Survivors of preterm birth may present with various ocular conditions later in life. Long-term ophthalmic care in formerly preterm individuals is important as their vision may be compromised by sequelae of retinopathy of prematurity (ROP), refractive errors, strabismus, and cerebral vision impairment. They are also at risk of developing cataracts, angle closure glaucoma, and retinal detachment later in life. A protocol for follow up of preterm children with and without ROP at different ages needs to be established.

Purpose: To find the proportion of patients who are blind or have low vision prior to undergoing free cataract surgery at a tertiary referral center, selected from free eye camps. To evaluate which patient groups are more in need of free cataract surgery, a series of consecutive cases of cataract that attended free eye camps and were operated during three years, 2008-2010, were evaluated. Materials and Methods: Using computerized assessment systems, we congregated data on pre-operative visual status, diagnosis, condition of other eye, age, gender, caste, and locality for 2507 patients. Visual status was defined as per World Health Organisation (WHO) classification. Results: A total of 2507 (15.06%) operations were performed out of 16,637 cases who attended eye camps, 63.3% were blind (V.A.<3/60) patients, 19.2% were with low vision (V.A. <6/60). Five hundred and seventy-eight (23.1%) patients were between 60-64 years of age followed by 491 (19.6%) in 70-74 years of age, and 456 (18.2%) in 65-69 years of age group. About 74.9% operations were performed on patients above 60 years of age. Females outnumbered males in ratio 1.3: 1.0 and operated cases of backward caste were 86.59% in comparison to general population (13.4%). Conclusion: The demand for free surgery amongst blind patients is still high for underprivileged urban as well as rural population. Backward caste, females, and citizens of age groups 71-80 and 81-90 are most in need of services of cataract programs because of lack of awareness and affordability.

Purpose: To determine the variation in the intraocular pressure (IOP) at the same time on different days using Goldmann applanation tonometer in normal eyes. Materials and Methods: Two hundred eyes of hundred included subjects underwent detailed eye examination including vision assessment, slit lamp examination, baseline IOP measurement, and fundus examination. The IOP was measured on 4 days with the Goldmann applanation tonometer. The measurements were taken on consecutive days or separated by no more than one day between daily testing sessions. A difference of 1 hour on either side from the first day's IOP reading was considered. The readings taken on 4 days were compared to find if there was any statistical difference between them. Results: There was no significant difference between the IOP's measured at the same time on four different days in both eyes. The IOP measured in the right eye on days 1, 2, 3, 4 when compared were not statistically significant (median 12.5, 12.0, 12.0, 12.0, respectively and P-value 0.201). The IOP measured in the left eye on days 1, 2, 3, 4 when compared were also not statistically significant (median 13.0, 13.0, 12.0, 12.5, respectively and P-value 0.062). Conclusion: In normal eyes, the IOP measured using Goldmann applanation tonometer at the same time on different days within a week was not significantly different.

Purpose: The purpose was to elaborate difficulties encountered during the transition from external dacryocystorhinostomy (Ex-DCR) to endonasal endoscopic DCR (EN-DCR) by an oculoplasty surgeon and to evaluate the outcome of EN-DCR. Materials and Methods: A retrospective study of consecutive 24 patients who presented with epiphora and underwent EN-DCR between August 2008 and December 2009. All procedures except for one case were performed under general anesthesia and under the direct visualization of the rigid fiberoptic endoscope (Hopkin II, 30°, Karl Storz, Germany, endoscope). Success was measured by both improvement of the epiphora and patency of the lacrimal system on irrigation. Results: The total of 25 EN-DCRs were performed of which the first 12 together with an otorhinolaryngologist. Of 24 patients 18 were females and 6 were males. The mean age was 43.8 ± 20.2 years. In one patient, the procedure was performed bilaterally. After an average follow-up 15.92 ± 4.57 months, success was achieved in 92% of all patients. No significant intra- and post-operative complications were detected. Conclusion: The success rate of EN-DCR was 92%. The success rate of EN-DCR compares favorably with Ex-DCR. We are of the opinion that the surgery is best learned in conjunction with an otorhinolaryngologist ENT surgeon who has expertize in endoscopic nasal surgery. Although the learning curve of EN-DCR is steep and requires thorough knowledge of nasal anatomy it is to be performed by an oculoplastic surgeon to keep up with the times.

Background: Diabetic retinopathy has become a serious public health problem. Aim: To evolve a reliable and scalable model of diabetic retinopathy screening and awareness usable at the national level. Setting and Design: Community-based cross-sectional observational study. Materials and Methods: The model was used in Pune and surrounding districts in 25 locations, between March to November 2014. It involved the local communities to arrange, enrol attendees, and disseminate information about the mission before and after the program. This was done through a women's self-help group "Tanishka" with over 70,000 volunteer members distributed throughout Maharashtra. Screening was done by telemedicine using an indigenous low-cost portable retinal camera, with a remote reporting capability. All programs were reported by the vernacular press to ensure a force multiplier effect by conveying the message to its entire readership. Results and Conclusion: A total of 25 programs were held and attended by 2,965 persons. One thousand four hundred and eighteen diabetics patients were screened out of which 193 were found to have retinopathy requiring further investigation and treatment. Repeated press coverage over an extended period ensured high reader uptake. Creating awareness and screening were used simultaneously and to complement each other. Local participation, affordable indigenous technology, and awareness through the press were the three pillars of this model. The model was found to be viable, reliable, reproducible, and scalable. It can be expanded to function at a national level.

