BackgroundThe problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide.MethodsA total of 200 references from articles were retrieved using the PubMed database. Each article was individually checked for OA. Full texts of non-OA (i.e., “paywalled articles”) were examined to determine whether they were available using institutional and Hinari access in each institution studied, using “alternative ways” (i.e., PubMed Central, ResearchGate, Google Scholar, and Online Reprint Request), and using the website Sci-Hub.ResultsThe number of full texts of “paywalled articles” available using institutional and Hinari access showed strong heterogeneity, scattered between 0% full texts to 94.8% (mean = 46.8%; SD = 31.5; median = 51.3%). We found that complementary use of “alternative ways” and Sci-Hub leads to 95.5% of full text “paywalled articles,” and also divides by 14 the average extra costs needed to obtain all full texts on publishers’ websites using pay-per-view.ConclusionsThe scant number of available full text “paywalled articles” in most institutions studied encourages researchers in the field of ophthalmology to use Sci-Hub to search for scientific information. The scientific community and decision-makers must unite and strengthen their efforts to find solutions to improve access to scientific literature worldwide and avoid an implosion of the scientific publishing model. This study is not an endorsement for using Sci-Hub. The authors, their institutions, and publishers accept no responsibility on behalf of readers.

Purpose: To describe the prevalence of dry eye disease (DED) and its subtypes in elderly population with cataracts prior to surgery in Jakarta, Indonesia. Patients and Methods: Forty-nine eyes of 49 patients (16 males, 33 females; mean age: 66.6 years) planned for phacoemulsification surgery were consecutively recruited from two tertiary eye hospitals in this hospital-based cross-sectional study. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and the patient was defined as symptomatic if their OSDI score was ≥13. Objective examinations included the noninvasive tear film break up time (NIBUT) and Schirmer tests. The results were deemed abnormal if they were <10 seconds and <10 mm for NIBUT and Schirmer, respectively. Results: Participants were classified into four groups: DED (positive symptoms and short NIBUT), preclinical dry eye (positive symptoms without short NIBUT), predisposition to dry eye (short NIBUT without symptoms), and normal group. Median OSDI score was 12.5 (0-45.0), NIBUT was 10.4 (5.1-28.9) seconds, and Schirmer score was 8.0 (2.0-28.0) mm. The prevalence of DED, preclinical dry eye, and predisposition to dry eye were 22.5%, 22.5%, and 26.5%, respectively, while the other 28.5% subjects were normal. The DED group had significantly lower Schirmer test results (4.0 [2-17] mm) compared to all other groups. Older age (>70 years) was associated with poorer NIBUT and Schirmer test results and a significant difference between age groups was observed, especially in males. Conclusion: Dry eye is a common problem among the elderly population with cataracts in Indonesia. Almost half of the subjects presented with dry eye symptoms and either categorized as DED or preclinical dry eye, while more than one quarter were predisposed to dry eye. Care must be taken prior to cataract surgery to rule out existing dry eye with additional attention on those presenting without any symptoms as dry eye may develop after surgery.

PurposeTo evaluate the outcome of glaucoma drainage device (GDD) implantation with and without intravitreal bevacizumab (IVB) injection in treating neovascular glaucoma (NVG) at Cipto Mangunkusumo Hospital Jakarta, Indonesia.Patients and methodsThis retrospective study involved 39 eyes with NVG which underwent GDD implantation between 2012 and 2014. Thirty eyes underwent GDD implantation alone (control group) while 9 eyes underwent GDD implantation and IVB injection (IVB group). Visual acuity (VA), intraocular pressure (IOP), number of antiglaucoma medications, and success rate were compared between groups.ResultsThere were no significant differences in preoperative characteristics. On the last visit, VA was 2.6 (0.2–4.0) logMAR in the control group and 2.3 (0.4–4.0) logMAR in the IVB group (P=0.97). In the control group, final VA was significantly worse compared to initial VA (P<0.01), while in IVB group VA was apparently stable (P=0.24). Final IOP was 16.3±10.3 mmHg in the control group and 12.0 (2.0–49.0) mmHg in IVB group (P=0.40). The number of antiglaucoma medications was similar between groups (P=0.57). Surgical success rate in the IVB group (66.7%) was better than the control group (56.7%), but this difference was not statistically significant (P=0.71). Kaplan–Meier survival analysis showed the probability of success 37 months after surgery as 53.6% in the IVB group and 31.6% in the control group. No significant difference was found between the groups (P=0.45).ConclusionIn cases of NVG, GDD combined with IVB could maintain VA compared to GDD alone. However, there were no significant differences in final IOP, number of antiglaucoma medications, and surgical success rate.

Secondary glaucoma may develop after vitreoretinal surgery as it is a known risk factor for its development. When the risk factors are more than one, for instance along with neovascular glaucoma (NVG), the secondary glaucoma may become recalcitrant and very difficult to manage. Surgical intervention is often warranted to control intraocular pressure (IOP) and prevent progressive glaucomatous damage in patients with refractory glaucoma, and glaucoma drainage implant may be preferred as the primary choice. We describe a patient who develop secondary glaucoma after vitrectomy and silicone oil (SO) injection due to unresolved vitreous hemorrhage in proliferative diabetic retinopathy (PDR) and subsequent NVG. Baerveldt glaucoma implant (BGI) was carried out and placed in the superotemporal quadrant with longer anterior chamber tube placement to prevent escape of SO through the tube. Qualified success was achieved with additional one fixed-drug combination (FDC). However, 3 years later, the tube was blocked by the iris tissue at the inferior edge of the pupil. Tube trimming was performed efficiently using a simple technique. The distal end of the tube was pulled out of the anterior chamber through a paracentesis just next to the tube entrance and trimmed to the appropriate length. More than a year after the surgery, IOP was still well controlled with the same FDC. Unfortunately, the visual acuity could not be recovered due to advanced PDR.

