R Venkataramanan

R Venkataramanan

R Venkat's Blog

R Venkat's Blog
"To be an Inspiring Teacher,one should be a Disciplined Student throughout Life" - Venkataramanan Ramasethu

SNK

SNK

Sunday, October 31, 2010

Venkataramanan Ramasethu - R Venkat - SNK - Sankara Nethralaya,Kolkata





Born on the 4th of July, 1978, Venkataramanan Ramasethu is an academician in the Eye Care Field and a Senior Low Vision Consultant. Further to completion of B.S.Optometry from the prestigious Elite School of Optometry, Sankara Nethralaya, Chennai in the year 2000, he further completed a One Year Fellowship in Clinical Optometry from L.V.Prasad Eye Institute, Hyderabad in the year 2001. After a brief stint at LVPEI as an Academic Faculty at LVPEI, Bausch & Lomb School of Optometry and Consultant at the Low Vision Clinic for three years, he shifted base to Kolkata in the year 2004 and holds office at Sankara Nethralaya, Kolkata as Academic Head, Department of Optometry & Senior Low Vision Consultant and Head of Low Vision Care Clinic since then. He is attached with Sankara Nethralaya, Kolkata since the time of its inception. He had also completed his MBA with specialization in HR management from Symbiosis Institute of Management, Pune in the year 2006.His other passions include Creative Writing and Literature. He believes, “To be an Inspiring Teacher, one should be a disciplined student throughout Life”.











Venkataramanan Ramasethu - R Venkat - SN Kolkata @ International Symposium on Community Ophthalmology,Kolkata,Science City,31-10-2010









Thursday, October 14, 2010

Retinoblastoma - agony, despair, hope

A visit to Chennai was never on Ardhendu Ghosh’s wish list, but so weren’t other things.He never wished to lose his elder brother in an accident or look after two households witha single income or shift his family from Hooghly, West Bengal, to Ramgarh, Jharkhand for a better life. But it all happened. And just when the Ghosh family was beginning to see a glimmer of hope for a bright future, tragedy struck once again. Ardhendu Ghosh’s one and-a-half-year-old son was diagnosed with Retinoblastoma or cancer of the eye.

Distraught at the thought of losing yet another family member, the Ghosh family’s search for help ended when they were referred by the local doctor to visit Sankara Nethralaya.And so, on Monday, November 16, 2009, Ardhendu Ghosh, along with his wife and son came to Sankara Nethralaya, Chennai. “Coming to Sankara Nethralaya, was our only hope, as there was no treatment available in Ramgarh, says Ardhendu Ghosh. And hope they did find at Nethralaya. A detailed examination revealed that Debdeep Ghosh had bilateral retinoblastoma (tumor in both eyes). What followed was an intensive session of chemotherapy and external beam radiation. But despite the treatment, doctors were not able to save the left eye, as the tumor threatened to spread to other parts. Undeterred by the initial set back, doctors now concentrated their efforts in trying to save Debdeep’s right eye.

However, by this time the Ghosh family was beginning to feel the strain of the medical expenses. With a meager income of Rs.10,000 and with the responsibility of supporting his parents, his daughter’s education and his deceased brother’s family, on his shoulders, Ardhendu Ghosh was finding it increasingly difficult to meet the costs of the chemotherapy sessions. Having expressed his inability to pay for further treatment to the doctors, Ardhendu Ghosh was expecting to be turned away from the hospital. But like the many surprises he has faced in life, the doctor’s response came as yet another surprise!

The hospital, under the Mahema Devadoss Endowment Fund, offered to provide free treatment to Debdeep. Not satisfied with the results, despite 10 sessions of chemotherapy, doctors began exploring other options that could help save Debdeep’s
eye and restore vision. Intra-arterial chemotherapy was identified as the next best option to help little Debdeep.Although Sankara Nethralaya does not offer intra arterial chemotherapy, the hospital referred him to the Sri Ramachandra Medical Hospital at Chennai where Debdeep has undergone two cycles of intra-arterial chemotherapy. The treatment costs for the first cycle were borne through the Mahema Devadoss Endowment Fund. The Lions Club of Central Madras and the Chityala family from New York shared the expenses for the second cycle of treatment. While Debdeep has shown signs of improvement, following the two cycles of intra-arterial chemotherapy, doctors will have to wait till he completes his next cycle of chemotherapy to gauge its success.

Debdeep is one among the 1,500-odd children who are diagnosed with Retinoblastoma every year in India. Every year,anywhere between 80 and 1 20 cases of retinoblastoma are seen at Sankara Nethralaya. Doctors at Nethralaya believe that due to lack of awareness, many people delay seeking medical assistance. Most of the unilateral cases of retinoblastoma(tumor in one eye) that doctors see at the hospital are those which are in the D or E stages, considered to be advanced stages,of the disease. The considerably large financial expenses that the treatment entails forces many people, especially the poor,to not opt for any remedial measures or seek delayed medical help.Thanks to the Mahema Devadoss Endowment Fund, set up by renowned artist Manohar Devadoss in memory of his wife,Mahema, and through support from well-wishers, Sankara Nethralaya has been able to help children like Debdeep. The efforts by today’s ophthalmologists, government & non-government agencies and hospitals in developing better strategies in the management and treatment of Retinoblastoma will hold great promise, in the future, for children like Debdeep.

The Mahema Devadoss Endowment Fund is meant to support paediatrictreatment/surgeries for children from financially weaker sections of society. It will bear

Cost of paediatric surgeries for children

Cost towards treatment of children suffering from Retinoblastoma

Cost to be made to other hospitals referred by Sankara Nethralaya for specialized treatment of children undergoing treatment in Sankara Nethralaya

You can contribute to the Mahema Devadoss Endowment Fund by supporting Paediatric surgeries/treatment for indigent children at

http://www.supportsankaranethralaya.org/donate/Donate_Now.aspx

Cheques in favour of Medical Research Foundation can be sent to Sankara Nethralaya, 18 College Road, Chennai - 600006.

Please indicate in the covering letter the purpose of donation i.e. the Mahema Devadoss Endowment Fund.

Manohar Devadoss is an artist par excellence. Despite being diagnosed with Retinitis Pigmentosa, a degenerative eye condition,Manohar Devadoss continues to draw with the same zeal and precision. Proceeds from greeting cards bearing his drawings are given
to charitable organisations, including Sankara Nethralaya.

EIVOC 2010

ELITE SCHOOL OF OPTOMETRY INTERNATIONAL VISION SCIENCE AND OPTOMETRY CONFERENCE



ESO International Vision science and Optometry Conference 2010 was conducted during 12-14 August 2010. The event was a grand success with over 700 delegates attending the conference and about 170 scientific presentations. In addition to sensitizing the professional fraternity on the recent research in various optometric sub specialties, the conference also had various symposia and workshops on various clinical skills and standards. Status of Optometric Education and Scope of
Optometry in India were special sessions conducted for focus group. EIVOC Grand Optometry Quiz was also conducted for Optometry Students and Practitioners. The conference paved the way for the practitioners, vision scientists and academicians to meet under one roof and share their expertise with others.



Release of Elite School of Optometry logo, launch of project “SIGHT 2010” and inauguration of FBDO programme are the salient areas of the conference. Prof Jay M Enoch's Plenary talk on “Optometry and its Future in India, Elite School of Optometry- 25 years later” (rendered by Prof. Vasudevan
Lakshmi Narayanan) and Dr. S. S. Badrinath's “Optometry practice into rural areas- a dream or reality” instigated the audience.

Stalls exhibited new models of instruments and gadgets. But for the sponsors and donors, the success of the conference would have been far. We express our sincere thanks for all those who helped EIVOC 2010 achieve its goal.

Sunday, October 3, 2010

Road to Top




Dr. SS Badrinath opened Sankara Nethralaya with an aim to open a hospital that has a missionary spirit.

Dr. Badrinath, along with a group of philanthropists founded the Medical & Vision Research Foundations in Madras in 1978. A charitable, not-for-profit hospital, Sankara Nethralaya, one of the finest eye hospitals in the country was thus born as a unit of the Medical Research Foundation.Dr. Badrinath graduated from the MMC, Madras and did his internship and a year of internal medicine residency at the Glasslands Hospital, New York, USA. He studied basic sciences in ophthalmology at the New York University postgraduate Medical School and did his residency in ophthalmology at the Brooklyn eye and Ear Infirmary, New York. Dr. Badrinath also did a a fellowship with the legendary Dr. Charles Schepens at the Retina Service of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Dr. Badrinath has been a fellow of the Royal College of Surgeons of Canada and Diplomate of the American Board of Ophthalmology. After coming back to India in 1970, Dr. Badrinath worked as a Consultant at the Voluntary Health Services, Chennai. He also set up his private practice in ophthalmology and vitreoretinal surgery at the HM Hospital and Vijaya Hospital, Chennai, respectively.

Under the able leadership of Dr. Badrinath, Sankara Nethralaya, has been highly acclaimed for its excellent services.

Shop called home




Private old-age homes require only a trade licence to operate. Most get away with utter negligence. Soumen Bhattacharjee & Poulomi Banerjee report

“You broke it, now you fix it,” says a stern voice inside. An old trembling voice answers something feebly.

The place: An old-age home in the interiors of Behala. Ponds dot the area and shrubbery and mosquitoes abound. The roof is made of red tiles and the rooms are small and cramped.

In one room, one of the occupants sits on her bed looking dazed. The old women, cooped up in their one-bed existence, look like prisoners. There’s no hall or recreation area, except for a small room with a television in it. The person who runs the place proudly informs that he offers room service: boarders are served their meals in their room. The monthly charges are Rs 4,000 and a security amount of Rs 5,000 has to be deposited.

● A home for the aged in Chetla can take in 88 occupants and is full. “We don’t have a vacancy now. It might sound harsh, but the fact is that occupants leave this place only in a hearse,” says a caretaker. The dining room is on the ground floor. A single room comes for Rs 1,000 per month, a dormitory bed for Rs 800. There are no attached bathrooms. The dining hall and common room look bare, with just a television and plastic chairs and tables. Meals are served at fixed hours. If an inmate wants a maid, he has to pay extra charges. Ditto for an attendant to go out of the home. Medicine charges are extra.

When a Metro reporter, posing as someone who wanted to place a relative there, wanted to see the rooms, the caretaker said visitors were not allowed inside. “Why are you asking so many questions?” she was asked.
“Don’t keep your relative here. We don’t have an option but to stay here because we can’t afford better facilities,” whispered an inmate when the caretaker went out for a minute.

The story is the same, often worse, in a large number of old age homes in the city. Paramita Ganguly (name changed), 72, an inmate of a south Calcutta home, was so harassed at the home that she wrote to one of her relatives. She was barred from speaking to anyone about her problems. The relative wrote another letter to the governor nearly four months ago. The letter came to the social welfare department for inquiry. But Paramita, fearing a backlash, skipped the inquiry.
Yet old-age homes such as these are mushrooming in the city. The city’s young adults are missing; the elderly need greater care and private old-age homes can start to function with only a trade licence issued by the Calcutta Municipal Corporation (CMC) under the Shops and Establishments Act. A private old-age home is equal to a shop, in the eye of the law.

“There are three types of homes. One is run directly by the government; the second category gets aid from the government while the rest are private,” says a senior official of the social welfare department of the state government.
Uma Mukherjee, the director of the social welfare department, says the department has no authority to ascertain the internal condition of the private old-age homes. “They do not need our clearance. So our activities are only restricted to the government-aided homes.” She adds that it is not mandatory to have state-run old-age homes in every district.

The state government has only one state-run old-age home near Garia and there are around 30 homes in the state that get aid from the central government. The social welfare department has some control over the running of the two categories of homes. Private old-age homes number around 230 in the city, says the CMC, and their number is growing.

