Showing papers in "Indian Journal of Ophthalmology in 2020"

COVID-19 pandemic: Lessons learned and future directions.

Abstract: Emerging pandemics show that humans are not infallible and communities need to be prepared. Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Worldwide countries are responding differently to the virus outbreak. A delay in detection and response has been recorded in China, as well as in other major countries, which led to an overburdening of the local health systems. On the other hand, some other nations have put in place effective strategies to contain the infection and have recorded a very low number of cases since the beginning of the pandemics. Restrictive measures like social distancing, lockdown, case detection, isolation, contact tracing, and quarantine of exposed had revealed the most efficient actions to control the disease spreading. This review will help the readers to understand the difference in response by different countries and their outcomes. Based on the experience of these countries, India responded to the pandemic accordingly. Only time will tell how well India has faced the outbreak. We also suggest the future directions that the global community should take to manage and mitigate the emergency.

Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey.

Abstract: Purpose: In early 2020, the World Health Organization declared the outbreak of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV as a global pandemic. The government of India ordered a nationwide lockdown for 21 days, limiting movement of people as a preventive measure. This survey was designed and conducted during the lockdown period to assess its effect on ophthalmic practice and patient care in India. Methods: An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed. Results: A total of 1260 ophthalmologists responded to the survey. Most of the respondents (775/1260; 61.5%) were in private practice and 14.8% (187/1260) were affiliated to ophthalmic institutes. At the time of taking the survey, 72.5% of the respondents (913/1260) were not seeing any patients due to the lockdown. Of those who were still examining patients, 82.9% (287/347) were only seeing emergency cases, based on their own clinical judgement. The proportion of ophthalmologists in ophthalmic institutes, government and municipal hospitals (126/253;49.8%) who were still seeing patients was significantly higher (P < 0.0001) than those in private practice (174/775;22.4%). Apart from emergencies such as trauma, retinal detachment, and endophthalmitis (81.8%), other surgeries that were still being performed included intravitreal injections (9.1%) and cataract surgeries (5.9%). Approximately, 77.5% (976/1260) of the respondents had begun telephonic/e-mail/video consultations or consultations over social media applications since the lockdown began. In addition, 59.1% (745/1260) felt that ophthalmologists were potentially at a higher risk of contracting COVID-19 compared to other specialties while examining patients. When asked about the resumption of practice upon easing off of the restrictions, 57.8% (728/1260) of the respondents said they were unsure of when to resume elective surgeries; furthermore, 62.8% (791/1260) were unsure about the preferred screening strategy or precautionary approach prior to resuming surgeries and were awaiting guidelines. Conclusion: Our survey shows that majority of ophthalmologists in India were not seeing patients during the COVID-19 lockdown, with near-total cessation of elective surgeries. Emergency services were still being attended to by 27.5% of ophthalmologists who responded. A large proportions of ophthalmologists had switched over to telephonic advice or other forms of telemedicine to assist patients. Most of the responding ophthalmologists were unclear about when and how to resume surgeries upon easing off of the COVID-19 related restrictions. Regulatory bodies should take note of this and issue appropriate guidelines regarding the same.

The impact of COVID-19 related lockdown on ophthalmology training programs in India - Outcomes of a survey.

