When the ophthalmologists turn blind

The cost of technology is high in ophthalmology but given the increasingly competitive environment and the social demand, there is a pressure to progressively lower the costs to the consumer. To keep costs down there is a tendency to do as many surgeries as possible in an assembly line fashion both in hospitals as well as in the charitable camps. This article provides ophthalmologists an insight into the legal pitfalls in practice of ophthalmology in India and the dangers of the constant lowering of costs of surgery as well as of free service. This lowering of costs would have been ideal in a Utopian world, but times have now changed and there is cost to be paid even for providing free service. In India the prevalent tradition of providing free service, has also resulted in a lowering of guard by the eye surgeons. These mass eye surgery assembly popularly called “free eye camps” has seen millions of people benefited. But recently there is an increase in number of cases where exorbitant penalty has been imposed by the courts, on these philanthropic surgeons for any deficiency in service, and this has destroyed the careers of many ophthalmologists. Time has now come to introspect and to factor the cost of litigation and compensations into the cost of surgeries so that we not only benefit the patients but also safeguard the ophthalmologists and help them fulfill their responsibilities towards their own dependents.

The impact of primary open-angle glaucoma: Quality of life in Indian patients

Purpose: Glaucoma significantly affects the quality of life (QoL) of a patient. Despite the huge number of glaucoma patients in India, not many, QoL studies have been carried out. The purpose of the present study was to evaluate the QoL in Indian patients with varying severity of glaucoma. Methods: This was a hospital-based, cross-sectional, analytical study of 180 patients. The QoL was assessed using orally administered QoL instruments comprising of two glaucoma-specific instruments; Glaucoma Quality of Life-15 (GQL-15) and Viswanathan 10 instrument, and 1 vision-specific instrument; National Eye Institute Visual Function Questionnaire-25 (NEIVFQ25). Results: Using NEIVFQ25, the difference between mean QoL scores among cases (88.34 ± 4.53) and controls (95.32 ± 5.76) was statistically significant. In GQL-15, there was a statistically significant difference between mean scores of cases (22.58 ± 5.23) and controls (16.52 ± 1.24). The difference in mean scores with Viswanathan 10 instrument in cases (7.92 ± 0.54) and controls (9.475 ± 0.505) was also statistically significant. QoL scores also showed moderate correlation with mean deviation, pattern standard deviation, and vertical cup-disc ratio. Conclusion: In our study, all the three instruments showed decrease in QoL in glaucoma patients compared to controls. With the increase in severity of glaucoma, corresponding decrease in QoL was observed. It is important for ophthalmologists to understand about the QoL in glaucoma patients so as to have a more holistic approach to patients and for effective delivery of treatment.

Clinical profile of Acute Pancreatitis in Malwa region of Punjab and its correlation with Balthazar CT Severity Index

Background: Acute pancreatitis is a common condition with wide clinical variation, ranging from mild self-limiting pancreatic inflammation to extensive pancreatic necrosis with life-threatening consequences. The present study aimed to assess the clinical profile of acute pancreatitis in Malwa region of Punjab where there increased prevalence of alcoholism and gall stone disease and to assess the efficacy of Ranson’s score and Balthazar Computed tomography severity index (CTSI) in predicting the prognosis. Materials and methods: 50 patients with proven acute pancreatitis were included and data was collected to study their clinical, laboratory and radiologic profile to obtain prognostic indices Ranson’s score and CTSI which were then compared with outcome. Results: Mean age recorded was 43.40 ±12.004 years with a range of 19-64 years and male to female ratio 2.12:1. 62% of patients had alcohol induced pancreatitis and 32% had gall stone pancreatitis. Observed morbidity rate was 44% and mortality rate was 6%. Most common complications encountered were pleural effusion (18%), Hypocalcemia (20%) and sterile pancreatic necrosis (20%). 18 patients had Ranson’s score more than 3, whereas 11 patients had CTSI more than 7 indicating severe acute pancreatitis. On correlation Ranson’s score was found to be more sensitive while CTSI was more specific for an adverse outcome. Conclusion: Severe acute pancreatitis remains a significant cause of morbidity and mortality due to increased prevalence both alcoholism and gall stone disease in Malwa region of Punjab. In our setup Ranson’s score and CTSI when used in combination showed improved sensitivity for detection severe acute pancreatitis.