A comparative clinical study of postoperative care by teleophthalmology and in-person consultation at hospital outpatient department after an uncomplicated cataract surgery.

BACKGROUND: Teleophthalmology provides an opportunity to conduct consultations in far-flung and remote areas that have no access to specialized eye care. However, there is a paucity of studies to assess the effect of missing in-person follow-up on initial postoperative visits. The study thus aims to compare postoperative satisfaction and uncorrected distance visual activity after an uneventful phacoemulsification cataract surgery in patients with teleconsultation approach to those with hospital visit. MATERIALS AND METHODS: The prospective observation study (n = 240) was conducted in patients who underwent surgery for cataract. Pre- and post-operative data were collected and divided into two groups based on the type of postoperative follow-up. All patients were scheduled for ophthalmic reviews in the hospital on day 1, day 7, and day 30-40 (hospital visit group) or through teleconsultation on days 1 and 7 followed by a hospital visit on days 30-40 (teleconsultation group). Outcomes evaluated in both groups were complications, patient satisfaction, and uncorrected distance visual acuity. RESULTS: Most patients in both groups were in the age group of 51-70 years. Overall satisfaction was comparable in teleconsultation and hospital visit groups (3.74 ± 0.23 vs. 3.72 ± 0.27; P = 0.22). The majority of patients had visual acuity 6/18-6/6 on postoperative day 1, day 7, and day 30-40 in both groups. Lid edema, pain, redness, watering, and congestion complications were more in the hospital visit group on postoperative day 1. CONCLUSION: The study concludes that patients with no preexisting ocular and systemic comorbidity undergoing an uneventful phacoemulsification cataract surgery teleconsultation approach can be used for follow-up without any impact on the postoperative visual outcome and patient satisfaction, thereby increasing the efficiency and productivity of health-care system.

A comparative study to evaluate the effect of various postoperative treatment protocols on dry eye and patient satisfaction after phacoemulsification.

Purpose: Foreign body sensation and irritation are common after cataract surgery, as is the exacerbation of dry eye disease if present. This study compared postoperative dry eye treatments and patient satisfaction. Methods: Age-related cataract patients undergoing phacoemulsification were recruited and were divided randomly into 4 postoperative treatment groups: Group A: Antibiotic + Steroids; Group B: Antibiotic + Steroids + Mydriatic; Group C: Antibiotic + Steroids + Mydriatic + Non-steroidal Ant-inflammatory drugs (NSAIDs); Group D: Antibiotic + Steroids + Mydriatic + NSAID + Tear substitute. Patients were assessed at 1, 3, and 5 weeks post-operatively for uncorrected distance and near vision, best corrected visual acuity (BCVA) for distance and near, Schirmer's-1 test, and Tear Film Break-Up Time test. At each visit, patients were assessed for dry eye-related subjective parameters using Ocular Surface Disease Index questionnaire. Results: Study participants numbered 163. (87 male and 76 female patients). No statistically significant difference was present in visual acuity for near and distance. The mean values of Schirmer's test and TFBUT were better in group D patients at each postoperative visit, with significant differences noted in comparison with other groups. The patient response to pain and dry eye symptoms was superior in groups C and D, with group D producing the best results. Compared to group A, patients in groups C and D were more satisfied with their vision and surgery. Conclusion: The addition of tear substitutes to steroids and NSAIDs has been associated with decreased dry eye-related symptoms and a better subjective feeling of vision, although no significant difference was noted in vision measured objectively.

Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery.

