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Vol 1, Issue 1, 2017.

Editorial- Welcome to the Inaugural Issue of Inside Optometry.

Khan HA, Rasheed F.

Optometry is one of the most rapidly progressing medical field around the globe. With the advent of latest techniques like OCT, OCTA & advancement in low vision and contact lenses has worked wonders in the progression of the field. In Pakistan, Optometry is relatively an emerging specialty needing so much attention, research & development. No doubt, Pakistan is producing quality Optometrists, who are representing the country worldwide but still a large number of graduates are in pursuit of higher education, latest clinical trends, and newer modalities. This brought in resolution to launch a quality Optometry Journal in the country which could publish latest research studies, case reports, and clinical articles and to provide Optometrists with a platform to discuss the problems they are currently facing.

The first issue of Journal “Inside Optometry” is in hand. This issue projects the diversity of research, from patients’ education regarding the dietary improvements for age related macular degeneration to diagnosing the early leukocoria with a simple yet very effective red reflex in neonates. The effectivity of proper refraction procedure in low vision patients is also highlighted for newer practitioners which will greatly help them understand the techniques and management options for such patients.

Contact lens practice is really tricky in a sense that it involves the quality of tear film, corneal & conjunctival health and blinking pattern. An article thoroughly explains the ocular changes induced by contact lens usage which is interrelated, as the use of contact lenses is thought to reduce the oxygen supply to ocular tissues and contact lens wear lead to various adverse ocular changes among contact lens user, especially in persons using contact lenses for more than one years.

Starting a journal from a developing country with lacking trends of research was not less than any challenge. We are thankful to our kind peer reviewers from different parts of the world who helped us maintain some standards and improve the level of articles accepted for publication. In addition, we are also very grateful to our advisory board, particularly Prof Joseph J. Pizzimenti for his kind support round the clock, without whom we would not be able to begin or continue this project.



Improved Macular Pigment Optical Density and Visual Function in Four Patients Using a Carotenoid-rich Dietary Supplement.

Herman JP, Kleiner-Goudey SJ, Davis RL, Pizzimenti JJ.


Purpose. These case reports demonstrate visual, retinal, and macular pigment optical density (MPOD) improvements achieved in patients using a specific, carotenoid-based dietary supplement.

Methods. We performed a comprehensive history, along clinical examination, MPOD testing, visual function testing, and spectral domain optical coherence tomography (SD-OCT) of the central retina. We prescribed a carotenoid-rich antioxidant supplement and conducted follow-up visits at appropriate intervals over a 2-year period.

Results. We noted improvements in MPOD and various visual function parameters. We also noted stabilization or improvement in macular appearance, SD-OCT findings, and patient self-reported parameters, including improvement in metamorphopsia.

Conclusions. Our four patient cases suggest that a lutein/zeaxanthin/fish oil/antioxidant dietary supplement with zinc improved MPOD and visual function. Patient education about sun protection, nutrition and lifestyle may benefit those at risk for and/or showing signs of age-related macular degeneration (AMD).



Relationships between blink rate, tear break up time and corneal changes among contact lens users.

Ammer R.


Purpose. Use of contact lenses is thought to reduce the oxygen supply to ocular tissues and many studies found that contact lens wear lead to various adverse ocular changes among contact lens users. The purpose of study was to rule out associations among ocular changes (blink rate, tear film break-up time and corneal changes) in contact lens users, those used contact lenses for more than 1 year.

Methods. It was a cross-sectional study and convenient sampling was used to collect the sample of 100 contact lens users. This study was conducted in 4 months from 05-04-2016 to 05-08-2016 and sample was recruited from Madinah Teaching Hospital Faisalabad, E Plomer Optics and Punjab Optics Lahore. Tear film break up time (TBUT) and corneal changes were determined by using slit lamp and blink rate was recorded by direct observation and counting. SPSS version 23 was used for data analysis. Inferential statistics was reported for variables.

Results. A highly significant (p = .000) negative correlation was found between blink rate and tear film break up time (TBUT). A significant (p = .000) association was found between blink rate and corneal changes. A significant (p = .000) association was found between tear film break up time (TBUT) and corneal changes.

Conclusions. It was concluded that ocular changes induced by contact lens use are interrelated. A cascade of changes started with the use of contact lens wear.

Knowledge Attitude and Practices Regarding Red Reflex in Neonatology Units of Lahore.

Takmeel S.


