Welcome to eOphtha the online portal of ophthalmology.

Normal flora /Microbiome of the Eye: 10 Facts

Dr. Sanchita Mitra

1. Definition of Microbiome Microbiomes are communities of organisms (bacteria, fungi, viruses) that normally reside on any part of the human body (both external and internal) and are in a symbiotic relationship with the host. The members of the microbiome live in close harmony, sharing food and shelter and offering benefits to each other, e.g. some members give protection by secreting extracellul ...Read More

i-File: Normal Tension Glaucoma

Dr. Tamonash Basu

Chief Complaint: A 37 years old male presented to us with a history of progressive deterioration of vision on 30/09/2020. History of Present Illness: He was diagnosed elsewhere to have glaucoma and came to us for further management. Past Ocular History: He was already on on Latanoprost ED HS, Dorzolamide + Timolol combination BD. The patient underwent Trabeculectomy in both eyes in the year 2010 a ...Read More

Top-Ten-Must-Not-Forget-In-Strabismus-Evaluation

Dr. Goura Chattannavar, DNB, FICO,Dr. Virangi Doshi MBBS and Dr. Ramesh Kekunnaya, MD, FRCS(Ophthal)

1. External face features affecting the eye position Facial asymmetry and palpebral fissure shape changes alter the ocular position, possibly due to extra-ocular muscle heterotopy The common extra-ocular features affecting ocular position are craniosynostosis, hydrocephalus, facial fracture, mongoloid and anti-mongoloid slant, telecanthus, congenital superior oblique palsy (face fuller on the affe ...Read More

Pictionary of Eye

Dr. Parthopratim Dutta Majumder

It is a human tendency to compare everything with day-to-day life happening, objects around them. Proverbs are one such example; they give some form of life advice with examples of very commonly occurring incidents/things in our daily life. In medical science, we often come across such analogical expressions that had been picked up from some common objects. Because of the resemblance with the morp ...Read More

Ten Pearls for Treating A Case of Retinopathy of Prematurity

Prof. Mangat Ram Dogra,Dr Deeksha Katoch

Introduction Retinopathy of Prematurity (ROP) is a potentially blinding retinal vasoproliferative disorder affecting premature and low birth weight infants. With improving survival of preterm infants with lower birth weights and gestational ages, ROP is reaching epidemic proportions in many middle- income countries.1 Although a majority of infants would develop a mild self-limiting disease, some c ...Read More

Visual Fields in Neuro-Ophthalmology : 10 Pearls for the Postgraduates

Dr. Simranjeet Aulakh

1. Is there something we can do before ordering a visual field in neuro-ophthalmology? Confrontation visual field testing is an important clinical examination, especially when it comes to neuro-ophthalmology cases. A simple test can give us clues as to what may be the underlying cause of patients’ symptoms. The test is done presuming the visual field of the examiner is normal. Both the patient and ...Read More

Central Retinal Vein Occlusion: A Comprehensive Review

Dr Priyanka Gupta,Dr Sandeep Kumar and Dr Daraius Shroff

Introduction: The clinical entity of Central Retinal Vein Occlusion (CRVO) has been known since 1878 (1), and it is a common visually disabling disorder that may cause significant ocular morbidity. It commonly affects men and women equally and occurs predominantly in persons over the age of 65 years (2-4). Associated systemic vascular disease, including hypertension and diabetes, are present in th ...Read More

Ten Clinical Signs A Postgraduate Must Look For While Examining the Fundus

Dr. Sashwanthi Mohan,Dr. Snehal Bavaskar

1. Red Dots! : Microaneurysms Seen in Diabetic Retinopathy, retinal vein occlusions, hypertensive retinopathy, radiation retinopathy. Microaneurysms are usually the first ophthalmoscopically detectable sign of diabetic retinopathy. They are focal saccular outpouchings of the capillary wall due to pericyte loss. Arise from the deep part of the inner retinal capillary plexus, and are present in the ...Read More

Basics of limbal Stem Cell Deficiency for the Postgraduates

Dr. Purvasha Narang

Limbal Epithelial Stem Cells Anatomy: The healthy corneo-scleral limbus (Figure 1) is a gradual transition zone from the stratified, non- keratinised squamous epithelium of the cornea to the stratified, non- keratinised columnar epithelium with mucin-secreting goblet cells of the conjunctiva. It has 7-10 layers of cells, which have attachments similar to the corneal cells. Figure 1: Slit-lamp phot ...Read More

Ten Points One Must Know on Toxic Anterior Segment Syndrome (TASS)

Dr. Priya Rasipuram Chandrasekaran

TASS is an uncommon, non-infectious condition causing severe inflammation of the anterior segment structures without vitreous involvement [1],[2],[5]. The name TASS was coined by Monson and colleagues in 1992 [1],[3]. It is usually associated with phacoemulsification surgery but can also happen after procedures like penetrating keratoplasty, descemet stripping automated endothelial keratoplasty, d ...Read More

Ptosis Surgeries: Made Simple for The Postgraduates

Dr. Namrata Adulkar

Ptosis refers to a vertical narrowing of the palpebral fissure secondary to drooping of the upper eyelid to a lower than normal position. Multiple surgical procedures can be used to correct ptosis including, frontalis sling, levator advancement, Fasanella Servat operation, and Mullerectomy. The selection of one technique over another depends on the consideration of several factors including the de ...Read More

Anomalies of Accommodation

Dr. Jameel Rizwana Hussaindeen M.Phil Opt, Ph.D.,FCOVD-I, FAAO

Ocular accommodation is an integral visual function that optimizes the visual perception through the focusing ability of the crystalline lens. This closed-loop system constantly interacts with the oculomotor system for finer focusing and alignment of the eyes under naturalistic binocular viewing conditions. This write-up is intended to provide an overview of the commonest anomalies of accommodatio ...Read More

i-File: Floppy Eyelid Syndrome

Dr. Kirthi Koka,Dr. Jazz K Manadan

History of Present Illness: A 60-year old male patient presented with recurrent episodes of watering and foreign body sensation of both eyes for 8 years. He gave no history of redness or discharge from the eyes. There was no history of spontaneous eversion of the eyelids. He was treated conservatively with lubricants but had no relief of symptoms. He complained of snoring during sleep with associa ...Read More

How to Quickly Read a Macular OCT Scan?

