When cataract can be glaucoma
Dr R. Kumar
Mrs Jyoti Devi, wife of a wealthy businessman at Ludhiana and mother of five grown up sons, all well-to-do, did not know that darkness was lurking in her store, at the sunset of her life. That happened sooner than later when she lost her husband on the one hand and lost vision (in her eyes) on the other.

AYURVEDA & YOU
Acidity: prevention and treatment
Dr R. Vatsyayan
Last fortnight we had discussed the causes, types and the signs and symptoms of acidity. In fact, before going into the detailed treatment of any disease, one must ponder over its known causative factors. Ayurveda emphasises that the shortest form of the treatment lies in removing the cause that produces any particular disease.

When cataract can be glaucoma
Dr R. Kumar

Mrs Jyoti Devi, wife of a wealthy businessman at Ludhiana and mother of five grown up sons, all well-to-do, did not know that darkness was lurking in her store, at the sunset of her life. That happened sooner than later when she lost her husband on the one hand and lost vision (in her eyes) on the other. The sons became too busy to distribute the spoils after the death of their father, and the poor mother had to get operated one of her eyes in a free camp. The surgery was apparently successful, but she did not regain her vision in the operated eye. Consequently, she was declared a habitual complainer in the home and was tactfully shifted to an old age home at Chandigarh.

Because of her falling eyesight the caretaker of the home, who had volunteered to give free consultation to the hapless inmates of the old age home, took her to an eye-specialist. On examination it was revealed for the first time that the eye, which was successfully operated for cataract, had signs of optic nerve atrophy due to glaucoma. So, now it was not possible to recover any vision in that eye. On examination of the other eye, it was found that she has changes suggestive of early cataract, but the loss of vision is profound and disproportion to the extent of cataract. Investigations for glaucoma discovered the underlying cause of loss of vision i.e. she had glaucoma, also called "kala motia" in the other eye as well. She was reluctant to undergo surgery on her left eye due to her unfavourable experience in the right eye. More so, where was the money for surgery?

Unfortunately, it has become customary to presume as cataract or "chitta motia", when an ageing person suffers from failing vision, by the doctor as well as the patient. It is a dangerous practice, indeed! The person keeps on waiting for the maturation of the so-called cataract (not a right approach in any case) and when he reports for surgery after the so-called maturation, he is told "it is all over, you had ‘kala motia’, which has caused irreversible blindness; no recovery of sight is possible now." Who is at fault? Misbeliefs and myths, of course.

It is a serious disease of the eye, generally associated with the rise of pressure inside the eye, often silent, certain to lead to blindness if not detected and treated early. In a normal eye the watery fluid, aqueous humor, circulates freely and excess goes out through an exit. In cases of glaucoma, the exit develops some obstruction, and resultantly, the pressure inside the eye rises beyond normal. This high pressure causes damage to the optic nerve, the channel which carries images to the brain.

This rise of pressure may be sudden, as in the case of acute glaucoma or more often slow, called chronic glaucoma. The patient loses vision slowly, first of all from the sides, called field defects. The patient may not have any complaints, or there may be a feeling of unsatisfactory quality of vision, fatigue, dull aches, rainbow colours around the light, headaches, night-vision problem or frequent change of glasses. The establishment of diagnosis may require several investigations for glaucoma viz. tonometery, ophthalmoscopy, perimetery also called field-testing, gonioscopy and several others.

After 40 years of age a routine examination for eyes is advised, from an eye-specialist and not from a spectacle-seller. If there is a family history, it becomes even more essential. The incidence of glaucoma is higher among women and those who suffer from diabetes or those who have to use steroid treatment either as drops in the eye or tablets or nasal spray, e.g. in allergies.

The answer is yes, but if it is detected at an early stage. The answer is no, if the detection and treatment are delayed until vision is lost or there are marked field defect. Further treatment will depend on the evaluation by an eye-specialist. Not all cases of glaucoma require surgery; many of them can be managed with the continuous use of eye drops or a laser shot. Laser is especially effective in preventing the painful attack of glaucoma in the predisposed eyes. Now the outcome of glaucoma treatment has improved with a number of modalities for early diagnosis, newer eye drops which are effective even in hitherto refractory cases, and improved surgical techniques. Early and correct diagnosis and appropriate treatment are the keys. Unfortunately, not even half the affected population is either aware about the existence of disease or not taking regular and proper treatment due to ignorance or apathy.

