Showing papers by "Santosh G Honavar published in 2022"

The Management of Ocular Surface Squamous Neoplasia (OSSN)

Abstract: The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.

Women in ophthalmology – An upsurge!

Abstract: “For most of history, anonymous was a woman” – Virginia Woolf The 19th century was the period wherein women all over the world made a remarkable impact by overcoming the barriers of gender inequality, political issues, and racial differences. Despite the strife trickling down to the medical field, our women left no stone unturned in attempting to participate equally as their male counterparts. Indeed, the number was less, but the impact was strong and significant. The struggles of these women shall not be forgotten for eons to come as they have paved the way for generations of women in ophthalmology, inspiring them to be astute clinicians, skillful surgeons, methodical researchers, and leaders, and most important of all, to stand up for themselves with determination and brook no refusal. We herein highlight important women who were the first to light the torch of equality in the 19th century and made their mark in ophthalmology. Amy Stokes Barton (1841–1900) Born on October 1, 1841 in Camden Country, New Jersey to a farmer Joseph Barton and Rachel B. Evans, Amy Barton was high on principles and values. Her dedication made her rise and she graduated in 1874 from the Woman’s Medical College of Pennsylvania (WMCP) and evolved to be the first woman physician in Pennsylvania.[1] Her zest, brilliance, and interest in ophthalmology made her overcome the encumbrance of gender inequality and she was successfully assigned to assist George Strawbridge at Wills Eye Hospital. She worked under his guidance for over a decade till his resignation in 1890. She got promoted as professor in 1891 and returned to the WMCP. Her wish was to establish a dispensary associated with Woman’s College in Philadelphia with multispecialty care. She raised funds and founded such a system on October 31, 1895 at 1212 South Third Street, Philadelphia as the Hospital and Dispensary of the Alumnae of the WMCP, which got later shifted to 333 and 335 Washington Avenue, known as Amy S. Barton Dispensary and Health Clinic [Fig. 1].[234] She passed away in Philadelphia on March 19, 1900 from stroke; however, her indefatigable hard work and assiduity shall be praised over centuries to come.Figure 1: (a and b) The patients waiting at the Amy S. Barton Dispensary and Health Clinic[4]Olga Arkadeovna Mashkotseva (1851–1933) One of the most renowned women ophthalmologists that Russia gifted to the world was Olga Arkadeovna Mashkotseva. She was an ardent student of Dobrovolskij’s in Petersburg, who graduated in 1878 from the Nicholas Army Hospital. She contributed significantly by actively participating in new eye societies and educating others via several of her presentations in regional and national meetings. Her interests ranged from primary care to research, and she practiced from 1887 to 1933 in Simeropol.[5] Charloette Louisa Ellaby (1854–1909) Born in 1854 at Clifton, Somerset, England to James Watts Ellaby and Emma Field of Woodston, Peterborough, UK, Charloette Louisa Ellaby was the youngest daughter of the family. Dr. Ellaby graduated in 1884 from Paris and in her thesis, she presented her research work in ophthalmology. She happened to be one of the first few staunch supporters of ophthalmology at that time. Garrett Anderson recommended her to work in coordination with Edith Pechey in Bombay, India and in November 1884, she was recruited as Dr. Pechey’s junior medical officer by George Kittredge.[6] She established the first of its kind ophthalmic department for women at Bombay’s Khetwadi dispensary.[7] She later established the Department of Ophthalmology at the Cama Hospital (currently affiliated to Grant Medical College) [Fig. 2], a hospital for women and children constructed by Pestonjee Horsumjee Cama, a Parsi philanthropist,[8] and markedly increased the outpatient department, giving a boost to the practice of ophthalmology in India.