.1±0.4, P=0.45). Overall success was comparable at months 1 and 3, but higher in group B at month 6 (82.0% vs.63.3%, P=0.036 for criterion 1 and 78.9% vs.59.2%, P=0.044 for criterion 2). Hypotony was more prevalent in group B (8.0% versus 2.0%) but the difference was not significant (P=0.38). Endothelial cell density loss (2.2±7.3 vs 0.9±6.3%, P=0.567) was comparable between the study groups.Conclusion: Corneal endothelial loss following trabeculectomy was comparable with MMC application before and after scleral flap dissection. The sequences were comparable in terms of postoperative IOP and glaucoma medications. Overall success rate was higher at six months in group B and the rate of hypotony was also higher, although insignificantly.

Purpose: To explore the relationship between lens power and refractive error in older adults following age-related hyperopic shifts.Methods: From the Shahroud Eye Cohort Study, subjects aged 55‑64 years without clinically significant cataracts (with nuclear opacity of grade 0 to 1) were included to maximize the proportion of subjects with age‑related hyperopic shifts that normally occur between 40 to 60 years of age, before interference from the myopic shift due to nuclear cataracts. Mean axial length (AL) values, corneal power, anterior chamber depth, lens thickness, and lens power were analyzed and compared among three refractive groups (myopes, emmetropes, and hyperopes).Results: A total of 1, 006 subjects including 496 (49.63%) male subjects were studied. Corneal power was similar in all refractive groups. Hyperopes had+1.69 diopters higher mean spherical equivalent refractive error and - 0.50 mm shorter AL than emmetropes. Myopes had 0.67 mm longer AL than emmetropes.Hyperopes had significantly increased lens thickness as compared to emmetropes (4.42 vs.4.39 mm respectively). In this adult sample, the hyperopic group had lower lens power (+22.29 diopters vs.+22.54 diopters in emmetropes, P=0.132). Myopes had similar lens power as emmetropes.Conclusion: Axial length is the principal determinant of refractive errors. Lens power may have importance in determining hyperopia in adults free of cataract.

Purpose: To determine the prevalence of amblyopia and refractive errors among 7 to 12-year-old primary school children in Tehran, Iran.Methods: This population-based cross-sectional study included 2, 410 randomly selected students.Visual acuity was tested using an E-chart on Yang vision tester. Refractive errors were measured by photorefractometry and cycloautorefraction. Strabismus was checked using cover test. Direct ophthalmoscopy was used to assess the anterior segment, lens opacities, red reflex and fundus. Functional amblyopia was defined as best corrected visual acuity £20/40 in one or both eyes with no anatomical problems.Results: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9%) of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004). Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ³+2.00D, myopia £-0.50D, astigmatism ³0.75D, and anisometropia (³1.00D) was 3.5%, 4.9%, 22.6%, and 3.9%, respectively.With increasing age, the prevalence of myopia increased (P<0.001), that of hyperopia decreased (P=0.007), but astigmatism showed no change. Strabismus was found in 2.3% of cases. Strabismus (OR=17.9) and refractive errors, especially anisometropia (OR=12.87) and hyperopia (OR=11.87), were important amblyogenic risk factors.Conclusion: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.

Purpose: To evaluate the feasibility of screening for retinopathy of prematurity (ROP) by assessing the pupillary response to mydriatics.Methods: This observational case series included 134 eyes of 67 premature infants with birth weight less than 2, 000 grams and gestational age less than 33 weeks. A composite eye drop composed of phenylephrine 1%, tetracaine and tropicamide 0.5% was applied 3 times within 5‑minute intervals and pupil diameters were measured. The eyes were examined by experienced ROP specialists using an indirect ophthalmoscope.Zone and stage of ROP, presence of plus disease and need for treatment were recorded. The relationship between the pupillary response to mydriatics, and presence and severity of ROP was evaluated. Logistic regression was used for statistical analysis.Results: According to receiver operating characteristic (ROC) curve analysis, final pupil diameter after mydriatic administration was found the most accurate factor among other factors to recognize ROP zone I from zones II and III (Area under ROC: 0.92 [95%CI: 0.85‑0.98]). The best cutoff value for final pupil diameter was 5.6 mm, because it could differentiate involvement of zone I from zones II and III with sensitivity of 80% and specificity of 100%.Conclusion: Response of the pupil to mydriatic eye drops may be useful as a less invasive method for rough estimation of ROP in high risk babies who need emergent attention; however, it cannot be considered as a screening test due to its low sensitivity.

