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Insights in Ophthalmology: 2021

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Future Vision 2020 and Beyond—5 Critical Trends in Eye Research

Suber s. huang.

∗ Retina Center of Ohio, Cleveland, OH

† National Eye Health Education Program Steering Committee, National Eye Institute, National Institutes of Health, USA

‡ Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Ophthalmology has been at the forefront of many innovations in basic science and clinical research. The randomized prospective multicenter clinical trial, comparative clinical trials, the bench to beside development of diagnostic and therapeutic devices, the powerful combination of biostatistics and epidemiology, gene therapy, cell-based therapy, stem cell therapy, regenerative medicine, artificial intelligence, and the development of personalized molecular medicine continue to propel us forward. This article summarizes several critical trends in eye research.

Innovative translational research continues to bring new solutions to blinding retinal diseases. The discovery of the genetic code presaged a day when the development of molecular tools and understanding of the basis of disease would lead not only to disease management but potentially lifelong cure. After decades of investigation, gene therapy is now a reality for a single autosomal recessive bi-allelic disease, Lebers Congenital Amaurosis. Its success has paved the way for a myriad of conditions once thought to be untreatable. In parallel, the progress to utilize pluripotential stem cells, immunomodulation, computational biology, and continued investigation into the fundamental mechanisms of cell and molecular biology is breathtaking in its rapidity. The next decade is likely to be the most exciting in the history of medicine. It will be essential that research progresses in a meticulously thoughtful, ethical, and collaborative process that safeguards the trust of our work and that of the society we serve.

Presented as the International Award Lecture, Asia-Pacific Vitreoretinal Society meeting, November 2019, Shanghai China.

GENE THERAPY

Hereditary diseases of the retina represent a group of diseases with several heterogeneous mutations that have the common result of progressive photoreceptor death leading to blindness. Retinal degenerations include multifactorial diseases such as age-related macular degeneration, Lebers congenital amaurosis type 2, Stargardt disease, and retinitis pigmentosa. There is currently no cure for degenerative retinal diseases; ophthalmology has been at the forefront of the development of gene therapy, which offers hope for the treatment of these conditions. Clinical trials for achromatopsia, choroideremia, MERKT, Leber congenital amaurosis 2, Leber hereditary optic neuropathy, neovascular age-related macular degeneration, retinitis pigmentosa, Stargardt disease, Usher syndrome 1B, X-linked retinitis pigmentosa, and X-linked retinoschisis are underway ( www.ClinicalTrials.gov )

The first successful gene therapy product for an inherited disease was approved by the US Food and Drug Administration (FDA) in December 2017. Of note, indication statement was not for a specific disease but “for the treatment of patients with confirmed biallelic RPE65 mutation-associated retinal dystrophy.” 1 , 2 This seminal observation highlights a key difference between traditional pharmacologic therapy and that of gene therapy where clinical phenotypes may have a common genetic basis. Approval followed 20 years of research to identify the mutation causing Lebers congenital amaurosis type 2 (LCA2), development of an animal model, 3 techniques for viral transfection, and establishment of biomarkers to evaluate efficacy. 2 , 4 – 7 The capability to develop animal models for testing of gene therapy is a critical precursor to human clinical trials.

The eye is well-suited for target organ gene therapy. Its uniqueness as an immune-privileged organ that is isolated from much of the systemic host immune response is that retinal cells do not divide after birth, and its small size confers singular advantages over other areas of human gene therapy. These advantages are key factors for gene therapy success, an isolated target organ/tissue with little opportunity for spillover effect, that transfected retinal cells are likely to maintain transgene production for life, and that the volume of distribution is also small. All are critical factors for transfection efficiency and clinical success.

CHALLENGES AND STRATEGIES

Despite the success and approval of gene therapy for bi-allelic RPRE65 mutation-associated retinal dystrophy, many challenges remain. Identification of a causative gene for retinal and ocular disease is difficult and elusive. Although treatment of single gene mutations is most likely to have positive clinical results, the treatment of common causes of blinding retinal disease [diabetic retinopathy (DR), age-related macular degeneration, and retinopathy of prematurity] are likely to be polygenic in nature. These conditions may require different approaches targeting neurotrophic factors that preserve function, by blocking apoptotic or degenerative pathway, or through expression of a blocking anti-vascular endothelial growth factor protein. 8

A second major challenge is the size of genetic payload. Adeno-associated virus (AAV) has emerged has an efficient method of gene delivery with low levels of immunogenicity and side effects as compared with lentivirus, adenovirus, or nonviral transfection systems. 9 – 11 AAV-2 and AAV-8 are among many possibilities for naturally occurring viral vectors but have an effective payload of only 5 kb of DNA. 12 Most genes encoding for major structural or regulatory functions are significantly larger. Strategies to address this include a double vector approach where each vector carries a unique fragment into the cell. Host mechanisms anneal each transgene via intermolecular recombination to form a product nearly twice the size of a single vector. Protein expression was noted to be lower but was sufficient to improve the retinal phenotype in mouse models of Stargardt disease and Usher IB. 10 , 11

Assessment of clinical response and efficiency of transgene expression is a third area of study. The use of promotors and directed evolution of high efficiency mutant AAV has been shown to transfect the outer retina in small animal models but failed to reproduce similar levels of expression in dogs and nonhuman primates. 13 , 14 It is unknown whether the anatomy of humans, volume of distribution, the level of transgene production needed to ameliorate the gene defect, or other mechanisms contribute to these disappointing results. Measurement of transfection efficiency in human clinical trials is also a challenge. Measurement of aqueous/vitreous transgene protein levels is a useful biomarker for production but does not necessarily reflect whether these are enough to produce similar physiologic changes noted in preclinical studies. Subjective measurement of function including visual acuity, microperimetry, and visual field assessment remains the primary outcome measures in studies of inherited retinal disease but is severely limited in assessing functional changes for the entire retina. Objective testing such as electrophysiology combined with increasingly detailed anatomic assessment holds promise. A unique test of visual function was created to test patients receiving gene therapy for patients with RPE65-mediated Leber congenital amaurosis type 2. A new quantitative for visual function and mobility was created in collaboration of the FDA, the multiluminance mobility test. Twelve different mazes were created for the subject to navigate with arrows to guide the subject around and over a variety of obstacles under light conditions ranging from dim to bright. The subjects were filmed and scored via a masked independent reading center. 2 , 15 To date, this is the standard for testing visual function in patient with inherited retinal disease who have progressive night blindness. Optimization of delivery systems, viral vectors, and improved functional testing are needed.

To date, immunogenicity of AAV vectors and adverse events are low in early-phase studies for a variety of conditions. On December 16, 2017, the US FDA approved Luxturna (voretigene neparvovec-rzyl) to treat children and adult patients with bi-allelic RPE-65 mutation-associated retinal dystrophy. Luxturna is the first directly administered gene therapy approved in the United States that targets a disease caused by mutations in a specific gene. However, many questions remain unanswered. Will every gene therapy have an acceptable profile of safety and efficacy? What is the durability of effect? Will transgene production remain constant over a lifetime? Will promotors and other enhancements to drive gene production have adverse effects? Could there be unanticipated effects if additional gene therapy is desired in the same eye/fellow eye? What are the financial and economic implications of cure? This milestone is but a first step in the treatment of our most intractable blinding diseases.

Presaged by the discovery of the genetic code, 25 years of gene therapy research has culminated in the first successful gene therapy for inherited disease in the US. Gene-targeted mutations have determined the functions of genes, their functional domains, and the mechanisms underlying the dysfunction of their disease alleles. Ongoing discovery will provide new molecular targets and will form the basis for clinical trials for many blinding inherited retinal dystrophies. Viral vector-mediated pronuclear transgenesis for retinal disease has promise but polygenic and multifactorial diseases such as age-related macular degeneration (AMD) are likely to require different approaches. 8 , 16 – 18 Whole gene editing or gene silencing using CRISPR/Cas9 technology can be used to directly treat target tissues and to develop target-specific strategies using iPSC (induced pluripotential stem cells). Other strategies of inducing mechanisms which promote neuroprotection or retard cell damage are likely pathways to pursue. For eye diseases which have a genetic determinant, we begin a decade where the goal is not just management, but cure.

Immunomodulation

There is increasing recognition of the role of host immunity in disease. Immunotherapy, immunomodulation, tumor targeting, and chimeric antigen receptor T-cell immunosensitization techniques have emerged as another strategy for clinical treatment. Public confusion exists over the term stem cells. Human embryonic stem cells and induced pleuripotential stem cells (iPSCs) can be manipulated in a wide variety of ways in the treatment of retinal disease. These will be discussed in the section on Regenerative Medicine to follow.

