S. Reddy, Agrima Bhatia, Priyesh Kumar, S. Mohan, HemantSingh Trehan
Ophthalmia nodosa is an ocular inflammatory reaction due to the lodging of foreign bodies such as caterpillar spines and tarantula hair. Initial manifestations include edematous eyelids, conjunctival injection associated with multiple corneal abrasions. Subsequent migration of insect hair anteriorly to posteriorly may result in nodular conjunctivitis, iridocyclitis, vitritis, and even panophthalmitis. We report a case of ophthalmia nodosa in a military recruit who presented to us 1 week after the injury. By the time, he presented the setae were deep-seated leading to significant ocular manifestations and was initially managed conservatively before actively intervening to remove the setae.
{"title":"Delayed presentation, deeper peril: Ophthalmia nodosa","authors":"S. Reddy, Agrima Bhatia, Priyesh Kumar, S. Mohan, HemantSingh Trehan","doi":"10.4103/kjo.kjo_176_21","DOIUrl":"https://doi.org/10.4103/kjo.kjo_176_21","url":null,"abstract":"Ophthalmia nodosa is an ocular inflammatory reaction due to the lodging of foreign bodies such as caterpillar spines and tarantula hair. Initial manifestations include edematous eyelids, conjunctival injection associated with multiple corneal abrasions. Subsequent migration of insect hair anteriorly to posteriorly may result in nodular conjunctivitis, iridocyclitis, vitritis, and even panophthalmitis. We report a case of ophthalmia nodosa in a military recruit who presented to us 1 week after the injury. By the time, he presented the setae were deep-seated leading to significant ocular manifestations and was initially managed conservatively before actively intervening to remove the setae.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"35 1","pages":"86 - 88"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47579852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneurysmal bone cyst(ABC) is a rare vascular tumor arising usually from long bone and vertebrae,very rarely involves the skull and facial bone. Here, we present a case of a 9-year-old child presented with progressive proptosis and strabismus of the left eye associated with nasal obstruction and epistaxis. Computed tomography was done which gave us an insight into the possibilities of ABC, giant cell tumor, adenomatoid odontogenic tumor, etc., Biopsy was taken for histopathological confirmation. Usually, ABC of the maxillary sinus presents with pain, cheek swelling, and nasal obstruction. Our patient presented with ocular findings which are rare among maxillary bone ABCs.
{"title":"An unusual presentation of aneurysmal bone cyst of the maxillary sinus in a child: A rare case report","authors":"Suchismita Mishra, A. Das, Chinthala Navyasree","doi":"10.4103/kjo.kjo_173_21","DOIUrl":"https://doi.org/10.4103/kjo.kjo_173_21","url":null,"abstract":"Aneurysmal bone cyst(ABC) is a rare vascular tumor arising usually from long bone and vertebrae,very rarely involves the skull and facial bone. Here, we present a case of a 9-year-old child presented with progressive proptosis and strabismus of the left eye associated with nasal obstruction and epistaxis. Computed tomography was done which gave us an insight into the possibilities of ABC, giant cell tumor, adenomatoid odontogenic tumor, etc., Biopsy was taken for histopathological confirmation. Usually, ABC of the maxillary sinus presents with pain, cheek swelling, and nasal obstruction. Our patient presented with ocular findings which are rare among maxillary bone ABCs.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"35 1","pages":"93 - 95"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48229329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renuka Rawat, Charudatt Chalisgaonkar, D. Tripathi, S. Jain
The aim is to study the association between macular morphological changes and macular ischemia in retinal vein occlusion (RVO) involving macula by spectral domain-optical coherence tomography (SD-OCT). Observational cross-sectional study. The study included a total of 31 eyes of 30 RVO patients involving macula divided into two groups on the basis of fundus fluorescein angiography: Group A (RVO with macular ischemia) and Group B (RVO without macular ischemia). In each patient, macular cube and horizontal HD raster scans of the macula were performed to evaluate quantitative (central foveal thickness [CFT]) and qualitative (loss of inner retinal layers, loss of foveal inner segment/outer segment [IS/OS] junction, and prominent middle-limiting membrane [p-MLM] sign) macular morphological changes, respectively. The continuous and categorical data were analyzed using unpaired t-test and Fisher’s exact test, respectively, with GraphPad Prism 9 software. The mean CFT was thinner in Group A (432.71 ± 172.30 µm) as compared to Group B (564.57 ± 151.16 µm) and the difference between the two groups was statistically significant (P < 0.05). In this study, we found that the loss of inner retinal layer and loss of foveal IS/OS junction were more commonly associated with the macular ischemia group and this difference was statistically significant P = 0.0245 and 0.0292, respectively. We did not find any significant relationship between p-MLM sign with macular ischemia. SD-OCT parameters such as CFT, loss of inner retinal layer, and loss of foveal IS/OS junction were observed to predict macular ischemia to some extent.
