ophthalmology

“We have already made a lot of modifications and many would be there in future. We will ensure that there are numerous stations for patients to visit while maintaining social distancing. We are segregating various areas: patients-workup area, investigation area and the intervention area,” said the new chief of RP Eye Center, Padma Shri Dr JS Titiyal, while taking to Medically Speaking about the upcoming challenges with the new charge.

Congratulations on the new post. What changes do you want to make now that you have such a big charge under you?

It is an honor for me to be the chief of the centre which is more than 5 decades old, a part of AIIMS New Delhi and named after the first president of India. This institute was established to provide best possible technical help to the society and educate and bring out the best talent of the country. This institute was first to come up with blindness program in the year 1976 and many blindness programs from various parts of the world followed up.

As far as challenges are concerned, we have many of them to come across. They are manifold, like taking care of patients in a manner which they desire, providing highest possible technical support in terms of investigation and surgery and improve the space for the patients and relatives for their best comfort, diagnostics and treatment. Apart from this, I will have to look upon the improvement of various functioning of the center making it more approachable for all sectors of the society and the government.

Only a few institutes like AIIMS cater to those who cannot afford the best medication or the best doctors of the country. How do you plan to meet that challenge?

There is definite disproportionate manpower in terms of giving appropriate care to our patients. Different patients of different age groups ranging to newborns to the elderly come to us with different types of visual disabilities, therefore we need to set up different care units for each group.

Talking about the technical support, we have a good number of faculty members who are well trained and well-equipped. But what we lack is proper staff that includes at least two technical helpers for each ophthalmologist in the center.

Considering we are in the Covid era, how do you plan to implement these changes in such a difficult time?

We cannot have same facility work for this particular time. We have already made a lot of modifications and many would be there in future. We will make sure there are various stations for patients to go through while maintaining the social distancing. We are segregating various areas: patients-workup area, investigation area and the intervention area. We just require more time but we are working on that as well.

As far as OPD service is concerned, what do you want to tell the people who want to come to your center for treatment but are apprehensive of Covid?

No one should hesitant for treatment. Only thing necessary is to ensure proper precautions. First protect yourself and protect others also. If the problem is not very serious, you can have a teleconsultation that is being carried out by AIIMS since the last one and a half year. If anyone there is diagnosed with a serious problem, they are given appointment to come to the hospital. We have also opened direct access to our patients with the decrease in number of cases. We are making masks available for them, staff maintains social distancing and directs the patients to the appropriate sections to avoid any confusion and crowding. Every precautionary measure is taken in the OPD, medical staff wears PPE kits and sanitizers are available at every corner of the hospital. People are first tested for Covid and if they test negative, only then are they taken for surgery. If somebody is positive, they are advised to stay at home for 3 months and get treated after that. But if in case one has a serious eye problem, then also the hospital is available for treatment with proper precautions.

What is your roadmap to achieve the changes that you just spoke about?

First thing is that we need to have new guidelines for all kind of approaches. We are going to issue new guidelines countrywide for how to deal with the patients living in the remote areas as well as the urban areas. Secondly, we are looking for taking for taking care of people who come up with different kinds of blindness like diabetic blindness, corneal blindness. I am looking for a preventable treatment of blindness that is available at the doorstep and for that we are conducting rapid assessment for the root cause of the blindness that can be prevented, like injuries, malnutrition of use of inappropriate medications. Thus, we are going to work with the government to check the preventable blindness which is going to be based on some sort of mobile act.

Apart from this, we are looking after the guidelines for the children since they are constantly attending online classes and hence their screen time should be monitored keeping in mind there can be an extension due to the third wave.

What is your message to the people who are hesitant to donate their eyes due to the fear of Covid infection in a time when it is most required?

Corneal transplant can give vision back to people with blindness due to corneal opacity. Covid period decreased the number of eye donations across the world. Now we have started collecting tissues from the nasal and oral passage from the donor after conducting RTPCR tests after their death and later transplant these tissues to the patient.

Pledge for an organ donation or eye donation through AIIMS online portal is very much possible and if you have a death at home, we are available at your doorstep to collect the donation. We have counselors across the city who give them a message that they are providing a good service to the society.

Consuming large amounts of daily caffeine may increase the risk of glaucoma more than three-fold for those with a genetic predisposition to higher eye pressure according to an international, multi-center study. The research led by the Icahn School of Medicine at Mount Sinai is the first to demonstrate a dietary — genetic interaction in glaucoma. The study results published in the June print issue of Ophthalmology may suggest patients with a strong family history of glaucoma should cut down on caffeine intake.

The study is important because glaucoma is the leading cause of blindness in the United States. It looks at the impact of caffeine intake on glaucoma, and intraocular pressure (IOP) which is pressure inside the eye. Elevated IOP is an integral risk factor for glaucoma, although other factors do contribute to this condition. With glaucoma, patients typically experience few or no symptoms until the disease progresses and they have vision loss.

“We previously published work suggesting that high caffeine intake increased the risk of the high-tension open angle glaucoma among people with a family history of disease. In this study we show that an adverse relation between high caffeine intake and glaucoma was evident only among those with the highest genetic risk score for elevated eye pressure,” says lead/corresponding author Louis R. Pasquale, MD, FARVO, Deputy Chair for Ophthalmology Research for the Mount Sinai Health System.

A team of researchers used the UK Biobank, a large-scale population-based biomedical database supported by various health and governmental agencies. They analyzed records of more than 120,000 participants between 2006 and 2010. Participants were between 39 and 73 years old and provided their health records along with DNA samples, collected to generate data. They answered repeated dietary questionnaires focusing on how many caffeinated beverages they drink daily, how much caffeine-containing food they eat, the specific types, and portion size. They also answered questions about their vision, including specifics on if they have glaucoma or a family history of glaucoma. Three years into the study later they had their IOP checked and eye measurements.

Researchers first looked at the relationship looked between caffeine intake, IOP and self-reported glaucoma by running multivariable analyses. Then they assessed if accounting for genetic data modified these relationships. They assigned each subject an IOP genetic risk score and performed interaction analyses.

The investigators found high caffeine intake was not associated with increased risk for higher IOP or glaucoma overall; however, among participants with the strongest genetic predisposition to elevated IOP — in the top 25 percentile — greater caffeine consumption was associated with higher IOP and higher glaucoma prevalence. More specifically, those who consumed the highest amount of daily caffeine- more than 480 milligrams which is roughly four cups of coffee — had a 0.35 mmHg higher IOP. Additionally, those in the highest genetic risk score category who consumed more than 321 milligrams of daily caffeine — roughly three cups of coffee — had a 3.9-fold higher glaucoma prevalence when compared to those who drink no or minimal caffeine and in lowest genetic risk score group.

“Glaucoma patients often ask if they can help to protect their sight through lifestyle changes, however this has been a relatively understudied area until now. This study suggested that those with the highest genetic risk for glaucoma may benefit from moderating their caffeine intake. It should be noted that the link between caffeine and glaucoma risk was only seen with a large amount of caffeine and in those with the highest genetic risk,” says co-author Anthony Khawaja, MD, PhD, Associate Professor of Ophthalmology University College London (UCL) Institute of Ophthalmology and ophthalmic surgeon at Moorfields Eye Hospital. “The UK Biobank study is helping us to learn more than ever before about how our genes affect our glaucoma risk and the role that our behaviors and environment could play. We look forward to continuing to expand our knowledge in this area.”

National Eye Institute which is part of the National Institutes of Health, and New York Eye and Ear Infirmary of Mount Sinai helped to fund this study.

Source: The Mount Sinai Hospital / Mount Sinai School of Medicine