Another cell type is the mesenchymal stem cell (MSC). Neither derived from mesenchyme nor a true progenitor cell, the MSC is traditionally defined as a bone marrow stromal cell which may develop into chondrocytes, adipocytes, myocytes, and osteoblasts. They are found in enriched populations in the bone marrow, umbilical cord, adipose tissue, molar teeth, and in amniotic fluid. They do not have the ability to differentiate to produce hematopoietic cells. Long thought to be a structural connective cell, our laboratory in 2012 demonstrated elimination of corneal scarring in a murine model of bacterial keratitis and reduction in the neovascular response in a laser injury model in the rodent retina. 19 , 20 Numerous other studies have confirmed that MSCs exert strong immunomodulatory effects through a variety of mechanisms including those that “cloak” the MSC surface rendering it invisible to host immune response, that modulates lymphokine and cytokine response, and placing erythropoietin gene modified MSC in the subretinal space for the treatment of retinal degeneration. 21 – 23 Dubbed “nature's natural healers,” these cells have chemotactic attraction to sites of inflammation and exert immunomodulation of scarring in multiple studies of microbial infection. 24 MSCs have been shown to improve corneal regeneration, further supporting the integrated role of limbal and MSC therapy. 25

In 2011 and 2012, we described a new mechanism for the pathogenesis of DR. 26 – 28 We found convincing evidence that there was pericyte autoimmunity in the retinal capillaries of deceased patients with DR. An autoimmune mechanism may explain how retinal microvascular disease might progress even with good glycemic control. With time and immune attack on capillary pericytes, endothelial dysfunction leads to loss of endothelial cell integrity, macular edema, and eventually nonperfusion. These findings suggest that therapeutic immunomodulation may be a pathway to retard or ameliorate diabetic microvascular disease throughout the body. Although there is growing recognition for a therapeutic effect of MSCs in ocular degenerative disorders, problems of precision targeting of tissues and survivability remain practical issues of concern. 29 , 30 The role of systemic or periocular MSC infusion for DR disease requires additional investigation.

Chimeric antigen receptor T-cell therapy is the latest immunomodulatory therapy to use host immune mechanisms to specifically identify target cells. Primarily used in the treatment of cancer, this technique uses T-cells modified by chimeric antigen receptors to selective target tumor surface antigens. 31 , 32 This approach has not been used in the eye but is an example of a novel approach for targeted immune therapy.

Regenerative Medicine

Strategies for tissue replacement or regenerative therapies have been building momentum as understanding of stem cell biology, substrates, delivery systems, nanomaterials, and 3-D machined structures converge. Investigations using structures which combine cells and/or substrates include preclinical investigations of corneal disease, glaucoma, cataract, age-related macular degeneration, and retinitis pigmentosa. The use of 3-D and microengineering of bionic interfaces is being tried in many areas. Phase I studies include: implantation of ex vivo cultured corneal stroma stem cells to reverse stromal scarring, and replacement of glaucomatous trabecular meshwork with stem cell-derived trabecular meshwork cells for intraocular pressure regulation. Phase II studies include cell suspension and cells on matrix subretinal implantation of stem-cell derived retinal pigment epithelium (RPE), subretinal RPC (retinal progenitor cell) transplant, and trophic support to retard or prevent the progression of retinal cell death. 33

Retinal stem cell transplantation and tissue engineering have largely focused on replacement or regeneration of photoreceptors (PRs) and retinal pigment epithelial cells (RPEs). 34 , 35 Retinitis pigmentosa is a heterogeneous genetic mix of diseases which may affect PRs, RPEs, or both. Similarly, age-related macular degeneration is also characterized by PR loss. Whether PR loss is primary or a secondary effect due to RPE dysfunction, the ability to regenerate normal function of the PR and RPE is an attractive therapeutic option. For patients in advanced stage of outer retinal degeneration, gene therapy is unlikely to restore function and, at best, may only preserve the integrity of remaining tissues. Whether tissue replacement techniques ultimately improve vision has yet to be conclusively determined. 35

Sources for RPE transplantation include human fetal RPE cells, allogenic human cadavers, alternative cell sources, and human pluripotential stem cells (hPSCs) (including human embryonic stem cells, and human iPSCs). Each has demonstrated the ability to assume some of the functions of native tissue without conclusive improvement in vision. The need to provide large numbers of clinical grade replacement cells has tipped the process toward the use of human pluripotential stem cells. hPSCs are induced to undergo embryologic differentiation into immature PR cells or RPE cells. For conditions primarily characterized by PR loss such as some forms of RP, a suspension of immature PR cells may be placed in the subretinal space. For patients with RP or atrophic AMD characterized by absent PR and RPE, both tissues may be required. For RPE dystrophic changes with preservation of PR, an RPE cell suspension alone might be used. 33 – 35 Successful implantation of a bioengineered RPE cell on a monolayer has been successfully performed and demonstrates proof of principle in patients with advanced, dry age-related macular degeneration, and macular atrophy. 36 Ultimately, success of this technology will be defined by sustained viability of host and transplanted tissue, restoration of physiologic function, and stabilization or improvement in visual function. 33 – 35

Rescue strategies that seek to induce positive trophic effects from implanted tissue are being investigated. The subretinal space is believed to have moderate immune privilege. However, inflammation was noted in studies of subretinal injection of transplanted allogenic iPSC-RPE cells in rhesus macaques and minipig models. 37 , 38 It is becoming apparent that transfer of cytoplasmic materials between transplanted cells and the host cells occurs when enough viable host cells are present but does not occur when disease is advanced, and PRs are in low number. 36 These findings suggest that the timing of tissue transplantation is important to rescue existing PR function and maximize transplantation effect. Numerous Phase 1/2 studies are underway and explore intravitreal cell suspension, subretinal cell suspension, stem cell on scaffold, and suprachoroidal subretinal techniques. Designed primarily as proof of principle studies, these human trials have demonstrated broad tolerability and evidence of cell integration. 35 Whether retinal stem cell transplantation for retinal dystrophy or advanced dry AMD can retard disease progression or to improve retinal function is unknown and awaits further investigation.

Regenerative medicine holds significant promise for those for whom replacement of tissue is the best approach to restore neuroretinal function. An intriguing recent study of in vitro cortical brain organoids demonstrated oscillatory potentials at a level equal to the visual potentials noted in a 12-week-old premature infant. This extraordinary finding demonstrates the potential of regenerative medicine strategies to repair or replace neural tissue. Because the eye is an extension of the central nervous system, guiding eye precursor cells to full development may be a future approach to inherited and degenerative eye disease. 39

Artificial Intelligence

Perhaps no technological advance is as widely anticipated as the introduction of artificial intelligence (AI) into the medical biome. Alternately feared and hailed as a paradigm shift in clinical care, AI engenders deep feelings that accompany transition into civilization's fourth industrial revolution. 40 Each medical specialty will have areas where AI will help analyze massive data sets, identify clinically relevant patterns of disease, anticipate disease progression, guide clinical care, and optimize operations and resources. Electrocardiography, dermatology, radiology, and breast cancer screening all utilize image recognition. 40

In ophthalmology, the data generated from increasingly sophisticated imaging modalities are surpassing the ability to synthesize the clinical dataset. The rapidly expanding number of tests and the amount of data gathered are overwhelming the clinician's capacity to perform detailed analysis. AI will have the ability to identify patterns, progression, and most importantly, new markers that guide management. 41 – 43 It is worthwhile goal of AI programs to enhance the clinician's ability to practice more efficiently, more effectively, and to intervene before function is lost.

DEFINING AI

AI broadly refers to computer programs with the ability to learn and reason like humans. After training extensively on fundus images of patients with known grades and severity of DR, AI independently provides diagnostic recommendation. In the example of DR, AI might perform screening of patients with known diabetes and provide a simple output: DR present, DR absent, or needs triage for additional testing.

Machine Learning algorithms feature programing that instills the ability to learn without being explicitly programed. Machine learning is a subset of AI that permits independent review of datasets with previously known DR to “learn” what DR looks like, identify key features, and assign a diagnosis and stage. Much more sophisticated than “simple” AI, most current AI is at or near this level of sophistication. Ten thousand known imaging data sets are needed to begin to acquire this more sophisticated level of analysis.

Deep Learning subset of machine learning is the most powerful of the 3 modalities. Deep learning utilizes artificial neural networks that can learn and adapt from vast amount of data. Deep learning requires large curated data sets. One hundred thousand image sets were used in the National Institutes of Health chest x-ray studies and for dermatology deep learning projects. 44 , 45 Deep learning for DR would be able to identify and assign classification of DR from unknown retinal images. Over time, continuous learning on millions of images would permit searches for new patterns, biomarkers, and prognostic factors for disease progression. The ability to predict progression and the optimal time for intervention would forever change the paradigm for management, selection of subjects for clinical trials, and the efficiency of clinical care.

It is estimated that Deep Learning on 3D reconstructed images combining multimodal imaging would require training on 500,000 stereo paired images. Image sharpening using adaptive optics and image synthesis that sharpen weak imaging will be critical to avoid imprecise interpretation to default to human imaging. 46 , 47 , 42 Other challenges include the identification of training data sets, validation testing of data sets, sensitivity testing for heterogeneous populations, generalizability, display of analyzed data, algorithms for clinical care, deployment of systems, and financial impact. 41

Opportunities for AI in Medicine

Diagnostics.

