Innovative ophthalmology

“Synergy and serendipity often play a big part in medical and scientific advancements.”

-Julie Bishop

Seasonal Greetings!!!

Choroid, the most important vascular tissue of the eye, has not been extensively researched in Indian context. With the advent of enhanced depth imaging, it has become possible for us to conduct in-depth research studies on choroidal structures.[1] Choroidal thickness (CT) is a very important predictor of glaucoma,[2] visual acuity in myopia,[3] diabetic retinopathy[4] and age-related macular degeneration.[5] Although previous studies[6,7] have evaluated some degree of CT in healthy individuals, Indian data is found to be scarce. Besides, the scare data available included individuals with extreme axial lengths that bias the study results. Chhablani et al. in this issue has published a study where they have assessed the CT in healthy individuals without any retinal or choroidal abnormalities with normal axial lengths in different age groups. The authors evaluated CT from various loci and it was found to correlate well with age. This data serves as a reference for other researchers to compare the CT in various chorioretinal disorders in Indian population of different age groups.

Retinoblastoma, the most common primary ocular malignancy in children is one of the most aggressive tumors that metastasise.[8] Various high-risk histopathologic risk factors (HRFs) that have been identified as indicators of metastatic spread of the tumor include optic nerve invasion, particularly retro laminar or to the transection line, and choroidal, scleral, and extra scleral (orbital) involvement. The published rate of occurrence of these factors show a wide range: 7–56% for invasion into the retro laminar optic nerve and from the optic nerve to the transaction line; 12–42% for choroidal involvement; and 3–30% for scleral and extra scleral spread.[9,10,11,12,13,14,15] However, recently the incidence of HRFs has declined over time, possibly because of earlier detection of cases. Seema et al. in this issue has published a retrospective study where the authors have evaluated HRF in Indian retinoblastoma patients and correlated these with p53 gene expression. p53 gene expression has been observed in 50–60% of patients with retinoblastoma.[16] In the present study, the authors found necrosis (70.5%), calcification (64.7%), and retinal detachment (58.8%) as common HRFs. Additionally, the incidence of various morphological parameters such as anterior chamber seeding, ciliary body involvement, iris involvement, choroid involvement, scleral invasion, extra scleral invasion and optic nerve infiltration were found ranging between 11% and 58% in the study participants. p53 expression was present in four out of 13 cases (30.7%) and showed significant association with choroid invasion. Although the authors found a higher incidence of HRFs in Indian patients with retinoblastoma that dictates the use of adjuvant chemotherapy, the study in general stresses the importance of looking into all these HRFs in patients by the treating physicians.

Goldmann applanation tonometer (GAT) has been the gold standard for measurement of intraocular pressure in glaucoma patients.[17] Despite being the gold standard calibration method, errors have been frequently reported to occur with GAT[18,19] especially a high proportion in a recent Indian study.[20] Choudhari et al. in this issue explored the possibility of a new self-taught technique to rectify such calibration errors in GAT from a pilot study and found to be promising. However, a large adequately powered study is required before recommendation of this technique. Additionally, Dada et al. in this issue published an in-depth analysis of the use of scanning laser polarimetry in the diagnosis and monitoring of glaucomatous optic neuropathy that may help detect the changes earlier than the conventional methods. This issue also emphasises my firm belief that one should publish or perish. The article gives an overview of key steps to good manuscript preparation and the need to have a research based outlook even when engrossed in clinical practice.

Let us synergize this new year, learn and share.

Read loads this new year, Happy Reading!!!