Optometry 360 - 4th edition

Issue No. o4  •   January, 2022    

OPTOMETRY

ALO's Official Magazine 360

CONVERGE 2022

THE ROAD LESS TRAVELLED
ANTHROPOMETRY IN SPECTACLE DISPENSING
REVERSE GEOMETRY LENS FOR ORTHOKERATOLOGY
"WHAT" IS NOT ENOUGH!

Photo Credits:
Dr Srinivas Marmamula

@sri.marmamula

Sri Marmamula Photography

WWW.ALOPTOM.COM/OPTOMETRY360

ALUMNI OF LVPEI OPTOMETRISTS

OPTOMETRY 360

ALO'S OFFICIAL MAGAZINE

OPTOMETRY 360

CONTENTS

KNOWLDEGE + FUN + INNOVATION

04 EDITOR'S NOTE

11 ANTHROPOMETRY IN SPECTACLE
DISPENSING

21 "WHAT" IS NOT ENOUGH

23 INNOVATIONS
29 TALENT HUNT

31 FUN CORNER

SHARE YOUR SMILE
AND MOTIVATE

07 17 36 MEMES AND QUOTES CORNER

THE ROAD LESS UNDERSTANDING
TRAVELLED REVERSE GEOMETRY
LENS FOR
ORTHOKERATOLOGY 45 CHRONICLES

Read the most interesting and inspiring
journeys of our alumni.

41 CLINICAL PHOTOGRAPHS E T R [email protected] 0

Exclusive feature about the successful alumni Y 36
of LVPEI, their talents and career paths.
WWW.ALOPTOM.COM
O P T O M44 ALUMNI CORNER
Exclusive feature about the successful alumni
of LVPEI, their talents and career paths.

ALO'S OFFICIAL MAGAZINE

SANDHYA Editor's
SHEKAR Note

EDITOR Wish you all a Happy and a Prosperous 2022!

Welcome to the 4th edition of Optometry 360. 2021 has been quite
a productive year despite being tough and eventful. Team ALO
announced its new general body and executive team members and
the new team has brought in their fresh perspectives in 2021.
Optometry 360 and ALO Chronicles are the most distinguished
among the other initiatives. I take this opportunity to laud the
efforts of Team ALO in crafting and bringing to you a wholesome
edition of this magazine and other initiatives and also express my
gratitude to those who made valuable contributions.

We are also ecstatic to announce Converge, 2022. Converge is a
scientific conference organized by Team ALO for optometry
students, practitioners and professionals from all optometry
organizations across India. We are excited that it is going to be in-
person at Hyderabad. It’s time to Connect, Capture and Celebrate.
Hope you all blocked your calendars for this weekend to begin your
new year connecting and celebrating with friends and peers.

In this edition of Optometry 360, we bring to you varied optometry
and eye care related content contributed by optometrists, both in
house and from other optometry institutes. Peruse through our
Perspective Column to know more about community optometry,
anthropometry in spectacle dispensing, orthokeratology and
conventional and modern learning and teaching processes. They are
thoughtfully written by some of our esteemed alumni and experts
from other eye care organizations. Team ALO also recognizes and
congratulates Dr. Vinod Maseedupally and Mr. Lalith Kumar Reddy
for their achievements and contributions.

We appreciate your participation and encourage you to further
contribute to our magazine. Please read through the guidelines to
understand how to pitch to us. Team ALO eagerly awaits to work
with all of you.

Until next time,
Sandhya Shekar

January Connect, Capture & Celebrate
8th & 9th

20
22

Leonia Destination Resorts,
Hyderabad

GOLD SPONSORS

OTHER SPONSORS

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PERSPECTIVE
COLUMN

TIPS FOR CONTRIBUTING TO

THE PERSPECTIVE COLUMN


20

Optometry 360 aims to cater to both practicing optometrists and students, both from LVPEI and from SEPTEMBER 2021 | ISSUE 03
other optometry schools and institutes. We envisage to bring to you the best practices and interesting
stories from different institutes across the country. Hence we are excited to extend this invitation to
contribute to the optometry fraternity. One such section where everyone can contribute is the
“Perspective Column.” Perspective column is a mix of scientific and science writing. While they both
could mean the same, there is a slight nuance between them. Scientific writing is an objective
communication of science related best practices and research shared by clinicians and researchers.
Science writing, although does the same, engages the readers and keeps them enthused with your
passion for the subject. While the former doesn’t encourage subjective beliefs, wishes and hopes, the
latter encourages you to share your beliefs and hopes to explain the motivation of your science or
practice. We want to bring the best of both these features in our column. Hence we invite optometry
or related articles elucidating a scientific revelation, a concept or a topic sporadically discussed,
evidence based best practice, story of a new invention/discovery or anything that keeps our audience
engaged, in your own words. We have four such articles in our current edition.
If you wish to contribute to this section, please send us your pitch. Our team of editors will walk you
through the process and help you in bettering the article when necessary. Here are some guidelines for
pitching to us:

