Topic

#Preferred Practise Pattern

30 articles
  1. Articles 9 Mar 2022 11 min read

    i-File: Pigmentary Glaucoma

    A 30-year-old male presented to the glaucoma clinic with complaints of gradually progressive diminution of vision in both eyes, left eye more than right, since 5 years. The visual disturbance was not associated with redness, pain, photophobia, or colored haloes. Past Ocular History: He was diagnosed with glaucoma elsewhere 5 years ago and started on anti-glaucoma medications(AGM). His baseline intraocular pressure (IOP) according to the old records was 52 mmHg In both eyes. At the time of his visit to the hospital, he was using 3 AGMs which he had stopped using for the past 7 days. No history of trauma or laser in the past Past Medical history: No history of any systemic illness Family history: No family history of glaucoma Systemic Examination: All vitals and systemic examination was within normal limits Ocular Examination Best Corrected Visual Acuity (Snellens) Right Eye (OD) 6/9 Left Eye (OS) 3/60 Ocular Motility/Alignment Full, free and painless in all gazes Intraocular pressure (I

    Dr. K. Sugepriya · Dr. Rathini David
  2. Articles 25 Oct 2021 8 min read

    Anti-VEGFs made Easy for the Postgraduates

    The retina is a highly metabolic tissue and needs a constant high supply of oxygen. Insult to either choroidal or retinal vasculature can lead to a hypoxic state. Throughout the years, neovascularization has been seen to occur in areas neighboring such hypoxic areas. In 1989, this hypoxia-inducible and diffusible factor was discovered to be Vascular Endothelial Growth Factor (VEGF), initially coined as Vascular Permeability Factor (VPF). VEGF was found to be answerable for many types of retinopathies and the increased vascular permeability seen in them. VEGF is a heparin-binding dimeric glycoprotein with di-sulfide-linked A and B subunits. VEGF has been found to be produced by many cell types in the retina including vascular endothelial cells, retinal pigment epithelium, pericytes, Muller cells, retinal neurons, and astrocytes. It is necessary for the survival of retinal cells; prenatally for proper embryological development of the retina as well as postnatally for preserving adult mic

    Dr. Gunjan Prasai · Dr. Anadi Khatri · +1 other
  3. Articles 23 Sep 2021 13 min read

    Ten Pearls for Treating A Case of Retinopathy of Prematurity

    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 can progress to tractional retinal detachment and become permanently and irreversibly blind. Timely detection and treatment along with good supportive neonatal care offer the best chance of successful outcomes in these infants. Key pearls of ROP management are described as under: Pearl 1: Which infants should be examined for ROP? The guidelines for screening infants for ROP vary between different countries and geographical regions based on individual incidence rates. For India, the current guidelines recommend that all infants with a birth weight of 2000 grams or less and /or gestational age le

    Prof. Mangat Ram Dogra · Dr. Deeksha Katoch
  4. Articles 1 Sep 2021 9 min read

    Ptosis Surgeries: Made Simple for The Postgraduates

    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 degree of ptosis, the degree of levator muscle function as well as the surgeon experience. Detailed examination and accurate measurements help to decide the procedure that may be required in each patient. When to treat The primary indications for treatment of congenital ptosis are amblyopia and abnormal head positioning. In the setting of severe unilateral ptosis, stimulus deprivation amblyopia is imminent and early surgery is advised and routinely performed at preschool age. Severe bilateral (or unilateral) ptosis can cause a patient to assume an obvious chin-up head position that can interfere

    Dr. Namrata Adulkar
  5. Articles 30 Aug 2021 5 min read

    Anomalies of Accommodation

    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 accommodation encountered by an eyecare practitioner through case-based learning. For detailed reading, the readers are requested to refer to Scheiman & Wick.1 The table below provides an overview of the commonest clinical signs, and symptoms seen in different anomalies of accommodation. 1, 2 ANOMALIES OF ACCOMMODATION DIAGNOSTIC CRITERIA ETIOLOGY PRIMARY SIGNS SYMPTOMS Accommodative insufficiency (Not due to sclerosis of the crystalline lens) Accommodation amplitudes (AA) lesser than expected for the patient’s age Usually idiopathic, can result from certain systemic medications Decreased AA for age (2D l

