Polluted environment causes corneal diseases: Dr Shahzad

By Azizullah Sharif Prominent ophthalmologist and a former president of Ophthalmological Society of Pakistan (OSP), Dr M. H. Shahzad, who had remained associated with different prestigious healthcare institutions of the country and abroad, said here that polluted and filthy environment plays a vital role in causing corneal diseases such as trachoma and conjunctivitis. Ironically, most of sanitary staff, including sweepers and kundi men, get affected with trachoma (a contagious viral disease), he deplored during an interview with the Medical News. Dr Shahzad, who has vast experience of different branches of ophthalmology, did his graduation from King Edward Medical College, Lahore, in 1970 and FRCS in 1978, besides getting Diploma in Ophthalmology in1974. He received training at different prestigious hospitals like Sussex Eye in Brighton, and Oxford Eye Hospital, Oxford. In 1979, he went to Saudi Arabia to work in Riyadh University and finished his contract in 1984. He came back to Pakistan in 1984 and joined Aga Khan University Hospital and Akhter Eye Hospital, Karachi where he worked until 2016. Currently, he is medical director at Gulshan-e-Iqbal's Shahzad Eye Hospital. Being a senior eye surgeon, he has been providing all specialties such as cataract, retinal surgery, glaucoma, squints at the well-equipped hospital having the latest equipment like OCT, OCT angiography, ultrasound, fluorescein angiography, visual fields examinations, etc. Apprising about the eye diseases causing blindness in Pakistan, Dr Shahzad said that cataract, glaucoma, diabetes and corneal diseases/infections are the four major factors responsible for alarming increase in blindness in the country. Divulging into details, he said that cataract, which is commonly called `Safaid Motia' due to its appearance like a white pearl, is number one cause of blindness in the country. It usually appears in both the eyes of those over 50 years of age and, in some cases even at birth. Cataract was now being treated with most modern laser technology whereby vision is restored as close to nearly normal sight, he said, adding that a lens is implanted in the eye after removing the natural lens in cataract operations. Highlighting the importance of laser technology, he said that its usage is multipurpose. For stance, it is used for the treatment of retinal disease, like diabetes, to seal off any retinal hole; for devising any membrane that develops after a cataract surgery to clear vision as well as for getting rid of spectacles. In this connection, he pointed out that Excimer laser is commonly used for myopic and it gives best results for those having numbers ranging between minus 3 and minus 12. Giving details of inter-ocular lens (IOL), he said that there are two types of lenses - mono focal and multifocal. Those who get mono focal lens implanted in their eyes may not need glasses, but only for reading, whereas those with multi-focal lenses will be glass-free for both the distance as well as near sight. BRIDAL LENS : Narrating an incident in which a bride, who had got affixed coloured or tinted contact lenses in her eyes during her make-up at a beauty parlour on the eve of her wedding, Dr Shahhzad said that the bride had developed serious corneal scarring with acute pain in her eyes the very next morning of her marriage. "The bride's in-laws brought her to my hospital shortly after she developed this condition where she was immediately given treatment," he said, advising that tinted contact lenses must not be worn while sleeping as they may cause serious corneal scarring and that may need corneal grafting. GLAUCOMA: Describing glaucoma as the No.2 cause of blindness across the world, he urged the people having family history of glaucoma, myopia (shortsightedness or nearsightedness) and diabetes to get their eyes' pressure checked off and on so as to know whether it is under control or not. If the pressure ranges between eight (08) and 18mm mercury then it is fine, but if it is 20 and above mm of mercury, then such a person is suspected of having glaucoma. At this stage, it is preventable and curable and such a patient is given medicine after every four months. If the glaucoma is diagnosed at an advanced stage then such a person undergoes surgery, yet the chances of his/her recovery are not promising, he opined. In this regard, Dr Shahzad cationed the people that once eyesight is lost owing to glaucoma then it cannot be restored. Describing diabetes as the third common cause of blindness in Pakistan, he advised diabetics, specifically young and insulin-dependents, to control their sugar level, have regular check-ups, or else the chances of the chances of their becoming victim of diabetic retinopathy, in which retina's blood vessels become weak and blood start oozing, cannot be ruled out. In fact, retinal detachment is a disorder of the eye in which retina separates from the layer underneath and its symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field, he said, adding that it may be described as a curtain over part of the field of vision and in about seven (07) per cent of such cases both eyes are affected and without treatment permanent loss of vision might occur. Elaborating about the eye disorder, he said that the mechanism most commonly involves a break in the retina that then allows the fluid in the eye to get behind the retina. A break in the retina can occur from a posterior vitreous detachment, injury to the eye, or inflammation of the eye and as such those having such symptoms, particularly those who are myopic, must consult doctors. Underscoring the need for controlling their sugar level and checking eye pressure, he exhorted such patients to undergo a test called HbA1C so once the disease is diagnosed at an early stage, it can be treated through laser. However, if it remains undiagnosed or diagnosed at an advanced stage, the chances of recovering from it become quite remote, he added. CONJUNCTIVITIS: Talking about conjunctivitis, he said that it is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Although allergens differ among patients, the most common cause is hay fever. As far as its symptoms are concerned, they comprise redness (mainly due to vasodilation of the peripheral small blood vessels), edema (swelling) of the conjunctiva, itching, and increased lacrimation (production of tears) and if this is combined with rhinitis, the condition is termed allergic rhino-conjunctivitis. These symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears, he added. Asked if it is true that one should avoid applying ‘Arq-e-Gulab’ while suffering from conjunctivitis, he said, of course, one should not use it for the treatment of conjunctivitis as it  (Arq-e-Gulab) reportedly contains steroids and as such it is harmful. "In fact, treatment of allergic conjunctivitis is by avoiding the allergens (e.g., avoiding grass in bloom during "hay fever season" and treatment with antihistamines in the form of eye drops, or systemic in the form of tablets). Antihistamines, medication that that stabilize mast cells, and non-steroidal anti-inflammatory drunds (NSAIDs) are general safe and usually effective, he added. TRACHOMA: Deploring that most of the sanitary staff get affected with trachoma, he explained that it's a chronic viral disease marked by inflammation of the conjunctiva and cornea of the eye and the formation of scar tissue. Asked if the sight of a person born blind could be restored, he replied in the `negative', saying that some conditions by birth are usually non-treatable. At the outset, Dr Shahzad advised the motorcyclists to wear helmets and motorists should fasten seatbelts to avoid eye injuries which are common in traffic/road accidents, or there could be visual losses.