From Antibodies to Artificial Intelligence: A Comprehensive Review of Diagnostic Challenges in Hashimoto's Thyroiditis.

Hashimoto's thyroiditis (HT) poses diagnostic challenges due to its diverse clinical presentation and the intricacies of autoimmune thyroid diseases. This comprehensive narrative review explores the evolving landscape of diagnostic challenges in HT, aiming to provide a thorough understanding of the complexities involved in its diagnosis. The diagnostic criteria for HT involve a multifaceted approach, including clinical features, laboratory findings, and imaging studies. Serum antibodies against thyroid antigens, primarily thyroperoxidase (TPO) and thyroglobulin, play a crucial role in confirming the autoimmune nature of the disease. However, seronegative HT adds complexity by presenting without detectable antibodies. The significance of addressing diagnostic challenges lies in potential delays and misdiagnoses, emphasizing the need for accurate and timely intervention. The review explores future directions, emphasizing molecular and cellular aspects, genetic factors, and the emerging field of thyroid regeneration. Standardized diagnostic criteria are essential, considering the subjective nature of the current process. The heterogeneity of disease manifestations complicates targeted treatments, necessitating a deeper understanding of clinical presentations and underlying pathophysiology. Future research directions and challenges outlined in this review contribute to advancing our understanding and improving diagnostic precision in HT.

A pilot non-randomized trial of smartphone-based anaglyph system for treatment of adult amblyopia through VR (Virtual Reality).

Purpose: To evaluate the effectiveness of amblyopia treatment through a smartphone-based anaglyph system by virtual reality (VR) in adult patients. Methods: A total of 10 subjects diagnosed with anisometropic amblyopia were enrolled during the study period. Best Corrected Visual Acuity (BCVA), stereoacuity, and contrast acuity were evaluated during three visits (at presentation, 3 months and 6 months) of smartphone-based anaglyph video run in the VR mode. All the amblyogenic factors including stereopsis, color vision, and contrast acuity were compared using Friedman two-way analysis of variance. Statistical significance was considered if P < 0.05. Results: Mean BCVA in amblyopic eye improved significantly from a logMAR value of 0.73 ± 0.64 before Virtual reality vision therapy (VRVT) to a post-training VRVT value of 0.48 ± 0.44 (P < 0.01). Mean stereoacuity changed from a value of 560.00 ± 301.58 before VRVT to a value of 263.00 ± 143.58 seconds of arc after training (VRVT) (P < 0.01). Mean accommodation changes from a value of 15.00 ± 7.40 before training or VRVT to value of 12.60 ± 6.10 cm after training (P < 0.01). Mean contrast acuity changes from a value of 1.21 ± 0.72 at presentation to a value of 1.52 ± 0.49 log unit after VRVT. Conclusion: A smartphone-based anaglyph system using VR vision therapy appears to be an effective treatment option for amblyopia in adults.

Role of 0.01% atropine in high myopic children of Moradabad, India (RAMCOM Study).

Purpose: Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy remains uncertain among high myopic children. This study aimed to evaluate the efficacy and safety of low-concentration atropine eye drop (0.01%) in high myopic children. Methods: A non-randomized, parallel-group, longitudinal interventional cohort study. Myopic children were divided into two groups: (1) the intervention arm of children who received one drop of topical 0.01% atropine once a day at bedtime and (2) the control arm, in which enrolled children who were on observation only. Repeated measurements of spherical equivalent refractive errors (SERs) were performed at baseline and 1 and 2 years after treatment. Results: A total of 37 eyes were enrolled in the intervention arm (allocated to 0.01% atropine at year 1 follow-up) and 23 eyes in the control arm. After 1 year of 0.01% atropine therapy, the myopia progression was 0.15 ± 0.9 D in the intervention group versus 1.1 ± 1 D in the control group (P = 0.001). Similarly, after 2 years of treatment, the myopia progression was 0.3 ± 1.1 D in the intervention group versus 1.4 ± 1.1 D in the control group (P ≤ 0.001). Conclusion: Compared to no treatment, 0.01% atropine treatment had shown better effect on myopia progression in high myopic children.

Refractive errors among commercial drivers.