Purpose: Functional recovery after cataract surgery depends on the anatomical recovery of the eye. This study compared the improvement in visual function parameters after uniocular manual small-incision cataract surgery (MSICS) and phacoemulsification cataract surgery. Methods: This study included 310 patients divided randomly into two groups: 155 who received MSICS (MSICS group) and 155 who underwent phacoemulsification (phaco group) for cataract treatment. Outcome measures assessed included vertical and horizontal keratometry reading. The mean corneal astigmatism tear function measured using Schirmer 1 test results were recorded preoperatively, and on postoperative day 1, day 7, and day 30. Optical coherence tomography (OCT) was done to record the average central macular thickness (µm) on day 7 and day 30. Results: The mean corneal astigmatism and anterior chamber inflammation were more in the MSICS group than in the phaco group immediately postoperatively. However, no statistically significant difference was found between the groups with respect to corneal sensation, mean corneal astigmatism, tear film function, and visual outcomes on postoperative day 30. Uncorrected visual acuity was better in the phacoemulsification group than in the manual SICS group on postoperative day 1, day 7, and day 30 (P < 0.001). Conclusion: Both phacoemulsification cataract surgery and manual small-incision sutureless cataract surgery (MSICS) are safe and effective for visual rehabilitation. Phacoemulsification is the preferred technique where resources are available with the advantages of less mean corneal astigmatism, less anterior chamber inflammation, and better uncorrected visual acuity (UCVA) in the immediate postoperative period.

The impact of early intervention on a child with vision loss in infancy - A parental perspective.

Purpose: : To assess the impact of early intervention services provided to children with visual loss and to report how parents perceive them in terms of a child's development and the family dynamics. Methods: : A qualitative descriptive study was conducted on a purposively selected sample of 15 children with severe visual impairment, availing early intervention services at a tertiary care facility in Pune, Maharashtra. Data were collected by conducting in-depth interviews of the parents with the help of a semi-structured interview topic guide. Participants were asked in detail about how and whether various components of the early intervention program (EIP) had an impact on their child. The interviews were audio-recorded, transcribed, and translated into English, and the resultant textual data were analyzed using the qualitative research software NVIVO 12 to identify themes and sub-themes under each domain. Results: : A total of 15 children were included in the study, with ages ranging from 13 months to 5 years. All the children included in the study suffered from severe visual impairment in infancy (Vision 3/60 - PL). In the course of this EIP, the majority of the children showed consistent progress in various aspects of child development. According to the parents, the most beneficial components of EIP were visual stimulation exercises, an improvised teaching methodology, and counseling services. Conclusion: : Almost all the parents included in the study reported a positive change in the behavior and development of the child as well as improved family dynamics after implementation of EIP.

Effects on ocular aberration and contrast sensitivity after implantation of spherical and aspherical monofocal intraocular lens - A comparative study.

Purpose: Phacoemulsification with intraocular lens (IOL) implantation is the standard of care for cataractous eyes. Monofocal IOLs are spherical or aspheric. The aspheric design of IOLs reduces the spherical and higher-order aberrations and impacts contrast sensitivity post cataract surgery. There are some studies, but data in the Indian setting with the IOLs we used is lacking. We aimed to compare the effect of implantation of spheric and aspheric foldable intraocular lenses on postoperative quality of vision, spherical aberration, and contrast sensitivity. Methods: This prospective observational study was conducted at a tertiary care hospital with an ophthalmology specialty, data collection from January 2017 to May 2018 in 100 patients. Patients meeting the inclusion criteria were selected. Their preoperative and postoperative data were collected and divided into groups based on whether spherical or aspheric IOL was implanted after cataract surgery. Variables assessed were visual acuity on days 7 and 30, spherical aberrations, and contrast sensitivity was assessed at 1-month postoperative. Results: The mean age of the patients in this study was 64 ± 8 years with a majority of patients (60%) being females. There is no significant difference in postoperative visual acuity between the two groups. Internal SA was significantly lower (~50%) in eyes implanted with aspheric IOLs (P value = 0.004, 0.0001) compared with the spherical group. Contrast sensitivity of patients of the aspheric group was significantly better (P value <0.05). Conclusion: The optical design of the aspheric IOLs reduced spherical aberrations and increased contrast sensitivity.

Cost analysis of pediatric cataract surgery in a tertiary eye care hospital in Western India.

PURPOSE: To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider's perspective. METHODS: Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered. RESULTS: The per-patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76). CONCLUSION: Pediatric cataract surgeries are cost-intensive. High-volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness-free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.

Prevalence of Anxiety and Depression in Patients With Primary Glaucoma in Western India.