Originality: Please ensure that you send us your own work. We want to hear your story in your own
words. You may use information or research to corroborate your results or understanding but make
sure to rephrase them
Plagiarism: We take plagiarism very seriously. If you have used information from text books,
scientific articles or a website, please cite their references appropriately in Vancouver style. To
ensure that plagiarism is under 10%, please run your article on any of the online plagiarism check
software. We will also run a check at our end once we receive your articles. We reserve the right to
reject any article we deem unfit
Images and photographs: Feel free to add photographs, graphs, flow charts to articulate your
concepts. If you plan to use photographs taken by you or your team, please add a watermark. If you
choose to use an online image, cite the reference below the image in a small font with the web link
Grammar: Grammar is of utmost importance. There are several free grammar check platforms
available online. Use them to check your basic tenses, spellings and punctuations. Our editing team
will also work with you by providing valuable inputs, suggestions and corrections wherever
necessary. The attractiveness of correct grammar cannot be overstated
Practice the art of brevity: The briefest construct of words that explicitly states a thought is long
enough - Herbert Brün. Try saying a lot in under 1200 words (references excluded)
Time: Please allow at least 2-3 days to hear back from the team. If you don’t hear back from us
within the time, please feel free to check with us. You can expect to receive the first draft with the
editor’s comments in track changes in under 5-days’ time. You are free to accept the changes or
provide justifications where ever necessary
We take this process seriously and we expect the same from you. While we are happy to help you
by providing our inputs and suggestions, we cannot make them for you
When in doubt, reach out to our team at [email protected]

We look forward to receiving your interesting articles and working with you. 6

TravelledThe Road Less

Public Eye Health / Community Optometry

DR SRINIVAS MARMAMULA
ASSOCIATE DIRECTOR - PUBLIC HEALTH RESEARCH AND TRAINING

(GPR ICARE)
SCIENTIST - BRIEN HOLDEN EYE RESEARCH CENTRE AND
BRIEN HOLDEN INSTITUTE OF OPTOMETRY AND VISION SCIENCE

L V PRASAD EYE INSTITUTE

What is Public Health and Public Eye Health?

According to the World Health Organisation (WHO), public health is defined as ‘the art and science of
preventing disease, prolonging life and promoting health through the organized efforts of society. Public
Eye Health is similar to public health but predominantly deals with eye health. It includes three components,
a) research to understand the burden of visual impairment using epidemiological tools, b) evaluation of
service delivery models to address the burden of visual impairment, c) service to communities. In addition,
academic teaching and training in public eye health are activities that come under the domain of public eye
health.
One major factor that distinguishes clinical eye care and community eye care is the primary focus. In
clinical care, individual patients visiting the clinics are the focus whereas, reaching out to the community to
provide care is the hallmark of community eye care.

Advantages of Public Eye Health as a Career Option:

In this scenario, public eye health or community optometry provides an excellent career option for budding
optometrists. This emerging career option provides a job that is never the same and leaves you with a
feeling of gratitude at the end of the day, as you care for the most underprivileged communities.

7

Importance of Public Eye Health: There are several online and offline courses
offered by LVPEI and other institutions to acquire
With over a billion people affected with vision loss, the knowledge and skillset required for public eye
ocular health is a public health challenge. Hence we health.
need a holistic public health approach to meet this
challenge. As primary eye care providers, the role of A four-week Certificate course in Community Eye
optometrists is pivotal as a substantial proportion of Health (CCEH) offered by LVPEI is the most
vision loss is due to uncorrected refractive errors and appropriate for both young and experienced
presbyopia. Conventional individual focussed clinical optometrists to get started in this area of work.
care is essential, but this alone may not address the Those who are seriously considering getting into a
growing burden of vision loss. Public eye health full-time public eye health may consider doing a
approaches are needed to address the challenge of M.Sc. in Public Health for eye care offered by the
vision loss. London School of Hygiene and Tropical Medicine,
University of London, UK. Scholarships are also
For those interested in travel and always want a available for meritorious candidates. In addition,
change in their routine, public eye health offers an Master’s in Public Health (MPH) is offered by
excellent career option. It provides numerous several universities both in India and aboard.
opportunities to uniquely contribute to the profession Though most of these courses are generic and do
through research, services and teaching and always not focus exclusively on eye health, the underlying
leaves you with a sense of feeling of ‘giving back to principles are still applicable to eye health. Several
the community.’ workshops on research methods are also
conducted in India for the benefit of those aspiring
There are several other advantages for taking up to get into public health.
public eye health as a career and here are a few:
For those who are about to graduate or have
• a new avenue in optometry graduated recently, LVPEI PGDOVS (Post
•opportunities for networking with research Graduate Diploma in Optometry and Vision
colleagues Science) with Public Eye Health specialty is a very
• stimulation of a job that is never the same from good option that combines theoretical training and
one day to the other hands-on research experience. This course is
• travel to remote locations envisaged to act a launchpad for those who wish
• satisfying career to pursue research / Ph.D. as a career.
• working with the community and being a part of the Also, consider subscribing to Community Eye
‘social change’ Health Journal (https://www.cehjournal.org/) that
• direct impact on the lives of the people provides excellent articles on public eye health.
• a better understanding of the underlying problem - This is a free subscription and is also available as
“causes of causes” app for any device- ‘Community Eye Health
Journal’ or ‘CEHJ’ for both Android and iOS
Getting into Public Eye Health: platforms.

To work in this area additional training is needed as The Litmus Test – Do You Have it in You?
the current undergraduate programmes in optometry
provide a very limited knowledge of public eye “Am I the right candidate to get into public health?”
health. Basic skills and knowledge such as research This is the most common question that I get to
methods including epidemiology and biostatistics, hear from young optometrists and graduate
eye health promotion, monitoring and evaluation of students. Here is a checklist to check if public eye
eye care programmes and proposal writing are health is the right career choice for you or not:
essential for public eye health.
like traveling to places and meeting people
bored with routine clinics / constantly looking
for a change

8

“adventurous and have the personality to deal with Background: Vision loss adversely impacts the
the unexpected quality of life of the elderly. Previous studies (done
willing to make a difference in the lives of people outside India) have reported the prevalence of
team player who can work with people from other vision loss in this vulnerable population residing in
disciplines ‘homes for the aged.’ But the research done in
has patience, persistence, and passion to care for India in this field is limited. With the increase in
the well-being of others aging population in India, the number of residential
homes for the elderly is also on the rise. The
Avenues in Public Eye Health: HOMES (Hyderabad Ocular Morbidity in Elderly
Study) project was carried out to understand the
Public eye health offers a wide range of employment prevalence and causes of vision loss among the
opportunities beyond the routine clinical care. Few elderly in homes for the aged in Hyderabad in
employment avenues are highlighted below: Telangana.