• Reading imaging scans such as x-Rays, magnetic resonance imagings, ultrasounds, and so on, with increased accuracy
• Conduct virtual biopsies and assist in screening for cancer

Administrative

• Automate routine tasks for hospital staff
• Monitor member interactions with call center staff to ensure that calls are compliant
• Utilize Electronic Health Records as a predictor of patient risk

Patient Monitoring

• Integrate with smart devices to alert and to aid in the prevention of complications such as sepsis
• Leverage data provided by patient devices such as smart watches and mobile pictures to scan for risk factors while the patient is not at the site of care

Clinical Research

• Collapse data set to eliminate patients who are unlikely to progress or to respond to treatment
• Will help direct patient management by making recommendations on follow-up

This daunting challenge would seem to be on a distant horizon but consider the story of Stockfish and AlphaZero. 48 From its earliest inception, computer programming had its roots in game theory. The race to surpass the human mind in games of multidimensional thinking like Go, Shogi, and Chess were felt to be forever beyond the grasp of nascent computer programming. In 2018, Stockfish version 9 was the undisputed king of the chessboard. With every move of every game in recorded history in its database and computational speed of 60 million moves per second, Stockfish was lightyears ahead of the programs than first conquered the best human players in the world. Pitted against an upstart program in a 1000 match challenge was AlphaZero. The program could calculate a mere 60,000 moves per second and had not one game in its database. With no match experience and armed only with the instructions of play, AlphaZero was armed only with Deep Learning and a novel neural network. The rest is history. After 3 hours of self-study, AlphaZero registers its first win against the most powerful chess program in history. After 9 hours of play at a limit of 15 minutes a move (a lifetime in computer chess), AlphaZero never lost again.

The power and speed of deep learning programs will improve our ability to care for patients and accelerate every aspect of our journey to molecular medicine and individualized care. The future is now.

CONCLUSIONS

This review of critical trends in retinal research has touched on some of the vast efforts of clinician scientists around the world. The last critical trend is the need for collaboration. The randomized clinical trial, the Diabetic Retinopathy Clinical Research network, the Human Genome Project, and virtually every area and strata of civilization will depend on the ability of people to work together toward a common goal. Opportunities for misconduct, misuse, or worse may intensify. The ability to alter the human genome through gene editing and somatic gene rearrangement provides limitless chances for unintended consequences.

And yet, we are living in the most hopeful time in our history. We have limitless chances to improve the human condition and the opportunity to do so together. “If you want to go fast, go alone. If you want to go far, go together.”

The authors have no conflicts of interest to disclose.

Financial Disclosure: American Academy of Ophthalmology—C; American Society of Retina Specialists—C; Asia Pacific Academy of Ophthalmology—C; Asia Pacific Vitreoretinal Society—C; Diopsys—C, L, S; i2i Innovative Ideas, Inc. —C, O; Lumoptik—C, O; NEHEP/National Eye Institute/NIH—C; RegenXbio—C; Regenerative Patch Technologies—C; Second Sight—C; Spark Therapeutics—C; Volk Optical—C, L; Washington University, St. Louis—C. Category Code Legend: C indicates Consultant/Advisor; E, Employee; L, Lecture Fees; O, Equity Owner; P, Patents / Royalty; S, Grant Support.

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Subthreshold micropulse laser therapy for early postoperative macular thickening following surgical removal of epiretinal membrane

This study aimed to investigate the functional and anatomical outcomes of subthreshold micropulse laser (SMPL) therapy in eyes with early postoperative macular thickening after idiopathic epiretinal membrane (...

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage of both eyes after COVID-19 infection: a case report

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is commonly observed in myopia with tilted optic disc. It presents with typical features on the fundus and follows a self-limiting co...

Visual outcome of various dose of glucocorticoids treatment in nonarteritic anterior ischemic optic neuropathy– a retrospective analysis

The objective of this investigation was to assess the therapeutic efficacy of distinct glucocorticoid therapy dosages in the management of acute nonarteritic anterior ischemic optic neuropathy (NAION).

Epstein-Barr virus-positive iris diffuse large B-cell lymphoma detected by metagenomic next-generation sequencing

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a relatively rare subtype of DLBCL. Herein, we report a case of a patient with EBV-positive iris DLBCL after undergoing penetrating ke...

Self-supervised pre-training for joint optic disc and cup segmentation via attention-aware network

Image segmentation is a fundamental task in deep learning, which is able to analyse the essence of the images for further development. However, for the supervised learning segmentation method, collecting pixel...

Efficacy of 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) in high-risk pediatric retinal detachment; randomized clinical trial

Pediatric rhegmatogenous retinal detachments (PRRDs) are complex, rare occurrences and are often related to trauma or congenital abnormalities. Children often do not recognize or report symptoms of retinal det...

Acute retinal pigment epitheliitis during treatment of hyperprolactinaemia

Acute retinal pigment epitheliitis (ARPE) is a rare, idiopathic and self-limiting disease. The article aims to present ARPE in a patient using D2 dopamine receptor agonists for the treatment of hyperprolactine...

Comparison of cognitive workload and surgical outcomes between a three-dimensional and conventional microscope macular hole surgery

Performing a surgical task subjects the surgeon to multitudinal stressors, especially with the newer 3D technology. The quantum of cognitive workload using this modern surgical system in comparison to the Conv...

The non-linear relationship between serum albumin and diabetic retinopathy in type 2 diabetes mellitus: a secondary analysis based on a cross-sectional study

Most studies had shown a linear relationship between serum albumin (sALB) and the prevalence of diabetic retinopathy (DR). Thus, the purpose of this study is to investigate whether their relationship is non-li...

Study of myopia progression and risk factors in Hubei children aged 7–10 years using machine learning: a longitudinal cohort

To investigate the trend of refractive error among elementary school students in grades 1 to 3 in Hubei Province, analyze the relevant factors affecting myopia progression, and develop a model to predict myopi...

Psychometric assessment of patients with central serous chorioretinopathy and correlation with disease stage and progression: a case control study

Central serous chorioretinopathy (CSC) has frequently been associated with increased stress levels as well as an increased prevalence of other psychiatric conditions. This study used standardized psychometric ...

Micropulse transscleral cyclophotocoagulation (MP-CPC): efficacy endpoints for the treatment of refractory paediatric glaucoma - a retrospective case-series

This study evaluates the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-CPC) in paediatric patients.

Could driving help us to “see better”? A comparative assessment of saccadic efficiency, visual speed, and attention

This study aimed at comparing drivers’ and non-drivers’ results in the Adult Developmental Eye Movement with Distractors test (ADEMd) and the Useful Field of View test (UFOV).

Investigation of alterations in retrobulbar hemodynamics and their correlation with choroidal thickness after strabismus surgery

To evaluate the changes in retrobulbar circulation after strabismus surgery and to assess the relationship of these changes with choroidal thickness (CT).

Outcomes of gonioscopy-assisted transluminal trabeculotomy in primary congenital glaucoma treatment: a retrospective study

This retrospective study aimed to evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in Chinese patients with primary congenital glaucoma (PCG) and identify factors influ...

Differences in anterior chamber depth in keratoconus patients with binocular very asymmetry ectasia

To evaluate the difference in anterior chamber depth (ACD) between two eyes among keratoconus patients with binocular very asymmetric ectasia (VAE) and to explore the influencing factors.

Clinical performance and shape analysis of trifocal intraocular lenses via scanning electron microscopy

To evaluate visual performance after implantation of the TFNT (Acrysof Panoptix, Alcon, Fort Worth, Texas, USA) and CNWT (Clareon Panoptix, Alcon, Fort Worth, Texas, USA) intraocular lens (IOL), and compare th...

Early choroidal and retinal changes detected by swept-source oct in type 2 diabetes and their association with diabetic kidney disease: a longitudinal prospective study

To evaluate structural changes in retina and choroid in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD).

Morphological and functional characteristics of the meibomian gland in pediatric patients with epiblepharon

To observe morphologic and functional changes in meibomian glands in pediatric patients with and without lower eyelid epiblepharon.

Goldenhar syndrome with limbal neoformation, microtia and skeletal deformities: a case report and literature review

To report a case of a 4-year-old patient with Goldenhar syndrome.

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EyeWiki:Suggested Topics

Below is a list of suggested topics identified by the EyeWiki editorial team.

To submit a topic not already in EyeWiki, you can use these directions .

• 1 Cataract/Anterior Segment
• 2 Cornea/External Disease
• 4 Miscellaneous
• 5 Neuro-ophthalmology/Orbit
• 6 Ocular Trauma
• 7 Oculoplastics/Orbit
• 8 Oncology/Pathology
• 9 Pediatric Ophthalmology/Strabismus
• 10 Refractive Management/Intervention
• 11 Retina/Vitreous

Cataract/Anterior Segment

NOTE: Articles that are added and have no content or are very incomplete may be deleted after 30 days of inactivity . Please do not submit article proposals unless you plan to complete them within 30 days.

• No suggested topics found.

Cornea/External Disease

Miscellaneous, neuro-ophthalmology/orbit, ocular trauma, oculoplastics/orbit, oncology/pathology, pediatric ophthalmology/strabismus, refractive management/intervention, retina/vitreous.

Research Topics

The Department of Ophthalmology and Visual Sciences offers medical students and residents a variety of research opportunities. Please browse the basic science, translational and clinical research projects currently underway below.

Research Topic: Corneal endothelial health judged by endothelial image analysis

Description.

Endothelium is critical for dehydrating the cornea and keeping it clear. With loss of its barrier and pump function, the cornea swells and corneal transplantation may be needed.

