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Purpose: To compare the five-year incidence of acute post-operative endophthalmitis following cataract surgery, between centers with and without laminar air flow and high-efficiency particulate air (HEPA) filters in operating rooms. Methods: Retrospective analysis of medical records of patients operated in a single network of a tertiary and four secondary hospitals across north India. Cases of endophthalmitis were identified from the records between January 2013 and June 2018. Protocols and consumables were standardized across all hospitals. The only infrastructural difference being the presence of laminar air flow and high energy particulate air filters in operating rooms of the tertiary center. The type of surgery, along with the demographic and socio-economic details, were captured and analyzed, using z-test for proportions and logistic regression. Results: Out of 88,297 cataract surgeries conducted, 36 cases of endophthalmitis were reported. The incidence of endophthalmitis across the network was estimated to be 0.041%, (95% CI: 0.027 to 0.054). There was no statistically significant difference between the incidence of POE at the tertiary (0.042%) and secondary centers (0.039%). Certain risk factors for high endophthalmitis incidence were identified, namely patients undergoing small incision cataract surgery and belonging to lower socio-economic status. However, for both factors the difference was not statistically significant. Conclusion: The five-year incidence of acute post-operative endophthalmitis in our network was found comparable to the best reported in literature. Incidence at secondary centers, without laminar air flow and high energy particulate air filters was found comparable to that in the tertiary center having these facilities.

Background A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Objective Our organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs. Methods In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Results Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Conclusions Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. Trial Registration ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718 International Registered Report Identifier (IRRID) DERR1-10.2196/31951

This study assesses the practice patterns of diagnosing ophthalmologists, as reported by glaucoma patients attending specialty glaucoma clinics in urban and rural areas of North India, for a second opinion. Prospective cross-sectional study using a structured interview-based survey was conducted from 1 November 2011 to 31 October 2012 on patients attending two specialty glaucoma care facilities in North India. Both clinics were in North India; however, one was rural (Kaithal) and one was urban (Delhi). Patients were asked through descriptions of machines and processes, regarding practice patterns of their glaucoma diagnosing ophthalmologists. The interview was conducted by ophthalmic assistants in tune with the vernacular of the region, in a language understood by the interviewee. A total of 1506 patients consented to participate in the survey. The majority of patients reported undergoing tests for intraocular pressure measurement; however, 56–60% of these tests were carried out by the non-contact tonometer. More than 90% of patients reported no knowledge regarding the type and severity of the glaucoma they suffered from, and even less reported undergoing gonioscopy (3.6% Karnal and 16% Delhi). 84–86% patients who underwent perimetry reported undergoing at least some digital imaging of the optic disc. Better counselling of, and communication with, the patient would help increase their awareness regarding their condition and the care required. This has the potential to enable better compliance with and adherence to treatment. Standardized training of ophthalmologists to improve clinical diagnosis of glaucoma would also go a long way.

Purpose: The presence of central visual field loss does not infer the extent of peripheral visual field loss. In advanced stage glaucoma, we evaluated whether automated kinetic perimetry provided additional visual field information to that of central static perimetry. Materials and Methods: We undertook a prospective cross-sectional study of advanced-stage glaucoma defined as stages 3–4. Visual field assessment for right and left eyes was undertaken within one clinic visit using the Octopus 900 G programme and kinetic strategy. Results: We recruited 126 patients (170 eyes). Mean patient age at assessment was 55.86 years (SD 15.15). Mean kinetic reaction time was 1503.96 ms (SD 801.68). Kinetic I4e was plotted in 71% of eyes with an unadjusted area of 2513.68 degrees2 (SD 2397.91) and mean isopter radius of 23.16 degrees (SD 13.07). Kinetic I2e was plotted in 53.5% of eyes with an unadjusted area of 627.07 degrees2 (SD 1291.94) and mean isopter radius of 7.47 degrees (SD 10.59). Increased reaction time was associated with a poorer visual field (p = .001). Mean sensitivity, mean deviation and standard loss variance values on static perimetry were higher in patients who had a defined kinetic field boundary than in patients with no kinetic response to I4e stimulus (p = .0001). However, this corresponded to only small-to-medium correlation between static fields and existent kinetic fields: the presence of poor static fields did not always infer a poor kinetic visual field as poor static fields could also have good kinetic visual fields. Conclusions: Although we confirmed a lack of agreement and only a small to medium correlation between the extents of central versus peripheral visual field loss, automated kinetic perimetry did provide additional peripheral (outside the static 30-degree central field) visual field information which was clinically useful in the presence of non-informative severely defected central visual fields.

