Welcome to eOphtha the online portal of ophthalmology.

Dr. Madhuvanthi Mohan MBBS, MS Ophthalmology,Dr. Sashwanthi Mohan, MBBS, DNB, FICO, MRCS (Edinburgh) and Dr. Mohan Rajan, MBBS., DO., FMRF., MNAMS.,DD, M.Ch., FACS.,DNB., FRCS., Ph.D., D.S

Posterior Polar Cataract is associated with remnants of Tunica vasculosa lentis. (1) It presents as a white opacity situated on the posterior capsule appearing as a circular plaque with concentric whorls. (2) Surgical management of posterior polar cataracts is a challenge even for skilled surgeons due to high risk of posterior capsular rupture and vitreous loss during surgery. (3) 1. Preoperative ...Read More

Ocular Manifestations of HIV

Dr. Sharanya Abraham, DO DNB FICO

Human immunodeficiency virus (HIV) disease is a pandemic of global concern, not only due to serious health issues affecting all organs of the body but also due to its huge economic burden.(1) The diagnosis is often associated with social stigma that includes changing sexual practices, lack of availability of a vaccine and the chronicity of the disease requiring lifelong treatment.(2) The disease r ...Read More

Diplopia Charting: A Ready Reckoner for the Postgraduates

Dr.(Capt.) V.R Vijayaraghavan

Diplopia charts are kept in postgraduate examinations during viva sessions. Even in theory examinations also, these topics may be asked. It is not difficult to interpret the charts and all PGs should practice recording the results of these charts. Principle: Dissociation of eyes by means of complementary colors. We use red and green goggles (Armstrong google). In diplopia charting, Red is always i ...Read More

Anti-VEGFs made Easy for the Postgraduates

Dr. Gunjan Prasai,Dr. Anadi Khatri and Dr. Eli Pradhan, MD, MRCSEd ( UK)

The retina is a highly metabolic tissue and needs a constant high supply of oxygen. Insult to either choroidal or retinal vasculature can lead to a hypoxic state. Throughout the years, neovascularization has been seen to occur in areas neighboring such hypoxic areas. In 1989, this hypoxia-inducible and diffusible factor was discovered to be Vascular Endothelial Growth Factor (VEGF), initially coin ...Read More

Normal flora /Microbiome of the Eye: 10 Facts

Dr. Sanchita Mitra

1. Definition of Microbiome Microbiomes are communities of organisms (bacteria, fungi, viruses) that normally reside on any part of the human body (both external and internal) and are in a symbiotic relationship with the host. The members of the microbiome live in close harmony, sharing food and shelter and offering benefits to each other, e.g. some members give protection by secreting extracellul ...Read More

Top-Ten-Must-Not-Forget-In-Strabismus-Evaluation

Dr. Goura Chattannavar, DNB, FICO,Dr. Virangi Doshi MBBS and Dr. Ramesh Kekunnaya, MD, FRCS(Ophthal)

1. External face features affecting the eye position Facial asymmetry and palpebral fissure shape changes alter the ocular position, possibly due to extra-ocular muscle heterotopy The common extra-ocular features affecting ocular position are craniosynostosis, hydrocephalus, facial fracture, mongoloid and anti-mongoloid slant, telecanthus, congenital superior oblique palsy (face fuller on the affe ...Read More

Ten Pearls for Treating A Case of Retinopathy of Prematurity

Prof. Mangat Ram Dogra,Dr Deeksha Katoch

Introduction Retinopathy of Prematurity (ROP) is a potentially blinding retinal vasoproliferative disorder affecting premature and low birth weight infants. With improving survival of preterm infants with lower birth weights and gestational ages, ROP is reaching epidemic proportions in many middle- income countries.1 Although a majority of infants would develop a mild self-limiting disease, some c ...Read More

Visual Fields in Neuro-Ophthalmology : 10 Pearls for the Postgraduates

Dr. Simranjeet Aulakh

1. Is there something we can do before ordering a visual field in neuro-ophthalmology? Confrontation visual field testing is an important clinical examination, especially when it comes to neuro-ophthalmology cases. A simple test can give us clues as to what may be the underlying cause of patients’ symptoms. The test is done presuming the visual field of the examiner is normal. Both the patient and ...Read More

