Protocol on a multicentre statistical and economic modelling study of risk-based stratified and personalised screening for diabetes and its complications in India (SMART India).

INTRODUCTION: The aim of this study is to develop practical and affordable models to (a) diagnose people with diabetes and prediabetes and (b) identify those at risk of diabetes complications so that these models can be applied to the population in low-income and middle-income countries (LMIC) where laboratory tests are unaffordable. METHODS AND ANALYSIS: This statistical and economic modelling study will be done on at least 48 000 prospectively recruited participants aged 40 years or above through community screening across 20 predefined regions in India. Each participant will be tested for capillary random blood glucose (RBG) and complete a detailed health-related questionnaire. People with known diabetes and all participants with predefined levels of RBG will undergo further tests, including point-of-care (POC) glycated haemoglobin (HbA1c), POC lipid profile and POC urine test for microalbuminuria, retinal photography using non-mydriatic hand-held retinal camera, visual acuity assessment in both eyes and complete quality of life questionnaires. The primary aim of the study is to develop a model and assess its diagnostic performance to predict HbA1c diagnosed diabetes from simple tests that can be applied in resource-limited settings; secondary outcomes include RBG cut-off for definition of prediabetes, diagnostic accuracy of cost-effective risk stratification models for diabetic retinopathy and models for identifying those at risk of complications of diabetes. Diagnostic accuracy inter-tests agreement, statistical and economic modelling will be performed, accounting for clustering effects. ETHICS AND DISSEMINATION: The Indian Council of Medical Research/Health Ministry Screening Committee (HMSC/2018-0494 dated 17 December 2018 and institutional ethics committees of all the participating institutions approved the study. Results will be published in peer-reviewed journals and will be presented at national and international conferences. TRIAL REGISTRATION NUMBER: ISRCTN57962668 V1.0 24/09/2018.

Incidence and management of rhegmatogenous retinal detachment after pars plana vitrectomy and sutureless scleral-fixated intraocular lens.

Purpose: To evaluate the incidence, risk factor(s), and surgical outcomes of rhegmatogenous retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) with sutureless scleral-fixated intraocular lens implantation (SFIOL). Methods: Records of patients (1311 eyes, 1234 patients) who underwent PPV and sutureless SFIOL from 2017 to 2018 were retrospectively analyzed. Results: The indications SFIOL were subluxated lens (33.7%), dislocated IOL (21.7%), surgical aphakia (20.1%), congenital lens subluxation (11.1%), nucleus drop (6.9%), and post-open globe injury (OGI) repair (6.5%). History of closed-globe injury (CGI) was present in 27.2% eyes.Twenty-two eyes (1.7%) developed RRD. The incidence of RRD in eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post-OGI repair was 1.4% (n = 6), 2.5% (n = 7), 1.1% (n = 3), 3.4% (n = 5), 0 and 1.2% (n = 1), respectively (P = 0.382). The incidence of RRD in eyes with and without CGI was 1.7% each (P = 0.996).Twenty-one eyes underwent RD surgery. Retinal reattachment was achieved in 76.2% eyes, while 66.7% eyes required only one surgery. The eyes in which retina failed to reattach had a high grade of proliferative vitreoretinopathy present at the time of presentation. Final best-corrected visual acuity of ≥20/60 and <20/60 to ≥20/200 and <20/200 was seen in 38.1%, 19.0%, and 42.9% eyes. Conclusion: Eyes with the congenital subluxated lens are at a marginally higher risk of developing post-SFIOL RRD. The surgical outcome of RD surgery in these eyes is good.

The Ophthalmology Surgical Competency Assessment Rubric for Panretinal Photocoagulation.

PURPOSE: To develop an internationally valid skill-based rubric that can be used as a global standardized platform for teaching, training, and evaluation of panretinal photocoagulation (PRP) in training programs. DESIGN: A panel of educators and experts in retinal lasers was assembled to develop a standardized objective skill-based rubric. PARTICIPANTS: Sixteen international educators and retina specialists. METHODS: The steps to performing slit-lamp delivery of PRP was described in detail. A group of 6 authors reviewed and agreed on the steps and assigned descriptors to expectation levels of novice, beginner, advanced beginner, and expert according to a modified Dreyfuss model. The tool then was vetted by an international panel of 10 retina specialists who are involved in training ophthalmologists in other countries. MAIN OUTCOME MEASURES: Final version of the tool agreed on by the international review panel. RESULTS: The consecutive steps to performing PRP were outlined and broken down into preparation, procedure, and postoperative care. Descriptive words explaining what to expect from a novice, beginner, advanced beginner, and expert were listed for each step of PRP. Expert comments were incorporated, establishing face and content validity. CONCLUSIONS: This group of authors clearly defined expectations of a trainee at 4 levels of training according to the modified Dreyfus model, and an international panel of retina specialists agreed to its accuracy. This tool, the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for Panretinal Photocoagulation, has face and content validity. It can be used globally in training programs both to teach and assess this important comprehensive skill in ophthalmic training.