Development of an Index for a Tooth to Receive a Full-Coverage Crown.

PURPOSE: To develop a system for assessment of the status of a tooth to receive a full coverage crown and depict it on a measurable scale, and to validate its use by assessing examiner reproducibility. METHODS: The index was developed based on the inputs from experts in the field with a consensus on factors (4 periodontal, 2 endodontic, and 4 prosthodontic), stages of severity (stage 1 to stage 4), assigned scores, and relative weights pertaining to varied clinical scenarios. Based on the selection of factor-stage combination, an overall tooth crownability index (TCI) score along with three-factor scores were computed. The validation study included clinical and radiological assessment of cases based on the index criteria by four independent examiners (periodontist, prosthodontist, endodontist, and general practitioner). RESULTS: Forty teeth were assessed. The distribution of repeated selection by the examiners was quite identical to the initial (kappa = 0.93). There was no statistically significant difference in the mean scores of examiners in TCI and factorial scores. An excellent agreement between the measurements was observed among the examiners (ICC =0.993; Crohnbach α = 0.993). CONCLUSIONS: A tooth crownability index has been developed for a tooth to receive a full coverage crown which has an excellent agreement and good reproducibility among the examiners. TCI will serve as a baseline tool in treatment plan decision-making based on the status of the teeth and in research for evaluating the efficacy of various treatment options available (standard criteria for outcome assessment).

Impact of Auxiliary Features on Retention of Short Dental Crowns: An In-Vitro Analysis of Box and Groove Preparations.

BACKGROUND Several auxiliary features have been proposed to achieve sustainable retention for short-prepared dental crowns; however, achieving retention is challenging. This study aimed to assess the impact of increased total occlusal convergence and auxiliary preparation factors like box and groove on the retention form of short tooth preparations. MATERIAL AND METHODS Eighty resin machine-milled dies with a height of 3 mm and a deep chamfer margin of 1 mm were prepared to mimic the short-prepared molar. Initially, 2 teeth were prepared following the guidelines, and the total occlusal convergence was kept at 10° and 20°, respectively. Auxiliary features such as the proximal box and buccal groove were prepared on separate 20° dies. Eighty dies were prepared with 10 samples each for 10°, 20°, 20° with proximal box and 20° with buccal groove for zirconia (n=40) and metal crowns (n=40). Cementation was done with glass ionomer luting cement, and a pull-off test was conducted. Data were analyzed using one-way analysis of variance and post hoc fisher least significant difference test (P<0.05). RESULTS The highest mean was observed in the proximal box group with the metal crown (14.59), and the lowest in the group with 20° zirconia crowns (9.12). Within groups, the highest retentive values were found for the 20° taper with proximal box preparation; the lowest was for the 20° taper group. CONCLUSIONS Within the study limitations, it could be concluded that incorporating a proximal box or buccal groove in short tooth preparations with an increased total occlusal convergence improved retentive values.

Pediatric corneal transplantation: techniques, challenges, and outcomes.

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.

Bibliographic analysis and evaluation of the mesh keywords in the journal of prosthodontics: Implant, esthetic, and reconstructive dentistry.

BACKGROUND: Various studies have been conducted to analyze data via bibliometric analysis in different dentistry, including prosthetic dentistry. However, these studies evaluated the most cited published articles in dentistry. OBJECTIVE: To analyze and evaluate the characteristic development of several mesh keywords in the Journal of Prosthodontics - Implant, Esthetic, and Reconstructive Dentistry between 1992 and 2022. METHODS: The Scopus databases was searched to retrieve the data related to 8 categories, including published articles, most cited documents, authors and organizations, and maximum articles cited during the evaluation period. The data retrieved were exported to a Microsoft Excel sheet and were analyzed using the bibliometrix package. The data were first analyzed for ten years and then for 30 years. The highest of 10 were reported for each category, and co-authorship, reoccurrence, and linked data were also reported. RESULTS: 2603 published documents were recorded from the Scopus databases. Articles comprised 87.9% of the total published work, followed by review articles at 5.46%. The most productive decade was between 2013 and 2022. 3793 terms were used during the evaluation period, with the maximum number in 2003-2012 (2481). A total of 5392 keywords were used during 1992-2022, with the highest number (3232) from 2013 to 2022. A total of 6108 authors were acknowledged, with the maximum number (3964) from 2013 to 2022 and the fewest (767) from 1992 to 2002. Authors from different countries increased from 17 countries in 1992-2002 to 52 countries in 2013-2022 (total = 63 countries). Similarly, the number of organizations increased from 312 organizations in 1992-2002 to 1315 organizations in 2013-2022 (total = 1976 organizations). CONCLUSION: The current bibliometric analysis delivered a comprehensive overview about more spread research topics and its impactful role in contemporary dentistry, especially prosthetic dentistry.

