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



Tuesday, January 26, 2010

The legacy of Jyoti Basu - Leader of the People

JYOTI BASU (b. 1914). Born in India, Jyoti Basu is known primarily for his many-sided elaboration in practice of a combination of Communist parliamentary and extraparliamentary political tactics aimed at establishing a seemingly indestructible Communist control over some of the levers of the state-level political power in West Bengal (India). A pioneer in such politics in India since 1945, and still its most successful exemplar in 1984, Basu was elevated to the Central Committee of the Communist Party of India (CPI) for the first time in June 1950, resigned in december 1950, but rejoined in April 1951. He has been a member of Central Committee and Politburo of the Communist Party of India (Marxist) (CPI[M]) since its foundation in 1964.

Initially distrustful of parliamentary politics as the politics of the “bourgeois talking-shops,” Basu contested and barely won his first parliamentary election to the Bengal Legislative Assembly of colonial India. His intent was to extend and legitimize Communist control over a trade union in a reserved constituency of railway workers. He ran again in the first elections in the Indian subcontinent after independence in 1951. This time, too, his involvement in bourgeois parliamentary politics was primarily due to some “other” interests, i.e., reorganizing the Communist Party in West Bengal, which had been weakened organizationally by bitter internecine conflict in 1948-49 but had extended its mass political influence ( which was fully capitalized in the Communist electoral successes in the 1951 elections).

But by now he was a firm believer in Lenin's* recommendation that Communists must contest bourgeois elections to serve as tribunes of the people in order to expose parliamentary “cretinism” from within, so as to prepare the masses for participation in revolutionary antiparliamentary politics. Since then, more fully than any other Indian Communist, Basu has explored the scope as well as the limits of such a combination of Communist parliamentary with extraparliamentary political tactics. But because of grim and unanticipated political events involving clashes of almost equal severity with Congress “enemies”, left party “allies,” as well as explosive “Naxalite” Communist dissent originating within a newly formed CPI(M) in the 1960s and 1970s, these tactics have produced a bizzare outcome.

Over the years, the more effectively the West Bengali Communists exposed the parliamentary system from within and from without, the more decisively did the West Bengali highly politicized voter vote for them. But there was no matching advance of the Communist parliamentary and/or extraparliamentary presence in the rest of India, where (except in Tripura and perhaps in Kerala) there was a recession of whatever Communist political influence had existed. The result was that by 1983 the West Bengali Communists were the encircled but semipermanent political managers of a capitalist economy in West Bengal, which was a less developing fraction of an unevenly developing but dependent Indian capitalist economy.

There are several causes of West Bengal's low rate of capitalist development. First, there is the extensive damage caused by the policies of successive central governments of the all-India bourgeoisie, which have led to a drain of reinvestible resources from West Bengal. This drain has been caused by its tax measures and also by statutory all-India price differentials, which have deprived West Bengal of its comparitive advantage in coal and engineering products. On the other hand, denial to West Bengal of its due share of foreign aid received by the centarl government, and deficit spending by it, has weakened West Bengal's government's fiscal powers.Second, multinational and Indian monopoly concerns have shown, apparently on grounds of political realism, only minimal interest in investment in West Bengal, despite public overtures by Basu (acting on behalf of West Bengal ministry as well as the central leadership of the CPI(M).

These overtures have been made to them on the basis of the doctrine that until capitalist monopolies are eliminated every where in India, West Bengal under under Communist control will compete with the bourgeois governments of other Indian states to attract them. Third, the CPI(M)'s “democratic” rich peasant bourgeois “allies” in West Bengal probably habitually reinvest less out of their profits as compared to the “democratic” rich peasant bourgeoisies of other Indian states.

Fourth, repeated though somewhat half-hearted appeals have been made by Basu and others to the civil employees of the West Bengal government to step up production as a token of political support for their own government to set up producation as a token of political support for their own government. But they have not agreed to do so – not even the workers and employees belonging to the CPI(M) or the trade unions led by it.

Written By ARUN BOSE


Passing of Pioneering Canadian Educator and American Academy Fellow: Emerson Woodruff

Academy Fellow of long standing and Professor Emeritus of the University of Waterloo School of Optometry, Merrill Emerson Woodruff, OD, MS, PhD FAAO passed away on May 8,2005 after a long illness. Emerson was born and raised in Medicine Hat, Alberta. Following high school graduation, he served in the Second World War in the Canadian Air Force. Upon his discharge in 1945, he enrolled in the College of Optometry in Toronto. He set up successful practices in southwestern Ontario. However, in 1962, his keen interest in academic optometry took him to Indiana University to study under the late Henry Hofstetter. He received his PhD in physiological optics in 1967. He then joined the faculty of the School of Optometry, just as it opened its doors at the University of Waterloo. These were exciting times for optometry in Canada. Optometric education in Ontario and indeed for most of English speaking Canada had just been merged into a university program within the faculty of science at Waterloo. Emerson was immediately appointed clinic director and then served as the school's director from 1975 to 1981.

In 1967 he became an integral part of a small faculty who had been given the task of developing and shaping optometric education within Ontario and throughout Canada. There is little argument today that the optometric profession provides the major portion of primary eye care in Canada. However, that role was not so clear when Emerson vigorously articulated it back in those early university years. The School's graduate program, with close to 50 students, is one of the largest vision science programs in the world. Emerson played a key role in the establishment of its MSc and PhD degrees. He was also a leading advocate for the need to provide effective continuing education for the profession. He contributed to scientific and clinic research in the areas of pediatric optometry and epidemiology, publishing over 70 articles. He was the recipient of many academic awards. He retired from the University of Waterloo in 1990.

In recognition of his contribution to optometric education, his School established an annual Woodruff lecture in 1994. The lecture series serves to recognize clinician scientists in the field of vision and important topics in the continuing education of optometrists. Upon his death, the Dr. Emerson Woodruff Graduate Scholarship Fund in Vision Science has been established in his honor through the School of Optometry, University of Waterloo.

Emerson was a deeply loved and loving husband to his wife, Doris, who shared his life to the end. He was a devoted and caring father to his daughters, Elaine, Ann, and Susan and their husbands, and an affectionate grandfather to his six grandchildren and one great grandchild. He shared with everyone his avid love of reading, music, nature, history, and travel, and passed on to his family his life long interest in learning and the importance of making a contribution to one's community.

Academy Fellows will surely miss him, and we pay tribute to his strong sense of the Academy mission of improved patient care through education and research.

Sankara Nethralaya to launch academy

Object of the academy is to train those working in eye hospitals.

Sankara Nethralaya has proposed to launch an academy to offer several certificate and fellowship programmes to equip ophthalmologists, optometrists, nurses and administration personnel with additional skills.

The proposal for the project was submitted to Kanchi Sankaracharya Jayendra Saraswathi at a function in the hospital on Monday,25-01-10. Presenting the proposal, S.S. Badrinath, chairman emeritus of the hospital, said the object of the academy was to train those working in eye hospitals.

They would be taught “A to Z on how to perform, conduct in a service oriented organisation and deliver care in a professional manner,” he said.