Changes in the number, shape and size of the cells may predict loss of function.

Key Research Question/Hypothesis 

Effect of drugs, surgery, devices, and preservation media on the endothelium.

Images of the endothelium captured with either a specular or confocal microscope that can take repeated pictures of the endothelial cells non-invasively in patients. Once images are captured, they can be analyzed with special software in the Cornea Image Analysis Reading Center (CIARC) of the Department.

Student learn these techniques working with both patients and technicians, depending on the project.

Ongoing projects.

Status of IRB/IACUC approval

Image analysis studies in CIARC approved; ongoing projects have IRB approval. If launching a new project, IRB approval will need to be obtained.

Prospects for Publishing and Presenting

Excellent; we have a long track record of publications in major journals and presentations at national and international conferences.

Contact Information

Tanisha Rankins

Secretary to Dr. Jonathan Lass

• Email:  [email protected]  
• Phone: 216.983.5164

Research Topic: Retinopathy of Prematurity and other Pediatric Studies

Effect of low birth weight on the eye’s development.

Data analysis, chart review.

Several ongoing projects—long-term data collection.

Current study has IRB approval. Any new studies will need IRB approval.

Excellent; the data base study has been presented at ARVO and is in preparation for publication in a major pediatric journal.

Dr. Faruk Orge

• Email:  [email protected]
• Phone: 440.684.1743

Research Topic: Cholesterol and function of the retina

Cholesterol is essential for life in mammal. Yet, if it is chronically in excess, it is a risk factor for cardiovascular and Alzheimer's disease and likely age-related macular degeneration.

To delineate the putative link between cholesterol and age-related macular degeneration.

Characterization of retinal function of mice deficient in different enzymes involved in cholesterol elimination. Animals are assessed by optical coherence tomography, electroretinography, fluorescein angiography and optomotor response.

Students learn these techniques working with post-doctoral researchers responsible for these projects.

All studies are approved by the IACUC.

Dr. Irina Pikuleva

• Email:  [email protected]
• Phone: 216.368.3823

Research Topic: Contact Lens Related Complications

Ongoing clinical trials related to corneal infiltrative events associated with daily or extended wear of soft contact lenses. Fungal and bacterial biofilm-contact lens models and susceptibility to contact lens care products.

Assessment of sub-clinical corneal inflammation with confocal microscopy. Assessment of bacterial endotoxin and relationship to infiltrative events with soft lenses.

• Ocular and lens cultures for assessment of bioburden
• Reading/Assessment of stored confocal images
• Collection of worn lenses for biofilm formation
• Lab Assays (in conjunction with Dr. Pearlman’s lab) for endotoxin on lens surfaces or within solution

Active approved IRB protocols exist for current clinical trials on infiltrative events, biofilm studies, and assays of previously collected lenses, tears and images.

Excellent chance for authorship on investigator initiated studies of biofilm and endotoxin assays. Listing of authors will follow standard publishing guidelines. 

Other corporate-funded work may or may not allow authorship.

Dr. Loretta Szcztoka-Flynn

• Email:  [email protected]

Research Topic: Mechanisms of retinal degenerations

How do mutations in the light receptor rhodopsin cause retinal degenerations like retinitis pigmentosa? How does the retina protect against oxidative stresses that can lead to retinal degenerations such as retinitis pigmentosa and age-related macular degeneration?

A multi-disciplinary approach is employed that includes biochemistry, molecular biology, animal models and biophysics.

All animal studies have approved IACUC protocols.

Excellent with track record of publications in major journals and presentations at national and international conferences.

Information about the laboratory can be found by browsing the Park Lab webpage.

50 Thesis Topics in Ophthalmology to Know What to Write About

Table of Contents

Ophthalmology Thesis Topics: What Should They Be?

Thesis topics in ophthalmology should represent solid research in the sphere on the basis of strong evidence. While writing a thesis, one should pay attention to the statistical measures in the field to address the methods and techniques of solving difficult medical tasks. Thesis topics in ophthalmology are significant for the examination of the urgent topics on eye diseases and the discovery of the means of treating the eye conditions.

Ophthalmologists have long been engaged in eye treatment, the study of physiology, but in recent years, science has made a huge leap forward. Today, these doctors create new methods of treatment, conduct scientific activities, trying to find the causes of the development of various diseases, work with congenital and acquired pathologies.

Ophthalmology Research Data to Think Over

If we talk only about statistics in America , then 24, 4 million Americans suffer from cataracts. By the age of 75, this figure reaches half the total population of America of this age. Glaucoma, in turn, affects 2.7 million Americans over 40 years of age.

These figures determine the demand for ophthalmologists in the labor market and the popularity of training in the specialty “Ophthalmology”. Innovative techniques, modern scientific knowledge, and equipment today make it possible to cure eye diseases, which 10 or 15 years ago deprived patients of sight forever.

That is why medical students are involved in scientific activities starting from college, and the successful writing of a dissertation is almost a guarantee of high professionalism of the graduate and his readiness to help people maintain the ability to see the world. Below we have collected 50 topics of dissertations in ophthalmology. Choose the most interesting to prove that you have the right to call yourself a doctor and treat people.

To begin with, due to the negative impact of computers and laptops, the majority of individuals experience eye pain and dry eye condition. This might be an important topic for discussion since it is estimated that millions of adults suffer from the dry eye. The controversies in ophthalmology have arisen over a long time concerning the etiology of dry eye and experience of pain. The evidence from other fields shows that alterations in the central nervous system exacerbate the irritative symptoms and eye pain. Sometimes, the patient can complain about chronic pain syndrome that is characterized by systemic pain.

Dry eye disease occurs in 5% to 35% of the world population and is more present in females. The condition has severe consequences for life quality negatively influencing visual activity, productivity at work, social interaction, and physical functioning. The sources reveal that individuals with dry eyes of the moderate and severe degree have similar either social or psychological life as people experiencing angina of the same degree or those who made hospital dialysis. The dry eye condition is connected with the disorder of the tear film, meibomian glands, violation of normal ocular surface, and inflammation of the eye surface. The disease is accompanied by the huge discomfort, disturbance of tear film, and visual difficulties that might lead to the damage of the ocular surface. Patients suffering from dry eye disease have problems with focus because of the tear film osmolarity and ocular surface inflammation.

Corneal sensation remaining intact is essential to keep the healthy ocular surface as well as quality and quantity of tears because corneal nerves have the direct trophic impact on maintaining the corneal epithelium. Corneal confocal microscopy (CCM) might be used to reflect the cornea involving the sub-basal nerve layer in people with dry eye disease. As a matter of fact, the condition can be triggered by the majority of mechanisms that result in the ocular irritation; however, it is still not understood what is the cause of dry eyes when the tears are normally produced and the ocular surface is moist enough.

To conclude, the discordant dry eye appears because of the tear production discordance and ocular surface staining. The processes in the central nervous system are interchangeably connected with the severe symptoms of eye strain and ocular surface damage. Further research should be done to relieve the symptoms and find the adequate treatment of the disease.

50 Ophthalmology Dissertation Topics to Choose From

Feel free to check the following list of topics.