PRCIS: Glaucoma can cause disturbance in psychological and emotional functioning of patients, leading to anxiety and depression, even early in the disease. Identification and management of these problems should be included as a part of the holistic approach for patient care. PURPOSE: The purpose of this study was to assess the prevalence of anxiety and depression in patients with primary glaucoma using a standard validated questionnaire. METHODOLOGY: A cross-sectional prevalence study was carried out on 200 patients attending the glaucoma outpatient clinic at a tertiary care eye hospital in Pune, India. After obtaining written consent, all patients underwent a thorough ophthalmic examination. Those with primary glaucoma were included in the study and classified on the basis of the Hodapp-Parrish-Anderson criteria. Participants were asked to respond to the Hospital Anxiety and Depression Scale (HADS) questionnaire, and responses were analyzed statistically. RESULTS: The mean HADS-Anxiety score was 4.5 (SD=3.4), while HADS-Depression was 4.1 (SD=3.8). The severity of the disease was associated with significantly higher HADS scores. Mean HADS-Anxiety scores were 3.1 (SD=2.9) for mild glaucoma, 4.4 (SD=2.6) for moderate, and 7.7 (SD=3.0) for advanced disease (P<0.001). Similarly, mean HADS-Depression scores were 2.0 (SD=2.6), 4.2 (SD=3.0), and 8.3 (SD=3.3), respectively for mild, moderate, and severe glaucoma (P<0.001). Based on HADS scores, a third of patients (34.5%) were symptomatic for anxiety or depression, out of which 25 (12.5%) could be classified as definite cases. Duration of treatment had no association with HADS scores. CONCLUSIONS: An association exists between the amount of visual loss among patients with glaucoma and symptoms of anxiety and depression, irrespective of disease duration. This information may help to choose treatment approaches most likely to be beneficial to the patients.

Impact of a structured training program to enhance skills in phacoemulsification surgery.

PURPOSE: The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases. METHODS: This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done. RESULTS: Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1. CONCLUSION: A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Comparison of bleb morphology by anterior segment optical coherence tomography and clinical outcome after phacotrabeculectomy with mitomycin C or Ologen implant.

PURPOSE: To compare the bleb morphology by Anterior Segment Optical Coherence Tomography (ASOCT) and clinical outcome after Phacotrabeculectomy with either mitomycin C or Ologen implant. METHODS: In a prospective interventional active controlled study, 93 patients aged 18 years and above underwent phacotrabeculectomy with either mitomycin C (53 eyes) or ologen implant (40 eyes), followed up for 12 months. The primary outcome measure was to note the evolution of bleb morphology by ASOCT in the two groups over 12 months. Secondary outcome measures were mean IOP, reduction in the need for anti-glaucoma medications, and complications seen in the two groups. RESULTS: All parameters in the two groups were comparable preoperatively (P>0.05). Best corrected visual acuity at 12 months was 0.38±0.27 in mitomycin group and 0.31±0.23 in ologen group (P=0.151). Post-operative IOP at 12 months was 14.09±3.1mmHg (95%CI 13.22-14.97) in mitomycin group, and 13.25±2.5 mmHg (95%CI 12.40-14.30) in ologen group (P=0.254). The mean number of medications was 0.36±0.68 in mitomycin group and 0.38+/-0.70 in ologen group at 12 months (P=0.91). Overall success was achieved in 98.1 % of patients in mitomycin group and 90 % of patients in ologen group at 12 months. No major sight-threatening complications were noted in any group. AS-OCT imaging at 12 months showed multiform reflectivity with multiple large cystic spaces in both groups, with good IOP control. CONCLUSION: Phacotrabeculectomy using Mitomycin C and Ologen implant resulted in similar morphologic and functioning blebs at one year with comparable efficacy in controlling intraocular pressure.

Can the postoperative follow-up visit be deferred up to four weeks after an uneventful cataract surgery? - A randomized controlled trial.