The proposed academy will come on a one-acre plot in Mahabalipuram. The courses will commence in April at Sankara Nethralaya premises on College Road in the city. Courses for ophthalmic theatre assistants, orthoptics, contact lens, hospital management and fellowship programmes in vision therapy and ophthalmology would be offered.

Two days ago, the hospital signed a memorandum of understanding with the Tirumala Tirupati Devasthanam on conducting surgeries in Tirupati, Dr. Badrinath said.

Sunday, January 24, 2010

Providing care for children with low vision

The importance of providing care for children with low vision is recognised by many initiatives, such as VISION 2020, the 2004 Oslo Workshop on Low Vision,1 and the United Nation's global campaign, Education for All.

In 1992, the World Health Organization (WHO) published a working definition of low vision2: "A person with low vision is one who has impairment of visual functioning even after treatment and/or standard refractive correction, and has a visual acuity of less than 6/18 to light perception, or a visual field of less than 10 degrees from the point of fixation, but who uses, or is potentially able to use, vision for the planning and/or execution of a task for which vision is essential."

Functionally, low vision is characterised by irreversible visual loss and a reduced ability to perform many daily activities, such as recognising people in the street, reading blackboards, writing at the same speed as peers, and playing with friends.Many children with low vision can perform better than their parents or carers expect and have the same quality of life as any other child, provided that their treatment follows these steps, and in this order:

1.Examination to establish the cause of visual loss
2.Surgical interventions where appropriate (such as cataract surgery)
3.Assessment of the child's various visual functions (distance vision, near vision, contrast sensitivity, and visual field)
4.Accurate refraction and provision of spectacles
5.Assessment for and prescription of low vision devices, such as magnifiers
6.Suggestions for non-optical low vision devices such as reading stands or reading slits
7.Educational support and training in the use of low vision devices (with follow-up).

Comprehensive care: an ideal

Care for children with low vision involves diverse groups, such as eye hospitals, schools, and community programmes. It should be provided in a structured and integrated way, known as comprehensive care.A comprehensive system of care for people with low vision has clinical, educational, and social components. It ideally starts by locating people with visual problems and referring them to eye care or clinical low vision services. This is not always straightforward: differences exist between genders in access to care. A retrospective study of low vision programmes undertaken by Karin van Dijk in Asia3 showed that girls have poorer access to low vision care than boys. Girls may therefore need to be approached directly, and not only indirectly via community leaders or schools/school teachers.

Once children with low vision are identified, professionals in eye units can provide the clinical components of low vision care. They provide a diagnosis, treat acute problems, perform surgery, assess the most relevant visual functions (for instance distance vision, near vision, contrast sensitivity, and visual field), and prescribe distance glasses and/or low vision devices.Regular follow-up visits to clinical services are very important, as the visual needs of children can change rapidly (e.g. the size of the text used in school books gets smaller as they progress through school).

Social and educational care

The social and educational components of care for children with low vision, such as training and counselling others in their environment, are often overlooked by clinical staff. This can include such diverse activities as informing peers of the visual abilities of their classmate, convincing the head of a pre-school to include a child with low vision, and teaching parents activities which can improve their baby's visual skills (such as fixation and tracking).Educational care for children with low vision includes training children directly in the effective use of their best vision. This can involve their learning to write at closer distance, to use magnifying devices, or to use creative strategies to determine what is written on a blackboard (such as asking a child seated nearby to read aloud while the teacher writes). This training is important, as it enables children to attend local schools. Itinerant teacher programmes (see page 26) are one way of achieving many of these social and educational components of care for children with low vision.

Responsibility and co-ordination

A major obstacle to the provision of low vision services is a lack of co-ordination between eye care services and education or rehabilitation services. Each believes that the other will arrange for children to come for an eye examination and/or clinical low vision care or ensure that they obtain the surgery and/or spectacles needed.Experience teaches that, in most cases, it is vital for staff in eye units to ensure that children with low vision are treated and managed appropriately. In situations where the eye care service provider is unable to do this, education programmes must take responsibility.Caregivers, (special) schools, and community-based rehabilitation programmes often give cost as a reason for a child not receiving the clinical components of low vision care. However, transport costs, hospital fees, and the cost of a pair of glasses compare well to the long-term costs of interventions, such as enlarging print using photocopiers, the use of Braille, and education in a special school, for children who may not actually need them.

The importance of refraction

The importance of accurate refraction is illustrated in the study of low vision programmes undertaken by Karin van Dijk in Asia.3 Among the children aged 4–15 years enrolled in these programmes, more than two-thirds could achieve a distance visual acuity of 6/60 or better after receiving the correct spectacles. For many children, this level of vision is sufficient to allow them to read a blackboard from the front row in a classroom; these children generally only require minimal additional support. However, only 36% of the children in the study already had spectacles when they presented, and half of those needed a new pair.A total of 75% of the children examined achieved a best corrected near vision of 1.25M (N10) or better, and an additional 18% could read a large print size of 2–2.5M (N16–N20) after refraction and/or magnification. These children thus had sufficient near vision to read the print used in school books (sometimes with some assistance). None of them needed to learn Braille (although some had already been taught it), and they gained the ability to attend local mainstream schools with their fully sighted peers.This study illustrates that, even in the absence of a special clinical service dedicated to low vision, any eye unit can help many children with low vision, as long as it is capable of providing accurate refraction services.It is important to recognise that any improvement in distance visual acuity for a child with low vision can make a big difference to his or her life; it can also improve near vision. This is particularly true for children with hyperopia, aphakia, or nystagmus. When providing low vision care for children, it is therefore vital to consider both distance and near vision.The use of magnifying devices can be important for children whose near vision, after refraction, still remains insufficient to read print of the size used in their school books (children should be asked to bring their school books to the low vision clinic). Such devices are not necessarily expensive: in the 2005 study, 83% of the magnifying devices were locally produced and cost, on average, US $5 (rangingfrom US $0.5 to US $10).Another lesson learnt from the study is that interventions should not be provided free of charge. When parents are charged according to their ability to pay they tend to be more motivated and to value the services. This requires co-operation between all service providers.In conclusion, eye care providers, community workers, and teachers should firstly direct their efforts towards organising access to eye care, then towards providing surgical and optical interventions, and lastly towards determining what educational support is needed by a child with low vision.‘It is vital to consider both distance and near vision’


1. Toward a reduction in the global impact of low vision. Report on an October 2004 meeting in Oslo. Published by The International Society for Low-vision Research and Rehabilitation. New York, March 2005.
2. Bangkok: 1992. WHO. Managementof low vision in children.
3. Van Dijk K. Unpublished retrospective study of low vision programmes in Asia, 2005, which analysed data extracted from standardised clinical records of 1,823 children, aged from 0 to 15 years, attending six low vision programmes in India, Indonesia, and Nepal in 2002 and 2003.

Treatment of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a chronic eye condition that affects people age 50 and older. When a person has macular degeneration, the macula begins to deteriorate, causing symptoms that range from blurred or slightly distorted central vision to a blind spot in the center of the visual field. Macular degeneration is categorized into stages: dry disease and wet disease. Wet disease occurs when abnormal blood vessels form as a complication of the dry disease and cause rapid vision loss.

