In this day and age of research and constantly improving methods of research conduct and protocols, policies are determined, to a large part, by the results of these researches, most of which are numbers. So in addressing the growing need to prevent blindness from Retinopathy of Prematurity (ROP), experts worldwide, in at least 2 major landmark studies and 4 World ROP Congresses, agreed on the definitions of high-risk criteria, with emphasis on timely referral. These were all meant to guide the pediatricians in referring premature babies for ROP screening. These efforts were meant to drive home a very important point: the occurrence of visually-debilitating stages of ROP are preventable. The incidence of blindness from ROP is quite small, but nonetheless, catastrophic to the patient. To speak of those numbers is not my purpose today. My purposes are to put a face and a voice to those who are “the tiny number … the small incidence” crying out from the outer edges of bar graphs, and to remind everyone that that tiny number of blind and nearly blind children are people with lives to live, and futures to look forward to, just like the rest of us. Certainly, opening that golden window of opportunity is the most important thing that one can do for the premature baby at risk of developing ROP. One is not born with ROP. No one wants to have it. No parent will want his child to have it. And if one does have it, one must be protected from the deleterious consequences of ROP. This will happen only if everyone concerned will just do what they have to do. Screening of a high-risk baby by an ophthalmologist cannot be done without a referral from the attending pediatrician. The tireless efforts of neonatologists and pediatricians in keeping the premature babies alive and managing all their life-threatening conditions are truly laudable. However, we must insist that sight is just as important. We must insist that high-risk babies be referred to an ophthalmologist for ROP screening. The importance of a wholistic approach in the management of a premature baby cannot be overemphasized. Quality of life should be a primary consideration when it comes to any situation where something has been compromised. To drive home a point, please do this: Imagine your child blind. Then think of everything that a blind child will miss in his life. Think of all the difficulties that the blind child will encounter in his entire life. Think of all the difficulties and the heartaches for the parents of the blind child. Then think of how this blind person will be when the doting parents who took care of him will one day no longer be around. A parent of an ROP blind child once said “To a parent there are no statistics. My child is always 100%.” And finally, think about these wise words from Nelson Mandela: History will judge us by the difference we make in the everyday lives of children.
Retinopathy of Prematurity ; Blindness

Neuroretinitis is an inflammatory optic neuropathy with a classic fundoscopic appearance of optic disc swelling and hard exudates on the macula in a star formation. It can be a manifestation of systemic, infectious or autoimmune disease. In nearly half of cases, the etiology is idiopathic. This review aims to summarize the clinical presentation, fundoscopic mimics, etiologies, investigation, and treatment of neuroretinitis. Cat-scratch disease, the most common cause of infectious neuroretinitis, and recurrent idiopathic neuroretinitis, which can cause ocular morbidity, are discussed in detail.
Retinitis ; Cat-Scratch Disease

Objective: To identify maternal and infantile risk factors for retinopathy of prematurity (ROP) among preterm infants screened in St. Luke’s Medical Center, Quezon City (SLMC-QC) from 2014-2017. Methods: This was a retrospective study that included the ROP databank of the Eye Institute and the Research and Biotechnology Group of St. Luke’s Medical Center, Quezon City from 2014 to 2017. This study included medical records of all premature infants screened for ROP and excluded those who had incomplete data or other ocular pathologies other than ROP. Risk factors were analyzed using univariate analysis. Odds ratio (OR) and 95% confidence interval (CI) were also calculated with significant P value set at <0.05. Results: Among the 455 infants screened for ROP, 118 (25.9%) had any stage of ROP while 23 (5.0%) had treatment-warranted ROP (TW-ROP). Univariate regression analysis showed that the top 5 infantile risk factors associated with any stage of ROP and TW-ROP were low birth weight (97.5% and 100%, respectively), prematurity (87.3% and 100%, respectively), history of blood transfusion (21.2% and 13%, respectively), sepsis (21.2% and 17.4%, respectively), and oxygen supplementation (16.1% and 8.7%, respectively). After multivariate analyses, the most important adjusted risk factors associated with any stage of ROP include low birth weight (OR 52, CI 16.20166.96, P =0.001), prematurity (OR 25.73, CI 14.10-46.95, P =0.001), and history of blood transfusion (OR 8.79, CI 4.08-18.96, P =0.0001). Conclusion The most significant infantile risk factors associated with any ROP include low birth weight, prematurity, and history of blood transfusion. There were no significant probable maternal risk factors. Timely ROP screening is recommended especially among infants with any of these risk factors in their profile.
Retinopathy of Prematurity ; Risk Factors ; Blood Transfusion ; Infant, Low Birth Weight