Abstract: Purpose: In 2020, in response to the emergence and global spread of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV, the government of India ordered a nationwide lockdown for 21 days, which was then extended to a total of over 50 days. The aim of this study is to assess the effect of the lockdown on ophthalmic training programs across India. Methods: An online survey was sent across to trainee ophthalmologists across India through various social media platforms. Results: In all, 716 trainees responded; the average age was 29.1 years. Results showed that majority of the respondents were enrolled in residency programs (95.6%; 685/716) and the others were in fellowship programs. About 24.6% (176/716) of the trainees had been deployed on 'COVID-19 screening' duties. Nearly 80.7% (578/716) of the trainees felt that the COVID-19 lockdown had negatively impacted their surgical training. Furthermore, 54.8% (392/716) of the trainees perceived an increase in stress levels during the COVID-19 lockdown and 77.4% (554/716) reported that their family members had expressed an increased concern for their safety and wellbeing since the lockdown began. In all, 75.7% (542/716) of the respondents felt that online classes and webinars were useful during the lockdown period. Conclusion: Our survey showed that majority ophthalmology trainees across the country felt that the COVID-19 lockdown adversely affected their learning, especially surgical training. While most found online classes and webinars useful, the trainees' perceived stress levels were higher than normal during the lockdown. Training hospitals should take cognizance of this and reassure trainees; formulate guidelines to augment training to compensate for the lost time as well as mitigate the stress levels upon resumption of regular hospital services and training. Going ahead, permanent changes such as virtual classrooms and simulation-based training should be considered.

Impact of the COVID-19 lockdown on digital device-related ocular health.

Abstract: Purpose: Since the declaration of the lockdown due to COVID-19, the usage of digital devices has gone up across the globe, resulting in a challenge for the visual systems of all ages. The purpose of this study is to assess the impact of the lockdown on digital device usage, and consequently, the ocular surface health implications and circadian rhythm abnormalities related to digital eye strain. Methods: An open online survey was sent through various social media platforms and was open for a period of 2 weeks. Results: A total of 407 usable responses were obtained; the average age of respondents was 27.4 years. Typically, 93.6% of respondents reported an increase in their screen time since the lockdown was declared. The average increase in digital device usage was calculated at about 4.8 ± 2.8 h per day. The total usage per day was found to be 8.65 ± 3.74 hours. Sleep disturbances have been reported by 62.4% of people. Typically, 95.8% of respondents had experienced at least one symptom related to digital device usage, and 56.5% said that the frequency and intensity of these symptoms increased since the lockdown was declared. Conclusion: The study highlighted the drastic increase in use of digital devices after the initiation of the COVID-19 lockdown, and along with it, the slow deterioration of ocular health across all age groups. Awareness about prevention of digital eye strain should be stressed, and going forward, measures to bring these adverse effects to a minimum should be explored.

All India Ophthalmological Society - Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic.

Abstract: The COVID-19 pandemic has taken tragic proportions and has disrupted lives globally. In the wake of governmental lockdowns, ophthalmologists need practical and actionable guidelines based on advisories from national health departments on how to conduct their duties during nationwide lockdowns and after these are lifted. In this paper, we present a preferred practice pattern (PPP) based on consensus discussions between leading ophthalmologists and health care professionals in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. In this document, the expert panel clearly defines the range of activities for Indian ophthalmologists during the ongoing lockdown phase and precautions to be taken once the lockdown is lifted. Guidelines for triage, governmental guidelines for use of personal protective equipment from ophthalmologists' point of view, precautions to be taken in the OPD and operating room as well as care of various ophthalmic equipment have been described in detail. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics and should help Indian ophthalmologists in performing their professional responsibilities without being foci of disease transmission.

Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India.

Abstract: Purpose: To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India. Methods: An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. Conclusion: A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.

Retinal vein occlusion in COVID-19: A novel entity

Abstract: Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the “cytokine-storm” as the pathogenesis for systemic manifestations of COVID-19.

Modern treatment of retinoblastoma: A 2020 review.