Dr. Deepak Bhojwani

Optical Coherence Tomography (OCT) is a quick, non-invasive, reproducible, and optical analog of ultrasound imaging which is as good as in vivo viewing of individual retinal layers histologically. In today’s practice, OCT is indisputably an essential diagnostic tool for every retinal surgeon. And so correct interpretation of OCT scans helps us in understanding the disease pathologically which in t ...Read More

How to Make Your Online Presence Felt : Tips & Tricks

Dr.Deepak Garg

Introduction Covid has accelerated the digital shift for healthcare. We all know that It was probably going to take a few more years to happen but now as more and more people take the digital route for any requirement they may have, it becomes important for business owners to think about their online presence. This is true even for ophthalmologists. More so for those who have established their own ...Read More

i-File: Asteroid Hyalosis

Dr. Priya Rasipuram Chandrasekaran

Chief Complaint: A female patient of 58 years old who came for a routine eye examination. History of Present Illness: No specific complaints. Past Ocular History: No H/O any previous injury. Past Medical History/ History of Medication: Known diabetic for the past 10 years and on control with oral hypoglycemic agents. Family History: No significant family history. Review of Systems/Systemic Examina ...Read More

Ten Mistakes to Avoid while Treating a Case of Diabetic Retinopathy

Dr. Rajiv Raman, MS, DNB, FRCS Ed, Hon DSc.

Diabetic Retinopathy is a common retinal disorder that is seen, managed, and followed up by not only a retina specialist but all ophthalmologists. It is a disease that is easy to diagnose, but often difficult to manage in a long run. For achieving optimal results besides the role of an ophthalmologist, one needs to have the involvement of a physician. The single most important factor for achieving ...Read More

Retina Case Presentation in Practical Exam: 10 Tips

Dr. Puja Maitra, DNB , FICO, MRCS(Ed), FMRF,Dr. Dhaivat Shah, MBBS MS DNB FMRF

DNB practical exam is a time-bound test of knowledge, presentation skills, swiftness and presence of mind. In the exam, a candidate usually gets 4 long cases with 20 mins per case (a whole 2 minutes more than you can take to write each answer in the theory exam). That usually includes 2 anterior and 2 posterior segment cases. Although 2 posterior segment cases may seem like a daunting task, there ...Read More

Pearls for Practical Exam in Ophthalmology for Postgraduates

Dr. (Capt) V.R Vijayaraghavan

Facing PG practical examination in ophthalmology is not difficult. However, the student must prepare properly to face it. Please remember the examiners are coming to help only. Therefore, the student should not be afraid of the examiners. Preparations for the practical exams During the course The preparation to face the exams is a continuous process starting from the beginning of the course. Stude ...Read More

Ten Tips for OSCE

Dr. Meenakshi Swaminathan

Objective structured clinical exam (OSCE) has regained popularity as a significant part of practical examinations in recent times. This is in part due to the pandemic making it difficult to hold exams with actual patients. It also removes subjective bias and is considered a fair way to examine candidates. There are certain strategies that enable the student taking an OSCE based exam to do well and ...Read More

Practical Tips for DNB Practical

Dr. Krishnaprasad R

It’s time to brace yourself for DNB practicals, in its new Avatar! One look at its design tells that it has been well designed for accurate and speedy assessment of Examinees with little room for chance or bias. So let’s deconstruct it for better understanding and decode it for exploiting to our advantage! Firstly 50% of marks i.e 150 marks comes from Objectively Structured Clinical Evaluation or ...Read More

Papilledema- A Ready Reckoner for Postgraduates

Prof. Rohit Saxena MD, PhD,,Dr. Monika Yadav, MS and Dr. Swati Phuljhele, MD

Introduction Papilledema is used to describe optic disc edema resulting from increased intracranial pressure while disc edema could be due to any cause. While disc edema can be unilateral or bilateral, papilledema is usually bilateral, however, it can be asymmetric, to begin with. Another important differential of true papilledema is pseudo papilledema which is seen in conditions like a small hype ...Read More

Astigmatism - The clinical pearls in Refractive care

Najiya Sundus K. Meethal,Dr. Krishna Kumar Ramani

Preface: Astigmatism is a common type of refractive error that we come across in vision clinics on a regular basis. It causes the deterioration of retinal image quality and leads to specific vision-related symptoms. Prevalence of this condition is reported to vary with age, gender, and ethnicity. The clinical diagnosis and management of astigmatism necessitate an understanding of its nature and ch ...Read More

i-File: Thyroid Eye Disease

Dr. Rwituja Thomas, MBBS, DNB, FICO, FNN,,Dr. Garvita Singh, MBBS, MS, FICO

Case presentation: A 65-year-old man presented to our clinic with gradually progressive protrusion and swelling of both eyes and double vision for 1 year associated with progressive drooping of the right upper eyelid. There is acute onset of pain in the left eye for 10 days. A smoker for 25 years. Past ocular history No h/o previous ocular surgery or trauma Past medical history The patient is a di ...Read More