[9]Figure 2: Cama hospital (source – Wikipedia)After few years of dedicated work in India, she returned to England where she passed the examination of the society of apothecaries to obtain a registrable British qualification. The recent opening of women in this society enabled her to fulfill her dreams. The graph of her success was steep, as she was appointed as the first ophthalmic surgeon by the committee of the New Hospital for Women in 1890. In her tenure, she proved to be a passionate life force of ophthalmology. She was requested to travel back to India in 1894 by William McClelland to use her surgical skills and expertise to perform a cataract surgery upon the Maharani of Jamnagar. She went on take leading positions as a member of the Faculty of Medicine of the University of London and lecturer in ophthalmic surgery at the London School of Medicine for Women. She worked extensively on the amplitude of convergence, strychnine, and a report on a case series of retinitis patients. She passed away at the age of 55 on May 14, 1909 at her house in Harley Street.[9] Elizabeth Sargent (1857–1900) A political leader, Aaron A. Sargent (senator from California, later United States Minister to Germany), and a prominent women’s suffragette, Ellen Clark Sargent, were blessed with a daughter in 1857 – Elizabeth Sargent. Since the early years, she was encouraged to participate actively as a suffragist and work in sync with her parents for women’s rights. A large sum of money was also contributed to the cause of women’s rights by the Sargent family.[10] Following the footsteps of Isabel Hayes Chapin Barrows,[1112] Ms Sargent attended the Howard University Medical College and earned her medical degree from Cooper Medical College (formerly known as Medical College of the Pacific and currently, the Stanford University’s School of Medicine).[13] Pertaining to her father’s political journey in Germany, she got the opportunity of getting trained by Professor Johann Friedrich Horner. Dr. Sargent stayed unmarried and was acknowledged for her dedication toward children’s health care and eventually turned out to be one of the leading eye specialists at San Francisco. She donated selflessly at the Pacific Dispensary for Women and Children’s hospital, San Francisco,[14] where she later practiced as a pediatric ophthalmologist. She believed strongly in women empowerment and encouraged her peers to work with enthusiasm, while breaking all boundaries keeping gender equality as her ideology.[15] Her paper published in 1892 on ocular complications in pernicious anemia in Herman Knapp’s Archives of Ophthalmology was very well appreciated and her writings on women suffrage have been considered of very high value and impact.[11] She represented the American Medical Association (AMA) section on ophthalmology in an international meeting in Germany, following which she succumbed to endocarditis in 1900 [Fig. 3].Figure 3: Elizabeth Sargent (1857–1900)[11]Trinidad Arroyo Villaverde de Márquez (1872–1959) Born in Palencia, Spain, to a liberal family of industrial dyers on May 26, 1872, Trinidad Arroyo Villaverde rose beyond the limitations that were set for women in the times of yore. Her academic excellence was her strength; however, she was highly looked down upon by her male peers. On March 16, 1882, the University of Valladoid had eliminated the admission of women as per the royal order. However, with the constant encouragement and support of her father, Don Laureano Arroyo, she pulled out all the stops and on December 31, 1888, she was permitted to register to study medicine. She earned her degree in 1895, following which she became Spain’s first female ophthalmologist in 1896.[16] Her dedication toward ophthalmology helped several individuals all over the region, as she opened a practice alongside her brother in Spain in 1898. After her brother’s demise, she donated his legacy, his library, to the Palencia College of Physicians. In the world of gender bias, there existed men with strong belief in women and their potential, and Manuel Márquez became her lifelong encourager as they got married on February 6, 1902. Inspired by his wife, Dr. Manuel Márquez also chose ophthalmology as his specialty and together with his loving wife, made several historical contributions. Dr. Trinidad Arroyo Villaverde de Márquez participated in various conferences and spoke on the use of atropine in corneal ulcers, ocular analgesia of codeine hydrochloride, adrenaline in ophthalmology, retinal detachment, astigmatism and diagnosis and therapy of ocular tuberculosis.