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Changes seen in ophthalmology private practice over 25 years
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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