There are many unofficial ones, where a house may be shown to be rented out to several tenants who are senior citizens.

Susmita Ghosh, the regional director (East and North) of HelpAge India, an NGO for the elderly, feels that 70 per cent of the homes in and around Calcutta answer to the NGO’s guidelines (see box). But a senior citizen questions the figure. “When I was researching, most of the homes would not let us enter and check the facilities. That makes one wonder whether everything is okay there,” she says.
As it is, the old are not legally secure in the country. If someone is unhappy in a home, he can call the HelpAge helpline and we can inform the local police station and request them to investigate, says Anuradha Sen of HelpAge India. But another social worker adds: “If a senior citizen is being abused, he will be covered under the general civil and criminal laws, but there is no specific law just to help them.”

The Shops and Establishments Act makes it worse. Most of the homes cater to senior citizens belonging to the middle-class or lower-middle class.

Most home inmates refuse to identify themselves out of fear. “I was told that during load-shedding we will get generator service round the clock. But we get the service only if there is load shedding at night,” says an inmate of a Dum Dum home. He pays Rs 8,000 per month for himself and his wife. A 78-year-old man, a widower, who lives in a private home at Madhyamgram, pays Rs 4,000 per month for his stay.
“All medical expenses are borne by us. Moreover the room is too shabby. I accept it. After all, at this age we cannot rebel or go home-hopping,” he says. The physically handicapped suffer a greater ordeal.

Geriatric experts call for specialised care for the inmates of an old- age home as staying away from family needs psychological support apart from the physical support of food and shelter. “The Centre is spending a huge amount to train people in geriatric care. But as there is no rule to have geriatric experts in old-age homes, no one is going to recruit them,” says Indrani Chakrabarty, who works with the eastern zonal committee of the National Policy on Older Population. She also stresses the need to formulate government norms for private old-age homes.
“The number of persons above 60 in the country is about 8.5 million. It is shocking that abuse of the elderly too is rising at an alarming rate,” she adds. It is coinciding with the prosperity of the younger generation, says a volunteer at the east zone branch in the city of the Central Metropolitan Institute of Gerontology.
“The homes need to promote the concepts of productive ageing and intergenerational solidarity. Otherwise the inmates feel lonely,” says Chakrabarty.

Psychologists add that bad treatment and abandonment of the elderly damage the young irreparably. “The children begin to wonder where they come from. Studies show that children who are in touch with their grandparents are more stable socially and mentally,” says Kunal Dey, a member of the juvenile justice board.
Forget intergenerational solidarity. Inmates of old-age homes sometimes don’t get proper food. “We are completely at the mercy of the people who run the home. Here complaints do not work. We survive by making requests as we have to stay here,” says a 75-year-old woman, inmate of another Madhyamgram home.

Yet the demand to enroll aged relatives into such homes is on the rise.

The home in Chetla has a waiting list of over 20 people.

Not that all private homes are in a deplorable state. Some high-end homes offer better service.

Situated on the Barrackpore-Kalyani Expressway, Godhuli looks inviting, resort like. Landscaped lawns, shrubbery, birds in a spacious cage and fish in a little pool give it a tranquil air.

Every room has a bed, writing table, dressing table and television. The deluxe rooms have air-conditioners and refrigerators. There are attached bathrooms, fitted with geysers. Room service is available. There is also a cottage with its own small kitchen. There are meals every two hours and one can ask for tea or coffee anytime.
“We provide maids for cleaning and washing clothes at no extra cost, but if they need an attendant in addition to that, it can be arranged at an extra cost. If any resident wants to go out, a car is arranged,” says the caretaker. One can smoke or drink alcohol in the room. A physician visits once a month. There are nine residents now, but there is room for more.

A standard single room requires a security deposit of Rs 6 lakh and Rs 7,000 per month, a standard double demands a security deposit of Rs 8 lakh and Rs 12,000 per month. Deluxe rooms come for more. The cottage for single occupancy requires a security deposit of Rs 15 lakh and Rs 10,000 per month. Not everyone can pay that.
For many, who have no choice but to remain in an old- age home, respite comes only in the form of death.

GUIDELINES FROM HELPAGE INDIA TO SELECT THE RIGHT HOME:
● Check the environment at the home
● Are there enough employees and is the staff trained for elder care? Are they caring and attentive?
● Check the location
● Can your friends and family visit you?
● Are you comfortable with the nature of accommodation and the bathroom facilities?
● Will you be happy with the meals?
● Are there regular activities?
● Check the health and personal care facilities
● Are there telephones in the room or can you access one easily?
● Can you practise your religion?

Sunday, September 12, 2010

Why are you being educated?

I very recently heard that the 4 yr Optometry Programme at WBUT ( West Bengal University of Technology & Science) would be discontinued from next academic year,the reason for the decision being the violent gherao enacted by a group of students,passed out from the various institutes under WBUT,fighting towards Optometry Legislation & Professional Independence.I believe the Vice Chancellor of the University was gheroed the whole day and subjected to various threats.Although it’s frustrating that Optometry as a profession was & is unarguably denied it’s right professional space by the so called health policy makers of our great nation,I strongly believe that violence leads to more destruction than construction.As we trace the history of our beloved profession across the globe we could clearly see that,it’s only through academic & clinical excellence of highest standards that the Optometrists have achieved what they have,in their professional endevours.

In this context the following transcript from a talk delivered by J. Krishnamurti,fondly addressed as Jiddu Krishnamurti by his innumerable followers across the globe in a talk delivered at the Indian Institute Of Technology, Bombay, February 1984 is noteworthy,

One wonders why in a place like this we are being educated - for what? What is the relationship between this institution and the world? What place has knowledge, whether it is scientific, biological, or physics and so on - what relationship has that knowledge towards the world? And throughout the world we are all being educated along various lines and with their disciplines; and we human beings have very little place in this world. So one must, I feel, ask why these elaborate years of study, acquiring great deal of knowledge, great effort, and where is it all ending up? What place your scientific, and other disciplines, have relationship, actual, with the existing world? The existing world - the world in which we live our daily life, whether in America, Russia, Europe, or in India or Japan, that very life is being threatened by war. Not only conventional war, but also by nuclear war. Some scientists, we were told, top scientists gathered and wrote what they thought would happen if there was a nuclear war. They said that the whole earth will be covered by a thick layer of dust and smoke, and so the sun cannot possibly penetrate that, and the temperature will fall to 5 degrees below zero. So at the end of a nuclear war not a living thing will exist on the earth. That is one activity of human endeavour, highly technological, highly concerned, each technician with his own particular life, with his own particular discipline and totally disregarding what is happening to human beings throughout the world.

And also, as one observes, there is this vast technological advancement - tremendous, so rapid, and it may lead to extraordinary results. And also our human brains - not that the speaker is an expert in the study of the brain - but if one watches one's own activity in daily life, one sees there the various activities in the brain. There is this technological world which is progressing with abnormal speed in the last two hundred years, and added to that the computer, which probably will take over all the activities of human beings - most of it. Perhaps it will not be able to write great music, of Beethoven, Mozart or Bach, classical western music, but it will do most of the things that human beings are now doing. And what is going to happen to human brain? That is the technological world and the human world. We have given tremendous importance to the technological world. That is why you have this Institution, scientific and various other forms of study with their discipline. And we seem to neglect, perhaps totally, the whole human way of living, what is happening to man. That is, what is happening to you as a student or as a professor, what is your relationship with all the world, with all the things, most terrible things, horrible things that are happening and also all the excellent things like in the world of technology - rapid communication, surgery, medicine and all that side. And also they are inventing all the instruments of war that can destroy whole of humanity with one blow. This is not an exaggeration on the part of the speaker but this is a fact. If one lived in America, they have been talking a great deal about what will happen if there is a nuclear war. Ten million people in New York will be evaporated, completely gone, and hundred million people within a radius of hundred miles, or more or less. Technology is developing all that side. And human misery - the hovels, that you see in this country, especially in towns like this - human beings living in those hovels, breeding, children living in dirt, squalor, misery - on the other side. What relationship has knowledge - not only the scientific knowledge - every kind of knowledge that human beings have acquired during the last forty-five thousand years that they have been on earth as human beings, and we end up like this: war which has been going on for last five to six thousand years, destruction, hatred, misery, utter confusion and sorrow.

And on the other side, man trying to find something beyond himself, beyond his own misery, his own selfishness, his utter insufficiency, his lack of affection. They invent gods, especially in this country. I believe there are over three hundred thousand gods, and all that superstition and vast sums of money spent on all that. We were told the other day that a temple in south India, every third day it has a million dollars. So, we are asking you, professors with their knowledge and you acquiring their knowledge and searching for a vocation which will be imitation - and what has all that got to do with your daily living? The word and the deed are so far apart, and one wonders if we are aware of all this. Or you are enclosed in your own institution, enclave, so that you forget the world.

So we are asking what place all your knowledge - we are not against knowledge - we are asking, enquiring what place has knowledge which you are acquiring, which may be necessary in a certain area, what place has that in your relationship with the rest of humanity? Please, the speaker is not giving a lecture, he is not doing any kind of propaganda or trying to convince you of anything, but we are trying to observe together, see exactly what is happening, without any bias, without the speaker's or your prejudices, to see exactly what is taking place and facing it answer what is our response to all this.

We are enquiring together what place has knowledge in the world of human relationship. What place has all your scientific information, gathered, stored in the brain as memory? And memory is always in the past. Knowledge is never complete, whether in the future or in the past, knowledge is never complete because experience from which knowledge arises is also limited, incomplete. There can be no complete experience. So from experience knowledge, whether it is scientific, human and so on, stored in the brain as memory, and from that memory arises thought, and thought is the very essence of knowledge. The thinker is knowledge, is the activity of knowledge, and the thought of the thinker is also part of knowledge. There is no thinker apart from thought. And the world, both in the scientific world, in all the cruelty that is going on - brutality, torture, inhumanity, the utter disregard for other human beings, all the things that are taking place in the world - poetry, great paintings, music. And this evening when you saw the sunlight on the water, the sparkling water, clear, so extraordinarily beautiful, and all that thought has built, except nature. Nature - tiger is not created by thought. That lake which you see everyday - probably you have got used to it, probably you hardly look at it - man has not created that. Apart from nature, the heavens and all the things of the earth, thought has not built, had no relationship to all that. But thought has invented gods, thought has built the most marvellous architecture: the great temples of this country, the great mosques, the great cathedrals of Europe, and all the things that are in it are put together by thought. And thought is limited; there is no complete thought. Thought can never be complete. It can imagine, it can measure the heavens, but thought is always limited. And technology, the technological world is the product of thought. Without thought you couldn't produce a submarine or go to the moon or invent the nuclear bomb. Thought has been responsible for all this. And facing all this we have innumerable problems - the world is faced with tremendous problems both politically, economically, socially, and also, if you are interested in that kind of affair, in religion - not the religion that is going on throughout the world which is mere superstition, lot of faith and belief, which has nothing whatever to do with what is true religion.

So, having laid down, laid before you what is going on in the world - of which I am quite sure you are quite aware - what is your response to all this? Not just one particular aspect of life but to the whole of existence of man, that is, your whole existence till you die, from now till you die - what is the meaning of all this? So what is your answer, your response to the world, to your vocation, which is imitation, conformity, absorption, either using that knowledge skilfully or inefficiently. And what is you relationship with your neighbour, with your wife, with your husband? And what is the relationship with the rest of humanity? If you are at all thinking about these things, one must have a answer. We have lived on this earth, as the biologists and others point out, as Homo sapiens, for forty to fifty thousand years. We have had wars, confusion, uncertainty, insecurity, misery, great anxiety. After all these thousands and thousands of years, we are still very primitive. We may be extraordinarily technologically advanced, but inwardly, in the psychological world which dominates always the outer, the external, we are primitive, brutal, violent, selfish, superstitious, frightened and so on. So, we are keeping the two, that is, the external, the technological, the daily travail, and the inward life - these two are completely separate. You may have excellent theories about human nature in the psychological world, you may be great technicians, and all that which are the movement of memory, knowledge, and that has nothing whatever to do with your daily behaviour. The two are divorced, the word and the deed, and that is what we have been educated for. So, our education, our knowledge, which is completely limited, will always be limited, what has knowledge to do with our human relationship? Doesn't knowledge kill love?

