Aim To understand the barriers in utilisation of low vision assistive products (LVAPs) from the perspective of patients with low vision. Methods Patients referred to low vision clinic in a tertiary eye care hospital in India who were prescribed LVAPs but were un-willing to accept the products were interviewed using questionnaires. Data pertaining to the age, diagnosis, gender, occupation, preferred LVAPs, patient's perception of vision loss and the primary reason for non-acceptance of LVAPs were analysed.Results A total of 235 among the 413 patients who noticed improvement in visual performance with LVAPs were unwilling to utilise these products. The questionnaire revealed that 53% of the patients who felt they were not candidates for LVAPs were experiencing severe visual impairment (p < 0.02). Non-acceptance was highest (68.6%) in patients < 15 years of age. The most common causes of non-acceptance were social stigma in patients < 40 years (41.3%; p < 0.0001), fear of loss of employment in patients 41-60 years (26.6%; p < 0.01) and low necessity in patients > 60 years (25%; p < 0.001). Denial of the magnitude of their illness was more common in patients above 60 years (16.5%). Non-acceptance rate was lowest for macular disorders (39.6%) and highest for retinitis pigmentosa (81%). Among devices, hand and stand magnifiers had the lowest non-acceptance rate (41%). Telescopes and electronic devices had the highest rate of non-acceptance (92% and 89%, respectively). Conclusion Reasons for poor utilisation of LVAPs are multifactorial extending beyond affordability or accessibility. Knowledge of these barriers can help in creating content for awareness campaigns among patients, healthcare professionals and general society. Further research is necessary on the psychological and psycho social contributors to this process.

Background/AimsThere are limited data from India on genetic variants influencing late age-related macular degeneration (AMD). We have previously reported associations from a population-based study in India (the India age-related eye disease study (INDEYE)) of early AMD and single nucleotide polymorphisms (SNPs) in ARMS2/HTRA1 and no association with CFH, C2 or CFB. Late AMD cases were too few for meaningful analyses. We aimed to investigate SNPs for late AMD through case enrichment and extend the loci for early AMD.MethodsFundus images of late AMD hospital cases were independently graded by the modified Wisconsin AMD grading scheme. In total 510 cases with late AMD (14 geographic atrophy and 496 neovascular AMD (nvAMD)), 1876 with early AMD and 1176 with no signs of AMD underwent genotyping for selected SNPs. We investigated genotype and per-allele additive associations (OR and 95% CIs) with nvAMD or early AMD. Bonferroni adjusted P values are presented.ResultsWe found associations with nvAMD for CFHY402H variant (rs1061170) (OR=1.99, 95% CI 1.67 to 2.37, P=10−6), ARMS2 (rs10490924) (OR=2.94, 95% CI 2.45 to 3.52, P=10−9), C2 (rs547154) (OR=0.67, 95% CI 0.53 to 0.85, P=0.01), ABCA1 (rs1883025) (OR=0.77, 95% CI 0.65 to 0.92, P=0.04) and an SNP near VEGFA (rs4711751) (OR=0.64, 95% CI 0.54 to 0.77, P=10−3). We found no associations of TLR3 (rs3775291), CFD (rs3826945), FRK (rs1999930) or LIPC (rs10468017) or APOE ε4 alleles with nvAMD or early AMD, nor between early AMD and rs1883025 or rs4711751.ConclusionsThe major genetic determinants of nvAMD risk in India are similar to those in other ancestries, while findings for early AMD suggest potential differences in the pathophysiology of AMD development.

Combined cataract extraction with PPV and metallic IOFB removal through sclerocorneal tunnel using the "magnet handshake" technique gives good visual and surgical outcomes.

The purpose of the study is to report an unusual case of encapsulated iron intraocular foreign body (IOFB) of long duration presenting with cystoid macular edema (CME) and normal full-field electroretinogram (ERG). A 28-year-old male presented with a history of metal injury 5 years back and subsequent visual loss in the left eye for 3 months. Fundus examination of the left eye showed an encapsulated cyst-like structure inferior to the disc with the surrounding pigmentary changes and CME. B-scan ultrasonography and computed tomography scan confirmed metallic IOFB. A full-field ERG performed before surgery showed a normal response. He underwent pars plana vitrectomy with IOFB extraction and silicone oil injection as a tamponade. Two months later, silicone oil removal was combined with intravitreal triamcinolone acetonide (IVTA) injection for persistent edema. Meticulous clinical evaluation, imaging, electrophysiological testing coupled with surgical intervention, and IVTA injection resulted in resolution of CME with minimal visual improvement. In conclusion long-standing encapsulated iron IOFB on the retina can cause vision-threatening complications without siderosis.

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Diffuse unilateral subacute neuroretinitis (DUSN) is a subacute outer retinal inflammation due to the presence of a subretinal worm. The worm is identifiable in only 30% of the cases. The identification of the worm and laser photocoagulation of the worm remains the mainstay of treatment. Here, we describe a case of DUSN with a subretinal worm in the macula which was captured on Optical coherence tomography (OCT) scans and treated with laser photoooagulation.

Purpose: To assess patient experience of intravitreal injections using vital-signs, visual-experience, pain-rating and emotional response during intravitreal anti-VEGF injections. Methods: A prospective observational study of patient experience of intravitreal anti-VEGF injections done following metrics were collected pre-injection, during injection, and post-injection: pain assessment using visual analog score, fear-response rating, visual-experience questionnaire, and vital-signs. Results: A total of one-hundred-and-seventy-four patients undergoing intravitreal anti-VEGF injections for retinal pathologies were included in the study. Mean age was 58.8 ± 10.4 years in <5 injection group ( n = 133) and 59.02 ± 9.0 years in ≥5 injection group ( n = 41) ( P = 0.90).During injection, 90.2% of patients in <5 injection group reported moderate or severe pain compared to 78% of patients in ≥5 injection group. In pre and post-injection phases, mild-to-moderate pain was reported in both groups ( P = <0.001). Ninety-two (52.9%) patients reported having a mild frightening experience. There was no statistical significance in patients assessment of fear with respect to age, sex, or number of injections. The Systolic Blood Pressure (SBP) during and following injection ((SBP 171.7 ± 21.1,150.8 ± 16.2) procedures was significantly higher in cases with <5 injections when comparing to cases with >5 injections (SBP 159.7 ± 26.4, 143.2 ± 17.0) ( P = 0.003), ( P = 0.011). DBP, heart rate, pulse rate measurements were similar among patients in all phases of the study. Conclusion: We report a large sample size with comprehensive assessments of the patient experience. Higher pain ratings in the <5 injection group, the increase in the SBP in the pre-and during injection phases, and the overall rating of mild-to-moderate fear during the procedure.