PURPOSE:The purpose of this study was to study ocular dominance and its association with retinal nerve fiber layer (RNFL) and macular thickness.METHODOLOGY:A cross-sectional study was conducted on 432 participants with nonpathological eyes. We determined the ocular dominance by the hole-in-card test (Dolman method). A comprehensive eye examination was conducted on the participants, including best-corrected visual acuity, intraocular pressure, and anterior and posterior segment examination. The RNFL thickness was measured using optical coherence tomography. The findings were analyzed using paired t-tests to compare between dominant and nondominant eyes.RESULTS:Out of the 432 participants, 70.4% (304) showed right eye dominance of study population had right eye dominance. The average RNFL (AvRNFL) thickness showed a small but significantly higher value in dominant eyes compared to nondominant eyes. We found significantly higher RNFL thickness in temporal, inferior and nasal quadrants in dominant eyes compared to nondominant eyes. Age had minimal effect on the difference in AvRNFL thickness between dominant and nondominant eyes (P = 0.144). There was no significant difference in macular retinal thickness between the eyes.CONCLUSIONS:Ocular dominance was found predominantly in the right eye. The dominant eye showed greater AvRNFL thickness compared to nondominant eye. AvRNFL, inferior RNFL, Nasal RNFL, Temporal RNFL thickness were greater in the dominant eye compared to the nondominant eye. There was no difference in macular thickness. Our findings suggest the need to consider dominance in various disease entities, in clinical decision making and normative data particularly concerning retinal nerve fiber layer.

PURPOSE:The purpose of this study was to introduce a standardized tool, developed through expert consensus with face and content validation, that integrates a comprehensive rubric with a scoring system for evaluating the ophthalmology residents’ competency in peribulbar anesthesia: The Skills and Keystone Assessment for Regional Anesthesia (SanKARA) Scoring System.MATERIALS AND METHODS:A multidisciplinary expert panel from Sankara Eye Hospital, Jaipur, India, each with experience of ≥2000 peribulbar anesthesia blocks, was established to develop a tool that combined a comprehensive rubric outlining essential competency criteria with a scoring system designed to assign numerical values to performance. The explicit behavioral descriptors for each crucial step of the peribulbar block were scored using a modified four-point Dreyfus scale of skill acquisition.RESULTS:The SanKARA Scoring System encompassed 20 crucial steps for evaluating competency in peribulbar anesthesia. These steps were further subgrouped into specific categories (pre-procedural-related, procedural-related, and post-procedural-related) to summarize the specific stages of the whole procedure. Key procedural aspects included needle positioning, drug administration, patient monitoring, and adverse event management.CONCLUSIONS:The SanKARA Scoring System integrates a structured rubric and scoring system to standardize peribulbar anesthesia training. This system can be globally adopted to assess and improve the training of ophthalmology residents, guide them in learning this paramount skill, and set a global competency benchmark.

The purpose of this case series is to delineate the rationale for employing oral cyclophosphamide along with rituximab in three patients with nonparaneoplastic autoimmune retinopathy (npAIR) secondary to birdshot chorioretinopathy. Case 1: A 50-year-old male with a history of amblyopia in the right eye (OD) presented with floaters and reduced vision in the OD. He was diagnosed with birdshot chorioretinopathy (BSCR) in both eyes (OU). He was successfully treated with cyclosporine and mycophenolate mofetil; however, later, he developed npAIR. He started rituximab infusion and oral cyclophosphamide. After 7 months of treatment, oral cyclophosphamide was stopped due to severe side effects. Case 2: A 58-year-old male presented with an acquired color vision problem in the left eye. He was diagnosed with BSCR in OU. He responded to a clinical trial study for BSCR; however, later, he was diagnosed with npAIR. This patient failed oral cyclophosphamide therapy due to ineffectiveness and side effects. He, subsequently, failed rituximab and bortezomib therapy. Case 3: A 52-year-old female was diagnosed with BSCR. She was successfully treated with mycophenolate mofetil and infliximab for BSCR. She, subsequently, was diagnosed with npAIR, which failed oral cyclophosphamide therapy due to ineffectiveness and side effects and was successfully treated with rituximab and intravenous immunoglobulin infusions. The inclusion of oral cyclophosphamide into the treatment regimen for patients with npAIR secondary to BSCR may raise concerns regarding its safety and efficacy, suggesting the need for careful consideration and evaluation during treatment.

