Comment on: Impact of intraocular lens decentration and tilt on higher-order aberrations in patients with high and super-high myopia following cataract surgery Ankita Bandyopadhyay, Chaithu S Aimol, Suraj K Chaurasiya Indian Journal of Ophthalmology, 2026 Dear Editor, We read with great interest the article titled “Impact of intraocular lens decentration and tilt on higher-order aberrations in patients with high and super-high myopia following cataract surgery,” published by Wang Y et al.[1] The authors offer valuable insights into a challenging population subset. However, we wish to highlight several methodological limitations and clinical considerations that warrant caution in interpreting and generalizing the results. The relatively small sample size, particularly in the super-high myopia group (n = 17), limits statistical power and may obscure meaningful associations. Furthermore, the 24% loss to follow-up (16 out of 66 patients) introduces potential attrition bias, which may skew the outcome measures.[2] The short follow-up period of only 3 months may not be sufficient to capture long-term changes in intraocular lens (IOL) position. Capsular contraction and zonular instability, especially in highly myopic eyes, often cause late decentration or tilt, affecting visual outcomes over time.[3] Although the use of CASIA2 anterior segment OCT system (Tomey Corporation, Nagoya, Japan) is commendable for its high-resolution measurements, assessments were conducted under photopic, undilated conditions. Higher order aberration (HOA)s were analyzed at a fixed 3 mm pupil size using the iTrace system, which does not reflect real-world mesopic or scotopic scenarios, where pupils dilate and visual symptoms such as glare and halos are more pronounced.[4] The study lacks stratification based on the severity of IOL malposition. Without categorizing outcomes by decentration or tilt magnitude, it becomes difficult to evaluate threshold effects or establish clinical guidelines.[5] Another notable limitation is the absence of subjective visual quality measures. Incorporating tools like the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) or other patient-reported outcome metrics would better reflect functional vision and satisfaction, which do not always correlate with objective visual acuity or Modulation transfer function (MTF) scores.[6] The study exclusively evaluated a single IOL model (A1-UV), thereby limiting generalizability. Optical tolerance to decentration and tilt varies among different IOL design—monofocal, aspheric, multifocal, and toric—and some are specifically engineered to reduce HOAs under decentered conditions.[7] In conclusion, while the study emphasizes the critical role of IOL centration in visual quality for high myopes, future investigations should include larger, more diverse cohorts, longer follow-up durations, subjective patient-reported data, and comparative IOL models. These refinements will contribute to a more comprehensive understanding of IOL positioning effects and guide individualized surgical planning.
Objective Evaluation of Relationship Between Tear Film Stability and Visual Fatigue [Letter] Ankita Bandyopadhyay, Firdoos Jaman, Suraj Chaurasiya Clinical Optometry, 2025 Between Tear Film Stability and Visual Fatigue" by Watanabe et al. 1 The authors investigate the association between non-invasive tear film break-up time (NIBUT) and binocular fusion maintenance (BFM) as indicators of visual fatigue a commendable effort, given the increasing clinical burden of digital eye strain (DES) in today's screen-dominant lifestyle.However, we wish to highlight certain methodological limitations and areas for improvement that would enhance the study's clinical relevance and scientific rigor.A key concern is the study's small sample size (n = 11) and restricted demographic (young, healthy adults).Dry eye disease and visual fatigue affect a wider population, including older individuals, people with refractive errors, and those with binocular vision disorders. 2The homogeneity of the sample limits the generalizability of the results.Future studies would benefit from including a more diverse cohort to better represent the population experiencing digital fatigue.The 30-minute screen task used in this study, although aligned with prior protocols, may not fully capture the temporal dynamics of ocular surface changes.Research suggests that visual discomfort and tear film instability tend to intensify with prolonged screen exposure, often beyond 30 minutes. 3 Additionally, compensatory mechanisms such as altered blink behavior or ocular surface exposure emerge more prominently with longer tasks.Including extended screen durations in future research would improve ecological validity.Another limitation is the exclusive reliance on NIBUT as an objective tear film parameter.Although NIBUT provides quantitative insight, the test requires patients to suppress blinking, which is inconsistent with natural screen use.Moreover, blink rate and blink completeness critical factors in tear film stability were not assessed.These parameters have been shown to significantly influence ocular comfort and tear dynamics during screen tasks. 4Incorporating eye-tracking or blink-monitoring tools would provide a more comprehensive evaluation of the ocular surface environment under screen stress.We also noted the absence of subjective symptom assessment tools, such as the Ocular Surface Disease Index (OSDI) or the Computer Vision Syndrome Questionnaire (CVS-Q).While the study aims to reduce reliance on subjective reporting, visual fatigue remains a subjective experience that is often not fully captured through objective testing alone.Validated questionnaires would allow correlation between measurable tear film changes and perceived discomfort, thereby enhancing clinical applicability. 5The correlation between NI-BUT and BFM (R = 0.385) is statistically significant, the modest effect size indicates the potential involvement of additional variables such as accommodative and vergence anomalies, both known contributors to DES.Evaluating parameters like accommodative amplitude, vergence ranges, and fixation disparity would help interpret the observed changes in binocular function more accurately.In conclusion, Watanabe et al present an important preliminary study linking tear film instability with visual fatigue.To advance the field, future studies should include larger, more heterogeneous populations, longer task durations, blink analysis, and validated symptom questionnaires, while considering the broader visual system.
