Glaucoma is estimated to affect 60.5 million persons worldwide by the year 2010.1 The estimated p... more Glaucoma is estimated to affect 60.5 million persons worldwide by the year 2010.1 The estimated prevalence of glaucoma for India is 11.9 million.2 These estimates have been derived from population based studies conducted worldwide. The availability of population based data from India is relatively recent as compared to Western countries. We present a summary of the findings from different population based studies in the country. These have been five populations based studies, three from the state of Tamil Nadu, one from Andhra Pradesh and one from Bengal (Table 1).2-6 Data from North India is unfortunately lacking. These studies have been carried out from 1993 to 2003. To our best knowledge at least one more population based study (from Central India) is underway. All these studies have used differing methodology and diagnostic criteria for glaucoma. To improve comparability the prevalence reported by different studies has been age standardized to the population of India (2001 censu...
In eye movement perimetry (EMP), the saccadic reaction time (SRT) to ‘seen’ visual stimuli are de... more In eye movement perimetry (EMP), the saccadic reaction time (SRT) to ‘seen’ visual stimuli are delayed in glaucoma. Evaluating SRT behaviour in hemi-field sectors could refine its clinical implication. The development phase included 60 controls retrospectively and for the test cohort in evaluation phase, another 30 healthy subjects and 30 glaucoma patients were recruited prospectively. The SRTs were used to calculate the normative limits within 5 predefined hemi-field sectors. Scores were assigned to probabilities for SRT at the level of 5%, 2.5% 1% and 0.5%. Per sector pair, a probability score limit (PSL) was calculated at each of the four levels and were compared with the scores obtained from the test cohort. The classification accuracy ‘normal versus abnormal’ was assessed for PSL in EMP and compared with glaucoma hemi-field test in standard automated perimetry. We found no statistically significant differences in SRTs between the mirror sectors in healthy subjects. The PSL at 2...
Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian p... more Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population. Settings and Design: Population-based cross-sectional study. Exactly 3850 subjects aged 40 years and above from Chennai city were examined at a dedicated facility in the base hospital. Materials and Methods: All subjects had a complete ophthalmic examination that included best-corrected visual acuity. Low vision and blindness were defined using World Health Organization (WHO) criteria. The influence of age, gender, literacy, and occupation was assessed using multiple logistic regression. Statistical Analysis: Chi-square test, t-test, and multivariate analysis were used. Results: Of the 4800 enumerated subjects, 3850 subjects (1710 males, 2140 females) were examined (response rate, 80.2%). The prevalence of blindness was 0.85% (95% CI 0.6–1.1%) and was positively associated with age and illiteracy. Cataract was the leading cause (57.6%) and glaucoma was the second cause (16.7%)...
To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary ... more To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that reported blindness rates for both PACG and POAG. A systematic search was performed in PubMed for articles published in English between 2000 and 2020 reporting the prevalence of POAG as well as PACG among various ethnic populations. A study was included if it was (1) population-based (2) had published prevalence and blindness rates for both PACG and POAG in the same cohort. (3) Glaucoma was defined as per the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) criteria. The proportion of blindness for both POAG and PACG for each study and the cumulative proportion taking all the studies were calculated. We included 23 studies with 78,434 participants. POAG was diagnosed in 1702 persons with 151 (8.9%) blind. There were 724 cases of PACG with 196 (27.0%) blind. The risk ratio of blindness in PACG to POAG varied from 0.73 to 10.6 among the studies. The cumulative risk ratio was 2.39 (95% confidence interval (CI); 1.99, 2.87). Risk ratios for studies including visual field restriction while defining blindness were similar to studies that did not (1.92 vs 2.64, P = 0.11). Risk ratios were also similar for studies that used greater than 2 instead of 3 or more quadrants of iridotrabecular contact to define angle closure (2.79 vs 2.25). Primary angle-closure disease is more likely to be associated with blindness.
