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

Wednesday, April 27, 2011

A Patient Perspective on Macular Hole Surgery

Page 1 of 11 pages
A Patient Perspective on Macular Hole Surgery:
Experiences of and Suggestions from
Someone Who Has Had this Operation
If you are reading this, probably you or someone you care about is considering having macular hole surgery. You may have already decided to do so.
This communication does not provide medical information.
Its purpose is to help you comply with your doctor’s instructions,
to make this experience as comfortable and positive as possible, and
to answer questions you might have now or during your healing period.
The healing period after macular hole surgery is not fun but it is hardly all bad.
One good thing is that you, the patient, have a chance to contribute to improving the possibility that your operation will be successful. Unlike most illnesses where you are almost totally dependent on other people and factors beyond your control, you have a role in your own recovery.
Hopefully, the suggestions that follow will be helpful. The content can be read in any sequence, depending on your interests.
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Personal variables
What’s the operation like?
Know your limitations.
You and your helpers
Pre-operation planning
How to stay face-down when sleeping, drinking,
eating, and during other activities
Safety, hygiene and health habits
Coping with discomfort, boredom, and other emotions
You can open Bookmarks at left in Adobe Acrobat Reader
to view the topics headers above and, if you wish,
go directly to any topic.
This communication was prepared by Kristen McNutt
who had macular hole surgery in April of 1999. It was slightly updated in March 2005.
Your suggestions for additions, deletions or other changes for future revisions
would be greatly appreciated.
Please send them to her at KristenMcNutt2@cs.com.
Page 2 of 11 pages
Personal Variables
Every individual’s macular hole experience can be influenced by several variables.
Those below are in no priority order. Some are important to some people, others to others.
You might now be worrying about some of these variables.
On the other hand, you might not have thought about some things
which make this experience less challenging for you than for other people.
♦ Your relationship with a Higher Power might be a source of strength and peace.
♦ Your comfort level with your doctor. Knowing that your doctor really cares about you can, for some people, make a lot of difference in your motivation to comply and your ability to cope.
♦ Your personality and pace of life. If you are happier when you can usually control what happens to you or if you are constantly busy with various activities, you probably will have a more difficult experience unless you can, at least temporarily, let go and slow down.
♦ Your helpers at home. You need help from others, not just for doing things you cannot physically do yourself, but also for emotional support. Your helpers can make a big difference in your ability to cope with the challenges of your healing period.
♦ The amount of time you have to prepare. Too much time before surgery could increase anxiety about the unknown. Too little might cause you not to have easily accessible things that could make your healing period less stressful.
♦ Whether you have a disease or health limitation. Some physical limitations or medical conditions make the healing period more difficult.
♦ Whether you usually sleep on your back or on your stomach makes a big difference.
♦ Your job and the needs of others who depend on you. Worrying about what’s happening at work or about people who usually need your help can cause stress.
♦ The physical layout of where you live. Having several places at home to pass the time of day can reduce boredom. On the other hand, going up and down stairs can be dangerous.
♦ Your financial resources will affect whether you can purchase some supplies and services that might make your healing period more pleasant.
♦ How well you see with your other eye will determine to a certain degree what you can and cannot do during your healing period.
♦ The season of the year. If the weather is nice, sunshine can brighten your spirits and you can enjoy being outside. If it’s cold and streets are icy, you don’t have as many options.
Page 3 of 11 pages
What’s the Operation Like?
Your doctor will explain what a macular hole is and tell you about the operation. He or she may also give you additional information to read or listen to regarding this procedure and the healing period. If you want a more detailed medical explanation, ask your doctor for reference books or sources such as Web sites. Be careful, however, about relying on sources other than those recommended by your doctor. The Internet can be an excellent resource but advice found there is not necessarily based on the best available medical knowledge or may not be applicable to your situation.
My experience was challenging because, although I was 57 years old, I had never before had an operation. If you have had one, your questions will be fewer and your anxiety level lower.
♦ Someone from the hospital will tell you what you must do prior to the operation. Just don’t forget, as I did, to brush your teeth right before the no-fluids-by-mouth period begins.
