Awareness, knowledge and challenges faced by beneficiaries and non-beneficiaries of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana with special reference to eyecare in three districts of Uttar Pradesh state: A cross-sectional study.

Purpose: The aim was to analyse the knowledge and awareness regarding Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) within the operational districts of two high-volume non-profit eye organisations in Uttar Pradesh. Challenges faced by beneficiaries and non-beneficiaries are also examined. Methods: A prospective cross-sectional survey from November 2021 to April 2022 was conducted across operational districts of organisations A and B. Cluster sampling was used to select participants in randomly selected villages with 200 or more households, within 10-15 km of existing vision centres. A semi-structured interview schedule was used to collect data. The means of AB-PMJAY indicators were estimated. Awareness was estimated as a summed score. Multivariate logistic regression was applied to check the effects of the socio-economic and socio-demographic factors on the awareness of AB-PMJAY for both organisations separately and together. Results: A total of 1151 participants were interviewed: 52.9% from the catchment area of organisation A and 47.1% from that of organisation B. From the catchment of organisations A and B, 82.6% and 22.9% participants, respectively, had heard of the scheme, mostly from family and friends. Whereas 43% interviewees from the catchment area of organisation A and 8.5% from that of organisation B had knowledge about at least one topic, only 8.5% and 2.8%, respectively, were knowledgeable about all topics. Village effect was found to be significant for most of the knowledge and awareness indicators in both catchments. Only 37.8% and 20.2% of the catchment from organisations A and B, respectively, were AB-PMJAY cardholders. Of the services availed, 50% were cataract surgery. Almost 40% of the applicants faced some challenges while securing the AB-PMJAY card and 9% while using the AB-PMJAY card. Family income was found to be the only common predictor of knowledge at both locations. Conclusion: Varied awareness and limited knowledge in catchment villages put the onus on community eyecare organisations to spread awareness in their catchment, which may increase the uptake and utilisation of the scheme.

Harnessing Generalizable Real-World Ophthalmic Big Data: Descriptive Analysis of the Bodhya Eye Consortium Model for Collaborative Research.

BACKGROUND: Eye care organizations and professionals worldwide are increasingly focusing on bridging the gap between population health and medical practice. Recent advances in genomics and anthropology have revealed that most Indian groups trace their ancestry to a blend of 2 genetically distinct populations: Ancestral North Indians, who share genetic affinities with Central Asians, Middle Easterners, Caucasians, and Europeans; and Ancestral South Indians, genetically distinct from groups outside the Indian subcontinent. Studies conducted among North Indian populations can therefore offer insights that are potentially applicable to these diverse global populations, underscoring significant implications for global health. OBJECTIVE: The Bodhya Eye Consortium is a collaboration among 8 high-volume nonprofit eyecare organizations from across North India. The consortium aims to harness real-world data consistently and with assured quality for collaborative research. This paper outlines the formation of the consortium as a proposed model for controlled collaborative research among the leading eyecare organizations of North India. METHODS: We detail the creation and effective implementation of a consortium following a structured road map that included planning and assessment, establishing an exploratory task force, defining specialty areas, setting objectives and priorities, and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Central to this process was a comprehensive data audit aimed at standardizing data collection across all participating organizations. RESULTS: The consortium currently comprises 9 organizations, each represented in the governance structure by the Governing Council. Scientific standards for published research are established and overseen by the Scientific Committee, while the Conflict Resolution Committee manages any unresolved disputes. The consortium's working groups, organized by various eyecare specialties, collaborate on research projects through virtual interactions. A foundational step in this process was the organizationwide data audit, which revealed that most organizations complied with accurate and standardized data collection practices. Organizations with deficiencies in data completeness developed action plans to address them. Subsequently, the consortium adopted data collection proformas, contributing to the publication of high-quality manuscripts characterized by low dropout rates. CONCLUSIONS: The collaborative research conducted by the Bodhya Eye Consortium-a group of high-volume eyecare organizations primarily from North India-offers a unique opportunity to contribute to scientific knowledge across various domains of eyecare. By leveraging the established heterogeneity of anthropological and genomic origins within the population, the findings can be generalizable, to some extent, to European, Middle Eastern, and European American populations. This access to potentially invaluable, generalizable data has significant global health implications and opens possibilities for broader collaboration. The model outlined in this descriptive paper can serve as a blueprint for other health care organizations looking to develop similar collaborations for research and knowledge sharing.

Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty.

PURPOSE: To report the indications for keratoplasty and analyze trends in two decades in India. METHODS: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. RESULTS: Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. CONCLUSION: Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.

Preferred practice patterns for keratoconus: An e-survey among Indian cornea specialists.