Syphilis is a great mimicker of diseases and has a broad presentation ranging from painless chancre, constitutional symptoms, adenopathy, rash, synovitis, neurological, and ocular findings. Syphilis-related bone and joint involvement is usually found in congenital form, but it can also be seen in adults with acquired syphilis as a rare sequela of infectious syphilis. We report a case of a patient diagnosed as rheumatoid arthritis, who presented to the ophthalmology outpatient department with an acute onset of black spots in his visual field, whose clinical examination was a diagnostic dilemma, for which the patient underwent extensive investigations and was diagnosed to have syphilitic uveitis. In hindsight, it was concluded that the patient was suffering from reactive arthritis due to syphilis.

Nystagmus, characterized by involuntary ocular movements, presents significant challenges in both congenital and acquired forms, often significantly impacting visual acuity and quality of life. This comprehensive review examines the current landscape of pharmacological interventions for nystagmus, highlighting several key drug classes and their mechanisms of action. To identify relevant studies, an extensive literature search was conducted in PubMed, Web of Science, and Scopus, covering English-language articles from 1960 to 2025. Gabapentin, a calcium channel blocker with potential effects on gamma-aminobutyric acid (GABA) activity, and baclofen, a GABAergic agent, have shown promise in treating both congenital and acquired forms, whereas glutamate antagonists like memantine have demonstrated efficacy in some cases. Potassium channel blockers, including aminopyridines, have proven especially effective for certain acquired nystagmus types, particularly downbeat nystagmus. The potential of anticholinergic drugs and benzodiazepines in specific nystagmus subtypes is also discussed. Efficacy often varies among individuals, highlighting the need for personalized approaches. This review underscores the importance of both nystagmus reduction and preservation of normal eye movements. Although many medications show promise, most studies have small sample sizes and lack long-term data, making direct comparisons challenging. Therefore, further research (particularly large-scale randomized controlled trials) is needed to support the development of novel targeted therapies, including combination treatments or adjunctive nonpharmacological approaches, to improve management of this complex condition.

INTRODUCTION:Diabetic retinopathy (DR) is a leading cause of vision loss globally, and its burden is increasing, particularly in regions with a high prevalence of diabetes like Oman. Early detection and timely intervention are crucial for preventing vision loss and improving patient outcomes. This study aimed to evaluate referral patterns and screening outcomes for DR at Bowsher Specialized Polyclinics (BSP) in Muscat, Oman.METHODOLOGY:In this cross-sectional study conducted between January 1 and December 31, 2023, data were retrospectively collected from the electronic health records of 6677 patients referred to BSP. The assessment included referral sources, reasons for referral, patient demographics, waiting times, screening results, and follow-up plans.RESULTS:A high proportion of external referrals (79%), with 90.6% being routine. Nearly half of the referrals were for DR screening, and among those screened, 16.9% had abnormal findings, with mild nonproliferative DR (NPDR) being the most prevalent. Males showed a significantly higher proportion of abnormal screening outcomes. In addition, mean waiting times were long (145.8 days), and 39.5% of patients were defaulters.CONCLUSIONS:These findings highlight the need for targeted interventions to optimize referral pathways, expand screening capacity, and enhance patient engagement to improve DR management.

Characteristic features of Noonan syndrome include dysmorphic facies, short stature, and congenital cardiac defects. Pathogenic variants in PTPN11 are one of the common causes and may result in optic nerve head anomalies. We describe the optic nerve findings in two families with Noonan syndrome due to pathogenic variants in PTPN11. Optic nerve anomalies, including an enlarged cup/disc ratio, are a feature of Noonan syndrome due to pathogenic variants in PTPN11. This optic nerve anomaly could potentially lead to the misdiagnosis of glaucoma. PTPN11 is important for functional fibroblast growth factor signaling, which, if interrupted, may lead to optic nerve dysgenesis and ocular coloboma.

Nonpenetrating deep sclerectomy (NPDS) was initially developed back in 1989. The procedure stands out in the field of glaucoma for its significant safety profile and good efficacy. Unlike other surgical alternatives, evidence has noted that NPDS results in a controlled and gradual reduction of intraocular pressure. The purpose of this literature review is to summarize the technique, challenges posed, current innovations, and overall outcomes mentioned in the literature on NPDS for various types of glaucomas and its various disease stages.