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86 articles
  1. Articles 2 Apr 2021 11 min read

    Newer Imaging Technology in Glaucoma

    Clinical examination of the disc has been the basis of disc and nerve fibre layer evaluation for ages but it is marred by its subjectivity and non-reproducibility, in the diagnosis and detection of glaucoma. Though visual field changes give concrete and reproducible evidence of glaucomatous changes, it becomes manifest only after considerable damage has occurred to the retinal ganglion cells(RGCs) and the nerve fibre layer(NFL). There are normally 1.2 - 2.4 million nerve fibres and corresponding number of ganglion cells in the retina. Kerrigan-Baumann and Quigley et al 1 documented that a loss of 35.7% of the RGCs was required for the manifestation of corrected pattern standard deviation(CPSD) 90 seconds per eye Figure4: Print out of a normal C20 programme Threshold program (N20 and N30): This program uses more contrast levels to search for the patient's threshold at each of the tested location. N30- horizontal area extended to include an extra portion of the nasal visual field, result

    Prof. Sushmita Kaushik · Dr. SS Pandav
  2. Articles 2 Apr 2021 21 min read

    Long Case of Ptosis

    Blepharoptosis refers to the inferodisplacement or drooping of the upper eyelids.The condition can be congenital associated with the presence of a dystrophic levator muscle or acquired due to a myogenic, neurogenic, mechanical, aponeurotic or traumatic cause. We aim to provide certain general guidelines to the management of a patient with ptosis. In assessment of long case of ptosis the clinical examination should start with History as with any other case. History: Obtain a thorough medical and ophthalmic history. The onset of ptosis, Alleviating or aggravating factors, Family history of ptosis Whether increasing, decreasing, or constant since the time of manifestation Association with Jaw movements Abnormal ocular movements Abnormal head posture History of Trauma or previous surgery Poisoning Use of steroid drops Any reaction with anesthesia Bleeding tendency Previous photographs may prove to be of great help. Ocular Examination: Head Posture: A significant head posture (usually chin

    Dr. A. K. Grover · Dr. Shaloo Bageja · +1 other
  3. Articles 2 Apr 2021 28 min read

    Medical Management of Glaucoma

    Introduction The primary goal in the treatment of glaucoma is to prevent or retard the loss of visual function caused by damage to the optic nerve. Our therapeutic approaches, however, are currently limited to reducing IOP. This approach of lowering a potentially harmful pressure will apply to patients with documented optic nerve damage and visual field loss as well as those with elevated IOP or other well-described risk factors so that treatment is indicated to prevent the onset of damage. We now have five major randomized glaucoma clinical trials stating that intraocular pressure is important for protecting the susceptible optic nerve in patients with glaucoma. Basic Pharmacology Before going into the details of the drugs used in glaucoma, let us have a look at the basic pharmacologic principles in topical ocular treatment. Bioavailability of topical ocular medications: The penetration of topically applied medication into the eye is proportional to the concentration of the drug that

    Dr. Rita Singh
  4. Articles 2 Apr 2021 14 min read

    Eyelid Trauma

    In recent times, eyelid injuries are on the rise primarily because of the increasing incidence of road traffic accidents, industrial mishaps and intentional assaults on the human body. Injury to the eyelids, lacrimal system or orbital wall may be isolated or may occur in association with mid facial injuries. History A precise history is essential to assess the severity of the injury. In some cases, an ophthalmologist can anticipate the extent and severity of injury from the mechanism of injury. It is important to elicit the mode of injury, whether it is with sharp or blunt objects or due to thermal or chemical injury or due to dog bites. In cases of animal bites, a complete tetanus immunization history is obtained and if required proper immunization should be given. Examination Of The Patient The patient’s injury must be dealt with according to the priority. The basic “ABC’s” (Airway, Breathing, Circulation) must be evaluated, before proceeding to the management of localized injury. Th

    Dr. A. K. Grover · Dr. Shaloo Bageja · +1 other
  5. Articles 2 Apr 2021 14 min read

    Advances in Retinal Imaging

    Modern imaging modalities in the field of the retina have expanded our understanding of common pathologies including diabetic retinopathy (DR), age-related macular degeneration (AMD), central serous chorioretinopathy (CSCR), and many rare retinal diseases such as dystrophies, which were poorly understood before. This chapter describes newer emerging techniques in retinal imaging which enables advanced screening, monitoring and provide objective measures for treatment monitoring. MULTICOLOUR IMAGING Compared to standard fundus cameras, multi-colour images produced by the scanning laser ophthalmoscope(SLO) have a higher resolution due to reduced light scatter and allow image acquisition at different planes and higher contrast through a non mydriatic pupil using different wavelengths. SPECTRALIS Optical Coherence Tomography SDOCT(SPECTRALIS SD-OCT, Heidelberg Engineering,Heidelberg, Germany) uses the confocal scanning laser ophthalmoscope(cSLO) to capture three simultaneous reflectance im

