Efficacy of low-vision devices in elderly population with age-related macular degeneration

Purpose: Age?related macular degeneration (AMD) is a common cause of blindness, residual damage to macular area in spite of treatment necessitates visual rehabilitation by means of low?vision aids (LVAs). Methods: Thirty patients suffering from different stages of AMD requiring LVAs were included in this prospective study. Patients with nonprogressive, adequately treated AMD were enrolled over a 12?month period, prescribed requisite LVAs and followed?up for a minimum 1?month period. Before and after provision of LVAs, near work efficiencies were evaluated by calculating reading speed as words per minute (wpm) under both photopic and mesopic light conditions, and impact of poor vision on activities of daily living (ADL) was quantified by modified standard questionnaire based on Nhung X et al. questionnaire. Results: Of the 30 patients mean studied with mean age of 68 ± 10 years, 20 patients (66.7%) had dry AMD in better eye and 10 (33.3%) had wet AMD. Post?LVA, near visual acuity improved significantly and all cases were able to read some letters on near vision chart with an average improvement of 2.4 ± 0.96 lines. The different LVAs prescribed were high plus reading spectacles (up to 10 D) in 23.3%, hand?held magnifiers in 53.3%, base in prisms in 10%, stand held magnifiers in 6.7%, and bar and dome magnifiers in 3.3%. Conclusion: LVAs are effective in visual rehabilitation in patients with AMD. Self?reported reduction in visual dependency and improvement in vision?related quality of life post use of aids corroborated perceived benefit.

Retropupillary iris claw lens versus Gore-Tex assisted scleral fixated intraocular lens in children with large lens subluxations

Purpose: To compare the functional outcome of retropupillary iris claw lenses (RPIC?IOL) and scleral fixated intraocular lenses (SFIOL) in children with large lens subluxations. Methods: Sixty eyes of patients between 6 and 18 years of age having ?7 clock hour lens subluxation were included and equally divided into group A (RPIC?IOL implantation) and group B (Gore?Tex sutured SFIOL implantation). Cases with anterior and posterior segment abnormalities, trauma and glaucoma were excluded. Primary outcome was improvement in best?corrected visual acuity (BCVA) at 1.5 years. Secondary outcomes were assessment of intraocular lens (IOL) tilt, mean change in astigmatism at 1.5 years, and median operating time. All surgeries were performed by the same surgeon. Results: The mean improvement in BCVA in group A was 0.28 ± 0.41 logMAR and group B was 0.44 ± 0.45 logMAR (P = 0.3). Significant IOL tilt was seen in 4 eyes in group A (13.33%) and 5 eyes in group B (16.66%) (P = 0.120). Mean change in astigmatism was 4.38 ± 5.9D in group A and 4.91 ± 4.4D in group B (P = 0.299). The median operating time was 40 min in group A and 90 min in group B (P < 0.001). No significant posterior segment complications were seen in either technique. Conclusion: Both procedures had comparable visual outcomes. RPIC?IOL implantation was relatively quick and comparatively easier; it may be preferred in cases with high risk of retinal detachment.

Ocular sequelae in severe COVID-19 recovered patients of second wave

Purpose: To evaluate the retinal microvascular changes in patients, recovered from severe COVID?19 during the second wave of the pandemic in North India. Methods: In this observational cross?sectional study, 70 eyes of 35 patients who recovered from severe COVID?19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied. Result: The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell?inner plexiform layer (GC?IPL) was significantly reduced in comparison to controls (P < 0.001). Conclusion: Severe COVID?19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature

Clinically relevant colour album test for the colour defective medical student

Purpose: To evaluate the impact of color vision deficiency (CVD) in medical undergraduates by a more clinically applicable test. Methods: Cross?sectional study of 31 students with CVD (Ishihara diagnosed) asked to identify subject?specific signs/tests requiring color identification on a customized medical multispecialty designed color album test (CAT). They were further subjected to Farnsworth D?15 testing. Results: The error score of CVD students (4 ± 3.2) on 39 plates of color album test was highly significant as compared to the error score of color normal (0.3 ± 0.6). The CAT depicted linear correlation with Farnsworth D?15 and emerged as a valid tool of assessment. Ishihara interpretation did not correlate with the clinical impact of CVD. Nature of error suggests that CVD students can anticipate problems in dermatology, pathology, hematology, microbiology, and biochemistry. Conclusion: Color album test is a more clinically relevant test for CVD doctors to identify specialties where they can anticipate difficulties

Frequency and management of gestational diabetes mellitus according to the new diabetes in pregnancy study group of India guidelines among Sikkimese women attending tertiary teaching hospital of East Sikkim

