Clinical and demographic profile of herpes zoster ophthalmicus: A hospital-based study of 1752 Indian patients.

PURPOSE: To describe the clinical and demographic profile of herpes zoster ophthalmicus (HZO) in patients presenting to a multitier ophthalmology hospital network in India. METHODS: Cross-sectional hospital-based study included 3,004,470 new patients between August 2010 and October 2021. Patients with a clinical diagnosis of HZO in at least one eye were included. Data were collected using an electronic medical record system. RESULTS: In total, 1,752 (0.058%) patients were diagnosed with HZO. Nearly two-thirds were male (63.76%) in the seventh decade of life (339;19.35% patients) with unilateral (98.34%) affliction. Higher prevalence was seen in patients from higher socioeconomic status (0.059%) and metropolitan geography (0.062%). Most common ocular signs included eyelid edema (44.19%), conjunctival congestion (65.69%), punctate keratopathy (23.36%), and anterior uveitis (21.22%). Of the 1,781 eyes, mild/no visual impairment was seen in 952 (53.45%) eyes, moderate in 258 (14.49%) eyes, and severe to blindness in 363 (20.39%) eyes. Oral antivirals were started within 72 h (Group A) in 361 (20.61%) patients and after 72 h in 1391 (79.39%) patients (Group B). Significantly lesser severity of ocular involvement was noted in Group A ( P < 0.00001). Surgical intervention was required in 211 (11.85%) eyes. CONCLUSION: HZO more commonly affects males in the seventh decade of life and is predominantly unilateral. It more commonly affects those from higher socioeconomic strata and metropolitan regions. Half of the eyes have mild or no visual impairment, while others have moderate to severe impairment. Institution of antivirals within 72 h is associated with less severe involvement. Surgical intervention is warranted in a tenth of the eyes.

Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India.

PURPOSE: To describe the clinical profile, demographics, and management of Posner-Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS: Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. CONCLUSION: PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes.

Keratoconus in India: Clinical presentation and demographic distribution based on big data analytics.

PURPOSE: This paper aims to describe the clinical presentation and demographic distribution of keratoconus (KCN) in India by analyzing the electronic medical records (EMR) of patients presenting at a multitier ophthalmology hospital network. METHODS: This cross-sectional hospital-based study included the data of 2,384,523 patients presenting between January 2012 and March 2020. Data were collected from an EMR system. Patients with a clinical diagnosis of KCN in at least one eye were included in this study. Univariate analysis was performed to identify the prevalence of KCN. A multiple logistic regression analysis was performed using R software (version 3.5.1), and the odds ratios are reported. RESULTS: Data were obtained for 14,749 (0.62%) patients with 27,703 eyes diagnosed with KCN and used for the analysis. The median age of the patients was 22 (inter-quartile range (IQR): 17-27). In total, 76.64% of adults (odds ratio = 8.77; P = <0.001) were affected the most. The majority of patients were male (61.25%), and bilateral (87.83%) affliction was the most common presentation. A significant proportion of the patients were students (63.98%). Most eyes had mild or no visual impairment (<20/70; 61.42%). Corneal signs included ectasia (41.35%), Fleischer ring (44.52%), prominent corneal nerves (45.75%), corneal scarring (13.60%), Vogts striae (18.97%), and hydrops (0.71%). Only 7.85% showed an association with allergic conjunctivitis. A contact lens clinic assessment was administered to 47.87% of patients. Overall, 10.23% of the eyes affected with KCN underwent a surgical procedure. the most common surgery was collagen cross-linking (8.05%), followed by deep anterior lamellar keratoplasty (1.13%) and penetrating keratoplasty (0.88%). CONCLUSION: KCN is usually bilateral and predominantly affects males. It commonly presents in the second and third decade of life, and only a tenth of the affected eyes require surgical treatment.

From Scylla to Charybdis: Fixed drug combinations for tuberculosis and increased ethambutol-induced optic neuropathy in India.

Purpose: To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program. Methods: This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute. Results: During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41-60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019. Conclusion: The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute.

Clinical profile and demographic distribution of ophthalmia nodosa: An electronic medical record-driven big data analytics from a multitier eye care network.

