The Pandemic of Eyes

Prologue

I wrote a blog on my issues with Hypermetropia, Myopia and Presbyopia Digital Ophthalmology | Kapil Khandelwal KK. It was around December 2021 and we were getting back to regular work after the Covid vaccinations. On my annual health checkup, my eye correction numbers were reduced for both my eyes for distance and reading glasses. But the eyes were seeing some other things. That’s the start of journey of my cataract.

Blurring of Vision

Over the next one year, I was able to see but there were situations when my eyes would hurt me especially under bright light. By December 2022, the eyes would accept my current spectacles would work on some days and on some days, there would be a hazy vision, dryness in the eyes. My lifestyle took a big dip as I was not able to play sports and do my regular walks. All activities were restricted to indoors. Work-life balance took a huge dip. Also my right eye’s vision was deteriorating faster and I could see better from the left eye. In other words, I would behave like the Mad-Eye Moody of the Harry Potter fame.

The Cataract – The Pandemic of Eyes

Cataract is a medical condition that causes clouding of the lens of the eye, which is typically clear. The cloudiness can cause a decrease in vision and may lead to eventual blindness if left untreated. Symptoms of cataracts include clouded, blurred or dim vision, trouble seeing at night, sensitivity to light and glare, seeing “halos” around lights, frequent changes in eyeglass or contact lens prescription, fading or yellowing of colors, and double vision in one eye. According to the Global Burden of Disease Study 2019, the global burden of cataracts has been increasing over the years, with a rise of 91.2% in disability-adjusted life years (DALYs) from 1990 to 2019. The study also found that globally, age-standardized prevalence and DALYs rates of cataracts peaked in 2017 and 2000, respectively. The prevalence rate of cataracts in 2017 was 1283.53 per 100,000 population, while the DALYs rate was 94.52 per 100,000 population in 2000. The burden of cataracts is expected to decrease by 2050. This may not hold true in the post Covid Era.

Earlier as per WHO, the prevalence of cataracts increases with age, from 3.9% at age 55 to 64 years to around 92.6% at age over 80 years. This epidemiology is fast changing to younger co-horts as per consensus building with the doctors and the intra ocular lenses (IOL) manufacturers. What is this new wave of cataract emerging from?

Sedentary lifestyle during lockdown leading to diabetes, high blood pressure or obesity
Excessive exposure to devices such as mobile, laptops over long working hours during work from home
Some of the experts believe (yet to be proven by longitudinal research) that it is the side effect of the covid vaccine.

But it is certain that cataract is spreading in a much wider age cohort.

Why did I go for Cataract IOL Implant Surgery?

After June 2023, the right eye’s sight started deteriorating faster than usual, despite the eye drops treatment. By early October, various tests recommended a surgical intervention. The surgeon also recommended for the IOL implant to the other eye within a month or two. Times up now. But the issue were:

What are my lifestyle requirements that the IOL implant needs to fulfill?
What type of IOL implant to select?
What make of IOL implant for the type selected?
Are there post-surgical life style modifications to be undertaken?

My Lifestyle Requirements

It is very important for those going in for surgery to decide on what sort of lifestyle modifications you would like to achieve post-surgery. In my case,

Reading: At the outset, I needed to get my eyes vision corrected that will enable me to read books, files on my laptop for 6 to 8 hours a day. I didn’t mind reading with corrective vision via spectacles. Therefore, post-surgery, there will still be a need for reading glasses.
Outdoor sports and activities: Wearing spectacles and playing aggressive sports has always been a handicap for me for years. Therefore, a full correction of my distance sight was very important to me

Types of Intra Ocular Lenses (IOL) to Select From

Depending on the requirements of the condition of the eyes and the vision correction for the lifestyle, there are different types of IOLs available. These include:

There are several types of lenses that can be used to replace the natural lens of the eye during cataract surgery. The most common types of lenses are:

Monofocal lenses: These lenses provide clear vision at a single distance, either near, intermediate, or far. You may need glasses to see clearly at other distances.
Multifocal lenses: These lenses have multiple focal points, allowing you to see clearly at different distances without glasses. However, they may cause some visual disturbances such as halos and glare.
Toric lenses: These lenses are designed to correct astigmatism, which is a common condition that causes blurred vision. They can also correct nearsightedness or farsightedness.
Extended depth-of-focus lenses: These lenses provide a continuous range of vision from near to far, with less visual disturbances than multifocal lenses.

