Eye Care Hospital Research Articles

Topical mitomycin in endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in older children.

Mitomycin C has been used in ophthalmic surgery to mitigate postoperative scarring. However, the outcomes of endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction with adjunctive mitomycin C in children remain unknown. Our study was aimed to evaluate the efficacy and safety of adjunctive application of mitomycin C after endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in children. This is a retrospective chart review performed in a tertiary eye care hospital involving children with congenital nasolacrimal duct obstruction, who underwent endoscopic-assisted probing from October 2013 to August 2015. We compared children who underwent endoscopic-assisted probing with mitomycin C (mitomycin C group) versus others who underwent endoscopic-assisted probing without mitomycin C (endoscopic-assisted probing group). The mitomycin C group received 0.2 mg/ml within 4 min to the nasolacrimal duct ostium using a cotton tip applicator immediately after probing. Probing was considered successful when patient complaints of tearing were reduced or the results of the dye disappearance test were normal. Demographic data, clinical features, and intraoperative and postoperative variables were correlated to the success rate. The study sample comprised 68 lacrimal vies. The majority of children had bilateral obstruction and no previous history of probing. The mean age of the patients was approximately 4 years. Most obstructions were considered complex. The success rates were high in both groups (p>0.05). There were no adverse events related to the use of mitomycin C (p>0.05). Although mitomycin C has no adverse effects when applied to the opening of the nasolacrimal duct, its use after lacrimal probing for the treatment of congenital nasolacrimal duct obstruction does not improve the chance of success.

Early results of SubCyclo laser in glaucoma patients visiting a tertiary care hospital in South India: A pilot study

Purpose: To study the safety and effectiveness of SubCyclo (subliminal transscleral cyclophotocoagulation [TSCPC] – Vitra 810, Quantel Medical) laser procedure for patients with various subtypes of glaucoma. Methodology: This pilot study was conducted in a tertiary eye care hospital in South India from October 2019 to December 2019. The study included ten eyes of nine patients who were diagnosed with different types of glaucoma and received subliminal TSCPC under local anesthesia. The laser settings were customized based on the patients' intraocular pressure (IOP). The patients were followed up after 1 week, 1 month, and 2 months after the laser procedure. Results: Ten eyes of nine patients were treated with subliminal TSCPC and were followed up 2 months of the procedure. The mean age of the patients was 63.33 years. The mean preoperative IOP was 31 mm Hg, which reduced to 20.7 mmHg 1 week after the procedure. At 1 month, the average IOP was 19.3 and 17.3 mmHg at 2 months. The mean number of antiglaucoma medications used was 3 before the laser intervention, which reduced to 2.8 following the treatment. In our pilot study using SubCyclo laser, we observed a 33.22% drop in the IOP from the baseline after 1 week and 44.19% reduction in IOP at the 2nd month follow-up with a single laser session. Conclusions: This study concludes that a satisfactory decrease in IOP could be achieved by SubCyclo laser procedure in the early postoperative visits with a low-risk profile.

Ectasia after keratorefractive surgery: Analysis of risk factors and treatment outcomes in the Indian population.

Purpose:To analyze the risk factors in eyes developing ectasia following keratorefractive procedures. In addition, the study assessed visual outcomes following various treatment modalities for ectasia.Methods:In this retrospective study, data of patients who underwent keratorefractive procedures, presenting to the refractive services of a tertiary eye care hospital in South India between January 2016 and May 2019 was analyzed. Of these, the eyes that developed ectasia were noted and the possible risk factors were determined. Visual outcomes following treatment with corneal collagen crosslinking (CXL) with or without intracorneal ring segment implantation (ICRS) or topography-guided corneal ablation (T-PRK) were analyzed.Results:Forty eyes of 26 patients developed ectasia following keratorefractive procedures, with a mean interval of 73.1± 45.4 months between primary procedure and ectasia development. Of these, 14 patients had bilateral presentation. Identifiable risk factors included ablation depth >75 μm (59.25%), percentage of tissue altered (PTA) >40% (48.14%), residual stromal bed <300 μm (22.22%), mean refractive spherical equivalent >8 D (25.92%), inferior–superior (I–S) asymmetry >1.4D (7.40%), central corneal thickness (CCT) <500 μm (7.40%), Belin Ambrosio Display (BAD) >2.5 (7.40%), posterior float elevation maximum ≥18 μm (3.70%), and pellucid marginal degeneration (PMD; 3.70%).Conclusion:Our study shows that only 70% of the eyes demonstrated an identifiable risk factor for the development of ectasia. Ablation depth of >75 μm and the PTA >40% were the most common risk factors. Treatment following CXL with ICRS or T-PRK demonstrated significantly better visual outcomes in comparison with CXL alone.