Purpose: The aim of this study was to compare the postoperative visual outcome after a Day 0 examination in patients with two follow-ups, one between Day 3 to Day 7 and other between Day 25 to Day 30 to those with a single ophthalmic follow-up directly after 25-30 Days and to assess the safety of deferral of the first follow-up visit at 1 week. Methods: Randomized Controlled Trial was conducted at a tertiary eye care hospital, with 848 patients enrolled for the study. Patients meeting the inclusion criteria were selected. Their pre-operative and post-operative data was collected and the patients were divided into groups based on the type of cataract surgery and the postoperative follow-up protocol through randomization. Results: No significant difference was observed in the postoperative visual outcome in patients that underwent postoperative review at Day 3-7 and Day 25-30 as opposed to those that followed up directly at Day 25-30 after a mandatory Day 0 examination for all patients. Conclusion: In patients with no preexisting ocular or systemic comorbidity undergoing an uneventful cataract surgery, the postoperative follow-up visit can be safely deferred until 4 weeks, without any impact on the postoperative visual outcome, thereby conserving the available resources which can be deviated towards better eye care services.

Comparison of diagnostic ability of standard automated perimetry, short wavelength automated perimetry, retinal nerve fiber layer thickness analysis and ganglion cell layer thickness analysis in early detection of glaucoma.

Purpose: The aim of this study was to compare the diagnostic ability of macular ganglion cell layer (GCL) analysis using spectral domain optical coherence tomography against retinal nerve fiber layer analysis (RNFL), short-wavelength automated perimetry (SWAP), and standard automated perimetry (SAP) in early detection of glaucoma. Methods: Participants fulfilling the inclusion criteria were consecutively enrolled from the glaucoma clinic of tertiary care eye hospital in Western India from November 2015 to October 2016. The subjects underwent a detailed evaluation by trained glaucoma specialists. On suspicion of glaucoma, the patients underwent SAP, SWAP, and SD-OCT for GCL and RNFL analysis. Results: There were 91 patients in total of which experts classified 54 eyes into GON and 37 eyes into nonglaucomatous group. Sensitivity of SAP (42.59%) was significantly lower (P < 0.05) than that of average GCL thickness (79.63%) and average RNFL thickness (72.22%). Specificity and positive LR of SWAP (97.3% and 19.19, respectively) and SAP (94.6% and 7.88, respectively) were greater than those of GCL (81.08% and 4.21) and RNFL (67.57% and 2.23) parameters. Negative LR of average GCL thickness (0.25) was superior to that of average RNFL thickness (0.411), SWAP (0.495), and SAP (0.607). Conclusion: Macular GCL parameters perform better than RNFL parameters in patients with early glaucomatous damage. There is superior ability of SWAP over SAP in detecting glaucomatous changes in glaucoma suspect group. GCL thickness analysis has higher sensitivity and negative likelihood ratio, whereas SWAP had higher specificity and positive likelihood ratio. Thus, combining both tests can lead to better diagnostic ability for early glaucomatous damage.

Comparative evaluation of qualitative performance of technical human resource in school eye health program.

PURPOSE: To measure sensitivity and specificity of vision screeners in identifying children with visual impairment and positive signs and symptoms and assess association of effectiveness with individual characteristics of screeners and type of schools screened. METHODS: A total of 1096 children from age 5 to 15 years of age were screened. A total of 396 children were screened from a municipal school, 200 children from a government-aided school, and 500 children from a private school were screened. Four persons with basic 12th standard science qualification willing to be a part of school eye health program were selected who carried out screening in school children after receiving appropriate training. RESULTS: The two vision screeners who had a background of conducting community eye health programs and worked in eye hospital had 100% sensitivity and specificity for presenting visual acuity, squint detection, and blurring. The screening by these screeners was done in private and semi-private schools, respectively. The other two screeners with no such background conducting screening in government schools had 60% and 75% sensitivity in detecting presenting visual acuity, respectively. CONCLUSION: People with a background of organizing community eye health programs and those working in eye hospitals are the best candidates for being trained as new cadre of vision screeners with best results being obtained in private and government-aided schools.

A clinical study to assess feasibility, acceptance, and outcome of multifocal intraocular lens in patients with bilateral immature cataract at a tertiary eye care institute.

