Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : NC01 - NC04 Full Version

Correlation between Interpupillary Distance, Inner-outer Canthal Distance and Inter Limbal Distance: A Cross-sectional Study

Published: March 1, 2022 | DOI:
Sheetal V Girimallanavar , Vittal I Nayak , Sahana Chetty , C Vasundhara

1. Assistant Professor, Department of Ophthalmology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. 2. Professor and Head, Department of Ophthalmology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. 3. Junior Resident, Department of Ophthalmology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. 4. Junior Resident, Department of Ophthalmology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.

Correspondence Address :
Dr. Sheetal V Girimallanavar,
Staff Quarters A4, VIMS and RC, EPIP Area, Nalurhalli, Whitefield,
Bengaluru, Karnataka, India.


Introduction: Interpupillary Distance (IPD) is the distance between the centres of two pupils which can be anatomical or physiological. There are various inter orbital distances which are important in studying the orbitofacial configuration and also in prescribing a correct spectacle. Among the various measurements IPD is the most important which is routinely measured using AutoRefarctometer (AR) machine or Pupil distance meter.

Aim: To find the correlation between IPD and Inner Canthal-Outer Canthal Distance (ICOC) and Right Nasal Limbus to Left Temporal Limbus (RNL-LTL) distance and to derive a regression equation in calculating IPD from measurements like ICOC and RNL-LTL which are easier to measure.

Materials and Methods: In this cross-sectional study with a sample of 100 subjects, participants were randomly selected from individuals attending Outpatient Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, between March 2021 to August 2021. The IPD was measured using Auto-Refarctometer/Autorefractor Keratometer (AR/ARK) (Model: UNIQUE-RK:UNICOS URK 800F) and Pupillary Distance Metre (PDM) (Essilor). All the other measurements like Inner Intercanthal Distance (IICD), Outer Intercanthal Distance (OICD), RNL-LTL distance were measured using a transparent plastic ruler. Data was entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 19.0. Categorical variables were presented as frequency and percentage. Multiple Linear regression was performed to find the factors associated with IPD using AR. The p-value <0.05 was considered as statistically significant. Independent sample t-test was performed to compare mean values between males and females.

Results: Of 100 subjects, 60 were males and 40 were females, five subjects were <20 years and 95 subjects were =20 years. The analysis of the various distances found positive correlation between IPD measured using AR and PD meter with the other distances ICOC and RNL-LTL measured with transparent ruler, the strongest correlation found between RNL-LTL and IPD. The results were found to be statistically significant (p-value <0.001 for all these comparisons). A regression equation was derived to calculate IPD using ICOC and RNL-LTL distances and also using other inter orbital variables.

Conclusion: Since there was a positive correlation between IPD and ICOC and RNL-LTL distances, these measurements which are easy to perform can be used to calculate IPD in situations where it’s difficult to get access to AR machine as in peripheral community based camps or rural settings and in children and uncooperative patients where it is difficult to use AR machine to measure IPD.


Autorefractor keratometer, Inner canthus, Limbus of eye, Outer canthus, Pupillary distance meter, Refraction

The Interpupillary Distance (IPD) is the distance between the centre of two pupils and has a function in stereopsis. The IPD can be of two types: anatomical IPD (between two pupils) or physiological (between the two visual axes) of both the eyes (1). The IPD is known to vary according to age, race and sex (1),(2),(3). The normal distance between the orbits varies during embryogenesis and then after birth with the normal craniofacial development (4),(5). The IPD increases with the growth of the individual. It is also found that the maximum increase in IPD occurs in early years of life and it continues to increase slowly in adulthood (1). The IPD is also defined as distance between temporal limbus of one eye with nasal limbus of the other eye (4). Inner Intercanthal Distance (IICD) is the distance between the point where the upper eyelid meets the medial canthus and not the caruncle (6). Outer Intercanthal Distance (OICD) is the distance between the lateral canthi with the patient looking in primary gaze (4),(6). There are various interorbital distances which are important in studying the orbitofacial configuration and more so in prescribing a correct spectacle and selecting an appropriate spectacle frame. There are various fields like ophthalmology, optometry, oculoplasty, genetics and traumatology where the knowledge of IPD has importance (1). Amongst the various measurements like IPD, ICOC, Right Nasal Limbus to Left Temporal Limbus Distance (RNL-LTL) distances, IPD is the most important. IPD is ideally measured using AR machine or PD meter.

The present study was done to find a regression equation to calculate IPD from other easily measurable parameters like IICD, OICD, Inner Canthal-Outer Canthal Distance (ICOC), RNL-LTL distances as it can be helpful in situations like working on paediatric age groups, and in settings where availability of AR, which are routinely used to measure IPD, is a challenge.

