Impact of weight reduction on structural and functional parameters of the optic nerve in idiopathic intracranial hypertension.

PURPOSE: To evaluate the effect of weight reduction on the structural and functional parameters of the optic nerve in established cases of papilledema in Idiopathic Intracranial Hypertension (IIH). METHODS: A prospective observational study in early and established cases of papilledema in IIH presenting from December 2019 to February 2021. Functional parameters (visual acuity, contrast sensitivity, mean deviation, VER), structural parameters (RNFL, GCL-IPL, and optic disc height), and clinical grading of papilledema were measured at baseline and every 6 weeks for 6 months. All patients underwent medical (oral acetazolamide) and diet therapy. RESULTS: Mean body mass index (BMI) at presentation was 26.32 ± 3.52 kg/m² and the mean change in BMI over 6 months was 1.27 ± 0.50 kg/m². 67% of eyes had papilledema of grades 2-3 at the presentation. At the end of 6 months, 75% of eyes had grade 1 papilledema while 13% showed complete resolution. A reduction of 5.32 ± 3.58 in mean deviation (r = 0.316; p-value 0.01) and gain in VER P100 amplitude of 4.2 ± 2.7 µV (r = 0.40; p-value 0.003) were noted over 6 months with reduction in BMI over 6 months. A statistically significant reduction in optic disc height (ODH) was noticed with BMI reduction over 6 months (p = 0.0007; r = 0.45).A reduction of 1.72 ± 0.90 kg/m² (equivalent to 6.53% weight loss) in BMI was associated with a four-grade change in clinical grading of papilledema. CONCLUSION: Reduction in BMI had a significant impact on both structural and functional parameters of the optic nerve in IIH. The involvement of a well-certified dietician should be an integral part of treatment in IIH.

Awareness and eye health-seeking practices for cataract among urban slum population of Delhi: The North India eye disease awareness study.

PURPOSE: The objective of the study was to assess the awareness and health-seeking practices related to cataract in urban slums of Delhi. METHODS: This study design was a population-based cross-sectional study. Participants aged 18-60 years were recruited from randomly selected five slums of South Delhi. They were interviewed using a semi-structured interview schedule on awareness and eye health-seeking practices related to cataract. The practices were recorded if the respondents themselves or any other member of the family was diagnosed with cataract in previous 2 years. RESULTS: A total of 1552 respondents participated in the study, of which, 89.9% had heard of cataract but only (42%) were aware of any symptom of cataract. The common symptoms of cataract reported by the participants were white opacity in eyes (25.9%) and loss of vision (20.6%). Surgery as a treatment of cataract was known to only 559 (40.1%) participants. Awareness about surgery as treatment of cataract was significantly higher among people aged 45-60 years (adjusted odds ratio = 2.89, 95% confidence interval = 2.11-3.97) and in educated people (adjusted OR = 3.69 95% CI = 2.37-5.73). Out of 84 respondents who had been diagnosed with cataract, the health-seeking practices were observed by 70 (83.3%) participants. Among them, 51 (72.9%) had undergone surgery and another 19 (27.1%) had been advised to wait for surgery. Most of the operated patients 48 (94.1%) attended the postoperative follow-up. CONCLUSION: The study findings suggest the majority of participants have heard of cataract, but there is low awareness of its symptoms and treatment, and good eye health-seeking practices observed for cataract in urban slum population. Gaps in awareness observed can be filled up by implementing proper eye health education programs.

Models for primary eye care services in India.

Blindness and visual impairment continues to be a major public health problem in India. Availability and easy access to primary eye care services is essential for elimination of avoidable blindness. 'Vision 2020: The Right to Sight - India' envisaged the need for establishing primary eye care units named vision centers for every 50,000 population in the country by the year 2020. The government of India has given priority to develop vision centers at the level of community health centers and primary health centers under the 'National Program for Control of Blindness'. NGOs and the private sector have also initiated some models for primary eye care services. In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.