OBJECTIVE Although there have been many population-based studies of age-related macular degenerat... more OBJECTIVE Although there have been many population-based studies of age-related macular degeneration (AMD) only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC). DESIGN Cross-sectional meta-analyses. PARTICIPANTS A total of 97,213 individuals aged 40 years and older. METHODS Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined based on standardized grading systems. GA was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall, age-, gender-, and region-specific pooled prevalence of GA. MAIN OUTCOME MEASURES Prevalence of GA per 1000 persons RESULTS: The mean age was 60.8 ±10.8 years, 42,673 (43.9%) were males. Overall, a total of 223 (0.2%) individuals had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% Confidence Interval [CI], 1.04-2.10), which was three times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97-6.43). Compared to those aged 50-59 years, the prevalence of GA rose from 0.34 per 1,000 persons (95% CI, 0.07-0.62) to 2.94 per 1,000 persons (95% CI, 1.60-4.29) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22 [95% CI, 1.23-3.23]) and rural residents (1.55 [95% CI, 0.87-2.23]). GA was more prevalent in South Asia (based on studies from India and Nepal, 3.78 per 1,000 persons; 95% CI, 1.67-5.89), compared to East Asia (based on studies from China, Korea, and Japan, 0.76 per 1000 persons; 95% CI, 0.31-1.22, P=0.006). CONCLUSIONS GA is uncommon in Asian populations compared to those of European ancestry. Even within Asia geographical differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA, and it may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.
Parikshit Gogate, Ronnie George, Partha Biswas Institutional affiliation: 1. Department of Ophtha... more Parikshit Gogate, Ronnie George, Partha Biswas Institutional affiliation: 1. Department of Ophthalmology, D.Y.Patil Medical College, Pimpri, Pune, India 2. Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Pune, India. 3. Sankara Netralaya, Medical Research Foundation, Chennai, India 4. B.B.Eye Foundation, Kolkata, West Bengal, India Source of funding: All India Ophthalmological Society, Academic & Research Committee (2014-17) Address for correspondence: Parikshit Gogate, Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, 102, Kumar Garima, Tadiwala Road, Pune, India. 411001 Email: [email protected] Disclosure: The authors declare no conflict of interest.
Supplemental Digital Content is available in the text. Precis: Phacotrabeculectomy with adjunctiv... more Supplemental Digital Content is available in the text. Precis: Phacotrabeculectomy with adjunctive mitomycin C is a good option for the management of coexisting cataract and glaucoma. Strict preoperative control of inflammation and close follow-up are essential in the management of eyes with uveitic glaucoma (UG). Purpose: The purpose of this study was to compare the outcomes of phacotrabeculectomy with adjunctive antimetabolites in the management of patients with UG and patients with primary open-angle glaucoma (POAG). Materials and Methods: A retrospective case-control study of 112 patients with UG and 120 patients with POAG who underwent phacotrabeculectomy with mitomycin C and had a follow-up of ≥12 months between January 2000 and June 2015 was performed. Patients who had undergone intraocular surgery or cyclodestructive procedures earlier were excluded. The primary outcome was intraocular pressure (IOP) control; secondary outcomes included visual acuity and complication rates. Results: IOP control was similar at the final visit in the UG group (14.52±6.74 mm Hg) and the POAG group (14.39±4.18 mm Hg) (P=0.867). Kaplan-Meier survival analysis showed a cumulative probability of survival (IOP: 6 to 18 with or without medications) in 71% and 77% at the end of 5 years (P=0.094) in the UG and POAG groups, respectively. Visual outcomes were worse in the UG group (0.5±0.68 logMAR units), as compared with the POAG group (0.27±0.47 logMAR units) (P=0.002). Complications such as cystoid macular edema (P=0.025) and posterior capsular opacification (P=0.004) were more common in the UG group. Recurrence of inflammation occurred in 34 eyes (30.04%) in the UG group. Conclusion: Meticulous control of perioperative and postoperative inflammation could have contributed to the favorable long-term outcomes of phacotrabeculectomy in UG, as compared with POAG.
ABSTRACT Purpose: The protein composition of aqueous humour (AH) has held significant relevance a... more ABSTRACT Purpose: The protein composition of aqueous humour (AH) has held significant relevance and remains to be the prime sample in the discovery of biomarkers in glaucoma. The purpose of this study is to analyze the AH protein concentrations in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) and further examine the proteome changes compared to cataract control. Methods: AH was collected from 90 POAG, 72 PACG, 78 cataracts (controls) in this study. The total protein was quantified using Bradford’s assay. Samples were subjected to trypsin digestion followed by liquid chromatography-mass spectrometry (LC-MS) for proteomic studies (n = 3 per group). The extracellular matrix has a major influence on the AH outflow, and the regulator proteins osteopontin (OPN), cathepsin D, and cystatin C detected by mass spectrometry are validated in AH samples by Western blot and turbidimetric immunoassay. Results: We observed a significant increase in protein levels of POAG (p = .0009); interestingly, a similar increase in PACG compared to cataract (p < .0001) and POAG (p = .02). Proteomics analysis identified 184, 190, and 299 proteins in control, POAG and PACG. OPN was increased in POAG (p = .0319) and PACG (p = .0103) compared to control. The precursor form of cathepsin D was increased in POAG and decreased in PACG, though not significant compared to control. Cystatin C was also increased in both POAG (p = .0310) and PACG (p = .0125) compared to control. Conclusion: In this study, we report for the first time that PACG cohort had higher total protein compared to controls. A qualitative comparison of proteomes revealed increased numbers of proteins identified in PACG. We assume that elevated levels of OPN and cystatin C in POAG and PACG along with altered cathepsin levels may contribute to ECM aberration in glaucoma.
