Tuesday, November 2, 2010

Protect your eye from Fire Cracker during Diwali Festival by Dr Suresh K Pandey, Suvi Eye Institute Kota India

Posted by Dr Suresh K Pandey, Dr Vidushi Sharma
Suvi Eye Institute, C 13 Talwandi, Kota, India (http://www.suvieye.com/) Phone +91 744 2433575, 3292721We should celebrate Diwali Festival (the festival of light) while protecting our eyes from Fire Crackers.

Eye Trauma from Fireworks
     The use of fireworks by non-professionals leads to a significant number of injuries each year, many of which go unreported. The "legal" status of amateur fireworks varies from state to state, but certain types of fireworks are clearly more dangerous than others. Nevertheless, even sparklers, which are often dismissed as having minimal risk, burn at 1800 degrees (hot enough to melt gold).  Sparklers accounted for 10% of reported injuries in 1997.
Firecracker use accounted for 32% of the injuries reported (with 42% of the injuries associated with nationally illegal firecrackers).  Sky rockets, or bottle rockets, accounted for 15% of the injuries.  These are largely eye injuries, with bottle rockets accounting for most of the 2000 eye injuries per year associated with fireworks usage.

Fireworks Injuries by Type of Device
The U.S. Consumer Product Safety Commission (CPSC), through the National Electronic Injury Surveillance System (NEISS), collects data on injuries associated with consumer products, including fireworks. The data indicate which consumer product was associated with a particular injury, but do not mean that the product necessarily caused the injury.
For 1997, there were an estimated 8,300 fireworks-related injuries. The breakdown, by type of device, for the estimated injuries during the peak holiday season (June 23 to July 23, 1997) is:
Fireworks Device
% of Estimated Injuries
Sky Rockets
Spinners and Novelties
Roman Candles
Reloadable Mortars
Public Displays
Repeating Mines and Shells
Homemade Devices
Smoke Devices
1. Illegal firecrackers represent 42% of all firecracker injuries.

Fireworks Eye Injuries
Injuries to the eye from fireworks, most commonly bottle rockets, can be devastating:
·         Approximately 2000 eye injuries occur each year from consumer fireworks use.
·         About one-third of these injuries result in permanent eye damage and one-fourth in permanent vision loss or blindness.
·         Almost one in twenty fireworks-related eye injury victims lose all useful vision or require removal of the eye.
·         Data from the United States Eye Injury Registry shows that bystanders are more often injured by fireworks than operators themselves.
·         44 percent of the injured are children ages 19 years old and under.
·         72 percent of the victims were male. 

Prevent Blindness America warns that there is no safe way for non-professionals to use fireworks. It is only safe to enjoy the splendor and excitement of fireworks at a professional display.
While most injuries occur with legal fireworks, some states are debating legalizing an even broader range of fireworks. Heavy lobbying by the fireworks industry, promising more tax revenue through fireworks sales, may result in an increase in fireworks-related injuries.
The single most dangerous type of firework is the bottle rocket, which flies erratically and causes bystander injury.  The bottles and cans used to launch them often explode, showering fragments of glass and metal.
From 1980-1994, fireworks accounted for 29 fires, 65 explosions and 114 deaths. The victims of these accidents ranged in ages from 4 months to 88 years old.

Ocular Trauma from Fireworks
Eye injuries from fireworks and especially bottle rockets can be severe, with total loss of vision possible. This following photographs represent possible external eye injuries from fireworks. Internal eye injuries can also occur, easily leading to loss of vision through blunt trauma. Retinal injury can lead to an immediate loss of vision. Cataract and glaucoma can be long term problems. Remember, children bystanders are the most frequently injured.  
Examples of the Types of Injuries Possible with Direct Trauma from a Projectile type of Firework
Blood on Ocular Surface
Traumatic Eyelid Laceration
Torn Iris
Blood Layering out in Front Part of Eye (Hyphema)
Rupture of Cornea with Iris Prolapsing Out
Rupture of Cornea with Iris Prolapsing Out

Attending a public fireworks display on the Fourth of July is a safe and patriotic way to honor out tradition of independence, our shared values, and our hopes for a healthy future. Professional displays rarely lead to injury.
If an accident does occur during a non-professional display, what can you do right away to minimize the damage to the eye.  These eight action can help save your child's sight.
·         Do not delay medical attention even for seemingly mild injuries. "Mildly" damaged areas can worsen and end in serious vision loss, even blindness, that might not have happened if treatment had occurred immediately.
·         Stay calm, do not panic; keep the child as calm as possible.
·         Do not rub the eye. If any eye tissue is torn, rubbing might push out the eye's contents and cause more damage. Trying to rub the eye is an automatic response to pain, but pressure will only do more harm. Take the child's hand from his or her face.
·         Do not attempt to rinse out the eye. This can be even more damaging than rubbing.
·         Shield the eye from pressure. Tape or secure the bottom of a foam cup, milk carton or similar shield against the bones surrounding the eye: brow, cheek and bridge of the nose.
·         Avoid giving aspirin or ibuprofen (or other non-steroidal anti-inflammatory drugs, called "N-SAIDS") to try to reduce the pain. They thin the blood and might increase bleeding. Acetaminophen is the over-the-counter drug of choice. Unfortunately, non-prescription painkillers will not be of much help. It is better to by-pass the drugstore or medicine cabinet and get to the emergency room right away.
·         Do not apply ointment or any medication. It is probably not sterile. Also, ointments make the eye area slippery. This could slow the doctor's examination at a time when every second counts.
·         Above all, do not let your child play with fireworks.  If you must attend a non-professional fireworks display, have all present wear safety goggles (which may not prevent all injuries). Regular glasses will not prevent injury, and may break or shatter if impacted by flying debris.  Again, the best option is to attend a professional fireworks display.

