Pakistan Journal of Ophthalmology

Assessment of Macular Ganglion Cell/Inner Plexiform Layer Thickness with Swept Source Optical Coherence Tomography in Glaucoma Patients: A Comparative Study with Retinal Nerve Fiber Layer Measurements

Asif Chandio — 2026-09-30

Purpose: To assess the thickness of Macular ganglion cell/inner plexiform layer in glaucoma patients by using swept-source OCT and compare itwith peripapillary RNFL thickness.

Study Design: Descriptive Cross-Sectional Study.

Place and Duration of Study: Liaquat University of Medical and Health Sciences Jamshorofrom June 2021 to June 2022.

Methods: Total 140 patients were enrolled in our study and divided in two groups. Group A included patients diagnosed with glaucoma and group B (control group), included non-glaucoma patients. Patients of either gender, above 30 years of age and intraocular pressure (IOP) of more than 21 mm Hg with open angle on gonioscopy were included in the study. All participants underwent examinations including visual acuity, refraction, IOP measurement, Gonioscopy, slit lamp examination with dilated fundus examination. Swept source OCT measurements Ganglion cell layer/inner plexiform layer (GCL/IPL) and Retinal nerve fiber layer (RNFL)thickness were measured. The independent t test and the chi-square were used. P-values less than 0.05 were deemed statistically significant.

Results: There were 65.7% males and a mean age of 46.8±12.08 years. Glaucoma cases showed significantly higher IOP and cup to disc ratio compared to controls (p<0.001). RNFL and GCIPL thickness was markedly reduced in glaucoma eyes versus controls (p<0.001). GCIPL demonstrated strong discriminatory ability similar to RNFL for detecting glaucomatous changes.

Conclusion: GCIPL thickness showed diagnostic performance comparable to RNFL measurements. Incorporating GCIPL assessment may enhance early and reliable detection of glaucoma.

Lid, Ocular and Orbital Lesions, Their Patterns of Presentation, Diagnosis and Therapeutic Outcome in Adults at a Tertiary Care Hospital of Karachi

Nazia Qidwai — 2026-09-30

Purpose: To determine patterns of presentation, diagnosis and therapeutic outcome of lid, ocular surface, orbital and adnexal lesions in adults at a tertiary care hospital of Karachi.

Study Design: Retrospective observational study.

Place and Duration of Study: Isra Postgraduate Institute of Ophthalmology from January 2025 to December 2025.

Methods: Medical records of patients with eyelid, ocular surface, orbital and adnexal lesions were retrieved. Lesions that did not require biopsy were excluded. Detailed history including age, gender, presenting complaints, duration and site of lesion, and provisional diagnosis, were noted for each lesion. Follow-up and biopsy reports were also included in the analysis.

Results: Out of54 records, 18 (33.3%) involved orbital masses, 25 (46.3%) involved eyelid lesions, and 11 (20.3%) had conjunctival lesions. The mean age of patients with eyelid lesions was greater (42.24 ± 13.12 years) than those with conjunctival lesions (40.27 ± 16.33 years).Recurrence was observed in 2 (11.1%) cases of orbital lesions and in 1 (4%) case of eyelid lesions. The most common orbital lesions were dermoid cysts and epidermoid cysts. Papilloma and squamous cell carcinoma (SCC) were each diagnosed in 4 (16%) cases. In conjunctival lesions, conjunctival intraepithelial neoplasia (CIN) was the most frequent diagnosis, seen in 5 (45.5%) cases, followed by dysplasia in 4 (36.4%) cases.

Conclusion: Eyelid lesions were the most common lesions. Benign cystic lesions predominated in the orbit, while both benign and malignant pathologies were observed in the eyelid.

BYNOCS Dichoptic Therapy for the management of Amblyopia

Shua Azam — 2026-09-30

Purpose: To evaluate visual acuity and stereopsis after Bynocs dichoptic therapy in amblyopic subjects.

Study Design: Descriptive observational study.

Place and Duration of Study: Laser Sight Eye Clinic, Hyderabad from February 2024 to November 2025.

Methods: Bynocs® AmblyoGo cloud-based software with Dichoptic games was utilized for amblyopia therapy. LogMAR visual acuity chart was used to measure Visual acuity.Stereopsis and binocularity were examined using the Randot Stereotest and the Worth 4-dot test, respectively, to assess depth perception and sensory fusion.The sample consisted of 9 patients who had completed the prescribed therapy regimen and had fully documented pre- and post-treatment records.

