Current Issues
Current Issues - Vol. 22, No. 1, January - March 2026
Al-Shifa Journal of Ophthalmology
Editorial:
The Myopia Tsunami: A Looming Public Health Crisis
Saif Ullah
Comparing Effect of Pre and Post Pupil Dilatation on Biometry Obtained by AL-Scan
Mehvash Hussain, Fizzah Farooq, Madiha Waseem
Objective: To assess the effect of pharmacologic pupil dilation on ocular biometric measurements and to determine whether dilation influences intraocular lens (IOL) power calculations or not.
Methods: A cross-sectional study, was conducted at the Department of Ophthalmology, Civil Hospital Karachi. Data was collected in designed questionnaire via non probability consecutive sampling technique. Biometric assessments including axial length (AL), anterior chamber depth (ACD), kerato-metric values (K) and central corneal thickness (CCT) were obtained using the AL-Scan device. All parameters were recorded twice, first under un dilated conditions and then after dilation with 1% tropicamide. The power of the intraocular lens (IOL) was determined with the SRK/T formula, keeping target of an emmetropic postoperative refraction. SPSS 26 was used for analysis. Paired t-test was applied to examine relationships between variables. A p-value of ≤0.05 was considered statistically significant.
Results: 100 eyes were examined, with twice as many male participants as female. The average age of participants was 66.1 years. The mean intraocular lens (IOL) power measured was 19.9 D both before and after pupil dilation, showing no significant change following mydriasis. No clinically significant difference was evaluated for parameters like AL, Avg K readings, CCT and IOL power in pre and post dilated phase (p>0.01). Whereas a mean increase of 0.09mm was noted in ACD (p>0.01).
Conclusion: Biometric values recorded via AL-Scan showed pupil size has no significant effect on measurement accuracy. This support’s device’s consistency and effectiveness and hence helping in reducing unnecessary follow-up, time, and cost.
Contrast Sensitivity in Patients with β-Thalassemia Major: A Cross-Sectional Study
Muhammad Asif, Asad Ullah, Fazal Noman, Safia Yaseen, Hafsa Sabir, Ahmad Jamal Khan
Objective: To assess the contrast sensitivity in patients with β-Thalassemia major using reliable testing methods.
Methods: This observational cross-sectional study was conducted at Fatimid Foundation Hospital, Hayatabad, from Sep 1, 2019, to Mar 1, 2020. The sample size of 44 patients was selected from those aged 15–40 years with β-thalassemia major, a transfusion history of 360– 600 units, and visual acuity of ≥6/9. Visual acuity was measured using the Snellen chart, while contrast sensitivity was measured using the Pelli-Robson chart at a 3-metre distance. Frequencies and percentages were calculated; ANOVA and chi-square tests were used to analyze data in SPSS V27.
Results: Out of 44 patients, females comprised a high percentage (59.1%), while rural residents were more common (63.6%). Most of the patients were aged between 15–20 years (59%). Contrast thresholds showed 4.5% with <2.5, 31.8% with 2.5, and 63.6% with >2.5, with a significant difference between groups (ANOVA: F=25.6, p<0.001). In word recognition, most patients in both age groups recognized 11–20 words. Blood transfusion volume was significantly associated with word recognition, with those receiving 360–480 ml showinghigher odds of better performance (OR=6, p=0.0044).
Conclusion: The contrast sensitivity was reduced in β-thalassemia major patients, suggesting that ocular examination, like contrast sensitivity and visual acuity, should be tested on a routine basis to detect early ocular involvement.
Progression of Myopia Among Age Groups: A Retrospective Study
Iftikhar Ahmed, Zainab Hussain, Maaz Allah, Sarah Saleem, Rashid Hassan Alvi, Muhammad Nizamuddin
Objective: To scrutinize the annual progression of myopia among individuals from an urban setting of Pakistan across age demographics and ascertain its correlation with the myopia severity.