Do you understand what we are saying? May I go on with what I am saying because this is not, as I have pointed out, a lecture to inform and to instruct. So this is not a lecture. This is a conversation, a dialogue between us, in which you are taking part. You are not merely, if I may most respectfully point out, you are not merely listening to the speaker, words, intellectually grasping certain concepts, ideas, but we are having a dialogue, a conversation about the whole of existence as human beings. So please, you are taking part in what the speaker is saying, not merely listening to certain words. We live by words. Our whole brain is a network of words, and words are not the actual. This microphone, the word 'microphone' is not the actual thing you see. But we are so caught up, so conditioned by words, by language, by tradition, by knowledge, and so our brain is never free. We are problem-solving machines, aren't we? We have been trained from childhood to learn mathematics, and that becomes a problem for a child - or geography, or history, physics and so on - and also it becomes a problem in a school, in college, in universities, in institutions. We are problem-solving machines. That is a fact. And we have made life, the living, into a vast dreadful problem. So we are so conditioned, our brains, and our brain has divided the world. That is, a Christian, into the Hindu, the Buddhist, the Islamic world - separate, divided. And this division of nationalism is one of the causes of war. The causes of war is economic division, each country concerned with itself.

There is great misery, poverty, brutality in this country. When you drive down from Bombay, you see all those huts, tents, filthy; human beings are living there. You want to cry when you see all that, and nobody cares. I know, you listen to this, what the speaker has to say, but it will make very little dent. Governments don't care, individuals don't care, because they are only concerned with themselves, with their power, with their knowledge, with their money. The modern civilisation is based on power and money. And students throughout the world, because the speaker has spoken at many universities in America and some of the institutions in this country, and they are all being trained to seek a vocation of imitation, to be safe, to pass examinations, get a degree, PhD and all the rest it, and get a job either in this country or go to America. Probably, as I was informed this afternoon, 30 per cent of you go to America where you make a lot of money. That's all your knowledge is leading you to. And we are asking, if you are at all serious - and youth generally is serious about certain matters - what is your response, your action to all this that is going on? Either you withdraw from it, join some cranky institution, ashrama, some gurus who are making tons of money, or enter into the world, caught in it. Or you have a life of your own. And what is the purpose of your existence? What is the meaning of your existence?

Please, the speaker is saying all this in humility. He is only challenging you. What is the purpose of all this? Is life's purpose merely to earn money, to be married, house, power, position? Is that the purpose of your life? And apparently it is. That is what you are all being trained for. That is what you want, and if you are dissatisfied with that, then you invent a purpose; the purpose is to find god or some kind of imaginative illumination. Or if that doesn't satisfy you, you take to drugs, drink, and all the rest of vast amusement. One wonders if you have realised what the entertainment industry is doing to you. There is not only the religious entertainment - going to temples, puja and all the circus that goes on round a temple, or a church or mosque. Please don't get annoyed, I am just pointing this out. And what is the purpose of all this? On earth we have lived for forty to fifty thousand years. Please realise this. We have evolved, we have gone through great many tears, laughter, pain, anxiety and yet we remain what we are - selfish, narrow-minded, concerned with ourselves, and to hell with everything else. That's an actual fact.

So, if one may ask, are you wasting your life? Life, which is so complex, which has no readymade answers, life which is so vast and therefore it is something most extraordinarily sacred, and what do we do with it? You have to answer this question, whether you are old or young, well established in a position - wealth, power - is that the whole meaning of life? And if that is the whole meaning of life, which is to have knowledge, knowing that knowledge will always be limited, therefore thought will always be limited and therefore divisive, therefore bringing about great conflict in oneself and therefore outwardly, externally, and knowing - if one has examined it objectively, without any fear - that the whole religious structure throughout the world is just utterly meaningless. So, you as students and professors, with that marvellous lake, with the sun on it, the beauty of it, the poem of it, the grandeur, what is your response, what is your responsibility?
You see, we have always had leaders. In this country especially and also in Europe, more so, you had leaders here, one after the other, both religious, political, social and all that business. And where have they led you? Where has Marx led the communist world? Where has all your sacred - so-called sacred - literature: Upanishads, Gita and all those books - there is nothing sacred about them, no book is sacred. All those things that we have invented. So, what is the meaning of all this existence? You may not want to look at it, you may want to avoid. You may say 'I am too young, it's not my business.' And the older people say 'Sorry, we are too old, we can't face it any more.' They are willing to die. And so what is your knowledge leading to - conformity? Imitation? Absorption of all this information? And nothing original, nothing pristine. And what place has knowledge in love? Is not knowledge the enemy of love, the destroyer of love? Would you please consider this? You give about twenty or thirty years to acquiring - in the acquisition of physics, linguistic experimentation, with biology, sociology, with philosophy, psychoanalysis, psychiatry and so on - you give years and years and you don't give one day or one hour to find out for yourself what you are and why you are living like this.

After all, sirs and ladies - you don't mind if I say 'Sirs'? Sirs includes the ladies, all right? Don't be offended if we do not say sirs and ladies. After all sirs, have you observed, that human beings whether they live in America, both the affluent and also a great deal of poverty, misery in America, a great deal of poverty in Europe, nearly four million people unemployed in England, and all the tyranny that is going on in Russia, the brutality of it all in the name of Marx and socialism, and you come to this country: poverty, incurable, most appalling poverty. We have been brought up in it, not you perhaps who have wealth, power - all of us of my generation, that particular people, have lived through poverty. And have you realised, if I may most politely point out, that whether they live in an affluent society, whether they live in castles or in huts, or whether they live as students, this human consciousness is shared by all human beings because all human beings suffer, go through great agonies, great sense of loneliness, despair, meaningless of this existence. All human beings on this earth, which is so extraordinarily beautiful, which you are very sedulously destroying it. We are living on this earth and all human beings, whether they are the poorest, the most illiterate or the highly sophisticated, great professors of great knowledge, they all suffer, they all face death, they go through great sense of desperate loneliness. We share all this. Every human being on this earth shares all this.

Do please listen to what speaker is saying. Don't get bored. Nobody is going to tell you all this. We share the common sorrow, the sorrow of the whole of mankind. Our consciousness is made up of all this. Your consciousness is not yours, though your tradition, both religious, economic, social, says you are a separate individual. Your whole consciousness, your consciousness is what you are - your belief, your superstitions, your fears, your anxieties, your faith, your lack of love, your selfishness is the consciousness of all humanity. There is no escape from - that's a fact. And therefore you are not an individual. You may be tall, you may be a woman or a man, you may have fair skin and so on, but you are not an individual - not the individual in the sense, in the communist sense, Marxist sense - we are talking of something much deeper than social product.

So you are not an individual. You are the whole of humanity, because you smile, you laugh, you shed tears, you go through great turmoil, you make effort, conflict, facing insecurity. And the Americans are doing exactly the same thing, so are the Russians. So you are actually the rest of mankind. You are not a Hindu though you like to call yourself a Hindu. That is just your local, provincial, narrow conditioning.

So facing all this, are you going to waste your life getting a job, passing some examinations, being trained to imitate? That's what you are being taught - to imitate, to conform, to fit into the pattern. And is that the end of life? Then you will ask: What shall we do? Is there something else? To find something totally different from all this you have to have a great deal of intelligence. Intelligence is not knowledge. Knowledge gives you capacity, knowledge gives you position, status. Knowledge is not love. Knowledge is not compassion. It is only where there is love and compassion there is intelligence, and that intelligence has nothing whatsoever to do with the cunning intelligence of thought. So we must ask - if the speaker can most politely put it before you - what is the meaning of your existence? Are you wasting your life? And this is the only life you have. You may think there is reincarnation, that you will be born next life. That may be merely theory. But what matters is - even if you believe in reincarnation - what matters is how you live now - if you are good, if you are not violent, if you are a total human being, not broken up into scientists, biologists, special careers - then your life is broken up, conflict, and so your life is never a holistic movement. So considering all this, will you waste your life? Nobody can answer that question except yourself. If the speaker were to tell you, which he won't because it is absurd, unintelligent, stupid, to say what is the purpose of life. The purpose of life is what you are doing now - study or you have already a job, earn more money, more status, more power. And that is what you want, and that is the purpose of your life. And also you have to face the ultimate thing which is death. You may not, as you are all young people, but also it is there for you as well as for the older generation - it is always there. And can you live with death? That requires a great deal of enquiry, to live with death. Not commit suicide, not run away from death, but to know the depth and the greatness and the tremendous vitality of death.

This is all of life. This is the whole of life, to have knowledge, to be able to enquire into the whole psychological world of which you are. To understand all that - not from books, not from philosophers, not from your professors, but learn from yourself what you are. And you will discover, if you go into yourself, that your whole life is based on becoming something, as a clerk becomes a manager, the reader becomes the professor, the chief minister ultimately becomes the prime minister and so on - they are always both outwardly and inwardly trying to become something. And this is what we call living. Never a moment of quietness, never a moment of great beauty in our life, but the incessant chattering of the brain.
And you, if one may point out, you are facing all this. Don't disregard all this because the psychological world, the inner world, what you are inwardly, overcomes whatever social structure, governments are established - always overcomes all that. As you see it in Russia, they started out by having no government, no army, no division, no nationality; they said governments will disappear, but the psyche was far more stronger than the superficial social structure. So they have there now the privileged, the top people who have everything in the world, the best of everything, like here, the top people.

So, what are you going to do after listening to this talk - not a lecture - a conversation between you and the speaker? What is your responsibility? Is your brain open to all this? A global affair, or your own narrow little yard, the narrow little self, the 'me', which is a very small affair. Or you are going to be concerned with the whole world, which means you cannot be an Indian any more, you cannot be a Christian, a Hindu, a Buddhist. All those divisions are destructive, they have no meaning. We have to bring a new civilisation, a new culture, a new way of looking at life.

I've finished talking. Do you want to ask questions? The speaker has stopped, do you want to ask any questions, written or otherwise? I am not the oracle. Mon Dieu.

Question 1: Knowledge of any kind cannot be bad. What could possibly be bad is the use of it, the use it is put into. In the opinion of this listener the call of the day is to acquire or cultivate the sense, which is again knowledge, of properly using knowledge for proper causes. Kindly comment.

Krishnamurti: Who is the user? Who is the entity that is using knowledge properly or wrongly? Right? Is not the entity, the user, of knowledge, himself knowledge? You understand my question? You have asked a question that if we use knowledge rightly it is all right, it is the wrong usage of knowledge that is wrong - that's bluntly put. But I am asking, the speaker is asking the questioner, who is the user who uses knowledge rightly? Is not the user, the thinker, the entity, isn't he also knowledge? Is he separate from knowledge? Or the problem is not the right usage of knowledge, right or wrong usage, but what place has knowledge? It has knowledge in the right place, which is to drive a car, to write a letter, if you are a carpenter, to use the knowledge that you have acquired about the wood, the shape of the wood, the quality of the wood, the grain of the wood and so on. There you need knowledge, but do we need knowledge about oneself? Because oneself is knowledge. I don't know if you understand it. Is the speaker answering your question, sir?
First of all, if I may most respectfully point out, the question is wrong. You assume - if I may point out most politely - you assume that the user of knowledge is different from knowledge. Who are you who is going to use knowledge? Are you not the result of centuries of knowledge - unconscious, conscious? You, the self, is knowledge. So you have divided knowledge and the entity that uses knowledge, but both are based on knowledge. So we are saying that knowledge has a definite place in the world of daily activity, but psychological knowledge, that is, the knowledge that you have about your wife, and you have about your husband, that knowledge is divisive, that knowledge prevents love. You can see this simply. You have an image about your wife, and the wife has an image about you, and the images are built through knowledge. You have been with her for twenty years or five days, and you have already got knowledge about her, so you have built an image about her, and the images have relationship, not you and the woman or the man. Sir, these are all facts if you examine it closely.