    Dr. Sushma J · Dr. Jay Chhablani
  6. Articles 2 Apr 2021 17 min read

    Primary Intraocular Lymphoma

    Introduction Intraocular lymphoma, a great non-infective masquerader occurs intraocularly in either the vitreoretinal( primary vitreoretinal lymphoma PVRL)) or in the uveal space( primary choroidal, iris lymphoma). By definition, PVRL denotes the presence of pathology limited to vitreoretinal space without its occurrence in the central nervous system. The term ‘primary’ is however controversial as almost 56-90% of PVRL patients will ultimately go on to involve the CNS over few months to years( 8-29 months) and is considered a subset of primary CNS lymphoma( PCNSL) [1]. Incidentally, 25% of patients with PCNSL will have concurrent ocular involvement at presentation [2]. Primary choroidal and iridial lymphomas are rarer, less aggressive as compared to their vitreoretinal counterpart and due to their rarity, the following section will deal primarily with PVRL. Pathophysiology of Primary Vitreoretinal Lymphoma The origin of lymphoma cells in the retina is a point of debate. Two etiologies

    Dr. Bikramjit Pal
  7. Articles 2 Apr 2021 20 min read

    Corneal Topography

    WHAT IS CORNEAL TOPOGRAPHY? Corneal topography is the study of the shape of the corneal surface. Traditionally, such measurements were limited to the near-spherical central portion of the anterior corneal surface. With the advent of corneal refractive procedures, the necessity to study the more peripheral parts of the cornea and to understand better the optics of both the anterior and posterior corneal surfaces has spawned a number of new devices that allow the clinician to better understand corneal shape, power, and optical performance. EVOLUTION OF CORNEAL TOPOGRAPHY KERATOSCOPY: It is the evaluation of the corneal surface using circular mires reflected from its surface. The earliest device designed to perform this function was the PLACIDO’S DISC, developed by Antonio Placido. It consists of equally spaced alternating black and white rings with a hole in the centre to observe the patient’s cornea. The central opening houses a convex lens for magnification and to aid the examiner’s ac

    Dr. Srinivas K Rao, DO DNB FRCSEd · Dr. Ramya Subramaniam, DNB
  8. Articles 2 Apr 2021 10 min read

    Lattice degeneration of the retina

    Lattice degeneration is a vitreoretinal degenerative process of the peripheral retina with visible lesions that predispose to retinal tears and detachment. Vitreous traction at sites of significant vitreoretinal adhesion is responsible for most retinal breaks that lead to retinal detachment. GOALS of identifying the patients with risk of RD are: Identify patients at risk of RRD Examine patients with symptoms of acute PVD to detect and treat significant retinal breaks Manage patients at high risk of developing retinal detachment Educate high-risk patients about symptoms of PVD, retinal breaks, and retinal detachments and about the need for periodic follow-up. Natural history of precursors to rhegmatogenous retinal detachment Precursors to retinal detachments are PVD, symptomatic retinal breaks, asymptomatic retinal breaks, lattice degeneration, and cystic and zonular traction retinal tufts. Because spontaneous reattachment is exceedingly rare, nearly all patients with asymptomatic RRD w

    Dr. Manoj Khatri
  9. Articles 2 Apr 2021 9 min read

    Persistent Fetal Vasculature Syndrome

    It is a congenital ocular disorder where fetal vasculature persists. It can be either subtle (no disturbance in vision) or severe (profound visual loss) Anatomy The fetal vasculature is composed of two parts: Tunica vasculosa lentis: It is situated anteriorly encircling the lens. It has anterior and posterior divisions. Anteri­or division has additional attachments to the pupillary frill of the iris. Posterior division has additional attachments to the cil­iary process and continues with the hyaloid artery posteriorly. Hyaloid artery: It is situated porteriorly behind the lens. It is also called primary vitreous. The hyaloid vessel extends from posterior surface of lens to the disc. The vasculature fills the vitreous cavity & has many attachments to the retinal surface Normal regression of embryonic vascular system1 During development blood flow to the eye is through hyaloid artery. At the 240-mm stage (seventh month), blood flow in the hyaloid artery ceases. Hyaloid vascular regressio

    Parag K. Shah, DNB
  10. Articles 2 Apr 2021 10 min read

    Diplopia and Hess Charting

    Diplopia Charting Diplopia chart is the record of separation of the diplopic or double images in the nine positions of gaze. It can be plotted charted in patients who cooperate and can appreciate the double vision and with incomitant or comitant deviation. The method The patient should be comfortable with his head erect and should preferably be still throughout the examination. The test is preferably carried out in a dark room. Red glass is put in front of one of the eyes (red in front of right, R for R, is a convention). It is desirable to use Armstrong goggles since these are shaped to fit the orbital margin and therefore patient would be looking only through the colored medium. The examiner holds the torch (vertical source of light) at around ½ m or 1 m (It is important to mention the distance on the chart). This source of light could be horizontal if the complaint is of vertical separation of images The light is held directly in front of the patient at first. If the patient sees a

    Dr. Jitendra Jethani, MS, DO, DNB, FNB

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