dos_Sep_2015

Figure 3: shows representative photograph of topographic 3-D response PRACTICE REQUISITES
density plot showing ‘the foveal peak’ and blind spot depression.
Ȉ Stargardt’s disease: Patients with Stargardt disease have
decreased amplitude in the region of fovea with normal or
minimal delay in implicit time.

Ȉ › ”‡–‹ƒŽ ϐŽ—‹† ȏ ‡–‹ƒŽ †‡–ƒ…Š‡–ǡ ‘’–‹… ’‹–•ǡ ‡–”ƒŽ
‡”‘—• ‡–‹‘’ƒ–Š› ƒ† ›•–‘‹† ƒ…—Žƒ” ‡†‡ƒ ȋ ȌȐ
seems to either diminish the amplitude of the waveform or
…‘’Ž‡–‡Ž› ϐŽƒ––‡ ‹–Ǥ

Ȉ Retinitis pigmentosa: Both implicit time delay and
decreased amplitudes are seen in mfERG waveform in this
condition. Delay in implicit time being more important as
implicit time delay has been found at times in patients with
normal amplitude responses.

Ȉ ˆ
…ƒ „‡ —•‡† –‘ •‡”‹ƒŽŽ› ˆ‘ŽŽ‘™Ǧ—’ ƒ† ‘‹–‘”
response after intervention in patients with retained
intraocular foreign body / early siderosis, after
photodynamic therapy (PDT), after macular hole surgery
or follow-up of CSR or macular edema, after stem cell
therapy in retinitis pigmentosa.
The N1 response amplitude is measured from the starting

baseline to the base of the N1 trough.
The P1 response amplitude is measured from the N1trough

to the P1 peak.

Advantages:

Ȉ • ˆ
‰‹˜‡• ƒ •’ƒ–‹ƒŽ †‹•–”‹„—–‹‘ ‘ˆ ”‡–‹ƒŽ ˆ—…–‹‘
and a topographic representation, it helps in identifying
the site of retinal pathology

Ȉ ˆ
†‹•–‹‰—‹•Š‡† „‡–™‡‡ –Š‡ ‘—–‡” ƒ† ‹‡” ”‡–‹ƒŽ
disease

Ȉ – Š‡Ž’• ‹ ‘‹–‘”‹‰ –Š‡ ’”‘‰”‡••‹‘ ‘ˆ –Š‡ †‹•‡ƒ•‡Ǥ

Indications:

Ȉ ‘ †‹ˆˆ‡”‡–‹ƒ–‡ †‹•‡ƒ•‡• –Šƒ– ƒˆˆ‡…– –Š‡ ‘—–‡” ”‡–‹ƒ ˆ”‘
those that affects the ganglion cells or optic nerve.

Ȉ Outer Retinal disease: The spatial mfERG responses seem
–‘ …‘””‡Žƒ–‡ ƒ† ƒ–…Š ™‹–Š ˜‹•—ƒŽ ϐ‹‡Ž† †‡ˆ‡…–• ‹ ”‡–‹ƒŽ
diseases like multiple evanscent white dot syndrome
(MEWDS), Retinal detachment, focal cone dystorphy,
choroidal neovascularization and commotion retina.

Ȉ Inner Retinal disease: Š‡ ƒ”‡ƒ• ‘ˆ ϐ‹‡Ž† †‡ˆ‡…– …‘””‡Žƒ–‡•
and match with topographic plots of mfERG in retinal
artery occlusions. Especially useful in differentiating the
inner retinal disease from the optic nerve disease is the
second order kernel.

Ȉ Toxic retinopathies: Various studies have shown to role of
mfERG in detecting early drug induced toxic retinopahties.

Ȉ Diabetic Retinopathy: The implicit time measures are
more sensitive in detecting retinal dysfunction in early
diabetic retinopathy. The foveal thickness measurement
on Optical Coherence Tomography (OCT) has been found
–‘ …‘””‡Žƒ–‡ •‹‰‹ϐ‹…ƒ–Ž› ™‹–Š ˆ
”‡…‘”†‹‰•Ǥ

Financial Interest: Š‡ ƒ—–Š‘” †‘‡• ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

www. dos-times.org 59

PRACTICE REQUISITES

INTERPRETATION OF PENTACAM MAPS

Hitendra Ahooja, Ashwini Ranganath

…Š‡‹’ϐŽ—‰ ‹ƒ‰‹‰ ‘ˆ –Š‡ …‘”‡ƒ ’”‘˜‹†‡• ‡š…‡ŽŽ‡– ‹ƒ‰‹‰

the corneal topography and other additional information
PentacamTM is the trade name of Comprehensive
Anterior Segment Analyser – an innovation from purposes of detection of the size and orientation of the pupil
the Oculus, Germany. ƒ† –‘ …‘–”‘Ž ϐ‹šƒ–‹‘Ǥ Š‡ •‡…‘† ‹• ‘—–‡† ‘ ”‘–ƒ–‹‰
™Š‡‡Ž –‘ …ƒ’–—”‡ …Š‡‹’ϐŽ—‰ ‹ƒ‰‡• ‘ˆ –Š‡ ƒ–‡”‹‘” •‡‰‡–Ǥ
PRINCIPLE This rotating measuring process supplies picture in three
dimensions. It obtains 50 scans in 2 seconds with 500 true

Š‹• ™‘”• ‘ –Š‡ ’”‹…‹’Ž‡ ‘ˆ …Š‡‹’ϐŽ—‰ elevation points per scan surface, i.e., about 25,000 measured
‹ƒ‰‹‰ ȋ ‹‰—”‡ ͳȌǤ Š‡ …Š‡‹’ϐŽ—‰ Žƒ™ •ƒ›• –Šƒ– and analyzed true elevation points. It calculates a 3-D model
to get a higher depth of focus, move the three planes, provided of the anterior segment of the eyeball, based on the measured
–Šƒ– –Š‡ ’‹…–—”‡ ’Žƒ‡ǡ –Š‡ ‘„Œ‡…–‹˜‡ ’Žƒ‡ ƒ† –Š‡ ϐ‹Ž ’Žƒ‡ elevation data. All further information is deducted from this
has to cut each other in one line or one point of intersection. 3-D model. Pentacam uses Blue light (UV-free), 475 nm, to
 …Š‡‹’ϐŽ—‰ …ƒ‡”ƒǡ –Š‡ •—„Œ‡…– ’Žƒ‡ǡ Ž‡• ’Žƒ‡ ƒ† ϐ‹Ž illuminate the eye.

’Žƒ‡ ‹–‡”•‡…– ƒ– ’‘‹– ‘ˆ ˆ‘…—• ȋ ‘ Ȍǡ ”‡ˆ‡””‡† ƒ• …Š‡‹’ϐŽ—‰ FUNCTION (OUTPUTS):
line. With this condition, a planar subject that is not parallel

to the image plane can be completely in focus. The system Pentacam generates the following outputs:

integrates two cameras. One is located in the centre for the …Š‡‹’ϐŽ—‰ ‹ƒ‰‹‰ •›•–‡ ‘„–ƒ‹• ƒ …Ž‡ƒ”ǡ •Šƒ”’ǡ

…Š‡‹’ϐŽ—‰ ‹ƒ‰‡ ȋ ‹‰—”‡ ʹȌ †‡’‹…–‹‰ –Š‡ ‡–‹”‡ ƒ–‡”‹‘”

segment from the cornea to the posterior lens surface, including

the most distal 100-150 μm.

Ȉ ‡•‹–‘‡–”› ‘ˆ –Š‡ Ž‡• ‹ƒ‰‡† „› –Š‹• •›•–‡ ’”‘˜‹†‡•

the ophthalmologist with an analysis of the lens thickness

and of structural alterations like radial opacities and early

‘” ƒ†˜ƒ…‡† …ƒŽ…‹ϐ‹…ƒ–‹‘ ‘ˆ –Š‡ Ž‡• …‘”‡Ǥ –• ƒ†˜ƒ–ƒ‰‡•

are:–

i. The evolution of a cataract can be made visible even at

an early stage

‹‹Ǥ – ƒ‡• …Žƒ••‹ϐ‹…ƒ–‹‘ ‘ˆ –Š‡ …ƒ–ƒ”ƒ…– ‡ƒ•›

iii. Long-term controls of cataracts are possible

iv. The extension of the cataract can be measured

Figure 1: 5EJGKORƀWI RTKPEKRNG

Corneal Densitometry

Densitometry of the Lens

Figure 2: 5EJGKORƀWI KOCIG KP 2GPVCECO

www. dos-times.org 61

PRACTICE REQUISITES

Cooler colour – Warm colour –
ϐŽƒ– ƒ”‡ƒ steep area

Figure 3: Depicting the concept of corneal elevation imaging ‡•– ϐ‹– •’Š‡”‡

Green colour –
ƒ”‡ƒ• ™‹–Š „‡•– ϐ‹–
between sphere
and eye surface

Ȉ ‡•‹–‘‡–”› ‘ˆ …‘”‡ƒ ‹• —•‡ˆ—Ž
evaluation of corneal haze and its
progression or regression, e.g.,
post viral keratitis, corneal scars,
post collagen cross-linking with
”‹„‘ϐŽƒ˜‹Ǥ
Corneal topography: …Š‡‹’ϐŽ—‰

imaging provides topography maps
of the anterior and posterior surfaces
of the cornea, based on true elevation
measurement. Elevation maps display the
height of the cornea relative to a spherical
”‡ˆ‡”‡…‡ •—”ˆƒ…‡ ȋ‹Ǥ‡Ǥ „‡•– ϐ‹– •’Š‡”‡Ȍ ƒ•
shown in the (Figure 3):

Curvature maps: Axial and sagittal
curvature maps measures the curvature
of the cornea in diopters. It is a simple
way to describe the overall shape of the
cornea. Ten patterns of corneal curvature
on video keratography are recognized.

Few example as seen on Pentacam
are shown in (Figures 4-9).

PACHYMETRY MAP Figure 4: Symmetric Bow-tie (with the rule astigmatism)

Pachymetry Maps (Figure 10) b. Preoperative planning for any ELEVATION MAPS:
calculate the differences in elevation
between the anterior and posterior corneal refractive surgery These maps (Figure 12) measure
surfaces of the cornea. The corneal the difference in the height or elevation
thickness is displayed as a colour image c. Progression control after of the cornea, measured in microns from
over its entire area from limbus to limbus. the reference sphere. Pentacam gives true
corneal surgery elevation data.
The most important pachymetry
points are displayed in values and d. Improved IOL calculation for Elevation upto 6 microns in the 3-5
location (Figure 11), such as: mm zone in the anterior elevation map
post-LASIK patients and upto 12 microns in the posterior
a. Thickness in pupil centre
b. Thickness in apex e. Intraocular pressure
c. Thinnest location
‘†‹ϐ‹…ƒ–‹‘ ™‹–Š ”‡‰ƒ”† –‘
APPLICATIONS
corneal thickness
a. Keratoconus detection

Ahooja Eye & Dental Institute, Gurgaon, Haryana

Dr. Hitendra Ahooja MS Dr.Ashwini Ranganath DNB

62 DOS TIMES - SEPTEMBER-OCTOBER 2015

PRACTICE REQUISITES

Figure 5: Showing Asymmetric Bow-tie with Skewed radial Axis Figure 6: Showing Symmetric Bow-tie (Oblique Astigmatism)

Figure 7: Showing Inferior Steepening Figure 8: 5JQYKPI $WVVGTƀ[ 2CVVGTP

Figure 9: Showing Irregular pattern Figure 10: Showing Pachymetry map Figure 11: Showing the pachymetry values in
various points

elevation map is considered normal.
Elevation maps in Pentacam are very
sensitive to detect Keratoconus and to
note its progression.

Two patterns are seen on Elevation
map are the saddle pattern (Figure 13)
and island pattern (Figure 14).

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PRACTICE REQUISITES

Figure 12: Normal Anterior and Posterior Elevation map

Figure 13: Saddle Pattern Figure 14: Island Pattern

Figure 15: Belin Ambrosio enhanced ectasia display – Normal Eye
64 DOS TIMES - SEPTEMBER-OCTOBER 2015

PRACTICE REQUISITES

Figure 16: Belin Ambrosio enhanced ectasia display - Keratoconus Figure 17: Important information in
the 4-map refractive display

Figure 18: Example 1: 4-map refractive display of a normal cornea Figure 20: Example 3: 4-map refractive display of a keratoconic eye
Points to note:
Figure 19: Example 2: 4-map refractive display in a post-myopic Lasik Ŗ 5VGGR - CDQXG &
eye. Points to note: Ŗ +PHGTKQT UVGGRGPKPI FKQRVGTU
Ŗ %GPVTCN EQTPGCN ƀCVVGPKPI Ŗ #U[OOGVTKE DQY VKG QP CZKCN OCR YKVJ UMGYGF TCFKCN CZKU
Ŗ %QTPGCN VJKPPKPI YKVJQWV CUUQEKCVGF CPVGTKQT QT RQUVGTKQT GNGXCVKQP Ŗ +PETGCUGF CPVGTKQT CPF RQUVGTKQT GNGXCVKQP
Ŗ 2GPVCECO KU WUGHWN KP RQUV .CUKM G[GU VQ EJGEM HQT EGPVTCVKQP CPF UK\G Ŗ %QTPGCN VJKPPKPI EQTTGURQPFKPI VQ VJG UVGGR CTGC QP GNGXCVKQP CPF
of ablation zone axial maps