Purpose: To determine the pattern of refractive error among commercial drivers in north India. Methods: Descriptive study with convenient sampling conducted among commercial drivers of north India. Results: A total of 213 (75.8%) heavy-vehicle and 68 (24.2%) light-vehicle drivers were screened for eye diseases. Refractive error for distance was reported in 44 (15.7%; 95% CI: 11.6-20.4) drivers. Hyperopia was reported in 23 (8.2%; 95% CI: 5.2-12) drivers, followed by myopia in 15 (5.3%; 95% CI: 3-8.6) drivers and astigmatism in six (2.1%; 95% CI: 0.7-4.5) drivers. Presbyopia was reported in 157 (55.8%) drivers. Dry eye was reported in 70 (24.9%), stereo deficiency in 77 (27.4%), and color vision deficiency in 11 (3.9%) drivers. Three drivers were diagnosed with cataract, and two were referred for retina evaluation. Conclusion: Hyperopia in both eyes was the most common refractive error. Dry eye disease and color vision deficiency were also reported. Most of the drivers were not using spectacles for refractive error correction. Due to their mobile nature, drivers with cataract and retina diseases did not turn up for follow-up.

Comparison of eyecare utilization at two service delivery levels during the COVID-19 pandemic as a measure of their impact: A multicentric retrospective analysis across four North Indian high-volume eyecare organizations.

Purpose: The purpose of this study was to assess the performance of the tertiary centers (TCS) and vision centers (VCs) of the four organizations participating in this research, once the lockdown was lifted, and to compare it with the performance during the same period of the previous year. Methods: This was a cross-sectional study assessing eyecare utilization in the first 2 months after resumption of services post the lockdown in 2020 and comparing that across the same time period in 2019. Anonymized data containing basic demographic details, proportions of patient visits and their reasons, as well as referral information was collected. The drop percentage method was used, and P values were calculated using paired t-tests. Results: Four TCs and 60 VCs were included. Overall, outpatient attendance dipped 51.2% at TCs and 27.5% at VCs, across the 2 years. At both levels of care delivery, the percentage drop in females was more than that in males; however, the overall drop at VCs was less than that at TCs, for both sexes. Eyecare utilization in pediatric populations dropped significantly more than in adult populations, across the overall sample. There was no significant change in referrals for refractive error as a proportion of total outpatients, although there was a significant decline in the same for cataract and specialty treatment. Conclusion: VCs are valuable and successful model for eyecare delivery especially in the continued aftermath of the COVID-19 pandemic.

Survival analysis of phacomorphic glaucoma at a tertiary hospital in North India.

PURPOSE: To report the intraocular pressure (IOP) and visual outcomes in patients operated for phacomorphic glaucoma in a developing country. METHODS: Patients undergone surgery for phacomorphic glaucoma between January 2015 and February 2018 with a minimum follow-up of 6 months were reviewed. Multinomial logistic regression was used to predict final visual acuity with different preoperative variables. A Kaplan-Meier analysis was done to calculate survival probabilities at different time points. RESULTS: Presenting IOP of study eye was 38.3±13.4 mmHg with 97.91% (n=94/96) patients on AGMs (mean: 2.7±1.08). Mean duration of complaints was 7.7±6.3 days. The most common postoperative complication was severe anterior chamber inflammation with or without fibrin membrane (in 29.16% eyes). The mean follow-up period was 14.5±9.2 months. At the last visit, the CDVA was 20/30 or better in 54/96 (56.25%) eyes, the mean IOP was 13.6±2.6 mmHg and 30 (31.25%) eyes required additional AGM with the mean number being 1.5±0.6. Two eyes required trabeculectomies for IOP control. The mean survival time of complete and qualified success was 28.5±1.9 and 41.2±0.05 months respectively. The probability of complete and qualified success at month 42 was 11% and 98%. Duration of complains and VCDR were found to be associated with final visual acuity. CONCLUSIONS: There was a positive correlation between shorter duration of symptoms with post-operative visual gain, but the glaucomatous damage showed a plateau effect at the IOP of around 35 mmHg. It is not the level of IOP, rather its duration which determines the degree of visual loss.

Clinical profile and treatment outcomes of Fusarium keratitis.

PURPOSE: To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis. METHODS: A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019. RESULTS: The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4-13.3; P=0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9-71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis. CONCLUSION: Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

Suture Selection for Incision Closure in Pediatric Cataract Surgery: A Dilemma for Pediatric Ophthalmologists.

