TOSVISION

TOSVISION

Newsletter of the TAMBARAM OPHTHALMIC SOCIETY

PUBLISHED BY TOS COPYRIGHT OF TOS, TBM ISSUE 1 Volume 1 : Oct 2022

TAMBARAM OPHTHALMIC SOCIETY

108, Ayyasamy Street, West Tambaram, Chennai - 600045

Email : [email protected]

TOS OFFICE BEARERS – (2021 – 2023)

Post Name
Founder President Dr. T. Nirmal Fredrick
Founder Secretary Dr. Rachula Daniel
Founder Treasurer Dr. Sheela Ramani

Imm Past President Dr. V. Karunanidhi
Imm Past Secretary Dr. T. Vimala
Imm Past Treasurer
Dr. V. S. Vimala
President
Vice President Dr. Rachula Daniel
Hony. Secretary Dr. Kavitha Lakshmi K
Hony. Treasurer Dr. Ramya Chelliah
Joint Secretary
Joint Treasurer Dr. A. Palaniraj
Dr. Moses Rajamani
Managing committee member
Managing committee member Dr. Uma Devi . J
Managing committee member
Managing committee member Dr. Sunitha Nirmal
Dr. L. Subha
Scientific committee member
Scientific committee member Dr. V. K. Malathi
Dr. V. Ganesh

Dr. T. Vimala
Dr. Anu M Rajadyn

TABLE OF CONTENTS

SL.NO TITLE AUTHOR PAGENO
Dr. R. Ramakrishnan
1 TNOA President Message Dr. T. Nirmal Fredrick 4
2 TOS Founder President Message Dr. Rachula Daniel 5
3 TOS President Message Dr. V. Karunanidhi 6
4 TOS Imm Past President Message Dr. Ramya Chelliah 7
5 TOS Secretary Message Dr. A. Palaniraj 8
6 TOS Treasurer Message 10

Vision Therapy for paediatric patients – Our Dr. T. Nirmal Fredrick 11
7 experience
Dr. Soundaram 16
8 Keratoconus – Approach to management Dr. Uma Devi. J 20
9 Practical Tip – Ocular surface foreign bodies Dr. K. Kavithalakshmi 21
10 An interesting case of ciliary body cyst Dr. Anu M Rajadyn 27
11 At the cross roads - Cataract and glaucoma
Dr. Viswanathan Latha, 30
Case report of tubercular choroiditis clinically Dr. Sundar Deepak
12 mimicking as central serous chorio retinopathy 36
Dr. Chockalingam 38
13 Understanding medicolegal doctrines - 1 Dr. Rachula Daniel 46
14 The Journey of TOS Dr. T. Vimala 52
15 Report on TOS Activities (2019-2021) Dr. T. Vimala 54
16 TOSCON 21 Dr. Rachula Daniel 58
17 TOS Community Outreach – Glaucoma Rally Dr. Ramya Chelliah 59
18 Feedback Dr. Evangeline D
19 Water colour painting

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 3

TNOA PRESIDENT’S MESSAGE

Dear Members of TOS,
Greetings to all!

Thank you very much for inviting me as the Chief Guest for 8th TOS meeting on 2nd October
2022.
On behalf of TNOA & myself, I congratulate the office bearers & members of TOS for
organizing this meeting. I am very happy to know that TOS under the leadership of Dr. Rachula
Daniel & Dr. Nirmal is organizing such a meeting every year with scientific session and
Glaucoma Oration in the name of my good friend & well-wisher Professor Dr. APCV.
Velayutham & lifetime achievement award. I am really honoured to participate in this meeting
where my teacher Professor Dr.V.M.Loganathan is receiving the lifetime achievement award
and dear friend Dr.Ronnie George is receiving the Dr.APCV Velayutham Glaucoma oration
award. TOS as a district ophthalmic association under TNOA is very active & congratulate
all the office bearers & members for their active contribution to the ophthalmic
community. Wishing the function all the success.
Dr.R.Ramakrishnan
President ,
TNOA

TOS FOUNDER PRESIDENT’S MESSAGE

Dear friends and Delegates

It gives me immense pleasure to know that Tambaram Ophthalmic
society is organising the 8th Annual conference of Tambaram
Ophthalmic society on 2nd October 2022 at Hotel Hablis, Chennai.

TOSCON the Annual conference of the Tambaram Ophthalmic
Society is always a grand event and an important ophthalmic
conference of our region to look forward every year.

The TOSCON team is known for their team work, meticulous planning and organisational
excellence. I have no doubt that this conference will be another milestone in the history of TOS.

I take this opportunity to congratulate the TOS Life Time Achievement awardee, my Guru and
mentor Capt. Prof Dr. V. M. Loganathan, former Director RIO GOH and Recipient of 6th Prof
V. Velayutham Glaucoma Oration Dr. Ronnie George for their mentorship and academic
excellence.

I hope the academic programme, scientific presentations and deliberation will be useful to all
the delegates and will inspire them to strive for excellence in their practice and career.

Giving someone a book - can be a thoughtful gesture for any occasion. I am sure, this
TOSVISION – the first issue of TOS NEWS will be nice souvenir and memorabilia.

I would like to compliment the President and Editor Dr. Rachula Daniel, Secretary Dr. Ramya,
for bringing out this publication & wish them all success in their endeavours.

I place on record my sincere thanks to the Organising team, congratulate Dr. Anu Rajadyn,
Dr. Vimala Scientific Chair and Treasurer Dr. Palaniraj and the entire organizing team for
their team effort.

My best wishes for the success of TOSCON 22 Coimbatore.

Prof. Dr. T. Nirmal Fredrick

Founder President TOS,

President Elect, TNOA

MD, Nirmals Eye Hospital,

Chennai 45

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 5

TOS PRESIDENT’S MESSAGE

Greetings from TOSVISION !
It is indeed an honour and privilege to present the First issue of TOSVISION : Volume I : Issue
1[Oct – 2022] , the first issue of the year 2022 and look forward to more such inspiring and
invigorating content in years to come.
We are delighted to see how our Society has grown leaps and bounds from where it started in
2015 and hence it is only appropriate that such a Newsletter is brought out by the Society for
the benefit of our members and our ophthalmic fraternity.

I would like to thank our TNOA President, Dr. Ramakrishnan for his inspiring presence at
TOSCON 2022 to launch this Newsletter.
I extend my heartfelt thanks to Founder President, Dr.T. Nirmal Fredrick, who had been a
pillar of support to TOSVISION.
Special thanks to our TOSCON organizing Committee - Dr. Anu M Rajadyn, Dr. K.
Kavithlakshmi, Dr. Uma Devi, Dr. T. Vimala , Dr. Ramya Chelliah , Dr. Soundaram, Dr.
Chockalingam for their enthusiasm and valuable contributions to the Newsletter and Dr. Latha
Viswanathan for sending their submissions for this issue. We look forward to your continuing
support and participation towards our Newsletter !
“Follow effective actions with quiet reflection. From the quiet reflection will come even more
effective action.” Peter Drucker
Happy reading !
DR. RACHULA DANIEL MD, DO, AFIH
President – TOS
e- mail : [email protected]
Ph : 9962421779

IMM. PAST TOS PRESIDENT MESSAGE

It’s my pleasure to pen a few words on the glorious occasion of TOSCON 2022
Our 8th Annual TOSCON conference is happening at Hotel HABLIS chennai is going to
be an extravaganza .
The organising committee has put in mammoth efforts in bringing this conference. I
congratulate them for their efforts.
I wish the conference a grand success.

Dr.V.Karunanidhi
Imm. Past President - TOS

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 7

TOS SECRETARY’S MESSAGE

Greetings !!