Awareness regarding eye donation among staff of a tertiary eye care hospital in North India.

To assess the awareness, knowledge and attitude regarding eye donation in staff of a tertiary eye care hospital in North India. A prospective, cross-sectional study was conducted on the employees of a tertiary eye care centre (urban area) along with its four secondary centres (rural area). Socio-demographic profile, awareness, knowledge and attitude of 507 employees regarding eye donation were evaluated through a pretested, self-administered questionnaire. Knowledge-based questions were scored. Of the 507 participants, 327 (64.5%) participants were from medical/paramedical field (Group 1) and 180 (35.5%) were from non-medical field (Group 2). Awareness about eye donation was 99%. Twenty (3.95%) participants scored poor (0-8), 90 (17.75%) had a fair score (9-16) and 397 (78.30%) had a good score (17-24). Good knowledge was found in significantly more (P = 0.01) participants in Group 1 (77.37%) as compared to Group 2 (70.1%). Four hundred and fifty-seven (90.13%) participants were willing to pledge their eyes for donation, the prime motivational force being spreading vision to the blind [346 (68.24%)]. The perceived reasons for not pledging were religious [28 (5.52%)], thought of family getting upset [29 (5.72%)] and scepticism regarding proper usage of tissue [64 (12.62%)]. The study demonstrated that although there is a substantial awareness about eye donation, there are certain lacunae in the knowledge and perceptions among staff of an eye care hospital. With the correct knowledge and attitude, they can contribute by creating awareness and motivating the people for eye donation while carrying out their routine hospital activities.

Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results.

To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results. Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded. Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14days (2-60days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients. Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents.

Impact Of Visual Impairment Among With Cerebral Palsy

Visual impairment and Cerebral Palsy is often a significant component of multiple handicapping conditions affecting individuals. Early identification of visual impairment and treatment helps the children overall development in the sensory and motor skills through vision training. Often the visual problems are not noticed and seems unidentified due to the primary disability of Cerebral Palsy .Identification of the visual conditions like Cortical visual impairment, Field loss and visual problems of refractive errors and Strabismus at the early stage and the constant training in the visual skills will improve their functional vision and skills to a great extent. The purpose of the study is to identify the prevalence of visual conditions among cerebral palsy and the impact of the vision training in the visual skills of the children with cerebral palsy. In this descriptive study , purposive sampling techniques was used on 30 children having eye conditions of Cortical visual impairment, Refractive errors who underwent complete clinical and functional assessment at vasan eye care hospital ,Chennai were included in this study. This study states that children with the secondary problems of eye conditions need to be diagnosed at the earliest so that their visual skills on optical and optical perceptual skills may be improved to a great extend especially in their educational activities. The evaluation and management of the visual problems of this population can therefore greatly facilitate their rehabilitation. A thorough clinical assessment coupled with a functional evaluation was useful in planning suitable rehabilitation for these children in a comprehensive manner.

Comparison of Axial Length and Anterior Chamber Depth Measurement among Optical, Applanation and Immersion Biometry