PURPOSE: To measure and compare suture-related complications in children undergoing cataract surgery with a surgical incision closure performed by either a 10-0 nylon suture followed by suture removal within 1 to 2 weeks after surgery or a 10-0 polyglactin suture left in situ. METHODS: This was a prospective, non-randomized cohort study. All children with bilateral cataracts who underwent cataract surgery with a surgical incision closure by non-absorbable 10-0 nylon sutures followed by suture removal within 1 to 2 weeks after surgery in their first eye and incision closure by absorbable 10-0 polyglactin sutures left in situ after their second eye surgery. The frequency of suture-related complications (vascularization near to suture, loosening of suture, mucus accumulation, early rupture, and infective keratitis) was noted for 10-0 nylon and 10-0 polyglactin sutures. RESULTS: Eighty-two eyes of 41 children were enrolled in the study. All children were observed until 3 months after surgery. Of the 10-0 nylon sutures, 2 (4.9%) were loose and 2 (4.9%) had underlying corneal edema. The remaining sutures (n = 37, 90.2%) were removed within 1 to 2 weeks after surgery. Of the 10-0 polyglactin sutures, 5 (12.2%) were loose, 2 (4.9%) were vascularized, and 3 (7.3%) had mucus infiltration. These sutures (n = 10, 24.3%) were removed 2 to 5 weeks after the second eye surgery. The remaining polyglactin sutures (n = 31, 75.6%) were left in situ. CONCLUSIONS: A higher frequency of suture-related complications was observed with the 10-0 polyglactin sutures than the 10-0 nylon sutures. The authors recommend using 10-0 nylon sutures with suture removal within 1 to 2 weeks after surgery over using 10-0 polyglactin sutures for incision closure in pediatric cataract surgeries. [J Pediatr Ophthalmol Strabismus. 2022;59(4):243-247.].

Impact of E-Schooling on Digital Eye Strain in Coronavirus Disease Era: A Survey of 654 Students.

PURPOSE: To assess digital eye strain (DES) among schoolchildren during lockdown. METHODS: An online questionnaire-based, cross-sectional study was conducted. A validated, self-administered, electronic questionnaire was circulated among students of 5-18 years of age. The duration of data collection was from May 18, 2020 to May 24, 2020. Rasch-based Computer-Vision Symptom Scale was deployed to measure the DES. RESULTS: A total of 654 students (mean age: 12.02 ± 3.9 years) completed the survey. The average per day digital device exposure was 5.2 ± 2.2 h. A total of 507 (92.8%) children reported experiencing at least one asthenopic/dry eye symptom (AS/DS). The most prevalent symptoms were eye redness (69.1%) and heaviness of eyelids (79.7%). Significant positive correlation was reported between age and per day duration of digital device exposure (Pearson correlation 0.25; P < 0.001). Computer vision syndrome (CVS) score for spectacle users was significantly higher (P < 0.001). CVS score was found to correlate significantly with age and duration of digital device exposure (P < 0.001). CONCLUSION: Most of the students surveyed, experienced at least one symptom of DS or AS, indicating a need to educate them about the possible deleterious effects and help them adapt to the currently evolving education system.

Anterior chamber morphology changes in eyes with narrow angles by Scheimpflug imaging: Pilocarpine versus laser peripheral iridotomy.

PURPOSE: To evaluate morphometric variables, like anterior chamber angle (ACA), anterior chamber volume (ACV) and central anterior chamber depth (CACD) after pilocarpine administration and after prophylactic laser peripheral iridotomy (LPI) in eyes with primary angle-closure disease (PACD). DESIGN: Prospective cohort study METHODS: Ninety-one eyes of 91 patients with narrow angles were consecutively enrolled in this prospective interventional study. All patients were classified into primary angle-closure suspect (PACS), primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). If both eyes were eligible, one eye was randomly selected for study inclusion. ACV, ACD and ACA were evaluated using Scheimpflug imaging technology at three time points: at baseline (T0), 45 min after application of pilocarpine before LPI (T1) and at one-month post-LPI (T2). RESULTS: PACS, PAC and PACG groups included 25 (27.4%), 24 (26.3%) and 42 (46.1%) eyes, respectively. At both time points T1 and T2, mean pupil diameter, ACV and ACA changed significantly (P = 0.00). In all subgroups, ACD decreased significantly at T1 and then increased significantly at T2. ACA was widened by 6 degrees in angles < 26 degrees as compared to 3 degrees in > 26 degrees eyes. In PACG group, mean ACV increased significantly between T0 and T2 (P = 0.0). Other parameters like mean cornea volume (P = 0.27), central corneal thickness (P = 0.29) showed no significant change between time points (T0, T1 and T2). Pilocarpine instillation caused a significant increase in ACA, ACV and ACD CONCLUSION: Scheimpflug imaging detected significant changes in ACD post-LPI and post-pilocarpine in all groups. However, ACV changed significantly only in PACS and PACG. CLINICAL TRIALS REGISTRATION: Gels and blots/image manipulation: Author declares that the final image submitted represent the original data. All unprocessed images are with corresponding author and will make available if required.

"Depression, Anxiety and Stress" in a Cohort of Registered Practicing Ophthalmic Surgeons, Post Lockdown during COVID-19 Pandemic in India.