Ten Clinical Signs A Postgraduate Must Look For While Examining the Fundus

Dr. Sashwanthi Mohan,Dr. Snehal Bavaskar

1. Red Dots! : Microaneurysms Seen in Diabetic Retinopathy, retinal vein occlusions, hypertensive retinopathy, radiation retinopathy. Microaneurysms are usually the first ophthalmoscopically detectable sign of diabetic retinopathy. They are focal saccular outpouchings of the capillary wall due to pericyte loss. Arise from the deep part of the inner retinal capillary plexus, and are present in the ...Read More

Anomalies of Accommodation

Dr. Jameel Rizwana Hussaindeen M.Phil Opt, Ph.D.,FCOVD-I, FAAO

Ocular accommodation is an integral visual function that optimizes the visual perception through the focusing ability of the crystalline lens. This closed-loop system constantly interacts with the oculomotor system for finer focusing and alignment of the eyes under naturalistic binocular viewing conditions. This write-up is intended to provide an overview of the commonest anomalies of accommodatio ...Read More

How to Quickly Read a Macular OCT Scan?

Dr. Deepak Bhojwani

Optical Coherence Tomography (OCT) is a quick, non-invasive, reproducible, and optical analog of ultrasound imaging which is as good as in vivo viewing of individual retinal layers histologically. In today’s practice, OCT is indisputably an essential diagnostic tool for every retinal surgeon. And so correct interpretation of OCT scans helps us in understanding the disease pathologically which in t ...Read More

Ten Mistakes to Avoid while Treating a Case of Diabetic Retinopathy

Dr. Rajiv Raman, MS, DNB, FRCS Ed, Hon DSc.

Diabetic Retinopathy is a common retinal disorder that is seen, managed, and followed up by not only a retina specialist but all ophthalmologists. It is a disease that is easy to diagnose, but often difficult to manage in a long run. For achieving optimal results besides the role of an ophthalmologist, one needs to have the involvement of a physician. The single most important factor for achieving ...Read More

Retina Case Presentation in Practical Exam: 10 Tips

Dr. Puja Maitra, DNB , FICO, MRCS(Ed), FMRF,Dr. Dhaivat Shah, MBBS MS DNB FMRF

DNB practical exam is a time-bound test of knowledge, presentation skills, swiftness and presence of mind. In the exam, a candidate usually gets 4 long cases with 20 mins per case (a whole 2 minutes more than you can take to write each answer in the theory exam). That usually includes 2 anterior and 2 posterior segment cases. Although 2 posterior segment cases may seem like a daunting task, there ...Read More

Pearls for Practical Exam in Ophthalmology for Postgraduates

Dr. (Capt) V.R Vijayaraghavan

Facing PG practical examination in ophthalmology is not difficult. However, the student must prepare properly to face it. Please remember the examiners are coming to help only. Therefore, the student should not be afraid of the examiners. Preparations for the practical exams During the course The preparation to face the exams is a continuous process starting from the beginning of the course. Stude ...Read More

Practical Tips for DNB Practical

Dr. Krishnaprasad R

It’s time to brace yourself for DNB practicals, in its new Avatar! One look at its design tells that it has been well designed for accurate and speedy assessment of Examinees with little room for chance or bias. So let’s deconstruct it for better understanding and decode it for exploiting to our advantage! Firstly 50% of marks i.e 150 marks comes from Objectively Structured Clinical Evaluation or ...Read More

Papilledema- A Ready Reckoner for Postgraduates

Prof. Rohit Saxena MD, PhD,,Dr. Monika Yadav, MS and Dr. Swati Phuljhele, MD

Introduction Papilledema is used to describe optic disc edema resulting from increased intracranial pressure while disc edema could be due to any cause. While disc edema can be unilateral or bilateral, papilledema is usually bilateral, however, it can be asymmetric, to begin with. Another important differential of true papilledema is pseudo papilledema which is seen in conditions like a small hype ...Read More

Ten Pearls for the Management of Posterior Capsular Rupture

Dr. Arup Chakrabarti, Senior consultant, Cataract and Glaucoma services,,Dr. Nirupama Kasturi, Associate Professor, Department of Ophthalmology