Glaucoma and cataract are quite different from each other, though they occur in the same age group. Cataract is due to the clouding of the naturally transparent lens of the eye, whereas glaucoma is due to raised pressure in the eye. Vision lost due to cataract is recoverable, in almost all cases, whereas the vision lost due to glaucoma cannot recover. This is the reason why it is called "kala motia" in vernacular. A careful examination by a doctor will easily establish the cause of loss of vision. Remember, glaucoma does not cause cataract. However a delayed treatment of cataract can result in glaucoma as well. Do not go to a non-doctor. And no self-medication, please.

The writer, an eye-specialist, was earlier associated with the PGI, Chandigarh. Phones 0172-772776, 770499.

AYURVEDA & YOU
Acidity: prevention and treatment
Dr R. Vatsyayan

Last fortnight we had discussed the causes, types and the signs and symptoms of acidity. In fact, before going into the detailed treatment of any disease, one must ponder over its known causative factors. Ayurveda emphasises that the shortest form of the treatment lies in removing the cause that produces any particular disease. Given below is a multi-pronged action plan which, while treating acidity with classic ayurvedic treatment and certain home remedies, highlights measure for its management and prevention.

General measures: In the majority of the cases acidity occurs as a sequel to wrong dietary habits. Those patients who suffer from its recurrent episodes or in whose case it has come to stay in its chronic form should keep the following tips in mind:

One should carefully examine his/her food pattern in totality. Suitability of any food article varies from person to person and it is very necessary that one should choose only that diet which is conducive to him.

Heavy, spicy and fried food items play havoc with the persons prone to acidity. Food should be light and easily digestible. It is generally seen that vegetables with gravy and juice of citrus fruit also aggravate acidity. Avoid frequent eating in restaurants and social functions. Non citrus fruit can be a good substitute for fried snacks in the evening.

One should reduce the intake of tea, coffee, alcohol and smoking. Adhering to a proper time schedule for meals and making a gap of at least two hours between dinner and sleep help in proper digestion of food. Always remember that overeating is a sure shot invitation to acidity.

Try to overcome anxiety, depression and other psychological problems. Exercises like walking, adopting easy postures of yoga and doing regular meditation will not only reduce episodes and intensity of such problems but will also keep the total digestive process in a healthy state. However, patients suffering from gastro-esophageal reflux disease (GERD) are advised not to do any strenuous exercise.

Home remedies: Mild to moderate cases of acidity or amla pitta respond well to certain home remedies. Such patients should start their day by slowly taking at least two glasses of water which should be neither too cold nor too hot. Amla (Indian gooseberry) is the best antacid herb and by mixing it with half a teaspoonful of sugar, one to two gm of its dry powder can be taken with warm milk or simply with a teaspoonful of honey. Eating a few dry flakes of amla cooked with prescribed vegetables or daals also reduces post-meal acidity.

Fresh coconut water (100 to 200 ml) and juice of fresh green petha (up to 50 ml) are soothing agents for inflamed mucosa of the stomach and have very good nutritional value also. Cold milk also reduces acidity but should be used only in the case of the disease having upward force. Two gm powder of the shatavar root can also be taken with water two or three times a day. One to two gm of sajjikshar (soda bi carb) or powder of mulethi (liquorice) douse the burning feeling of the epigastrium but should not be used as a long-term measure. Taking a pinch of roasted zeera powder after meals reduces belching and dispels abdominal wind downwards.

Classic ayurvedic treatment: Of the vast array of medicines to treat hyperacidty, Avipattikar Churna is the best and simplest among all. Taking two or three gm of it before meals with water relieves both the upward and downward tendency of amla pitta. A mild laxative, this churna gently clears the bowels also.

Sootshekhar Rasa plain or gold compounded and Kamdudha Rasa plain or with pearls are also very prestigious classic medicines and should be given in a dose of 250 to 500 mg or according to the severity of the disease. Similarly, Leela Vilas Rasa, Amla-Pittantak Lauh and Dhatri Lauh are some of other well-known ayurvedic medicines for it. The legendary Chyavanprash with its high amla content acts like an antacid.

The writer is a senior ayurvedic consultant based in Ludhiana. Phones - 2423500, 2431500. E mail- sanjivni@satyam.net.in