May 21, 2003, Chandigarh, India
an emerging cause of blindness
AYURVEDA & YOU
How to get the best
out of LASIK
Only a spectacle-wearer can experience the handicap without the glasses. It generates the keen desire to be able to see clearly without glasses. Contact lenses have been fulfilling this desire for many years. The recognition and acceptance of LASIK as a safe procedure has offered a new choice to millions of spectacle-wearers. The American Academy of Ophthalmology has recognised LASIK as "safe procedure for moderate myopia".
Like any other procedure in medicine, it is not a panacea for all spectacle-wearers.
The appropriate case selection is crucial for the safety and efficacy of the procedure. Besides the surgeon’s bank, it is important for the prospective lasik case to know about the apt criteria of case selection.
Are you suitable for LASIK? The answer comes from a two-step approach. The first step: Is the person suitable for LASIK? And the second is: Is the eye suitable for LASIK?
For the first step the following three strict criteria should be met: 1. The person should be above the age of 18 years. There is no upper age limit for the procedure. 2. The number of the glasses is more than one. 3. Stable power of glasses that has not fluctuated by more than half a number during the previous year.
LASIK is not a procedure where a technician feeds the number in computer and the machine corrects the vision to 6/6. A lot of parameters need to be evaluated and controlled. Make sure that you are evaluated for all these parameters.
The assessment of the number to be corrected is crucial. Make sure that the assessment of your vision with the spectacle is perfect. If you are not happy with the quality of vision during spectacle testing, fix another appointment with the doctor for repeat testing. Make sure that your "resting eye number" is checked after instilling cycloplegic drops. These drops temporarily paralyse the focusing muscles and permit the accurate evaluation of the power of the eye. The number should be reconfirmed after the effect of the drug is over in a day or so.
The use of contact lenses leads to reversible changes in the cornea. The tissue should be allowed to come back to normal before the evaluation of the cornea for LASIK is carried out. If you are a contact lens wearer, please honestly take off the lenses for two weeks. Hard and semisoft lenses need to be removed for longer times.
Retinal degeneration is more common in myopes. In the presence of retinal breaks, the risk of retinal detachment is high. Make sure that a detailed dilated pupil fundus examination is carried out, and if the surgeon identifies retinal breaks they should be sealed with laser before LASIK can be performed. If you are pregnant, or taking HRT or systemic steroids or have keratoconus or irregular astigmatism, you will be better off with glasses.
It is normal for patients to experience temporary dryness after LASIK. The patients who have inadequate tears before surgery are at a higher risk of prolonged dry-eye symptoms after LASIK and should have increased lubrication before surgery.
Pachymetry is a medical term for ‘corneal thickness." The LASIK procedure involves creating a flap on the surface of the cornea and using the laser to reshape the cornea by removing tissue. It is possible that too much tissue can be removed by the laser. This can destabilise the cornea and lead to corneal bulging. This condition is called ectasia and results in distorted vision.
A multi-point measurement of corneal thickness is mandatory. Without pachymetry how can the surgeon be sure that the laser is not going too deep?
emerging cause of blindness
Due to the faulty and excessive intake of food along with an increasing lack of physical activity, the incidence of life-style diseases like diabetes is rising fast. It is estimated that 25 per cent of the population above 40 years of age in the urban areas is at the risk of developing diabetes, sooner than later. Uncontrolled diabetes invites changes on the retina of the eye along with damage in the vital organs. The changes on the retina that lead to irreversible blindness are called diabetic retinopathy. Uncared, it can progress to a severe form characterised by the growth of new blood vessels on the retina and vitreous. Macular edema, characterised by retinal thickening from leaky blood vessels, can develop at all stages of retinopathy. Pregnancy, puberty, blood glucose control with insulin, hypertension, and cataract surgery can accelerate these changes. Diabetic retinopathy is the most frequent cause of new cases of blindness. More than 60 per cent cases of adult onset diabetes can develop this problem. Good control of diabetes and a healthy life-style is the answer.
Central vision may be impaired by macular edema or capillary non-perfusion. New blood vessels and contraction of the accompanying fibrous tissue can distort the retina and lead to retinal detachment. In addition, the new blood vessels may bleed, leading to further complications of vitreous hemorrhage. The duration of diabetes is probably the strongest predictor for the development of retinopathy. Intensive therapy to control diabetes reduces the mean risk of retinopathy by 76 per cent.
After only two years, laser treatment was shown to significantly reduce the severe visual loss. At present, laser photocoagulation for diabetic retinopathy is effective at slowing the progression of retinopathy and reducing visual loss, but the treatment does not restore lost vision. It is important to identify and treat patients in the early stage of the disease. To achieve this goal, patients with diabetes should be routinely evaluated to detect treatable disease. For patients with moderate-to-severe retinopathy, frequent eye examinations are necessary to determine when to initiate treatment. Patient education also occurs during examinations. Patients know the importance of controlling their blood glucose, blood pressure and serum lipids, and this importance can be reinforced at a time when patients are particularly aware of the implications of vision loss.
