Changing Trends in Ophthalmic Practice

1979 to 2004A marathon of 25 years

Dr. Anand SudhalkarBaroda

Aim :

To identify the trends in : 1. disease patterns. 2. diagnostic and Treatment methods.

Study the adaptive measures in practice.Is it a change for better?

Study DesignReview of 1000 consecutive OPD cases from each selected years 1982, 84, 87, 93, 97, 2001, 2004.Compare the incidence various ocular manifestations.Correlate with changing trends, acquisition of newer skills and additional equipments.Identify any significant changes in pattern

The background & setting

Basic training comprehensive ophthalmologyRetina fellowshipHonorary Teaching attachmentSolo General Ophthalmic PracticeInherited, well set basic infrastructure

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 :% 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 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 :

Indirect ophthalmoscopy Cryo and scleral

buckle

Argon laser

Fundus camer

a

Diode green

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

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 camer

aNon contact

tonometer

Events :

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

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

Pattern 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 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 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 :

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

The Message