PURPOSE: : To assess feasibility, acceptability, and outcome of multifocal intraocular lenses (IOL) in patients with bilateral immature cataract. METHODS: 1691 patients with bilateral immature cataract were included in the study. The feasibility of these IOLs was calculated by studying ocular parameters using Visionix VX120 and subjective characteristics. A prospective study was then conducted in 148 eyes of 74 patients in which multifocal IOLs were implanted. Their visual outcome was assessed using LogMAR for distance and Snellen's chart for near vision, contrast sensitivity by Pelli-Robson chart, and satisfaction using visual function-7 questionnaire. RESULTS: Considering ocular and subjective characteristics, it was feasible to implant the lens in 920 patients (54.40%) and the acceptability rate was 8.04%, most common reason for decreased acceptability was cost (85%) of IOL. The median distance uncorrected visual acuity (UCVA) at day 7 and at 30 days was LogMAR 0.2 (0.1-0.3) and 0.15 (0.1-0.2), respectively, which was statistically significant compared to preoperative distance UCVA (P < 0.001). The median near UCVA at day 7 and 30 days was N6 for both and statistically significant (P < 0.001) compared to preoperative near UCVA. 77.02% patients had distance UCVA of LogMAR (0.0-0.2) and 91.8% had near UCVA of N6-N8 at 30 days. The contrast sensitivity was decreased in all patients. CONCLUSION: Appropriately selected patients can achieve spectacle independence and good visual satisfaction which begins with proper patient education, lifestyle and personality dynamics, and individualized weighing of benefits and side effects of multifocal IOLs.

Assessment of psychosocial impact of primary glaucoma and its effect on quality of life of patients in Western India.

PURPOSE: : To assess the impact of primary glaucoma of varying severity and duration on psychosocial functioning and quality of life of patients. METHODS: A cross-sectional observational study was carried on 200 patients attending the glaucoma clinic of a tertiary care hospital in western India. After obtaining approval from the institutional ethics committee, written informed consent was taken. All patients underwent a thorough ophthalmic examination. Those with primary glaucoma were classified as per Hodapp-Parrish-Anderson criteria and asked to respond to the National Eye Institute Visual Function Questionnaire (NEIVFQ)-25 questionnaire. Responses were analyzed statistically. RESULTS: : Overall mean NEIVFQ 25 composite score was 74.4 ± 18.6. Mean scores were 87.0 (SD 7.2) for mild, 75.9 (SD 8.1) for moderate, and 47.0 (SD 13.7) for severe glaucoma groups. Lower scores were associated with males. Driving (62.2, SD 34.6) and ocular pain (63.5, SD 18.7) were maximally affected while color vision (90.1, SD 18.7) and social health (86.7, SD 20.1) were least affected. The duration of treatment had no effect on mean composite scores with impaired scores seen even in newly diagnosed cases. Age of the patient negatively correlated with NEIVFQ 25 composite score. CONCLUSION: : With disease progression, the psychosocial functioning of the patients is negatively affected. This effect is irrespective of treatment duration and newly diagnosed cases can have impaired Quality of life scores. Quantification of psychosocial status along with education and counseling for all patients may play a definitive role in customizing treatment and providing patients with a better quality of Life.

Evaluation of skills transfer in short-term phacoemulsification surgery training program by International Council of Ophthalmology -Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR) and assessment of efficacy of ICO-OSCAR for objective evaluation of skills transfer.

Purpose: To evaluate skills transfer in short-term phacoemulsification surgery training program by International Council of Ophthalmology -Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR) and assessment of efficacy of ICO-OSCAR for objective evaluation of skills transfer. Methods: Prospective analysis of total 1300 phacoemulsification surgeries performed by 52 phacoemulsification trainees divided into three groups based on the previous cataract surgical experience. The pretraining and posttraining average mean scores, independent completion rates (ICR), and complication rates among the groups were calculated and statistically analyzed. Results: Mean age of trainees (N = 52) was found to be 30.98 ± 2.44 years. Mean pretraining scores in the three groups were 42.8 ± 0.2, 46.6 ± 0.2, and 50.1 ± 0.1, respectively, and posttraining mean scores of the groups were 88.4 ± 0.2, 92.3 ± 0.2, and 94.3 ± 0.2, respectively, out of 100. Pretraining independent completion rates (%) were 22.1 ± 2.5, 52.1 ± 2.5, and 62 ± 3.7, respectively, and posttraining independent completion rates (%) were 74.8 ± 3, 79.7 ± 3, and 90.6 ± 3.5, respectively. Learning curves of all groups were noted to be steep. Rate of complications was within acceptable range, overall complication rate being 12.30% (160 out of 1300 cases). OSCAR scores correlate significantly (P = 0.0004) with ICR. Conclusion: Steep learning curve for phacoemulsification can be made easy by the use of standardized rubrics, proper techniques, expert guidance, and adequate surgical volume. The previous SICS experience provides smoother learning curve. ICO-OSCAR is indicator of proficiency and provides constructive feedback and objective evaluation immediately after surgery as well as at the end of training. Short-term (1 Month) training program is an effective, efficient, and safe approach to progressively master phacoemulsification skills for trainees with SICS experience.