Abstract: Retinoblastoma management remains complex, requiring individualized treatment based on International Classification of Retinoblastoma (ICRB) staging, germline mutation status, family psychosocial factors and cultural beliefs, and available institutional resources. For this 2020 retinoblastoma review, PubMed was searched for articles dated as early as 1931, with an emphasis on articles from 1990 to the present day, using keywords of retinoblastoma, chemotherapy, intravenous chemotherapy, chemoreduction, intra-arterial chemotherapy, ophthalmic artery chemosurgery, intravitreal chemotherapy, intracameral chemotherapy, cryotherapy, transpupillary thermotherapy, laser, radiation, external beam radiotherapy, plaque radiotherapy, brachytherapy, and enucleation. We discuss current treatment modalities as used in the year 2020, including intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), intracameral chemotherapy (IcamC), consolidation therapies (cryotherapy and transpupillary thermotherapy [TTT]), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and enucleation. Additionally, we present a consensus treatment algorithm based on the agreement of three North American retinoblastoma treatment centers, and encourage further collaboration amongst the world's most expert retinoblastoma treatment centers in order to develop consensus management plans and continue advancement in the identification and treatment of this childhood cancer.

Central retinal vein occlusion with COVID-19 infection as the presumptive etiology.

Abstract: Thromboembolic phenomenon related to Coronavirus disease 2019 (COVID-19) has been well documented in literature; however, reported ocular manifestations of COVID-19 are limited to vision sparing ocular conditions like conjunctivitis. We report a case of a 17-year-old female who presented to us with central retinal vein occlusion with proven recent past COVID-19 infection as presumed etiology which was not known to her at the time of presentation.

Therapeutic opportunities to manage COVID-19/SARS-CoV-2 infection: Present and future.

Abstract: A severe form of respiratory disease - COVID-19, caused by SARS-CoV-2 infection, has evolved into a pandemic resulting in significant morbidity and mortality. The unabated spread of the disease is due to lack of vaccine and effective therapeutic agents against this novel virus. Hence, the situation demands an immediate need to explore all the plausible therapeutic and prophylactic strategies that can be made available to stem the spread of the disease. Towards this effort, the current review outlines the key aspects of the pathobiology associated with the morbidity and mortality in COVID-19 patients, which includes a viral response phase and an exaggerated host response phase. The review also summarizes therapeutic agents that are currently being explored along with those with potential for consideration. The broad groups of therapeutic agents discussed include those that: (i) block viral entry to host cells, (ii) block viral replication and survival in host cells, and (iii) dampen exaggerated host immune response. The various kinds of pharmaceutical prophylactic options that may be followed to prevent COVID-19 have also been discussed.

Big data and the eyeSmart electronic medical record system - An 8-year experience from a three-tier eye care network in India.

Abstract: Purpose: To assess the demographic details and distribution of ocular disorders in patients presenting to a three-tier eye care network in India using electronic medical record (EMR) systems across an 8-year period using big data analytics. Methods: An 8-year retrospective review of all the patients who presented across the three-tier eye care network of L.V. Prasad Eye Institute was performed from August 2010 to August 2018. Data were retrieved using an in-house eyeSmart EMR system. The demographic details and clinical presentation and ocular disease profile of all the patients were analyzed in detail. Results: In an 8-year period, a total of 2,270,584 patients were captured on the EMR system with 4,730,221 consultations. More than half of the patients presented at tertiary centers (n = 1,174,643, 51.73%), a quarter at the secondary centers (n = 564,251, 24.85%) followed by the vision centers (n = 531,690, 23.42%). The ratio of males and females was 1.18:1. Most common states of presentation were Andhra Pradesh (n = 1,103,733, 48.61%) and Telangana (n = 661,969, 29.15%). In total, 3,721,051 ocular diagnosis instances were documented in the patients. Most common ocular disorders were related to cornea and anterior segment (n = 1,347,754, 36.22%) followed by refractive error (n = 1,133,078, 30.45%). Conclusion: This study depicts the demographic details and distribution of various ocular disorders in a very large cohort of patients. There is a need to adopt digitization in geographies that cater to large populations to enable insightful research. The implementation of EMR systems enables structured data for research purposes and the development of real-time analytics for the same.

Impact of COVID-19 pandemic on people living with visual disability.