Transforming Dental Caries Diagnosis Through Artificial Intelligence-Based Techniques.

Diagnosing dental caries plays a pivotal role in preventing and treating tooth decay. However, traditional methods of diagnosing caries often fall short in accuracy and efficiency. Despite the endorsement of radiography as a diagnostic tool, the identification of dental caries through radiographic images can be influenced by individual interpretation. Incorporating artificial intelligence (AI) into diagnosing dental caries holds significant promise, potentially enhancing the precision and efficiency of diagnoses. This review introduces the fundamental concepts of AI, including machine learning and deep learning algorithms, and emphasizes their relevance and potential contributions to the diagnosis of dental caries. It further explains the process of gathering and pre-processing radiography data for AI examination. Additionally, AI techniques for dental caries diagnosis are explored, focusing on image processing, analysis, and classification models for predicting caries risk and severity. Deep learning applications in dental caries diagnosis using convolutional neural networks are presented. Furthermore, the integration of AI systems into dental practice is discussed, including the challenges and considerations for implementation as well as ethical and legal aspects. The breadth of AI technologies and their prospective utility in clinical scenarios for diagnosing dental caries from dental radiographs is presented. This review outlines the advancements of AI and its potential in revolutionizing dental caries diagnosis, encouraging further research and development in this rapidly evolving field.

Comparison of Composite Resin (Duo-Shade) Shade Guide with Vita Ceramic Shades Before and After Chemical and Autoclave Sterilization.

BACKGROUND This study aimed to compare a composite resin (Duo-Shade) shade guide with Vita ceramic shades before/after chemical and autoclave sterilization. MATERIAL AND METHODS Color values (L*a*b*) were recorded directly from shade tabs of prefabricated composite resin (Brilliant NG Universal Duo-Shade) and ceramic (Vita classic) shade guide with a calibrated spectrophotometer (Vita Easy Shade Advance 4.0). Seventy-two composite resin disk samples with 6 different shades (A1/B1, A2/B2, A3/D3, A3.5/B3, A4/C4, and C2/C3) (n=12 each) were divided into 2 groups (Gp) - Gp A (Autoclave) and Gp C (Chemical) (15 cycles) - to assess their influence on respective shades. Mean values calculated the color differences (ΔE) while differences in color values (L*a*b*) were graded on the National Bureau of Standards (NBS) 6-grade scale and assessed for Clinical Acceptance/Perceptible Threshold (CAT), (CPT). All differences were considered significant if the color difference ΔE was ≥3.3. RESULTS Only 2 out of 12 Shade tabs (C2C3, A4C4) of composite resin matched to Vita shade tab C2 and C4 (ΔE ≤3.3). Both groups showed notable color differences after respective sterilization protocols, with color differences in Gp A significantly higher than Gp C (DE ³3.3). Within groups, all shades in Gp A showed remarkably different color changes, with shade C2C3 and A1B1 being denoted as clinically unacceptable. CONCLUSIONS Manufacturer-provided shade guides do not match ceramic shades as claimed and chemical sterilization using 10% Deconex was associated with less color changes than with autoclave sterilization.

Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness.

Purpose: To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non-contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT). Methods: This was a prospective, cross-sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non-glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland-Altman graph was plotted. Results: Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037). Conclusion: The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.

Radiographic Evaluation of the Gap between Cemented Post and Remaining Gutta-Percha in Endodontically Treated Teeth Performed by Undergraduate Students: A Retrospective Cross-Sectional Study.

The coronal seal in root canal-treated teeth may be compromised depending on the accuracy of post space preparation and post cementation along with remaining gutta-percha. Root canal treatment can be compromised by endotoxins released by the coronal bacteria as a result of microleakage. The study was conducted by undergraduate students to measure the gap between the cemented post and residual gutta-percha. In total, 217 endodontically treated teeth were evaluated with intraoral peri-apical radiographs. Based on the intraoral periapical radiographic examination in the CS-R4 program, Group I had no gap, Group II had a gap of >0 to 2 mm, and Group III had a gap of more than 2 mm between the end of the cemented post and the remaining gutta-percha. In total, 40% (n = 87) of the teeth had no gap, 59% (127) had a gap of >0 to 2 mm, and 1% (n = 3) had a gap of more than 2 mm between the cemented post end and remaining gutta. Chi square test revealed a significant difference in the gap between the post and remaining gutta-percha between males and females students (p < 0.001). In terms of the gap between the cemented post end and the residual gutta-percha, the root canal treated teeth with post and core by undergraduates were clinically acceptable.