Aberrometric outcome of customized toric IOL in cataract with very high corneal astigmatism due to pellucid marginal degeneration.

A case of pellucid marginal degeneration (PMD) with cataract where a customized high-power toric IOL was implanted is reported. The patient had preoperative corneal astigmatism of 13.96 diopters (D), and a customized toric IOL of 19 D toricity was implanted; postoperative visual acuity was 6/9 on Snellen chart. The visual quality and aberrometric outcome were assessed with a ray-tracing aberrometer. The toric IOL gave not only a better uncorrected visual acuity but also better quality of vision in this patient with corneal astigmatism due to PMD.

Comprehensive diabetes care: The Goa model.

Diabetes mellitus continues to increase in epidemic proportions globally as well as in India. Poor glycemic control in long-standing diabetes mellitus eventually leads to chronic complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Diabetic retinopathy is emerging as an important cause of avoidable visual impairment and blindness in India across all strata of society. Much of this vision loss can be prevented by improving control of known risk factors, annual fundus screening, with prompt treatment of individuals with sight-threatening retinopathy. The Queen Elizabeth Diamond Jubilee Trust has made a significant contribution by supporting such a program across India, including Goa. The newly established medical retina clinic at Goa Medical College now provides facilities for screening, a detailed evaluation of advanced retinopathy, and therapeutic modalities such as laser and intravitreal injections. The peripheral centers are equipped to screen all people with diabetes mellitus and refer those with sight-threatening retinopathy to the medical college. The provision of a foot scanner to evaluate the risk of foot ulcers and microalbuminuria assessment as part of the nephropathy screening would encompass the entire gamut of diabetic microvascular complications. The next decade would provide evidence if this initiative, with the enthusiastic partnership of the state government, results in reduction of blindness in the people of Goa and an overall reduction in diabetes-related morbidity and mortality.

Intrastromal voriconazole: An adjuvant approach for recalcitrant mycotic keratitis.

Purpose: To evaluate the efficacy of intrastromal voriconazole for the management of fungal keratitis not responding to conventional therapy. Methods: Patients having microbiologically proven fungal keratitis with poor response to 2 weeks of conventional topical therapy were included in the study. After obtaining informed consent, an intrastromal injection of voriconazole was administered around the ulcer. Response to treatment in the form reduction in the size of the ulcer and infiltration was recorded on regular follow-ups. Results: Out of a total of 20 patients, 14 responded to intrastromal treatment and resolved, whereas six patients progressed to perforation. Mean resolution time was 35.5 ± 9.2 days. The most common organism isolated was Fusarium in six patients while Aspergillus and Mucor were isolated in two each. The causative organism could not be isolated in eight patients. The size of the ulcer at presentation and height of hypopyon were found to be significant risk factors associated with treatment outcomes. Conclusion: Intrastromal voriconazole as an adjuvant therapy appeared to be effective in treatment of fungal keratomycosis not responding to conventional therapy, thus, reducing the need for therapeutic or tectonic keratoplasty.

Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India.

PURPOSE: To estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services. METHODS: 'Rapid assessment of avoidable blindness and diabetic retinopathy' methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software. RESULTS: The response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. 'Need not felt' (36.6%) and 'cost' (31.7%) were the most common barriers for cataract surgery. CONCLUSION: Prevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.