• Research Institutes - As researchers on public eye ≥The process:
health and epidemiological projects
• Optometry schools & colleges - Teaching research In total, 1,512 elderly residents (aged 60 years)
methods, epidemiology and biostatistics and support were enumerated and, 1,182 participants (78.1%)
student projects as a part of their curriculum were examined from 41 ‘Homes for the Aged’ in
• International and National Non-Governmental Hyderabad. A makeshift clinic was set up in each
organizations – Grant administrators and evaluators of these homes. A trained team of investigators
for funded projects and clinicians carried out a detailed interview
• Hospitals – Planning and organizing community eye followed by an eye examination for each of the
care services participants in the homes.
• Developmental organizations – Support in terms of
provision of technical expertise for community Main findings:
programmes · Over 30% of the elderly were found to have
• Universities – Teaching faculty and mentoring vision loss. Cataract was identified as the leading
doctoral students cause of vision loss (46.3%), followed by
• Government programmes – Policy and advocacy, uncorrected refractive errors (27.0%).In total, over
technical support for government eye care 88.2% of the vision impairment could be either
programmes treated or corrected.
• Freelancing – Research and advisory support for the · One-third of the elderly individuals who had
government and non-governmental organizations on previously undergone cataract surgery had visual
specific projects. impairment. Posterior Capsular Opacification (a
cloudy layer formed behind the implanted lens)
My Experience – The HOMES Story: was the leading cause of visual impairment
(31.8%; n=129) followed by uncorrected refractive
I have been in public eye health for close to two error (24.1%; n=98) among those who were
decades now and counting. I never regretted the operated.
choice I made in my career to walk the road less
travelled. It has been a fulfilling journey so far and I · The prevalence of falls was higher among those
look forward to exciting challenges to create more with visual impairment due to uncorrected
impact in the years ahead. I want to share the refractive errors.
highlights of one of the recent research projects that · Nearly half of the elderly in residential care had
was very gratifying and made me feel proud for being near visual impairment.
a public eye health specialist and optometrist. Here is . Elderly with dual sensory loss (vision and hearing
the story: loss) were five times more likely to have
depression.

9

Impact: All the participants who were identified with eye problems were referred to LV Prasad Eye
Institutes where all services were provided at ‘no cost’. Spectacles were provided to all those who had
distance and near vision impairments. We have nine papers from this study and few more are in the
pipeline.

Implications: Our study is one of the most comprehensive eye health studies done among the elderly in
residential care in India. It provides insights on the prevalence, causes, and association of vision loss in
this vulnerable population. As the Indian population ages, there will be an increasing burden of vision
loss in these homes. Addressing visual impairment can also result in fewer falls and contribute to
healthy aging in India. The information from this study can be used for developing strategies to ensure
that this vulnerable population does not suffer due to needless vision loss in their ‘sunset’ years of life.

My advice: “Two roads diverged in a
While public eye health is a great career option, wood, and I took the one
always follow your heart when you choose your less travelled by and that
career. Where there is passion, there is no monotony
or boredom. If there is a passion for what you do, then has made all the
work becomes fun and you seldom look for a holiday. difference.”
No vacation is needed as every day is a vacation in
the chosen endeavour.
I conclude my article with a quote from The Road Not
Taken by Robert Frost:

References:
Rechel, B. and McKee, M., 2014. Facets of Public Health in Europe. European Observatory on Health Systems and
Policies Series.
GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease
Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the
Global Burden of Disease Study. Lancet Glob Health. 2021 Feb;9(2):e130-e143. PMID: 33275950; PMCID: PMC7820390.
Marmamula S, Barrenkala NR, Challa R, et al. Hyderabad Ocular Morbidity in Elderly Study (HOMES) - Rationale, Study
Design and Methodology. Ophthalmic Epidemiol. 2020;27(1):83-92. doi:10.1080/09286586.2019.1683867
Marmamula S, Barrenakala NR, Challa R, et al. Prevalence and risk factors for visual impairment among elderly residents
in 'homes for the aged' in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES) [published online ahead of
print, 2020 Mar 25]. Br J Ophthalmol. 2020;bjophthalmol-2019-315678. doi:10.1136/bjophthalmol-2019-315678
Marmamula S, Barrenkala NR, Challa R, et al. Uncorrected refractive errors for distance among the residents in 'homes
for the aged' in South India-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Ophthalmic Physiol Opt.
2020;40(3):343-349. doi:10.1111/opo.12684
Marmamula S, Barrenakala NR, Challa R, et al. Visual outcomes after cataract surgery among the elderly residents in the
'homes for the aged' in South India: the Hyderabad Ocular Morbidity in Elderly Study. Br J Ophthalmol. 2021
Aug;105(8):1087-1093. doi: 10.1136/bjophthalmol-2020-317167. Epub 2020 Aug 27. PMID: 32855164; PMCID:
PMC8311112.
Marmamula S, Barrenkala NR, Challa R, et al. Falls and visual impairment among elderly residents in 'homes for the
aged' in India. Sci Rep. 2020;10(1):13389. Published 2020 Aug 7. doi:10.1038/s41598-020-70066-2
Marmamula S, Barrenkala NR, Khanna RC R, et al. Near Vision Impairment among the elderly in residential care – The
Hyderabad Ocular Morbidity in Elderly Study (HOMES). (In press), Eye (London)
Marmamula, S., Kumbham, T.R., Modepalli, S.B. et al. Depression, combined visual and hearing impairment (dual
sensory impairment): a hidden multi-morbidity among the elderly in Residential Care in India. Sci Rep 11, 16189 (2021).
https://doi.org/10.1038/s41598-021-95576-5

