What is Dengue?
Dengue, also known as breakbone fever, is a mosquito-borne viral disease caused by Dengue Virus (DENV). Till now, four distinct strains of dengue virus have been known, namely DEN-1, DEN-2, DEN-3, DEN-4.
How does it spread?
It is mainly spread by the bite of infected Aedes Aegypti mosquito. These mosquitoes are most active at daytime, so biting period ranges from early morning to dusk before sunset. Dengue is not transmitted from one person to another, but an infected person can be the source of virus for another mosquito.
What are the symptoms of Dengue?
Symptoms of Dengue can be seen at earliest from 3 days and late up to 14 days from the day of biting.
1) In case of Dengue Fever
High fever (40°C/ 104°F), accompanied by at least two of the following symptoms:
- Pain behind eyes
- Swollen glands,
- Joint, bone or muscle pains,
- Skin Rash
2) In case of Severe Dengue
Severe Dengue appears in the lethal forms of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). It occurs in the patients with multiple medical conditions. It may also develop if a person who has developed immunity against one strain of Dengue Virus gets infected with another strain.
As a person develops Severe Dengue, initial fever may decrease, which should not be mistaken for recovery. S/he may show following symptoms:
- Severe abdominal pain
- Blood Plasma Leakage
- Bleeding gums
- Vomiting blood
- Rapid breathing
- Fatigue/ restlessness
- Blood in urine
- Persistent vomiting
If any suspicion of Dengue arises, blood test should be done immediately for the confirmation of Dengue Virus.
Cure and Treatment
There is no specific cure or treatment available for Dengue yet. According to World Health Organization (WHO), patients should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.
Community awareness and participation plays a key role in prevention and control of Dengue. Aedes Aegypti mosquitoes, are mainly found in damp and wet places, as water is the perfect place to lay their eggs. So the main step would be to eliminate the mosquitoes egg laying sites like discarded bottles, containers, potholes, drums for collecting water, etc. Apart from that, exposure to mosquito should be avoided as far as possible, using mosquito repellent, mosquito netting, wearing long sleeved shirt and pants etc.
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Myopia Management & OrthoKeratology
If you are wearing glasses, you surely do remember your first visit to your eye doctor. Many of you might have been prescribed spectacles or contact lenses as a remedy to the refractive correction (Glass Prescription). As a small kid, I remember my eye care professional prescribing me a -0.75 refractive correction (lens power) when I was around 11 years old. By the time I was 20 years old, my refractive correction was -2.75. I always used to wonder and ask myself why my refractive correction was increasing even though I was wearing spectacles as prescribed by my eye care professional. Could this -2.00 Diopter of increase in power have been controlled? Is there any way we can help children of 4 to 5 years, already having -1.00 Diopter of correction, stop them from becoming high Myopic (>-6.00 D) when they grow? Should we really worry about myopia control in children? What are the risk factors that comes after having a high myopia?
We have to be asking all these questions now and try getting the answers. One of the reasons of Myopia progression is due to the elongation of the eyeball with its increase in axial length. Myopia control wizards (Optometrists) have been trying their best to control this phenomenon of increasing the axial length of the eye ball to control the Myopia progression. Controlling Myopia does not just improve the patient’s quality of life but it also prevents vision threatening conditions like retinal detachments and retinal maculopathy. Now, the question arises how do we control this normal phenomenon of the elongation of the eyeball? Luckily for us, many researchers has already found a way to control this phenomenon by various methods.
- Simply get out of your room and play outside: Sounds simple yet very effective. If you want your children, brothers or sisters to be less vulnerable to refractive error, then send them outside to play. Though the exact reason for this is not known yet, many researchers have found out that spending just about 10 to 12 hours a week outside the room and indulging in outdoor activities helps to reduce myopia progression in Children.1 Hence, taking kids out of their digital gadgets and spending time outdoors can be beneficial in reducing Myopia progression.
- Low Dose Atropine: A low dose atropine of 0.01% is considered to be really helpful in controlling the progression of Myopia. The ATOM & LAMP trials study has shown that low dose atropine of 0.01% & 0.05% is more effective than 1% atropine with much less side effects and rebound effect. 2, 3
- Multifocal Contact Lens: The use of center distance design Multifocal Contact Lenses helps to reduce the elongation of the eye ball by creating a myopic defocus in the periphery of the retina. With normal spectacle and contact lenses, hyperopic defocus is created in the peripheral retina which makes the peripheral retina to elongate in order to focus the light rays into the retina. The center distance multifocal lenses has high add in the periphery which corrects this hyperopic defocus and pushes the light rays in front of the retina creating a myopic defocus which helps to control the elongation of the axial length of the eye ball.