Purpose A prospective longitudinal cohort study was performed to assess the incidence of and risk... more Purpose A prospective longitudinal cohort study was performed to assess the incidence of and risk factors for the development of glaucoma following surgery for congenital/infantile cataract. Methods One hundred and one eyes of one hundred and one children, ≤12 years of age who had follow-up of ≥24 months were included. Group I included those who underwent surgery using an anterior approach, group II included those who underwent surgery using a posterior approach, and group III included those who underwent surgery using an anterior approach along with foldable intraocular lens implantation. Standard definitions for glaucoma and glaucoma suspect were used. The Cox proportional hazard model was used to analyze risk factors for glaucoma. Results Group I: 30 eyes (29.7%); group II: 11 eyes (10.9%); group III 60 eyes (59.4%). The incidence of glaucoma + glaucoma suspect was 7.9% (95% CL: 2.6, 13.2%) in the entire group. The incidence in group I was 16.7% (95% CL 3%, 30%), in group II was 18.2% (95% CL: 0, 41%) and in group III was 1.7% (95% CL: 0, 4.9%). Gonioscopy revealed high iris insertion with grade I (modified Shaffer grading) in one eye each in the glaucoma and glaucoma suspect group and open angles in the rest. Age at surgery of ≤3 months (HR: 6.6, 95% CL: 1.4, 30.6, p = 0.01) was found to be a significant risk factor within the aphakic group. Conclusions Younger age at the time of surgery was the only identifiable risk factor for glaucoma. Glaucoma remains one of the serious vision-threatening complications following surgery for congenital and infantile cataract with the incidence varying from 2 to 60% [1-7]. Variations in the incidence reflect differences in the study populations, in the definitions of glaucoma used, in the techniques of cataract surgery performed, as well as the duration of follow-up reported. Risk factors reported for the development of glaucoma include younger age at the time of surgery, microcornea, persistent fetal vasculature, aphakia, inflammation, type of cataract, bilateral cataract, number of additional surgeries performed and a longer follow-up period [8-13]. There is, however, a paucity of information on the baseline characteristics of patients which may influence the outcome of surgery with regard to the development of glaucoma, such as central corneal thickness (CCT), preoperative horizontal corneal diameter (HCD, axial length (AXL) and preoperative gonioscopic features. We performed a prospective study on the incidence of and risk factors for the development of glaucoma following surgery for congenital/infantile cataract in children who underwent a detailed preoperative assessment.
BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA syste... more BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.ResultsIn Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individ...
To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients... more To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients with glaucoma or history of steroid responders. A retrospective study of patients who received DEX implant was conducted in a tertiary care center in India. Demographic details and IOP measurements at preinjection and postinjection were collected. The proportion of patients with and without IOP rise after DEX implant was noted, and the number of antiglaucoma medications to control the IOP was analyzed. The changes in IOP were also compared in the group with no glaucoma/steroid responder. A total of 815 patients, 767 patients in the nonglaucoma group and 48 patients in the glaucoma referral group, who underwent DEX implant were included in this study. The overall mean (SD) age of study participants was 56.3 (SD = 12.6) years. The overall mean (SD) IOP at baseline and at follow-up after injection for both nonglaucoma and glaucoma referral groups was found to be significant (P < 0.001)....
To obtain information on the prevailing practice patterns of glaucoma specialists in India. Glauc... more To obtain information on the prevailing practice patterns of glaucoma specialists in India. Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India (GSI) were surveyed. This survey, conducted in 2013, was based on an interactive audience response system. The information was obtained from 146 glaucoma specialists. Approximately half (n=83; 57%) had ≥10y of experience in managing glaucoma and were in institutional practice (n=74, 51%). Goldmann applanation tonometry was preferred by 103 (72%) specialists whilst n=25 (17.4%) used non-contact tonometer. Indentation gonioscopy was favoured by two-thirds (n=90, 66%) whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed (n=115, 86% and n=114; 83% respectively). Nearly three quarter specialists (n=96; 72%) preferred optical coherence tomography for imaging. The primary choice for treatment of angle closure disease and prima...