Tambaram ophthalmic society is no more a new name amongst the ophthalmic fraternity.
Over the years TOS has established itself as a strong society working together and towards
the goal.
TOS was the seed sowed by the founder president Dr.NirmalFredrick,with a thought to
strenghthen the professional development amongst the ophthalmic practitioners in and
around tambaram, but we now have doctors from all corners of the city and outside.
TOS was formally inaugurated by Dr.Premraj , the then president TNOA,in Aug 2015, got
affiliated to TNOA in 2018.
Till date there has been 23 Continuing Professional Development programs and 7 annual
conferences conducted.In memory of our beloved teacherprof.V.Velayutham,to pay our
respect to him, TOS- Prof.V.Velayutham glaucoma oration was initiated in 2017 and till date
5 emminentglaucomatologists have been awarded.
Lifetime achievement awards are being presented in recognition of their commendable
service rendered to the community and in training of ophthalmologists.
The last annual conference TOSCON was held at hotel Hablis on 29th November 2021.After
a long spell of webinars and covid scare, this was the first physical conference.Inspite of bad
weather, it attracted a huge number of participants!
Dr.MohanRajan the then president of TNOA was the chief guest and Dr.Nirmal Fredrick, the
then vice president of TNOA was the guest of honour.
The 3rd lifetime achievement award was presented to Dr.R.Selvamani and the 5th Prof
.V.Velayutham glaucoma oration was rendered byDr.Sathyanparthasarathy.
The scientific sessions included talks by the experts from the field of cornea/ cataract/retina
.We had VAST session on cataract and the ignite session winners were awarded with prizes.

The new office bearers were introduced by the then incoming president
Dr.RachulaDaniel.The new office bearers with Dr.Rachula Daniel as the president,
Dr.RamyaChelliah, secretary and Dr.Palani Raj as the treasurer took over and conducted
the following,

2022, march,13th, TOS teamed up with WGA, GSI,TNOA,MCOA,Bharath medical college
,FORWA to observe the world glaucoma week. The glaucoma walkathon conducted on
Agaramthen road,attracted more than 300 participants from diverse age group.

The program was presided by the chief guest Dr.M.Elangovan commissioner Tambaram
corporation, Dr.mohanrajan, the then president TNOA and Lion Govindarajan,president
FORWA.

The tambaram fit and spin doctors group’s athletic challenge grand finale for 10km was
conducted, which was flagged of by the chief guests, Dr.NirmalFredrick.T and the Dean of
Bhaarath medical college, Dr.Elumalai.There was an energising zumba session before the
athletic challenge. The 5km and 3 Km rally was flagged of by the chief
guests.Dr.MuraliAriga and Dr.Jamuna rani were felicitated and the program concluded with
finisher medals and prize distribution.

The 23rd TOS –CPD was held on 17thjuly at hotel Zone by The Park. The focus was on
paediatric eye care,withDr.ManjulaJeyakumar on strabismus for general ophthalmologist,
Dr.AnkitaBisanion myopia management and Ms.Benita Regina on spectacle dispensing in
paediatrics. Panel discussion was held in challenges and opportunities in ophthalmic
practice. Chaired by Dr.Nirmal Fredrick and Dr.Karunanidhi.V, panellists included, Prof.
K.Vasantha,Dr.D.PPrakash, Dr.Rajinikantha,Dr.Venkatesh,Dr.Lakshmanan, Dr.Stephen,
Dr.RadhaAnnamalai, Dr Yogeshwari.

We have our next academic activity, the annual conference TOSCON ’22 to be held at hotel
Hablis, Guindy ,Chennai on the 2nd of Oct 2022.

So far, our TOS activities has provided mentoring and guidance from the senior faculty. It
has provided a platform for knowledge and skills transfer.

Practice related sessions have helped us learn and grow. There is more opportunity for the
growth of the younger generation andresponses to our community reach programs havebeen
tremendous. We now have brought extra focus on health and fitness.

Looking forward to more such interesting activities in future and I encourage participation
from all ophthalmologists.

Thank you,

Dr.Ramya Chelliah

Secretary –TOS

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 9

TOS TREASURER’S MESSAGE

Greetings from TOS,
Yes the wait is over.With the COVID wave dying down, let us welcome the

scientific tsunami from Tambaram ophthalmic society.
With mentor and founder Dr.Nirmal guidance and with Dr.Rachula and Dr.Ramya pulling

the triggers and with a dynamic organising team and with a galaxy of speakers, there is no
doubt that this Annual event will bang hit right on the target..
I, as treasurer of this esteemed society wish TOSCON 22 and the release of this souvenir a
grand success
Dr. A. Palaniraj
Treasurer – TOS

VISION THERAPY FOR PAEDIATRIC PATIENTS –OUR
EXPERIENCE

Prof. Dr. T. Nirmal Fredrick, Dr. Sunitha Nirmal,
NVT Paediatric Eye Clinic, Nirmals Eye Hospital, Tambaram, Chennai

INTRODUCTION

In modern medicine, there is now great emphasis not only on early diagnosis and treatment of all
disorders and diseases but also on measures that aim at their prevention. Ophthalmology leads the
other specialities in instituting rehabilitation and prevention activities.

Doctors in general and the lay public in particular have been ignorant about the effects of squint on
child development. On one end of the spectrum these patients are celebrated as a lucky person and
the other end they are ridiculed and bullied during the formative years.

In Ophthalmic practice, the most common problems are related to problems of binocular vision and
ocular motility. According to reliable estimates, about 2% of the children of our country have crossed
eyes. The majority of them, it is hoped are receiving treatment of one kind or the other.

The parents of the child with crossed eyes are naturally upset and worried about their child and many
questions about the problem arises in their minds. Often the eye surgeon is so busy that he does not
have the time to explain the condition properly to the parents. Frequently the parents cannot fully
understand such an explanation if it is given in its entirety during a single visit to the doctor’s office.
The bite would be too big to chew.

The successful treatment of squint and amblyopia demands the closest cooperation between the
parents and the eye surgeon.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 11

Squint in children with its associated loss of normal binocular vision, and frequently with the reduced
or loss of vision in one eye due to amblyopia (lazy eye) if early treatment is not initiated - has been a
neglected area because of an inadequate appreciation of simple principles relating to its investigations
and treatment.
Doctors including specialists do not focus on the importance of various grades of vision, e.g.,
Simultaneous perception, fusion and stereopsis and not much interest has been shown to understand
the importance of binocular vision and depth perception. This article is written to present a simple
approach to the subject of Squint, Amblyopic, Binocular vision, like 3-D perceptions and stereopsis.
Binocular single vision (BSV) is one of the most important features of the human race that has
bestowed upon it the supremacy over the rest of the animal kingdom. It is not without reason that
about 60% of the brain tissue and more than half of the twelve cranial nerves serve the eyes.
This binocular single vision is accomplished by a perfect coordination of the two eyes both at rest
and movement. The two-dimensional images of an object of interest formed at the fovea of each
eye is processed and perceived in the brain as one three-dimensional (3-D) image. This requires
constant and controlled activity of the appropriate eye muscles to maintain fixation of the two eye-
cameras on the concerned object, irrespective of the movement between it and the observer. It also
requires the accommodational or focusing mechanism to maintain clear view even as the object
moves closer or farther.

FIGURE 1 AMBLYOPIA
VISUAL ASSESSMENT AND ORTHOPTIC EVALUATION
Apart from the Regular vision assessment, subjective and objective refraction, a detailed orthoptic
evaluation is mandatory in these patients. Orthoptic Evaluation to assess sensory, motor, vergence
and accommodation is important. Evaluation include assessment of Stereopsis, Extraocular motility,
AC/A ratio, Near point convergence, Fusional Vergence, Amplitude of Accommodation, NRA/PRA,
Accommodative Response (MEM) and Accommodative Facility

AIM OF THE TREATMENT: In children with eye muscles problems and amblyopia are:

1. Good and full vision in each eye.
2. Eyes that appear cosmetically straight.
3. Eyes that see straight (Eyes that work

together as a team).
4. Stereopsis (3-D Vision) or depth

perception.