Ten Pearls for the Management of Posterior Capsular Rupture

Dr. Arup Chakrabarti, Senior consultant, Cataract and Glaucoma services,,Dr. Nirupama Kasturi, Associate Professor, Department of Ophthalmology

Posterior capsular rupture (PCR) is an important complication of cataract surgery whose timely recognition and appropriate management can ensure a good visual outcome. Here are ten pearls for its prevention and management. Pearl 1: Understand the risk/predisposing factors It is imperative to assess the preoperative and intra-operative risk to prevent the development of a PCR. Elderly, anxious, and ...Read More

Anterior Segment Optical Coherence Tomography in Diseases Of The Ocular Surface And Cornea

Dr. Supriya Sharma, DNB,Dr. Somasheila Murthy

I. Introduction : Anterior segment optical coherence tomography (ASOCT) is a sophisticated non-contact imaging device that produces high-resolution images for detailed assessment of the structures of the ocular surface and anterior chamber in various disease conditions. Starting from the earlier generation time-domain devices first described in 1991 by Huang et al [1] to the current Fourier-domain ...Read More

Zotero: A Quick Start Guide

Najiya Sundus K. Meethal,Deepmala Mazumdar

Tracking, collecting, organizing, reading, and assimilating the relevant references is an integral process of any scientific research. But this process is laborious when done manually. Hence was the development of reference management softwares (Zotero, Mendeley, EndNote, etc.) for the digitalization of relevant scholarly materials and facilitating the process of managing references. Reference man ...Read More

Making Sclerotomy Ports during a Vitreoretinal Surgery: Tips, Tricks and Concerns

Dr. Aditya Verma

The advancement of vitreous surgery from the 20-gauge (20G) era to the present day Transconjunctival Sutureless Vitrectomy (TVS) has favorably transformed patient outcomes in the surgical management of retinal diseases. The 20G system (O’Malley and Heintz, 1974) has been the gold standard technique in modern vitreous surgery for nearly three decades, beginning from the earliest 17G vitrectomy as i ...Read More

OCT-Angiography in Retinal Diseases Made Incredibly Simple For Post Graduates

Dr. Ramesh Venkatesh MS, FMRF,Dr. Nikitha Gurram Reddy and Dr. Naresh Kumar Yadav, D.O., FRCS (Glasgow),

Introduction: Optical coherence tomography angiography (OCT-A) has emerged as a novel imaging technique for visualizing the retinal and choroidal microvasculature at the macula and optic disc.1 It provides in vivo 3D vascular information by analyzing the movement of flowing red blood cells and thereby enabling the visualization and quantification of functional vessel networks within microcirculato ...Read More

Complications of Penetrating Keratoplasty

Dr. Bhupesh Jain,Dr. Priyanka Kashelkar

Penetrating keratoplasty (PK) is a procedure in which full-thickness host corneal tissue is replaced with donor corneal tissue. Objectives of PK maybe Optical-to establish a clear visual axis or to minimize refractive error in severely distorted corneas Tectonic-to provide structural integrity Therapeutic-to eliminate infection Occasionally for cosmoses Complications of PK may be divided as intrao ...Read More

i-File: Rhegmatogenous Retinal Detachment

Dr. Anju Gupta,Dr. Dhaivat Shah

Brief Scenario of the case: Decreased vision in the right eye in a 20-year-old high myopic female History of Present Illness: The patient is a 20-year-old female who presented with decreased vision in the right eye for 8 months. No history of headache, ocular pain, redness, and trauma were reported. She had no visual changes or symptoms in the left eye. Past Ocular History: High myopic using glass ...Read More

Pearls in the Diagnosis and Management of Rhino-Orbito-Cerebral-Mucormycosis

Dr. Rolika Bansal,,Dr. Santosh G Honavar,

“The more you know about the past, the better you are prepared for the future.” – Theodore Roosevelt 1. Elicit adequate history Considering the lethal and angio-invasive nature of Rhino-Orbital-Cerebral-Mucormycosis (ROCM) supplemented in this COVID-19 era, it is mandatory to understand the causative factors of the disease. Diabetes mellitus, oral and systemic corticosteroids, immunosuppressive dr ...Read More

Trials in Glaucoma You Should Know

Dr. Parveen Rewri

Ocular Hypertension Treatment Study (OHTS) This multicentric trial recruited 1,632 patients of ocular hypertension (OHT) to answer two questions. First, if early treatment in patients of OHT with topical medication would prevent the onset of primary open-angle glaucoma (POAG). Second, which patients of OHT are more likely to develop POAG, in other words, what are the risk factors for conversion fr ...Read More

Ten Microbiological Facts on Mucormycosis All Ophthalmologists Should Know

Dr. A.R Anand, Ph.D.,

The present overview highlights major microbiological aspects of mucormycosis and attempts to increase the awareness of this ubiquitous group of fungi that are responsible for the difficult-to-manage infections presently being encountered in the setting of the ongoing COVID-19 pandemic. 1. What is Mucormycosis and why is mucormycosis emerging as a serious threat in the present COVID-19 pandemic? M ...Read More

i-File: COVID-19 associated Mucormycosis

Dr. Nisar Sonam Poonam. M.S.(ophthal), F.M.R.F (Orbit & Oculoplasty)

A 53-year-old female presented to the emergency with chief complaints of drooping of the left eyelid for 3 days and sudden loss of vision in the left eye for 2 days. History of Present Illness: The patient was recovering from COVID-19 infection prior to presentation when she noticed a sudden, rapidly progressive drooping of the left eyelid over 3 days duration. It was associated with the limitatio ...Read More