- OrthoK Lenses: The OrthoK lenses corrects the Myopia by flattening the center of the cornea without the need of surgery. As in LASIK surgery, the OrthoK lenses helps to flatten the central corneal area which corrects the Myopia. The peripheral cornea creates a myopic defocus that helps to control the Myopia progression as well. The OrthoK lenses are the gold standard treatment for myopia control and is also one of the options for myopia correction.
Why should we worry about Myopia Progression?
Myopia progression today has become a topic of discussion for many of the eye health care practitioners. It is estimated that by the year 2050 about half of the world’s population will become myopic. So, if something is not done to control this progression, we will be seeing rise in more and more myopic patients in the days to come. But why should we actually worry about Myopia Progression?
With this digital age, children today spend most of their time in their electronic devices which is turning them into an early Myopes. We are now getting myopic cases more than ever. It is common to find more than -1 Diopter of Myopia in children of 5 to 6 years. If this is not corrected and controlled, these children are bound to become high Myopic at the age of 18. With high Myopia comes the high risk of many eye health conditions like Cataract, Glaucoma, Retinal Detachment & Maculopathy.
The only goal of Myopia Control & Orthokeratology is to stop these children from progressing from -1 Diopter to -6 or -7 Diopters. If we can start Myopia Control now, the Myopia progression can be controlled by more than 50% and these children can be saved from the risk factors of high Myopia.
We are treating Myopia as a refractive error but now it’s time to take myopia as a disease and start treating it and help those children from progressing their myopia to become high Myopic. If you are a parent, brother or sister of a young myopic child, then please do start talking about myopia control with your eye health care professionals. Pediatric Ophthalmologists along with Optometrists who practices Myopia Control can stop the progression of Myopia. Refractionists and Ophthalmic Assistants can help you find if your children has any refractive errors and will refer you to the Myopia Control practitioner.
Things to know before buying a Soft Contact Lens
When we get a prescription for refractive correction we start thinking about spectacles. Spectacles has become a very good means of correcting refractive error but sometimes we do want to break free from the glasses and enjoy our coffee without the fog, enjoy rain without the blur & enjoy the dance floor without worrying about the glasses. There are various other options that we can choose if we are fed up with the spectacles. The very first option that I, as an Optometrist suggest to my patients are Contact Lenses. But before buying Contact Lenses we should always know about these wonderful invention and the way to handle it.
Should I buy Contact Lenses Online?
We find a lot of online stores selling contact Lenses these days but is it a right way to get your contact lenses? If I was an owner of an online store I might have said, “Contact Lenses are just like spectacles you can buy anywhere you want if you have the prescription” but being an Optometrist I know the risk of buying contact lenses without proper fitting and evaluation of your eye health conditions. Buying your contact lenses is fine if the seller can arrange an eye examination from an eye health care practitioner who is authorized to dispense contact lenses but it can lead to serious complications if you buy those contact lenses without consulting with a contact lens practitioner.
How long can I wear a Contact Lens?
If you can understand how long you can stay underwater without oxygen then you will get your answer of how long a contact lens can be worn. This is just an analogy but when the Contact lens sits in front of your eye ( the Cornea ), the time that it can be worn depends upon how much oxygen can be passed into the cornea through the contact lens. This is determined by the property of the contact lens material called Oxygen permeability (Dk). When contact lenses are made with the material having certain Dk the amount of oxygen that will go through that contact lens will now be dependent upon the thickness of the contact lens which will be termed as oxygen transmissibility (Dk/t). So every material with which the contact lens is made has a Dk value.
Now the actual question of how long a contact lens can be worn will be dependent upon the dk/t value of the lens.
For Daily Wear modality lenses ( lens that are worn on day for 10 to 14 hours ), the Dk/t value according to Holden & Mertz criteria is 24 x 10-9
For Extended Wear Modality lenses ( lens that are worn overnight while sleeping ) the Dk/t value according to Holden & Mertz criteria is 87 x 10-9
Another thing to know in order to understand how long you can wear a contact lens is to know the replacement schedule of the contact lens. This means when you should dispose your lenses.
There are currently four contact lens replacement schedule:
- Daily Disposable Contact Lens
- Biweekly Disposable Contact Lens
- Monthly Disposable Contact Lens
- Yearly Disposable Contact Lens
The daily disposable lenses are worn and disposed every day. So you can wear a fresh pair of lenses every day. This type of contact lens usually come in a 30 or 32 piece lens in a box. Some of the Contact lens also comes in a small eco pack of 4 to 8 piece lens in a box. These lenses are the most recommended contact lens to wear because of very less chance of infections and other complications because every day the lenses are disposed and a new one is worn. Because these lenses are daily disposable you will not need any lens care solution to clean these every day. Simply dispose it and use a new pair of lens. Do Not wear the same daily disposable lenses more than 1 day.
