An ophthalmology professionalism survey tool: outcomes from a multi-center study in Central India.

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi-center survey study. Methods: A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included "personal characteristics," "physician-patient relationships," "workplace practice and relationships," and "socially responsible behaviors." A mean attribute score (%) was calculated and compared to "gold standard" responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for "personal characteristics" (93 ± 9.7) and "physician-patient relationship" (82 ± 15.8) were the highest, whereas scores for "socially responsible behaviors" (73.9 ± 18.6) and "workplace practices" were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Pathophysiology of the comorbidity of glaucoma with obstructive sleep apnea: A postulation.

Glaucoma is a serious and progressive optic neuropathy, the exact pathophysiology of which is still poorly understood. Furthermore, glaucoma exhibits significant comorbidity with obstructive sleep apnea (OSA) that warrants an in-depth study in view of highly probable beneficial and far-reaching clinical implications. In this brief paper, the authors have studied the existing theories in an attempt to explain the comorbidity and its underlying pathophysiology. From the ensuing evidence, the role of connective tissue strength has emerged as a major factor and which appears to play a pivotal role not only in the development of glaucoma but also in the underlying pathophysiology of its enigmatic comorbidity with OSA. Understanding the pathophysiology of the comorbidity can stimulate newer therapeutic strategies targeted toward strengthening of connective tissues that may at least retard if not arrest the progression of glaucomatous changes and their complications.

Angiostrongylus cantonensis in anterior chamber.

Live worm in anterior chamber is a rare finding. We hereby report a case of ocular Angiostrongylus cantonensis, which, to the best of our knowledge, is the third case report from India. A 70-year-old female presented with the complaints of watering and foreign body sensations in right eye since 2 months. On examination, a translucent worm of approximately 15 mm length was found freely moving in anterior chamber. Patient underwent surgical removal of live worm, which was identified as A. cantonensis. Educating people regarding importance of hygiene is important for prevention of worm infestation.

Comparison of flow velocity in ophthalmic artery between glaucomatous and normal subjects.

Purpose: To study the hemodynamic parameters in ophthalmic artery (OA) using color Doppler imaging in subjects with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and age matched normals. Methods: Sixty-eight eyes of 68 subjects (41 males and 27 females) constituted material for this prospective observational study. They were divided into three groups; Group A had 24 patients with POAG, Group B had 18 patients with NTG and Group C had 26 normal subjects. They underwent CDI of OA. The outcome variables were peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI). Data were compiled and analyzed using one-way ANOVA analysis. Results: The mean ± SD age of POAG patients, NTG patient and normal subjects was 59.95 ± 7.35, 58.11 ± 9.97 and 57.73 ± 5.39 years, respectively. The mean intra ocular pressure (IOP) was 29.8 ± 5.0, 15.9 ± 2.4 and 16.6 ± 1.7mm Hg in Group A, B and C, respectively. In group A, the mean PSV, EDV, RI and PI were 18.2 ± 3.80, 3.71 ± 1.40, 0.93 ± 0.12 and 2.8 ± 0.42. In group B, 26.6 ± 1.72, 4.93 ± 1.32, 0.84 ± 0.02 and 1.32 ± 0.20 and in group C, 35.4 ± 3.04, 8.08 ± 0.69, 0.77 ± 0.03 and 1.80 ± 0.17, respectively. All the values were found to be statistically significant (p < 0.05). Lower PSV and EDV were found in POAG and NTG patients, while RI was higher than in normal subjects. Conclusion: The hemodynamic parameters are significantly affected in POAG and NTG patients. The PSV and EDV are decreased and RI is increased. EDV is more sensitive for the assessment of hemodynamic changes.

Influence of learning effect on reliability parameters and global indices of standard automated perimetry in cases of primary open angle glaucoma.

Aim. To find out the influence of learning effect on various reliability parameters and global indices of standard automated perimetry in cases of primary open angle glaucoma. Method. Thirty eyes of 30 patients of Primary Open Angle Glaucoma constituted material for this prospective observational study. All the patients underwent standard automated perimetry three times on three different days within one week on G program of Octopus Visual Field Analyzer. The details of reliability indices, global indices, and test duration were compiled and analyzed. Result. A male preponderance was observed with a mean age of 53.43 years. The mean false positive was found to be 11.13, 6.07, and 2.40 on visit 1, visit 2, and visit 3, respectively. The mean false negative was found to be 13.73, 9.33, and 6.30 on visit 1, visit 2, and visit 3, respectively. The mean fixation loss was found to be 7.53, 3.83, and 1.60 on visit 1, visit 2, and visit 3, respectively. The mean deviation was found to be -10.14, -5.75, and -3.11 on visit 1, visit 2, and visit 3, respectively. The pattern standard deviation was found to be 5.58, 4.63, and 4.35 on visit 1, visit 2, and visit 3, respectively. The mean test duration was found to be 7.68, 6.21, & 5.51 minutes for visit 1, visit 2 and visit 3, respectively. All the values were statistically highly significant except for the pattern standard deviation. Conclusion. At least three standard automated perimetry tests should be performed for all glaucoma patients in order to obtain a base line perimetry chart.

Bilateral combined anterior and posterior lenticonus in Alport's Syndrome.

Alport's syndrome is an inherited disease characterized by hearing loss, progressive renal failure and ocular abnormalities like anterior lenticonus, corneal opacities, cataract, fleck retinopathies, and temporal retinal thinning. To have anterior and posterior lenticonus in the same eye in this syndrome is a rare finding and only a few such reports are available. Hereby, we report a case of a 22-year-old male with bilateral combined anterior and posterior lenticonus with sensorineural deafness and nephritis leading to the diagnosis of Alport's syndrome.