Prasanna Venkatesh Ramesh

Mahathma Eye Hospital Private Limited · Glaucoma Surgery and Research

Purpose: To understand the factors that explain compliance to anti-glaucoma medication (AGM) in terms of application,purchase, stocking and compliance behaviour. Methods: This was a cross-sectional study conducted in the outpatient department of an urban tertiary eye care center in South India. Interviews were completed with consenting, consecut...

In this manuscript, the role of human‑in-the‑loop machine learning for augmenting and supporting glaucoma detection artifical intelligence models are highlighted.

Flecked Retina Syndrome

Innovations in Ophthalmology Holographic elysium of a 4D ophthalmic anatomical and pathological metaverse with extended reality/mixed reality Extended reality is one of the leading cutting-edge technologies, which has not yet fully set foot into the field of ophthalmology. The use of extended reality technology especially in ophthalmic education an...

In this manuscript, we have reported an augmented reality (AR) application named, 'Eye MG AR' innovated by us, to show different anatomical/pathological parts of the eyeball pertaining to glaucoma, from multiple customized angles of the user's choice to simplify glaucoma learning and clinical counseling. It is available free of cost from the Google...

Retinochoroidal colobomas are rare congenital anomalies of the eye. It has varying clinical presentations depending on the extent and involvement of ocular tissue, which can either be unilateral or bilateral. Choroidal colobomas are the most common type of ocular colobomas, and it is important to learn its various types. It can present with other a...

Secondary open-angle glaucoma (SOAG) is a rare yet consequential complication following implantable collamer lens (ICL), also known as a phakic intraocular lens insertion, particularly in high myopia patients. This case report emphasizes the importance of recognizing SOAG and details the diagnostic complexities, reevaluation procedures, and success...

The foetal vasculature gives nourishment to the developing lens and retina during embryonic development and then regresses after the formation of the retinal vessels. The failure of the foetal ocular vasculature to go through the usually planned involution results in persistent foetal vasculature (PFV), which causes blindness or severe vision loss....

Glaucoma, a prevalent and debilitating eye disease, has long been associated with vision impairment and blindness. However, recent research has shed light on the often-underestimated psychological dimensions of this condition. Anxiety and depression, two pervasive psychiatric comorbidities, have been increasingly recognized among glaucoma patients....

This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma (NTG), a condition that continues to baffle clinicians and researchers alike. NTG, characterized by optic nerve damage and visual field loss despite normal intraocular pressure, has long puzzled clinicians. One eme...

Standard automated perimetry (SAP) is the gold standard and an internationally accepted device for evaluating the presence of visual field defects (VFDs) in the glaucoma patients. Nevertheless, it needs some unavoidable conditions, such as prolonged attention, stable fixation, and space restriction. Moreover, it was nearly impossible to assess the...

Diabetic retinopathy (DR) is a complication of diabetes that damages the retina and can cause blindness if untreated due to high blood sugar levels. To accurately diagnose and grade DR, it is important to identify retinal lacerations or biomarkers. Optical coherence tomography (OCT) imaging is a commonly used tool by ophthalmologists due to its det...

Ophthalmology-related concepts have many theoretical frameworks, which the ophthalmology residents and surgeons may have to conceptualize during their training period. Only a high-powered, understandable tool can fill these cognitive mental gaps of neophytes in this modern era. For example, using a three-dimensional (3D) eyeball model with real-tim...

Ophthalmic imaging has shown tremendous progress in the past century in terms of numerous advancements in the way we image and interpret the human eye, with all its intricacies. Recent times have emphasized imaging as a diagnostic tool, a modality to document patient progress, and a useful learning medium for budding clinicians. Imaging in ophthalm...

Glaucoma is a chronic, progressive eye disease that causes irreversible damage to the optic nerve head. Visual field loss, the functional change seen in glaucoma correlates well with structural loss in the neurosensory part of the eye involving the retinal ganglion cell layer (GCL) and retinal nerve fibre layer (RNFL). Early assessment and preventi...

Axenfeld-Rieger syndrome (ARS) is a rare disease characterized by anterior segment anomalies with or without glaucoma. A 28-year-old antenatal female diagnosed with ARS presented with uncontrolled intraocular pressures (IOPs) and advanced glaucoma despite maximal medical therapy and progressive vision loss during her third trimester. The refractory...

BACKGROUND Axenfeld-Rieger syndrome (ARS) is a rare cause of congenital glaucoma and may result in loss of vision. ARS is mostly autosomal dominant in nature characterized by developmental abnormalities in the angle of anterior chamber and iris of the eye, also associated with structural abnormalities in the body. AIM To study and observe the demo...

The field of ophthalmology has long been at the forefront of medical innovation, with continuous advancements in technology driving improvements in patient care. Among these innovations, the emergence of 3D Stimulative Fundus technology has revolutionized the way physicians interpret and diagnose retinal conditions. In this article, we delve into t...