♦ Putting in the I.V. was like a pin-prick and I felt no discomfort thereafter.
♦ Though I was technically not asleep, I was not, as I had dreaded, anxious or frightened.
♦ I vaguely remember being moved onto the operating table.
♦ During the operation, I was aware that what seemed to be a blood pressure cuff on my arm was periodically inflated.
♦ I didn’t see anything but, because of the anesthetic, lovely kaleidoscope-like colors played in my head.
♦ I recall hearing some conversation among the others in the operating room.
♦ The next thing I knew I was awake in the recovery room and my husband was with me. After about an hour, I put on my shirt and shoes to go home. A metal guard was taped over my eye. I was tired but I was not uncomfortable.
What Can You See?
Early on, I realized that my bubble was there to help me
and to increase the probability that my macular hole would heal properly.
We named it Buddy.
Immediately after the operation, Buddy blocked the vision in the eye that was operated on. I could see light and detect motion, but everything was blurry. I usually just kept that eye closed and used the other one.
Gradually, as Buddy became smaller and I was allowed to lift my head, when I looked straight ahead I could see fairly clearly above a curved area at the top of my field of vision. At one time I was taught in Physics why the bubble blocked the bottom of the vision field, although it was actually at the top of the inside of my eye when I was standing up. I’m not sure I ever understood it in school and I don’t now, but that is what you see.
Later, Buddy became a circle in the middle of what I saw.
Over a few weeks, it got smaller and smaller.
Eventually, it was barely a speck. Then one day, my Buddy was gone.
[2005 P.S. On rare lucky days, I see a teeny, tiny Buddy; my old friend is still there to help me.]
Page 4 of 11 pages
Know Your Limitations.
After your operation, you are not sick. You simply cannot see with the eye that was operated on.
1. As with any surgery, for several days after the operation (ask your doctor how long for you), you have to keep the incision area dry. You must avoid flushing water into your eye, and therefore must be careful about bathing and washing your hair.
2. Your more significant limitations result from the gas bubble initially blocking your vision, except for blurred images. The severity of these limitations decreases as the gas bubble becomes smaller.
♦ You cannot see things on the side of your healing eye; crossing a street alone is dangerous.
♦ You lack depth perception; you might miss a curb when walking or a step on the stairs, and objects, closer than they appear to be, might hit you in the face.
♦ It’s harder to keep your balance when standing or walking.
♦ Although you can see with your other eye, mine tired quickly. I couldn’t do concentrated reading until my glasses prescription was corrected for post-operative changes in the vision of the eye that was operated on.
♦ Because the gas bubble would be affected by air pressure changes, you do not want to get on an airplane. And check with your doctor about traveling via car or train to a location at a different altitude, such as from sea level to the mountains or vice versa.
3. Other limitations occur because of the face-prone requirement. My doctor’s instructions were to keep my eyes looking straight down as well as my face parallel to the floor.
♦ When you walk face-prone and eyes straight down, you cannot see things above waist height. You can avoid things you might trip on, but you might hit your head on protruding objects such as an open upper kitchen cabinet door.
♦ When you walk as you should, you might run into things ahead of you. Ask others to keep your frequent paths clear of obstacles.
Something else to expect – Your face looks pretty ugly!
Our joke was that it looked like I’d been in a street fight . . . and lost.
After the surgery, my entire eye area was swollen and red. This gradually subsided but my eye lid was puffy for several weeks.
Another surprise was that, if you faithfully keep your head down, water in the cells of your face shifts to the part of your cheeks and your chin that is lowest when you are in that position. We considered my "chipmunk cheeks" a good sign. It meant that I was doing what I was supposed to do.
You only see how bad you look if you look in a mirror – I avoided doing that.
Page 5 of 11 pages
You and Your Helpers
Face-prone and with only one eye functioning, you simply cannot do a few things and doing others is difficult. You definitely need someone to drive you to post-operation doctor appointments.
If possible, it also helps to have someone:
♦ Put in your eye-drop medication several times a day.
♦ Thoroughly clean your eye guard and tape it on at night.
♦ Prepare your meals.
♦ Steady you when you go up or down stairs.
♦ Guide you when walking outside.
♦ Watch whether you are staying face-prone and, when you forget,
remind you to get back in position.
♦ Massage your neck, shoulders and back that ache from keeping your face prone.
♦ Help keep you face-prone while you sleep and . . . pull the covers up over your shoulders.
Be Kind to Those Who Are Caring for You.
Macular hole surgery is stressful and frightening for the people who care for you,
