Viney Gupta

Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity

Objective:To test the validity of internationally accepted waist circumference (WC) action levels for adult Asian Indians.Design:Analysis of data from multisite cross-sectional epidemiological studies in north India.Subjects:In all, 2050 adult subjects >18 years of age (883 male and 1167 female subjects).Measurements:Body mass index (BMI), WC, waist-to-hip circumference ratio, blood pressure, and fasting samples for blood glucose, total cholesterol, serum triglycerides, and high-density lipoprotein cholesterol.Results:In male subjects, a WC cutoff point of 78 cm (sensitivity 74.3%, specificity 68.0%), and in female subjects, a cutoff point of 72 cm (sensitivity 68.7%, specificity 71.8%) were appropriate in identifying those with at least one cardiovascular risk factor and for identifying those with a BMI >21 kg/m2. WC levels of ⩾90 and ⩾80 cm for men and women, respectively, identified high odds ratio for cardiovascular risk factor(s) and BMI level of ⩾25 kg/m2. The current internationally accepted WC cutoff points (102 cm in men and 88 cm in women) showed lower sensitivity and lower correct classification as compared to the WC cutoff points generated in the present study.Conclusion:We propose the following WC action levels for adult Asian Indians: action level 1: men, ⩾78 cm, women, ⩾72 cm; and action level 2: men, ⩾90 cm, women, ⩾80 cm.

Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment

PURPOSE: To compare anterior segment parameters using quantitative imaging by anterior segment optical coherence tomography (AS‐OCT) and ultrasound biomicroscopy (UBM). SETTING: Tertiary‐care glaucoma research center. METHODS: Sixty‐three eyes of 63 subjects had anterior segment evaluation by AS‐OCT (Visante‐Zeiss) and UBM (Paradigm). Central corneal thickness (CCT), anterior chamber depth (ACD) (measured from the central corneal endothelium to the anterior lens capsule), and the peripheral iridocorneal angles (temporal and nasal) were assessed and compared. RESULTS: There was an excellent correlation between AS‐OCT and UBM measurements for the nasal angle (r = 0.84; P<.0001), temporal angle (r = 0.86; P<.0001), ACD (r = 0.97; P<.0001), and CCT (r = 0.91; P<.0001). There was no significant difference (paired t test) between the mean ACD, CCT, and angle parameters measured by AS‐OCT or UBM. The mean values of the parameters measured by AS‐OCT and UBM were, respectively, as follows: nasal angle, 26.25 degrees ± 11.0 (SD) and 28.27 ± 11.3 degrees (P = .3); temporal angle, 25.1 ± 11.4 degrees and 28.3 ± 13.5 degrees (P = .15); ACD, 2.85 ± 0.5 mm and 2.78 ± 0.5 mm (P = .2); and CCT, 512 ± 46 μm and 502 ± 46 μm (P = .25). The AS‐OCT images showed sharper definition of the scleral spur than the UBM images. CONCLUSION: Anterior segment optical coherence tomography and UBM can both be used for anterior segment measurements and yielded comparable results.

Utility values among glaucoma patients: an impact on the quality of life

Aim: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients. Methods: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months’ duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the time-trade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse). Results: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years’ duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40). Conclusions: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.

Topical cyclosporin A in the management of vernal keratoconjunctivitis

Purpose To study the efficacy of topical cyclosporin A in children with vernal keratoconjunctivitis in a prospective randomised double-masked trial.Methods Twenty-four children between 5 and 16 years of age were randomly treated with cyclosporin A (CsA) and placebo (vehicle) and followed up for 4 months.Results Of the 12 patients given CsA, 11 showed symptomatic improvement by 7 days of starting treatment whereas only 3 patients in the placebo group showed mild symptomatic improvement.Conclusions Topical cyclosporin is a safe and effective treatment in vernal keratoconjunctivitis.

Post-penetrating keratoplasty glaucoma

To study the risk factors in the development of glaucoma following penetrating keratoplasty, we retrospectively analysed 190 eyes of 185 consecutive patients who had undergone surgery during 1990. The donor button was larger by 0.2 mm and 0.5 mm in phakia and aphakia/pseudophakia patients, respectively. Over a mean follow-up period of 14.5 months, 52 of the 190 eyes (27.4%) either developed glaucoma de novo or had worsening of preexisting glaucoma. Of these 52 eyes, 38 were managed medically and 14 required surgery. From our study, aphakia (37%), pseudophakia (24%), preexisting glaucoma (81.8%), and regrafting (43.18%) were found to be the significant risk factors in the development of glaucoma following penetrating keratoplasty.