10

Anthropometry in
Spectacle Dispensing

Dr Anitha Arvind
Freelance Consultant Optometrist & Optometry Educator

Co-Founder & Director Academics Learn Beyond Vision
Faculty

H V Desai eye hospital, School of Optometry
Chandigarh University



A spectacle frame should fit and correspond to These spectacles may not conform to the
the anatomical features of the head and face. facial characteristics of all ethnic groups
A well-fitting pair of spectacles not only and the very reason why online spectacle
ensures comfort but also provides aesthetics frame purchases would not be a good
thus ensuring better compliance. Poorly fitted idea.
spectacle wearers present with a variety of A thorough knowledge of the facial
symptoms ranging from soreness along the characteristics of adult and child in
root of the nose, behind the ears as well as different age groups is essential in
headaches and vertigo. The facial spectacle dispensing. Dispensing a pair of
characteristics of children and adult are spectacles is an art and ophthalmic
different and so the unique facial anthropometry plays a great role in help
characteristics should be reflected in the recommend and fit the right pair of
choice of frame. Poorly fitted spectacles in spectacles to the wearers. This article
children could lead to a variety of problems helps understand the various facial
ranging from reduced visual acuity to measurements and its importance in
discomfort as well as permanent damage to spectacle dispense.
the facial features (Keirl A, 2010). As the child
grows, the facial features keep changing and What is Anthropometry?
so the spectacle frame should ensure that no It is the scientific study of the
harm is done to the developing features of the measurements and proportions of the
face due to an ill fit. Studies have shown that human body
across the globe nose represents the most
distinguishing feature of the face amongst What is ophthalmic anthropometry?
different ethnic groups and races and hence
forms an important feature for spectacle With respect to spectacle frames, it
frame designing (Farkas et al, 2005). Large
scale ophthalmic anthropometry data is involves facial measurements for
unavailable for different populations across
the globe which results in import of large- dispensing a pair of anatomically fit
scale spectacle frames in low- and middle-
income countries. spectacle frames. Ophthalmic

anthropometry for spectacle frames

involves a set of facial and frame

measurements for spectacle dispense.

Anthropometry in spectacle dispensing

Importance of facial and frame measurements Equipment for facial and frame
measurements:
To understand the compatibility of face to the
frame chosen or vice versa Facial measurement ruler (figure 1)
To be able to understand the facial Frame measurement ruler (figure 2)
symmetry/asymmetry so as to suggest the Pupillary distance (PD) ruler (figure 3)
appropriate frame Pupillometer (figure 4)
To be able to order a bespoke/customized Head calipers (figure 5)
spectacle frame

Figure 1: Fairbanks facial measurement ruler Figure 2: Frame measurement ruler
(PC: www.abdo-college.uk)

Figure 4: PD ruler for measuring monocular PDs

12

Anthropometry in spectacle dispensing

Figure: Pupillometer (PC: Figure 5: Head calipers (PC: www.sussex-vsion.co.uk)
www.essilorinstrumentsusa.com)

Significance of facial measurements in spectacle dispensing

Pupillary Distance Measurement:

The pupillary distance (PD) is the distance from the pupil centre of one eye to the pupil
centre of the other eye (figure 6). This distance is important as it ensures that the
pupillary centre matches the optic centre of the lens. The pupillary distance can be
measured with either a pupillometer or a PD ruler. Monocular PDs are more valuable in
spectacle dispensing especially in moderate to high powered prescriptions as well as
bifocal and progressive lenses.

Figure 6: Pupillary distance

13

Anthropometry in spectacle dispensing

Crest Height
Controls the vertical position of the frame
front. It determines how low or high the
frame sits on the face (figure 7). Children
have a lower crest height than adults so we
need to select a frame with lower crest
height so that the frame sits higher on the
face and also ensure that the child looks
through rather than over the glasses.

Figure 7: Crest height measurement

Figure 8: Profile view for bridge projection

Bridge Projection
Controls the horizontal position of the frame front in order that the spectacles fit away
from the lashes. A positive bridge projection means that the nasal bridge extends
beyond the lashes so we need to recommend a spectacle frame with positive bridge
projection. A negative bridge projection means that the eyelashes protrude beyond the
nasal bridge so appropriate recommendation needs to be made. Children usually have
negative bridge projection due to undeveloped nasal bridge. A profile view of the face
(figure 8) helps in identification of the bridge projection as shown in figure

Frontal & Splay Angles
Determines the angle of the pad bridge or the pad on arms in the horizontal plane
(figure 9). The splay angle determines the angle of the pad bridge or pad on arms in the
horizontal plane (figure 10 ). Flat nasal bridge results in large frontal and splay angles
and hence spectacle frames with large frontal and splay angles are recommended.
Children with undeveloped nasal bridges have larger frontal and splay angles in
comparison to adults.

