CHILDREN AND COMPUER USE - points to remember

Millions of children work on the computer on a daily basis. While this may be a necessity in some cases as they may have school assignments, some may be just playing computer games for hours on end. It is important to be aware of the harmful effects of computer use in children.

Dry eyes
Adults do complain of symptoms of dry eyes like redness, pain , irritation of the eyes  after prolonged computer use. Children also have the same symptoms but they have some unique aspects which makes them more susceptible to the eye problems

Use of adult computer
Children may not adjust to the table height or the ergonomics may be wrong. Hence they may end up having eye strain or back and neck pain

Increased tolerance
Children are too engrossed in their own world and may ignore the warning signs like eye strain . If they have an underlying refractive error or eye problem they may ignore the poor vision as something that everyone may have. Children many a times have a hypermetropia or plus number which they can overcome with their eye power, but this may become an issue when they use the computer for long hours.

Reduced blinking
Children are not bothered about other things when they are hooked on to computer games and reduced blinking will lead them to forcefully blink their eyes or to severe eye strain.

Accommodation problems
Focussing can be at strain and the internal eye muscles may fatigue because of the excess eye strain .
This can lead to difficult focusing for distance - accommodative spasm.

Room lighting
The room light should not be too bright nor too dark. Comfort while viewing is a must.

POINTS TO REMEMBER
1, PREVENT CONTINOUS USE
2, GET THEIR EYE EXAMINED IN CASE OF ANY ISSUES
3, CHECK THE ERGONOMICS
4, USE OPTIMAL LIGHTING
5, ENCOURAGE THEM TO PLAY OUTDOORS

SQUINT AND BINOCULARITY

When we talk of binocularity we refer to the use of both the eyes together. This means that the two eyes can work together as a single unit and relay images to the brain. The direct result of this is depth perception - which is the judgment of the distance a person or object is from us.

Squint needs to be rectified at an early age as this can improve our depth perception and there is no permanent loss of this function.

What happens when one operated at an older age, maybe once a person is an adult ? Research has shown us that even in an older age, the depth perception can be preserved and improved. So when we operate on a squint at an older age, when he or she is an adult there are two benefits of the surgery - not only does the individual have better cosmetic appearance, the person also regains most of the depth perception. 

So it is worth correction of the squint at any age.

ADVANCES IN SQUINT SURGERY

Squint surgery has become one of the most technically uncomplicated surgeries now. The outcome is mainly dependent on the careful planning and assessment of the patient before surgery. This needs a lot of knowledge and understanding on the part of the clinician and surgeon. Only an experienced and well trained surgeon can perform and give a good result.

Understanding the nature of the squint, the extent and severity and the possible future outcomes need to be understood before embarking on the squint surgery. It is easy to understand this based on tests performed in the clinic. Sometimes it is best to observe the squint for some months in an effort to understand the nature of the squint.

Surgery is technically simple especially for the patient. The patient walks in and walks out of the clinic after surgery. There is no need for special rest, the patient can watch TV, read and work on the computer.

The precautions would be not wetting the eyes for a month, so no swimming for a month and no head bath for a week.

Squint surgery has become technically simple to perform, scarless, and cosmetic in nature. Cosmetic because there is no scar of the surgery. There are no tell tale signs of surgery.

RESURGERY IN SQUINT

Most people wonder if operating again in a patient with squint is going to be successful. It is interesting to note that this is possible and one must realize that there are various ways by which one can increase the success rate of surgery.

Adjustable suture technique is a very useful method of ensuring that the results of squint surgery are good. The muscle is out on a shoe lace kind of knot and the same can be adjusted with the patient awake in the evening. This ensures excellent outcome and this can be shown to the patient also with the use of a mirror. 

Muscle surgery is quite forgiving and one can definitely operate again on muscles to ensure good outcome. Operating on the second eye can also give good results in patients.

Repeat surgery or a second or third surgery is definitely possible in squint and can give excellent results with the proper techniques....

