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Charm J.,Centre for Sight
Clinical Optometry | Year: 2017

Orthokeratology (ortho-k) is a special rigid contact lens worn at night to achieve myopic reduction and control. This review provides an overview on prescribing ortho-k, including clinical consideration on patient aspect and lens design; its clinical outcomes; and clinical efficacy and safety. Patient satisfaction was summarized. In order to achieve long-term healthy ortho-k treatment, it requires both patient and practitioners’ care and rapport to maintain good ocular health and lens conditions. © 2017 Charm.


Daya S.M.,Centre for Sight
Current Opinion in Ophthalmology | Year: 2017

PURPOSE OF REVIEW: To provide an overview of conjunctival–limbal autografting (CLAU) for ocular surface rehabilitation with emphasis on more recent literature detailing outcomes of the procedure over the last 2 decades as well as technique variations and adjuvant techniques. RECENT FINDINGS: Limbal autografting initially described in 1964 by Barraquer and Strampelli and later popularized by Kenyon and Tseng is considered the best option for restoration of corneal phenotype in unilateral limbal stem-cell deficiency. Although there have been developments in alternative limbal epithelial stem-cell techniques including ex-vivo tissue engineering methods, because of the benefit of immunohistocompatability, this procedure still provides better long-term outcomes. As autograft donor tissue is valuable, optimization of the recipient eye preoperatively with good lid closure and reduction of inflammation is vital for success as is close postoperative follow-up. Variations in the technique described have included the modified Cincinnati technique combining CLAU with cadaveric keratolimbal allograft to avoid conjunctivalization. In addition, simple limbal epithelial autograft transplantation, a less-invasive technique combined with amniotic membrane transplantation, has shown promise. SUMMARY: In spite of the development of new epithelial transplant techniques, in unilateral limbal stem-cell deficiency, CLAU from a healthy unaffected fellow eye remains the best option available for restoration of corneal phenotype. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.


Mulay K.,Centre for Sight | Wick M.R.,University of Virginia
Seminars in Diagnostic Pathology | Year: 2016

IgG4-related disease (IgG4-RD) is a distinct entity that frequently occurs in an ophthalmic location. As such, IgG4-RD is not limited to the orbit but may also involve other anatomical structures in and around the eye. Hence, the term 'ophthalmic IgG4-RD' is preferred over 'orbital IgG4-RD.' A high level of suspicion for the diagnosis can be derived from careful clinicoradiologic examination; the use of immunohistochemical staining for IgG4 in the context of characteristic histopathologic features is needed to reach a correct diagnosis. Recently described diagnostic criteria for ophthalmic IgG4-RD address subtle, yet significant, differences from IgG4-RD as seen in other systemic sites. Serum IgG4 titers are neither sensitive nor specific for the diagnosis of IgG4-RD and should not relied upon solely. Although most cases respond well to therapy with glucocorticoids, refractoriness to treatment and relapses are common. They necessitate the use of additional immunotherapy in such patients. © 2016 Elsevier Inc.


Gothwal V.K.,Centre for Sight | Bharani S.,Centre for Sight | Mandal A.K.,L V Prasad Eye Institute
Investigative Ophthalmology and Visual Science | Year: 2015

Purpose: We developed and validated an instrument to measure the quality of life (QoL) of caregivers of children with primary congenital glaucoma (PCG): the Caregiver's Congenital Glaucoma Quality of Life (CarCGQoL) questionnaire. Methods: A total of 70 caregivers of children with PCG under follow-up at a tertiary eye care center in India participated in a series of focus groups, and pre- and pilot testing phases in the development of the 45-item CarCGQoL questionnaire. Subsequently, this instrument was administered to 111 caregivers of children with PCG awaiting glaucoma surgery. Response to each item was rated on a four-category scale. Rasch analysis was used to validate the instrument's psychometric properties, such as unidimensionality (by principal components analysis [PCA] of residuals), item fit to model, measurement precision (by person separation [PS]), response category performance, differential item functioning (DIF), and targeting of items to participant's QoL. Results: Categories required reorganization resulting in a shortened rating scale of 3 categories. The instrument showed misfit to the Rasch model and lacked unidimensionality. Deleting 15 items (obtained through PCA of residuals) restored unidimensionality, but additional items misfit, necessitating item reduction. In addition, 2 items showed DIF and were deleted. Finally, a 20-item CarCGQoL instrument showed good fit and unidimensionality. Targeting was good (0.69 logits) and PS was 2.51, indicating good measurement precision. Conclusions: We have developed a psychometrically robust 20-item caregiver derived questionnaire, the CarCGQoL, that is a valid and reliable measure of QoL of caregivers of children with PCG. Given its brevity, it is quick and easy to administer in the clinic, and has potential for use as an outcome measure in clinical trials of treatment of PCG. © 2015 The Association for Research in Vision and Ophthalmology, Inc.


