Anshu Khare

Associations of early age-related macular degeneration with ocular and general parameters. The Central India Eyes and Medical Study.

Purpose:  To assess associations between age‐related macular degeneration (AMD) and ocular and general parameters.

Pseudoexfoliation: Normative Data and Associations. The Central India Eye and Medical Study

Purpose To assess the prevalence of pseudoexfoliation (PEX) and its associations in a population-based setting. Design Population-based, cross-sectional study. Methods The Central India Eye and Medical Study included 4711 individuals. All study participants underwent a detailed ophthalmological examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp based biomicroscopy. Results Slit lamp examination results were available for 4646 (98.6%) study participants with a mean age of 49.3±13.3 years (range: 30–100 years). PEX was detected in 87 eyes (prevalence: 0.95±0.10% (95%CI: 0.75, 1.15) of 69 subjects (prevalence: 1.49±0.18% (95%CI: 1.14, 1.83). PEX prevalence increased significantly (P<0.001) from 0% in the age group of 30–39 years, to 2.85±0.56% in the age group of 60–69 years, to 6.60±1.21% in the age group of 70–79 years, and to 12.3±4.11% in the age group of 80+ years. In multivariate analysis, PEX prevalence was associated with higher age (P<0.001; regression coefficient B:0.11; odds ratio (OR): 1.11 (95%CI: 1.09, 1.13)), lower body mass index (P = 0.001; B: −0.12; OR: 0.88 (95CI: 0.82, 0.95)) and higher diastolic blood pressure (P = 0.002; B: 0.02; OR: 1.03 (95%CI: 1.01, 1.04)). In the multivariate analysis, PEX was not associated with retinal nerve fiber layer cross section area (P = 0.76) and presence of open-angle glaucoma (P = 0.15). Conclusions In a rural Central Indian population aged 30+ years, PEX prevalence (mean: 1.49±0.18%) was significantly associated with older age, lower body mass index and higher diastolic blood pressure. It was not significantly associated with optic nerve head measurements, refractive error, any ocular biometric parameter, nuclear cataract, early age-related macular degeneration and retinal vein occlusion, diabetes mellitus, smoking, and dyslipidemia.

Prevalence and Associated Factors of Diabetic Retinopathy in Rural Central India

Prevalence of diabetic retinopathy (DR) in patients with diabetes was recently estimated to be 34.6% (1–4). Living conditions in markedly rural regions differ considerably from those in urban areas where most previous studies were performed, and there are almost no data on the prevalence of DR available for the rural regions of India. We therefore performed this study in rural central India close to a remote tribal region. We assessed the prevalence of DR in this population mostly untouched by modern industrialization, examined the prevalence of DR within the group of subjects with diabetes, explored the relationship between DR and associated factors, and finally compared the findings with those obtained in studies from other regions and societies. The population-based Central India Eye and Medical Study …

Prevalence and associations of retinal vein occlusions: the Central India Eye and Medical Study.

Purpose: To determine the prevalence of retinal vein occlusions (RVOs) in rural Central India. Methods: The population-based Central India Eye and Medical Study was performed in rural Central India and included 4,711 subjects (30 years and older). Using fundus photographs, we assessed the prevalence of branch retinal vein occlusions and central retinal vein occlusions. Results: An RVO was detected in 38 eyes (0.42 ± 0.07%; 95% confidence interval: 0.29–0.56) of 35 subjects (0.76 ± 0.13%; 95% confidence interval: 0.50–1.01). Prevalence of branch retinal vein occlusions was 0.66% ± 0.12% per subject (95% confidence interval: 0.42%–0.90%) and of central retinal vein occlusions was 0.11% ± 0.05% per subject (95% confidence interval: 0.01%–0.21%). In binary logistic analysis, presence of RVOs was associated with higher age (P = 0.007), systolic blood pressure (P < 0.001), blood concentration of urea (P = 0.02), and narrower anterior chamber angle (P < 0.03). The RVO prevalence was not significantly (all Ps > 0.10) associated with body mass index; blood concentrations of glucose, cholesterol, high-density lipoproteins, and creatinine; presence of diabetes mellitus, tuberculosis and malaria; nutritional parameters; alcohol consumption; refractive error; and optic disk size. The age-specific prevalence rates of RVOs were 0.18% ± 0.13%, 0.29% ± 0.15%, 0.89% ± 0.34%, 1.07% ± 0.36%, 2.72% ± 0.85%, and 3.64% ± 2.55%, respectively, for decadal age groups. In two (5%) eyes, RVO had caused low vision (visual acuity <20/60 and ≥20/400). Conclusion: In the rural agrarian low-income population of Central India, RVOs were detected in 0.8% of adults, with branch retinal vein occlusions being approximately seven times more common than central retinal vein occlusions. Main associated factors were higher age, blood pressure, urea blood concentration, and narrow chamber angle. RVOs were no major reason for visual impairment.

Anterior chamber depth and its associations with ocular and general parameters in adults.

Background:  To investigate the normative data of anterior chamber depth and its associations in adults in rural Central India.

Retinal nerve fibre layer cross‐sectional area, neuroretinal rim area and body mass index

To examine associations between body mass index, neuroretinal rim area and retinal nerve fibre layer cross‐sectional area (RNFLCRA) in a population‐based setting.

