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Search Results: 1 - 10 of 116 matches for " Jayaprakash Muliyil "
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Estimating cataract blindness in India
Thomas Ravi,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 1997,
An introduction to clinical decision analysis in ophthalmology
Korah Sanita,Thomas Ravi,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 1999,
Abstract: Ophthalmologists are often confronted with difficult clinical management problems. In such cases, even published experience may be limited; consequently multiple, generally unproven management options are usually available. When placed in such situations, most of us decide on the most appropriate course of action based on intuition or (limited) previous experience. In this article, we use examples to introduce the concept of decision analysis, a method of generating objective decisions for complex clinical problems.
The role of central corneal thickness in the diagnosis of glaucoma
Thomas Ravi,Korah Sanita,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 2000,
Abstract: Purpose: To determine the effect of central corneal thickness (CCT) on applanation tonometry and any resultant misclassification of normals as ocular hypertension. Method: The central corneal thickness was measured using the ultrasound pachometer in 50 normals, 25 glaucoma and 23 ocular hypertensive patients. The student′s "t" test was used to determine any significant difference in CCT between the three groups. Results: There was a statistically significant difference in the mean CCT of the ocular hypertensives ( 0.574 + 0.033mm) as compared to the glaucomas (0.534 ± 0.030mm) and normals (0.537 ± 0.034mm). Applying the described correction factor for corneal thickness, 39% of eyes with ocular hypertension were found to have a corrected IOP of 21mmHg or less. Conclusions: Increased corneal thickness in ocular hypertension may lead to an overestimation of IOP in 39% of cases. Measurement of central corneal thickness is advisable when the clinical findings do not correlate with the applanation IOP.
Comparison of optical and ultrasound pachometry
Korah Sanita,Thomas Ravi,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 2000,
Screening for hypertension among older adults: A primary care "High Risk" approach
John Jacob,Muliyil Jayaprakash,Balraj Vinohar
Indian Journal of Community Medicine , 2010,
Abstract: Background: Recommendations for early detection and management of elevated blood pressure through opportunistic clinic-based screening may be inadequate for the rural population in India as access to health facilities is limited. Materials and Methods: Sixteen Health Aides (trained primary care workers) were trained to measure blood pressure using a standardized training procedure. Six of those assessed competent in initial evaluation were allotted a stratified random sample of about 150 persons each, 50 years or over, in the village under their care to measure blood pressures during their regular scheduled visits. Results: 14/16 of the health aides (83%) met the stipulated criteria for the simulation study using a module from British Hypertension Society. In the field survey of 920 individuals where 20% of the population was evaluated by a blinded investigator, the weighted Kappa for agreement, using normal, pre-hypertension and hypertension as categories, ranged between 62% and 89%. Only 75/286 (25%) of those detected to be hypertensive knew their status prior to the study. All those detected with hypertension were referred to a physician at a referral facility. 70% of those referred were evaluated at the referral facility and 64% of them initiated on treatment for hypertension within 3 months. Conclusion: Using primary care workers to screen for hypertension through the model suggested here will ensure that the population over 50 years of age will be screened once every 2 years without burdening the worker. This screening process will enable the health system to identify and cater to needs of this vulnerable population.
Assessment of clinical significance: The number needed to treat
Thomas Ravi,Padma P,Braganza Andrew,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 1996,
Abstract: The practising ophthalmologist is frequently confronted with treatment options shown to be "statistically significantly better" than those currently in use. Unfortunately what is statistically significant may not necessarily be clinically significant enough for the practitioner to change from the currently preferred method of treatment. In this article we use common ophthalmic examples to introduce the "number needed to treat" (NNT), as a simple clinical approach for the practising ophthalmologist wishing to assess the clinical significance of treatment options.
Visual field defects in non-functioning pituitary adenomas.