{"title":"Macular morphological changes in retinal vein occlusion with macular involvement and their association with macular ischemia","authors":"Renuka Rawat, Charudatt Chalisgaonkar, D. Tripathi, S. Jain","doi":"10.4103/kjo.kjo_201_21","DOIUrl":"https://doi.org/10.4103/kjo.kjo_201_21","url":null,"abstract":"The aim is to study the association between macular morphological changes and macular ischemia in retinal vein occlusion (RVO) involving macula by spectral domain-optical coherence tomography (SD-OCT). Observational cross-sectional study. The study included a total of 31 eyes of 30 RVO patients involving macula divided into two groups on the basis of fundus fluorescein angiography: Group A (RVO with macular ischemia) and Group B (RVO without macular ischemia). In each patient, macular cube and horizontal HD raster scans of the macula were performed to evaluate quantitative (central foveal thickness [CFT]) and qualitative (loss of inner retinal layers, loss of foveal inner segment/outer segment [IS/OS] junction, and prominent middle-limiting membrane [p-MLM] sign) macular morphological changes, respectively. The continuous and categorical data were analyzed using unpaired t-test and Fisher’s exact test, respectively, with GraphPad Prism 9 software. The mean CFT was thinner in Group A (432.71 ± 172.30 µm) as compared to Group B (564.57 ± 151.16 µm) and the difference between the two groups was statistically significant (P < 0.05). In this study, we found that the loss of inner retinal layer and loss of foveal IS/OS junction were more commonly associated with the macular ischemia group and this difference was statistically significant P = 0.0245 and 0.0292, respectively. We did not find any significant relationship between p-MLM sign with macular ischemia. SD-OCT parameters such as CFT, loss of inner retinal layer, and loss of foveal IS/OS junction were observed to predict macular ischemia to some extent.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70823914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the efficacy and safety of 0.03% tacrolimus eye ointment with 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis. Comparative, Hospital-based, Prospective, Randomized, Clinical study. About 56 children diagnosed with Vernal keratoconjunctivitis (VKC) were enrolled in the study. All the subjects underwent a comprehensive ophthalmic evaluation. Total subjective symptom scoring (TSSS) and Total objective sign scoring (TOSS) were done for each patient based on their history and clinical examination. They were divided into two groups. One group was treated with 0.03% tacrolimus ointment bd and the other with 2% cyclosporine eye drops tid. Both groups were also put on carboxymethylcellulose eye drops four times a day. Steroids were never used during the study. The patients were followed up at intervals of two weeks, four weeks, and eight weeks. At each follow-up, the TSSS and TOSS were done for each patient. Patients were also questioned about any adverse effects encountered by them during the treatment. A comparison was done between both groups based on the above scoring. There was progressive reduction which was statistically significant (P < 0.05) in the TSSS and TOSS in both the groups throughout treatment. Reduction in TSSS The only adverse effect reported by a few patients was a burning sensation that was not severe enough to discontinue treatment. Both tacrolimus 0.03% eye ointment and cyclosporine 2% eye drops are effective in the treatment of VKC without any significant severe side effects. Tacrolimus eye ointment was more effective than cyclosporine drops.