14

Anthropometry in spectacle dispensing

Figure 9: Frontal angle Figure 10: Splay angle

Pantoscopic Tilt

Determines the angle of side of the frame when
it is in primary position on the face (figure 11).
Adult frames usually have a pantoscopic tilt
ranging between 8 and 12 degrees while
paediatric frames have pantscopic tilt close to
zero to prevent the frame from resting on the
cheeks. During Progresive Addition Lens (PAL)
dispense, pantoscopic tilt plays an important
role as it ensures that the reading portion is
brought closer to the eye and also increases
filed of vision through the reading area.

Figure 11: pantoscopic angle

Head & Temple Width

Head width (figure 12) is the horizontal distance from ear point to ear point while
temple width (figure 13) is the horizontal distance from temple to temple. Both the
measurements are made with head calipers. The spectacle frame chosen should not
be wider than the widest part of the frame. Ridges on the sides of the face and head
of the spectacle wearer indicate a poor fitting frame. In adults, choosing a spectacle
frame whose Boxed Centration Distance (BCD) matches the frame PD ensures
minimum decentration during glazing and a lighter and cosmetically better
appearing glasses.

15

Anthropometry in spectacle dispensing

Figure 13: Temple width13 Figure 12: Head width

A good understanding of facial and frame measurements will go a long way in
recommending and dispensing the correct pair of spectacles to the wearer. In addition,
choosing the right frame material, bridge styles, temple sides and ophthalmic lenses
help promote comfort, compliance as well as aesthetics in the spectacle wearer.

Pictures courtesy: www.opticianonline.com

References :
1. Keirl A, 2010, Paediatric Eyecare - part two, Anthropometry and spectacle frames for children, Dispensing
Optics, 25, 10.
2. Farkas, Leslie G MD, PhD, DSc, FRCSC*; Katic, Marko J BA † ; Forrest, Christopher R MD, MSc, FRCSC*
International Anthropometric Study of Facial Morphology in Various Ethnic Groups/Races, Journal of
Craniofacial Surgery: July 2005 - Volume 16 - Issue 4 - p 615-646 doi: 10.1097/01.scs.0000171847.58031.9e
3. Obstfeld H, 1997, Spectacle Frames and their Dispensing, W B Saunders and Co Ltd London UK, pp188-189
4. Griffiths A. Practical Dispensing,2000 ABDO publication
5. BrookesC and Borish I. System for Ophthalmic Dispensing, 2007, 3rd edition
6. CET articles from www.opticianonline.net

16

Understanding Reverse Geometry
Lens for Orthokeratology

MS. IRENE SOPHIA JOSEPH
M.OPTOM, FIAOMC, RESEARCH SCHOLAR
FELLOW AND BOARD MEMBER OF THE INTERNATIONAL
ACADEMY OF ORTHOKERATOLOGY AND MYOPIA CONTROL
(IOAMC, USA)
SECRETARY OF BRITISH INDO PACIFIC ORTHOKERATOLOGY
MYOPIC CONTROL ACADEMY (BIPOK)

Orthokeratology is a fantastic alternative for This led to the invention of “orthofocus”—a
managing myopia in both children and adults. forerunner of orthokeratology—and, later, the
Knowing the overall anatomy of an “recessed optic” lens, in which the optic zone
orthokeratology contact lens is vital for was cut flatter than the lens's periphery to
practitioners interested in delivering this service to increase centration (Mountford et al, 2004).
patients. While competence in orthokeratology The polymethyl methacrylate (PMMA) lens were
lens design may appear to be more necessary for worn throughout the day and contact lenses
those seeking to develop custom lenses, anyone were fitted up to 1.50D flatter-than-K based on
planning to use orthokeratology in their practice the patient's refractive error and the
should have a basic understanding. This practitioner's personal preference, in the early
understanding is strongly connected to the days of orthokeratology. These lenses which
physiology and optics of the process, which were fitted flatter than K, had poor success due
improves troubleshooting approaches and to adverse reactions, induced astigmatism, poor
capacity to clarify inquiries about the process from tolerance and was almost aborted. Nick Stoyan
patients, parents, and other healthcare and Richard Wlodyga produced the first reverse
professionals. geometry lens in 1989, which dramatically
Since the 1960s, when the notion was initially put increased the efficiency of orthokeratology
into reality, the anatomy of ortho-k lenses has employing high Dk material by taking these
changed dramatically. Practitioners noticed that corneal changes into account. Modern
rigid contact lenses produced changes in the orthokeratology treats the cornea as a visco-
curvature of cornea, refractive status, and elastic material, which includes corneal
uncorrected visual acuity of adult myopic and rheology, a field of science concerned with the
sometimes astigmatic patients and they became flow and deformation of matter caused by
interested in using them to reduce myopia. stress.

17

Understanding Reverse Geometry Lens for
Orthokeratology

Fig.1: The red line denotes the reverse geometry lens and its zones.

