Aravind Eye Care System

Madurai, India

Aravind Eye Care System

Madurai, India
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Srinivasan M.,Aravind Eye Care System | Mascarenhas J.,Aravind Eye Care System | Rajaraman R.,Aravind Eye Care System | Ravindran M.,Aravind Eye Care System | And 9 more authors.
Archives of Ophthalmology | Year: 2012

Objective: To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers. Methods: Randomized, placebo-controlled, doublemasked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization. Main Outcome Measures: The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/ scar size, reepithelialization, and corneal perforation. Results: Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P=.82), infiltrate/scar size (P=.40), time to reepithelialization (P=.44), or corneal perforation (P>.99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P=.03) and ulcer location (P=.04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P=.03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P=.02). Conclusions: We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers. Application to Clinical Practice: Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers. Trial Registration: Identifier: NCT00324168. ©2012 American Medical Association. All rights reserved.

Patel V.,London School of Hygiene and Tropical Medicine | Chatterji S.,Health Statistics and Informatics | Ebrahim S.,London School of Hygiene and Tropical Medicine | Ebrahim S.,Public Health Foundation of India | And 7 more authors.
The Lancet | Year: 2011

Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved. © 2011 Elsevier Ltd.

Mascarenhas J.,Aravind Eye Care System | Lalitha P.,Aravind Eye Care System | Prajna N.V.,Aravind Eye Care System | Srinivasan M.,Aravind Eye Care System | And 7 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To determine risk factors and clinical signs that may differentiate between bacterial, fungal, and acanthamoeba keratitis among patients presenting with presumed infectious keratitis. Design Hospital-based cross-sectional study. Methods We examined the medical records of 115 patients with laboratory-proven bacterial keratitis, 115 patients with laboratory-proven fungal keratitis, and 115 patients with laboratory-proven acanthamoeba keratitis seen at Aravind Eye Hospital, Madurai, India, from 2006-2011. Risk factors and clinical features of the 3 organisms were compared using multinomial logistic regression. Results Of 95 patients with bacterial keratitis, 103 patients with fungal keratitis, and 93 patients with acanthamoeba keratitis who had medical records available for review, 287 (99%) did not wear contact lenses. Differentiating features were more common for acanthamoeba keratitis than for bacterial or fungal keratitis. Compared to patients with bacterial or fungal keratitis, patients with acanthamoeba keratitis were more likely to be younger and to have a longer duration of symptoms, and to have a ring infiltrate or disease confined to the epithelium. Conclusions Risk factors and clinical examination findings can be useful for differentiating acanthamoeba keratitis from bacterial and fungal keratitis. © 2014 by Elsevier Inc. All rights reserved.

Sun C.Q.,University of California at San Francisco | Lalitha P.,Aravind Eye Care System | Prajna N.V.,Aravind Eye Care System | Karpagam R.,Aravind Eye Care System | And 7 more authors.
Ophthalmology | Year: 2014

Purpose To assess the association between minimum inhibitory concentration (MIC) and clinical outcomes in a fungal keratitis clinical trial. Design Experimental study using data from a randomized comparative trial. Participants Of the 323 patients enrolled in the trial, we were able to obtain MIC values from 221 patients with monocular fungal keratitis. Methods The Mycotic Ulcer Treatment Trial I was a randomized, double-masked clinical trial comparing clinical outcomes of monotherapy with topical natamycin versus voriconazole for the treatment of fungal keratitis. Speciation and determination of MIC to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute guidelines. The relationship between MIC and clinical outcome was assessed. Main Outcome Measures The primary outcome was 3-month best spectacle-corrected visual acuity. Secondary outcomes included 3-month infiltrate or scar size; corneal perforation and/or therapeutic penetrating keratoplasty; and time to re-epithelialization. Results A 2-fold increase in MIC was associated with a larger 3-month infiltrate or scar size (0.21 mm; 95% confidence interval [CI], 0.10-0.31; P<0.001) and increased odds of perforation (odds ratio, 1.32; 95% CI, 1.04-1.69; P=0.02). No correlation was found between MIC and 3-month visual acuity. For natamycin-treated cases, an association was found between higher natamycin MIC with larger 3-month infiltrate or scar size (0.29 mm; 95% CI, 0.15-0.43; P<0.001) and increased perforations (odds ratio, 2.41; 95% CI, 1.46-3.97; P<0.001). Among voriconazole-treated cases, the voriconazole MIC did not correlate with any of the measured outcomes in the study. Conclusions Decreased susceptibility to natamycin was associated with increased infiltrate or scar size and increased odds of perforation. There was no association between susceptibility to voriconazole and outcome. © 2014 by the American Academy of Ophthalmology.

