Health Watch

Benefits of LASIK surgery

Ruwanthi Abeyakoon

Spectacles or contact lenses are vision correction devices mechanically adjusted to human eyes. These very devices which are of immense help in life at times hinder our daily activities. Losing your glasses or contact lenses is one such worry. Spectacles may also get in the way when you play any sport or enjoy any outdoor activity or you might just not feel confident on how you look in glasses. The Nawaloka Hospital's LASIK centre offers a solution for this issue with the introduction of latest state of the art technology in LASIK Surgery.

“LASIK is a laser surgery that reshapes the middle layers of the cornea so that light rays entering the eye are correctly focused (refracted) on the retina, the layer of tissue at the back of the eye responsible for vision. LASIK vision correction is a permanent change and reduces the need to wear glasses or contact lenses,” said Dr. C.A.B Makuloluwa, Consultant Eye Surgeon.

LASIK is the abbreviation for “Laser assisted In-situkeratomileusis”. Despite the long name, this surgery is a very short, easy and relatively painless procedure. “LASIK eye surgery can correct nearsightedness (myopia), farsightedness (hyperopia) and astigmatism, which are usually corrected with glasses or contact lenses. Certain people with presbyopia (normal age-related loss of near vision), also may benefit from LASIK eye surgery, although there are limitations,” Dr. Makuloluwa said.

LASIK improves vision without having to rely on glasses or contacts. The procedure offers a faster recovery time for best vision and less discomfort than similar laser surgeries. “To under go this surgery one should be a suitable candidate. One should possess generally healthy eyes and cornea, free from diseases and have had stable refractive errors for at least one year. This surgery is not performed on pregnant or nursing mothers,” Dr. Makuloluwa said.

“Some people are better candidates than others therefore it is important to consult your Eye Surgeon to discuss the realistic benefits which differ from patient to patient,” he added.

Dr. Makuloluwa said that there are three parts to the procedure. “The eyelids will be kept open by a device called a speculum, while the patient is requested to maintain eye fixation on a red light during the procedure. A thin flap of corneal tissue is peeled off with one end of it still attached to the cornea which is called a flap. It is similar to a door being opened,” he said.

“The cornea is then reshaped to individual requirement by laser. The cornea flap is placed back on the cornea (like a door being closed) within five minutes the flap adheres to its original position without the use of stitches. The procedure is performed on an “outpatient” on the day of the surgery. Anesthetic eye drops are administered to numb the eye for painless surgery.

The overall procedure takes only a few minutes to perform,” Dr. Makuloluwa added.

This method has been in operation for over 25 years.

Epilepsy ‘is a global health problem’

Epilepsy is twice as common in low and middle-income countries as it is in the developed world, according to an international team of researchers.

They say the higher incidence is linked to increased risk factors, including head injuries and infections such as pork tapeworm and river blindness.

And more than 60% of sufferers in those countries receive no appropriate treatment, they say in the Lancet.

A Lancet editorial said epilepsy had to be a global health priority.

Epilepsy is a condition in which disturbances to the brain's normal electrical activity cause recurring seizures or brief episodes of altered consciousness.

There are about 40 different types. Epilepsy is not a mental illness, but can develop after injury or damage to the brain.

About 85% of the global burden of epilepsy occurs in low and middle-income countries.

‘Bewitched’

Writing in the Lancet, researchers led by Prof Charles Newton, of the University of Oxford, say the death rate in developing countries is much higher than in developed ones - and that the reason for this is likely to be a failure to treat people with the condition.

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It is time for all governments to take epilepsy more seriously”

Prof Newton said: “The burden of epilepsy in these regions is at least double that found in high-income countries, and sadly, adequate facilities for diagnosis, treatment and ongoing management of epilepsy are virtually non-existent in many of the world's poorest regions.”

He added: “Many people with epilepsy or their families do not even know that they have a disorder that can be controlled with biomedical treatment, so it is vitally important that awareness is raised and medical care improved in these regions.”

Medications are available - but there can be problems distributing them, especially to remote areas.

The researchers say there are low-cost ways of improving the situation and of reducing the stigma often faced by people with epilepsy and their families - such as working with traditional healers and awareness campaigns to increase understanding of the condition.

In some countries, traditional beliefs about the causes of the condition, including bewitchment, spiritual causes and curses, lead to stigma and increase the chance that a person with epilepsy will not get the treatment they need.

A Lancet editorial adds: “Given the prevalence of epilepsy globally, it should be included as a priority on the public health agenda, and access to treatment should be greatly improved in developing countries.

“It is time for all governments to take epilepsy more seriously.”

BBC

IQ linked to levels of happiness

People with lower intelligence are more likely to be unhappy than their brighter colleagues, according to UK researchers.