Belin ambrosio enhanced ectasia display (BAD)
The goal of this display is to combine elevation based and
pachymetric corneal evaluation in a single display to help in
quick screening for ectatic disease. The left side of the display
shows exclusion elevation maps (Figure 15,16).
Ȉ ‘’ –™‘ ƒ’•Ǧ•–ƒ†ƒ”† ‡Ž‡˜ƒ–‹‘ ƒ’•
Ȉ ‹††Ž‡ –™‘ ƒ’•Ǧ ‡š…Ž—•‹‘ ‡Ž‡˜ƒ–‹‘ ƒ’• Ǧ ‡”‡ –Š‡
„‡•– ϐ‹– •’Š‡”‡ ‹• …ƒŽ…—Žƒ–‡† —•‹‰ ‡Ž‡˜ƒ–‹‘ †ƒ–ƒ Ž‘…ƒ–‡†
outside the 3 mm circle centered on the thinnest point on
the cornea.
Ȉ ‘––‘ –™‘ ƒ’• Ȃ ‹ˆˆ‡”‡…‡ ‡Ž‡˜ƒ–‹‘ ƒ’• Ȃ –Š‡•‡ ƒ’•
show relative change in elevation from standard elevation
map to the exclusion map. Areas in yellow and red in the
difference map suggest ectasia.
The right side of the display shows pachymetry data
symmetric.

www. dos-times.org 65

PRACTICE REQUISITES

Figure 21: Example 4: 4-map refractive display in Pellucid marginal Figure 22: Example 5: 4-map refractive display of an irregular cornea
degeneration. Points to note: post penetrating Keratoplasty – no pattern is recognizable on any map
Ŗ .CTIG CUVKIOCVKUO WUWCNN[ KP FQWDNG FKIKVU KP CFXCPEGF ECUGU
Ŗ %NCUUKE DWVVGTƀ[ RCVVGTP QP CZKCN OCR Important information in the 4-map refractive display
Ŗ +PHGTKQT UVGGRGPKPI FKQRVGTU (Figure 17) includes:
Ŗ +PETGCUGF CPVGTKQT CPF RQUVGTKQT GNGXCVKQP Ȉ –‡‡’ǡ ϐŽƒ– ƒ† ‡ƒ ‡”ƒ–‘‡–”› ȋ‘ˆ …‘”‡ƒŽ ˆ”‘– ƒ†
Ŗ %QTPGCN VJKPPKPI DGNQY VJG CTGC QH GNGXCVKQP
back) in diopters
Ȉ ‘”‡ƒŽ –Š‹…‡•• •’ƒ–‹ƒŽ ’”‘ϐ‹Ž‡ ȋ Ȍ Ȃ Š‘™• –Š‡ Ȉ ‘”‡ƒŽ ƒ•–‹‰ƒ–‹• ƒ† ƒš‹•
average pachymetry along 22 concetric circles from the Ȉ ‘”‡ƒŽ –Š‹…‡••
thinnest point to the periphery. Ȉ –‡”‹‘” …Šƒ„‡” †‡’–Š

Ȉ ‡”…‡–ƒ‰‡ –Š‹…‡•• ‹…”‡ƒ•‡ ȋ Ȍ Ȃ Š‘™ –Š‡ ’‡”…‡–ƒ‰‡ A few case examples of the quad refractive map displays
thickness increase value at those same points. are included here for better understanding (Figure 18-22):
The graph displays the data in red. If the red line is outside
To conclude, Pentacam is a comprehensive ocular analyser,
the broken dark lines (which represent upper and lower double capable of many more functions, the description of which is
standard deviation in a normal population), it represents beyond the scope of this article. This article covers the basics
abnormal thinning of the cornea. of Pentacam required for basic refractive and ectasia screening
with relevant case examples.
4 map refractive display gives a comprehensive overview
of the surface of the eye.

REFERENCES and limitations - a review. Clin Experiment Ophthalmol.
2009;37:144-54.
1. Konstantopoulos A, Hossain P, Anderson DF. Recent advances 3. Galletti JD, Ruiseñor Vázquez PR, Minguez N, Delrivo M,
in ophthalmic anterior segment imaging: a new era for Bonthoux FF, Pförtner T, Galletti JG. Corneal asymmetry
ophthalmic diagnosis? Br J Ophthalmol. 2007;91:551-7. ƒƒŽ›•‹• „› ’‡–ƒ…ƒ •…Š‡‹’ϐŽ—‰ –‘‘‰”ƒ’Š› ˆ‘”
keratoconus diagnosis. J Refract Surg. 2015;31:116-23.
2. Wegener A, Laser-Junga H. Photography of the anterior
‡›‡ •‡‰‡– ƒ……‘”†‹‰ –‘ …Š‡‹’ϐŽ—‰ǯ• ’”‹…‹’Ž‡ǣ ‘’–‹‘•

Financial Interest: Š‡ ƒ—–Š‘”• †‘ ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

For Kind Attention of DOS Members
Non Receipt of DOS TIMES issue

DOS members not receiving DOS TIMES may please write to [email protected] with their details.

Call for contribution to DOS Times

* All DOS MEMBERS may send good quality manuscripts for consideration for publication in
DOS TIMES – 2015-2016.

* Acceptance will be subject to editorial review
* Please refer to AUTHOR GUIDELINES for manuscript preparation
* Please note change in email address for all future correspondence to me.

Dr. M. Vanathi MD
General Secretary – DOS
[email protected]

66 DOS TIMES - SEPTEMBER-OCTOBER 2015

PRACTICE REQUISITES

ANALYSING CHANGE IN KERATOCONUS WITH THE
HELP OF TOPOGRAPHIC INDICES

Nikhil Gokale

Ȉ —Ž–‹’Ž‡ ƒ…“—‹•‹–‹‘• ƒ– ‡ƒ…Š ˜‹•‹– ȋ’”‡ˆ‡”ƒ„Ž› ͵Ȍ ƒ†

Dr. Nikhil Gokale MD selecting the most reliable image. It is well known that
Gokhale Eye Hospital, the inter-test variability is higher in eyes with abnormal
Dadar West, Mumbai, India corneas so taking multiple images is preferable7,8.
Ȉ ’ƒ…– ‘ˆ …‘–ƒ…– Ž‡• ™‡ƒ” ‘ …‘”‡ƒŽ •Šƒ’‡ ‹• ™‡ŽŽ
Keratoconus is described as a degenerative established. Adequate period off lenses is essential to
„‹Žƒ–‡”ƒŽǡ ’”‘‰”‡••‹˜‡ǡ ‘Ǧ‹ϐŽƒƒ–‘”› …‘”‡ƒŽ obtain maps, which can be compared for change analysis.
disorder characterized by ectasia, thinning, For rigid lenses at least 3 weeks off lenses is essential and
and increased curvature1. A large number of for soft lenses it is about 3 days. However in patients who
studies have addressed the issue of topographic show evidence of warpage, this period is extended till the
diagnosis and grading of keratoconus based on topography returns to normal and remains stable9.
topography and tomography2-4. Ȉ ”‡† ƒƒŽ›•‹• …‘’ƒ”‹‰ –Š‡ ‹†‹…‡• –‘ ƒƒŽ›•‡ …Šƒ‰‡ ‘
With the advent of corneal collagen crosslinking (C3R) the computer. Measured values which exceed the standard
a decade back it became essential to not only diagnose †‡˜‹ƒ–‹‘ „› ƒ ˆƒ…–‘” ‘ˆ ‘”‡ –Šƒ ʹǤͷ ƒ”‡ …Žƒ••‹ϐ‹‡† ƒ•
keratoconus early but also analyse its progression, because abnormal and highlighted in yellow, and pathological
collagen crosslinking can help patients with progressive values, i.e., values that exceed the standard deviation by a
factor of more than three, are highlighted in red.

‡”ƒ–‘…‘—•Ǥ Š‡”‡ ‹• ƒ ‘‰‘‹‰ ‹–‡”ƒ–‹‘ƒŽ ‡ˆˆ‘”– –‘ †‡ϐ‹‡ USEFUL INDICES IN OCULUS PLACIDO AND PENTACAM

’”‘‰”‡••‹‘ ƒ† Š‡Ž’ •‡Ž‡…– ’ƒ–‹‡–• ™Š‘ ™‘—Ž† „‡‡ϐ‹– ˆ”‘ Ȉ Ȃ †‡š ‘ˆ —”ˆƒ…‡ ƒ”‹ƒ…‡ Ȃ ƒŽ—‡ ‘ˆ …—”˜ƒ–—”‡
C3R. variation from the mean curvature. A general measure of
corneal surface irregularity.
Žƒ…‹†‘ …‘”‡ƒŽ –‘’‘‰”ƒ’Š› ƒ† …Š‡‹’ϐŽ—‰ ‹ƒ‰‹‰ „‘”ƒŽ ε ͵͹ ƒ†
ƒ–Š‘Ž‘‰‹…ƒŽ ε Ͷͳ
provides qualitative and ‹ƒ‰‹‰ ’”‘˜‹†‡• Ȉ Ȃ †‡š ‘ˆ ‡”–‹…ƒŽ
Asymmetry – Value of curvature
quantitative data of corneal …Š‡‹’ϐŽ—‰
shape. Oculus Placido and
Pentacam (Optikgerate GmbH, qualitative and quantitative data of
Wetzlar, Germany) provide corneal shape. Oculus Placido and
kcƒfswmchaalsooutohnr eehanraerrarldbpidgnafŠnctauiifeteh‘hgltucosiaue•eoegtelcl–ydsvrfo ig.huaiesnnonrdalhr‘uraiavinracaˆdsnlpero po5igepr,mnet6go.•egboupg’rinnebrila‡aTaoemelur…nyrdhspni‹tdiseϐseati‹ooaiyn…stoafnsie danenutderinoarƒimevoiatelfineyfsngme–ldsskndo‡.weivieeTosi”pcrecnr‹isehei‘retaotaisdheysss”tfl,oy cho
pgwPaenlnrea‡uphasntt”tioediactenroaihdnbniƒcojttegoascrhtm›aaiswvaȌsnee vsliysd(utes’aOhpsra”sopfek‘nsbastte˜asceiCkrt‹le3eh†yagRens‡teoi irsrcadƒrootee Ȉenf vg ŠuceuG‘os clleom•ƒr an–– nprŠt Ȃbr‘ieea t ŽH‘l‘ady‡k‰ˆl,e‹ …–r‡sƒaWf”Ži•ht oon卒ac ‡erͳdo”‡pǤtƒnͲiz…–u͹ec‘t‹ls…ehϐa.‘i‹snre…,,— • mc –st Ȉ kthhyu eƒ I†eeemrr–naŠ‡avcmsšta‘urou tŽpeȂesu‘cr a tupoe‰r rs„„ peen‹y e…or.…eusȂƒ”fr‘‘s Ž‡iaw ””.doε ƒnrii• ‡cfdͲt‡ƒƒfo”hǤe ƒŽŽ͵m™ rl–tʹaoe‘h‹pεεnn–w…eaŠ dc‘er es•irͳͲes‡—ǤǤobv˜ʹͲ•aiene‡͹ͺn rrt” fe wi‹eta–yrƒƒ›e†.i e‡o‘ooAn††šrˆff

BASIC PREREQUISITES FOR ANALYZING CHANGE „‘”ƒŽ ε ͳǤͲ͵ ƒ† ƒ–Š‘Ž‘‰‹…ƒŽ ε ͳǤͲ͵
Ȉ ‹ Ȃ ‹‹— ƒ‰‹––ƒŽ …—”˜ƒ–—”‡ Ȃ ƒŽŽ‡•– •ƒ‰‹––ƒŽ
Ȉ ƒ‰‹‰ •Š‘—Ž† „‡ †‘‡ ‘ –Š‡ •ƒ‡ ƒ…Š‹‡ ƒ– ‡ƒ…Š ˜‹•‹–Ǥ
We cannot compare data obtained from two dissimilar curvature in the measured area. (Radius of curvature at
machines. Avoid comparing dissimilar printouts even if Kmax ie. at apex of the cone).
done on a similar machine. „‘”ƒŽ δ ͸Ǥ͹ͳ ƒ† ƒ–Š‘Ž‘‰‹…ƒŽ δ ͸Ǥ͹ͳ
Ȉ Ȃ †‡š ‘ˆ ‡‹‰Š– •›‡–”› Ȃ ƒŽ—‡ ‘ˆ Š‡‹‰Š– †ƒ–ƒ
Ȉ ‹‹Žƒ” †‡ˆƒ—Ž– •‡––‹‰• ƒ† •…ƒŽ‡• •Š‘—Ž† „‡ —•‡† ƒ– ‡ƒ…Š symmetry comparison of the upper and lower area. (Based
visit on the machine. For eg. We can’t compare a sagittal on corneal elevation).
map with a tangential map.

www. dos-times.org 67

PRACTICE REQUISITES

Figure 1: Indices from 2002 to 2012 in a case of progressive keratoconus Figure 2: Indices from 2002 to 2011 in a case of stable keratoconus

„‘”ƒŽ ε ͳͻ ƒ† the diagnosis, progression,
ƒ–Š‘Ž‘‰‹…ƒŽ ε ʹͳ and surgical follow up of
keratoconus10. For very early
Ȉ Ȃ †‡š ‘ˆ ‡‹‰Š– detection of progression ISV
Decentration – Value of is the most sensitive index
the decentration of height (except in grade 4 keratoconus)
data in vertical direction. followed by IHD (except in
(Calculated with Fourier grade 1 keratoconus) 10 Hersh
Analysis) et al.5 found improvements
in ISV, IVA, KI and Rmin at one
„‘”ƒŽ ε ͲǤͲͳͶ ƒ† year following C3R suggesting
ƒ–Š‘Ž‘‰‹…ƒŽ ε ͲǤͲͳ͸ an overall improvement of

CASE EXAMPLES Figure 3: Indices pre C3R (2007 to 2008) and post C3R (2009 to 2012)

Progressive keratoconus

In progressive keratoconus all the
indices except Rmin show a progressive
increase in values as the keratoconus
increases. Rmin values drop progressively
indicating an increasing curvature at the
apex of the cone (Figure 1).