Question 2: As said by you, we are problem-solving machines, which means machines meant for research and scientific investigation. Do you think then that all the problems of humanity would be solved if life is organised from the point of view of developing, producing and maintaining these machines scientifically with an aim to promote research and science, and not left to develop haphazardly as is going on today?

K: I don't...

Questioner: He says, you say we are all problem-solving machines, in which case...

K: Organise it. Yes, organise it. May I tell you a story? Two friends who were walking in one of the dirty streets of Bombay, and one of them picks up something from the pavement and looks at it, and his face is tremendously illuminated, happy - he cannot hold himself. And he keeps looking at this extraordinary thing he has picked up. And his friend says, 'What have you picked up? You look so happy, so radiant, something has happened to you, what have you picked up?' He said, 'I have picked up truth.' And the friend says, 'Marvellous, let's go and organise it.' No laugh? Do you see the point of that story? You want everything organised, put in their categories. Organisation demands hierarchy, and you are used to hierarchy, both religiously, politically, socially - somebody always in authority above you. So what does authority do to you? Of course the professor knows more about physics than you do, the surgeon knows more than the beginner in medicine, but why do you need hierarchy, authority, in the spiritual world - forgive me if I use that word 'spiritual' because that has been misused that word - why do you want authority about yourself? Who is going to tell you about yourself? The professors? Volumes have been written, from the ancient Greeks and Egyptians, what you are. And probably some of you have read them but you remain what you are. And you want what you are to be organised.
So organisation in certain areas are necessary, and in the other psychological world it is destructive because then psychologically we become slaves to organisations.

Question 3: Throughout your talk you claimed that there is already a lot of confusion in this world, but I do not remember you having given a suggestion or a solution regarding that. Don't you think that this adds to the confusion rather than reduce it? (Laughter)

K: Certainly. Certainly it adds more confusion. But I didn't say the confusion is not there, it is there. I don't claim it. Walk down any street in Bombay, or in Paris or in New York, or where you will, there is a great deal of confusion - that's a fact. Aren't you in confusion? And the questioner says that's a negative statement. What is your positive statement? You understand? You have said that there is confusion - I claim, as the questioner says - I don't claim it. It would be absurd if I claimed - but it is a fact. The fact is that where there is confusion there is conflict; like the Arab and the Jew, both are semitic people, divided by propaganda on the part of the Jews for four to five thousand years, on the part of the Muslim between sixteen hundred years - they are fighting each other, killing each other. That is the essence of confusion, it's not I claim it - it is so. Aren't you all confused? When you look at yourself honestly, clearly, aren't you all confused? You may be good at your science, you may have a good job, settled, but inwardly aren't you all asking what is it all about? You are confused. And the questioner says what is your positive remedy, positive action, or suggestion about this confusion. The speaker says there is no suggestion. He is not offering you a thing. He is not telling you what to do. But look at this confusion carefully, don't say there is no confusion. You mean to say when you drive to Bombay, the centre of Bombay, you don't see all those hovels, people living there, breeding, those children, unhealthy - is that not confusion. Poverty is confusion, isn't there confusion about gods - the Christian god, your Hindu god - isn't that all confusion?
So the speaker says, look at the confusion, don't run away from it. Then what happens? Where does the confusion begin? Out there, or in here? Please answer that question, who put this question. Where does the confusion lie, who has created those hovels which we pass daily by? We human beings - you - because you have rotten government, unconscious community, scandalous behaviour, and you allow all that day after day, year after year. So if you realise you have brought this about, your government, your gods, you are responsible for all this. You are responsible for war because you are a Hindu or you are a Jew or a Christian. Therefore don't be a Jew, don't be a Hindu, so that you are the whole of humanity, you are a human being not a label.
One more.

Question 4: What is love and how does it arise?

K: Good god! (Laughter) Don't you know what love is? Apparently you don't. Do you love your wife, if you are married? Do you love your children? If you loved your children would you make them conform to this particular rotten society, immoral society, send them to war to be killed?
So the questioner says, what is love and how does it arise? My god! It means, sir, first of all, what is love? Can you describe it? Can you put it into words? Or would you find out what is not love? Would you approach it negatively, not positively - say what is love, tell me how to get it. Do you realise, sir, who put this question, what this implies? That you have never loved anybody, whether you are married, whether you have had sex, children. So what is love? Would you approach it negatively, saying what it is not. Is love jealousy? Is love devotion? Is love possessiveness, domination - man dominating the woman as in this country it is happening? Is that love? Is love attachment? Where there is attachment there is fear. Right? If you are attached to your wife and she turns away from you, you become jealous, angry, hatred - all the ugly things that go on. So could you, if one may point out most gently, find out what love is by negating what is not.
An ambitious man, as most of you are, can never know love, he is only concerned with himself. A man who is devoted to god, goes to temples, mosques, churches, tremendous devotion to his guru - you know how they kowtow to the guru, go almost on their knees to the so-called guru, who is just like you. Is devotion love? Or real sentiment, emotion? So find out, sir. Find out what it is not, and then you have that perfume, that extraordinary thing, then life has a meaning, not all your knowledge.

I am afraid we must stop now. It is a quarter to eight.

And also - if I may spend two minutes - Hindus are accustomed to meditation. It's one of their games. What is meditation? Why do you meditate? You meditate in order to achieve something. Right? Achieve happiness, peace, or whatever you like - illumination, peace of mind and all that business. Your meditation is just like any other person who says, 'I am going to become a businessman', only you call it meditation, the other calls it business. Both want to achieve something. Is that meditation? Or meditation is something entirely different? I won't go into that question, it is too complicated. But you should look at all this - not think about it, look at it. If you have time, if you have the inclination, if you are interested, and obviously if you are serious and concerned with what is happening in the world, happening to yourself, you have to look at all this. And of course you are too busy studying books and you won't have time, and therefore you are destroying the world, not looking at your own life and your relationship to the world.

Right, sir.

Feuds between Ophthalmologists,Optometrists & Opticians




Ophthalmologists have always relied on accessory trades to ply their practice, never having shown any inclination to grind their own lenses.
Yet when the spectacle makers' charter was granted by Charles I in 1629, the science of refraction was unknown. As it developed in the
Late nineteenth century, both craftsman and ophthalmologist began to step into the new field. Unsurprisingly, they soon clashed, and the optician/ophthalmologist feud was reported in the medical press in more colourful terms than we would venture today!

The editor of the Ophthalmologist reported with distaste that a Kent optician was advertising’ such elaborate apparatus in his "consulting rooms" that he was able to give the best advice in every respect of the visual organs.' It is reported that this 'optician evidently desires to set up as an ophthalmic surgeon.' The editor hopes that his ‘surgical proclivities will not lead him into the-clutches of the law'.

The opticians' use of private sight testing rooms, to 'ape the consulting rooms of the medics' was widely criticised in medical journals.
At more than one point, the 'audacity of baser members of the optical trade' is described as astonishing.

Nevertheless, it was clear that legislation on these new 'opticians' would be necessary, and Britain, France, and the United States began
deciding on terms. On 27 May 1908, New York state legally recognised 'sight testing opticians', a fact which was reported in the Ophthalmoscope with the comment - 'more's the pity!'.

This sarcasm may have been prompted by an epidemic of exuberant publicity by 'opticians’, such that even The Opticians' Trade Journal promised to check up on 'unfortunate advertising’. The ophthalmologists took to reporting more fraudulent examples themselves. For example, the (large) poster 'Does your child
complain of headache? It is probably eye defect. Consult us - we are opticians!' probably raised the blood pressure of a good number of medics. To their credit, the 'Worshipful Company of Spectacle Makers' undertook to curb this, although they threatened that having done so,
They would deal harshly with 'people who maliciously slander the optical profession'. No names were mentioned, but the phrase 'malignant medical groups' was.
By 1911, 24 states in the United States permitted’ optometry'. This situation did not please ophthalmologists, who commented in the journals that 'optometrists would fail to diagnose grave disease', that 'they were not subject to the ethical standards of a learned profession' (ouch!), and that 'their purely commercial outlook prevented them from protecting the public when their own pockets were in question'.

That year, the American Ophthalmological Committee recommended that every medical student be urgently taught to refract, presumably
in anticipation of a future scourge of opticians. The French, however, took the medics’ side, amending their act of 1892 such that prescribing spectacles by refraction or indeed selling spectacles at all without a medical doctor’s prescription was illegal.

In Britain there was confusion about the opticians' role for a long time, and court cases resulted. A good example from 1911 was that against Richard Thomas, a Manchester optician, who treated a lady with various spectacles over a period of 2 years. On finally consulting an ophthalmologist, the diagnosis of 'conical cornea? Was made, and the lady was advised that earlier diagnosis would have helped. The prosecution held that unless an optician could detect disease of the eye, he should not be allowed to prescribe spectacles. The defence asserted that opticians did not profess to diagnose and cure disease, but merely to sell spectacles, and that this fact was widely known to the general public - caveat emptor!

As Thomas was advertising as an 'eye specialist' with designated 'consulting hours' this is debatable! The defence further countered that as doctors unanimously regarded opticians as undesirable aliens, all the medical evidence would be biased. Obviously the judge disagreed, fining the unhappy 'eye specialist' £25, presumably to
the great delight of the medics.

Tuesday, September 7, 2010

R Venkat at Patna as Invited Guest Speaker,CME Optometry Society,Magadh




Prescription Eye Drops

For many eye conditions, there are prescription eye drops that can bring about healing or relief. While there are many debilitating injuries that we can suffer, few places on our body are more sensitive to abnormalities than our eyes. The Hawaiian teenager who gets her eyes scratched because of dry contact lenses not taken care of properly and the oil rig operator who get a piece of dirt in his eye on the Oklahoma plain both know the incredible pain and almost shutdown effect an eyesight issue can have. The big wrestler who gets his head smashed in with a fold up chair or a flying hammer throw gets up and grins, but if the eyes are poked, both hands go up in total protection and care of the eyeball and that big bruiser is as helpless as a kitten. Go into any drugstore and there is an entire row of products devoted to over the counter relief of minor eye irritations. But when those OTC products fail, it's the more powerful prescription drops to the rescue.

Probably the most common need for ocular drops, either over the counter or prescription eye drops is for the relief of allergies. It sounds like a commercial, but that burning, itching and redness of the eyes can be a real pain and make a lot of us just come to a standstill, no matter what we are doing. So in we walk to the local apothecary shop and behold the selection of dazzling answers to our problem. Of course, the world's advertising blast is soon evident on us, and we are drawn to those brands we have seen on television. After all, if it's on TV, it must be good! And many times, the over the counter brand of eyesight care solution really does work because some of them carry lower doses of what is in the more potent prescription eye drops.

There are many reasons why vision care professionals will prescribe prescription eye drops. One of the most common issues needing prescriptive therapy that anyone will face is the highly contagious conjunctivitis commonly known as pink eye. This is redness of the white part of the eyes and membranes on the inner part of the eyelid and is very easily spread to other persons. This condition is most prominent in children who aren't as careful about hygienic issues as they should be. There may be other symptoms that accompany this condition, such as a runny nose and sinus congestion. Since there are two forms of this condition, viral and bacterial, it is important that the sufferer be seen by a vision care professional to ascertain the exact type. Some cases of conjunctivitis may need prescription drops and others just warm compresses applied to the eyes.