Thomas Ravi,Shenoy Kashinatha,Seshadri Mandalam,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 2002,
Abstract: PURPOSE: To report the prevalence and pattern of visual field loss in non-functioning pituitary adenomas and to study the relationship between the tumour size and severity of field defects. METHODS: Ninety-three patients with histologically confirmed pituitary adenomas, non-functional on hormonal assessment, underwent a complete ophthalmic assessment and automated perimetry using the HFA 30-2 programme. Defects with quadrantanopic or hemianopic characteristics, defined using criteria on the threshold/pattern deviation plots were considered typical. Typical defects were graded as mild, moderate and severe. All other defects were considered atypical. A neuroradiologist measured tumour size on a CT or MRI Scan. The Chi-square test for trend was used to test association of tumour volume with severity of typical defects. RESULTS: Eighty-eight (94.6%) of the 93 patients had a field defect. Typical field defects were seen in 69 (74.2%) patients and atypical in 19 (20.4%). A severe typical defect involving at least 3 quadrants in one or both eyes was the most common (24 patients or 25.80%). All 31 patients (33.3%) with a tumour size greater than 20 cc had field defects. Severity of field defect increased with tumour volume (Chi-square test for trends significant p = 0.0096). CONCLUSIONS: Field defects occurred in 95% of patients with non-functioning pituitary macroadenoma. A severe visual field loss involving at least 3 quadrants in one or both eyes was the most common. 20% of patients had atypical field defects. Severity of field defects increased with tumour volume
Confidence with confidence intervals
Thomas Ravi,Braganza Andrew,Oommen Lekha,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 1997,
Abstract: When considering the results of a study that reports one treatment to be better than another, what the practicing ophthalmologist really wants to know is the magnitude of the difference between treatment groups. If this difference is large enough, we may wish to offer the new treatment to our own patients. Even in well executed studies, differences between the groups (the sample) may be due to chance alone. The "p" value is the probability that the difference observed between the groups could have occurred purely due to chance. For many ophthalmologists assessing this difference means a simple look this "p" value to convince ourselves that a statistically significant result has indeed been obtained. Unfortunately traditional interpretation of a study based on the "p" value at an arbitrary cut-off (of 0.05 or any other value) limits our ability to fully appreciate the clinical implications of the results. In this article we use simple examples to illustrate the use of "confidence intervals" in examining precision and the applicability of study results (means, proportions and their comparisons). An attempt is made to demonstrate that the use of "confidence intervals" enables more complete evaluation of study results than with the "p" value.
Surgical magnification for intracapsular cataract surgery in a rural hospital
Braganza Andrew,Cheng Arthur,Thomas Ravi,Muliyil Jayaprakash
Indian Journal of Ophthalmology , 1996,
Abstract: Intracapsular cataract extraction is still the most common type of operation performed in India, especially in eye camps, and most of these are done without magnification. To assess the surgical outcome of intracapsular cataract surgery in a rural hospital with various magnifying systems, 121 consecutive eyes (121 patients) with uncomplicated cataract were randomly allocated to surgery with the operating microscope, binocular loupe or unaided eye. The surgery was performed by either consultants or first year residents. The best corrected vision at least four weeks post-operatively was compared among the three groups. The performance between the consultants and the junior residents was also compared. The improvement of surgical outcome with magnification was statistically significant (p=0.0045); and clinically important with a relative risk reduction of 60.6%. The comparison between microscope and loupe magnification did not show a significant difference (p=0.24). However, with an operating microscope, the consultants performed significantly better than the junior residents. These findings suggest that the use of magnification in intracapsular cataract extraction provides a definite advantage over an unaided eye and that the binocular loupe is a good alternative to the operating microscope in this kind of surgery.
Comparison between latanoprost and brimonidine efficacy and safety in Indian eyes
Thomas Ravi,Parikh Rajul,Muliyil Jayaprakash,George Ronnie
Indian Journal of Ophthalmology , 2003,
Abstract: Purpose: To compare the short-term efficacy and safety of topical latanoprost and brimonidine in Indian eyes. Materials and Methods: Twenty-eight patients with ocular hypertension, primary open-angle, pseudoexfoliation or pigmentary glaucoma were enrolled. Following baseline measurements, latanoprost was applied topically once daily in the evening for 12-weeks. After a washout period, brimonidine was applied twice daily in all patients for 6 weeks; 16 patients continued for 12 weeks. Patients were examined at 2, 6 and 12 weeks. The primary outcome measure was the difference in mean intra ocular pressure (IOP) reduction at 6 and 12 weeks. The mean diurnal variation of IOP at baseline and at 12 weeks was also compared. Results: Twenty-six of 28 enrolled patients completed the study. One randomly selected eye of each patient was used for analysis. At 6 weeks, the mean IOP reduction was 11.2 mm Hg (± 2.9 mmHg) with latanoprost and 6 mmHg (± 3.3 mmHg) with brimonidine. At 12 weeks this was 10.8 mmHg (± 2.8 mmHg) and 6.9 mmHg (± 3.1 mmHg) respectively. At 6 weeks 85.7% (24) eyes obtained more than 25% reduction in IOP with latanoprost compared to 13 (46.4%) with brimonidine. IOP reduction was maintained with both drugs throughout the study period. Two eyes did not show any response to brimonidine. Latanoprost reduced the diurnal variation of IOP from 5.10 to 2.90 mmHg; brimonidine reduced it from 4.70 to 3.90 mmHg. Conjunctival hyperaemia was present in one patient on latanoprost and three patients on brimonidine. Two patients experienced drowsiness with brimonidine. Neither drug produced side effects necessitating withdrawal from the study. Conclusion: In this short-term study, both latanoprost and brimonidine effectively reduced IOP and stabilised the diurnal curve in Indian eyes. Latanoprost was more effective than brimonidine.
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