Never neglect cataract problems

By Nilma Dole

Did you know that in Sri Lanka, 80,000 cataract operations are performed annually and out of that number, while it is estimated that 100,000 are suffering in silence? Estimates from the Health Ministry’s Vision 2020 survey mentions that another 100,000 will add to this figure very soon if nothing is done to restore vision.

Dr. Shamintha Amaratunga

But for Dr. Shamintha Amaratunga, sight is life’s most precious gift. A veteran eye surgeon, Dr. Amaratunga has created a world record for the 20 cataract surgeries he does in an hour; all these operations are performed free of charge.

Speaking to the Sunday Observer Dr. Amaratunga said, “Cataract has been identified as the most common cause of reversible blindness and the only treatment is surgery.” He launched an e-book recently called ‘Beyond the threshold’ Efficiency in Cataract surgery’ that explains knowledge and techniques through his professional experience.

“I want to share my secrets with the Sri Lanka medical industry so that we can help make our medical industry better. The secret of performing a surgery in two minutes and 20 seconds is effective time management and 100 percent mental concentration on the operation at hand without any distractions.” He said that it might seem like a simple technique but it makes a world of a difference.

Dr. Amaratunga uses a technologically innovative cataract surgery called ‘Phaco emulsification and foldable intra-ocular lens implantation’ to ensure that sight is quickly restored to his patients.

“What happens in Phacoemulsification (phaco for short) is a small incision is made on the side of the cornea. We then insert a tiny probe into the eye and this device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. After that, sight is restored in a few days provided the area around is clean,” said Dr. Amaratunga.

Most cataract surgeries today are done by phacoemulsification, also called “small incision cataract surgery” and this is one of the effective means of correcting cataract vision.

Another method is 'Extracapsular surgery' where a longer incision is made on the side of the cornea and removes the cloudy centre of the lens in one piece. The rest of the lens is removed by suction. After the natural lens has been removed, it often is replaced by an artificial lens, called an Intra Ocular Lens (IOL).

Just like any surgery, cataract surgery also poses risks, such as eye infections or bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery.

“After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision,” said the doctor. Cataract removal is one of the most common operations performed in Sri Lanka.

Dr. Amaratunge said, “Since the benefits outweigh the risks, it's one of the safest and most effective types of surgery where in 90 percent of cases, people who have cataract surgery have better vision afterward.”

Taking this distinguished eye surgeon’s advice won’t go wrong.

Dr.Amaratunge’s portfolio includes a collosal 45,000 surgeries encompassing 35,000 of Phacoemulsification and IOL implants from 2006 to 2010.

He handles an average of 85 to 100 Phaco emulsification surgeries per surgical list and last year alone, he did 12,611 Phaco surgeries of which over 2200 had been performed at free eye camps. What is special about this eye surgeon is that he wants to share his knowledge with Sri Lanka’s eye doctors because his aim is to contribute to improving the efficiency in cataract surgery with the existing infrastructure.

Facts about cataract:

1. A cataract is the cloudy appearance that occurs in the lens of the eye affecting vision.

2. Most cataracts are related to ageing where by 80 years most Sri Lankans have cataract or have had cataract surgery.

3. A cataract can occur in either one eye or both eyes. It cannot spread from one eye to the other.

4. Some types of cataract include secondary cataract, traumatic cataract, congenital cataract and radiation cataract.

5. As we age, some of the protein in the lens of the eye may clump together and start to cloud a small area of the lens causing cataract.

6. Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.

7. Cataract detection is done via a visual acuity test, a dilated eye exam or tonometry.

Three-parent babies on the way, say IVF experts

by Jeremy Laurance

Leading scientists have appealed to Andrew Lansley to set a timetable for the introduction of a controversial technique known as “three-parent IVF” after a scientific review found no evidence it was unsafe.

The procedure involves swapping genetic material before the IVF embryo is implanted in the womb to prevent the transmission of some of the most severe inherited disorders. But it would lead to permanent changes in the genetic make-up of children that would be passed on to subsequent generations and breaks new ground in IVF research.

Mitochondrial disease mutations in small structures called mitochondria which surround the cell nucleus is carried by thousands of women and is passed down the maternal line, leading to the birth of about 100 severely disabled children every year. Some women with the disorder have had up to six children who have died because of the severity of their disabilities.

In an open letter to the health secretary signed by the heads of the Academy of Medical Sciences, the Medical Research Council, the Wellcome Trust and four other bodies, the scientists said regulations governing use of the gene-switching technique should be drawn up now so it can be introduced without delay once sufficient evidence of its safety and efficacy has been amassed.