Ophthalmologists collaborate with colleagues in different specialties to design a macular degeneration treatment plan to meet each patient's needs. Their overall aim is to improve quality of life for patients with macular degeneration by preserving as much eyesight as possible, and preventing further deterioration of vision.


People with macular degeneration may notice either a rapid onset of symptoms, slight symptoms that progress gradually, or no symptoms at all. Doctors may decide to test for the disease based on family history and symptoms the patient is experiencing. A thorough eye examination is performed by the doctor to identify any abnormalities in the back of the eye, in a portion of the retina called the macula.

Eye exam

During the eye exam, the doctor looks for abnormalities in the macula, such as yellow deposits called drusen. In addition, the appearance of the macula is important to sharp central vision. If the pigmentation is mottled or uneven, instead of its normal even reddish color, macular degeneration may be the cause.

Amsler grid test

As a part of the eye examination, the doctor may evaluate vision using a printed grid. If macular degeneration is present, the lines of the grid may seem faded, broken or distorted. By noting where the distortion occurs (usually near the center of the grid), the doctor can better determine the location and extent of macular damage.

Fluorescein angiography

After diagnosis, the doctor may perform a fluorescein angiography test to determine the extent of damage from macular degeneration. First, the doctor injects fluorescein dye into a vein in the patient's arm. As the dye circulates through the bloodstream and eventually to the eye, a camera takes flash photographs of the eye every few seconds for several minutes. The photos help identify pigmentation changes, blood circulation patterns and abnormal blood vessels.

Indocyanine green angiography (ICGA)

ICGA is another type of angiography of the eye vessels that sometimes provides additional useful information for the doctor to review. ICG is a dye that lights up when exposed to infrared light. Infrared light is used to take pictures of the back of the eye to visualize retinal blood vessels, and the deeper, harder to see choroidal blood vessels.

Optical coherence tomography (OCT)

OCT is an imaging method that uses ultrasound technology to provide detailed, cross-section images of the retina and its underlying layers. OCT is useful for checking retinal thickness and thinness because it is capable of clearly displaying well-defined tissue boundaries in high resolution. Bright colors are added to the image to highlight specific areas of the retina and to determine how much light they reflect.

Genetic testing

In nearly half of patients with age-related macular degeneration, a gene mutation occurs that is responsible for a protein associated with immune system function called Complement Factor H. This is one of the most important discoveries in macular degeneration to date. Mayo Clinic was the first medical center to have routine testing for this gene available to patients.


The goal of macular degeneration treatment is to stop further vision loss. In most cases, damage that has already occurred cannot be reversed, making early detection very important for vision preservation.

Dry Macular Degeneration

No treatment is currently available to reverse dry macular degeneration. This condition normally progresses slowly, and many people who have it can live relatively normal lives, especially if vision is affected only minimally.

Progression of dry macular degeneration can be slowed by taking high doses of the vitamins A, C and E, and the minerals zinc and copper. Patients should discuss these vitamin and mineral supplement treatment options with their primary care doctor. Research is under way to identify other vitamin and mineral combinations that may be viable treatments for dry macular degeneration.

A recent study conducted by the National Eye Institute found that a specific vitamin and mineral supplement formulation reduced the risk of dry macular degeneration from advancing to more severe cases by up to 25 percent for some patients. Another study currently under way is testing the benefits of treatment with lutein, an antioxidant, and omega-3 fatty acids in halting or slowing the progression of dry macular degeneration.

Wet Macular Degeneration

In wet macular degeneration, new abnormal blood vessels behind the retina form rapidly. These vessels begin to leak blood and fluid, causing damage to the macula, the region of the retina responsible for central vision. The doctor prescribes treatment based on the location and extent of the abnormal blood vessels.

Anti-angiogenic therapy (injectable drug treatment)

Injectable drug treatments that directly target the growing blood vessels in patients with wet macular degeneration. After the ophthalmologist numbs the eye with an anesthetic, the drug ranibizumab (Lucentis®) or bevacizumab (Avastin®) is injected into the affected eye. The medicine stops or slows the blood vessels from growing, leaking and bleeding.

The treatment is given every four to six weeks to prevent the blood vessels from causing more vision loss. This therapy causes less damage to the retina than laser treatments. The most common side effect after receiving an injection is redness and scratchiness in the eyeball.

Photocoagulation (laser surgery)

Photocoagulation uses a high-energy laser beam to create small burns in areas of the retina that have abnormal blood vessels. This treatment is used when the abnormal blood vessels are not yet under the area of central vision (fovea). Because it is uncommon for the blood vessels to spare the fovea, only a small number of patients are candidates for the procedure.

The doctor determines who may benefit from the treatment based on the location and appearance of the blood vessels, the amount of blood leakage, and the overall health of the macula. The laser may destroy some surrounding healthy eye tissue and some vision. New blood vessels also may develop after this treatment.

Photodynamic therapy

In this treatment, the drug verteporfin (Visudyne®) is injected into the bloodstream. The drug concentrates in the abnormal blood vessels under the macula. The doctor then focuses cold-laser light at the macula, which activates the drug and leads to the closing off of abnormal vessels without damaging the macula. Photodynamic therapy is commonly performed as a combination therapy with other treatments.

The location of the abnormal blood vessels often determines which treatment is selected. The macula is the central portion of the retina responsible for central vision, and the fovea, responsible for the sharpest vision, is directly in the center of the macula. If the abnormal vessels are located directly under the fovea, hot laser treatment (photocoagulation) would damage the fovea and decrease central vision. In these cases, photodynamic therapy may be an excellent option.

Submacular hemorrhage displacement surgery

Although the procedure is used in rare circumstances, patients with recent vision loss associated with blood under the macula who still have healthy tissue around the fovea may be candidates for this surgery. Vitrectomy surgery is performed in conjunction with injections to dissolve the clot and displace the hemorrhage. After the hemorrhage is moved away from the center of vision, the underlying blood vessel that caused the bleeding can then be treated.

Treatment of Macular Hole

A macular hole is a small break in the macula, the tissue near the center of the eye's retina that's responsible for central vision. Macular holes usually occur in patients (more commonly women) over 60 years old. Most macular holes require surgical repair.

Holes can occur when the vitreous gel that fills the center of the eye begins to sag and shrink and separates from the retina. Sometimes, this shifting pulls on the macula, causing a hole to form.

Macular holes can develop gradually or suddenly. Early signs are slight distortions or blurriness in straight-ahead vision. A blind spot develops in the central vision as the hole progresses.

Macular holes are repaired with a vitrectomy. During the surgery, a gas bubble is placed in the eye. The bubble pushes on the macula when the patient looks down, and allows the hole to heal. After surgery, most patients must maintain a facedown position for 10 days to two weeks to allow the bubble to press against the macula, sealing the hole.

With this approach, more than 90 percent of macular holes are successfully repaired. Most patients have some vision improvement. Vision recovery can take up to three months after surgery.

