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To compare the performance of OSDI and SPEED questionnaires in a non-clinical sample in Pakistan. SPEED and OSDI questionnaires were simultaneously administered to a sample of 600 participants in Pakistan with an average age of 31.0 ± 10.1 years. Mean SPEED scores were calculated according to the OSDI categories and were found to be 3.33 ± 3.44, 5.45 ± 3.77, 7.86 ± 4.33, and 9.39 ± 4.56 for the normal, mild, moderate, and severe groups, respectively. Using Cronbach's alpha, the total OSDI and SPEED scores were calculated to be 0.924 and 0.879, respectively. A receiver operating curve was plotted, and the area under the curve (AUC) was estimated to be 0.791. Using this curve, the cutoff score for the SPEED questionnaire was found to be 4.00 (P < 0.001). The SPEED questionnaire can be used as an effective alternative to the OSDI.

The aim of this study was to assess the effects of age, gender, axial length and retinal thickness on the vascular density in a normal population using the Optovue optical coherence tomography angiography (OCT-A). A total of 209 eyes of 209 healthy subjects were scanned using the OCT-A on an outpatient basis. Patients were 20-75 years of age. The built-in software covered a 3×3 mm circle centered at the macula. The circle was divided into five sectors: a 1 mm central foveal circle and an upper, lower, nasal and temporal sector each spanning 1-3 mm away from the central circle. The vascular density (VD) at the superficial capillary plexus was measured, which spanned from the inner limiting membrane to the inner plexiform layer. The fovea was the least dense area (32.5%±5.9%), and the temporal area was the densest (52.4%± 4.4%). Similarly, the fovea was the thinnest part of the retina (237.8±20.7 µm); however, the nasal sector was the thickest (308.5±15.1 µm). We found a correlation of the retinal thickness ( =0.541, <0.001) with VD only at the fovea. Similarly, males had a greater density at the fovea ( =0.002). All regions significantly and negatively correlated with age even after adjusting for axial length. The age sees a decline in the density after the fifth decade where the variability also seems to increase. This study provides normative data for the Pakistani population. Additionally, it demonstrates that VD is affected by the retinal thickness at the fovea and the density begins to decline after the fifth decade.

To quantify and assess the reproducibility of the corneal stromal thickness profiles captured by the SD-OCT. Secondly, we correlated the zonal thicknesses to the age, gender and axial length. We included 227 normal eyes of 227 patients with a maximum hypermetropia of +5 and myopia of -6 diopters (D). Subjects with an intraocular pressure exceeding 22 mm Hg, evidence of cataract formation, history of ophthalmic surgery or disease were excluded. Lastly, reproducibility was evaluated in a subset of 50 participants by means of an identical scan protocol repeated by 2 different OCT operators. Stromal values were consistently thicker in the peripheral cornea (p<0.001). Age was negatively correlated with approximately every sector of the stroma with notable exceptions of the center (r=0.117, p=0.088) and the superior inner (r=0.057, 0.409), middle (r=0.086, p=0.209) and outer locations (r=0.120, p=0.079). There was no statistical significance in most sectors when looking at the axial length, gender and K1/K2. This method was highly reproducible in terms of both the ICC and COV. Corneal stromal mapping is highly reproducible and shows a negative correlation to age. Additionally, the periphery of the stroma is consistently thicker to the center. Other variables like gender and axial length show no relationship to the corneal stroma.

Celiac disease (CD) is an autoimmune condition that mainly affects the small intestine and often leads to issues with nutrient absorption. People with CD commonly experience symptoms like diarrhea, bloating, stomach pain, fatty stools, unintended weight loss, and low iron levels. In addition to its intestinal manifestations, CD is also associated with a range of extraintestinal features and comorbid conditions. Although uveitis is a rare manifestation of CD, we report, to our knowledge, the first documented case from Pakistan of posterior uveitis secondary to CD in an 11-year-old girl. The patient presented to the OPD with complaints of a gradual, painless loss of vision in both eyes over a four-month period. Notably, she exhibited no associated ocular, GI, or malabsorptive symptoms. On examination, her best-corrected visual acuity was 6/24 in the right eye and hand movement only in the left eye. Ocular findings included bilateral +1 anterior chamber cells without keratic precipitates, posterior synechiae, or iris nodules. The anterior segment inflammation was accompanied by bilateral vitritis, vasculitis, choroiditis, and optic disc atrophy. A multidisciplinary team was assembled to rule out other potential causes of uveitis and to develop a treatment plan. Despite oral and topical corticosteroids, there was no significant control of intraocular inflammation. Immunosuppressive therapy was initiated, but disease progression continued, ultimately resulting in complete vision loss. Typically, children with CD who present with classic symptoms, such as bloating and diarrhea, are promptly diagnosed and treated. However, patients without these hallmark intestinal symptoms may remain undiagnosed, potentially leading to irreversible complications like severe vision loss. This case, along with previous reports in the literature, highlights the importance of considering CD in the differential diagnosis of uveitis, even in the absence of GI symptoms, particularly in patients who are unresponsive to standard steroid therapy and after exclusion of other known causes of uveitis.

