Ophthalmology Pakistan

Gene Therapy in Ophthalmology: Promise and Pragmatism

2025-12-16T19:45:32+00:00

The aim of gene therapy is long lasting improvement or sure of a certain disease by transfer of genetic material to the patient. It may involve either of gene replacement, gene slicing, gene editing or addition.¹ Over the years, gene therapy has been extensively in practice with the use of adeno-associated virus (AAV) vectors for gene delivery and has been applied to neurodegenerative disease, cardiovascular disease, cancers and ocular disease.²

Eye is an excellent organ for gene vector delivery due to its immune privilege and direct visibility.³ In 2017, ‘’Voretigene Neparvovec’’ was the first gene vector to be approved by Food and Drug administration (FDA) for the treatment of RPE65 related inherited retinal dystrophy. Gene vector can be introduced into the eye by sub retinal injection after pars plana vitrectomy, intravitreal or suprachoroidal injections.⁴

Autosomal dominant retinitis pigmentosa (ADRP) is the most prevalent form of this disease and rhodopsin P23H (RHO-P23H) being the frequent mutant gene locus. Yan et al. developed sgRNA to specifically target the mutated rhodopsin RHO-P23H, subsequently resulting in knockdown in an ADRP mouse model induced by RHO-P23H mutation.⁵Choroideremia is an X linked recessive disorder due to mutations in CHM gene. Five clinical trials have been conducted on gene therapy for this disease with the first commencing in 2011. Adeno assisted virus vector (AAV) was introduced in subject’s eyes after pars plana vitrectomy. Different strengths of AAV were used in these five trials. At 1 year, minimum gain of ETDRS letters was 2 while maximum gain was 17 letters in one of the trials. Only one patient diagnosed to have retinal tractions and stretching.^{6, 7}

Effectiveness Of Google Lookout App On Functional Task Performance In Low Vision Patients With Macular Disease

2025-12-03T17:48:17+00:00

Purpose: To determine the influence of the Google Lookout smartphone application on enhancing the performance of functional vision; reading and medicine recognition in patients with macular disease.

Methodology: The comparative quasi-experimental study was a within-subject study carried out at the Low Vision Clinic, Mayo Hospital, between April and September 2025 following the Ethical Review Board approval. At 5% significance, 80% power of test, and 95% confidence level there was a calculated total sample of 36 participants. Since the same participants were measured in both of the conditions, within-subject design was used. Each participant used the app to complete a two-functional vision task, including short-text reading and medicine identification, in two different conditions, first without the app and secondly with the Google Lookout application. A ten-minute instruction on using the app and the interpretation of voice feedback was given to the participants before the test with the app. Both conditions were time taken and accuracy. The Wilcoxon Signed Ranks Test with the level of significance of p <0.05 was used in data analysis.

Results: Google Lookout was found to be helpful in enhancing the accuracy of reading and medicine-recognition tasks. The mean reading accuracy improved between 9.4 ±1.6(without app) and 13.1 ±1.2 (with app) (p <0.001) and the performance of medicine-identification was also significantly improved (p = 0.001). In spite of the fact that the time to complete tasks was higher because of the audio processing stage and the additional time required for comprehension. The general accuracy of the tasks and the rates of success were higher. According to these findings, Google Lookout is useful in supporting activities that rely on central vision and improving functional independence of macular disease patients.

Conclusion: The Google Lookout app effectively enhances the accuracy of reading and medicine-recognition tasks in patients with macular disease, supporting its role as a supplementary low-vision rehabilitation tool.

Ocular disorder among students with hearing impairment at a special education complex

2025-12-02T04:52:38+00:00

Purpose: To investigate the ocular disorders among students with hearing impairment at a special education complex.

Methodology: This cross-sectional study was conducted from October 2021 to April 2022 at a Special Education Complex, Peshawar, Pakistan, following ethical approval from the research and ethics committee of the Pakistan Institute of Community Ophthalmology. All students with hearing impairments (HI) in a special education complex were included. The history regarding HI was taken from the school records. Visual acuity, anterior segment examination, and refraction were performed on each student. Chi-square and Pearson correlation were conducted using SPSS software.

Results: Out of 156 students, 120 (76.90%) were male. The mean age was 16 ± 4.47 years. Based on the school record, 121 (77.6%) students had congenital HI, and 35 (22.4%) had acquired HI. According to the severity of HI, 13 (8.3%) students had moderate, and 57 (36.5%) had severe HI. The ocular disorders were found in 57 (36.5%) students. Anterior segment pathologies were present in 55 (35.3%) students. Refractive error was found in 47(30.1%) students, heterophoria in 64 (41%), and amblyopia in 12 (7.7%). Ocular disorders were more common in children with profound HI. The association between ocular disorders and the severity of HI was not statistically significant. Twenty-three (14.7%) participants were referred for further detailed ophthalmological examination.

