Letters to the editor
1. It was good to know about the ventilator settings for critically sick H1N1 patients. Is anybody having hands on experience with Lung Bypass (ECMO - Extra Corporeal Membrane Oxygenator) used for H1N1 patients, who are too sick to respond to ventilators? Kindly share which hospital is giving this facility etc etc. Dr Vivek Chhabra.
2. Dr Aggarwal, thank you for your newsletter. I am sure a lot of people like me read it regularly and appreciate the contents. Shelly Batra, MD
3. respected sir, i regularly go through ur e-medinews, great effort. make a small gynae section also. wish u a very best of luck. Poonam.
4. Dear Brother DR.KK Simply MAGNIFICIENT. It can only come from a person like you WHO PRACTICIZES.. God bless. Our Profession is both ENRICHED AND GLORIFIED to have a SAGE like YOU amongst us. It will take Generations for Medical Fraternity to REALIZE YOUR TRUTH. GOD BLESS. Loving regards always Dr. N. K. Bhatia
5. Dear Dr Aggarwal: Let me again Congratulate for Keeping Up the Momentum of Academic Exercise every Day In the Morning. It is very easy to start anything but its takes lots of effort to keep the Programme going and Your single handed enthusiasm cannot me matched. I have to again request you to Kindly through your ejournal inform the members about the Medicine Update2009 being held at MAMC from 21st Dec. http://mamc.ac.in/medicine-update2009. Prof K Srinath Reddy , President ,Public Health Foundation of India will be the Chief Guest and will inaugurate the Update at 12.30 PM on Monday 21st Dec. I will also request you to Kindly cover the Update and Key messages can be disseminated to all those who due to some reasons cannot attend the same. Also the Update is accredited by DMC for 21hrs. With Warm Regards. DR NP SINGH(Nanu),
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Eye care snippets by Dr. Narendra Kumar (OptometryToday@gmail.com)
RECORDING OF VISUAL ACUITY
Vision is the result of the dioptric apparatus of the eye, the retina, the nerves, and the central nervous system. The first step in the optical examination of the patient is to determine his/her visual acuity.
In the testing of the acuity of vision, Snellen's test types are commonly used. These consist of a series of letters of gradually smaller size. The first line of type is so constructed that it should be read by a person with normal vision from a distance of 60 meters, the second line from 36 meters, the third from 24, the fourth from 18, the fifth from 12, the sixth from 9, and the seventh from 6 meters. Thus if the patient sits at a standard distance of 6 meters, s/he should be able to read the seventh line of the test types easily with each eye separately. If s/he can not read this line, his/her distant vision is defective.
The acuity of vision is recorded as a fraction, the numerator denoting the distance at which the patient sits away from the test types (6 meters), and the denominator indicating the line that s/he sees at this distance. If his/her vision is normal, s/he should read the seventh line from a distance of 6 meters, and his/her visual acuity would be 6/6. If from this distance, s/he can only see the first line which a person with normal vision should see from a distance of 60 meters, his/her V.A. is 6/60.
In the United States, the fraction is written in terms of feet; vision of 6/6 is, thus, 20/20 and of 6/60, 20/200.
The test types should be clear in print and with uniform illumination, the light being shaded from the patient's eyes. If 6 metre distance between the test types and the patient is not available, reversed test types above the patient's head and a mirror on the opposite wall at a distance of 3 meters may be used.
One eye is covered at a time, and the patient asked to read the lowest possible line. The other eye is then covered and vision recorded. In a person with normal vision, the result will be recorded as follows: RE = 6/6, LE = 6/6.
Many patients cannot read even the top letter; the vision is less than 6/60 in these cases and it is better to bring the patient nearer to the test types at a distance from where s/he can recognize the top letter. Vision recorded will now be designated by the fraction 2/60, 3/60 or 4/60 as the case may be.
Where vision is lower even than this and no test letter at any distance can be recognized, the counting of fingers is resorted to, the practitioner holding up his/her hand in front of the patient and asking him/her the number of fingers s/he can see. The result is then recorded thus: V = C.F. at 1 meter, or whatever the case may be. In case the patient cannot count fingers at any distance, the practitioner then moves his/her hand in front of the patient's eye, and if the patient can notice the movement the result is recorded as: V = H.M. When this is also unavailing the final test i.e., the ability to determine between light and dark is tried; patient is asked to tell whether the light in the practitioner's hand is switched on or off. Failure to recognize this is recorded as 'No PL' (no perception of light). When mere PL exists, the light is thrown into the eye from different directions, and the patient is asked to tell the direction from which the light appears to be coming; this is known as projection, and a note is made (indicating '+' for 'perception', ' ' for 'no perception', and '+' for doubtful perception). In case of malingerers, illiterates, or young children, a 'C' (Landolt's broken ring test) or 'E' chart may be used instead of the ordinary 'English' or 'Hindi' test types.
After recording distant vision, the testing of near vision is also important. The patient remains seated with enough light coming from above the left shoulder. S/he is given the near vision test type (Jaeger' or Roman) and asked to read at the average reading distance (35 cm. or 14 in.) or at his/her nrmal working distance. Vision is recorded as the smallest type which can be read comfortably, as follows: N.V. = J1 or N5 at 35 cm. (J1, J2, J3, J4, J5, J6; or N5, N6, N8, N10, N12, N14, N18, N24, N36, N48, as the case may be).
Legal blindness varies in definition from country to country. A person who cannot be corrected to more than 6/60 in the better eye is considered blind in India.