Treatment Options for Retinal Diseases

Laser photocoagulation
Laser photocoagulation is most often used to repair a retinal tear or hole.

In laser photocoagulation, the surgeon directs a high-energy laser to burn small pinpoints on the retina. For a retinal tear or hole, the burns create scar tissue, which adheres the retina to the underlying tissue.

Photocoagulation is nearly always done on the peripheral surface of the retina. Burns on the retinal surface cause blind spots.

Photocoagulation is usually an outpatient procedure and doesn't require any incisions. It's less irritating to the eye than surgical procedures such as cryopexy.

Panretinal photocoagulation (PRP)
Panretinal photocoagulation, also called scatter photocoagulation, is a procedure used for proliferative (advanced) diabetic retinopathy to shrink abnormal new blood vessels that are bleeding into the vitreous, the gel-like substance that fills the eye cavity.

In this technique, the surgeon treats the retina with multiple laser burns. The macula, responsible for central vision, is excluded. This treatment usually requires two or more sessions.

Panretinal photocoagulation offers benefits and drawbacks. The burns cause the new blood vessels to shrink and disappear, but they also cause some peripheral vision loss. By sacrificing some side vision, surgeons can preserve as much central vision as possible.

For some patients, panretinal photocoagulation can stop vision loss from diabetic retinopathy. PRP can also be used to stop proliferating blood vessels in other diseases such as retinal vein occlusions.

Cryopexy (KRI-o-pek-see) is used to treat retinal tears. It's often used when tears are along the retinal periphery and difficult to reach with a laser.

In cryopexy, the surgeon uses intense cold to freeze the area around a retinal tear or hole. The surgeon applies a freezing probe to the outer surfaces of the eye, over the defect in the retina. The freezing produces inflammation that causes scarring. The scarring seals the hole and holds the retina to the underlying tissue to prevent fluid from passing through the tear, (which can lead to retinal detachment).

Cryopexy is an outpatient procedure, done with local anesthetic.

Pneumatic retinopexy
Pneumatic retinopexy is a treatment for uncomplicated retinal detachment when the tear is in the upper half of the retina.

First, your surgeon performs cryopexy around the retinal tear to seal it off. Then, a bubble of gas is injected into the vitreous cavity. The bubble expands over the next few days, sealing the retinal tear, and causing the retina to reattach itself to the wall of the eye.

To ensure that the bubble continues to press against the tear, you may need to keep your head upright or in a sideways position for a few days following surgery. The gas will dissipate from the eye in two to eight weeks. During that time, you need to avoid lying or sleeping on your back to reduce the risk of cataract formation or a sudden increase in eye pressure.

Pneumatic retinopexy does not require an incision and it's done on an outpatient basis with local anesthesia.

Scleral buckling
Scleral buckling is one of the most common surgeries for repairing retinal detachment. It slightly reduces the circumference of the eyeball, which aids in reattachment of the retina.

Doctors usually start this procedure by treating the retinal tear or detachment with cryopexy. Then the surgeon sews a tiny synthetic band (buckling material made of solid or spongy silicone) to the eye wall or sclera (white part of the eye). This buckle indents the sclera and pushes the wall against the retina. This indentation helps close the separation between the retina and underlying layers and reduces the circumference of the eyeball. Pressure from the buckle promotes healing and helps prevent further pulling and separation.

Scleral buckling successfully repairs retinal detachment in more than 90 percent of cases. Vision preservation depends on how much the macula was affected before surgery. In some cases, some vision may be lost due to wrinkling or puckering of the macula. See epiretinal membrane.

Your doctor may recommend local or general anesthesia for this procedure. Scleral buckling is done in an operating room, but often on an outpatient basis.

Mayo Clinic doctors perform a vitrectomy to correct several concerns with the retina, including diabetic retinopathy, retinal detachment, macular hole, epiretinal membrane and intraocular eye infection. The procedure also may be used to remove a foreign body from the eye or to repair eye trauma.

In this procedure, the surgeon makes tiny incisions in the sclera (white portion of the eye) and uses delicate instruments to suction out blood-filled vitreous. A salt solution is injected to maintain the shape of the eye.

This surgery is used when bleeding or inflammation clouds the vitreous and obstructs the surgeon's view of the retina. Sometimes, removing the cloudy vitreous is the only surgical goal. In other instances, other procedures may be performed, such as peeling of scar tissue, laser photocoagulation, scleral buckle placement or gas injection.

For most patients, vision improves after several weeks of recovery. New bleeding can occur after the procedure in some diabetics, but this is rare. As the blood dissipates, vision improves.

The surgeon may recommend local or general anesthesia. A vitrectomy is usually an outpatient procedure.

Treatment of Epiretinal Membrane

Epiretinal membrane is a scar tissue-like membrane that forms over the macula, the tissue near the center of the eye's retina that's responsible for central vision. It's also known as macular pucker, macular wrinkling, scar tissue or cellophane membrane. Many cases of epiretinal membrane are mild enough that no treatment is necessary. If vision is significantly affected, your doctor may recommend a vitrectomy to remove the membrane. The procedure improves vision by smoothing out the macula.

Epiretinal membrane typically progresses slowly and affects central vision by causing blurring and distortion. As it progresses, the pulling of the membrane on the macula may cause swelling.

This condition most commonly affects older adults and may be associated with diabetic retinopathy, retinal detachment, trauma or other disorders.

Understanding Stargardt's Disease

Stargardt's Disease is a form of macular dystrophy that begins early in life. Dr. Stargardt first described this condition in 1909 giving it its name. It is one of the most common forms of a juvenile macular degeneration. Stargardt's disease may occur in one of every 20,000 children over the age of 6 and is usually diagnosed before the age of 20. Boys and girls are equally affected by this condition. Over 25,000 Americans have Stargardt's disease.

Stargardt's is usually a recessive inherited condition requiring the person to receive a gene from each parent to cause the disease. However, there have been a number of cases identified as dominant inheritance, requiring only one gene from either parent. Recently researchers have identified the gene, ABCR, now called abca4, which causes Stargardt's Disease. This brings hope that a treatment will eventually be available.

With Stargardt's Disease, the macula and surrounding retina are affected. The macula is the very center of our retina. The images we see are focused on the retina like the film in the camera. Unlike camera film where every part of the film is equally sensitive, our retina concentrates the most sensitive vision in the very center. Additionally, our best color vision resides in the macula. Thus, damage to the macula results in loss of visual acuity or sharpness of vision, decreased color vision and small blind spots.


Early in the disease, the macula may appear normal which may slow the initial diagnosis of Stargardt's. Children may be misdiagnosed with a psychological vision loss given as the diagnosis. In time, characteristic changes occur in the retinas that help facilitate diagnosis. Fluorescein angiography is a test in which a dye is injected into the arm and the flow of this dye as it enters the eye is studied. The damaged retina sits above a layer called the choroids which is rich in blood vessels that supply nutrients to the retina. During angiography in a patient with Stargardt's, the damage to the retina blocks the flow of light from the choroids causing a "dark choroid" and this may be used to help diagnosis. This test alone is not considered to be completely diagnostic of the disease.