as well as for you. Your helpers are busy with their usual responsibilities, plus taking care of you and doing chores you normally handle in the household. Also, they have the tough-love task of correcting you when you forget to stay face-prone.
Except for aching neck and shoulder muscles and lack of sound sleep, I was rarely physically uncomfortable. But, because leaning forward with your head down is how many people sit when they hurt, I probably appeared to be miserable and in pain.
And lying face-down looks pretty pathetic.
Watching you experience what appears to be painful
can be painful to those who love you.
Re-assure them that you are OK!
Page 6 of 11 pages
Pre-Operation Planning
Most preparations are not mandatory. Don't worry. Things will get done when they need to be done. You should, however, give some thought before the operation to where you will sleep, or at least rest, face-prone right after the operation. (See following section about “How to Stay Face Prone")
Unless someone else can do them for you after the operation, a few other things worth considering in advance are:
♦ Get a necklace-type chain for your glasses so you don’t lose them.
♦ Find your extra eye glasses. If you misplace your usual ones, you will want a spare pair handy. You’ll probably also need sunglasses when outside.
♦ Wash your hair – it might be several days before you can do that.
Consider whether you should get a haircut before the operation;
that’s difficult post-op when your face is parallel to the floor.
♦ Organize any medications for your helpers.
♦ Put on the lower shelf of the refrigerator and pantry things you want to be able to get for yourself, rather than bothering your helper.
♦ Get straws and/or sports bottles for drinking fluids – you cannot tilt your head back to drink.
♦ Stock up on Kleenex or other tissue – both eyes water.
♦ Buy at the hardware store a tiny screwdriver set for eye glasses repair. I was taking mine of and off so often that the lenses loosened in the frame.
♦ Take with you to the hospital a pillow to rest your head on when you ride home.
♦ Think through the sort of things you do before leaving on vacation – many are relevant now.
Things we did before that could have been done after the operation:
♦ Bought CD’s of relaxation music and audio tapes of books/short stories.
♦ Stocked up on my favorite snacks and childhood "comfort foods."
♦ Made arrangements for a massage therapist to come to the house.
Page 7 of 11 pages
How to Stay Face-Prone
Staying face-prone for several days sounds horrible
to anybody who has never done it.
What worked for me may not work for you, but
believing you can do it is the first step in doing so.
SLEEPING
The challenge boils down to figuring out:
♦ How to breathe, when your face is straight down and you are not awake.
♦ How to stay face-prone when you are asleep and can’t control your turning over.
♦ Ideally, how to be comfortable enough to drop off to sleep for daytime naps and during the night.
The Rite Time* equipment helped a lot. The 2-legged bed-extension, which we put at the foot of the bed, can be adjusted to the height of your bed. The oval hole in the extension, above which you position your head, solves the breathing problem. Because there was no bed mattress on either side, having my head and arms on the extension seemed to reduce the likelihood of my turning over when I was asleep.
We made the following adaptations:
• We put a 4-foot long cushion from a loveseat on the bed, in line with the Rite Time upper-body-support cushion. That lifted my hips and legs to the same elevation as my upper body.
• The Rite Time foam rings and inflatable pillow work well but, with that set-up my chin seemed to usually bear the weight of my head, thus causing strain on my jaw muscles. Therefore, we switched to a larger hole-in-the-middle foam rubber Softeze pillow** that was made for people who have hemorrhoids. The added advantage was that this larger pillow was less likely to fall off the bed extension during the night.
• We made up the bed with two separate sets of top sheets and blankets, one for me and the other for my husband. This helped because my head was beyond the end of the bed, and his wasn’t.
A few other things you might add to your sleeping set-up:
• Put a small table directly below the bed extension, close enough that you can reach it when you wake during the night. Mine held an easily lightable clock, my pills, a straw-sipper non-spill water bottle, and my eyeglasses.
• We kept a night-light on so that my husband could see, when he woke, whether I was face-prone. Also, this helped me not to trip when I went to the bathroom during the night.
* Rite Time Corporation, 2950 East Dover Street, Mesa, Arizona 85213-695; www.ritetime.com
Phone 602/832-1592 or 800/266-2924.
** Softeze Comfort Ring, available at medical supply stores or from The Comfortable Solution
Hermell Products, Inc. 522 Cottage Grove Road, Building C, Bloomfield, CT 06002
Page 8 of 11 pages
DRINKING
This is very important because you must not tilt your head back.
Flexible straws are found in the paper-goods section of the grocery store. Use them for all beverages and liquids.
Another challenge is the possibility of spilling. We found a Rubbermaid bottle that has a plastic straw inside, a screw-on lid, and a twist-snap spout that can be closed so that it doesn’t leak if knocked over. In stores, it is located with other kitchenware plastic containers.