ObjectivesIn this study, we sought to evaluate the extent of further visual field that could be assessed when using stimulus size V in standard automated perimetry compared with size III in advanced stage glaucoma and whether cut-off values could be determined for when to switch from size III to size V.DesignProspective cross-sectional study.SettingSingle-centre outpatient eye clinic in India (New Delhi).ParticipantsAdvanced stage glaucoma defined as stages 3–4.InterventionCentral static perimetry with Octopus 900 G programme (size III stimulus dynamic strategy) and low vision central programme (size V stimulus dynamic strategy).Primary and secondary outcome measuresVisual field assessment for right and left eyes with both sizes III and V were undertaken within one clinic visit.ResultsWe recruited 126 patients (170 eyes). Mean patient age at assessment was 55.86 years (SD 15.15). Means (SD) for size III versus size V, respectively, were 6.94 dB (5.58) and 12.98 dB (7.77) for mean sensitivity, 20.02 dB (5.67) and 19.22 dB (7.74) for mean deviation, 5.89 dB (2.29) and 7.69 dB (2.78) for standard loss variance and 3.32 min (1.07) and 6.40 min (1.43) for test duration. All except mean deviation were significantly different between size III and V tests.ConclusionUseful visual field information was obtained with size V stimuli which allowed continued monitoring of these patients that was not possible with size III. Increased test duration, standard loss variance and mean sensitivity were found with size V, as expected, given that more visual responses were obtained with the increased target size. A switch from size III to V may be considered when mean sensitivity reaches 10 dB and/or mean deviation reaches 18 dB.

Aims: This study analyzes the prevalence and types of refractive errors among truck drivers, as well as their uptake of glasses. Subjects and Methods: Retrospective cross-sectional study of data collected between July 2017 and June 2018, through eye camps held across the national capital region. An optometrist conducted a comprehensive eye examination. Refractive error was defined as myopia (spherical equivalent of at least −0.5 diopter [D]), hyperopia (spherical equivalent of at least +0.5 D), or astigmatism (only cylinder of 0.5 D or more). Drivers requiring spectacles to read at a normal distance (35–40 cm) were categorized as having presbyopia. Those needing both distance and near vision correction were analyzed separately. Statistical Analysis: Data were analyzed for the prevalence of refractive errors and its types. Spectacles uptake and its association with age categories, number of affected eyes, type and severity of refractive errors were analyzed. Statistical analysis was carried out using R software version 3.1.1 and Excel 2013. Results: Refractive error (including presbyopia) was over 26% in the 4059 truck drivers screened. 8.8% needed distance correction, 24.3% needed near correction and 6.6% needed both, at least in one eye. Uptake was only 47% among those prescribed glasses and was higher among drivers requiring only near correction. Conclusions: Our study highlights the importance of eye examination among truckers. There is a need to increase the uptake of spectacles by increasing awareness and developing better models of spectacle delivery.

Purpose: Vision loss in Sturge-Weber syndrome (SWS), a rare congenital disorder, is primarily due to glaucoma. Methods: We reviewed the data of all consecutive SWS-associated glaucoma cases in patients who had undergone combined trabeculotomy-trabeculectomy (CTT) at a tertiary glaucoma facility between January 1993 and December 2015. We analyzed the preoperative and postoperative intraocular pressure (IOP), corneal clarity, visual acuity, success rate, need for repeat surgery, and number of topical antiglaucoma medications needed at last follow-up. Results: Twenty-six eyes of 20 patients with SWS (surgical age 0.7-96 months; mean 18.64 ± 29.74 months) had undergone primary CTT. The mean preoperative IOP was 32.76 ± 7.86 mm Hg (range 22-54 mm Hg) with medication (mean 3.11 ± 1.17; range 1-5). At the last follow-up (61-288 months); mean SD 134.73 ± 67.77 months), two eyes had IOP Conclusions: Combined trabeculotomy-trabeculectomy showed promising results as a treatment for SWS-associated glaucoma in children. Long-term visual and surgical outcomes are encouraging.

The aim of the study was to assess level of glaucoma awareness amongst glaucoma patients by studying characteristics amongst urban and rural glaucoma populations in North India. A questionnaire was designed and administered after appropriate validation amongst patients to identify determinants of glaucoma awareness. Trained personnel delivered the 11 questions to 1506 patients, aged 18 and above through random sampling. The questionnaire evaluated source of awareness, education, gender, location and age on the level of awareness of glaucoma. The outcomes were assessed based on patient’s responses. Age and education essay a significant role in glaucoma awareness. Awareness levels increased with the level of education significantly in both rural and urban settings (P value