HELLO!

AVANTIKA EYE CARE &

GLAUCOMA SERVICES

I am Dr. Neha Midha

MBBS MD(AIIMS) DNB FICO(UK) MNAMS

Director: Avantika Eye Care and Glaucoma Services

Ex.Senior Resident RPC, AIIMS

Ex-Glaucoma Fellow, Clinique Montchoisi, Switzerland
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Pre Perimetric Glaucoma

TREAT IMMEDIATELY!
PRE PERIMETRIC
GLAUCOMA
AAO Glaucoma Severity
Staging
 THIS IS A SLIDE TITLE

⊡ Mild/early: Structural optic nerve changes consistent with

glaucoma with no evidence of visual field changes with
standard automated perimetry (preperimetric glaucoma).

⊡ Moderate: Optic nerve changes consistent with glaucoma and glaucomatous

visual field changes in one hemifield and not within five degrees of
fixation.

⊡ Severe: Optic nerve changes consistent with glaucoma and glaucomatous

visual field changes in both hemifields or loss within five degrees of
fixation in at least one hemifield, or both.

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 With pre-perimetric
glaucoma do not have
symptoms of the disease,
and treatment may make
the patient symptomatic!
 THIS IS A SLIDE TITLE

⊡ Glaucoma even in advanced stage will not have any symptoms.

⊡ Starting treatment later in the course of disease will make the

patient more burdened with medication and preservatives!

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Glaucoma is a slow disease!
 THIS IS A SLIDE TITLE

⊡ Yes it is slow!

⊡ But now the life expectancy has also increased!

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Starting treatment vs
Quality of life
⊡ No treatment improves quality of life, It prevents
deterioration!

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The risk of visual field progression in untreated PPG eyes is considered
to be high, so the PPG eyes enrolled in the above-mentioned studies,
as well as those in the present study, received topical treatment with
IOP-lowering agents. There have not been any reports on the natural
course of PPG because of ethical reasons. Thus, PPG patients with
risk factors such as ONH blood impairment should consider starting at
least the minimal treatment.
⊡ We don’t need to wait for that 40% RGC loss to
happen, scotoma develop and then we intervene!

⊡ What is the use of OCT/OCTA then!

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⊡ Glaucoma progression was detected in 72 of127 eyes (56.7%).

⊡ Optic disc hemorrhage (hazard ra-tio [HR][1.718,P[.031) and the

percentage reduction in intraocular pressure (IOP;
HR[0.964,P[.002) were significantly associated with disease pro-
gression.

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15
⊡ Seventy-one eyes (54.6%) developed a glaucomatous
VFD during the follow-up period. The mean deviation
slope varied from −0.90 to 0.41dB/year.

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 ⊡ The glaucoma progres-sion probability at 5 years was
39% by structural criteria and 5% by functional criteria

Bak, E., Kim, Y. W., Ha, A., Kim, Y. K., Park, K. H., & Jeoung, J. W. (2020). Preperimetric Open Angle
Glaucoma with Young Age of Onset: Natural Clinical Course and Risk Factors for Progression. American
Journal of Ophthalmology.
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⊡ Incidence of glaucoma in the lost-to-follow-up NTG suspect patients 9.7 % over a
44-month follow-up loss period with a rate of 2.6 %/year. Compared with the 0.1
%/year rate of progression to glaucoma in normal subjects based on the Melbourne
Visual Impairment Project [3] and a rate of0.55 %/year based on the Barbados Eye
Study [4], the results in the present study were relatively greater

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⊡ Beware of Red Disease
⊡ Clinical ONH assessment, should corroborate with
OCT finding
⊡ RNFL thinning at superior and inferior poles
⊡ Monitor progression
⊡ Patient mindset– preventive health check up concept
is not so prevalent in INDIA.
⊡ The likelihood of missing follow up in absence of any
sympotoms along with NO medication is HIGH!

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Pre Perimetric Glaucoma

TREAT IMMEDIATELY!
 THANKS!

Any questions?
You can find me at
Neha.midha1@gmail.com

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 2

NETWORKING

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 MEET, MEET, MEET

General Ophthalmologists, Other sub-specialists, Physicians

Don’t Shy away!! Meeting once is not enough….
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⊡ EVEN PRE PERIMETRIC HAVE SHOWN SOME
CHANGES ON
There was PERIMETRY.
a significant difference in MD between
healthy VFs and PPGVFs (0.0361.11 and0.9161.56 dB
[mean6standard deviation], respectively;P<0.001,
linearmixed model) and in PSD (1.5660.33 and
1.9760.43 dB, respectively;P<0.001). Asignificant
difference was observed in the TD values between
healthy VFs and PPGVFs at 25(P<0.001) of 52 test
points (linear mixed model). The AROC obtained by
using the RandomForests method was 79.0% (95%
confidence interval, 73.5%–84.5%).