Purpose: To describe the demographics and clinical profile of ophthalmia nodosa in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional, hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of ophthalmia nodosa in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 434 (0.014%) patients were diagnosed with ophthalmia nodosa. Most of the patients were male (71.43%) and had unilateral (97.7%) affliction. The most common age group at presentation was during the third decade of life with 116 (26.73%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.015%) presenting from the urban geography (0.019%) and in professionals (0.027%). The setae were identified and removed at presentation in 287 (66.13%) patients. The most common location of the setae was conjunctiva (45.72%) followed by cornea (39.64%). Most of the eyes (355; 79.95%) had mild or no visual impairment (<20/70). The most documented ocular signs were eye lid edema (35.81%), conjunctival congestion (73.87%), and corneal abrasion (29.05%). Less than one-tenth of the eyes required a surgical intervention for removal of the setae, corneal foreign body removal was performed in 10 (2.25%) eyes and conjunctival foreign body removal in four (0.90%) eyes. Conclusion: Ophthalmia nodosa more commonly affects males presenting during the third decade of life and is predominantly unilateral. The setae are most commonly lodged in the conjunctiva followed by the cornea, and the majority of the eyes have mild or no visual impairment.

Retinitis pigmentosa in Laurence-Moon-Bardet-Biedl syndrome in India: Electronic medical records driven big data analytics: Report II.

Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in Laurence-Moon-Bardet-Biedl (LMBB) syndrome patients. Methods: This is a cross-sectional observational hospital-based study wherein 244 patients with RP in LMBB syndrome presenting to our hospital network between March 2012 and October 2020 were included. An electronic medical record database was used for data retrieval. Results: There were 244 patients in total, with a hospital-based prevalence rate of 0.010% or 1000/100,000 population. The mean and median age of patients was 15.22 ± 7.56 and 14 (IQR: 10-18.5) years, respectively, with the majority being in the age group of 11-20 years (133/244 patients; 54.50%). Males were more commonly affected (164 patients; 67.21%), and the majority (182 patients; 74.59%) were students. All 244 patients (100%) complained of defective central vision at presentation. More than one-fourth of the patients had severe visual impairment to blindness at presentation. Prominent retinal feature at presentation was diffuse or widespread retinal pigment epithelial degeneration in all patients. Conclusion: Patients with RP in LMBB syndrome present mainly in the first to second decade of life with severe visual acuity impairment to blindness early in life. It is important to rule out LMBB syndrome in early-onset RP with central visual acuity impairment. On the contrary, all patients diagnosed or suspected with LMBB syndrome systemic features at physician clinic should also be referred for ophthalmic evaluation, low vision assessment, rehabilitation, and vice versa.

Clinical profile and demographic distribution of band shaped keratopathy in India: A study of 8801 patients.

Purpose: To describe the clinical profile and demographic distribution of band-shaped keratopathy (BSK) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 2,664,906 new patients presenting between January 2011 and January 2021 (10-year period). Patients with a clinical diagnosis of BSK in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 8801 (0.33%) patients were diagnosed with BSK. The prevalence rates were 0.47% in children (age: <16 years) and 0.31% in adults. The majority of patients were males (62.87%) with unilateral affliction (85.21%). The mean age of the patients was 40.43 ± 23.14 years. The majority (16.93%) of the patients were in the age bracket of 11-20 years. A larger proportion of the patients were from higher socioeconomic status (60.46%) and the urban region (45.9%). Of the 10,103 eyes affected with BSK, the common ocular comorbidities were status post-vitreoretinal surgery (20.55%) and uveitis (12.7%) in children and corneal scar (41.23%) and spheroidal degeneration (13.7%) in adults. Most of the eyes had mild or no visual impairment (24.74%). Among the eyes that needed surgical intervention, chelation with ethylenediaminetetraacetic acid (EDTA) was the most performed surgical procedure (1.68%) along with phototherapeutic keratectomy (0.32%). Conclusion: BSK commonly affects adult males and is unilateral in nature. The majority of the patients in this cohort belonged to higher socioeconomic strata and urban geography. At initial presentation, visual impairment was mild to moderate in a vast majority of the patients, and the most common surgical intervention performed was chelation with EDTA during the study period.

Effect of COVID-19 Pandemic on Presentation of Patients With Diabetic Retinopathy in a Multitier Ophthalmology Network in India.