Methods: The study design of this report is retrospective, and the patients were recruited from Sindh Government Qatar Hospital, Karachi, from 2016 to 2022. Data was collected through a consecutive sampling technique; subjects were stratified into two age groups: <15 years and ≥15 years. The spherical equivalent (SE) was calculated at baseline and at follow-up after 300– 415 days (approximately one year). The univariate Mann–Whitney U test, chi-square test, and multivariate logistic regression analyses were used for statistical analysis in SPSS 26.
Conclusion: We concluded that pterygium surgery is associated with a statistically significant improvement in corneal topography including astigmatism, corneal irregularity, refractive power as well as improvement of corneal sensitivity. Conclusion: The progression of myopia among pediatric and teenage individuals in Karachi is substantial, particularly among individuals younger than 15 years. The findings of this study highlight the requirement for early identification and strategies for prevention and mitigationof the increasing incidence of myopia in Pakistan. Download Issue
Comparison of Changes in High Order Ocular Aberrations after Near Work in Myopic and Myopic Astigmatic University Students
Kashif Ullah Yousafzai, Muhammad Shaheer, Asima Rafique, Arooj Amjad, Muhammad Moin
Objective: To compare changes in high order ocular aberrations (HOA) in myopic and myopic astigmatic university students after doing near work (reading continuously for 30 minutes).
Methods: This Quasi experimental study was conducted after the approval of ethical review board of College of Ophthalmology and Allied Vision Sciences, (KEMU) Lahore. The study took place in COAVS/Mayo Hospital Lahore from March, 2024 to November, 2024. Sample size was 60 in which 22 were male and 38 were female students. Myopic university students ageing between 18 to 30 years were included. Data collection procedure consisted of pre and post reading measurement of HOAs with SIRIUS ORB scan. Data was entered and analysed using SPSS version 26. Paired t test was applied to check for statistical significance. P value ≤ 0.05 was considered significant.
Results: A total of 2377 patients receiving intravitreal Bevacizumab injection were included in the study. Of these, 1201 (50.53%) were female and 1174 (49.47%) were male. Two cases (0.084%; 95% CI: 0.010–0.302%) of post-injection endophthalmitis occurred. Minor complications included subconjunctival hemorrhage (n=7; 0.29%) and conjunctival hyperemia(n=9; 0.38%). No retinal detachments, lens trauma, or sustained intraocular pressure rises were observed.
Results: After near work for 30 minutes, myopes showed mean increase in spherical Abs i.e. 0.10 ± 0.03 to 0.12 ± 0.05 (P 0.001), Coma i.e.0.14 ± 0.06 to 0.16 ± 0.07 (p 0.021), astigmatic i.e. 0.45 ± 0.36 to 0.50 ± 0.38 (P 0.014). However, Compound myopic astigmatic patients showed mean decrease in spherical Abs i.e. 0.12 ± 0.05 to 0.09 ± 0.06 (P 0.037) and Coma abs i.e. 0.16 ± 0.14 to 0.15 ± 0.13 (P 0.026).
Correlation of Rubbing of Eyes with Keratoconus
Ayesha Bibi, Muhammad Affan, Muhammad Irfan Sadiq, Waqas Ali, Muhammad Usman Sadiq, Arooj Zahid
Objective: To investigate the correlation between eye rubbing and the development of keratoconus and to assess the severity of keratoconus in patients who have a history of habitual eye rubbing.
Methods: A cross-sectional observational study was conducted on 120 patients (222 eyes) who were referred to the outpatient department (OPD) due to astigmatism, ocular pain, frequent prescription changes, suspected keratoconus, or for refractive surgery evaluation. Nonprobability sequential sampling was used. Ocular history was recorded, including habitual eye rubbing and comprehensive ocular assessment was performed. The KISA% index, derived from topographic data, was used to confirm keratoconus diagnosis. Data were entered and processed using Microsoft Excel, and R software was utilized for statistical analysis. Statistical significance was set at a p-value of less than 0.05.