Background: Precise biometry is one of the major key factors for obtaining desired refractive outcome after cataract surgery. Visual outcome strongly depends on accuracy of ocular parameters especially axial length (AL) and anterior chamber depth (ACD). It is very important to evaluate different biometry methods to have accurate measurements for IOL power calculation.&#x0D; Objective: The aim of the study is to compare and analyze the difference between the measurement of axial length (AL) and anterior chamber depth (ACD) using ultrasound applanation, immersion and optical biometry.&#x0D; Methodology: A prospective study conducted on 168 patients enrolled for cataract surgery from January 2018 to December 2018 in Dhaka Eye Care Hospital, Dhaka. 280 eyes have been tested by a single observer. Axial length (AL) and anterior chamber depth (ACD) was measured consecutively by optical, applanation and immersion biometry. The results have been statistically evaluated to establish efficacy and correlation among the three methods of biometry.&#x0D; Results: Statistical analysis showed the mean of axial length (AL) obtained from optical biometry is 23.36 ± 1.99 mm, which is 0.10mm (p=0.00) less by applanation biometry and 0.04 mm (p=0.00) less by immersion biometry. For anterior chamber depth (ACD), the mean value from optical biometry is 3.13 ± 0.47mm. This value is highest in compare to both applanation (0.002 mm less with p = 0.824) and immersion (0.04 mm less with p = 0.00) biometry. Further analysis reveals strong correlation of optical biometry with applanation biometry (r = 0.994 for AL and 0.945 for ACD) and immersion biometry (r = 0.995 for AL and 0.947 for ACD).&#x0D; Conclusion: The study reveals that among optical, applanation and immersion method the optical biometry method appeared to be the most precise way of measuring axial length (AL) and anterior chamber depth (ACD) of eye. The study also shows an excellent agreement and strong positive correlation of optical biometry with applanation and immersion biometry.&#x0D; J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 59-64

Ocular trauma in school going children- An analytical study

Ocular trauma in school going children- An analytical study - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.096, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Validation of a Customized Algorithm for the Detection of Diabetic Retinopathy from Single-Field Fundus Photographs in a Tertiary Eye Care Hospital.

The study was done to validate the real time efficacy of a customised algorithm in detecting diabetic retinopathy (DR) among diabetic patients being examined at the vitreo retinal outpatient department (VR OPD) of a tertiary care hospital, Diabetic Retinopathy algorithm showed sensitivity of 79% and specificity of 57% which is an acceptable methodology to diagnose diabetic retinopathy and avoid unnecessary referrals.

Descemet Membrane Suturing for Large Descemet Membrane Detachment After Cataract Surgery

To study the outcomes of Descemet membrane (DM) suturing for moderate to severe Descemet membrane detachment (DMD) after cataract surgery. This is a retrospective case review of all patients who underwent DM suturing for moderate to severe DMD after cataract surgery in a tertiary training eye care hospital from January 2017 to December 2017. Demographic details, type of cataract, type of cataract surgery, intraoperative complications, severity of DMD, time to repair, and post-DM suturing visual and clinical outcomes were documented. Forty-nine patients were included during the study period with a mean age of 67.7 ± 9.7 years. In total, 79.5% had immature cataracts. Median precataract LogMAR visual acuity was 0.78 (IQR 0.69-1.13). In total, 61.2% underwent manual small-incision cataract surgery, 32.6% had phacoemulsification, 2% had extracapsular cataract extraction (ECCE), and 6% underwent small-incision cataract surgery with trabeculectomy. In total, 44.9% were operated on by trainees and 55.1% were operated on by consultants. In total, 22.4% had primary air descemetopexy during the cataract surgery and failed treatment. All patients had attached DM in the immediate postoperative period. None of them had secondary angle closure glaucoma. At the final follow-up, 42 (85.7%) had clear corneas and 7 (14.3%) had corneal decompensation needing endothelial keratoplasty. Of these 7 patients, 2 (28.5%) had Fuchs dystrophy and 3 (42.8%) had associated DM loss. The median LogMAR visual acuity at the final follow-up was 0.39 (IQR 0.3-0.78). DM suturing can reattach DM, especially in moderate to severe, recurrent DMD with fewer postoperative complications and thereby reduce the need for corneal transplantation.

Barriers in utilisation of low vision assistive products.