EATING
At mealtime, the goal is to get your face directly over your plate and not let your eyes wander off from straight down.
• I ate using an end table with stable legs, rather than a wobbly TV tray.
• The table was about 4 inches higher than the seat of my chair. It was narrow enough to wrap my legs around, allowing me to lean directly over my plate.
• Reach for your beverage – don’t move your eyes to find it.
• Eat from one dish at a time. Soup bowls, salad plates and dessert should be directly below your face.
• My snacks were kept on the bottom shelf of the refrigerator and the pantry. The milk and juice cartons would only fit on the top refrigerator shelf, but they were always at the front of that shelf so I could reach them without looking up.
WALKING
My doctor said I could walk around as long as I kept my eyes straight down. If yours says the same,
Polish your shoes. You’re going to look at them a lot.
Going outside is a mixed blessing. It relieves cabin-fever but increases the temptation to look up or off down-center.
Ask your helper to stand and walk on the side of your healing eye. That reduces the possibility that someone will walk up to you and expect you to know they are there, but you don’t. And don’t step backwards; I almost hurt a child whom I couldn't see standing behind me.
Wearing an eye-patch and/or using a Rite Time mirror
is a good way of warning others that you might not see them.
Also, it's a convenient way to let strangers know
why you’re walking with your head down which looks weird to others.
SHOWERING/BATHING
My doctor said I could shower as long as I covered my eye so that water didn’t flow into it. I was afraid, however, that I would lose my balance and fall in the shower. Therefore, for the first few days, I just bathed at the sink with a wash-cloth. When I washed my legs and feet, I sat on the toilet seat lid so that I wouldn’t fall.
Page 9 of 11 pages
OTHER WAYS TO PASS THE TIME
• "Watching" TV and videos
We have twin guest room beds which were not being used while I was healing. We put one mattress on the floor in the den where the TV is located. I could lie down on the mattress and lean forward over the end, supporting my upper body on my elbows. Since my head was over the end of the mattress, I could look straight down and see what was on TV by putting the Rite Time mirror* on the floor in front of the mattress. This works but not for long periods because of the strain on neck and shoulder muscles.
I learned quickly that for most TV, you really don’t need to see much of what’s on the screen. A few mirror glimpses allows you to link characters with voices. Then you can just listen, keeping your head down parallel with your body, resting your forehead on pillows on the floor in front of and at the same height as your mattress. This position greatly reduced muscle aches and pains.
* This patented three-panel mirror is designed so that you can hold it when looking down and see what is in front of you. One comes as part of the Rite Time equipment set. I ordered two extra and kept one in the bedroom, one with me wherever I went and the third for when I forgot where I put the others.
• Listening to CD’s and tapes
In my daytime room, we put our second twin mattress on top of both sets of springs. This arrangement let me lie higher above the floor than I would have been on a regular bed with only one set of springs. We put the Rite Time bed extension at the front of the springs and mattress. From that elevation and with my head beyond the end of the springs and mattress, I could look straight down to change tapes or CD’s and even do a little reading.
Sometimes I would just lie on the floor with two pillows, one for my forehead and the other for my chin. This worked fine for relatively short periods of time when I was doing nothing but resting.
• Talking on the telephone
Some people recommended using the speaker phone but I don’t like that echo. I would sit and lean forward. I kept a pillow on the desk right next to the phone to help me remember not to lift my head while talking.
My auto-dial phone feature was a big help. I could stand and lean over the phone to select a number, and then go back to my sit-with-head-on-pillow position to talk.
• Reading
For short periods, I could read with my other eye. I would lean forward, placing my book directly between my feet and my head on a pillow on the desk. Another option is to use the Rite Time extension table and place your reading material at a comfortable height directly below the oval face opening in the extension table. My brother suggested taking a leaf out of an extendible dining room table, lying down on the table and reading through that opening, but I never tried that technique.
TIMES WHEN I WAS MOST LIKELY TO FORGET FACE-PRONE.
• Looking for something in the refrigerator.
• Selecting what to wear from my closet.
• When I misplaced my water bottle, my mirror or my glasses.
• When I tried to use the Rite Time mirror to download e-mail.
We decided that was not allowed!
Page 10 of 11 pages
Safety, Hygiene and Health Habits
SAFETY
Most things that are usually dangerous are even more dangerous now.
• Stay away from the stove, especially if it is gas range.