Results: Nine patients with amblyopia were included in this pilot study.Distance visual acuity improved significantly following Bynocs dichoptic therapy. Median distance visual acuity improved from 0.68 (IQR: 0.60–0.80) before therapy to 0.50 (IQR: 0.16–0.54) after therapy (Wilcoxon signed-rank test, p = 0.004). Near visual acuity also improved significantly from a median of 0.50 (IQR: 0.48–0.64) before therapy to 0.34 (IQR: 0.34–0.46) after therapy (p = 0.004). The mean improvement was 0.18 LogMAR.One participant showed measurable stereopsis at baseline, while eight participants did not. Five participants continued to exhibit no measurable stereopsis after therapy, whereas four participants showed measurable stereopsis ranging from 50 to 1200 seconds of arc.

Conclusion: Bynocs dichoptic therapy results in a statistically significant improvement in distance and near visual acuity. While depth perception remains variable and may require extended treatment.

Contrast Sensitivity Across Different Grades of Non-Proliferative Diabetic Retinopathy: A Cross-Sectional Study from Peshawar, Pakistan

Rasham Jehan — 2026-09-30

Purpose: The purpose of this study was to assess contrast sensitivity (CS) across the spectrum of Non-Proliferative Diabetic Retinopathy(NPDR) severity and explore clinical and demographic variables associated with it.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Ophthalmology, Hayatabad Medical Complex, Peshawar from October 2020 to November2021.

Methods: We enrolled 245 patients with mild, moderate, or severe NPDR, analyzing one eye per participant. Contrast sensitivity was assessed using Pelli-Robson chart, alongside a range of clinical and ocular variables including diabetic macular oedema (DME), visual acuity, HbA1c, and duration of diabetes. Differences across NPDR grades were examined using ANOVA and Kruskal-Wallis tests, while correlation analysis, multivariable linear regression, and sensitivity analyses were used to further explore the data.

Results: Mean CS showed a declining trend across mild, moderate, and severe NPDR (1.26±0.38, 1.23±0.40, and 1.13±0.39 log units, respectively), although the difference was not statistically significant (p=0.175). CS was not significantly correlated with NPDR grade. In multivariable analysis, neither DME (β=-0.251, p=0.082) nor NPDR grade (β=-0.076, p=0.526) was independently associated with CS. Excluding eyes with DME did not materially alter the findings.

Conclusion: CS showed a modest decline with increasing NPDR severity but was not independently associated with disease severity after adjustment for relevant clinical factors. It may provide complementary functional information but should not be considered an independent marker of NPDR severity.

Visual Performance after Bilateral Implantation of RayOne EMV Intraocular Lens using Micro-Monovision Strategy

Muhammad Ali Haider — 2026-09-30

Purpose: To examine the visual outcomes following bilateral Rayone enhanced mono-vision intraocular lens (EMV IOL) implantation.

Study Design: Retrospective chart review.

Place and Duration of Study: Al-Ehsan Welfare Eye Hospital, Lahore from January 2024 to December 2024.

Method: Twenty patients (40 eyes) who underwent bilateral Rayone EMV (enhanced monovision) IOL implantation were included. Uncorrected distance visual acuity (UCDVA) at 6 meters, intermediate visual acuity (UCIVA) at 66 cm, and near visual acuity (UCNVA) at 40cm were measured after three months of cataract surgery. Binocular defocus curveand patient-reported satisfaction were also analyzed.

Results: The mean age was 53.9 ± 4.5 years, with 65% males. After 3 months of IOL implantation, 90% of patients achieved UCDVA of 0.10 logMAR or better, with 70% reaching 0.00 (20/20). Ninety percent had UCIVA of 0.00 logMar or better. The defocus curve in both eyes showed a smooth functional vision from distance through -2.50D, reflecting strong performance across the visual range. In 75% of patients, spectacle independence was attained, with occasional near vision aid required in a minority. Reports of glare and halos were minimal. Patient satisfaction had mean score of 9.2/10).

Conclusion: Bilateral Rayone EMVIOL implantation with a micro-monovision strategy achieved excellent near, intermediate, and distance vision with high level of spectacle independence and minimal disturbances.

