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To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program.This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute.During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41-60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019.The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute.

PurposeAlbinism is known to disrupt emmetropisation in animal models. However, it is not clear if the same effect is seen in humans. This study aimed to investigate the refractive profile in individual diagnosed with ocular albinism (OA) and oculocutaneous albinism (OCA) based on a large dataset.MethodsRequired data from 618 individuals (61% males and 39% females) diagnosed with albinism were exported from the eyeSmart electronic medical records of L V Prasad Eye Institute. Overall, there were 112 (18%) individuals diagnosed with OA and 506 (82%) with OCA. Based on the spherical equivalent refraction (SER), individuals were classified as emmetropes, myopes, and hyperopes.ResultsThe overall spherical equivalent refraction of the individuals ranged from -25.00D to +12.00D with median 0.25 (-2.00 to 2.25). The proportion of individuals with albinism (combined OA, OCA) having hyperopia and myopia (overall: N=282;46% vs. N=245;40%) were similar (p = 0.18), and the least were with emmetropia (overall: N=91;14%). Across all the age groups (0-10, 11-20, 21-30, > 30 years) the frequency of hyperopes and myopes were significantly higher (pConclusion The presence of both high hyperopia and high myopia and very less numbers with emmetropia across all age groups indicates disrupted normal refractive development in individuals with albinism. With-the-rule astigmatism and nystagmus may result in meridional degradation of retinal image leading to impairment of normal emmetropisation process in individuals with albinism.

Purpose To describe the incidence, demographics, types and risk-factors of dry eye disease (DED) in patients presenting to a multi-tier ophthalmology hospital network in India. Methods This was an observational hospital-based study of 1,458,830 new patients presenting between 2010 and 2018. Patients with recent onset of both symptoms and signs, as defined by the tear film and ocular surface society dry eye work shop (TFOS DEWS) II guidelines, were considered as DED subjects. The data was prospectively collected using an electronic medical record system. Multiple logistic regression with odds ratio (OR) estimation was performed to identify the high risk-factors of DED. Results Overall, 21,290 (1.46%) patients were diagnosed with recent-onset DED. The incidence of DED was 2688 and 16,482 per million population in children and adults, respectively (p Conclusion The study results indicate that age, sex, residence, occupation, and socio-economic status have significant impact on development of DED. Since India is an emerging economy with a growing middle-class, increasing urban-migration and large aging population, the country is on the brink of a DED epidemic.

To report the pattern of noninfectious scleritis across a tertiary eye-care network.A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system.1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32-685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%).This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations.

India is home to 1.3 billion people. The geography and the magnitude of the population present unique challenges in the delivery of healthcare services. The implementation of electronic health records and tools for conducting predictive modeling enables opportunities to explore time series data like patient inflow to the hospital. This study aims to analyze expected outpatient visits to the tertiary eyecare network in India using datasets from a domestically developed electronic medical record system (eyeSmart™) implemented across a large multitier ophthalmology network in India. Demographic information of 3,384,157 patient visits was obtained from eyeSmart EMR from August 2010 to December 2017 across the L.V. Prasad Eye Institute network. Age, gender, date of visit and time status of the patients were selected for analysis. The datapoints for each parameter from the patient visits were modeled using the seasonal autoregressive integrated moving average (SARIMA) modeling. SARIMA (0,0,1)(0,1,7)7 provided the best fit for predicting total outpatient visits. This study describes the prediction method of forecasting outpatient visits to a large eyecare network in India. The results of our model hold the potential to be used to support the decisions of resource planning in the delivery of eyecare services to patients.

Albinism is known to disrupt emmetropisation in animal models. However, it is not clear if the same effect is seen in humans. This study aimed to investigate the refractive profile in individuals diagnosed with ocular albinism (OA) and oculocutaneous albinism (OCA) based on a large dataset.Required data from 618 individuals (61% males and 39% females) diagnosed with albinism were exported from the eyeSmart electronic medical records of L V Prasad Eye Institute. Overall, there were 112 (18%) individuals diagnosed with OA and 506 (82%) with OCA. Based on the spherical equivalent refraction (SER), individuals were classified as emmetropes, myopes, and hyperopes.The overall spherical equivalent refraction of the individuals ranged from -25.00D to + 12.00D with a median + 0.25D (-2.00 to + 2.25 D). The proportion of individuals with albinism (combined OA, OCA) having hyperopia and myopia (overall: N = 282;45.6% vs. N = 245;39.6%) were similar (p = 0.18), and the least were with emmetropia (overall: N = 91;14.7%). Across all the age groups (0-10, 11-20, 21-30, 30 years), the frequency of hyperopes and myopes was significantly higher (p 0.05) compared to emmetropes. Both high degrees of hyperopia and myopia were found in individuals diagnosed with OA and OCA. Irrespective of the albinism type, with-the-rule (70%) astigmatism was the most prevalent compared to other types of astigmatism. The frequency of with-the-rule astigmatism was significantly high in the presence of nystagmus compared to individuals with no nystagmus in both OA (75% vs 25%, p = 0.01) and OCA (77% vs 23%, p = 0.014) groups.The presence of both high hyperopia and high myopia and very few numbers with emmetropia across all age groups indicates disrupted normal refractive development in individuals with albinism. With-the-rule astigmatism and nystagmus may result in meridional degradation of the retinal image leading to impairment of normal emmetropisation process in individuals with albinism.

