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Background and Purpose: Empathy is essential in patient-centered compassionate health care. Lack of formal training, workload, patient factors, and digitalization have been attributed to its regression. Empathy can be nurtured by educational interventions. A structured empathy education module for postgraduate trainees is not available in India. The aim for this research was to develop, deliver, and evaluate one for ophthalmology postgraduate trainees. Methodology: This interventional study was conducted in the tertiary ophthalmology department of Western India during 2022-2023. Four workshops comprising of interactive lectures, literature, creative arts, and role plays were delivered with trained facilitators. Data from surveys for trainee self-assessment, patient perception of trainee empathy, pre-post knowledge test, and trainee and facilitator feedback were collected and analyzed. Results: Seventy-nine ophthalmology postgraduate trainees participated in this intervention. Excessive workload and lack of training were shared as the barriers to empathetic care. Trainees showed improved knowledge, skills, and attitude in empathy after the workshops. The facilitators and trainees were satisfied with the learning goals, execution, utility, feasibility, and relevance of the workshops. Ninety-three percent trainees want this module to be a part of postgraduate curriculum. Conclusion: This study substantiates the use of structured interactive training for cultivating empathy in postgraduate trainees. Barriers against empathy were identified and can be mitigated by restorative measures. Literature, arts, and role plays are the effective education tools for empathy.

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Both cataract and glaucoma significantly affect the quality of life of an individual and they are often found to coexist, either primarily or secondary to one another. Clear-cut guidelines are not available for this subgroup of coexistent morbidities. Through this article, we attempt to discuss the risks and benefits of staged and combined surgery, their short- and long-term effects on the intraocular pressure and pre and postoperative management. The indication and type of surgery will depend on the type, severity and control of glaucoma, and the clinical significance of cataract; and the surgical outcome on the surgical technique used, site of surgery, use of anti-fibrotic agents, and most importantly, the surgeon's skill and experience.

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Purpose: Ripasudil hydrochloride hydrate (0.4%) is the first Rho-associated protein kinase (ROCK) inhibitor eye drop that lowers intraocular pressure (IOP) by increasing conventional aqueous outflow through the trabecular meshwork and Schlemm's canal. We aimed to evaluate the safety and efficacy of ripasudil in patients using the maximum topical anti-glaucoma medications and with uncontrolled IOP. Methods: In our prospective interventional study, we enrolled 27 eligible and consenting patients (46 eyes) who presented to us between January 2021 and June 2021. Ripasudil 0.4% was added as adjunctive therapy to the ongoing glaucoma treatment. On follow-up visits at 7 days, 15 days, 1 month, 2 months, and 3 months, the visual acuity, IOP with applanation tonometer, anterior segment, and fundus were evaluated. The IOP before and after the use of ripasudil eye drops was compared by paired t-test. Results: Among the 27 patients, 18 were males and 9 were females. A statistically significant reduction in IOP was noted at all time durations (P < 0.00001) with the maximum reduction at 3 months with all patients achieving their target IOP. No patient developed any side effects necessitating the omission of ripasudil. The most common adverse event noted was conjunctival hyperemia (22 patients), which was mild and transient. Conclusion: Ripasudil showed additional IOP-lowering effect with other antiglaucoma medications and exhibited no significant side effects.

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Purpose: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.

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Surgical skills training and assessment have always remained a critical issue for both trainees and trainers. Ophthalmology being a microsurgical specialty, its training in the operating theater further faces a lot of challenges. Wet laboratory training and simulation training were, therefore, developed so that residents acquired certain basic skills in controlled laboratory settings before they could operate on patients and patient safety could thereby be ensured. Unfortunately, most literature focuses on the benefits such practice has on operating room performance; but not much attention has been paid to the use of such training for formative assessment, feedback, and its importance in effective learning. In this article, we highlight the challenges faced in surgical skill transfer and also give an insight into how wet or dry laboratory training can be of formative value in postgraduate training.