Stable Keratoconus additional data to determine change and
gives a trend analysis which can be very
In stable keratoconus all the indices useful to document change in shape with
remain more or less similar, however they time.
may show some variation, which could be
due to inter-test variability (Figure 2). Figure 4: Difference map pre and post C3R showing improvement in shape of cornea

Pre and Post C3R Analysis index was most useful to analyse change. Figure 5: Indices pre and one year post C3R
All indices (except RMin) show a decrease with p values
In this example progressive increase at one year indicating an improvement in
in indices is seen in pre C3R period the corneal shape (more regular), while
from 2007 to 2008 and post C3R there an increase in RMin values indicate a
is stabilization of the indices (2009- ϐŽƒ––‡‹‰ ‘ˆ –Š‡ …‘”‡ƒǤ ‡ ˆ‘—† ǡ
ͳʹȌ ™‹–Š •‘‡ ϐŽƒ––‡‹‰ ƒ• •‡‡ „› ƒ ƒ† ‹ •Š‘™‡† •–ƒ–‹•–‹…ƒŽŽ› •‹‰‹ϐ‹…ƒ–
increase in RMin values (Figure 3). change at the end of one year (Figure 5).

†‹ˆˆ‡”‡…‡ ƒ’ •Š‘™• ϐŽƒ––‡‹‰ Kanellopoulos and Asimellis have
of the steep cone with compensatory also reported that ISV and IHD are the
•–‡‡’‡‹‰ ‘ˆ –Š‡ ϐŽƒ– •—’‡”‹‘” ƒ”‡ƒ ‘•– •‡•‹–‹˜‡ ƒ† •’‡…‹ϐ‹… …”‹–‡”‹ƒ ˆ‘”
(Figure 4). This essentially means a more
uniform shape of the cornea with better
…‘–ƒ…– Ž‡• ϐ‹–Ǥ

ANALYSIS OF INDICES POST C3R

We analysed the change in indices
after C3R at the end of one year in 41
eyes of 28 patients with documented
progressive keratoconus. A statistical
analysis was done to determine which

68 DOS TIMES - SEPTEMBER-OCTOBER 2015

PRACTICE REQUISITES

the corneal shape. However they could then yearly if there is no progression. 8. McMahon TT, Anderson RJ, Joslin CE,
‘– ϐ‹† …‘””‡Žƒ–‹‘ „‡–™‡‡ ‹†‹˜‹†—ƒŽ Rosas GA; Precision of three topography
indices and visual acuity post C3R. The above criteria can be used to instruments in keratoconus subjects.
Optom Vis Sci. 2001 Aug;78:599-604.
HOW DO WE DEFINE †‡ϐ‹‡ ’”‘‰”‡••‹‘ ‹ ƒ› –‘’‘‰”ƒ’Š›
9. Ambrosio R Jr, Klyce SD, Wilson SE.
PROGRESSION? machine. The Oculus Indices provide Corneal topographic and pachymetric
screening of keratorefractive patients. J
Criteria for progression are debatable REFERENCES Refract Surg 2003;19:24-9.
ƒ† „‡‹‰ †‡ϐ‹‡† „› ƒ ‹–‡”ƒ–‹‘ƒŽ
study group. Commonly accepted criteria 1. Krachmer JH, Feder RS, Belin MW. 10. Kanellopoulos AJ, Asimellis G. Revisiting
for progression11,12,13 are, ‡”ƒ–‘…‘—• ƒ† ”‡Žƒ–‡† ‘‹ϐŽƒƒ–‘”› keratoconus diagnosis and progression
Ȉ ƒš ε ͳ …”‡ƒ•‡ ȋ ‘ “—ƒŽ‹ˆ› ˆ‘” corneal thinning disorders. Surv …Žƒ••‹ϐ‹…ƒ–‹‘ „ƒ•‡† on evaluation of
Ophthalmol. 1984;28:293–322. corneal asymmetry indices, derived from
͵ ε ͳǤͷ ƒ› „‡ ’”‡ˆ‡”ƒ„Ž‡ †—‡ …Š‡‹’ϐŽ—‰ ‹ƒ‰‹‰ ‹ ‡”ƒ–‘…‘‹…
to wider variation in measurement 2. Rabinowitz YS. Videokeratographic and suspect cases. Clin Ophthalmol.
of Kmax in keratoconic eyes than indices to aid in screening for keratoconus. 2013;7:1539-48.
normal eyes14. J Refract Surg. 1995;11:371–79.
Ȉ ‹ ε ͳ …”‡ƒ•‡ 11. O’Brart DPS, Chan E, Samaras K, Patel P,
Ȉ ‡ˆ”ƒ…–‹˜‡ •–‹‰ƒ–‹• ε ͳ ‹…”‡ƒ•‡ 3. Abad JC, Rubinfeld RS, Del Valle M, Shah SP. A randomised, prospective study
Ȉ ƒ…Š›‡–”› ε ʹΨ †‡…”‡ƒ•‡ ‹ Belin MW, Kurstin JM. Vertical D: a –‘ ‹˜‡•–‹‰ƒ–‡ –Š‡ ‡ˆϐ‹…ƒ…› ‘ˆ ”‹„‘ϐŽƒ˜‹Ȁ
Ȉ ƒ‹ˆ‡•– ‡ˆ”ƒ…–‹˜‡ ’Š‡”‹…ƒŽ novel topographic pattern in some ultraviolet A (370 nm) corneal collagen
“—‹˜ƒŽ‡– ε ͲǤͷ keratoconus suspects. Ophthalmology. crosslinkage to halt the progression of
It is equally important to know the 2007;114:1020–1026. keratoconus. Br J Ophthalmol 2011;
time frame in which this progression 95:1519-24.
occurs. Usually if this occurs over a 4. Ambrosio R Jr, Simonato RS, Luz A,
period of one year of follow up one Coca Velarde LG. Corneal- thickness 12. Hersh PS, Greenstein SA, Fry KL. Corneal
would strongly consider a C3R, however •’ƒ–‹ƒŽ ’”‘ϐ‹Ž‡ ƒ† …‘”‡ƒŽǦ˜‘Ž—‡ collagen crosslinking for keratoconus
If this change occurs say over 10 years distribution: tomographic indices to and corneal ectasia: one-year results. J
™‡ ™‘—Ž† ‘– …‘•‹†‡” ‹– •‹‰‹ϐ‹…ƒ– ƒ† detect keratoconus. J Cataract Refract Cataract Refract Surg 2011; 37:149-60.
would not warrant a C3R. The frequency Surg. 2006;32:1851–59.
of monitoring is important and should be 13. Wittig-Silva C, Whiting M, Lamoureux
based on the expected progression rate. 5. Greenstein SA, Fry KL, Hersh PS. Corneal E, Lindsay RG, Sullivan LJ, Snibson GR. A
This could be 3 to 6 months initially and topography indices after corneal collagen randomized controlled trial of corneal
crosslinking for keratoconus and corneal collagen cross-linking in progressive
ectasia: one- year results. J Cataract keratoconus: preliminary results. J Refract
Refract Surg. 2011;37(7):1282–90. Surg 2008; 24: S720–S725.

6. Faria-Correia F, Ramos IC, Lopes BT, 14. Szalai E, Berta A, Hassan Z, Módis Jr., L.
et al. Topometric and tomo- graphic Reliability and repeatability of swept-
indices for the diagnosis of keratoconus. source Fourier-domain optical coherence
International Journal of Keratoconus –‘‘‰”ƒ’Š› ƒ† …Š‡‹’ϐŽ—‰ ‹ƒ‰‹‰ ‹
Ectatic Diseases. 2012;1:92–99. keratoconus. J Cataract Refract Surg 2012;
38(3): 485–94.
7. Hashemi K, Guber I, Bergin C, Majo F.
Reduced precision of the Pentacam HR in
eyes with mild to moderate keratoconus.
Ophthalmology. 2015;122:211-2.

Acknowledgement: ”Ǥ ƒ”–Š‘ ƒ•Š‹ ˆ‘” –Š‡ ’‘•– ͹ ƒƒŽ›•‹•

Financial Interest: Š‡ ƒ—–Š‘” †‘‡• ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

www. dos-times.org 69

COMMUNITY OPHTHALMOLOGY

CORNEAL BLINDNESS: CURRENT SCENARIO IN INDIA

Noopur Gupta, Praveen Vashist, Radhika Tandon, Sanjeev K Gupta
Corneal blindness is a major form of visual
deprivation in developing countries and has been recruited randomly from 25 village clusters of Gurgaon district,
recognized as a public health problem. The burden state of Haryana, India using random cluster sampling strategy.
of corneal blindness on the individual and the All individuals were examined in detail with a portable slit lamp
community at large can be huge, particularly as it for evidence of any corneal disease during the door-to-door
tends to affect people at a younger age in contrast examination. Comprehensive ocular examination including
to other blinding conditions such as cataract and glaucoma. logMar visual acuity, slit lamp biomicroscopy, non-contact
It also disproportionately affects poor rural communities, tonometry and dilated retinal evaluation was performed at a
because of the increased risk of eye injuries with agricultural central clinic site in the respective villages (Figure 1).
material, limited access to treatment, and higher prevalence
of communicable diseases such as trachoma due to poor The overall prevalence of corneal blindness (presenting
environmental conditions. ˜‹•—ƒŽ ƒ…—‹–› δ͵Ȁ͸Ͳ ‹ –Š‡ „‡––‡” ‡›‡Ȍ ‹ –Š‹• •–—†› ’‘’—Žƒ–‹‘ǡ
Corneal blindness, including corneal opacity and trachoma, including both unilateral and bilateral cases, was 0.56% (95%
contributes to 7% of the blindness burden globally1. This CI:0.42, 0.69); prevalence of bilateral cases was 0.11% (95% CI:
translates to nearly 2.7 million blind people worldwide due to 0.05,0.17) and that of unilateral corneal blindness was 0.45%
corneal diseases. It has been reported that nearly 90% of the (95% CI: 0.33,0.56) (Table 2). Majority of the corneal blind
global cases of ocular trauma and corneal ulceration leading patients were females (61.5%) and were aged 60 years and
to corneal blindness occur in developing countries1. Being a above (84.6%). On multivariable analysis, the odds of having
corneal blindness increased with age and were higher for
females and unemployed participants.

developing country with a predominantly rural population, CAUSES OF CORNEAL BLINDNESS

†‹ƒ ˆƒ…‡• ƒ •‹‰‹ϐ‹…ƒ– …ŠƒŽŽ‡‰‡ ‹ ‡Ž‹‹ƒ–‹‰ …‘”‡ƒŽ Corneal diseases contributing to blindness were aphakic
blindness. and pseudophakic bullous keratopathy following cataract
surgery (46.2%), corneal degenerations and dystrophies
Table 1 illustrates the various community-based studies

conducted in India and the reported burden of corneal blindness (23.1%). Unilateral corneal blindness was mostly contributed

from 1987 through 2010 in the country2-12Ǥ ƒ”‹‡† †‡ϐ‹‹–‹‘• ‘ˆ by ocular trauma (25.9%), infectious keratitis (22.2%) and

blindness have been used in these blindness surveys. Blindness post-surgical bullous keratopathy (14.8%) (Table 3).

as per international criteria The burden of corneal blindness on the The study highlights the
ȋ †‡ϐ‹‹–‹‘Ȍ ‹• †‡ϐ‹‡† ƒ• changing trends in the pattern

visual acuity of less than 3/60 individual and the community at large of corneal diseases in the rural
in the better eye with available Indian population. The success
correction while the Indian can be huge, particularly as it tends to of prevention programmes

†‡ϐ‹‹–‹‘ ‘ˆ „Ž‹†‡•• ȋƒ……‘”†‹‰ affect people at a younger age in contrast related to keratomalacia and
to National Programme for trachoma have led to marked
Control of Blindenss-NPCB) to other blinding conditions such as reduction in their prevalence,

includes visual acuity of less cataract and glaucoma ƒ• ‹• ‡š‡’Ž‹ϐ‹‡† „› –Š‡

than 6/60 in the better eye with study. We need to be cautious

available correction. As there are about the increasing prevalence

substantial differences in the methodology, age group studied, and occurrence of corneal complications due to high-volume

†‡ϐ‹‹–‹‘ ‘ˆ „Ž‹†‡••ǡ ’ƒ”–‹…‹’ƒ–‹‰ •ƒ’Ž‡ •‹œ‡ǡ †‹ˆˆ‡”‡– cataract surgery, which is shifting the burden from cataract
response rate, and marked geographical heterogeneity-it is blindness to corneal blindness in a developing country like
virtually impossible to identify trends from these blindness India.

surveys. A meta-analysis of seven population-based blindness CONCLUSION
studies (2001-2010) conducted in India demonstrated that
–Š‡ ’”‡˜ƒŽ‡…‡ ‘ˆ …‘”‡ƒŽ „Ž‹†‡•• ȋƒ• ’‡” †‡ϐ‹‹–‹‘ ‘ˆ In aiming to eliminate corneal blindness, a multi-pronged
blindness) was 0.45% (95% CI: 0.27, 0.64) in adults aged 50 strategy needs to be developed. In a country with limited
years and older13. resources and a vast population, optimization of available
facilities and prioritization of healthcare commitments need

PREVALENCE OF CORNEAL BLINDNESS to be proportioned rationally. Control of preventable causes
requires extensive public support and community participation.
Available literature on corneal blindness in India is either Curable or treatable blindness requires a spectrum of care,
hospital-based or has been extrapolated data from blindness including medication, optical rehabilitation and corneal

•—”˜‡›• –Šƒ– ™‡”‡ ‘– •’‡…‹ϐ‹…ƒŽŽ› †‡•‹‰‡† ˆ‘” •–—†›‹‰ …‘”‡ƒŽ transplantation. Overall, continued assessment of the burden

morbidity. The Corneal Opacity Rural Epidemiological Study of corneal blindness with periodic review of trends is required

ȋ Ȍ ‹• ƒ ϐ‹”•–Ǧ‘ˆǦ‹–•Ǧ‹† ’‘’—Žƒ–‹‘Ǧ „ƒ•‡† •–—†› –‘ ”‡ϐŽ‡…– to effectively plan preventive, promotive and rehabilitative

the magnitude of corneal diseases in a large sample of Indian blindness control strategies in order to eliminate corneal

population14. The study involved 12,899 participants of all ages blindness from the country.

www. dos-times.org 71

COMMUNITY OPHTHALMOLOGY

Table1: Magnitude and Causes of Corneal Blindness in India (Population-based Studies)