MANAGEMENT INCLUDE THE FOLLOWING:

• Glasses – accepted full correction

• Eye drops or ointment (Penalisation)

• Patching

• Surgery

• Orthoptic training

• Pleoptics and active vision therapy

VISION THERAPY is an attempt to develop or improve visual skills and abilities; improve visual
comfort, ease, and efficiency; and change visual processing or interpretation of visual information.

Vision Therapy is a behavioural approach to correcting various eye problems that affect one's ability
to receive and process visual information. A person may have "perfect" vision while reading an eye
chart, pass a vision screening by reading 20/20, and still have developmental vision problems. The
areas most often affected are focusing, eye teaming, eye movements and visual processing.

Vision Therapy is an individualized treatment program designed to improve and sometimes eliminate
conditions such as lazy eye (amblyopia), crossed eyes (strabismus), focusing insufficiency and
excess, ocular muscle dysfunction, and learning-related vision disorders. An optometric vision therapy
session consists of supervised in-clinic and at home reinforcement exercises performed over weeks
to months. In addition to exercises, lenses (“training glasses”), prisms, filters, patches, electronic
targets, or balance boards may be used. Specialized lenses, filters, prisms and instruments are used
in theprogram and is customized for each patient.

NVT VISION THERAPY CLINIC has specialized in the assessment and treatment of both strabismic
and non - strabismic binocular vision anomalies. A team of trained optometrists assess and evaluate
eye muscle coordination and binocular alignment. Other visual skills necessary for learning or sports,

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 13

depth perception, peripheral vision, eye-hand coordination is also assessed. VTC also carries out
occlusion therapy, management of diplopia and other strabismus related issues using prism glasses
and computer assisted software programmes

Vision Therapy is generally advised for:

• Accommodation system anomalies

• Vergence system anomalies

• Suppression

• Amblyopia

• Computer vision syndrome and

Other Non-strabismic binocular vision anomalies

THE GOAL OF VISION THERAPY is to optimize the visual system, and areas of the brain that control
vision, visual efficiency, visual perception and other
vision-related functions. By treating the entire visual
system, vision therapy aims to change reflexive
(automatic) behaviours to produce a lasting cure. VT can
help reduce eyestrain and other symptoms of computer
vision syndrome experienced by many children and
adults that cannot be treated successfully with
eyeglasses, contact lenses and/or surgery alone, and
help people achieve clear, comfortable binocular vision.

TEAM MATTERS: The Optometrist, Orthoptist under the

guidance of Ophthalmologist will decide the best course of

treatment suitable for the patient. Orthoptist will try to educate or re-educate the two eyes to work

together by breaking down the faulty visual habits and attempting to establish correct ones.

OUR VISION THERAPY SUCCESS STORIES:

Patient: Mala (Name Changed)

Completed Vision Therapy in July 2022

Mala was skipping words, repeating groups of words and having trouble staying focused on school
work. After beginning Vision Therapy, she is more confident in class and fluency has increased to

normal grade level. She has fewer errors when reading and writing and actually enjoys reading now!
Her family feels that Vision Therapy has been a life-changing experience for her.

Patient: Ashraf (name changed)

Completed Vision Therapy in August 2022

Ashraf had reading and writing challenges at school. His right and left eyes were not working together
properly and it was causing problems with his ability to focus on tasks in school in addition, he was
inverting letters and skipping over words. Since completing Vision Therapy, his reading and writing
have significantly improved and he’s much happier and willing to read for long periods!

CONCLUSION: There are few conditions in the field of medicine that demand greater cooperation
between children, parents, teachers, family doctors, paediatricians and Ophthalmologist than the care
of a child with crossed eyes with or without the presence of amblyopia (Lazy eyes).

The significance of this new field is that the vision of
the child with or without squint can usually be
improved to equal and full vision in both eye with
good fusion and full stereopsis -if treatment is begun
at a very early age and followed up as advised.

Our experience has been that the quality of results
improves in direct proportion to the effort put into the
orthoptic training and active vision therapy. Our attitude towards the value of these visual training
methods has been influenced by the efforts of our team and the children themselves who come to us
for treatment.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 15

KERATOCONUS: APPROACH TO MANAGEMENT

DR.SOUNDARAM, KLARITI EYE CARE

Keratoconus(KC) is a progressive degenerative noninflammatory ectatic disease and
compromises the integrity of collagen matrix in the corneal stroma. Its hallmark
characteristic is localized cone-shaped bulging with thinning at the site of the cone. 1This
condition can lead to blindness as the irregular astigmatism increases.
KC usually affects both eyes, although only one eye may be affected initially. The affected
patient is usually a teenager, with complaints of photophobia, glare, monocular diplopia,
itching and ocular irritation.2Eyes with KC have significant aberrations that affect visual
quality, with higher levels of vertical coma, primary coma and coma-like aberrations as
compared to normal eyes.
The diagnosis is usually with the clinical findings on the slit lamp, refraction of a myopic
astigmatism which is progressing in nature and corneal tomography imaging the anterior
and posterior cornea, keratometry and pachymetry values in the quad map.
A number of approaches have been developed to improve the quality of vision in affected
patients and also to slow or stop disease progression. The choice of therapy depends on
the severity of the disease and the age of the patient, as well as the contraindications and
possible complications of these treatment modalities. Patients with higher risk factors,
including pregnancy or young age (under 20 years), require evaluation every three
months.3 Patients with severe KC often require combination therapy.
The treatment of keratoconus involves 2 goals:
Stopping progression and visual improvement.
To prevent progression, corneal cross-linking is recommended to increase the
biomechanical stability and rigidity of the cornea, with early intervention normally warranted.
KC patients should be advised to avoid eye rubbing as it may contribute to disease onset
and progression. In corneal collagen crosslinking(CXL) with the UV rays with riboflavin to
strengthen the cornea. The main effect of CXL is that it prevents disease progression
through the formation of chemical bonds among collagen fibrils.
For visual improvement in keratoconus patients, the various options that can be selected
depends on the stage of disease, progressing nature and associated scarring.

Spectacles can provide acceptable vision for patients in very early stages, and they are
especially appropriate for those who achieve 20/40 or better visual acuity. However,
spectacles cannot correct irregular astigmatism, and in such cases, soft toric lenses or hard
contact lenses can provide better vision for the patient.4

Current advances in contact lens design offer various fitting options for the correction of
irregular astigmatism in keratoconus patients. Different lenses can be fit depending on the
type, location, and the size of the cone, after imaging the cornea with corneal topography.
The different variety of contact lenses include:

• Soft toric contact lenses
• Rigid gas permeable (RGP) lenses
• Hybrid lenses (rigid center and soft peripheral hydrophilic skirt)
• Scleral lenses
• Piggyback system (rigid lens on soft lens)

Toric soft lens may be sufficient for correcting myopia and regular astigmatism. Soft corneal
contact lenses offer adequate vision, sufficient tear exchange, corneal oxygenation along
with ease of handling and low rates of infection if handled properly. RGPs offer better vision
than soft lenses in more advanced cases but are often associated with discomfort and
foreign body sensation, difficulty with centration of the optics in highly decentered cone
apices, and the inability of the lens to be properly fitted in some advanced cases.5 In cases
of RGP intolerance, both piggyback lens combination and hybrid lenses can improve
wearing time.6

Hybrid lenses consist of a central RGP lens and a soft peripheral skirt lens, thus combining
the visual performance of a rigid lens with the comfort and stability of a soft lens. Further
variety includes corneoscleral lenses and scleral lenses which are often reserved for
advanced cases. Scleral lenses have a larger diameter and rest on the sclera, vaulting over
the cornea and offer good visual performance and comfort. With these lenses, there is a
fluid layer between the lens and cornea. Scleral lenses have a higher cost and more
challenging fitting process.They offer increased stability, improved visual outcomes, and
better comfort compared with standard contact lenses.7The piggyback approach
incorporates a corneal RGP lens over a soft silicone hydrogel lens, combining increased
patient comfort with adequate visual performance. For example, a soft lens with low positive
power improves centration of a rigid lens in case of a sagging cone.