Posterior capsular rupture (PCR) is an important complication of cataract surgery whose timely recognition and appropriate management can ensure a good visual outcome. Here are ten pearls for its prevention and management. Pearl 1: Understand the risk/predisposing factors It is imperative to assess the preoperative and intra-operative risk to prevent the development of a PCR. Elderly, anxious, and ...Read More

Anterior Segment Optical Coherence Tomography in Diseases Of The Ocular Surface And Cornea

Dr. Supriya Sharma, DNB,Dr. Somasheila Murthy

I. Introduction : Anterior segment optical coherence tomography (ASOCT) is a sophisticated non-contact imaging device that produces high-resolution images for detailed assessment of the structures of the ocular surface and anterior chamber in various disease conditions. Starting from the earlier generation time-domain devices first described in 1991 by Huang et al [1] to the current Fourier-domain ...Read More

Making Sclerotomy Ports during a Vitreoretinal Surgery: Tips, Tricks and Concerns

Dr. Aditya Verma

The advancement of vitreous surgery from the 20-gauge (20G) era to the present day Transconjunctival Sutureless Vitrectomy (TVS) has favorably transformed patient outcomes in the surgical management of retinal diseases. The 20G system (O’Malley and Heintz, 1974) has been the gold standard technique in modern vitreous surgery for nearly three decades, beginning from the earliest 17G vitrectomy as i ...Read More

OCT-Angiography in Retinal Diseases Made Incredibly Simple For Post Graduates

Dr. Ramesh Venkatesh MS, FMRF,Dr. Nikitha Gurram Reddy and Dr. Naresh Kumar Yadav, D.O., FRCS (Glasgow),

Introduction: Optical coherence tomography angiography (OCT-A) has emerged as a novel imaging technique for visualizing the retinal and choroidal microvasculature at the macula and optic disc.1 It provides in vivo 3D vascular information by analyzing the movement of flowing red blood cells and thereby enabling the visualization and quantification of functional vessel networks within microcirculato ...Read More

Pearls in the Diagnosis and Management of Rhino-Orbito-Cerebral-Mucormycosis

Dr. Rolika Bansal,,Dr. Santosh G Honavar,

“The more you know about the past, the better you are prepared for the future.” – Theodore Roosevelt 1. Elicit adequate history Considering the lethal and angio-invasive nature of Rhino-Orbital-Cerebral-Mucormycosis (ROCM) supplemented in this COVID-19 era, it is mandatory to understand the causative factors of the disease. Diabetes mellitus, oral and systemic corticosteroids, immunosuppressive dr ...Read More

Trials in Glaucoma You Should Know

Dr. Parveen Rewri

Ocular Hypertension Treatment Study (OHTS) This multicentric trial recruited 1,632 patients of ocular hypertension (OHT) to answer two questions. First, if early treatment in patients of OHT with topical medication would prevent the onset of primary open-angle glaucoma (POAG). Second, which patients of OHT are more likely to develop POAG, in other words, what are the risk factors for conversion fr ...Read More

Ten Microbiological Facts on Mucormycosis All Ophthalmologists Should Know

Dr. A.R Anand, Ph.D.,

The present overview highlights major microbiological aspects of mucormycosis and attempts to increase the awareness of this ubiquitous group of fungi that are responsible for the difficult-to-manage infections presently being encountered in the setting of the ongoing COVID-19 pandemic. 1. What is Mucormycosis and why is mucormycosis emerging as a serious threat in the present COVID-19 pandemic? M ...Read More

Seven Tips to Treat A Treatment Resistant Microbial keratitis

Dr. Shweta Agarwal,Dr. Bhaskar Srinivasan and Dr. Geetha Iyer

Microbial keratitis is a common potentially sight-threatening condition and is considered an ocular emergency. Managing them brings forth multiple challenges to the ophthalmologist one of them being to primarily distinguish an infective from non-infective keratitis. Based on signs, symptoms, history, and laboratory investigations a treatment plan is laid out which is modified based on clinical res ...Read More