“Given the importance of such research for couples wishing to have children free of mitochondrial disease, and the speed at which research in the field is developing, researchers and patients now need assurance that such techniques will move into the clinic.

We consider it essential that UK patients should benefit from treatments resulting from research conducted here,” the scientists led by Professor Sir John Bell, president of the Academy of Medical Sciences, say.

Mr Lansley ordered a review of the science of the technique, carried out by a panel appointed by the Human Fertilisation and Embryology Authority (HFEA), which concluded that though there was nothing to suggest it was unsafe, further research was necessary.

The mitochondria are the power packs of the cell, contained in the cytoplasm that surrounds the nucleus, which provide it with energy.

They carry very small amounts of genetic material, mutations in which lead to potentially fatal problems such as organ failure and symptoms including blindness.

Women may be carriers of the inherited disorder without being affected themselves and some, or all, of their children may be affected.

To avoid it, the nucleus of the woman’s egg or embryo, containing more than 99 per cent of her genes, is removed, leaving the affected mitochondria in the cytoplasm surrounding it behind, and placed in a donated egg or embryo with unaffected mitochondria, whose own nucleus has been removed.

The resulting child has more than 99 per cent of the genes belonging to its father and mother and less than 1 per cent from the donor.

The scientific review of the technique, co-chaired by Robin Lovell-Badge of the Medical Research Council, says further work is needed into the two methods of switching the nucleus the maternal spindle transfer, conducted before fertilisation, and the pronuclear transfer, conducted after fertilisation to check offspring born to rhesus monkeys are unaffected and that human eggs and embryos similarly treated grow normally in the laboratory.

Dr Lovell-Badge said: “Some people seem to be taking our report as negative and hesitant. It is not meant to be at all. We just need a little bit more information. In my view it won’t take very long a year and a few months. We don’t know which of the two techniques is best.”

Ethical and legal reviews still had to be conducted one method involved the destruction of fertilised embryos alongside the preparation of new regulations but these should happen in parallel with the extra scientific research so measures were in place to treat the first patients as soon as the technique was approved, he said.

Case study: ‘This would have changed my life’

Ruth Safak’s 20-year-old son, Deniz, is confined to a wheelchair, has regular seizures and suffers severe migraines. Ruth, 54, is his sole carer.

“I think the research into three-parent IVF to prevent mitochondrial disorders is fantastic and nothing should stand in its way.

“The only people who should have the right to criticise it are those who suffer from the disease.

“I didn’t know until Deniz was eight that he was affected by it and I was a carrier. He can’t do anything for himself, he needs round-the-clock care and suffers terribly. If I could have avoided this, what a marvellous life we would have had.”

Courtesy: The Independent

Potential cardio-protective mechanism in heart

New insight into the physiology of cardiac muscle may lead to the development of therapeutic strategies that exploit an inherent protective state of the heart.

The research, published by Cell Press online on April 19th in the Biophysical Journal, discovers a state of cardiac muscle that exhibits a low metabolic rate and may help to regulate energy use and promote efficiency in this hard-working and vital organ.

Muscle cells are highly specialized cells that are able to physically contract and produce force. Many variables contribute to the active generation of force, with the availability of calcium in the cell interior playing a major role in the process of muscle contraction.

However, recent studies have also implicated the state of a key contractile protein called myosin. Myosin is a motor protein that binds to another contractile protein (called actin) and, using energy it liberated from ATP, pulls on the actin to physically shorten the muscle.

“We have recently identified a new ‘super’ relaxed state of myosin in resting skeletal muscle, called the SRX,” says senior study author, Dr. Roger Cooke from the University of California, San Francisco. “The SRX state has a much smaller ATP turnover rate and shows that “relaxed” myosin comes in at least two states that differ with regards to energy utilization.

By analogy with another motor, active myosin generating force is akin to a car racing down the road. The normal relaxed myosin is similar to a car stopped at a traffic light with the motor running, and the counterpart of the SRX is a car parked beside the road with the motor off. In the current study, we sought to build on our earlier work in skeletal muscle and examine the SRX state in cardiac muscle cells.”

Dr. Cooke’s group showed that there is an SRX state in resting cardiac muscle cells that is similar to the SRX state in resting skeletal muscle cells. The researchers went on to show that when you look at active muscle, the SRX state is quite different in cardiac muscle compared to skeletal muscle.

“We observed a rapid transition of myosin out of the SRX state in active skeletal muscle cells, while, somewhat surprisingly, the SRX state was maintained in active cardiac muscle cells,” says Dr. Cooke.

This suggests that the SRX plays a very different role in these different types of muscle.