Comments on "the effect of 2% pilocarpine on depth of field in different time intervals among presbyopic subjects" Suraj Kumar Chaurasiya, Pradeep Agarwal Indian Journal of Ophthalmology, 2025 Dear Editor, I recently read the article titled “The Effect of 2% Pilocarpine on Depth of Field in Different Time Intervals Among Presbyopic Subjects” by Tripathi A et al.[1] with great interest. This study provides valuable insights into the pharmacologic management of presbyopia using pupillary miotics. However, I would like to highlight certain limitations and suggest improvements that could enhance the robustness of the findings and their applicability. The study’s methodology for measuring baseline depth of field (DOFi) does not include sufficient comparison with age-matched controls not using pilocarpine. As DOFi can vary based on environmental and physiological factors, the inclusion of a control group would have better contextualized the outcomes. Additionally, the subjective method of assessing DOFi, where participants indicate when they can or cannot see the chart clearly, introduces potential observer bias. Prior studies have shown that objective methods, such as wavefront aberrometry, offer more precise measurements and could have strengthened the study’s reliability.[2,3] The study attributes changes in DOFi primarily to pupil miosis without fully exploring the potential contribution of pilocarpine-induced accommodation. Research has shown that pilocarpine affects both pupil size and accommodative amplitude.[4] Objective accommodative response measurements, such as those obtained through autorefractometry or optical coherence tomography, could have provided a clearer understanding of the mechanisms involved. Furthermore, the study evaluated DOFi changes only within 45 min of pilocarpine instillation. While these results are insightful, the absence of longer-term follow-up limits the understanding of sustained efficacy and potential rebound effects. Investigations into the duration of pilocarpine’s effects are essential for assessing its practical clinical use. The study briefly mentions that some participants experienced mild to moderate headaches but lacks detailed data on their incidence or severity. Comprehensive documentation of adverse effects, as seen in related studies, is essential for a thorough evaluation of pilocarpine’s safety in presbyopia management.[5] In conclusion, while this study highlights the potential of pilocarpine in extending DOFi in presbyopes, addressing the aforementioned limitations would significantly enhance the scientific rigor and clinical relevance of the findings. These considerations could serve as a foundation for future research to advance pharmacological treatments for presbyopia. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
BCLA CLEAR Presbyopia: Evaluation and diagnosis James S Wolffsohn, David Berkow, Ka Yin Chan, Suraj K. Chaurasiya, Daddi Fadel, Mera Haddad, Tarib Imane, Lyndon Jones, Amy L. Sheppard, Marta Vianya-Estopa, Karen Walsh, Jill Woods, Fabrizio Zeri, Philip B. Morgan Contact Lens and Anterior Eye, 2024 It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.