{"title":"Evaluation of tacrolimus and cyclosporine in the treatment of vernal keratoconjunctivitis in children","authors":"A. Suresha, G. Shashidhar, H. Prabhudeva","doi":"10.4103/kjo.kjo_46_22","DOIUrl":"https://doi.org/10.4103/kjo.kjo_46_22","url":null,"abstract":"To compare the efficacy and safety of 0.03% tacrolimus eye ointment with 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis. Comparative, Hospital-based, Prospective, Randomized, Clinical study. About 56 children diagnosed with Vernal keratoconjunctivitis (VKC) were enrolled in the study. All the subjects underwent a comprehensive ophthalmic evaluation. Total subjective symptom scoring (TSSS) and Total objective sign scoring (TOSS) were done for each patient based on their history and clinical examination. They were divided into two groups. One group was treated with 0.03% tacrolimus ointment bd and the other with 2% cyclosporine eye drops tid. Both groups were also put on carboxymethylcellulose eye drops four times a day. Steroids were never used during the study. The patients were followed up at intervals of two weeks, four weeks, and eight weeks. At each follow-up, the TSSS and TOSS were done for each patient. Patients were also questioned about any adverse effects encountered by them during the treatment. A comparison was done between both groups based on the above scoring. There was progressive reduction which was statistically significant (P < 0.05) in the TSSS and TOSS in both the groups throughout treatment. Reduction in TSSS The only adverse effect reported by a few patients was a burning sensation that was not severe enough to discontinue treatment. Both tacrolimus 0.03% eye ointment and cyclosporine 2% eye drops are effective in the treatment of VKC without any significant severe side effects. Tacrolimus eye ointment was more effective than cyclosporine drops.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70825391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To systematically review the randomized control trials (RCTs) of the various prostaglandin(PG) analogues, comparing the effectiveness in treating glaucomas, safety and adverse effects of the individual agents. Articles were searchedusing the following key words “PG analogues”, “Latanoprost”, “ Bimatoprost”, “Travoprost”, “ Tafluprost”, “Unoprostone”, “ophthalmology”, “randomized controlled trial”, either singly or variably combined. Databases searched included Pubmed, Embase, Cochrane library, and Science direct. The search strategy was to identify randomized control trials (RCTs), either singly or variably combined. 24 Randomised control trials that had evaluated the efficacy and adverse effects of different PG analogue agents were selected and were used in this review Average JADAD value of the researches was found to be 2.83. Bimatoprost was found to be the most effective agent in IOP lowering efficacy but it had the maximal incidence of local adverse effects. Latanoprost, Travoprost and Tafluprost had similar efficacy. Latanoprost had the best tolerability. Unoprostone had weaker antiglaucoma action, compared to the other agents. Bimatoprost is probably one of the best antiglaucoma medications available at present. Its tolerability could be improved by using preservative free formulations. Latanoprost is a well tolerated agent with reasonably good antiglaucoma action.
{"title":"Ophthalmic prostaglandin analogs revisited - A systematic review of commonly used formulations","authors":"K. Feroze","doi":"10.4103/kjo.kjo_5_22","DOIUrl":"https://doi.org/10.4103/kjo.kjo_5_22","url":null,"abstract":"To systematically review the randomized control trials (RCTs) of the various prostaglandin(PG) analogues, comparing the effectiveness in treating glaucomas, safety and adverse effects of the individual agents. Articles were searchedusing the following key words “PG analogues”, “Latanoprost”, “ Bimatoprost”, “Travoprost”, “ Tafluprost”, “Unoprostone”, “ophthalmology”, “randomized controlled trial”, either singly or variably combined. Databases searched included Pubmed, Embase, Cochrane library, and Science direct. The search strategy was to identify randomized control trials (RCTs), either singly or variably combined. 24 Randomised control trials that had evaluated the efficacy and adverse effects of different PG analogue agents were selected and were used in this review Average JADAD value of the researches was found to be 2.83. Bimatoprost was found to be the most effective agent in IOP lowering efficacy but it had the maximal incidence of local adverse effects. Latanoprost, Travoprost and Tafluprost had similar efficacy. Latanoprost had the best tolerability. Unoprostone had weaker antiglaucoma action, compared to the other agents. Bimatoprost is probably one of the best antiglaucoma medications available at present. Its tolerability could be improved by using preservative free formulations. Latanoprost is a well tolerated agent with reasonably good antiglaucoma action.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70825557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bappal, Rashmi Jain, R. Shambhu, Keerthan Peralaya, V. Hegde, Chaithanya Singh
Introduction: Retinopathy of prematurity (ROP) is one of the causes for preventable blindness in preterm babies. An important reason for delay in treatment and, hence, blindness is delayed follow-up, attributed to the lack of cognizance regarding ROP among parents. Methodology: This cross-sectional questionnaire study was conducted from September 2018 to January 2020 with an aim to assess knowledge, attitude, and practices about ROP among parents of preterm babies. They all had been counselled during previous screening sessions and the questionnaire was administered during the last follow-up for ROP screening. The questionnaire included basic demographic data and questions to assess knowledge, attitude, and practices about ROP. Association between follow-up pattern with knowledge, attitude, economic status, and educational level were analysed. Results: Questionnaire study was conducted on 30 parents of preterm babies. About 83.3% parents were aware that “ROP” is a blinding disease of preterm babies. Twenty-one parents (70%) did not bring their babies for follow-up as per the schedule mentioned in “ROP follow-up card.” Delay in follow-up ranged from 7 to 160 days (median 30 days). Better economic status had statistically significant influence on prompt follow-up. Conclusion: In spite of counselling, sharing educational pamphlets, and having knowledge about blinding complication of ROP, 70% parents did not bring the babies for follow-up on time. Hence, there is a need to strengthen the ROP counselling program.
