Ocular morbidity profiles of out-of-school children in a North Indian urban slum.

PURPOSE: This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India. METHODS: In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded. RESULTS: A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye-related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years ( P = 0.003) and children playing outdoors ( P = 0.001). There was a significant association noted for age and use of digital devices ( P = 0.037). CONCLUSION: The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children.

Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals.

Background: Glaucoma is an optic neuropathy associated with characteristic structural damage to the optic nerve and associated visual dysfunction that may be caused by various pathological processes. A number of pharmacological agents are used to reduce the intraocular pressure (IOP), involving the usage of two or three medications concurrently. Literature is sparse regarding prescription patterns of antiglaucoma drugs, especially regarding variability in public sector vs private sector hospitals. Drug utilization studies can add insight for crafting rational, affordable, and ocular surface friendly prescriptions. Aim: This study assessed the prescription pattern in glaucoma patients of a public sector, tertiary care hospital vs a private sector tertiary care hospital. Materials and methods: In this retrospective study, pertinent data of diagnosed and labeled glaucoma patients were reviewed. Data collected included demographic details, type of glaucoma, number and nature of drugs prescribed, whether innovator or generic drugs were prescribed, if fixed-drug combinations (FDCs) and preservative-free formulations were prescribed. The prescription patterns between the two sectors were compared, as were the prescription patterns between primary open-angle glaucoma (POAG) and primary angle-closure disease (PACD). Results: A total of 336 prescriptions were evaluated (216 from public sector, group I; 120 from private sector, group II). Travoprost 0.004% was the most prescribed antiglaucoma medication in both group I (30.09%) and group II (38.33%). Brimonidine and brinzolamide (14.17%) was the most prescribed combination in group II, while Brimonidine with Timolol (7.87%) in group I. In group I, Timolol and Travoprost were the most prescribed medications for both PACD and POAG. Conclusion: This study showed that both public sector as well as private sector tertiary care centers prescribe antiglaucoma medications in tune with current principles of rational drug use. Preservative-free drugs were preferred in both the groups for better adherence. How to cite this article: Bhartiya S, Ichhpujani P, Parmar UPS, et al.Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals. J Curr Glaucoma Pract 2024;18(1):16-22.

Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis.

Aim: In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma. Materials and methods: In this internet-based cross-sectional study, we used search keywords "glaucoma," "lifestyle," "glaucoma," and "exercise" on the most popular internet platforms-Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated. Results: The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management. Conclusion: The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube. Clinical significance: Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures. How to cite this article: Chahal R, Jindal A, Parmar UPS, et al. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023;17(3):141-148.

Can We Ever Win with a Suprachoroidal Implant?

How to cite this article: Au L, Bhartiya S. Can We Ever Win with a Suprachoroidal Implant? J Curr Glaucoma Pract 2023;17(2):55-57.

New Gonioscopy Technique for Finding Schwalbe's Line: The Ortiz Maneuver.

A new technique for performing gonioscopy that facilitates finding Schwalbe´s line, and lowers the amount of time and light that enters through the pupil is presented. The technique is an alternative to the classic corneal wedge technique and is feasible in the horizontal quadrants without further adjustments to the slit lamp, in contrast to the tilting usually needed for these quadrants. Clinical photos and online videos are presented. How to cite this article: Albis-Donado O, Ortiz-Arismendi GE, Bhartiya S. New Gonioscopy Technique for Finding Schwalbe's Line: The Ortiz Maneuver. J Curr Glaucoma Pract 2023;17(1):37-39.

Long-term effect of panretinal photocoagulation on optic nerve head parameters in diabetic retinopathy using Heidelberg retinal tomography III.

