Cataract management has evolved to refractive surgery
Cataract is caused due to the opacification of the natural lens in the eye, leading to cloudy vision. It is a common occurrence in the elderly -- and a commonly performed surgery across the world. The management of cataract has evolved recently from a stage of visual restoration to a stage of refractive surgery. Several new technologies have come up over the recent past to achieve this outcome.
 
Femtosecond laser cataract surgery is now the most popular method used and has recently gained more importance. It is an ultrashort pulse infrared laser used in making clear corneal incisions to create an opening in the cataractous lens to break down and remove the cataract. This enhances the precise quality of the incision and makes the opening in the lens perfectly circular with a required size making it more predictable. The use of femtosecond laser further simplifies cataract surgery and increases the ease and precision of the surgery.
 
Another technique used is the Zepto precision pulse capsulotomy which makes a precise circular opening in the cataract and is especially beneficial in cases of white intumescent or hard brown cataracts.
 
Recent advances in the intraocular lenses (IOLs) -- the artificial lenses which are inserted in the eye after removing the cataract -- have revolutionised cataract surgery. The various advanced lenses available in the market are aspheric lenses, presbyopia correcting IOLs like multifocal IOLs, accommodative IOLs and extended depth of focus IOLs. These help in eliminating the use of glasses both for distance and near vision. Based on various mechanisms, they are divided into different categories. Multifocal IOLs are the ones which are bifocals or trifocals, where the image is focused in more than one point, helping in both distance and near vision. However, due to the split of light, there may be some amount of loss of contrast sensitivity as well as night vision difficulties. 
 
Accomodative IOLs function by forward and backward displacement of lenses, but several factors post cataract surgery may influence the outcome of these type of IOLs.
 
At present, the extended depth of focus IOLs are being widely used. They have an increased range of focus which help in intermediate and near vision. To implant these lenses, the patient needs to be counselled thoroughly about the expected outcomes.
 
The intraocular materials used also play a major role in the surgical outcome. Viscoelastic devices are used to protect various structures inside the eye from damage during the surgery. They coat the inner layers of the eye and prevent any sort of damage to the eye. They help in smoothening the surgical course and prevent unnecessary complications.
 
The solutions used in the eye also evolved such that they resemble the normal fluids present in the eye and do not cause any sort of reaction. All these enhance early rehabilitation and better outcomes in cataract surgery.
 
Proper, systematic testing of the patient and selecting the given technology based on the patient's requirement is equally important. Proper education of the patient is necessary and is a mandate for their satisfaction with the outcomes of the cataract surgery.
 
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.
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A Surgeon So Bad It Was Criminal
The pain from the pinched nerve in the back of Jeff Glidewell’s neck had become unbearable.
 
Every time he’d turn his head a certain way, or drive over bumps in the road, he felt as if jolts of electricity were running through his body. Glidewell, now 54, had been living on disability because of an accident a decade earlier. As the pain grew worse, it became clear his only choice was neurosurgery. He searched Google to find a doctor near his home in suburban Dallas who would accept his Medicare Advantage insurance.
 
That’s how he came across Dr. Christopher Duntsch in the spring of 2013.
 
Duntsch seemed impressive, at least on the surface. His CV boasted that he’d earned an M.D. and a Ph.D. from a top spinal surgery program. Glidewell found four- and five-star reviews of Duntsch on Healthgrades and more praise seemingly from patients on Duntsch’s Facebook page. On a link for something called “Best Docs Network,” Glidewell found a slickly produced video showing Duntsch in his white coat, talking to a happy patient and wearing a surgical mask in an operating room.
 
There was no way Glidewell could have known from Duntsch’s carefully curated internet presence or from any other information then publicly available that to be Duntsch’s patient was to be in mortal danger.
 
In the roughly two years that Duntsch — a blue-eyed, smooth-talking former college football player — had practiced medicine in Dallas, he had operated on 37 patients. Almost all, 33 to be exact, had been injured during or after these procedures, suffering almost unheard-of complications. Some had permanent nerve damage. Several woke up from surgery unable to move from the neck down or feel one side of their bodies. Two died in the hospital, including a 55-year-old schoolteacher undergoing what was supposed to be a straightforward day surgery.
 
Multiple layers of safeguards are supposed to protect patients from doctors who are incompetent or dangerous, or to provide them with redress if they are harmed. Duntsch illustrates how easily these defenses can fail, even in egregious cases.
 
Neurosurgeons are worth millions in revenue for hospitals, so Duntsch was able to get operating privileges at a string of Dallas-area institutions. Once his ineptitude became clear, most chose to spare themselves the hassle and legal exposure of firing him outright and instead let him resign, reputation intact.
 