• Surgical Treatment of Exophoria Complicated by Horizontal V-Syndrome;
• Possibilities of Detecting Early Disturbances in Eye Hydrodynamics in Patients with Cataracts and Ocular Manifestations of Pseudoexfoliation Syndrome;
• Ultrasound Biomicroscopy in the Diagnosis of Pathology of the Extreme Periphery of the Fundus;
• Experimental Clinical Rationale for the Use of Nd: Yag Laser with a Wavelength of 1.44 Microns in the Technology of Anterior Capsulorhexis and Remote Hemostasis;
• Medico-Technological System of Surgical Treatment of Progressive Keratectasia of Various Origins;
• Subthreshold Micropulse Laser Treatment with a Wavelength of 577 Nm in the Treatment of Central Serous Chorioretinopathy;
• The Clinical and Experimental Rationale for the Combined Use of Neodymium Ion 1.44 Microns and Helium-Neon 0.63 Microns Lasers in Cataract Surgery;
• Yag-Laser Activation of Trabeculae in the Treatment of Patients with Primary Open-Angle Glaucoma;
• The Study of the Effectiveness of Micropulse Laser Irradiation with a Wavelength of 577 Nm in Macular Edema After Surgical Removal of Idiopathic Epiretinal Membrane;
• The Clinical and Experimental Rationale for Optimized Uv-Crosslinking Technology in the Treatment of Keratoconus;
• Clinical And Laboratory Substantiation of the Use of Orthokeratology Lenses in Progressive Myopia in Children;
• Optimization of Surgical Treatment of Retinal Vein Thrombosis Outcomes;
• The Results of Surgical Correction of High Myopia with Anterior Chamber Phakic Intraocular Lenses;
• The System of Treatment and Rehabilitation Activities in Patients with Paralytic (Paretic) Strabismus;
• Surgical Treatment of Keratectasia of Various Origins by the Intrastromal Keratoplasty Method with Polymeric Corneal Segments;
• Comparison of Spectral Optical Coherence Tomography and Confocal Scanning Laser Ophthalmoscopy in the Diagnosis of Primary Glaucoma;
• Clinical and Functional Results of Surgical Treatment of Rhegmatogenous Retinal Detachments Using the Method of Peri-Basal Vitrectomy;
• The Modern System of Diagnostics, Treatment, and Organization of High-Tech Ophthalmic Care for Children with Active Stages of Retinopathy of Prematurity;
• Limbal Co-Transplantation in the Prevention of Rejection of Donor Corneas in High-Risk Keratoplasty;
• Vascular Disorders in the Anterior Part of the Eye at Different Stages of Pseudoexfoliation Syndrome;
• Induction of Posterior Vitreous Detachment in the Surgical Treatment of Retinal Detachment;
• Combined Phacoemulsification Method in Patients with Operated Glaucoma;
• Features of the Quality of Life of Patients with Cataract and Glaucoma Before and After Surgical Treatment;
• Ophthalmologic Diagnostics and Tactics of Treatment of Cranio-Orbital Injuries in the Acute Period of Traumatic Brain Injury;
• Features of Pupillary Reactions and Regional Hemodynamics of the Eye in Patients with Diabetes Mellitus with Different Levels of Glycemia;
• Prevention and Treatment of Corneal Lesions in Endocrine Ophthalmopathy;
• Antibacterial Drugs in the Prevention of Complications of Cataract Phacoemulsification;
• Possibilities for Stimulating the Secretion of Tears in Patients with Hypolacrimia in the “Dry” Eye Syndrome;
• Diagnosis and Treatment of Actinomycotic and Mycotic Diseases of the Lacrimal Ducts;
• Study of the Clinical Efficacy of Diaphragm Glasses;
• The Study of Sclera Rigidity In Healthy and Glaucomatous Eyes;
• Clinical and Instrumental Diagnosis of Malignant Tumors of the Orbit;
• Ophthalmotonus Biorhythms in Health and Glaucoma;
• Clinical And Laboratory Diagnosis of Early Stages of Keratoconus;
• The Clinical and Functional Rationale for the Tactics of Surgical Treatment with a Combination of Retinal Detachment with Lens Opacities;
• Combined Surgical Treatment of Retinal Detachment in the Advanced Stage of Proliferative Diabetic Retinopathy;
• Mathematical, Experimental and Clinical Rationale for the Prevention and Correction of Corneal Astigmatism and Capsular Bag Pathology in Cataract Surgery;
• The Method of Combined Treatment of Progressive Myopia;
• Modification of Sinusotomy in the Treatment of Primary Open-Angle Glaucoma;
• Optimization of Diagnosis and Surgical Treatment of Involutional Entropion of the Lower Eyelid;
• Peripheral Vortical Dystrophies and Retinal Detachment in Pregnant Women: Diagnosis, Treatment, Choice of Method of Childbirth;
• Indices of Intraocular Pressure of a Newborn Child Due to the Morphological Features of the Drainage System of the Eye at Different Periods of Gestation;
• The Use of Silicone-Hydrogel Contact Lenses in the Treatment of Ulcerative Keratitis;
• Prolonged Pharmacotherapy of Glaucomatous Optic Neuropathy;
• Modern Aspects of Viscosurgery in Ophthalmology;
• Current Possibilities for the Prevention and Treatment of a Blepharo Conjunctival Form of Dry Eye Syndrome of Demodectic Etiology;
• An Experimental Study of the Effectiveness of Cell Transplantation in Post-Traumatic Pathology of the Retina;
• Vitreoretinal Changes in Case of Eye Injury by Splintering;
• Diagnosis and Treatment of Optic Nerve Hypoplasia in Children;
• Ocular Manifestations of Antiphospholipid Syndrome.

10 Resources to Find More Information on Ophthalmology Topics

Here are some scientific journals websites you may look through.

• American Journal of Ophthalmology Case Reports
• Clinical Ophthalmology
• Current Trends in Ophthalmology
• Digital Journal of Ophthalmology
• International Journal of Keratoconus and Ectatic Corneal Diseases
• International Journal of Ophthalmology & Visual Science
• IP International Journal of Ocular Oncology and Oculoplasty
• Journal of Current Glaucoma Practice
• Medical Hypothesis, Discovery, and Innovation in Ophthalmology
• Neuro-Ophthalmology & Visual Neuroscience

5 References to Write an Ophthalmology Thesis

• Bron, A. J., Tomlinson, A., Foulks, G. N., Pepose, J. S., Baudouin, C., Geerling, G., … & Lemp, M. A. (2014). Rethinking dry eye disease: a perspective on clinical implications. The ocular surface, 12(2), S1-S31.
• Dry eye disease: risk factors and selecting treatment. (2015). The Pharmaceutical Journal. http://dx.doi.org/10.1211/pj.2015.20069420
• Shtein, R. M., Harper, D. E., Pallazola, V., Harte, S. E., Hussain, M., Sugar, A & Clauw, D. J. (2016). Discordant dry eye disease (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society, 114.
• Sullivan, B. D., Crews, L. A., Messmer, E. M., Foulks, G. N., Nichols, K. K., Baenninger, P., … & Lemp, M. A. (2014). Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta ophthalmologica, 92(2), 161-166.
• Yun, C., Kang, S., Kim, H., & Song, J. (2012). Prevalence of Dry Eye Disease among University Students. Journal Of The Korean Ophthalmological Society, 53(4), 505. http://dx.doi.org/10.3341/jkos.2012.53.4.505

Hopefully, you will find our article useful and be able to write the best ophthalmology dissertation ever! Despite choosing a topic, the thesis writing process takes a lot of time to take the other steps – brainstorming, research, note-taking, outlining, structuring, drafting, writing itself, formatting, proofreading, etc. If you want to save you time or nerves, you know what to do. Right? DoMyPapers.com is 24/7 open to you.

Too busy to write your paper by yourself?

• Paper Presentations

Presented paper on on comparative study between 0.5 % Ropivacaine with Fentanyl and 0.5 % bupivacaine with fentanyl in USG guided supraclavicular Block in Upper Limb Surgeeries

Presented e-paper on the effect of ketamine in lowering the incidence and severity of post op sore throat after endotrttacheal in patients receiving GA on 19 DEC 2020 at TNISA PG Conclave

Ashish , Logeshwari P

Presented an e-poster on’A randomised control study comparing effect of intravenous dexmedetomidine vs IV esmolol omn attenuation of pressor response to laryngoscopy and endotracheal intubatiion’ and e-paper on ‘the effectiven3ess of dexmedetomidine as an additive to Ropivacaine in supraclavicular brachial plexus block.

Presented e-paper on MAHAYUVAISACON 21 on 20 th Feb 2021 titled as “the effect of nebulised ketamine in decreasing the incidence and severity of post operative sore throat after endotracheal intubation in patients receiving general anaesthesia.

Biochemistry

Made presentation on scientists and clinicians preceptorship for translational research in Webinar 'Biology to Omics' organized by TMS-ACTREC, Navi Mumbai during March 10-12, 2021

Community Medicine

Sero Surveillance in the Wardha District of central India to monitor

SARS Cov 2 infection status among asymptomatic General population

International conference Conquering COVID-19 , at Kasibai Navle

Medical College, Pune.18-19 December 2020

Participated in 5th National IAPSM postgraduate quiz Competition 48th Annual National Conference of Indian Association of Preventive and Social Medicine (IAPSMCON),PGIMER, Chandigarh,19-21 March 2021

Kolhe R , Gupta SS

Relationship of Father's engagement in responsive caregiving with child development a cohort study - presented at IAPSMCON 2021, PGIMER, Chandigarh, 19-21 March,21(poster presentation)

48th Annual National Conference of Indian Association of Preventive and Social Medicine (IAPSMCON),PGIMER, Chandigarh,19-21 March 2021 - Participated in (WAR OF VIDEO COMPETITION) “MAHASANGAM”

2nd IAPSM Young Leaders National Conclave,26-27 March 2021 Participated in (Worth A Thousand Word: Public Health Photography Competition)

Forensic Medicine

Moderate a session topic- crime scene examination-role of doctor in state conference of MLAM“forensicon 2020 on 10 th april 2021 Organized by Department of Forensic Medicine &Toxicology, TNMC & BYL charitable , hospital, Mumbai

Khandekar I L

Chaired a session in 42 nd Annual National conference of IAFM “FORENSIC MEDICON 2021” organized at SCB medical college cuttack, odisha from 23 rd - 24 th Jan 2021,

Moderate a session topic- Non uniformity of medical & medicolegal certificates in state. in state conference of MLAM“ forensicon 2020 on 10 th april 2021 Organized by Department of Forensic Medicine &Toxicology, TNMC & BYL charitable , hospital, Mumbai

Politics of Science in a Pandemic: Impact of Evidence Based Medicine (Guest Speaker)

8 th National Bioethics Conference, 12 December 2020

SP Kalantri

Predictors of Mortality in Venomous Snakebites: Sevagram Story (Guest Speaker)

Amrita Institute of Medical Science (AIMS) Kochi. Amrita National Conference on Snakebite. 22 November 2020

How Covid Vaccines Are Being Developed: Clinical Trials in India (Guest Speaker)