The Anterion image shows nuclear sclerotic cataract in the form of an ‘eye’ in the centre of the lens. There are various worldwide cataract grading systems to compare the amount of opacification in the center and the back surface of the lens to the percentage of obstructed visual area. Nuclear sclerotic cataract is a subtype where the nucleus of cr...

The Anterion image shows posterior polar cataract (PPC), which is a clinically and surgically unique subtype of congenital cataract. The pathophysiology of PPC, which manifests as a raised plaque-like onion ring-shaped central discoid lens opacity thickly adhering to the posterior capsule, has been linked to a number of genes. It impairs the patien...

Purpose: Our study was designed to determine ophthalmologists' dexterity in performing standard ophthalmic procedures at various levels of expertise via a structured questionnaire. Methods: A structured questionnaire was administered via the Google platform from August 20 to September 19, 2022, to assess the perspectives and preferences of ophth...

Diabetes mellitus (DM) is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics. It threatens healthy life around the globe, with mild-to-severe secondary complications and leads to significant illness including nephropathy, neuropathy, retinopathy, and macrovascular abnormalities including peripheral vasculopa...

Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon techniqu...

Aims This study aimed to compare central corneal thickness (CCT) using ultrasound pachymetry (USP) (CCT apex) and specular microscopy (CCT vertex) and also to find out the intra-reading variability from the two instruments. Settings and Design A prospective, observational study was conducted in a tertiary eye care center in southern India. Materi...

An uncommon ophthalmic emergency condition, bilateral acute angle-closure glaucoma (AACG), is a potentially sight-threatening adverse effect of several local and systemic drugs in high-risk individuals. The majority of cases with drug-induced pupillary block closed-angle glaucoma are preventable, if high-risk patients are recognized and treated pro...

A 25-year-old male presented with recurrent swelling in the left upper eyelid despite multiple surgeries in the past 6 years. He was initially misdiagnosed as capillary hemangioma elsewhere, for which multiple surgical excision procedures were done. In 2020, he presented to us for a second opinion regarding the same painless swelling which recurred...

Photo Essay A 75-year-old male patient came for a regular ophthalmic examination with a best corrected visual acuity of 20/20 in both eyes. Examination revealed involuntary closure of his right eyelid on opening his mouth [Figure 1]. On questioning, the patient revealed that he had developed facial paralysis 40 years ago, after which he had involun...

The Lockdowns are back, as the cities are once again bracing for a steep influx of patients suffering from or suspected to be infected from the novel coronavirus (COVID-19), owing to the soaring second wave of COVID-19. We as practicing ophthalmologists, need to keep our guard up now, more than ever. The need of the hour is the safety for our healt...

Netarsudil (Rho-associated protein kinase inhibitor) is one of the newer anti-glaucoma medications used for the management of glaucoma. It has the most common side effects, such as conjunctival hyperemia, subconjunctival hemorrhage, and cornea verticillata. This manuscript focuses on a rarer side effect of netarsudil-associated reticular corneal ep...

Purpose: A novel convolutional neural network approach in detecting diabetic retinopathy (DR) was employed to overcome the black box dilemma in artificial intelligence (AI). In addition to identification and classification, this tool is intended to identify signs such as microaneurysms, hard exudates, dot-blot haemorrhages and flame-shaped haemorrh...

Vascular brain damage can manifest as various ophthalmic pathologies. It is important to understand cerebral circulation to understand the aetiopathogenesis of the disease. It can manifest as various ocular pathologies with visual field defects, cranial nerve palsies, orbital diseases, etc. In this review, with the help of three-dimensional (3D) im...

Glaucoma in its early stages is left undiagnosed as it starts affecting the vision from the periphery and gradually move towards the centre. In general, 24‐2 and 30‐2 threshold VF testing strategies, are done routinely to pick up early glaucomatous changes. 10-2 VF testing is reserved for advanced glaucoma and those who have tunnel vision in 24-2 o...

The development of a lens in intrauterine life reacts to any insults by losing its clarity and developing opacity, which manifests as congenital or developmental cataract. Developmental mixed morphology cataracts are seen when there is occurrence of multiple forms of cataracts in a single crystalline lens. Although the prevalence of mixed morpholog...

Vogt-Koyanagi-Harada (VKH) syndrome is a rare bilateral granulomatous panuveitis typically affecting the more pigmented races, and women more than men. VKH syndrome is theorized due to a T-cell-mediated autoimmune reaction against antigens related to melanin and melanocytes, that may happen due to cutaneous or viral triggers. Along with the clinica...

A Striking Imaging Canvas in a Patient With Ischemic Central Retinal Vein Occlusion With Minimal Haemorrhages

A 70-year-old female presented with blurring of vision and gush of warm fluid in the left eye (OS). She gave history of ocular surgery without lens implantation 20 years back in OS and five years back in the right eye (OD). On examination, visual acuity was hand movements in OS. The slit lamp examination revealed pseudoexfoliation with aphakia in b...