Thursday, October 21, 2010

World Elder’s Day Celebrated at Suvi Eye Institute, Kota, Rajasthan, India

World Elder’s Day Celebrated

Kota. International day for Elderly people was celebrated at SuVi Eye Hospital and Research Centre, Talwandi, Kota on October 1, 2010. At this occasion an eye camp was organized and free eye checkup was performed by team of eye doctors- Dr Suresh K Pandey, Dr Vidushi Sharma, and Dr Nidhi Verma. Two hundred and fifty five elderly people were benefited. A public Seminar on topic “common eye problems in elderly people and their treatment” was held at SuVi Eye Institute campus. This was inaugurated by Chief Medical and Health Officer, Kota- Dr G S Sisodiya. Yog gurus Swami Harsanand, Sant Prabhakar Saheb (Kabir Ashram, Kota), Senior Physician Dr R N Tandon, Senior Eye Surgeon Dr K K Kanjoliya were also present as special guest.

Speaking at public seminar, Dr Vidushi Sharma, Director of SuVi Eye Institute, mentioned that age-related cataract remains the commonest cause of visual impairment in the elderly people. Other important causes of visual impairment are glaucoma, retinal diseases such as diabetic retinopathy and macular degeneration. It is possible to delay formation of cataract by eating nutritious diet, protection from harmful sun (UV) rays by using protective glasses. Dr Suresh Pandey mentioned that elderly people should undergo regular eye check up for detection of glaucoma (increase intraocular pressure). Diabetic patients should undergo regular retinal examination to detect diabetic retinopathy. Dr. G S Sisodiya appreciated effort of Dr. Suresh Pandey and Dr Vidushi Pandey to organize such event to benefit elderly people of the society. Swami Harsanand demonstrated some Yogic posture to keep body healthy. Sant Prabhakar Saheb shared few tips to keep elderly people mentally relaxed.

1. Dr G S Sisodiya inaugurating the public Seminar held at SuVi Eye Institute campus, Kota.

2. Dr Vidushi Sharma speaking at public Seminar entitled “common eye problems in elderly people and their treatment”.

Group Practice in Opthalmology

Group Practice in Ophthalmology

Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK)
Dr. Suresh K Pandey, MS (PGIMER), ASF (USA)
SuVi Eye Hospital & Research Centre
Kota, Rajasthan, Phone 0744-2433575,  09351412449
Website: www.suvieye.com

Why Ophthalmic Group Practice?
In recent years, Group Practice has become a concept, that is often talked about, and everyone seems to wax eloquent on how good and useful Group Practice can be for all involved. And yet, there are very few examples of a really successful group practice, where the stakeholders are all happy and the association can last for a long time. So, what is it about Group Practice that makes it an idea, “easier discussed than implemented”? Why is it that the list of perceived advantages of Group Practice is so long, and yet there are few models in practice, from which beginners can take inspiration and follow their example? Or is it that ophthalmologists are simply not suited for the concept? And after all, why make the change from Solo to Group practice, when solo practices have survived and done well for years?

The reason why we need to discuss all this is because our society, medical science, the nature of practices and everything else around us is changing so fast, that we need to respond equally fast to these changes and evolve new methods of keeping up. While it was alright till even 2-3 decades ago to take things easy, and a reasonable level of competence was enough for a doctor to survive and do well in society, with adequate financial remuneration and lot of respect; today the scenario has changed dramatically. It is still a matter of individual choice and personality to take things easy or not, but we now live in a very demanding society, with constant pressure to do more, be more and give more and there is ever increasing competition. Our role models are all ophthalmologists, who strived hard and achieved tremendous financial success and acclaim; and to achieve even a fraction of that today, needs a lot more hard work and varied skills to establish and run a successful ophthalmic practice. For doctors, the real need of the hour is to somehow become more efficient and achieve more (more technology, more expertise, more volumes, more attractive workplace) with less (less time, less staff and less money) and the need of the hour for the society is to contain the spirally rising costs of medical treatment. It would also be in the interest of ophthalmologists and doctors in general to try and evolve new models to contain medical costs, before we are forced to do so by society and government.