To understand the barriers in utilisation of low vision assistive products (LVAPs) from the perspective of patients with low vision. Patients referred to low vision clinic in a tertiary eye care hospital in India who were prescribed LVAPs but were un-willing to accept the products were interviewed using questionnaires. Data pertaining to the age, diagnosis, gender, occupation, preferred LVAPs, patient's perception of vision loss and the primary reason for non-acceptance of LVAPs were analysed. A total of 235 among the 413 patients who noticed improvement in visual performance with LVAPs were unwilling to utilise these products. The questionnaire revealed that 53% of the patients who felt they were not candidates for LVAPs were experiencing severe visual impairment (p < 0.02). Non-acceptance was highest (68.6%) in patients < 15 years of age. The most common causes of non-acceptance were social stigma in patients < 40 years (41.3%; p < 0.0001), fear of loss of employment in patients 41-60 years (26.6%; p < 0.01) and low necessity in patients > 60 years (25%; p < 0.001). Denial of the magnitude of their illness was more common in patients above 60 years (16.5%). Non-acceptance rate was lowest for macular disorders (39.6%) and highest for retinitis pigmentosa (81%). Among devices, hand and stand magnifiers had the lowest non-acceptance rate (41%). Telescopes and electronic devices had the highest rate of non-acceptance (92% and 89%, respectively). Reasons for poor utilisation of LVAPs are multifactorial extending beyond affordability or accessibility. Knowledge of these barriers can help in creating content for awareness campaigns among patients, healthcare professionals and general society. Further research is necessary on the psychological and psycho social contributors to this process.

Digital eye strain among undergraduate medical students in a tertiary eye care hospital of south India – A questionnaire based study

Purpose: To assess the frequency of digital eye strain (DES) among undergraduate medical students in a tertiary eye care hospital in South India and to correlate the optical correction and device usage factors with DES related symptoms. Materials and Methods: A cross sectional questionnaire based study on undergraduate medical students was done in Yenepoya medical college over the period of 2 months after obtaining ethical clearance from institutional ethics committee, the filled questionnaire was collected, data was tabulated and analysed. Result: In our study the male to female ratio was almost equal. Out of the total 120 participants, 55.83% had symptomatic DES females were more affected (53.7%). Headache was the most common symptom experienced (73.33%) followed by Dry eyes ( 63.33%), Eye strain (53.33%). 64 (84.21%) of 76 participants who used their digital devices for > 4 hours per day and, 33 (67.34%) of 49 participants who held their device approximately at < 33cm> Conclusion: DES is more prevalent in females, and higher the hours of use of digital device, greater is the risk of DES. A greater viewing distance and high contrast reduce the chances of developing DES and hence is advisable. Frequent use of habitual refractive correction is recommended with antiglare, however, prolonged use of contact lens especially in air conditioned environment should be avoided. Keywords: Asthenopia, Blurred vision, Computer vision syndrome, Digital eye strain, Questionnaire.

Digital eye strain among undergraduate medical students in a tertiary eye care hospital of south India – A questionnaire based study

Digital eye strain among undergraduate medical students in a tertiary eye care hospital of south India – A questionnaire based study

OUTCOME OF AUTOLOGOUS LIMBAL CONJUNCTIVAL TRANSPLANTATION IN TERMS OF RECURRENCE RATE, AS THE MAIN OUTCOME MEASURE AND COMPLICATIONS AS THE SECONDARY OUTCOME

Purpose: To find the outcome of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome.&#x0D; Methods: The present study retrospective study conducted from a tertiary eye care hospital. Pterygium excision with limbal conjunctival autograft from the affected eye was performed for primary pterygium. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18 months for recurrence and other complications.&#x0D; Results: A total of 36 eyes of 36 patients with primary pterygia from November 2016 and October 2017 were included in the study. The study recruited 19 (52.7%) males and 17 (47.2%) females with mean age of 38.2 ±10.42 years. Pterygium was diagnosed more commonly in left eye(55.5%) as compare to right eye(44.4%). Out of 36 cases 32 (88.8%) cases of nasal and 4 (11.1%) cases of temporal pterygium noted. Out of 36 cases Graft edema in 1 (2.7%) case, graft retraction in 2 (5.5%) cases and 1 (2.7%) case of granuloma were noted. Any kind of pterygium recurrence and graft necrosis was not noted in present study.&#x0D; Conclusions: Pterygium excision with autologous limbal conjunctival autograft is safe and effective method to treat primary pterygium.