Multimodal Imaging Device Comparison for Central Corneal Thickness Assessment in Primary Open-Angle Glaucoma and Non-Glaucomatous Eyes

Teuku Muhammad Agra Setianto — 2026-09-30

Purpose: To compare central corneal thickness (CCT) in eyes with primary open-angle glaucoma (POAG) and non-glaucomatous eyes using four different devices, and to evaluate the agreement and comparability of these devices in both groups.

Study Design: Cross sectional study.

Place and Duration of Study: Tertiary hospital in Semarang City from May 2025 to February 2026.

Methods: CCT in right eye was measured using standard ultrasonic pachymetry (USP), optical coherence tomography (OCT), non-contact tono-pachymetry (NCT), and specular microscopy (SM). Differences, correlation levels, and agreement between the measurement results were assessed.

Result: A total of 69 participants participated in this study (33 patients with glaucoma and 36 without glaucoma).The mean CCT measured using NCT (580.50±27 mm), USP (578.50±26 mm), SM (569.50±28 mm), and OCT (564.50±27 mm) did not differ statistically in the non-glaucoma group. Similar results were seen in glaucoma group with NCT (528±22 mm), USP (527±22 mm), SM (518±25 mm), and OCT (518±27 mm)(p>0.05). The difference between the two groups was statistically significant (p < 0.001). A strong positive correlation was observed among the four devices within each group (p<0.001). Bland-Altman analysis comparing each device to the USP gold standard showed bias values of 2.6 (NCT), -12.03 (SM), and -6.03 (OCT) in the glaucoma group, and 9.8 (NCT), -9.1 (SM), and -14.6 (OCT) in the non-glaucoma group.

Conclusion: The CCT measurements using NCT, SM, and OCT were aligned with the USP measurements in both groups. This finding highlights that CCT monitoring may be interchangeable between devices.

Keywords: Central Corneal Thickness, Non-Contact Tono- Pachymetry, Optical Coherence Tomography Specular Microscopy, Ultrasound Pachymetry.

Evaluating the Efficacy of Topical Insulin Compared with Preservative-Free Artificial Tears in Ocular Surface Restoration among Patients with Dry Eye Disease: A Randomized Controlled Trial

Shafiq Tanveer — 2026-09-30

Purpose: To evaluate the efficacy of topical insulin (1 U/mL) compared with preservative-free artificial tears in improving ocular surface parameters in patients with Dry Eye Disease (DED).

Study Design: Randomized Controlled Trial.

Place and Duration of Study: Department of Ophthalmology,Khyber Teaching Hospital, from Peshawar.

Methods: A total of 128 patients were enrolled in a prospective, randomized, participant-masked controlled trial. Patients meeting standardized DED criteria i.e Schirmer test <10 mm, tear break-up time (TBUT) <10 seconds, ocular surface disease index (OSDI >20) were randomized 1:1 to topical insulin group (IDG) or carboxymethylcellulose 0.5% artificial tears group (ATG), four times daily for 12 weeks. Primary outcome was the proportion achieving OSDI ≤20. Secondary outcomes were Schirmer test and TBUT. Repeated measures ANOVA and intention-to-treat analysis were performed.

Results: At 12 weeks, 89.06% of IDG patients achieved OSDI ≤20 versus 40.63% in the ATG (RR: 2.19, OR: 11.90). Schirmer test improvement was significantly greater in the IDG (4.75 ± 1.64 mm vs. 2.41 ± 1.24 mm), as was TBUT (4.34 ± 1.88 vs. 2.73 ± 2.28 seconds;). The insulin advantage was most pronounced in females, patients under 40, those with diabetes, and those with severe baseline OSDI >32. No major adverse effects were reported.

Conclusion: Topical insulin (1 U/mL) is significantly superior to artificial tears in improving tear production, tear film stability, and symptom burden in DED. These findings make it a cost-effective suitable option for DED in lower-middle income countries.

Sub-threshold 577-nm Yellow Laser treatment in Central Serous Chorioretinopathy (CSCR): Bridging the Therapeutic Gap in Resource-Constrained Settings

Mariam Kashif — 2026-09-30

Purpose: To assess the anatomical and functional outcomes of sub-threshold 577-nm yellow laser in patients with Central serous chorioretinopathy (CSCR).

Study Design: Interventional case series.

Place and Duration of Study: POB Eye Hospital, Karachifrom February 2025 to July 2025.