Lalitha P.,Aravind Eye Care System | Sun C.Q.,University of California at San Francisco | Prajna N.V.,Aravind Eye Care System | Karpagam R.,Aravind Eye Care System | And 6 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To describe the minimum inhibitory concentration (MIC) of fungal isolates to natamycin and voriconazole, and to compare these MICs to previous ocular susceptibility studies. Design Experimental laboratory study using isolates from a randomized clinical trial. Methods The Mycotic Ulcer Treatment Trial I was a randomized, double-masked, multicenter trial comparing topical natamycin and voriconazole for fungal keratitis treatment. Susceptibility testing to natamycin and voriconazole were performed according to Clinical and Laboratory Standards Institute methods. The relationship between organism and MIC was assessed. A literature review was performed to compare results to previous ocular susceptibility studies. Results Of the 323 patients enrolled in the trial, MICs were available for 221 (68%). Fusarium (n = 126) and Aspergillus species (n = 52) were the most commonly isolated organisms. MICs to natamycin and voriconazole were significantly different across all genera (P <.001). The MIC median (MIC50) and 90th percentile (MIC90) for natamycin were equal to or higher than voriconazole for all organisms except Curvularia species. Compared to other organisms, Fusarium species isolates had the highest MICs to voriconazole and Aspergillus flavus isolates had the highest MICs to natamycin. Our results were similar to previous reports except that the voriconazole MIC90 against Aspergillus species was 2-fold higher and the natamycin MIC90 against Aspergillus fumigatus was 4-fold higher in our study. Conclusion In this large susceptibility study, Fusarium isolates were least susceptible to voriconazole and A flavus isolates were least susceptible to natamycin when compared to other filamentous fungi. In the future, susceptibility testing may help guide therapy if performed in a timely manner. © 2014 BY ELSEVIER INC. ALL RIGHTS RESERVED.

Rathinam S.R.,Aravind Eye Care System | Babu M.,Aravind Eye Care System | Thundikandy R.,Aravind Eye Care System | Kanakath A.,Aravind Eye Care System | And 8 more authors.
Ophthalmology | Year: 2014

Objective: To compare the relative effectiveness of methotrexate and mycophenolate mofetil for noninfectious intermediate uveitis, posterior uveitis, or panuveitis.Design: Multicenter, block-randomized, observer-masked clinical trial.Participants: Eighty patients with noninfectious intermediate, posterior, or panuveitis requiring corticosteroidsparing therapy at Aravind Eye Hospitals in Madurai and Coimbatore, India.Intervention: Patients were randomized to receive 25 mg weekly oral methotrexate or 1 g twice daily oral mycophenolatemofetil and weremonitored monthly for 6months. Oral prednisone and topical corticosteroids were tapered.Main Outcome Measures: Masked examiners assessed the primary outcome of treatment success, defined by achieving the following at 5 and 6 months: (1) ≤0.5+ anterior chamber cells, ≤0.5+ vitreous cells, ≤0.5+ vitreous haze and no active retinal/choroidal lesions in both eyes, (2) ≤10 mg of prednisone and ≤2 drops of prednisolone acetate 1% a day, and (3) no declaration of treatment failure because of intolerability or safety. Additional outcomes included time to sustained corticosteroid-sparing control of inflammation, change in best spectacle-corrected visual acuity, resolution of macular edema, adverse events, subgroup analysis by anatomic location, and medication adherence.Results: Forty-one patients were randomized to methotrexate and 39 to mycophenolate mofetil. A total of 67 patients (35 methotrexate, 32 mycophenolate mofetil) contributed to the primary outcome. Sixty-nine percent of patients achieved treatment success with methotrexate and 47% with mycophenolate mofetil (P = 0.09). Treatment failure from adverse events or tolerability was not different by treatment arm (P = 0.99). There were no differences between treatment groups in time to corticosteroid-sparing control of inflammation (P = 0.44), change in best spectacle-corrected visual acuity (P = 0.68), or resolution of macular edema (P = 0.31).Conclusions: There was no statistically significant difference in corticosteroid-sparing control of inflammation between patients receiving methotrexate or mycophenolate mofetil. However, there was a 22% difference in treatment success favoring methotrexate. © 2014 by the American Academy of Ophthalmology.