Short Term Phacoemulsification Courses in India

Team eOphtha

Centre for Sight, New Delhi Duration of Fellowship: 3 months Mode of Selection: Written exam and Interview Webpage Email: fellowship@centreforsight.net Contact number: Dr. Tulika Chauhan +91-9535133800 Session: Every 3 Months: JANUARY, APRIL, JULY, OCTOBER Course Fee: Rs. 50,000 H. V. Desai Eye Hospital, Pune, India Duration of Fellowship: 1 Month Mode of Selection: Interview Webpage Email: desaie ...Read More

Seven Points You Should Know about Mucormycosis

Dr. Akshay Gopinathan Nair

What is Mucormycosis? Mucormycosis is a fungus that is ubiquitous. This organism is present in the soil and all around us and is also a commensal that is present in the nose and oropharynx. It is an opportunistic organism – this means that it invades and causes infection only when the host’s immune system is compromised. A normal healthy person’s immune system would easily be able to fight a funga ...Read More

Simple Limbal Epithelial Transplantation: A Review

Dr. Supriya Sharma,Dr. Swapna Shanbhag and Dr. Sayan Basu

I. Introduction The cornea is lined by non-keratinized, stratified squamous epithelium. At the limbus, there is a gradual transition of these cells to non-keratinized, stratified columnar epithelial cells, along with mucin-secreting goblet cells, forming the conjunctival epithelium. The corneoscleral limbus lies between these two epithelia in a healthy eye. The limbus contains palisades of Vogt, t ...Read More

Balancing Clinical and Research Work

Dr.Lingam Gopal, MBBS (India); MS (PGIMER, India); FRCS Ed; DNBE (India) MSc (Epi)

How does one balance between clinical and research work? This is an often-repeated question-probably because the answer is never clear. The fulcrum of the balance is not the same for everyone. Let us pause for a while and try to define certain things to bring clarity. What is clinical work? This is perhaps best defined as the time and effort involved in direct care of patients. Obviously, it also ...Read More

Facial Spasms: Diagnosis and Management

Dr. Varshitha Hemanth Vasanthapuram,Dr. Milind N Naik

Introduction Dystonia is defined as a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both [1]. They may be isolated or combined with other neurological symptoms or movement disorders [1]. Dystonia is classified based on the age of onset, etiology, clinical features, and body distribution. The body distrib ...Read More

Anterior Vitrectomy Made Easy For Cataract Surgeon

Dr. Vishal Agrawal, MD ( AIIMS ) , FRCS( Glasgow ),Dr. Ketan Rathod and Dr. Neha Mohan

One of the most dreaded complications of cataract surgery is a posterior capsular tear (PCR). Its rate ranges from 1.3% to 9.6% (from skilled surgeons to trainees)1-5. Early recognition of the PCR and skilled management is necessary for good surgical outcomes and to avoid any devastating sequelae. Hence, anterior vitrectomy is an important skill that every cataract surgeon should master. There are ...Read More

Ten Pearls for Treatment of TB Uveitis

Prof. Amod Gupta

1. In TB-endemic countries, think of TB as a probable/possible etiology of uveitis in Presence of one or a few large full-thickness choroidal granulomas that show enhanced vascularity/RAP on FFA Retinal periphlebitis with subvascular retinitis/choroiditis lesions/scars that show extensive peripheral retinal ischemia. Multifocal serpiginoid choroiditis/Serpiginous-like choroiditis lesions with vitr ...Read More

Down's Syndrome: Ten Points All Ophthalmologists Should Know

Dr. Nikita Pathare

Down’s syndrome is a trisomy caused by an extra copy of chromosome 211. The extrachromosomal material is transmitted either by non-disjunction, unbalanced translocation, or mosaicism. It is the most common chromosomal anomaly seen in live births2. As an ophthalmologist, it is important to screen for ocular abnormalities since the incidence of ophthalmic disorders is between 46-100%3. One study fou ...Read More

Ten points A Postgraduate Should Know while Reading a Fundus Fluorescein Angiogram

Dr. Neha Mohan

Fundus Fluorescein Angiography (FFA) is still a gold standard investigation, for studying the circulation of the retina and partly choroid and highlights the dynamic interaction of the dye with the same. Many adjunct investigations like Optical Coherence Tomography (OCT), Fundus autofluorescence (FAF), Optical Coherence Tomography Angiography (OCTA), etc. help in retinal diagnosis and management, ...Read More