Methods: This study involved 35 patients with CSCR clinically diagnosed and confirmed on OCT. The patients were subjected to sub-threshold 577 nm yellow laser in neurosensory detachment areas. The best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT) were assessed at baseline, 1, 3, and 6 months after therapy. Acute (<3 months) and chronic (>3 months) CSCR were analyzed separately.

Results: A total of 35 participants were involved in the study, with amean age of 41.2 ± 6.5 years. There were 80% males. Twenty-three participants (65.7%) had acute CSCR, and 12 (34.3%) had chronic CSCR. The BCVA improved significantly from 0.30 (0.25-0.35) to 0.00 (0.00-0.08) logMAR (p < 0.001) at 6 months, and CMT reduced from 0.426 ± 87um to 0.259 ± 64 um at 6 months (p < 0.001). Acute cases had better anatomical recovery and reduced CMT than chronic cases, but there were no differences between visual gains in acute and chronic cases. No negative effects of lasers were found.

Conclusion: Sub-threshold 577-nm yellow laser therapy is safe and effective in the treatment of acute and chronic CSCR, as it leads to resolution of subretinal fluid and improvement in visual acuity.

Agreement of Central Corneal Thickness and Anterior Chamber Depth between Oculus Pentacam and Advanced Anterior Segment Optical Coherence Tomograph (CSO MS-39)

Ayesha Bibi — 2026-09-30

Purpose: To access the agreement between central corneal thickness and anterior chamber depth using two anterior segment imaging devices, Oculus Pentacam and CSO MS-39.

Study Design: Cross-sectional study.

Place and Duration of Study: Amanat Eye Hospital from July 2025 to October 2025.

Methods: A total of 263 patients were included through consecutive sampling. Patients aged 18 years or above having clear corneas, no active ocular surface disease and no history of ocular surgery or corneal refractive procedures were included in this study. Central corneal thickness (CCT) and anterior chamber depth (ACD) were determined for each eye using the Oculus Pentacam and Advanced Anterior Segment Optical Coherence Tomograph (CSO MS-39). Paired t-test, Correlation analysis, and Bland-Altman plots were used to estimate mean differences and limits of agreement between the two devices.

Results: The paired t-test showed no statistically significant changes between Pentacam and MS-39 for CCT and ACD measurements. The CCT mean difference was -0.51µm (p=0.4189), while for ACD the mean difference was -0.0154mm(p=0.2115). Interclass correlation analysis demonstrated excellent reliability for both CCT (ICC = 0.956, 95% CI: 0.945–0.966) and ACD (ICC = 0.813, 95% CI: 0.768–0.851) values. Bland-Altman analysis showed relatively low mean bias with 95% limits of agreement.

Conclusion: The Pentacam and MS-39 showed good agreement in measuring CCT and ACD, with no systematic bias and no statistically significant differences. These findings support the use of either instrument for routine clinical evaluation andclinical decision making.

Ocular Biometry: Surgical Implications in Primary Pediatric Cataract

Saleh A. Al-Khaldi — 2026-09-30

Purpose: To evaluate ocular biometric characteristics and assess the predictability of refractive outcomes following intraocular lens (IOL) implantation in children.

Study Design: Retrospective chart review.

Place and Duration of Study: Tertiary care hospital in Riyadh, Saudi Arabia from 2021 to 2024.

Methods: This study included children aged 1-6years who underwent cataract surgery with primary or secondary IOL implantation. Demographic, biometric, and refractive data were extracted. Prediction error (PE) was defined as predicted minus actual post-operative spherical equivalent (SE), while absolute prediction error (APE) represented the magnitude of deviation irrespective of direction.

Results: A total of 359 eyes from 235 patients were analyzed. The mean age at IOL implantation was 2.90±1.25 years. The mean axial length (AL) was 21.58±1.60mm, mean keratometry (K) was 44.22±2.44D and mean post-operative spherical equivalent (SE) was 1.82±3.12D, compared to a predicted SE of +1.80±1.77D. The mean PE was -0.34±3.15D, and the mean APE was 2.40±2.1D, reflecting substantial variability in refractive outcomes. Myopic shift was observed at ages 2 and 6years, whereas hyperopic trends predominated at ages 1,3,4, and 5years. The highest APE was noted at 2y of age. No statistically significant differences in PE and APE were observed across age groups (p>0.05). A mild positive correlation was found between PE and AL (rho=0.186, p=0.006) and a weak negative correlation was observed between PE and K(rho=-0.150, p=0.03).