BOOM, 6 August 2020

Aarupadai Veedu Medical College & Hospital. AVMC Webinar Series – ‘Forefront of Future Frontiers’ (Guest Speaker)

Clinical Trials in COVID -19: The Science and Ethics’, 31 July 2020

The Need for Evidence Based Medicine in Treating Covid19 (Guest Speaker)

20 July 2020

14th National Cancer Grid webinar on COVID19 Preparedness (Guest Speaker)

Research Priorities for COVID-19, 18 July 2020

Can Alternative Medicine Be Subject To Modern Rigour? (Guest Speaker)

The Hindu Podcast by Jacob Koshy,3 July 2020

Webinar: Ethical Challenges of Research in a Pandemic (Guest Speaker)

Sunoindia podcast, 27 June 2020

The Why, How & What of Research during COVID era (Guest Speaker)

11 th National Cancer Grid webinar on COVID-19 preparedness, 20 June 2020

Covid and Rural India: Wardha Story (Guest Speaker)

Podcast: SoundCloud by Rukmini S, 10 June 2020

Hydroxychloroquine: More Questions than Answers (Guest Speaker)

BOOM, 5 June 2020

TheEvidence and/or Lack of Evidence for the Effectiveness of Hydroxychloroquinein Treating COVID-19

BBC (British Broadcasting Corporation) Talk , 20 May 2020

Dr. Amrish Saxena

Poster Presentation on Magnitude and determinants of depression in chronic kidney disease patients on maintenance hemodialysis in rural tertiary care hospital at ISN-WZ 2020, 36 th Annual ISN West Zone Conference, Nagpur, 19 th & 20 th September, 26 th & 27 th September 2020.

Microbiology

Presented a paper (Oral Presentation) on “Co infection of pneumocystis

carinii and cryptococcus neoformans” in the 2 nd Annual Conference of

Vidarbha Association of Medical Microbiology VAMMCON-2021 (online) held at Akola on 20 th and 21 st February, 2021

Maraskolhe D

Presented a paper (Oral Presentation) on “Are tuberculosis patients at greater risk of acquiring COVID-19 MGIMS data and Review of literature” in the 2 nd Annual Conference of Vidarbha Association of Medical Microbiology VAMMCON-2021 (online) held at Akola on 20 th and 21 st February, 2021 and received Dr. Ashok Pathak Junior Best Oral Paper Award

Obstetrics and Gynaecology

Presentation on Elderly Girls and How can we keep the rural work force we have ?” Unwanted pregnancies in adolescent girls – Global Challenges

Virtual 17 th WONCA World Health Rural Conference (Speaker)

Primary Care and Rural Health Bangladesh (PCRHB), Bangladesh, 15 th -18 th April, 2020

Critical Obstetric Care (Transfusion protocol, use of anticoagulants, Labour and Delivery in ICU training Webcast conference ( Panelist)

FOGSI 26 th April, 2020

4 th Global Virtual summit featuring wizard of endoscopy

Indian association of Gynaecology Endoscopist 21 st June, 2020

Mid Life Health Issue (Panelist)

Mid life Health committee Online conference (Chairperson nominee) Amravati Obstetrics and Gynaecology Society, Amravati, 12 th August, 2020

Management of worst Obstetric emergencies, PPH Online workshop on “ PPH Management” ( Panelist)

Ghaziabad Obstetrics and Gynaecological Society 13 th August, 2020

Hypertensive DS of Pregnancy Online Conference on “Hypertensive Pregnancy” (Panelist)

Nagpur Obstetrics and Gynaecological Society, Nagpur, 18 th August, 2020

USG in Infertility E-conference on “USG in Infertility “The Third Eye” ( Guest lecture)

Revari Obstetrics and Gynaecological Society, Rewari, Haryana, 4 th Sept, 2020

Classic For Clinician - RH Incompatibility in Obstetrics

Classic for Clinician Webinar Series 2, 25th November, 2020

NHM-UNICEF-NQOCN Webinar on Management of Post Partum Haemorrhage With Bundle Approach -Management Of Mother And Newborn In Labour Room

NQOCN with support of UNICEF, 28th November, 2020

Family Integrated Care

NQOCN 14 th December, 2020

Gestational Diabetes – Early intervention key to best Outcome

Rewari Obst & Gynaec Society, 11th January, 2021

Virtual conference on High risk pregnancy, infertility and Gynaecologic

Pune Obstetric and Gynaecology Society, 5 th -7 th March, 2021

Appropriate Blood and Blood Product Transfusion Guidelines PPH- Prevent the Catastrophe Part -5

Association of Madhya Pradesh Obst & Gynae Society and Raipur Obst & Gynae society 9th March, 2021

Amenorrhoea - Clinician's Perspective 29 th Annual POGS Conference “REEDIFY 2021” (Panelist)

Organised by Pune Obstetrics and Gynaecological Society, Pune, 5 th -7 th March, 2021

Maternal Health Care Bundles Classic for Clinician Webinar Series

25th March, 2021

Case Presentation & Table Viva Orator- Respectful Maternity Care (Late Dr. Leela Dube Oration) Virtual PG Force-2021 Nagpur Obstetrics and Gynaecology (Faculty)

Organized by Dept of OBGY, NKP Salve Institute of Medical Sciences & Research Centre & Lata Mangeshkar Hospital, Nagpur in Association with Nagpur Obstetrics and Gynaecology Society, Nagpur 16 th -21 st March, 2021

PMNCH Call to action on COVID 19 Webinar on PMNCH Stratergry outline

WHO 30th March, 2021

Infertility E-conference on “Roll of USG in Pregnancy” ( Chief Guest) Rewari Obst & Gynaec Society Rewari, Haryana 4 th September, 2020

Unwanted Pregnancies in Adolescent Girl, Global Challenges For Safe Baby, Safe Childhood, Safe Motherhood, Safe Womenhood, Maternity Violence must stop. How?

Rural Tribal Elderly Women’s suffering in a low resource region

Workshop-How Can We Keep the Rural Workforce We Have?”: A

Workshop on Rural Workforce Retention

TUFH Network : Primary Health Care: A Path towards Social Justice-

System and Community Based response to Covid-19,

Mexico, 23 rd -25 th September,2020

"Partograph and its interpretation: Risk for mother and Newborn"

NQOCN for Madhya Pradesh 15 th September, 2020

Developing prospective authors from QI teams across India for preparing QI reports for publication in peer reviewed journals

NQOCN 27 th October, 2020

Checklist For Immediate Postpartum Vigilence- For Mother And Newborn

Nqocn 10 th December, 2020

The Nuances of Infertility Webinar on The Nuances of Infertility ( Chaired the Session)

Nagpur Obstetrics and Gynaecology Society, Nagpur, 23 rd December, 2020

Triaging and Emergency Management in Obstetrics emergency (Guest Speaker) Topic of Webinar- Respectful Maternity Care in Covid/ Non-Covid era: Pregnant Women deserves the Quality Care in any Situation

13th February, 2021

Post natal care – recent advances (Guest speaker) Topic of Webinar- Respectful Maternity Care in Covid/ Non-Covid era: Pregnant Women deserves the Quality Care in any Situation - Day 4

27th February, 2021

Infection Prevention Practices- Covid/ Non Covid Topic of Webinar- Respectful Maternity Care in Covid/ Non-Covid era:

Pregnant Women deserves the Quality Care in any Situation

31st March, 2021

Ophthalmology

Diabetic Retinopathy Screening by Teleophthalmology (Guest Speaker)

Annual Delhi Ophthalmic Society International Hybrid Conference of 19 th December, 2020

Enhancing Clincal Skills in Ophthalmology using OSCE’s (Guest Speaker)

Annual Delhi Ophthalmic Society International Hybrid Conference of 18 th December, 2020

Lens Induced Glaucoma

Annual Delhi Ophthalmic Society International Hybrid Conference of

19 th December, 2020

Tayde D , Shukla A K, Singh S, Sheikh A, Lilhare K

Correlation between ablation depth and change in corneal curvature after

LASIK surgery”

45 th Virtual Annual Conference VOS-VRCON 2020 of the Vidarbha Ophthalmic Society from 26 th & 27 th December, 2020

More A , Shukla A K, Singh S, Sheikh A, Bhosale N

Management of Diabetic Patients with Vision Threatening Diabetic

Retinopathy in Rural Vidarbha region”

Peddawad S , Shukla A K, Singh S, Sheikh A, Bhosale N

Screening for vitamin A deficiency in tribal Maharashtra (Melghat)”

Bhosale N , Shukla A K, Singh S, More A

Visual outcome after small incision cataract surgery (SICS) in diabetic and non-diabetic patients”

Rathi N , Singh S, Shukla A K, Tayde D

Corneal topographic patterns in myopic eyes”

Taneshwari S , Dhabarde A, Shukla A K, Pednekar N, Sarode K

Analysis of Causes of Protposis in a Rural Based Tertiary Care Hospital

Tejashree B , Shukla A K, Singh S, Bang P, Peddawad S

An Insight into the Burden of Concomitant Strabismus among Primary School Children in Central India”

Yadav V , Shukla A K, Singh S, Tayde D, Malwe G

A case of lid ptosis and total ophthalmoplegia Annual Delhi Ophthalmic

Society International Hybrid Conference of 18 th December, 2020

Study of change in contrast sensitivity and corneal aberration in eyes

undergoing LASIK (Laser in situ Keratomileusis)

