Sunday, November 23, 2014

Ophthalmology has a long way to go

What's most important for a salesperson? Making a sale.
For a business person? Profit.
An ophthalmologist? Salary or the patient's vision or both.
A patient? To see clearly.

I've worn spectacles for more than a decade, and never had any problems other than the usual increase in eye power which necessitated a change in spectacles every two or three years. During the past three years however, I've suffered and almost recovered from chronic eye strain and during this time, been to more than twelve ophthalmologists and got a much closer look at the business of corrective vision.

Disclaimer: I'm not a doctor, and these are my own opinions. Don't consider this as medical advice.

Some insights

Random advice: People will always have their recommendation of which hospital and ophthalmologist is best. Remember that most people just repeat what they've heard from others. Ask them specifically what is it about the ophthalmologist or hospital that is so good that they recommend it. Consider it only if you get good reasons.

The specialist myth: A doctor once told me that 95% of ailments can be cured in a general hospital. You don't need to see a specialist. A dermatology specialist once charged me Rs.400 for a consultation and prescribed Rs.300 worth of medicines for a tiny infection which when it happened the next time, a general physician at another hospital charged Rs.25 as his fee and prescribed a Rs.75 worth medicine which cured the problem. Same with the eyes. Remember that an eye speciality hospital has no other way of making money other than by treating eye problems. When I went to one, I was charged Rs.300 for registration, the ophthalmologist barely even checked my eye, prescribed an incorrect lens power and his speciality being dry eyes, he asked me to go to a nearby diagnostic centre (which I'm quite sure they have a tie-up with) and get my vitamin B12 levels checked, and to come back for another assessment within a week. When I went to a general hospital instead, I was charged Rs.25 for registration, the ophthalmologist examined my eyes thoroughly and prescribed an eye gel that gave me instant relief (as opposed to prescribing a new lens). I like it when I meet a doctor who really cares about the patient, rather than about the money. People speak of how eye speciality hospitals offer a free check-up the next time you visit, but think of this: At a general hospital, for two visits you spend Rs.25 + 25 = Rs.50. That's already six times cheaper than what you spend at the eye speciality hospital, so what's the point of the free visit?

Rest is necessary: Make sure your eyes feel rested and comfortable before you get your eye power checked. The best way to ensure this is to get an eight hour uninterrupted sleep at night and to get your eyes checked in the morning. Strain can make a difference of 0.25 to 1 dioptre. I've known ophthalmologists who recommend glasses for normal sighted people for whom the computerized eye test detects a -0.25 dioptre power. The power would just be because the person didn't get a full night's sleep, or because of using a computer all day. They don't really need spectacles.

Careful of cliches: The textbooks and the internet will tell you that one of the reasons for eye strain is astigmatism. Every ophthalmologist I went to, prescribed lenses for astigmatism. Even the computerized eye test showed astigmatism, although I couldn't tolerate lenses with astigmatism correction for more than 10 minutes. Only one experienced ophthalmologist listened to the symptoms I narrated and prescribed an eye gel which reduced the strain and recommended proper sleep (which reduced the strain over a course of many months). If you're experiencing dry eyes, it's not only sleep you need, but also at least 5 minutes of rest at least every 45 minutes. If you still feel strain, get more rest. Keeping your eyes closed is best while resting. Although eye exercises are good, I haven't found them to help in strain-related cases. Only rest helps.

Computerized eye tests are inaccurate: Each and every one of the computerized eye tests I've undergone at five hospitals, have given an incorrect reading (even at times I didn't suffer from strain). One hospital made it mandatory to do a computerized eye test because apparently a patient sued them for giving them an eye prescription which turned out to be different at a different hospital. So the computerized eye test was their way of saying "look, the machine detected your eye power, and it can't be wrong. Now you can't sue us". If only the patient had known the relation between strain and eye power they wouldn't have sued the hospital. I still don't understand why people depend on those machines. btw, even the lenses that an ophthalmologist or optician uses to assess your eye power, can be inaccurate. It's best to get your eyes checked at at least three different places before deciding what your eye power is, and purchasing spectacles. Do it during a single morning and see the difference in prescriptions you get from various hospitals. If you don't want to spend too much money, go to a medical college which does these checkup's for free.

If uncomfortable, don't wear the spectacles: Take this very very seriously. If wearing spectacles gives you a headache, strain or burning in the eye, remove it immediately and get a new one. Don't ask the optician/ophthalmologist for an opinion. They'll try their best to hide the fact that they made a mistake or that they prescribed the wrong lens/power for you. Once when one lens of my spectacles got twisted vertically (like in a pantoscopic tilt), I told the optician to fix it and they couldn't do it completely, as it could break the glass. He said "Try it for a week sir and see". It only got worse from then on. Lesson: don't wear spectacles that make you uncomfortable. Get a new pair. There are medical colleges where you can get spectacles made for less than one third of what will be charged at a store.

Glass lenses are definitely different from plastic lenses: Everyone will tell you that vision with a glass lens and plastic lens is the same. It isn't. A glass lens has much better visual acuity and will give your eyes lesser or no strain as compared to a plastic lens. I'm unsure why this happens, but have personally experienced it.

You don't have a pore in your retina: A new trend emerging in hospitals is to frighten a patient by saying that they might have pores in their retina if they use the computer too much, when the patient might have simply come for a simple eye checkup. This is almost always utter nonsense. Instead of getting it checked at that hospital, go to another hospital and get it checked if you really feel you might have symptoms of pores in your retina.

Proper sleep is necessary
Modern life has strangely encouraged children to wake up very early during exam days to study, or for working professionals to get stressed out and subject themselves to a lack of exercise and sleep deprivation. You'll see many of these people having red eyes, feeling sleepy many times during the day and losing their general lack of concentration. Many of these people could have unknowingly entered into the cycle of  polyphasic sleep, where even if they try, they won't get an eight hour sleep at night. Some just get four hours of sleep and wake up feeling refreshed. Then they feel sleepy again multiple times during the day. This is a dangerous situation for the eyes. It builds up strain slowly, and can become chronic.

Polyphasic sleep. Images from Wikipedia
Apart from the usual advice on getting proper sleep that you'll find on the internet (which didn't help me at all), there's this one I offer (which might help only some of you): Cold weather can be a problem. Keep yourself warm enough to get a full night's sleep.

The field of ophthalmology has a very long way to go before being able to cure people of vision related problems. Right now the best they can do is offer you pair of crutches for your eyes (the spectacles or contact lenses).


Heard the truth about Lasik?
The person who approved Lasik surgery in the U.S.A, is now campaigning against it. He asks: "How many eyes are you willing to ruin to make a living?".
When approved, they agreed to a 1% problem rate in Lasik surgeries. They hid the fact that in reality it was 20%. 



Lasik, contact lenses or just spectacles; it's like any other industry that survives on money. Use your discretion when you receive recommendations from opticians and ophthalmologists. Search for doctors who really care about the patient. Your eyes are important.

1 comment:

Chandani Bhosale said...
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