Utility of Abraham Lens in YAG Laser Capsulotomy: A Prospective Study

Introduction: Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser capsulotomy remains the safest treatment for Posterior Capsular Opacification (PCO). The use of capsulotomy lens has some benefits to offer especially when learning the procedure and in uncooperative patients. With changing curriculum in medical teaching which focusses more on practical aspects it will serve as an asset for the trainees. Even if not used routinely its importance cannot be altogether undermined. Aim: To assess the utility of Abraham capsulotomy lens in YAG laser capsulotomy procedure and compare it with capsulotomy performed without lens. Materials and Methods: This was a prospective, longitudinal study conducted in the Department of Ophthalmology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from June 2020 to February 2021. A total of 79 patients who developed PCO after more than six months of cataract surgery and had decrease in visual acuity on Snellen’s chart by two or more lines from baseline were included. Visual acuity, Intraocular Pressure (IOP) measurement, fundoscopy, Ocular Coherence Tomography (OCT) was done for Central Macular Thickness (CMT) in all patients at presentation, one and three months following YAG capsulotomy. Nd-YAG laser capsulotomy was then done with and without the use of Abraham’s capsulotomy lens in two groups. Parameters such as visual acuity change, IOP, CMT, energy used in capsulotomy, type of PCO were then compared between the two groups. Independent t-test, repeated Analysis of Variance (ANOVA) and Spearman’s correlation tests were used to analyse the data. Results: Of the 79 patients, 40 underwent capsulotomy without the Abraham lens (Group 1) and 39 with Abraham lens (Group 2). Females were more than males in both the groups. The improvement in visual acuity was statistically significant in both groups. There was statistically significant difference in CMT in both groups at each visit. The average energy used for dealing with fibrous type of calcification was significantly more than that used in elsching pearls (13.96 mj). Complications like Intraocular Lens (IOL) pitting, raised IOP, cystoid macular oedema, uveitis and retinal detachment were encountered which were managed by appropriate medical and surgical therapy. Conclusion: Use of capsulotomy lens decreases the amount of energy needed for capsulotomy and helps to stabilise the eye and to focus better especially for ophthalmologists in their initial training days

Effectiveness and Acceptance of DOAP Session as a Teaching Method for Visual Assessment among Interns at a Tertiary Care Center in Eastern part of India

Background:Visual Assessment is a basic competency required by all medical graduates. The Graduate Medical Education Regulation Amendment 2019 by the Medical Council of India, envisages a competency based and outcome driven undergraduate curriculum. The primary objective of this study was to find out if the interns were competent in the skill of visual assessment. The second was to determine the effectiveness and acceptance of DOAP (Demonstration, Observation, Assistance & Performance) session as teaching-learning method. Methods:This was a prospective quasi experimental, observational study conducted at a tertiary care center in Eastern India between May 2019 to Nov 2019. After approval from IEC, 75 interns consented to take part in the study. All participants underwent a Pre-test to know their proficiency in the skill of visual assessment. An educational intervention was done using the DOAP session and a post-test was conducted at the end of their training. A feedback was collected from the interns regarding their perceptions on DOAP sessions. The two tailed Fisher’s Exact Test (Graph pad Prism 9) was used to compare the Pre-test and Post-test results. P value ≤ 0.001 was considered to be significant.Results:Pre-test performance on different components of visual assessment demonstrated that 21.3 % of interns could assess the distant vision satisfactorily and 24 % the near vision. More than 80 % could not assess the color vision, Visual fields and menace reflex satisfactorily. Post test results showed improvement in each component of visual assessment, color vision(P<0.0001), Distant vision(P<0.0001), Near vision(P<0.0001), Field of vision(P<0.0001) and menace reflex(P<0.0001) after the educational intervention. Feedback from the participants strongly favored the DOAP as an effective method of teaching and learning.Conclusion:Interns were found to be grossly lacking in basic skills of visual assessment. DOAP sessions as a teaching method for visual assessment was found to be effective and acceptable. Incorporation of this teaching method will help realize the goal of achieving competent medical graduates

Assessment of quality of life in glaucoma patients in a tertiary care center in Eastern India

Purpose: The aim of this study is to assess the quality of life (QOL) in glaucoma patients and find out the sociodemographic factors predicting QOL. Methods: A cross-sectional study was conducted in a tertiary care center from August 2021 to February 2022. Subjects diagnosed with glaucoma for at least 6 months were enrolled. After taking informed consent, demographic details and detailed history were collected for all patients. Comprehensive eye examination (visual acuity, intraocular pressure, gonioscopy, fundoscopy, visual field assessment, ocular coherence tomogram assessment) was done for all and they were asked to fill the WHOQOL-BREF questionnaire. Data were collected and analyzed using SPSS 21. Results: One hundred and ninety-nine patients were recruited. Mean age of participants was 57.99 ± 10.76 years. Based on various domains and subgroups, QOL values were significant with respect to income (P = 0.016). Gender-wise QOL in females was lower than that of males with respect to all the domains (P = 0.001). While marital status affected both environmental and social domain, literacy affected only the social domain. A variation in intraocular pressure affected the QOL in the psychological domain. QOL was not significantly associated with the severity of the disease. Gender was the most predominant predictor out of all sociodemographic factors. Conclusion: Chronic diseases affect the QOL of individuals in many ways. Glaucoma being a chronic disease hampers patients' vision irreversibly and by extension the various physical, social, and psychological aspects of the patient's life as well. Hence, knowledge of the change in QOL it brings about can help plan the treatment, counseling, and management of these patients