    Dr. Jameel Rizwana Hussaindeen, M.Phil Opt, Ph.D.,FCOVD-I, FAAO
  6. Articles 17 Aug 2021 5 min read

    Ten Mistakes to Avoid while Treating a Case of Diabetic Retinopathy

    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 a good outcome is patient compliance, as the disease, diabetes needs lifelong care. Here are few mistakes we need to avoid while managing a case of DR. 1. I can detect DME clinically, I don’t need OCT OCT is not mandatory if there are no signs of DR, or in very mild retinopathy (1 D, Amblyopia, Unilateral elevated intraocular pressure, Complete posterior vitreous detachment, Unilateral carotid artery stenosis, and Chorioretinal scarring 5. Ignoring a rapid progression of milder NPDR to PDR A rapidly progressive NPDR to proliferative retinopathy in a span of a few months (4-6 months) is rare a

    Dr. Rajiv Raman
  7. Articles 27 Jul 2021 13 min read

    Astigmatism - The clinical pearls in Refractive care

    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 characteristics. Hence, this particular write-up is prepared as a consolidation of integrated information related to ‘astigmatism’ by focusing on its definition, classic types, relevant clinical evaluation components, and appropriate management options. What is astigmatism? Astigmatism is a type of refractive error/ametropia that occurs when parallel rays of light entering the ocular media (non-accommodative state) are not focused well on the retina. In an optical system with astigmatic error, light rays propagate in two different planes and the incident light rays fail to converge at a single f

    Najiya Sundus K. Meethal · Dr. Krishna Kumar Ramani
  8. Articles 16 Jun 2021 14 min read

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

    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 microcirculatory tissue beds in a non-invasive manner without the use of dye injection.2 Understanding the anatomy of retinal and choroidal microvasculature (figure 1): Retinal microvasculature: Studies have identified 4 retinal vascular capillary networks at the macula which are broadly grouped into 2 vascular plexuses; superficial and deep.3 The superficial vascular plexus (SVP) consists of the superficial capillary plexus and radial peripapillary capillary plexus. The former is located in the ganglion cell layer and the latter in the retinal nerve fibre layer. The SVP receives its blood supply from the c

    Dr. Ramesh Venkatesh · Dr. Nikitha Gurram Reddy · +1 other
  9. Articles 7 Jun 2021 5 min read

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

    “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 drugs like tocilizumab, remdesivir, hospital admission, supplemental oxygen, mechanical ventilation, primary or secondary immunodeficiency, hematological malignancies, stem cell transplantation, solid organ malignancies and solid organ transplantation, iron overload etc have been considered the important predisposing factors. The history acts like the guiding lantern onto the path towards appropriate management. “Ignoring the signs is a good way to end up in the wrong destination” 2. Identify the Red Flag signs In-depth knowledge about the red flag signs enables the clinicians to recognize the w

    Dr. Rolika Bansal · Dr. Santosh G Honavar, MD, FACS
  10. Articles 4 Jun 2021 15 min read

    Trials in Glaucoma You Should Know

    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 from OHT to POAG? The patients who had IOP of at least 24 mmHg in one eye and 21 mmHg in other eye, were recruited in this study. They were randomized into two groups-those who received intraocular pressure (IOP) lowering drops (Medication arm) and those who did not receive any IOP lowering drops (Observation arm). The IOP reduction was targeted at 20% in the medication group. After enrollment, patients were examined every 6-months and follow-up included a white-on-white visual field at every visit and stereoscopic disc photograph annually. The endpoint was the development of new, reproducible d

    Dr. Parveen Rewri

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