Source: Elisabeth Lyons Cell Press

Study shows that a cluttered brain doesn’t remember

Lapses in memory occur more frequently with age, yet the reasons for this increasing forgetfulness have not always been clear. According to new research from Concordia University, older individuals have reduced learning and memory because their minds tend to be cluttered with irrelevant information when performing tasks.

Published in The Quarterly Journal of Experimental Psychology, these findings offer new insights into why aging is associated with a decline in memory and may lead to practical solutions.

“The first step of our study was to test the working memory of a younger and older population and compare the results,” says Mervin Blair, first author and a PhD student in Concordia’s Department of Psychology and a member at the Centre for Research in Human Development.

“In our study, working memory refers to the ability of both retaining and processing information.”

Some 60 participants took part in the study: half were an average of 23 years old, while the other half was about 67 years old.

Each participant was asked to perform a working memory task, which included recalling and processing different pieces of information.

“Overall, we showed that our older participants had reduced working memory compared to our younger participants,” says Blair. “Younger adults were better than the older adults at recalling and processing information.”

“Our study was novel because we looked at how the ability to recall and process information at the same time changes as people get older,” adds Karen Li, senior author and a professor in Concordia’s Department of Psychology and a member of the Centre for Research in Human Development.

Older people don’t purge irrelevant info The next step was to determine if there was a timeframe when the ability to delete irrelevant information, known as inhibition deletion, changed. This was measured using a sequential memory task .

Images were displayed in a random order and participants were required to respond to each image in a pre-learned manner. Once again, the youngsters outperformed their older counterparts. “The older adults had poor inhibition, repeatedly responding to previously relevant images,” says Blair.

Analyses were conducted to determine the relationship between the ability to clear irrelevant information and working memory ability. “Poor inhibition predicted a decline in the recall component of working memory and it also predicted decline in the processing component of working memory,” says Blair.

“Basically, older adults are less able to keep irrelevant information out of their consciousness, which then impacts on other mental abilities.” For those who are having trouble remembering, Blair suggests that focusing and reducing mental clutter may help. “Reduce clutter, if you don’t, you may not get anything done.”

Keeping a mind clutter-free can be more difficult as people age, especially during periods of stress when people focus on stressors, yet Blair says relaxation exercises can help de-clutter the brain.

What’s more, the brain continues to function optimally into old age when it is mentally stimulated by learning a new language, playing an instrument, completing crossword puzzles, keeping an active social life and exercising. About the study:

The study, “The role of age and inhibitory efficiency in working memory processing and storage components,” was authored by Mervin Blair, Kiran Vadaga, Joni Shuchat and Karen Li of Concordia University.

Partners in research: This work was supported by funds from the Natural Sciences and Engineering Research Council of Canada.

Source: Sylvain-Jacques Desjardins Concordia University

Why dieters are easily misled by food names

Dieters are so involved with trying to eat virtuously that they are more likely than non-dieters to choose unhealthy foods that are labelled as healthy, according to a new study in the Journal of Consumer Research. It seems dieter focus on food names can work to their disadvantage.

“Keeping your weight-loss goal in mind as you scan the lunch menu at a café, you are careful to avoid pasta selections and instead order from the list of salad options,” write authors Caglar Irmak (University of South Carolina), Beth Vallen (Loyola University), and Stefanie Rosen Robinson (University of South Carolina). “But before you congratulate yourself for making a virtuous selection, you might want to consider whether your choice is a salad in name only.”

These days, restaurant salads can include ingredients that dieters would be likely to avoid (meats, cheeses, breads, and pasta).

Potato chips are labelled “veggie chips,” milkshakes are called “smoothies,” and sugary drinks are named “flavoured water.” Why are dieters, who are supposedly more attuned to healthy foods, likely to be confused by these labels?

“Over time, dieters learn to focus on simply avoiding foods that they recognize as forbidden based on product name,” the authors explain.

“Thus, dieters likely assume that an item assigned an unhealthy name (for example, pasta) is less healthy than an item assigned a healthy name (for example, salad), and they do not spend time considering other product information that might impact their product evaluations.”

Non-dieters do not learn to avoid foods based on names and, given that they are not focused on healthful eating, are more likely to dismiss cues that imply healthfulness, including name.

Participants in one study were presented with a mixture of vegetables, pasta, salami, and cheese, served on a bed of fresh romaine lettuce.

The item was either identified as “salad” or “pasta.” When it was called pasta, dieters perceived it as less healthy. In another study, participants were given samples of a product, which was labelled either “fruit chews” or “candy chews.”

Source: Mary-Ann Twist University of Chicago Press Journals