{"title":"Awareness in parents of preterm babies screened and counselled for retinopathy of prematurity – A study from rural India","authors":"A. Bappal, Rashmi Jain, R. Shambhu, Keerthan Peralaya, V. Hegde, Chaithanya Singh","doi":"10.4103/kjo.kjo_174_21","DOIUrl":"https://doi.org/10.4103/kjo.kjo_174_21","url":null,"abstract":"Introduction: Retinopathy of prematurity (ROP) is one of the causes for preventable blindness in preterm babies. An important reason for delay in treatment and, hence, blindness is delayed follow-up, attributed to the lack of cognizance regarding ROP among parents. Methodology: This cross-sectional questionnaire study was conducted from September 2018 to January 2020 with an aim to assess knowledge, attitude, and practices about ROP among parents of preterm babies. They all had been counselled during previous screening sessions and the questionnaire was administered during the last follow-up for ROP screening. The questionnaire included basic demographic data and questions to assess knowledge, attitude, and practices about ROP. Association between follow-up pattern with knowledge, attitude, economic status, and educational level were analysed. Results: Questionnaire study was conducted on 30 parents of preterm babies. About 83.3% parents were aware that “ROP” is a blinding disease of preterm babies. Twenty-one parents (70%) did not bring their babies for follow-up as per the schedule mentioned in “ROP follow-up card.” Delay in follow-up ranged from 7 to 160 days (median 30 days). Better economic status had statistically significant influence on prompt follow-up. Conclusion: In spite of counselling, sharing educational pamphlets, and having knowledge about blinding complication of ROP, 70% parents did not bring the babies for follow-up on time. Hence, there is a need to strengthen the ROP counselling program.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"35 1","pages":"54 - 59"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43671982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A carotid-cavernous sinus fistula (CCF) is an abnormal vascular communication between internal carotid artery or external carotid artery and veins within cavernous sinus (CS). CCF commonly present with ophthalmic manifestations due to venous drainage of the orbit from the CS. Here, we present case series of four CCFs; two direct and two indirect and discuss their ophthalmological and neuroradiological features and management outcomes with digital subtraction angiography and endovascular coiling. CCF is a rare clinical presentation and its early diagnosis and treatment prevents life and vision-threatening complications.
{"title":"Case series of carotid cavernous fistula: Clinical and management outcomes","authors":"Appurv Kachhwaha, L. Mohanty, Sitaram Barath","doi":"10.4103/kjo.kjo_88_21","DOIUrl":"https://doi.org/10.4103/kjo.kjo_88_21","url":null,"abstract":"A carotid-cavernous sinus fistula (CCF) is an abnormal vascular communication between internal carotid artery or external carotid artery and veins within cavernous sinus (CS). CCF commonly present with ophthalmic manifestations due to venous drainage of the orbit from the CS. Here, we present case series of four CCFs; two direct and two indirect and discuss their ophthalmological and neuroradiological features and management outcomes with digital subtraction angiography and endovascular coiling. CCF is a rare clinical presentation and its early diagnosis and treatment prevents life and vision-threatening complications.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"35 1","pages":"79 - 82"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43968344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correlation and regression are two commonly used statistical techniques in modelling medical data. It s essential for clinicians to understand the methodology of these techniques in general and their implications in clinical area of expertise. This article provides an overview on correlation and regression methods from an ophthalmologic perspective.