Choosing the appropriate type of lens and proper fitting can help avoid the need for corneal
transplantation in severe cases of keratoconus. Even after corneal grafting, patients may
need special contact lenses to correct residual astigmatism.

Intrastromal corneal ring segments (ICRS) are made of polymethyl methacrylate (PMMA)
and are implanted deep in the stroma to reduce the corneal curvature.ICRS reduce corneal
distortion by flattening the steep area of the cornea and reshaping it. A sizeable reduction in
corneal astigmatism occurs ranging from 1-3D and in mean Ks by 3-5D with ICRS.8

Phakic intraocular lenses are recommended for cases with high irregular astigmatism who
are at least 21 years of age do not achieve sufficient correction with spectacles or contact
lenses. Unlikecorneal-based treatments that aim to normalise the shape of the keratoconic
cornea, IOLs can correct only spherical and cylindrical error.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 17

In eyes with poor BCVA and poor tolerance of RGP we can perform lamellarkeratoplasty
(deep anterior lamellar keratoplasty; DALK) if the patient has associated apical corneal
scar, very steep cornea (maximum keratometry [K] more than 65.00 D), or a thin cornea at
the site of ICRS insertion.In eyes with deep corneal opacities, penetrating keratoplasty
(PKP) may be needed.

Over the past two decades, technological advancements have improved the early diagnosis
and management of KC. The diagnostic workup should involve a detailed medical history, a
thorough slit-lamp examination, and imaging analysis techniques such as tomography.
Treatment plans remain patient specific and should be based on a collaborative discussion
that appropriately addresses the individual’s concerns and expectations for visual outcome.

REFERENCES:

1. Krachmer JH, Mannis MJ, Holland EJ. Cornea: Fundamentals, Diagnosis, and
Management. 3rd ed. Philadelphia; Elsevier Inc.: 2011.

2. Lee LR, Hirst LW, Readshaw G. Clinical detection of unilateral keratoconus. Aust N Z J
Ophthalmol. 1995;23:129-133.

3. Gomes JA et al. CORNEA. 2015;34(4):359-369
4. Heikal MA, Abdelshafy M, Soliman TT, Hamed AM. Refractive and visual outcomes after

Keraringintrastromal corneal ring segment implantation for keratoconus assisted by
femtosecond laser at 6 months follow-up. ClinOphthalmol. 2016;23(11):81–86.
5. Pilskalns B, Fink BA, Hill RM. Oxygen demands with hybrid contact lenses. Optom Vis
Sci. 2007;84:334–342.
6. Rathi VM, Mandathara PS, Dumpati S. Contact lens in keratoconus. Indian J
Ophthalmol. 2013;61(8):410–415.
7. Koppen C et al. AM J OPHTHALMOL. 2018;185:43-4.
8. Colin J, Cochener B, Savary G, Malet F, Holmes-Higgin D. INTACS inserts for treating
keratoconus: one-year results. Ophthalmology 2001; 108: 1409–14

PRACTICAL TIP – OCULAR SURFACE FOREIGN BODIES

Dr. J. Umadevi, M.B.B.S., D.O, F.A.I.C.O.,
Senior Consultant ophthalmologist and Refractive Surgeon

Dr. Agarwal’s Eye Hospital, Tambaram- Chennai.

In Cases with Ocular foreign body sensation, Ocular surface evaluation with vital staining is
must.

If you notice Corneal abrasions - look for foreign body
in the corresponding upper or lower tarsal

Conjunctiva and remove it

Commonly missed foreign bodies are

1. Caterpillar setae - tip of the setae visible as brownish black spot on Conjunctival surface

2. Triradiate thorn –pale - beige coloured foreign body mimics Mercedes Benz Sign on
Conjunctival surface

3.Glass pieces

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 19

AN INTERESTING CASE OF CILIARY BODY CYST

Dr K Kavitha Lakshmi, M.S(ophthal), FMRF

Dr KK Surgical & Paediatric centre

Selaiyur East Tambaram, Chennai 600078.

[email protected]
We present a rare case of multiple ciliary body cyst with no signs of angle
closure or IOP spike but detected on routine eye examination. In addition to
gonioscopy, Ultrasound Biomicroscopy is considered the conclusive method
for accurate diagnosis, as it reveals the underlying cysts even in a seemingly
normal eyes. This case report will also stress the importance of examining
each and every patient before dilatation, by the ophthalmologist himself.

A 58 year old gentleman presented to our centre for routine eye examination
and spectacle power correction on 13.07.2021.

He is a known Diabetic and hypertensive well controlled and on treatment for
more than 8 years.

He was not on any topical medication like prostaglandin analogs

There was no history of any recent injury to the eye or any surgery on the eyes.

His visual acuity was OU 6/9 with correction (+0.5DCyl @ 180 and NV add +2.50 D Sph)

improved to 6/6 N6

IOP OD 14 mmHg OS 16mmHg

Slit lamp examination revealed a bump in the peripheral iris between 7 and 9’ o clock on his Right
eye. Left eye looked normal

Gonioscopy OD temporal and inferior closure

OS Inferior closure

CCT OD 542microns OS 549 microns

Fundus OU normal with a cup disc ratio of 0.3 and a healthy euro retinal rim

Visual Fields were normal.

The patient was referred for UBM and the report revealed

OD moderate sized CB cysts 7-9 ‘o clock hours

OS moderate sized CB cysts (posterior to iris root) 5-6 and 11 ‘o clock hours. Rest of the clock hours
imaged small sized cysts in both the eyes.

The patient was referred to an ocular oncologist who opined in favour of a benign cyst.

Our patient underwent prophylactic YAG peripheral iridotomy both eyes on 23.07.2021and is being
closely followed and observed for angle closure or inflammation.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 21



Discussion

Since the advent of ultrasonographic biomicroscopy UBM, it has become evident that cysts of the iris
or ciliary body epithelium can mimic the plateau iris syndrome. Patients with pseudo plateau iris had
a greater degree of trabecular meshwork pigmentation, had fewer clock hours of gonioscopic angle
closure and were more likely to be male and have a bumpy peripheral iris appearance ( visualised by
using a narrow slit beam. It is not known whether these sectoral CB cysts could potentiate angle
closure in eyes with narrow angles. If significant angle closure is not present , the prognosis is
generally good. In case of significant angle closure, treatment may necessitate puncture of the cyst
with a needle or with an Nd YAG laser. Iridoplasty can also be helpful.

Conclusion

In eyes anatomically at risk of PAC, the development of these cysts may potentiate sectoral angle
closure and we therefore recommend UBM as the imaging modality of choice to help diagnose and
monitor these cysts.

It is easier to assume that small lumps or bumps in the iris are benign, but in the back of your mind,
you need to consider other more serious differential diagnoses. Always remember that tumors can
be occasionally associated with cysts or have a cystic component.An ocular oncologist opinion
should be considered before you start your intervention.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 23

AT THE CROSS ROADS……. CATARACT AND GLAUCOMA

DR ANU M RAJADYN

SENIOR CONSULTANT

DR AGARWAL EYE HOSPITAL

Cataract and glaucoma form a major chunk of our daily practice; and rightfully
so. Cataract is the leading cause of curable blindness. Glaucoma is the second
most common cause of preventable blindness. Inspite of all the screening
camps and awareness programmes conducted, the awareness levels about
glaucoma especially in rural areas is abysmally low. This remains the major
reason for its under detection and the dilemma we face in treating patients with coexistant cataract
and glaucoma.