PURPOSE: This study aimed to report practice patterns in the management of keratoconus in India. METHODS: An e-survey was conducted among members of the Cornea Society of India to assess preferred practice patterns for keratoconus. RESULTS: Of the 912 members, 234 (25.7%) completed the survey. About 88.4% worked in private eye care facilities and 76.1% in cities. Of all the respondents, 91.5% had access to a Scheimpflug-based device or an Orbscan II®; 71.4% of the respondents dispensed scleral contact lenses, and 66.7% dispensed Rose K contact lenses; 92.7% of the respondents performed corneal cross-linking (CXL); and 73.1% of the respondents performed deep anterior lamellar keratoplasty (DALK). A Scheimpflug device or Orbscan II®, Rose K or scleral contact lenses, and CXL were more readily available (P < 0.05) in private eye care facilities. The diagnostic criteria for keratoconus followed by the majority of the respondents (52.1%) were increase in corneal curvature, elevation, and thickness. An increase in keratometry values greater than 0.5 or 1.0D in a 6-month to 1-year period was considered the most favored criterion for keratoconus progression. Epithelium-off, 0.1% riboflavin solution in dextran, and accelerated protocol were the more commonly reported techniques in CXL. About 77.2% of the respondents routinely performed CXL in corneas <400 microns thick. Spectacles (91.0% of the respondents) and topography-guided photorefractive keratectomy (37.6% of the respondents) were, respectively, the preferred optical and surgical methods used to improve vision. CONCLUSION: While keratoconus management in India is comparable to other developed healthcare systems, the concentration of trained corneal surgeons in cities and private eyecare facilities may lead to less equitable distribution of treatment across the country.

Trends in keratoplasty from central and northern India. Part II: Types of keratoplasty.

PURPOSE: To report the types of keratoplasty and analyze trends over a period of two decades in central and northern India. METHODS: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and north India from 2005 to 2021. The indications and various keratoplasty procedures were compared between 2005-2012 and 2013-2021 to analyze the trend. RESULTS: A total of 13,223 corneal grafts were performed, of which therapeutic penetrating keratoplasty (TPK) (5719, 43.3%) was the most common procedure, followed by optical penetrating keratoplasty (OPK) (5528, 41.8%), Descemet stripping endothelial keratoplasty (DSEK) (1279, 9.7%), deep anterior lamellar keratoplasty (DALK) (376, 2.8%), Descemet membrane endothelial keratoplasty (DMEK) (215, 1.6%), patch grafts (75, 0.6%), and keratoprostheses (31, 0.2%). Overall, OPK procedures decreased (-14.1%, P < 0.001), but TPK (+3.1%, P < 0.019), DSEK (+7.1%, P < 0.001), and DMEK (+1.9%, P < 0.001) procedures increased. Although there was an increasing trend in the use of DALK (+0.8%, P < 0.083) and keratoprostheses (+0.3%, P = 0.074) procedures, the trends were not statistically significant. CONCLUSION: In keeping with worldwide trends, an increasing trend in lamellar keratoplasties was observed in central and northern India during the past decade. The trend was significant for DSEK. However, as corneal ulcers and scars were the major indications for keratoplasty, TPK and OPK remained the most common procedures.

Antibiotic susceptibility pattern of bacterial isolates from microbial keratitis in North and Central India: A multi centric study.

Purpose: This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics. Methods: The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher's exact test were applied to check the significance of difference between the susceptibility levels of antibiotics. Results: The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa-induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034). Conclusion: Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.

Role of 0.01% atropine in high myopic children of Moradabad, India (RAMCOM Study).

Purpose: Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy remains uncertain among high myopic children. This study aimed to evaluate the efficacy and safety of low-concentration atropine eye drop (0.01%) in high myopic children. Methods: A non-randomized, parallel-group, longitudinal interventional cohort study. Myopic children were divided into two groups: (1) the intervention arm of children who received one drop of topical 0.01% atropine once a day at bedtime and (2) the control arm, in which enrolled children who were on observation only. Repeated measurements of spherical equivalent refractive errors (SERs) were performed at baseline and 1 and 2 years after treatment. Results: A total of 37 eyes were enrolled in the intervention arm (allocated to 0.01% atropine at year 1 follow-up) and 23 eyes in the control arm. After 1 year of 0.01% atropine therapy, the myopia progression was 0.15 ± 0.9 D in the intervention group versus 1.1 ± 1 D in the control group (P = 0.001). Similarly, after 2 years of treatment, the myopia progression was 0.3 ± 1.1 D in the intervention group versus 1.4 ± 1.1 D in the control group (P ≤ 0.001). Conclusion: Compared to no treatment, 0.01% atropine treatment had shown better effect on myopia progression in high myopic children.

Comparison of eyecare utilization at two service delivery levels during the COVID-19 pandemic as a measure of their impact: A multicentric retrospective analysis across four North Indian high-volume eyecare organizations.

Purpose: The purpose of this study was to assess the performance of the tertiary centers (TCS) and vision centers (VCs) of the four organizations participating in this research, once the lockdown was lifted, and to compare it with the performance during the same period of the previous year. Methods: This was a cross-sectional study assessing eyecare utilization in the first 2 months after resumption of services post the lockdown in 2020 and comparing that across the same time period in 2019. Anonymized data containing basic demographic details, proportions of patient visits and their reasons, as well as referral information was collected. The drop percentage method was used, and P values were calculated using paired t-tests. Results: Four TCs and 60 VCs were included. Overall, outpatient attendance dipped 51.2% at TCs and 27.5% at VCs, across the 2 years. At both levels of care delivery, the percentage drop in females was more than that in males; however, the overall drop at VCs was less than that at TCs, for both sexes. Eyecare utilization in pediatric populations dropped significantly more than in adult populations, across the overall sample. There was no significant change in referrals for refractive error as a proportion of total outpatients, although there was a significant decline in the same for cataract and specialty treatment. Conclusion: VCs are valuable and successful model for eyecare delivery especially in the continued aftermath of the COVID-19 pandemic.