The base curve is the steepest curve in a Flat K : 44.50 D
traditional lens design, while the succeeding BC: Flat K – (Target Refraction + Jessen factor )
curves are gradually flatter. This design was 44.50 – (4.00 + 1.25 ) = 39.25 D
meant to mimic the typical corneal shape, in
which the cornea is sharpest at the apex and The Jessen factor is that amount of over correction
flattens out towards the periphery. The reverse that gives room for regression during the day.
curve (the second curve after the base curve) is The clearance under the BC is about 5 - 15 microns
made steeper than the base curve in a reverse and is visible on slit lamp as a bearing. This curve is
geometry lens design, whereas the remaining mostly spherical but can also be made aspherical to
curves are gradually flatter. improve the myopic correction by increasing the
paracentral clearance.
Shape of the lens: The modern orthokeratology
lens has 4-6 curves. Reverse Curve (RC) : Next to the BC is the steeper
reverse curve which can be 0.5mm to 1mm wide
Base curve (BC): This is the central curve that and determines the adequate apical clearance by
ranges from 5mm to 6.8 mm depending on if it is a lowering or raising the BC. The depth of tear film
myopia control lens or myopia correction design. under this curve is proportionate to the amount of
This forms the treatment zone on the cornea. The error being corrected. The lower the target
radius is determined by the calculating the Jessen refraction, the shallower the RC clearance and vice
formula (Montford 1998). The first step is to versa. If the RC is too steep it will result in increased
calculate the target refraction which is the apical clearance and under correction of myopic
spherical equivalent of the manifest refraction. error. This will show as a central island on the
Eg. topography map. If RC is too flat then the lens would
Manifest Refraction : - 3.50 DS / -1.00 DC * 180 rock on the flat meridian and create a decentered
Target Refraction : - 4.00 DS treatment zone.

The BC is calculated by flattening the flattest
meridian by the target refraction and adding the
Jessen factor which can range from 0.50 D to 3D
depending on the design (Mountford et al 2004) .

18

Understanding Reverse Geometry Lens for
Orthokeratology

Alignment Curve (AC): This is the curve after the RC under which mid peripheral bearing appears on the
fluorescein pattern and ranges from 0.6mm to 1mm in width. It can be spherical, aspheric or a tangent
depending on the mid peripheral eccentricity (e-value) of the cornea along the flat meridian. On an
average the eccentricity of cornea is 0.5mm but it can vary. Corneas with lower e- value will require a
steeper alignment curve and vice versa, to land in alignment with the cornea at the mid-periphery.
Epithelial thinning also occurs at this zone to aid para-central steepening and thereby myopia correction.
Some designs incorporate more than one alignment curve which helps in more uniform fluid forces on the
cornea for better myopia correction.

Peripheral Curve (PC) : This curve is about 0.2mm to 0.5mm in width and should be around 80 microns
to 100 microns deep for proper edge lift. This curve ensures tear exchange and eases lens removal
process.

Toric periphery (TP) : The lens has a spherical BC and toricity in the periphery improves centration and
uniform landing of lens all around 360 degrees in the mid periphery. This is required when the sagittal
height difference between the two principal meridians at the 8 mm cord is > 30 microns on the
topography map (Kojima et al, 2016). Limbus to limbus astigmatism >1.25d and apical astigmatism
>1.75d also requires TP design for good centration(Pauné J 2016).

Total Diameter (TD): The diameter must be 0.8mm to 1mm smaller than HVID. Diameter of the lens is also
an important parameter for proper centration of the orthokeratology lens.

How it works on the cornea:

Fig 2: A reverse geometry
lens (red color) on the
cornea (black color)

showing the push forces
(black arrows) and pull

forces (red arrows)



The BC pushes the cornea in (+ force) while the RC pulls it out (-force), during accelerated
orthokeratology. The contact lens in ortho-k causes a stress that changes the structure of the
cornea. The strain reaction of the cornea to the stress produced by the contact lens causes the
change in shape. The cornea's stress/strain relationship is linear up to a physiologic limit, allowing

for a predictable outcome.



19

Understanding Reverse Geometry Lens for
Orthokeratology

Myopia Control designs: The latest development is the modification of optic zone size to 5.4mm to
reduce the treatment area and direct the paracentral optics through the pupil. This will help reduce the
peripheral hyperopic defocus and achieve good myopia control.

Fig 3: fluorescein MYOPIA CONTROL
pattern showing smaller DESIGN - SMALLER

optic zone for myopia OPTIC ZONE
control and larger optic

zone for myopia
correction



MYOPIA CORRECTION

DESIGN - LARGER

OPTIC ZONE



References:
Mountford J, Ruston D, Dave T. Orthokeratology Principles and Practice. London:Butterworth-Heinemann,
2004.
Caroline PJ. Contemporary orthokeratology. Cont Lens Anterior Eye. 2001;24(1):41-46.
Chan B, Cho P, Mountford J. The validity of the Jessen formula in overnight orthokeratology: a
retrospective study. Ophthalmic Physiol Opt. 2008 May;28:265-268.
Korszen E, Caroline P. The anatomy of a modern orthokeratology lens. Contact Lens Spectrum. 2017
Mar;32:30-5.
Kojima R, Caroline P, Morrison S, Kinoshita B, Andre M, Lampa M. Should all orthokeratology lenses be
toric? Poster presented at the 2016 Global Specialty Lens Symposium, Jan. 2016, Las Vegas.
Pauné J. From bowtie to casual: dealing with toric corneas in ortho-k. Lecture at GSLS, January 21-24,
2016; Las Vegas, NV.

20

"What" is not enough!

-Confronting the conventional wisdom in the
learning process

The world is emerging rapidly at a faster

pace than ever. Gone are the days of

visiting libraries and struggling to acquire

academic content. Technological

advances have made information more Praveen k Bandela

accessible, and innovations including PhD Candidate
Associate Lecturer - School of
augmented and virtual reality have made Optometry and Vision Science
Brien Holden Vision Institute, RMB
learning more enjoyable. Australia

While advancing with the emerging world,

it is worth considering a few questions.

Firstly, have our learning, teaching,

educational systems adapted to the

modern world? Secondly, is there a

necessity to revisit traditional, didactic

approaches (e.g., a one hour long, only

lecturer talking) of teaching? - specifically

for health care professions such as

optometry. Also, with an imbibed notion

of conventional wisdom (e.g., written

closed book exam is the best and only way

to assess a student's understanding),

which might restrict the learning

capability, it may be the time to revisit

where we stand.