Purpose: To report the incidence and risk factors for retinopathy of prematurity (ROP) among preterm infants referred to Amiralmomenin Eye Hospital, Rasht, Iran.Methods: This cross-sectional retrospective study included all preterm infants with birth weight£2500 g and/or gestational age£36 weeks who had been referred to our facility for ROP screening over a five year period from September 2005 to September 2010. Possible risk factors and findings related to eye examinations were extracted and analyzed.Results: Among 310 infants, ROP was diagnosed in 64 (20.6%) of referred preterm infants (95% CI: 17.7%‑23.5%); these included stage I in 48%, stage 2 in 29%, and stage 3 or higher disease in 23% of subjects. Mean gestational age (GA) and birth weight (BW) in the ROP–affected infants was 30.18±2.28 weeks and 1, 422.8±420.8 g, respectively. Low BW, low GA, oxygen therapy, phototherapy, blood transfusion and apnea were risk factors for ROP. After logistic regression analysis, only low GA and low BW were independently associated with the condition.Conclusion: ROP is a relatively common finding in preterm infants of Guilan Province in the North of Iran.Low BW and low GA were significant risk factors for the disease.

Purpose: To investigate the effect of tinted filters on visual acuity (VA), contrast sensitivity and patient satisfaction in diabetic retinopathy associated with low vision.Methods: In a prospective study, 51 patients with diabetic retinopathy and low vision were assessed. We chose a simple random sampling method and used the patient’s files for data collection. LogMAR notations were applied for assessing VA and a contrast sensitivity chart (CSV-1000) was employed for measuring contrast sensitivity. First, measurements were performed without tinted filters and then using them.Appropriate lenses were given to the patients for 2 days, and they were questioned about their satisfaction using them in different places.Results: A total of 20 male and 31 female patients with mean age of 57.3 years participated in the study. With a 527±10 nm filter, mean VA improved significantly (P£0.05). Using the 527±10 nm and 511±10 nm filters, mean contrast sensitivity was improved significantly at 3 and 6 cycles/degree frequencies (P<0.05). The effect of other filters on VA and contrast sensitivity was not significant. Patient satisfaction rate was generally high.Conclusion: Tinted filters are able to rehabilitate low-vision patients due to diabetic retinopathy. The 527±10 and 511±10 nm wavelength filters improved contrast sensitivity and the 527±10 nm filter improved VA to some extent. Further investigations are recommended to assess the effect of these filters in patients with other causes of low-vision.

Purpose: Dyslexia is one of the most common learning disabilities affecting millions of people worldwide. Although exact causes of dyslexia are not well‑known, a deficit in the magnocellular pathway may play a role. We examined possible deficiency of magnocellular, as compared to parvocellular and koniocellular pathway function by measuring luminance and color perception.Methods: Visual stimuli consisted of a series of natural images, divided into layers of luminance, red-green and blue-yellow, which probed magnocellular, parvocellular, and koniocellular pathways, respectively. Thirteen children with dyslexia and 13 sex- and age-matched controls performed three psychophysical tasks.In the first task, subjects were instructed to match the contrast of luminance (magno) and red‑green (parvo) images to that of the blue-yellow (konio) images. In the second task, subjects detected the isoluminant point of red-green images to probe parvocellular pathway. In the third task, temporal processing was assessed by measuring reaction time and percentage of correct responses in an identification task using four categories of images, activating all three pathways.Results: The dyslexic group had significantly elevated luminance and color contrast thresholds and higher isoluminant point ratio in comparison to the control group. Furthermore, they had significantly less correct responses than the control group for the blue‑yellow images.Conclusion: We may suggest that dyslexic subjects might suffer from both magnocellular and parvocellular deficits. Moreover, our results show partial impairment of the koniocellular pathway. Thus, dyslexia might be associated with deficits in all three visual pathways.