Anyone with a TV will probably know the commercial that has been running ad nauseum for over a year touting the product Restasis for dry eyes syndrome. The eyes can certainly get dry and itchy if one is out in the wind, or perhaps sitting before a computer monitor for any length of time. In that case, a quick trip to the drug store will put a person in front of those many over the counter choices for relief of that very condition such as Visine, Bausch and Lomb and Theratears. But there are those folks that do suffer from chronic dry eye, and that's where prescription eye drops come in such as Restasis. God has promised to Christians that the day of tearing eyes and sadness will one day be gone forever. "For the Lamb (Jesus Christ) which is in the midst of the throne shall feed them and shall lead them unto living fountains of waters: and God shall wipe away all tears from their eyes." (Revelation 7:17)

When it comes to functional problems with the eye, the most common needing prescription eye drops would probably be glaucoma. This condition is excess pressure on the eye due to fluid not draining from it properly. The disease can seriously reduce peripheral vision and can lead to blindness if not treated. There are three types of prescription eye drops that are used for this condition, including pilocarpine, epinephrine and beta-blockers. Some drugs are not appropriate for people with certain health issues, so it is very important that a person's vision care specialist know all of the drugs a person is taking. Medicine for the eyes can be just as deadly as medicine taken orally.

That's really the bottom line here in this article. People can get lulled into a sense of complacency by the many almost recreational over the counter solutions for eyes that are so very common. If one's eyes are a little itchy, just tilt the head back and instant gratification by a seven dollar solution. But prescription eye drops are just as potent in many cases as any other drug we might take by injection or orally in pill form and should be viewed that way by the person using them. So have clean hands when using them, and pull the lower eyelid down to form a small pool for receiving the medicine. Experts are now advising that if the medicine prescription says one or two drops then one is all that should be applied, because certain droppers might actually dispense two as a result of misuse. With the intent of putting two in, more might actually be introduced into the system.

For more information: http://www.christianet.com

Sunday, August 15, 2010

RV at EIVOC 2010,Chennai,India


RV with DrSSB,Chairman Emeritus,Sankara Nethralaya at EIVOC 2010

RV presented a Scientific Poster on "Clinical Significance of Filters as a Rehabilitative Tool in Low Vision" which fetched Best Scientific Presentation Award in Low Vision Category at EIVOC 2010

Sunday, August 8, 2010

Dr Kanchan Gaba,Head,NAB,National Association For Blind,Kolkata - A source of inspiration to Visually Impaired

Kanchan Gaba was only eight years old when her world became dark. She was in Std II, and one morning she woke up to see… nothing. "I rubbed my eyes several times and then screamed out in horror. I felt the world closing up around me…" Doctors said she had glaucoma with retinal detachment. “I was too young to understand what I had lost,” she says, but her parents refused to believe that their daughter had become blind. She remembers their mood; for one year, they took their daughter everywhere possible for treatment. They finally reconciled themselves to the fact that their daughter would never see again.

"I was admitted to the Calcutta Blind School. I started learning Braille. My mother tongue was Punjabi, and the medium of instruction was Bangla. So even though I scored 94% or 96% in all subjects, I got only 36% in Bangla,” Kanchan remembers. “I was determined to excel in that subject too.” In her Std X exams, this strong-minded young girl topped the Handicapped Section in West Bengal. She then finished her Std XII exams from Lady Brabone College, and went on to go to law college on a national scholarship.

In school, she had joined the four-and-a-half year Girl Guide programme with other children, all sighted. "Once again I was happy. The programme included first-aid training, tent pitching, fire fighting, forest and mountain trekking." Along with completing her secondary and higher secondary level exams with elan, Kanchan completed her Girl Guide course – learning first-aid, survival skills in a jungle, walking over wooden bridges, crossing streams, etc.

Later, Kanchan did a full-fledged course in rock climbing at the Darjeeling Institute of Mountaineering, scaling the Tenzing Rock, the Gambhu Rock and the Sandakfu. She won the state's Best Girl Guide medal, and qualified for the national meet in Adra, Purulia. Here, she defeated nearly 600 non-disabled competitors from all over the country to win the President's award, presented by Shri Shankar Dayal Sharma, in 1994.

The President of India is the chief patron of the Bharat Scouts and Guides, which is affiliated to the International Scouts and Guides, headed by the Queen of England. Kanchan has represented India twice at international Girl Guide meets: in London (1997) and Bangladesh (2001).

In London, she was the only blind person among 700 participants. The gruelling competition’s 40 challenges could be completed by only 40 children, Kanchan being one of them.

She did everything much faster and better than others. "I climbed the difficult Harrison Rocks, abseiled from a 150 feet high tower, rappelled down rocks and did river rafting...," and scored much higher to win the Best Girl Guide in the World Award.

Queen Elizabeth II, while presenting the award, admitted, "I would not have believed Kanchan’s story had I not seen her perform with my own eyes." A dinner was hosted at the Buckingham Palace in her honour.

In 1997, Kanchan received the SCORE award for Sporting Excellence (in the blind category), given to her by Kiran Bedi, and the Neelam Kanga ‘Successful Woman’ Award in 2003, presented by the Mumbai branch of National Association of the Blind.

Why did she take up law as a profession? “I have been very competitive since childhood,” she reveals. “Law is a prestigious profession, and it also lets me help people who need assistance.” For her studies, she had a reader who recorded relevant material for her. She studied by listening to those recordings as there were “no Braille books at that time”.

She started work with a senior lawyer while in her fifth year of L.L.M., organising briefs for clients and doing consultancy work. Today, she works at K.D. Associates, and is a successful lawyer in Kolkata, dealing with intellectual property issues.

Computers are a great help when she is preparing her briefs. She has screen reading software, and uses CDs a lot. She also has a reader for her work.

Kanchan is a person of myriad interests. She has worked on a year-long research project on the plight of women prisoners in Bengal. Her work was supported by the Scholar of Peace award from the Foundation for Universal Responsibility, an NGO headed by the Dalai Lama. “I have a background in both sociology and law, and women’s issues always interest me,” explained Kanchan. The second reason for her choice of subject was more personal. “There is a belief that disabled people only work for disability. But given a chance, we would like to serve society as a whole.” She has presented her findings at a seminar; and hopes to publish them soon.

“If you want to be a lawyer, you have to be a good talker,” she advises. “It is your mode of talking which influences your client. You have to be very communicative.”

Why she does what she does is motivated by a strong desire to transform the social mindset that takes blind or visually impaired people for granted, or views them as fit only for charity.

She feels that she has been lucky that she has found good people to help her. Society functions on a give-and-take basis; if you want something from people, then you have to contribute your share too – whether you are blind or not.

Kanchan Gaba can be contacted at kanchangaba@yahoo.com.

Breakthrough in stem cell therapy


A collaborative effort between the Vision Research Foundation and Nichi-In Biosciences has borne fruit with the invention of a novel procedure which will help treat diseases like persistent corneal ulcers, Stevens-Johnson Syndrome and other severely damaging injuries to the corneal epithelium.


In 2003, VRF scientists identified a synthetic material — the Mebiol Gel — which was used to grow corneal limbal stem cells of rabbits.

According to Dr. HN Madhavan, President, Vision Research Foundation, who headed the VRF team, the stem cells multiplied rapidly in the Mebiol Gel, which liquefies when cooled.

The cell culture dish was placed in a refrigerator and once the gel liquefied, scientists injected the stem cells, after separating it from the liquid, into the eyes of 12 rabbits blinded because of ocular surface damage.

The results were promising —vision was completely restored in seven rabbits and partially restored in three rabbits. The procedure, however, failed to yield any significant response in the remaining two rabbits.

Dr. Madhavan, who is also Director & Professor of Microbiology, Sankara Nethralaya, said that cultivating stem cells using the Mebiol Gel prevented rejection and infection.

The team applied for a patent in 2005 and in March 2010, both VRF and Nichi-In Biosciences were awarded the patent for “a method for cultivating cells derived from corneal limbal tissue.”

Describing the patent as a “great achievement,” Sankara Nethralaya Chairman Emeritus Dr. SS Badrinath said, “It is a red letter day for Sankara Nethralaya. This product will be of service to humanity, benefiting patients with corneal blindness.”

Deputy Consul General of Japan in Chennai, Mr. Takayuki Kitagawa, who was the chief guest, said India was emerging as a major destination for stem cell research and called for enhanced collaboration and cooperation between the countries in the field of medicine.

Dr. Samuel JK Abraham, Director, Nichi-In Biosciences, spoke on the hurdles that the organisations had to overcome while undertaking the research.

Annual meeting on ophthalmic research held

Nineteen scientists from the Vision Research Foundation participated at the 18th Indian Eye Research Group (IERG) meeting at Hyderabad held from July 31 to August 1, 2010.

Held from 1992, the annual IERG meeting brings together investigators involved in different areas of basic and clinical eye research across India to discuss the latest research methodologies and current trends in ophthalmology.

The two-day meeting included oral presentations on Gene and Cell based therapy, Community Eye Health, Cornea and Lens, Glaucoma and Retina and numerous poster presentations. Talks and papers, presented by researchers, on ocular stem cells, lens crystallines, age-related macular degeneration were very informative.

Dr. S Krishna Kumar, Head of Department, Ocular Pathology, gave a talk on “Epcam, Myself, Retinoblastoma and the Continuing Journey;” Dr. Ronnie George, Senior Consultant, Glaucoma, spoke on “Population based studies: implications for Glaucoma Care in India,” and Dr. LS Vardharajan spoke on “Models of Amblyopic Vision.”

One of the highlights of the meeting was the talk given by Abraham Scaria from Genzyme on “Gene Therapy for the treatment of Wet-AMD.”

Dr. Namperumalswamy, Chairman, Aravind Eye Care Centre, Dr. G. N. Rao, Founder, L.V. Prasad Eye Institute and Dr. SS Badrinath, Chairman Emeritus, Sankara Nethralaya, were honored with mementos for their monumental work on clinical eye research and their service.

In the validation ceremony, it was announced that IERG will unite with ARVO (India chapter) and will be called as IERG –ARVO.

Sunday, July 25, 2010

Dialling for danger?

Does the use of cell phones increase the risk of cancer? Even if scientists are divided about it, here are some suggestions that could minimise the radiation.



Radiation is a loaded word that conjures up unreasonable fear. So let's be clear about what we're talking about. Your cell phone is a tiny transceiver — a combination transmitter and receiver. Power is radiated when you use it. But it's not the same kind of radiation produced by nuclear reactions and X-rays. That's the far more dangerous type called ionising radiation.



Cell phones produce less harmful non-ionising radiation. However, as exposure time and power level increases, non-ionizing radiation is a hazard too. The real argument is over how much non-ionising radiation is too much. To be clear, there is no proof that using your cell phone will increase your chances of getting cancer. But several scientists believe there is a correlation between heavy cell phone use and cancer.



Here are some ways to reduce the amount of radiation you get from cell phones. Even if some final study says there is no danger, there's no risk in following these tips.



So let's start with the fact that not all cell phones are created equal. Some produce more radiation than others. Use a low radiation phone. Next, consider spending less time on your cell phone. When you know the conversation will be a long one, use a wired phone. But some people don't even have a regular wired phone. That means exposure to cell phone radiation is a bigger deal than when cell phones weren't as common. So let's talk about ways regular cell phone users can reduce the risk a bit.



The closer your cell phone is to your body, the more radiation you get. Even holding a phone two inches from your ear dramatically reduces the amount of radiation zapping your brain.



You'd think clipping your phone to your belt and using a hands-free earpiece and microphone would be a no-brainer next step. But it isn't. Wired earpieces can serve as an antenna that actually concentrates the radiation that your brain receives. And many wireless earpieces are just tiny transmitter/receivers that produce their own radiation.



