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#Tips & Pearls

50 articles
  1. Articles 10 Sep 2021 10 min read

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

    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 inner nuclear layer.1 Features: Appear as small round red dots - usually seen at the posterior pole, especially temporal to the fovea. 10- 100 microns in diameter. Only > 30 microns is visible ophthalmoscopically (better on red-free illumination). < 30 microns can be seen on FFA and hence more microaneurysms are seen on FFA than fundus examination. Shapes – saccular, fusiform, pedunculated, focal bulge, irregular, mixed. FFA- Hyperfluorescent with leakage. OCT – Ring sign, span more than 1 retinal layer. Course- disappear in 3-6 months. Can continue to exudate, bleed or thrombose. 2. And it wa

    Dr. Sashwanthi Mohan · Dr. Snehal Bavaskar
  2. Articles 4 Sep 2021 6 min read

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

    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, deep anterior lamellar keratoplasty, vitrectomy and anterior and posterior segment phakic intraocular lenses. The alternative names of TASS include sterile post -operative endophthalmitis, toxic lens syndrome, toxic endothelial cell destruction syndrome and localized endophthalmitis [1],[3],[7]. 1. What is TASS? It is an acute sterile post-operative inflammatory condition affecting the anterior segment structures following intraocular surgery. It is usually seen within 12-48 hours of surgery and is due to the reaction of anterior segment structures to some toxic substance usually associated wit

    Dr. Priya Rasipuram Chandrasekaran
  3. Articles 26 Aug 2021 6 min read

    How to Quickly Read a Macular OCT Scan?

    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 turn aids in prognosticating and making treatment decisions. How to quickly read a macular OCT? An OCT image gives you layer by layer information of retinal tissue. So if we segment the OCT image into 5 layer-wise sub-segments, it becomes very easy to read and interpret the retinal pathology. And also just by looking at the diseased/damaged retinal layer, we can identify probable clinical disease. These 5 OCT sub-segments can be used for quick interpretation of macular OCT scans. 1: VR (Vitreo-Retinal) Interface 2: Inner Retina 3: Outer retina 4: RPE/ BRUCHS MEMBRANE 5: Choroid Let us first rev

    Dr. Deepak Bhojwani
  4. Articles 24 Aug 2021 7 min read

    How to Make Your Online Presence Felt : Tips & Tricks

    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 practices versus working in an eye institute and this difference is because those who have established their own practices have in one way become entrepreneurs and whether they like it or not as time goes by the most important job as the owner of an ophthalmic practice would be to increase or drive patients to that practice. This is where online presence comes in. So what does online presence mean? When people look for you or for things you do there are places that showcase you or your practice. These could be Youtube videos Listing in Practo and similar sights A Website Writing a Blog A News

    Dr. Deepak Garg
  5. Students Gallery 24 Aug 2021 2 min read

    i-File: Systemic Hypertension

    A 60-year male presented with C/O diminution of vision in the Right Eye. The patient is not a known case of any known systemic illness, although gives a vague c/o chest pain and the occasional headache. Examination revealed a vision of 4/60 with an IOP of 16mmHg as measured by GAT. The right Eye reveals the unremarkable anterior segment with minimal lenticular changes. Vitreous cavity quiet with fundus as shown. The left eye reveals a normal anterior and posterior segment. Question What are the positive findings as depicted in the fundus photo.? What are the investigations you would ask for? How will you manage this case? Answer Ocular 1) FUNDUS FLUORESCEIN ANGIOGRAM: disruption of retinal layers. These in turn will again help in educating the patient in terms of visual gain he is expected to gain In this case if one had to choose between FFA and OCT, FFA would be a better option. Management Managing this case is again in collaboration with a physician/ cardiologist Ocular 1) After con

    Dr. Bikramjit Pal
  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. Students Gallery 12 Aug 2021 10 min read

    Retina Case Presentation in Practical Exam: 10 Tips

    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 are ways to excel the viva; otherwise, the sheer stress of exam often changes the performance, pace and quality and a lot of brilliant minds start fumbling under stress. The 20 minutes that are provided are for not just taking the case (which includes history taking and examination) but also writing the case sheet and in retina cases- a good diagram or illustration preferably on the Amsler-Dubois chart. Here are 10 simple tips for presenting a retina-based case in a DNB practical exam. 1. Don’t screw the basics: In the exam, unlike in the clinics of most DNB hospitals (where we have an optomet

    Dr. Puja Maitra · Dr. Dhaivat Shah
  8. Students Gallery 9 Aug 2021 5 min read

    Pearls for Practical Exam in Ophthalmology for Postgraduates

    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. Students must discuss about the patients with classmates, seniors also, apart from presenting to the teachers. Always take the guidance of teachers. Don’t feel shy to ask any doubts to your teachers. Teachers will definitely help you. Don’t hesitate to present cases many times before appearing for the exams. Nothing wrong with presenting the same patient to different consultants. This will help you to know the different views of different teachers. These types of approaches during your residency period will give you enough confidence. Learn the method of interpreting different investigations charts

    Dr. (Capt) V.R Vijayaraghavan
  9. Students Gallery 5 Aug 2021 2 min read

    Ten Tips for OSCE

    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 score maximum points. Here are some tips Preparation stage 1. Go through images in an atlas. Most OSCEs are image-based. So pay attention to clinical features by going through as many online free atlases that are available on the internet. Practice describing findings to your study partner. 2. Go through surgical videos. Videos of surgery may be shown as part of OSCEs with a review of steps and complications may be asked as an OSCE. 3. Revise the clinical trials and the acronyms. These are often asked as well. Many websites and textbooks have comprehensive tables that make revising trials eas

    Dr. Meenakshi Swaminathan
  10. Articles 4 Aug 2021 10 min read

    How to Present a Case of Corneal Ulcer in the Examination

    1. Obtain a detailed history : a. A history of injury and the injuring agent - some pointers from this would be the occurrence of fungal infections in injuries with vegetable matter/insect wing cases; bacillus infections in patients with broomstick injuries; gram-positive infections with metal foreign bodies and so on b. A history of past such similar episodes - typically, this suggests the possibility of viral infections c. History of contact lens use - in such cases, while there is the possibility of a sterile infiltrate, especially if such infiltrates are present at 3 and 9 o? clock periphery, it is imperative to keep in mind serious infections such as pseudomonas d. Prior treatment history - obtain a detailed history of the name of antibiotic used, the frequency of use suggested, and the compliance of the patient with therapy. Failure to respond to adequate dose and duration of appropriate antibiotics suggests the possibility of a fungal or parasitic infection. e. Pain, discharge,

    Dr. Srinivas K Rao, DO DNB FRCSEd

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