Conjunctival necrosis is a rare complication known to occur following use of topical antibiotics,... more Conjunctival necrosis is a rare complication known to occur following use of topical antibiotics, subconjunctival or intravitreal corticosteroid, microbial infections, chemical burns, and cryosurgery. We describe a patient who presented with severe conjunctival necrosis and glaucoma after subconjunctival injection of methylprednisolone acetate suspension (80mg/ml) andwas being treated as necrotizing scleritis.
Exfoliation syndrome (XFS) is the most common known risk factor for secondary glaucoma and a majo... more Exfoliation syndrome (XFS) is the most common known risk factor for secondary glaucoma and a major cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A, have previously been associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results across populations, and to identify new variants associated with XFS. We identified a rare protective allele at LOXL1 (p.Phe407, odds ratio (OR) = 25, P = 2.9 × 10(-14)) through deep resequencing of XFS cases and controls from nine countries. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 × 10(-8)). We identified association signals at 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the patholo...
Background: Population-based studies on the prevalence of non-strabismic anomalies of binocular v... more Background: Population-based studies on the prevalence of non-strabismic anomalies of binocular vision in ethnic Indians are more than two decades old. Based on indigenous normative data, the BAND (Binocular Vision Anomalies and Normative Data) study aims to report the prevalence of non-strabismic anomalies of binocular vision among school children in rural and urban Tamil Nadu. Methods: This population-based, cross-sectional study was designed to estimate the prevalence of non-strabismic anomalies of binocular vision in the rural and urban population of Tamil Nadu. In four schools, two each in rural and urban arms, 920 children in the age range of seven to 17 years were included in the study. Comprehensive binocular vision assessment was done for all children including evaluation of vergence and accommodative systems. In the first phase of the study, normative data of parameters of binocular vision were assessed followed by prevalence estimates of non-strabismic anomalies of binocular vision. Results: The mean and standard deviation of the age of the sample were 12.7 AE 2.7 years. The prevalence of non-strabismic anomalies of binocular vision in the urban and rural arms was found to be 31.5 and 29.6 per cent, respectively. Convergence insufficiency was the most prevalent (16.5 and 17.6 per cent in the urban and rural arms, respectively) among all the types of non-strabismic anomalies of binocular vision. There was no gender predilection and no statistically significant differences were observed between the rural and urban arms in the prevalence of non-strabismic anomalies of binocular vision (Z-test, p > 0.05). The prevalence of non-strabismic anomalies of binocular vision was found to be higher in the 13 to 17 years age group (36.2 per cent) compared to seven to 12 years (25.1 per cent) (Z-test, p < 0.05). Conclusion: Non-strabismic binocular vision anomalies are highly prevalent among school children and the prevalence increases with age. With increasing near visual demands in the higher grades, these anomalies could significantly impact the reading efficiency of children. Thus, it is recommended that screening for anomalies of binocular vision should be integrated into the conventional vision screening protocol.
The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis... more The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis and management of glaucoma among subspecialists and general ophthalmologists in India. Materials and Methods: This is an interactive audience response system (ARS) based poll of ophthalmologists attending the annual conference of the Glaucoma Society of India in 2013. Results: The information was obtained from 379 ophthalmologists (146 glaucoma specialists, 54 nonglaucoma subspecialists, and 179 general ophthalmologists). The majority of polled ophthalmologists (236; 62%) had 10 or more years of experience in ophthalmology. The glaucoma specialists differed from nonglaucomatologists in their preference for Goldmann applanation tonometer (P < 0.01), four-mirror gonioscope (P < 0.01), Humphrey perimeter (P < 0.01), laser peripheral iridotomy in primary angle closure disease (P = 0.03), postiridotomy gonioscopy (P < 0.01), and usage of antifibrotic agents during filtering surgery (P < 0.01). Optical coherence tomography was the most preferred imaging modality and was utilized more often by the subspecialists than general ophthalmologists. The ophthalmologists also differed in their choice of antiglaucoma medications. More glaucoma specialists were performing surgery on children with congenital glaucoma (P < 0.01), implanting glaucoma drainage devices (P < 0.01), and using scientific journals to upgrade knowledge (P = 0.03) than the other ophthalmologists. Conclusions: This poll is the first of its kind in India, in its usage of the ARS, and in comparing the practice patterns of care for glaucoma among subspecialists and general ophthalmologists. It has revealed substantial diversity in a few areas among those who did and did not receive specialty training in glaucoma.