Objective: To validate WINROP, a web-based screening tool for retinopathy of prematurity (ROP), in the detection of any-stage ROP or treatment-requiring ROP among Filipino preterm infants screened for ROP from January 2013 to April 2017. Methods: Charts of preterm infants who were screened for ROP at a tertiary hospital from January 2013 to April 2017 were reviewed. Birth date, gestational age, birth weight, and weekly postnatal weight measurements were collected and entered into WINROP. The number of infants that were tagged by WINROP with alarm signals for any-stage ROP or treatment-requiring ROP were noted and compared with actual ROP screening findings. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the WINROP application in predicting any-stage ROP and treatment-requiring ROP were computed. Results: Charts of 138 preterm infants were included in the study. Sixty-four (64) had a chart diagnosis of anystage ROP and 13 had treatment-requiring ROP. WINROP tagged 77 and 10 preterm infants with any-stage ROP and treatment-requiring ROP, respectively. The sensitivity and specificity rates of WINROP for detecting any-stage ROP were 63.5% (95% CI: 51.5% - 74.2%) and 78.1% (95% CI: 65.7% - 87.1%), respectively. While the sensitivity and specificity rates at identifying treatment-requiring ROP were 76.9% (95% CI: 45.9% - 93.8%) and 46.4% (95% CI: 37.5% - 55.5%), respectively. Conclusion WINROP is fairly sensitive and specific in predicting any-stage ROP but has fair sensitivity and poor specificity in predicting treatment-requiring ROP. WINROP may aid in ROP prediction, but regular screening of preterm infants at risk for ROP based on current criteria remains to be the standard of care.
Retinopathy of Prematurity

Objective: To report the epidemiology of canalicular lacerations and surgical outcomes of canalicular laceration repair with Mini-Monoka® (FCI Ophthalmics, Issy-les-Moulineaux, Cedex, France) intubation. Methods: This is a retrospective interventional case series of patients who underwent Mini-Monoka® intubation in the repair of canalicular laceration from 2010 to 2015 at a tertiary state-owned hospital in Manila, Philippines. Patient demographics, surgical outcomes, and complications were analyzed. Results: Fourteen patients (12 males and 2 females) underwent Mini-Monoka® intubation for monocanalicular laceration. The mean age at presentation was 27 years (range, 16-47 years). The mean duration of follow-up was 2.92 years (range, 1.28-6.15 years). Canalicular patency was achieved in 12 out of the 14 patients (86%). None of the 12 patients experienced epiphora following stent removal resulting in a functional success rate of 100%. Two patients had punctal slitting (14%). Premature stent loss occurred in 2 out of the 14 patients (14%). Conclusion Mini-Monoka® intubation is effective in maintaining the long-term anatomical patency of the lacerated canaliculus. It is a simple and minimally invasive procedure making it a safe and reasonable alternative to the traditional methods of canalicular repair.
Lacerations ; Eyelid Diseases

Objective: To measure the ciliary sulcus diameters (CSD) in phakic eyes of adult Filipinos using ultrasound biomicroscopy (UBM). Methods: This was an observational, cross-sectional study involving Filipino patients recruited from the Outpatient Department of Makati Medical Center, Philippines from September 2006 to December 2006. Vertical and horizontal CSDs in phakic eyes were measured using a UBM Scan 1000 (Ophthalmic Technologies Inc., Toronto, Ontario, Canada). Three repeated measurements of each meridian were taken and averaged. The average CSD for each eye was computed as the average of the horizontal and vertical CSDs. Student’s t-test was used to analyze data. Results: Seventy-one (71) patients (142 eyes) were included in the study. Mean CSD measurements were as follows: horizontal CSD = 9.76 ± 0.42 mm; vertical CSD = 10.00 ± 0.48 mm; average CSD = 9.88 ± 0.47 mm. There was a significant difference between the means of the vertical and horizontal CSD measurements (P<0.01). There was no significant difference in the mean CSD measurements of the right and left eyes (P= 0.50). Conclusions In this cohort of adult Filipino patients, the UBM-measured vertical CSD is significantly greater than the horizontal CSD. Establishment of CSD measurements of adult Filipino eyes may be helpful in selecting appropriately-sized intraocular lenses for ciliary sulcus implantation.
Microscopy, Acoustic

Ischaemic optic neuropathy (ION) is the commonest adult optic neuropathy encountered in Southeast Asia and will increase in incidence with an ageing population. It occurs in two forms: arteritic and non-arteritic. The latter variety being by far the commoner encountered in the region and presenting as an anterior optic neuropathy with optic disc swelling. The clinical presentation of both varieties is described with particular reference to the hyperaemic disc appearance of the non-arteritic disease as opposed to the ischaemic, pale, swollen, infarcted disc seen in arteritic anterior ION. Essential visual field defects found in both varieties are emphasized; the prognosis and treatment are discussed. Pathological specimens are also illustrated. Posterior ION is briefly mentioned being a diagnosis of exclusion. The anatomy, especially the blood supply of the optic nerve head, is discussed along with its role in the production of the different varieties of ION.
Optic Nerve Diseases ; Pathology