Seven Tips to Treat A Treatment Resistant Microbial keratitis

Dr. Shweta Agarwal,Dr. Bhaskar Srinivasan and Dr. Geetha Iyer

Microbial keratitis is a common potentially sight-threatening condition and is considered an ocular emergency. Managing them brings forth multiple challenges to the ophthalmologist one of them being to primarily distinguish an infective from non-infective keratitis. Based on signs, symptoms, history, and laboratory investigations a treatment plan is laid out which is modified based on clinical res ...Read More

Short Term Phacoemulsification Courses in India

Team eOphtha

Centre for Sight, New Delhi Duration of Fellowship: 3 months Mode of Selection: Written exam and Interview Webpage Email: fellowship@centreforsight.net Contact number: Dr. Tulika Chauhan +91-9535133800 Session: Every 3 Months: JANUARY, APRIL, JULY, OCTOBER Course Fee: Rs. 50,000 H. V. Desai Eye Hospital, Pune, India Duration of Fellowship: 1 Month Mode of Selection: Interview Webpage Email: desaie ...Read More

Ten Pearls for the Diagnosis & Management of Binocular Vision Anomalies

Dr. Jameel Rizwana Hussaindeen M.Phil, PhD, FAAO, FCOVD-I

The prevalence of non-strabismic binocular vision anomalies is on the rise over the last decade. The prevalence reports from various parts of the globe quote a high prevalence ranging between 28.5-31.5% among school children (1,2). It is also shown in a recent study that clinically significant convergence insufficiency can impair stereo-acuity in children necessitating the diagnosis and management ...Read More

i-File: Vogt-Koyanagi - Harada disease

Dr. Navneet Mehrotra,Dr. Nivesh Gupta

Brief Scenario of the case: A 25 year-old-female, resident of Rajasthan presented to us with the chief complaints of diminution of vision in the right eye for a period of 3 days and redness with mild pain in both eyes for one month. History of Present Illness: The patient was apparently well 3 days back when she started to develop diminution of vision in her right eye. She had mild pain and rednes ...Read More

Seven Points You Should Know about Mucormycosis

Dr. Akshay Gopinathan Nair

What is Mucormycosis? Mucormycosis is a fungus that is ubiquitous. This organism is present in the soil and all around us and is also a commensal that is present in the nose and oropharynx. It is an opportunistic organism – this means that it invades and causes infection only when the host’s immune system is compromised. A normal healthy person’s immune system would easily be able to fight a funga ...Read More

Smartphone Gonio-imaging: The Truly Frugal Indian Revolution

Dr. Nilesh Kumar

Introduction: Gonioscopy is the evaluation of the angle of the anterior chamber, a term coined by Alexios Tarantas.[1] It is one of the three important components to diagnose and classify glaucoma, the visual field changes and the optic nerve head evaluation being the other two. This clinical skill which should be performed on each patient visiting the clinic for the first time is not performed as ...Read More

Simple Limbal Epithelial Transplantation: A Review

Dr. Supriya Sharma,Dr. Swapna Shanbhag and Dr. Sayan Basu

I. Introduction The cornea is lined by non-keratinized, stratified squamous epithelium. At the limbus, there is a gradual transition of these cells to non-keratinized, stratified columnar epithelial cells, along with mucin-secreting goblet cells, forming the conjunctival epithelium. The corneoscleral limbus lies between these two epithelia in a healthy eye. The limbus contains palisades of Vogt, t ...Read More

i-File: Commotio Retinae

Dr. Priya Rasipuram Chandrasekaran

Chief Complaint: A 12-year-old boy presented with redness and a decrease in vision in the left eye within four hours of injury with a top. History of Present Illness: Redness and decrease in vision in the left eye. No other significant complaint. Past Ocular History: No H/O any previous injury. Past Medical History/ History of Medication: No significant ocular past history for which he has used me ...Read More

Balancing Clinical and Research Work

Dr.Lingam Gopal, MBBS (India); MS (PGIMER, India); FRCS Ed; DNBE (India) MSc (Epi)

How does one balance between clinical and research work? This is an often-repeated question-probably because the answer is never clear. The fulcrum of the balance is not the same for everyone. Let us pause for a while and try to define certain things to bring clarity. What is clinical work? This is perhaps best defined as the time and effort involved in direct care of patients. Obviously, it also ...Read More

Facial Spasms: Diagnosis and Management

Dr. Varshitha Hemanth Vasanthapuram,Dr. Milind N Naik

Introduction Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both [1]. They may be isolated or combined with other neurological symptoms or movement disorders [1]. Dystonia is classified based on the age of onset, etiology, clinical features, and body distribution. The body distrib ...Read More

i-File: Exfoliation Glaucoma

Dr. Sahebaan Sethi ,MS,DNB,FICO,FMRF (glaucoma)

A 65-year-old male presented to the OPD with complaints of painless, gradually progressive dimunision of vision of the right eye over several months. History of Present Illness: The Patient was apparently normal 1 year ago since when he noticed dimunision of vision of the right eye by closing the left eye by chance. The vision progressively got worse. No h/o pain, watering, halos, glare or double ...Read More

Mendeley Reference Manager: A Step-by-step Guide

Deepmala Mazumdar,Najiya Sundus K. Meethal

Reference managers (such as Mendeley, Zotero, Endnote) are applications that help scientific writers to search, store and organize literature. Additionally, these platforms allow to systematically insert citations and references in any chosen style while writing manuscripts. These tools allow changing reference style with a few clicks. Reference managers are tools made aiming at academicians and a ...Read More