Glaucoma is estimated to affect 60.5 million persons worldwide by the year 2010.1 The estimated p... more Glaucoma is estimated to affect 60.5 million persons worldwide by the year 2010.1 The estimated prevalence of glaucoma for India is 11.9 million.2 These estimates have been derived from population based studies conducted worldwide. The availability of population based data from India is relatively recent as compared to Western countries. We present a summary of the findings from different population based studies in the country. These have been five populations based studies, three from the state of Tamil Nadu, one from Andhra Pradesh and one from Bengal (Table 1).2-6 Data from North India is unfortunately lacking. These studies have been carried out from 1993 to 2003. To our best knowledge at least one more population based study (from Central India) is underway. All these studies have used differing methodology and diagnostic criteria for glaucoma. To improve comparability the prevalence reported by different studies has been age standardized to the population of India (2001 censu...
In eye movement perimetry (EMP), the saccadic reaction time (SRT) to ‘seen’ visual stimuli are de... more In eye movement perimetry (EMP), the saccadic reaction time (SRT) to ‘seen’ visual stimuli are delayed in glaucoma. Evaluating SRT behaviour in hemi-field sectors could refine its clinical implication. The development phase included 60 controls retrospectively and for the test cohort in evaluation phase, another 30 healthy subjects and 30 glaucoma patients were recruited prospectively. The SRTs were used to calculate the normative limits within 5 predefined hemi-field sectors. Scores were assigned to probabilities for SRT at the level of 5%, 2.5% 1% and 0.5%. Per sector pair, a probability score limit (PSL) was calculated at each of the four levels and were compared with the scores obtained from the test cohort. The classification accuracy ‘normal versus abnormal’ was assessed for PSL in EMP and compared with glaucoma hemi-field test in standard automated perimetry. We found no statistically significant differences in SRTs between the mirror sectors in healthy subjects. The PSL at 2...
Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian p... more Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population. Settings and Design: Population-based cross-sectional study. Exactly 3850 subjects aged 40 years and above from Chennai city were examined at a dedicated facility in the base hospital. Materials and Methods: All subjects had a complete ophthalmic examination that included best-corrected visual acuity. Low vision and blindness were defined using World Health Organization (WHO) criteria. The influence of age, gender, literacy, and occupation was assessed using multiple logistic regression. Statistical Analysis: Chi-square test, t-test, and multivariate analysis were used. Results: Of the 4800 enumerated subjects, 3850 subjects (1710 males, 2140 females) were examined (response rate, 80.2%). The prevalence of blindness was 0.85% (95% CI 0.6–1.1%) and was positively associated with age and illiteracy. Cataract was the leading cause (57.6%) and glaucoma was the second cause (16.7%)...
To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary ... more To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that reported blindness rates for both PACG and POAG. A systematic search was performed in PubMed for articles published in English between 2000 and 2020 reporting the prevalence of POAG as well as PACG among various ethnic populations. A study was included if it was (1) population-based (2) had published prevalence and blindness rates for both PACG and POAG in the same cohort. (3) Glaucoma was defined as per the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) criteria. The proportion of blindness for both POAG and PACG for each study and the cumulative proportion taking all the studies were calculated. We included 23 studies with 78,434 participants. POAG was diagnosed in 1702 persons with 151 (8.9%) blind. There were 724 cases of PACG with 196 (27.0%) blind. The risk ratio of blindness in PACG to POAG varied from 0.73 to 10.6 among the studies. The cumulative risk ratio was 2.39 (95% confidence interval (CI); 1.99, 2.87). Risk ratios for studies including visual field restriction while defining blindness were similar to studies that did not (1.92 vs 2.64, P = 0.11). Risk ratios were also similar for studies that used greater than 2 instead of 3 or more quadrants of iridotrabecular contact to define angle closure (2.79 vs 2.25). Primary angle-closure disease is more likely to be associated with blindness.
