Abstract
PURPOSE:
The aim of this study was to evaluate the effect of dietary omega-3 fatty acid (O3FA) supplementation on dry eye symptoms, tear film tests, and conjunctival impression cytology in patients with contact lens wear-associated dry eye.
METHODS:
In this randomized, double-blind, multicentric trial, contact lens wearers (n = 496) were randomized to receive either O3FAs or placebo capsules (corn oil) twice daily for 6 months. Subjects underwent examinations at baseline, 3 months, and 6 months. At each visit, a questionnaire of dry eye symptoms and lens wear comfort was administered. Subjects further underwent measurement of tear film break-up time (TBUT) and a Schirmer test. Conjunctival impression cytology was performed by the transfer method. Improvement in symptoms and lens wear comfort were primary outcome measures. Changes from baseline in TBUT, Schirmer, and Nelson grade at 6 months were secondary outcome measures.
RESULTS:
The mean improvement in symptom score in the O3FA group was 4.7 ± 2 (2.0) as compared with 0.5 ± 2 (0.9) in the placebo group (P < 0.0001). Lens wear comfort levels improved significantly (P < 0.0001) from baseline. There was a significant increase in TBUT [3.3 ± 2 (1.5)] and Nelson grade [0.7 ± 2 (0.6)] in the O3FA group (P < 0.0001) as compared with 0.3 ± 2 (0.6) and 0.1 ± 2 (0.4) in the placebo group (P = 0.164 and 0.094, respectively). However, the magnitude of increase in Schirmer score [2.0 ± 2 (1.5)] was relatively small (P = 0.08).
CONCLUSIONS:
The results of this study point toward benefits of orally administered O3FAs in alleviating dry eye symptoms, improving lens wear comfort, and cytological changes in contact lens wearers.

WORLD GLAUCOMA WEEK
11TH MARCH TO 17TH MARCH


GENE DIRECTED THERAPY: A HOPE FOR GLAUCOMA PATIENTS

Glaucoma, a hereditary disease, is the second major cause of blindness in the world. Almost 4 % of the population after the age of 40 suffers from glaucoma and the greatest tragedy is 30 to 40 percent of them are not aware and gradually become irreparably blind. Some people even after diagnosis do not follow doctor’s advice and become blind.

Every eye has certain intraocular pressure which is essential to maintain health and function of the eye. A fluid called Aqueous humor is constantly formed by the Ciliary body. This fluid provides nutrition to the lens and cornea and is gradually drained out of the eye along with waste products through the Trabecular Meshwork ( T. M) located at the Angle of Anterior Chamber.. Normally a balance is maintained so that the Intraocular Pressure remains within normal range, i.e. 15 to 19 mm of mercury. In most of the glaucoma patients, due to some hereditarily acquired Gene defect, trabecular meshwork creates resistance, thereby the IOP gradually increases and it causes Ganglion Cell death, which are vital for visual function. This leads to damage to Optic Nerve head and the Field of Vision gradually get constricted. If this process is allowed to continue, the eye becomes totally and irreparably blind...
Most of the time such glaucoma, which is called, Chronic Simple Glaucoma has no alarming symptoms and hence the patient does not consult an Ophthalmic surgeon or Glaucoma specialist. The only symptoms may be little heavy ness of eyes or slight ocular pain or fatigue or little watering from the eyes. The vision may remain normal, i.e., 6/6 even in some advanced cases of glaucoma.
.That is the reason that 30 to 40 percent of patients gradually progress towards blindness without being aware of the disease. Some patients may develop early or disproportionate presbyopia or dusk blindness and in advanced stage, night blindness. The disease is relatively more common in Myopes and diabetic patients.
There is another type of Glaucoma, called Acute Glaucoma, which gives lot of pain in the eyes and the eyes become blind rapidly. It needs prompt medical, laser or surgical treatment. These patients mostly have hypermetropic refractive error.

How Glaucoma is diagnosed?

Ophthalmologist when suspects the patient to have glaucoma, records the pressure of the eye by Tonometry and examines the fundus by Ophthalmoscopy to evaluate the effect of IOP on the Optic Disc. Finally, he records the fields of vision by Automated Perimetry and visualizes the Angle of Anterior Chamber by Gonioscopy and reach to final diagnosis.



