Even though both intraocular pressure (IOP) fluctuation and peak IOP have been demonstrated to be significant risk factors for glaucoma progression, the latter has been shown to be a better predictor of disease progression. Peak IOP is also a more practical tool for guiding management protocols.^[1-3]

How to cite this article: Bhartiya S, Ichhpujani P. Water drinking test: The second innings scorecard. Cli Exp Vis Eye Res J 2020;3(2):1-3.

Received: 21-12-2020;

Accepted: 27-12-2020

In the new era with ever-growing research and development of new concepts for patient care, it is important to interpret the information from the trials judiciously with the incorporation of patient targeted approach (precision medicine [PM]) along with evidence-based medicine to provide holistic care to the patient. As randomized controlled trials are usually conducted with strict criteria and a homogenous group of patients, the real-world situations are different, thus the individual-based approach has to be considered while managing patients, especially with chronic diseases which have a great impact on the patient's quality of life. This write-up highlights the importance of PM for glaucoma care and the factors which can help with decision making. A holistic and empathetic approach, with emphasis on lifestyle modifications including stress management, yoga therapy, and ocular motility exercises, can go a long way in improving both, the patient's coping skills, and the disease course. Newer empirical therapies, especially those without a demonstrable evidence base, may sometimes be considered for cases where all else fails, customized to the individual patient's requirements.

Key words: Biomarkers, Chronic Diseases, Randomized Trials

How to cite this article: Bhartiya S, Dhingra D, Ichhpujani P. Is it time for Precision Medicine in Glaucoma? Cli Exp Vis Eye Res J 2020;3(2):4-12.

Received: 04-12-2020;

Accepted: 11-12-2020

Objective: The objective of the study was to determine whether breast cancer-associated gene (BRCA1/2) mutations are associated with wet age-related macular degeneration (AMD), together with other risk factors of older age and impaired DNA repair. In addition, role of RAD51B in the BRCA pathway was also investigated.

Design: This was a prospective, hospital-based study.

Participants: Ninety-four patients (26 male/26 female Ashkenazi Jews and 24 male/18 female non-Ashkenazi Jews) with a clinical diagnosis of wet AMD.

Methods: Genomic DNA was extracted and tested for mutations in BRCA1 (c.5382insC and 185delAG) and BRCA2 (c.6174delT). RAD51B analysis for rs17105278, rs4902566, and rs8017304 was performed using single-nucleotide polymorphisms (SNP) genotyping analysis. The results were validated by direct sequencing.

Results: No BRCA1 mutations were found in the Ashkenazi or non-Ashkenazi Jews, and only one Ashkenazi Jew (1.92%) carried the BRCA2 mutation. In the RAD51B SNP analysis, the Ashkenazi Jews showed 1.75-fold higher frequency in rs17105278 and 1.43-fold lower frequency of rs4902566 SNP than the non-Ashkenazi group, and no difference in rs8017304.

Conclusions: Ashkenazi Jews with wet ARMD did not show a higher rate of BRCA1/2 mutations than the general population (<2.5%), suggesting that BRCA1/2 plays no role in wet AMD in this ethnic group. No difference was found between Ashkenazi and non-Ashkenazi Jews suffering from wet AMD patients. The differences in the SNP variations of RAD51 need to be further explored.

Key words: Age-related macular degeneration, breast cancer-associated gene 1, breast cancer-associated gene 2, DNA repair, retinal neovascularization

How to cite this article: Weiss S, Azab M, Zahavi A, Tessler-Betzalel G, Axer-Siegel R, Cohen Y, Goldenberg- Cohen N. Breast cancer-associated gene 1/2 mutations are not associated with risk of exudative age-related macular degeneration in Ashkenazi Jews. Cli Exp Vis Eye Res J 2020;3(2): 13-16.

Received: 10-07-2020;

Accepted: 14-08-2020

Aim: The aim of the the study was to evaluate and to compare the side effects of topical anti-glaucoma drugs in patients of POAG, OHT, ad NTG.

Introduction:Topical drugs are the mainstay of glaucoma management but are associated with various adverse effects which can influence compliance and quality of life of the patient.

Materials and Methods: We studied 308 eyes of 154 patients above 15 years, having POAG, OHT, or NTG and using at least one anti-glaucoma medication. A structured validated questionnaire was used followed by ocular examination to collect data which were analyzed statistically.

Results: Out of 308 eyes of 154 patients, 80.51% patients experienced at least one side effect, more in females. The incidence increased to 72.52%, 92.10%, 91.66%, and 100% among 50-59, 60-69, 70-79, and 80-89 age groups, respectively. TBUT was normal in 62.79% eyes when duration of therapy was ≤ 5 years but not when beyond 11 years and normal only in 34% eyes exposed to benzalkonium chloride. Only 8.45% patients experienced systemic side effects but none required emergency care. Change of therapy due to side effects occurred in 8.11% patients.