Abstract: People living with visual disabilities/impairment are more likely vulnerable to get contracted from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2) than people without visual impairment This means more than 253 million people globally will be at higher risk of affecting by the COVID-19 The current pandemic, followed by a nationwide emergency lockdown to slow the unprecedented spread of the virus, will have a serious impact on people living with visual disabilities and even endangers their lives in the long run Many restrictive and control measures, including the adoption of new behavioural changes (for example, social distance during outdoor movement, limiting touch or tactile contact) recommended by the government will pose immense challenges to individuals with a visual loss This serious impact, including challenges in healthcare access, can be minimized through inclusive service approaches, involving persons with visual disabilities, caregivers, family members, and healthcare providers, along with the community to a large extent, and finally, support to improve the overall outcomes The government, along with profit or non-profit private sectors, should consider initiating such inclusive approaches while planning responses to the pandemic Indeed, the present COVID-19 pandemic provides an opportunity for health care planners and decision-makers of various organizations across India for a reformation of disabilities care Impacts due to the pandemic and lockdown can be reduced substantially if planning and policy are in place before any emergency happened in the future

Presence of viral RNA of SARS-CoV-2 in conjunctival swab specimens of COVID-19 patients.

Abstract: Purpose: To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimens of coronavirus disease-19 (COVID-19) patients. Methods: Forty-five COVID-19 patients positive for real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Results: Out of 45 patients, 35 (77.77%) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23%) out of 45 patients was positive for RT-PCR SARS-CoV-2 in the conjunctival swab. Conclusion: This study shows that SARS-CoV-2 can be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Though the positivity rate of detecting SARS-CoV-2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID-19.

To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.

Abstract: Purpose: To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute. Methods: Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions. Results: The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5%, 96.5%, 98.7% and 99.7% respectively compared from the corresponding time last year. Around 38.8% patients could be triaged as non-emergency cases based on history alone while 59.5% patients could be triaged as non-emergency cases after examination. Only eighty-four patients opted for video-consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9% patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown. Conclusion: A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post-COVID-19-era, especially those requiring immediate in-person attention. A large number of patients can be classified as non-emergency cases. These patients need to be encouraged to follow-up via video-consultation to carve adequate in-person time for the high-risk patients.

Clinical profile and prevalence of conjunctivitis in mild COVID-19 patients in a tertiary care COVID-19 hospital: A retrospective cross-sectional study.

Abstract: Purpose: To find the clinical profile and prevalence of conjunctivitis and other ocular manifestations in mild COVID-19 positive patients in a nodal COVID-19 hospital. Methods: A retrospective cross-sectional, single-center study conducted in 127 mild cases of COVID-19 positive patients admitted between 27th March and 19th April 2020 in a tertiary care COVID-19 hospital in north India. From the hospital records, demographic data is collected. Ocular history and ocular examinations were done by face-to-face survey during ward rounds. Results: A total of 127 patients were included in the study with a median age of 38.8 years. Forty-eight (37.80%) patients had upper respiratory tract symptoms, 20 (15.75%) patients had systemic illness, 18 (14.17%) patients were using spectacles, and 50 (39.37%) patients had history of hand-eye contact. Out of 12 (9.45%) patients who had ocular complaints, 11 (8.66%) had ocular manifestation after admission. Among 11 patients, eight (6.29%) had conjunctival congestion. Three (3/8) patients had developed conjunctival congestion even before the manifestation of definite COVID-19 symptoms. Five patients (5/8) patients had no other associated ocular symptoms other than congestion. Six patients (6/8) had symptoms of upper respiratory tract infection. Conclusion: Mild conjunctivitis manifesting as conjunctival congestion is common and is one of the major ocular manifestations in COVID-19 positive patients even with milder disease.

Prevalence and causes of childhood blindness in India: A systematic review.

Abstract: Childhood blindness is one of the priority targets of Vision 2020-Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.

Management of corneal perforations: An update.