Conclusion: Despite minimal mean prediction error, refractive outcomes following pediatric cataract surgery remain highly variable.

Hyperopic Surprises in Children Undergoing Cycloplegic Autorefraction: A Cross-Sectional Study from an Eye Clinic in Jalalpur Jattan, Pakistan

Abdullah Murtaza — 2026-09-30

Purpose: To determine the frequency and magnitude of hyperopic surprises in children and to evaluate associated demographic and clinical correlates.

Study Design: Descriptive observational study.

Place and Duration of Study: EyeclinicinJalalpurJattan,Pakistan, from March 2025 to August 2025.

Methods: A total of 410 consecutive pediatric patients, 1–16 years of age were included. Non-cycloplegic auto refraction followed by cycloplegic autorefraction was performed after instillation of cyclopentolate hydrochloride 1%. A cycloplegic shift of ≥+0.50 diopters (D) wereconsidered a clinically significant hyperopic surprise. Data were analyzed using paired t-test, one-way ANOVA, McNemar's test, and Pearson's correlation (SPSS v26;
p < 0.05).

Results: Mean agewas8.6 ± 3.9 years and 52.2%were male.Ahyperopicsurprisewas identifiedin 61.7% (95% CI: 57.0–66.4%). Mean cycloplegic SE shift was +0.73 ± 0.67 D. Hyperopia frequency rose from 18.6% to 53.2% post-cycloplegia (p < 0.001). Children aged 1–5 years showedthegreatestmeanshift(1.18±0.85D)versus6–10years(0.74±0.63D)and11–16years (0.52±0.48D;ANOVA,p<0.001).Amongchildrenclassifiedasmyopicoremmetropicwithout cycloplegia,65.3%werereclassifiedashyperopic.Nosignificantsex-baseddifferencewasfound (p = 0.617). A moderate negative correlation existed between hyperopic surprise magnitude and uncorrected visual acuity (r = −0.47, p < 0.001).

Conclusion: Non-cycloplegic autorefraction substantially underestimates hyperopia in children and produces clinically significant refractive miscalculations. Cycloplegic refraction is indispensable for accurate pediatric refractive assessment, particularly in preschoolchildren.

Role of Combining Suprachoroidal Triamcinolone with Intravitreal Bevacizumab on Refractory Diabetic Macular Edema

Muhammad Irfan Karamat — 2026-09-30

Purpose: To evaluate the effectiveness and safety of combination therapy using suprachoroidal triamcinolone acetonide (TA) and intravitreal bevacizumab in patients with refractory diabetic macular edema (DME).

Study Design: Interventional case series.

Place and Duration of Study: Ibrahim Eye Center, from December 2024 to September 2025.

Methods: This interventional case series included ten eyes with refractory DME that remained unresponsive despite receiving at least three previous intravitreal anti-VEGF injections. All patients received a single session of combination therapy consisting of intravitreal bevacizumab (1.25 mg/0.05 mL) and suprachoroidal triamcinolone acetonide (4 mg/0.1 mL). Central subfield thickness (CST) was measured using optical coherence tomography (OCT) at baseline and eight weeks after treatment. Changes in CST and treatment-related adverse events were evaluated.

Results: There were 5 males and 5 females, all with uncontrolled type II diabetes mellitus (HbA1c >6.5%). The duration of diabetes ranged from 12 to 17 years, with a mean of 14.3±2.7 years. Mean CST decreased significantly from 667.5±150 µm at baseline to 363.4±150.22µm at eight weeks following treatment (p = 0.006). Eight eyes (80%) achieved a reduction in CST of at least 50µm. No serious ocular or systemic adverse events were observed. A transient rise in intraocular pressure occurred in two patients and was successfully controlled with topical anti-glaucoma medication.

Conclusion: Combination therapy with suprachoroidal triamcinolone acetonide and intravitreal bevacizumab produced significant anatomical improvement in refractory DME with a favorable safety profile.

Assessing The Impact of Vision Therapy in Pediatric Age Group on The Rate of Myopia Progression: A Randomized Control Trial

Jamshed Ali — 2026-09-30

Purpose: To evaluate the effect of a structured vision therapy program in children with myopia by assessing its impact on refractive error progression, axial length, corneal curvature, and binocular visual function.

Study Design: A randomized control trial.