Purpose: To assess the magnitude of mental health problems among ophthalmologists in India post lockdown during COVID pandemic.Method: Cross-sectional survey conducted online on registered practising ophthalmologists of India, post lockdown at the start of elective surgeries (20th to 25th May, 2020). The degree of symptoms of depression, anxiety and stress was assessed by DASS -21 questionnaire. DASS -Subscales: DASS- D (depression), DASS- A (anxiety) and DASS-S (stress) and grading of severity (mild, moderate, severe) were analysed.Results: A total of 144 ophthalmologists aged 29-72 years responded to online survey. Of all participants, 94 (64.2%) of ophthalmologists suffered from mental health problems. Seventy six (52.7%) ophthalmologists had depression and anxiety whereas 20 (14%) reported stress. Women ophthalmologists scored highest total DASS mean score and DASS-stress mean score (p = .04 and p = .03). Results of DASS-D and DASS-A showed female preponderance (men vs women 42.5% vs 61.5%, p = .02; 42.5% vs 60%, p = .04). Severity of symptoms revealed that ophthalmologists above 40 years of age with more than 10 years' experienced severe stress (p = .005). Comprehensive ophthalmologists presented with severe stress and ophthalmologists practicing speciality with severe anxiety. Pearson's correlation analysis showed positive correlation between total DASS-21 score with each of the three subscales scores (DASS D, r-0.88: p < .001; DASS-A, r = 0.96: p = <0.001; DASS-S, r = 0.95: p < .001).Conclusion: Screening by Dass-21 scale has brought noticeable transient mental health issue among ophthalmologist to the fore. Few with high risk may require professional mental care to alleviate it.

Clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis.

PURPOSE: To report clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis. METHODS: Retrospective chart review of consecutive culture-proven Curvularia keratitis patients who presented to a tertiary eye care center in north India. Patients with mixed infections with Curvularia as one of the pathogens were also included. Standard case report form was developed to capture demographic information, clinical features, etiology, treatment, and outcome. Binary logistic regression was done to ascertain the effect of identified variables on final visual acuity. RESULTS: Medical records of 97 patients of Curvularia keratitis were reviewed. Median age of patients was 45.3 years. Seventy-nine (79.4%) patients presented during the months of September to November. History of corneal trauma was present in 69.1%. Trauma from sugarcane leaf was identified in 66.1% of cases with corneal trauma with vegetative matter. Presenting visual acuity was worse than 20/60 in 57.8% of patients. Hypopyon and pigmented plaque-like infiltrate was present in 16.5% and 28.8% of patients, respectively. Mixed infection was reported in 14.4% of cases. Median time of antifungal therapy was 24.5 days. Surgical intervention was required in 18.5% cases. Of all, 11.1% patients achieved final VA of more than 20/200 who were managed surgically as compared to 68 (86%) patients who were managed medically. Younger age, absence of comorbidities, and lesser infiltrate size were found associated with good final visual acuity. CONCLUSION: Working males were most affected by Curvularia keratitis. Corneal trauma with sugarcane leave was the most common predisposing factor in the study area. Most of the cases presented with worse visual acuity but could be managed medically.

Impact of Visual Impairment on the Wellbeing and Functional Disability of Patients with Glaucoma in India.

PURPOSE: To investigate the impact of glaucoma-associated vision loss on quality of life and social functioning in Indians. METHODS: A cross-sectional study with prospective enrollment was conducted. Participants were divided as: mild, moderate, and severe. Severity of glaucoma was stratified by the degree of binocular visual field loss in accordance with the Nelson Glaucoma Severity Scale (NGSS). The Glaucoma Quality of Life-15 (GQL-15) and a self-developed social function scale (SFS) were utilized to assess patients' wellbeing. RESULTS: A total of 260 patients (mean ± SD age = 58.1 ± 12.01 years; 106 females) participated in the study. Univariate analyses revealed a significant relationship between final quality of life score and number of anti-glaucoma medications (P = 0.01), previous surgeries (P = 0.00), patients age (P = 0.00), patients education level (P = 0.02), and severity of glaucoma (P = 0.00). Previous surgeries (P = 0.04) and severity of glaucoma (P = 0.00) were significant predictors of GQL-15 summary score. With increasing glaucoma severity, patients noted greater difficulty with peripheral vision, glare and dark adaptation, and outdoor tasks (P < 0.0001). Severe glaucoma also impacted patients' functional performance-a significant decline was observed in sense of personal (P < 0.0001) and social wellbeing (P < 0.0001). CONCLUSIONS: Patients with advanced glaucoma report significant decline in functioning, their ability to interact in community, take care of self, and do leisure activities. Glaucoma imposes greater social burden on the elderly by impacting their sense of personal safety. Targeted visual and social rehabilitative programs are necessary to improve their wellbeing and independent functioning.