What can you do?
Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist shortly after diagnosis. An ophthalmologist, who is knowledgeable and experienced in diagnosing the presence of diabetic retinopathy and is aware of its management, should repeat subsequent examinations for diabetic patients. Examinations will be required more frequently if retinopathy is progressing. When planning pregnancy, women with pre-existing diabetes should have a comprehensive eye examination done and should be counselled with regard to diabetic retinopathy. The women with diabetes who become pregnant should have a comprehensive eye examination done in the first trimester and should go in for close follow-up throughout pregnancy Early referral to an ophthalmologist is particularly important for patients with diabetes, since laser treatment at an early stage is associated with a 50 per cent reduction in the risk of severe visual loss.
In the absence of the risk factors such as the onset of retinopathy, insulin use, or the disease duration greater than 20 years, they recommend screening for retinopathy every year for patients with controlled diabetes. They also recommend that the presence of any of these risk factors should prompt twice a year screening, and patients with mild pre-proliferative retinopathy should be examined every four months.
Though India in general is a tropical country, there are variations of seasons at different places at a single time. If areas falling in the Himalayan range are always cold, most of the places situated south of the Vindhyas experience moderate-to-intense heat where fans and airconditioners could be seen working round the year. Practically, the months of ‘jyeshtha’ and ‘ashadha’, which correspond to the period ranging from mid-May to mid-July of the western calendar, constitute the summer season in India.
Keeping in view the northward and southward movement of the Sun in relation to the earth, ancient Indian scientists broadly divide a solar year into two parts — ‘uttrayana’ and ‘dakshinayana’. Ayurvedic scholars understood these two divisions as ‘adana kala’ and ‘visarga kala’, respectively. Each of these periods is further divided into three seasons, thus making a total of six seasons in a year. The first part consists of seasons of late winter, spring and the summer whereas the rainy season, autumn and winter constitute the other one.
The summer season is the culmination of ‘adana kala’. It is during this period when due to its conjugation with the powerful sun, the atmosphere becomes hot, sharp and dry. As ‘adana’ in Sanskrit means taking way, it is the season when increased atmospheric heat not only dries up moisture of the earth and its vegetation but also reduces ‘kapha’ in the human bodies. This leads to reduced immunity, resulting in increased susceptibility to ill health and a fall in general vitality and energy. Here are a few tips for a conducive diet plan and other lifestyle modifications to be adopted in summer:
As ‘kapha’ is on the decline in summer, ayurveda advises to take sweet, cold and unctuous diet in this period. One should avoid taking food items which are overwhelmingly salty, sour, pungent, dry and hot in effect. Since the infection rate and incidents of gastro-intestinal upsets are quite high in summer, instead of eating out, one should opt for home-made fresh and easily digestible food. Excessive use of alcohol and non-vegetarian food should be avoided.
Due to increased sweating, our body system requires extra-consumption of water. To meet this requirement, one should take water at regular intervals. It is better to take a glass or two of it before setting out, whereas the same should be avoided for a moment immediately after returning from severe heat. Sufficient intake of water also helps to keep away some urinary problems frequenting in summer like its scantiness, burning and subsequent infection. Patients of chronic constipation should increase fibre in their diet as regular use of laxatives in summer may lead to weakness in the body.
Water loss and electrolyte imbalance resulting due to excessive sweating can lead to the lowering of body strength and exhaustion. Instead of aerated soft drinks, the traditional home-made ones are more effective in replenishing the lost energy. Use of buttermilk, lime water and various ‘sharbats’ like that of sandal, rose and khus beat the summer heat in a natural way. Taking a decoction of either the dry barley powder, popularly known as ‘sattoo’, or 10 to 20 ml of milk diluted in a glass of sweetened cold water work as good diuretics. ‘Panna’ of raw mango is an effective home remedy to keep appetite and digestion in good condition.
One should not opt for heavy and strenuous exercise in summer. When out in the heat, take particular care to keep your head and back of the neck covered. Getting up early in the morning, taking a short nap at noon, wearing light dresses, staying in cool places and avoiding much of the late nights is the recommended daily routine.
Acharya Charaka describes two distinct types of diseases occurring in summer. The first ‘anshughat jwara’ is the milder form of heat fever or the heat exhaustion while the second one described as ‘anshughat sannipata’ is the severe and serious manifestation, also known as sunstroke. Heat exhaustion can be managed with some of the general measures mentioned above, but sunstroke is a life-threatening problem and should be effectively managed in a hospital as an emergency case.
The writer is a senior ayurvedic
consultant based at Ludhiana. Phones: 2423500, 2431500. E-mail-
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