21

"WHAT" IS NOT ENOUGH!

The change:

Consider the following hypothetical scenarios given to a batch of optometry students:
Group A: What is the principle of a lensometer?
Group B: Construct a lensometer setup with five convex lenses and measure the
power of a testing lens.
The Group A students will answer the question easily and score well, but it is just
testing the students’ memory. Such evaluations limit the students’ potential. However,
Group B students would critically evaluate the step by procedure in building the
lensometer, even while they learn the principle via textbooks. There is a great scope for
improvement in designing our teaching and fostering students' critical thinking and
analytical skills.
Undergraduate students require a different teaching strategy compared to young
school-going kids. It is commonly observed that there is a longer transition in our
system between these two. The aim should be to use teaching techniques that
improve critical thinking and analyzing skills rather than memorization.

Being in a healthcare profession,
optometry educational methods need to
be tailored to equip students with the
required skills. While using traditional
strategies, including a variety of teaching
methods as an essential part of the
curriculum, would improve the student
learning experience. For example, there
is a greater hesitancy to introduce open
book examinations in our system, which
is common (at least partially) in the rest
of the world. It is encouraging to see
that some organizations have already
implemented different teaching
methods (e.g., problem-based learning).
However, change and advancements are
needed throughout all the optometry
institutions.

22

"WHAT" IS NOT ENOUGH!

With inevitable economic, social and political constraints, our education system is
racing to compete with rest of the world, so as the profession. The optometry
governing bodies in India are striving to standardize the profession, and with an
enormous effort, we are moving towards that goal.
While it may take several years, even decades, to see any significant changes, it is
time to revisit and reevaluate our learning and teaching methods. It is a collective
effort to make these changes, and soon we will flourish in our efforts to develop a
profession that competes well, and delivers the highest standard of care.

References:
Figures: https://fineartamerica.com/

22

INNOVATIONS

PIONEERING DEVELOPMENT TO MAINTAIN VISUAL ACUITY:
IMPLANTABLE MINIATURE TELESCOPE (IMT)

The Implantable Miniature Telescope (IMT) is a miniaturised Galilean telescope which
magnifies image size on the macula by more than two and a half times the original image size.
Clinician from Mater Private Hospital in Dublin treated a 78-year-old patient who has age
related macular degeneration with IMT. IMT do not treat ocular disease pathology. This IMT
can assist when medical therapy or treatments fails to maintain adequate vision. Authors
mentioned that the improvement in vision acuity is not always sustained longterm, delay in
deterioration positively impact quality of life and is considered very useful and impactful in
elderly population.

Read more about IMT here
https://www.aop.org.uk/ot/science-and-vision/technology/2021/08/01/78-year-old-patient-
has-miniature-telescope-implanted-in-eye

TELEMEDICINE: ROBOTICALLY ALIGNED OCT

Robotically aligned Optical Coherence Tomography (RA-OCT) provides high-quality
volumetric retinal and optic nerve images of patients.
This technology has the potential to be useful in telemedicine. A research group from Duke
University, School of Medicine presented pilot study results at the Women in Ophthalmology
symposium where they tested the ability of RA-OCT to obtain remote fundus imaging of
patients who presented with ocular complaints.

RA-OCTA is an investigational Nielle Ramos
device which provides 32° field of
view of the retina, including the
fovea and optic nerve head.
Thickness maps were also
generated with semiautomatic
segmentation of selected
volumes. Pilot study showed high
quality clinical pictures which
highly correlated with clinical
presentations.

Read more on RA-OCT here on https://www.ophthalmologytimes.com/view/robotically-

aligned-oct-an-option-for-use-in-telemedicine 23

INNOVATIONS

RESTORING VISION AFTER STROKE: NEW GENE THERAPY
Researchers from Purdue University conducte
d in vivo experiments to potentially explore the

application of gene therapy for restoring vision in ischemic injury.
NeuroD1-mediated in vivo direct reprogramming on visual cortical circuit integration and
functional recovery in a mouse model of ischemic injury. This technology replenishes lost
neurons and successfully integrates them into the existing neural circuit. The researchers
shared that this process is easier to do than stem cell therapy, and there's less damage to the
brain. The study showed that NeuroD1 reprogrammed neurons were integrated into the
cortical microcircuit and acquired direct visual responses. Thus, leading to vision recovery.
Study more about this study here
https://www.frontiersin.org/articles/10.3389/fcell.2021.720078/full

MISIGHT 1-DAY CLINICAL TRIAL: SEVEN YEAR CLINICAL TRAIL

CooperVision recently presented MiSight 1-day
clinical trial results in the American Academy of
Optometry (Nov 2021, Boston) from its seven-year
clinical trial. MiSight contact lenses are approved
by US FDA. Results suggest MiSight 1- day
contact lenses achieved to slow the progression
of myopia. The 6-year study results showed
abnormal axial length slowed by an average of
approximately 50 % in children aged 8-17 years.
Chinese National Medical Products
Administration also recognized this product that
may show the progression of axial length.

Read more about this here:
https://coopervision.com/practitioner/our-products/misight-1-day/misight-1-day

ANESTHETIZATION - NEW TECHNIQUE CORRECTS AMBLYOPIA IN
CATS AND MICE

Researchers from MIT and Dalhousie University corrected amblyopia in cats and mice by

temporarily anesthetizing the retina of the good eye. The study suggests that short-term

inactivation of the only functional eye is sufficient to promote and recover from amblyopia,

when conventional treatments fail. Researchers also suggest that this new approach is safe

and effective for people who can no longer use patch therapy, such as adults.

