Thyroid eye disease (TED) is a heterogeneous autoimmune reaction typically occurring in the orbit of middle age group. The orbital inflammation of Graves' disease may parallel or remain isolated from a related inflammatory reaction in the thyroid gland. Development and severity of TED may dependent to both endogenous (genetic factors, increased age, male sex) and, or exogenous factors (smoking, thyroid dysfunction, and radioiodine treatment). Although rescue medical therapy for severe TED is often initiated with glucocorticoids, steroid-sparing medications may be an alternative area of efficient treatment.

Background: Professionalism is an important competence to be taught and assessed for ophthalmology residents; however, presently, there is no structured curriculum available for the same in India. Objectives: This educational research project was undertaken to develop, implement, and evaluate a formal training in professionalism for ophthalmology residents using reflections and role-plays on simulated patients before using it on real patients. Materials and Methods: This interventional study with pre- and post-intervention assessment was conducted from November 01, 2014, to March 31, 2015, with study sample of 12 residents in Ophthalmology Department of a Medical College in Western India. A resident professionalism log-book was prepared to document the course objectives, course outline, student groups, evidence-based rationale, and specific professionalism behaviors to be learned. Training modules were prepared and validated. Interactive lectures by subject experts, reading assignments, and seminars were used to teach basics of professionalism. Specific professionalism behaviors such as empathy, altruism, and informed consent were practiced using demonstration videos, role-plays, and reflections on their learning. Results: There was statistically significant improvement in resident's perceived importance of professionalism (P < 0.005). Mini-clinical evaluation exercise encounters observed were 71 with mean scores of 5.48, 5.45, and 4.81 on a 9-point scale for empathy, altruism, and informed consent, respectively. 100% faculty and residents were satisfied with this training program. Resident portfolios showed improvement in their humanistic/professionalism qualities. Conclusion: There is a need to have a structured training module for professionalism. Combination of reading assignments, interactive lectures, seminars, demonstration videos, role-plays, and reflections are effective methods to teach professionalism. Seeing the impact of this project, we have decided to continue it in future and also disseminate it to other departments.

Background: Uncorrected refractive errors continue to remain a public health problem in the different population groups. Among children, it has a considerable impact on learning and academic achievement, especially in under-served communities. Optical correction of refractive errors in children is indicated when the refractive errors are sufficiently large to cause amblyopia or impairing the child's ability to function normally. Objective: The study aimed to investigate the distribution pattern of refractive errors and related visual impairment due to amblyopia in children. Materials and Methods: The recorded data of 183 children examined at optical center during the period (2007-2011) were reviewed and analyzed to show refractive status. The examination included visual acuity measurements, cover test, and noncycloplegic refraction (retinoscopy and/or autorefraction). The best-corrected visual acuity was noted. Results: The age range of children was 5-15 years, of whom 72 (39.3%) were males and 111 (60.7%) females. There was no significant difference in the correction of the two eyes and no gender associations. In this study, 97 (53.0%) were myopic, 17 (9.3%) hypermetropic, 42 (22.9%) pure astigmatic, and 27 (14.8%) normal. An adequate improvement of vision after correction in each eye reached 1.0 (6/6) achieved in 123 (67.2%) children (P < 0.0001) while binocular amblyopia found in 46 (25.2%) children and monocular amblyopia found in 14 (7.6%). Cover test mainly for near showed 126 (68.9%) children with associated exophoria, 7 (3.8%) with esophoria, and other 7 (3.8%) have manifest strabismus, and only 43 (23.5%) have orthophoria. Conclusions: Significant refractive errors revealed among children aged 5-15 years. Therefore, there is a need to have eye examination in school-age children at least at the commencement of school so as to early tackle disabilities due to amblyopia in children.

Purpose: To study the compliance of contact lens (CL) wearers and the prevalence of CL-related ocular complications. Materials and Methods: This was a cross-sectional study conducted from December 2012 to May 2013 which included CL wearers coming to outpatient department or emergency department where these patients underwent ophthalmic examination. An interview was performed about the use and care of CLs. Results: The study included 102 patients, where 26 (25.50%) were men and 76 (74.50%) were women. Patient's ages ranged from 13 to 55 with an average (mean ± standard deviation) 29.48 years. Results showed myopia in 41 (40.19%), hyperopia 13 (12.74%), astigmatism 37 (36.27%), keratoconus 8 (7.84%), and others 3 (2.94%). More than 2/3 of the patients had, at least, one complication in their eyes. The average complication rate of gas permeable (GP) lenses was significantly (P < 0.04) lower than soft CLs (SCLs) (0.75). The most common complications were papillae, giant papillary conjunctivitis, conjunctival injection, corneal infiltrates, and corneal abrasions in both GPs and SCLs wearers. Silicone SCLs had a lower average number of complication rates per eye (0.73) than nonsilicone SCLs (0.76), but the difference was not statistically significant (P = 0.19). Extended wear CL use was associated with higher complication rate (86.84%) as compared to daily wear CL use (67.85%) and it was statistically significant (P < 0.03). Conclusion: Use of CL is associated with ocular complications. Most of these complications are minor and easily manageable. It is advised that patients should adhere with the recommendations of both manufacturer and optometrist to avoid complications.