Their study of 6,870 people showed low intelligence was often linked with lower income and poor mental health, which contributed to unhappiness.

The researchers are calling for more help and support to be targeted at people with lower IQs.

Their findings were published in the journal Psychological Medicine.

The researchers, at University College London, analysed data from the Adult Psychiatric Morbity Survey in England. One of the questions was: “Taking all things together, how would you say you were these days - very happy, fairly happy or not too happy?” People's verbal IQ was also assessed.

The highest proportion saying they were “very happy” was found in people with an IQ between 120 and 129 - 43% said they were very happy.

However, the highest proportion saying “not too happy” - 12% - was found in people with an IQ between 70 and 79.

Dr Angela Hassiotis said: “People in the lower end of the normal spectrum are more likely to consider themselves not happy.”

The study said lower intelligence was linked to lower income, worse health and needing help with daily life, such as shopping or housework - all of which contributed to unhappiness.

Dr Hassiotis said: “There is some evidence that long term intensive strategies directed at young children from socially deprived backgrounds can have a positive impact not only on IQ, but also on wellbeing and life opportunities.

“Such interventions are likely to be costly, but the initial costs may be offset by future benefits such as a reduced reliance on state benefits and better mental and physical health.” Dr Jonathan Campion, a consultant psychiatrist and director of public mental health at the South London and Maudsley NHS Foundation Trust, said: “The study suggests that higher IQ appears to be associated with improved wellbeing, but that this relationship between IQ and wellbeing is partly due to higher IQ being linked with better income, health and less mental illness.” He added that the study was particularly helpful as it identified some of the factors that mediate the association between IQ and happiness, as well as highlighting interventions to prevent lower IQ leading to greater unhappiness.

BBC

Hi-tech radiotherapy ‘not only answer’

Richard Evans CEO of the Society and College of Radiographers

Radiotherapy has wrongly been “in the shadows” of cancer drugs and chemotherapy, say those who use it to treat patients.

In this week's Scrubbing Up, Richard Evans, CEO of the Society and College of Radiographers, says this is beginning to change - but that there has been too much focus on one hi-tech version, which won't be right for all.

Amongst the radiotherapy community, there has long been the view that the pharmaceutical companies are enviably effective in publicising and marketing their cancer drugs, even those with marginal benefit.

There is also concern that this has had a restraining effect on the ability of radiotherapy to achieve the prominence it deserves, both within the public perception and in terms of political focus.

However, all of this seems to have changed with the emergence of new technology known as Sterotactic Ablative Radiotherapy (SABR) and of one specific device to deliver it: the Cyberknife.

‘Righteous indignation’

The goal of all radiotherapy is to deliver a lethal dose of radiation to the cancer cells, whilst minimising damage to normal, healthy body tissues.

What SABR can do is to achieve this in some parts of the body that previously would have presented too much risk to those healthy organs. Hard to treat cancers can, in some cases, now be effectively treated.

There are several excellent machines capable of giving SABR treatments.

The particular success of the Cyberknife is that it's promoters have overcome the constraints of poor perception of radiotherapy and have succeeded in making the product known to politicians, the media and public alike.

This has been so successfully done that the Cyberknife phenomenon is beginning to take on characteristics similar to a pharmaceutical campaign.

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No one believes that you need to have a heart surgeon to operate on your bunions”

There have been on-line petitions demanding access to Cyberknife for all cancer patients; politicians apparently believing that they have a duty to see Cyberknife installed in their local cancer centre; the media carrying pages of righteous indignation over the lack of “life-saving Cyberknife treatment” and consequently people fighting cancer and their families caught up in the frenzy.

Just as radiotherapy receives something approaching appropriate publicity, there are real worries that it is the “wrong type” of publicity.

The fact is that, despite its brilliance, Cyberknife is simply not the best machine to treat the vast majority of people that need radiotherapy.

No one believes that you need to have a heart surgeon to operate on your bunions.

In the same way, SABR (including Cyberknife) is best employed in specialist centres where there is appropriate expertise and support.

‘Genuine danger’

Of course, every patient that may benefit from SABR should be able to receive it. However, this does not mean that there has to be a grossly under-used expensive Cyberknife in every radiotherapy centre. With many radiotherapy machines reaching the end of their useful lives, it has to be folly to believe that replacement should be with anything other than the best equipment to treat the largest numbers of people. It has been estimated that, in the UK, up to two people in every six who need radiotherapy still do not receive it.

There is a genuine danger that the focus on Cyberknife is causing a distraction that may slow the progress that is being made to close the gap.

Nevertheless, it is not too late to see the enthusiasm in Cyberknife as an opportunity rather than a threat.

After all, it should not be too far-fetched to believe that everyone really wants the same things.