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Assessment is a process that includes ascertainment of improvement in the performance of students over time, motivation of students to study, evaluation of teaching methods, and ranking of student capabilities. It is an important component of the educational process influencing student learning. Although we have embarked on a new curricular model, assessment has remained largely ignored despite being the hallmark of competency-based education. During the earlier stages, the assessment was considered akin to "measurement," believing that competence is "generic, fixed and transferable across content," could be measured quantitatively and can be expressed as a single score. The objective assessment was the norm and subjective tools were considered unreliable and biased. It was soon realized that "competence is specific and nontransferable," mandating the use of multiple assessment tools across multiple content areas using multiple assessors. A paradigm change through "programmatic assessment" only occurred with the understanding that competence is "dynamic, incremental and contextual." Here, information about the students' competence and progress is gathered continually over time, analysed and supplemented with purposefully collected additional information when needed, using carefully selected combination of tools and assessor expertise, leading to an authentic, observation-driven, institutional assessment system. In the conduct of any performance assessment, the assessor remains an important part of the process, therefore making assessor training indispensable. In this paper, we look at the changing paradigms of our understanding of clinical competence, corresponding global changes in assessment and then try to make out a case for adopting the prevailing trends in the assessment of clinical competence.

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Purpose: Effective communication lies at the heart of a patient--doctor relationship. Communication skills (CS) teaching and assessment is not a part of the postgraduate (PG) curriculum. Lack of effective CS in current PG students' results in patient distrust and dissatisfaction, conflicts, and compromised healthcare. The regulatory authorities of medical education have recognized the need to inculcate soft skills among medical graduates, one of which is CS. The purpose of this study was to assess the need for teaching CS to ophthalmology PG students and develop and introduce a module for the same. Methods: In this prospective, interventional study done at the ophthalmology department of a tertiary hospital, a validated 8 day CS workshop was conducted for 60 PG students through interactive lectures, observations, video sessions, and role plays. Feedbacks were obtained through narratives, validated Google survey, reflections and verbal method and analyzed. Results: In the needs assessment done on 27 departmental faculties, 20 faculties found poor communication to be a major reason for patient complaints. All faculties agreed that CS should be taught to medical students. Statistically significant improvement in CS awareness was noted among students after the workshop. Lack of CS training, work burden, and language were identified as main barriers to effective communication. All the students were satisfied with the workshop and wanted it to be conducted regularly. Conclusion: This study establishes that CS training is essential to improve patient satisfaction and patient-doctor relationships. Barriers to effective CS could be identified, for which possible solutions could be found.

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OBJECTIVES: The study was aimed to analyze commonly used antimicrobials in outdoor patients of ophthalmology department. MATERIALS AND METHODS: The study was an observational, cross-sectional study carried out in the Department of Pharmacology and Ophthalmology after approval from the head of departments and Institutional Ethics Committee. All the patients age 18 years and above who were prescribed antimicrobials and gave consent were included in study. Data were recorded in a case study form containing relevant patient information and results of general, ocular, and special examinations along with the details of antimicrobials prescribed. Data were analyzed according to the World Health Organization/International Network for Rational Use of Drugs indicators and appropriate statistical tests. RESULTS: A total of 900 patients who were prescribed antimicrobial agents (AMAs) were included in the study. The most common chief complaint was diminution of vision (25.78%). The most common indication of use of AMAs was for treating ocular infections (50.22%). The most commonly prescribed antimicrobial group was fluoroquinolone (FQ) (63.8%) and the most common drug was moxifloxacin (35.95%). The most common dosage form of AMAs was eye drops (68.55%). The average number of drugs per encounter was 4.41. The percentage of encounters with injectables prescribed was 0.67%. The percentage of use of antibiotics was 100%. The percentage of total drugs and AMAs prescribed by generic name was 41.5 and 11.92, respectively. The percentage of antimicrobial drugs prescribed from essential drugs list was 34.24%. The mean duration of antimicrobial therapy was 7.2 ± 4.54 days. CONCLUSION: More than half of the patients are prescribed multiple AMAs. Moxifloxacin, a newer generation FQ , was the most commonly prescribed AMA in our study. Educational interventions and strict adherence to hospital antimicrobial use policy are needed to restrict the use of AMAs and increase rational prescribing.