Bhosale N , Shukla A K, Singh S, More A, Malwe G

Bilateral Optic neuropathy: a rare presentation of Systemic lupus erythematosus ( e Poster)

Rosai Dorfmann Disease of Orbit” ( e Poster)

A case of optic nerve head drusens mimicking optic disc oedema” ( e Poster)

Yadav V , Shukla A K, Singh S, Tayde D, Chauragade S

An unusual presentation of mucormycosis in a known diabetic 45 th Virtual

Annual Conference VOS-VRCON 2020 of the Vidarbha Ophthalmic Society from 26 th & 27 th December, 2020

CISP II Workshop (Convener and Resource Person)

28—29 August 2020 at MGIMS, Sevagram

Graduate Medical Education Regulation (2019) on 28 th August 2020

Alignment & Integration on 29 th August 2020

Skills training on 29 th August 2020

Panel discussion on the impact of the corona pandemic on medical

education in the country. ( Panelist )

The Indian Medical Association- Indian Medical Students Network and the Medical Students Association of India, 14 Jun 2020

Enhancing learner engagement in online sessions. (Guest speaker)

Medical Education Unit, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, 27 May 2020

Case based learning in Pathology . (Resource person)

E-course on Competency based learning in Pathology. 6 May 2020

Online teaching learning: Modalities for student engagement. (Guest speaker)

Webinar by Indian Association of Public Health Dentistry, 16 May 2020

Anshu Attention please: Tips for enhancing learner engagement online. (Guest speaker)

Webinar organized by Academy of Health Professions Educators, 19 April 2020

MGIMS Sevagram's Village Adoption Scheme and Social Service Camp for medical students. (Guest speaker)

Organized by the Network Towards Unity for Health (TUFH) Social Accountability Institute. 14 Apr 2020

Enhancing student engagement in online teaching. (Guest speaker)

Medical Education Unit, MGIMS, Sevagram, 17 Aug 2020

Enhancing student engagement in online teaching: Tips and tools (Guest speaker)

Centre for Continuing Education and Inter professional Development (CCEID), Manipal Academy of Higher Education, 25 Jul 2020.

Effective strategies for online learning. (Resource person)

Personal and Professional Development Group of Melaka Manipal Medical College for Malaysian students of I MBBS, 11 Jul 2020

Should a pathologist be a jack of all trades or a master of one? (Debate,

Invited speaker)

Vidarbha Association of Pathologists and Microbiologists, Nagpur, 20 Dec 2020

Pharmacology

National Level e-poster competition

Dr. P.R. Pote Patil College of Pharmacy, Amravati, June 2020

Gorjelwar P

Transfusion-Related Adverse Reactions in patients admitted in medicine department at Tertiary Care Teaching Hospital of Central India

Virtually Online, IPCON 2021 Date: 25 Feb 2021

Gorjelwar P & Kale R

Poster presentation in National Level e poster competition on Proposed

treatment of Covid 19

PR Pote Patil College of Pharmacy, Amravati, 31 st May 2020

Singh Rajput A

To study the effect of wound healing activity of Musa Balbisiana Sp.peel as anti-inflamatory activity on wistar Rats

2 nd World Congress on infectious Disease & Antibiotics 2020

J.N. Tata Auditorium, Indian institute of Science, Bengluru, 17 th Oct 2020

Knowledge attitude and practice towards covid 19 among medical students: a questionnaire based study (Poster Presentation)

Asian ACPCON 2021 organised by American college of physician- india chapter supported by acp chapters, 6 th 7 th feb 2021

International Webinar on Cardiovascular & VO 2 Max Assessment”

AD Instruments, South East Asia, 9 Sep 2020

Webinar : IPS community psychiatry seminar “Healthy eating, under nutrition and obesity among Indian children and adolescent (Guest Speaker)

Organized by : Dr.KS Shubrata, 2 nd May 2020

Annual National CME of industrial Psychiatry of India “Mental Health Issues in IT Industry” Theme - Current and emerging mental health issues in different industries, on 12/12/2020 (Guest Speaker)

KK Mishra, Ahmed

Title – ‘Absenteeism in Health Care Industries’ (Award Paper)

18 th ANCAIPI” held at DY Patil, Pune on 4 th to 6 th March 2021.

“IK Mujawar Award Poster”

Annual Conference IPS West Zone 2 nd & 4 th Oct. 2020.(Webinar)

Radiotherapy

Palliative radiotherapy to triage patients for radical treatment in locally

advanced oral cavity cancer during COVID CRISIS’ Annual Conference of

Association of Radiation Oncologist of Maharashtra, 19 Dec 2020

Clinical outcomes of reirradiation of brain metastasis with erlotinib in

metastatic adenocarcinoma lung’ 10 th Annual Conference of Indian Society

for study of lung cancer, Association of Radiation Oncologist, 26 Sept 2020

Covid 19 a double edge sword for cancer patients’

The Federation of Obstetric & Gynecological Societies of India and POGS international Conference of Indian society for study of lung cancer, Association of Radiation Oncologist, 11 Dec 2020

Efficacy and outcomes of hypofractionation in locally advanced head and neck cancer’

Annual Conference of Association of Radiation Oncologist of India North zone, 2 Oct 2020

Evaluation of nasogastric tube feeding during radiotherapy in head and neck cancer patients’

Annual Conference of Association of Oncologist of North East India, 19 Jan 2021

Left Coronary Artery Dose Exposure Predicts Major Adverse Cardiac Events in Coronary Heart Disease Negative Lung Cancer Patients’

Best of ASTRO 2020, 15 Aug 2020

The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R): Real-World Data on

Elderly Stage III Non-Small Cell Lung Cancer Treated with Definitive

Chemoradiation

Best of ASTRO 2020 16 Aug 2020

Changing Paradigm in Radiotherapy of Postmastectomy Breast Cancer patients A comparative study of 3DCRT vs IMRT : Dosimetry,Toxicity and Outcome at the end of 4 years’

Annual Conference of Indian Society of Medical and Paediatric Oncology, 6 Nov 2020

How to optimally utilize the waiting time/area of patients while they are in

waiting hall before their RT commences for the purpose of patient education 43rd Indian Cooperative Oncology Network Virtual Conference, 9 Oct 2020

Role of prophylactic nasogastric feeding tube to maintain nutrition during

radiotherapy in head and neck cancer patients” Virtual Symposium on

Nutrition in Cancer Care & Management of Mucositis to be held on Friday,

26th February 2021

Kale P, Kalbande P , Rangari P , Datta NR

An evaluation of cost-effective nutrition supplement using homemade recipes vs commercially available formulations in cancer patients on liquid diet from low-middle-income group countries”

Virtual Symposium on Nutrition in Cancer Care & Management of Mucositis to be held on Friday, 26th February 2021

Skin & VD

Puzzling papules on the neck: Cutaneous metastasis from the breast ( e-Poster)

49th National Conference of IADVL, 5th to 7th February, 2021

Patrick S , Kar S, Gangane N, Deshmukh A

Lepromatous Hansen’s disease simulating Still’s Disease: a parodying case

report with diagnostic conundrum (e-Poster)

Manwar P , Kar S, Sawant A, Patrick S, Nandwani S

Blaschkolinear Atrophoderma of Pasini and Pierni with shortening of foot –A

Rare Entity ( e-Poster)

Nandwani S , Kar S, Sawant A, Patrick S, Manwar P

Leprosy presenting as a diagnostic challenge in a case of HIV with Pulmonary Tuberculosis at a rural tertiary care hospital (e-Poster)

Approach to obstructive Jaundice (Guest Lecture)

ASICON-2020 (virtual) from 14 - 19 th Dec. 2020

• Departments
• NAAC Cycle 3
• Courses Attended
• Academic Activities Conducted
• CME Attended
• Conference Attended
• Students Activities
• Student Awards
• Academy of Medical Sciences
• Medical Education Unit
• Institutional Ethics Committee
• Internal Quality Assurance Cell
• Dr Sushila Nayar School of Public Health
• UG Students
• PG Students
• Teaching Staff
• Non-Teaching Staff
• Senior Residents
• Non PG Junior Residents
• Outpatient Services
• Inpatient Services
• Accident and Emergency
• Investigation Facilities
• Information Technology
• Hospital in Numbers
• Hospital Charges
• Life Saving Equipment
• Bio Medical Waste
• Institutional Research
• Student Research
• In-house Publication
• Journal of MGIMS
• Publications
• Community Activities
• Community Based Medical Education
• Social Impact
• Government Approval
• History and Heritage
• Our Founder
• Administration
• Citizen Charter
• Life at Sevagram
• Anti-Ragging
• Right to Information
• Women's Complaints Committee
• Annual Report
• Employe's Information
• Audited Statements
• Foreign Contributions
• Human Rights Complaints
• Mandatory Disclosure
• Getting Here
• NMC Disclosure
• MUHS Mandate

• Dr. V – Our Founder
• Our Group Profile
• Vision & Mission
• Board of Trustees
• Management Team
• Partners in Service
• Awards & Recognitions
• In the Media
• Annual Activity Reports
• Aravind News
• Hospital Locations
• Specialty Clinics
• Vision Centre
• Eye Hospitals
• Tele-Ophthalmology
• Education & Training
• Consultancy (LAICO)
• Manufacturing (Aurolab)
• Publications
• IT Products
• For AOP Trainers
• For Eye Hospitals
• Case Studies
• Covid 19 Resources
• About the eye
• Eye Diseases & Treatment
• What to expect at Aravind?
• Give us your Feedback
• For International Patients
• கண் ஒளி (Tamil Magazine)
• Training Overview
• Postgraduate Institute
• Residency Programmes
• Fellowships
• Short Term Courses
• Custom Designed Courses
• Campus Life
• Eye Donation
• Aravind Eye Foundation
• Organise an Eye Camp
• MLOP Recruitment

Theme: Teaching clinical topics to AOP trainees

Congenital glaucoma, author: ananthi s, aravind eye hospital – tirunelveli.