Some of the factors that also need to be also considered are:

Visual needs: The type of IOL you choose will depend on your visual needs. Monofocal lenses are designed to provide the best possible vision at one distance, while multifocal IOLs have corrective zones built into the lens, allowing you to see both near and far objects. Extended depth-of-focus (EDOF) IOLs have only one corrective zone, but this zone is stretched to allow distance and intermediate vision. Accommodative lenses can also correct vision at all distances, using the natural movements of your eye’s muscles to change focus. Toric lenses have extra built-in correction for astigmatism.
Lifestyle: Your lifestyle can also play a role in choosing the right IOL. For example, if you enjoy outdoor activities or sports, you may want to consider an IOL that reduces glare and enhances contrast sensitivity.
Budget: Not all IOL types are covered by insurance, and some can cost more than INR 50,000 out of pocket. Medicare and most insurance companies cover the cost of the most common IOL, the monofocal lens. Multifocal, EDOF, toric, light-adjustable lenses, and accommodative IOLs are considered premium lenses and can reduce the need for glasses or contact lenses.
Health: Your overall health and medical history can also play a role in choosing the right IOL. For example, if you have a history of eye disease or other medical conditions, your ophthalmologist may recommend a specific type of IOL.

Based on the above-mentioned types and factors, I decided to go for monofocal IOLs.

Not all manufacturers make all types of lenses. Moreover, many of these players are leaders in one type of lenses in terms of innovation or have invented specific materials. So which are the key manufacturers that I shortlisted.

Key IOL Manufacturer’s in My Consideration List

For monofocal IOL, my recommendation list is as under:

Johnson & Johnson: Johnson & Johnson Vision is a subsidiary of Johnson & Johnson that specializes in eye health products. They offer a range of IOLs, including the TECNIS Eyhance™ Intraocular Lens.
Alcon: Alcon is a global leader in eye care and offers a range of IOLs, including the AcrySof IQ PanOptix Trifocal IOL.
Hoya Corporation: Hoya Corporation is a Japanese company that specializes in optics and photonics. They offer a range of IOLs, including the iSert Preloaded IOL.
Bausch Health Companies: Bausch Health Companies is a Canadian pharmaceutical company that offers a range of IOLs, including the Crystalens AO.
Carl Zeiss Meditec AG: Carl Zeiss Meditec AG is a German company that specializes in medical technology. They offer a range of IOLs, including the AT LARA Toric.

The key issue here is that not all eye surgeons implant all manufacturers IOLs. Therefore, eye surgeons will recommend the IOLs that they are trained to implant.

Post Operative Eye Sight Recovery

Voila! My distance eyesight was fully corrected. I have no myopia now. But there was residual eye sight correction for reading and near distance such as laptop. My eye surgeon recommended me for a progressive lenses spectacles. Although, progressive lenses are a popular choice for people like me, who need vision correction for both near and far distances. However, there are some drawbacks to consider when choosing progressive lenses:

Adjustment period: It can take some time to get used to progressive lenses. I experienced dizziness while my eyes adjust to the new lenses.
Peripheral distortion: Progressive lenses have a small area of clear vision in the center of the lens, with the prescription gradually changing towards the edges. This has some distortion in my peripheral vision.
Cost: Progressive lenses can be more expensive than traditional bifocal or trifocal lenses. The cheapest lenses are worth INR 15,000.
Limited frame options: Progressive lenses require a specific shape and size of the lens, which can limit your frame options.
Prescription changes: If your prescription changes, you may need to replace your progressive lenses.

It has been 5 weeks since my surgery. However, I am still struggling with my progressive lenses from Titan EyePlus after two rounds of measurement and lenses. I have still 4 weeks of protective eyewear when I step outside. I have started using Polaroid Ultraviolet rays protection sunglasses when outdoors in the sun during the day.

This is my first extended time in front of the screen to work. Coming back to the Pandemic of Eyes. I did see people who were younger than me for cataract surgery waiting in the pro-operative area getting prepped. Look out for more on this issue.