In later stages of Stargardt's Disease, the classic appearance of the retina allows a much easier diagnosis. The appearance of a "beaten metal" macula combined with small yellowish-white flecks (fundus flavimaculatus) in the peripheral retina is typical of Stargardt's disease.

Emotional Impact:

Adolescent years are difficult for every child, but imagine suddenly learning that your vision is failing. The sudden awareness to the child and parents that the child is losing vision can be devastating. The family and the child need to learn immediately about low vision care. Knowledge of the options to help the child can help the family and child put the problem in perspective. Counseling may be needed to help the child through their fears. Support groups or interaction between the parents of other Stargardt's patients can be beneficial.

Decrease of Visual Acuity:

Stargardt's disease may first be detected by a mild loss of visual acuity or sharpness of vision. In the early stages, however, the vision may be near normal. Visual acuity measurements may also vary due to the effects of light exposure and one should not be alarmed if your visual acuity varies on each test. Most Stargardt's patients have visual acuities from 20/100 to 20/400. One study of Stargardt's patients found that all persons tested had decreased visual acuities of at least 20/200 within approximately nine years after onset.

Come and Go Vision:

As Stargardt's disease progresses, patients may experience small areas of vision loss or blind spots. As images fall upon the damaged areas of the retina, objects may disappear and reappear causing a come and go effect.

Eccentric Viewing:

Stargardt's disease creates central blindspots that increase in size as the disease progresses. Patients learn to turn their eyes in a specific direction to see around the blindspots. They must place the image on an area adjacent the macula. Family members and teachers need to understand that this is an adaptive step used to maximize their vision.

Photostress and Dark Adaptation:

Children with Stargardt's disease often complain of difficulty adapting to the dark after sunlight exposure. Light striking our retina causes chemical reactions to occur in the rods and the cones. Our retina must continuously create new photo-reactive chemicals and remove the waste products of these chemical reactions. When a Stargardt's patient is exposed to bright sunlight, the retina may become bleached by the light and the sharpness of vision may decrease and blind spots may become denser. These are temporary conditions, but can be prevented or lessened by use of sun filters and hats.

From laboratory studies in mice, it has been suggested that sun filters may lessen the formation of lipofuscin, which is the waste products of the rods and cones. Lipofuscin, if allowed to accumulate, may damage the retina. Mice, without the ABCR gene like patients with Stargardt's, do not accumulate these waste products when raised in darkness. Additionally, younger patients, under 26 years old, transmit more ultraviolet light to the retina due to the clarity of the crystalline lens which in theory may lead to more retinal damage in Stargardt's patients. More research is needed.


The damage to the retina also leads to greater internal reflection of light often causing an increase in light sensitivity.

Color Vision:

Though new theories indicate the damage may begin in rod cells, our black and white vision, surrounding the macula, the condition eventually damages the macular area where cone or color vision cells are. Color vision declines as the disease progresses, but patients usually maintain a significant amount of color vision.

The Paradox of Peripheral Vision Sensitivity:

Patient may miss or see poorly objects that fall in their central vision, but the far peripheral vision remains intact with Stargardt's. It is not uncommon to not be able to see a face, but notice a piece of lint on the shoulder. Family members often mistake this ability as an indication that the patient can see better than he or she claims.

Phantom Vision / Charles Bonnet Syndrome:

In more severe stages of vision loss, patients may experience Phantom vision or visual hallucinations. These episodes are not usually related to underlying psychiatric problems, but rather are normal attempt by the brain to make sense of impaired sensory information. The brain may embellish the image making it very real just as it does in our dreams.

Depth Perception:

Depth perception is dependent on two good eyes. Anything that decreases vision in one or both eyes will cause an immediate drop in our depth perception.

The Good News:

Stargardt's never causes total vision loss. Peripheral vision is left intact. Central vision is usually in the range of 20/100 to 20/400 with younger patients usually showing less loss. Low vision care can help Stargardt's patients lead very normal lives. Following diagnosis every Stargardt's patient should have a low vision examination by a doctor skilled in low vision rehabilitation.

Low Vision Care:

Stargardt's patients respond well to magnification. Simple bifocals may be used in the early stages. In later stages, CCTV systems are helpful. It is important to maintain good cosmetic appearance for young patients. Mobility is usually minimally affected. Some Stargardt's patients can become bioptic drivers, but it may be for a limited time.

School Age Issues

In children and teens with Stargardt's disease, it is very important to have adequate low vision care. These students may have light and glare control problems in their classrooms. Adaptations including sitting away from the window or shutting the curtains may be necessary. Also, these students should be allowed to wear special sun filters when needed to decrease glare and light sensitivity.

Large print materials may be indicated for these children. This may include textbooks, worksheets, and tests. Due to their vision loss and difficulty reading, some students may require extended time on tests and quizzes.

Because the vision loss may progress over time, each student should have a Teacher of the Visually Impaired. A VI teacher will assess the classroom and educational plan for the child. With the low vision specialist's recommendations, the VI teacher makes adaptations including low vision devices, large print materials and other special services the child will need each year in school.

Because of the vision loss, there are also safety issues to look at in young active students. Eyewear with polycarbonate lenses should be worn for protection of the eyes from unexpected injury. Counseling should include safety issues in physical education. Sports like swimming and track are good options. Sports with fast moving projectiles may put young Stargardt's patients at risk. Protective face shields are essential if the patient is to play in such a sport. With the proper safety devices, patients have played hockey successfully.

Good Advise from a Stargardt's Patient:

"Don't listen to negative influences. Believe in yourself, and show others what you can do. Only "you" can find your potential."

Marla Runyan, US Olympian and Stargardt's patient and the first legally blind athlete to compete in the Olympics

75th Jayanti Celebrations of His Holiness Sri Jayendra Saraswati Swamigal

Sunday, January 3, 2010

Issues Affecting Research Capacity in Blindness and Low Vision

Issues Affecting Research Capacity in Blindness and Low Vision

This paper was prepared for a meeting with Edward J. Kame'enui, Ph.D., Commissioner, National Center for Special Education Research, Institute for Education Sciences and Louis C. Danielson, Ph.D., Director, Research To Practice Division, Office of Special Education Programs, U.S. Department of Education

December 6, 2006

The American Foundation for the Blind appreciates the opportunity to discuss some of the issues affecting the nation's capacity to conduct educational research in blindness and low vision. We believe, as did the National Plan for Training Personnel To Serve Children with Blindness and Low Vision (Mason, Davidson, & McNerney, 2000) that research issues are integrally related to the personnel shortage, both in terms of having the leadership personnel to train adequate numbers of special educators and in terms of producing the quantity and quality of research that allows faculty to identify and teach best practice.

In a study of leadership personnel in special education, Smith, Pion, Tyler, Sindelar, & Rosenberg (2001) identified a number of issues affecting the preparation of leadership personnel, including diminished capacity, funding, declining enrollments, critical mass of students and faculty, financial assistance to students, working conditions, salaries, and mentoring. While these same factors are shared by the field of visual impairment, they are perhaps more acute in low-incidence fields already plagued by persistent teacher shortages and little evidence to support its practice. Rather than repeat issues already in the public discourse, we have focused in this brief on the literature in visual impairment that addresses the research needs of the field.

