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Magazine
Focus on the eye
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Problems of the eye and the intestinal tract dominate this month's column. Our panel of doctors offers its advice and suggestions.
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Name withheld
I have one eye vision, the left eye being defective called "Lazy eye" from childhood although I am able to see light and colour through the left eye.
I underwent Cataract surgery, six months back in my right eye (visible eye) and the operation was successful.
But I experience a sort of reflection from the new lens and it has been termed as "optic edge". Please let me know why the reflection is caused.
If I undergo cataract surgery in the left eye (lazy eye) after few months, will I face any problem?
Dr. N.R. Rangaraj, Eye Surgeon replies:
The "optic edge" is technically called "edge glare". Edge glare and reflections are optical issues associated with the design of the intraocular lens.
Square edges of the intraocular lens cause the light to reflect off the internal edge and focus it onto the retina. The light is then concentrated in a crescent shaped pattern, which leads the patient to complain of glare and reflections.
The intraocular lenses, which have a smooth edge on the front edge of the intraocular lens cause the light to scatter when reflected off the edge. The light is diffused and not focused on to the retina and hence suppress the glare and reflections.
Since modern cataract surgery is so successful today, the hope is to get better vision than before.
When only colour and light is seen in a lazy eye, the loss of vision is termed "profound impairment of vision". The improvement in such an eye after phacoemulsification and foldable lens is the vision lost due to cataract alone.
Before surgery in such eye conditions the patient and doctor should discuss realistic expectations of vision after surgery. Double vision could be a problem only when there is near normal vision.
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N. Subramanian writes:
How does an implanted Intra-occular lens function? Does a foldable IOL have flexibility to adjust with the focal length of the object? If not so, what is the advantage in going for a Phaco-emulsification surgery, which is expensive?
Dr. N.R. Rangaraj replies:
Cataract surgery with Intraocular lens replaces the natural human lens in the same position or the nodal point. When no intraocular lens is implanted and a high power spectacle lens is worn the nodal point is displaced to the front of the eye. This leads to severe optical distortions. Examples being magnification of objects, Jack in the box phenomenon and pincushion effect of flat surfaces.
Phacoemulsification is the procedure in which the lens is dissolved using sound energy or ultrasound. This allows an exceedingly small incision, from which the dissolved lens material is vacuumed using the same probe. A foldable monofocal lens is rolled into a cartridge and implanted into the eye through the same small incision which is 1/5th the overall size of the implanted lens. The result being perfectly clear vision after surgery.
The residual correction if any due to corneal astigmatism that was already present before surgery and near vision correction would be correct on the glasses usually in a week. The small incision is strong and watertight hence requires no sutures that cause irritation. This allows a return to daily routines earlier than the larger wound in a cataract surgery that requires sutures.
Foldable multifocal intraocular lens allows full range of vision restoration to see all distances, thereby enhancing the effect of the small incision cataract surgery with phacoemulsification.
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Runny nose
JKM writes:
Early in the morning I have a running nose. I drink only boiled water. I avoid cool drinks, fruits and cakes. At lunch, I am forced to eat in a hurry. As I start sneezing severely again it makes me uncomfortable. I am 68 years old, a teetotaller.
Dr. H. Ganapathy, ENT Surgeon replies:
You have a problem called allergic rhinitis. This means that something does not suit you. As a result you have sneezing, running nose, nose block etc. There is always a genetic predisposition in such individuals. Eradicating the problem is possible provided we are able to identify the offending agent and avoid it totally. It is easily said rather than done. By a process of trial and error and elimination you can achieve this. In the meantime examination of your nose might reveal the sequel of allergic rhinitis and if warranted, surgery can be done. Medical treatment should be instituted to prevent further complications and give you symptomatic relief.
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Hormone imbalance?
Name withheld:
My daughter aged 26 got married in February 1999 and is now in the U.S.. As she was having irregular periods and did not conceive, she consulted doctors there who said that the problem was due to hormone imbalance. She was also told that it could also be due to stress and weather changes. She was in Singapore also for some time. What is your suggestion?