Purpose: To compare ultraviolet (UV) ray transmission in four UV-blocking soft contact lenses with Z80.20 standards set by the American National Standards Institute (ANSI).Methods: Four soft contact lenses including Acuvue Oasys (Johnson & Johnson, Ireland), Acuvue 2 (Johnson & Johnson, Ireland), Zeiss CONTACT Day 30 (Zeiss, Germany), and Sauflon 55 UV (Sauflon, UK) were evaluated for UV transmission. One-way ANOVA testing was performed to compare mean values of UVA and UVB transmission for the contact lenses.Results: Acuvue Oasys, Acuvue 2, Zeiss CONTACT Day 30 and Sauflon 55 UV showed UV-B transmittance values of 0.24%, 1.46%, 10.37%, and 2.52%, respectively. Corresponding values for UV-A transmittance were 20.81%, 33.49%, 44.03% and 42.53%, respectively. One-way ANOVA showed a statistically significant difference among the tested contact lenses in terms of UV-B (P<0.001) and UV-A (P<0.001) transmission.Conclusion: Acuvue Oasys met the ANSI criteria for UV transmission and may thus be a good choice for eye and vision care specialists and contact lens wearers seeking UV protection.

Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population.Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table

This review study provides information regarding the construction, design, and use of six commercially available endothelial allograft insertion devices applied for Descemet’s stripping automated endothelial keratoplasty (DSAEK). We also highlight issues being faced in DSAEK and discuss the methods through which medical devices such as corneal inserters may alleviate these issues. Inserter selection is of high importance in the DSAEK procedure since overcoming the learning curve associated with the use of an insertion device is a time and energy consuming process. In the present review, allograft insertion devices were compared in terms of design, construction material, insertion technique, dimensions, incision requirements and endothelial cell loss to show their relative merits and capabilities based on available data in the literature. Moreover, the advantages/disadvantages of various insertion devices used for allograft insertion in DSAEK are reviewed and compared. The information presented in this review can be utilized for better selection of an insertion device for DSAEK.

Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti‑tumor necrosis factor‑alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.

To report two cases of bilateral conjunctival granuloma with histopathological features of the Splendore-Hoeppli phenomenon and review of the literature. Two female patients, one with a history of pulmonary eosinophilic infiltration and another with a history of vernal keratoconjunctivitis, presented with bilateral cream to yellow colored nodules in the superior bulbar conjunctiva. Histopathologic examination revealed characteristic features of the Splendore-Hoeppli phenomenon manifesting as zones of amorphous eosinophilic material surrounded by aggregations of epithelioid histiocytes, giant cells, eosinophils and lymphoplasmacytic infiltrates. No evidence of infectious organisms was found. Our report adds to non‑infectious cases of conjunctival Splendore-Hoeppli phenomenon. Previous history of allergic disorders may have contributed to the occurrence of this entity.

To report a patient with juxtapapillary choroidal osteoma (CO) with serous retinal detachment (SRD) not associated with choroidal neovascularization (CNV) who was successfully treated with a single intravitreal injection of bevacizumab. A 20‑year‑old woman presented with decreased vision in her right eye. Ultrasonography, fundus autofluorescence, fluorescein angiography (FA) and optical coherence tomography (OCT) were performed. She was diagnosed with juxtapapillary CO with SRD in the absence of CNV. The treatment involved a single intravitreal injection of bevacizumab. Visual acuity (VA) was 20/100 pre-injection which was dramatically improved to 20/20 one week after the injection without any additional treatment. Fundus examination and OCT one week after the injection revealed complete absorption of the subretinal fluid (SRF) in the macula. Eighteen months after the injection, vision remained stable and she did not show re‑accumulation of SRF in her right eye. Intravitreal injection of bevacizumab may be effective in managing CO associated with SRF without CNV.

To describe the clinical and optical coherence tomography (OCT) characteristics of ischemic maculopathy in two patients with acquired immunodeficiency syndrome (AIDS). Two patients with AIDS and cytomegalovirus (CMV) retinitis developed ischemic maculopathy. Both patients presented with central visual loss and active granular CMV retinitis. The presence of opacification of the superficial retina in the macular area and intraretinal edema suggested the diagnosis. Fluorescein angiography changes were similar in the two cases with enlargement of the foveal avascular zone and late staining of juxtafoveal vessels. OCT changes were suggestive of retinal ischemia: Increased reflectivity from the inner retinal layer and decreased backscattering from the retinal photoreceptors due to fluid and retinal edema. Ischemic maculopathy may cause a severe and permanent decrease in vision in AIDS patients. Fluorescein angiography and OCT should be considered in any patient with AIDS and unexplained visual loss. The mechanism of ischemic maculopathy may be multifactorial.