What We Know
The National Plan for Training Personnel To Serve Children with Blindness and Low Vision (NPTP) (Mason et al., 2000) was the culmination of an investigation spearheaded by the Office of Special Education Programs (OSEP) in response to concerns raised by the field regarding the shortage of personnel and the diminishing number of programs preparing teachers of students with visual impairments/deaf-blindness and orientation and mobility instructors. NPTP was led by professional organizations in blindness, including the Council for Exceptional Children, and involved stakeholders from multiple constituencies. NPTP recognized the connection between leadership development, personnel preparation, and research by stating:

At the same time the numbers of leaders is [sic] declining, the research capacity of the field of blindness and low vision is diminishing. With fewer faculty in positions, the demands to teach are high, and time for research and related grant preparation is reduced. This situation results in a lack of consistent, reliable data related to the number of students and direct service personnel in the field of blindness and low vision coupled with less research related to effective practices and outcomes for students. . . . Clearly, personnel preparation for this field will be strengthened by research that assesses educational results for children with blindness or low vision . . . . The complexity of factors that affect educational outcomes-ranging from variations in the children's visual and other disabilities, in their age and other characteristics, to variations in their educational settings and geographic and socio-economic status-requires systematic, long-range, cumulative, and outcomes-based research. (pp. 41-42)
To address these issues, NPTP recommended the creation of a Research to Practice Institute in Blindness and Low Vision that would design, conduct, and disseminate empirical studies of service delivery patterns, student outcomes, and specialized methodologies.

Faculty Load. In developing its recommendations, NPTP relied in part on a 1998 survey conducted with stakeholders from a geographically stratified random sample of 17 states that found that the average professor in visual impairment spent 62% of his or her time on teacher training, 25% on administration, and only 12% on research (Kirchner & Diament, 1999). At universities with a three-course teaching load, scholarly activity would typically consume 20% of faculty time; with a two-course teaching load, the proportion of time devoted to scholarly activity would be considerably more. NPTP attributed this diminished research activity to the demands on faculty-particularly in one-person programs-to teach, coordinate, recruit, and supervise in an environment constrained by the economics of higher education. Personnel preparation programs in visual impairment at public institutions seldom generate enough tuition to cover the costs of instruction (Ahearn, 1997), and faculty often struggle to make their programs economically viable.

Similarly, in a survey of external funding for university programs in blindness and visual impairment, Corn and Ferrell (2000) found that 58.6% of university programs receiving funding in 1997-98 applied for 33 additional grants in the same year, thus suggesting that a large proportion of faculty are devoting significant amounts of time to writing grant proposals at the same time as they are administering existing grants. They concluded:

Faculty in a program with few resources carry heavier teaching loads and have little time to conduct research. Faculty in programs that are dependent on external funding have shifted their scholarly activities to grant writing and fundraising. . . . It is a Catch-22 situation, in which faculty devote scholarly activities to obtaining funds to keep the programs functioning, yet face losing their positions because their scholarship does not meet traditional standards. (p. 383)
Faculty Tenure. Tenure and promotion policies generally require faculty to engage in research and other scholarly activities. Research in blindness and low vision, however, has documented that the proportion of full-time faculty in nontenure-track positions has increased over the years, from 13.2% (Silberman, Corn, & Sowell, 1989), to 22% (Corn & Silberman, 1999), to 36.5% (Silberman, Ambrose-Zaken, Corn, & Trief, 2004). Increased numbers of faculty in nontenure-track positions means that fewer full-time faculty are expected to engage in research and scholarship.

Research Capacity of Doctoral Programs. NPTP also recommended the creation of "innovative and collaborative leadership development opportunities." In response to an unsolicited proposal, OSEP funded in 2003 the National Center for Leadership in Visual Impairment (NCLVI), a consortium of 14 universities that work together to provide enhanced doctoral training to 21 Fellows currently enrolled in special education doctoral programs across the United States. Corn and Spungin (2002) pointed out that "only nine of the 15 programs that responded had one or more doctoral students" (p. 739). The National Center on Low-Incidence Disabilities (NCLID) has collected data on enrollments and graduates annually since 1995-96. The data document that until NCLVI, (a) the mean number of doctoral students in visual impairment enrolled at universities was 1.2; (b) only four doctoral graduates in visual impairment have been produced annually; and (c) .only five universities (Arizona, Northern Colorado, Teachers College, Texas Tech, and Vanderbilt) have consistently reported doctoral student enrollments over this time period (NCLID Research Clearinghouse, 2006).

In an effort to examine current research capacity of doctoral programs, Table 1 lists the 18 universities that indicated to Silberman et al. (2004) that they had doctoral programs in special education with an emphasis in visual impairment (universities are listed alphabetically). All but two of the universities are public institutions. The majority of institutions are classified by the Carnegie Commission on Higher Education (2006) as comprehensive doctoral granting institutions. Fifteen of the institutions participate in the NCLVI consortium, although only 10 actually enroll NCLVI Fellows. Only three of the institutions (Vanderbilt, Teachers College, and Ohio State) are among the top-ranked universities in special education (US News, 2006). Four institutions are designated as IES Pre- and Post doctoral Interdisciplinary Training Programs, suggesting that the programs might have excellent resources in educational research.

Clearly, some universities, by virtue of their faculty and research funding, will have greater capacity to train leaders in educational research. Examination of Table 1. Selected characteristics of universities with doctoral programs in special education and focus in visual impairment , however, indicates that (a) we have little information on which to judge the research training of doctoral students in blindness and low vision; and (b) there does not seem to be a pattern in the selection of programs. The more prestigious special education programs do not attract larger numbers of students in blindness and low vision, and while doctoral students are enrolled at IES Interdisciplinary Training institutions, there is no evidence that the quality of research training is better for students interested in low-incidence populations.

It is not surprising that there are few data to document the educational research capacity in blindness and low vision. Indeed, this absence of supporting evidence is characteristic throughout the field of visual impairment and precipitated our discussions with OSEP and IES. The American Foundation for the Blind therefore makes the following recommendations:

FY 2007

Update the surveys of faculty in visual impairment (Silberman et al., 1989; Corn & Silberman, 1999; Silberman et al., 2004) to determine current status of faculty funding and FTE. [In process at Hunter College]
Conduct a series of fact-finding studies to update knowledge about (a) the content of doctoral training programs; (b) external funding of programs; (c) research capacity, experience, and interests of faculty; (d) evidence-based practice.
Analyze research published in the last 5 years to create a database of designs utilized, participant characteristics, independent variables, dependent variables, strengths, and weaknesses.
Establish a Technical Work Group on Educational Research in Blindness and Low Vision.
Within Next 2 Years (by FY 2009), if warranted by FY 2007 activities:

Establish a Research to Practice Institute in Blindness and Low Vision, as recommended by Mason et al. (2000). Fund initially for 5 years (to be replaced by regional centers of excellence once capacity is strengthened).
Provide training for faculty in designs appropriate for low-incidence populations.
Include faculty in blindness and low vision on IES and NCSER reviews.
Connect faculty in blindness and low vision with established researchers in NCSER projects, for mentorship and collaboration.
Within 5-10 Years:

Create regional centers of excellence that implement a coordinated program of research across universities and that serve as training and internship sites for pre- and post-doctoral students.
Continue some version of coordinated leadership training modeled after the National Center for Leadership in Visual Impairment university consortium, revised as evaluation data suggest.
The American Foundation for the Blind appreciates this opportunity to share its concerns and recommendations. We hope that we can work together to expand the knowledge and understanding of the needs of infants, children, and youth with blindness and low vision, and we hope that a larger discussion of these recommendations among NCSER, OSEP, the field of visual impairment, and the broader field of special education will occur. Please let us know how we can work with you to facilitate these conversations.