Authors & Year of Place of study Sample size & Age Prevalence Proportion Causes of corneal
Group
publication (Urban or rural) of Corneal of total blindness

Blindness (%) blindness (%)

Murthy GV et al, Navsari, Gujarat; Ͷ͹͵ͺǢ ηͷͲ ›‡ƒ”• 0.25 3.7* NA

20102 Urban & rural

Neena J et al, 15 states; Urban & 42722; 50 years and 0.31 3.9* Corneal opacity; trachoma
20083
rural above

Vijaya L et al, Tamil Nadu; Rural 4800 ; 40 years and NA 4.26§ NA
20064 above

Murthy GV et al, 15 states of India; 72044; 50 years and 0.07 0.89* Corneal opacity
20055
Urban & Rural above

Thulasiraj RD Tamil Nadu; Rural 17,200; 40 years NA 2‡ NA
et al, 20036 and above

Nirmalan PK et al, Tirunelveli, Tamil 5795 ; 50 years and NA 2.8* NA
above
20027 Nadu; Urban &

Rural

Thulasiraj RD Sivaganga, Tamil 5081; 50 years and NA 4* NA
et al, 20028 Nadu; Urban & above
rural

Murthy GV et al, Bharatpur, 4284; 50 years and 1.75 14.7* Corneal infection,
20019 Rajasthan; Rural above trachoma & other corneal
opacity

Dandona L et al, Andhra Pradesh; 10293; 30 years and 0.13† 7.1 Ȉ ‡”ƒ–‹–‹• †—”‹‰
2001 APEDS10 Urban & Rural above childhood-37.3%
Ȉ ‡”ƒ–‹–‹• ‹
adulthood-22.2%
Ȉ ”ƒ—ƒǦʹ͵ǤʹΨ
Ȉ ƒ–”‘‰‡‹…ǦͷǤͲΨ
Ȉ ’Š‡”‘‹†ƒŽ
degeneration-4.0%
Ȉ –‡”›‰‹—Ǧ”‡Žƒ–‡†
corneal scarring-4.0%
Ȉ ”ƒ†‹–‹‘ƒŽ ‡›‡
medicine-4.0%

Mohan M, 198911 Nationwide survey 2,54,758; All age 0.03 1.91|| Corneal opacity; trachoma
groups

Mohan M, 198712 India (7 3,95,788; 0.1 7|| NA
centres namely All age groups
Ahmedabad,
Cuttack, Delhi,
Indore, Madurai &
Varanasi) Urban &
Rural

Ž‹†‡•• †‡ϔ‹‡† ƒ• * ”‡•‡–‹‰ ˜‹•—ƒŽ ƒ…—‹–› θͼȀͼͶ ‹ „‡––‡” ‡›‡Ǣ † ”‡•‡–‹‰ ˜‹•—ƒŽ ƒ…—‹–›θ ͼȀͼͶ ‘” …‡–”ƒŽ ˜‹•—ƒŽ ϔ‹‡Ž† θ ͸ͶͶ ‹ –Š‡ „‡––‡” ‡›‡Ǣ ‡ ‡•–
…‘””‡…–‡† ˜‹•—ƒŽ ƒ…—‹–› θ͹ȀͼͶ ‹ „‡––‡” ‡›‡Ǣ § ‡•– …‘””‡…–‡† ˜‹•—ƒŽ ƒ…—‹–› θ͹ȀͼͶ ƒ†Ȁ‘” Ž‡•• –Šƒ ͷͶ Ͷ ˜‹•—ƒŽ ϔ‹‡Ž† ‹ „‡––‡” ‡›‡Ǣ || Visual acuity less than
ͼȀͼͶ ‹ –Š‡ „‡––‡” ‡›‡ ™‹–Š •’‡…–ƒ…Ž‡ …‘””‡…–‹‘Ǥ

1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences,All India Institute of Medical Sciences, New Delhi, India.
2. Centre for Community Medicine,All India Institute of Medical Sciences, New Delhi, India.

Dr. Noopur Gupta MS, DNB, PhD1 Dr. Praveen Vashist MD, MSc1 Dr. Radhika Tandon MD, DNB, FRCOphth1 Dr. Sanjeev K Gupta MD2
72 DOS TIMES - SEPTEMBER-OCTOBER 2015

Mapping cluster selection and deciding cluster boundaries Network and motivation Enumeration process COMMUNITY OPHTHALMOLOGY

Collection of socio-demographic details

Informed consent process Informed consent process House to house examination for corneal opacity House to house examination for corneal opacity

Setting up central clinical facility in the study cluster Visual acuity estimation and refraction Detailed ophthalmic examination Detailed ophthalmic examination

Recording Intra ocular pressure Retinal evaluation after dilation of pupils Clinical examination during home visits Clinical examination during home visits

Figure 1: Pictorial illustration of the study procedures followed during implementation of the CORE (Corneal Opacity Rural Epidemiological)
study (2011-2013)

Table 2: Prevalence of Unilateral and Bilateral Table 3: Causes of Corneal Blindness*
Corneal Blindness as per international (WHO) and
Corneal pathology Bilateral Unilateral blind
National (NPCB) criteria (n=12113) blind n=13 n=54
n (%)
Category Corneal blind Prevalence n (%)

people (n) per 1000 Aphakic/Pseudophakic 6 (46.2) 8 (14.8)
bullous keratopathy
Bilateral Blin 13 1.1
ȋ δ͵Ȁ͸Ͳ ‹ „‡––‡”
eye) Dystrophy and degenerations 3(23.1) 4 (7.4)

Bilateral Blind 18 1.5 Trachoma 2(15.4) 6 (11.1)
ȋ δ͸Ȁ͸Ͳ ‹ „‡––‡”
eye) Infectious keratitis 1(7.7) 12 (22.2)

‹–ƒ‹ †‡ϐ‹…‹‡…› 1 (7.7) 1 (1.9)
associated CO
Unilateral blind 54 4.5
ȋ δ͵Ȁ͸Ͳ ‹ ƒ› Trauma 0 (0.0) 14 (25.9)
eye)
Exanthema 0 (0.0) 7 (13.0)

Unilateral blind 127 10.5 Glaucoma with corneal 0 (0.0) 1 (1.9)
ȋ δ͸Ȁ͸Ͳ ‹ ƒ› decomposition
eye)
Iatrogenic CO 0 (0.0) 1 (1.9)
ȗ ε ‘”Ž† ‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘Ǣ ε ƒ–‹‘ƒŽ
”‘‰”ƒ‡ ˆ‘” ‘–”‘Ž ‘ˆ Ž‹†‡••Ǣ ε ”‡•‡–‹‰ ȗ Ž‹†‡•• †‡ϔ‹‡† ƒ• ’”‡•‡–‹‰ ˜‹•—ƒŽ ƒ…—‹–› θ͹ȀͼͶ ‹ „‡––‡” ‡›‡Ǣ
‹•—ƒŽ …—‹–› ε ‘”‡ƒŽ ‘’ƒ…‹–›

REFERENCES 2. Murthy GV, Vashist P, John N, Pokharel 3. Neena J, Rachel J, Praveen V, Murthy
G, Ellwein LB. Prevelence and causes GV. Rapid Assessment of Avoidable
1. Whitcher JP, Srinivasan M, Upadhyay of visual impairment and blindness in Blindness India Study Group. Rapid
MP. Corneal blindness: A global older adults in an area of India with a Assessment of Avoidable Blindness in
perspective. Bull World Health Organ high cataract surgical rate. Ophthalmic India. PLoS One. 2008 Aug 6;3:e2867.
2001;79:214-21. Epidemiol. 2010;17:185-95.
4. Vijaya L, George R, Arvind H, Baskaran

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M, Raju P, Ramesh SV, et al. Prevalence blindness, cataract surgery, and 11. Mohan M. National Survey of
and causes of blindness in the rural visual outcomes. Br J Ophthalmol. Blindness-India. NPCB-WHO Report.
population of the Chennai Glaucoma 2002;86:505-12. New Delhi: Ministry of Health and
Study. Br J Ophthalmol 2006;90:407- 8. Thulasiraj RD, Rahamathulla R, Family Welfare, Government of India;
10. Saraswati A, Selvaraj S, Ellwein LB. 1989.
5. Murthy GV, Gupta SK, Bachani D, The Sivaganga eye survey: I. Blindness
Jose R, John N. Current estimates of and cataract surgery. Ophthalmic 12. Mohan M. Collaborative Study on
blindness in India. Br J Ophthalmol. Epidemiol2002;9:299-312. Blindness (1971-1974): A report. New
2005;89:257-60. 9. Murthy GV, Gupta S, Ellwein LB, Munoz Delhi, India: Indian Council of Medical
6. Thulasiraj RD, Nirmalan PK, SR, Bachani D, Dada VK. A population- Research; 1987:1-65.
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Blindness and vision impairment in vision impairment, blindness, and Sreenivas V, Vashist P. Burden of
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7. Nirmalan PK, Thulasiraj RD, Maneksha Giridhar P, Vilas K, Prasad MN, et al. 14. Gupta N, Vashist P, Tandon R, Gupta
V, Rahmathullah R, Ramakrishnan Blindness in Indian state of Andhra SK, Dwivedi S, Mani K. Prevalence of
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Financial Interest: Š‡ ƒ—–Š‘”• †‘ ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

74 DOS TIMES - SEPTEMBER-OCTOBER 2015

MISCELLANEOUS

NANO-MEDICINE IN OCULAR DRUG DELIVERY

Sushmita G. Shah

Ǥ ƒ‘‡—Ž•‹‘• Ȃ —Ž•‹‘• ƒ”‡ ϐ‹‡ †‹•’‡”•‹‘• ‘ˆ

Dr. Sushmita G. Shah DNB, FICO, FLVPEI ‹ϐ‹‹–‡•‹ƒŽ †”‘’Ž‡–• ‘ˆ –™‘ ‹‹•…‹„Ž‡ Ž‹“—‹†•Ǥ ƒ‘‡—Ž•‹‘•
Consultant Cornea & Anterior Segment Surgeon, have one or more amphiphilic lipids or surfactants of submicron
Eye Life Eye Hospital, or nanometer size in a dispersed phase. They are either oil-
Mumbai, Maharashtra, India in-water or water-in-oil solutions. The can solubilize both

hydrophilic and hydrophobic drugs to improve stability, half-

Drug delivery of topical Ophthalmic formulations Ž‹ˆ‡ ƒ† –Š‡”ƒ’‡—–‹… ‡ˆϐ‹…ƒ…›Ǥ ƒ”‹‘—• ‡šƒ’Ž‡• ‹…Ž—†‡ ‡•–ƒ•‹•ǡ
is a challenge. It has been demonstrated that ˆ‘” †”› ‡›‡•ǡ —”‡œ‘Žǡ ˆ‘” –Š‡ –”‡ƒ–‡– ‘ˆ ‘…—Žƒ” ‹ϐŽƒƒ–‹‘Ǥ
20% of topically administered drug is available Lipimix and Soothe XP Emollient have been used for the
to the eye of which only 5% reaches the deeper restoration of lipid layer of lacrymal gland3.
ocular tissues. Multiple factors that come in the
B. Nanomicelles – Nanomicelles are self assembled
nanosized (10 to 100nm) colloidal suspensions with a
hydrophobic core and hydrophilic shell. Nanomicelles solubilize

way of effective drug delivery into the eye and hydrophobic drugs within their hydrophobic core. Nanomicellar

include loss of administered drug through lacrymation, through formulation of Rapamycin showed effective penetration into

–Š‡ ƒ•‘Žƒ…”‹ƒŽ †—…–ǡ ”‡ϐŽ‡š „Ž‹‹‰ ƒ† †‹‰‡•–‹‘ „› ‡œ›‡• the posterior segment of the eye in rabbit models3.

present in tears. The corneal epithelium also poses a barrier C. Nanoparticles – Nanoparticles are of size 1 to 100nm

which does not allow molecules of high molecular weight to ƒ† …ƒ „‡ …Žƒ••‹ϐ‹‡† ‹–‘ ‡–ƒŽŽ‹…

pass through. Also it is selectively permeable and allows easy (gold, silver, platinum), polymeric (polyethyleneimine,

permeability of lipophilic drugs and does not allow hydrophilic albumin, chitosan, polyethelene glycol) and hybrid (metallic

drugs to pass through. nanoparticles conjugated with polymers) nanoparticles.

Achieving therapeutic drug concentration within the Nanoparticles have been demonstrated to deliver genes into

posterior segment of the eye the cornea both in vivo and in vitro2.

is even more challenging. Nanotechnology based Ophthalmic drug Ǥ ƒ‘ϐ‹„‡” •…ƒˆˆ‘Ž†• Ȃ
Often we need to administer formulations potentially offer various Nanostructured cell sheets
drugs through other routes have been developed to culture

like periocular, intravitreal advantages over the currently available corneal endothelial cells. Ma et al
and systemic routes. While Ophthalmic formulations. These include have successfully demonstrated
intravitreal drug delivery the use of PLGA as a scaffold for

involves repeated punctures sustained release, better penetration growth of rabbit adipose tissue
across corneal epithelial barrier, lesser derived stem cells which were
which can be painful and frequency of applications, increased used to heal corneal stromal
defects2.
can have complications like

endophthalmitis, retinal

detachment etc, systemic and bioavailability E. Nanodevices – Contact
periocular administration have Ž‡• Ž‘ƒ†‡† ™‹–Š …‹’”‘ϐŽ‘šƒ…‹

the disadvantages of decreased have been developed to work

bioavailability due to the barriers like blood retinal barrier and against Pseudomonas aeruginosa. However, these devices have

barriers to trans scleral drug delivery, respectively1. not found much clinical application due to high cost, patient

Nanomedicine involves use of nanotechnology for studying discomfort and problems with drug clearance2.

living cells at molecular level and nanomaterials to develop F. Nanodelivery – Nanotechnology based drug delivery

newer drug delivery modalities for the treatment of human systems like liposomes, dendrimers etc. Liposomes are

diseases2. phospholipid bilayer membranes which can be single or

Nanotechnology based Ophthalmic drug formulations multiple and encompass aqueous medium within it. They are

potentially offer various advantages over the currently being extensively explored for corneal diseases as they can

available Ophthalmic formulations. These include sustained easily reach target cells. Their use has mostly been tried in

release, better penetration across corneal epithelial barrier, order to enhance the bioavailability of antimicrobials. Drugs

lesser frequency of applications, increased bioavailability etc. whose liposomal formulations have been worked upon include

Š‡ ϐ‹”•– ‡˜‡” •—…Š ˆ‘”—Žƒ–‹‘ ‹• ‡•–ƒ•‹• ȋ ŽŽ‡”‰ƒ …Ǥ ”˜‹‡ǡ antifungals like Itraconazole and Fluconazole and antibiotics

CA, USA) which is a water in oil suspension of Cyclosporin A Ž‹‡ ‹’”‘ϐŽ‘šƒ…‹ǡ
‡–ƒ›…‹ ƒ† ‘”ϐŽ‘šƒ…‹Ǥ ‘™‡˜‡”ǡ –Š‡‹”

which got US FDA approval for human use in 2002. Few other ‹˜‹–”‘ ‡ˆϐ‹…ƒ…› Šƒ• „‡‡ “—‡•–‹‘‡† †—‡ –‘ †‹•ƒ†˜ƒ–ƒ‰‡• Ž‹‡

drugs have been made available for human use, thereafter. instability, degradability etc1,2.