Covid Pandemic is Bust : The Population Pandemic Awaits

Introduction

Recently, the World Health Organisation (WHO) played Beating the Retreat on Covid-19 and proclaimed that the global emergency on Covid is Over. The end tally of the Covid War Losses:

765,222,932 confirmed cases;
6,921,614 deaths;
Glaring short comings of healthcare infrastructure;
Economic and social disruption:
- Nearly half of the world’s 3.3 billion global workforce are at risk of losing their livelihoods, pushing nearly 0.82 billion into extreme poverty
25% increase in prevalence of anxiety and depression worldwide, affecting the mental health and well-being of people of all ages.
Entire food system is affected due to weather changes and disruptions in the supply chains, reducing access to healthy, safe and diverse diets.

While the post Covid war reparations are underway, there was another bugle on the population front. Last year we added the 8^th billion human on earth. This is going to be another pandemic in the waiting. The healthcare needs for 8 billion people is a horror war movie in the making. Closer home, India is going to be the most populated country in the world next year.

The Demographics of Population Pandemic

Global Population Pandemic

As a thumb rule, global population growth will stabilize when the birth rate and the death rate are equal. We will continue to grow till the fertility rate ie. the number of children born per woman falls below 2.1. As per various scenarios, the world population, currently around 8 billion, is expected to reach 9.8 billion in 2050 and 11.2 billion in 2100, and then decline gradually.

How we reached 8 Billion People on Earth?

India’s Population Pandemic

India’s population is expected to peak at 1.65 billion by 2060 and then decline gradually. According to reports woman fertility rate falls below 2.1 by 2030. India’s demographic transition from a high-fertility and high-mortality society to a low-fertility and low-mortality society. (From 2.33 children per woman in 2015 to 2.03 children per woman in 2021, while the life expectancy at birth has increased from 67.7 years in 2015 to 69.4 years in 2021. The population pyramid also shows that the number of children under 15 years old peaked in 2011 and has been declining since then, while the number of elderly above 65 years old has been increasing steadily. Also read: According to a report by The Times of India, India’s population will stabilize only in 2050 (2047 is our Amrit Kaal Amrit Kaal : Budget 2022 | Kapil Khandelwal KK) when the death and birth rate will be balanced. Also we have a higher than usual healthcare acuity due to our genetic make up Tedx Archives | Kapil Khandelwal KK

Managing India Population Pandemic, Its About Quality of Life and Health

For the Covid pandemic, India quickly ramped up the production of Covid Vaccine and also played the vaccine diplomacy. Over billion doses of Covid vaccine was supplied globally to different countries apart from immunising billion Indians. India has built global scale capacity for facing the pandemics. India is also looking to champion the agenda of healthcare for the Global South in its Chairmanship for the G-20 this year. But the issue around the demographics of the population pandemic goes beyond providing for healthcare.

As we plan ahead for the Amrit Kaal 2047 when India’s population growth stabilises, I have been writing and speaking on what is required. Let’s use the Roti, Kapda, Makaan, Dava-Daru (the last one is already addressed in my Tedx Talk Read Healthcare For All | Kapil Khandelwal KK)

Food security: We have to feed 1.6 billion mouths by 2047 two square mealsx365 days a year. We don’t have enough land mass to be able to produce food at that large quantum. Intensive, industrial scale agriculture would have to be introduced with Green Revolution 2.0. (see PM Task Force Report on Food and Agri Reform Food And Agri Reforms | Kapil Khandelwal KK)
Water Scarcity: For sustaining life, we had addressed linking of north rivers to south rivers and regenerating the water table
Sustainable Smart Cities: by 2047 over 60% of the population will be urbanized and would need sustainable and healthy living environment on a very concentrated urban land mass with lower levels of pollution.
Healthcare for All: We urgently need to invest USD 360 billion to come up to global standards on healthcare metrics. In addition, another USD 675 billion in the healthcare and life sciences value chain to sustain our current and future population and the health acuity today.

Let’s live and let live in a world that can sustain this population pandemic!

Assisted by ChatGPT 😉

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The Destiny is in Your Fingertips!

Many don’t know the miracles and health benefits of keeping your fingers in good shape. Here are seven key facts that you need on your fingertip about your fingertips.

Direct Connect to your brain

Like your feet, the fingers have millions of nerve endings that connect to the brain providing it with six different type of sensations as heat, tactile pressure, vibrations, texture, pain, and the position of the body in relation to its surroundings. This direct connection to brain of the fingers leads to stimulating and improving the neural functions of the brain.