Results: A total of 120 individuals with 222 eyes (mean age 19.55±5.79 years) were examined in this study. 55.4% of the patients were men and 44.6% were women. After excluding 18 eyes that had previously undergone ocular surgery, 204 eyes remained in the final analysis. Amsler- Krumeich classification was used to stage keratoconus. 52 eyes had stage-1 keratoconus, 42had stage-2, 14 had stage-3 and 7 had stage-4 keratoconus. Keratoconus and eye rubbing were found to be statistically significant (p<0.05)
Conclusion: Our study concludes that rubbing of the eyes is a significant risk factor for the onset of keratoconus and may exacerbate disease progression in diagnosed patients.
Complications of Manual Small Incision Cataract Extraction Surgery
Shehroze Bin Masood, Shehla Khan, Muhammad Sajid Khan, Fahad Zafar Zafar, Sohaib Ali, Ehsan Sayyed, Masiha Shafee
Objectives: To determine the frequency and types of early complications following Manual small-incision cataract surgery (MSICS) among local population.
Methods: The study design was cross-sectional, conducted at Ophthalmology Department of Hayatabad Medical Complex, Peshawar, from September 2020 to 2021, including 135 patients undergoing cataract surgery, recruited using consecutive sampling technique. MSICS was performed under peribulbar anaesthesia. Demographic and clinical data were collected using a structured proforma. Post-operative complications, including increased intraocular pressure (IIOP), hypotony, hyphema, and corneal decompensation, were assessed on the first post-op day. Data were analyzed using IBM SPSS version 27. Associations were evaluated using the Fisher Exact test, with p ≤ 0.05 considered statistically significant.
Results: The mean age of participants was 56.5±5.3 years, with 53.3% males and 46.7% females. Most surgeries were performed on the left eye (71.1%). Post-operative complications included IIOP (8.1%), hypotony (3%), hyphema (3%), and corneal decompensation (3.7%). IIOP was more frequent in patients aged 51-70 years (8.5%) and procedures lasting >20 minutes (11.8%). Hypotony and corneal decompensation were observed only in patients aged 51-70 years (3.4% and 4.3%, respectively) and procedures lasting >20 minutes (4.3% and 5.4%, respectively). Hyphema was more common in patients aged 35-50 years (5.6%) and procedures lasting >20 minutes (3.8%).
Conclusion: Manual small incision cataract surgery is a safe procedure with a low frequency of early postoperative complications. Surgeons should exercise care during surgery, especially in longer procedures, to minimize early complications.
Unseen Challenges: Presbyopia in Free Eye Camp
Sadiqullah Khan, Siraj Safi, Sami Uddin, Zia Ullah, Muhammad Zahid Jadoon
Objectives: Free eye camps were conducted to find the magnitude, gender distribution and age of onset of presbyopia in the underserved communities.
Methods: Cross sectional study was conducted in 17 free eye camps in Peshawar District during 2016-2020. Those aged ≥30 years and with visual acuity (VA) of 6/6 to 6/12 at distance who complained of near vision problems were included. Presbyopia defined as the inability to read at N4 corrected with at least +1.0 D lens. Snellen chart was used to assess visual acuity and retinoscopy was used for the assessment of refraction. Data collected were analyzed descriptively and by using chi-square tests in the Statistical Package for the Social Sciences (SPSS) version 22.
Results: Of 10,983 patients examined, 1,867 (17.0%) were presbyopic. Females accounted for 61.0% and males 39.0% (ratio 1:1.56). The highest prevalence was seen in the age group of 35-40 years, which was prior to the global averages. Patients aged 56-60 were most affected, up to +2.50 required to correct near vision. There was a statistically significant association found between age group and gender (χ² = 38.09, p < 0.001).
Conclusion: The prevalence of presbyopia is high in the rural communities and onset of presbyopia occurs at an earlier age and is more of a burden for females. Free eye camps successfully meet unmet needs and, especially, the needs of women who are excluded from hospital based care. There is a high need for sustainable outreach and incorporation of presbyopia in national vision care planning.