[16] Dr. Manuel Márquez was appointed as Dean of Faculty of Medicine at San Carlos in October 1934, and Dr. Trinidad Arroyo Villaverde de Márquez worked incessantly to cut down on the struggles faced by women in that era by collaborating with political and social organizations and established a cultural exchange between Spain and the Union of Soviet Socialist Republics. She was considered an epitome of energy and inspiration in Spain, as she worked tirelessly to provide for the women rights. Her leadership qualities and persistence enabled her to become a member of the Lyceum Club Femenino, Vice President of the Comité Femenino de Higiene Popular in Madrid, and cofounder and honorary president of the Spanish Association of Women Physicians. She added a controversial section, “Feminist notes. From woman to woman,” in the Spanish Social Medicine journal.[17] She exiled in Mexico during the civil war. After her death on September 28, 1959 in Mexico, a statue was built in her honor at the Instituto Jorge Manrique in Madrid [Fig. 4][18] and a school was built in Palencia to commemorate her contributions.[17]Figure 4: Statue of Dr. Trinidad Arroyo Villaverde de Márquez (1872–1959) in Palencia[18]Lizzie Maud Carvill (1873–1934) The year 1873 brought forth one of the earliest women researchers, Lizzie Maud Carvill. Little is known about her childhood. However, while growing up, she faced several instances of gender discrimination. She was an epitome of determination and persistence. In 1898, Maud Carvill, early in her career, happily took the job as an instructor in physical training for women at the Tufts College.[19] In 1899, she graduated from Tufts College and as Dr. Carvill from Tufts College Medical School in 1905. She happened to be the first woman ophthalmologist at the Massachusetts Eye and Ear Infirmary [Fig. 5] and is known for her perpetual happy-go-lucky nature and positive joyous vibe that she brought to the work environment and for her patients. She joined as ophthalmic staff at the New England Hospital for Women and Children and also worked there as a consultant.Figure 5: Maud Carvill examining patients in 1923 at her clinic (Source – Massachusetts eye and ear social portals)She embraced the struggles faced by women in that era and was welcomed to be a part of professional societies – AMA, New England Women’s Medical Society, American College of Surgeons, American Academy of Ophthalmology and Otolaryngology, the New England Ophthalmological Society, and the American Ophthalmological Society. The list of her remarkable research work included[20] congenital fistulae of the lacrimal canaliculi, persistent hyaloid artery, tubercular iritis, occurrence of pregnancy-induced bitemporal contraction of the visual field,[21] and treatment of interstitial keratitis with antisyphilitic treatment.[22] Her excellent handpicked team, including late Dr. George S. Derby, extolled her scientific contributions and services. Her death in 1934 was considered a severe loss for the medical profession and for the community.[20] Her vivacity was kept alive in the memories of her colleagues, and her positive spirit was carried forward by her successors. Conclusion The courage, grace, determination, strength, dedication, and perseverance of women in the 19th century were beyond comparison. The struggles faced by them were unfathomable, and yet, they never gave up and the barriers of gender inequality, social liabilities, and racial discrimination were set ablaze by this upsurge of women in ophthalmology, leaving a fresh ground for the future generations. The ingenuity of these women has inspired us to be go-getters and leaders in our respective fields, with our heads held high. These women of substance have made us believe that nothing is impossible and we must go that extra mile to be able to create opportunities for self and several generations to come. “History has shown us that courage can be contagious and hope can take on a life of its own.” – Michelle Obama