{"title":"An overview of correlation and regression methods in medical research – An ophthalmologic perspective","authors":"NSreekumaran Nair, S. Ganapathy","doi":"10.4103/kjo.kjo_32_23","DOIUrl":"https://doi.org/10.4103/kjo.kjo_32_23","url":null,"abstract":"Correlation and regression are two commonly used statistical techniques in modelling medical data. It s essential for clinicians to understand the methodology of these techniques in general and their implications in clinical area of expertise. This article provides an overview on correlation and regression methods from an ophthalmologic perspective.","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"35 1","pages":"103 - 108"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48997118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"IOL opacification: My perspective","authors":"S. Saikumar","doi":"10.4103/kjo.kjo_94_23","DOIUrl":"https://doi.org/10.4103/kjo.kjo_94_23","url":null,"abstract":"","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70826891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical education is about the patient in all respects. Sir William Osler emphasized that “the student begins with patient, continues with the patient and ends his study with the patient, using books and lectures as tools, as means to an end.[1]” A student should therefore be with the patient, reading the books about the condition of the patient, coming back to the patient for re-examination, discussing with their teachers the condition and the differential diagnosis of that condition, and then going back again to the patient to elicit further details, all the time communicating appropriately with the patient. Hence, it is the patient all the way who occupies the center stage in medical education. In recent years, more and more instances of case presentations are happening without the patient in the classroom. The pandemic has exacerbated this situation to an extreme level. Most of the postgraduate medical teaching is now scenario-based. A scenario is where an imaginary patient with a name has a few symptoms and signs pre-described. The student presents it as a case without the need for eliciting the signs. This scenario is repeatedly played out in multiple sessions. Such training grooms a set of students who have no skills in eliciting a proper history or conducting a proper examination. Their teachers are unable to interrupt them to demonstrate a sign that the student had failed to elicit or to take a history that was omitted. The students do not perfect the art of correlating the patient’s signs with the symptoms and thereby providing a differential diagnosis. Furthermore, their familiarity with the scenario prevents the development of touch, respect, empathy, and the art of professional communication. The increased availability of online classes has greatly helped the students to be up to date with the current standards of care. It has also facilitated exposure to different standards of teaching. The negative is that everybody is forced to believe what the student has presented. The online classes must be used by the student as a resource for advancing knowledge, but learning to elicit skills is equally important. A squint case presentation is taken as an example. The student should be well versed in eliciting the primary and secondary deviations and various types of cover tests, including those with the use of prisms and in the forced duction tests. These skills should be demonstrable during the case presentation. Then only the discussion assumes significance. The relevance lies in repeatedly coming back to the patient for examination. I am sure that there will be proponents of a skill laboratory, but the patient must occupy center stage. Another important malady in patient education is the “no touch.” The pandemic has increased the propensity of no-touch technique of examining the patients, which was already seeping into the examination culture. This, along with the fear in the minds of the teachers of lesser skills in the students causing
{"title":"The patient is our teacher","authors":"Smita Narayanan","doi":"10.4103/kjo.kjo_22_23","DOIUrl":"https://doi.org/10.4103/kjo.kjo_22_23","url":null,"abstract":"Medical education is about the patient in all respects. Sir William Osler emphasized that “the student begins with patient, continues with the patient and ends his study with the patient, using books and lectures as tools, as means to an end.[1]” A student should therefore be with the patient, reading the books about the condition of the patient, coming back to the patient for re-examination, discussing with their teachers the condition and the differential diagnosis of that condition, and then going back again to the patient to elicit further details, all the time communicating appropriately with the patient. Hence, it is the patient all the way who occupies the center stage in medical education. In recent years, more and more instances of case presentations are happening without the patient in the classroom. The pandemic has exacerbated this situation to an extreme level. Most of the postgraduate medical teaching is now scenario-based. A scenario is where an imaginary patient with a name has a few symptoms and signs pre-described. The student presents it as a case without the need for eliciting the signs. This scenario is repeatedly played out in multiple sessions. Such training grooms a set of students who have no skills in eliciting a proper history or conducting a proper examination. Their teachers are unable to interrupt them to demonstrate a sign that the student had failed to elicit or to take a history that was omitted. The students do not perfect the art of correlating the patient’s signs with the symptoms and thereby providing a differential diagnosis. Furthermore, their familiarity with the scenario prevents the development of touch, respect, empathy, and the art of professional communication. The increased availability of online classes has greatly helped the students to be up to date with the current standards of care. It has also facilitated exposure to different standards of teaching. The negative is that everybody is forced to believe what the student has presented. The online classes must be used by the student as a resource for advancing knowledge, but learning to elicit skills is equally important. A squint case presentation is taken as an example. The student should be well versed in eliciting the primary and secondary deviations and various types of cover tests, including those with the use of prisms and in the forced duction tests. These skills should be demonstrable during the case presentation. Then only the discussion assumes significance. The relevance lies in repeatedly coming back to the patient for examination. I am sure that there will be proponents of a skill laboratory, but the patient must occupy center stage. Another important malady in patient education is the “no touch.” The pandemic has increased the propensity of no-touch technique of examining the patients, which was already seeping into the examination culture. This, along with the fear in the minds of the teachers of lesser skills in the students causing ","PeriodicalId":32483,"journal":{"name":"Kerala Journal of Ophthalmology","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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