OBJECTIVE Although there have been many population-based studies of age-related macular degenerat... more OBJECTIVE Although there have been many population-based studies of age-related macular degeneration (AMD) only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC). DESIGN Cross-sectional meta-analyses. PARTICIPANTS A total of 97,213 individuals aged 40 years and older. METHODS Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined based on standardized grading systems. GA was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall, age-, gender-, and region-specific pooled prevalence of GA. MAIN OUTCOME MEASURES Prevalence of GA per 1000 persons RESULTS: The mean age was 60.8 ±10.8 years, 42,673 (43.9%) were males. Overall, a total of 223 (0.2%) individuals had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% Confidence Interval [CI], 1.04-2.10), which was three times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97-6.43). Compared to those aged 50-59 years, the prevalence of GA rose from 0.34 per 1,000 persons (95% CI, 0.07-0.62) to 2.94 per 1,000 persons (95% CI, 1.60-4.29) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22 [95% CI, 1.23-3.23]) and rural residents (1.55 [95% CI, 0.87-2.23]). GA was more prevalent in South Asia (based on studies from India and Nepal, 3.78 per 1,000 persons; 95% CI, 1.67-5.89), compared to East Asia (based on studies from China, Korea, and Japan, 0.76 per 1000 persons; 95% CI, 0.31-1.22, P=0.006). CONCLUSIONS GA is uncommon in Asian populations compared to those of European ancestry. Even within Asia geographical differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA, and it may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.
Parikshit Gogate, Ronnie George, Partha Biswas Institutional affiliation: 1. Department of Ophtha... more Parikshit Gogate, Ronnie George, Partha Biswas Institutional affiliation: 1. Department of Ophthalmology, D.Y.Patil Medical College, Pimpri, Pune, India 2. Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Pune, India. 3. Sankara Netralaya, Medical Research Foundation, Chennai, India 4. B.B.Eye Foundation, Kolkata, West Bengal, India Source of funding: All India Ophthalmological Society, Academic & Research Committee (2014-17) Address for correspondence: Parikshit Gogate, Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, 102, Kumar Garima, Tadiwala Road, Pune, India. 411001 Email: [email protected] Disclosure: The authors declare no conflict of interest.
Supplemental Digital Content is available in the text. Precis: Phacotrabeculectomy with adjunctiv... more Supplemental Digital Content is available in the text. Precis: Phacotrabeculectomy with adjunctive mitomycin C is a good option for the management of coexisting cataract and glaucoma. Strict preoperative control of inflammation and close follow-up are essential in the management of eyes with uveitic glaucoma (UG). Purpose: The purpose of this study was to compare the outcomes of phacotrabeculectomy with adjunctive antimetabolites in the management of patients with UG and patients with primary open-angle glaucoma (POAG). Materials and Methods: A retrospective case-control study of 112 patients with UG and 120 patients with POAG who underwent phacotrabeculectomy with mitomycin C and had a follow-up of ≥12 months between January 2000 and June 2015 was performed. Patients who had undergone intraocular surgery or cyclodestructive procedures earlier were excluded. The primary outcome was intraocular pressure (IOP) control; secondary outcomes included visual acuity and complication rates. Results: IOP control was similar at the final visit in the UG group (14.52±6.74 mm Hg) and the POAG group (14.39±4.18 mm Hg) (P=0.867). Kaplan-Meier survival analysis showed a cumulative probability of survival (IOP: 6 to 18 with or without medications) in 71% and 77% at the end of 5 years (P=0.094) in the UG and POAG groups, respectively. Visual outcomes were worse in the UG group (0.5±0.68 logMAR units), as compared with the POAG group (0.27±0.47 logMAR units) (P=0.002). Complications such as cystoid macular edema (P=0.025) and posterior capsular opacification (P=0.004) were more common in the UG group. Recurrence of inflammation occurred in 34 eyes (30.04%) in the UG group. Conclusion: Meticulous control of perioperative and postoperative inflammation could have contributed to the favorable long-term outcomes of phacotrabeculectomy in UG, as compared with POAG.
ABSTRACT Purpose: The protein composition of aqueous humour (AH) has held significant relevance a... more ABSTRACT Purpose: The protein composition of aqueous humour (AH) has held significant relevance and remains to be the prime sample in the discovery of biomarkers in glaucoma. The purpose of this study is to analyze the AH protein concentrations in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) and further examine the proteome changes compared to cataract control. Methods: AH was collected from 90 POAG, 72 PACG, 78 cataracts (controls) in this study. The total protein was quantified using Bradford’s assay. Samples were subjected to trypsin digestion followed by liquid chromatography-mass spectrometry (LC-MS) for proteomic studies (n = 3 per group). The extracellular matrix has a major influence on the AH outflow, and the regulator proteins osteopontin (OPN), cathepsin D, and cystatin C detected by mass spectrometry are validated in AH samples by Western blot and turbidimetric immunoassay. Results: We observed a significant increase in protein levels of POAG (p = .0009); interestingly, a similar increase in PACG compared to cataract (p < .0001) and POAG (p = .02). Proteomics analysis identified 184, 190, and 299 proteins in control, POAG and PACG. OPN was increased in POAG (p = .0319) and PACG (p = .0103) compared to control. The precursor form of cathepsin D was increased in POAG and decreased in PACG, though not significant compared to control. Cystatin C was also increased in both POAG (p = .0310) and PACG (p = .0125) compared to control. Conclusion: In this study, we report for the first time that PACG cohort had higher total protein compared to controls. A qualitative comparison of proteomes revealed increased numbers of proteins identified in PACG. We assume that elevated levels of OPN and cystatin C in POAG and PACG along with altered cathepsin levels may contribute to ECM aberration in glaucoma.