Medical Therapy.

In modern time there are various types of drugs which can normalize the IOP to a level of 14-16 mm of mercury. It is extremely important that the patient follows doctor’s instructions as regards time and frequency of instillation of one or multiple drugs and the patient has to visit the doctor regularly for recording of IOP and if necessary, Field of Vision. For some of the patients, an ideal IOP would not be 16 or 17 but 12 or 13 mm of Hg and such an IOP is called Target IOP for that particular patient.

Laser Therapy

Laser procedure to create a hole in the iris is an extremely useful procedure in Acute Glaucoma. In Chronic Simple Glaucoma, in Indian eyes, laser surgery is not much rewarding. It is only reserved for patients who are unfit for elective surgery

Surgery.

When inspite of maximum tolerated medical therapy, we are unable to achieve ideal Target IOP, a surgery is advised. The surgical procedure, most commonly and successfully done is called Trabeculectomy. In expert hands, it practically has no risk and can be successful in 95 percent of eyes to control the pressure with out the help of glaucoma drugs. The success of the surgery may even be life long.

New Evolving Therapy of Glaucoma: Gene Therapy and Stem Cell Therapy.

Gene Therapy.

Glaucoma occurs mostly due to two reasons: either excess of formation of Aqueous Humor or normal formation of Aqueous but gradual obstruction of the drainage of the Aqueous due to some Gene defect in the Trabecular Meshwork located at the Angle of Anterior chamber.
Certain Genes, namely, Myocillin, Optineurin and WDR36 have been identified as the causative factor of glaucoma. Scientists have developed some Genes which can be injected in the eyes to modify or block the function of glaucoma causing genes.
Therapeutic genes are attached to some viruses/adenoviruses which act as vector to be injected in the eyes. Researchers have noted significant reduction of IOP after such injections in laboratory animals.
Secondly, the raised IOP cause death of Ganglion cells which are extremely essential for visual function. Scientists have found a Gene, namely, Trk B, which can be injected with the help of adenovirus as vector in the vitreous. These injected Genes were to a great extent successful to prevent death of Ganglion cells and hence prevention of blindness. The injection of Neuroprotective Brain Derieved Neurotrophic factors (BDHF) in the vitreous too has given very encouraging results.
Researchers are trying to use the therapy to permanently incapacitate the glaucoma causing genes and to safe guard or prevent the death of Ganglion Cells.




Stem cell Therapy.

The blindness in Glaucoma occurs due to death of Ganglion cells which results in changes in the Optic Disc. (Cupping of the disc). Scientists have taken stem cells from the bone marrow which were so processed to produce Neurotrophins which are essential for survival or activation of ganglion cells. Scientists were successful to reactivate some of the Ganglion cells, there by giving some vision to practically blind rats...


We are hopeful that in coming decade or two we shall be able to identify all glaucoma prone patients by Gene evaluation much in time and shall be able to modify or block the function of such genes. National Eye Institute USA is sponsoring Phase 1 clinical trial and studies are also taking place in U.K. Stem cell therapy gives some hope to patients who are already in advanced stage of blindness due to glaucoma.


Prof M. R. Jain
Glaucoma Expert & Editor, Text Book Of Glaucoma
Medical Director
Jain Eye Clinic & Hospital
Jaipur

In today's busy and stressful life, number of new diseases are coming up which are actually modifiable. Common person can never think of losing their vision because of there stressed life which they think is a part of life.
One such disease is Central Serous Retinopathy. In this disease fluid ( subretinal fluid) gets accumulated between sensory retina and retinal pigment epithelium. It is seen more commonly in males but doesnt mean females are less involved. There
are known factors which predispose the patients for this disease like hypertension, type A personality, use of steroids in any form. Endogenous steroids and increasd sympathetic activity are also contributory.
My purpose of writing this article is not to tell about the dsease per se as information regarding CSR can be retrived from multiple sources, but to make people aware about the small modifications in life which can help to decrease recurrence thus increasing the possibility of retaining good vision.
Just telling the patient to avoid sress doesnt finish our duty towards patient . Patient actually doesnt know what to do and how to do, so he/she ends up doing nothing . The whole purpose of our examining patient finishes. The best part of CSR is it is self resolving, so ask patient to relax by going for morning walk , doing meditation , reading books( whether religious or whatever he likes), listening to music, playing games , drawing, may be shopping....
I jst talked about this to a sister in the hospital what would you do relax yourself if you get full one week leave( which is no doubt unthinkable in our set up), her reply was,I will sleep, and go for shopping because then I have to join back. That means people are more worried about futur and dont live and enjoy present. Maximum of patients of CSR wich we see has stress has the precipitating factor and no other factors mentioned above.
Believe me this is the only disease where you can control your vision with a smile on your face. Always remember to avoid-HURRY, WORRY and CURRY.....