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Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients. Due to its multifactorial etiology, surveillance of such an event is extremely important to identify the causative factor and to prevent recurrences in future. For surveillance, a team of ophthalmologists and microbiologists is often appointed by the local health department, and it is imperative that this team investigates thoroughly, reports appropriately safeguarding the interests of all, and also suggests remedial measures for future. Much literature is available on postoperative endophthalmitis and sterilization and disinfection protocols, but to the best of our knowledge, there is none to guide the surveillance team regarding the conduct of the entire process of investigation in the case of such unfortunate incidents. Through this article, we have made an attempt to formulate recommendations for expert teams investigating cases of postoperative cluster endophthalmitis.

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PURPOSE: To study the effect of injection bevacizumab on iris neovascularization (NVI) and angle neovascularization (NVA) and compare its efficacy in terms of visual outcome, NVI, NVA, and intraocular pressure (IOP) control between intracameral, intravitreal, and combined use. MATERIALS AND METHODS: This was a prospective study conducted at a tertiary center for patients of neovascular glaucoma (NVG), including 20 eyes of 20 patients. After thorough evaluation, patients were divided into three groups: Intracameral, intravitreal, or combined, according to the route of injection bevacizumab required. RESULTS: About 30% of patients belonged to the age group 51 to 60 years of which 80% were female. In 50%, vein occlusion was the cause of NVG, and 50% needed intravitreal injection bevacizumab. After 4th week of injection 90% and after 12th week 60% were found to have absence of NVI. Patients who had IOP in the range of 11 to 20 mm Hg and 21 to 30 mm Hg showed lower IOP as compared to other groups. But no significant difference was noted in higher IOP groups. Only two patients required antiglaucoma surgery. There was no statistically significant difference in visual outcomes in any groups. In all routes, there were statistically significant changes in NVI and NVG in the 1st and 4th weeks. CONCLUSION: The effect of injection in all routes deteriorates after 8 weeks. Intracameral route of injection is found to be most effective in terms of control of IOP. There was no statistically significant difference in terms of improvement in best corrected visual acuity (BCVA) in any route. Injection bevacizumab is effective and statistically significant in reducing the need of antiglaucoma surgery for NVG patients. How to cite this article: Bhagat PR, Agrawal KU, Tandel D. Study of the Effect of Injection Bevacizumab through Various Routes in Neovascular Glaucoma. J Curr Glaucoma Pract 2016;10(2):39-48.

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INTRODUCTION: Benzalkonium chloride (BAK), included as a preservative in many topical treatments for glaucoma, induces significant toxicity and alters tear breakup time (TBUT). BAK-containing latanoprost, an ester prodrug of prostaglandin F2α, can cause ocular adverse events (AEs) associated with BAK. The purpose of this study was to evaluate the efficacy and safety of BAK-free latanoprost. PATIENTS AND METHODS: A prospective, open-label, single-arm, multicenter, 8-week study in patients with primary open-angle glaucoma or ocular hypertension taking BAK-containing latanoprost for ≥12 months was performed. Patients were switched to BAK-free latanoprost ophthalmic solution 0.005% administered once daily, and eyes were assessed after 28 and 56 days. Primary efficacy and safety variables were TBUT and treatment-emergent AEs, respectively. RESULTS: At day 56, 40 eyes were evaluable. Mean TBUT increased significantly from baseline (3.67±1.60 seconds) to 5.03±2.64 and 6.06±3.39 seconds after 28 and 56 days of treatment with BAK-free latanoprost (P<0.0001). Ocular Surface Disease Index(©) (OSDI(©)) score also decreased significantly to 12.06±13.40 and 7.06±10.75 at 28 and 56 days, respectively, versus baseline (18.09±18.61, P<0.0001). In addition, inferior corneal staining score decreased significantly to 0.53 from baseline (0.85, P=0.0033). A reduction in conjunctival hyperemia and intraocular pressure was observed at both time points. No treatment-related serious AEs were evident and 12 (26.08%) treatment-emergent AEs occurred in seven patients, with eye pain and irritation being the most frequent. No clinically significant changes in vital signs or slit lamp examinations were observed. CONCLUSION: Results indicate that switching from BAK-containing latanoprost to BAK-free latanoprost resulted in significant improvements in TBUT, OSDI(©) score, and inferior corneal staining score, and measurable reductions in conjunctival hyperemia score. Furthermore, BAK-free latanoprost was well tolerated with only mild-to-moderate and self-limiting AEs. BAK-free latanoprost appears to be effective in protecting ocular surface integrity in glaucoma patients but further studies are needed to confirm this beneficial effect.