Conclusion: Topical anti-glaucoma drugs are quite safe but incidence of side effects increases with age, duration of therapy, and number of medications. Although few, they affect the quality of life and compliance potentially limiting success of the treatment.

Clinical Significance: Knowledge of side effects helps us in tailoring, monitoring, and revising treatment as necessary, to minimize side effects and maximize outcomes.

Key words: Adverse event, anti-glaucoma medications, benzalkonium chloride, compliance, glaucoma, side-effects

How to cite this article: Bhagat PR, Trivedi KY. Evaluation and comparison of the safety profile of topical anti-glaucoma drugs in patients of primary open angle glaucoma or ocular hypertension or normal tension glaucoma. Cli Exp Vis Eye Res J 2020;3(2):17-29.

Received: 29-06-2020;

Accepted: 24-07-2020

Purpose: The purpose of the study was to assess the outcome, complications, and its predictors in novel modified sutureless-glueless-flapless scleral fixated intraocular lens (IOL).

Methods: Prospective study of 86 eyes of 74 patients who underwent sutureless, glueless, and flapless scleral fixated IOL from June 2016 to March 2019. All patients underwent standard scleral fixated IOL without sutures or glue. Pre-operative best-corrected visual acuity(BCVA) and intraocular pressure was assessed. Horizontal corneal white to white (hWTW) diameter and axial length (AL) were assessed. All patients were followed up on day 1, 1 month, 3 months, and 6 months. All patients had a minimum follow-up of 6 months. Post-operative BCVA, intraocular pressure, IOL centration, and IOL-related complications were noted including tilt, decentration, dislocation, haptic extrusion, and optic capture.

Results: Mean age was 66 ± 13.4 years. Eighty-six eyes of 74 patients with aphakia, subluxated IOL, and subluxated crystalline lens were included in the study. The mean pre-operative BCVA was 1.21 ± 2.8 (Log MAR). The mean post-operative BCVA at 6 months was 0.34 ± 0.21 (Log MAR). Significant improvement in mean BCVA was noted at 6 months after the procedure(P=0.011). From the final analysis, 10 eyes were excluded for insufficient follow-up, missing data, or concomitant surgery. There were six eyes excluded for technique modification and two eyes for isolated haptic erosion from the scleral tunnel without lens malposition. From our final analysis of 68 eyes, 8 eyes (12%) developed complications of the IOL. Of these, 3 (38%) eyes underwent surgical intervention. Patients with large hWTW experienced significantly higher rate of complications (P = 0.04). Longer AL was not predictive of higher complication rate (P = 0.08).

Conclusion: Suture or glue is not an absolute must for scleral fixation of an IOL. Sutureless, glueless, and flapless scleral fixation of IOL is a safe surgical option in eyes without capsular support with fewer complications, stable IOL, reduced surgical time, shorter learning curve, good refractive outcome, and without any suture or glue-related complications.

Key words: Complications, outcome, sutureless, glueless, and flapless scleral fixated intraocular lens

How to cite this article: Ganekal S, Dorairaj E, Dorairaj S. Novel modified sutureless, glueless and flapless scleral fixated intraocular lens. Cli Exp Vis Eye Res J 2020;3(2):30-34.

Received: 21-12-2020;

Accepted: 28-12-2020

Purpose: Our aim was to examine the new working routines embraced by the ophthalmologists during the COVID-19 pandemic and to use the ""wisdom of crowds"" to create a new set of practical tools to face the enormous challenges in this new era.

Materials and Methods: We have conducted a survey by distributing an anonymous self-reported questionnaire. The questionnaire included 34 questions regarding the practices of ophthalmologists in the era of the COVID-19 pandemic.

Results: The questionnaire was answered by 173 ophthalmologists, from all sub-specialties. The survey revealed a wide diversity in the way that the participants interpreted and implemented the guidelines published by the Israeli Ophthalmological Society. Various strategies were deployed by the participants to prevent an infection and wide range of tactics was used to examine and to treat patients.

Conclusion: Prevention is the most important aspect in our fight against pandemics. Rearrangement of our working routines and tactics, improved precaution measures based on risk assessment, and establishment of evidence-based medicine to support decision-making are mandatory to maximize both our patients and our own safety.

Key words: Coronavirus, COVID-19, pandemic, questionnaire, working routines in ophthalmology

How to cite this article: Levy I, Gabbay IE, Zahavi A, gaton D, Bahar I, Geffen N. Practices among Israeli ophthalmologists during the rapid rise period of the COVID-19 outbreak. Cli Exp Vis Eye Res J 2020;3(2):35-42.

Received: 12-12-2020;

Accepted: 27-12-2020

Purpose: The aim of the study was to investigate the potential association between gene variation and the response of Israeli patients with age-related macular degeneration (AMD) to treatment.