Place and Duration of Study: School of Allied & Health Sciences CT University, Ludhiana, Punjab. from February 2025 to January 2026.

Methods: This study included children aged 10–14 years with progressive myopia (–0.50 D to –6.00 D). Children who had previously undergone treatment for myopia andthose with eye and systemic diseases that could affect their vision were excluded from the study. Spherical equivalent refraction(SER) was measured using cycloplegic autorefraction at baseline, 3rd and 6th month of treatment with an average of three repeated measurements for each eye. Secondary endpoints included axiallength (AL), cornealcurvature,and binocular vision.

Results: The study included 100 children (mean age, 12.12 ±1.44 years) including 49 males 51 females. Stability of SER was seenin patients with vision therapy (-0.05 D; 95% CI: -0.20 to -0.1 D; P<.05).Between-group comparisons revealed statistically significant differences in primary outcomes. Axial elongation of the eye in the therapy group was moderate (+0.10 mm; 95% CI: +0.05 to +0.15 mm; P=.02), while the control group had a large progression of SER and AL (-0.75 D; 95% CI: -0.95 to -0.55 D; P<.001).

Conclusion: Vision therapy resulted instability of SER, AL and corneal curvature compared to the control group. Participants receiving the therapy demonstrated clinically significant improvement in controlling myopia progression.

Prophylactic Intravitreal Bevacizumab before Cataract Surgery in Diabetics: Effect on Postoperative Macular Thickness

Usman Rasheed — 2026-09-30

Purpose: To assess whether preoperative intravitreal bevacizumab reduces central macular thickness after phacoemulsification in patients with diabetes.

Study Design: Quasi Experimental Study.

Place and Duration of study: Department of Ophthalmology, Gujranwala Medical College from March 2023 toSeptember 2023.

Methods: Ninety diabetic patients aged 30–55 years scheduled for phacoemulsification were enrolled in this study. Participants were assigned 1:1 to receive 1.25mg/0.1ml intravitreal bevacizumab one week before phacoemulsification or to undergo phacoemulsification without injection. Patients having complicated cataracts and any stage of diabetic retinopathy including clinically significant macular edema were excluded. Spectral-domain OCT measured central macular thickness at baseline and 30 days postoperatively. Analysis used SPSS v25. Statistical significance was set at p ≤ 0.05.

Results: Study included 19 males and 71 females. Baseline thickness did not differ between groups. On day 30, mean thickness was 254.98 ± 8.12 µm in the bevacizumab group versus 279.27 ± 7.22 µm in the control group,
p < 0.0001. The difference remained significant across age, sex, and comorbidity subgroups.

Conclusion: Preoperative bevacizumab significantly limited postoperative macular thickening in diabetic patients undergoing cataract surgery.

Uveitis in Rheumatologic Practice: A Window to Systemic Autoimmune Disease and Collaborative Care

Nauman Ismat Butt — 2026-09-30

The relationship between rheumatology and ocular inflammation has evolved significantly over recent decades. Uveitis is now recognized as one of the most important extra-articular manifestations of several rheumatologic conditions including spondyloarthritis, juvenile idiopathic arthritis, Behçet disease, sarcoidosis, inflammatory bowel disease-associated arthritis and systemic vasculitides. Every episode of uveitis represents more than an ocular inflammatory event; it may be the first visible sign of an underlying systemic immune disorder, placing ophthalmologists in a unique position to identify patients who require rheumatologic evaluation. Conversely, rheumatologists must recognize that ocular symptoms may represent an urgent manifestation requiring immediate ophthalmic assessment. Strengthening collaboration between ophthalmologists and rheumatologists should therefore become a priority in modern clinical practice. By building integrated care pathways, improving education and ensuring access to appropriate therapies, we can transform uveitis from a cause of preventable blindness into a model of successful multidisciplinary disease management.