Comment on: Impact of intraocular lens decentration and tilt on higher-order aberrations in patients with high and super-high myopia following cataract surgery A Bandyopadhyay, CS Aimol, SK Chaurasiya Indian Journal of Ophthalmology 74 (4), 619 , 2026 2026 Citations: 1
Objective Evaluation of Relationship Between Tear Film Stability and Visual Fatigue A Bandyopadhyay, F Jaman, SK Chaurasiya Clinical Optometry, 241-242 , 2025 2025
Clinical Outcomes of Implantable Collamer Lenses for the Treatment of Myopia in Eyes with Anterior Chamber Depth (< 3.0 mm) at a Single Center in the United States SK Chaurasiya, A Bandyopadhyay, SA Chaithu Clinical Ophthalmology, 2549-2550 , 2025 2025 Citations: 1
Practice Patterns of Subjective Refraction Among Eye Care Practitioners in Delhi NCR PK Athreya, S Thakur, K Pant, J Sinha, GK Bhardwaj, SK Chaurasiya Vascular and Endovascular Review 8 (11s), 59-64 , 2025 2025
Association of Screen Time with Refractive Error and Computer Vision Syndrome in Young Adults K Kayina, SK Chaurasiya, A Lalnunsiami Delhi Journal of Ophthalmology 35 (3), 196-200 , 2025 2025
Comments on “the effect of 2% pilocarpine on depth of field in different time intervals among presbyopic subjects” SK Chaurasiya, P Agarwal Indian Journal of Ophthalmology 73 (Suppl 2), S350-S351 , 2025 2025 Citations: 1
Comment on: Age-matched Analysis of Axial Length Growth in Myopic Children Wearing Defocus Incorporated Multiple Segment Spectacle Lenses SK Chaurasiya, F Jaman, A Yadav 2025
Anterior and Posterior Corneal Higher-order Aberrations in Keratoconus and Pellucid Marginal Corneal Degeneration by Pentacam S Kumari, V Sharma, SK Chaurasiya, A Khurana, L Chauhan Delhi Journal of Ophthalmology 35 (1), 22-27 , 2025 2025
Combination of Jelly Bump and Protein Deposits in a Conventional Prosthetic Contact Lens: A Rare Case Report SK Chaurasiya, S Chanda, M Sharma Delhi Journal of Ophthalmology 35 (1), 50-52 , 2025 2025
Comment on:“Mean cycloplegic refractive error in emmetropic adults: The Tehran eye study” SK Chaurasiya, M Optom Journal of Optometry 18 (1) , 2025 2025
Effect of Contact Lens Solutions in Stabilizing the Activity of Tear Lysozyme SK Chaurasiya, A Khurana, T Soni Clinical Optometry, 53-54 , 2024 2024
A Randomized, Controlled Trial Comparing Tearcare ® and Cyclosporine Ophthalmic Emulsion for the Treatment of Dry Eye Disease (SAHARA) SK Chaurasiya, M Singh, P Kohli Clinical Ophthalmology, 817-818 , 2024 2024 Citations: 1
Effects of Lens-Induced Astigmatism at Near and Far Distances SK Chaurasiya, AR Yadav, F Jaman, M Singh Clinical Optometry, 31-32 , 2024 2024 Citations: 1
Ocular Cysticercosis: Live Worm in Anterior Chamber T Soni, P Agarwal, SK Chaurasiya Ophthalmology , 2024 2024 Citations: 1
Bilateral Cataract after Electric Shock Injury CN Rajbanshi, SK Chaurasiya, TR Pandey, RK Shah Delhi Journal of Ophthalmology 34 (4), 303-305 , 2024 2024
Comment on the Case Report of “A Miniscleral Contact Lens Fitting in a Patient of Unilateral Terrien’s Marginal Degeneration” SK Chaurasiya Delhi Journal of Ophthalmology 34 (4), 336 , 2024 2024
Comment on: intraocular pressure after combined photorefractive keratectomy and corneal collagen cross linking for keratoconus SK Chaurasiya, R Ray, M Singh International Ophthalmology 44 (1), 389 , 2024 2024
Comments on the case report of “fleeting diplopia and wobbly feet: Miller-Fisher syndrome presenting as bilateral abducent nerve palsy” SK Chaurasiya, M Singh, P Agarwal Kerala Journal of Ophthalmology 36 (3), 310-311 , 2024 2024
BCLA CLEAR Presbyopia: Evaluation and diagnosis JS Wolffsohn, D Berkow, KY Chan, SK Chaurasiya, D Fadel, M Haddad, ... Contact Lens and Anterior Eye 47 (4), 102156 , 2024 2024 Citations: 27
Comment on “Study of Etiology of Vitreous Hemorrhage in Adult Patients Attending Tertiary Care Eye Center in Western India” M Singh, SK Chaurasiya, R Pushkar Delhi Journal of Ophthalmology 34 (3), 245-246 , 2024 2024
MOST CITED SCHOLAR PUBLICATIONS