CATARACT.

Q. What is a cataract?
A. Any opacification of the human lens of the eye is called a cataract. The human eye is like a camera – the front portion, which is clear and transparent, is called the cornea. This corresponds to the front glass of the camera. The lens is biconvex, exactly like the lens of a conventional camera and is situated behind the pupil of the eye (the jet-black window in the brown/blue/green iris of the eye). It is made up of protein and water and is normally transparent. Due to aging process, these lens proteins coagulate, losing their transparency over time. Certain drugs such as steroids as well as certain diseases such as diabetes hasten this biochemical change. Several studies blame pollution, cigarette smoking and prolonged exposure to the ultraviolet rays of the sun as some causative factors. The reason it occurs in some people at 45 while others live to be a 100 without developing any cataract is at present unclear. Whenever we doctors cannot give a logical explanation, we normally say there must be a genetic factor either causing the development of cataract or preventing it in different sets of patients.

Q. Is there a medical treatment for cataract?
A. Unfortunately,(for patients – fortunately for eye doctors!) there is no scientifically proven medical treatment for cataract. There are plenty of grandmother’s remedies touted as cures or preventive treatments, such as honey, certain vegetable extracts, cow’s urine and even auto-urine therapy. None of them work. There are also a host of eye drops made by homeopathic and ayurvedic companies which burn and sting on application (besides burning quite a hole in the pocket!), which claim to stop the progress of cataract. None of them work. The reason they become popular is many a time the cataract can stop progressing or remain stationary for years on its own, for reasons, which are unknown. If at that time the patient is using any of the above remedies, he will tell a minimum of 50 people about the miraculous drug or therapy, convinced that that is the reason for the lack of progress of the cataract. Unfortunately, patients who are on no therapy and have non-progress of their cataracts are never known to brag!

Q. Does every cataract need to undergo surgery?
A. Just as every one does not have to climb Mount Everest just because it is there, so also you do not have to undergo cataract surgery just because your doctor has diagnosed that you have a cataract. The indication for cataract surgery is when the cataract has progressed to such a stage that it hampers your day-to-day or routine activities. This varies tremendously from person to person. If you live in the US of A for example, and the cataract causes you glare and difficulty in night driving, your eye surgeon may advise surgery the next week. This is because you are probably living alone or with your spouse and if you cannot drive at night, you are considered handicapped. In case you have a medical emergency at night and have to drive to the chemist or hospital for treatment you would otherwise be in a soup! In India however, in most cities, you would be able to use a taxicab or would be able to ask your other relatives living with you or a phone call away, to take you to the hospital! A 50-year-old busy executive may feel handicapped if he finds it difficult to read the fine print in important contracts that he has to sign daily. A 75 year old housewife with a much more advanced cataract may have no complaints as she is able to see the big print of her religious books easily and is not interested in the “rubbish” they show on TV! For the executive, his early cataract may require surgery, while for the housewife, I may ask her to see me after a year for reassessment!

Q. Some people say that if I delay my cataract surgery, it may become too ‘ripe’ or may ‘burst’ and I may lose the eye permanently or it may become too ‘hard’ causing difficulty in surgery later. How true are these statements?
A. Not true. A cataract is considered ‘over-mature’ or in danger of rupture only if it is pearly white in appearance or the vision has dropped such that the patient can only see light projected into his eye but cannot recognize objects even if shown from a distance of less than one meter. As long as you are showing your eye to the ophthalmologist every 6months to a year, he will be able to guide you for surgery long before that stage is reached. As far as hardening of a cataract is considered, it is true that brown and black cataracts can harden over time, making their surgery technically a little more difficult. However, with modern day methods of cataract surgery, they no longer pose a problem to the experienced cataract surgeon.

