EYESIGHT
How diabetes threatens our eyes
Dr Mahipal Sachdev

World Diabetes Day on November 14 is aimed at spreading awareness about the alarming rise of diabetes throughout the world. Introduced by the International Diabetes Federation (IDF) and the World Health Organization (WHO), it features a new theme every year to address issues facing the global diabetes community. The theme of World Diabetes Day this year is “Diabetes in Children and Adole-scents”.

Diabetes is growing at the rate of 5 per cent per year among pre-school children and 3 per cent per year in children and adolescents which translates into 70,000 children under the age of 15 developing Type I diabetes per year or 200 children per day. Diabetes is the leading cause of blindness in the developed world with a rising trend in Asian population.

The most significant problem with diabetes is diabetic retinopathy which damages the blood vessels of the retina, the light sensitive structure of the eye, leading to leakage of fluid and swelling, formation of fragile blood vessels which can bleed inside the eye resulting in vitreous haemorrhage and formation of scar tissue which can pull away the retina causing retinal detachment and eventual blindness.

The longer the duration of diabetes, greater the risk of diabetic complications. It has been observed that 80 per cent of the people who suffer from diabetes for more than 15 years will have some damage to the retina. Poor metabolic control, associated renal failure and hypertension also aggravate the risk of diabetic retinopathy.

To reduce the incidence and intensity of various diabetic eye problems, it is important to keep the blood sugar levels under control, avoid smoking, exercise regularly and adopt a healthy lifestyle.

Diabetic retinopathy can be divided into two main stages: NPDR and PDR. In non-proliferative diabetic retinopathy (NPDR) there may be no or minimal symptoms such as mild distortion of letters while reading or disturbed vision on close concentration. NPDR may in turn be mild, moderate or severe wherein some retinal blood vessels get blocked depriving the retina of its blood supply.

If unchecked or undetected, this progresses to proliferative diabetic retinopathy (PDR) in which lack of blood supply to the retina causes hypoxic stimulation of fragile blood vessels which are at risk of bleeding. This may result in vitreous haemorrhage and consequently sudden loss of vision. The most common cause of blindness in diabetics is diabetic maculopathy in which vision loss is 5 times more common than in PDR.

Since in the early stages of diabetes, there are no symptoms of any eye problems, regular eye check-ups by an eye specialist are important to detect early changes. All diabetic patients must have a complete eye evaluation at the time of diagnosis and at least annually thereafter. It has been noted that diabetic retinopathy is present in 20 per cent patients of NIDDM at the time of first diagnosis itself. Subsequent check-ups depend on the severity of changes within the eye.

Patients with early changes need a six monthly evaluation while patients with moderate changes need an eye check-up once every three months. During an eye check-up the ophthalmologist would examine the anterior segment of the eye and the eye pressure followed by dilation to examine the retina for changes of diabetic retinopathy. Presence of microaneurysms, dot blot haemorrhages and hard or soft exudates is seen in NPDR while macular thickening and exudates are seen in diabetic maculopathy.

Neo-vascularisation at the disc or elsewhere, pre-retinal or vitreous haemorrhage or retinal detachment may occur in PDR. If required, a fluroscein angiography may be advised to detect any areas of leakage or non-perfusion of the retina and guide subsequent treatment.

Various treatment options include laser or photo-coagulation, injection of drugs and vitreo-retinal surgery as the case may be. Photocoagulation will reduce the risk of severe vision loss in PDR by 50-60 per cent. This strategy of early detection and prompt management will help to decrease the incidence of blindness due to diabetes mellitus.

Remember that diabetes can affect the entire eye, including the nerves, refractive power, lens and retina and need special monitoring and care by an expert eye specialist. A good control of blood sugar, blood pressure, cholesterol, renal and cardiac problems will delay the progression of diabetic retinopathy and will help you maintain maximum vision and have healthy eyes for a much longer period. On the occasion of World Diabetes Day let us pledge to take greater care of our diabetic friends and relatives and provide them with the best possible medical services.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com.

Managing Parkinson’s disease
Dr R. Vatsyayan

Called “Kampavata” in ayurvedic parlance, Parkinson’s disease (PD) is one of the most common progressive neurological disorders affecting 2 per cent of individuals older than 60 years of age. Occurring due to the loss of dopamine-producing brain cells, it is reported that in a patient suffering from PD, 60-80 per cent of the damage is already done before the motor signs of this disease emerge.