All India Ophthalmological Society (AIOS) Task Force guidelines to prevent intraocular infections and cluster outbreaks after cataract surgery

Abstract: Infectious endophthalmitis is a serious and vision-threatening complication of commonly performed intraocular surgeries such as cataract surgery. The occurrence of endophthalmitis can result in severe damage to the uveal and other ocular tissues even among patients undergoing an uncomplicated surgical procedure. If the infections result from common factors such as surgical supplies, operative or operation theater-related risks, there can be a cluster outbreak of toxic anterior segment syndrome (TASS) or infectious endophthalmitis, leading to several patients having an undesirable outcome. Since prevention of intraocular infections is of paramount importance to ophthalmic surgeons, the All India Ophthalmological Society (AIOS) has taken the lead in the formation of a National Task Force to help ophthalmic surgeons apply certain universal precautions in their clinical practice. The Task Force has prepared a handy checklist and evidence-based guidelines to minimize the risk of infectious endophthalmitis following cataract surgery.

Specific location of ocular adnexal lymphoma and mortality: an international multicentre retrospective study

Abstract: Aims To examine whether the specific location of ocular adnexal lymphoma (OAL) and the American Joint Committee on Cancer (AJCC) TNM tumour stage are prognostic factors for mortality in the main OAL subtypes. Methods Clinical and survival data were retrospectively collected from seven international eye cancer centres. All patients from 1980 to 2017 with histologically verified primary or secondary OAL were included. Cox regression was used to compare the ocular adnexal tumour locations on all-cause mortality and disease-specific mortality. Results OAL was identified in 1168 patients. The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=688, 59%); follicular lymphoma (FL) (n=150, 13%); diffuse large B-cell lymphoma (DLBCL) (n=131, 11%); and mantle cell lymphoma (MCL) (n=89, 8%). AJCC/TNM tumour-stage (T-stage) was significantly associated with disease-specific mortality in primary ocular adnexal EMZL and increased through T-categories from T1 to T3 disease. No associations between AJCC/TNM T-stage and mortality were found in primary ocular adnexal FL, DLBCL, or MCL. EMZL located in the eyelid had a significantly increased disease-specific mortality compared with orbital and conjunctival EMZL, in both primary EMZL and the full EMZL cohort. In DLBCL, eyelid location had a significantly higher disease-specific mortality compared with an orbital or lacrimal gland location. Conclusion Disease-specific mortality is associated with AJCC/TNM T-stage in primary ocular adnexal EMZL patients. Lymphoma of the eyelid has the highest disease-specific mortality in primary EMZL, and in the full cohort of EMZL and DLBCL patients.

Orbital dermoid cyst

Abstract: Background: Dermoid cyst, a developmental benign choristoma, is the most common orbital tumor of childhood, arising from ectodermal sequestration along the lines of embryonic fusion of mesodermal processes, lined by keratinized stratified squamous epithelium and expanding slowly due to constant desquamation and dermal glandular elements. Approximately 80% are found in the head and neck region and comprise 3-9% all orbital masses. Purpose: It is mandatory to know about the variable presentations of orbital dermoids and the surgical techniques that can be adopted based on the site, extent, age and aesthetic needs, presence of inflammation and possibility of intraoperative rupture. Synopsis: Orbital dermoids can be classified as juxta-sutural, sutural or soft tissue cysts; superficial or deep; intraosseous or extraosseous, and intraorbital or extraorbital. These smooth, painless, mobile or partially mobile lesions mostly present at the fronto-zygomatic suture with proptosis, displacement, ptosis or diplopia, depending on depth and extent. Therefore, it is important to understand the various presentations and the appropriate surgical techniques. Highlights: We describe the embryological origin, types and clinical features of dermoids in this video and demonstrate the surgical and minimally invasive techniques for their management. Video link: https://youtu.be/-q3xD2igjcQ

Oculomics – The eyes talk a great deal

Abstract: Retina being the only directly accessible extension of the brain allows non‐invasive real‐time characterization of the microvascular structure and function of the central nervous system. Oculome denotes the composite set of macroscopic, microscopic, and molecular ophthalmic features associated with health and disease.[1] Comprehensive decrypting of the oculome by integrating the information generated by multimodal imaging to identify the specific ophthalmic biomarkers of systemic diseases is termed oculomics.[1] The goal of oculomics is to develop rapid, noninvasive, cost‐effective biomarkers to screen and diagnose systemic diseases and stratify the risks to prioritize treatment.[1] Biomarkers are defined as objective parameters that help predict, assess, or diagnose a disease and plan treatment.[2] The convergence of big data, artificial intelligence (AI), and oculomics and their robust integration has helped make the biomarkers reliable and reproducible enough to be used in clinical applications.[3]