A 22-year-old female presented to us with redness, pain and intermittent blurring of vision in the left eye of one month duration. She had been diagnosed as a case of conjunctivitis elsewhere for which she was being treated with topical antibiotics. Examination of the anterior segment revealed diffuse conjunctival congestion, the presence of an inferonasal iris bulge and a streak of hyphema. Ultrasound biomicroscopy revealed an irregular echogenic mass lesion in the iris extending into the ciliary body. Fine needle aspiration cytology revealed the presence of large giant cells with multiple nuclei and pigments in the cytoplasm suggestive of Touton giant cells and multiple histiocytes confirming the diagnosis of juvenile xanthogranuloma. The patient was prescribed oral and topical steroids and the lesion resolved. Juvenile xanthogranuloma can masquerade as conjunctivitis and simple aspiration cytology can be helpful in establishing the diagnosis instead of a more invasive incision or excision biopsy.

Purpose: A cross-sectional prospective nonrandomized study was undertaken to find out whether Heidelberg retinal tomography (HRT3) and Optical coherence tomography (Stratus OCT) could be used interchangeably for the measurement of different parameters of optic nerve head in clinical practice. Materials and Methods: Measurements of disc area, cup area, rim area and cup-disc area ratio were obtained with the HRT3 and Stratus OCT printouts in 18 patients aged 20 to 70 years. True agreements between methods in measuring disc area, cup area, rim area and cup-disc area ratio were assessed using Bland-Altman statistical analysis. Eighteen patients with a mean age of 27.05 ± 5.04 years were enrolled. Result: Differences between mean (bias) were -0.81 ± 0.58 mm2 for disc area, -0.31 ± 0.32 mm2 for cup area,-0.50 ± 0.64 mm2 for rim area, -0.04 ± 0.09 for cup-disc area ratio while using HRT3 and Stratus OCT, respectively. Conclusion: Large range of differences were observed in measurements of disc area, cup area, rim area and cup-disc area ratio with HRT3 and Stratus OCT.

A 12-year-old boy presents with difficulty in night vision since 2 months. Physical examination showed polydactyly, obesity, and mental retardation. Ophthalmic evaluation with slit lamp biomicroscopy, indirect ophthalmoscopy, RetCam imaging, and electrophysiological tests were suggestive of Bardet Biedl syndrome with pigmentary retinopathy with associated vitreous hemorrhage and peripheral tractional retinal detachment. This case report shows the rare association of vitreous hemorrhage and peripheral tractional detachment in retinitis pigmentosa. Treatment with laser photocoagulation and cryotherapy to the avascular retina may be required for preventing the further deterioration of the condition.

A 14-year-old female patient presented with sudden blindness in both eyes and inability to move both upper and lower limbs for 1 day. Clinical findings, magnetic resonance imaging (MRI), and cerebro-spinal fluid (CSF) examination fulfilled the diagnostic criteria of Devic's disease, one of the rare forms of demyelinating disease. After intravenous methylprednisolone treatment, her visual acuity and motor functions returned to normal.

Purpose: To propose a novel internet based digital course to help standardize post-graduate education in Ophthalmology across all programs in India. Problem: India needs, at the least, 25,000 ophthalmologists by the year 2020, which would require growth at the rate of 300 additional training slots per year. However, lack of standardization and unequal distribution of resources in the training programs resulted in poor quality of training across most programs. We suggest that by examining the post-graduate training programs of the United States of America (USA) and United Kingdom (UK), one can formulate a standardized method of training safe, effective and efficient b>Proposed Solution: We propose that establishing a set of comprehensive, agreed-upon goals of training implemented by most programs would standardize ophthalmology post graduate training in India. These goals are defined by the following competency domains: Clinical training, surgical training, academic activities and resident as a Teacher. The most cost and resource effective way to achieve these goals may be by using internet based novel digital courseware. As exemplified by the training programs of the UK and USA, the proposed courseware will put forth a clearly defined curriculum which includes detailed methods of asessment and feedback.

Devices that evaluate corneal properties are an indispensible tool in a eye clinic nowadays. With the arrival of new technology in addition to placido based devices, the options available now are many. Cornea based refractive surgery in Indian eyes poses a challenge due to relatively thinner corneas. This is also compounded by lack of well defined, rigid and universal criteria for case selection for the same. In this article we attempt to look at the most common methods of corneal assessment in relation to the selection of candidates for corneal refractive surgery with a review of relevant literature. This is not meant to be exhaustive, but a primer to ease the clinician into understanding and taking up to learn and practice corneal evaluation.