Ophthalmology

It's a doc's life – Workplace violence against doctors Mrittika Sen, Santosh G Honavar Indian Journal of Ophthalmology 2019 67(7):981-984

Machine learning in clinical care: Quo vadis? Vasant G Honavar Indian Journal of Ophthalmology 2019 67(7):985-986

The second time around Li‐Anne L Lim, Md K Hasanuzzaman, Carol L Shields Indian Journal of Ophthalmology 2019 67(7):987-987

Robotics and ophthalmology: Are we there yet? Suresh K Pandey, Vidushi Sharma Indian Journal of Ophthalmology 2019 67(7):988-994 Ophthalmology is a field that is now seeing the integration of robotics in its surgical procedures and interventions. Assistance facilitated by robots offers substantial improvements in terms of movement control, tremor cancellation, enhanced visualization, and distance sensing. Robotic technology has only recently been integrated into ophthalmology; hence, the progression is only in its initial stages. Robotic technologies such as da Vinci Surgical System are integrated into the field of ophthalmology and are assisting surgeons in complex eye surgeries. Ophthalmic surgeries require high accuracy and precision to execute tissue manipulation, and some complex ocular surgery may take few hours to complete the procedures that may predispose high-volume ophthalmic surgeons to work-related musculoskeletal disorders. A complete paradigm shift has been achieved in this particular field through the integration of advanced robotic technology, resulting in easier and more efficient procedures. Where robotic technology assists the surgeons and improves the overall quality of care, it also projects several challenges including limited availability, training, and the high cost of the robotic system. Although considerable studies and trials have been conducted for various robotic systems, only a few of them have made it to the commercial stage and ophthalmology, on its own, has a long way to go in robotics technology.

Computer-assisted navigation in orbitofacial surgery Priti Udhay, Kasturi Bhattacharjee, P Ananthnarayanan, Gangadhar Sundar Indian Journal of Ophthalmology 2019 67(7):995-1003 The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.

Artificial intelligence in diabetic retinopathy: A natural step to the future Srikanta Kumar Padhy, Brijesh Takkar, Rohan Chawla, Atul Kumar Indian Journal of Ophthalmology 2019 67(7):1004-1009 Use of artificial intelligence in medicine in an evolving technology which holds promise for mass screening and perhaps may even help in establishing an accurate diagnosis. The ability of complex computing is to perform pattern recognition by creating complex relationships based on input data and then comparing it with performance standards is a big step. Diabetic retinopathy is an ever-increasing problem. Early screening and timely treatment of the same can reduce the burden of sight threatening retinopathy. Any tool which can aid in quick screening of this disorder and minimize requirement of trained human resource for the same would probably be a boon for patients and ophthalmologists. In this review we discuss the current status of use of artificial intelligence in diabetic retinopathy and few other common retinal disorders.

Commentary: Rise of machine learning and artificial intelligence in ophthalmology John Davis Akkara, Anju Kuriakose Indian Journal of Ophthalmology 2019 67(7):1009-1010

Commentary: AI for an eye leaves the whole world… Ashwin Mohan, Rashmin Gandhi Indian Journal of Ophthalmology 2019 67(7):1011-1011

Tribal Odisha Eye Disease Study (TOES) report # 5: Comparison of prevalence and causes of visual impairment among tribal children in native and urban schools of Odisha (India) Lapam Panda, Suryasmita Nayak, Vivekanand Uttamrao Warkad, Taraprasad Das, Rohit Khanna Indian Journal of Ophthalmology 2019 67(7):1012-1015 Purpose: To compare the prevalence and causes of blindness and visual impairment in tribal school students in the rural day-care and in a residential urban school. Methods: This was a cross-sectional comparative study. The 4-Stage screening in the native habitat of the tribal students performed in the school and hospital involved the trained school teachers, optometrists, comprehensive ophthalmologist, and pediatric ophthalmologist. The 2-Stage screening in the urban school involved only the optometrists and pediatric ophthalmologist. In both instances, vision (presenting and best corrected) was recorded and refraction performed. In addition, fundus photo was taken in all students in the urban school using a non-mydriatic fundus camera. Results: The comparison of blindness, visual impairment, and ocular anomalies were between tribal children (153,107 children; mean age 9.3 ± 2.7 years) examined in the native school and tribal children (10,038 children; mean age 8.8 + 1.64 years) in an urban residential school. Mild and moderate visual impairment was higher in the urban settings (P < 0.05), but severe visual impairment and blindness were similar in both settings. Refractive error, amblyopia, and posterior segment anomaly were detected more often in an urban settings (P < 0.05). Vitamin A deficiency (Bitot's spot) was detected only in children studying in the native schools (P < 0.05). Conclusion: The location, urban or rural, did not influence the visual impairment profile of tribal children. The food habit and environment seem to impact nutritional status.

Analysis of macular, foveal, and retinal nerve fiber layer thickness in children with unilateral anisometropic amblyopia and their changes following occlusion therapy V Kavitha, Mallikarjun M Heralgi, Patel Deep Harishkumar, Sneha Harogoppa, HM Shivaswamy, H Geetha Indian Journal of Ophthalmology 2019 67(7):1016-1022 Purpose: To analyze macular thickness (MT), foveal thickness (FT), and retinal nerve fibre layer thickness (RNFLT) in children with unilateral anisometropic amblyopia and their changes following occlusion therapy. Methods: A prospective, longitudinal, and comparative study of 60 children aged between 5 and 18 years consisted of two groups, group 1: 30 children with unilateral anisometropic amblyopia; group 2: 30 normal children. Best corrected visual acuity (BCVA), a detailed ocular examination, spectral domain optical coherence tomography for MT, FT, and RNFLT in both eyes were done at visit one (baseline) and every 3 months for a year following occlusion therapy (initiated one month after first visit) in group 1. Results: Mean BCVA, MT, FT, and RNFLT in amblyopic eyes at first visit were 0.63 ± 0.405, 286.9 ± 6.522 μm, 195.90 ± 8.462 μm, and 100.87 ± 6.240 μm, respectively and at last visit after occlusion therapy were 0.50 ± 0.318, 248.9 ± 11.681 μm, 169.47 ± 10.941 μm, and 99.43 ± 5.722 μm, respectively. At first visit, mean BCVA, MT, FT, and RNFLT in nonamblyopic eyes (group 1) were 0 ± 0, 240 ± 10.447 μm, 159.27 ± 9.285 μm, 98.63 ± 4.723 μm and in normal eyes (group 2: average of right and left eyes) were 0 ± 0, 239.8 ± 4.294 μm, 143.6 ± 4.61 μm, 100.5 ± 2.895 μm, respectively. Conclusion: MT and FT, which were more in amblyopic eyes as compared to normal fellow eyes and group 2, decreased with improvement in BCVA after occlusion therapy. However, there was no difference in RNFLT between amblyopic eyes and normal fellow eyes and group 2 before and after occlusion therapy.

Alexandros Sfakianakis
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