Changing Trends in Changing Trends in Ophthalmic PracticeOphthalmic Practice

1979 to 20041979 to 2004

A marathon of 25 yearsA marathon of 25 years

Dr. Anand SudhalkarDr. Anand Sudhalkar

BarodaBaroda

Aim :Aim :

To identify the trends in : To identify the trends in :

1. disease patterns.1. disease patterns.

2. diagnostic and Treatment2. diagnostic and Treatment

methods.methods.

Study the adaptive measures in Study the adaptive measures in practice.practice.

Is it a change for better?Is it a change for better?

Study DesignStudy DesignReview of 1000 consecutive OPD cases Review of 1000 consecutive OPD cases from each selected years 1982, 84, 87, 93, from each selected years 1982, 84, 87, 93, 97, 2001, 2004.97, 2001, 2004.

Compare the incidence various ocular Compare the incidence various ocular manifestations.manifestations.

Correlate with changing trends, acquisition Correlate with changing trends, acquisition of newer skills and additional equipments.of newer skills and additional equipments.

Identify any significant changes in patternIdentify any significant changes in pattern

The background & settingThe background & setting

Basic training comprehensive Basic training comprehensive ophthalmologyophthalmology

Retina fellowshipRetina fellowship

Honorary Teaching attachmentHonorary Teaching attachment

Solo General Ophthalmic PracticeSolo General Ophthalmic Practice

Inherited, well set basic Inherited, well set basic infrastructureinfrastructure

YEARGR

20042001199719931989198619841982

Va

lue

100

90

80

70

60

50

40

30

20

10

0

SQUINT

SAC

RETINA

REFRACTI

NEUROLOC

LOSTEYE

LIDS

IRIS

GLAUCOMA

CORNEA

CONGENIT

CATARACT

51112967788

5

9813

10657

3341

34

39

47435250

55

6

2020

1418

2119

11

17

Disease patterns :Disease patterns :% distribution of various OPD cases% distribution of various OPD cases

Ocular Surface diseases

Trauma

Squint

YEARGR

20042001199719931989198619841982

Va

lue

CA

TA

RA

CT

240

220

200

180

160

140

120

100

232

204

144

184

210

185

114

187

Pattern in CataractPattern in Cataract

Intracap

PROTEGE

Photo-slit Lamp& A-Scan Millenium

ECCE PCIOL PHACO

Zeiss MDOOp. Microscope

Events :

Retina cases

YEARGR

20042001199719931989198619841982

Va

lue

RE

TIN

A

140

120

100

80

60

40

20

108

75

129

95

37

5552

71

Pattern in Retina : Pattern in Retina :

Indirect ophthalmoscop

y Cryo and scleral buckle

Argon laser

Fundus camer

a

Diode green

Events : Cryo and buckle Argon, Diode Laser Pars plana vitrectomies

Pattern in Glaucoma Pattern in Glaucoma Glaucoma cases

YEARGR

20042001199719931989198619841982

Va

lue

GL

AU

CO

MA

40

30

20

10

26

17

2930

24

29

27

13

Slit-lamp Gonioscopy and applanation 90D

Autoperimeter

Fundus

camera

Non contact

tonometer

Events :

Schiotz, Lister, Direct ophth Autoperi. Applana. Gonioscopy, 90D

Pilocarpine, Trabec. Timolol, ALT, PI New drugs, non penetrat.

Pattern in StrabismusPattern in Strabismus

Strabismus cases

YEARGR

20042001199719931989198619841982

Va

lue

S

QU

IN

T

60

50

40

30

20

10

46

35

52

36

22

32

42

33

Synaptophore 1

Synaptophore 2DIGITAL

PHOTOGRAPHY

Events :

Cosmetic correction

Simple diagnostics Cam stimulator, Occluders, Synaptophore

Parent aware. Amblyopia manage.

Pattern in refractionPattern in refraction

Refraction

YEARGR

20042001199719931989198619841982

Va

lue

R

EF

RA

CT

I

600

500

400

300

385

409

337

386

475

428

516

545

Plain mirror retinoscopy

Contact lens

Keratometry Autoref Topography

PRKSpectaclesEvents :

Contact lens Autoref

RK Lasik

Pattern in Surface disordersPattern in Surface disordersOcular Surface disorder

YEARGR

20042001199719931989198619841982

Val

ue S

UR

FA

CE

140

120

100

80

60

40

130

119

90

60

7267

80

91

Environmental pollution, Two wheelers, Computers, TVsEvents :

ConclusionsConclusionsThe pattern of various eye disorders The pattern of various eye disorders remains the sameremains the sameChanging trends in Ophth. influence Changing trends in Ophth. influence practice.practice.Acquisition of newer skills and equipments Acquisition of newer skills and equipments accelerates patient flow. accelerates patient flow. Basic skills can be improved upon at any Basic skills can be improved upon at any stage.stage.There is no need to sacrifice other skills in There is no need to sacrifice other skills in favour of one sub-speciality.favour of one sub-speciality.

The MessageThe Message