Q. Now that I have decided to have my surgery done, what are the different options available? Which method is the “best”?
A. If you have trust in your ophthalmologist, it is wisest to allow him to decide what method of cataract extraction he should use for your eye. It depends on the type of cataract. The procedure he chooses depends on many factors, e.g. the type of cataract you have, his experience, and his familiarity with the phacoemulsification machine etc.

Q. Now that you mention it, what is ‘phacoemulsification’? How does it differ from ‘laser surgery’ for cataract, which my neighbour has undergone and paid a large sum for?
A. Phacoemulsification is the use of a machine to which is attached a probe, a pencil like instrument which vibrates at a very high frequency emitting ultrasonic energy. This breaks up or emulsifies the lens (Greek ‘phakos’=lens and ‘emulsify’ is to liquefy),
into tiny bits, which are then sucked out through tiny openings in the same probe. This is what the lay public refers to as ‘laser surgery’. In actual fact there is no use of the laser at all for cataract removal in these machines! Probably a few black sheep in the ophthalmic fraternity who do not have the time to explain Phaco-emulsification to their patients or do not feel their patient’s I.Q. level will allow them to understand such big words, combined with some inaccurate and exaggerated stories in the press have helped spread the myth of ‘laser cataract surgery’. For the record, let it be said that there are a handful of genuine laser machines, which are combined with Phacoemulsification machines for cataract surgery. However, at the current time, laser machines take more time, cannot remove hard cataracts and therefore have proved very unpopular with the vast majority of cataract surgeons.

Q. What are the other methods of cataract surgery?
A. Some surgeons are very adept at using the phaco machine and would be able to manage to remove all cataracts using this machine. Others use the Phaco machine for most cases and may use ‘a non-phaco method for certain types of cataract such as very hard cataracts or even very soft cataracts which can sometimes be a little difficult to remove safely using the phaco machine. Still others may not be conversant with the phaco machine at all and may remove the cataract by non-phaco means in all cases. In non-phaco methods, there are some, who will use a small ‘sutureless incision’ to enter the eye, while others will use a larger incision which will require to be closed with stitches.

Q. Is any method superior to the others?
A. That is a loaded question! The method using phacoemulsification and the small incision non-phaco method are both ‘sutureless’. Hence healing is rapid. Usually in about a week or so, the patient is seeing fairly well and is able to go back to a fairly normal life with no restrictions. In larger incision surgeries, where sutures are taken, the patient may have some restrictions on having a shower etc for a few weeks. It may also sometimes take a month to 6 weeks to regain good vision. In a small percentage of ‘sutured’ cases, there may be a slightly higher ‘astigmatism’ or cylinder number left over at the end of 6 weeks compared to the sutureless surgeries. However, in a majority of patients at the end of 6 weeks, there is almost no difference in the appearance of the eye or the best-corrected visual acuity irrespective of which method was used. Hence the choice of method may sometimes also depend on the lifestyle of the patient. Taking the previous example of the busy executive who needs to go back to office as soon as possible after the surgery, it may be preferable to do a phaco or a sutureless surgery on him. For the 75-year-old housewife, any of the procedures would be acceptable. Hence this decision is best taken jointly after discussing the pros and cons with your eye surgeon.

Q. What about the IOL (Intra-ocular lens) implant? How safe are they? What is the life span of the IOL? Are imported IOLs superior?
A. The IOL is a thin plastic or acrylic or silicon lens. The first ones were put shortly after the Second World War. They then became unpopular due to a high
complication rate. They were then modified and the present type has been in use since the early eighties. In the present day, almost 100% of cataract
surgeries the world over are done with the simultaneous implantation of an IOL including in most eye camps. They are extremely safe and are well tolerated
by the body. There is no rejection of the material of the lens, which is biologically inert. Judging from the complete lack of complications in the vast
majority of well-done surgeries over the past 2 decades, it is safe to extrapolate that there should be no problems due to the lens for the average life span
of the patient.
As regards the controversy of Indian versus foreign IOLs, I have no hesitation in saying with pride that Indian IOLs have come of age. They are as good as
and in some cases even superior to the imported variety and are even being exported to over 50 countries including Europe and the Americas. However, as
with most other gadgets and gizmos, there is the craze for foreign IOLs in the patient population, which we eye surgeons happily satisfy, as the patient
does not mind paying a bit more for an imported IOL!

