Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.

Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p < 0.001). During the study period, the average number of intravitreal injections was 3.5 per patient. There was no report of endophthalmitis in any eye. Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.

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The growing incidence of neovascular age-related macular degeneration (nAMD) in India and its debilitating consequences, such as physical, psychological, and emotional stress, are a cause of significant concern. Failing eyesight due to nAMD hinders the ability of patients to perform daily tasks, leading to dependency on others -often resulting in anxiety and depression. Although treatment options such as anti-vascular endothelial growth factors (anti-VEGFs) are readily available, long-term treatment compliance is often compromised. Thus, it is important for health care providers to be aware of the burden associated with nAMD for both patients and caregivers. India, with its large urban and rural population base, faces varied challenges in health care accessibility and affordability. Further, there is a paucity of India-specific studies to ascertain patient and caregiver burden related to nAMD. A deeper understanding of disease awareness and treatment expectations from an Indian perspective may further help clinicians to provide optimum management to patients. The current review provides insights into the quality of life (QoL) and treatment-related burden for patients with nAMD and their caregivers. Further, it emphasizes the need of PAN-India studies to ascertain the patient and caregiver burden related to nAMD, which may assist in devising treatment algorithms and pricing policies suited to the Indian population and enable patients to receive quality eye care.

Neovascular age-related macular degeneration (nAMD) is the leading cause of severe vision loss and blindness across the globe. Aging is one of the main risk factors that can be attributed to development and progress of nAMD. This review article focuses on the various nAMD associated challenges that clinicians face with respect to its diagnosis, treatment and follow up. Challenges associated with diagnosis of nAMD include delayed diagnosis and challenges related to Optical Coherence topography (OCT) imaging. Even though anti-VEGFs are the mainstay of treatment and are effective in maintaining or improving vision, treating nAMD comes with its own set of burdens from the clinician's perspective. Clinicians are faced with the choice of different types of anti-VEGFs, treatment regimens and the chronic, variable and unpredictable nature of nAMD all of which can have a major impact on treatment outcomes. Monitoring associated with treatment is also a major burden. Newer anti-VEGFs which have a longer, sustained action may help decrease this burden. Other challenges include stressed out clinic capacities, lack of equipment and trained personnel. The aim of this review article is to highlight the challenges attributed to the diagnosis and management of nAMD from a clinician's perspective, especially important in developing countries like India which face a combination of high disease burden, lack of disease awareness, lack of facilities, equipment and personnel. Together, they can have a disastrous effect, impacting vision of the aging population. There is a dearth of India-specific data on the various challenges of diagnosis and treatment of nAMD. Such data can act as a building block upon which strategic steps can be developed and implemented which in turn may help save the vision of the huge Indian population who are afflicted by nAMD.