The biweekly disposable lenses are worn and disposed in every two weeks. That means you store these lenses in a lens storing case for 2 weeks and get a new pair after 2 weeks. The lenses are worn each day for 8 to 14 hours depending upon the contact lens material and removed and stored in a lens case after cleaning. The lenses should be cleaned with a lens care solution every day before wearing and after removing during the 2 weeks period time of wearing. These lenses will come in a 6 piece lens pack. That means when you buy one box of biweekly disposable lens you will have 6 lenses to wear and each lens can be worn for 2 weeks. Do Not wear the same biweekly disposable lenses for more than 2 weeks.
The monthly disposable lenses are worn and disposed in every one month. Similar to biweekly you should clean these lenses every day with lens care solution for the period of one month and dispose it at the end of the month and wear a new one. The lenses are worn each day for 8 to 14 hours depending upon the contact lens material and removed and stored in a lens case after cleaning. These lenses will also come in a 6 piece lens pack and you can wear each lens for 1 month. Do not wear the same monthly disposable lenses for more than 1 month.
Yearly disposable lenses are not prescribed in western and developed countries now a days because of high chances of infection and complications than other disposable lenses. They usually come in a pair and the same lens is worn for a year. Similar to monthly and biweekly these lenses should be cleaned every day with a lens care solution. These lenses are not usually recommended to wear.
In short, while buying a contact lens you should know which replacement schedule contact lens you need ( daily, biweekly, monthly or yearly) and when to dispose it. Before buying any lenses make sure you have a detailed eye examination and after buying the lenses make sure you are taught how to correctly insert and remove the lenses with proper maintenance and lens handling.
Contact Lenses are great alternative for your spectacles. There are daily disposables, biweekly disposables, monthly disposables and yearly disposables contact lens currently in market. Make sure to choose the right one with the help of your Optometrist. Don’t buy any contact lens without consulting with an Optometrist and make sure you are taught the proper way of lens care and maintenance. A good Optometrist will always help you to make you comfortable with your contact lens.
( Only Soft Contact Lens is discussed in this article. There are many other contact lens which are used as specialty contact lenses )
Living with motion sickness
Though I love to go to new places, I never really enjoyed traveling. I envy everyone of those who enjoy their bus rides, singing songs, giggling and laughing, excited about the trip while I would be sitting on one of those corner seats, suffering, holding a little more, trying not to puke, trying not to spoil the mood. I would find myself facing out of the bus so that no one knows, praying that the distance shortens or the engine of the bus breaks down, regretting why I even bothered to come, thinking how comfortably I would’ve been sleeping on my bed instead, swearing that I am never traveling again, not even on a request or even for a reward, if there will be any.
And then, it would become too hard to hold, and everything I feared would happen. Then, I would be too embarrassed to be there, everyone staring at me, some with sympathy, some with disgust or some trying to hold themselves from throwing up. They would come to help and worry if I am okay. I would nod that I’m fine (though I’m not.) They would suggest that I should travel more or that I should enjoy the ride, distract myself from thinking about it but it had always been like that as long as I can remember. It’s not like I didn’t try. I tried traveling on empty stomach, half-full, full stomach, taking pills, ginger, lemon, distract myself with music, talking, not talking, front seat, rear seat, middle one, everything. But as soon as the engine starts, everything would go in vain. I didn’t realize the seriousness of the problem, it was not just the moving bus, everything that moved (motorbikes are exception though) made me dizzy, nervous and nauseated. Talking about fun parks, they were never really fun. I could only notice everything moving, everyone screaming, wanting everything to stop or getting out of that place. I didn’t know what was wrong.
So, I did some research here and there. I was introduced to the term “kinetosis” meaning motion sickness. It is the state of being dizzy and nauseated because of the motion. It is basically caused by the conflicting messages sent to the brain by ear, eyes and body. Ears hear the moving sound and thus, sends the message that it’s moving but the body remains still and eyes see that everything is still inside the bus thus, sends the message that it’s not moving. The conflict messages received by brain concludes that the person is hallucinating and due to some poison ingestion. Then the brain responds by inducing vomit to clear the toxin. That’s how one feels nauseated and vomits. Almost everyone goes from this state where some have mild ones and some suffer severe ones. And I lie in the latter group.
Now that I’d learned the cause, I looked for treatments. There are some medications and devices recommended for its treatment but there are no such convincing ways or preventions. It’s sad that I won’t be able to travel joyfully for the time being until some solid treatments are discovered. It’s not easy to accept the fact but nevertheless, I’m not going to refrain myself from traveling and no one should. I shall suffer, puke, feel the embarrassment and everything but I am still willing to go to places. For those who cannot relate, it may not be much of big deal but the struggle is real.
By: Manju Maharjan
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