Research in ophthalmology


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Ophthalmology is a very vast and quite interesting field in which research can be done in various fields

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Research in ophthalmology

  1. 1. RESEARCH IN OPHTHALMOLOGY Dr Vijay Joshi Department Of Ophthalmology Government Medical College, Haldwani
  3. 3. RESERACH  Re ---------------- Search  Re means (once more, afresh, anew) OR (back; with return to a previous state)  Search means (look thorough or go over thoroughly to look something) OR (examine to find anything concealed)  Research: literally means..  To establish or confirm facts, reaffirm the results of previous work, solve new or existing problems, support theorems, or develop new theories.
  4. 4. RESEARCH  According to B.W. Tuckman (1978) following are the characteristics of research:  An older description of research may be explained with the five characterizations spelling out the word MOVIE. M stands for mathematical precision and accuracy O stands for Objectivity V stands for verifiability I stands for impartiality E stands for Expertness
  5. 5. WHY UNDERTAKE CLINICAL RESEARCH?  Efficacy  Safety  Ethnic and racial variations  Pattern of clinical conditions/ management  Reporting of unusual clinical situations  Reporting of index case
  6. 6. RESEARCH IN OPHTHALMOLOGY..  Ophthalmology is a very vast but quite interesting in which research can be done in various fields..  Community ophthalmology  Occuloplasty  Cornea and refractive surgeries  Glaucoma  Cataract  Vitero-retina  Pediatric ophthalmology  Low vision aids  Ocular pathology  Ocular microbiology
  7. 7. RESEARCH IN OPHTHALMOLOGY 1. Role of Avastin in Pterygium surgery 2. Role of Caretenoids, Vit A, Vit E in management of age related macular degeneration. 3. Torsional Phaco Vs Longitudinal Phaco. 4. Manifestations of tuberculosis in eye. 5. Association of borderline hypertension with hypertensive retinopathy 6. Comparison of optic nerve imaging methods to distinguish normal eyes from glaucoma 7. Laser DCR Versus External DCR 8. Virtues of Polymerase chain reaction in ophthalmology 9. Outcome of chemotherapy in advanced retinoblastoma 10. Hyper homocystenemia is a risk factor for retinal venous occlusion
  8. 8. ROLE OF AVASTIN IN PTERYGIUM SURGERY  Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and fibrovascular proliferation.  High rates of recurrences when operated via conventional surgery (50- 80%).  Vascular growth factors such as vascular endothelial growth factor (VEGF) have been detected in pterygium.  Avastin (Bevacizumab, anti VEGF) known to inhibit vascular endothelial growth factor.  Subconjunctival injection of bevacizumab is useful in treatment of patients with primary and recurrent pterygium without local or systemic adverse effects
  9. 9. LASER VS EXTERNAL DCR  Dacryocystorhinostomy (DCR) is treatment of choice for chronic dacryocystitis.  The operative approach to the sac may be external or endoscopic and endoscopic approach may be with or without laser.  External approach leaves a cutaneous scar, long duration, longer rehabilitation.  Laser DCR via trans-canalicular route is an OPD procedure with fairly good results.
  10. 10. COMPARISON OF OPTIC NERVE IMAGING METHODS TO DISTINGUISH NORMAL EYES FROM GLAUCOMA  Glaucoma is leading cause of preventable, irreversible loss of vision.  In diagnosis of Glaucoma approx. 40% of RFNL needs to be lost in order to detect changes in standard automated perimetery.  With use of newer machines we can detect the Glaucoma at very early stage(pre- perimetric stage).  Newer machines:  Heidelberg retinal tomography.  GDx variable corneal compensation.  Optical coherence tomography.
  11. 11. ASSOCIATION OF BORDERLINE HYPERTENSION WITH HYPERTENSIVE RETINOPATHY  Hypertension is a worldwide problem that affects one billion worldwide.  Hypertensive retinopathy is among the vascular complications of essential hypertension.  Hypertensive retinopathy can be vision threating in advanced stages.  Should be diagnosed and documented early with help of fundus camera, fundus fluorescein angiography and treated(advanced stages) with help of laser(argon).