Comparison of corneal endothelial cell loss during manual small-incision cataract surgery using viscoelastic-assisted nucleus removal versus continuous balanced salt solution plus technique - Randomized controlled trial.

Purpose: The purpose of this study was to compare and analyze the endothelial cell loss during manual small-incision cataract surgery (MSICS) using the viscoelastic-assisted nucleus removal versus basal salt solution plus technique. Methods: This was a prospective randomized trial of 204 patients who underwent MSICS using viscoelastic-assisted nucleus removal (Group 1- OVD) versus basal salt solution plus technique (Group 2- BSS) at a tertiary eye care hospital in North India from January 2018 to 2021. Of these 204 patients, 103 (50.5%) and 101 (49.5%) were allocated to Group 1 and 2, respectively. The parameters assessed were detailed history, demographics, and anterior and posterior segment details. Visual acuity, intraocular pressure (IOP), keratometry, pachymetry, and endothelial cell density were evaluated preoperatively and postoperatively on day 1 and 30. Results: The mean age of the patients was 64.5 ± 8.2 years (range 48-82 years). There were 129 (63.2%) males and 75 (36.8%) females. The mean LogMAR visual acuity for both groups on day 1 (Group 1- 0.3 ± 0.1, Group 2- 0.5 ± 0.2) and day 30 (Group 1- 0.1 ± 0.2, Group 2- 0.1 ± 0.1) was statistically significant (P < 0.001), and the mean IOP value showed a statistically significant value (P < 0.009) on day 1 in Group 2 (15.0 ± 2.4 mmHg) and on day 30 (P < 0.001) in both the groups (Group 1- 13.6 ± 1.8 mmHg, Group 2- 13.5 ± 2 mmHg). The horizontal and vertical k values also showed a statistically significant difference on day 1 and day 30 (P < 0.001). The mean percentage change of central corneal thickness (CCT) in Group 1 was 17.7% and in Group 2 was 17.4% on day 1, and it was 1.1% on day 30 in both the groups, which was statistically significant (P < 0.001) compared to preoperative values. The percentage change in endothelial cell density on day 1 was 9% in Group 1 and 4.6% in Group 2, which was statistically significant (P < 0.001). On day 30, it was 9.7% and 4.8%, respectively, which was statistically significant (P < 0.001). Conclusion: Our study highlights statistically significant endothelial cell loss with viscoelastic-assisted nuclear delivery compared to BSS-assisted nuclear delivery during MSICS in a short follow-up of 1 month. The CCT values showed a slight increase, and the keratometry and IOP were unaffected compared to the preoperative parameters in both the groups.

Effect of Miswak Derivatives on Color Changes and Mechanical Properties of Polymer-Based Computer-Aided Design and Computer-Aided Manufactured (CAD/CAM) Dental Ceramic Materials.

BACKGROUND Miswak is a form of chewing stick used to clean teeth in different parts of the world, including Saudi Arabia. We present a description of the effects of miswak derivatives, namely toothpaste, mouthwash, and brushing sticks, on the mean color changes (DE00), compressive fracture resistance values, and fracture modes of polymer-based computer-aided design (CAD) and computer-aided manufactured (CAM) prosthetic materials. MATERIAL AND METHODS Eighty-one rectangular-shaped samples were prepared from lithium disilicate glass-ceramic (IPS e.max CAD), zirconia-reinforced lithium silicate (Vita Suprinity), and monochromatic tooth-colored feldspar (Vitablocs Mark II) CAD/CAM ceramics. The color parameters were recorded using spectrophotometer before and after exposing the specimens to the different miswak oral hygiene derivatives for 15 days. Compressive fracture resistance values and fracture types were also assessed, and statistical analysis was performed. RESULTS Vita Suprinity and Vitablocs Mark II miswak sticks had the highest ΔE00 values. Moreover, miswak mouthwash had the lowest ΔE00 values, with significant differences among groups. IPS e.max CAD miswak sticks had the highest mean values of compressive fracture. Vitablocs Mark II had the lowest values for mouthwash and toothpaste. Significant differences were found within the IPS e.max CAD group. Reparable fractures were found in IPS e.max CAD, while semi-reparable fractures were seen in other groups. CONCLUSIONS Most ΔE00 values were within the acceptable clinical range, with IPS e.max CAD showing superior color stability. The mouthwash group showed minimal ΔE00. IPS e.max CAD had the highest mean compressive fracture resistance values with reparable fracture types.

Assessment of Conventionally and Digitally Fabricated Complete Dentures: A Comprehensive Review.