The management of cataract and glaucoma independently is fairly straight forward. But there are lots
of gray areas and unanswered questions about combined management. There are no rule of thumb
approaches. A thorough preoperative evaluation is the key to effective management.

When assessing a patient with cataract it is either the NCT value or the cup disc ratio which alerts us
to the possibility of a coexistant glaucoma. This article is aimed at throwing light as to how to proceed
and manage such patients

EVALUATION OF CATARACT

When dealing with the cataract look specifically for the following details:

TYPE AND LOCATIONOF CATARACT: Take note of glaucomflecken, intumescent cataract,
hypermature cataract, posterior subcapsular cataract which could point towards a secondary
glaucoma

ZONULAR INTEGRITY – Look for phacodonensis which indicates zonular weakness and
expect a subluxation of lens

PSEUDOEXFOLIATION – usually associated with poorly dilating pupil and zonular weakness.
It is noteworthy that glaucoma associated with pseudoexfoliation has greater IOP fluctuations
and progression of glaucoma is faster.

AC DEPTH- take note whether the Ac is shallow by the Van Herricks method

RELATIVE ANTERIOR MICROPHTHALMOS –It is characterized by the following:

Horizontal corneal diameter <11MM
Axial length>/= 20 MM

Associated cornea guttata, pseudoexfoliation,poorly dilating pupil

In this entity there is no visible malformation in the anterior segment.

PUPIL DILATATION- preoperative assessment of pupillary dilatation will help you plan your surgery
better. You can choose between hooks and rings depending on the AC depth in poorly and non
dilating pupils

LENS INDUCED GLAUCOMA

In the current post covid scenario, we are faced with a lot more mature cataracts and lens induced
glaucomas. Let me briefly revisit the different types.

Glaucoma secondary to lenticular changes form a subset of secondary glaucomas. The different types
are:

PHACOMORPHIC GLAUCOMA –seen into intumescent cataracts. It is characterized by increased
lens thickness, shallow AC Depth, iridolenticular apposition and raised IOP

PHACOLYTIC GLAUCOMA –presents with severe pain and redness associated with a drop in vision.
The presence of high IOP, steamy cornea, deep AC, and lens proteins floating in AC or hypopyon
makes the diagnosis.

LENS PARTICLE GLAUCOMA –raised IOP is caused by the obstruction of aqueous outflow by lens
particles. It occurs secondary to trauma; either surgical or accidental

PHACOANTIGENIC GLAUCOMA – This is an immune mediated reaction against lens protein
following surgery or trauma.

EVALUATION OF GLAUCOMA

■ IOP AND TARGET IOP:-Assess the IOP by the GAT.It will enable you to start antiglaucoma
medication with a target IOP and which is safe to perform a cataract surgery

■ GONIOSCOPY: - It is imperative to do a gonioscopy and find out whether the angles are open
or narrow. Also look for angle recession, pigment clumps, pseudoexfoliative material, new
vessels.Narrow occludable angles warrant a YAG PI

■ ONH CLINICAL EVALUATION:– Five rules for ONH assessment in glaucoma are
Look first at the rim and not at the cup
Look at the peripapillary region
Look at theretinal nerve fibre layer
Look at the lamina cribrosa
Look for optic disc haemorrhage

■ PERIMETRY :- Essentially done preoperatively. In patients with VA less than than 6/18 the
perimetry may be unreliable. it will have to be repeated after the cataract surgery

■ PACHYMETRY

■ OCT DISC AND RNFL:-In dense cataracts it will give us an idea of the severity of glaucoma,
though the report may not be reliable

Once the issues relating to the type and severity of glaucoma are sorted out, it becomes easy
to plan well for the cataract surgery

PREOP CATARACT WORKUP

IOL POWER CALCULATION: a good and accurate calculationis the cornerstone to delivering a good
visual outcome.

In shorter eyes usethe HAEGIS/ HOLLADAY 2 formula

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 25

IOL SELECTION: MF IOL may influence the visual field results and imaging techniques. It also redces
the contrast sensitivity

INTRA OP CONSIDERATIONS

Use highly retentive cohesiveviscoelastics like healon in eyes with shallow AC

Use pupil stretching techniques /iris hooks/pupil expanding rings for poorly dilating pupils

SURGICAL OPTIONS

■ ONLY PHACO – considered in lens induced glaucoma or in mild to moderate glaucoma ;
especially if the patient is compliant with medications and likely to come for regular followup.
The reduction in IOP is believed to be around 4 mm HG

■ ONLY TRAB – considered in patients with very early lens changes. It may be performed with
adjuvant wound modulators like Mitomycin C or biodegradable collagen matrix(ologen). Here
the IOP reduction will be greaterbut the surgery itself is cataractogenic. It is also to be
remembered that cataract surgery at alater date may result in bleb failure.

■ COMBINED PHACO TRAB – this results in more IOP reduction. But the post op complications
are more and a close watch is required. You can opt for either of the two following methods
SINGLE SITE- it involves a single superior site for both cataract and trabeculectomy. A fornix
based flap is preferred.

TWO SITE- it involves atemporal phaco and superior site trabeulecomy. It is preferred in
patients with deep sockets and thick eyebrows. Though it causes less astigmatism, it is more
time consuming and the endothelial cell loss is more.

SURGICAL GUIDELINES

CATARACT
WITH

GLAUCOMA

MOD TO SEVERE GL MILD GL DAMAGE
DAMAGE

CAT SIGNIFICANT; IOP CAT NOT SIGNIFICANT; IOP CONTROLLED; SINGLE IOP NOT
CONTROLLED IOP NOT CONTROLLED MEDICATION CONTROLLED;
MULTIPLE MEDICATION

COMBINED SURGERY TRAB FOLLOWED BY CATARACT SURGERY COMBINED SURGERY
CATARACT ALONE

CASE REPORT OF TUBERCULAR CHOROIDITIS CLINICALLY
MIMICKING AS CENTRAL SEROUS CHORIO RETINOPATHY

Viswanathan Latha, Sundar Deepak
Dr Agarwal's Eye Hospital, Chennai, Tamilnadu

Abstract:

30 year old male patient who had typical risk factors of Central Serous Chorio Retinopathy (CSCR)
presented with minimal hypermetropic shift associated with pigment epithelial detachment and
exudative retinal detachments at the macula, after investigations he was diagnosed to have
posterior choroiditis of probable tubercular etiology. We report this case to emphasize Ocular TB is
a great mimicker.

Introduction:

Tuberculosis is caused by Mycobaterium tuberculosis which is an obligate intracellular aerobic
bacilli [1] It causes multisystem infection. Haematogenous spread is the main mechanism by which
TB affects the eye [2] A high index of suspicion is essential to diagnose this great mimicker.
Our patient is a young male, who presented with a sudden onset of deteriorating vision in the left
eye. Signs initially were retinal elevation at the posterior pole with turbid fluid underneath. Within few
days, he had progressive vision loss with pain in that eye. Investigations revealed probable
tubercular etiology.

Case Report:

30 year old male patient presented with complaints of cloudy vision in the left eye for about 1 week
duration. He had similar complaints in the same eye few years back that resolved completely.
He was an asthmatic on intermittant steroid inhalers. Ocular examination at initial presentation was
BCVA 6/6 N6 in the Right eye and with +1.5 DS 6/18 N12 in the left eye. Right eye anterior and
posterior segment examination was unremarkable. In the left eye anterior segment examination was
normal. On posterior segment examination, there was a less transparent retinal elevation at the
posterior pole. He was clinically diagnosed as CSCR with fibrinous exudation and was advised OCT
and FFA. OCT macula of the right eye was normal and that of the left eye showed elevation of the
neurosensory retina with pigment epithelial detachment containing fibrin like material with high
reflectivity (Figure 1)

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 27

Figure 1: OCT of the left eye showing pigmented epithelial detachment and neurosensory retinal
elevation
He was advised FFA, he was reluctant to have any more investigations. He was advised life style
modifications and avoidance of stress.
Five days later, he revisited the clinic with eye pain and discomfort and further drop in his vision.
Right eye anterior and posterior segment examination was normal. Left eye BCVA was 5/60 and
N<36. Anterior segment examination was normal. On fundus examination massive chorioretiretinal
elevation at posterior pole was noted that had yellowish appearance with multiple pockets of
subretinal fluid (Figure 2).

Figure 2: Colour fundus photograph of the left eye showing yellow chorioretinal elevation between
the arcades

Figure 3: FFA hypoflourescence pattern in early frames at posterior pole

Figure 4: FFA hyperflourescence pattern in late frames at posterior pole

FFA was done which showed early hypofluorescent (Figure 3) and late hyper flourescent pattern
(Figure 4) at the posterior pole suggestive of Inflammatory etiology.

USG B scan showed diffuse choroidal thickening along with choroidal elevation and associated
exudative retinal detachment at the posterior pole. (Figure 5)

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 29

Figure 5: USG B Scan of the left eye showing diffuse choroidal thickening with chorioretinal
elevation at the posterior pole with exudative retinal detachment.
Working diagnosis of posterior choroiditis of probable tubercular etiology was made
Blood investigations were advised, Blood inflammatory markers were marginally elevated. Mantoux
was positive. He was advised CT chest and pulmonologist opinion was sought.
Patient was started on 1 mg kg per day oral steorids in tapering dose along with Anti Tubercular
Treatment (ATT).
After 2 weeks of steroids and ATT patient symptomatically improved with BCVA in the left eye
6/36 N24. On Fundus examination minimal chorioretinal elevation and reduced exudation at the
posterior pole was noted (Figure 6). The same findings were confirmed on the OCT also (Figure 7)

Figure 6: Colour fundus photograph of the left eye after initiation of steroids and ATT

Figure 7: OCT after initiation of steroids and ATT showing reduced chorioretinal elevation

Discussion:

Mycobacterium tuberculous (MTB) ocular infection is very common in our country. Ocular TB is
defined as infection by MTB in the eye, around the eye or on its surface. It has varied ocular
presentations. It should be considered as differentials in various uveitic entities when there is
significant intraocular inflammation. Ocular inflammation in Intra Ocular TB (IOTB) may be anterior,
intermediate, posterior or panuveitis.
Tuberculous anterior uveitis can be unilateral or bilateral which has an insiduous onset and run a
chronic course. They present with granulomatous inflammation complicated with cataract and
synechiae formation.
Posterior Uveitis is the most common form of Intraocular TB[3]. Inflammation of the choroid can
present as focal, multifocal or serpiginous like choroiditis. They can also present as solitary or
multiple choroidal nodules, choroidal granulomas, choroidal abscess, neuroretintis and retinal
vasculitis.
Most patients with IOTB do not have a history of pulmonary or systemic TB involvement. Nearly
60% of patients with extrapulmonary TB do not have pulmonary involvement [4].
Diagnosis of presumed Ocular TB can be made if any one of the following features are present
like, typical ophthalmic findings consistent with ocular TB, confirmed TB exposure (positive
Tuberculin skin Test (TST) or positive Interferon Gamma Release Assay (IGRA) or tubercular lesion
on chest X Ray or CT chest [5].

Treatment:

The initial treatment regimen consists of Isoniazid, Rifampicin, Ethambutol and Pyrazinamide.
Ethambutaol and Pyrazinamide are stopped after initial two months, Isoniazid and Rifampicin are
continued for 9 to 12 months. CDC recommends prolonged therapy for those sites that are slow to
respond, hence ocular TB needs longer duration of treatment[6] Evidence indicate ATT significantly
reduces the rate of recurrence in ocular TB. Steroids and immunosuppresives reduce the
inflammatory response in ocular tissue. Utility of these agents in ocular TB is controversial.

References:

1) J.D.Siegel, E.Rhinehart, M.Jackson, L.Chiarello. The healthcare infection control practicers advisory committee, 2007
Guidelines for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect
Control, 35(suppl 2) (2007), pp.S65-S164.
2) A. Sharma, B. Thapa P. Lavaju.Ocular tuberculosis: an update. Nepal J Ophthalmol, 3 (5) (2011), pp. 52-67.
3) V.Gupta,A.Gupta,N.A.Rao. Intraocular tuberculosis- an update. Surv Ophthalmol,52(6)(2007), pp.561-587.
4) Parchand S, Tandan M, Gupta V, Gupta A. Intermediate uveitis in Indian population.
J Ophthalmic Inflamm Infect. 2011;1(2):65–70.
5) Sanghvi C, Bell C, Woodhead M, Hardy C, Jones N. Presumed tuberculous uveitis: diagnosis, management, and
outcome. Eye (Lond). 2011 Apr;25(4):475-80.
6) Centers for Disease Control :Treatment of Tuberculosis American Thoracic Society, CDC, and Infectious Diseases
Society of America. MMWR Morb Mortal Wkly Rep. 2003; 52: RRI

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 31

UNDERSTANDING MEDICO – LEGAL DOCTRINES – I

Dr. M. Chockalingam DO DNB FRCS (Glasgow) PGDHM
Medical Director, Vignesh Meenu Eye Clinic, Porur, Chennai – 116

The author is a visiting faculty who teaches Health Law and Ethics in AIHMAS,
Chennai and KMCH, Coimbatore

RES IPS LOQUITOR

Res Ipsa loquitur (In Latin: "the thing speaks for itself") is a doctrine in the Anglo-American
common law that says in a civil lawsuit, a court can infer negligence from the very nature of
an accident or injury in the absence of direct evidence on how the defendant behaved.Thus,
this doctrine provides an exception to the need for an expert testimony given by an
expert in the field.

• EVOLUTION OF THIS DOCTRINE
This Doctrine goes back to an English tort law case decided in 1863 (Byrne v Boadle, Eng.
Rep. 299, 1863)
The Plaintiff Byrne was walking down the street and was hit by a barrel of flour what had
rolled out of a warehouse owned by Boadle. The Plaintiff Byrne had filed a civil suit against
Boadle. There were two witnesses who had seen the injury. However, there was no witness

as to how the barrel fell out and hit the plaintiff. Although the precise negligent act could not
be proven, the Sir Charles Edward Pollock, an English judge observed

“The present case upon the evidence comes to this, a man is passing in front of the premises
of a dealer in flour, and there falls down upon him a barrel of flour. I think it apparent that the
barrel was in the custody of the defendant who occupied the premises, and who is
responsible for the acts of his servants who had the control of it. A barrel could not roll out
of a warehouse without some negligence, and to say that a plaintiff who is injured by it must
call witnesses from the warehouse to prove negligence seems to me preposterousand in my
opinion the fact of its falling is prima facie evidence of negligence, and the plaintiff who was
injured by it is not bound to show that it could not fall without negligence, but if there are any
facts inconsistent with negligence it is for the defendant to prove them”

• THREE CARDINAL CONDITIONS TO PROVE RES IPSA LOQUITOR
1. The accident must be of a type that normally would not occur without somebody’s

negligence
2. The defendant must have had control of the apparent cause of accident
3. The plaintiff could not have contributed to the accident.

Examples of medical negligence that can be proved by sole application of this doctrine
without a need for expert testimony are -

1. Leaving behind foreign objects in a patient after surgery
2. Surgery on the wrong site especially if the patient is under anaesthesia
3. Going beyond the scope of the consent especially when it is not informed beforehand

to the patient / attendant. Examples : -
- Doing a hysterectomy when only a tubectomy was planned
- Performing a Trabeculotomy for congenital glaucoma when consent is taken only

for evaluation under General Anaesthesia

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 33

THE JOURNEY OF TOS

-Dr. Rachula Daniel, Founder Secretary- TOS

Background : Dr. Nirmal Fredrick had the vision to start a local association, aimed at
professional development, on a regular basis, without having to travel much. Many of us
shared this idea and met and discussed to make this dream come true, so here we are today
as a registered Society called Tambaram Ophthalmic Society.
Group of many with one mind

Objectives :
• Receive mentoring and guidance from more experienced professionals.
• Share best practices, new techniques, handling tough situations, and case studies.
• Update on emerging trends and Next Practices.
• With ever changing medico-legal challenges, this becomes an
• important part of practice and Professional development.
• The secure feeling that you have a support network behind you, can boost confidence
when problems arise.
• Organize charitable events, medical events, community activities as a group which
may otherwise not be feasible as a single individual.

To fulfill these objectives an Interim Committee was formed which worked from 2015 till formal
registration of the Society.

ü Registration of Society.
ü Getting a Pan Card.
ü Opening a bank account , so that all meetings are conducted by the TOS.
ü Applying for 12A exemption, so that we get IT exemption for academic activities.
ü To have a constitution and by- laws so that the Association functions democratically.
1. The Inaugural function of the Tambaram Ophthalmic Society took place on 23rd August
2015 following IMA Ophthalmic Oration.The Tambaram Ophthalmic Society was
formally inaugurated by President TNOA 2015- Dr. K. Premraj.

2. The 2nd meeting of TOS was held on 23rd August 2015. Topic was
ORBITOCULOPLASTY.Speaker, Dr. E. Ravindra Mohan spoke on ‘Approach in

management to a child with watering eyes’. There was a Panel Discussion on practice
related issues . Panelists : Dr. Vasumathy Vedantham, Dr. Syed Asghar Hussain, Dr.

S. Gnaneswaran , Dr. Sankar Kumar. Case presentation were done by Dr. Anjana
ChristyDr. Anu Rajadyn and Dr. Suhasini . The session’s Chairperson : Dr. Mohan

Raj, Co-chairperson - Dr. S.Venkatesh and Moderator -Dr.Srinivasa Rao.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 35

3. The 3rd TOS Meeting on 24th Jan 16 RETINA . Topic : APPROACH TO A PATIENT
WITH DIABETIC RETINOPATHY. Speaker- Dr. Ramana Kumar, Chairperson : Dr. K.
Rajasekar, Co-chairperson : Dr. Syed Asghar Hussain, Moderator : Dr. T. Vimala.
Case presentations were by Dr. Kirthana, Dr. S. Manish and Dr. Syed Moosa

4. 4th TOS Meeting - 1st May 2016 GLAUCOMA. Topics : Interpretation of a single field
perimetry -Dr. Murali Ariga, OCT in glaucoma - Dr. Sangeetha followed by PANEL
DISCUSSION on Therapeutic options in Glaucoma - Panelists :Dr. V. Velayudham,
Dr. Nirmal Fredrick, Dr. Murali Ariga, Dr. S. Venkatesh , Dr. K. Kavithalakshmi

5. 5th TOS Meeting – 28th August 2016 CORNEA

TAMBARAM OPHTHALMIC SOCIETY- MC MEETING (First Official MC Meeting) on 10
November 2016 at Hotel Parkway, West Tambaram.

Attended by : Dr. Nirmal, Dr. Karunanidhi, Dr. Rachula, Dr. Sheela, Dr. Anu, Dr. Sunitha,
Dr. Srinivasan G Rao, Dr. V.S.Vimala , Dr. Ramya, Dr. Jayashree, Dr. T. Vimala, Dr. Balaji,
Dr.Savitri.

Agenda and points discussed :

1. Life Membership fee of Rs. 1000 / annual membership fees of Rs. 500 to be
announced to TOS members on or before 30 Nov 2016.

2. Fixed day and time : Meetings can be conducted once every 3 months on the last
Sunday of the month following lunch. There will be 4 meetings per year or more if
required.

3. Pattern of meeting- Continuing Professional Development
• Meeting called to order
• Prayer
• President address
• Secretary Report
• Guest speaker- 30 minutes
• 2 or 3 case presentations ( 10 minutes of which 5 min presentation & 5 min
discussion., one of the cases to be a practice – related/medicolegal topic )
• Once in 6 months Quiz
• Journal Update- JTNOA and other journals
• MC meeting follows every cpd program

4. Venue : To begin with, initially Hospital venue for economy reasons. Later move to
other venues.

5. Membership drive: We need to increase membership from practicing
ophthalmologists and post-graduates.( It also becomes easy for company
sponsorship.) Towards this goal ,’ Each one reach five members’ idea was accepted

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 37

by all, so that each mc member is allotted 5 members to speak to and bring them for
our TOS meetings.
6. Community activities : For patients : Adopt a village /school
7. Recreation and get together for TOS members: Walking, cycling, sports & other
cultural activities.
6. 6th TOS Meeting 30th April 2017 on Cataract : Dr. Ramesh Dorairajan -Managing
Astigmatism in Cataract patients and Dr. M. Kumaran -Optimizing IOL power
calculations for better visual outcomes – an update, followed by interesting Post-
graduate presentations.

7. 7th TOS Meeting TOSCON 2017

8. 8th TOS Meeting- OCULOPLASTY : 4th February 2018

9. 9th TOS Meeting – Emerge 2018 2018

10. 10th TOS Meeting – 28th August 2016 OCULAR SURFACE DISORDERS 3rd August
2018

• Affiliation of TOS to TNOA - presented in the TNOA MC meeting on 9.8.18 and
was ratified in GB meeting on 10.8.18. in TNOA Annual Conference- PUDHUVUE

2018,Puducherry

• 11th TOS ..TOSCON 2018 , the 4th Annual Conference of the Tambaram Ophthalmic
Society was held on Sunday, 9th September 2018 between 8.00 am to 5.00 pm, at
Royal Court, Hotel Radisson Blu, Chennai-16. TOSCON 2018 - first conference after

affiliation presided over by the TNOA President, Dr. Siddharthan. Oration by DR. R.
RAMAKRISHNAN, Chief Medical Officer & Professor of Ophthalmology at Aravind Eye

Hospital, Tirunelveli. “Update in Glaucoma Surgery” A total of 122 ophthalmologists
had participated as faculty and delegates. The conference was accredited with 2

TNMC credit points.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 39

12. The 12th Continuing Professional Development Program of the Tambaram Ophthalmic
Society on Neuro- Ophthalmology , “ Demystifying Neuro-ophthalmic
Conundrums”was held on Sunday, 20th January 2019 , between 12.30 pm to 5.30
pm, at Hotel Grand Park, West Tambaram. Chennai-45. 62 phthalmologists and post-
graduate students participated and were benefited. The educational activity was
accredited with TNMC credit hours.

13. The 13th Continuing Professional Development Program of the Tambaram Ophthalmic

Society on Cataract “CATARACT CONUNDRUMS”was held on 31st March 2019,

between 12.30 pm to 5.30 pm, at Hotel Kalyan Hometel, Vandalur.

REPORT ON TOS ACTIVITIES (2019 - 2021)

Dr. T. VIMALA

Secretary – TOS ( 2019 – 2021)

Since its inception in the year 2015, CPD programs and annual conferences have been held
on a regular basis.