SQUINT ---- TIMELY INTERVENTION

Time is crucial in the management of squint.....

It is important to understand that time is crucial in the management of squint. Time lost is going to cost the patient a lot and maybe include loss of vision. Hence it is important that one consults a pediatric ophthalmologist or squint specialist as soon as possible.

Many a times parents come with the complaint or doubt that the child seems to have a squint especially in the photographs. More often than not, there is no squint or there is a pseudo squint due to the exaggerated folds of the skin near the eyes. But sometimes there is a true squint which is actually present and can be treated. 

One must not forget that squint can itself lead to amblyopia or lazy eye. This can be a reason for vision loss or impairment in children. The earlier this is detected the better it is for the patient. 

Again the squint detected earlier is more amenable to treat with exercises or glasses and most cases may not need surgery or one can avoid surgery altogether. 

Many reasons you will agree to get the eyes checked and to rule out the possibility of a squint....

ACCOMMODATIVE ESOTROPIA

One might wonder what is accommodative esotropia. In this condition the eyes converge and squint that is the eyes turn in. This starts much after birth usually at the age of 2 years or so.
When the child wears glasses the eyes become straight and when the child removes glasses the eyes
turn in. This may be variable and may not be present all the time.

Usually the child has a high plus ( hypermetropic) refractive error ( glass number) and due to this the child strains the eye in an effort to overcome the high plus. This leads to the eyes turning in and squinting. When the child wears glasses this extra effort is not there and the child has straight eyes.

Surgery is only reserved for the cases where there is any residual squint.

Sometimes this occurs due to excess convergence phenomenon of the eyes and even this can be treated well with bifocals and rarely there is a need for surgery.

In other words these are interesting conditions and are easy to treat. Read more and see patient pictures on www.axiseyeclinic.com

AWARDS

I am glad to announce that I have received the prestigious  INTERNATIONAL SCHOLAR AWARD from the AMERICAN ACADEMY OF OPHTHALMOLOGY this week...

I have received a total of 5 awards from America, 4 from AAO and 1 from AMA

4 from AMERICAN ACADEMY OF OPHTHALMOLOGY
1) ACHIEVEMENT AWARD
2) INTERNATIONAL OPHTHALMOLOGIST EDUCATION AWARD
3) LEO AWARD
4) INTERNATIONAL SCHOLAR AWARD

1 from AMERICAN MEDICAL ASSOCIATION
1) PHYSICIAN RECOGNITION AWARD


For me this is a great achievement more so as I have received all these awards at such a young age and also being on my own in practice in this relatively small city, Pune...
for my work on Oculoplasty, Cometic eye surgery, Squint (strabismus), Low vision aids, artificial eyes...and my research work

Botox and Fillers

Botulinum toxin works by paralyzing the muscles. The good thing is it is temporary and there are no significant side effects. But when given for cosmetic purposes this has to be repeated every few months.

The dynamic wrinkles are removed by this, but the static wrinkles can only be removed by fillers. Both these do not last long.

As regards administration, these can be given easily and there is no pain or swelling. The patient can get back to work immediately after the injection.

Good medication for getting a fresh face, though expensive. Of course it can also be used for small squints and for double vision...

Squint - achieving success

Squint is definitely not a bad disease. Having operated and treated many patients with squint, I can surely say that it is definitely treatable and one can achieve good results with adequate experience and knowledge of the anatomy of the eye muscles.

There are small nuances for instance the tightness of a muscle, the amount of squint in different gazes, the eye movements which are important. The results are based on these parameters and an accurate assessment of the squint. Using additional tools like manipulation of the glass power, use of agents like botulinum toxin.. all add to the success of squint treatment.

Performing the surgery is a small part of the whole process. Understanding the nature of the squint, the various needs and problems of the patient, in other words the entire evaluation process is the most important part.

Achieving success is definitely possible in all forms of squint.