OBJECTIVE: This study aimed to describe the demographics and clinical profile of patients with diabetic retinopathy (DR) presenting during the novel coronavirus disease 2019 (COVID-19) lockdown and unlock phases in India. METHODS: This hospital-based cross-sectional study included patients presenting from March 25, 2019, to March 31, 2021. All patients who presented with DR were included as cases. The data were collected using an electronic medical record system. RESULTS: In total, 88,012 patients diagnosed with retinal diseases were presented to the network and included for analysis. There were 21,271 (24%) DR patients during the study period and the majority were men (71%) from the urban area (45%). An increasing number of patients with proliferative DR (56%), sight-threatening DR (79%), need for vitreoretinal procedures (31%), and intravitreal injections (19%) were seen during the lockdown (phase one-four). There was a significant increase in the number of patients with blindness in pre-lockdown (20%), lockdown (32%), and post-lockdown (26%). Patterns of sight-threatening DR and blindness were similar in both fresh and follow-up patients. CONCLUSION: The presentation of DR patients in hospital is evolving because of the COVID-19 pandemic. The footfalls of patients during the unlock (phase 1-10) regained to two-thirds of the pre-COVID-19 level. There was an increase in patients with sight-threatening DR and the need for vitreoretinal surgery and intravitreal injections during the lockdown (phase 1-4).

Clinical profile and demographic distribution of Terrien's marginal degeneration in a multitier ophthalmology network in India.

PURPOSE: To describe the clinical profile and demographic distribution of Terrien's marginal degeneration (TMD) in patients presenting to a multitier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 2,470,793 new patients presenting between September 2012 and September 2020 (~8 years period). Patients with a clinical diagnosis of TMD in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS: Overall, 184 (0.007%) new patients were diagnosed. Over half of patients were males (56.52%) with bilateral affliction (54.89%). The mean age of the patients was 38.63 ± 16.75 years. Majority (28.26%) of the patients were between 21 and 30 years of age bracket. The number of patients were from rural and urban districts were comparable (41.85% vs. 48.37%). The most common clinical signs were ectasia/thinning (50.53%), corneal scar (44.21%), and prominent nerves (5.26%). Associated ocular comorbidities included vernal keratoconjunctivitis in 6 (2.11%) eyes, meibomitis in 6 (9.7%) eyes, squamous blepharitis in 2 (3.2%) eyes, dry eye in 2 (3.2%) eyes, cataract in 46 (74.2%) eyes, and glaucoma in 6 (9.7%) eyes. Most of the eyes had mild or no visual impairment (43.86%). Two (0.7%) eyes had spontaneous perforation patients. None of patients had hydrops in the years of follow-up. Keratoplasty was performed in 3.86%. CONCLUSION: TMD is a rare disease affecting patients seeking eye care at the ophthalmology network. It commonly affects adult males and is predominantly bilateral. The disease progression is slow, and risk of spontaneous perforation was low. At initial presentation, visual impairment was mild to moderate in majority and the most common surgical intervention was cataract surgery during the study period.

Clinical profile and demographic distribution of pellucid marginal corneal degeneration in India: A study of 559 patients.

PURPOSE: The aim of this study was to describe the clinical profile and demographic distribution of pellucid marginal corneal degeneration (PMD) in patients presenting to a multitier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 2,470,793 new patients presenting between September 2012 and September 2020 (~8 years period). Patients with a clinical diagnosis of PMD in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS: Overall, 559 (0.02%) new patients were diagnosed with PMD. The prevalence rates were 0.004% in children (age <16 years) and 0.03% in adults. The majority of patients were males (70.13%) with the bilateral affliction (77.1%). The mean age of the patients was 37.91 ± 13.19 years. The majority (30.23%) of the patients were between 31 and 40 years of age. A significant number of patients were from higher socioeconomic status (93.74%) and from the urban region (45.08%). Of the 990 eyes, the most common clinical signs were ectasia/thinning (58.99%), corneal scar (17.47%), and corneal hydrops (1.01%). The majority of the eyes (87.97%) were managed with either spectacles or contact lenses. Among those who had surgical intervention, collagen cross-linking was the most performed procedure (5.25%) followed by cataract surgery (4.14%). CONCLUSION: PMD is a rare disease affecting patients seeking eye care in India. It commonly affects adult males and is bilateral in nature. The disease progression is slow and usually occurs beyond 3 years. Conservative management is more common than surgical intervention.