PURPOSE: The aim of this study was to evaluate the effect of panretinal photocoagulation (PRP) in diabetic retinopathy patients using Heidelberg retinal tomography III (HRT). SUBJECTS AND METHODS: A total of 90 eyes of 90 consecutive newly diagnosed patients with diabetic retinopathy (nonproliferative diabetic retinopathy, NPDR, Group I and proliferative, PDR, Group II) were recruited for the study. The eyes with PDR were subjected to PRP. The effect of PRP was measured on optic nerve head (ONH) parameters using HRT. RESULTS: Follow-up up to 4 years in both groups indicated that in Group II proliferative diabetic retinopathy (PDR) participants undergoing PRP, the ONH parameters showed a significant difference in cup area (P = 0.023), cup volume (P = 0.001), mean cup depth (P = 0.015), maximum cup depth (P < 0.001), mean retinal nerve fiber layer (RNFL) thickness (P < 0.001) at 1 year of follow-up, and remained significant in all at 4 years of follow-up, whereas there was no significant difference in any of the optic disc parameters in the participants of Group I belonging to NPDR group as compared to PDR group after 4 years. CONCLUSION: PRP affected the ONH morphology in the PDR group and the effect of this change should be interpreted with caution. This may require setting a new baseline for RNFL measurements using the HRT when documenting RNFL loss or glaucoma progression in patients who have undergone PRP.

Is GATT the Answer?

How to cite this article: Bhartiya S, Aktas Z, Ichhpujani P. Is GATT the Answer? J Curr Glaucoma Pract 2023;17(4):167-168.

Glaucoma Screening: Is AI the Answer?

How to cite this article: Bhartiya S. Glaucoma Screening: Is AI the Answer? J Curr Glaucoma Pract 2022;16(2):71-73.

Seroprevalence of SARS-CoV-2 infection among frontline police personnel in Mumbai, India.

Introduction: A serosurvey was designed to ascertain the extent of infection among police personnel in Mumbai, India, during the last week of January 2021, at the end of the first wave of the COVID-19 pandemic, and just before the introduction of vaccination. Methods: The survey was carried out to screen for SARS-CoV-2 among 3232 police personnel. Of the 3176 participants willing for blood sample collection, 3077 personnel were found to be eligible for testing antibodies against the SARS-CoV-2 virus using the Roche Diagnostics' Elecsys Anti-SARS-CoV-2 assay. Results: The overall seroprevalence was 74.1% (95% CI 72.5-75.6). Males (75.1%, 73.4-76.8) had significantly higher seroprevalence than females (69.8%, 66.0-73.3), 18-39 years age group (76.4%, 74.4-78.3) than 40-59 years age group (70.6%, 67.9-73.1), non-officers (75.2%, 73.5-76.7) than officers (63.8%, 58.2-69.0), and personnel without comorbidities (75.0%, 73.3-76.6) than with comorbidities (69.7%, 65.6-73.5). Additionally, personnel with resident members positive for COVID-19 (89.6%, 84.7-93.1), personnel having reported COVID-19 earlier (95.5%, 93.8-96.7), and personnel having PCR positivity earlier (96.4%, 94.7-97.6) had significantly higher seroprevalences than others. All other variables, including diabetes and blood glucose status, lipid levels and thyroid enzymes, were not significantly associated with the seroprevalence levels. Conclusions: Almost three-fourths of frontline police personnel had evidence of past COVID-19 infection at the end of the first wave in January 2021, just before the introduction of COVID-19 vaccination. These frontline non-healthcare essential workers are an important risk group, and amenable to rapid serosurveys. These findings may help in estimating transmission status in the general community, along with disease burden, aiding prioritization of healthcare services.

Surgical trends in glaucoma management: The current Indian scenario.