Abstract: Corneal perforation is a potentially devastating complication that can result from numerous conditions that precipitate corneal melting. It is associated with significant morbidity and prompt intervention is necessary to prevent further complications. Causes include microbial keratitis, ocular surface disease, and autoimmune disorders and trauma. Various management options have been described in the literature to facilitate visual rehabilitation. This rview discusses the treatment options that range from temporising measures such as corneal gluing through to corneal transplantation, with decision making guided by the location, size, and underlying aetiology of the perforation.

Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India.

Abstract: Purpose: To describe the experience of tele-consultations addressed at the centre of excellence of a multi-tier ophthalmology hospital network in India during the ongoing novel coronavirus (COVID-19) lockdown. Methods: This cross-sectional hospital-based study included 7,008 tele-consultations presenting between March 23rd and April 19th 2020. A three-level protocol was implemented to triage the calls. The data of patient queries were collected using a Google Form/Sheets and the tele-calls were returned using the patient information retrieved from the electronic medical record system. Results: Overall, 7,008 tele-calls were addressed, of which 2,805 (40.02%) patients where a clinical-related query was answered were included for analysis. The most common queries were related to redness/pain/watering/blurring of vision (31.52%), closely followed by usage of medications (31.05%). The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). Less than one-fifth of the patients were from the lower socio-economic class (16.08%) and one-fourth were new patients (23.96%). The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). Emergency requests requiring further evaluation by an ophthalmologist accounted for a small percentage (16.36%) of patients. Conclusion: Tracking of tele-consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID-19 pandemic. The current experience provided valuable insights to the possibility of managing patient follow-up visits remotely in the future.

Tele-ophthalmology: Need of the hour.

Abstract: Telemedicine and tele-ophthalmology have been in existence since many years, but have recently gained more importance in the present scenario of pandemic COVID-19 The attitude and perception of the doctors and patients has been changing gradually Telemedicine has many advantages including providing care in inaccesible areasIn the present scenario, tele-ophthalmology gives an oppurtunity to patient for seeking consultation while also protecting against the contagion There are many barriers faced by the patients and doctors that have restricted use of this technology in the past However, with a systematic approach to designing the best suited technology, these barriers can be overcome and user friendly platforms can be created Furthermore, the demand and use of teleconsulation had increased presently in this area of pandemic Recent survey conducted by the All India Ophthalmological Society also reveals that many ophthalmologists who have not used tele-ophthalmology in the past are more keen to use it presently In this article, we have reviewed telemedicine and tele-ophthalmology literature on Google and PubMed to get a holistic idea towards teleconsultation, its advantages, increased importance and prefrence during COVID-19 pandemic and various barriers faced so that the known challenges can be understood, which can pave way for better understanding and future incorporation into practice

All eyes on Coronavirus- What do we need to know as ophthalmologists .

Abstract: “Of course it is (a pandemic). We’re there. It doesn’t matter what kind of terminology you use. To me, the pandemic is a mindset. We can either use pandemic as a word that makes us all quake with fear or we can use it as a rallying cry to say—This is what we’re going to do to fight it.”—Dr. Michael Osterholm, Director, Center for Infectious Disease Research and Policy, University of Minnesota, MN, USA.

Operational guidelines for ROP in India: A summary.

Abstract: Retinopathy of Prematurity (ROP) is a potentially blinding disease of the eye that can affect infants born four or more weeks preterm and have received intensive neonatal care. ROP is a dynamic, time-bound disease that is not present at birth. Preventing visual loss from ROP in India requires scaling up services for screening and treatment for ROP to match the exponential growth in neonatal intensive care in India and other low- and middle-income countries. Operational guidelines for prevention of visual loss from ROP will facilitate rapid scale up of services, by identifying key players and their roles and responsibility in the Indian context. The guidelines recommend broad eligibility criteria for screening (gestational age ≤34 weeks, birth weight ≤2000 gms) as the special newborn care unit (SNCU) have varying quality of neonatal care. Treatment is based on the early treatment for retinopathy of prematurity (ET-ROP) study treatment criteria. The screening criteria could be revisited when more contextual evidence on the risk of ROP is available in India.