For further information, contact:

Mark Richert, Esq.
Director, Public Policy
American Foundation for the Blind

Kay Alicyn Ferrell, Ph.D
Associate Director, Policy Research
American Foundation for the Blind

Ahearn, E. M. (1997). Policy forum report: Training educators to work with students who are blind or visually impaired. Alexandria, VA: National Association of State Directors of Special Education.

Carnegie Commission on Higher Education. (2006). The Carnegie classification of institutions of higher education. Retrieved December 5, 2006 at http://www.carnegiefoundation.org/classifications/

Corn, A. L., & Ferrell, K. A. (2000). External funding for training and research in university programs in visual impairments: 1997-98. Journal of Visual Impairment & Blindness, 94, 372-384.

Corn, A. L., & Silberman, R. K. (1999). Personnel preparation programs in visual impairments: A status report. Journal of Visual Impairment & Blindness, 93, 755-789.

Corn, A. L., & Spungin, S. J. (2002). Graduates and current students in leadership programs in visual impairments. Journal of Visual Impairment & Blindness, 96, 736-740.

Kirchner, C., & Diament, S. (1999). NPTP national needs assessment activities. Unpublished manuscript, American Foundation for the Blind.

Mason, C., Davidson, R., & McNerney, C. (2000). National plan for training personnel to serve children with blindness and low vision. Reston, VA: The Council for Exceptional Children.

NCLID Research Clearinghouse. (2006). New personnel produced, 1995-96 to 2003-04. Retrieved December 6, 2006 from http://nclid.unco.edu/rch/index.php?option=com_content&task=view&id=1364&Itemid=2

Silberman, R. K., Ambrose-Zaken, F., Corn, A. L., & Trief, E. (2004). Profile of personnel preparatin programs in visual impairments and their faculty: A status report. Journal of Visual Impairment & Blindness, 98, 741-756.

Silberman, R. K., Corn, A. L., & Sowell, V. M. (1989). Profile of teacher educators and the future of their personnel preparation programs for serving visually handicapped children and youth. Journal of Visual Impairment & Blindness, 83, 150-155.

Smith, D. D., Pion, G., Tyler, N. C., Sindelar, P., & Rosenberg, M. (2001). The study of special education leadership personnel with particular attention to the professoriate. Washington, DC: U.S. Department of Education. Retrieved December 6, 2006 from http://hecse.org/pdf/SPED_Leadership_Study.pdf

U.S. News & World Report. (2006). American's best graduate schools 2007: Education specialties: Special education. Retrieved December 5, 2006 from http://www.usnews.com/usnews/edu/grad/rankings/


1) In Singapore, the vision of 421,116 males between the ages of 15 and 25 was examined. In 1974-84, 26.3% were myopic; in 1987-91, 43.3% were myopic. Both the prevalence and severity of myopia were higher as the level of education increased. The prevalence rate was 15.4% in males with no formal education and increased steadily through the education levels to reach 65.1% among the university graduates in 1987-91. The authors state that their findings confirm indications from other sources that the association between the prevalence and severity of myopia and education attainment is real (M.T. Tay, K.G. Au Eong, C.Y. Ng and M.K. Lim, "Myopia and Educational Attainment in 421,116 Young Singaporean Males," Ann Acad Med Singapore, 1992, Nov;21(6):785-91).

2) Regarding the prevalence of myopia in Asian countries, Lam and Goh (Lam, C.S. and Goh, W.S., "The incidence of refractive errors among schoolchildren in Hong Kong in relationship with the optical components", Clin. Exp. Optom., 74:97-103, 1991) found that in 383 school children from ages 6 to 17 years, the prevalence of myopia increased from 30% at ages 6-7 years, to 70% at ages 16-17 years.

3) Lam and Yap (Lam, C.S. and Yap, M. "Ocular dimensions and refraction in Chinese Orientals", Proc. Int. Soc. Eye Res., 6:121, 1990) found that in a group of optometry students at The Hong Kong Polytechnic University, the prevalence of myopia was 75% in females and 69% in males.

4) Goh and Lam (Goh, W.S. and Lam, C.S., "Changes in refractive trends and optical components of Hong Kong Chinese aged 19-39 years," Ophthal. Physiol. Opt., 14:378-382, 1994) found that in 2000 first-year students at the University of Hong Kong, the prevalence of myopia was 87.5%.

5) Lin et al (Lin, L.-K, Chen, C.J., Hung, P.T., and Ko, L.S., "National- wide survey of myopia among schoolchildren in Taiwan, Acta Ophthalmol.", 185:29-33, 1988) found that in a national survey of children in Taiwan, the prevalence of myopia was over 70%.

6) Lin et al (Lin, L.K., Shih, Y.F., Lee, Y.C., Hung, P.T., and Hou, P.K., " Changes in ocular refraction and its components among medical students - a 5-year longitudinal study", Optom. Vis. Sci., 73:495-498, 1996) found that in a study of 345 National Taiwan University medical students, the myopia prevalence increased from 92.8% to 95.8%! over the five year period.

7) A recent study in Hong Kong showed what other studies have shown - wearing less than a full correction will slow the progress of the myopia. Children selected for the study were between the ages of 9 and 12. All were nearsighted, with 1.00 to 5.00 D of myopia. The children were separated into three groups. Each group was given a different type of eyeglasses to wear for the two-year period of the study.

The first group wore single vision lenses with a full correction; the second group wore progressive lenses with a +1.50 add; the third group wore progressive lenses with a +2.00 add. All children were examined at 6-month intervals to check the progression of their myopia. Sixty-eight children completed the study. As expected, more undercorrection meant slower myopia progression.

Single vision lenses: 1.23 D increase
Progressive lenses with +1.50 add: 0.76 D increase
Progressive lenses with +2.00 add: 0.66 D increase

Source: Leung JT, Brown B. Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses. Optom Vis Sci 1999; 76:346, 354. Published 10/07/00.

8) Myopia Increases Among Children
By Liu Shao-hua
Staff reporter
Taipei Times
December 6, 2000

One of every five children in the first grade in Taiwan's elementary schools is myopic (nearsighted). The proportion of myopics in this group has increased from 12.1 percent in 1995 to 20.4 percent this year, according to the results of a survey released by the Department of Health yesterday.