Q. What is the difference between rigid and foldable IOLs? What are multifocal IOLs?
A. Rigid IOLs are usually made of a medical grade plastic called PMMA and have a maximum width of 5to6mm.. Hence to insert them into the eye, the incision in the eye also has to be approximately the same size. They can be inserted after any type of cataract surgery. The foldable IOLs are made of acrylic or silicon material and can be folded so as to enable them to be slipped into the eye through a smaller incision, even as small as 1mm. These can only be inserted after cataract surgery by phacoemulsification. Research is in progress to mass manufacture IOLs, which can be put in through still smaller incisions. The smaller the incision, the less chance for astigmatism or cylinder number induced by the incision. Multifocal IOLs are special IOLs, which can correct both, distance and near vision hence reducing the patient’s dependence on glasses for both distance and near. They are a little more expensive than the other IOLs. However, not all patients are suitable candidates. It is best to discuss the pros and cons of the type of lens to be inserted with your ophthalmologist before the surgery. The costliest option is not necessarily the best option for all patients.
Q. There are some latest “yellow” IOLs. What are they?
A. They are coated with a special pigment to give the patient more natural vision, especially for night driving. They are at present among the most expensive foldable IOLs available in the market.

Q. What about anaesthesia for the surgery?
A. Most surgeons would operate you under local anaesthesia. This involves giving you a tiny prick with a very fine injection needle around the eye along with some local anaesthetic eye drops. At the end of surgery, a patch is applied to keep the eye closed. This is removed a few hours later or the next day, by the surgeon. Some surgeons prefer (in very co-operative patients) to give only topical drops anaesthesia, with no injection around the eye. In such cases, there is no need to patch the eye following surgery. However, serious complications can sometimes occur if the patient inadvertently moves the eye or blinks hard during the surgery. It is best to discuss this aspect too with the surgeon before surgery, to prevent him from blaming you for any mishap later. Make sure, in case the surgeon is going to use only topical anaesthesia, that he is well experienced and is not doing this only to impress you! A tiny, tiny percentage of eye surgeons claim to operate patients with no anaesthesia at all, not even topical drop anaesthesia. Thankfully, the tribe of such surgeons is not growing.

Q. How soon will I start to see clearly after the surgery? Will I need glasses after the surgery?
A. It depends on the type of surgery. If you have had surgery with topical anaesthesia, you will see reasonably well immediately after the surgery. For those who have been patched, they will see reasonably well on removal of the patch. Some eye surgeons prefer to leave an air bubble in between the cornea and the implant after the surgery, for added safety. This air bubble can considerably blur the vision for up to a week post operatively. If your surgeon has taken sutures to close the incision, clarity may come only after a month or so. Most patients will develop a small number for distance and for near after the surgery and will need glasses to see clearly, though not of high number. It is wise to wait for a month or 6 weeks after the surgery for the number to stabilize before having glasses made, especially if stitches have been taken during surgery.

Q. What are the dos and don’ts after surgery?
A. This is very individual and varies from surgeon to surgeon. However, the number of don’ts has dropped drastically over the years, as cataract surgery got safer. Most surgeons allow you a head bath about a week after the procedure. In case stitches have been taken, you may be asked to wait a bit longer. You can read, write, watch TV, fight with your spouse and shout at your kids almost immediately after the surgery. There is usually no restriction in your diet. You do not have to stop most medication you have been taking for any other medical condition. However, if you are on aspirin, for thinning the blood, please mention it to your eye doctor. He may ask you to stop these tablets a few days before and after the cataract surgery. Your anti-diabetic pills may have to be omitted on the morning of surgery.

Q. My neighbour saw well after her surgery for 6 months. Now vision is getting blurred. Her doctor has advised her ‘YAG laser treatment’. What does this mean?
In a certain percentage of patients, the bag or capsule in which the IOL is placed can become opaque with time. This may happen as soon as one month after surgery or even many years following the surgery. In a majority of patients it does not happen at all. This can occur even after excellently done surgery. It is not considered a complication of surgery but as an unpredictable side effect, which results in haziness of vision. This is corrected by a painless 5-minute procedure called “YAG laser capsulotomy” in which an actual laser is used to burn a small hole in the centre of the capsule or bag, so as to restore vision. This is a one time procedure, which does not usually have to be repeated.