Anterior Vitrectomy Made Easy For Cataract Surgeon

Dr. Vishal Agrawal, MD ( AIIMS ) , FRCS( Glasgow ),Dr. Ketan Rathod and Dr. Neha Mohan

One of the most dreaded complications of cataract surgery is a posterior capsular tear (PCR). Its rate ranges from 1.3% to 9.6% (from skilled surgeons to trainees)1-5. Early recognition of the PCR and skilled management is necessary for good surgical outcomes and to avoid any devastating sequelae. Hence, anterior vitrectomy is an important skill that every cataract surgeon should master. There are ...Read More

Choroidal Neovascular Membrane: Made Easy For Postgraduates

Dr. Santosh Gopi Krishna Gadde,Dr. Nikitha Reddy Gurram and Dr. Chaitra Jayadev, DOMS, PhD

Introduction Choroidal neovascularization (CNV) or choroidal neovascular membrane (CNVM) is a growth of new choroidal vessels into the subretinal space through breaks in the Bruch's membrane. Ophthalmoscopically the CNVM appears as a greenish-grey lesion, often with a detachment of the sensory retina, subretinal blood, and exudates. Choroidal neovascularization can be multifactorial with the c ...Read More

i-File: Valsalva Retinopathy

Dr. Maradula Gangawar MBBS,Dr. Dhaivat Shah MS DNB FMRF

Brief Scenario of The Case: A 50-year-old male patient was seen on 27th January 2021 with a chief complain of sudden painful loss of vision in his right eye for 1 week after lifting a heavyweight object at work. History of Present Illness: The patient’s only complain was a black spot and decreased vision in an otherwise normal right eye, which occurred after lifting a heavyweight object (100 kg) a ...Read More

Ten Pearls for Treatment of TB Uveitis

Prof. Amod Gupta

1. In TB-endemic countries, think of TB as a probable/possible etiology of uveitis in Presence of one or a few large full-thickness choroidal granulomas that show enhanced vascularity/RAP on FFA Retinal periphlebitis with subvascular retinitis/choroiditis lesions/scars that show extensive peripheral retinal ischemia. Multifocal serpiginoid choroiditis/Serpiginous-like choroiditis lesions with vitr ...Read More

Down's Syndrome: Ten Points All Ophthalmologists Should Know

Dr. Nikita Pathare

Down’s syndrome is a trisomy caused by an extra copy of chromosome 211. The extrachromosomal material is transmitted either by non-disjunction, unbalanced translocation, or mosaicism. It is the most common chromosomal anomaly seen in live births2. As an ophthalmologist, it is important to screen for ocular abnormalities since the incidence of ophthalmic disorders is between 46-100%3. One study fou ...Read More

i-File: Fuchs Endothelial Dystrophy

Dr. Hema Joshi, MBBS, DO, DNB

A 55-year-old female presented to the Cornea clinic with gradually progressive diminution of vision in both eyes for 1 year, which was associated with intermittent photophobia and colored haloes around lights, especially on waking up in the morning. The blurry vision gradually became clearer as the day progressed. No history of associated pain, watering, redness, itching, or discharge. Past Ocular ...Read More

Ten Pearls in Interpreting Humphrey Visual Field

Dr. Faisal Thattaruthody,Prof. Sushmita Kaushik

A visual field encompasses the area of space or area of the external environment that is seen by a steadily fixating eye. Advances in the technology of visual field testing have changed our clinical perception of normal and abnormal fields of vision. It is of great importance to diagnose and monitor optic nerve diseases, notably glaucoma. Automated perimetry is now the current gold standard for bo ...Read More

Ten points A Postgraduate Should Know while Reading a Fundus Fluorescein Angiogram

Dr. Neha Mohan

Fundus Fluorescein Angiography (FFA) is still a gold standard investigation, for studying the circulation of the retina and partly choroid and highlights the dynamic interaction of the dye with the same. Many adjunct investigations like Optical Coherence Tomography (OCT), Fundus autofluorescence (FAF), Optical Coherence Tomography Angiography (OCTA), etc. help in retinal diagnosis and management, ...Read More

Evaluation of a case of Diplopia

Dr. Kavitha Kalaivani, Dr. Hennaav Kaur Dhillon,

What is diplopia or double vision? Diplopia or double vision by definition is the simultaneous perception of two images of a single object that may be displaced in any direction. Other terms could be blurred vision, shadowing, or confusion. Is it uniocular or binocular diplopia? The first step to evaluate diplopia is to differentiate between uniocular and binocular diplopias as the management vari ...Read More

Scleral Fixated Intraocular Lens Implantation- A Comprehensive Review

Dr Dhanashree Ratra,Dr. Abhinav Dhami, MS, FMRF and Dr Nimrata Bajaj Dhami

Introduction Ideally a cataract surgery should result in the placement of an intraocular lens (IOL) within the capsular bag. However, this desirable outcome might be averted due to either preexisting zonular deficit or intraoperative posterior capsular tear, resulting in aphakia. This necessitates the need for an alternate means of IOL implantation. The surgeon can exercise the options of an anter ...Read More

The Novice VR Surgeon -Ten mistakes to avoid

Dr. P. Mahesh Shanmugam

Mastering vitreoretinal surgery is a slow and arduous process with each case being different from the other and it is just about possible to have only a “feel” of a kind of case during the fellowship, not mastery of it. The budding VR surgeon would necessarily have to hone her / his skills in the real world outside their alma mater and the following guidelines can aid mitigate the stress and angst ...Read More