Year one of COVID-19 pandemic in India: Effect of lockdown and unlock on trends in keratoplasty at a tertiary eye centre.

PURPOSE: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on keratoplasty trends at a tertiary eye care center in India. METHODS: This cross-sectional hospital-based study included 6,277 patients presenting between March 25, 2017 and March 31, 2021. The data of the patients who underwent keratoplasty during the lockdown and unlock phases were compared with the respective periods in the previous three years before COVID-19. RESULTS: During the year one of pandemic, there was a 29.46% decline in the total number of keratoplasty performed at the institute compared to previous year's annual numbers. The patients undergoing keratoplasty decreased by 90.28% (28/288) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 40.6% reduction in the proportion of patients requiring interstate travel. There was complete recovery in the number of patients undergoing keratoplasty to 129.27% (184/142) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen across all types of keratoplasty in Descemet stripping endothelial keratoplasty (135.29%), penetrating keratoplasty (117.6%), therapeutic keratoplasty (122.22%), anterior lamellar keratoplasty (150%), and Descemet membrane endothelial keratoplasty (141.18%) by March 2021 with the gradual ease of lockdown regulations. The eye bank affiliated to the institute saw a 55.44% decline in donor cornea collection and an increase in utilization rate from 58.12% in previous years to 83.78% in year one of the pandemic. The overall eye bank donor cornea collection recovered to 86.96% (627/721) and tissue utilization increased by 109.99% (455/414) by March 2021. CONCLUSION: The first year of the COVID-19 pandemic saw an overall reduction of 29.46% of the patients undergoing keratoplasty at the institute. There was a gradual and incremental increase in all types of keratoplasty in the unlock phase, which surpassed the preceding years' monthly numbers in February and March.

Impact of age-related macular degeneration on diabetic retinopathy: An electronic health record based big data analysis from a tertiary eye centre in South India.

PURPOSE: To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy. METHODS: This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD. RESULTS: Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = -0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = -0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = -0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR. CONCLUSION: The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.

Year one of COVID-19 pandemic: Effect of lockdown and unlock phases on cataract surgery at a multi-tier ophthalmology network.

Purpose: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on cataract surgery at a multitier ophthalmology network. Methods: This cross-sectional hospital-based study included 106,279 eyes operated between March 23, 2019 and March 31, 2021. The data of patients who underwent cataract surgery presenting during the lockdown and unlock phases were compared with the respective periods in the previous year before COVID-19. Results: The cataract surgeries performed decreased to 5.6% (839/14,994) of pre-COVID-19 volumes during the lockdown phase. There was a gradual recovery of the cataract surgeries performed to 86.7% of pre-COVID-19 volumes by May 2020 and exceeded by 17.9% by September 2020. There was a decrease in the number of women who underwent cataract surgery during the lockdown phase (49.11%) compared to the pre-COVID-19 (52.59%) or unlock phase (52.29%, P < 0.001). Patients operated during the lockdown phase were younger when compared to other groups (P < 0.001). The mean LogMAR presenting visual acuity at the time of surgery was worse in patients operated during the lockdown phase (1.84 ± 1.16) as compared to pre-COVID-19 (1.39 ± 1.05) and unlock phases (1.51 ± 1.08, P =<0.001). The proportion of patients with total cataracts were higher during the lockdown and unlock phases compared to the pre-COVID-19 phase (P < 0.001). Conclusion: The first year of the COVID-19 pandemic saw a drastic reduction in the surgical volume in the lockdown phase, which recovered quickly during the unlock period. Patients of younger age, male gender, poor presenting visual acuity, denser cataracts, and living close to the surgical center were able to access surgical care due to lockdown restrictions.

Cataract Surgery in Dry Eye Disease: Visual Outcomes and Complications.

