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PurposeTo determine whether a community health worker (CHW) program increases referrals to local eye care providers and ultimately reduces the incidence of corneal ulcers.DesignCluster-randomized trial performed from 2014 to 2017 in rural South India.MethodsThis was a community-based study that included all inhabitants of 42 rural South Indian communities. CHWs were trained to diagnose corneal abrasions and assist participants in seeking care at a local vision center. Given the nature of the intervention, the trial was not masked. The main outcome measure was incident corneal ulcer, defined as an active infiltrate or evidence of a new opacity, as assessed by means of penlight examination during an annual door-to-door census.ResultsTwenty-one study clusters were randomized to the CHW intervention and 21 to no intervention. Vision centers diagnosed 195 corneal abrasions from the intervention clusters during the 2-year study (rate, 223 per 100,000 person-years; 95% CI, 28-1743) and 62 from the control clusters (rate, 62 per 100,000 person-years; 95% CI, 8-496; incidence rate ratio, 3.57; 95% CI, 2.01-6.35; P < .001). The estimated incidence of corneal ulceration during the study period was 60 per 100,000 person-years (95% CI, 25-141) in the intervention group and 32 per 100,000 person-years (95% CI, 13-80) in the control group (incidence rate ratio, 1.86; 95% CI, 0.5-6.4; P = .32).ConclusionsA CHW program resulted in 3.5 times more referrals to local eye care providers for corneal abrasions, but no difference could be detected in the incidence of corneal ulceration. CHW programs provide a mechanism for increasing referrals to eye hospitals.Trial registrationClinicalTrials.gov ID: NCT02284698.

Purpose: To understand the perspectives of physicians regarding the role of webinars on continuing medical education. Methods: An online survey comprising of 34 questions in nine sections was conducted using Google Forms. The link for the questionnaire was shared via e-mail and social media to practicing physicians. The survey accepted responses from September 10, 2020, to September 30, 2020. Results: In total, 509 ophthalmologists and 91 physicians from other specialties participated in the survey. The physicians were predominantly employed in nongovernmental institutes (25%) or were in private practice (33.2%). The preference was to attend a weekend webinar (62.8%), in the evening (52.8%), not extending more than 2 hours (97.7%), by ≤3 reputed national speakers (89.8%), each given 15 to 30 minutes for their presentation, and the topic being clinical or surgical skill demonstration (47.5%) or recent advances (39.5%). The residents were perceived to be the most benefited (65.3%). There was an equal preference for watching a webinar live or recorded (50.7% vs. 49.3%). Zoom Video Communications, Inc., was described as the platform that offers the best experience (43.8%). Webinars were considered to be better than conferences or continuing medical education (CME) activities (55.8%). The majority (43.8%) also preferred to get CME credit points by attending paid webinars. However, the broad consensus was that webinars should not completely replace the conferences (42.5%). Conclusion: Our survey evaluated the participants' perspective and the advantages and the disadvantages of a webinar and provides suggestions for the conduct of an ideal webinar with maximum active participation. Future programs would greatly be benefited by this survey.

Purpose To assess the outcomes of the non-valved Aurolab aqueous drainage implant (AADI) in neovascular glaucoma (NVG). Methods Data of consecutive patients with NVG who underwent AADI and had a minimum follow-up of 2 years were included. The primary outcome measure was the cumulative rate of surgical failure defined as intraocular pressure (IOP) >21 mm Hg or reduced <20% below baseline, IOP ≤5 mm Hg, reoperation for glaucoma or a complication, or loss of light perception vision. Results We included 85 eyes of 85 patients with NVG, with a mean age of 61.2±9.3 years. The most common aetiologies were proliferative diabetic retinopathy (n=43) and central retinal vein occlusion (n=24). The mean IOP decreased from 36.8±12.5 mm Hg at baseline to 15.8±7.5 mm Hg at 2-year follow-up (p<0.001) and the number of IOP-lowering medications reduced from 3.4±0.8 to 1.5±1.1 (p<0.001). The cumulative rate of failure increased from 3.1% (95% CI 1.1% to 11.8%) at 1 year to 33.8% (95% CI 20.4% to 52.5%) at 2 years. Multivariable analysis showed that eyes with open angles had a lower risk of failure (HR 0.17, 95% CI 0.10 to 1.03, p=0.09). The logarithm of minimum angle of resolution visual acuity declined from 0.98±0.7 to 1.8±1.0 at 2 years (p<0.001). Conclusion Approximately one-third of NVG eyes that received the AADI failed after 2 years of follow-up similar to other series. Early AADI implantation at the open angle stage of NVG may yield better results. [ABSTRACT FROM AUTHOR]

This article discusses the reasons for the dropout of acute primary angle closure (APAC) patients during the COVID-19 period. APAC is a serious eye condition that requires urgent treatment to prevent irreversible damage. The study found that a high percentage of APAC patients who underwent laser peripheral iridotomy (LPI) at a tertiary eye hospital were lost to follow-up within 12 months. Factors such as lack of formal education, low socioeconomic status, and increased distance traveled by the patients were identified as common reasons for poor follow-up. The study highlights the need for targeted strategies to improve follow-up in these patients. [Extracted from the article]

Purpose To report the results of a glaucoma screening campaign targeting first-degree relatives of glaucoma patients in South India. Methods 1598 glaucoma patients were contacted via letter or letter and phone call and asked to bring their siblings and children to a glaucoma screening. Participants underwent standardised eye examinations and completed questionnaires that assessed barriers to participation and awareness of glaucoma risk. Two-proportion z-tests were used to compare categorical data. Costs associated with the screening were recorded. Results 206 probands (12.9%) attended the screening along with 50 siblings and children. Probands were nearly twice as likely to attend if they had been contacted via both letter and phone call rather than letter only. Over half of probands reported that their relatives could not participate because they did not live in the region, and one-fifth reported that their relatives had other commitments. Fifty-eight per cent of the siblings and children who attended did not know that they were at increased risk for glaucoma due to their family history, and 32.0% did not know that the relative who had invited them to the screening had glaucoma. Thirteen siblings and children (26.0% of those who attended) were found to have findings concerning for glaucoma. The average cost per first-degree relative who was screened was INR2422 (£26). Conclusion Participation in this glaucoma screening campaign was poor. The major barrier to participation was distance from the screening site and associated indirect costs. Better strategies for bringing first-degree relatives in for examinations are needed. [ABSTRACT FROM AUTHOR]

Purpose: There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screening for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment. Methods: We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM. Results: The prevalence of DR in 44,599 subjects aged =40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR. Conclusion: In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM. [ABSTRACT FROM AUTHOR]