Your sleeve could be closer to the burner than you realize.
• If you must go up or down stairs, wait until someone can walk with you.
• When you dress, sit down to put on your pants, rather than standing on one foot.
• Choose good support shoes and do not wear a bathrobe that might cause you to trip.
• Whenever possible, steady yourself as you walk by keeping your hand on counters or furniture.
• Be sure that all head-level cabinet doors are kept shut.
• Be careful with knives, pens or anything with a pointed end that might be near your face or eyes.
• If your neighborhood is not completely safe, think carefully before going out alone.
• Do not open the door to strangers, unless someone is home with you and nearby.
HYGIENE As with safety, be doubly careful about your usual hygiene habits.
• Wash your hands often and well, and keep them away from your eye.
• If you wear an eye guard at night, always wash it well and line it with a fresh, sterile bandage.
• I used a fresh wash cloth every time I cleaned my eye. Although it was probably overly cautious, I even used different wash clothes for my healing eye and the other one to avoid transferring an infection from either to the other.
• Be especially careful about food safety – now is not the time to be vomiting or have diarrhea.
HEALTH HABITS
• Ask your doctor if and how vigorously you can exercise.
• Constipation was a problem because I wasn't moving around much. Eating more fruit and high fiber foods might be helpful.
• When your doctor asks what medications you are taking, don't forget about vitamin/minerals, herbal products, or other supplements which might have dangerous side effects related to your surgery.
• If you drink alcoholic beverages, ask your doctor whether and for how long you should abstain.
• If you are on a doctor-prescribed diet, ask whether you might temporarily relax some dietary restrictions if doing so would reduce stress during your healing.
• I gained a few pounds because of inactivity and snacking a lot. That was easy to take off later.
Page 11 of 11 pages
Coping with Discomfort, Boredom, and Other Emotions
For some people, the emotional challenge of macular hole surgery is greater than the physical challenge of the face-prone position. Obviously, every person must cope with fear about the outcome of the surgery, the frustrations of being a burden on others, worry about being away from your job, concerns about others who need your help, etc. Everybody has to figure those things out for themselves. In comparison to such emotions, discomfort and boredom are relatively easy to deal with.
DISCOMFORT
I had very little eye-related pain. My doctor prescribed a pain pill that I used at low dosage for the first few days. Thereafter, I used it occasionally to help me sleep and during the day for mild headaches caused by reading with one eye and neck/shoulder muscle pain. Most of the time, however, a non-prescription pain pill was sufficient to handle my relatively minor discomfort.
After checking to be sure it was okay with my doctor, we had a massage therapist come to the house daily during my face-prone period. That definitely helped the muscle aching and probably made me sleep better. This service is expensive, however, and was not covered by our medical insurance.
The only other discomfort worth mentioning was being tired.
I longed for a night of good solid sleep.
BOREDOM
I was not nearly as bored as I had feared I’d be.
• One good thing about not being able to sleep well at night was that it was easier to sleep during the day. At least once a day, I would put on a relaxing-music CD and drift off to sleep for an hour.
• This was a great time to listen to conversation tapes for a foreign language I’m trying to learn.
• I discovered books on tape. For me, short stories and monologues were more enjoyable than novels.
• We enjoyed renting lots of videos. Musicals were much more fun than dramas because I could enjoy the singing without having to watch the screen.
• The daily massages not only felt good but gave me something to look forward to each day. Also, this provided a pleasant chance to visit with someone without being self-conscious about not being able to make eye contact.
• Occasionally, the weather was nice enough for my husband to take me on walks around the neighborhood, and we even took a short car trip, carrying all my pillows and paraphernalia.
• A thoughtful friend brought over her puppy. It was small enough to play with while sitting on the floor and keeping my eyes straight down.
CABIN FEVER
My doctor and I agreed on 14 days of face-prone eyes-straight-down. For a while thereafter, I continued sleeping face down but could hold my head up during half of my waking hours. By then, my bubble was no longer totally blocking my vision.
This period was challenging. I resumed some business and personal activities and could walk outdoors by myself. Maybe it was a mistake but, since my business office is in my house, I chose not to risk driving the car until the bubble was barely a speck. Not being able to go places independently for several weeks was one of the most frustrating parts of my healing period.
Having choices is sometimes harder than complying with rules set by others. That is one of the many things I learned from my macular hole surgery experience . . . and am trying not to forget.