The results also show that 60.7 percent of sixth graders in elementary schools, 80.7 percent of third graders in junior high schools, and 84.2 percent of third graders in senior high schools suffer from myopia. In addition, the number of seriously myopic children is also on the rise. The proportion of seriously myopic children among sixth graders in elementary schools has increased from 2 percent five years ago to 2.4 percent this year.

Serious myopia is defined as exceeding 600 degrees (6 diopters). Anything over 25 degrees (0.25 diopters) is myopia. Normal eyesight is zero degrees.

"We appeal for reductions to children's work load in schools and the amelioration of visual environments in daily life," said Chen Tzay-jinn, director-general of the health promotion bureau, under the health department.

The survey was conducted by the department, in cooperation with National Taiwan University and its hospital, and involved a sample of 12,000 students from four million students between the ages of 7 and 18 nationwide. Myopia has been on the increase in Taiwan ever since the first myopia survey in 1983. The department manages the survey every four or five years.

The growth of nearsightedness among young children is thought to result from learning to read very young and using computers very young, Chen pointed out.

Last year, the department and the Ministry of Education delivered official documents to kindergartens nationwide demanding that children not be taught to read or use computers too early. "But many teachers and parents protested against this appeal," said the department officials. "They questioned exactly what they were permitted to teach if reading was not allowed."

"We do hope that parents and teachers can heighten their awareness of myopia and understand that early learning does not guarantee students' performance in the future, but it does bear a strong correlation to defects in vision," Chen said. The department also appealed for children under the age of 10 not to be taught how to use computers.

Senior high school students suffer the highest rates of nearsightedness, at over 84 percent. "It reached a plateau five years ago and has not changed this year. But their myopia has become more serious," Chen said. According to the survey, 20 percent of third graders in senior high schools are seriously nearsighted.

Many people thought operations could cure myopia. "But the superficial improvement of vision does not better the health of the eye. More importantly, it might reduce people's awareness of other problems associated with nearsightedness, apart from visual ones," said Lin Lung-kuang, ophthalmology professor at National Taiwan University. "Myopia cannot be cured. We have to prevent children from becoming nearsighted. Don't let them use their vision too early," Lin urged.

Because of the public's lack of awareness of myopia, the department estimated its prevalence would continue to grow. "Singapore resembles Taiwan in many respects and the extent of its myopia problem might serve as a warning for us," Chen said.

In Singapaore, 60% of the children are myopic by age 12; 80% are myopic by age 18; 79% of adults are myopic. And over 90% of university graduates are myopic. And eye doctors around the world ontinue to say this is inherited. Singapore is the first country in the world to take a timid step forward and publicly state that myopia is caused by prolonged close work. But so far, in order not to upset the optical industry, they only pay lip service to the idea. They do not mention the use of plus lenses and they do not mention the dangers of minus lenses. The only pitiful advice they offer is to look up from time to time as you read. See their website at Singapore National Myopia Prevention Program.

Common Contact Lens Complications

Common Contact Lens Complications

Giant papillary conjunctivitis
Corneal abrasion
Corneal neovascularisation
Corneal oedema
Corneal ulcer

All contact lenses are still foreign bodies to the eyes, they can and sometimes do give rise to eye problems. However, these complications are fairly uncommon and easily remedied. The incidence of these complications from lens wearing can be prevented if they are utilized properly, in terms of proper lens fitting, appropriate wearing schedule and stringent lens hygiene. Wearers should view the warning signs and symptoms seriously. Consult your eye-care practitioner immediately if prolonged red-eye, eye discomfort, reduced vision, sensitivity to light and eye discharge develops.

Giant papillary conjunctivitis(GPC) is the most common contact lens related problem.

It appears as numerous tiny swelling on the inside surface of the eyelids, particularly on the upper tarsal plate.
The most common underlying cause is an allergic reaction to the lens protein deposit, lens material or solution. Although it's not sight-threatening, the itchiness, increased lens awareness, sticky discharge and reduced vision make lens wearing unbearable.

Once GPC occurs, it's best to discontinue contact lens wear until the signs and symptoms have resolved and your practitioner has given you green light to resume lens wear. The recurrence of this condition is not uncommon. When resume NEW lens wear, you are advised to pay particular attention on lens maintenance, replace your lenses more frequently, or consider switching to disposable or RGP contact lenses.

Corneal abrasion may occur from a tiny particle (for example sand or some airborne debris) getting under the lens. This is far more common with RGP than soft lenses. There is a varying degree of pain or discomfort and a feeling of foreign body sensation.

It may result from wearing an RGP lens with an edge defect or a soft lens with an edge tear. Often does not require medical treatment. If deeper corneal layer is affected or the abrasion is over a large area, immediate medical treatment is needed.

Corneal neovascularisation is the ingrowth of abnormal blood vessel into the cornea from the limbus (junction of cornea and eye-white).The cornea normally has no blood vessels. Contact lens wear slightly reduce the oxygen deliver to the cornea, when lens wear is prolonged for days at a time or a lens that significantly limit the oxygen supply to the cornea, the cornea responds to this chronic oxygen deprivation by growing new abnormal blood vessels.

Further progression involves ingrowth of larger vessels accompanied by increasing amount of connective tissue into the transparent cornea. This fibrovascular scar is called Pannus, if unchecked it can grow over the pupil region of the cornea.

The occurrence of neovascularisation requires immediate lens change to allow sufficient oxygen supply to the cornea, by using of higher oxygen transmissibility lens material and stop extended wearing schedule.

Corneal oedema (swelling), like neovascularisation, related to insufficient oxygen to the cornea. Improperly used extended wear lenses are the most likely cause. If detected early and remedial action taken, the cornea will most likely without complications.

There are often no symptoms. In some cases, wearer may experience hazy vision, haloes around lights and pain upon removal of the lenses . Allowing the condition to continue can cause breaks on the corneal surface and lead to corneal infection and permanent scarring of the cornea.

Prevention is the best treatment. Regular follow-up examinations can detect oxygen deprivation and microscopic cornea changes before they become problematic. Replacing contact lenses as recommended and refrain from over-night lens wear is necessary to maintain normal eye health.

Corneal ulcer is the most devastating contact lens complication. The responsible micro-organisms to this complication may be bacteria, fungi or parasitic amoeba.
Wearing a lens without proper cleaning and disinfection, small break or abrasion on the cornea as a result of foreign body or excessive corneal stress, have the greater likelihood for infectious micro-organisms to cause corneal infection. The risk is greater in soft lens wearers and those wearing lenses on extended wear basis.

Symptoms of acute eye pain, foreign body sensation, eye discharge and a red-eye should warn the wearer to remove the lens and seek advice immediately from your practitioner. Delay in treatment of this condition can lead to corneal scarring or corneal perforation in extreme case.

Prevention is to:

Stop extended lens wearing to minimize the possibility of break on the cornea.
Maintain stringent lens hygiene.
Use only recommended lens solutions as your practitioner's direction.