Various options in nanotechnology based drug therapy are Dendrimers are 1-10nm three dimensional nanostructures.

highlighted below: Š‡ ϐ‹”•– †‡•…”‹„‡† †‡†”‹‡”ǡ Šƒ• „‡‡ —•‡† ˆ‘”

www. dos-times.org 75

MISCELLANEOUS

delivery of antimicrobials but has been used in the treatment of eye disorders —•ƒ”‹— •‘Žƒ‹ ƒ† ‘–Š‡” ϐ‹Žƒ‡–‘—•
reported to cause blurring of vision2,5. like dry eyes, keratitis, uveitis, fungal isolates, when compared to
endophthalmitis and proliferative Natamycin alone6.
FUTURE DIRECTIONS vitreoretinopathy. Search revealed 15
US patents for liposomal formulations Nanomedicine based ophthalmic
Commonly targeted ocular diseases for treatment of various eye disorders. drug delivery seems to be a promising
for nanomedicine include Age Related Since the corneal surface is negatively avenue that could lead to drug
Macular Degeneration, Posterior segment charged, positively charged liposomes formulations with better bioavailability,
‹ϐŽƒƒ–‹‘ ƒ† —˜‡‹–‹•ǡ ”› ‡›‡•ǡ have been used to enhance penetration. ‡ˆϐ‹…ƒ…› ƒ† Ž‡••‡” •‹†‡ ‡ˆˆ‡…–•Ǥ ‘™‡˜‡”ǡ
Microbial keratitis and other infections. Cationic (positively charged) and neutral most of the studies conducted so far have
Liposomal formulation of Bevacizumab charged liposomes containing timolol been in vitro and animal studies. Lot of
was demonstrated to have much longer maleate showed greater reduction R&D is still required before we come to
retention time within the posterior in intraocular pressure than anionic formulations that are stable, cost effective
segment of the eye as compared to the (negatively charged) liposomes loaded and can achieve the above targets, in vivo,
water soluble Bevacizumab. Similarly, timolol maleate3. Liposomal formulations in humans.
liposomal formulation of Gancyclovir of Amphotericin B, Abelcet (Sigma
showed longer intravitreal retention Tau) and AmBisome (Astellas/Gilead) REFERENCES
of the drug at much lower doses and which got US FDA approval in 1995
therefore, lesser toxicity to retina5. The and 1997, respectively, for invasive 1. Patel A, Cholkar K, Agrahari V, Mitra
stability of liposomal formulations can fungal infections, were developed to A. Ocular drug delivery systems:
be increased further with the addition of avoid the nephrotoxicity of systemic an overview. World J Pharmacol.
Polyethylene glycol (PEG) to the surface AmphotericinB therapy and their use has 2013;2:47-64.
of the liposomes. been reported for ocular fungal infections
also. 2. Chaurasia SS, Lim RR,
Prostaglandin analogues like Lakshminarayanan R, Mohan RR. J.
bimatoprost, latanoprost and travoprost Cell Penetrating Peptides are a class Funt. Biomater. 2015;6:277-298.
are very commonly used for the of positively charged amino acid chains
management of glaucoma. These agents which can translocate across negatively 3. Ako-Adounvo A, Nagarwal RC,
have poor water solubility and are charged cell membranes by virtue of their Olieviera L, Boddu SHS, Wang XS,
chemically unstable in aqueous solution. positive charge. Thus they can help in the Dey S, Karla PK. Recent patents in
Carli et al have described a formulation translocation of hydrophilic molecules Ophthalmic nanoformulations and
of an oil phase containing prostaglandin which are otherwise permeable only to therapeutic implications. Recent Pat
analogues dispersed in aqueous phase lipophilic molecules. We have successfully Drug Deliv Formul. 2014;8: 193-201.
and stabilised by two or more surfactants. developed CPP conjugated Natamycin
This formulation was found to be more which could easily penetrate across 4. Kompella UB, Amrite AC, Ravi RP,
stable with no in vivo or in vitro toxicities5. epithelial cell lines without causing their Durazo SA. Nanomedicine for back of
disruption and thus improve the corneal the eye drug delivery, gene delivery
Polymeric micellar formulation of penetration of Natamycin. It was found and imaging. Prog Retin. Eye Res.
Ketorolac with other copolymers was to be non toxic to corneal epithelial cell 2013;36:172-98.
found to have better corneal penetration lines and to corneal endothelial cell, in
ƒ† ƒ–‹Ǧ‹ϐŽƒƒ–‘”› ƒ…–‹˜‹–› †—‡ –‘ vitro. The conjugate was found to have 5. Honda M, Asai T, Oku N, Araki Y,
‹–• ’ƒ”–‹…Ž‡ •‹œ‡ ȋδͷͲ †‹ƒ‡–‡”Ȍ ƒ† comparable in vitro susceptibility against Tanaka M, Ebihara N. Liposomes and
better mucoadhesive property. nanotechnology in drug development:
focus on ocular targets. Int. J.
Liposomes have been extensively Nanomed. 2013:8;495-504.

6. Jain A, Shah SG, Chugh A. Cell
‡‡–”ƒ–‹‰ ‡’–‹†‡• ƒ• ‡ˆϐ‹…‹‡–
nanocarriers for delivery of antifungal
compound, Natamycin for the
treatment of fungal keratitis. Pharm
Res. 2015; 32:1920-30.

Financial Interest: Š‡ ƒ—–Š‘” †‘‡• ‘– Šƒ˜‡ ƒ› ϔ‹ƒ…‹ƒŽ ‹–‡”‡•– ‹ ƒ› ’”‘…‡†—”‡Ȁ’”‘†—…– ‡–‹‘‡† ‹ –Š‹• ƒ—•…”‹’–Ǥ

76 DOS TIMES - SEPTEMBER-OCTOBER 2015

DOS QUIZ

DOS Times Quiz 2015-16

Episode-2

Last date: completed responses to reach the DOS OFFICE by e-mail or mail before 5 pm on 30th September, 2015

Q1. What is the principle depicted by
the two pictures shown, and in
which surgery is it applicable?

Q2. 44-year-old female with Q4. Shortening an encircling band by 6mm produces an indent
high myopia presented with a. 1 mm high.
gradual painless diminution b. 2mm high.
of vision for distance since 6-8 c. It varies depending on the axial length.
months. Patient had a history d. None of the above
of Refractive surgery 3 years
ago. Give your diagnosis? Q5. Tick the correct statement
a. The tamponade effect at the top of an air bubble is greater than it is at the side.
b. The isovolemic concentration of SF6 is 14%.
c. A 0.28 ml bubble of air in an eye of normal volume (5.5ml) tamponades a 90
degree arc of retina.
d. Laplace law describes the tendency of a larger bubble to empty into a smaller
one until both have an equal volume.

Q6. Spontaneous pulsation of the central retinal artery is observed at the end of
surgery. This implies that the IOP is:
a. Greater than the systolic pressure in the central retinal artery.
b. Less than the diastolic pressure in the central retinal artery.
c. Between the systolic and diastolic pressures in the central retinal artery.
d. Cannot predict the IOP status

Q3. 9-year-old male child Q7. Name the condition seen in this picture?
presented with head tilt to
”‹‰Š– •‹†‡ ™‹–Š †‹ˆϐ‹…—Ž–› ‹
reading due to diplopia since
6 months. Give probable
diagnosis and name two
‹’‘”–ƒ– –‡•–• –‘ …‘ϐ‹” –Š‡
diagnosis?

Compiled by:
Dr. Rajendra Prasad Centre for Ophthalmic Sciences,All India Institute of Medical Sciences, New Delhi, India

Dr. Ravi Bypareddy MD Dr.Anita Ganger MS
Senior Resident Senior Research Associate
Retina Services

www. dos-times.org 77

DOS QUIZ

Q8. 50 year female presented to OPD with complaints of decrease in vision DOS TIMES Quiz Rules

in both eyes since 3 months. History of cataract surgery one year back 1. DOS TIMES QUIZ will now feature as 5 Episodes
(Episode 1: July-August, Episode 2: September
in both eyes. She also gives history of improvement in vision after – October, Episode 3: November – December,
Episode 4: January – February, Episode 5: March
intravitreal antiVEGF. What could be the Diagnosis? – April). Entries will have to be emailed before
the last date mentioned in the contest questions
a. IPFT (macular telangectasia) b. Cystoid macular edema form. Late entries will not be entertained.

c. Chronic CSR d. PED 2. Please email (as scanned PDF ONLY) completed
responses for the quiz along with details of the
Q9. In WHO criteria for Low vision, the visual acuity in the better eye is between: contestant ϐ‹ŽŽ‡† ‹ ƒ† •‹‰‡† to dostimes10@
a. 6/18- 3/60 b. 3/60-no light perception c. 6/6-12 d. 6/12-6/18 gmail.com (with cc to [email protected])
or mail to DOS Times Quiz, Dr. M. Vanathi, Room
Q10. Thirty year old cricket player was referred to the uveitis service with refractory No. 479, 4th Floor, Rajendra Prasad Centre
for Ophthalmic Sciences, All India Institute of
a. glaucoma and an inferior retinal detachment. On examination, the iridocorneal Medical Sciences, New Delhi.
c.
e. angle open, cells + in AC and vitreous no KPs. was managed with antiglaucoma 3. Nonmembers may also send in their entries
but will be required to send along with their
treatment. No previous ophthalmic problems except hypermetropia. completed entries, the completed membership
application (with the required documents) to
Indentation I/O revealed superonasal retinal dialysis RE. The fellow eye wnl. enroll as member. Failing this their entries into
the contest will not be considered.
The diagnosis is:.
4. Contestants are requested to attempt all the
Ghost cell glaucoma. b. Schwartz-Matsuo syndrome. 5 episodes of the QUIZ contest and send in
–Š‡‹” ƒ’’Ž‹…ƒ–‹‘• ™‹–Š‹ –Š‡ †ƒ–‡ •’‡…‹ϐ‹‡†Ǥ ‘
Uveal effusion syndrome. d. Nanophthalmic uveal effusion. entries will be entertained after the last date.
The scores of each contestant for all 5 episodes
Posner-Schlossman Syndrome together will be compiled at the end of episode
5 and the winner will be announced in the
DOS Annual Conference in April 2016. In the
event of more than one winning contestants,
a draw of lots will decide the winner. Winner
of each episode will also be published in the
next episode along with the previous episode
answers.

5. Please write to [email protected]/
†‘•”‡…‘”†•̷‰ƒ‹ŽǤ…‘ˆ‘” ˆ—”–Š‡” …Žƒ”‹ϐ‹…ƒ–‹‘•
if any.



Q. No. Completed Responses for DOS Times Quiz: Episode 2

1. ___________________________________________________________________________________________________________________________________________
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78 DOS TIMES - SEPTEMBER-OCTOBER 2015

Dr. Manish Mahabir MD ROSSWORD DOS CROSSWORD
Senior Resident,
Dr. R.P. Centre, Episode-2 5
All India Institute of Medical Sciences, 9
New Delhi 2
4 13
1

3

6 8
7 10

11 12

14 15

ACROSS DOWN

3. Lens used for peripheral iridotomy (7) 1. Immunomodulator drug, neuroprotectant in glaucoma (10)
͸Ǥ —’”ƒ•‡ŽŽƒ” …ƒŽ…‹ϐ‹…ƒ–‹‘ ™‹–Š „‹–‡’‘”ƒŽ Š‡‹ƒ‘’•‹ƒ •‡‡ ‹ 2. Valve which prevents regurgitation of air in nasolacrimal duct