The safest way to use a cell phone is to hold it away from your body and use the speakerphone setting. Almost everyone agrees that radiation exposure in that mode is minimal.



Many may not routinely use the speakerphone setting. It eliminates privacy and isn't practical in many situations. But there is still a way to reduce radiation, even when you must hold the cell next to your ear. Simply shift the phone from one ear to the other at regular intervals. That means you aren't concentrating all that radiation on one side of your head.



The last tip involves those bars displayed on the cell phone screen. The bars indicate the strength of the signal. Cell phones are most dangerous when the signal is very weak. Here's why: In weak signal areas the cell phone cranks up its power automatically in an attempt to compensate. So you are exposed to more radiation during times like that.



Adopt as many of these tips as you can. Even if the radiation fears prove groundless, your stress levels and mental health are bound to improve by spending less time on the cell phone.

Principles of modern low vision rehabilitation

Low vision rehabilitation is a new emerging subspecialty drawing from the traditional fields of ophthalmology,


optometry, occupational therapy, and sociology, with an ever-increasing impact on our customary concepts of

research, education, and services for the visually impaired patient. A multidisciplinary approach and

coordinated effort are necessary to take advantage of new scientific advances and achieve optimal results for

the patient.Accordingly, the intent of this paper is to outline the principles and details of a modern low vision

rehabilitation service.

All rehabilitation attempts must start with a firsthand interview (the intake) for assessing functionality and

priority tasks for rehabilitation, as well as assessing the patient’s all-important cognitive skills.The assessment

of residual visual functions follows the intake and offers a unique opportunity to measure, evaluate, and

document accurately the extent of functional loss sustained by the patient from disease. An accurate

assessment of residual visual functions includes assessment of visual acuity, contrast sensitivity, binocularity,

refractive errors, perimetry, oculomotor functions, cortical visual integration, and light characteristics affecting

visual functions. Functional vision assessment in low vision rehabilitation measures how well one uses residual

visual functions to perform routine tasks, using different items under various conditions, throughout the day.

Of the many functional vision skills known, reading skills is an obligatory item for all low vision rehabilitation

assessments.

Results of assessment guide rehabilitation professionals in developing rehabilitation plans for the individual and

recommending appropriate low vision devices. The outcome from assessing residual visual functions is

detection of visual functions that can be improved with the use of optical devices. Methods for prescribing

devices such as image relocation with prisms to a preferred retinal locus, field displacement to primary gaze

position, field expansion, and manipulation of light are practiced today in addition to, or instead of,

magnification. Correction of refractive errors, occlusion therapy, enhancement of oculomotor skills, and field

restitution are additional methods now available for prescribing devices leading to rehabilitation of visual

functions.The outcome from assessing residual functional vision is detection of functional vision that can be

improved with the use of vision therapy training. After restoration of optimal residual visual functions is

achieved with optical devices, one can follow with training programs for restoration of lost vision-related skills.

If an optical dispensary is available where prescribing of low vision devices routinely take place, this will help

ensure familiarity and specialization of the dispensary and staff with low vision devices and their special

dispensing requirements.The dispensing of low vision devices is an opportunity to introduce the device to the

patient, train the patient in the correct use of the device for the task selected, and create a direct and

continuous connection with the patient until the next encounter. Following assessment, prescribing, and

dispensing of devices, a low vision practitioner, ophthalmologist or optometrist, is responsible for

recommending and prescribing vision therapy training to improve residual functional vision.

An attempt to present a template for a comprehensive modern low vision rehabilitation practice is made here

by summarizing scientific developments in the field and stressing the multidisciplinary involvement required for

this kind of practice. It is hoped that this paper and other initiatives from colleagues, the public, and

government will promote and raise awareness of modern low vision rehabilitation for the benefit of all.

Tuesday, May 25, 2010

“SURVIVING” RECOVERY FROM MACULAR HOLE SURGERY

“SURVIVING” RECOVERY FROM MACULAR HOLE SURGERY:


HELPFUL HINTS FROM ONE WOMAN’S EXPERIENCE

© Joy R. Efron, Ed.D.



ABSTRACT: The author was diagnosed with a full-thickness macular hole (January 2009) and had a vitrectomy (March 2009). One year post-surgery, her visual acuity had recovered to 20/25 and distortion was practically non-existent. This article provides information, resources and motivation for macular hole patients to assist in complying with post-surgery face-down positioning in order to help maximize visual outcomes.

********************

INTRODUCTION

What is a Macular Hole?

Symptoms

What Takes Place during Surgery for a Macular Hole?

Why Is Face-Down Positioning Required Following Surgery?

How Long Must a Patient Remain Face-Down?

Why Is A Subsequent Cataract Surgery Usually Required?

What Outcomes Can Be Anticipated?



FACTORS CONTRIBUTING TO SUCCESSFUL OUTCOME

A highly skilled surgeon

Information, resources and support

Maintaining face-down positioning and use of equipment

The presence of a helper you trust

Visitors

IMPORTANCE OF FACE-DOWN POSITIONING

GENERAL PRECAUTIONS

SPECIFIC SUGGESTIONS TO MAINTAIN FACE-DOWN POSITIONING

Vitrectomy (Face-Down) Equipment

Advance Preparation

Sleep Aids

Eye Drops

Eating/Drinking

Comfort Techniques and Aids

"Silly" Suggestions



AFTER FACE-DOWN POSITIONING IS NO LONGER REQUIRED

CATARACT SURGERY

OTHER CONCERNS

AUTHOR’S CONTACT INFORMATION

ACKNOWLEDGEMENTS



INTRODUCTION



The purpose of this article is to assist patients facing surgery for a macular hole. The required face-down positioning following surgery is extremely uncomfortable and challenging. However, maintaining that position is essential to maximize functional vision recovery. I have had an extremely successful recovery and the purpose of this article is to offer hints and tips to others to assist in “surviving” this difficult post-operative period. Suggestions discussed were very beneficial to me. With adaptation for individual needs, it is hoped that many of these ideas may be of value to others. Throughout the article, various resources are mentioned. Since I live in Southern California, several of the specific resources refer to this geographic area.



What is a Macular Hole? The macula is the area of central vision in the retina. A macular hole should not be confused with macular degeneration or a retinal detachment. The eye is filled with a gel-like substance called vitreous, which helps maintain the shape of the eye. As people age, the vitreous starts to shrink away from the retina. This is normal and usually causes no problems. In isolated cases (about three per 1,000 people over the age of 60), some resilient fibers refuse to let go of the retina. Essentially, a “tug-of-war” takes place with the body of the vitreous shrinking while the “stubborn” fibers hold tight to the retina. This “tug-of-war” can cause a hole in the macula. Once a hole is formed, the body’s defenses create scar tissue on the retina. The hole and the scar tissue cause blurriness and visual distortion.



Symptoms: A macular hole is characterized by blurry vision (both near and far) as well as visual distortion. My story: Following 42 years as an educator of blind and visually impaired children, it was a great surprise to me to suddenly experience a visual impairment on a first-hand basis. While driving in January 2009, I became aware that the painted highway lane markers appeared to be extremely wavy when viewed through my left eye. Everything (whether near or far) was blurry. A visit to the ophthalmologist determined that I had a full thickness macular hole (through all layers of the retina). During the two months between diagnosis and surgery (March 2009), my vision continued to deteriorate. Every horizontal and vertical line appeared to have at least five “S” curves. The City looked devastated, with buildings at eccentric angles. At times, while I was looking at a person, it would suddenly appear as if his/her head would shrink to a miniscule globe sitting on the neck. Items appeared smaller with my left eye than with my right eye. Scanning became extremely difficult, i.e. while walking in a grocery store, items on shelves appeared to be jumbled together. While trying to read, letters were skewed and wavy. Letters become smaller while reading across a line of print. My corrected visual acuity had deteriorated from normal to less than 20/200. All visual tasks had become fatiguing and additional lighting had become critically important.



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What Takes Place during Surgery for a Macular Hole? Surgery consists of a vitrectomy (removal of the vitreous), peeling of the scar tissue that formed over a portion of the retina, and insertion of a gas bubble in place of the vitreous.



Why Is Face-Down Positioning Required Following Surgery? The pressure of the gas bubble, over several weeks, causes the hole to close. However, since gas rises and the macula is located at the back of the eye, the patient must be face-down following surgery for the gas bubble to be properly positioned to exert the necessary pressure on the macula.



How Long Must a Patient Remain Face-Down? There is no definitive research relative to either the number of hours per day or the total number of days a patient must be face-down. Some doctors suggest two to three days; others suggest six weeks or until the gas dissipates. Due to the lack of research, I tried to contact other people who had been through a similar experience. Through networking with friends and professionals, I spoke with individuals, from Massachusetts to Hawaii, who had gone through macular hole surgery. Based on their informal reports, there appeared to be a dramatic correlation between visual outcome and compliance to the face-down regimen with respect to number of hours per day and the total number of days.



Based on my doctor’s recommendations and my own research, I was face-down for six weeks following surgery. For the first 29 days, this meant face-down positioning 24 hours per day, with the only exceptions being four brief periods per day, when I rolled onto my back for eye drops. For the next 14 days, I was face-down at night and during most of the day. Face-up periods were brief.



It was extremely unpleasant, but I was goal-directed and determined to do everything in my power to contribute to the best possible visual results following surgery. Patience, perseverance and determination paid off.



Why Is A Subsequent Cataract Surgery Usually Required? The gas bubble causes a cataract (in patients who have not previously had cataract surgery). Thus, a follow-up cataract operation is required, usually within six months to a year following the macular hole surgery.



What Outcomes Can Be Anticipated? According to the literature, most patients get some visual improvement following surgery, but outcomes vary greatly among patients. It can take a year before maximum visual improvement occurs. One year post-surgery, my visual functioning has far surpassed expectations. Visual acuity in my operated eye is 20/25, with very minimal (insignificant) distortion, and image size is essentially the same with both eyes.







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For more information, Google “Macular Pucker” and “Macular Hole”. Three suggested sites are:

http://www.nei.nih.gov/health/pucker/pucker.asp

http://www.nei.nih.gov/health/macularhole/macularhole.asp

http://vitrectomysolutions.com/whyfacedown.asp





FACTORS CONTRIBUTING TO SUCCESSFUL OUTCOME



I am extremely fortunate. I feel that my successful outcome is due to a highly skilled surgeon and my strict adherence to the six-week regimen of face-down positioning. Remaining face-down for six weeks would not have been possible for me without the assistance of others, face-down positioning equipment, mentoring and encouragement by others who have gone through macular hole surgery, and support of family and friends. Essential factors to consider include:



1. A highly skilled surgeon: Make sure you have a highly skilled, experienced retinal surgeon. Ask a lot of questions, including how many vitrectomies and macular hole surgeries the doctor has performed as well as the frequency of performing those operations. Ask about the surgeon’s anatomical success rate, i.e. percent of holes that close following surgery and the incidence of holes that later reopen. (According to the literature, about 90% of holes close following recovery from surgery; about 15% of those reopen.) Ask about the surgeon’s functional success rate, i.e., improvement you might anticipate in visual acuity. (The literature provides nebulous information, such as “…most patients improve two lines on the Snellen chart…” or….”….regain half their vision…”) The subsequent cataract surgery on post-macular hole patients presents special challenges for the surgeon. Make sure you have a highly skilled cataract surgeon who has successful experience with post-vitrectomy patients. If you were measured for a cataract replacement lens prior to macular hole surgery, ask if you should be measured again, prior to cataract surgery. (See Cataract Surgery, p. 15, for more information.)