  12. 12. TORSIONAL PHACO VS LONGITUDINAL PHACO  In longitudinal phaco, the needle tip uses an in-and-out motion to break up the lens material.  Energy utilized to break lens in going in but not in coming out.  Torsional phaco utilizes less ultrasound energy by virtue of torsional movement of phaco tip.  Advantages of torsional phaco over longitudinal phaco: 1. Torsional phaco more effective than longitudinal phaco in the amount of applied fluid and the quantity of Ultra Sound energy expend. 2. Safe in patient with endothelial dysfunction. 3. Short duration. 4. Lesser complications.
  13. 13. EYE- A UNIQUE ORGAN  Systemic diseases affect eyes in various ways  Many of the systemic diseases may be diagnosed first by ophthalmologist
  14. 14. EYE IS THE MIRROR OF THE WHOLE BODY  In various departmental research, ophthalmology can be integrated.  In diabetics, hypertension , endocrine disorders, neurology,cardiovascular diseases, rheumatology, skin, haemopoeitc & lymphoproliferative disorders there can be ocular involvement in various ways.  Visual loss may occur through  Retinopathy  Cataract  Glaucoma  Field changes related to the tumours  Ischaemic Optic Neuropathy  Retinal vein and artery occlusions  IIIrd, IVth and VIth nerve palsies  Even before the visual loss and other obvious findings ,there can be early retinal changes which indicates need for vigorous control of disease.
  15. 15. ENDOCRINE DISORDERS AND THE EYE  Thyroid  Pituitary  Hypothalamus  Parathyroid  Adrenals
  16. 16. PITUITARY TUMOURS  Headache  Visual field defect  Optic nerve dysfunction  Colour deficit  Visual deterioration  Optic atrophy
  17. 17. THYROID EYE DISEASE (TED)  Patient may be  Euthyroid  Hypothyroid  Hyperthyroid :-40% of patients with Graves disease get eye signs  4-8% loose vision
  18. 18. OTHER ENDOCRINE DISORDERS AFFECTING EYES: Gland Disorder Ocular manifestations Hypothalamus Suprasellar tumours Optic atrophy, Papilledema Parathyroids Hyper/ Hypo- parathyroidism Conjunctival & corneal calcification, cataract Adrenals Pheochromocytoma Addison’s disease Cushing’s disease Hypertensive retinopathy hyperpigmentation Cataract, exophthalmos
  19. 19. HYPERTENSION AND EYE  Damage to the retina from high blood pressure  Duration increases risk  Worse with  Diabetes  high cholesterol  smoking  Malignant hypertension
  20. 20. CARDIOLOGY AND OPHTHALMOLOGY  Atrial fibrillation  Aortic stenosis  Hyperlipidaemia- arcus  Hypercholesterolaemia  xanthalasma  Thromboembolism: retinal arteriolar occlusions  Clot  Calcium  cholesterol
  21. 21. NEUROLOGY AND OPHTHALMOLOGY  Multiple sclerosis:  Optic neuritis,  eye movement disorders  Neurofibromatosis:  Proptosis, lid lesions, glaucoma, optic nerve gliomas/ meningiomas  Myasthenia gravis:  Ptosis, diplopia, ocular motility disorders
  22. 22. GASTROINTESTINAL DISORDERS  Crohn’s disease  Ulcerative colitis  Inflammatory bowel disease  Vitamin A deficiency  Abetalipoproteinaemia Episcleritis and anterior uveitis Bitot’s spots, nightblindness, retinitis pigmentosa
  23. 23. INFECTIOUS DISEASES  Tuberculosis  Phlycten  Uveitis  Choroidal deposits  Syphilis  Interstitial keratitis  Uveitis  Chorioretinopathy  Rubella  Microphthalmia  Cataract  Glaucoma  Uveitis  Salt & pepper retinopathy  Others  Viral infections: Varicella-Zoster  Parasitic: Toxoplasmosis  Granulomatous: Sarcoid  Fungal
  24. 24. VIRAL DISEASES • Herpes Simplex • Varicella-Zoster (Chickenpox, Herpes Zoster) • Cytomegalic Inclusion Disease • Poliomyelitis • Rubella (German Measles) • Measles (Rubeola) • Mumps • Infectious Mononucleosis • HIV May have their initial presentation in the eye..!!