(17) (6)
7. World Glaucoma Day is celebrated internationally on 12th of ͶǤ ‡…Š‹“—‡ ‘ˆ –‡ƒ” ϐ‹Ž •–—†› —•‹‰ ‘†‹— Ž—‘”‡•…‡‹ ȋͳ͸Ȍ
5. Measles spot seen on conjunctiva (6)
........ (5) 9. Common higher order aberration in patients with decentered
8. Principle of stereotest used in synaptophore (11)
11. Bionic eye for retinitis pigmentosa with external camera, 20 corneal graft, keratoconus and decentered laser ablation (4)
10. Famous trial which set research ethics principles for human
†‡‰”‡‡ ϐ‹‡Ž† ‘ˆ ˜‹‡™ ȋ͸Ȍ
12. In KF ring, copper is deposited in this layer of cornea (9) experimentation (9)
14. Combined corneal and intraocular refractive procedure (8) 13. Plot for graphically representing a meta-analysis of the results

of RCTs (6 )
15. L-shaped trabecular micro-bypass device made of titanium

(6)

www. dos-times.org 79

QUICK PICKS

VISUAL ACUITY CHARTS

Dr. Soumya MD •ƒŽŽ‡” •‹œ‡•ǡ †‡•‹‰‡† –‘ „‡ ’”‡•‡–‡† ƒ– ƒ ϐ‹š‡† †‹•–ƒ…‡ ƒ†
Dr. Rajendra Prasad Centre for on one side usually show visual acuity belonging to each row
Ophthalmic Sciences, All India Institute
of Medical Sciences, New Delhi, India TYPES
1) Snellen’s : based on a minimum angle of resolution of 1
DEFINITION
minute of arc.
The resolving power of the eye used to assess and quantify the Ȉ Š‡ ‡ŽŽ‡ ‘’–‘–›’‡ Šƒ• ‘˜‡”ƒŽŽ †‹‡•‹‘• –Šƒ– ƒ”‡
eye’s ability to resolve varying letter sizes
5 times the detail
STANDARD TEST DISTANCES
Snellen fraction
Ȉ ‹•–ƒ…‡ ˜‹•—ƒŽ ƒ…—‹–› ȋ Ȍǣ ʹͲˆ– ‘” ͸ Ǧ ‡“—‹˜ƒŽ‡– –‘ Ȉ ‡•– †‹•–ƒ…‡ †‹˜‹†‡† „› –Š‡ †‹•–ƒ…‡ ƒ– ™Š‹…Š ‘’–‘–›’‡
‘’–‹…ƒŽ ‹ϐ‹‹–›
would subtend 5 minutes of arc at the retina.
Ȉ ‡ƒ” ˜‹•—ƒŽ ƒ…—‹–› ȋ Ȍǣ ͶͲ … Ȉ Š‡ …Žƒ••‹… ‡ŽŽ‡ ˆ”ƒ…–‹‘ ‹• –Š‡ ”‡…‹’”‘…ƒŽ ‘ˆ –Š‡

‡›‘—–Š Žƒ••‹ϔ‹…ƒ–‹‘ ‘ˆ ‹•—ƒŽ …—‹–› ‡ƒ•—”‡‡–•ǣ minimum angle of resolution.
1) Minimum distinguishable (or minimum visible): The 2) Bailey- Lovie chart:
Ȉ ‘‰ ƒ” …Šƒ”– ǡ —•‡† ƒ– ͸Ǥ
ability to see something as being distinguishable from the Ȉ ƒ…Š Ž‹‡ Šƒ• ͷ Ž‡––‡”• ƒ† •’ƒ…‹‰ „‡–™‡‡ ‡ƒ…Š Ž‡––‡”
background
2) Minimum separable: The ability to determine a group of and each row is related to the width and the height of
points or lines as separate and distinct the letter
3) Minimum cognizable or legible: The ability to form 3) ETDRS chart: LogMar chart, used at 4 m
sense (e.g., Landolt C) or minimum legible (e.g. letters or 4) Optoype projectors: Letter and number cards
numbers) 5) Landolt ring

TESTS FOR VISUAL ACUITY Near Vision Charts
1. Detection acuity tests:
Ȉ ƒ–ˆ‘”† †”— 1) Reduced Snellen Acuity card
Ȉ ‰”ƒ†‡† „ƒŽŽǯ• –‡•– -Test distance at 16 in (or 40 cm)
Ȉ …Š™ƒ”–‹‰ǯ• ‡–”‘‘‡
Ȉ ‘‡… …ƒ†› „‡ƒ†• 2) Jaeger Acuity Card
Ȉ ‘– ˜‹•—ƒŽ ƒ…—‹–› Ǧ ʹͲ Ž‡––‡” •‹œ‡• …Žƒ••‹ϐ‹‡†
ͳ –‘
ʹͲ
2. Recognition acuity tests:
ȋ Ȍ ‹”‡…–‹‘ ‹†‡–‹ϐ‹…ƒ–‹‘ –‡•–•ǣ - Test distance at 14in
Ȉ Œ‘‰”‡ǯ• Šƒ† –‡•– 3) Point system
Ȉ ƒ†‘Ž–ǯ•
Ȉ ‡ŽŽ‡ǯ• - Each point is 0.35mm
Ȉ ””‘™• 4) M notation
ȋ Ȍ ‡––‡” ‹†‡–‹ϐ‹…ƒ–‹‘ –‡•–•ǣ
Ȉ ‡ŽŽ‡ǯ• …Šƒ”– - Based on meter unit
Ȉ Š‡”‹†ƒǯ• Ž‡––‡” –‡•–
Ȉ ‹’’ƒǯ• –‡•– TESTS FOR VISUAL ACQUTIY IN DIFFERENT AGES
Ȉ Ž‘‘ǯ• •›„‘Ž –‡•– A) In infancy:
ȋ Ȍ ‹…–—”‡ ‹†‡–‹ϐ‹…ƒ–‹‘ …Šƒ”–•ǣ
Ȉ ‡ƒŽ‡ ‘ŽŽ‹ǯ• ’‹…–—”‡ …Šƒ”–• 1) Catford Drum test
Ȉ ‹‰Š– Š‘—•‡ –‡•– Mc Ginnis drum
Ȉ ŽŽ‡ǯ• ’‹…–—”‡ …ƒ”†• German’s canopy
Ȉ ‘‹‘ …ƒ”†• –‡•–
Ȉ ‹‹ƒ–—”‡ –‘› –‡•– ‘ˆ Š‡”‹†ƒ 2) Preferential looking tests
ȋ Ȍ ‹…–—”‡ ‹†‡–‹ϐ‹…ƒ–‹‘ ‘ „‡Šƒ˜‹‘—”ƒŽ ’ƒ––‡”ǣ - Teller Acquity cards test
Ȉ ƒ‹Ž‡›Ǧ ƒŽŽ …‡”‡ƒŽ –‡•–
Ȉ ƒ”†‹ˆˆ ƒ…—‹–› …ƒ”†• 3) OKNOVIS
Ȉ - based on Optokinetic nystagmus

(E) Resolution acuity tests: 4) Cardiff Acquity tests
Ȉ ’–‘‹‡–‹… †”— 5) Visually evoked response
Ȉ ”‡ˆ‡”‡–‹ƒŽ Ž‘‘‹‰ –‡•–• 6) Indirect assessment
‹Ȍ ‡ϐŽ‡š ”‡•’‘•‡ Ǧ „Ž‹ ”‡ϐŽ‡š
- Forced choice /Operant
-Teller acuity cards - menace refex
Ȉ ‹•—ƒŽ ‡˜‘‡† ”‡•’‘•‡ ‹‹Ȍ ‹šƒ–‹‘ ”‡ϐŽ‡š Ǧ ϐ‹šƒ–‹‘ „‡Šƒ˜‹‘” –‡•–
Optotype cards: formed by rows of optotypes of progressively Ǧ „‹‘…—Žƒ” ϐ‹šƒ–‹‘ ’ƒ––‡”
B) In 1-2 years

1) Boeck candy test
2) Worth’s Ivory Ball test
3) Sheridan’s Balls test
C) In 2-3 years
1) Miniature toys test
2) Coin test
3) Dot visual acquity test
D) In 3-5 years
1) Tumbling E
2) Landolt’s C
3) Sheridan Letter test
4) Lippmann’s HOTV test

www. dos-times.org 81

NEWS WATCH

Prof. R.S. Nanda
(1942 - 2015)

With profound grief we inform u the sad demise of Dr. R.S. Nanda on
25.6.15.

Dr. R.S. Nanda was born on 1.5.1942 in Himachal Pradesh. After
completing his primary education he joined medical college in
Amritsar. He was a honest and hardworking medical student, always
ready to help his fellow students. After completing his MBBS he
™‘”‡† ƒ• ƒ ‡†‹…ƒŽ ‘ˆϐ‹…‡” ‹ †‹•–”‹…–Ǥ

He joined Maulana Azad Medical College for post graduate training
in ophthalmology. Forever smiling and helpful he worked in the
Department of Ophthalmology at Safdarjung Hospital. He believed
in delivering quality care to patients. He was compassionate and
empathetic towards his patients. He passionately worked in the
Department of Ophthalmology at Safdarjung Hospital for 35 years. He was a great teacher as well. He was
engaged in teaching of postgraduate students and nurses. With his kind and helpful nature he guided
many post graduate students in ophthalmology. After retirement in 2002 he continued teaching nurses
‹ ƒŒ—ƒ”‹ ”‹–•ƒ” ‘ŽŽ‡‰‡Ǥ ‡ ™‘”‡† ‹ „ƒ•‡ Š‘•’‹–ƒŽ ˆ‘” ϐ‹˜‡ ›‡ƒ”• –‹ŽŽ Š‹• ’‘‘” Š‡ƒŽ–Š ˆƒ‹Ž‡† Š‹ ‹
ʹͲͳͲǤ ‡ „”ƒ˜‡Ž› ˆ‘—‰Š– ’”‘•–ƒ–‹… …ƒ”…‹‘ƒ ˆ‘” ϐ‹˜‡ ›‡ƒ”• ƒ† Ž‡ˆ– ˆ‘” Š‡ƒ˜‡Ž› ƒ„‘†‡ ‘
—‡ ʹ͸ǡ ʹͲͳͷǤ

DOS Membership Benefit

With a total membership of over 7500 members, the Delhi 4. Discounted registration fees for National and other

Ophthalmological Society is one of the largest state ophthalmic conferences of DOS

societies in the world. The hallmark of our society is the excellent 5. Free Access to full text articles of numerous international

academics in the form of regular academic programmes which journals through OVID available at the DOS ONLINE

includes the following: Library

Š DOS monthly clinical meetings (I – IX) 6. Attend DOS Teaching Programme for PG Students (DOST is

Š Winter Conference a structured resident training module)

Š Sub-specialty Meetings [DOS-Enhanced Subspecialty 7. Travel Fellowships: National & International Travel Grants

‘”‡” ȋ ȌȐ 8. Receive Digital Directory of Members

Š DOS teaching Programme (DOST) Download application from the website www.dosonline.

Š –‡”ƒ–‹‘ƒŽ ‘ˆ‡”‡…‡ ȋ‹Ǧ Ȍ ȏ ‹‡‹ƒŽȐ org

Š Annual Conference For any further queries:

MEMBER BENEFITS OF DELHI OPHTHALMOLOGICAL SOCIETY Please E-mail [email protected] or visit our website:

1. Complimentary DOS Times [Bulletin Magazine (published www.dosonline.org

‘…‡ ‹ –™‘ ‘–Š•ȌȐ

ʹǤ ‘’Ž‹‡–ƒ”›
ȏ …‹‡–‹ϐ‹…
‘—”ƒŽ ȋ’—„Ž‹•Š‡† DR. M. VANATHI
“—ƒ”–‡”Ž›ȌȐ General Secretary - Delhi Ophthalmological Society
DOS SECRETARIAT
3. Free Access to the members section of website providing Room No. 479, 4th Floor, Dr. R.P. Centre for
Ȉ ……‡•• –‘ ‹‰‹–ƒŽ ‹”‡…–‘”› ‘ˆ ‡„‡”• Ophthalmic Sciences, AIIMS, Ansari Nagar,
Ȉ ……‡•• –‘ ’ƒ•– ‹••—‡• ‘ˆ ‹‡• Ƭ
New Delhi, Delhi, India
Ȉ ……‡•• –‘ Š—†”‡†• ‘ˆ Š‘—”• ‘ˆ •—”‰‹…ƒŽ ˜‹†‡‘•ǡ –ƒŽ Tel.: +91-11-26588074

and recordings of past conferences, workshop and Email: [email protected]
meetings Website: www.dosonline.org

82 DOS TIMES - SEPTEMBER-OCTOBER 2015

NEWS WATCH

www. dos-times.org 83

NEWS WATCH

DOS Clinical Monthly Meet – I (Dr. R.P. Centre, AIIMS)

The DOS Clinical Monthly Meet – I was held at J.L. Auditorium, Dr. R.P. Centre, All Mini-Symposium:
India Institute of Medical Sciences, New Delhi on July 26, 2015 from 11:00 A.M. Complex Conditions in
to 1.15 P.M. The meeting which was well attended by 188 ophthalmologists., Vitreo-Retinal Scenarios
commenced at 11.00 AM and concluded on time at 1.15 PM followed by lunch .
Chair Persons:
Prof. Yograj Sharma,

Prof. Atul Kumar

2CFCOUJTGG 2TQH #VWN -WOCT,
delivering his lecture on Myopic Traction
Maculopathy in the Mini Symposium

Padamshree Prof. Yograj Sharma, Chief of Dr. R.P. Centre, AIIMS, New Delhi on the dais
along with the DOS President Dr. Cyrus Shroff, Padamshree Prof. Atul Kumar and DOS
General Secretary Dr. M. Vanathi (right to left).

Case Presentations and Clinical Talk

&T 2CTKLCV %JCPFTC, Vitreo-Retina
Services, delivering his lecture on Current
Perspectives in the management of ROP
in the Mini Symposium

Dr. Dewang Angmo, Senior Research Dr. Medha Sharma, Senior Resident,
#UUQEKCVG RTGUGPVKPI VJG ſTUV ENKPKECN ECUG QH presenting the second clinical case of
Malignant Glaucoma Recurrent Scleritis

Dr. Rohan Chawla, Vitreo-Retina
Services, delivering his lecture on
&KHſEWNV 8KVTGQ TGVKPCN 5WTIKECN 5EGPCTKQU
in the Mini Symposium

&T 4COGPFTC $CMUJK making the guest case Prof. Radhika Tandon presenting the Clinical
presentation of simultaneous bilateral crosslinking Talk on Intraoperative OCT in Corneal &
with INTACS for progressive keratocomus Ocular Surface Surgeries

The meeting was supported by Academic Grant from FDC. Prof. Yograj Sharma, Chief of Dr. R.P.
centre, distributing the Early Bird Prizes to
Early Bird Prizes were sponsored by SUNWAYS. the meeting delegates

www. dos-times.org 87

NEWS WATCH

DOS Travel Fellowship for Partial Financial Assistance to Attend Conferences

’’Ž‹…ƒ–‹‘• ƒ”‡ ‹˜‹–‡† ˆ‘” ‡ŽŽ‘™•Š‹’ ˆ‘” ’ƒ”–‹ƒŽ ϐ‹ƒ…‹ƒŽ ƒ••‹•–ƒ…‡ –‘ ƒ––‡† …‘ˆ‡”‡…‡ȋ•ȌǤ

Conferences

International: Four fellowships per year (Two fellowships can be awarded at a time if committee feels that papers are very good)
Ȉ ƒš‹— ‘ˆ •Ǥ ͷͲǡͲͲͲȀǦ ’‡” ˆ‡ŽŽ‘™•Š‹’ ™‹ŽŽ „‡ •ƒ…–‹‘‡†
National fellowship:
Ȉ Š‡ ™‹‡” ‘ˆ –Š‡ „‡•– ’ƒ’‡” ȋ Ǥ Ǥ ‰‰ƒ”™ƒŽ ”‘’Š›Ȍ ™‹ŽŽ „‡ ƒ™ƒ”†‡† …‘’Ž‹‡–ƒ”› ”‡‰‹•–”ƒ–‹‘ ˆ‘” –Š‡ ‹–‡” ‘ˆ‡”‡…‡

and DOS Annual Conference of the subsequent year.