The present study is the first one to deduce regression equations for all the different variables like IICD, OICD, ICOC, RNL-LTL to calculate IPD whereas previous few studies, have derived only for one or few of the variables. The primary objective of the present study was to correlate the IPD with other easily measurable parameters like IICD, OICD, ICOC, RNL-LTL and the secondary objective was to derive a regression equation to calculate IPD from those parameters.

Material and Methods

The cross-sectional study was done on 100 patients out of which 40 were females and 60 males who were randomly selected from the patients who visited the Ophthalmology Outpatient Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, from March 2021 to August 2021. The study was approved by the Ethical and Research Committee (EC Reg No: ECR/747/Inst/KA/2015/RR). The informed consent was taken from all participants.

Inclusion criteria: Patients of all ages who were healthy (except for refractive errors) were included in the study.

Exclusion criteria: The exclusion criteria considered were craniofacial anomalies, strabismus, trauma to the face and orbit, poor vision with nystagmus, Pupillary abnormalities, corneal abnormalities (dryness, ectasia), iris abnormalities, orbital inflammation, tumors of the orbit or globe and those who did not consent for their participation in the study.

Study Procedure

The patients were divided into age groups <20 years having faster facial and orbital growth and ≥20 years. The IPD was measured using a PD meter having a fixed and sliding cursor (7). The IPD was also measured using an Auto Ref/Keratometer and Hand Held Scale (HHS). A transparent ruler was used to take the other measurements like IICD, OICD, ICOC, RNL-LTL distance. The IICD was measured from a point where upper lid meets the lower lid and not from any point on the caruncle (4). The OICD was measured between the two lateral canthi with the patient looking in primary gaze (4). The RNL-LTL was measured between Nasal Limbus of right eye (3’o clock position) and temporal limbus of the left eye (3’o clock position). The various measurements are schematically represented in the (Table/Fig 1).

For far IPD the examiner closed her right eye and asked the patient to look at her open left eye. The fixed cursor was placed at the centre of patient’s right pupil. Then the examiner closed her left eye and asked the patient to focus on her right eye. The sliding cursor was now placed at the patients left pupil. The distance between the two cursors was taken as the far IPD. Near IPD values were not taken into consideration in the present study.

All the measurements were taken by the same person to avoid inter observer bias and also they were repeated till two consecutive readings were similar. The measurements were repeated if the patient moved his or her eyes or head. Correlation between IPD and IICD, OICD, ICOC, RNL-LTL distance was studied and a regression equation was derived to calculate IPD using above mentioned variables.

Statistical Analysis

Data was entered in MS Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 19.0. Categorical variables were presented as frequency and percentage. Multiple linear regression was performed to find the factors associated with IPD using AR. The p-value <0.05 was considered as statistically significant. Independent sample t-test was performed to compare mean values of IPD AR, IPD PDM, IPD HHS, IICD, OICD, IC-OC, RNL-LTL between males and females.


The demographic details of the study subjects included were 60 males and 40 females, out of which five subjects were <20 years and 95 subjects were ≥20 years.

The mean difference and Standard Deviation (SD) of IPD (with AR, PD meter and HHS), IICD, OICD, ICOC, RNL-LTL in males and females is shown in (Table/Fig 2). Statistically significant values were obtained in all the variables among males and females. The values of mean difference between males and females are presented in (Table/Fig 3). Levene’s Test was performed to check for equality of variances between males and females and equal variances were assumed.

The various correlation coefficients of the measured variables in the study subjects have been shown in (Table/Fig 4), (Table/Fig 5). A positive correlation was noted between the various measured variables like IICD, OICD, ICOC, RNL-LTL and IPD. Strong positive correlation was observed between IPD AR, IPD PDM, IPD HHS and RNL-LTL (r=0.91366, 0.92971 and 0.93036 respectively), with a p-value=0.001.

(Table/Fig 6) shows the regression equations derived for calculating the IPD based on these different variables.


The various measurements like IPD, Intercanthal distances (Inner and Outer), Inner Outer Intercanthal distance, Nasal Limbus Temporal Limbus distance are useful in various fields of Ophthalmology like diagnosis and treatment of congenital orbital and craniofacial anomalies and post traumatic deformities (7) and also in mounting of spectacle lenses for avoiding the unwanted prismatic effects (7).

The IPD forms one of the most important measurements for calculating interorbital distance or distance between eyeballs, which can be calculated by various ways, but it is difficult to measure in children (8), uncooperative patients and those having severe deformities (8),(9). Lack of contrast between pupil and darkly pigmented iris and individuals with ocular instability also pose difficulty in measuring IPD (9).