  25. 25. TB CHEST AND OPHTHALMOLOGY  Tuberculosis  Sarcoidosis  Wegner’s granulomatosis Retina involved in Tuberculosis
  26. 26. RHEUMATOLOGY AND OPHTHALMOLOGY  Rheumatoid arthritis  Still’s disease  Ankylosing spondylitis  Reiter’s syndrome PUK in RA
  27. 27. SKIN AND OPHTHALMOLGY  Atopic conditions  Dry skin around lids  Conjunctivitis  keratoconus  Leprosy (Hansen’s Disease)  Acne rosacea: rhinophymoma, keratoconjunctivitis
  28. 28. SKIN AND OPHTHALMOLOGY  Steven Johnson Syndrome: May present as  Conjunctivitis  Mucosal ulceration  Corneal ulceration  Symblepharon  Ankyloblepharon  Uveitis
  29. 29. OBSTETRICS AND GYNECOLOGY AND OPHTHALMOLOGY  Fundus changes  Preeclampsia  Eclampsia  Severe Anaemia
  30. 30. PAEDIATRICS AND OPHTHALMOLOGY  Inborn errors of metabolism  Ectopia lentis  Retinal detachment  2°glaucoma  Cataract  Retinitis pigmentosa
  31. 31. ENT AND OPHTHALMOLOGY  Dacryocystitis: Comparative study of DCR through endonasal done by ENT surgeons & external DCR by ophthalmologists.  Trauma Orbit  Foreign Body  Maxillary Tumors
  32. 32. COMMUNITY MEDICINE & OPHTHALMOLOGY  Various research work can be undertaken in  Nutritional deficiency diseases like vitamin A deficiency in preschool and primary school children  Incidence and prevalence of various eye diseases in community  Comparison of ocular problems among children of rural and urban school
  33. 33. THE FUTURE IS BRIGHT..!!  The Bionic Eye  Artificial cornea  Femtosecond laser surgery  Refractive surgeries  Keratoprosthesis  Stem cell transplantation in retinal diseases  Advanced utility of the donated eye
  34. 34. FUTURE..  Bionic eye  Is an experimental visual device intended to restore functional vision in those suffering from partial or total blindness.  Patients with vision loss due to degeneration of photoreceptors (retinitis pigmentosa, choroideremia, geographic atrophy macular degeneration) are the best candidate for treatment.
  35. 35. FUTURE..  Artificial Cornea:  According to the World Health Organization, corneal blindness is the world’s fourth leading cause of blindness.  Treated primarily by corneal transplants.  However, due to the dearth of eye donors, the problem of corneal blindness in India remains largely unaddressed  Artificial cornea is made from artificial collagen in the lab and, when transplanted into a patient's eye, encourages damaged cells to regenerate and colonize the new tissue.  After two years a majority of patients with the artificial corneas had significantly improved vision.
  36. 36. FUTURE..  The treatment of cataract has been dramatically changed from needling procedures to femtosecond cataract surgery.  Cataract surgery is now bladeless, suture less, painless..with the help of femtosecond lasers.  There is also various landmark advancements in IOL’S from PMMA to Rollable IOL’S enabling NICS..needle incision cataract surgery.  The day is not so far when the cataract surgery will become an OPD procedure..!!
  37. 37. FUTURE..  Refractive surgeries:  The new era of refractive surgeries namely Customized LASIK, I- LASIK, Lenticular extraction are more precise in correcting the refractive error.
  38. 38. FUTURE..  Stem cell transplantation in retinal diseases  Stem-cell transplants can survive, migrate, differentiate, and integrate within the retina.  Stem cells from various developmental stages have been used in experiments, including embryonic stem cells, neural stem cells, mesenchymal stem cells, retinal stem cells, and adult stem cells from the ciliary margin.  Not only can these transplants adopt retina-like morphologies and phenotypes, but they have also shown evidence of synaptic reconnection and visual recovery in both animal and human studies.  Still, work must be done to achieve higher yields of functioning retinal neurons and to promote better integration within the host retina
  39. 39. FUTURE..  Resection of the involved and diseased optic nerve in glaucoma and anastomosis of the healthy nerve can be tried in glaucomatous optic atrophy patients ( novel scientific thought by me still work has to be established in this direction).
  40. 40. ALL THE BEST..!!