Children and glasses

Let us suppose one goes to an optician or ophthalmologist. The child is noted to have a refractive error.

Does it mean all children need glasses ?

No. There is a process of normalization of the refractive error of the eye called as  EMMETROPZATION.
Any refractive error in any child should not be treated. There are limits in the refraction only beyond which one needs to prescribe glasses.

The very young child like the toddler has very little need to see distant objects. For an infant the most interesting part of the world in the mother's face at a distance of 25 cm. Hence one does not  need to prescribe glasses to this age group unless the numbers are very large.

Squint and Glasses

It is interesting to note that in many instances, squint in children can be succesfuly treated with simple glass prescription. Glasses especially plus numbers are useful in accommodative convergent squints and the minus numbers in intermittent divergent squints.

Most of the times, the glasses also help the child to see better and prevent complications like amblyopia or lazy eye. Hence it is important that children are properly refracted and given glasses if needed.

One may wonder what the natural progression of refractive error in children. Children are born with a small plus number which gradually progresses towards normal. This process is called emmetropization.

It is important to note that most plus number reduce over time, minus numbers may increase and cylindrical numbers are unlikely to change much.

Thyroid eye disease

Thyroid eye disease is an under diagnosed condition. Many patients are not diagnosed till late in the disease, when there are serious problems due to the disease. The eyes are usually red and congested. There is persistent watering from the eyes. The lids start to behave abnormally with widely open eyes which gives an angry look to the patient. The movements of the eyes can also get limited when the patient starts getting double vision. Protrusion of the eyes occurs due to the increase in fat in the orbit and enlargement of the eye muscles. The vision may drop when there is compression of the optic nerve by the eye muscles.

The serious manifestations are loss of vision and double vision. The treatment in the initial stages when the eyes are red is giving oral steroids or intravenous steroids so that the patient can tide over the inflammation or redness in the eyes.

Control of the thyroid status is also essential for the eye disease to become stable. For the double vision one can give prisms or even injection of botulinum toxin in the acute stages. Orbital decompression is needed if there is sight threatening optic nerve compression or for cosmetic reduction of the proptosis. Squint surgery may be needed for the double vision especially as there may be vertical displacement of images and adjustable sutures are used while performing the squint surgery.

I routinely perform surgery and manage many patients with thyroid eye disease, with a good outcome.

Integrating Ayurveda and Allopathy

I had a unique opportunity yesterday. I gave a lecture at the national conference of shalakya, that is the branch of ayurveda dealing with the eyes, ENT and dentistry. My lecture was an overview of oculoplasty and ocular oncology.

It is interesting to see the way both these forms are medicine are taught to students there and they are able to use both the practices to treat patients. There are many forms of treatment which are unique to ayurveda which are missing in allopathy. It was wonderful listening to some of the lectures..

IMA PUNE YOUNG ACHIEVER AWARD

I am happy to share this good news with all. I got the Indian Medical Association, Pune's YOUNG ACHIEVER AWARD yesterday in a glittering ceremony at Pune. It came in the papers also. 

I am the first recipient of this award and this was given for outstanding work in clinical and academics. 

good feeling....

ADJUSTABLE SQUINT SURGERY

Getting perfect results in any form of surgery is always a challenge. More so in case of squint, where the results are there for all to see. In such cases especially in adults, it is easier to perform adjustable squint surgery.

At the end of the day or the next day, the patient is called back to the clinic and based on the need, the muscle position is perfectly adjusted. This gives optimum results and the best outcome possible.
I have done this for many cases referred to me after one squint surgery and have got good results.
For the patient it is never unpleasant, they feel good with the correction and can actually see the good outcome.

CHILDREN AND THEIR EYES

DID YOU KNOW ?

Amblyopia or lazy eye can be treated even upto 17 years of age. This is what the latest research has to tell us. This comes from the PEDIG ( pediatric eye disease investigator group)..

I thought I should give it a try. Previously the thought was that vision could not be improved in cases of amblyopia beyond 7-8 years of age.