The Novice VR Surgeon -Ten mistakes to avoid

Dr. P. Mahesh Shanmugam

Mastering vitreoretinal surgery is a slow and arduous process with each case being different from the other and it is just about possible to have only a “feel” of a kind of case during the fellowship, not mastery of it. The budding VR surgeon would necessarily have to hone her / his skills in the real world outside their alma mater and the following guidelines can aid mitigate the stress and angst ...Read More

Ten Tips for Clearing the FRCS Examination

Dr. Devendra Venkatramani, MBBS DNB FRCS(Gl) MRCS(Ed) FICO

The FRCS examinations have for long been considered an elite qualification in ophthalmology. While the format and pattern of the examination will evolve in the future, more so due to the special circumstances brought about by the COVID pandemic, certain principles will continue to prevail. The examination generally comprises a written component (multiple-choice questions and/or essay questions) an ...Read More

Understanding Optic Disc Pallor- Shades of White

Dr. Ambika Selvakumar

Introduction The optic nerve consists of approximately 1.2 million axons that arise from the retinal ganglion cells and acquire myelin sheath proximal to lamina cribrosa. These axons do not have the capacity to regenerate. The normal optic disc is pink in color due to the fact that light entering the optic disc is conducted along the transparent nerve fibers and they diffuse among columns of glial ...Read More

Cytomegalovirus Retinitis Simplified

Dr. Swapnil Parchand,Dr. Anil Gangwe

Introduction: Cytomegalovirus (CMV) retinitis is an opportunistic viral posterior uveitis that occurs mostly in severely immunocompromised Acquired Immunodeficiency Syndrome (AIDS) patients or, rarely, in those on immunosuppressive therapy after organ transplantation, or who are on systemic corticosteroids.1 More than 75% of AIDS patients with CD4+ counts less than 50 cells/?L have CMV retinitis. ...Read More

Instruments used in Corneal Procedures and Surgeries

Dr. Hema Joshi, MBBS, DO, DNB,Dr. Ankita Patil, MBBS, MS

Although tales and myths of ocular surgery and organ transplantation appear in numerous ancient texts, the earliest accounts of ophthalmic diseases were written as a treatise by Sushruta, in the 6th century BC. Sushruta described 76 eye diseases, out of which 51 required surgical treatment. In the western world, the concepts of corneal surgery date back to Greek physician Galen (130-200AD). The co ...Read More

Dos and Donts In Managing Cluster Endophthalmitis

Dr. Dhaivat Shah,Dr. Meghna Jain

“Everything in life has some risk, and what you have to actually learn to do is how to navigate it.” -Reid Hoffman The above quote holds true for any surgical procedure whether minor or major. The biggest fear of any surgical intervention is that of infection postoperatively. Infection can occur in the best of hands and also in the most modern operating rooms. Cataract surgery is one of the most c ...Read More

Ten Clinical Trials in Retinal Diseases Every Postgraduate Should Know

Dr. Neha Goel ,MBBS MS MNAMS DNB FRCS (Glasgow)

1. CATT (Comparison of Age-related Macular Degeneration Treatments Trials)1 Description A prospective, multicenter, single-blind, noninferiority randomized clinical trial. 1208 patients with neovascular AMD were enrolled from February 2008 and randomly assigned to receive intravitreal injections of ranibizumab (0.5 mg/0.05 ml) or bevacizumab (1.25 mg/0.05 ml) on either a monthly schedule or as nee ...Read More

Download Ophthalmology Fellowship Information Booklet

Dr. Rohit Rao,Dr Soumya Podury

Why this book? It was the question that prompted us to find answers in this form. Despite obtaining rigorous theoretical and practical lessons during post-graduation, most of today's Ophthalmologists are finding themselves in gridlock when confronted with actual clinical and surgical situations. In the present era doing fellowships has become of utmost importance because, in fellowships, they ...Read More

Ocular Surface Squamous Neoplasia

Dr. Kavya M Bejjanki,Dr. Swathi Kaliki

A. Introduction There have been multiple refinements in the terminology of the epithelial squamous neoplasia until the introduction of the term “Ocular surface squamous neoplasia” (OSSN) by Lee and Hirst in 19951. OSSN is an umbrella term and refers to a spectrum ranging from mild/moderate/severe dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva and/or co ...Read More