Ten Tips for Clearing the FRCS Examination

Dr. Devendra Venkatramani, MBBS DNB FRCS(Gl) MRCS(Ed) FICO

The FRCS examinations have for long been considered an elite qualification in ophthalmology. While the format and pattern of the examination will evolve in the future, more so due to the special circumstances brought about by the COVID pandemic, certain principles will continue to prevail. The examination generally comprises a written component (multiple-choice questions and/or essay questions) an ...Read More

Understanding Optic Disc Pallor- Shades of White

Dr. Ambika Selvakumar

Introduction The optic nerve consists of approximately 1.2 million axons that arise from the retinal ganglion cells and acquire myelin sheath proximal to lamina cribrosa. These axons do not have the capacity to regenerate. The normal optic disc is pink in color due to the fact that light entering the optic disc is conducted along the transparent nerve fibers and they diffuse among columns of glial ...Read More

Cytomegalovirus Retinitis Simplified

Dr. Swapnil Parchand,Dr. Anil Gangwe

Introduction: Cytomegalovirus (CMV) retinitis is an opportunistic viral posterior uveitis that occurs mostly in severely immunocompromised Acquired Immunodeficiency Syndrome (AIDS) patients or, rarely, in those on immunosuppressive therapy after organ transplantation, or who are on systemic corticosteroids.1 More than 75% of AIDS patients with CD4+ counts less than 50 cells/?L have CMV retinitis. ...Read More

Instruments used in Corneal Procedures and Surgeries

Dr. Hema Joshi, MBBS, DO, DNB,Dr. Ankita Patil, MBBS, MS

Although tales and myths of ocular surgery and organ transplantation appear in numerous ancient texts, the earliest accounts of ophthalmic diseases were written as a treatise by Sushruta, in the 6th century BC. Sushruta described 76 eye diseases, out of which 51 required surgical treatment. In the western world, the concepts of corneal surgery date back to Greek physician Galen (130-200AD). The co ...Read More

Ten Things You Should Know about Brolucizumab

Dr. Anmol Naik, MS, DNB, FMRF, FICO (UK), MRCS (Ed), MNAMS

1. Brolucizumab is a humanized, single-chain variable fragment (scFv) antibody with a molecular mass of approximately 26 kDa that inhibits VEGF-A.[1] (An scFv is an autonomous binding agent that is no longer dependent on a heavy molecular support structure but still retains the full binding capacity to its target). Mechanism of Action of Brolucizumab Unique Properties of Brolucizumab 2. The pharma ...Read More

Valved Drainage Devices for Pediatric Glaucoma

Dr. Rinal Pandit,Dr. Abhay Raghukant Vasavada

Introduction Pediatric glaucoma includes a wide variety of conditions that result in elevated intraocular pressure and optic nerve damage, ranging from primary congenital glaucoma since birth to developmental glaucoma associated with other diseases and acquired glaucoma secondary to multiple causes. Depending on the age of the patient, it presents with particular features and circumstances that ne ...Read More

Various Classifications and Grading Systems in Oculoplasty

Dr Joyeeta Das MBBS,DNB,

Introduction: Grading & Classification of diseases is an ever-evolving concept. This article is a collection of various clinical grading and Classification systems in the practice of various Oculoplasty and Orbital diseases. These grading systems are useful for Trainee doctors, PG students, PG residents, and optometrists which will help them in preparations of various examinations and the initial ...Read More

Dos and Donts In Managing Cluster Endophthalmitis

Dr. Dhaivat Shah,Dr. Meghna Jain

“Everything in life has some risk, and what you have to actually learn to do is how to navigate it.” -Reid Hoffman The above quote holds true for any surgical procedure whether minor or major. The biggest fear of any surgical intervention is that of infection postoperatively. Infection can occur in the best of hands and also in the most modern operating rooms. Cataract surgery is one of the most c ...Read More

Learn from the Masters : Viral Keratitis Decoded

Dr Jaya Gupta, DNB, FICO,FMRF

Viral Infections are more commonly encountered in individual practice than what presents in tertiary or referral eye care. Its presentation is myriad & baffling often a misdiagnosis as bacterial or fungal causing more harm. Also, with more choices on the availability of antivirals, individual practice varies. Here we discuss key presenting clinical features & know from the leading cornea experts t ...Read More

Anatomy of Uvea

Dr. Parthopratim Dutta Majumder

Uvea is the middle vascular coat of the eyeball. From anterior to posterior, the uvea or uveal tract can be divided into three parts- Iris, Ciliary body, and choroid. The name “uvea” has originated from the Latin word grape. Why a grape? If the stem is removed from a grape, the hole looks like the pupil and the grape the eyeball. Iris : Iris is the anterior-most part of the uveal tract. It is a th ...Read More

Ten Clinical Trials in Retinal Diseases Every Postgraduate Should Know

Dr. Neha Goel ,MBBS MS MNAMS DNB FRCS (Glasgow)

1. CATT (Comparison of Age-related Macular Degeneration Treatments Trials)1 Description A prospective, multicenter, single-blind, noninferiority randomized clinical trial. 1208 patients with neovascular AMD were enrolled from February 2008 and randomly assigned to receive intravitreal injections of ranibizumab (0.5 mg/0.05 ml) or bevacizumab (1.25 mg/0.05 ml) on either a monthly schedule or as nee ...Read More

Visual Electrophysiology Made Simple for the Postgraduates

Dr. Parveen Sen,Karthika Pandurangan and Ramya Sachidanandam

Visual electrophysiology is an extremely useful tool to study the retinal function objectively. It assesses the functional aspects of not only the retina but also the visual pathway as a whole. Even in this era of advanced imaging, one cannot ignore the importance of the functional aspects of the cellular network in the retina. The commonly used tests with their salient applications are enumerated ...Read More