Teleconsultation at a tertiary care government medical university during COVID-19 Lockdown in India - A pilot study.

Abstract: Purpose: COVID-19 related pan- India lockdown brought teleophthalmology to the forefront The study ventures to understand the relevance of this modality in a government setup The objective is to understand the feasibility, clinical profile and addressability of patients using teleconsultation in ophthalmology at a tertiary care government medical university during the COVID-19 Lockdown in India Methods: An online survey targeting faculty members and resident doctors in a tertiary eye center in a government medical university in north India was conducted Various aspects of teleconsultation were analyzed including the number and preferential mode of consultations, commonest complaints and diagnoses made Frequency and factors mandating physical examination of patients was also analyzed Results: The questionnaire was sent to 40 ophthalmologists of whom 38 responded A total of 4880 teleconsultations were given The commonest mode of communication was by WhatsApp messages (656%) and E-mail was the least preferred medium More than 80% consultations were from previously seen patients Red eye was the commonest presenting complaint (228%), followed by watering (187%) and foreign body sensation (145%) Computer vision syndrome was the commonest diagnosis (259%) followed by conjunctivitis (177%) and refractive error (177%) About 40% required physical examination, mostly due to uncertain diagnosis (22%) or inadequate response to prescribed treatment (19%) Conclusion: Teleconsultation was feasible in a government medical university for providing ophthalmic services during lockdown WhatsApp was the preferred communication modality, computer vision syndrome was the most frequent tentative diagnosis and approximately 60% did not require in-person physical examination

Drug-induced uveitis: A review.

Abstract: Uveitis maybe induced by the use of various medications known as drug-induced uveitis (DIU), though rare it is an important cause of uveitis which one needs to be aware of. The drugs may be administered through any route including systemic, topical, and intravitreal. Ocular inflammation can be in the form of anterior, intermediate, posterior or pan uveitis, and rarely may present as episcleritis and scleritis. Identification of drug as the offending agent of uveitis is important as many a times stopping the drug may help recover the uveitis or the concomitant use of corticosteroids. An extensive literature review was done using the Pubmed. An overview of DIU is provided as it is important for us to be aware of this clinical entity.

Validation of Deep Convolutional Neural Network-based algorithm for detection of diabetic retinopathy - Artificial intelligence versus clinician for screening.

Abstract: Purpose: Deep learning is a newer and advanced subfield in artificial intelligence (AI). The aim of our study is to validate a machine-based algorithm developed based on deep convolutional neural networks as a tool for screening to detect referable diabetic retinopathy (DR). Methods: An AI algorithm to detect DR was validated at our hospital using an internal dataset consisting of 1,533 macula-centered fundus images collected retrospectively and an external validation set using Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (MESSIDOR) dataset. Images were graded by two retina specialists as any DR, prompt referral (moderate nonproliferative diabetic retinopathy (NPDR) or above or presence of macular edema) and sight-threatening DR/STDR (severe NPDR or above) and compared with AI results. Sensitivity, specificity, and area under curve (AUC) for both internal and external validation sets for any DR detection, prompt referral, and STDR were calculated. Interobserver agreement using kappa value was calculated for both the sets and two out of three agreements for DR grading was considered as ground truth to compare with AI results. Results: In the internal validation set, the overall sensitivity and specificity was 99.7% and 98.5% for Any DR detection and 98.9% and 94.84%for Prompt referral respectively. The AUC was 0.991 and 0.969 for any DR detection and prompt referral respectively. The agreement between two observers was 99.5% and 99.2% for any DR detection and prompt referral with a kappa value of 0.94 and 0.96, respectively. In the external validation set (MESSIDOR 1), the overall sensitivity and specificity was 90.4% and 91.0% for any DR detection and 94.7% and 97.4% for prompt referral, respectively. The AUC was. 907 and. 960 for any DR detection and prompt referral, respectively. The agreement between two observers was 98.5% and 97.8% for any DR detection and prompt referral with a kappa value of 0.971 and 0.980, respectively. Conclusion: With increasing diabetic population and growing demand supply gap in trained resources, AI is the future for early identification of DR and reducing blindness. This can revolutionize telescreening in ophthalmology, especially where people do not have access to specialized health care.