Instruments Used in Oculoplasty

Dr. Rohit Rao

Oculoplasty Instruments Oculoplasty deals with the aesthetic part of ophthalmology. Precision is the key in Oculoplasty as the outcomes depend on it. Good precision can be achieved with good knowledge of the instruments used in oculoplasty and when to use them. This article would give a brief idea on basic instruments used. Nettleship Punctum Dilator It is the instrument with very fine blunt tip, ...Read More

Corneal Trauma and its Management

Dr. Sanjeev P Srinivas,Dr. Amanda Mohanan and Dr. Srinivas K Rao

Introduction The cornea is prone to a variety of injuries by virtue of its location as the window of the eye. Apart from chemical injuries, physical trauma to the cornea can range from epithelial abrasions to loss of integrity of the stroma. Corneal injuries of this nature can occur in two distinct populations – in young children from play-related activities, and in young adults from due to their ...Read More

Ten Tips for Youngsters to Increase Proficiency in Phacoemulsification

Prof. (Dr.) Mahipal S. Sachdev

Phacoemulsification, like any other surgery, comes with its learning curve. Here are some pearls, from my experience, to help you ‘shorten’ and ‘Flatten the curve’. 1. Believe in yourself: The first step to successfully doing anything in life is to believe in yourself. Believe you can and you are half way there. 2. Observe, Observe, Observe & Learn I am a firm believer of this quote by Marilyn vos ...Read More

Corneal Dystrophy: A Ready Reckoner for Postgraduates

Dr. Samrat Chatterjee

Corneal dystrophies are classically defined as a group of inherited disorders of the cornea which is bilateral, symmetric, slowly progressive, and not related to any environmental or systemic factors.1,2 Most of the corneal dystrophies begin in the early decades of life and progress gradually. The effect of these changes in some of the dystrophies may not be clinically apparent till the later year ...Read More

Ten Tenets of Fundus Autofluorescence

Dr. Kumar Saurabh,Dr. Suraj Mistry

1. What is fundus autofluorescence? Fundus autofluorescence is a study of the topographic distribution of naturally occurring molecules in the human fundus. These molecules are called fluorophores. In principle, FAF is similar to fundus fluorescein angiography as both of them study the fluorescence pattern of molecules. However, the fluorophore molecules are naturally occurring compounds in the fo ...Read More

Ten Tips on Textbooks to Thrive in Ophthalmology

Dr. Amanda Mohanan,Dr. Prabrisha Banerjee

At the very outset, please allow us to congratulate you on having chosen to specialize in ophthalmology. Welcome to this fascinating world! Most of us breeze through ophthalmology during our MBBS by reading either Parsons or any other textbook available out there which suits us. Unlike, say medicine, where we are familiar with books like Harrison's, in ophthalmology, we find it rarely necessar ...Read More

Ten Pearls for a Safe Vitrectomy

Dr Giridhar Anantharaman

This write up is based on my own learning experience over many years and what I have observed while training fellows. This also includes the common mistakes that I have made and what the fellows make during the training process. Today with micro incisional vitreous surgery (MIVS) and better fluidics, learning basic Vitrectomy is a very quick process for most trainees. I will now enumerate 10 steps ...Read More

Evaluation of The Optic Nerve Head in Glaucoma

Dr Sahebaan Sethi, MS,DNB,FMRF

Introduction The diagnosis of primary open-angle glaucoma is based on the triad of increased intraocular pressure, visual field changes and optic nerve head changes. Apart from the glaucomatous changes in the optic nerve head, the other two factors in isolation lack diagnostic sensitivity. In fact, studies have shown that careful evaluation of the optic nerve head has high specificity and that an ...Read More

Ten Pearls to Write a Case Report

Dr. Aniruddha Agarwal, MD

A thorough and detailed analysis of a single patient history, clinical presentation, course, and outcomes often helps in improving our understanding of the pathophysiological mechanisms of disease. However, at times, there are certain nuances in every patient that cannot be explained by large dataset-based manuscripts, where there is every chance that several minor, but relevant aspects can be ign ...Read More