There are various ways in which IPD can be measured like using a ruler (10),(11),(12), sliding calipers (13),(14), corneal reflection pupillometer (15), and radiological techniques (16), but in some studies it is shown that IPD can also be calculated using more simple objective measurements like IICD, OICD (17),(18). Holland and Siderov used three methods in measuring IPD: Victorin’s method, corneal reflection and pupillometer (19). They have found not much difference in the calculated value of IPD by these techniques hence the results were not clinically significant (19). However, the gold standard method of measuring IPD is pupillometer (20). The AR was the fourth method of measuring IPD in a study conducted in Iran (1). The AR was used in the present study as it helps in measuring IPD and refractive errors simultaneously.

In 1969 Pryor HB, found a simple objective method for derivation of an indirect estimate of IPD from IICD and OICD (9). Feingold M and Bossert WH, in 1974 reported a different statistical measure by multiple linear regression to calculate IPD using IICD and OICD (18). The present study is the first one to deduce regression equations for all the different variables like IICD, OICD, ICOC, RNL-LTL to calculate IPD whereas previous few studies have derived only for one or few of the variables.

The IPD values are determined between individuals of various ethnicities (7). It is found that IPD of Chinese population is similar to Caucasians (14). It is also found that Chinese and Arab children have similar IPD (17), however African-American children have wider IPD (7). Pointer JS, found an approximate increase of 3% in the far IPD from mid-teens to late middle age in Caucasian population, but with a difference in sexes suggesting that this value has a little change beyond early middle ages in males but continues to increase till later middle ages in females (21).

In our study, mean IPD by AR in females was 60 with a SD of 2.3 and in males were 64.5 with a SD of 2.7 which was clinically significant. Gupta VP et al., in his study found that there was significant difference in mean IPD between the two genders in certain age groups (22). It is also shown that males have larger IPDs in certain age groups (18). Larger IPDs in males were reported in African population by Murphy WK and Laskin DM; and Pivnick EK (8),(23). A study among Arabs by Osuobeni EP and Al-ibraheem AM found a difference of 2mm in IPD being greater in males compared to their female counterparts in ages 5 to 55 years (17). This difference can be attributed to the fact that maturation process occurs faster in females (1).

In few studies, mean IICD was reported to be 25.5 to 38.5 mm in Whites and 32 to 34 mm in mixed European population (24),(25). Freihofer HPM found no difference between the genders and a mean IICD of 31±2.7 mm in his study (26). Mean IICD in the present study was 29.3 mm in females and 31.5 mm in males. According to data from various studies (22),(25), the descending order of OICD and IPD in various races was found to be Africans >Chinese >Caucasians >Arabs >Indian. In the present study, the mean OICD was 79.8 mm in females and 82.5 mm in males, a value between white population and Indians. As per the literature review there is only one study by Gupta VP et al., which has derived a correlation between IPD and NLTL (22). The present study is the first one to have studied correlation between different interorbital variables and IPD and also to have derived a regression equation in calculating IPD based on the values of the other variables which helps in certain difficult situations like paediatric age group, specially challenged individuals where using AR gets cumbersome, and also in peripheral and community based health checkup camps where availability of AR becomes a concern.

In the present study the mean ICOC distance was found to be 58.4 mm in females and 62.5 mm in males. The mean RNL-LTL was found to be 60.1 mm in females and 63.6 mm in males. There was a similarity noted to certain extent between ICOC distance between the two eyes and IPD, which indicates that it is a better variable to approximately conclude regarding IPD measurements when time factor in giving an exact estimate becomes a constraint. However, the present study has also derived regression equations in calculating the IPD based on different inter orbital variables. There was a much stronger correlation noted between RNL-LTL and thus it could be concluded that RNL LNL measurement can be used to deduce IPD with a strong correlation coefficient.


Though the present study helps in these difficult times, it still has some limitations like lesser number of subjects less than 20 years, smaller sample size and IPD for near was not considered which gives scope for further research in this regard.


The IPD is important in various situations like studying congenital craniofacial anomalies, after orbital trauma and most importantly in optical industry where even a little mistake in the same can cause significant reduction in quality of the image and lead to development of various types of aberrations. Hence, measuring IPD can be aided by regression equations as calculated by the present study, especially in some special situations like paediatric age group, uncooperative patients, especially challenged individuals and in periphery community camps, using other easily measurable inter orbital variables, where the gold standard of using AR becomes a challenge.

Declaration of patient consent: The authors declare of having taken all patients appropriate consent forms. All the patient/s has/have given his/her/their consent for his/her/their relevant clinical information and images to be included in the journal. They also understand that their names or initials will be concealed and that their identity will be kept confidential, but anonymity cannot be guaranteed.


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DOI and Others

DOI: 10.7860/JCDR/2022/52322.16047

Date of Submission: Sep 10, 2021
Date of Peer Review: Nov 25, 2021
Date of Acceptance: Jan 14, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 11, 2021
• Manual Googling: Jan 12, 2022
• iThenticate Software: Feb 21, 2022 (12%)

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