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population.

Comparison of ultrasound biomicroscopic parameters after laser iridotomy in eyes with primary angle closure and primary angle closure glaucoma

PurposeTo study changes in anterior segment morphology after laser peripheral iridotomy (LPI) in primary angle closure (PAC) and primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM).MethodsNinety-three eyes of 93 patients underwent anterior segment evaluation including gonioscopy, disc evaluation with + 90D lens, applanation intraocular pressure, and standard achromatic perimetry. UBM was performed before and 2 weeks after Nd:YAG LPI to measure the trabecular-iris angle (TIA), the angle-opening distance (AOD 250/500), and the central anterior chamber depth (ACD).ResultsThe superior TIA widened from a mean of 7.54±3.15 to 15.66±6.69° (P=0.0001), the inferior TIA increased from a mean of 9.0±4.7 to 15.9±6.8° (P=0.0001) after LPI in PAC. In PACG, the mean superior angle changed from 4.55±2.5 to 6.12±3.8° (P=0.4) and the inferior angle increased from 4.75±2.0 to 7.9±3.7° (P=0.1). The mean ACD increased from 2.19±0.36 to 2.30±0.36 mm in PAC group (P=0.0003), with no significant change seen in the PACG group (1.79±0.32 vs1.82±0.33 mm, P=0.13).ConclusionLPI leads to a widening of the anterior chamber angle and a deepening of the anterior chamber in eyes with PAC. It does not significantly change any anterior segment parameters in eyes with PACG.

Neuroprotection in glaucoma

Glaucoma is a neurodegenerative disease characterized by loss of retinal ganglion cells and their axons. Recent evidence suggests that intraocular pressure (IOP) is only one of the many risk factors for this disease. Current treatment options for this disease have been limited to the reduction of IOP; however, it is clear now that the disease progression continues in many patients despite effective lowering of IOP. In the search for newer modalities in treating this disease, much data have emerged from experimental research the world over, suggesting various pathological processes involved in this disease and newer possible strategies to treat it. This review article looks into the current understanding of the pathophysiology of glaucoma, the importance of neuroprotection, the various possible pharmacological approaches for neuroprotection and evidence of current available medications.

Risk factors for delayed suprachoroidal haemorrhage following glaucoma surgery

Aim: To determine the incidence, risk factors and outcomes of delayed suprachoroidal haemorrhage (DSCH) after glaucoma surgery. Methods: A retrospective case-control study was performed at a tertiary referral eye hospital on patients who presented with DSCH following glaucoma surgery. Cases were compared with a matched-control population that underwent equivalent procedures but did not develop DSCH. The main outcome parameters were incidence of DSCH, risk factors associated with its occurrence, visual outcome and prognostic factors. Results: Of the 2752 glaucoma surgeries performed during the 10-year recruitment period, 29 cases of DSCH (1%) were identified. An increased incidence of DSCH was observed after glaucoma drainage device implantation compared with trabeculectomy-associated DSCH (p<0.0001; odds ratio 3.4; 95% CI 1.9 to 5.4). Risk factors for DSCH included low postoperative intraocular pressure (⩽3 mm Hg; p<0.001), aphakia (p<0.001), prior intraocular surgery (p<0.002), hypertension (p<0.001), anticoagulation (p = 0.002), ischaemic heart disease (p = 0.001) and respiratory disease (p = 0.008). The visual outcome of patients with haemorrhage was poor (logMAR 1.34 (SD 0.41)) and was significantly worse when compared with the control group (p = 0.002). Conclusions: In this study cohort, DSCH occurred more frequently after glaucoma drainage device implantation compared with trabeculectomy. Caution should be exercised when operating on patients with known ocular and systemic risk factors.

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

Purpose:  To comparatively evaluate the optic nerve head (ONH) using Optical Coherence Tomography (OCT) in normal subjects, primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) patients.