Preserve vision with timely action
Today the number of blind persons according to a survey worldwide is
37 million while a further 124 million in developing countries have low
vision. Although Sri Lanka's blind population is much less than her
neighbouring countries, it is estimated that blind persons total over
100,000 although the actual figures may be higher according to recent
Preliminary results of a survey by Vision 2020 Sri Lanka reveals that
2.5 percent of all persons over 40 years of age have some form of visual
impairment and that 90 percent of them suffer from Cataract blindness.
Senior Registrar Public Health and researcher on blindness in Sri
Lanka, Dr KAPILA PIYASENA gives us the following insights into what
causes blindness and those most at risk, while discussing obstacles that
stand in the way of health authorities battling to eliminate avoidable
blindness in our nation.
Normal vision and same
scene as viewed by a person with glaucoma
Q. I understand there are different levels of visual
impairments. How do you categorise blindness within these levels?
A. If you check your vision and it is less than 6/18 you will
be called ‘visually impaired'. this includes people who are blind and
those with low vision.
Q. What is low vision?
A. Low vision is considered as visual acuity of more than 3/60
and less than 6/18.
Q. What is the most common type of blindness in Sri Lanka?
A. Cataract blindness, which is also the most preventable and
treatable type of blindness, which can be reversed.
Q. What is cataract? How does one get a cataract?
A. Cataract develops when the eye lens which is a proteinous
transparent substance become opaque or cloudy and the light can’t pass
through making vision activity less.
Q. What are the causes? Does it happen suddenly?
A. It is a gradual process caused by several factors.
Preconditions such as: 1) poorly controlled diabetes, 2) foreign bodies
in the eye, 3) trauma or injury to the eye, 4) age 5) exposure to strong
sunlight, 6) malnutrition could cause cataracts to form.
Steroid containing eye drops used for some eye conditions like
inflammation can also lead to cataract. In addition asthmatic patients
who use pretizalone for a long period can be at risk.
A cataract patient
Q. Where can it be treated?
A. Surgery is the only way to treat it in this country. The
procedure is simple and if it is done in a government hospital it will
cost the patient much less. Almost all our state hospitals have the
facility to do cataract surgery.
Q. Does it always have to be done in a hospital setting?
A. Yes. Because it needs extremely sterile conditions to prevent
infection, and insert the inctro-occular lens into the affected eye by
the surgeon. This can therefore be done only in a hospital theatre.
Q. After the surgery does the patient have to be warded for
A. Not if he is physically well and has no pressure or diabetes,
in which case we will observe him for a while. When he returns home, his
carers will have to be told how to administer the drops he needs to take
at the prescribed times and he will need to return for follow up
Q. Does blindness affect certain age groups more than others?
A. Any age group can become blind. It is a disease that cuts
across age, race and gender.
Q. What about children?
A. Some children are born with metabolic conditions or
developmental problems or with malignancies in the eye. Premature babies
are born with cataract due to metabolic problems, and not because of
some fault of the mother as it wrongly believed.
Q. Today there is a rising incidence of blindness in school
children. Why is this?
A. This is mainly due to what we call ‘Refractive errors’ and
trauma to the eye.
Q. What are refractive errors?
A. They include conditions such as astigmatism and myopia.
Q. What happens if they don't get treatment in time or these
errors are not detected early?
A. Children's eyes develop up to the ages of 8-10 years. After
that their vision would be the same.
So if these eye defects are not corrected early or detected in time,
it would be too late to reverse them and these children will always have
Q. Can these defects cause blindness?
A. No. But the affected eye will always have low vision and be
considered ‘blind'. We call this condition ‘amblyopia'.
Q. How can such defects be treated?
A. To correct them they have to be first identified and this can
be done only by qualified eye physicians. Most of the defects can be
corrected with spectacles while the more complicated cases may need
Q. Does watching T.V. and playing with Computer games increase
the gravity of these conditions?
A. Watching T.V. and using the laptop for long periods can
increase vision related problems but does not cause visual impairments.
Parents must control the use of T.V. and computers by their children.