Eye Care for All

Abstract: The data curated by the International Association for the Prevention of Blindness (IAPB) shows that there are 1.1 billion people globally with vision loss and this is projected to increase to 1.7 billion by 2050.[1] The main contributors to the vision loss include:[1] 1. Uncorrected refractive error (671 million) 2. Cataract (100 million) 3. Glaucoma (8 million) 4. Age‐related macular degeneration (8 million) 5. Diabetic retinopathy (DR) (4 million)

To a new researcher: A communication in retrospect

Abstract: For interns, residents, and fellows, the thrill of the first scientific publication is almost as high as the first surgery. The academic period is the best time to develop a research base and a scientific attitude. It is true that a lot depends on the institute and mentors, their encouragement for research, and their own interest in guiding and reviewing young researchers. At an individual level, there are some simple things one can keep in mind to initiate and continue scientific research. KEEP YOUR EYES OPEN AND EARS SHARP In the clinic or emergency or even a busy operation theater, there will always be a case or two that will catch your attention in a day. It may be a patient that you examine or diagnose yourself, or one that your senior happens to mention an interesting point about, or even indirectly if something strikes you while talking to the patient himself or you chance upon an unusual finding during the surgery or on pathology. Keep your own record of the name of the patient, the medical record number, date seen, and the diagnosis with the unique point. It is good to carry pocketbooks or loose blank notes to quickly jot it down and then make a fair version of your list. You will be surprised how quickly you will have a list of unusual cases to turn to whether it is for an abstract whose deadline is round the corner, a case presentation or a publication. ORGANIZE YOUR WORK Organization is easier said than done. But making an effort to sort and group from the beginning will help make your work much simpler in future. It can begin in a very simple way, classifying your list of unique cases or patients in folders on your laptop. Make folders for the eye tissue, subfolder for diagnosis, and subfolder for the last and first name of the patient or their medical record number. You can then save patient images, consent forms, visit records, and investigation reports within these subfolders. Once you start preparing the manuscript, organize each paper into the main folder with the title of the project and journal name. Within this, keep subfolders with the manuscript, illustrations, patient charts, and published literature. Save each version with the date in the same format per your choice, year, date, month, or something similar. The same thing can be done for naming spreadsheets, presentations, and literature PDFs with the title of the article, journal, year, and first author. An organized mind will always know what to look for when the time comes. It will save you from searching a hundred emails, and multiple pen drives for content. The search function of your laptop will have your answers. KEEP BACK UP In an age where the phone is a man’s best friend and a laptop is a friend with benefits, utilize technology to the full extent. However, be wary, they can leave you stranded when you need them the most, the battery can fail, they can get stolen, or your files may not be supported in a different machine. Try to keep multiple back ups in the form of iCloud or Google Drive as well as on hard disks. This will allow you to always have something to fall back on instead of lamenting on loss of precious data collected over several years. DOCUMENT EVERYTHING, FOLLOW A TEMPLATE Whether it is on a paper chart or electronic medical records, document every detail in the form of large drawings and bulleted notes. Follow a template for examination and documentation. It minimizes errors and is very helpful for retrospective reviews. For instance, you may want to retrospectively study the association of the size of squamous cell carcinoma with the risk of recurrence. You will be able to do the study if you have noted the maximum dimensions horizontally and vertically in the initial visit. Take a standard set of photographs after informed consent. The postoperative images should also match the initial set of pictures. Avoid taking pictures from the computer monitors and poorly focused images. They should be cropped and saved by the same coding method elaborated in the preceding paragraphs. START SMALL, DREAM BIG Do not lose an opportunity to present your work at conferences but never leave a project incomplete at the level of the abstract, a PowerPoint or a poster. Write down the report while you are working on it, you will never have the time to go back to it. It is a good practice to start publications with short case reports, or pictures and perspectives. They are quick projects that can be done with minimal institutional support. Choose a journal based on your topic and read the guidelines of the journal properly. Most articles are rejected in the initial stages because they do not meet the journal specifications. It is always good to start preparing a manuscript after deciding on the journal. Aim for the best journal, with a high impact factor. This will entail maximum hard work at the initial stages. If it gets rejected, modifying it for the next best journal is very straightforward and does not require a long time. Once you get a hang of the process, you will automatically be working toward more constructive and elaborate studies. A research paper is made up of several parts. No, not the abstract, introduction, methods, results, discussion, and conclusion. It is made up of patients and doctors, a keen mind, folded, crumpled pieces of papers, hours of deliberation, days of literature searches, weeks of late nights and burnt midnight oils, months of reviews amongst the authors, and a single beating heart that is waiting to find its way into a journal. Toil for it, respect it, and cherish it, for nobody can take that away from you!