Eligibility

Ȉ ‹ˆ‡ ‡„‡”• ȋ ‡ŽŠ‹ ‡„‡”• ‘Ž›Ȍ
Ȉ ͹ͷ ‘” ‘”‡ ‘‹–•
Ȉ ……‡’–‡† ’ƒ’‡” ˆ‘” ‘”ƒŽ ’”‡•‡–ƒ–‹‘ǡ ’‘•–‡”ǡ ˜‹†‡‘ ‘” ‹•–”—…–‹‘ …‘—”•‡Ǥ

Time since last DOS Fellowship

Preference will be given to member who has not attended conference in last three years. However if no applicant is found suitable the
fellowship money will be passed on to next year. Members who has availed DOS fellowship once will not be eligible for next fellowship
for a minimum period of three years.

Authorship

Š‡ ˆ‡ŽŽ‘™•Š‹’ ™‹ŽŽ „‡ ‰‹˜‡ ‘Ž› –‘ ’”‡•‡–‹‰ ƒ—–Š‘”Ǥ ”‡•‡–‹‰ ƒ—–Š‘” Šƒ• –‘ ‘„–ƒ‹ …‡”–‹ϐ‹…ƒ–‡ ˆ”‘ ƒŽŽ ‘–Š‡” …‘Ǧƒ—–Š‘”• –Šƒ– –Š‡›
are not attending the said conference or not applying for grant for the same conference. (Preference will be given to author where other
authors are not attending the same conference). If there is repeatability of same author group in that case preference will be given to new
ƒ—–Š‘” ‘” ‡™ ‰”‘—’ ‘ˆ ƒ—–Š‘”•Ǥ ”‡ˆ‡”‡…‡ ™‹ŽŽ ƒŽ•‘ „‡ ‰‹˜‡ –‘ ’”‡•‡–‡” ™Š‘ ‹• ƒ––‡†‹‰ –Š‡ …‘ˆ‡”‡…‡ ˆ‘” –Š‡ ϐ‹”•– –‹‡Ǥ

Quality of Paper

The applicant has to submit abstract along with full text to the DOS Fellowship Committee. The committee will review the paper for its
•…‹‡–‹ϐ‹… ƒ† ƒ…ƒ†‡‹… •–ƒ†ƒ”†Ǥ Š‡ ’ƒ’‡” •Š‘—Ž† „‡ …‡”–‹ϐ‹‡† „› –Š‡ Š‡ƒ† ‘ˆ –Š‡ †‡’ƒ”–‡– Ȁ ‹•–‹–—–‹‘ –Šƒ– –Š‡ ™‘” Šƒ• „‡‡ …ƒ””‹‡†
out in the institution. In case of individual practitioner he or she should mention the place of study and give undertaking that work is
‰‡—‹‡Ǥ Š‡ ˆ‡ŽŽ‘™•Š‹’ …‘‹––‡‡ ™Š‹Ž‡ •…”—–‹‹œ‹‰ –Š‡ ’ƒ’‡” ƒ› •‡‡ ˆ—”–Š‡” …Žƒ”‹ϐ‹…ƒ–‹‘ ˆ”‘ –Š‡ ƒ’’Ž‹…ƒ– „‡ˆ‘”‡ •ƒ–‹•ˆ›‹‰ ‹–•‡Žˆ
about the quality and authenticity of the paper. Only Single best paper has to be submitted by the applicant for review (6 copies). Quality
‘ˆ –Š‡ ’ƒ’‡” ™‹ŽŽ …ƒ””› ͷͲΨ ™‡‹‰Š–ƒ‰‡ ™Š‹Ž‡ †‡…‹†‹‰ –Š‡ ϐ‹ƒŽ ’‘‹–•Ǥ

Poster and Video
The applicant will need to submit poster and video for review.

Credit to DOS

Š‡ ’”‡•‡–‡” ™‹ŽŽ ƒ…‘™Ž‡†‰‡ ’ƒ”–‹ƒŽ ϐ‹ƒ…‹ƒŽ ƒ••‹•–ƒ…‡ ‹ –Š‡ ƒ„•–”ƒ…– „‘‘ Ȁ ’”‘…‡‡†‹‰•Ǥ
The author will present his or her paper in the immediate next DOS conference and it will be published in DJO/DOS Times.

Points Awarded

1) Age of the Applicant Points

ƒȌ δ ͵ͷ ›‡ƒ”• ͳͲ

b) 36 to 45 years 07

c) 45 years plus 05

2) Type of Presentation

a) Instructor/ Co-instructor of Course 12

b) Free Paper (Oral) / Video 07

c) Poster 05

͵Ȍ •–‹–—–‹‘ƒŽ ˆϐ‹Ž‹ƒ–‹‘

a) Academic Institution 15

b) Private Practitioner 20

4) The points awarded for DCRS rating in the immediate past year:

ƒȌ ε ͳͷͲ ͳͲ

b) 75 – 150 5

…Ȍ δ ͹ͷ ‘– Ž‹‰‹„Ž‡

Documents

Ȉ ”‘‘ˆ ˆ‘” ƒ‰‡Ǥ ƒ–‡ ‘ˆ ‹”–Š ‡”–‹ϐ‹…ƒ–‡Ǥ
Ȉ ”‹‰‹ƒŽ Ȁ ƒ––‡•–‡† …‘’› ‘ˆ Ž‡––‡” ‘ˆ ƒ……‡’–ƒ…‡ ‘ˆ ’ƒ’‡” ˆ‘” ‘”ƒŽ ’”‡•‡–ƒ–‹‘ Ȁ ˜‹†‡‘ Ȁ ’‘•–‡” ‘” ‹•–”—…–‹‘ …‘—”•‡Ǥ
Ȉ ‡–ƒ‹Ž• ‘ˆ ƒ‘—…‡‡– ‘ˆ –Š‡ …‘ˆ‡”‡…‡Ǥ
Ȉ ‡–ƒ‹Ž• ‘ˆ „‘–Š –‡”ƒ–‹‘ƒŽ Ƭ ƒ–‹‘ƒŽ ‘ˆ‡”‡…‡• ƒ––‡†‡† ‹ ’”‡˜‹‘—• –Š”‡‡ ›‡ƒ”•Ǥ
Ȉ ‘’› ‘ˆ Ž‡––‡” ˆ”‘ ‘–Š‡” ƒ–‹‘ƒŽ ‘” ‹–‡”ƒ–‹‘ƒŽ ƒ‰‡…› Ȁ ƒ‰‡…‹‡• …‘‹––‹‰ –‘ „‡ƒ” ’ƒ”–‹ƒŽ …‘•– ‘ˆ …‘ˆ‡”‡…‡ ‹ˆ ƒ›Ǥ
Ȉ ”‹‰‹ƒŽ ƒ‹” –”ƒ˜‡Ž „‘ƒ”†‹‰ ’ƒ••‡• ƒ† ’Š‘–‘…‘’› ‘ˆ –Š‡ ƒ––‡†ƒ…‡ …‡”–‹ϐ‹…ƒ–‡ ‘ˆ –Š‡ …‘ˆ‡”‡…‡Ǥ
Ȉ ‡ŽŽ‘™•Š‹’ ‘‡› ™‹ŽŽ „‡ ”‡‹„—”•‡† ‘Ž› ƒˆ–‡” •—„‹••‹‘ ‘ˆ ƒŽŽ –Š‡ ”‡“—‹”‡† †‘…—‡–• ƒ† ˜‡”‹ϐ‹‡† „› –Š‡ …‘‹––‡‡Ǥ
Ȉ †‡”–ƒ‹‰ ˆ”‘ –Š‡ ƒ’’Ž‹…ƒ– •–ƒ–‹‰ –Šƒ– ƒ„‘˜‡ ‰‹˜‡ ‹ˆ‘”ƒ–‹‘ǯ• ƒ”‡ –”—‡Ǥ

Ȉ ˆ ˆ‘—† ‰—‹Ž–› –Š‡ …ƒ†‹†ƒ–‡ ‹• Ž‹ƒ„Ž‡ –‘ „‡ „ƒ””‡† ˆ‘” ˆ—–—”‡ ˆ‡ŽŽ‘™•Š‹’•Ǥ
’’Ž‹…ƒ–‹‘ •Š‘—Ž† ”‡ƒ…Š ‡…”‡–ƒ”›ǯ• ‘ˆϐ‹…‡ ƒ† •Š‘—Ž† „‡ ƒ††”‡••‡† –‘ Š‡ ”‡•‹†‡–ǡ „‡ˆ‘”‡ ƒ”…Š ͳͷǡ
—‡ ͳͷǡ ‡’–‡„‡” ͳͷ
and December 15. The committee will meet four times in a year in the month of March, June, September & December within 2 weeks of
last date of receipt of applications. The committee will reply within four week of last date of submission in yes/no to the applicant. No
fellowship will be given retrospectively, that means prior sanction of executive will be necessary.

Delhi Ophthalmological Society
Room No. 479, 4th Floor,
Dr. R.P. Centre for Ophthalmic Sciences

AIIMS, Ansari Nagar, New Delhi - 110029

88 DOS TIMES - SEPTEMBER-OCTOBER 2015

NEWS WATCH

'HOKL 2SKWKDOPRORJLFDO 6RFLHW\

(LIFE MEMBERSHIP FORM) Paste
Photo

The Photo Identity Card will be issued after
\RXU 0HPEHUVKLS LV UDWL¿HG E\ WKH *HQHUDO
Body during the next Annual DOS Conference

Name (In Block Letters)_______________________________________________________________________________________________

S/D/W/o ____________________________________________________________________________ Date of Birth___________________

4XDOL¿FDWLRQV________________________________________________________________________ Registration No. ________________

Sub Speciality (if any) ________________________________________________________________________________________________

ADDRESS

Clinic/Hospital/Practice __________________________________________________________________________________________

_____________________________________________________________________________ Phone _______________________

Residence ____________________________________________________________________________________________________

_____________________________________________________________________________ Phone _______________________

Correspondence _______________________________________________________________________________________________

_____________________________________________________________________________ Phone _______________________

Email ____________________________________________________________ Mobile No. _____________________________

Proposed by

Dr. _______________________________________________ Membership No. __________ Signature _________________________

Seconded by

Dr. _______________________________________________ Membership No. __________ Signature _________________________

>0XVW VXEPLW D SKRWRFRS\ RI WKH $GGUHVV SURRI 3DQ &DUG 0%%6 0' '2 6WDWH 0HGLFDO &RXQFLO 0&, &HUWL¿FDWH IRU RXU UHFRUGV @

Declaration: I hereby declare that the above details are correct. I wish to be Life member. I have carefully read the instructions overleaf. I shall abide
by the Rules, Regulation & Bye-Laws of the Society as in force and any subsequent amendment(s) made from time to time
(Life membership fee Rs. 5100/- payable by DD for outstation members. Local Cheques acceptable, payable to Delhi Ophthalmological
Society)

3OHDVH ¿QG HQFORVHG 5V BBBBBBBBBBBLQ ZRUGV BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB E\ &DVK BBBBBBBBBBBBBBBBB

Cheque/DD No.________________________________ Dated_______________ Drawn on__________________________________________

Signature of Applicant Three specimen signatures for I.D. Card.
with Date

FOR OFFICIAL USE ONLY

Dr._______________________________________________________________has been admitted as Life Member of

the Delhi Ophthalmological Society by the General Body in their meeting held on________________________________

His/her membership No. is _______________. Fee received by Cash/Cheque/DD No._______________ dated_________

drawn on __________________________________________________________________.