CAD/CAM technology is gaining popularity and replacing archaic conventional procedures for fabricating dentures. CAD/CAM supports using a digital workflow reduce the number of visits, chair time, and laboratory time, making it attractive to patients. This study aimed to provide a comparative review of complete dentures manufactured using CAD/CAM and conventional methods. The PubMed/Medline, Science Direct, Cochrane, and Google Scholar databases were searched for studies published in English within the last 11 years (from 2011 to 2021). The keywords used were "computer-engineered complete dentures", "CAD/CAM complete dentures", "computer-aided engineering complete dentures", and "digital complete dentures". The search yielded 102 articles. Eighteen relevant articles were included in this review. Overall, computer-engineered complete dentures have several advantages over conventional dentures. Patients reported greater satisfaction with computer-engineered complete dentures (CECDs) due to better fit, reduced chair time, shorter appointments, and fewer post-insertion visits. CAD/CAM allows for precision and reproducibility with fewer procedures compared to conventional dentures. Polymethyl methacrylate is used as the denture base material for conventional dentures. For CECDs, the resin can be modified and cross-linked to improve its mechanical properties. The advantages of CECDs include a reduced number of appointments, saving chairside time, a digital workflow allowing easy reproducibility and greater patient satisfaction with a better fit.

The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project "Fixing the missing link": Prevalence data from Madhya Pradesh and Chhattisgarh.

Purpose: : To determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in the states of Madhya Pradesh (MP) and Chhattisgarh (CG). Methods: : Diabetic patients were screened in the treating diabetologist/physician's clinic by a team that included an ophthalmologist, an optometrist, and a counselor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera. Results: : In total, 602 subjects were screened across five selected locations of MP and CG. The prevalence of DR was 13.62%. No significant difference with gender was seen. The presence and grade of DR were related to age, diabetic age, and diabetic control. Conclusion: : This study provides the prevalence data for DR among diabetic patients from the states of MP and CG and highlights important barriers to DR screening in our country.

Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial.

The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was −0.31 ± 0.11 mm (mesial) and −0.28 ± 0.09 mm (distal); and in the test group was −0.35 ± 0.11 mm (mesial) and −0.33 ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants.

Designing an immunoinformatic vaccine for peri-implantitis using a structural biology approach.

OBJECTIVES: Peri-implantitis is a destructive inflammatory process that affects the soft and hard tissues around dental implants. porphyromonas gingivalis, an anaerobic gram-negative bacterium, appears to be the main culprit. Since there is no efficient and specific vaccine to treat peri-implantitis, the goal of our research has been to develop a multi-epitope vaccination utilizing an immunoinformatics approach that targeted P. gingivalis type I fim A. MATERIALS AND METHODS: P. gingivalis peptides 6JKZ and 6KMF are suitable for vaccine development. B- and T-cell epitopes from 6KMF and 6JKZ were detected and evaluated based on critical factors to produce a multi-epitope vaccine construct. It was assessed based on allergenicity, antigenicity, stability. The vaccine's dual major histocompatibility complex (MHC-I and MHC-II) binding epitopes allowed it to reach a larger population. P. gingivalis fimbriae induce immune subversion through TLR -CXCR4 receptor complex pathway. The ClusPro 2.0 server was used to do the molecular docking using TLR2 - CXCR4 and vaccine epitopes as receptor and ligand respectively. RESULTS: The designed vaccine was non-allergenic and had a high antigenicity, solubility, and stability. The 3D structure of the vaccine revealed strong interaction with CXCR4(TLR2) using molecular docking. The vaccine-CXCR4 interface was more consistent, possibly because the vaccination has a higher affinity for the CXCR4-TLR2 complex. CONCLUSION: This study details the vaccine's distinct and sustained interaction with the CXCR4(TLR2) immunological receptor and its consistent and effective utterance in the bacterial system. As a result, our vaccine formulation will evoke a significant memory response and induce an adaptive immune response against P. gingivalis.

Clinical and Radiographical Measurements of Supraeruption and Occlusal Interferences in Unopposed Posterior Teeth.