OBJECTIVES: To assess the current trend in the surgical management of glaucoma in India. METHODS: An anonymous online survey evaluating the preferred choices in the surgical management of glaucoma was circulated among the members of Glaucoma Society of India (GSI). Survey responses were compared to prior survey among GSI members in 2013 and members of American Glaucoma Society (AGS), 2016. RESULTS: A total of 175 of 879(20%) GSI members participated in the survey of which 75.3% of the survey participants were practicing in the private sector. Trabeculectomy with or without augmentation with Mitomycin C(MMC) was the first-choice glaucoma incisional surgery for 96.6% of the survey participants. Of the participants doing tube surgery, use of valved GDD was the preferred choice (83.4%). Re-trabeculectomy was the preferred approach (60.7%) in case of trabeculectomy failure. For paediatric glaucomas, combined trabeculotomy with trabeculectomy was the preferred surgical approach for both hazy cornea (84.5%) as well as clear cornea (66%). For a POAG patient without prior incisional surgery and presenting with visually significant cataract, phacoemulsification with trabeculectomy was the preferred management approach by 58.7% of the participants. CONCLUSION: Trabeculectomy continues to be the clear winner for the Indian glaucoma surgeon because of its cost effectiveness, lack of expensive instrumentation, and a more robust surgical training for trabeculectomy during residency programs. A higher proportion of angle closure disease precludes the use of minimally invasive glaucoma surgery and very often tube shunts also. Economics, ease of access and follow-up made a combined cataract and glaucoma surgery a preferred choice among Indian surgeons.

Niacinamide and Neuroprotection: The Glaucoma Holy Grail.

How to cite this article: Bhartiya S. Niacinamide and Neuroprotection: The Glaucoma Holy Grail. J Curr Glaucoma Pract 2022;16(3):141-143.

Ocular and Systemic Factors Associated with Glaucoma.

Glaucoma is one of the leading causes of irreversible blindness in the world. Although numerous factors have been implicated in the pathogenesis of glaucoma, the main focus of management still remains lowering the intraocular pressure (IOP) by medical or surgical therapy. However, a major challenge is that many glaucoma patients continue to progress despite good control of IOP. In this regard, the importance of other coexisting factors that may contribute to disease progression needs to be explored. Ophthalmologists need to be aware of ocular risk factors and the impact of systemic diseases and their medications, along with lifestyle modifications on the course of glaucomatous optic neuropathy and adopt a holistic approach in treating the eye as well as the patient to alleviate the suffering from glaucoma in a comprehensive manner. How to cite this article: Dada T, Verma S, Gagrani M, et al. Ocular and Systemic Factors associated with Glaucoma. J Curr Glaucoma Pract 2022;16(3):179-191.

Minimally Invasive Glaucoma Surgery-to Remove or Preserve the Trabecular Meshwork: That is the Question?

How to cite this article: Dada T, Mahalingam K, Bhartiya S. Minimally Invasive Glaucoma Surgery-to Remove or Preserve the Trabecular Meshwork: That is the Question? J Curr Glaucoma Pract 2021;15(2):47-51.

Eye-tunes: role of music in ophthalmology and vision sciences.

Although the healing effect of music has been recognized since time immemorial, there has been a renewed interest in its use in modern medicine. This can be attributed to the increasing focus on holistic healing and on the subjective and objective aspects of well-being. In ophthalmology, this has ranged from using music for patients undergoing diagnostic procedures and surgery, as well as for doctors and the operation theatre staff during surgical procedures. Music has proven to be a potent nonpharmacological sedative and anxiolytic, allaying both the pain and stress of surgery. This review aims to explore the available evidence about the role of music as an adjunct for diagnostic and surgical procedures in current ophthalmic practices.

Habitual visual acuity in a large urban cohort of Western India and factors influencing poor habitual vision.