Conclusion: Ocular problems are more common in people with HI. Screening for ocular disorders and their management plays an important role in enhancing the quality of vision in hearing-impaired children to compensate for the poor auditory sense.

Effect of Eating Habits During Fasting Versus After Fasting on Biometric Parameters and Intra Ocular Pressure

2025-12-03T19:09:47+00:00

Objective: To compare the effect of eating habits during fasting versus three months after fasting on biometric parameters and intra ocular pressure.

Method: A Prospective observational study was done at institute of ophthalmology COAVS (College of Ophthalmology and Allied Vision Sciences) Mayo Hospital, Lahore. By using non-probability convenient sampling, 158 healthy participants who had no history of ocular or systemic diseases and a normal ocular status aged 20-30 years were included. Ocular parameters comprised intraocular pressure, axial length, anterior chamber depth, and central corneal thickness were measured by using standardized instruments. Each measurement was made twice, once during the Ramadan fast and once three-month after Ramadan. The data was analyzed by using SPSS version 27 and p-value < 0.05 was considered statistically significant.

Results: In this study 158 individuals were enrolled among those 61 (39%) were male and 97 (61%) were female with mean age of 24.5 & SD ± 2.6. The difference of IOP between both measurements was significant (during Ramadan: RE=13.9, LE=14.2 however 3-month post Ramadan: RE & LE=14.9) as the p-value was < 0.001. In contrast, biometric parameters including CCT, ACD, and AXL did not show any significant alteration between two observations because the p-value was > 0.05.

Conclusion: Fasting significantly lowers intraocular pressure, but it has no effect on biometric measurements (CCT, ACD, and AXL). Therefore, fasting has no effect on the structural integrity of the eye, but it does change the dynamics of ocular pressure.

Ocular Perfusion Pressure as a Mediator between Systemic Hypertension and Glaucoma

2025-12-03T18:35:02+00:00

Objective: To evaluate the relationship between systemic hypertension, ocular perfusion pressure and glaucoma.

Methodology: A cross-sectional comparative study was conducted, and the sample was divided into two groups (22 hypertensive patients and 22 normotensive controls) who had ages between 40 and 60 years. The participants were thoroughly examined with the measurement of systemic blood pressure, intraocular pressure and ocular perfusion pressure calculation. Fundus photography, optical coherence tomography (OCT), and automated perimetry were used to measure structural and functional damage. The SPSS was used to analyze data, with the help of the Mann-Whitney U test and correlation analysis.

Results: The hypertensive group's mean IOP was significantly higher (25.68 +- 8.98 mmHg) than the normotensive group's (18.22 +- 2.72 mmHg, p=0.001). However, there was no significant difference in the mean OPP between the groups (47.9 +- 9.8 mmHg vs. 46.2 +- 6.5 mmHg, p=0.49), which is indicative of compensatory hemodynamics, whereby elevated IOP compensated for elevated systemic blood pressure. More significantly, 40.9% and 45.5% of the hypertensive group, respectively, presented abnormal fundus photographs and OCT results, indicating a significantly higher prevalence of structural optic nerve damage (vs. 18.2 and 13.6, p=0.03 and p=0.01). According to the correlation analysis, there was a significant relationship between the OPP values and structural glaucomatous defects on fundus examination (r=-0.29, p=0.04) and OCT (r=-0.35, p=0.02).

Conclusion: Ocular Perfusion Pressure is the primary mediating factor, according to the data. It effectively connects glaucoma damage to systemic hypertension.

Comparison of Refined Cylindrical Axis by Straddling and Autorefractometer: A Clinical Study

2025-11-27T17:09:25+00:00

Objective: To compare two cylindrical refinements i.e. autorefractometer and straddling by taking patients response.

Method: Study protocols was approved by Ethical Review Board of College of Ophthalmology and Allied Vision Science, Lahore. A proforma based nonrandomized interventional method of study was conducted in National Eye Centre Lahore from August 2025 to September 2025. The size of obtained sample was 91 that included young healthy adults of age 18-35 having 1.00-3.00 D of astigmatism. Auto refraction, subjective refraction and then straddling was performed and then response was recorded by taking consent. Exclusion criteria for this study was individual with any ocular pathology. P-value was calculated by using Paired sample T test. Value of ˂0.05 was considered significant.

Results: No statistically visible significant differences were noted in between the methods (p-value > 0.05). Although minor variations exist in axis measurements, patients' satisfaction remained constant, showing that the interchangeability of the techniques was valid. These results agree with prior studies that stressed the flexibility yet accuracy needed in refractive assessment tools.

Conclusion: The straddling technique offers a reliable, time-efficient alternative to auto-refractometers for cylindrical axis refinement, ensuring comparable accuracy and patient satisfaction.