Daya S.M.,Centre for Sight | Nanavaty M.A.,Centre for Sight | Espinosa-Lagana M.M.,Centre for Sight
Journal of Cataract and Refractive Surgery | Year: 2014

Purpose To compare ultrasound time (UST) during femtosecond laser-assisted and conventional cataract surgery or refractive lens exchange and evaluate UST during femtosecond laser surgery with and without a new technique, translenticular hydrodissection. Setting Centre for Sight, East Grinstead, West Sussex, United Kingdom. Design Comparative case series. Method This single-surgeon study compared consecutive femtosecond laser-assisted surgery (with and without translenticular hydrodissection to assist lens mobilization) and consecutive conventional surgery performed immediately before adoption of femtosecond laser technology. The mean US power, UST, and effective phacoemulsification time (EPT) in the 2 groups were compared. Further analysis of the femtosecond group compared translenticular hydrodissection and no translenticular hydrodissection. Results The mean US power, UST, and EPT were significantly longer in the conventional group (n = 108) than in the femtosecond group (n = 108) as follows: 7.30% ± 2.56% (SD) versus 5.32% ± 2.48% (P=.000); 9.89 ± 5.32 seconds versus 8.58 ± 4.66 seconds (P=.044); 0.87 ± 0.85 seconds versus 0.57 ± 0.51 seconds (P=.002), respectively. In the femtosecond group, parameters were significantly higher in eyes without translenticular hydrodissection (n = 27) than in eyes with translenticular hydrodissection (n = 81) as follows: 5.78% ± 2.23% versus 5.16% ± 2.56% (P=.046); 10.95 ± 4.66 seconds versus 7.78 ± 4.41 seconds (P=.046); 0.72 ± 0.26 seconds versus 0.52 ± 0.53 seconds (P=.002), respectively. Conclusion Femtosecond laser capsulotomy and lens fragmentation statistically significantly reduced UST over conventional surgery. Translenticular hydrodissection further reduced UST. Financial Disclosure Dr. Daya is a consultant to Bausch & Lomb and Technolas Perfect Vision GmbH. No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Mcbrien N.A.,University of Melbourne | Stell W.K.,Centre for Sight | Carr B.,Centre for Sight
Ophthalmic and Physiological Optics | Year: 2013

In the following point-counterpoint article, internationally-acclaimed myopia researchers were challenged to defend the two opposing sides of the topic defined by the title; their contributions, which appear in the order, Point followed by Counterpoint, were peer-reviewed by both the editorial team and an external reviewer. Independently of the invited authors, the named member of the editorial team provided an Introduction and Summary, both of which were reviewed by the other members of the editorial team. By their nature, views expressed in each section of the Point-Counterpoint article are those of the author concerned and may not reflect the views of all of the authors. © 2013 The College of Optometrists.


Fezza J.P.,Centre for Sight | Massry G.,Centre for Sight
Plastic and Reconstructive Surgery | Year: 2015

Background: A numerical measurement of the length of the lower eyelid is valuable in understanding the aging process of the lower lid. This study recorded multiple values for the lower lid length to provide average values in each age group. This measurement will allow surgeons to better assess and treat the lower lid. Methods: Female patients were studied in age groups every decade starting in the 20- to 29-year-old group and ending in the 90- to 99-year-old group. Twenty patients were assessed in each age group for a total of 160 patients. In each age group, an average measurement was recorded for the lower lid length. Results: The lid length average was 10.4 mm in the 20- to 29-year-old group and increased to 18.6 mm in the 90- to 99-year-old group. A steady increase in lower lid measurements numerically confirms that lower lid length increases with age. For each decade, there was an almost linear increase in lower lid length, with the greatest increase in the 40- to 49-year-old group. Conclusions: This study numerically confirmed that the lower eyelid length vertically increases with age. Documenting that the lower lid does lengthen every decade of life and obtaining average numerical values of lower lid length allows physicians insight into the expected aging changes and typical amount of lower lid lengthening at each decade. This also provides blepharoplasty surgeons another tool to more accurately define the aging process and creates a baseline and a potential goal in restoring a more youthful lid. © 2015 by the American Society of Plastic Surgeons.


Gothwal V.K.,Centre for Sight | Bagga D.K.,Centre for Sight
Investigative Ophthalmology and Visual Science | Year: 2013

PURPOSE. A multi-attribute utility instrument (MAUI) consists of a descriptive system in which the items and responses seek information about a concept of the universe of health-related quality of life (QoL), and responses to these items then are weighted and combined to produce the index. To our knowledge, the 6-item Vision and Quality of Life Index (VisQoL) is the only available vision-related MAUI, developed and validated in Australia, specifically for visually impaired (VI) populations. To our knowledge, the psychometric properties of the VisQoL have not yet been investigated in an Indian VI sample; this was the aim of our study. METHODS. The Indian VisQoL was administered to 349 VI adults face-to-face by a trained interviewer at the Vision Rehabilitation Centres of a tertiary eye care facility, South India. Rasch analysis was used to assess the psychometric properties. RESULTS. Rescoring was necessary for all except one item before ordered thresholds were obtained. All items fit the Rasch model and unidimensionality was confirmed. Person separation was acceptable (2.01), indicating that the instrument can discriminate among three strata of participants" vision-related QoL (VRQoL). The VisQoL items were targeted substantially to the participants" VRQoL (-0.69 logits). One item ("ability to have friendships") demonstrated large differential item functioning by work status; working participants reported the item to be more difficult (-1.13 logits) relative to other items when compared to the nonworking participants. CONCLUSIONS. The 6-item Indian VisQoL satisfies unidimensional Rasch model expectations in VI patients. Disordering of response categories was evident; replication is required before a common rescoring option should be considered. © 2013 The Association for Research in Vision and Ophthalmology, Inc.


Honavar S.G.,Centre for Sight | Manjandavida F.P.,CMER Dennis Lam Eye Institute
Indian Journal of Ophthalmology | Year: 2015

Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.


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