Eye care snippets by Dr. Narendra Kumar
Eye care providers: Triangle
The spectrum of eye care services is complete only when the three categories of service providers, Ophthalmology, optometry and opticianry, work in cooperation with each other, and form the three sides of the eye care triangle.
The ophthalmologist, with a post graduate qualification in ophthalmology has to be registered with MCI. S/he specializes in the medical and surgical care of the eyes.
The optometrist, a graduate in optometry, examines for defects of vision and prescribes corrective lenses, and, in the absence of Government legislation, may or may not be enrolled with the Eye Care India
Optometric Register. S/he may be employed with an ophthalmologist, or be self employed as a primary eye care practitioner, specializing in eye refraction, eye motility evaluation, fitting of contact lenses, detection of common eye diseases, and rehabilitation with the use of low vision aids and counseling.
The dispensing optician fills the prescription for glasses, assists the patient in selecting appropriate frame and lenses, takes facial measurements, orders lenses from the optical laboratory, and dispenses and adjusts fitted spectacles. He guides the patient in selecting a suitable frame that is look (good looking), proper size and good quality. S/he advises about the types of lenses, tints, coatings and cleaning solutions.
Joe has been seeing a psychoanalyst for four years for treatment of the fear that he had monsters under his bed. It had been years since he had gotten a good night's sleep. Furthermore, his progress was very poor, and he knew it. So, one day he stops seeing the psychoanalyst and decides to try something different.
A few weeks later, Joe's former psychoanalyst meets his old client in the supermarket, and is surprised to find him looking well rested, energetic, and cheerful. "Doc!" Joe says, "It's amazing! I'm cured!"
"That's great news!" the psychoanalyst says. "you seem to be doing much better. How?"
"I went to see another doctor," Joe says enthusiastically, "and he cured me in just ONE session!"
"One!" the psychoanalyst asks incredulously.
"Yeah," continues Joe, "my new doctor is a behaviorist."
"A behaviorist?" the psychoanalyst asks. "How did he cure you in one session?"
"Oh, easy," says Joe. "He told me to cut the legs off of my bed."
Clinical Context (Dr G M Singh)
Urinary tract infection is one of the most common bacterial infections in children, affecting 2% of boys and 8% of girls by age 7 years. Children with more severe vesicoureteral reflux are more likely to sustain permanent renal damage, although not all children with renal scarring have vesicoureteral reflux at all. Many children with a history of urinary tract infection and vesicoureteral reflux receive antibiotics as a means to prevent recurrent urinary tract infection and renal damage.
Vesicoureteral reflux is categorized on a scale of increasing severity from grade 1 to grade 5. Children with more severe vesicoureteral reflux are more likely to sustain permanent renal damage, although not all children with renal scarring have vesicoureteral reflux.
Treatment with trimethoprim sulfamethoxazole among children at high risk for recurrent urinary tract infection has a moderate effect in reducing the risk for urinary tract infection.
Letter to the editor
1. Respected Sir,I needed guidance in managing a case i got in my clinic. This is a 39 yr old lady presenting about a month back with a 8-9 day history of migratory poly arthritis (arthritis confirmed on clinical examination-swelling and other signs of inflammation present) with pain in any one joint lasting for one two days at maximum accompanied by stiffness in joint involved . After that the symptoms would completely disappear from the joints and involve another joint for approximately same time. In addition she has a definite history of mild fever with sore throat since last few days before the pain started. At presentation to clinic she had no sore throat. On lab examination her hs CRP(32 mg/l), ESR(42mm in 1st hr) was significantly raised and other LFT, KFT and remaining haemogram were WNL. I put her on short course of Steroids for 7 days and she is now pain free except one episode of pains lasting 6-8 hrs about a week back.
I had requested her to get an ASO done approximately 4-5 wks after the episode of sore throat. The value of ASO done yesterday was 26.46 IU/ml. (range of the kit is 0-200IU/ml). Now with this value can I be sure that weather it was a case of rheumatic fever? Should I start patient on Penicillin V 250 Bid?
PS: Her real sister is a known case of SLE under management of same.
Except for polyarthritis migratory she satisfies no criteria. Dr Prashant.
A: thanks: First episode of rheumatic fever after the age of 35 is rare. Also the normal ASLO is not in favour. We need to work her up further. In migratory arthritis the pain will not last for only 1-2 days. What is her platelet count as it will be high in inflammatory arthritis. Does the stiffness improve with movement (will again happen in inflammatory arthritis). Dr KK Aggarwal
2. Respected sir, Thanks a tonne sir for giving my query, your valuable time. The stiffness and pain are not there at present! But , yes the pain was maximum in morning but reduced over the day...however it did worsen on walking "long" distances/climbing stairs...Her platelets were within normal range but on the higher side of normal. Sir, I have a very serious doubt that this may be very early stages of SLE...knowing that her real sister has already been diagnosed...but I am slighltly perplexed as to whether this would be the right stage for her to proceed on further investigations to rule out SLE since as on date of writing this mail, she is completely asymptomatic. Prashant
A: we should investigate her with auto immune inflammatory markers.