Materials and Methods: The study sample included 100 patients with AMD. One eye per patient was analyzed. The medical files were reviewed for demographic, systemic and ocular data, and measurements of best corrected visual acuity (BCVA), and central retinal thickness (CRT) at each visit were recorded. Treatment consisted of intravitreal bevacizumab alone (1.25 mg) or followed by ranibizumab (0.5 mg) in the event of no initial response to bevacizumab, at 3 months intervals. Blood was collected from each patient, and genotyping for eight single-nucleotide polymorphisms (vascular endothelial growth factor A [VEGFA] rs3025039, rs2010963, rs699947; complement factor H rs800292; age-related maculopathy susceptibility 2 rs10490924; high-temperature requirement A-1 rs11200638; and pigment epithelium-derived factor rs9913583, rs1136287) was performed by allele-specific polymerase chain reaction. A favorable treatment response was defined as an improvement or no change in logMAR BCVA and a reduction in CRT by optical coherent tomography.

Results: The study group consisted of 54 male and 46 female patients mean 77.6, mean follow-up 40.43 months. Vision improved in 70 patients. A correlation with BCVA was noted for two of the polymorphisms studied, vascular endothelial growth factor A rs2010963 and rs699947. The correlation with BCVA was stronger than the correlation with CRT. There was no difference in mean follow-up time between responders and non-responders, and no association between age at disease onset and the genetic variants identified.

Conclusion: Identification of the gene variants VEGFA rs2010963 and rs69994 in Israeli patients with AMD may help to predict their response to treatment. Furthermore, such investigations are important to aid clinicians in selection of the preferred treatment.

Key words: Age-related macular degeneration, vascular endothelial growth factor, single-nucleotide polymorphism, choroidal neovascularization, anti-vascular endothelial growth factor

How to cite this article: Tessler G, Weiss S, Axer-Siegel R, Goldenberg-Cohen N. Two variants in vascular endothelial growth factor gene affect response to treatment for age related macular degeneration in the Israeli population. Cli Exp Vis Eye Res J 2020;3(2):43-48.

Received: 15-12-2020;

Accepted: 24-12-2020

A 34 years old female presented with extreme ocular dryness sensation and bilateral blurred vision (hand motion). Past medical history included duodenal bypass 6 years prior to presentation and bipolar disorder. Drastic malnutrition and avitaminosis were diagnosed, leading to xerosis. Following treatment with Total Parenteral Nutrition, intravenous vitamin supplementations, and topical ocular treatment with lubricants her visual acuity improved to 6/7.5 in both eyes within two weeks. One month following surgical revision of the duodenal bypass, she regained visual acuity of 6/6 in both eyes.

Key words: Bariatric surgery, dry eye, visual impairment, Vitamin A deficiency, xerosis

How to cite this article: Arnon E, Vardizer Y, Keren D, Croitero M, Goldenberg-Cohen N. Reversible bilateral visual loss in a young adult. Cli Exp Vis Eye Res J 2020;3(2):49-50.

Received: 14-11-2020;

Accepted: 26-11-2020

Ocular myiasis is an infestation of eye by larvae of flies from Diptera family. It is a chance infection in humans when they come in contact with the actual commensal of these organisms such as sheep and goats. Anterior segment is often involved and common presentation is conjunctivitis and requires high index of suspicion for diagnosis and subsequent treatment. We present a case of myiasis in a 25-year-old female who visited the emergency ophthalmic services with conjunctivitis; however, slit lamp examination revealed live larvae. The patient was given a thorough wash with normal saline followed by manual removal of all the larvae with forceps under topical anesthesia. The disease per se in its external form is not savage; however, it is imperative for the ophthalmologists to be aware of this entity so as to institute a timely, and thorough treatment.

Key words: Ocular myiasis, Oestrus ovis, ophthalmomyiasis

How to cite this article: Singh T, Sheoran K, Arya SK. Ocular myiasis: Creepy crawlies in the eye. Cli Exp Vis Eye Res J 2020;3(2):51-53.

Received: 20-12-2020;

Accepted: 29-12-2020

Discuss a rare post-operative complication from routine cataract surgery. Routine cataract surgery is very common, retained intracameral chloramphenicol ointment is a post-operative complication that is rare but important to be aware of in practice. A 77-year-old lady was referred for routine cataract surgery. Although the case was uneventful and without intra-operative complication, follow-up the day after surgery revealed an intraocular foreign body in the form of a retained antibiotic ointment on the intraocular lens. Aspiration of the foreign body with lens exchange was performed and the patient was subsequently followed up without issue or further complication. Retained intraocular ointment can cause many deleterious effects, if addressed promptly and appropriately the patient can have a safe and satisfactory post-operative outcome.

Clinical Significance: Given the negligible evidence and the associated risks, applying ointment at the end of surgery, in our opinion, is not recommended.

Key words: Eye foreign bodies, cataract extraction

How to cite this article: Firouzbakht A, Sandhu S, Clement C. Retained intracameral chloramphenicol ointment following routine cataract surgery. Cli Exp Vis Eye Res J 2020;3(2): 54-56.

Received: 19-12-2020;

Accepted: 20-12-2020