Purpose: The purpose of the study was to estimate the Knowledge, Attitude and Practices (KAP) of the red reflex test in the neonatology units of Lahore. The article would brief about the significance of Red reflex test, an ophthalmic screening test, probably expected to be carried out at every neonatology unit in most part of the developed world. The presence of red reflex can indicate to normal eye or otherwise it is an indication towards many ophthalmic problems and pathologies like ROP, cataracts, Retinoblastoma, squints and vitreous opacities.

Methods: Knowledge, Attitude and Practices (KAP) study was conducted in the neonatology units, to assess the practice of red reflex in new born screening. Self-made questionnaires were used to assess the knowledge, attitude and practices of practitioners in nurseries. Sample size was 100 on duty practitioners and data was analyzed on SPSS version 20. The place of study was Lady Atchison Hospital and Lady Willingdon Hospital of Lahore. Duration of the study was from 5th September 2015 to 1st of November 2015.

Results: Results were found highly significant and different from the expected ranges. i-e the p value (p<0.05).Results were representing very little knowledge and attitudes regarding the red reflex test in neonatology screening units. Same was true for practices i-e negligible amount of practices were found regarding the performance of red reflex test.



Improvement in Visual Acuity with Refraction in Low vision Patients at Low Vision Clinic.

Saifullah, Ahmad Z, Shah M, Islam SB, Safi SK, Samiuddin.


To study the improvement in visual acuity with refraction in low vision patients visiting low vision clinic.

Methods. Nineteen patients that include 13 males (68.42%) and 6 females (31.58%), with low vision visiting the low vision clinic were examined. Visual acuity was tested using standard log MAR chart. Retinoscopy was performed using the standard technique at 67cm working distance. In cases with dimmer reflexes, Radical retinoscopy at a 10cm working distance was performed and verified through subjective refraction. The study was conducted at Low Vision clinic, ophthalmology department, Hayatabad Medical Complex, Peshawar over a period of six months.

Results. Median presenting visual acuity was 1.16 log MAR, with interquartile range of 2.1-0.6 log MAR. There was an improvement of 7 lines or more of visual acuity in 5 patients (26.32%), with 8 patients (42.11%) improving by 2-4 lines, and 3 patients (15.79%) improving by 1 line. There was no significant improvement in 3 patients (15.79%). A higher rate of improvement was attained in age groups 23-30 years and 80-95 years. When stratified by diagnosis, a higher rate of improvement in visual acuity (up to 13 lines) was attained in patients with Age-related macular degeneration. Other patients that also significantly improved (up to 7 lines) were patients with nystagmus and Optic atrophy. No improvement in visual acuity was seen in a patient with retinitis pigmentosa, 1 patient with nystagmus, and in 1 patient with Stargardt’s maculopathy. One patient who was falsely categorized as a low vision patient, attained a visual acuity of 0.2 log MAR after doing proper refraction.

Conclusions. A significant improvement in visual acuity was attained from the total low vision patients. With proper refraction, practitioner may take out a falsely categorized low vision patient from low vision category or may improve the visual acuity from severe to moderate level.

Effect on Quality of Life in Presbyopic Patients due to Excessive Near Work.

Maryam R,  Mobeen R, Chauhdry N.


To find the effect on quality of life in presbyopic patients and correlation of presbyopia    with near work.


It was institutional based cross sectional study conducted at College of Ophthalmology and Allied Vision Sciences, King Edward Medical University from September 2014 to November 2014. A questionnaire was designed to assess quality of life (QOL) of population suffering from presbyopia (PB). The sample of 150 subjects was collected and was assessed by using SPSS software.


Out of 150 respondents, 77 (51.3%) were male and 73 (48.6%) were females. Incidence of Presbyopia increased with the increasing age and had significance across both genders (p=0.01). 

Personal satisfaction was determined through questionnaires, and after that, results were further analysed. Diverse questions were asked from the selected individuals, in which 95.89% females reported trouble in sewing; 30.14% had trouble in hacking vegetables whereas 23.29% of the females faced problems in doing laundry; dealing with stones from rice was 80.04% and 97.26% experienced issues in threading needle.

Out of 77 males, 83.12% had trouble in driving; 90.91% had difficulties operating computers; 42.86% of the respondents were unable to check time by their watches; 87.01% faced difficulties in doing office work.

Due to impairment of vision by presbyopia 82.19% of subjects faced difficulties in reading regular prints; 41.56% had troubles recognizing smaller objects; 68.49% suffered problems while writing. Due to excessive work demanding focus, the complaint of fatigued eyes was 94.52 %.


The finding of this study exhibited the accompanying remarkable evaluation that there were troubles in day-to-day life exercises and living and social obstacles were present because of presbyopia. This was obvious that presbyopia gradually increases with age. It was more typical in females as contrast with males.