Purpose: To describe the visual outcomes and complications following cataract surgery in dry eye disease (DED). Methods: This retrospective study included 668 eyes of 399 patients with DED, who underwent cataract surgery between 2011 and 2019 at our multi-tier ophthalmology hospital network. Based on etiology, they were divided into three groups: cicatrizing conjunctivitis (CC), meibomian gland dysfunction (MGD), and Sjogren's syndrome (SS). The data on demographics, visual impairment, surgical technique, visual outcomes, and complications were collected using an electronic medical record system. Median LogMAR best corrected visual acuity (BCVA) with interquartile range (IQR) was compared using Wilcoxon's rank sum test. Results: The median age at which cataract surgery was performed was 58 (IQR: 47-65) years. Etiology of DED was CC in 279, MGD in 255, and SS in 134 eyes. Most (471) eyes underwent phacoemulsification, under peribulbar anesthesia (548) through a temporal clear corneal incision (209) with foldable intraocular lens implantation (417). The overall median LogMAR BCVA improved from 1.1 (IQR: 0.6-2.1) at baseline to 0.3 (IQR: 0.1-0.7) and 0.1 (IQR: 0-0.65) at 1 and 6 weeks (p < 0.0001) post-operatively. The median 6 weeks post-operative BCVA was 0.3, 0.1, and 0.1 in CC, MGD, and SS, respectively, and significantly better than at baseline (p < 0.0001). The leading cause of sub-optimal vision was corneal scarring (44; 9%), and the most common complication was posterior capsular rupture with vitreous loss (23; 3%). Conclusion: Cataract surgery has good visual outcomes in patients with DED, without any disconcerting rate of complications. Pre-existing keratopathy is the main determinant of the extent of post-operative visual recovery.

Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India.

Purpose: To describe the experience of tele-consultations addressed at the centre of excellence of a multi-tier ophthalmology hospital network in India during the ongoing novel coronavirus (COVID-19) lockdown. Methods: This cross-sectional hospital-based study included 7,008 tele-consultations presenting between March 23rd and April 19th 2020. A three-level protocol was implemented to triage the calls. The data of patient queries were collected using a Google Form/Sheets and the tele-calls were returned using the patient information retrieved from the electronic medical record system. Results: Overall, 7,008 tele-calls were addressed, of which 2,805 (40.02%) patients where a clinical-related query was answered were included for analysis. The most common queries were related to redness/pain/watering/blurring of vision (31.52%), closely followed by usage of medications (31.05%). The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). Less than one-fifth of the patients were from the lower socio-economic class (16.08%) and one-fourth were new patients (23.96%). The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). Emergency requests requiring further evaluation by an ophthalmologist accounted for a small percentage (16.36%) of patients. Conclusion: Tracking of tele-consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID-19 pandemic. The current experience provided valuable insights to the possibility of managing patient follow-up visits remotely in the future.

Epidemic Keratoconjunctivitis in India: Trend Analysis and Implications for Viral Outbreaks.

Purpose: To describe the correlation between the temporal pattern of presentation of acute epidemic keratoconjunctivitis (EKC) of presumed adenoviral etiology with meteorological parameters such as environmental temperature, rainfall, humidity, and wind speed. Methods: This cross-sectional hospital-based study included 2,408,819 patients presenting between August 2010 and February 2020. Patients with a clinical diagnosis of EKC in at least one eye were included as cases. A smaller cohort of patients with acute (≤1 week) presentation hailing from the district of Hyderabad during the calendar years 2016-2019 was used to perform correlation analysis with the local environmental temperature, rainfall, humidity, and wind speed (data obtained from the Telangana State Development and Planning Society). Results: Overall, 21,196 (0.87%) patients were diagnosed with EKC, of which 19,203 (90.6%) patients had acute onset; among which the cohort from the district of Hyderabad included 1,635 (8.51%) patients. The mean monthly prevalence in this cohort was 0.89% with a peak prevalence in April (1.09%). The environmental parameters of rainfall (r2 = 0.47/P = 0.0131), humidity (r2 = 0.65/P = 0.0014), and wind speed (r2 = 0.56/P = 0.0047) were significantly negatively correlated with the temporal pattern of EKC in the population. There was no visible trend or significant correlation seen with temperature (r2 = 0.08/P = 0.3793). Conclusion: Contrary to popular belief, epidemic viral infections like EKC may not be affected by temperature, but rather by a complex interplay of other environmental factors such as humidity, rainfall, and wind speed. An increase in rainfall, wind speed, and humidity contributes to a lower prevalence of EKC cases during the year.

Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I.

Purpose: To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas. Methods: This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed. Results: Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions. Conclusion: Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.