Q. Can a person operated for cataract donate his eyes after death?
A. Most certainly he can. Though the whole eyeball is removed at the time of eye donation, what is used is only the transparent layer in the front of the eye, called the cornea (this is like the transparent glass in front of a wrist watch). This is normally unaffected by successful cataract surgery, hence this cornea can restore sight to a blind person after successful cornea transplant surgery.

The Cardinal Role of Family Physicians
In
Enhancement of Eye Donation
And
Effective Eye Banking

ASSESSMENT OF THE PROBLEM OF CORNEAL BLINDNESS IN INDIA

India has the dubious distinction of having the highest number (Approx. 10 million) 0f blind people in the world. (Approx. 40 million).

25% of the total blind persons in India are due to the diseases of cornea (approx. 2.5 million) and 60% of them are below the age of 12 years. Every year the number of Corneally blind person increases by 20-25 thousand.

The corneally blinds often can be helped to regain useful vision and take up to their occupation by a simple operation of Cornea grafting or Keratoplasty, only if, there is access to good quality donor corneas.

Every year approx. 10 million people die in India, but however, only 12-15 thousand persons donate eyes.

In spite of preventive and curative measures undertaken by authorities and social service organizations the net figure of Corneally blind people in India is increasing by leaps and bounds. At the prevalent rate of 20-25 thousand per year, the estimated figure of Corneally blind in 2015 will be 3 million.

The magnitude of corneal blindness prevalent, particularly in young people jeopardizes their future. The immensity of loss to the society and the Nation can be imagined.

Family Physicians are vital links between motivation of people for eye donation, procurement of large number of good quality donor eyes and successful functioning of Eye Banks.

MANAGEMENT OF THE PROBLEM

Theoretically, the problem of tackling corneal blindness with cornea grafting surgery seems very simple. There should be 20 million corneas available in India, if 10 million potential donors who die every year donate their eyes. But in practice very few people donate eyes.

50% of 25-30 thousand corneas harvested are from Gujarat and city of Mumbai. It is imperative to motivate people all over India for more eye donations on a war footing.

REASONS FOR FEW DONOR EYES

A survey was carried out amongst 127 doctors from different parts of Mumbai and Ahmedabad, to elicit the reasons for, “Why family was unwilling to donate eyes of deceased?”

The reasons elicited:

(1) Lack of awareness and knowledge:

Some people are not aware that the eyes of a deceased can be donated and utilized for giving sight to corneally blind person. Some families who are aware do not have knowledge about the procedure of Eye Donation.


(2) Misconceptions:

(a) Some people believe that, “If eyes are donated the donor will be born as a blind in the next birth.”
(b) If eyes are donated and the final rites are performed on incomplete body then the donor will not achieve “Moksha” (salvation).
(c) Not only illiterate people but also few doctors have the misconception that, “Eyes are to be donated just prior to death, and if, by any chance, the donor survives he has to lead a dark life through out the rest of life”.

(3) Emotional:

After the death of a person the bereaved family is under tremendous emotional stress and may forget about eye donation.

Few consoling words and proper request for eye donation by a doctor at this stage will positively motivate the family to donate eyes.



(4) Religion:

Bereaved family members believe that their religion may be against eye and other organ donations.

In fact, no religion is against such donations. On the contrary, Hindu religious scripture Mahabharata has positive mention of eye and bone donation. There are Fatwas issued by Maulavies in Islam. Similarly there is mention of such donations in Bible of Christians and Talmud of Jews

EYE BANKS

The statistics from Eye Bank Association of India (EBAI) reveals out of few hundred eye banks in India, only 20 collect even the bare minimum of 50 (Fifty) donor eyes in a year.

To procure large number of good quality donor eyes following measures are vital:

(a) Continuous motivation of people through mass media and any
other Innovative way.
(b) Upgrading existing eye banks.

(c) Establishing new effective eye banks.