Radial optic neurotomy provides little benefit in non-ischemic CRVO

RADIAL optic neurotomy (RON) and a
complete vitrectomy are more effective in
the treatment of ischemic central retinal
vein occlusion (CRVO) that in the nonischemic
form of the disease, reported
Hugo Quiroz-Mercado MD at the
Frankfurt Retina Meeting.

“For radial optic neurotomy to have its
desired effect, we have to differentiate
between ischemic CRVO and nonischemic
CRVO. While vision improves in
the ischemic type, it does not in the nonischemic
type, and this is something that
retinal surgeons need to look out for.

Vitrectomy is of no use in non-ischemic
cases either,” said Dr Quiroz-Mercado,
Association para Evitar la Cequera en
Mexico, Mexico City.

In general, ischemic CRVO involves
poor visual acuity (≤ 20/200),
haemorrhage, afferent papillary defect, and
an abnormal electroretinogram. It
represents approximately 40 per cent of
cases. Non-ischemic CRVO, by contrast,
presents with good visual acuity (≥ 20/50),
less haemorrhage, absent afferent papillary
defect, normal electroretinogram. Most of
the cases an ophthalmologist will see in
his office are of the non-ischemic type.
Most CRVO patients, therefore, do not
require surgery, he noted, as non-ischemic
CRVO tends to improve without invasive
surgical intervention. Dr Quiroz-Mercado
noted that benign treatments, such as
intravitreal bevacizumab (Avastin,
Genentech) injections, would likely be all
that these patients need.

He said that RON needs to be
evaluated without vitrectomy, to
determine the actual extent of its effects.
He noted that in his experience, nearly all
RON surgeries were performed with a
complete vitrectomy and posterior
hyaloid removal, and therefore the effects
of RON without vitrectomy were virtually
unknown.

Vitrectomy is known to increase the
oxygen supply to the vitreous cavity. It
also removes growth factors as well as
the scaffold supporting proliferations within the posterior eye segment.
Vitrectomy also improves macular
function, he said, and therefore the
efficacy of RON itself without the added
effects of vitrectomy must be established.

Dr Quiroz-Mercado evaluated the role
of vitrectomy in laser-induced
chorioretinal venous anastomosis surgery
in patients with CRVO. He performed laser-induced anastomoses in nonischemic
CRVO eyes and also performed
pars plana vitrectomy using an erbium-
YAG laser in ischemic cases, perforating
the retinal vein as well as the Bruch’s
membrane.

He performed vitrectomies to prevent
proliferation in shunt surgeries.With the
use of vitrectomy and chorioretinal
anastomoses in ischemic cases, Dr
Quiroz-Mercado could nicely demonstrate
communicating circulatory paths with
angiography.

