Preserve vision with timely action

By Carol Aloysius

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 surveys.

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

Excerpts...

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.

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 long?
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 examination.

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 vision problems.

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 minor surgery.

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.

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 glaucoma?
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 from glaucoma.

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 glaucoma.

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 conditions.

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 medicine men.

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 days.

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 become disillusioned.

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 disheartened.

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 accurately.

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 pleasure.

- MNT

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 brain structures.

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 computer.

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.

- MNT