Objectives: The primary goal of this study was to determine the relationship between diabetic peripheral neuropathy and retinal nerve fiber layer (RNFL) thickness among elderly Filipinos with type 2 diabetes mellitus. Methodology: This was a cross-sectional study involving 106 subjects aged 60 years or older with type 2 diabetes mellitus recruited from the General Medicine and Diabetes Clinics of a tertiary government hospital. The diagnosis of peripheral neuropathy was made by performing a 10-gram monofilament test. Peripapillary retinal nerve fiber layer thickness was measured using the optic disc cube 200 x 200 protocol of the Cirrus® HD-OCT. T-test was used to compare RNFL thickness in those with and without peripheral neuropathy. The effects of age, sex, duration of diabetes, presence or absence of peripheral neuropathy, and retinopathy status on global and quadrantal RNFL thickness was assessed using multivariate analysis. Results: Compared to subjects without peripheral neuropathy, significant thinning of the superior (P=0.011), inferior (P=0.004), and global (P=0.008) RNFL thickness were observed in subjects with peripheral neuropathy. There were no significant differences in RNFL thickness in the temporal (P=0.211) and nasal (P=0.263) quadrants between the 2 groups. Multivariate regression analysis revealed that presence of peripheral neuropathy has a significant effect on their superior (P=0.036), inferior (P=0.010), and global (P=0.024) RNFL thickness. Other factors such as age, sex, duration of diabetes, and retinopathy had no effect on global and quadrantal RNFL thickness. Conclusion RNFL thinning in the superior, inferior, and global indices on optical coherence tomography has a significant correlation with diabetic peripheral neuropathy
Tomography, Optical Coherence ; Diabetes Mellitus

Objectives: To determine the retinal nerve fiber layer thickness (RNFL) in eyes with ethambutol-induced toxic optic neuropathy (ETON) at the time of diagnosis and to describe the visual outcomes at 1, 3, and 6 months after discontinuation of ethambutol Methods: This was a retrospective chart review of 8 patients (15 eyes) diagnosed with ETON that had RNFL thickness measurements using Cirrus® spectral-domain optical coherence tomography (OCT) at the time of diagnosis. Visual function was measured on initial visit and at 1, 3, and 6-month follow-up. Snellen visual acuity was converted to logMAR. Color vision was measured using Ishihara 14-plate test chart. Results: The mean duration from commencement of ethambutol intake to onset of visual symptoms was 16 weeks (range: 8-24). While, the mean duration from onset of visual symptoms to discontinuation of ethambutol was 4 weeks (range: 2-14). The mean global RNFL thickness at time of diagnosis was 101.2 ± 17.0 microns. Mean RNFL in the temporal, superior, nasal, and inferior sectors were as follows: 79.2 ± 15.4, 119.7 ± 27.9, 71.7 ± 9.2, and 136.7 ± 25.8 microns. Global and sectoral RNFL thicknesses were either normal or thick when compared to age-matched normal database. No eye displayed global or sectoral RNFL thinning. Mean baseline visual acuity and color vision were logMAR 1.2 and 5 plates, respectively. At 1, 3, and 6 months after discontinuation of ethambutol, mean visual acuity and color vision were 0.96 and 6, 0.63 and 11, and 0.44 and 13, respectively. Conclusion Patients with early ETON have normal or thick RNFL at time of diagnosis. They display good visual recovery 6 months following discontinuation of ethambutol.
Ethambutol ; Toxic Optic Neuropathy ; Tomography, Optical Coherence

Objective: The objectives of this study were to develop a cross-culturally adapted, Filipino version of the Ocular Surface Disease Index (OSDI) questionnaire and to assess its reliability. Methods: A Filipino-adapted version of the OSDI was developed following guidelines for language-specific questionnaires: forward translation into Filipino by 2 independent bilingual translators, back-translation into English by a language institution, and a final forward translation to Filipino resolved by a review committee. To check for equivalence, the English and Filipino versions of the OSDI were pretested on 16 patients in a dry eye clinic. The Filipino version was then administered to 36 participants, and a Cronbach alpha coefficient for reliability of the overall instrument and the alpha that would result if each item were removed were computed. Finally, the questionnaire was then retested on 11 dry eye patients to see if the coefficient would increase. Results: All reported no difficulty with the Filipino questionnaire, with 81.3% expressing preference in answering it. Most (81.3%) chose the same answer in at least half of the items in both languages, though the range of similar responses varied from 41.7% to 91.7%. Reliability testing of the Filipino questionnaire showed this to have fair internal consistency (α=0.5958). The value increased to moderate internal consistency (0.7576) when 3 items were removed. Conclusion A culturally-adapted OSDI in Filipino was successfully produced and was the preferred tool by most patient participants.
Dry Eye Syndromes