In the ischemic CRVO cases, 60 per
cent of the patients showed improved
visual acuity (without anti-VEGF drug
therapy).The results seen after RON
alone in ischemic cases (without posterior
hyaloid removal) did not give visual
improvement.There were, however, severe
complications in these cases.

Dr Quiroz-Mercado explained that the
retinal blood flow is reduced within the
first week following surgery.The blood
flow after pars plana vitrectomy, however,
is not changed, he observed.

He noted that eyes that had the
formation of chorioretinal anastomoses
did not show improved blood flow.
Interestingly, at six months following
surgery, retinal blood flow was
comparable to the pre-operative state.
There is also a gradual reduction of
macular oedema up to six months
postoperatively, without any improvement
in retinal blood flow. Dr Quiroz-Mercado
believes that the vitrectomy most likely
helped blood flow in these cases.
The optociliary veins provide a preexisting
shunt system that allows retinal
venous blood to bypass the central retinal
vein and exit from the orbit via the
choroidal circulation and its anastomoses.
This venous system protects CRVO eyes against anterior segment
neovascularisation, he said.

Of the ischemic CRVO cases, about 50
per cent will develop acquired optociliary
veins and are likely to experience stable
or improved visual acuity. Dr Quiroz-
Mercado observed that there have even
been investigations that suggested that
RON induces optociliary vein genesis.
He noted that certain CRVO cases
were likely to follow the course of their
natural history with or without surgery, as
shown in the Central Vein Occlusion
Study - CVOS (Arch Ophthalmol
1993;111:1095). This investigation
revealed the natural history and clinical
management of CRVO in 725 patients
with a three-year follow-up.
The patients were categorised into
three main visual groups: patients with
visual acuity of 20/40 or better; those
with 20/50 – 20/200; and those with visual
acuity of less than 20/200. Patients in the
last group had an 80 per cent chance of
having an outcome of below 20/200.Their
treatment plan included prevention of
visual acuity decrease and the
development of anterior segment
neovascularisation.

In contrast, 65 per cent of patients with
an initially good visual acuity of at least
20/40 maintained their vision at the end
of the study. In the 20/50-20/200 group, 19
per cent improved to better than 20/50,
44 per cent maintained their vision, and
37 per cent had final visual acuity of
worse than 20/200.

Based on this study and his own
experience with RON, Dr Quiroz-
Mercado recommended that
ophthalmologists perform a careful slitlamp
evaluation for iris neovascularisation
and anterior chamber angle
neovascularisation, upon the patient’s
initial visit. Patients with visual acuity
below 20/200 have a high correlation with
the presence and development of
ischemia.

He recommends no treatment for
patients with visual acuity over 20/40 -
these cases are mostly non-ischemic and
do well on their own, usually
spontaneously. For patients in the middle
group, he recommends vitrectomy as a
possible treatment. For patients
categorised in the worst vision group, Dr
Quiroz-Mercado believes that an effective
surgical treatment has yet to be found.

Bhagwan Sri Satya Saibaba's Legacy




Recently I had watched a news channel which had a talk show,which debated the legacy of Bhagwan Sri Satya Saibaba.The panelists were divided on their opinion about the legacy and repeatedly it was mentioned that,in no way the show was to undermine the greatness of the spiritual leader,but it aimed at only analyzing whether the legacy was a contentious one.Well,earlier I had posted an article in my blog titled “May GOD Exist and GODMEN Extinct”.

We need to realize that in the name of being rational and progressive,one cannot assume that every single GODMEN in this world are fake and pseudo.Satya Saibaba was more of a positive force and a spiritual gift this country would have ever dreamt of producing.Only two other people come to my mind close to this legacy one Swami Vivekananda & Sri Paramacharya Mahaperiyava.

All those who brag about rationalism and scientific temper being tampered by Godmen and Spirutalism should realize that Spirutality is a great science,which is purely based on logic and causation.For the rationalists it’s all about “I” and they always say ,” I Don’t Believe in so on and so forth”.