Detect Minutest of Objects

The touch receptors in the finger tips are so concentrated that even a thinnest of a pin of 0.2 mm can be felt. The fingertips are even more sensitive to dynamic (or in-motion) touch that you’ll find you have a whole new level of intuitive, precise control.

Feel Vibrations

Our fingertips can decipher tiny vibrations that are created when any surface meets them. Different structures create different vibrations based on the amount of friction and wrinkle width (which is how scientists gauge non-smooth textures) present on its surface. Fingertips interpret motion vibrations in order to assist touch.

Move Without Muscles

Our fingers have tiny arrector pili muscles, which can make the hair on the fingers stand up straight. The brain communicates directly to the fingers for movement

Move In Harmony With One Another

Because of this complex network of muscle, tendon, and bone, it is incredibly difficult, if not impossible, to move one finger by itself. There are 29 major and minor bones, 29 major joints, at least 123 named ligaments, 34 muscles, and 48 named nerves in the hand—and they all work in conjunction with one another to make the fingers functional.

Communicate with Others

The fingers’ dexterity also supplies a vast well with possibilities for non-spoken language. Gestures and hand motions can also increase understanding among non-signing people

Our Aadhar (Identity)

It’s common knowledge at this point that no two fingerprints are alike, and because of this they’ve been used as personal identifiers for millennia—even our unique identification number (UID) uses our fingerprints.

Why the need now?

As I am getting older, I am seeing some of my friends and acquaintances parents suffer from Alzheimer’s, A type of brain disorder that causes problems with memory, thinking and behaviour. This is a gradually progressive condition. Some other mental degradation conditions include:

Dementia: A group of symptoms that affects memory, thinking and interferes with daily life.
Parkinson’s Disease: A chronic and progressive movement disorder.
Huntington’s Disease: A condition that leads to progressive degeneration of nerve cells in the brain.
Early-onset Alzheimer’s disease: Early-onset Alzheimer’s disease, also called early-onset Alzheimer’s, or early-onset AD, is Alzheimer’s disease hits people between the ages of 30 to 65 years
Vascular Dementia: A condition caused by the lack of blood that carries oxygen and nutrient to a part of the brain.
Lewy Body Dementia: A progressive dementia that results from protein deposits in nerve cells of brain.
Multiple Sclerosis: A disease that affects central nervous system.

Over 1 million new cases of Alzheimer’s in India are appearing every year. This is a huge issue not only for the person suffering but also for the family members and care takers. I was wondering if the onset can be delayed or avoided. During the pandemic, I was witnessing many people falling prey to mental illnesses and that could further degenerate to Alzheimer’s if not properly diagnosed and treated. I wondered on the need for some solution to combat this during the lockdown and pandemic. I looked towards music.

My Experience with Music

From my childhood I have been musically inclined. Apart from singing I was exposed to various musical instruments. As I grew up I started playing the guitar and learnt strumming and composing as a hobby. Somewhere in between my busy work life I gave up. However, I encouraged my kids to take up playing a musical instrument. As they grew up, I realised that playing a musical instrument was therapeutic and help them focus better. During pandemic I took up to walking to remain fit and during my walks I would listen to rock music. This did help me in reducing my weight and remain calm and sharp while working alone in my office during the lockdown.

Another issue that I realised is that I am typing more and writing less. This is another reason that my finger tips were not being adequately used. To balance all this, I acquired a Yamaha acoustic guitar to connect back to music. How does this help?

There are several research papers on internet that tells how using the fingertips while strumming the guitar helps. Here are a few that I have felt:

Playing guitar helped to lower blood pressure and reduce heart rate as it is mentally calming. A recent BMJ study suggests the same heart health benefits.
Relieves stress and anxiety and reduces cortisol levels in me
My brain was sharper and memory clear. A recent study states, playing a guitar or any string musical instrument is helping to stave off degenerative diseases that are common in older people, including Alzheimer’s and dementia. In fact, seniors who engage in the kind of engaging mental activities like playing an instrument can reduce their risk of developing these conditions by up to 75%.
My creativity increased. Enough studies state that
Mathematical and numerical dexterity increased. It’s not that I am now going to sit for some competitive exams like CAT. But I could focus back on numbers
My vibrational energy significantly improved
Lastly, my interpersonal communications and relationships took a huge 360 degrees turn for the better

So it’s upto you. What strings you would like to pick up? Towards mental degradation or mental upgradation?

The destiny is in your fingertips.