Read more about this study here 24
https://elifesciences.org/articles/70023

CLINICAL
PHOTOGRAPHS

Diagnosis: Y-suture cataract (Right eye)- Direct illumination
Diagnosis: Y-suture cataract (Right eye)- Retro illumination

Mr. Prasanna V Murti, Consultant Optometrist
L V Prasad Eye Institute, Hyderabad, India

Ocular surface squamous neoplasia

Sartaj Ahmad
Optometry 3rd year student
Uttaranchal PG College of Bio-Medical Sciences Dehradun

TALENT HUNT

Hifza Mehmood Anam Saifi 29
Optometry Intern, 4th year Optometry 1st year student
Uttaranchal PG College of Bio-Medical Sciences, Uttaranchal PG College of Bio-Medical Sciences,
Dehradun Dehradun

Lalitha Koduri
Senior Optometrist (Pediatric Optometrist)

Pushpagiri Eye Institute, Hyderabad

Description of Artwork:
I have lovingly worked on this artwork because it might act as a drop in the
ocean to bring awareness about the lethal “Retinoblastoma”.
Retinoblastoma is a cancer that starts in the retina but can be life-
threatening when left untreated. This artwork demonstrates the treatment
cycle of a child with retinoblastoma and the parents' affection towards the
child. The light-colored background aptly highlights the contents I want to
deliver through the drawing. The eyebrow represents the instruments that
are involved in the treatment. The left part of the eye represents the child’s
face with leukocoria, the central part shows the grievance of the mother to
accept the truth, the right part explains treatment at the hospital, and the
happy family after treatment.

30



Word Search

Can you find eye-related words in the puzzle below?

Look for the words listed below.

SUDUKO

Fill in the puzzle so that every row across, every column down and

evLeoryo9kbfyo9r btohxecwonotaridnssthliestneumdbbeerslo1 two .9.

Source: Sudoku Generator - Puzzle Maker - Printable Sudoku Puzzles (printablecreative.com)

Answers:

1. MEM RETINOSCOPY
2.ACCOMMODATIVE FACILITY
3.VERGENCE FACILITY
4.POSITIVE FUSIONAL VERGENCE
5.PRISMBAR COVER TEST
6.NEGATIVE FUSIONAL VERGENCE
7.FIXATION DISPARITY
8.CYCLOVERTICAL STRABISMUS
9.EYE MOVEMENTS
10.CONVERGENCE INSUFFICIENCY
11.VISION THERAPY
12.CYCLOPLEGIC REFRACTION

WORD SCRAMBLE

Unscramble the words

MMSEIPONEYTOCR
CVECCTOFLTADMAYIOMIA
CYERVNIFECLETGA
NEFSITVEPOIEUNVGISLACROE
OTPSTCVIRBRMERASE
EGNGSTVLECVFNONAUEEAREII
PAIITTDFNXRIISYOA
TELOISBCIAUCCRRYLTMSASV

SMEEYTVONEEM
VINEGNUFNSCYCFEICCEIREON

TEIORNPISHAVY
GECPIANCCTLCRLFREIOYO

Unlike other vertebrates, the chameleon has a lens that

is concave and actually diverges light. This works like a

Galilean telescope that magnifies the retinal image

compared to a traditional eye. In addition, the

chameleon has large accommodative amplitude that

allows it to focus on nearby prey that roams within the

field of its elastic tongue. The chameleon uses its finely

tuned monocular accommodation and evaluation of

retinal size to judge distance. This is very different than

the binocular stereoscopic clues that we use to judge

distance. Source: versanthealth.com

Reference: OphthoBookwww.OphthoBook.comWritten and Illustrated byTimothy Root, M.D. Page no: 120

Meme corner

eme co
M
renr

Meme corner

eme co
M
renr

Meme corner

eme co
M
renr

FUNtastics

FUNtastics

FUNtastics

41

ALO
HIGHLIGHTS

Thus far....

x    x    x

ALUMNI

ACHEIVEMENTS




Dr Vinod Maseedupally was recently awarded the
UNSW Vice-Chancellor’s Award for Outstanding

Contributions to Student Learning (General).



This award recognises individuals for their
sustained, outstanding contribution to the quality of
student learning in a specific area of responsibility.



Team ALO congratulates Vinod for his

achievements and contributions.

Dr. Vinod Maseedupally

SEPTEMBER 2021 | ISSUE 03 Mr. Lalith Kumar Reddy V is a recipient of Lalith Kumar Reddy V
the prestigious "Johnson & Johnson GCI
funded Social Community Impact Project" 44

grant for "Project DRISHTI".
"It is an absolute honour that I will cherish for
the rest of my career. I acknowledge all those
who have been supporting me and would like

to express my gratitude for providing this
opportunity to serve the communities," he

said.



Team ALO congratulates Lalith for his
achievements and contributions.

A testimony for the phrase, dream it,
believe it, and achieve it.

Read more about Uday's Journey

To read full Chronicles

visit: www.aloptom.com/chronicles

ALO's fortnightly initiative called the ALO Chronicles is a cornucopia of
interesting, motivating, and relatable journeys of our alumni.

The chronicles aim to showcase the untold tales of people who have
contributed to the optometry community and are striving or
have strived to achieve their dreams.

The chronicles not only showcase career oriented accolades but also
the inspiring stories of journeys,

BLSO/LVPEI memories, failures and success of an optometrist.

ALO would love to hear from you. Write to us at
[email protected]



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