AIMS AND OBJECTIVES: This study compared the supraeruption of teeth for study casts (SCs) and panoramic radiographs (PRs) and its relation to tooth type, arch, facial sides, presence of occlusal interferences, and type of tooth movements. MATERIALS AND METHODS: A total of 65 patients with their SCs and PRs were recruited. Supraerupted tooth type, arches, sides involved, and the presence of occlusal interferences were recorded. The SCs for supraerupted teeth were photographed, and supraeruption from PRs was recorded from the patients' files. The values were transferred to a software program and assessed. RESULTS: The highest frequency was observed among the younger-age group and molars in both arches. Working side (WS) and retruded cuspal position (RCP) interferences were recorded the highest. Supraeruption values of 0.7-1.2 mm accounted for 47.5% (38) of the total. Tilting and tipping of teeth were the highest, followed by buccolingual displacement. Kappa tests showed good intraexaminer reliability and Bland-Altman plot showed 95% confidence interval band. CONCLUSIONS: No significant differences were observed in the supraeruption values between the type of tooth among different subgroups of SCs and PRs. Significant differences were recorded between the types and sites of teeth, with a higher ratio observed in molar teeth, mandibular arch, and young age group. RCP and WS were the most recorded occlusal interferences and buccolingual displacement, and tilting and tipping were the most noticeable occlusal tooth movements. CLINICAL SIGNIFICANCE: Diagnosis and measurements of supraeruption are essential, useful, and significant steps before treatments for replacement of missing tooth/teeth as well as corrections of occlusal interferences during different mandibular movements.

An Update on Assessment, Therapeutic Management, and Patents on Insomnia.

Insomnia is an ordinary situation related to noticeable disability in function and quality of life, mental and actual sickness, and mishappenings. It represents more than 5.5 million appointments to family doctors every year. Nonetheless, the ratio of insomniacs who are treated keeps on being low, demonstrating the requirement for proceeding with advancement and dispersal of effective treatments. Accordingly, it becomes significant to provide a compelling treatment for clinical practice. It indicates a need for the determination of various critical viewpoints for the evaluation of insomnia along with various accessible alternatives for treatment. These alternatives incorporate both nonpharmacological therapy, specifically cognitive behavioural therapy for insomnia, and a number of pharmacological treatments like orexin antagonists, "z-drugs," benzodiazepines, selective histamine H1 antagonists, nonselective antihistamines, melatonin receptor agonists, antipsychotics, antidepressants, and anticonvulsants. Besides in individuals whose insomnia is due to restless leg syndrome, depression/mood disorder, or/and circadian disturbance, there is insignificant proof favouring the effectiveness of different prescriptions for the treatment of insomnia though they are widely used. Other pharmacological agents producing sedation should be prescribed with care for insomnia therapy because of greater risk of next-day sleepiness along with known adverse effects and toxicities. This review is also aimed at providing an update on various patents on dosage forms containing drugs for insomnia therapy.

The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project "Fixing the missing link": Prevalence data from West Bengal.

PURPOSE: The aim of this study was to determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in rural and urban West Bengal (WB). METHODS: Patients were screened in the physician's clinic by a team of ophthalmologist, optometrist and counsellor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera. RESULTS: A total of 1553 subjects were screened over 39 camps across 14 districts of WB over 17 months. The prevalence of DR was 21.51%, with a significant difference between rural (26.55%) and urban (13.89%) areas (P < 0.01). No significant difference with gender was seen (P = 0.99). Presence and grade of DR were related to age, loss of vision, diabetic age, diabetic control, awareness of diabetic blindness and last eye checkup. CONCLUSION: This study provides the first major prevalence data from WB, and gives valuable insight regarding modifiable risk factors for DR. It is also the first DR study in India to be conducted in the physician's clinic. The study results emphasise the need to "fix the missing link" between ophthalmologists and treating physicians to win the battle against DR.

Utility of a smartphone assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center.

PURPOSE: To assess the use of smartphone-based direct ophthalmoscope photography for screening of diabetic retinopathy (DR) in known diabetic patients walking into a general practitioner's clinic and referring them to a vitreoretinal specialist for further evaluation and management if required. METHODOS: The study included 94 eyes of 47 walk-in patients in a general practitioner's OPD who were known to have type 2 diabetes mellitus and were already on treatment for the same. RESULTS: The study included 47 patients with diabetes with a mean age of 56.2 ± 9.4 years. The Cohen's kappa values revealed that the diagnosis related to the DR status made using a camera was in substantial agreement with the clinical diagnosis (Kappa value: 0.770). The Cohen's kappa values revealed that the diagnosis related to the DME made using a camera was in moderate agreement with the clinical diagnosis (Kappa value: 0.410). The agreement between the findings of the camera and clinical diagnosis was statistically significant (P < 0.05). CONCLUSION: Direct ophthalmoscope-based smartphone imaging can be a useful tool in the OPD of a general practitioner. These images can be assessed for retinopathy, and patients can be referred to a vitreoretinal specialist for further evaluation and management if needed. Hence, the burden of vision loss due to complications of DR in the rural sector can be abridged.