23 November 2014

Ophthalmology has a long way to go

Disclaimer: I'm not a doctor, and these are my own opinions. Don't consider this as medical advice.
During the past three years, I've suffered 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.

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.
  • Which is clearer? This or this?: Refractionists and ophthalmologists ask the wrong questions. If your eye power is -4.5, they'll place a -4.5 lens in front of your eye and if you can read the letters, they'll try -4.75 and ask you which is better. Obviously -4.75 will be better, and that's what you'll say. Then they'll prescribe -4.75. What's wrong with this process is, that your eye power is actually -4.5. The right question to ask is "Which was the minimum power with which you could read the letters?".
  • The specialist myth: It's not always necessary 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 center (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. 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 eight hour uninterrupted sleep at night and to get your eyes checked in the morning. Strain can make a difference of 0.25 if mild, and 1 if severe.
  • 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 computerised eye test and pupil dilation 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 a bit and recommended proper sleep (which reduced the strain over a course of many months). 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 (Think: what are you supposed to do when your muscles are tired? Take rest or exercise them more?). Only rest helps.
  • Computerised eye tests are inaccurate: Each and every one of the computerised eye tests I've undergone at five hospitals, have given an incorrect and different reading (even at times I didn't suffer from strain). I still don't understand why people depend on those machines. It's best to get your eyes checked at at least three to five different places before deciding what your eye power is, and purchasing spectacles. Do it during a single day 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 where these checkups are done for free or at a low cost. My most accurate diagnosis of eye power was obtained at a medical college, and it was done by a refractioninst, without a computerised eye test.
  • 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, stop using it immediately. Once when one part of the lens frame of my spectacles got twisted a bit, putting the lenses at different angles (like in a pantoscopic tilt), I told the optician to fix it and he couldn't do it completely, as it could break the frame or lens. He said "Try it for a week and see". It only got worse from then on. Lesson: don't wear spectacles that make you uncomfortable. Find out the problem and get a new pair. There are medical colleges where you can get spectacles made for less than half of what will be charged at a store.
  • You may not have a pore in your retina: I was in the waiting hall of a hospital one day, when a nurse frightened me saying that I might have pores in my retina if I use the computer too much. This, even before my eyes were examined. Turned out to be nonsense.
  • Proper sleep is necessary: Modern life has encouraged children to wake up very early for school and 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 other is to eat food that is properly cooked and has no burnt particles. Curd/yoghurt (especially probiotic curd) also seems to help, probably due to Tryptophan. Eating almonds also helps with deep sleep, but poor food can ruin 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).

Use your discretion when you receive recommendations. Search for doctors who care about patients health. Your eyes are important.

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