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BACKGROUND: Benzalkonium chloride (BAK) is a common preservative in topical ocular preparations; however, prolonged use may lead to deleterious effects on the ocular surface, affecting quality of life and reducing adherence to treatment and overall outcomes. This study compared the intraocular pressure (IOP)-lowering efficacy and safety of a novel once-daily, BAK-free, fixed-dose combination of latanoprost plus timolol with latanoprost or timolol administered as monotherapy or concomitantly. METHODS: This was a 6-week, randomized, open-label, parallel-group, active-controlled study in patients aged ≥18 years with open-angle glaucoma or ocular hypertension. A total of 227 patients were randomized to either a once-daily, BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% ophthalmic solution or concomitant administration of once-daily latanoprost 0.005% plus twice-daily timolol 0.5% or once-daily latanoprost 0.005% monotherapy, or twice-daily timolol 0.5% monotherapy. Efficacy end points were assessed at three time points on visits at weeks 1, 2, 4, and 6 versus baseline. RESULTS: The IOP-lowering efficacy of the fixed-dose combination of latanoprost/timolol was similar to that of latanoprost plus timolol administered concomitantly at all time points (mean IOP difference and 95% confidence interval within ±1.5 mmHg; P=0.4223 to P=0.9981). The fixed-dose combination of latanoprost/timolol demonstrated significantly better IOP-lowering efficacy than timolol monotherapy at all time points (P=0.001 to P<0.0001) and significantly better IOP-lowering efficacy than latanoprost monotherapy at all time points. Responder rates on at least one time point and on at least two time points with fixed-dose combination latanoprost/timolol were similar to those with concomitant latanoprost plus timolol (85.5% versus 82.1%, P=0.6360; 78.2% versus 75%, P=0.6923), but significantly better than either latanoprost or timolol monotherapy (68.5%, P=0.0355; 55.4%, P=0.0005; 57.4%, P=0.0202; and 46.4%, P=0.0006, respectively). No significant differences in ocular and nonocular treatment-emergent adverse events were found between the treatment groups. CONCLUSION: A BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% was as effective and well tolerated as concomitant latanoprost and timolol for treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension.

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PURPOSE: To determine the importance of ganglion cell complex (GCC) analysis as a parameter for early diagnosis of glaucoma and for following glaucoma progression and to compare glaucoma progression with conventional visual field analysis using a different type of spectral-domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: Two hundred eyes including 68 normal eyes, 70 eyes with pre-perimetric glaucoma and 62 eyes with perimetric glaucoma were analyzed in this prospective study undertaken during Jan 2013 to Dec 2013 in a tertiary ophthalmology institute. Automated visual field examination was done to group the subjects in above three categories. The thicknesses of the GCC and retinal nerve fiber layer (pRNFL) were measured using Topcon model 2000 version 7.1 SD-OCT images and compared. The statistical analysis was carried out by z-test. RESULTS: The average GCC was thickest in the normal group and the thickness decreased as the severity of glaucoma increased. The mean macular GCC at the start and end of the study in pre-perimetric (94.86 ± 8.31, 90.74 ± 8.46) and perimetric (82.48 ± 13.21, 79.80 ± 12.88) eyes was lower than those in normals (102.70 ± 7.19, 101.82 ± 7.42). CONCLUSION: Majority of the studies done on GCC analysis have used the Cirrus OCT (Zeiss). Our study has used the Topcon model 2000 version 7.1 to show that irrespective of the machine used, GCC analysis definitely plays an important role. To detect pre-perimetric glaucoma and may show progression earlier than pRNFL in pre-perimetric glaucoma. How to cite this article: Bhagat PR, Deshpande KV, Natu B. Utility of Ganglion Cell Complex Analysis in Early Diagnosis and Monitoring of Glaucoma using a Different Spectral Domain Optical Coherence Tomography. J Curr Glaucoma Pract 2014;8(3):101-106.