Study of Outcome of High Volume Manual Small Incision Cataract Surgery and Complications in Garhwal Himalayan Region

Aim of the Study: To compare High Volume with Low Volume Cataract Surgery Outcomes in a tertiary eye care hospital in Garhwal Himalayan Region, over a 30-day period, in terms of Quality as gauged in terms of Intra-operative complications and their management and Post-operative complications and their management (on day 1 and day 30).&#x0D; Materials and Methods: A prospective, randomized, observational study conducted on 300 eyes of 300 patients at a tertiary hospital, total duration of 4 months was taken for data collection. Patients were divided into 2 groups: A) those coming in the low volume season (summer months) and B) those coming in the high volume season (winter months). Normal standard protocols were followed pre/per/post operatively.&#x0D; Results: Intra-operative complications between the two months (settings) by independent t-test the p value was 1.00 which was not statistically significant (mean of complication: August=0.86+1.83; December=0.86 + 1.29). 1 month post-operative complications between the two months (settings) by independent t-test the p value was 0.56 which was not statistically significant (mean of complication: August=0.09 + 0.30; December=0.18 + 0.4).&#x0D; Conclusion: Intra-operative, post-operative complications on 1st day and at one month follow up, High Volume Cataract Surgery (greaterthan 40 Manual Small Incision Cataract surgeries) does not affect the quality when compared with Low Volume Cataract Surgery over a 30-days period in a tertiary institute in Central India.

Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh.

Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

Causes and Management Outcomes of Acquired Corneal Opacity in a Preschool Age (0-5 Years) Group: A Hospital-Based Study.

To evaluate the causes and management outcomes of acquired corneal opacity in a preschool age group (0-5 years) at a tertiary care hospital. Medical records of all cases (0-5 years) with acquired corneal opacity presenting to the cornea clinic of a tertiary eye care hospital from February 2013 to January 2014 were evaluated for age of onset, age at presentation, sex, laterality, cause of opacity, visual acuity, nutritional status, and socioeconomic class of the parents. The etiology of corneal opacity and the type of intervention with outcome at 3 months follow-up were recorded. A total of 106 cases were included in the study. The most common cause of corneal scarring was healed infective keratitis (35.8%). Chemical injury, mechanical trauma, and keratomalacia were the other causes, affecting 21.8%, 20.8%, and 16% of the cases, respectively. Optical iridectomy was the most commonly performed procedure (35.8%), followed by lens aspiration with intraocular lens implantation (17.9%) and penetrating keratoplasty (17%). The mean corrected visual acuity (spectacle or contact lens) at the time of presentation and at 3 months after treatment was 2.9 ± 0.3 (perception of light) and 2.2 ± 0.9 (hand motions) logarithm of minimum angle of resolution (logMAR) units, respectively. Chemical injury and keratomalacia are the major causes of acquired corneal opacity in preschool age groups in India and are associated with poor visual prognosis.

Strabismus and its Types in Children of Age 6 to 15 Years Presenting at A Public Sector Hospital of Karachi

Objective: To determine the frequency and types of strabismus in children aged 6-15 years presenting at tertiary eye care Hospital, Karachi. Methods: A prospective observational study was conducted from January to April 2018 at Department of Ophthalmology, Dow University Hospital, Karachi, Pakistan. All consecutive children suspected for strabismus referred to the Orthoptic clinic having 6-15 years of age of either gender without having strabismus surgery were enrolled. The vision of children, angle of deviation, types of strabismus with its diagnosis were assessed. The cover test and Hirschberg test were performed for the evaluation of strabismus. The presence of deviation of corneal Resuits: Out of 1400 children, 87 (6.21%) children were found with strabismus. Amongst these 87 strabismus patieClose Panelnts, 46 (53%) were females and 41 (47%) were males. True strabismus was observed in 74 (85.1%) patients. Comitant Esotropia was found to be higher, i.e. 40 (58%). Most of the children had greater than 6/12 distance visual acuity of both right eye (n=48, 55.2%) and left eye (n= 57, 65.5%). Similarly, greater than N10 near visual acuity of both right eye (n= 63, 72.4%) and left eye (n=65, 74.7%) was also found higher. Conclusion: The frequency of true strabismus was found higher among children referred to the Orthoptic clinic. In particular, concomitant Esotropia was the most common type of strabismus