Dry eye disease (DED) is one of most common ocular disease and reason for primary eye care visit worldwide. DED has gone through major evolutions over the past couple of decades. As stated in the latest DEWS II report in 2017, the definition of DED is now "a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles" [1].Prevalence of DED based on symptoms ranged from 14.5% to 39.2% in various countries [2][3][4][5]. This may still be an underestimated number as there are many who have symptoms but do not seek medical care. However, the reason behind the general increase in dry eye remains a question as it is not completely known if there is a true increase in prevalence or improved sensitivity to diagnosis.Lifestyle changes which include increasing screen time activities, diets poor in omega-3 fatty acids, and increased number of refractive treatments (contact lens wear, laser vision correction and cataract surgery) may play a role [6]. Moreover, recognition of autoimmune diseases which are associated with DED such as Sjogren disease, rheumatoid arthritis, and thyroid disease may lead to improved diagnosis and management.Dry eye complaints are frequently encountered by all ophthalmologists. Symptoms and signs of DED can be one of the most common causes of patient dissatisfaction during medical visits.6 Generally, patients with DED may experience ocular discomfort including pain, burning sensation, foreign body sensation, grittiness, and tearing. Others may complain of dryness, ocular fatigue, and sometimes redness [7,8].Visual disturbance is also a common symptom reported by patients with this disease. People with DED often report visual disruption such as glare, fluctuating and foggy vision; often despite normal visual acuity. Reduction in visual function can be measured by several methods including questionnaires, contrast sensitivity tests, functional visual acuity (FVA) tests, and measurement of higher-order optical aberrations (HOA) [9]. The symptoms of visual disturbance may vary from mild to severe degree which can affect daily activities including physical, social, psychological functioning, and workplace productivity [9][10][11][12].Consequently, DED has become a growing public health concern that interferes with many different aspects of quality of life. DED is associated with adverse impact on several common and important tasks of daily living, emotional well-being, and the ability to work [13,14]. The impairment of vision-related quality

Purpose To report clinical improvement after combined treatment of bandage contact lens and autologous serum eye drop in a patient with superior limbic keratoconjunctivitis (SLK) complicated with dry eye disease (DED) and meibomian gland dysfunction (MGD). Patients and Methods Case report. Results A 60-year-old woman was referred for unilateral chronic recurrent redness of the left eye not responding to topical steroids and cyclosporine 0.1% eye drop. She was diagnosed with SLK, which was complicated by the presence of DED and MGD. The patient was then commenced with autologous serum eye drop and fitted with silicone hydrogel contact lens in her left eye, and treated with intense pulsed light therapy for MGD in both eyes. Remission was seen Information Classification: General serum eye drop and bandage contact lens wear. Conclusion Long-term application of autologous serum eye drop combined with bandage contact lens can be used as an alternative treatment approach in SLK.

Background: To describe and evaluate the surgery results regarding resectability and clinical outcomes oftranscranial supraorbital approach for tumor removal of spheno-orbital meningiomaCase Illustration: A 58-year-old woman presented with proptosis of the right eye since 9 years prior.At initial examination, visual acuity was 6/15 with significant nasal visual field defect. There wereprominent proptosis and inferior globe displacement of the right eye with no palpable mass. A frontoparietalbone deformity was also observed. CT scan examination revealed hyperostosis of sphenoid,frontal, and temporal bone with extensive intraorbital mass with contrast enhancement suggestive ofmeningioma. Incisional biopsy was the performed and confirmed the histopathological diagnosis ofmeningothelial meningioma (WHO grade 1). Transcranial supraorbital in conjunction with lateralorbitotomy was performed in this patient as the definitive treatment for tumor removal of sphenoorbitalmeningioma. Craniotomy and opening of orbital roof were carried out by neurosurgeon toexpose intraorbital region. Total tumor removal was than completed.Conclusion: Transcranial supraorbital approach is an effective surgery for spheno-orbital meningiomaremoval as it offers excellent exposure. A radical resection through transcranial approach can be achievedwith low morbidity, providing a significantly improved clinical outcome in long term period. In thiscase, the spheno-orbital meningioma was grossly resected totally with excellent visual outcome andacceptable cosmetic appearance.Keywords: spheno-orbital meningioma, transcranial approach, tumor resection

Introduction: Due to difficulties in attending direct patient care and to limit the spread of COVID-19, the Indonesian ministry of health encourages hospitals to establish telemedicine services. This study aimed to report the initial practice of real-time teleophthalmology during the COVID-19 pandemic in Indonesia.  Methods: This retrospective descriptive-analytical study collected data from patients who had teleophthalmology consultations within 3 months (April 27 – July 27, 2020). All consecutive patients were included in this study, except those with incomplete records. Patients’ demographics, the main reason for the consultation, working diagnosis, prescribed medication, management plan, and satisfaction survey were collected for the analysis.  Result: There were 251 video consultations from 206 patients with 4 patients (1.9%) excluded due to incomplete medical records. There were 52 (25.7%) new patients. The median consultations were 2 (1-8) each day. The median age was 43.5 (from <1 year to 95 years). The main reasons for consultation were dry eye-related symptoms and red eye. The three most common primary working diagnoses were dry eye syndrome, conjunctivitis, and stye. Medication was prescribed for 149 patients (73.8 %) and 43 patients (21.3 %) were advised to have immediate direct consultation. The satisfaction survey revealed a 21.3% response rate, of which 41.9% and 58.1% felt very satisfied and satisfied respectively. Conclusion: Real-time teleophthalmology consultation seemed to be well-accepted by our population in spite of its early adoption with a high satisfactory rate.