Kumaragurupari R.,Library and Information Center | Sieving P.C.,U.S. National Institutes of Health | Lalitha P.,Aravind Eye Care System
Indian Journal of Ophthalmology | Year: 2010

Objective: The objective was to conduct a bibliometric analysis of Indian ophthalmic papers published from 2001 to 2006 in the peer-reviewed journals, to assess productivity, trends in journal choice, publication types, research funding, and collaborative research. Materials and Methods: We searched PubMed for articles indicating both vision-related content and author affiliation with an Indian research center. We identified research collaborations and funding from indexing for research support, and classified articles as reporting basic science, clinical science, or clinically descriptive research. Impact factors were determined from Journal Citation Reports for 2006. Results: The total number of published articles that were retrieved for the years 2001 to 2006 was 2163. During the six-year period studied, the annual output of research articles has nearly doubled, from 284 in 2001 to 460 in 2006. Two-thirds of these were published in international journals; 41% in vision-related journals with 2006 impact factors; and 3% in impact factor journals which were not vision-related. Fifty percent of the publications came from nine major eye hospitals. Clinical science articles were most frequently published whereas basic science the least. Publications resulting from international collaborations increased from 3% in 2001 to 8% in 2006. The focus of the journal with the highest number of publications corresponds to the most common cause of bilateral blindness in India, cataract. Conclusion: This bibliometric study of publications of research from India in the field of ophthalmic and vision research shows that research productivity, as measured in both the number of publications in peer-reviewed journals and qualitative measures of those journals, has increased during the period of this study.

Subburaman G.-B.B.,Aravind Eye Care System | Hariharan L.,University of Southern California | Ravilla T.D.,Aravind Eye Care System | Ravilla R.D.,Aravind Eye Care System | Kempen J.H.,University of Pennsylvania
American Journal of Ophthalmology | Year: 2015

Purpose To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere. Design Retrospective utilization analysis. Methods A historical review of the development of the Aravind Eye Care system was undertaken to evaluate the services provided by various tertiary services of the system. Demand for services is inferred based on the utilization statistics described below and distance traveled by patients to obtain services. Results Utilization of subspecialty services increased logarithmically for 17 years in all specialties. At all centers except one historically focused on glaucoma, retina services had the highest demand among subspecialty surgical services. The proportion of tertiary care patients among all new outpatients (39% in 2009 and 45% in 2013) and the proportion of specialty surgical and treatment procedures among all procedures (30% in 1997 and 49% 2013) increased over time. More patients traveled long distances (>100 kilometers) to receive specialty services than to receive cataract services (30% vs 23%). Conclusions These observations suggest that in regions where tertiary services are not widely available, (1) patients demand (travel further for) tertiary care more than general ophthalmology services; (2) demand for services can expand rapidly for many years; (3) tertiary care services tend to grow over time as a proportion of all services provided; and (4) retina services are the most highly demanded subspecialty surgical services. In such settings, it is likely that considerable latent demand exists; planned tertiary eye centers should anticipate sustained growth of tertiary services. © 2015 Elsevier Inc.

Joshi G.D.,Indian Institute of Technology Hyderabad | Sivaswamy J.,Indian Institute of Technology Hyderabad | Karan K.,Aravind Eye Care System | Krishnadas S.R.,Aravind Eye Care System
2010 7th IEEE International Symposium on Biomedical Imaging: From Nano to Macro, ISBI 2010 - Proceedings | Year: 2010

The shape deformation within the optic disk (OD) is an important indicator for the detection of glaucoma. In this paper, relevant disk parameters are estimated using the OD and cup boundaries. A deformable model guided by regional statistics is used to detect the OD boundary. A cup boundary detection scheme is presented based on the appearance of pallor in Lab colour space and the expected cup symmetry. The proposed scheme is tested on 170 images comprising 40 normal and 130 glaucomatous images. The proposed method gives a mean error 0.030 for normal and 0.121 for glaucomatous images in the estimation of cup-to-disk ratio which compares well with reported figures in literature. © 2010 IEEE.

Das T.,L v Prasad Eye Institute | Raman R.,Sankara Nethralaya | Ramasamy K.,Aravind Eye Care System | Rani P.K.,L v Prasad Eye Institute
Middle East African Journal of Ophthalmology | Year: 2015

Telemedicine is exchange of medical data by electronic telecommunications technology that allows a patient's medical problems evaluated and monitored by a remotely located physician. Over the years, telemedicine and telescreening have become important components in health care, in both disease detection and treatment. Highly visual and image intensive ophthalmology is uniquely suited for telemedicine. Because of rising disease burden coupled with high opportunity cost in detection, diabetic retinopathy is an ideal ophthalmic disease for telescreening and decision-making. It fits to Wilson and Jungner's all 10 criteria of screening for chronic diseases and the American Telehealth Association's 4 screening categories.

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