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 3

GIVER’S GAIN

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 “
GIVE REFERRALS
TO
GET REFERRALS

If You Keep Giving Anti VEGFs They Will

Continue To Prescribe AGMs

26
 4

FINANCES

27
 TYPE OF PRACTICE

STAND
MULTISPECIALTY
CORPORATE ALONE/GROUP
HOSPITAL
PRACTICE

28
RUNNING COST EQUIMPENTS FUNDING

APPLANATION PARENTAL SUPPORT

GONISCOPE
BANKS ARE VERY
PERIMETRY GOOD OPTION
OCT
HAVE BACKUP FOR
ATLEAST 1 YEAR

Setups With All Diagnostic Facilities Are More

Likely To Get Referrals
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 5

ETHICAL MARKETING

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 CREATE
EDUCATIONAL
CONTENT

31
 CONDUCT CME

(FUNDING FOR EDUCATIONAL ACTIVITIES CAN BE RAISED)

32
 5

HONESTY

PATIENT REFERRING DR.

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o Refer to higher center when needed

o Never hesitate for second opinions.

o Treat patient as whole, not just the IOP

o Communication is the KEY

34
REFER BACK
The patient and their known
to the primary physician whenever needed

35
 5

HAPPINESS

36
 DREAM BIG----------REALISTIC GOALS

 A GOOD WORK FAMILY LIFE BALANCE

 TAKE OUT TIME FOR YOURSELF: MEDITATE, EXERCISE.

37
Any questions?
You can find me at
neha.midha1@gmail.com

YOU
+919711580979

THA
NK
38
 AND TABLES TO
COMPARE DATA

A B C

Yellow 10 20 7

Blue 30 15 10

Orange 5 24 16

39
 MAPS

OUR OFFICE

40
89,526,124
Whoa! That’s a big number, aren’t you proud?

41
 89,526,124$
That’s a lot of money

185,244
And a lot ofusers
users

100%
Total success!

42
 OUR PROCESS IS EASY

first second last

43
 ROADMAP

Blue is the colour of the Red is the colour of danger Black is the color of ebony
clear sky and the deep sea and courage and of outer space

1 3 5

2 4 6

Yellow is the color of gold, White is the color of milk Blue is the colour of the
butter and ripe lemons and fresh snow clear sky and the deep sea

44

YELLOW
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
YELLOW
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
LET’S REVIEW
SOME CONCEPTS
BLUE
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
BLUE
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
45
RED
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
RED
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
4000

3000

2000

1000

You can insert graphs from

Excel or Google Sheets
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 MOBILE
PROJECT

Show your web,

...using these
app or software
gadget templates.
projects...

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 TABLET PROJECT

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gadget templates.
projects...

48
 COMPETITOR MATRIX
HIGH VALUE 2

Competitor
Compet
itor
Our company

Competitor

HIGH VALUE 1
LOW VALUE 1

Competitor

Competitor Competitor

LOW VALUE 2

49
 DESKTOP
PROJECT

Show your web, ...using these

app or software gadget
projects... templates.

50
 THANKS!

Any questions?
You can find me at
@username
user@mail.me

51
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 TIMELINE

Yellow is the color of

Blue is the colour of the Red is the colour of danger Black is the color of ebony gold, butter and ripe White is the color of milk Blue is the colour of the
clear sky and the deep sea and courage and of outer space lemons and fresh snow clear sky and the deep sea

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Yellow is the color of White is the color of milk Blue is the colour of the Red is the colour of danger Black is the color of ebony Yellow is the color of
gold, butter and ripe and fresh snow clear sky and the deep sea and courage and of outer space gold, butter and ripe
lemons lemons

55
 GANTT CHART
Week 1 Week 2

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Task 1

Task 2 ◆

Task 3

Task 4 ◆

Task 5 ◆

Task 6

Task 7

Task 8

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 SWOT ANALYSIS

STRENGTHS WEAKNESSES
Blue is the colour of the clear sky Yellow is the color of gold, butter
and the deep sea and ripe lemons

Black is the color of ebony and White is the color of milk and
of outer space fresh snow
OPPORTUNITIES THREATS

57
 BUSINESS MODEL CANVAS
Key Partners Key Activities Value Propositions Customer Relationships Customer Segments
Insert your content Insert your content Insert your content Insert your content Insert your content

Key Resources Channels

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 TEAM PRESENTATION

Imani Jackson Marcos Galán Ixchel Valdía Nils Årud

JOB TITLE JOB TITLE JOB TITLE JOB TITLE
Blue is the colour of the clear Blue is the colour of the clear Blue is the colour of the clear Blue is the colour of the clear
sky and the deep sea sky and the deep sea sky and the deep sea sky and the deep sea

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 WEEKLY PLANNER

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

09:00 - 09:45 Task Task Task Task Task Task Task

10:00 - 10:45 Task Task Task Task Task Task Task

11:00 - 11:45 Task Task Task Task Task Task Task

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⊡ If identifying preperimetric glaucoma using progression onOCT
accurately predicts perimetric vision loss, then it makessense to initiate
or increase therapy sooner instead of waiting forconfirmatory visual
field changes. If a clinician only has accessto 1 abnormal field,
however, then repeat examinations are needed,as the question is
whether the field is stable or still worsening.Some glaucoma suspects
may have normal fields and abnor-mal OCTs, and still others may
have normal fields and nor-mal OCTs but elevated IOPs. Given these
different glaucoma uspect situations, clinicians need to assimilate
multiple inputsof age, vision, IOP, nerve status, and visual field
65Asia Pac J Ophthalmol2016;5: 32–37)