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.

The L V Prasad Eye Institute: A comprehensive case study of excellent and equitable eye care.

Global healthcare delivery systems are facing ever-increasing challenges on multiple fronts. The need to study and define successful models of care delivery systems has become increasingly important. The L V Prasad Eye Institute (LVPEI) has a distinctive eye care delivery system offering rich lessons at many operational levels. The system has been developed on the basis of LVPEI's foundational public eye health study, and follows a complexity-driven (dependent on disease complexity) clinical care system forming a five-tier pyramidal model - at the apex is the quaternary care centre at Hyderabad, followed by increasing numbers of tertiary, secondary or community, primary, and rural eye care centres, where the revenue from paying patients covers free-care via an economic cross-subsidy. This has achieved a level of scale, efficiency, social impact, and clinical and scientific innovation rarely seen in a single health system. Building on the foundational principles of this pyramidal care with a robust economic cross-subsidy model, LVPEI has seamlessly established successful professional, academic, and educational systems that combine innovation, scientific discovery, and the development of in-house technologies focused on improving service quality and clinical decision making. In this case study, we show that all elements of the LVPEI model are practical and may be applicable to academic medical centres in diverse healthcare settings; currently, this is being tested in Liberia, West Africa.

Hydrogel tissue adhesive for sealing corneal incisions.

The purpose of the study was to assess the efficacy of a newly developed hydrogel tissue adhesive for sealing corneal incisions in ex vivo rabbit eyes. Simple through-and-through central linear corneal incisions measuring 1-5 mm were created in enucleated rabbit eyes. As controls, the leaking pressures were measured immediately after the incisions had been made. Afterwards, the incisions were sealed with hydrogel adhesive in group 1 and with a single 10-0 nylon suture in group 2. The leaking pressure of each incision was measured after the wounds had been sealed in both groups. The leaking pressures of the controls and the sealed incisions were compared for statistical significance using the Wilcoxon signed rank test. The difference between the leaking pressures before and after sealing the incisions in groups 1 and 2 were compared using the Mann-Whitney rank sum test. The leaking pressures were significantly higher after sealing in both groups 1 and 2 compared to the controls for all incision sizes. The differences in the leaking pressures before and after adhesive application were higher than before and after suturing in all incision sizes. The differences were all statistically significant except for the 1-mm incisions. We conclude that the hydrogel glue has the potential to be used for sealing corneal incisions measuring up to 5 mm.