Capacity building for diabetic retinopathy screening by optometrists in India: Model description and pilot results.

Purpose: The present study's objectives are 1) to describe a novel model of Diabetic Retinopathy Capacity Building (DRCB) for optometrists in the detection of diabetes-related retinal pathology in India and 2) to assess the outcomes of this model by comparing the ability of optometrists to detect these diseases using retinal photographs, vis-à-vis, a specialist ophthalmologist. Methods: The DRCB model for optometrists conducted between August 2016 and August 2018 included training, certification in the screening, and referral guidelines for Diabetic Retinopathy (DR) and hospital-and community-based service delivery. Training included a 7-month long fellowship in DR and mentored participation as cofacilitators in 1-day orientation workshops on DR screening guidelines across India. The sensitivity and specificity of study optometrists in screening for DR by fundus photography were compared to a retina specialist before certification. Results: A total of eight optometrists successfully completed their DR fellowship in the project duration of 24 months. The sensitivity and specificity of detection of any DR were 95 and 79%, any Diabetic macular edema (DME) was 80 and 86%. The sensitivity and specificity of detection of sight threatening DR were 88 and 90% and DME was 72% and 92% respectively. Seven workshops were cofacilitated by study optometrists training 870 optometrists in DR screening guidelines across India. Conclusion: The present DRCB model results advocate for an optometry coordinated DR screening in India. Lessons learnt from this model can be useful in designing community-based task sharing initiatives for optometrists in DR screening.

Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis.

PURPOSE: To report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC). MATERIALS AND METHODS: Records of patients with VKC, who visited our tertiary centre from 1992 and 2009, were reviewed and those with steroid-induced glaucoma were included in the study. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg on two consecutive visits (ocular hypertension) and/or glaucomatous optic disc damage. Blindness was defined as best corrected visual acuity of ≤20/400 or visual field <10°. RESULTS: Of the 4062 VKC subjects, 91 (157 eyes) had steroid-induced glaucoma (SIG), showing a prevalence of 2.24%. Of these 87% were men. The median (IQR) age at onset of VKC was 12 years (7-17). At presentation, the median duration of VKC was 48 months (24-72) and the median duration of steroid usage was 24 months (12-36). The median cup-to-disc ratio (CDR) was 0.9 (0.7-0.9) and median mean deviation was -21.9 dB (-30.0 to -10.2). IOP was medically controlled in 66% eyes (104/157) and 34% eyes (53/157) needed glaucoma surgery. High presenting IOP (OR: 1.04; p=0.05) and increased duration of steroid usage (OR: 1.07; p=0.02) were significantly associated with need for glaucoma surgery. At presentation, 29/91 subjects (31.8%) were bilaterally blind due to SIG. Higher CDR at presentation was significantly associated with blindness in this cohort (p=0.02). CONCLUSION: In this cohort of VKC with SIG, the disease predominantly affected adolescent males. Glaucoma was severe with one-third needing surgery and one-third blind due to SIG.

Prevalence and Profile of Central Serous Chorioretinopathy in an Indian Cohort.

AIMS: To determine the profile of CSCR patients from a tertiary health care set-up in India. METHODS AND MATERIAL: A total of 2780 (2447 males and 333 females) patients with a diagnosis of CSCR were included. Data regarding the demographics, profile of CSCR and systemic diseases, if any, were collected from a tertiary eye care network in South India from January 2012 to December 2016. RESULTS: The prevalence of CSCR was found to be 1.7% (A total 2780 patients, with mean age of 42.3±10.1 years). A total of 2031 patients had a unilateral and 749 had bilateral involvement. Acute and chronic CSCR was seen in 1932 (69.5%) and 848 (30.5%) eyes respectively. The mean uncorrected visual acuity of the patients was 0.51±0.45 log MAR (Snellen equivalent 20/60) while the mean best corrected visual acuity was 0.32±0.40 log MAR (Snellen equivalent 20/40). History of smoking and steroid use was present in 214 (7.7%) and 758 (27.3%) individuals respectively. Hypertension and diabetes mellitus was present in 106 (3.8%) and 51 (1.8%) patients respectively. Most of patients {824 (29.6%) patients} were shift-workers. Laser was done in 336 (12.1%) acute and 223 (8%) chronic CSCR patients. Photodynamic therapy was used in 12 acute and 12 chronic cases. CONCLUSION: Prevalence of CSCR was 1.7%. The study provides an overview of patient profile among Indian subjects.