A step forward in cataract surgery
Dr Mahipal Sachdev

Cataract surgery is one of the most commonly performed surgeries in the world.
The last few years have seen dramatic improvements in the quality of vision
that is obtained after cataract surgery thanks to innovations in technology and
surgical expertise.

The earliest technique of cataract surgery was ICCE or intra-capsular cataract extraction where the entire lens was removed along with the capsule. No intraocular lens was implanted and the patient needed to wear thick coke-bottle glasses which gave significant optical defects.

Then came ECCE or extra-capsular extraction which required a 12-mm-long incision and needed sutures to close the wound. A rigid PMMA lens was implanted and though thick glasses were not required, the vision took anything between 8-12 weeks to stabilise.

Phaco-emulsification has become popular in the last decade in which the lens is removed by breaking it down into smaller pieces and sucking it out with a vacuum-based aspiration system.

A foldable lens made of acrylic or silicone is implanted inside the eye through a very small incision ranging from 1.8 to 3.0 mm. Since this is a self-sealing incision, no sutures are required allowing faster healing and a rapid visual recovery.

Ongoing improvements in phaco technology have helped cataract surgeons to not only improve efficiency but also expand the margin of safety. This is especially important for patients with hard cataracts and weak zonules, both of which are extremely common conditions.

Hard cataracts need high ultrasonic power and vacuum for aspiration of the cataract during phaco-emulsification. This may cause corneal edema and prolong the healing time for complete visual recovery.

Weakness of zonules and deficiency of the posterior capsule which holds the lens in place are other important factors which may complicate cataract surgery.

To overcome these issues and provide a safe and smooth vision recovery, now ophthalmologists use the Ellips technology for cataract patients. This works in a dual manner to enhance the surgical result.

The duration of the ultrasonic pulse is shortened which decreases the production of heat and eliminates the risk of wound burn. Being more efficient, it also reduces turbulence inside the eye and prevents corneal damage.

Secondly, the ellipsoidal movement of the phaco-tip combines longitudinal and transverse movement to cut through even hard cataracts and improves followability, i.e. the lens matter is removed from the eye smoothly and completely.

This translates into better safety for the patient and the surgeon and a faster visual rehabilitation even in complicated cases.

An optimum combination of advanced technology and surgical expertise together provide good results. Choose the best for your eyes. Every eye deserves the best.

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

Watch your upper back
Dr Ravinder Chadha

Upper back posture (if correct) goes a long way in preventing pain, discomfort and permanent deformity. Children suffer from forward chin/neck posture when they sit for long periods in the school.

This difficult position is aggravated further due to a low table (forcing them to bend forwards while studying).

Generally, parents/teachers overlook such flaws, thinking that it will be rectified as the children grow older.

Parents should be cautious when they watch their child sit/ walk with the upper back bending forward or a hump or contour is noticed at the upper back.

The thoracic spine starts just below the neck to midway down the back. This comprises 12 thoracic vertebrae separated by discs and attached to each other by ligaments. The normal curvature of thoracic spine is between 20 and 50 degrees.

Causes of upper back pain

Postural round back is very common in adolescents due to an incorrect posture during sitting for a long period in front of the computer.

The computer screen if 15 to 20 degrees below the level of the eyes which exerts excessive stress on the upper back.

Sitting for hours in an uncomfortable car/train/airplane seat.

Sleeping on an uncomfortable mattress.

Individuals spending long hours in the car or at the office table.

In the middle age/old individuals suffering from osteoporosis and degenerative
disc disease, an upper back hump develops when the bones of the upper spine
become thin and collapse on each other due to osteoporosis. This also results in
the loss of height.

Mechanical backache occurs due to the following:

Sprained or torn ligament/ muscle.

Injury of the face joints which hold the backbone together.

Spinal nerve root impingement due to a slipped disc causing referral pain to the chest and abdomen associated with numbness/tingling. Investigations like X-rays and MRI often show age-related changes and spinal nerve roots being irritated, pinched or trapped.

Other causes

Rheumatoid arthritis, ankylosis spondylitis, etc.

Afflictions of stomach, liver, gall bladder and pancreas refer pain to the interscapular area. This is due to a shared sympathetic nerve supply between the spinal structures and the concerned viscera.

Treatment

Thoracic pain usually gets better within two weeks with conservative management.

Keeping active is the most important aspect of treatment. Spine is designed for movement and resting for more than a couple of days could cause muscle weakness/stiffness.

Manipulation and mobilisation of spine brings immediate relief by resetting the dysfunctional areas of the spine.

The long-term benefit can be achieved by maintaining a good posture while sitting, walking, etc.

Exercises regime when followed religiously to improve flexibility and strength of the upper back.

Posture

Good posture is mainstay of treatment as it avoids sustained shortening of muscles.

While sitting on a chair hips should touch the back of chair.

The keyboard should be close to the body with elbows bending at 90 degrees at the side of the body.

The screen or reading/writing material should not be below 10 to 15 degrees from the eye level.

Exercises

Scapular squeezing: While sitting or standing expand the chest by approximating the scapula towards each other. Do it 10 times.

Rowing exercise: Hold the theraband in both hands and with bend elbows, pull it backward above the shoulders.

Thoracic rotation: Sit on a chair and cross the arms across the chest. Slowly turn the trunk to the right 10 times and then repeat to the left.

Upper body raise: While lying the face downward, raise both arms towards the ceiling. Repeat it 10 times.

In order to prevent upper back pain, always maintain a good posture and regularly perform stretching and strengthening exercises of the upper back.

There’s mental strength in numbers
Steve Connor

Being part of a social group can be better for a person’s health and well-being, and can even provide better protection against memory loss and the effects of ageing than many drugs and medicines, according to scientists.

Studies have shown that when people feel part of a close-knit group they are less likely to suffer heart attacks, are more able to cope with stress and are better at retaining their memory than people who become socially isolated.

Conventional medical treatments have focused on the individual but it could be better to concentrate on making patients feel part of a wider social group, said Professor Alex Haslam of the University of Exeter.

“We are social animals who live and have evolved to live in social groups. Membership of groups, from football teams to book clubs and voluntary societies, gives us a sense of social identity,” Professor Haslam said.

“This is an indispensable part of who we are and what we need to be to lead rich and fulfilling lives. For this reason, groups are central to mental functioning, health and wellbeing,” he said.

A study of 650 stroke patients followed over a period of five years found that those who were part of a close-knit social group were significantly less likely to suffer a second life-threatening problem over a given period of time.

“Standard medical factors such as hypertension, lack of exercise and family history of coronary artery disease increased the risk of a second life-threatening incident by between 10 and 30 per cent,” Professor Haslam said.

“Social isolation increased the incidence of a secondary, life-threatening event such as a heart attack. It doubled the risk after one year,” he said.

Another study, involving 70 residents of care homes for the elderly, found that if people were put into groups of five individuals and asked to discuss their memories or play a game of skittles, they did better than those who did the same things on a one-to-one basis. — The Independent