Purpose A prospective longitudinal cohort study was performed to assess the incidence of and risk... more Purpose A prospective longitudinal cohort study was performed to assess the incidence of and risk factors for the development of glaucoma following surgery for congenital/infantile cataract. Methods One hundred and one eyes of one hundred and one children, ≤12 years of age who had follow-up of ≥24 months were included. Group I included those who underwent surgery using an anterior approach, group II included those who underwent surgery using a posterior approach, and group III included those who underwent surgery using an anterior approach along with foldable intraocular lens implantation. Standard definitions for glaucoma and glaucoma suspect were used. The Cox proportional hazard model was used to analyze risk factors for glaucoma. Results Group I: 30 eyes (29.7%); group II: 11 eyes (10.9%); group III 60 eyes (59.4%). The incidence of glaucoma + glaucoma suspect was 7.9% (95% CL: 2.6, 13.2%) in the entire group. The incidence in group I was 16.7% (95% CL 3%, 30%), in group II was 18.2% (95% CL: 0, 41%) and in group III was 1.7% (95% CL: 0, 4.9%). Gonioscopy revealed high iris insertion with grade I (modified Shaffer grading) in one eye each in the glaucoma and glaucoma suspect group and open angles in the rest. Age at surgery of ≤3 months (HR: 6.6, 95% CL: 1.4, 30.6, p = 0.01) was found to be a significant risk factor within the aphakic group. Conclusions Younger age at the time of surgery was the only identifiable risk factor for glaucoma. Glaucoma remains one of the serious vision-threatening complications following surgery for congenital and infantile cataract with the incidence varying from 2 to 60% [1-7]. Variations in the incidence reflect differences in the study populations, in the definitions of glaucoma used, in the techniques of cataract surgery performed, as well as the duration of follow-up reported. Risk factors reported for the development of glaucoma include younger age at the time of surgery, microcornea, persistent fetal vasculature, aphakia, inflammation, type of cataract, bilateral cataract, number of additional surgeries performed and a longer follow-up period [8-13]. There is, however, a paucity of information on the baseline characteristics of patients which may influence the outcome of surgery with regard to the development of glaucoma, such as central corneal thickness (CCT), preoperative horizontal corneal diameter (HCD, axial length (AXL) and preoperative gonioscopic features. We performed a prospective study on the incidence of and risk factors for the development of glaucoma following surgery for congenital/infantile cataract in children who underwent a detailed preoperative assessment.
BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA syste... more BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.ResultsIn Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individ...
To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients... more To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients with glaucoma or history of steroid responders. A retrospective study of patients who received DEX implant was conducted in a tertiary care center in India. Demographic details and IOP measurements at preinjection and postinjection were collected. The proportion of patients with and without IOP rise after DEX implant was noted, and the number of antiglaucoma medications to control the IOP was analyzed. The changes in IOP were also compared in the group with no glaucoma/steroid responder. A total of 815 patients, 767 patients in the nonglaucoma group and 48 patients in the glaucoma referral group, who underwent DEX implant were included in this study. The overall mean (SD) age of study participants was 56.3 (SD = 12.6) years. The overall mean (SD) IOP at baseline and at follow-up after injection for both nonglaucoma and glaucoma referral groups was found to be significant (P < 0.001)....
To obtain information on the prevailing practice patterns of glaucoma specialists in India. Glauc... more To obtain information on the prevailing practice patterns of glaucoma specialists in India. Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India (GSI) were surveyed. This survey, conducted in 2013, was based on an interactive audience response system. The information was obtained from 146 glaucoma specialists. Approximately half (n=83; 57%) had ≥10y of experience in managing glaucoma and were in institutional practice (n=74, 51%). Goldmann applanation tonometry was preferred by 103 (72%) specialists whilst n=25 (17.4%) used non-contact tonometer. Indentation gonioscopy was favoured by two-thirds (n=90, 66%) whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed (n=115, 86% and n=114; 83% respectively). Nearly three quarter specialists (n=96; 72%) preferred optical coherence tomography for imaging. The primary choice for treatment of angle closure disease and prima...
