Dr. Agarwal's Eye Hospital

In ectatic corneas such as keratoconus, maximum keratometry (Kmax) is commonly used to identify the cone apex and monitor disease severity and progression. However, with the advent of tissue-additive corneal-reshaping surgical techniques such as corneal allogeneic intrastromal ring segments (CAIRS), Kmax may no longer reliably reflect the true geometric changes of the diseased cornea. Automatically generated Kmax can be influenced by localized peripheral steepening over the implanted segments, leading to misinterpretation of the actual keratometric effect. We argue that Kmax is therefore a potentially misleading outcome parameter after CAIRS. A better capture of the true regularizing effect of CAIRS may therefore be mean keratometry, keratometry measured at the preoperative Kmax location, or maximum flattening on the difference map. Standardized reporting of these metrics is needed to enhance comparability between studies.

Purpose of review This review focuses on the use in patients with keratoconus, of corneal allogeneic intrastromal ring segments (CAIRS) as well as customized and custom shaped CAIRS for corneal reshaping, stabilization and individualized, tissue-based corneal contouring, while delaying or avoiding keratoplasty. Recent findings CAIRS is being widely used in advanced cases of keratoconus, as biological replacement for synthetic intra-corneal ring segments and to prevent the need for keratoplasty. It is also being adopted in early disease in combination with corneal cross-linking. Various techniques and modifications are described as well as its use in different situations. Femtosecond and double bladed trephined CAIRS are discussed, including recent unpublished data demonstrating comparable dimensional accuracy with both. Double bladed trephines may also offer potential for greater segment thickness and customization. Summary CAIRS is evolving into a customizable corneal contouring approach that may complement and potentially reduce reliance on, existing treatment modalities. When combined with corneal cross-linking, it offers both biomechanical stabilization and visual rehabilitation. Future advances are likely to center on data-driven personalization tailored to each patient's corneal phenotype and visual needs, an approach that becomes increasingly important as CAIRS use expands in keratoconus

Background and aim Workers on construction sites and in multiple industries experience many ocular injuries, which can affect their ability to continue working. Such injuries can be easily prevented with appropriate and effective eye protection. This study aimed to evaluate the awareness of occupational ocular injury risks and their potential implications, such as visual impairment and blindness, among construction workers (knowledge domain); assess worker attitudes regarding occupational ocular safety and the utilization of protective eyewear (attitude domain); assess the prevalence of protective eyewear usage and identify obstacles to its adoption among construction workers (practice domain); and determine the independent variables of protective eyewear utilization, including educational level, exposure to occupational hazards, length of work, and history of previous ocular injury, using multivariable logistic regression analysis. Methods A cross-sectional analytical study was conducted among 133 participants who presented to the All India Institute of Medical Sciences (AIIMS), Nagpur Ophthalmology OPD, and were engaged in various work at construction sites in and around Nagpur, Maharashtra. Data were collected over a period of 12 months from January 2022 to December 2022. Participants were given an expert-reviewed, content-validated, bilingual (English and Hindi) questionnaire, and responses were recorded by the investigator on a predesigned data collection form. Literate participants independently completed the structured bilingual questionnaire, while illiterate participants had each question read aloud in Hindi by the investigator, and their responses were recorded on a predesigned proforma. All statistical tests were performed with a 95% confidence interval, and p < 0.05 was considered statistically significant. Results A total of 133 participants were enrolled in the study. Nearly all respondents (132; 99.2%) knew that their job could cause eye injury. Upon analyzing education level, seven (15.2%) primary school-educated workers wore protection, compared with 17 (56.7%) post-high school-educated workers and three (50%) diploma holders. Educational status was significantly associated with the use of protective eye gear (p = 0.003). Educational status (adjusted odds ratios {AOR} = 2.865, 95% CI: 1.725-4.739, p < 0.001), type of work (AOR = 0.707, 95% CI: 0.549-0.911, p = 0.007; interpreted with caution given nominal scaling of work categories), and prior injury history (AOR = 3.886, 95% CI: 1.472-10.257, p = 0.006) were significant independent predictors of protective eyewear use. Duration of work was not a significant independent predictor of protective eyewear use (AOR = 0.864, 95% CI: 0.458-1.629, p = 0.650). Conclusion This study concluded that although workers' awareness of the use of protective eye gear was high, adherence and use were very low. Educational status, type of work, and prior history of ocular injury were key determinants of protective eyewear use.