Dr. Sumana Manohar, Obstetrician and Gynaecologist replies:
The reason for your daughter's irregular periods could be secondary to anovulatory menstrual cycles (resulting from non-releasing of the egg on regular basis). This could be because of simple reasons like change in the place, stress, weight changes or changes in the eating habits. It could also be secondary to hormonal problems. In your daughter's case, she should see a subspecialist in fertility medicine, she should undergo hormonal investigations and ultrasound scan of the pelvis to rule out the possibility of polycystic ovarian disease, which is one of the commonest causes of anovulation.
Her husband should be tested and a tubal patency test should be done before embarking on any treatment.
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Speaking right
Name withheld:
I have two questions. I stammer when using certain words like determination, development, depreciation, interception, intervention, dilapidated, improvement, heartening. 2. Often I get headaches because of which I also stutter and I feel tense though there is nothing.
Dr. Prithika Chary, Neurosurgeon and neurologist replies:
Stammering is both psychological and neurological in origin. You may have had some problem with the words you have listed, (mostly labiodentals) while you developed speech, which led to a psychological block making you pause awhile before saying them. This tension could lead to stammering. Frequent headaches may be independent, but because they make you tense, and you have a tendency to stammer, you probably do so during a headache. Some left-handed people when pressurised to change over to the right hand also tend to develop a stutter or stammer. To overcome this try saying the words which trouble you slowly and in a relaxed frame of mind several times. Speaking at a slower speed when you feel you are about to stutter, definitely makes the words come out better. Take things easy and you will begin to improve in your speech.
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Need for hygiene
G.Gopi Krishna writes:
E.S.H.Coli has been found in the stool culture. I am suffering from recurring pains in the intestine and inside the navel and foul smell in the mouth. Please mention what precautions I have to take.
Dr. Uma Krishnaswamy, General Surgeon, replies:
Escherichia Coli are bacteria which are found everywhere in our environment and are also normally found in our bowels where that serve as a source for Vitamin K and B Complex. Therefore, E. Coli will be normally found in stools. However some strains of E. Coli (o157:H7) may be acquired through contaminated food sources and lead to the onset of severe diarrhoea, which may be bloody, and abdominal pain.
Usually the problem is self-limiting and resolves without supportive treatment such as attention to hydration and nutrition. There is, in fact, no specific therapy. Only in rare instances do serious complications supervene.
Have you had a recent attack of diarrhoea? The mere presence of E. Coli in a stool culture without specific confirmation of the above-mentioned strain may have no significance. Please approach your doctor for a reassessment of your abdominal symptoms. Please ensure that your food and water is safe and those who handle your food adopt strict hygiene.
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Name withheld:
I am a 19-year-old girl. I had stayed in hostel for about six months. My digestive system got worse. It used to be perfect before. I had a stool test done and the result was that I have amoebiasis. Some medicines were prescribed but to no effect. I defecate more than once and feel like I'm having indigestion in the morning. It's ok in the later part of the day. Also as soon as I brush my teeth some whitish long things stick to the inner walls of my cheeks. When I asked my doctor she said it is mucous caused due to deficiency and asked me to use syrup zinovit. It didn't work. The medicines prescribed by my doctor for amoebiasis are "dazolic-for 5 days" and "sporlac-for a month thrice a day". I urinate frequently. But it is not so always.
Dr. Uma Krishnaswamy replies:
Amoebiasis is a common problem in India. It causes chronic diarrohea along with a host of other symptoms such as those you suffer from. In the long run, it affects your general health.
It is transmitted through food and water handled by chronic carriers of amoebiasis who do not practise even basic hygiene like washing hands, trimming nails before handling food.
It may be that your infection has recurred. Please approach your doctor to see if you need a repeat course of medicines. Also ensure that your food and drinking water is safe and handled only by those who follow strict hygiene.
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