Predicting visual outcome after open globe injury using classification and regression tree model: the Moradabad ocular trauma study.

OBJECTIVE: This study was conducted to identify factors associated with visual outcome in patients with open globe injuries (OGIs). DESIGN: Retrospective case series of OGIs presenting to a tertiary eye care institute in North India from October 2009 to December 2016. METHODS: A total of 157 patients with open globe injury have been included in the study. Multivariate analysis to ascertain the effects of different identified variables on the likelihood of poor visual outcome was done using binomial logistic regression. "Visual survival" (counting fingers or better) versus "minimal/no vision" (hand motion, light perception, and no light perception) was predicted using the classification and regression tree (CART) model. Main outcome measures were visual outcomes, risk factors, and rates of postoperative complications. RESULTS: Univariate analysis determined 9 predictors associated with poor visual outcome. Out of these, presence of relative afferent pupillary defect (RAPD), poor presenting visual acuity, presence of adnexal injuries, and location of injuries were the most significant predictors of vision loss. Absence of RAPD led to 79% chance of vision survival. Sixty-eight percent of patients with RAPD and initial visual acuity (VA) of less than 6/60 resulted in poor vision. CONCLUSION: The CART model is useful in predicting final VA based on some prognostic factors present initially.

Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach.

PURPOSE: To report outcome of trabeculectomy performed by single scleral suture in Indian eyes. METHODS: Non-randomized, non-masked, retrospective cohort analysis. Medical records of all consecutive patients who underwent trabeculectomy between 1 January 2011 and 31 December 2016 at CL Gupta Eye Institute, Moradabad (India), were reviewed and analyzed. Trabeculectomy was performed using single scleral suture for flap closure. The suture knot was buried inside sclera. The laser lysis of scleral suture was not done. Success was defined as complete success if an intraocular pressure (IOP) was >5 and ⩽21 mmHg without any glaucoma medications or re-surgery. Qualified success was defined as IOP ⩽21 mmHg with or without antiglaucoma medications. RESULTS: Data of 98 patients was analyzed. A total of 61 (62.2%) of them underwent trabeculectomy, and 37 (37.7%) underwent phacotrabeculectomy. The probability of complete success in patient underwent phacotrabeculectomy was 86% at 3 years, and in-patient underwent only trabeculectomy was 95% at 3 years. The probability of qualified success in patient undergone phacotrabeculectomy was 91% at 3 years, and in patient undergone only trabeculectomy was 97% at 3 years. CONCLUSION: The mean postoperative IOP was significantly less then mean preoperative IOP, at all follow-up visits. This simplified technique also resulted in high midterm success probabilities with low complication rates.

Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India.

Purpose: The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India. Methods: Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered. Results: Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes. Conclusion: Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.

Clinical profile of childhood blindness and inappropriate enrolment of children in schools for visually impaired in Uttar Pradesh, India.

PURPOSE: To assess major causes of severe visual impairment (SVI)/blindness (BL) in children studying in schools for the blind in western Uttar Pradesh, India and the extent of inappropriate enrolment of children in blind schools. METHODS: Students of five schools for the blind were examined in a tertiary care eye hospital. The anatomical sites and etiology for SVI/BL were recorded using the World Health Organization/Prevention of Blindness standard reporting form. Categorical variable were summarized using frequencies and percentages. RESULTS: A total of 93 students were examined. Male/Female ratio was 3.4:1. The most common anatomical sites of SVI/BL were the whole globe (40.3%) and the cornea (26.4%). Postnatal or childhood causes were noted in 13.8% cases. Forty-one (56.9%) students had hereditary diseases which was most likely caused by chromosomal abnormalities. Three students were having an associated disability, one was deaf and mute, one was physically handicapped, and one was intellectually challenged. Fifty-four (58%) children were blind and 21 (22.6%) children had no visual impairment but were studying in schools for the blind. CONCLUSION: Schools for the blind should be screened routinely to reduce the incidence of misdiagnosed visual impairment. This will prevent inappropriate enrolment and will definitely help in reducing the social and economic burden of society and of the schools of blind too.

Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India.

PURPOSE: The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance. METHODS: A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or) the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics. RESULTS: Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00). Paying patients were more compliant as compared to subsidized patients (P = 0.05). Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05). No other factor had significant association with compliance (P > 0.05). CONCLUSIONS: Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence.