Surgeon: Indian ophthalmology poised for global leadership

ByKatrina Altersitz

BANGALORE, India — With knowledge, expertise and technology, in addition to a growing economy, India is poised to become a global leader in the elimination of needless blindness, said the guest of honor here at the All India Ophthalmological Society meeting.

G. N. Rao

“I believe Indian ophthalmology is poised very well to become a global leader,” said G.N. Rao, MD. “But like everything else in life, if we are going to lead ... it takes certain fundamental changes and a lot of effort to accomplish those tasks.”

The opportunity comes in eliminating needless blindness within India, he explained. In order to achieve this goal, Dr. Rao laid out three necessary steps.

First, he said every qualified ophthalmologist should commit to providing quality eye care in a comprehensive manner to the general public.

“That means anybody that actually comes to us seeking our care should get the right kind of attention without compromising quality,” Dr. Rao said.

Second, he said there must be major changes in residency and postgraduate education to improve overall education and remove short-term fellowship programs and cataract surgery and laser training programs.

“Whether we like it or not, the truth is the quality of our postgraduate education today is grossly suboptimal,” Dr. Rao said. “If our residency training is up to quality, all these short-term training programs will not be necessary.”

Lastly, he said members must work to strengthen the All India Ophthalmological Society.

“All of us as members of the All India Ophthalmological Society have a responsibility to make sure this society becomes stronger, that this society actually represents us well and that this society will provide us adequate educational experiences,” Dr. Rao said.

He asked all the members attending the meeting to realize their own power to make a difference and to make a personal commitment to change.

“I hope that we choose the path of shifting the paradigm instead of shifting the responsibility to the next generation,” Dr. Rao said. “I think that is in our hands.”

These items appeared originally as daily coverage from the meeting on OSNSuperSite.com. Look for more in-depth coverage of these and other topics in upcoming issues of Ocular Surgery News.

INDEYE study shows cataracts remain a challenge

Cataracts remain prevalent throughout India and deserve continued attention, according to a surgeon.

G.V.S. Murthy, MBBS, MD, MSc, presented data from a preliminary analysis of the INDEYE study, which was conducted at the Dr. R.P. Centre for Ophthalmic Services in Delhi and the Aravind Eye Hospital in Pondicherry, thus covering the northern and southern regions of the country.

“Three out of every four individuals [aged older than 60 years] in this country do have a cataract,” Dr. Murthy said. “That is the challenge. We know cataracts exist. We know cataract surgery rates are increasing in this country. We also know that significant proportions are still untreated.”

In the study, investigators recruited approximately 3,000 people older than 60 years from each center, Praveen Vashisht, MBBS, MD, said before Dr. Murthy’s presentation.

All participants completed a questionnaire and gave a blood sample. Investigators also obtained photographs of each participant’s eyes to screen for cataracts and age-related macular degeneration, Dr. Murthy said.

Nuclear cataract was present in about 80% of people older than 70 years in Delhi and in 61% of men and 68.5% of women in Pondicherry, he said.

Cortical cataracts were present in 11.8% of men and 13.9% of women in Delhi and in 14.7% of men and 18.2% of women in Pondicherry. Posterior subcapsular cataracts were present in 33.7% of men and 42% of women in Delhi and in 26.1% of men and 34.4% of women in Pondicherry. Women had an 81% higher risk of having any cataract type, Dr. Murthy noted.

Eye banking standards need improvement in India

Although an increase in the quantity of donor corneas is still necessary in India, the quality of donated corneal tissue must also be improved, a surgeon said.

“Eye banking in India has great potential but is not adequate to meet the demand,” M. Srinivasan, MBBS, DO, MS, said. “The quality of harvested tissue is often not up to eye banking standards.”

In a study conducted at the Aravind Eye Hospital in Pondicherry, which looked at 1,759 donor eyes, researchers found that 982 eyes (55.8%) were not suitable for transplant. Of those that were suitable for use, 28 eyes (1.6%) were considered to be in excellent condition, 21 eyes (1.2%) were very good, 382 eyes (21.7%) were good and 346 eyes (19.7%) were in fair condition, Dr. Srinivasan said.

The reasons eyes were considered unsuitable for use ranged from age- related complications to previous disease, he said. Most eyes (80%) were older than 50 years and there were few young donors, Dr. Srinivasan said.

Surgeon: Preop preparation for retina surgery ‘one of the best indications’ for anti-VEGFs

Administering anti-VEGF medications before performing vitreoretinal surgeries can help induce the regression of inflamed vessels and lower the risk of complications such as hemorrhages, making it “one of the best indications for use of these kinds of drugs,” a surgeon said.

“I believe that use of these agents at least a week before the surgery has dramatically eliminated the complication of intraocular hemorrhage,” Amod Gupta, MD, said at a retina session.

Dr. Gupta presented data on 185 eyes, of which 120 received conventional treatments and 65 received surgery assisted by Avastin (bevacizumab, Genentech).

Results showed that both treatment groups had comparable improvements in visual acuity. Visual acuity was less than 6/60 in 70% of eyes in both groups at baseline and improved to better than 6/60 in 80% of eyes at follow-up, Dr. Gupta said. The main difference between the two treatment groups was in the reduction of vitreous hemorrhage, which was seen in the bevacizumab- assisted group, he said.

“In our experience, a single preoperative [intravitreal] injection … minimized poor operative intraocular hemorrhages,” Dr. Gupta said. “We can now perform more confidently more complex retinal detachments … and I believe the surgical outcomes since we started using [bevacizumab] have dramatically improved.”

A note from the editors:

To facilitate bringing news to readers rapidly, for OSN SuperSite articles and meeting wrap-up articles, OSN departs from its editorial policy and typically does not send these items out for source corrections.