Ten Pearls for Performing Vitrectomy in Diabetic Retinopathy

Dr. Raja Narayan

Important terms: Truncation: To relieve all the surrounding traction 360 degree Segmentation: Dividing a larger membranes/FVP into smaller islands of FVP by 360-degree truncation around them. Delamination: Separation of these membranes/FVP from the retinal surface to which they are firmly adherent by creating a plane of dissection between them. Pearl #1 When not to perform vitrectomy in diabetic r ...Read More

Syndromes in Ophthalmology

Dr. Niranjan Karthik Senthil Kumar

A syndrome is a recognizable complex of symptoms and physical findings that indicate a specific condition for which a direct cause is not necessarily understood. While medicine has innumerable syndromes, a similar scenario exists in ophthalmology too. It is crucial for a clinically astute ophthalmologist to be aware of these syndromes to initiate necessary workup for more sinister lesions associat ...Read More

Ocular Sarcoidosis: A Review for the Postgraduates

Dr Vinaya Kumar Konana,Dr Kalpana Babu

Introduction: Sarcoidosis is a chronic multisystemic granulomatous disorder caused by an exaggerated cellular immune response to a variety of self or non-self-antigens in a genetically predisposed individual resulting in non-caseating granulomas. Ocular involvement occurs in 25-60% of systemic sarcoidosis at some point of time1. In this article, we look at the emerging literature on epidemiology, ...Read More

Download Ophthalmology Fellowship Information Booklet

Dr. Rohit Rao,Dr Soumya Podury

Why this book? It was the question that prompted us to find answers in this form. Despite obtaining rigorous theoretical and practical lessons during post-graduation, most of today's Ophthalmologists are finding themselves in gridlock when confronted with actual clinical and surgical situations. In the present era doing fellowships has become of utmost importance because, in fellowships, they ...Read More

Ocular Surface Squamous Neoplasia

Dr. Kavya M Bejjanki,Dr. Swathi Kaliki

A. Introduction There have been multiple refinements in the terminology of the epithelial squamous neoplasia until the introduction of the term “Ocular surface squamous neoplasia” (OSSN) by Lee and Hirst in 19951. OSSN is an umbrella term and refers to a spectrum ranging from mild/moderate/severe dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva and/or co ...Read More

Instruments Used in Oculoplasty

Dr. Rohit Rao

Oculoplasty Instruments Oculoplasty deals with the aesthetic part of ophthalmology. Precision is the key in Oculoplasty as the outcomes depend on it. Good precision can be achieved with good knowledge of the instruments used in oculoplasty and when to use them. This article would give a brief idea on basic instruments used. Nettleship Punctum Dilator It is the instrument with very fine blunt tip, ...Read More

Basics of Grant Writing: From An Early Career Researchers Perspective

Dr Soujanya Kaup MS, DNB, FPRS, (MSc-Clinical Trials, LSHTM, UK),

“Writing a grant is considered to be more strenuous than doing research itself.”(1) With the number of grant applications on a rise and a steady decline in the funding, the nuances of grant writing become pertinent for a successful grant application. (2) In this article, we discuss the reasons for applying for a grant, how and when to apply, the common hurdles, and tips for a successful grant prop ...Read More

Corneal Trauma and its Management

Dr. Sanjeev P Srinivas,Dr. Amanda Mohanan and Dr. Srinivas K Rao

Introduction The cornea is prone to a variety of injuries by virtue of its location as the window of the eye. Apart from chemical injuries, physical trauma to the cornea can range from epithelial abrasions to loss of integrity of the stroma. Corneal injuries of this nature can occur in two distinct populations – in young children from play-related activities, and in young adults from due to their ...Read More

Anatomy of Retina

Dr. Parthopratim Dutta Majumder

The retina is the innermost of the three coats of the eye. This layer is responsible for converting relevant information from the image of the external environment into neural impulses that are transmitted to the brain. Broadly retina consists of two primary layers: an inner neurosensory retina and retinal pigment epithelium (RPE). 1 ? Sensory retina develops from the inner layer of the neuroectod ...Read More

How to Edit Your Surgical Videos

Dr. Kushal Delhiwala

Introduction Video recording in ophthalmology dates back to 1951 when Sir Harold Ridley filmed his pioneering lens implantation procedure in color. Ophthalmic surgical videos are a great source of demonstrating one’s technique on various platforms as well as discussing any unusual case tackled successfully in the operation theatre. It acts as an educational resource providing tips and tricks to po ...Read More

Ten Tips for Youngsters to Increase Proficiency in Phacoemulsification

Prof. (Dr.) Mahipal S. Sachdev

Phacoemulsification, like any other surgery, comes with its learning curve. Here are some pearls, from my experience, to help you ‘shorten’ and ‘Flatten the curve’. 1. Believe in yourself: The first step to successfully doing anything in life is to believe in yourself. Believe you can and you are half way there. 2. Observe, Observe, Observe & Learn I am a firm believer of this quote by Marilyn vos ...Read More

Corneal Dystrophy: A Ready Reckoner for Postgraduates

Dr. Samrat Chatterjee

Corneal dystrophies are classically defined as a group of inherited disorders of the cornea which is bilateral, symmetric, slowly progressive, and not related to any environmental or systemic factors.1,2 Most of the corneal dystrophies begin in the early decades of life and progress gradually. The effect of these changes in some of the dystrophies may not be clinically apparent till the later year ...Read More