Clinicians, patients, policy makers, carers, equipment manufacturers, pressure groups, charities, councillors. All want to see people with cancer receive the best possible care.

We must be able to agree what is best practice, separate from commercial interest.

This means ensuring wide access to radiotherapy for all those currently missing out and SABR for those who would benefit. It does not mean SABR in every radiotherapy department.

BBC

The fourth Annual Health Camp of Janasarana Foundation

The annual Health Camp of Janasarana Foundation was held at Moneragala Vipulananda Tamil Maha Vidyalaya recently. This year it was organized as a joint project with the office of the Deputy Inspector General of Police and 13 Police Divisions in the Moneragala District. More than 4000 people were examined and given free medications. The Health Camp had General, Paediatric, Maternity sections and also Blood Sugar tests, Eye Screening for cataract and Cancer Detection Tests were done free. Dr. Soma Edirisinghe, Founder/Chairperson of Janasarana Foundation and Mr. M. R. Latheef, DIG of Moneragala were also present at this event.

Insomnia: relax… and stop worrying about lack of sleep

What is the solution to the torture of insomnia? Drugs? Therapy? Or are different sleep patterns natural? A new book investigates.

Every night, about a third of adults have problems falling or staying asleep that aren't related to a persistent sleep disorder. As they lie in bed, many are caught in the classic paradox of insomnia: wanting sleep so badly that they can't get it. “The condition of sleep is profoundly contradictory,” notes Emily Martin, a professor at New York University who has studied insomnia. “It is a precious good … but it is a good like none other, because to obtain it one must seemingly give up the imperative to have it.”

For doctors, insomnia presents a chicken or egg problem. Is sleeplessness a result of another condition such as depression, or is the insomnia the root of the other problem? One report by the US National Institute of Mental Health found that depression rates were 40 times higher for patients with insomnia than those without sleep problems. Mental health experts increasingly view depression or anxiety as an effect, rather than a cause, of insomnia. Taking care of insomnia may therefore calm other aspects of a patient's life.

And yet insomnia is a unique and difficult condition to treat because it is self-inflicted.

The cause is often the brain's refusal to give up its unequalled ability to think about itself, a metaphenomenon that Harvard professor Daniel M Wegner has called “the ironic process of mental control”.

To illustrate this concept, imagine someone telling you that you will be judged on how quickly you can relax. Your initial reaction most likely is to tighten up. After he posed that challenge to research subjects, Wegner found that the average person becomes anxious as his or her mind constantly monitors its progress toward its goal, caught up in the second-by-second process of self-assessment.

In the same way, sleep becomes more elusive as a person's sleep needs become more urgent. This problem compounds itself each night, leading to a state of chronic insomnia.

Treating insomnia isn't easy. Part of the reason is that science, as a whole, has a fuzzy definition of what constitutes the disorder. One night of bad sleep because of a blaring car alarm or an upcoming stressful day at work doesn't classify as insomnia. Instead, it is generally thought of as a string of otherwise peaceful nights during which a patient can't fall asleep when he or she wants to.

The US National Institutes of Health (NIH) identifies the condition as “difficulty getting or staying asleep, or having non-refreshing sleep for at least one month”.

The classic form has no known cause, yet is widespread. About one in 10 people in the US suffer from it during their lifetime.

There is no medical test that proves whether someone is suffering from a temporary bout of sleepless nights or a more serious disorder.

Some patients go to sleep labs and undergo tests to rule out conditions such as sleep apnea, but knowing what they don't have offers little help in treating what they do.

Instead, doctors rely on self-reports from patients, which can be maddeningly vague, a result of the difficulty that we have with accurately noting how many hours we truly spent sleeping on any given night. Patients who have spent a night in a sleep lab, for instance, often complain that it took them more than an hour to fall asleep when a chart of their brain waves shows they were asleep within 10 minutes.

Problems of self-reporting aren't limited to judging how long it took to get to sleep. Some patients wake up in labs claiming that they didn't sleep at all during the night, despite hours of video and brain wave evidence to the contrary.

Stressed at work? Look out for your heart

People who have highly demanding jobs and little freedom to make decisions are 23 percent more likely to have a heart attack compared with their less stressed out colleagues, according to research published on Friday. But lighting up a cigarette or remaining chained to your desk rather than getting out to do some exercise is far more damaging for your heart health, researchers said.

A study of nearly 200,000 people from seven European countries found around 3.4 percent of heart attacks can be attributed to job strain - a significant proportion, but far less than the 36 percent attributable to smoking and 12 percent put down to lack of exercise.

For the study, which was published online in The Lancet medical journal, researchers analyzed job strain in employees who had no previous coronary heart disease (CHD).

Participants completed questionnaires about their job demands, workload, the level of time-pressure demands and their freedom to make decisions.

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