Four primary symptoms of PD are tremors or trembling in hands, arms, legs, jaw and face; rigidity or stiffness of the limbs and trunk, slowness of the movement and postural instability or impaired balance and coordination.

Though ayurveda describes vitiated vata as the root cause of most of the geriatric problems, including Parkinson’s disease, modern scientists believe that many symptoms of PD result from the lack of dopamine which has been described as the chemical messenger in the brain.

Early signs of the disease are sometime so subtle that these can go unnoticed for months and years. Men are more likely to develop Parkinson’s disease than women and it is seen that persons having one or more blood relatives having PD carry an increased risk of developing it.

Though no definite tests exist to confirm the diagnose of Parkinson’s disease, its early symptoms can be confused with many other neurological problems. Presence of symptoms like tremors, slowing of motion and muscle rigidity and findings like the onset of symptoms on only one side of the body and more pronounced tremors at rest lead the diagnosis towards PD.

Usually, the patient suffering from Parkinson’s disease additionally complain of problems like depression, insomnia, urinary incontinence, difficulty in chewing and swallowing, constipation and sexual dysfunction.

Ayurvedic masters have described several plant-based drugs which have been found effective in treating PD. The beans of famous herb Mucuna pruiens called Kapikachhu with its rich L-dopa contents has been validated in the prevention and treatment of PD after the determination of safety and efficacy profile in animal studies. Similarly, some other herbs like Celestrus paniculatus (Jyotishmati), Withania somnifera (Ashwagandha) and Tinosporia cordifolia (Gaduchi) have been found to show promising results.

Certain panchkarma procedures are helpful in containing muscle rigidity; these promote relaxation.

Like any other chronic disease, people suffering from Parkinson’s at times feel angry, depressed or discouraged. In advance cases, the loss of fine motor control makes it hard to button and zip cloths and falls become frequent. When walking, talking or even eating become difficult for the patient; he needs emotional support from friends and family members.

Eating a balanced diet that contains a reasonable amount of wholegrain cereals, green vegetables and fruits not only gives good nutritional support to the body, but also helps to keep constipation, the most irritating feature of PD, at bay.

Exercise is an important component of rehabilitating a patient suffering from Parkinson’s disease. Efforts to practice even simple movements like walking, making circular movements of arm and raising the legs up and down while sitting help to control muscle rigidity. Deep breathing and pranayam-type exercises are good in promoting relaxation and reducing anxiety. Gait training with the help of a physiotherapist additionally boosts the confidence of the patient.

The writer is a Ludhiana-based senior ayurveda physician. E mail - yourhealth@rediffmail.com.

Flu vaccine cuts risk of blood clots on long flights
John von Radowitz

Air passengers worried about the risk of “economy class syndrome” could protect themselves by having a flu jab, new research suggests.

Vaccinations against influenza significantly reduce the chances of developing dangerous blood clots in the veins, a study has found.

Researchers found that the jabs reduced the likelihood of developing a venous thrombotic embolism (VTE) by more than a quarter - 26 per cent. For women on the Pill, the risk was cut by as much as 59 per cent.

One type of VTE is deep vein thrombosis, or DVT - commonly known as “economy class syndrome”. It usually occurs in the legs and is often associated with long flights.

Sometimes a leg clot can break away and travel in the bloodstream to the lungs, producing a life-threatening pulmonary embolism.

French scientists conducting the Farive study compared a group of 727 VTE patients with an equal number of men and women who had no history of thrombosis. The average age of those taking part was 52.

Patients were questioned about VTE risk factors, including pregnancy, use of the contraceptive Pill or hormone replacement therapy, recent injury or surgery, prolonged periods of immobilisation, or travel lasting more than five hours.

The researchers also noted whether participants had received a flu jab in the previous year. Overall, the risk of suffering a VTE was found to be 26 per cent less for patients who had been given an influenza shot.

For people younger than 52, the level of protection was 48 per cent. Women under the age of 51 had their odds of developing a VTE reduced by 50 per cent after a flu jab, while those on the Pill were 59 per cent less at risk.

The protective effect of vaccination was the same for both DVT and pulmonary embolism.

Dr Joseph Emmerich, the study’s leader from the University Paris Descartes, said: “Our study suggests for the first time that vaccination against influenza may reduce the risk of venous thrombotic embolism.” — The Independent