Early detection and treatment can prevent blindness

By Carol Aloysius

Being blind is perhaps one of the most disabling and traumatic diseases one can have. Blindness not only plunges the victim from a world of light to a world of darkness, it is in most cases the cause of depression and its accompanying illnesses.

For those who have enjoyed a normal sight until they suddenly lost their vision for various reasons, the trauma and depression is doubly felt.

Yet blindness in most cases is preventable since the causes that lead to blindness are reversible, most cases like cataract which is the leading cause of blindness worldwide and in Sri Lanka. All it takes is early detection and a simple procedure that can be performed at any OPD in a state hospital.

Other common forms of eye impairments such as squints, short-sightedness and low vision can also be prevented with early detection and treatment, while the more serious, forms of blindness such as Glaucoma and Macular Degeneration although not reversible, can be controlled with proper medication and if necessary surgery.

The Sunday Observer spoke to Consultant Community Ophthalmologist, Ministry of Health and Co-ordinator of the 2020 vision program, Dr Asela Abeydeera, for his views on what causes blindness in Sri Lanka and the interventions we have to prevent it.

Question: Sri Lanka's blind population is on the rise with as many as 150,000 persons officially recorded as blind while another 400,000 have low vision. What are the causes? Can they be reversed?

Answer: The majority of cases are due to cataract. We have around 100,000 persons who don't see because of cataract, which is a reversible form of blindness. Another 18,000 are blind due to refractive errors which again can be treated. For those with low vision, their sight can be improved with spectacles. Glaucoma or eye pressure affects over 15,000 persons while Macular Degeneration is the cause for blindness in 11,000 persons, and over 6,000 have diabetic retinopathy. Then there are persons who are blind due to trauma nine injuries) to their eyes, especially the optic nerve.

Q. You referred to cataract blindness as a reversible form of blindness. If this is so, why are there so many people blind from cataract.

A. Many people are not aware they have cataract until it reaches the advanced stage. There are also many myths about this condition and fears about the operation which is really very simple and takes very little time.

Q. Tell us what is cataract.

A. Cataract is mostly an eye condition you find in elderly persons. The clouding of the lens of the eye is called a cataract.

This is an eye condition which is as common one's hair getting grey when one ages. Surgery is the only way to treat cataract. A simple, quick and painless operation can restore the vision of the affected eye/eyes.

The procedures in fact is the easiest in the whole world including Sri Lanka, and is currently available in all Sri Lankan hospitals, and takes 15 - 20 minutes.

Q. So what has discouraged patients from having this operation?

A. The main obstacle in the recent past has been the cost, of the cataract lens which is inserted into the eye. This had to be purchased from outside although the operation itself was free. Many patients who were unable to afford these lens, went back home without the operation.

Q. Is the situation different today?

A. Yes. Due to the recent intervention of Vision 2020 Secretariat of the Ministry of Health, which is an organisation which aims at improving sight and reducing blindness, these lens are made available free to anybody who cannot afford to pay for them.

This has been made possible by generous contributions from charitable organisations. The usual cost is around Rs 15,000 and upwards, but we are making it available to needy patients free.

Q. So, if a needy person wants to get a free lens, how does he/she go about it?

A. He can make a request at any government hospital.

Q. How does a doctor identify cataract?

A. He will first study the history of blurred vision in the patient. If the cataract is mature the pupil will be white in room light.

He may flash a torch and see the white reflection. He could also use an opthalmoscope at a distance and see disturbed red reflect.

After making sure that the cataract is mature, he will refer the patient to the eye unit.

Q. Are there complications after surgery?

A. As I said, this is a simple operation, quick and painless.

Complications are few with easy post operative care as long as the patient follows the doctor's orders relating to eye drops etc.

Q. What about the outcome?

A. Usually visual outcome is excellent with no long term follow up.

Q. What about other diseases like Glaucoma?

A. Glaucoma is caused by eye pressure which if neglected can destroy the optic nerve. Glaucoma can't be prevented. But loss of vision due to it can be treated if detected at an early stage before any vision is lost.

Life long medication is a must. Regular eye examinations especially if you have a family history of glaucoma and are over 40 years is very important.

If neglected, there will be a gradual loss of the visual field and later the central vision, and blindness when more than half the vision has been lost.

Q. What are the symptoms?

A. At the early stage there are no symptoms as it is painless. But frequent changes of spectacles could be an indication.

Q. Refractive errors - what are they?

A. Refractive errors included myopia (short sightedness) and hyperopia (long sightedness) with or without astigmatism. They can be rectified with appropriate optical corrections.

Q. What about people with low vision?

A. Having low vision means when all other methods including surgery to improve the vision have failed.

These persons can be helped with low vision devices such as magnifiers, reading stands, circuit television which help improve the environment to facilitate reading and mobility.

Q. Diabetic retinopathy - what is it?

A. This a complication of type 1 and type 2 diabetes. When the blood glucose levels remain too high for a long period changes can occur in the tiny blood vessels to the eye. Those with diabetes should get their eyes checked for diabetes retinopathy at least once a year if not more.

Q. Symptoms?

A. Blotches, blurriness and seeing dark spots around the eye.

Q. Tell us what Vision 2020 is doing.

A. Sri Lanka has become signatory to Vision 2020 global initiative in year 2000. A national program for prevention and control of blindness was prepared in line with following Vision 2020 priorities and was launched ceremonially in October 2007 as a five year plan. The program is under the guidance of Dr P G Mahipala, the DGHS of the Ministry of Health as the National Focal Point. Vision 2020 Secretariat is located within the Ministry of Health Room 37A.