2020 Secretariat Co-ordinator Dr Asela Abeydeera explains
goals and work of unique program
Goals: To eliminate avoidable blindness in Sri Lanka by 2020. Current
* training doctors in all districts to detect eye defects in adults
* Raising awareness to motivate more blind persons from cataract to seek
* Conducting mass cataract screening programs in rural areas.
* Distributing free spectacles to needy school children.
* Providing cataract surgery free in all government hospitals with eye
units. Since the cost of the artificial lens is very high , varying from
25,000 to over 30,000, Vision 2020 can purchase them for Rs 3,500 on
behalf of a needy patient and give them free of charge.
Goal: To obtain 25,000 lens annually by way of donations for needy
patients. For more information contact: The Vision 2020 Team: Tel.
* Enlisting media to spread the message that 90 percent of cataract
blindness can be reversed immediately with cataract surgery, a quick,
simple, painless procedure with minimal side effects and follow up.
* ensure coverage of 75 percent cases of childhood blindness by 2012.
* Basic eye examination of all patients over 40 years for glaucoma
* Increase coverage of refractive errors services upto 50 percent by
Q. What are the symptoms of children who suffer from too much
of television watching or playing computer games?
A. Headaches while reading or studying, photophobia (inability to
bear bright lights), imbalance, nausea. In fact a multitude of
complaints they have are related to this.
Q. Glaucoma is another eye disease on the rise. What is
A. It is estimated that Glaucoma accounts for around 12 percent
in the country though we have no national statistics.
Glaucoma is a group of eye diseases that cause progressive damage to
the optic nerve at the point where it leaves the eye to carry visual
information to the brain.
There are several types of glaucoma. Some may occur as a complication
of other visual disorders (the so called secondary glaucoma) but the
vast majority is ‘primary’ i.e. they can occur without a known cause.
It was once believed that the cause of most or all glaucomas was high
pressure within the eye (known as intocular pressure or IOP). It is now
established that even people without an abnormally high IOP may suffer
The most common types of glaucoma are Primary Open Angle Glaucoma (POAG)
and Angle Closure Glaucoma.
The latter which is rare is often chronic, like POAG, but can
sometimes be acute with the patient getting severe pain in the eye,
vomiting and headaches.
In the case of Open angle glaucoma which is much more common there
are no symptoms.
Q. What causes open angle glaucoma?
A. The main cause is eye pressure. But even those with normal eye
pressure can get glaucoma.
You can develop secondary glaucoma after eye surgery, trauma to the
eye, or even from cataract.
Q. How can cataract cause glaucoma?
A. If a cataract is untreated and becomes mature it could cause
Q. How is it identified?
A. A trained eye physician will be able to detect it after
examining the patient's eye and retina.
Q. From the Ministry of Health point of view, what do you see
as some of the problems that face you in delivering optimal eye care to
the public as a whole? Do you have enough human resources?
A. At present we have only 63 eye surgeons in the country, 43 of
whom are general surgeons and the others specialising in general retinal
There is a plan to train more doctors in this field but till such a
time, we have a shortfall.
We also lack community ophthalmologists. They are qualified eye
doctors working with grass root level heath workers who they teach how
to identify screen and detect eye diseases in people especially in rural
areas and refer them for examination by a qualified physician.
Q. Your message to the public?
A. Preserve your vision with proper care and timely preventive
action. If you have an eye problem seek help from a qualified western
doctor instead of resorting to dubious quack doctors and alternative
How you can learn to love exercise
We all know that exercise is good for us. We join gyms, start
running, buy home workout DVDs, all in the quest for a fitter, slimmer,
more toned body and improved health. But after a few weeks our interest
wanes, we skip a session or two, life gets in the way and then we stop
altogether. After a while we tell ourselves we really should do some
exercise and then the cycle starts all over again. Regular, long term
exercise feels like an elusive goal.
If this sounds all too familiar and you wish you could fit regular
exercise into your life without it feeling like a chore, Joanne Henson,
author of ‘What's your excuse for not getting fit?’ has some advice:
Understand that exercise doesn't have to be unpleasant Many fitness
professionals talk about workouts as if they're of no value unless they
leave you gasping for air, covered in sweat and sore for the next few
For example, Crossfit, High Intensity Interval Training (HIIT) and
obstacle races like Tough Mudder - are all about how hard you can work
and what you can endure. But absolutely any exercise is better than no
exercise - even at a moderate level.
