On 11 th March 2020, the World Health Organization (WHO) declared the COVID-19 caused by the 2019 novel coronavirus (2019-nCoV) a pandemic. [1] Currently, there are more than 3 million cases and one lakh deaths reported, and still counting. [2] This has brought radical changes in all aspects of our lives. Social distancing and restrictive movement policies have markedly deranged traditional educational practices. The time course of these changes is indeterminate. These have affected conventional in-person ophthalmic education and training. There is a pressing need to innovate and implement alternative educational and assessment strategies. The COVID-19 pandemic has provided us with an opportunity to pave the way for introducing digital learning in ophthalmology.

BackgroundBeedi also known as poor man’s cigarette is manufactured in almost all major states of India. Beedi workers are exposed to various health risks. There is an increased risk of systemic absorption of tobacco through skin and mucous membrane. The optic nerve is susceptible to damage from several toxic substances including tobacco. This group of disorders is known as toxic optic neuropathy (TON). The association of TON with occupational exposure to unburnt tobacco in beedi rollers has not been explored.ObjectivesAmong the beedi rollers in Mangaluru and Bantwal talukas of Dakshina Kannada District, Karnataka, India: to assess the magnitude of potential TON utilizing colour vision and contrast sensitivity as screening tools and to identify the demographic, biological and occupational factors associated with potential TON.MethodsA community-based cross-sectional study was conducted from April-Sept 2016 in Mangaluru and Bantwal talukas, of Dakshina Kannada district, Karnataka. Beedi rollers from twelve villages (six from each taluka) were included. In each of the selected villages, the investigators identified beedi collection centres and all the eligible beedi rollers were included in the study till the required number of beedi rollers for that village was achieved. Participants were screened at the study site for visual acuity, colour vision and contrast sensitivity and those with abnormal colour and contrast sensitivity in the presence of good visual acuity were considered to have potential TON.ResultsA total of 377 beedi rollers were approached; of which 365 consented to take part in the study (response rate: 96.81%). Women constituted the majority of the participants (n = 338, 92.6%). Based on the screening criteria, the prevalence of potential TON was 17.5% (n = 64, 95% CI: 13.5–21.9). On multiple logistic regression analysis, duration of beedi rolling (Adj OR: 1.061; 95% CI 1.015–1.109, p = 0.009), advancing age (Adj OR: 1.096; 95% CI 1.058–1.136, p<0.001) and presence of diabetes (Adj OR: 6.315; 95% CI 1.4572–27.376, p = 0.014) were independent correlates of potential TON.ConclusionIn the present study, almost one out of six beedi rollers displayed clinical signs of potential TON. Increased duration of beedi rolling, advancing age and presence of diabetes were the independent correlates of potential TON. However, with this cross-sectional study it is not possible to conclude if these factors play a role individually or collectively or are a serendipitous association, for which large scale analytical studies are required.