2. Information, resources and support: In addition to asking questions of your doctor,

you might research (i.e. Google, etc.) information about macular holes, macular hole surgery, vitrectomy, vitrectomy equipment, face-down equipment. If you can, talk with other patients who have been through successful macular hole surgery and recovery. You might ask your surgeon for patient contacts. I was fortunate to obtain valuable information, resources and support from both professionals and other patients.













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3. Maintaining face-down positioning and use of equipment: This is critical in order to achieve a successful outcome. As brutally uncomfortable as this is, a successful visual outcome is well worth considerable efforts. (Though not necessarily a "compliant" person, I was compulsively compliant during my recovery.) I don’t believe that strict compliance would have been possible for me without the use of appropriate equipment. (See “Vitrectomy (Face-Down) Equipment” section on pp. 6-8 of this article for specific recommendations as well as recommendations if your health plan does not cover rental of vitrectomy equipment.)



4. The presence of a helper you trust: I am incredibly grateful to my husband and highly recommend that a person who lives alone tries to arrange for household and related help in order to maintain the positioning. If you live alone and finances are a problem, check with your health plan or your county/state/Medicare health services department to see if you qualify for short-term in-home supportive services during your recovery period.



5. Visitors: Many people are “private” and wish to be alone when not feeling up to par. However, visitors can be a huge help in keeping your mind occupied. I am very grateful to friends and family who called, visited, sent food and provided a variety of diversions. Playing simple board games with my grandson as well as Scrabble with friends was possible while face-down.





IMPORTANCE OF FACE-DOWN POSITIONING



As stated previously, the pressure of the gas bubble is essential for the hole to close. Here is my layman's reasoning/interpretation: If you have a bad cut and put on a band aid, that band aid needs to stay on for good healing. If you keep taking that band aid off and then putting it back on, the cut does not heal well. The pressure of the gas bubble facilitates macular hole closure (like a band aid on a cut). The macula is located at the back of the eye. So, every time you lift up your head, it is similar to taking that band aid off a cut. (I walked, including up and down stairs, with my head down. I picked up my head only to rinse my hair after washing it and for inserting eye drops. It was brutal, but I was determined.) KEEP YOUR HEAD DOWN as much as you can possibly tolerate. Look at your toes, even when walking! Keep your face down! Do not "cheat". Do not lift your head to greet or visit with visitors. If you can, rent a two-way mirror to enable you to see and be seen by visitors and to watch TV. (See “Vitrectomy Face-Down Equipment,” Sec. a (6) on p. 7.)













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GENERAL PRECAUTIONS



1. Eye shield: Wear an eye shield while sleeping during the first week post-surgery.



2. Plane travel; Do not fly for several months or go above the altitude where the surgery is performed. (The gas bubble expands with altitude, due to the drop in atmospheric pressure; expansion can cause dangerous pressure within the eye.)



3. Washing: Do not get your face wet for several days.



4. Hair: Use dry shampoo for the first week or 10 days. (Walgreen’s Pharmacy carries a dry shampoo product.)



5. Swelling: Your face may be swollen for quite awhile on the operated side; this is normal.





SPECIFIC SUGGESTIONS TO MAINTAIN FACE-DOWN POSITIONING



The following was helpful for me, and I hope that some of this information will be helpful for you. However, everyone is different and you will probably discover other techniques/hints that work for you. Be sure to check with your doctor concerning any products mentioned in this document. You will find some suggestions at www.vitrectomy.com, under the heading “Tips and Hints”.



1. Vitrectomy (Face-Down) Equipment



Without strict compliance to the face-down positioning, surgery is most likely unsuccessful or of limited success. It would have been impossible for me to remain face-down consistently for the six week recovery period without vitrectomy (face-down) equipment.



Ironically, Medicare (and therefore, many health plans) considers face-down positioning equipment to be "comfort" and "convenience" equipment. It will literally take an act of Congress to change Medicare’s position.



Some health plans cover equipment rental for recovery from macular hole surgery. (Note: As of April, 2010, I have spoken with patients who were covered for rental of vitrectomy equipment by Aetna, United Health Care, Cigna, and Blue Cross PPO.)



Therefore, ask your doctor or your health plan administration if you have this coverage. You must get a letter from your doctor stating that the post-vitrectomy face-down equipment is “medically necessary” for patients who have undergone



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vitrectomy surgery and who are required to maintain a face-down position in the post-operative period. If either Medicare or your health plan subsequently denies you coverage, be sure to appeal their decision. Based on your doctor’s statement of medical necessity, there is an excellent chance that your health plan will ultimately approve funding the equipment rental.



I failed to get the “medically necessary” letter from my doctor and therefore had to pay for the rental/purchase of equipment.



If (despite the doctor’s letter about medical necessity) vitrectomy equipment is not covered by your health plan and you are financially unable to rent equipment, insist on being given suggestions to relieve the discomfort of face-down positioning. Ask your doctor or health plan for a referral to a physical therapist or other health-related professional who can suggest adaptations, i.e. improvising with the use of pillows, blankets and towels. Pillows placed at strategic body points can facilitate face-down sleeping. A large towel fashioned in a horseshoe shape can help support the head for sleep. Being able to lie comfortably on one's abdomen is extremely important. Ask for information about locating an inexpensive mat for this purpose.



You can use the internet to research, i.e. Google, "Vitrectomy Equipment" or "Face-down Equipment". I did so and called various companies to compare products and prices.

My choice was www.vitrectomy.com.

Phone number is 877/848-7328. (They were very knowledgeable and helpful.)



a. The following equipment was rented, most of which can be seen at www.vitrectomy.com.

(1) Kneeling massage-type chair for day use

(2) Head support/cradle for foot of bed and seated support

(3) Adjustable tray placed below the face cradle

(4) Arm rest shelf

(5) Sternum pad

(6) Two-way mirror to watch TV and see/interact with people

Note: Rental cost (March 2009) was $165 for the first week and $105 for each subsequent week; no shipping charge.



b. The following equipment was purchased, most of which can be seen at www.vitrectomy.com.

(1) Basic mat (to relieve lower back strain while sleeping on one’s stomach

(2) Fleece cover for the head rest (the cover of the face cradle can rub and become uncomfortable on the face; the fleece is much softer; see further discussion under Face Pillow on p. 13).

(3) BioFreeze gel (to relieve neck and shoulder pain). See 3b under Sleep Aids, p. 11. For additional information, see http://www.biofreeze.com.



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c. Look at the equipment on-line. Some of this equipment may be found at major massage supply stores. Try to locate one where you can sit in/on various pieces of equipment produced by a variety of manufacturers. In Southern California, a massage supply store that carries both massage and vitrectomy equipment, is:

Massage Central

12235 Santa Monica Blvd.

Los Angeles, CA 90025

(310) 826-2209

www.mcla.com.



d. I purchased an Ergo Spa Lounger, which is essentially a patio lounge chair with a large opening for the face. (It was probably designed for use at the beach for someone who wants to suntan their back and/or read with the book placed on the sand.) The Ergo Lounger worked well during the day. Coffee and other beverages (used with a flexible straw) and snacks can be placed on the floor below the face opening. Since the sides were hard, I draped a pillow over each side of the chair, under my armpits. A personal DVD player, for listening to Audio Books, was also placed on the floor.



The Ergo Lounger is available on-line from The Comfort Store.

The store site is www.sitincomfort.com.

The Ergo Lounger can be viewed at the following page: http://sitincomfort.com/erulbech.html.

The Comfort Store

459 Orange Point Drive Suite H

Lewis Center, Ohio 43035

888/867-2225



e. High table: We had an adjustable height computer table in the house. (A shelf mounted on an adjustable tripod would work just as well.) Setting the shelf surface at chest level was very helpful in order to rest my head (on my folded arms or on a pillow), eat, drink and even use the computer for short periods of time while standing and maintaining face-down positioning.





2. Advance Preparation



Anticipate what might be needed and make it accessible. The following may sound very compulsive, but for me, it was helpful to easily access what was needed. Obviously, everyone has different needs and different living styles.









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a. Make needed/desirable items accessible; Prior to surgery, try to anticipate what will be needed in each room and make those items easily accessible.



(1) Set up trays/baskets on the floor in each room with items needed, e.g. toothbrush & cosmetics in the bathroom; phone, paper and pad by the bed, etc.



(2) Organize all important papers so they are easily accessible



(3) Place frequently-used food on the lower shelf of the refrigerator door.



(4) Place bowls/cups/straws/cereal on a low (slide-out, if possible) shelf.



(5) Set up a power strip by the bed and have a stool/chair within reach. Place a box atop the stool/chair with everything needed--TV control, DVD player, portable phone with charger, cell phone and cell phone charger, Eucasol oil for congestion (see Sec. 3 (c) on page 11), eye patch and tape (first week), eye drops, tissues, hankie, audio books, pad and pen, etc.. A similar arrangement can be placed in a box on the floor near the Ergo Lounger.



(6) Place frequently worn articles of clothing in/on a low stool or box in the bedroom to avoid having to look up for clothing items in the closet and dresser. (I wore a limited number of outfits during the six weeks; they repeatedly went from the washing machine back to the stool and box in the bedroom.)



(7) Practice tactually finding the locations and operating/using light switches and thermostat controls on walls, while standing in face-down position.



(8) Make a "Vitrectomy folder" with tabbed sections and keep it handy.



(9) Maintain a journal and keep a daily record.



b. CD/DVD player: Buy or borrow a personal CD/DVD player. Some people are able to watch a DVD while face-down---either from the Ergo Lounger chair or on their tray below the face cradle. Personally, I was unable to read or watch a DVD. However, I did use the player a great deal to listen to audio books, many of which are available from the public library. Note: Make sure CD/DVD player is plugged in and accessible (on the floor) before surgery and practice using it.



c. Audio Books: Audio books are available from most public libraries and can usually be renewed on-line or by telephone. (In Southern California, the Sherman Oaks Branch, Los Angeles Public Library, has an excellent selection.) Check with friends; they may have audio books that you can borrow. In addition to those checked out from the library

pre-surgery, I made a list of other audio books of interest that someone else could check



9

out for me during my recovery process. (I also enjoyed listening to CD’s of old-time radio shows, including mysteries, humor and westerns.)



d. Talking Books: You can qualify temporarily to use Talking Books and a Talking Book machine for free (including free return postage) from the National Library Service for the Blind and Physically Handicapped, Library of Congress. For information, eligibility, and application, see: http://www.loc.gov/nls/. Call (1-888-657-7323) and ask to be connected with the library serving your area. With the new digital player that has recently become available, you may be able to download books using your home computer.



Residents of Southern California can contact the local library at the Braille Institute, 741 N. Vermont, in Los Angeles. See: http://www.brailleinstitute.org. Then click on Become a Patron to download the application. Phone numbers are (323) 660-3880 or (323) 663-1111.



(My doctor signed the application form, indicating that I had a temporary problem. The equipment was returned when my vision improved.)



e. Preparing Ahead--”Catching Up” with Tasks: Think about tasks you would normally want to do in the next six weeks. The activities listed below, attended to prior to surgery, allowed me to feel relaxed and fully concentrate on recovery during the face-down period.



(1) Prepared small meals, baked breads and made soup for the freezer; ground enough coffee for a month.



(2) Paid all bills (in advance, when possible) and addressed seasonal needs i.e. in my situation, prepared for income and property tax.



(3) Prepared visitors for what to expect when they visited. (I sent an e-mail with a photo of face-down equipment so visitors would not be surprised at my appearance.) You can find photos at the following sites:



http://www.vitrectomy.com/?gclid=COjjn5HAzaACFQtrgwodQi7Wzg

http://www.kellycomfort.com/



f. Planning a Special Project: Think about a special project or new skill you would like to learn during the recovery period. Keeping your mind occupied is very helpful. Try to identify a non-visual skill, e.g. learning a foreign language. Be sure you have the CD’s or DVD’s handy. (I decided to study Italian, something that had always been of interest. Limited progress was made. It was difficult to concentrate, but this activity was interesting and kept my mind productively occupied.)