Post-fever retinitis - Newer concepts.

Abstract: Post-fever retinitis (PFR) is an infectious or para-infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic symptoms such as joint pain, skin rash are common during the febrile stage. On the basis of only clinical presentation, it is difficult to pin-point the exact etiology for PFR. Serological investigations, polymerase chain reaction, and knowledge of concurrent epidemics in the community may help to identify the etiological organism. Bacterial causes of PFR such as rickettsia and typhoid are treated with systemic antibiotics, with or without systemic steroid therapy, whereas PFR of viral causes such as chikungunya, dengue, West Nile virus, and Zika virus have no specific treatment and are managed with steroids. Nevertheless, many authors have advocated mere observation and the uveitis resolved with its natural course of the disease. In this article, we have discussed the clinical features, pathogenesis, investigations, and management of PFR.

Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times.

Abstract: Purpose: The objective is to analyse and report the data of teleconsultations provided to paediatric ophthalmology and strabismus patients during COVID-19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists Methods: Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro-ophthalmology was done Patients with optic nerve related disorders were excluded Study period was one month Statistical analysis of collected data was done using Microsoft excel Results: A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day) The final analysis included 161 patients after excluding optic nerve related disorders The median age was seven years We had a near equal gender distribution (53% males and 47% females) of whom a third were new cases Video calling was used in 14%, review of clinical photos shared was used in 53% Rest of the 33% were given telephonic advice Allergic conjunctivitis (14%), pseudophakia (9%), strabismus (12%), status post strabismus surgery (8%), cranial nerve palsies (11%) were common diagnoses 19% (n = 30) were advised/needed visit in emergency services on same or next day Conclusion: Our experience of teleconsultation during COVID-19 times for paediatric ophthalmology and strabismus patients was very encouraging Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage for rest As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele-ophthalmology platform can provide a reliable service in patient care

Will COVID-19 pandemic-associated lockdown increase myopia in Indian children?

Abstract: Dear Editor: Children’s lives revolve around playing outdoors, reading, indoor games, watching television but the Corona virus disease 19 outbreak has left them with limited options. Like most other Asian countries, India has also seen a gradual increase in the incidence and prevalence of myopia.[1] Increased screen‐time, prolonged near work, reduced outdoor activities are some of the important risk factors for myopia according to various studies.[2,3] Countries like China, where schools have replaced books with tablets and computers, evidently have a higher incidence of myopia.[4]

Primary eye care in India - The vision center model.

Abstract: The World Health Organization (WHO) Global Action Plan (GAP) 2014-19 emphasize providing Comprehensive Eye Care (CEC) using the health system approach to achieve Universal Eye Health Coverage (UEHC). An important aspect of CEC is Primary Eye Care (PEC). The scope of PEC varies significantly with primary health workers providing PEC in most parts of the developing world, whereas in developed nations PEC is provided by specialized personnel such as optometrists. This article focuses on delivery of PEC models in India, specifically through the vision center (VC) approach. VCs are part of a larger eye care network and provide PEC in remote rural areas of the country. The authors describe the how PEC is delivered in more than 300 VCs operated by six mentor hospitals in India under the Global Sight Initiative (GSI). Key factors compared include: The role of leadership; human resource planning, including recruitment and retention; service delivery; leveraging technology for planning and reaching key populations; financial sustainability; supply chain management; and quality and monitoring. It also discusses issues to be considered to strengthen VCs as we move ahead towards our collective goal of achieving UEHC and eliminating avoidable blindness.