Also, exercise is not a punishment! If you use exercise to punish
yourself for what you've eaten, you're never going to enjoy it or feel
motivated to do it.
If you love it, you'll do it. So what do you enjoy? Do you like
exercising with a friend or do you need to exercise alone? Do you like
being outdoors, or do you hate being cold and wet? Do you need variety
or do you like the familiar? Do you like high energy activities or
something more calming? Keep trying different forms of exercise until
you find something which you enjoy - how about hiking, belly dancing,
martial arts, ballet, yoga, rowing, boxing, climbing, swimming? Exercise
doesn't have to involve joining a gym or running. There'll be something
out there which you'll find more fun, more satisfying and more
motivating than what you've done before.
Ease yourself into it
If you're new to exercise, or starting again after a long period of
inactivity, there's no need to go all-out straight away. Your body won't
thank you for going too hard too soon, and the pain, struggle and
post-workout soreness will just reinforce any belief that exercise is
unpleasant. Take it easy for the first few times - you can always work a
bit harder next time, and the next time, and the time after that...
Make it a habit
What do fit people have in common? They exercise regularly and
consistently. So make it your priority to establish the habit first -
you can concentrate on increasing your level of fitness later. If that
means getting yourself to a gym but doing only ten minutes’ exercise per
session for the first month, that's fine.
If you get there three or four times each week, you're establishing a
routine. Then you can turn your attention to improving your performance.
Pick the right exercise for your goal
One of the reasons people go so hard and give up so quickly is that
they are looking for a quick fix, and when they don't get one, they
Be patient, give it some time, and remember that exercise has long
term, ongoing health benefits beyond body shape. If you have a specific
goal, and you're going to invest time and effort in exercising, make
sure that time and effort is well spent.
What is it you want to achieve? Be honest with yourself, and if
necessary get some advice on what would be most effective.
For instance, if you want to tone up your bingo wings, target that
area with resistance training rather than go running.
Track your progress
One of the positives of regular exercise is experiencing improvement
and progress. If you didn't see any improvement, you'd eventually get
So track each small improvement to keep your motivation levels high.
For example, if you do your usual run today, and do it fifteen seconds
faster than three days ago you wouldn't be aware of this unless you had
a stopwatch, or used an app on your smart phone to time your run
If you knew you'd knocked off 15 seconds you'd be more likely to go
out again in two days’ time to try to knock another 15 seconds off.
Exercise does take time and effort, but if you find something you
enjoy, establish a habit and track your progress, you'll find it will
get easier to stick with it and your body will reward you. You'll look
better, feel better (mentally and physically) and be better able to live
a happy and active life. What once felt like a chore will feel like a
Computer simulation of the hippocampus shows how memories form
People who wish to know how memory works are forced to take a glimpse
into the brain. They can now do so without bloodshed: RUB researchers
have developed a new method for creating 3D models of memory-relevant
The way neurons are interconnected in the brain is very complicated.
This holds especially true for the cells of the hippocampus. It is one
of the oldest brain regions and its form resembles a sea horse
(hippocampus in Latin). The hippocampus enables us to navigate space
securely and to form personal memories. So far, the anatomic knowledge
of the networks inside the hippocampus and its connection to the rest of
the brain has left scientists guessing which information arrived where
and when. Accordingly, Dr Martin Pyka and his colleagues from the
Mercator Research Group have developed a method which facilitates the
reconstruction of the brain's anatomic data as a 3D model on the
This approach is quite unique, because it enables automatic
calculation of the neural interconnection on the basis of their position
inside the space and their projection directions. Biologically feasible
network structures can thus be generated more easily than it used to be
the case with the method available to date. Deploying 3D models, the
researchers use this technique to monitor the way neural signals spread
throughout the network time-wise. They have, for example, found evidence
that the hippocampus’ form and size could explain why neurons in those
networks fire in certain frequencies.
In future, this method may help us understand how animals, for
example, combine various information to form memories within the
hippocampus, in order to memorise food sources or dangers and to
remember them in certain situations.