Conjunctival necrosis is a rare complication known to occur following use of topical antibiotics,... more Conjunctival necrosis is a rare complication known to occur following use of topical antibiotics, subconjunctival or intravitreal corticosteroid, microbial infections, chemical burns, and cryosurgery. We describe a patient who presented with severe conjunctival necrosis and glaucoma after subconjunctival injection of methylprednisolone acetate suspension (80mg/ml) andwas being treated as necrotizing scleritis.
Exfoliation syndrome (XFS) is the most common known risk factor for secondary glaucoma and a majo... more Exfoliation syndrome (XFS) is the most common known risk factor for secondary glaucoma and a major cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A, have previously been associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results across populations, and to identify new variants associated with XFS. We identified a rare protective allele at LOXL1 (p.Phe407, odds ratio (OR) = 25, P = 2.9 × 10(-14)) through deep resequencing of XFS cases and controls from nine countries. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 × 10(-8)). We identified association signals at 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the patholo...
Background: Population-based studies on the prevalence of non-strabismic anomalies of binocular v... more Background: Population-based studies on the prevalence of non-strabismic anomalies of binocular vision in ethnic Indians are more than two decades old. Based on indigenous normative data, the BAND (Binocular Vision Anomalies and Normative Data) study aims to report the prevalence of non-strabismic anomalies of binocular vision among school children in rural and urban Tamil Nadu. Methods: This population-based, cross-sectional study was designed to estimate the prevalence of non-strabismic anomalies of binocular vision in the rural and urban population of Tamil Nadu. In four schools, two each in rural and urban arms, 920 children in the age range of seven to 17 years were included in the study. Comprehensive binocular vision assessment was done for all children including evaluation of vergence and accommodative systems. In the first phase of the study, normative data of parameters of binocular vision were assessed followed by prevalence estimates of non-strabismic anomalies of binocular vision. Results: The mean and standard deviation of the age of the sample were 12.7 AE 2.7 years. The prevalence of non-strabismic anomalies of binocular vision in the urban and rural arms was found to be 31.5 and 29.6 per cent, respectively. Convergence insufficiency was the most prevalent (16.5 and 17.6 per cent in the urban and rural arms, respectively) among all the types of non-strabismic anomalies of binocular vision. There was no gender predilection and no statistically significant differences were observed between the rural and urban arms in the prevalence of non-strabismic anomalies of binocular vision (Z-test, p > 0.05). The prevalence of non-strabismic anomalies of binocular vision was found to be higher in the 13 to 17 years age group (36.2 per cent) compared to seven to 12 years (25.1 per cent) (Z-test, p < 0.05). Conclusion: Non-strabismic binocular vision anomalies are highly prevalent among school children and the prevalence increases with age. With increasing near visual demands in the higher grades, these anomalies could significantly impact the reading efficiency of children. Thus, it is recommended that screening for anomalies of binocular vision should be integrated into the conventional vision screening protocol.
The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis... more The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis and management of glaucoma among subspecialists and general ophthalmologists in India. Materials and Methods: This is an interactive audience response system (ARS) based poll of ophthalmologists attending the annual conference of the Glaucoma Society of India in 2013. Results: The information was obtained from 379 ophthalmologists (146 glaucoma specialists, 54 nonglaucoma subspecialists, and 179 general ophthalmologists). The majority of polled ophthalmologists (236; 62%) had 10 or more years of experience in ophthalmology. The glaucoma specialists differed from nonglaucomatologists in their preference for Goldmann applanation tonometer (P < 0.01), four-mirror gonioscope (P < 0.01), Humphrey perimeter (P < 0.01), laser peripheral iridotomy in primary angle closure disease (P = 0.03), postiridotomy gonioscopy (P < 0.01), and usage of antifibrotic agents during filtering surgery (P < 0.01). Optical coherence tomography was the most preferred imaging modality and was utilized more often by the subspecialists than general ophthalmologists. The ophthalmologists also differed in their choice of antiglaucoma medications. More glaucoma specialists were performing surgery on children with congenital glaucoma (P < 0.01), implanting glaucoma drainage devices (P < 0.01), and using scientific journals to upgrade knowledge (P = 0.03) than the other ophthalmologists. Conclusions: This poll is the first of its kind in India, in its usage of the ARS, and in comparing the practice patterns of care for glaucoma among subspecialists and general ophthalmologists. It has revealed substantial diversity in a few areas among those who did and did not receive specialty training in glaucoma.
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