Background: Understanding the clinical profile of keratoconus is important in the diagnosis and management of the disease. Aim: This study aimed to investigate the clinical characteristics of keratoconus patients in Sudan with respect to age and gender. Materials and Methods: Clinical records of keratoconus patients were retrospectively reviewed in a period between April and June 2015. Records were collected from Makkah Eye Complex, Alwaledain Eye Charity Hospital and Sudan Eye Center, Khartoum City. Parameters investigated included patient's demography, keratometric readings, visual acuity, and manifest refraction. Classification of keratoconus was based on Amsler-Krumeich grading system. Results: A total of 208 patients' record was found diagnosed with keratoconus. The mean age of subjects was 21.43 ± 8.91 years. Around 78% of subjects were found with bilateral keratoconus. Analysis showed that keratoconus is more common in males (55.8%) than in females (44.2%) and manifest in young age (late teenage and early 20s). Age was not correlated with disease severity (P > 0.05). No significant difference was found between both genders in term of age, visual acuities, and severity of keratoconus (P > 0.05). Conclusion: Clinical profile of Sudanese keratoconus patients looks similar to that reported earlier worldwide.

Purpose: To determine whether central corneal thickness (CCT) is correlated to severity of visual field (VF) loss among patients of primary open-angle glaucoma (POAG) at initial evaluation. Materials and Methods: One hundred and two eyes with POAG were recruited in this cross-sectional study. Humphrey field analysis, applanation tonometry, and CCT measurement were done in all subjects. Based on severity of VF loss, the sample was split into mild (n = 55), moderate (n = 21), and severe VF loss (n = 26) as per Anderson-Patella criteria. For each of the three groups, calculated mean values were compared using analysis of variance (ANOVA). Results: The sample contained 102 eyes of 102 patients which were divided into groups of mild, moderate, and severe VF loss. The mean (±standard deviation [SD]) CCT for Group I was 543.07 μm (±24.60), for Group II was 539.24 μm (±22.30), and for Group III was 536.11 μm (±22.86). The mean (±SD) mean deviation for Group I was –2.78 dB (±1.65), for Group II was −8.91 dB (±2.18), and for Group III was –21.47 dB (±5.98). When analyzed, the mean differences of CCT in patients with mild, moderate, and severe VF involvement were not statistically significant (ANOVA, P = 0.43). Conclusion: We failed to find any significant association between CCT and severity of VF defect in the eyes with POAG.

Context: Globally, there are 366 million patients living with Type 2 diabetes mellitus (DM), of which, 62.4 million are living in India alone. Thus, diabetic keratopathy is an important entity for all ophthalmologists. Aims: The study aims to identify variables associated with Type 2 DM, which correlate well with specular microscopy parameters. Settings and Design: This is a population-based case–control study aimed at determining the correlation between severity of DM Type 2 and corneal morphology. Subjects and Methods: After obtaining informed consent, detailed history of onset, duration, and treatment of Type 2 DM was ascertained. A comprehensive eye examination was done including specular microscopy using noncontact technique. Blood investigations were performed by the endocrine department for documenting whether disease was controlled or not. Statistical Tests: Unpaired t-test and linear regression analysis were used to determine the effects of multiple variables on the various specular microscopy parameters. Results: There were 100 eyes of diabetic patients with the mean age of 52.02 years, and 100 eyes of nondiabetic subjects with the mean age of 54.76. Short-term glycemic control parameter such as fasting blood sugar (FBS) and postlunch blood sugar (PLBS) showed no correlation with three specular microscopy parameters. However, HbA1c and severity of diabetic retinopathy influenced those parameters significantly. Conclusions: Corneal endothelium in diabetic patients was compromised, and it correlated well with the long-term glycemic control (HbA1c) but not with the short-term glycemic control (FBS, PLBS) or the duration of disease.

A 26-year-old female presenting with unilateral loss of vision, was incidentally detected to have peripheral corneal thinning, clinically diagnosed to be Terrien's marginal degeneration in the right eye. Unusual presentation of a rare disorder, which is usually more common in males and bilateral, although asymmetrical.