Aims: To determine the profile of CSCR patients from a tertiary health care set-up in India. Methods and Material: A total of 2780 (2447 males and 333 females) patients with a diagnosis of CSCR were included. Data regarding the demographics, profile of CSCR and systemic diseases, if any, were collected from a tertiary eye care network in South India from January 2012 to December 2016. Results: The prevalence of CSCR was found to be 1.7% (A total 2780 patients, with mean age of 42.3±10.1 years). A total of 2031 patients had a unilateral and 749 had bilateral involvement. Acute and chronic CSCR was seen in 1932 (69.5%) and 848 (30.5%) eyes respectively. The mean uncorrected visual acuity of the patients was 0.51±0.45 log MAR (Snellen equivalent 20/60) while the mean best corrected visual acuity was 0.32±0.40 log MAR (Snellen equivalent 20/40). History of smoking and steroid use was present in 214 (7.7%) and 758 (27.3%) individuals respectively. Hypertension and diabetes mellitus was present in 106 (3.8%) and 51 (1.8%) patients respectively. Most of patients {824 (29.6%) patients} were shift-workers. Laser was done in 336 (12.1%) acute and 223 (8%) chronic CSCR patients. Photodynamic therapy was used in 12 acute and 12 chronic cases. Conclusion: Prevalence of CSCR was 1.7%. The study provides an overview of patient profile among Indian subjects.

INTRODUCTION This article describes the implementation of a novel technology tool to capture demographic distribution and clinical presentation of patients in rural vision centers using the eyeSmart electronic medical record (EMR) app in a three-tier eyecare network in India. METHODS A two-year retrospective review of all patients who presented to the rural vision centers of LV Prasad Eye Institute (LVPEI) eyecare network was performed from September 2016 to August 2018 using an in-house developed eyeSmart EMR app. RESULTS A total of 501 771 patients were captured on the eyeSmart EMR app across the LVPEI network. The ratio of males (n=273 985, 54.60%) and females (n=227 786, 45.40%) presenting to the rural vision centers was 1.2:1. The most prevalent ocular disorder was refractive errors (n=273 720, 44.32%). CONCLUSIONS This study details the demographic distribution and prevalence of ocular disorders in a large cohort of Indian patients and demonstrates the potential for real-time analytics through the use of EMR systems. This provides rigorous evidence for the community and eyecare providers that the use of a web application/tablet app (eyeSmart) aids in providing better eyecare services in rural areas. It helps in creating government policies and improves the treatment strategies for various preventable ocular disorders in India.

Purpose: To study the relationship between the severity of myopia and the severity of diabetic retinopathy (DR) in individuals with type 1 or type 2 diabetes mellitus (DM). Methods: This retrospective study was conducted using data from electronic medical records from a multicentric eyecare network located in various geographic regions of India. Individuals with type 1 or type 2 DM were classified according to their refractive status. Severe nonproliferative DR (NPDR), PDR, or presence of clinically significant macular edema (CSME) with any type of DR was considered as vision-threatening diabetic retinopathy (VTDR). Results: A total of 472 individuals with type-1 DM (mean age 41 ± 10 years) and 9341 individuals with type-2 DM (52 ± 9 years) were enrolled. Individuals with a hyperopic refractive error had a significant positive association with the diagnosis of VTDR (odds ratio (OR) 1.26; 95%CI 1.04–1.51, P = 0.01) and moderate nonproliferative DR (OR 1.27; 95%CI 1.02–1.59, P = 0.03) in type-2 DM; however, no significant association was found in type-1 DM. After adjusting for age, gender, anisometropia, and duration of diabetes, the presence of high myopia (< - 6 D) reduced the risk of VTDR in type 2 DM (OR 0.18; 95% CI 0.04–0.77, P = 0.02), but no association was found in type 1 DM. Mild and moderate myopia had no significant association with any forms of DR in both type-1 and type-2 DM. Conclusion: Hyperopic refractive error was found to increase the risk of VTDR in persons with type 2 DM. High-myopic refractive error is protective for VTDR in type 2 DM, but not in type-1 DM.

Purpose. This study describes the development of an attachment for a smart tablet to stream live video information of an eye examination through the slit lamp. Methods. A tablet attachment was developed that enables the live streaming of video from the slit lamp from the rural vision centers of the LVPEI network. A video streaming solution like Skype Lite was used to transmit the same. The eyeSmart app was utilized for the documentation of the clinical information of the patients. Results. A tablet attachment of eyeSmart Cyclops was developed and piloted in 3 vision centers of the LVPEI network. Conclusion. The use of real-time video transmission illustrates a novel teleophthalmology solution in low resource settings to screen rural populations. The ability to transmit live video enables gathering more information than static images.