(Secretary DOS)

www. dos-times.org 89

GlatiramerNEWS WATCH1 Abraham 3
Hasner 2 Craniopharyngioma 6
Fluorophotometry ,16758&7,2164March 7
Koplik 5 Haploscopic 8
Coma1. The Society reserve all rights to accept or reject the application.9Argus 2 11
Nuremberg2. No reasons shall be given for any application rejected by the Society.10Descemets 12
Forest3. Every new member is entitled to receive the Society’s Bulletin (DOS Times) and quarterly Journal DJO (Delhi13Bioptics14
Istent 15
Journal of Ophthalmology) of the Society free.
DOWN4. Every new member will initially be admitted provisionally and shall be deemed to have become a full memberACROSS

QPN[ CHVGT HQTOCN TCVKſECVKQP D[ VJG )GPGTCN $QF[ CPF KUUWG QH 4CVKſECVKQP QTFGT D[ VJG 5QEKGV[ 1PN[ VJGP JG QT
she will be eligible to vote, or apply for any Fellowship / Award, propose or contest for any election of the Society.
6Q DG RTQRQUGF CPF UGEQPFGF D[ 4CVKſGF .KHG /GODGT QPN[ 0Q CRRNKECVKQP HQTO YKNN DG CEEGRVGF WPNGUU KV KU
complete in all respects. Proposed and Seconded by existing Member of the Delhi Ophthalmological Society.
2JQVQ +& %CTF YKNN DG KUUWGF QPN[ CHVGT VJG OGODGTUJKR KU TCVKſGF D[ VJG )GPGTCN $QF[
7. Documents to be attached with application form:

Copy of Address Proof (Mandatory)
Passport/Licence/Voters Identity Card/Ration Card/ Electricity Bill/MTNL (Landline) Telephone Bill

(Delhi Life Member should either reside or practice in Delhi.
1. Copy of Degree (MBBS / MD / DNB)
%QR[ QH 4GIKUVTCVKQP %GTVKſECVG
/GFKECN %QWPEKN QH +PFKC QT 5VCVG /GFKECN %QWPEKN
3. Copy of PAN Card
4. One Stamp size Coloured Photograph to be pasted on the Application Form and one stamp size coloured

RJQVQITCRJ VQ DG CVVCEJGF YKVJ HQTO HQT KUUWG QH .COKPCVGF 2JQVQ +FGPVKV[ %CTF
VQ DG KUUWGF QPN[ CHVGT VJG
/GODGTUJKR TCVKſECVKQP D[ )$/

8. Membership Fee
There is life membership on one Time Payment of Rs. 5,100/- only.

.KHG OGODGTUJKR HGG 4U
6JKU OQPG[ YKNN DG RCTV QH EQTRWU QH 5QEKGV[
2. Admission fee Rs. 100/-
The application form should be complete in all respects and accompanied by a Demand Draft of Rs. 5,100/- in
favour of “Delhi Ophthalmological Society” payable at New Delhi should be sent:
Dr. M. Vanathi
Secretary

Delhi Ophthalmological Society

Room No. 479, 4th Floor, Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi – 29

9. For update address for sending application, please visit website www: dosonline.org

90 DOS TIMES - SEPTEMBER-OCTOBER 2015
ANSWERS OF DOS CROSSWORD EPISODE-2

NEWS WATCH

AUGUST December
22nd
30th DOS Enhanced Subspecialty Korner DESK - I 5th- 6th Winter DOS Conference
September
3th-4th DOS Monthly Meeting – Army Hospital, New 11th-13th KERACON, Kolkata
4th-6th Delhi
12th-13th Annual Conference of Strabismus and
5th-9th International Conference on Ocular Paediatric Ophthalmological Society of India
10th-12th Infections 2015 (ICOI), Barcelona, Spain (SPOSI), Coimbatore
11th-13th
12th-14th World Congress of Paediatric Ophthalmology 27th DOS Monthly Meeting – Deen Dayal Upadhyay
17th-20th and Strabismus 2015 Hospital, New Delhi
23th-25th
(WSPOS), Barcelona, Spain Forthcoming Events 2016
25th-27th
European Society of Cataract and Refractive January
20th Surgery Congress (ESCRS), Barcelona, Spain
October 1st-3rd •‹ƒ ƒ…‹ϐ‹…
Žƒ—…‘ƒ ‘…‹‡–› ‘‰”‡••ǡ Thailand
2nd-4th European society of Ophthalmic Plastic and
Reconstructive Surgery, Brussels, Belgium 31st DOS Monthly Meeting – Center for Sight, New
3rd-4th Delhi
7th-10th —ƒŽ …‹‡–‹ϐ‹… ‡‡–‹‰ ‘ˆ ’Š–ŠƒŽ‹…
7th-10th Anaesthesia Society, Chicago, USA February

9th-11th European Vitreo Retinal Society Meeting, 5th-9th World Ophthalmology Congress (WOC)
23rd-25th Venezia, Italy 2016, Guadalajara, Mexico
25th
November Euretina Congress, Nice France 17th-20th Congress of International Society for
3rd-5th Glaucoma Surgery, Muscat, Oman
4th-6th Annual Meeting British and Irish Paediatric
14th-17th Ophthalmology and Strabismus Association, 21st DOS Monthly Meeting – Bharti Eye Hospital,
29th Cardiff, UK New Delhi

Annual Conference of Uttarakhand State 25th-28th Annual Conference of All India
Ophthalmological Society, Jim Corbett Ophthalmological Society (AIOS), Kolkata
National Park, Nainital
27th Feb. – 3rd Annual Meeting of North American
DOS Monthly Meeting – Dr. Shroff Charity Eye (NANOS),
Hospital, New Delhi Mar. Neurophthalmology Society

Glaucoma Connect 2015 (Annual Conference Tuscan, AZ
of Glaucoma Society of India)- Silver Jubilee,
Mumbai March

Eye Bank Association of India (EBAI) CME, 3rd-6th Annual Meeting of American Glaucoma
New Delhi Society, Ft. Lauderdale, FL, USA

EVER (European association of Vision and 27th DOS Monthly Meeting – Guru Nanak Eye
Eye Research), Nice, France Centre, New Delhi

Annual Conference of Australasian Society April
of Cataract and Refractive Surgeons, Noosa
Heads, Australia 6th-10th Annual Meeting of American Association of
Paediatric Ophthalmology and Strabismus
Annual NZOS Conference (North Zone (AAPOS), Vancouver, Canada
Ophthamological Society), Panchkula, Haryana
15th-17th 67th DOS Annual Conference, New Delhi
Annual Conference of Maharashtra
Ophthalmological Society, Goa May

DOS Monthly Meeting – Dr. R.M.L. Hospital, 1st-5th May ARVO 2016, Seattle, USA
New Delhi
24th-26th May Royal College of Ophthalmologists Annual
Annual Conference of VitreoRetina Society Congress, Birmingham, England
of India (VRSI), Kumarakom, Kerala
June
Odyssey Oculoplasty Association of India
(OPAI), Bhubaneshwar, Orissa 19th-22nd June European Glaucoma Society Congress, Prague,
Czech republic
American Academy of Ophthalmology
(AAO), Las Vegas, USA October

DOS Monthly Meeting – Safdarjung Hospital, 5th-8th EVER 2016 (European association of Vision and
New Delhi Eye Research)

15th-18th American Academy of Ophthalmology
(AAO),Chicago, USA

December

2nd-4th Intercontinental Perspective of Paediatric
Ophthalmology & Strabismus: joint Conference
AAPOS/SPOSI, Jaipur

www. dos-times.org 91

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DOS TIMES 2015 – 2017 AUTHOR GUIDELINES

Our Author Guidelines is available online at www. dos-times.org

MANUSCRIPT SUBMISSION
DOS TIMES is published once in two months (i.e six issues in a year: July – August, September – October, November – December, January –
February, March – April, May – June). Solicited and unsolicited manuscripts of good quality academics are accepted provided that they are not
under consideration for publication in any other journal. All submitted manuscripts are subject to editorial review before acceptance.

You may submit your manuscripts along with a covering letter addressed to
Dr. M. VANATHI MD
Editor-in-chief DOS TIMES
DOS Secretariat
Room No 479, 4th Floor, Dr. R.P. Centre
AIIMS, New Delhi-110029
or by email to [email protected] / [email protected]
In case of any queries please contact Mr. Sunil Kumar, DOS TIMES assistant @ 011-65705229 or by email ([email protected]).

MANUSCRIPT SUBMISSION & PROCESSING
DOS TIMES publishes solicited and unsolicited articles. Acknowledgement of receipt of all manuscripts will be sent to the corresponding author,
once the editorial desk reviews the manuscript for conforming to the requirements of the journal. The initial screening of the articles by the
internal editorial staff assesses the formatting, topicality and importance of the subject, the clarity of presentation, and relevance to the target
audience of the journal.
If you are interested in submitting an article, or have any queries regarding article submission, please contact the Editor-in-chief (see Contact
details above).
We also have an active commissioning program whereby, under guidance from the Editorial Committee, we solicit articles directly for publication.
š–‡”ƒŽ ”‡˜‹‡™ǣ  ‘”†‡” –‘ ‡•—”‡ –Šƒ– ƒ—•…”‹’– ƒ……‡’–ƒ…‡ ‹• —„‹ƒ•‡†ǡ •…‹‡–‹ϐ‹…ƒŽŽ› ƒ……—”ƒ–‡ ƒ† …Ž‹‹…ƒŽŽ› ”‡Ž‡˜ƒ–ǡ ƒŽŽ ƒ”–‹…Ž‡• ƒ”‡ ”‡˜‹‡™‡†
„› –Š‡ †‹–‘”‹ƒŽ ‘ƒ”† ƒ† Ȁ‘” ‘–Š‡” •’‡…‹ƒŽ‹•–• ‹ –Š‡ ”‡Žƒ–‡† ϐ‹‡Ž†•Ǥ Š‡ ‹†‡–‹–‹‡• ‘ˆ ”‡˜‹‡™‡”• ƒ† ƒ—–Š‘”• ƒ”‡ ‡’– …‘ϐ‹†‡–‹ƒŽǤ —–Š‘”• ƒ†
‡˜‹‡™‡”• ƒ”‡ ”‡“—‹”‡† –‘ †‹•…Ž‘•‡ ’‘–‡–‹ƒŽ …‘ϐŽ‹…–• ‘ˆ ‹–‡”‡•–•Ȁ ϐ‹ƒ…‹ƒŽ ‹–‡”‡•–•Ǥ
Revision: Most manuscripts require some degree of revision prior to acceptance. Corresponding authors are requested to submit the revised
ƒ—•…”‹’– ƒŽ‘‰ ™‹–Š ‘‡ Š‹‰ŠŽ‹‰Š–‡† …‘’› ™‹–Š ”‡˜‹•‹‘• Š‹‰ŠŽ‹‰Š–‡†Ǥ Š‡ ϐ‹ƒŽ †‡…‹•‹‘ ‘ ƒ……‡’–ƒ…‡ ‘ˆ –Š‡ ƒ—•…”‹’– ˆ‘” ’—„Ž‹…ƒ–‹‘ Ž‹‡•
with the Editor-in-chief.
Authors Responsibility: Authors are responsible for the content of material and views expressed in the manuscripts. Authors must disclose
‡š’Ž‹…‹–Ž› …‘ϐŽ‹…–• ‘ˆ ‹–‡”‡•–ǡ ϐ‹ƒ…‹ƒŽ †‹•…Ž‘•—”‡• ȋ‘” –Š‡ Žƒ… ‘ˆ ‹–Ȍ –Šƒ– ƒ› „‡ ”‡Ž‡˜ƒ– –‘ –Š‡ ƒ—•…”‹’– —†‡” …‘•‹†‡”ƒ–‹‘Ǥ Š‹• •Š‘—Ž†
ϐ‹‰—”‡ ƒ– –Š‡ ‡† ‘ˆ –Š‡ ƒ—•…”‹’–Ǥ

MANUSCRIPT PREPARATION
Manuscripts of the following types may be submitted:
¾ FEATURING SECTIONS: Reviews, Perspectives, Experiences in the various subspecialties of Cataract, Refractive surgery, Cornea, Ocular

Surface, Oculoplasty, Glaucoma, Pediatric Ophthalmology, Ocular Oncology, Retina, Trauma, Squint and Neurophthalmology, Miscellaneous,
etc
¾ CLINICAL SPOTLIGHT: on issues of current interest in clinical practice
¾ INNOVATIONS: on new innovations of surgical technique or device
¾ DIAGNOSTICS DISCUSSION: on diagnostic characteristics of a rare / uncommon clinical condition with good photographic documentation
and investigative details
¾ PRACTICE REQUISITES: on Investigative modalities of importance in ophthalmic practice
¾ SNAPSHOT: on reports of clinical case scenarios of special interest with good clinical documentation
¾ CORRESPONDENCE: Letter to editor on published articles / issues of concern
¾ QUICK PICKS: Tear sheet brief write-up for quick reading / revision

ŽŽ ƒ—•…”‹’–• ȏ‹ ™‘”† ȋ†‘…ǤȌ ϐ‹Ž‡Ȑ ƒ”‡ ”‡“—‹”‡† –‘ ‹…Ž—†‡ –Š‡ ˆ‘ŽŽ‘™‹‰ †‡–ƒ‹Ž•ǣ
¾ Title of the manuscript, Type of manuscript
¾ Forename(s) and surnames of authors (see Authorship section below)
¾ —–Š‘” ƒˆϐ‹Ž‹ƒ–‹‘•ǣ ‡’ƒ”–‡–ǡ •–‹–—–‹‘ǡ ƒ† …‘–ƒ…– †‡–ƒ‹Ž• ȋƒ‹Ž‹‰ ƒ††”‡••ǡ ‡ƒ‹Ž ƒ† …‘–ƒ…– ‘„‹Ž‡ —„‡”Ȍ ‘ˆ ƒŽŽ ƒ—–Š‘”•
¾ ‹‰—”‡•ǡ ‡ˆ‡”‡…‡•ǡ ǡ ϐ‹‰—”‡•ǡ –ƒ„Ž‡• Ƭ ”‡ˆ‡”‡…‡• …‹–‡† ‹ –‡š–ǡ ϐ‹‰—”‡• ƒ† ”‡ˆ‡”‡…‡• —„‡”‡† ‹ –Š‡ ‘”†‡” ‘ˆ ƒ’’‡ƒ”ƒ…‡ ‹ –‡š–ǡ ϐ‹‰—”‡ Ȁ

table legends
¾ Good resolution face photographs of all authors
¾ Photographs, diagrams etc from internet, other manuscripts / books are not to be included. Copyright permission is required wherever

applicable, at the time of submission.
¾ Ž‡ƒ•‡ •’‡ŽŽ ‘—– ƒ…”‘›• ‹ –Š‡ ϐ‹”•– ‹•–ƒ…‡ ‘ˆ ƒ’’‡ƒ”ƒ…‡ ‹ –Š‡ ƒ„•–”ƒ…– ƒ† ’ƒ’‡”
¾ THE AUTHORS WILL BE RESPONSIBLE FOR ANY CONCERNS ARISING OUT OF TO PLAGIARISM, AUTHORSHIP OR RELATED ISSUES.
¾ THE BULLETIN OR THE SOCIETY WILL NOT BE RESPONSIBLE FOR THE VIEWS PROJECTED IN THE MANUSCRIPTS.

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