Should visual function tests be mandatory for a driving license?

Abstract: Road traffic accidents (RTA) continue to be a major public health problem, with over 1.3 million fatalities and 20‐50 million non‐fatal injuries and permanent disabilities.[1] RTA is currently the third major cause on the World Health Organization’s list of Global Burden of Diseases.[2] India contributes to 11% of RTA in the world – a gross asymmetry considering that India has only 1% of all motor vehicles on road.[3] India also has the dubious distinction of having the second‐highest number of RTA globally and the highest number of deaths. In 2019, there were 4,49,002 RTA in India and 1, 51,113 fatalities, accounting for an accident every minute and a death every three minutes.[3] The total estimated socioeconomic implication of RTA in 2018 was Rs 1,47,114 crores or 0.77% of India’s GDP.[3] Although the causes for RTA are multifactorial, over 95% of accidents and fatalities are directly attributable to human error.

Man vs machine – The future of manual small-incision cataract surgery

Abstract: Cataract surgery is one of the oldest medical interventions, documented as early as the fifth century BC.[1] It has evolved through several stages from couching, needling, intracapsular extraction, and extracapsular extraction to modern phacoemulsification, manual small‐incision cataract surgery (MSICS), and femtosecond-laser assisted cataract surgery.[1] The progress is fueled by the fast-paced momentum of innovations in surgical techniques, instrumentation, biometry, and intraocular lens design. Refinements in cataract surgery have transformed it into a remarkably rewarding, quick, predictable, safe, and effective surgery. Cataract surgery is currently one of the most common surgeries performed worldwide.[2,3]

The Eye in the Artist

Abstract: Vincent van Gogh (1853–1890) Perhaps the most talented and tragic of the lot, van Gogh, attained recognition posthumously having sold only a single painting in his lifetime. Nonetheless, his art is a reflection of the beauty and turmoil that lay within one of the most misunderstood artists of his time. The Sunflowers, 1888–1889, a set of five paintings that Vincent envisioned and drew have fascinated connoisseurs and even lay persons for years [Fig. 1]. A stark contrast from the large, blooming blossoms that one associates with sunflowers, van Gogh drew them in a more subdued form. He found the beauty in the drying or budding flowers. But what stands out to anybody who lays eyes on them is the color yellow! The yellow color also dominates many of his Self Portraits, The Bedroom, and The Yellow House. Historians and scholars have suggested that van Gogh was suffering from a condition known as xanthopsia, which results in the person seeing yellow. Walsh and Hoyt list 13 chemicals that can result in xanthopsia.[1] A possible cause could be that he was being treated for his manic depressive state by digitalis. One can see the foxglove plant in the painting of Dr. Gachet, Portrait of Doctor Gachet, 1890.[2] Prolonged and toxic doses of digitalis are known to produce xanthopsia.[3] Additionally, the consumption of absinthe, a popular liquor in France in that period, could have also resulted in his xanthopsia.[1,3] Santonin, a drug used to treat gastrointestinal disturbances, which the artist was known to suffer from, could also be the drug responsible for his xanthopsia.[1,4]