BCLA CLEAR Presbyopia: Evaluation and diagnosis JS Wolffsohn, D Berkow, KY Chan, SK Chaurasiya, D Fadel, M Haddad, ... Contact Lens and Anterior Eye 47 (4), 102156 , 2024 2024 Citations: 27
Changes in post-keratoplasty astigmatism after suture removal: refraction vs tomography vs aberrometry SK Chaurasiya, JC Reddy, PK Vaddavalli, CJ Rapuano International Journal of Ophthalmology 14 (11), 1707 , 2021 2021 Citations: 6
Incidence and clinical profile of Marcus Gunn jaw-winking phenomenon in congenital ptosis at a tertiary eye hospital in western Uttar Pradesh, India SK Chaurasiya, MM Alam, P Agarwal, L Chauhan Latin American Journal of Ophthalmology 6 , 2023 2023 Citations: 4
Causes of moderate to severe visual impairment and blindness among children in integrated schools for the blind and visiting a tertiary eye hospital in Nepal: the Nepal … M Singh, A Chander, SK Chaurasiya, Radhika Clinical Ophthalmology, 2761-2762 , 2023 2023 Citations: 2
Comment on: The relationship between multiple deprivation and severity of glaucoma at diagnosis SK Chaurasia, M Singh, N Sharma Eye, 1-1 , 2023 2023 Citations: 2
Comment on: Impact of intraocular lens decentration and tilt on higher-order aberrations in patients with high and super-high myopia following cataract surgery A Bandyopadhyay, CS Aimol, SK Chaurasiya Indian Journal of Ophthalmology 74 (4), 619 , 2026 2026 Citations: 1
Clinical Outcomes of Implantable Collamer Lenses for the Treatment of Myopia in Eyes with Anterior Chamber Depth (< 3.0 mm) at a Single Center in the United States SK Chaurasiya, A Bandyopadhyay, SA Chaithu Clinical Ophthalmology, 2549-2550 , 2025 2025 Citations: 1
Comments on “the effect of 2% pilocarpine on depth of field in different time intervals among presbyopic subjects” SK Chaurasiya, P Agarwal Indian Journal of Ophthalmology 73 (Suppl 2), S350-S351 , 2025 2025 Citations: 1
A Randomized, Controlled Trial Comparing Tearcare ® and Cyclosporine Ophthalmic Emulsion for the Treatment of Dry Eye Disease (SAHARA) SK Chaurasiya, M Singh, P Kohli Clinical Ophthalmology, 817-818 , 2024 2024 Citations: 1
Effects of Lens-Induced Astigmatism at Near and Far Distances SK Chaurasiya, AR Yadav, F Jaman, M Singh Clinical Optometry, 31-32 , 2024 2024 Citations: 1
Ocular Cysticercosis: Live Worm in Anterior Chamber T Soni, P Agarwal, SK Chaurasiya Ophthalmology , 2024 2024 Citations: 1
Comment on: Prevalence of refractive error within a Portuguese sample of optometric records N Sharma, M Singh, SK Chaurasiya Journal of Optometry 17 (3), 100509 , 2024 2024 Citations: 1
Comment on “Efficacy of low-vision devices in the elderly population with age-related macular degeneration” M Singh, SK Chaurasiya Indian Journal of Ophthalmology 72 (5), 753 , 2024 2024 Citations: 1
Comment on Management of ocular surface irregularity with scleral contact lenses: Experience from a tertiary eye care center SK Chaurasiya, M Singh, R Ray Kerala Journal of Ophthalmology 36 (1), 99-100 , 2024 2024 Citations: 1
Unilateral Purtscher’s retinopathy–A rare case report SK Chaurasiya, S Lailung, P Agarwal, P Kohli Latin American Journal of Ophthalmology 6 , 2023 2023 Citations: 1
Prevalence and causes of visual impairment and use of low-vision devices at a tertiary eye hospital in western Uttar Pradesh, India M Singh, SK Chaurasiya, L Chauhan IHOPE Journal of Ophthalmology 2 (2), 36-40 , 2023 2023 Citations: 1
A rare case report of unilateral twin crystalline lenses SK Chaurasiya, M Paul Delhi J Ophthalmol 31, 84-85 , 2020 2020 Citations: 1
Objective Evaluation of Relationship Between Tear Film Stability and Visual Fatigue A Bandyopadhyay, F Jaman, SK Chaurasiya Clinical Optometry, 241-242 , 2025 2025
Practice Patterns of Subjective Refraction Among Eye Care Practitioners in Delhi NCR PK Athreya, S Thakur, K Pant, J Sinha, GK Bhardwaj, SK Chaurasiya Vascular and Endovascular Review 8 (11s), 59-64 , 2025 2025
Association of Screen Time with Refractive Error and Computer Vision Syndrome in Young Adults K Kayina, SK Chaurasiya, A Lalnunsiami Delhi Journal of Ophthalmology 35 (3), 196-200 , 2025 2025