1. Articles 17 min read

   Understanding Optic Disc Pallor- Shades of White

   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 tissue and capillaries. When axons are damaged in optic atrophy, light is reflected from opaque glial cells and does not pass through the capillaries. In addition, the reduced capillary vascularity and loss of tissue causes visibility of opaque scleral lamina cause the disc to appear pale. Optic atrophy is the sequelae of progressive optic nerve disease that causes irreversible damage of ganglion cells and the retinogeniculate pathway. This degeneration along with gross reduction in capillaries results in loss of optic pathway conduction and pallor. Exploring the etiology of optic atrophy may

   Dr. Ambika Selvakumar
2. Students Gallery 4 min read

   Ten Tips for Clearing the FRCS Examination

   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) and face-to-face components – the viva voce and the clinical stations. 1. Know why you wish to clear this examination What is your motivation to appear for this examination? Do you wish to prove something to yourself and/or your peers? Are you excited by the prospect of additional degrees? Do you think your job prospects will improve? Once you have a clear goal of what it is that you wish to achieve by becoming an FRCS, your roadmap for appearing and passing the examination will become clear. I would strongly advise against setting down this path half-heartedly or changing one’s mind midway. It

   Dr. Devendra Venkatramani
3. Articles 16 min read

   Peek into the Past - Strabismus as a Subspecialty in India

   The most exciting thing is to revisit and know when and how it all started. As the saying goes, "You've got to always go back in time if you want to move forward," so what better way than to talk to pioneers in the field of strabismus to know the past to forge into a great future in strabismology. Dr. Sowmya R spoke to the pioneers in the field to know the history of strabismology and share their experiences. Dr. Pradeep Sharma MD, FAMS. is currently working as the Professor and Head of Section of Pediatric Ophthalmology, Strabismus, and Neuroophthalmology at Dr. RP Centre, AIIMS, New Delhi. He is also the Vice President of the Ophthalmic Research Association at RPC, AIIMS. After having finished his graduation ( 1979) and postgraduation (1982) at All India Institute of Medical Sciences, New Delhi, he did his Fellowship for Advanced training in strabismus in the USA at Jules Stein Eye Institute UCLA, Wills Eye Hospital Philadelphia and Richmond awarded by International Strabismological

   Dr. Sowmya R, MS,FMRF, FAICO
4. Articles 23 min read

   Scleral Fixated Intraocular Lens Implantation- A Comprehensive Review

   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 anterior chamber IOL or iris fixated IOL or a scleral fixated IOL. Developments in IOL designs and modifications in implantation techniques have rendered them safe and efficacious. Recent studies have reported no significant differences in the postoperative visual recovery or complications rate between the 3 approaches.1 However, each option should be analyzed not only in accordance with surgeon’s experience but also with patient’s age, local, and systemic comorbidities.2 Scleral fixated IOL (SFIOL) involves sutured/sutureless fixation of the IOL to the sclera. SFIOL’s position closely approximates

   Dr. Dhanashree Ratra · Dr. Abhinav Dhami · +1 other
5. Articles 19 min read

   Peripheral Retinal Degenerations: A Ready Reckoner

   Introduction Peripheral retinal degenerations (PRD) are considered a risk factor for rhegmatogenous retinal detachment (RRD) [1, 2]. The annual incidence of RRD varies between 6.3 and 18.2 cases per 100,000. RRD develops when liquefied vitreous humor accelerated by rotary eye movements passes through retinal tears or retinal holes into subretinal space and detaches neurosensory retina from the underlying pigment epithelium. PRDs when missed during retinal examination can lead to vision threatening complications.3 Classification [3] Retinal detachment Retinal drusen Lattice with holes Full-thickness tear Honeycomb degeneration Preretinal fibrosis Retinal tuft Unifocal hypertrophy of the retinal pigment epithelium Hemorrhage Grouped congenital hypertrophy of the retinal pigment epithelium (“bear tracks”) Pearl degeneration Retinoschisis Atrophic retinal hole Snail-track degeneration Dark-without-pressure Snowflake degeneration White-without-pressure Flap tear Operculated retinal tear Pav