Background: The screening of GDM is important as various pregnancy related complications are associated to it. With early screening and diagnosis, the complications associated with GDM can be reduced. Studies have shown various ethnic groups are at increasing risk of developing GDM with prevalence differing in different ethnicity. No data is available about frequency of GDM in different ethnic women of Sikkim. This study was performed to determine the frequency of GDM and its variation according to different demographic profiles of Sikkimese women.Methods: Pregnant women between 16-34 weeks of gestation, attending antenatal OPD were included for this study. All the patients were subjected to DIPSI recommended 75 gm oral glucose tolerance test. Diagnosis of impaired glucose tolerance was made when plasma glucose of ≥120-140 mg/dl and diagnosis of GDM was made when the plasma glucose of >140 mg/dl as per DIPSI guidelines.Results: A total of 202 consenting pregnant women during 16-34 weeks of pregnancy were evaluated with DIPSI recommended 75 g oral glucose tolerance test. Overall frequency of GDM was 11.9% among the Sikkimese women while 10.9% had impaired results in OGTT.Conclusions: Frequency of GDM was high (12%) in pregnant women attending tertiary hospital of Sikkim. This implies Sikkimese women should be universally screened for GDM. There was also high occurrence of GDM among Lepcha and Bhutia women which need further study to find out the contributing factors in these women.

Human Trafficking: New Challenge to Humanity

This paper addresses the situation of human trafficking inIndia. It argues that the focus on trafficking either as an issueof illegal migration or prostitution still dominates the discourseof trafficking, which prioritizes state security over humansecurity and does not adequately address the root causes oftrafficking and the insecurity of trafficked individuals. The rootcauses or vulnerability factors of trafficking such as structuralinequality, culturally sanctioned practices, poverty or economicinsecurity, organ trade, bonded labor, gender violence, whichare further exacerbated by corruption, have remainedunrecognized in academic and policy areas. This paper arguesthat emphasis needs to be given to such underlying rootcauses and modes and also crimes related to humantrafficking, that threatens human security of the traffickedpersons in India. Accordingly, it provides some preventivemeasures to address and deal with the problem.

Recurrent Headache in Pediatric Outpatients at a Public Hospital in Delhi.

This observational, descriptive study was conducted to study the clinical profile of children presenting with recurrent headaches to the general pediatric services of a tertiary-care, public hospital in northern India. 43 children, 3-18 year old (23 females, median age 10 years), were enrolled between April, 2011 to January, 2012. History, clinical examination (including fundus evaluation and detailed ophthalmological evaluation) and follow-up were done using a structured proforma. Headache diagnosis was made on the basis of International Classification of Headache Disorders, 2nd edition (ICHD-II). Headache disability and severity were assessed by pedMIDAS, and Visual analog scale and Faces scale, respectively. 26 patients (60.5%) had headache with migraine features (20, migraine without aura), 11 (25.6%) had Tension type headache (TTH), and 4 (9.3%) children had nonspecific headache. Stress was the commonest (42.3%) trigger identified by children with migraine. No patient in the study had an ophthalmological problem as cause of headache. 69.2% of migraine patients and 36% of TTH patients had been suffering from it for 1-2 years before reporting to the hospital. Majority of children with recurrent headache present late for medical attention. Ophthalmological problems are an infrequent cause of recurrent headache in these children.

Adult onset Still's disease as a cause of acute liver failure.

A 29-year old lady presented to the hospital with high-grade intermittent fever, arthritis and macular skin rash. Investigations revealed anaemia, polymorphonuclear leucocytosis and raised erythrocyte sedimentation rate. Other tests including those for antinuclear antibody and rheumatoid factor were normal. The serum ferritin level however was raised. On the basis of these parameters a diagnosis of Still's disease was made. Treatment comprising oral steroids and anti-inflammatory agents was instituted. The patient recovered and was discharged only to present ten days later following 3 episodes of generalised tonic clonic seizures. Investigations revealed a persistently high serum ferritin with abnormal liver function test results. Jaundice developed and the patient went into grade IV hepatic encephalopathy following which she died. Still's disease is an idiopathic disease, diagnosed purely on the basis of the typical clinical features of the illness which include persistent arthritis, high fever, anaemia and an erythematous rash. Treatment for Still's disease mainly includes steroids and non-steroidal anti-inflammatory agents. Second-line treatment includes that used for controlling the arthritis and comprises gold, hydroxychloroquine, penicillamine, azathioprine, methotrexate, and cyclophosphamide.

Leber's amaurosis with nephronophthisis and congenital hepatic fibrosis.

We describe a case of Leber's amaurosis in a one-year-old girl with unusual presentations. She presented with small clue like tachypnea and nystagmoid novement of eyeswhich when pursued revealed involvement like hepatic, renal and retina.