Until the year 2020, 15 CPD programs and 5 Annual conference were held. A new team of
office bearers took charge in September, 2019, with Dr. V. Karunanidhi as President, Dr. T.
Vimala as Secretary, Dr. Subha as Joint Secretary and Dr. Moses Rajamani as Treasurer.

On 29th December 2019, we had the 15th TOS CPD meet, which had inspiring talks by Dr.
Selvarangam and Dr.Siddharth Ravishankar and entertainment events as a part of New year
celebration.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 41

A detailed report on activities during the year 2020 to 2021 is as follows..
1. The 16th TOS CPD Program was an UPDATE ON UVEITIS, held on 1.3.2020, at

Nirmals eye hospital. Dr. Partho Prathim Dutta,consultant from Sankara Nethralaya
and Dr. Aravindhan, consultant rheumatologist, were the key speakers. Dr. B.

Chandrasekar , Dr. Nirmal Fredrick, Dr.Ravikumar , Dr.Balaji Ramanathan were part
of the panel discussion.

2. After our first meeting for the year 2020,came the greatest tests of all time…..COVID.
The onset of covid pandemic was a great setback to the human community and more
so for the medical fraternity. Yes, it did have an impact on us, making it practically
impossible to hold meetings and educational activities. But that dint deter our spirits,
we as a team were determined to continue our activities in the virtual platform.

3. The 17th TOS CPD program was a webinar, on DECODING RETINA
DIAGNOSISTCS, held on 24.4.20.Dr. Ravikumar ,from RIOGOH, Dr.Padmapriya ,
from RIOGOH, Dr. Prabhu Baskaran, consultant, Aravind eye hospital , spoke on
various retinal diagnostic modalities. This was followed by a panel discussion on
Practice management in COVID era.

4. The 18th TOS meet was an IMA – TOS Ophthalmology oration, held on 26th july,2020.

The oration was rendered by Dr. Gangadhar Sundar, senior orbit and oculoplasty
consultant from Singapore.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 43

The next challenge for us was the TOSCON 2020. Organizing a whole conference on a virtual
platform was demanding, but with a hardworking and ever enthusiastic team with you makes
anything possible.
The 6th annual conference, TOSCON 2020 was held on 27th sep.2020, with Dr. V.
Thangavelu, President TNOA, Dr. V. Madhavan, Secretary TNOA, Dr. Namrata Sharma,
Secretary AIOS,were the guests of honour. The scientific sessions were star studded with
speakers like Dr. Lalit Varma, Dr. Namrata Sharma, Dr. Soosan Jacob, Dr. Rishi Swarup, Dr.
Saravanan, Dr. Balaji Ramananthan.

The TOS Life Time Achievement award was presented to Prof. Dr. K.Vasantha, former

Director of RIOGOH,Chennai, for her outstanding contribution to the community. The 4th Prof.
Dr. V.Velayutham Glaucoma Oration was rendered by senior glaucoma consultant Dr.Murali
Ariga

TOS LIFE TIME ACHIEVEMENT 4TH PRF.DR.V.VELAYUTHAM
AWARD GLAUCOMA ORATION

DR. MURALI ARIGA- LASERS IN GLAUCOMA, MY
JOURNEY

The scientific sessions were followed by the IGNITE talks, which had presentations from
several post graduates from various medical colleges. Prizes were given away to the winners.

WINNERS

5. The 19th TOS CPD and the first for the year 2021 was a Glaucoma update. Dr. Deven
Tuli, Dr. Suneeta Dubey and Dr. Sathyan Parthasarathy were the key speakers.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 45

6. 2oth TOS CPD was an update on Paediatric Ophthalmology. Renowned
strabismologists Dr. Pradeep Sharma and Dr. Manjula Jayakumar were the guest

speakers. This was followed by a very interactive panel discussion with Dr. Praveen
Krishna, Dr. RamPrakash and Dr. Shruthi Nishanth. A brain stroming quiz was

conducted by Dr. Roshini Desai.

TOSCON 2021

Dr.T. Vimala

Scientific convener TOSCON 2021

TOSCON is the invigorating annual conference of Tambaram ophthalmic society,held every
year since its formation in 2015.

As COVID pandemic restricted most of our activities for 2 long years, most of the scientific
meetings were only happening through virtual platforms. when there was some respite from
the situation ,TOSCON 2021 , the 7th Annual Conference of TOS was held as a physical
meeting on 28th November 2021 at Hablis hotel. TOSCON 2021 had various interesting
sessions lined up with several star speakers.

The first session of the day was a very informative and interactive OSCE session for the
postgraduates, conducted by Dr. V.Sharmila Devi.

This was followed by the inaugural ceremony, which was graced by the President of TNOA,
Prof. Dr. Mohan Rajan and Prof. Dr. Nirmal Fredrick, vice president of TNOA. The
conference was formally inaugurated by lamp lightening by the guests of honour. The
Presidents address was delivered by Dr. V.Karunanidhi and secretary report was presented
by Dr. T.Vimala. Following the chief guests address, the 3rd TOS Lifetime achievement
award was presented to DR. R. Selvamani, for his outstanding contribution to the
community. The 5th TOS Prof. Dr. V.Velayutham glaucoma oration was rendered by
Dr.P.Sathyan,senior glaucomatologist from Coimbatore. The inaugural ceremony
concluded with the taking over of the new set of office bearers of TOS for the year 2021-
2023, with Dr. Rachula Daniel at the helm,as the 3rd president of TOS., Dr. Ramya
Chellaiah as Secretary and Dr. Palaniraj as the treasurer.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 47

.

A VAST session on cataract followed the inaugural ceremony. Dr. Ashok Rangarajan, Dr.
K.Kavithalakshimi, DR. Lalit Kumar and Dr. S.Venkatesh were the speakers, who made the
session absolutely enthralling with their videos and presentation.

Scientific session on cornea , had well known speakers like, Dr. Sujatha Mohan, Dr. Baskar
Srinivasan and Dr. Kalpana Suresh.

Retina and Uvea session was very informative with speakers like Dr. Kasinathan,Dr. Manoj
Khatri and Dr. Radha Annamalai, enlightening the audience with the latest advancements in
the speciality of retina and uvea.

Tambaram ophthalmic society has always been a forerunner in providing platform for the
budding ophthalmologists to show case their talent. IGNITE talks is one such initiative,
where in young ophthalmologists present interesting cases, innovations ,etc. this year too,
we had several interesting presentations, which was ably judged by Dr. Lily Daniel, Dr.
Soundharam and Dr. Suma Elangovan. The winners were awarded cash prizes.

TOSCON 2021 ended of in a very successful note, with more than 100 delegates attending
the conference. The conference was credited 2 credit hours by the Tamilnadu Medical
Council.We the members of TOS, look forward to host many more such scientific meets, to
share knowledge and get ourselves updated in emerging trends.

Thank you all for your great support and cooperation.

TOSVISION : Newsletter of the Tambaram Ophthalmic Society Page 49

COMMUNITY OUTREACH – A TOS INITIATIVE

WORLD GLAUCOMA WEEK – 6-12 MARCH 2022 OBSERVANCE
WALKATHON AND PUBLIC AWARENESS RALLY : A REPORT
The Tambaram Ophthalmic Society ( TOS) took part in the World glaucoma week 6-12
March 2022 observance in association with WGA, GSI, TNOA, MCOA, Bhaarath Medical
College , IMA Tambaram and FORWA (Federation of residents welfare association).
Theme : The World is bright, save your sight !

Glaucoma awareness walkathon was held on 13.03.2022 in Agaramthen Road. There were
three categories in which the registered participants took part, 10 km and 5 km run or walk
and 3 km rally.
There were more than 300 participants from diverse age groups, including five year old kids
and people from all walks of life, participating very enthusiastically.