Prevalence and Associated Factors of Glaucoma in Rural Central India. The Central India Eye and Medical Study

Purpose To assess the prevalence of glaucoma in rural Central India. Methods The population-based Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study included 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. Glaucoma was defined by glaucomatous optic disc morphology, and in a second step, by the criteria of the International Society of Geographical and Epidemiological Ophthalmology (ISGEO). Results Optic disc photographs were available for 4570 (97.0%) subjects. Glaucoma was detected in 122 subjects (51 unilateral) (2.67% (95%CI: 2.20, 3.14). Glaucoma prevalence for the age groups of 30–39yrs, 40–49yrs, 50–59yrs, 60–69yrs, 70–79yrs, and 80+ years was 0.54% (95%CI: 0.11, 0.98), 1.03% (95%CI: 0.49, 1.57), 1.40% (95%CI: 0.58, 2.23), 6.62% (95%CI: 4.92, 8.31), 8.71% (95%CI: 5.55, 11.75), and 14.3% (95%CI: 4.13, 24.4), respectively. In multivariable analysis, glaucoma was associated with higher age (P<0.001), lower body mass index (P = 0.025), lower blood hemoglobin concentration (P = 0.03), higher intraocular pressure (P<0.001), disc hemorrhages (P<0.001), higher prevalence of myopic retinopathy (P<0.001), lower level of education (P = 0.03), longer axial length (P<0.001), thinner retinal nerve fiber layer (P<0.001), higher vertical cup/disc diameter ratio (P<0.001), and narrow anterior chamber angle (P = 0.02). Ratio of open-angle glaucoma to angle-closure glaucoma was 7.7:1 (1.93% (95%CI: 1.64, 2.22) to 0.24% (95%CI: 0.14, 0.34)). Using the ISGEO criteria, glaucoma prevalence was 2.8% (95%CI: 2.3, 3.3) with a less clear association with older age. Conclusions Glaucoma prevalence in remote rural Central India is comparable to other regions. Associated factors were older age, lower body mass index, lower blood concentration of hemoglobin, lower level of education, higher intraocular pressure, disc hemorrhage, myopic retinopathy, and longer axial length. The ratio of open-angle glaucoma to angle-closure glaucoma was about 8:1.

Prevalence of retinitis pigmentosa in India: the Central India Eye and Medical Study

eyes with spontaneous resolution. Hypertony was successfully managed in 1 patient with carbonic anhydrase inhibitors. Oblique or angled incisions are believed to help decrease or prevent wound leakage by having an internal lip that presses against the outer lip when the eye is pressurized to normal IOP as well as a longer zone of tissue contact, thereby helping to close the incision (Lopez-Guajardo et al. 2006). This study supports the finding that oblique incisions provide better wound apposition and stability compared with straight incisions (Taban et al. 2009). No ciliochoroidal detachment was detected on any of the examined eyes. Vitreous incarceration in a TPPV sclerotomy has been reported to range from 0% to 72% (Lopez-Guajardo et al. 2007) (Chen et al. 2010) and can be explained by the use of different surgical techniques, the size of the trocars and the sclerotomy architecture (oblique versus straight incision) as well as care of postoperative evaluation. In our cases, we did not find any vitreous incarceration. In conclusion, this study demonstrates that oblique 20-gauge transconjunctival sclerotomies provide adequate wound apposition as evidenced by OCT Visante even immediately after the operation. Longer scleral tunnels provide increased security and better stability of the incision during healing. OCT is noninvasive, noncontact and very precise for studying such surgical wounds and the healing process during the postoperative period. References

Prevalence of Optic Disc Hemorrhages in Rural Central India. The Central India Eye and Medical Study

Purpose To determine the frequency of optic disc hemorrhages in a rural Indian population. Methods The population-based Central Indian Eye and Medical Study included 4711 subjects. Mean age was 48.5±12.9 years (range: 30-100 years). Color optic disc photographs were examined. Results Optic disc photographs were available for 4570 (97.0%) subjects. Prevalence of disc hemorrhages was 17/8869 (0.19%; 95%CI:0.10,0.28) per eye and 16/4570 (0.35±0.09%; 95%CI:0.18,0.52) per subject. Prevalence of disc hemorrhages increased from 0.05% (95%CI:0.00,0.13) in the age group of 30-39 years to 0.25% (95CI:0.00,0.49) in the age group of 60-69 years and to 0.91% (95%CI:0.24,1.58) in the age group of 70+ years. After adjusting for older age, higher systolic blood pressure, diabetes mellitus, myopic refractive error, smaller neuroretinal rim area and thinner retinal nerve fiber layer, occurrence of disc hemorrhages was associated only with glaucomatous optic nerve damage (P<0.001; Odds ratio: 87; 95%CI:32,239). Eleven of the 17 (65%; 95%CI:39,90) disc hemorrhages were found in glaucomatous eyes. Out of 193 glaucomatous eyes, 11 eyes (5.7%; 95%CI:2.4,9.0) showed a disc hemorrhage. Out of the 8676 non-glaucomatous eyes, 6 eyes (0.07%; 95%CI:0.01,0.12) had an optic disc hemorrhage. Conclusions Prevalence of disc hemorrhages (0.2% per eye; 0.4% per subject) in Indians aged 30+ years was strongly associated with glaucoma after adjustment for age, blood pressure and diabetes mellitus. A disc hemorrhage suggested glaucomatous optic nerve damage with a positive predictive value of 65%. About 6% of glaucomatous eyes showed a disc hemorrhage at the time of clinical examination highlighting the importance of optic disc hemorrhages for the diagnosis of glaucoma.

Visual impairment and blindness in rural central India: the Central India Eye and Medical Study

Purpose:  The aim of the study was to investigate prevalence of visual impairment in rural central India.