To map and view the effects of age, gender, and axial length on seven individual retinal layers around the optic nerve head (ONH). We scanned 242 healthy patients using the Spectralis spectral domain optical coherence tomography in an outpatient setting. The layers were observed on the Early Treatment Diabetic Retinopathy Study sectors using the standard Spectralis Family Acquisition Module 6.0.11.0. The center was the ONH, the inner circle (IC) was 1-3 mm away, and the outer circle (OC) was 3-6 mm away. The seven layers were retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), and retinal pigment epithelium (RPE). Additionally, we calculated the mean thickness of two combined layers: inner retinal layer (IRL) and photoreceptor layer (PL). Finally, we measured the mean of the total retinal thickness (TRT). The TRT was highest at the inferior end in the IC and at the nasal end in the OC. The RPE ( <0.001) and PL ( <0.001) were thicker in males; however, the IRL ( =0.015) was thicker in females. We found that the RNFL ( <0.001, =0.139), GCL ( <0.001, =0.116), IPL ( =0.016, =0.059), INL ( <0.001, =0.104), OPL ( =0.009, =0.064), ONL ( <0.001, =0.157), RPE ( =0.001, =0.079), IRL ( <0.001, =0.190), PL ( =0.030, =0.053), and TRT ( <0.001, =0.191) correlated negatively with age. The axial length significantly and negatively correlated at the GCL ( =0.003, =0.093), IPL ( =0.020, =0.072), INL ( =0.018, =0.073), ONL ( <0.001, =0.110), IRL ( =0.003, =0.092), and TRT ( =0.003, =0.094). We found poor reproducibility in the IC; however, this was excellent in the OC. We found significant differences in layers according to age, gender, and axial length. Additionally, reproducibility can be improved by altering the algorithm to account for the ONH parameters.

To quantify and view the possible influence of demographic variables on normal macular layers. Additionally, we wanted to assess the reproducibility using the Spectralis SD-OCT. A Spectralis SD-OCT machine using a commercially available algorithm was used to scan 242 healthy subjects in an outpatient setting. We examined retinal thicknesses in seven layers: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL) and retinal pigment epithelium (RPE). Combined retinal thicknesses were expressed as inner retinal layer (IRL), photoreceptor layer (PL) and total retinal thickness (TRT). Measurements were taken from each of the nine sectors defined by the Early Treatment Diabetic Retinopathy Study; the center was the fovea, the inner circle (IC) was 1-3 mm away, and the outer circle (OC) was 3-6 mm away. The TRT was thickest inferiorly in the IC, and superiorly in the OC. The RNFL ( =0.030), GCL ( =0.006), IPL ( =0.006), IRL ( =0.030), PL ( <0.001) and TRT ( =0.001) were found to be thicker in males. The GCL ( =0.078, =0.001), IPL ( =0.079, =0.001), IRL ( =0.072, =0.002), PL ( =0.076, =0.001) and TRT ( =0.090, <0.001) were found to decrease with age. The INL ( =0.060, =0.010), ONL ( =0.078, =0.001), and RPE ( =0.066, =0.004) were inversely related to axial length. Excellent reproducibility was observed in all layers. Our study shows differences in various retinal layers according to age, gender, and axial length. Additionally, we demonstrate excellent reproducibility of this algorithm using the Spectralis SD-OCT.

Central corneal thickness (CCT) can be used to assess the corneal physiological condition as well as the pathological changes associated with ocular diseases. It has an influence on the measurement of intraocular pressure and is being used as a screening tool for refractive surgery candidates. The aim of this study was to determine the median CCT among normal Pakistani population and to correlate CCT with age, sex, and refractive errors. We conducted a retrospective analysis of 5,171 healthy eyes in 2,598 patients who came to Hashmanis Hospital, Karachi, Pakistan. The age of the patients ranged from 6 to 70 years. The refractive error was gauged by an auto-refractometer, and CCT was measured using Oculus Pentacam . The median CCT of our study was 541.0 μm with an interquartile range (IQR) of 44.0 μm. The median age was 26.0 years (IQR: 8.0). Median spherical equivalent (SE) of the patients was -4.3 D (IQR: 3.3) with the median sphere value as -4.0 D (IQR: 3.8). Lastly, the median cylinder was -1.0 D (IQR: 1.3). Age has a weak negative correlation with CCT ( =-0.058) and shows statistical significance ( <0.001). Additionally, males had thinner CCT readings than females ( =0.001). The cylinder values, on the other hand, had a significant ( =0.004) and positive correlation ( =0.154). Three values showed no significant correlation: sphere ( =0.100), SE ( =0.782), and the left or right eye ( =0.151). Among the Pakistani population, CCT was significantly affected by three variables: sex, age, and cylinder. No relationship of CCT was observed with the left or right eye, sphere, and SE.

