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28th June 1998

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Vision: are you wearing glasses?

By Dr. A.B. Abeysinghe

The eye is comparable to the pinhole camera but in the eye, image is focused on the visual membrane by two parts namely a) the cornea and b) the lens. Further the length of the globe (eye ball) has to be within the focal length to obtain a clear image.These parameters are within the normal levels in a normal person who sees everything clearly unaided. In the others all or one of the parameters is defective, as a result of which an unfocused image is formed on the visual membrane which appears blurred to the subject. The diagrams indicate the poor focusing.

in association with Tha Sunday Times
in association with
The Sunday Times

There are four weaknesses that are described in the eye.

Pic 1 and 2

(1) Myopia where the image is not focused on the visual membrane but appears in front of the visual membrane

(2) Hypermetropia where the image is focused behind visual membrane

(3) Astigmatism where in different planes the light rays are focused in front or behind the visual membranes

(4) Presbyopia which is due to an age change occurring in the lens, at the age of forty. One is not able to read near due to this problem.

Correction of these problems with glasses is important if one is to get clear sight. These weaknesses tend to occur in families but sometimes can occur in a sporadic manner with no family members being involved. Therefore when one or both parents are wearing glasses the children should be tested in early life for glasses. In children, if weaknesses are not corrected early, their sight become poor, and sometimes even if they are corrected in later life the sight may not be correctable to hundred percent. Some children develop squints due to these weaknesses that disappear when the weakness is corrected.

How to recognize these problems. Some of the children who suffer from these problems will develop squints. Others will hold their reading matter very close to the eye or sit very close to the television

Screen. Others will make mistakes in identification of letters, figures and fare badly in their work in school, as they cannot see the blackboard clearly to copy. Some will complain of headache and tearing with reading. Adults too develop headache, tearing and discomfort in the eyes.

Some feel that they have to hold their reading matter further away than their normal reading distance to see clearly. Ladies especially find it difficult to thread the needle when they sew.


The commonest complications that can develop in the eyes due to eye strain are, tearing, headache, recurrent sties and lid infections. These problems will disappear after correction of the weaknesses. Sometimes when the spectacles are bought new the wearer gets headache and discomfort. These occur due to strong lenses or wrong lenses. Although the physician prescribes the lenses the optician may dispense them, wrongly in which case the wearer may not be able to tolerate them. Sometimes when glasses are worn for the first time the wearer develops headache. This problem will settle down when one gets used to the lenses. Bifocal lenses are another common problem where people cannot get used to wearing them. The bifocal lens has two parts. The top part is to see the distance and the lower part is for near vision. When we say near it is for normal reading distance only and you cannot see the floor with it. Most bifocal wearers get blurred sight when attempting to see the ground and tend to miss steps when going down the steps. The only way to overcome this problem is to take off the lenses when going down the steps or bend the head down to look through the upper part of the lens.

How long to wear the lenses.

This is a question most parents ask when a child is prescribed glasses. The spectacle is not a medicine like Panadol for headache. It’s a pair of lenses, worn to complete the weakness so that the image is focused clearly. A child needs clear sight to study, to see the blackboard while in class and of course to see the objects clearly when getting about. Hence children should wear the glasses most of the day. When glasses are prescribed to small children they should wear them throughout the day until they are about 8 to 9 years. Thereafter the wearing time can be relaxed. In children some weaknesses get better as they grow up and their glasses could be withdrawn when they do not require them any longer. Only the doctor should take this decision after an examination. Sometimes for students glasses are prescribed to help them with reading, particularly when they study for their ‘A’ level or ‘O’ level examinations. They could stop their glasses once the examination is over. Adults can wear their glasses whenever they want clear sight.

Tinted glasses. Tinted glass is a coloured glass where a colour is incorporated into the lens to prevent the noxious light rays entering the eye. The lens in the eye normally absorbs a larger portion of ultraviolet rays in sunlight. Smaller parts that enter the eye cause glare, or damage the visual membrane. The tints in the lens will absorb them and prevent the glare or damage to the visual membrane. The ultraviolet light that is absorbed by the lens in the eye too, over the years can cause cataracts. This risk becomes more with the present day ozone problem. The ozone layer normally cuts off most of the ultraviolet rays reaching the earth. But with the present day hole in the ozone layer the amount of ultraviolet rays reaching the earth has increased, which will increase the rate of cataracts especially with outdoor and field workers and they will develop cataracts in early life.

What colour to wear?

The purpose of wearing tinted lenses is to avoid the glare and to improve the clarity of vision on bright sunny days. Ideal colours for this purpose are brown, gray, green. Other colours like yellow, orange are worn when the clarity for colours is reduced due to eye diseases.

When to change glasses

The weaknesses in the eye do not remain the same throughout life. Hence once the glasses are obtained they should be rechecked and renewed at least once a year in case of children and once in two years in case of adults or whenever the doctor recommends.