There are five consultant eye surgeons in charge of each area of action who plan, implement and monitor the activities in their respective action areas, which include

1.Cataract

2.Glaucoma

3.Diabetic retinopathy

4.Refractive errors and Low vision or vision defects

5.Human Resource Development

Q. What is the overall aim of vision 2020?

A. To reduce avoidable blindness in Sri Lanka through the development of a sustainable and equitable national program for prevention and control of blindness as a part of national health system.

Q. What have been your achievements thus far?

A. Establishment of new eye unit at Lady Ridgeway Hospital for ChildrenThe establishment of new eye unit at Base Bospital Balapitiya. Provision of necessary eye equipment worth over 10 million rupees to Base Hospitals of Kantale and Balapitiy provision of an Auto refractor to General Hospital Vavuniya.We also conduct a special program to identify people with Diabetic retinopathy and Glaucoma and are making arrangement for treatment and follow up.

Q. What about programs for people with low vision and refractive errors?

A. For those with Refractive errors and low vision, we have established satellite clinics in out stations, and also launched training for mid level eye care personnel, awareness programs, provision of low vision devices for needy people free of charge funded by Sight-savers. We also had Primary Eye Care Programs to train midwives, public health inspectors and related staff to identify and refer eye diseases in many districts funded by Sight-savers.

Q. How do school children benefit?

A. We had a program to provide pairs of spectacles for schoolchildren around 13,000 glasses were provided to school children in Colombo, while similar programs are in 10 more districts and total of 21,000 custom made good quality spectacles are distributed free among schoolchildren.

Q. If anyone wants your help how can they contact you?

A. Vision 2020 Secretariat, Room 37A, Ground Floor, Ministry of Health, 385, Deans Road, Colombo 10.

Tel/ Fax -0094112693744.

Or on the website: [email protected], [email protected] www.vision2020.lk

UK medical journals will no longer consider tobacco industry's research funds

Decision marks a U-turn for the BMJ , which published a tobacco industry-funded study in 2003

The editors of Britain's leading medical journal and its sister publications have announced they will no longer consider research that is funded by the tobacco industry.

The British Medical Journal , along with Heart, Thorax, and BMJ Open join a number other journals which have already ruled out industry-funded research.

In a strongly-worded critique of the tobacco industry, published in BMJ Open, they argue that cigarette manufacturers have "used research to deliberately produce ignorance and to advance its ultimate goal of selling its deadly products, while shoring up its damaged legitimacy."

Leading journals including the US-based Public Library of Science publications PLoS Medicine, PLoS One, PLoS Biology already refuse to publish studies paid for by tobacco companies.

The decision will come as a blow to the tobacco industry. Publication of a study in the BMJ or an associated journal is an internationally-recognised rubber stamp of legitimacy, but editors said there was "a growing body of evidence" that sources of funding were influencing research outcomes. It also marks a u-turn for the BMJ, which published a tobacco industry-funded study in 2003, a decision which was defended by the then-editor Richard Smith as "pro-debate and pro-science".

However, Fiona Godlee, editor-in-chief of the BMJ, and her fellow editors said it was "time to cease supporting the now discredited notion that tobacco industry-funded research is just like any other research."

"The tobacco industry has not changed in any fundamental way, and the cigarette - the single most deadly consumer product ever made - remains widely available and aggressively marketed," the write.

"Refusing to publish research funded by the tobacco industry affirms our fundamental commitment not to allow our journals to be used in the service of an industry that continues to perpetuate the most deadly disease epidemic of our times."

Martin Dockerell, director of research and policy at the anti-smoking charity ASH said: "The tobacco industry has a long history of manipulating and distorting the scientific debate.

They have funded research and researchers to undermine the strong scientific evidence of the harm tobacco causes.

During the campaign for Smoke Free legislation, there was a lot of research into the economic impact of going smoke free. Once you eliminated research from the tobacco industry, it actually appeared that the impact would be moderately positive, and so it has turned out."

The UK Tobacco Manufacturer's Association was unable to respond to a request for comment.

The Independent

Scientists develop implant that can stop Parkinson's growth

The implant pumps proteins into the brain to encourage damaged cells to grow again

Scientists have developed a brain implant that could prevent the progression of Parkinson's disease.

A team in Bristol have created an implant that encourages cells damaged by the disease to grow again. It does this through a system of tubes and catheters that pump proteins into patients' brain once a month, potentially stopping the disease from progressing by encouraging the damaged cells to grow again.

The port located behind a patient's ear releases a protein called glial cell line-derived neurotrophic factor (GDNF).

Six patients at Frenchay Hospital, Bristol, have trialled the system, and doctors are now looking for another 36 to help them continue their research.Dr Kieran Breen, director of research and innovation at Parkinson's UK, said: "For years, the potential of GDNF as a treatment for Parkinson's has remained one of the great unanswered research questions.

"This new study will take us one step closer to finally answering this question once and for all.

"We believe GDNF could have the potential to unlock a new approach for treating Parkinson's that may be able to slow down and ultimately stop the progression of the condition all together.

"Currently there are very few treatments available for people with Parkinson's and none capable of stopping the condition from advancing.

"More than 127,000 people in the UK currently have the disease, which is caused when nerve cells in the brain die due to a lack of the chemical dopamine. Symptoms include slowness of movement, stiffness and tremors.

Professor Steven Gill said the equipment could be used to treat a variety of conditions.

"If this technology proves to be safe and reliable ... it has huge applications across neurological diseases, not only for treating neurodegenerative diseases like Alzheimer's and Parkinson's but also brain tumours and other conditions," he said.

- The Independent