Prevelance of diabetes mellitus in common ophthalmic disorders

Aim: To study the prevalence of diabetes mellitus in common ophthalmic diseases such as glaucoma, cataract and retinopathy. Materials and Methods: This cross sectional, observational study. The study was conducted in a tertiary eye care hospital. Patients with diseases of glaucoma, cataract and retinopathy in this study. Thorough eye examination was carried out in outward patient department at Tertiary eye care hospital. Examination was carried out in ophthalmology department with slit lamp examination, distant direct opthalmoscopy, fundus examination with the help of direct opthalmoscope, indirect opthalmoscope and slit lamp with 90D tonometry with help of applanation tonometer. First anterior segment examination was done with the help of slit lamp, and applanation tonometer after thorough examination of anterior segment, posterior segment was thoroughly examined. Pupils of patients were dilated with the help of Tropicamide 0.5% with Phenylepherine. After full dilatation of pupil fundus examination was done after 30 mins. The patients were evaluated for diabetic retinopathy and findings such as microaneurysm, dot and blot hemorrhages, venous dilatation, intraretinal microvascular aneurysm, neovascularisation at the disk, neovascularisation elsewhere, hard exudates, macular edema were noted. Results: Are during this study a total of 856 patients were included in the study. There were 42% male patients and 54% female patients. Out of 856 patients 75% were affected with cataract, 70% with retinopathy, and 58% with glaucoma. Prevalence of diabetes mellitus in glaucoma is 18.50%. Ocular disorders without diabetes mellitus in patients with cataract is 54.6, in retinopathy is 3.05% and in glaucoma is 11.56%. Conclusion: we then came to the conclusion that one of the most potential risk factor for eye diseaqses is diabetes mellitus. There were most strong association of diabetes mellitus in cataract and glaucoma. Keywords: Diabetes mellitus, Diabetic retinopathy, Dia

Neuro-Ophthalmology in South India.

We were greatly interested in the article by Dhiman et al (1) discussing their experience with neuro-ophthalmology in a central government–funded tertiary eye care hospital in North India. We wish to share our experience from a private nongovernmental organization (NGO) tertiary eye care hospital in South India. Our hospital offers services to patients in 3 tiers as per their choice: (1) paying section (where patient pays for the services); (2) free direct section (where consultation is free and the surgeries are steeply subsidized); (3) camp section (where consultation and surgeries [mainly cataract] are free). In our retrospective analysis from January 2017 to December 2017, there were 143, 946 referrals to various specialty clinics, of which 9,238 (6.4%) were referred for neuro-ophthalmic evaluation. Of these, 7,387 patients were referred from paying hospitals and 1851 were referred from free direct and camp sections. For our analysis, we included only the paying section referrals, of which 1851 patients (25%) were excluded as they turned out to be non–neuro-ophthalmic cases, compared to 16% in the study by Dhiman et al. Thus, our patient cohort comprised 5,402 patients. We compared our results with those of Dhiman et al. Optic nerve disorders were seen in 64.6% (n = 3,511) of our patients compared to 63.8% (n = 1,020) in their study. We saw 84.6% (n = 2,971) of optic nerve disorders without disc edema and 15.4% (n = 540) with disc edema compared to 67% (n = 635) and 33% (n = 335), respectively, in their study. The most common optic nerve disorder without disc edema was traumatic optic neuropathy seen in 13% (n = 383) compared to 27.7% (n = 190) in their study. In the optic disc edema group, ischemic optic neuropathy was present in 34.4% (n = 186) of cases compared to 37.6% (n = 126) in their study. Papilledema was seen in 23% (n = 124) compared to 23.2% (n = 78) in their study. The most common cranial nerve palsy occurred with the sixth nerve in 44.3% (n = 314), followed by third nerve in 26% (n = 184), fourth nerve in 11.3% (n = 80), and seventh nerve in 18.4% (n = 130). Dhiman et al reported involvement of sixth, third, fourth, and seventh nerves with frequencies of 44%, 21.9%, 20.1%, and 14%, respectively. Our comparative analysis demonstrated that the occurrence of neuro-ophthalmic diseases in 2 diverse tertiary care centers in North India (central government funded) and South India (NGO) is quite similar. We strongly agree with Dhiman et al that in a vast country like ours, with a population of over a billion people, more subspecialty-trained neuro-ophthalmologists are needed.