Effects of wearing wrong glasses

When one wears wrong glasses the image is not properly focused on the visual membrane and leads one to strain to see the objects. This then results in headache, pain in eyes, tearing or recurrent sties.

Contact lenses

The Contact lens is a small lens, which could be placed on the cornea or the black area of the eye to improve the sight. It does the same work as the spectacle but it is not visible to outsiders. Hence for people who prefer to improve their cosmetic appearance they are ideal. Sometimes the weakness in the eye is very high so that when the spectacle is constructed the lens appears to be very thick and heavy. These thick heavy lenses distort the vision if looked through the thick part of the lens. For them too the contact lenses are advised to improve the cosmetic appearance and the vision. There are some eye diseases for which too the doctors recommend contact lenses.

The only snag in wearing a contact lens is that they can be worn only for a specific period of time and they have to be cleaned properly before wearing them. Hence if to be worn by a child it is better to buy them only when the child is old enough to handle them unless they are prescribed by a doctor.

Glasses after Cataract surgery

Cataract surgery is completely revolutionized today with the new techniques. The present day surgery is called Day Surgery as the patient is not hospitalized even for a day. One enters a few hours before surgery and the cataract surgery is done with the new system THE ‘PHACO’ system and the patient walks out an hour or two later. All cataract surgery produces two changes in the eye.

Distortion of the front part of the eye, which causes blurring of vision for distance due to, as mentioned at the outset of this article ‘astigmatism’.

2. Inability to read near without glasses as the artificial lens that is replaced within the eye cannot adjust for near vision.

These two problems have to be corrected with glasses. But with present day surgery the distortion that is produced in the eye is so little, one is able to see at a distance without glasses but needs one to read near.

The writer is a consultant Opthalmologist, Centre for Sight, Kandy

Medical MeasuresHerbal cure for diabetes?

The daily dose of insulin could be a thing of the past. Indian research on a new herbal drug indicates that it rejuvenates the pancreas - a first in the medical world - and improves kidney and liver functions. Even the west has evinced interest in it.

Today Moorthy, 56, and diabetic has a more active work schedule and is completely off insulin. Even the sweetmeats he occasionally takes do not raise his blood sugar level above 185mg.

The daily dose of insulin could be a thing of the past. Indian research on a new herbal drug indicates that it rejuvenates the pancreas - a first in the medical world - and improves kidney and liver functions. Even the west has evinced interest in it.Moorthy’s life partnership with the insulin syringe would have remained intact if a young industrialist P.N.E. Balaram, had not gifted him a herbal tablet. Balaram had been making the tablets in a corner of his factory in Thrissur, Kerala, and giving them away to diabetic patients. Simultaneously, he was testing it scientifically.

Now the world famous Mayo Clinic of the US has shown an interest in doing the testing — to find out if the herbal preparation really rejuvenates pancreatic cells which produce insulin.

A silent killer, diabetes has no cure in modern medicine; allopathic drugs can achieve only ‘disease management’, which means they help patients live with it. Living with diabetes is a full-time occupation involving meters, test strips, hospital trips, tablets, insulin shots, diet control — and the Constant fear of losing life and limb.

Patients who have taken it vouch for it. Among them are scientists, professors and industrialists. All display a new vigour. “It is a miracle,” says K.N. Suryanarayanan, a businessman who took it for a month and lost all unwanted blood sugar.

Balaram, 36, says he makes the medicine from common plants in Kerala, and that he got the formula from an old palm leaf manuscript. Written in Sanskrit, it apparently has a cure for several major diseases.

Balaram had watched his father waste away and die of diabetes. He knew the pain and the fear it caused while he massaged his father’s legs and cleaned the carbuncles caused by diabetic neuropathy.

Yet he did not show great interest when an out-of-town Ayurvedic vaid offered him the palm leaf book. They had met at Sri Krishna Temple in Guruvayoor, Thrissur, and soon formed a bond of affection. One day the vaid brought with him a palm leaf bundle wrapped in cloth.

For several weeks, the palm leaves lay untouched in Balaram’s house in Thrissur. But every time he went to the Guruvayoor temple he felt a tinge of conscience.

A few months later he made some Sanskrit scholars translate the manuscript into Malayalam. He collected the ingredients, prepared a formulation, and in 1987 gave the first dose to the diabetic father of a close friend. It was just out of curiosity.

After a week the friend came back for more medicine. His father’s blood sugar, which had resisted allopathic oral anti-glucose medicines, had fallen sharply.

It changed the way Balaram looked at the medicine. His business antenna was up. He started a quest that would lead to the setting up of a herbal pharmaceutical company.

Instead of merely mixing and selling a ‘wonder cure’, he travelled the scientific lane, setting up a small lab at his factory in Thrissur and hiring a team of researchers headed by V.S. Parasuraman, a former drugs controller of Kerala.

Over half a decade the team refined the formulation to make it what it is now: a potent drug. Feedback from Balaram’s friends and acquaintances who tried it out was exciting. All of them, he says, reported a new feeling of well-being, besides a sharp drop in blood sugar.