Purpose: The aim of this study was to determine habitual visual acuity (HVA) in a large urban cohort in western India and identify factors associated with poor HVA. Methods: This was a prospective study conducted over 10 days in September 2018 to assess the HVA in individuals attending a 10-day festival in Western India. Participants who volunteered to undergo vision screening and also filled the questionnaire form pertaining to demographic information including their age, gender, address, income, and educational status were included in this study. HVA was recorded with the distance correction that the participants were wearing when they attended the screening. The study evaluated the prevalence of visual acuity 6/6 or <6/6, 6/12, and 6/18 and the factors associated with lower visual acuity. Results: Of the 6300 participants, 1660 (26.3%) were females. Majority of the participants were from urban background (6084, 96.6%) and were of younger age group (18-40 years--3786, 60.1%; 41-60 years--2187, 34.7%; >60 years--327, 5.2%). HVA was recorded as 6/6 both eyes in 4136 (65.6%), at least 6/12 both eyes in 5691 (90.3%), and at least 6/18 both eyes in 5974 (94.8%) individuals. Only 11 patients (0.17%) had VA worse than 6/60 with only 3 patients (0.003%) having bilateral VA <6/60. Older age, female sex, lower education status, and low annual income were significant risk factors for poor HVA. Conclusion: Poor education, lower income, female gender, and old age are significantly associated with poor HVA even in urban Western India despite relatively easy access to affordable eye care facilities.

Duration of anti-SARS-CoV-2 antibodies much shorter in India.

Seroprevalence survey, for antibodies to SARS-CoV-2, of healthcare workers (HCW) working in three Government run hospitals in Mumbai was carried out in June 2020. Among the 801 HCWs tested, seroprevalence was 11.1%. Males (13.5% vs. 8.9% in females) and ancillary workers (18.5% vs 6.9% in doctors and nurses) were more likely to be seropositive. Sixty-two (7.74%) had been previously diagnosed with RT PCR test for SARS-CoV-2. Of these, 44 (71%) were seronegative. Upto 28 days after a positive PCR test, 90% of subjects were found to be seropositive. This reduced to less than half (38.5%) between 29 and 42 days. None of 28 infected HCWs who had the RT-PCR more than 50 days ago tested positive for antibodies. It seems likely that cellular immunity plays a larger role in defence against the illness.

Generics versus brand-named drugs for glaucoma: the debate continues.

There are three options for a given class of drugs, including brand name drugs, generic and branded generic drugs. Brand name drugs are costlier as compared to generic and branded generic drugs because they are innovator molecules developed by a company after many years of research and come into the market with a patent, whereas branded generic drugs are produced by a different company once the patent of innovator company expires. Given that glaucoma is a chronic, largely asymptomatic disease, the choice of drugs is extremely important: the duration of medication is often lifelong, and the cost of drugs, side effects and efficacy affect compliance and adherence to therapy. This review is a brief overview of the available brand name and branded generic drugs for the management of glaucoma, in terms of efficacy and side effect profiles. It also aimed to guide rational and pragmatic drug choices in different clinical scenarios.

Patient Centricity and the Ethics of Glaucoma Care.

The ultimate goal of glaucoma therapy, as of any other therapeutic intervention, is to achieve superior clinical outcomes, patient satisfaction, and patient adherence to treatment. In a chronic asymptomatic disease, such as, glaucoma, where diagnostic and therapeutic algorithms may have multiple acceptable treatment arms, patient centricity becomes increasingly important. Shared decision-making, patient participation, quality of life (QoL) concerns, and risk-benefit analyzes further complicate this decision-making. In addition, the ethics of research in glaucoma and also that of glaucoma screening may often be in conflict with the ethics of patient care. This article aims to highlight the ethical dilemmas that confound decision-making in current glaucoma practice, and the doctors' fiduciary duties to the patient. How to cite this article: Bhartiya S. Patient Centricity and the Ethics of Glaucoma Care. J Curr Glaucoma Pract 2020;14(2):68-71.

Evaluating glaucoma surgeries in the MIGS context.

The challenges of glaucoma management are many: the disease is chronic, progressive, often asymptomatic, and very often, the quality of life and costs of treatment is unacceptable to the patient. This is true for both medical therapy and conventional glaucoma surgery. The choice of therapy, especially the transition from the former to the latter, is now being bridged by Minimally Invasive Glaucoma Surgeries (MIGS). Choosing from the several options now available in the surgical armamentarium requires a deeper understanding of the available modalities. This review aims to provide an overview of the decision-making process, keeping in mind age, type of glaucoma, life expectancy, socioeconomic status, patient expectations, and coexisting cataract.