Imparting knowledge about congenital glaucoma among sisters.

• Imparting theoretical knowledge: Theoretical knowledge will be transferred to Allied ophthalmic personal (AOP) through classes using PowerPoint presentation by senior glaucoma specialist. Then the same class will be taken by AOP tutor in-charge.
• Animation Video: Showing video on congenital glaucoma explaining its clinical presentation, History taking, investigation done under general anaesthesia, counselling, surgical management and importance of life time follow up.
• Observation: Observation in glaucoma clinic during Doctor examination, counselling, and in operation theatre during evaluation under anaesthesia and surgery.
• Seminar Presentation: Further their understanding can be improved and assessed through seminar presentation by Trainees
• Clinical discussion and Case presentation: A case will be given for the AOP trainees to present and will be discussed in the presence of glaucoma specialist.
• Conducting theory exams, Projects and mind mapping after classes will be done to evaluate the AOP trainees understanding on congenital glaucoma.

Training Allied Ophthalmic personal posted in vision centres on Optic nerve head changes in Glaucoma for early detection of glaucoma

Author: jenslin r j, aravind eye hospital – tirunelveli.

Glaucoma is a group of conditions characterized by a progressive optic neuropathy. The optic nerve head or optic disc describes the area of the optic nerve that is visible clinically on examination. The optic cup represents the central area of the optic nerve head where axons are absent. This area is generally fairly round or horizontally oval in healthy eyes. Glaucoma is characterised by progressive thinning of the neuroretinal rim. As retinal nerve fibres are lost due to glaucoma, the optic cup enlarges. The optic disc is normally vertically oval in dimension, but the cup itself is normally horizontally oval. Vertical elongation of the optic cup can be a common feature of the glaucomatous disc, as narrowing is greater in the superior and inferior poles. Knowledge about glaucoma, Optic nerve head changes and disease progression should be known to all Allied Ophthalmic personal. Knowledge is transferred through following ways.

• Theoretical knowledge is imparted through classes by glaucoma specialist
• Skill training on IOP measurement and Fundus examination using slit lamp
• Train using Fundus models and Fundus drawings to explain different stages of glaucoma
• Case discussions and presentations
• Seminars on Glaucoma, How to diagnose and referral protocol
• Teaching them fundus drawings
• Animation videos – used to visualise the fundus findings
• Skill training and assessment for Vision Centre AOP’s
• Conducting continuous medical education(CME) program for Vision centre AOP’s

Comparing the effectiveness of the traditional lecture model with the debate-style teaching for AOP - A Prospective Study

Author: monica, aravind eye hospital – coimbatore.

The study aims to compare the effectiveness of the debate-style of teaching versus the traditional lecture model. This prospective observational study included 37 students from the first and second year allied ophthalmic personnel (AOP) trainees. Initially, we subjected the trainees to a traditional lecture on refractory errors and conducted a post-lecture assessment. After a month, we led a debate on the same topic involving the senior personnel, which was video-taped. The recorded debate session was employed in the innovative teaching assembly, and a post-lecture assessment was done. We found a statistically significant difference between the traditional lecture model scores and the debate-style score, and the trainees performed better after viewing the debate video. This study proves that innovative pedagogical tools can be employed to improve the efficacy of our classroom, and debates and discussions are valuable techniques to engage the learners.

Evaluation of segregation of out patient case sheets for faster disposal and patient management

Author: krishnammal.n,  aravind eye hospital – tirunelveli.

To make patient disposal faster and more efficient by evaluation ways of outpatient case sheets segregation.

To find if a particular case sheet segregation method is better in aiding faster outpatient crowd management.

• Based on vision.
• Symptoms (Red eye, pain, sudden loss of vision, trauma, headache)
• Torch light examination
• Old case sheets
• Distance of patients home from hospital.
• Vulunerable patient(old age, wheel chair, one eyed, visibly sick, infants and toddlers)
• Personal grievance

Conclusion:

• To save patient waiting time.
• To use our resources efficiently.
• Faster management of emergency.

Flipped Classroom Model – An Effective Way to Teach Ophthalmology for Allied Ophthalmic been a recent proposal for a shift in Allied Ophthalmic Personnel

Author: renuka & kaveri, aravind eye hospital – coimbatore.

There has been a recent proposal for a shift in Allied Ophthalmic Personnel (AOP) education from the traditional lecture methods towards other interactive approaches that encourage higher-order thinking and active participation from students.

One such way that has received much attention is the Flipped Classroom (FC), which allows students to learn concepts as required homework independently, and then use this gained knowledge during class time to engage in analytical thinking opportunities and application of knowledge.

This study assesses the FC model’s effectiveness in teaching ophthalmology topics for residents in a teaching institute. A classroom was conducted where an essential ophthalmology topic was taught using the proposed approach. One week before each session, the AOP trainees were provided hand-picked articles and specially designed instructional videos.

After priming them with the essential information, the students attended the classroom session where they applied their learned concepts by active group discussions and questioning.

After the meeting, they were encouraged to re-evaluate their learning and come up with potential research questions. There are necessarily three P’s involved: Priming before the class, Participating during the class, and Pondering after the class. We found that the FC model provided a better learning experience for the students compared to the traditional didactic method. This study also provides valuable tips and techniques to put the FC into actual practice for the teachers.

Innovative Interactive ways of making learning fun

Author: k. sangeetha,  svaeh, tirupati.

Newly joined AOP are used to the one way lectures and memorizing their subject content in high school .We have come up with ideas that get them to be more interactive and interested. At the end of each method they present what they have learnt as a model, a Poster or a Rangoli and use these aids to teach each other. This server as a great way to revise and ensures their proper understanding role plays help with patient communication, empathy and when learning a new language through this presentation we would like to share our ideas with others.

3D Printing Ophthalmology Related Models For Enhancing Learning Through The Concept Of Puzzle Assembly - A Comprehensive Self Learning Tactile Tool Kit

Author: prasanna venkatesh ramesh, mahathma eye hospital private limited.

Practical sessions facilitate teaching, critical thinking and coping skills, especially among medical students and allied ophthalmic personnels. Currently in ophthalmology, virtual and augmented reality are employed for surgical training, using three-dimensional (3D) eye models. These 3D models when printed, can be used not only for surgical training, but also in teaching ophthalmic residents, fellows and AOPs for concept learning through tactile 3D puzzle assembly. 3D printing is perfectly suited for the creation of complex, bespoke items in a cost-effective manner, making it ideal for rapid prototyping. Puzzle making, when combined with 3D printing can evolve into a different level of learning in the field of ophthalmology. Though various 3D eye models are currently available, complex structures such as cerebral venous system and circle of Willis has never been 3D printed and presented as 3D puzzle for assembling and learning. According to our knowledge, this concept of ophthalmic pedagogy has never been reported. In this paper, we discuss in detail the 3D models created by us; for printing into multiple puzzle pieces for effective tactile learning by cognitive assembling.

Unmasking the Maze of Neuro - Ophthalmology for Optometry Students

Author: tulika ghoshal, kpc medical college & hospital.

To see if a novel technique of teaching Supranuclear Gaze Palsies (SGPs), especially the horizontal gaze palsies, with simple flow diagrams improved learning in Optometry students.

A single centre retrospective study. SGPs was taught to the students in the “standard” way and a written test taken. SGPs was again taught, by the same tutor, to the same group, with the additional aid of some simple flow diagrams and a written test taken. The data was then assessed.

Simple mean comparisons on the average test scores in the two exam treatment conditions were conducted. A one-tailed t-test revealed that these students scored significantly higher in their exam after the novel teaching. Students emphasised a subjective improvement in understanding after the novel method of teaching. This study shows a statistical superiority of using a novel method of teaching SGPs over a standard didactic method. Despite studies on new teaching strategies, practical methods to improve the teaching experience are uncommon. Novel teaching ways are now coming to the forefront. Educators introducing new teaching methodologies must evaluate the outcomes of these experiences. Study limitation- Improvement in test scores may be due to reinforcement of teaching- however feedback of subjective improvement suggests otherwise.

Didactic lectures alone are no longer adequate for training. Simple novel practical techniques should shorten the learning curve. My study gives an insight into the fact that this simple novel technique should be used to teach Neuro- Ophthalmology. It can also easily be adapted to teach other topics.