I wish to share 2 cases with you. One was a 11 year old boy, very intelligent and well behaved. His parents were shocked when it was discovered that he had a vision of 6/60 in one eye. They came to me and the refraction was +2.00. He was prescribed glasses and patching. He improved to 6/12 and could read a few letters on the 6/9 line as well. In other words he was out of the definition of amblyopia. Of course the credit goes to the young lad as he was sincere in the patching and serious about improvement in vision.

My second interesting patient was a 23 year old girl with squint ( convergent ). She had a vision of 6/36 in the left eye which was the squinting eye. She was again advised intense patching and within 2 weeks her vision had improved to 6/12. For her and her family it was very reassuring. She had been indoors for two weeks and taken a break from her work to ensure that her eyesight improves.

I used to counsel them well, with positive reinforcement of the benefits of patching and use of near exercises. 

My message is
1. try patching even in the older age group.
2. intense counselling
3. positive reinforcement of benefits
4. show them the response in a week's time, which will spur them to perform better...

This will be our contribution towards the elimination of preventable visual impairment.

THE YEAR GONE BY

The year 2012 has been a great year academically and in terms of achievements and awards. We have done well and got recognition in the form of awards for our surgical work and clinical expertise. 

We have seen many complicated clinical patients and have been able to give gratifying results in all cases. God has been kind to us in this regard.

The clinic has grown many fold with a substantial increase in surgeries and outpatient work. 

We are getting referrals from all branches of medicine and many consultants in the city are recognizing us for the work that we perform. 

We hope we can keep up the good work in the coming year...

with the blessings and good wishes of everyone...

EXCELLENCE AWARD

Receiving the Excellence Award from the Strabismological Society of India 

for outstanding contribution to Strabismus ( Squint ) in India was a happy 

occasion. This was on the 1st of December 2012 at the Annual meeting of the 

Strabismological Society of India meeting at Rohtak Haryana.   

 

I am not seeing more and more complicated patients with strabismus ( squint) and have been able to do justice and giving tremedous relief and even cure many of these patients completely.

Most recently I have improved the field of binocular single vision for a patient with Internuclear ophthalmoplegia and also treated a patient with medial rectus muscle injury with diplopia following endoscopic sinus surgery. It feels good to make the lives of these people better.

Implications of Squint

There have been various studies which have studied the social implications of squint. Squint is not only a functional impairment due to loss of binocularity but also a cosmetic blemish. The person with squint is less likely to land a job at an interview, less likely to be promoted as he is considered inept or disabled. However good you are if you have squint, you are less likely to get recognition as compared to your peers. 

It is difficult for the person in front to make eye contact with you and hence interactions are less likely and therefore opportunities get limited.

Squint surgery is very successful and alignment is perfect in most cases. Patients are very happy with the outcomes of surgery and it is always a life changing experience.

OCULOPLASTY MEETING AMRITSAR

The highlight of this meeting was the wonderful place Amritsar apart from the well planned scientific programme. Amritsar is most famous for the Golden Temple. As I sat in the precincts of this temple, the peace and tranquility enveloped me and made be feel very relaxed. There is no bar on any one for entering this temple, except one has to cover one's head. The temple with its rich gold carvings stands out like the sun. There was no jostling or pushing as in other temples, people stood quietly in queue letting infants and mothers and the elderly pass. There was contentment and patience as people waited slowly for their turn to visit the sanctum sanctorum.

The Wagah border was great, could see Pakistan on the other side. Inspiring patriotism in the masses, there was a crowd of nearly 15000 people on the Indian side. With songs and dancing, the jubilant indian crowd enjoyed every moment of the parade.

Oculoplasty meeting was a great success, my lecture was like the meeting point of squint and oculoplasty and was well appreciated especially as I highlighted the strong relation between the two. The intricate details which need to be looked into especially the cosmetic changes on the face when we perform a lid or squint surgery was highlighted. Overall a great break....