A 8-year-old female presented to the emergency department with sudden pain and diminution of vision in the right eye (OD). Slit lamp evaluation revealed an anteriorly luxated phakic crystalline lens with 360° visibility of the lens equator OD (Figure 1); the left eye (OS) revealed a small spherical lens with a visible equator on dilatation. Anterio...

The healthcare sector has had a relatively late implementation of environmental thinking in its setup. “Green electronic technologies and go green healthcare system” has recently evolved to address the biodegradability and biocompatibility issues faced by inorganic electronics and non-biodegradable materials. Green healthcare has the capability to...

Aims: This study aims to evaluate the non-mydriatic fundus image quality obtained with a confocal fundus device. Also, to evaluate the influence of non-mydriatic pupil size on image quality. Settings and Design: A cross-sectional study was conducted in the outpatient department of a high-volume tertiary eye care centre in South India during the thi...

My personal tips for cracking the competitive Royal College of Ophthalmology (practical) refraction certificate examination in the first attempt Dear Editor, For the first time since its commencement, the Royal College of Ophthalmology (RCOphth) has conducted the refraction certificate exam in India, making it accessible to aspiring candidates. We...

Traditional methods for neuroretinal rim width measurement in spectral domain optical coherence tomography (SD-OCT) employs the Bruch's membrane opening (BMO) as the anatomical border of the rim, referenced to a BMO horizontal reference plane, termed as "Bruch's Membrane Opening-Horizontal Rim Width" (BMO-HRW). BMO-HRW is defined as the distance be...

Big data has been a game changer of machine learning. But, big data is a form of centralized version of data only available and accessible to the technology giants. A way to decentralize this data and make machine learning accessible to the smaller organizations is via the blockchain technology. This peer-to-peer network creates a common database a...

A day-old male neonate presented with white forelock on his forehead. On evaluation, the neonate had telecanthus, broad nasal bridge, and surprisingly homochromic but hypochromic irides bilaterally. The W-index was 2.38 which was an indication of Type 1 Waardenburg syndrome (WS) with dilated fundus evaluation revealing pigmentary deficit in the ret...

The coronicle (corona + cubicle) provides state-of-the-art features required for comprehensive ocular evaluation. Assembling this cubicle requires acrylic sheets, aluminum beading, fevicol, araldite paste, and a jigsaw cutting blade, which can be done in a do-it-yourself template. Dimensions of the cubicle are 16 × 16 × 8 feet with only a total are...

Practical sessions facilitate teaching, critical thinking, and coping skills, especially among medical students and professionals. Currently, in ophthalmology, virtual and augmented reality are employed for surgical training by using three-dimensional (3D) eyeball models. These 3D models when printed can be used not only for surgical training but a...

A 10-year-old male child presented with blunt force injury to his right eye (OD), with best-corrected visual acuity of 20/200. Posterior segment evaluation showed vitreous hemorrhage, Berlin's edema, and choroidal rupture anterior to the equator, parallel to the ora serrata, associated with subretinal hemorrhages. In this manuscript, we have report...

Concepts pertaining to ophthalmology have lots of theoretical frameworks. Neophyte residents and novice surgeons may have to mentally visualize these concepts during the initial days of training. Only a powerful cognitive tool such as a three-dimensional (3D) eyeball model, with real-time TrueColor confocal images (and not animated images or models...

Purpose: For diagnosing glaucomatous damage, we have employed a novel convolutional neural network (CNN) from TrueColor confocal fundus images to conquer the black box dilemma in artificial intelligence (AI). This neural network with CNN architecture with human-in-the-loop (HITL) data annotation helps not only in diagnosing glaucoma but also in pr...

Thromboembolic manifestations of the eye can vary from a trivial tributary retinal vein occlusion to a catastrophic cerebral venous sinus thrombosis. These conditions can be classified as pathologies directly affecting the eye or those causing secondary lesions due to systemic issues and can be managed accordingly. Also, recently the incidence of t...

Cerebral circulation is the flow of blood through a group of arteries and veins which supply the brain. There are various diseases related to ophthalmology, due to pathologies in the cerebral arterial system. Arteries inside the skull can be blocked by plaque or disease, which in turn triggers a series of events leading to various cranial nerve pal...

The field of augmented reality (AR) and three-dimensional (3D) printing are rapidly growing with many new potential applications in medical education and pedagogy. In this chapter, we have used 3D AR and 3D printed models of the cerebral arterial circulatory system, created by us to simplify concept learning. Various cerebral circulation diseases p...

Background: Though various gonioscopy teaching platforms are available, they predominantly comprise of real time scenarios and videos. For a beginner, we suggest providing animations of the real time scenario for cognitive training; and then putting them in real time scenarios for a better concept application and practice. Purpose: This video hi...

Augmented reality (AR) has come a long way from a science‑fiction concept to a science‑based reality. AR is a view of the real, physical world in which the elements are enhanced by computer‑generated inputs. AR is available on mobile handsets, which constitutes an essential e‑learning platform. Today, AR is a real technology and not a science‑ficti...