   V Dr. Kartikey Singh.MS · Dr. Mridhula Sekar · +2 others
6. Articles 7 min read

   The Novice VR Surgeon -Ten mistakes to avoid

   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. This is just a comprehensive list, not a complete one, an addendum or a reinforcement of what has been imparted at the fellow ship. 1. Not being familiar with the equipment Vitreoretinal surgery is machine dependent and an optimal surgical outcome is the result of efficient use of equipment, be it the microscope, vitrectomy machine, laser console etc., Knowing the equipment’s capabilities and limitations by reading the manuals will help exploit the machine’s capabilities to the maximum, resulting in an optimal surgical outcome and also minimize complications during surgery. Equipment at the

   Dr. P. Mahesh Shanmugam
7. Articles 13 min read

   Evaluation of a case of Diplopia

   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 varies completely. If the diplopia disappears on covering either eye the diplopia is binocular. If diplopia is persistent or worsens if one of the eyes is occluded then it’s uniocular diplopia of the other eye. Uniocular diplopia Any corneal surface problems like tear film abnormalities, uncorrected astigmatism, early stages of cataract, subluxated lens, or early macular issues can cause uniocular diplopia. A simple pinhole test can confirm the same. The management of this is to address the cause. Binocular diplopia Binocular diplopia is double vision typically arising as a result of strabismus or

   Dr. Kavitha Kalaivani · Dr. Hennaav Kaur Dhillon
8. Articles 2 min read

   Ten Pearls for Treatment of TB Uveitis

   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 vitreous cells. 2. In the presence of any of the above clinical phenotypes, collect evidence of MTB infection by way of tuberculin skin test/QuantiFERON-TB Gold; X-ray/CT chest. The 2-step testing (Bayesian probability) improves the likelihood of MTB as a probable/possible etiology of uveitis in TB-endemic regions. 3. Polymerase chain reaction to detect MTB DNA from ocular fluids has low sensitivity limiting its utility in clinical practice. If positive, it confirms the diagnosis of TBU but a negative test does not rule out MTB. 4. Start 4-drug anti-TB drug regimen in consultation with an internis

   Prof. Amod Gupta
9. Interesting Reads 11 min read

   Understanding Retinal Imaging

   Retinal imaging has come a long way today. From times of appropriately concentrating the fluorescein dye from scratch in the lab itself to times where we have a dye-free angiography system, technology has covered vast boundaries. There is a platter of different modalities in the market today, each having their own ebb and flow. And what the future beholds for us is certainly inexplicable. To throw a light on these modalities, we have a special interview with someone who continues to extensively work on these technologies and modalities day in and out, Dr. Manish Nagpal Dr. Nagpal is practicing as a vitreoretinal consultant at Retina Foundation, Ahmedabad, since 1999. He completed his Ophthalmology training at M & J Institute of Ophthalmology, Ahmedabad in 1996 and further went on to accomplish the FRCS (Ed) at the UK in 1997. He is a recipient of the prestigious Distinguished Service Award of APAO in 2007, the Achievement award of APAO in 2012, the American Academy’s Achievement award

   Dr. Dhaivat Shah
10. Students Gallery 4 min read

    Mnemonics in Ophthalmology

    In this section, we tried to gather all the mnemonics of ophthalmology, which we think will be of great benefit for our readers especially the students of Ophthalmology. However, the database is now in its infancy. So, if you have any mnemonics on ophthalmology, told by your teacher, friends, please send it to me at drparthopratim@gmail.com Remember Keratoconus with the help of CONES Central scarring & Fleischer ring Oil drop reflex / Oedema (hydrops) Nerves prominent Excessive bulging of lower lid on downgaze (Munson’s sign) Striae (Vogt’s) Remember Iridocorneal Endothelial Syndrome with ICE Iris Naevus Chandler Syndrome Essential Iris Atrophy Remember Behcet's Disease with the help of ORAL UPSET Occlusive periphlebitis Retinitis Anterior uveitis Leakage from retinal vessels Ulceration (aphthous/genital) Pustules after skin trauma (Pathergy test) Scratching leaves lines (dermatographism) Erythema nodosum Thrombophlebitis Remember posterior scleritis with POST SCLER Proptosis Ophthalmo

    Dr. Parthopratim Dutta Majumder

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