To compare refractive outcomes, visual acuities, and satisfaction of patients between those treated with laser-assisted in situ keratomileusis (LASIK) using a Hansatome microkeratome (HM) and femto-assisted laser (FAL). This was a retrospective analysis of 1,366 eyes in 687 patients who underwent LASIK with an HM (n=1,137) and an FAL (n=229) at the two centers of Hashmanis Hospital, Karachi, Pakistan. Refractive outcomes, including sphere, cylinder, and spherical equivalent in diopters (D), and visual acuities were assessed both preoperatively and at 1 month follow-up. Patient satisfaction was gauged by contacting the patient at the time of chart review. The postoperative median sphere, cylinder, and spherical equivalent values for those treated with FAL were 0.3±0.7 (-5.5-1.8), -0.5±0.6 (-5.0-1.0), and 0.0±0.7 (-6.0-1.6), respectively. For the HM arm, they were 0.0±1.28 (-10.8-6.8), -0.5±0.5 (-4.5-1.5), and -0.3±1.3 (-11.6-6.8), respectively. All preoperative values were statistically insignificant between the groups, while postoperative values were significant with -values <0.001. Predictability and efficacy index was higher for the FAL (92.1%, 1.00) than the HM group (82.2%, 0.84). Similarly, patient satisfaction was slightly higher for those treated with FAL (93.3%) than HM (91.4%). Our large retrospective analysis of eyes that have undergone LASIK using HM and FAL shows superior refractive outcomes in the latter, with special regard to procedural efficacy and predictability.

Introduction We wanted to assess the efficacy, predictability, and stability of topography-guided, laser-assisted in situ keratomileusis (TGL) on normal untreated eyes with a preoperative best corrected visual acuity (BCVA) of 20/20. Methods This was a retrospective, non-randomized, and single arm study evaluating the outcomes of TGL in eyes with a preoperative BCVA of 20/20. We included 50 eyes of 50 patients who presented to the Hashmanis Hospital, Pakistan and were followed for six months postoperatively. All eyes underwent treatment using the Alcon Wavelight Allegro Topolyzer (Alcon Laboratories, Inc., TX, USA). Results The mean preoperative sphere, cylinder, and spherical equivalent (SE) values were -4.3 ± 1.6 dioptres (D), -1.0 ± 0.8 D, and -4.8 ± 1.8 D. On day one these values were 0.2 ± 0.8 D, -0.5 ± 0.3, and  0.3 ± 0.8, respectively, and on month six they were -0.1 ± 0.6, -0.5 ± 0.3, and -0.4 ± 0.6 D, respectively. On postoperative day one and month six, 86% and 94% of eyes had a UCVA of 20/20 or better, respectively. Two eyes (4%) had an SE change of greater than 0.5 D from three to six months. Conclusion Our study demonstrates good efficacy, predictability, and stability of eyes undergoing TGL with a follow-up of six months.

IntroductionThere is increasing recognition of dry eye disease (DED) as a significant factor influencing quality of life in seemingly normal individuals. Our goal was to determine the distribution of Ocular Surface Disease Index (OSDI) scores in non-clinical individuals in Karachi, Pakistan.MethodsWe distributed OSDI questionnaires to subjects aged > 18 years with no active ocular complaint. Examiners were selected from various areas of the city to administer questionnaires to students and the general population. The OSDI score was grouped as per the following: normal (0-12 points), mild (13-22 points), moderate (23-32 points), and severe (33-100 points).ResultsWe surveyed 2433 individuals with a mean age of 30.7±15.6 years. Additionally, the mean OSDI score was 22.4±18.7. To estimate prevalence, we used two OSDI score cutoffs: >13 (64.4%) and >22 points (43.6%). Statistical significance was found using multivariate regression in the following variables: age (p<0.001), contact lens wear (p<0.001), ocular allergies (p<0.001), hypertension (p<0.001), diabetes (p=0.003), and smoking (p=0.047). When graphing mean age against OSDI score, there was a large jump between the third and fourth decades; thereafter, there was a steady increase. Similarly, when plotting smoking, the score was steady until five years and then there was a sharp incline.ConclusionThere was a high prevalence of DED in the studied population. Additionally, many systemic and ocular factors were associated with this disease.