At least two facilities that quietly dumped Duntsch failed to report him to a database run by the U.S. Department of Health and Human Services that’s supposed to act as a clearinghouse for information on problem practitioners, warning potential employers about their histories.
 
“It seems to be the custom and practice,” said Kay Van Wey, a Dallas plaintiff’s attorney who came to represent 14 of Duntsch’s patients. “Kick the can down the road and protect yourself first, and protect the doctor second and make it be somebody else’s problem.”
 
It took more than six months and multiple catastrophic surgeries before anyone reported Duntsch to the state medical board, which can suspend or revoke a doctor’s license. Then it took almost another year for the board to investigate, with Duntsch operating all the while. Continue Reading....
 
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Study: Limit Your Child’s Screen Time To Develop Better Cognition
Recommendations made by the “Canadian 24-Hour Movement Guidelines for Children and Youth” for kids between the ages of 8 and 11 years, say that their day should include at least 60 minutes of physical activity, two hours or less of recreational screen time, and 9 to 11 hours of sleep. Yet, in a new study published in The Lancet Child & Adolescent Health, only one in 20 US children met all three of these recommendations. Childhood and adolescence are crucial periods for brain development and behaviour, during a typical 24-hour period, contributes to cognitive performance. Limiting children’s recreational screen time to less than two hours a day, ensuring sufficient sleep and physical activity has now been linked to better development of children’s cognitive abilities. 
 
The study used data from the Adolescent Brain Cognitive Development (ABCD) study of more than 4,500 children between the ages of 8 and 11 years from 21 study sites across the US. Researchers compared daily exercise, technology use and sleeping habits, to the established Canadian Guidelines. The participants’ ‘global cognition’ was then assessed using the standards developed by the National Institute of Health. The results indicate that US children engaged in an average of 3.6 hours a day recreational screen time. 
 
Authors of the new study say that adhering to the guidelines during childhood and adolescence, particularly for screen time, is vital for cognitive development. “Behaviours and day-to-day activities contribute to brain and cognitive development in children, and physical activity, sedentary behaviour, and sleep might independently and collectively affect cognition,” says Dr Jeremy Walsh of CHEO Research Institute (Ottawa, Canada). “Evidence suggests that good sleep and physical activity are associated with improved academic performance, while physical activity is also linked to better reaction time, attention, memory and inhibition. The link between sedentary behaviours, like recreational screen time, is unclear as this research is in the early stages and it appears to vary depending on the types of screen-based activity.”
 
Children and their parents completed questionnaires and measures at the outset of the trial to estimate the child’s physical activity, sleep and screen time. Children were also asked to complete a cognition test which assessed language abilities, episodic memory, executive function, attention, working memory and processing speed. Researchers used household income, parental and child education, ethnicity, pubertal development, body mass index and whether the child had had a traumatic brain injury, as controls in the study. 
 
The research found that only 5% of children met all three recommendations while 29% met none of those guidelines. Additionally, 63% spent more than two hours a day glued to screens, going over the recommended screen time limit; 82% failed to meet the guidelines for daily physical activity; and 49% did not get the recommended hours of sleep. 
 
The researchers were able to prove that the more recommendations the child met, the better was their cognition. Furthermore, meeting only the screen time guideline or both, the screen time and sleep guidelines, had the strongest associations with cognitive development. The study conclusively showed that of the three guidelines, the screen time recommendation seemed to correlate most strongly with superior cognition: as long as children meet the screen time recommendation, they outscored others in global cognition tests. 
 
Although there is substantial evidence for the association between physical activity and cognitive development, in this particular study, there is no association with cognition. The authors have admitted this as surprising and have suggested that the measure used may not have been specific enough. They were clear that physical activity remains the most important behaviour for physical health outcomes and there is no clear indication that it negatively affects cognition. 
 
Dr Walsh said, “We found that more than two hours of recreational screen time in children was associated with poorer cognitive development. More research into the links between screen time and cognition is now needed, including studying the effect of different types of screen time, whether content is educational or entertainment, and whether it requires focus or involves multitasking. Based on our findings, paediatricians, parents, educators and policymakers should promote limiting recreational screen time and prioritising healthy sleep routines throughout childhood and adolescence.”
 
The authors have also pointed out some limitations in the study, namely, that it shows an association between reduced screen time and children’s cognitive skills, but does not effectively establish a causal link. As the study is strictly observational, it is not able to establish the underlying cause or the direction of the association. Furthermore, the data is also self-reported and could be subject to bias. The questionnaires were only used at the outset of the study and, hence, are not able to track behavioural change over time. The researchers agreed that future cycles of the study will need to be analysed to understand trends over time.
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