Clinical profile and treatment outcomes of Fusarium keratitis.

PURPOSE: To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis. METHODS: A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019. RESULTS: The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4-13.3; P=0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9-71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis. CONCLUSION: Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

"Depression, Anxiety and Stress" in a Cohort of Registered Practicing Ophthalmic Surgeons, Post Lockdown during COVID-19 Pandemic in India.

Purpose: To assess the magnitude of mental health problems among ophthalmologists in India post lockdown during COVID pandemic.Method: Cross-sectional survey conducted online on registered practising ophthalmologists of India, post lockdown at the start of elective surgeries (20th to 25th May, 2020). The degree of symptoms of depression, anxiety and stress was assessed by DASS -21 questionnaire. DASS -Subscales: DASS- D (depression), DASS- A (anxiety) and DASS-S (stress) and grading of severity (mild, moderate, severe) were analysed.Results: A total of 144 ophthalmologists aged 29-72 years responded to online survey. Of all participants, 94 (64.2%) of ophthalmologists suffered from mental health problems. Seventy six (52.7%) ophthalmologists had depression and anxiety whereas 20 (14%) reported stress. Women ophthalmologists scored highest total DASS mean score and DASS-stress mean score (p = .04 and p = .03). Results of DASS-D and DASS-A showed female preponderance (men vs women 42.5% vs 61.5%, p = .02; 42.5% vs 60%, p = .04). Severity of symptoms revealed that ophthalmologists above 40 years of age with more than 10 years' experienced severe stress (p = .005). Comprehensive ophthalmologists presented with severe stress and ophthalmologists practicing speciality with severe anxiety. Pearson's correlation analysis showed positive correlation between total DASS-21 score with each of the three subscales scores (DASS D, r-0.88: p < .001; DASS-A, r = 0.96: p = <0.001; DASS-S, r = 0.95: p < .001).Conclusion: Screening by Dass-21 scale has brought noticeable transient mental health issue among ophthalmologist to the fore. Few with high risk may require professional mental care to alleviate it.

Clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis.

PURPOSE: To report clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis. METHODS: Retrospective chart review of consecutive culture-proven Curvularia keratitis patients who presented to a tertiary eye care center in north India. Patients with mixed infections with Curvularia as one of the pathogens were also included. Standard case report form was developed to capture demographic information, clinical features, etiology, treatment, and outcome. Binary logistic regression was done to ascertain the effect of identified variables on final visual acuity. RESULTS: Medical records of 97 patients of Curvularia keratitis were reviewed. Median age of patients was 45.3 years. Seventy-nine (79.4%) patients presented during the months of September to November. History of corneal trauma was present in 69.1%. Trauma from sugarcane leaf was identified in 66.1% of cases with corneal trauma with vegetative matter. Presenting visual acuity was worse than 20/60 in 57.8% of patients. Hypopyon and pigmented plaque-like infiltrate was present in 16.5% and 28.8% of patients, respectively. Mixed infection was reported in 14.4% of cases. Median time of antifungal therapy was 24.5 days. Surgical intervention was required in 18.5% cases. Of all, 11.1% patients achieved final VA of more than 20/200 who were managed surgically as compared to 68 (86%) patients who were managed medically. Younger age, absence of comorbidities, and lesser infiltrate size were found associated with good final visual acuity. CONCLUSION: Working males were most affected by Curvularia keratitis. Corneal trauma with sugarcane leave was the most common predisposing factor in the study area. Most of the cases presented with worse visual acuity but could be managed medically.

Migratory serpiginous corneal epitheliopathy (MSCE)- details of 4 cases.

BACKGROUND AND OBJECTIVE: To describe four cases of recurrent, fleeting corneal epithelial lesion, migratory serpiginous corneal epitheliopathy (MSCE). METHOD: Description of cases, histopathology and discussion of treatment outcome. RESULTS: The study included 4 consecutive male patients; mean age was 21.25 years. Only one eye was affected. The common symptoms were irritation and tearing. Typical interpalpebral corneal lesion was a superficial greyish-white elevated corneal epithelium with stippled fluorescein staining in various geographic patterns. Corneal scrapings did not show any microorganisms and culture was negative; histopathology did not show corneal dysplasia. The lesions recurred within 1-3 weeks despite repeated scraping, application of a bandage contact lens, and a combination of topical antibiotics and lubricants. The recurrent lesion was of a different shape and eventually healed within 3-6 months without scarring. CONCLUSION: We describe a possibly new entity, unilateral migratory serpiginous corneal epitheliopathy (MSCE) affecting young males, with inconspicuous inflammation. Etiology is not known and usually takes several months to heal after repeated epithelial debridement.