Re-Designing Direct-Entry Ophthalmic Education: Bachelor of Ophthalmic Medicine & Surgery (BOMS)

Hargun Das Lakhani — 2026-09-30

The ophthalmic care vacuum and provision of ophthalmic services in the third world and especially in Pakistan has come to a crossroads. According to the International Council of Ophthalmology, there are 1,860 Ophthalmologists in Pakistan with work ratio of 11 ophthalmologists per million.¹Nadir et al, surveyed 420 Pakistani medical students and found that 33.3% planned to leave Pakistan after graduation.² Meo & Sultan also documented the migration of 31,418 doctors from Pakistan between 1971 and 2022.³These studies suggesta significant “brain drain” of medical graduates who emigrate shortly after earning their degrees.Besides, 70% of ophthalmologists reside in urban areas, while 70% of the population lives in rural areas.¹

Adoption, Challenges, and Future Prospects of Tele-optometry: A Comprehensive Review

Roshni Sengupta — 2026-09-30

The ongoing problem of blindness and low vision affects India because rural areas lack sufficient access to eye care facilities. Tele-optometry involves the provision of eye care through communication media. People in remote regions with no access to eye care services show increasing demand for immediate medical attention which drives the growing acceptance of this solution. This review studies existing research on tele-optometry and teleophthalmology while examining three main topics which include adoption models, implementation frameworks and patient perceptions. The systematic search which followed PRISMA guidelines identified 24 open-access studies that Google Scholar, PubMed and ResearchGate published between 2014 and 2024. The operating capacity of tele-optometry depends on three essential requirements which include reliable digital infrastructure, secure data management and user acceptance by both clinicians and patients which enables early detection of eye conditions in while decreasing the number of preventable blindness and vision impairment cases.

Micro Pulse Transscleral Cyclophotocoagulation for Refractory Silicone Oil–Induced Glaucoma Complicated by Toxic Keratopathy: A Case Report

Monica Rizky Wigianita — 2026-09-30

Silicone oil (SO) tamponade is often used in complex retinal detachment surgeries and can cause secondary glaucoma through various mechanisms, including pupillary block, trabecular obstruction, and chronic inflammation. We present a case of a 35-year-old man with refractory glaucoma in his right eye after the second procedure of pars plana vitrectomy with SO tamponade. His intraocular pressure (IOP) was elevated to 47 mmHg despite maximum medical therapy and unsuccessful laser peripheral iridotomy. MicroPulse Transscleral Cyclophotocoagulation was performedtwice with an interval of five months and the IOP gradually decreased to 16-22 mmHg. Long-term use of antiglaucoma medications containing preservatives causes toxic keratopathy with chronic epithelial defects. The patient required both ocular surface management and a medication switch to preservative-free antiglaucoma medication. This case highlights the therapeutic challenges in glaucoma management including ocular surface diseases especially after anti-glaucoma therapy and surgical intervention.

Sequential Anti-VEGF Therapy for Recurrent Choroidal Neovascularization Secondary to Choroidal Osteoma: A Case Report

Muhammad Saad Aziz — 2026-09-30

Choroidal osteoma is a rare benign ossifying choroidal tumor associated with vision-threatening complications, most commonly choroidal neovascularization (CNV). CNV secondary to choroidal osteoma can be difficult to manage due to high recurrence rates and variable response to treatment.A 35-year- old woman presented with curtain-like superotemporal visual field loss in her right eye without associated visual acuity loss. Upon examination, best-corrected visual acuity was 6/6 OU. Multimodal imaging confirmed the diagnosis of choroidal osteoma with secondary CNV. Patient initially responded well to sequential intravitreal anti- vascular endothelial growth factor (anti-VEGF) therapy; however, recurrence of CNV required switching treatment modalities to a newer- generation anti-VEGF agent. Five months after the treatment switch, the patient was asymptomatic with stable examination findings. Multimodal imaging allowed for confident diagnosis while newer-generation anti-VEGF agents appeared successful in managing recurrent CNV secondary to choroidal osteoma.

Scleral Contact Lens Research in Keratoconus: A Bibliometric Analysis

Nidhi Pandya — 2026-09-30

This bibliometric study evaluated research trends on binocular vision dysfunction in keratoconus, with particular emphasis on knowledge gaps related to scleral contact lenses. A comprehensive Scopus search identified English-language original articles and reviews published between 2000 and 2025. Bibliometric mapping was performed using VOS viewer. A total of 334 publications were analyzed. Research output increased substantially after 2019, reflecting growing interest in scleral lens technology, lens design, corneal optics, and optical correction. Approximately 15 highly productive authors contributed prominently, with most studies published in specialized contact lens journals. However, keyword co-occurrence analysis revealed minimal focus on binocular visual function, with terms such as stereopsis, vergence anomalies, binocular coordination, and binocular dysfunction largely absent. These findings highlight a significant knowledge gap and underscore the need for future studies evaluating binocular visual outcomes in keratoconus patients fitted with scleral lenses.