Family Physicians are vital links between motivation of people, procurement of large number of good quality donor eyes and successful functioning of an Eye Bank.

It would be interesting to assess a well functioning eye bank.



PROFILE OF A SUCCESSFUL EYE BANK
(ARPAN EYE BANK)

Arpan eye bank at Ghatkopar, in Mumbai, was inaugurated on 26th April 1987. It is managed by a public charitable trust. Its area of operation is only Ghatkopar, one of the suburbs in Mumbai.

10 trained family Physicians available within the local area attend eye calls in rotation. Up to 03/09/2007 Arpan Eye bank has collected and distributed more than 8527 donor eyes.

On an average, each eye call was received 1 hour after death, was attended within 30-45 minutes of intimation and eyes were retrieved within 2 hours of death, ensuring good quality donor eyes

Success of Arpan Eye Bank confirms that Family Physicians are ideal personnel to work for an eye bank.

FAMILY PHYSICIANS IDEAL FOR MOTIVATION

Family Physicians are ideal persons to educate and motivate people because, he/she:

(1) Is usually present at the time of death.
(2) Is first one to declare and certify death.
(3) Has very good rapport with the family.
(4) His/Her word is a Gospel truth.

FAMILY PHYSICIANS IDEAL FOR EYE BANKING

Family Physicians working for an Eye Bank are ideal because, he/she:

(1) Is available round the clock at all places.
(2) Can master the Enucleation technique and other medical aspects of eye banking very easily.
(3) Eyes can be retrieved very early after death and in turn better quality of donor cornea is ensured.
(4) Is like a family member of bereaved family. Enucleation done by him/her is more acceptable to the family then the call attended by eye bank technicians or Ophthalmologists.
(5) It is not much taxing on their professional practice or family life. The fear of compromising with their practice and family life, very often, is misplaced.







CORRECTIVE MEASURES

Doctors should be exposed to the problem of Corneal Blindness, Eye Bank and it’s working from their student days in medical colleges.

If, Doctors get necessary training in Eye Banking, at this stage, then they will be definitely interested in motivating general public for eye donation during their professional careers. The will also extend co-operation to eye banks all over India, thus helping the National cause of “Removal Of Blindness”.

For government agencies this is very easy. If following suggested measures are implemented now, the problem of corneal blindness will be adequately tackled in near future.

(1) Eye Banking should be included in the subject of Preventive and Social Medicine (PSM).
(2) Performing a few Enucleations should mandatory. At present the medical students have to conduct few deliveries during Obstetrics term and also have to attend post mortem cases during pathology term. Similarly affixed number of Enucleations, also, should be a part of medical education. This can be easily implemented during anatomy term, when students dissect human body. Enucleation can be practiced on postmortem cases too.
(3) One to two weeks of practical training in Eye Bank should be a part of Internship. Performing Enucleations at donors’ residence will expose them to emotional atmosphere prevalent in bereaved family.
(4) This requisite will provide functioning eye bank in all medical colleges augmenting number of eye banks in India.
(5) Private charitable trust hospitals should be encouraged to set up new eye banks with the help of local doctors and social workers.
(6) Trained family physicians should be given a chance to take active part in eye banking by teaching others with lectures, training them with audio-visual aids and practical demonstrations.
(7) Facilities for training in eye banking should be made available to family physicians, who are interested in serving eye banks.
(8) Government authorities and Social service organizations should spare more energy and funds to tackle problem of corneal blindness, in view of affliction of young people.
(9) Mass media should take up the cause, give regular publicity and create awareness for Eye Donation as is done for blood donation and AIDS awareness.

RECOMMENDATIONS

(1) Training in Eye Banking should be a mandatory part of the Medical Curriculum.
(2) Trained Family Physicians should be given a chance to take active part in teaching.
(3) The training course in Eye banking should be made available for private practitioners.
(4) Private charitable trust hospitals and similar organizations should be encouraged to set up new eye banks. Its working should be totally transparent. An Ophthalmologist should be the Medical Director, looking after the quality aspect and other medial technicalities only. Day to day administration and other working should not be looked after by an Ophthalmologist.
(5) Government Authorities and Social Service Organizations should spare more funds and energy.
(6) Mass media should take up the cause, publicize it regularly and educate people.