But great avatars like Bhagwan Satya Sai are those who thought only about humanity and wellbeing of mankind.Those amongst us who had a chance to even think and analyze about this great spiritual soul,should consider ourselves blessed and gifted that we were born and existed in this universe when this great ATMA had lived amongst us and spread the language of LOVE and service to MANKIND.

In Bhagwans own words “ LOVE ALL , HATE NONE”

Friday, April 15, 2011

Seva Rathna Award to Cheif Dr S S Badrinath




The Srirangam Srimad Andavan Asramam honoured Sankara Nethralaya’s founder and Chairman Emeritus, Dr.SS Badrinath, with the Seva Rathna on April 10, 2011 at a function held in Chennai.

Dr. Badrinath was presented the award in recognition of his relentless battle to eradicate blindness, his leadership and pioneering role in providing quality and affordable eye care and spearheading India-centric research in ophthalmology.

Sunday, April 10, 2011

MCI Mulls sending Doctors back to School

Medical Council of India (MCI) is all set to send doctors back to lecture halls, failing which they would lose their license to practice.

According to the new rules, which will be announced on Tuesday, MCI is planning to make it mandatory for all doctors to attend 30 hours of continuing medical education (CME) every five years. If they fail to attend CME, their registration to practice would be suspended.

Shot in the Arm for Stem Cell Research

As research into regenerative therapies gains focus across the world, the government has decided to give a booster dose to stem cell-related studies and banking through a regulation. For this, a high-level committee has been formed for monitoring clinical trials and enforcing ethical guidelines.


The committee will have the responsibility to examine the scientific, technical, ethical, legal and social issues in the area of stem cell research, therapy and banking. Even though India worked out the fundamental guidelines for stem cell research more than two years ago, an effective surveillance system for the highly complex research has to be put in place. The Indian market has now opened up for collaborative projects because of government-authorised trials for stem cell-based therapies.

WHONET Workshop on Antimicrobial Resistance




Antimicrobial resistance is one of the most important challenges in the fight against infectious diseases as drug resistance hinders effective application of modern technologies, Dr. Rajesh Bhatia, Regional Adviser, SEARO/WHO, said at the inauguration of a WHONET workshop at Sankara Nethralaya.

The five-day workshop on “Laboratory based surveillance of antimicrobial resistance,” was inaugurated at Sankara Nethralaya on March 21, 2011.

The theme of World Health Day 2011 is Antimicrobial Resistance and the WHONET training programme, Dr. Bhatia said, “is part of WHO’s global efforts to contain antimicrobial resistance.”

The WHONET training programme will enable microbiologists and other infectious disease specialists gain new analytical tools to monitor and manage susceptibility test quality and the spread of drug resistance locally and outside their area.

“Antibiotic susceptibility test guides physicians in selecting the best antimicrobial agents for the management of infections in patients. The data generated will provide epidemiological information on the resistance pattern of microorganisms and is of great public health importance within the community,” Dr. HN Madhavan, President, Vision Research Foundation and Director, L&T Microbiology research centre, said in his welcome address.

Chairman Emeritus, Sankara Nethralaya, Dr. SS Badrinath described the opportunity to hold the prestigious workshop as a very important recognition for Sankara Nethralaya.

Twenty microbiologists from SEARO (Regional Office for South-East Asia) and WPPRO (Regional Office for the Western Pacific) countries like Philippines, Indonesia, Vietnam, Myanmar, Bhutan and Nepal are participating at the workshop.

WHONET is an information system developed to support WHO’s goal of global surveillance of bacterial resistance to antimicrobial agents. Microbiologists, clinicians and infection control workers may use WHONET —a free Windows-based software — to enhance monitoring of drug resistance in their hospitals and communities and to merge their files into national, regional, and global networks for surveillance of drug resistance.

The facilitators participating at the workshop include Dr. Rajesh Bhatia, Regional Adviser, SEARO/WHO; Dr. Gayatri Ghadiok Technical Officer, Essential Health Technologies Adviser WPRO/WHO; Dr. Anuj Sharma, WHO India; Dr. H. N. Madhavan, President, Vision Research Foundation, Director L&T Microbiology Research Centre and Dr. K. Lily Therese, Head of Department, L&T Microbiology Research Centre.