He knew the sceptical world of endocrinologists — diabetes specialists — would dismiss it as a quack remedy. He needed scientific validation to convince them.

In 1992 he took the formulation to the Indian Council of Medical Research (ICMR), New Delhi. It asked him to go back home — to the Amala Research Centre in Thrissur or to the Sree Chitra Institute of Medical Sciences in Thiruvananthapuram.

At Amala the director, Dr.Ramadasan Kuttan, had long been researching on a herbal cure for cancer. While working with the M.V. Anderson Hospital in New York he isolated circumine from turmeric and published a paper on its anticancer properties in several Western medical journals in 1985. His work led to global research on circumine, particularly at the National Cancer Institute in Maryland, USA.

Dr. Kuttan, who has published more than 80 international papers readily agreed to test Balaram’s formulation on animals. Balaram used Dr. Kuttan’s contacts in the US to obtain the protocol for animal testing and imported the chemical alloxan - researchers use it to induce diabetes in animals.

He found that the formulation lowered the blood sugar and glycosylated haemoglobin (another indicator of diabetes) and vitalised the liver and the kidney. More startling, the formulation had reversed the damage that alloxan had done to the rats’ pancreatic cells. It was a major breakthrough in diabetes research.

“The drug,” says Dr. Kuttan, “has shown a remarkable ability to rejuvenate the pancreatic beta cells in laboratory tests on rodents. It is the first drug to show such results.”

The next step was human testing. Dr. Kuttan prepared a protocol and chose ten willing diabetic patients, one of whom dropped out midway. Balaram’s researchers put them through a month-long regimen of exercise and diet. When it was clear that the regimen had made no difference to their blood sugar they were given the herbal medicine.

Dr. Kuttan monitored their blood sugar and glycosylated haemoglobin levels, and kidney and liver functions every month, and found these normal at the end of six months. All the nine patients had registered a remarkable improvement.

Balaram rushed the test report to Kerala Health Secretary V. Vijayachandran who scanned it and passed it on to Prof. R.V. Jayakumar of the Thiruvananthapuram Medical College. An endocrinologist Jayakumar had started a diabetic clinic at the college and is one of the three principal investigators in a diabetic research project of the ICMR.

“The technical report brought out one thing clearly,” says Jayakumar. “The herbal drug did have anti-diabetic properties and had shown a promising ability to repair damage to the pancreatic beta cells which are responsible for producing insulin.”

Balarams, got in touch with Mayo Clinic in Minnesota, the world leader in diabetes research. He faxed a report to Mayo’s research director Dr. Sreekumaran Nair, who belongs to Kerala.

Within weeks Dr. Nair flew into Kochi and went back with a pouchful of samples. A fortnight later Dr. Nair telephoned Balaram: Mayo would bear half the cost of human trials.

Dr. Nair was, however, cautious “The preliminary data does show that the drug has repaired the damage to the pancreas, but it needs to be confirmed by careful and well-controlled trials. If the results from the proposed study in Thiruvananthapuram are promising I will be happy to perform some additional studies in the US.”

Balaram’s drug, named Cogent db, has cleared toxicity tests, and the state drug controller has issued a licence to start serial production. There is no anxiety to obtain a patent because, as Dr. Kuttan said, India does not register product patents, and it costs $20,000 for a US patent.

While Dr. Kuttan is writing a paper on his findings Balaram has put the technical report of the animal trials on the Internet (www. indianmade. com/cybele). He is making the blueprint for a Cogent db production plant in Idukki, Kerala.

-The Week

The body’s glucose factory

Running in order

Glucose enters the blood from two sources: from the intestine where carbohydrates are absorbed from digested food, and from the liver.

Liver stores glucose in the form of glycogen, converts it back into glucose and releases it into the blood stream.

Pancreas assists cells to assimilate blood glucose by secreting insulin. This lowers the blood glucose level.

The herbal drug works by:
  • Rebuilding the damaged pancreatic beta Cells.
  • Correcting receptor sites of Cells to help them assimilate the blood sugar.
  • Improving the functioning of the liver and kidneys.

Dr. Ramadasan Kuttan’s findings are based on the analysis of the pancreatic tissue of diabetic rats given the drug. He compared the tissue with those taken from rats which were injected with alloxan but received no drug and with the tissue taken from normal rats. He also studied the liver, kidney and haematological parameters of rats and humans who took the drug.

The body’s glucose factory

Glucose is essential fuel for the cells. Normal blood glucose level is necessary for the functioning of the organs

Kinks in the system

Blood sugar level rises in the case of damaged pancreas or when receptors on the cell walls, supposed to absorb the sugar, are defective. Sugar level rises when the liver fails to detect the high blood sugar level which forces it to release excessive glucose into blood. When the blood glucose level exceeds 180mg/dl to 200mg/dl it starts spilling into the urine

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