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3. Sleep Aids



a. Wine is relaxing for many people. (Although I’m not normally a drinker, wine helped me to both relax and fall asleep.)



b. BioFreeze gel is a balm that helps deaden sensation. After having it rubbed on my sore neck and shoulders, I would start shivering (within about 90 seconds) and would feel incredibly cold in the application area. I would often have to wear a turtle neck as well as cover myself with several blankets. This usually enabled me to sleep 3-4 hours. An alternative cost-free suggestion is to try ice placed in a plastic bag and covered with a towel or to try warm heat to relax. (Heat or cold is an individual preference; I found cold to be more effective.)



For more information about BioFreeze, see http://www.biofreeze.com. Be sure to click on FAQs, located at the right side on this web page. BioFreeze gel is available on-line. I purchased mine from Vitrectomy.com.

(Disclaimer: This helped me and I had no adverse side effects. You may wish to check with your doctor.)



c. Nasal congestion: Lying face-down for extended periods tends to cause nasal congestion. Eucasol, an oil used to cut down on congestion, caused by face-down positioning, was extremely helpful. Eucasol is a natural product containing eucalyptus, peppermint, rosemary, pinetree and cinnamon oils. It is made in Switzerland and approved for use in the U.S. A few drops sprayed on a hankie that was placed on the tray below the face cradle eliminated all congestion problems. Though advertised to kill viruses and bacteria and relieve breathing, I can only vouch for the fact that it helped me tremendously to avoid face-down congestion.

(Disclaimer: This product helped me and I had no adverse side effects. You may wish to check with your doctor.)



For more information, you can Google "Eucasol Spray" or view the following website:

http://www.swissjustusa.com/htm/productos_sku.php?p_id_idioma=2&p_id_pais=10&p_codigo=69

The Southern California distributor is Kathy Yriarte, 661/478-4852.

Her e-mail address is: Kathy_yriarte@swissjust.net.



d. Tylenol PM was suggested by several people. (I didn't use it.)



4. Eye Drops



Many eye drops are required following surgery. In the beginning, I had three different prescriptions, each to be given four times per day. (Later, I developed high intra-ocular pressure and had to add additional drops.) It's important to keep track of the time and



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dosage. Cell phones can be set to automatically ring multiple times daily with one setting. Setting the cell phone alarm to ring every six hours kept me on schedule.



5. Eating/Drinking



Although told that I could be briefly face up to eat and drink, patients who had gone through the surgery advised me to try to do so while face down.



a. Eating; I found it helpful to sit in a regular chair with my head down and push the chair away from the table, with the plate on my lap. It was even more helpful to put a tray (atop a bean bag or small pillow for additional height) on my lap.



b. Flexible straws: Flexible straws can be used for all drinks, including coffee and wine. Be careful not to burn yourself while drinking hot liquids through a straw.



6. Comfort Techniques and Aids



a. Massage: Neck and shoulders become very sore while in face-down position. I found massages to be extremely helpful. Check with your health plan to see if massage is covered or discounted.

Kaiser patients can get information about discount massage through the Kaiser website: www.kp.org. When on the Kaiser site, click on the following links, in the following order:

Health Plans and Services Member Discount Programs Complementary Health and Fitness Programs Find a Provider Service Type Massage.



This only covers in-office massages. After calling several people on the list, I found some who would come to my home. In addition, friends were asked for referrals of massage therapists who would come to my home.

HINT: If anyone (or a group of friends) wants to get you a great gift, suggest massage. Many people contributed and I had massages every few days. These were extremely helpful.

(The massage therapist I preferred and who helped me greatly was Colette Widrin, 310/492-5014.)



b. Change positions/equipment: Keep changing positions! Move frequently between the sitting position and lying position to give your neck and shoulders a rest. I frequently changed positions from the Ergo Lounger to the kneeling massage chair to the bed (with face cradle and mat) to kneeling on the floor (all with face down) to lying on a sofa with the head hanging off the arm at the end. My home has a split-level room. That allowed me to sometimes lie on the floor of the upper portion with my head hanging over the stairs leading to the lower portion.





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c. Face pillow: Even though I bought a fleece cover, the face cradle still rubbed my skin uncomfortably. I found that a U-shaped "Sqush" neck pillow, placed atop the fleece cover of the face cradle (with the closed end of the U supporting my forehead) was softer on my face. The “Sqush” pillow is primarily a travel or therapy neck pillow with a soft silk-like cover that is filled with tiny polyethylene beads. These are available at some chain drugstores and over the internet. You can Google "Sqush pillow".



d. “Opening up the shoulders": David Kurihara, Kaiser Physical Therapist, explained to me that much of the discomfort due to face-down positioning is the result of the shoulders being in a forward and depressed position, which pulls on the scapular and neck muscles.



Two techniques help alleviate this problem:

(1) "Open up" the shoulders by standing in a doorway, holding on to a door jamb and stretching your chest and shoulders several times a day (but maintain face down positioning).

(2) Pile towels (or a pillow, doubled) under each shoulder while lying down.





7. “Silly” Suggestions



a. Suggest that your guests wear interesting socks/shoes since that's what you will be looking at!



b. Get a pedicure before surgery (I'm sorry that I did not do so) and paint each toe nail a different color or design!



c. Maintain a sense of humor and encourage your guests to do so. Children enjoyed seeing my “Torture Chamber”, the name we gave to the sleeping face-cradle arrangement at the foot of the bed! A friend laughingly commented that it was disconcerting talking with me “while your head is in your crotch”!





AFTER FACE-DOWN POSITIONING IS NO LONGER REQUIRED



1. “Jiggling” feeling: The gas bubble is slowly absorbed. When (finally!) face-down positioning is over, the remaining gas bubble jiggles and it may feel as if part of your face is underwater. People who can't close one eye (the operated eye) can wear a patch to keep from feeling woozy.



2. Avoid sleeping on your back: When (finally!) face-up, do not sleep on your back until the gas bubble is completely gone. Rationale: While on back, the gas bubble comes

in contact with the lens and accelerates the development of a cataract. (Of course, if



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you've had cataract surgery prior to macular hole surgery, this won't be of concern.) The ophthalmologist ideally wants to delay cataract surgery as long as possible following macular hole surgery.



What to expect: My personal experience is that macular hole recovery consists of

four phases over a period of a year.



a. Phase One is the face-down positioning discussed in this article.

b. Phase Two is a slow, gradual improvement in vision.

c. Phase Three is a deterioration of vision due to the development of a cataract.

d. Phase Four is a dramatic improvement in vision following cataract surgery.



Milestones differ for individuals. Information below represents a summary of material from a journal I kept, monitoring my visual progress. If anyone wishes additional details, I will be happy to share those with you.



During face-down positioning (Phase One), vision improves from light perception to color recognition to shape recognition to finger counting to central vision a few inches from the operated eye. With good lighting, I was able to read newspaper headlines and a few sentences of an article for a short period of time. Both eyes tired easily.



After face-down positioning is completed and the gas bubble has been absorbed, there is a slow, gradual improvement (Phase Two). Three months after surgery, my visual acuity had slowly improved to almost 20/200 and the distortion had become less significant. However, very good lighting was essential. With new glasses, my visual acuity in the operated eye measured 20/60, but that was not a functional measurement. I was unable to coordinate the very different images in the two eyes and could only use the glasses during seated activities, such as watching TV. Although I “read” the newspaper, it was very different than my previous meticulous reading. It took several sessions, due to tiring, and consisted only of the beginning of articles of interest. Reading outside in the sunlight was helpful. Large print books, available from most public libraries, were much easier to read and could be read for a longer period of time.



Phase Three is a deterioration of visual acuity due to the rapid development of a cataract (resulting from the gas bubble). Five months after surgery, my visual acuity had deteriorated to only being able to count fingers a few inches in front of my eyes. Excellent lighting became even more critically important than previously. In dim lighting conditions, especially at night, vision in the operated eye was reduced to shape recognition with no details. I was still unable to wear the glasses for more than a few minutes due to problems trying to reconcile the very different images. Glasses were becoming less and less helpful. My functional vision was dependent upon the unoperated eye, which tired easily. Reading had become more of a struggle, regardless of print size.



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Phase Four is cataract surgery, which is almost always required within a year of macular hole surgery. (Mine was performed seven months after the macular hole surgery.) Cataract surgery usually results in a dramatic improvement in visual acuity. The day after my surgery, visual acuity was measured at 20/40. This continued to improve for a few months. At eleven months post-macular hole surgery, my visual acuity had improved to 20/25 and distortion was nearly non-existent. With good lighting, I could read regular sized print. Glasses enable me to read small print comfortably.





CATARACT SURGERY



Cataract surgery is almost always required within a year following surgery for a macular hole. Ask your surgeon if your vitrectomy poses any particular risks or challenges and what kind of visual improvement you are likely to achieve.



Important advice: Most retinal surgeons measure the length of the eye prior to macular hole surgery in case they cannot see well enough through the lens to operate, thereby necessitating simultaneous macular hole and cataract surgery. (Surgeons typically only perform these two operations at the same time if absolutely necessary.) After the macular hole closes, the length of the eye may be shorter by the depth of the macular hole.



Therefore, the depth of the macular hole should be subtracted from the previous measurement. Ask your doctor about this calculation and/or if you should be measured

again (prior to cataract surgery) as the depth of the macular hole (though very small) may affect the choice of lens implanted during cataract surgery.





OTHER CONCERNS



1. Glaucoma: Surgery is traumatic. White cells start to proliferate; they can cause inflammation and can attack the eye. These white cells are held in check with steroidal drops. However, in about 15% of cases, patients react to steroids with high intra-ocular pressure (glaucoma), which can potentially cause serious eye damage. Usually the high pressure is temporary. In my case, the pressure was very high and it took two different types of glaucoma medication to control (lower) the pressure to a normal range. I was insistent on monitoring the pressure on a regular basis to make sure it didn't damage the eye.



2. Monitor the Good (Unoperated) Eye: According to the literature, 20-30% of the people who have a macular hole will end up getting one in the second eye. Therefore, it

is important to have frequent, periodic checks of the second eye. Monitor that eye for distortion and other vision problems. You can download an Amsler grid from the internet. It looks like graph paper with a bold dot in the center.

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An Amsler grid can be downloaded from http://www.allaboutvision.com/conditions/amsler-grid.htm.

For additional information, you can Google "Amsler Grid”.

Look at the grid weekly to make sure that all vertical and horizontal lines appear to be free from distortion, i.e. straight and parallel. At the first sign of distortion, make an appointment with the retinal specialist.





CONCLUSION



Face-down positioning, required for successful recovery from macular hole surgery is challenging and uncomfortable. With determination and innovation, it CAN be done and the results are worth all the effort.





AUTHOR’S CONTACT INFORMATION



Don't hesitate to contact me if I can be of any help or support. This recovery process is not easy, but it's worth the great effort required.



Best wishes!

Joy R. Efron, Ed.D.

joyrefron@yahoo.com

323/464-1877 (h)

323/854-1772 (c)

April 2010





ACKNOWLEDGEMENTS



Grateful appreciation is expressed to the following:

Dr. Fawaz Wagih Kaba, retinal surgeon, Department of Ophthalmology, Kaiser Los

Angeles Medical Center;

Dr. Mathew Yen Wang, cataract surgeon, Department of Ophthalmology, Kaiser Los

Angeles Medical Center;

Leonard Efron, my husband, who provided devoted support;

A variety of patients who had gone through macular hole surgery, in particular Christiane

Eminon, Pasadena, CA, and Jean Worfolk, Cottonwood, AZ for generously sharing

their experiences and providing guidance;

A large number of professionals, family members and friends who provided information

and gave generously of their time and support.







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