PRESENTATION: A 17‑year‑old female patient with a history of malaria fever, caused by Plasmodium falciparum, presented with sudden decrease of vision in her left eye 10 days after the onset of fever to an Ophthalmologist elsewhere. The patient was referred to our center one month later. On examination, vision was 20/20 and 20/1200 in the right and left eyes, respectively. The ophthalmic examination of the right eye was unremarkable. The left eye had relative afferent papillary defect and fundus examination revealed retinal hemorrhages, superior branch retinal vein occlusion, and neovascularization.

PRESENTATION: A 23-year-old man was presented with slowly progressive bilateral decreasing vision over the past 3 years. He had no remarkable medical, surgical or family history of ocular or systemic disease. Best-corrected visual acuity (BCVA) was 20/200 in both eyes with -1-0.75×90 and -1.50-0.50×90 correction in the right and left eyes, respectively. Anterior segment examination revealed diffuse neovascularization of iris (NVI) in both eyes [Figure 1]. Diffuse capillary non-perfused areas associated with occluded retinal vessels in both eyes, and fibrovascular membrane with traction on the macula in the left eye were present in dilated fundus examination [Figures 2 and 3].

We describe the utilization of indocyanine green (ICG) dye to facilitate combined/en bloc removal of epiretinal membranes (ERM) along with internal limiting membranes (ILM). The method utilizes a highly diluted preparation of ICG in dextrose water solvent (D5W). Elimination of fluid air exchange step facilitating staining in the fluid phase and low intensity lighting help minimize potential ICG toxicity. The technique demonstrates how ICG facilitates negative staining of ERMs and how ILM peeling concomitantly can allow complete and efficient ERM removal minimizing surgical time and the necessity for dual or sequential staining.

Sir: Recently, a new aberrometer, the iDesign advanced Wavescan studio (Abbott Medical Optics, Santa Ana, CA, USA) has been launched for commercial use. This device is considered as a new, upgraded and more sensitive version of the Wavescan aberrometer (Abbott Medical Optics, Santa Ana, CA, USA). It has five times greater resolution, encompassing over 1, 250 data points through a 7.0‑mm pupil as compared to 240 points for the Wavescan. However, it remains to be seen if this increase in sensitivity would hamper instrument repeatability by picking up extra signal noise, especially during testing of wavefront aberrations, which are variable to some extent.

Dear Editor: We read with great interest the paper by Jain and Aref entitled “Senile Dementia and Glaucoma: Evidence for a Common Link” published recently in Journal of Ophthalmic and Vision Research. We are grateful to the authors for sharing their valuable review article with the scientific community, and we would appreciate the opportunity to provide an additional viewpoint about a possible common clearance pathway linking Alzheimer’s disease (AD) and glaucoma

Dear Editor: We appreciate Dr. Wostyn, et al’s interest in our manuscript titled, “Senile Dementia and Glaucoma: Evidence for a Common Link”. Dr. Wostyn et al’s work in this area is indeed intriguing. Dr. Wostyn et al’s hypothesis states that deficient exchange between cerebrospinal fluid and brain interstitial fluid compartments along the optic nerve may allow the accumulation of neurotoxins, including amyloid‑b, and subsequently predispose to glaucomatous optic neuropathy.

Dear Editor: I read an interesting article on bilateral vitreous hemorrhage (VH) in children, its causes and management. The article was quite informative, and I would like to share my views and experience: • Low platelet counts are an important cause of VH, and various infections such as malaria, dengue etc. (which are quite common in India) frequently cause low platelet counts and various bleeding manifestations, both fatal and non‑fatal. Various ocular bleeding manifestations are very well described since long ago in malaria and very recently in dengue, which are quite similar to that of malaria. Vitreous hemorrhage has also been documented in malaria, which may be missed because of unconsciousness, or confusion with other causes of blindness such as cortical blindness and retro‑bulbar neuritis in a critically ill patient

Dear Editor: We thank Dr. Shubhakaran and express our gratitude for his interest in our article. He has brought up several points of interest for our esteemed readers. The subject of vitreous hemorrhage in infectious conditions such as dengue or malaria is of immediate concern to developing countries in general and India in particular, where these diseases are endemic amongst children and require urgent attention.