A to Z Eponyms in ophthalmology

Dr. Jigyasa Sahu,Dr. Shweta Viswanath

Often asked in vivas, ophthalmic eponyms or various signs/ instruments in ophthalmology which share the same name, are one of the favorite questions of many examiners. We have tried to compile common such terminologies in ophthalmology for the benefit of postgraduate students. A Amsler (Marc Amsler : Swiss ophthalmologist, 1891-1968) Amsler Grid- The Amsler Grid is a square-shaped grid used to det ...Read More

Ten Tenets of Fundus Autofluorescence

Dr. Kumar Saurabh,Dr. Suraj Mistry

1. What is fundus autofluorescence? Fundus autofluorescence is a study of the topographic distribution of naturally occurring molecules in the human fundus. These molecules are called fluorophores. In principle, FAF is similar to fundus fluorescein angiography as both of them study the fluorescence pattern of molecules. However, the fluorophore molecules are naturally occurring compounds in the fo ...Read More

New normal - Tenets with Cataract Surgery Every Ophthalmologist Should Know during COVID-19 pandemic

Dr. Jatinder Singh Bhalla,Dr. Satender Kumar Singh and Dr. Amit Mehtani, MBBS, MS,DNB (OPHTHAL)

Introduction: Cataract is the second most common cause of preventable blindness worldwide and the most common cause of preventable blindness in India, affecting nearly 65.2 million worldwide [1-5]. To control the number, a high cataract surgery rate (CSR) is required. Sudden lockdown due to the current pandemic led to the cessation of elective cataract surgery [6,7], causing a sharp decline in the ...Read More

Cytokines: Made Simple for the Ophthalmologists

Dr. Swathi Lingam, PhD

In the time of the global pandemic known as COVID- 19, everyone has heard the phrase ‘cytokine storm’ and how it can be a deadly consequence of the SARS- CoV2 virus infection. What are these cytokines though? What do they normally do in our bodies and why are they sometimes so deadly? Little multifunctional molecules The presence of pus-filled exudates, fever, localized swelling, and pain have bee ...Read More

Ten Tips on Textbooks to Thrive in Ophthalmology

Dr. Amanda Mohanan,Dr. Prabrisha Banerjee

At the very outset, please allow us to congratulate you on having chosen to specialize in ophthalmology. Welcome to this fascinating world! Most of us breeze through ophthalmology during our MBBS by reading either Parsons or any other textbook available out there which suits us. Unlike, say medicine, where we are familiar with books like Harrison's, in ophthalmology, we find it rarely necessar ...Read More

Ten Pearls for a Safe Vitrectomy

Dr Giridhar Anantharaman

This write up is based on my own learning experience over many years and what I have observed while training fellows. This also includes the common mistakes that I have made and what the fellows make during the training process. Today with micro incisional vitreous surgery (MIVS) and better fluidics, learning basic Vitrectomy is a very quick process for most trainees. I will now enumerate 10 steps ...Read More

Therapeutic Keratoplasty : A Comprehensive Review

Dr. Nikhil S. Gokhale MD, DNB,Dr. Bhupesh P Jain DNB,

Microbial keratitis is a common vision-threatening disease that occurs in all parts of the world and is an important cause of avoidable corneal blindness. Medical therapy is considered a mainstay in the management of microbial keratitis, however, cases that worsen despite medical therapy or have perforation require surgical management1. Therapeutic keratoplasty is a surgical procedure whose primar ...Read More

Entropion And Ectropion

Dr. Roshmi Gupta,Dr. Rwituja Thomas and Dr. Sushma Ananthakrishna

Entropion is the turning inward of the eyelid margin. Unlike ectropion, it is symptomatic and injures the ocular surface. The patient seeks medical care early. Ectropion is an eyelid malposition in which the eyelid margin does not oppose the globe. We shall discuss the relevant anatomy and clinical examination for the two entities together. Relevant Anatomy The eyelid can be grossly divided into A ...Read More

Ten Tenets on Corneal Collagen Crosslinking

Dr. Amanda Mohanan,Dr. Sanjeev P Srinivas and Dr. Srinivas K Rao

Corneal collagen crosslinking (CXL) is a minimally invasive procedure that is currently the gold standard treatment to arrest the progression of corneal ectatic conditions. It promotes the induction of crosslinks in stromal collagen of the cornea, thereby strengthening and stiffening the cornea in ectatic conditions. 1.HISTORY It was observed that corneas in diabetic patients were stiffer due to t ...Read More

Evaluation of The Optic Nerve Head in Glaucoma

Dr Sahebaan Sethi, MS,DNB,FMRF

Introduction The diagnosis of primary open-angle glaucoma is based on the triad of increased intraocular pressure, visual field changes and optic nerve head changes. Apart from the glaucomatous changes in the optic nerve head, the other two factors in isolation lack diagnostic sensitivity. In fact, studies have shown that careful evaluation of the optic nerve head has high specificity and that an ...Read More

Ten Tips for Managing a Case of Postoperative Endophthalmitis

Dr. Lalit Verma

1. Suspect : Any unusual post-operative reaction ( out of proportion to surgical trauma ) should be suspected for Endophthalmitis. 2. Differentiate from TASS : All unusual post-operative reactions may not be infective; Pointers towards Toxic Anterior Segment Syndrome could include: Early onset of Limbus to limbus corneal edema with good fundus glow and no exudates in the vitreous cavity. The prese ...Read More

Ten Pearls to Write a Case Report

Dr. Aniruddha Agarwal, MD

A thorough and detailed analysis of a single patient history, clinical presentation, course, and outcomes often helps in improving our understanding of the pathophysiological mechanisms of disease. However, at times, there are certain nuances in every patient that cannot be explained by large dataset-based manuscripts, where there is every chance that several minor, but relevant aspects can be ign ...Read More