Group Practice Vs Solo Practice:
Where does the concept of Group Practice stand amidst all this? The advocates of Group Practice consider this as one of the best methods to contain costs and increase efficiency of doctors, allowing them more personal time. Most certainly, it is obvious that if a group of doctors can share the same equipment and staff and expert managerial assistance, the costs would come down dramatically and this arrangement would also allow doctors more flexibility in their daily work schedules. This would also make the group of doctors more strong in society and give them better negotiating power when dealing with diverse elements like insurance companies, organizations for empanelment, civic agencies, medical equipment manufacturing companies etc. This would also protect them from unwanted elements like blackmailers, corrupt officials etc. who unfortunately make doctors a soft target. This could theoretically become a win-win situation for all – the doctors in the group as well as their patients.

On the other hand, there are definite advantages to Solo practice. Though it may seem less glamorous and more outdated to see a single doctor managing everything in a small, unassuming set-up, but it really suits those who like to make their own decisions and chart their own course. You can decide your own timings; your own direction for future growth, work at your own pace and the money you make is all yours. Your only arguments are with your spouse and there is no need to have endless discussions about revenue sharing etc. And then, there are many examples of individual ophthalmologists, who have single-handedly earned more name as well as money than even large institutions.

The key therefore is to choose the right option for yourself. It is unwarranted to have a debate over whether Group Practice is better than Solo Practice or vice versa, but to choose what suits you best. Whether for solo or for group, it is imperative to have clear objectives and goals beforehand and chart your course accordingly. At the same time it is equally important to be honest to yourself as well as your colleagues. For example, it is perfectly legitimate for a beginner to join a group practice for few years, before starting a solo practice, to gain experience and earn some start-up money. But it would be best to be clear about this course and let the colleagues in the group know about your future plans. At the same time, the group should also honestly make it clear to the new entrant about the kind of responsibilities and job profile.

Pros and Cons of Group Practice:
Let us also have a closer look at some of the perceived advantages and disadvantages of Group Practice. For example, one of the most often cited advantage of Group Practice is sharing the cost of medical equipment, bringing down the start-up cost. Now, a beginner Solo Ophthalmologist, basically starts with a phaco set-up and expands along the way as the earnings increase. So, he/she would need about 25-30 lakh rupees for a good operating microscope, phaco machine, A-scan, slit lamp, OPD instruments etc. On the other hand, a group practice would usually be with members taking interest in different sub-specialties, which would need about 2-3 crore rupees, if the set-up for all sub-specialties is included. If this is shared among say 5 people, it would give a cost of 40-50 lakhs per person. Of course, it is possible to have a group start only with phaco set-up, but it would be most impractical in a new set-up for all group members to focus only on cataracts in a limited base of initial patients. While, there may be many variations to the basic concept of group practice and these examples may not be universally true, but this applies to most situations. Also, the idea of having more flexible schedules and personal time generally isn’t true, for the amount of work increases as the size of practice increases and also because of heightened patient demands. However, the system of Group Practice certainly allows for some leeway in situations like illness, personal functions etc., without breaking the patient chain, unlike in a Solo Practice.

In a nutshell, Group Practice is not so much about making quick money with minimal investment, even while working less and having more free time, but is more about achieving a broader vision and being able to do better quality work with cutting edge technology. The patients are also benefited as all sub-specialties and cross-opinions are available under the same roof. The patient care improves and the cost to the patient also comes down in some situations, not to forget situations like the dreaded nucleus drop, which can be immediately taken care of. This kind of group also attracts more patients, because it looks bigger and better and raises lesser doubts among patients.

Group Practice remains an elusive goal, which everyone wants to achieve, but is mostly out of reach. The most common reason for this failure is inability among the members to share a common vision. And that is the reason why Group Practice will always be a difficult to achieve utopian ideal, for it is impossible for any 2-3 or 4 people to agree on everything for a long time. Differences of opinion are bound to arise, egos are going to be ruffled, financial matters will become more and more touchy as the revenues increase; and that is perfect recipe for divorce.  So, are ophthalmologists not suited for this concept and should give it up? No, but make sure you find the right partners for your group. Discuss your goals and priorities very clearly before associating rather than somehow roping in people to provide capital and then realizing that everyone is moving in a different direction. Also, there doesn’t have to be a set pattern for Group Practice. There can be many variations on the basic theme of sharing expenses, administrative duties and financial returns, based on the unique requirements of your practice setting. For example, in a big city, it is possible to have independent OPD set-ups in different parts of the city and share a common operating facility. In a smaller city, it is possible to have some mobile equipments, which can be shared on a rotatory basis with someone being independently responsible for maintenance. The most important requirement for any arrangement to be successful is of course, HONESTY and trying to avoid any one up-man ship. But ophthalmology being so competitive, one up-man ship can be avoided only if there are very rational and acceptable models for revenue sharing. It is a good idea to have revenue sharing based on share in capital as well as individual productivity. It is extremely important to remember that perfect equality is a myth and there is no such thing as a 50-50 partnership. It is just like marriage where you must “keep your eyes wide open before marriage and half shut afterwards”. Often, it is a rewarding exercise to stop comparing your deal with your colleague’s deal and compare instead with what you would achieve if you went Solo. In practices, with members belonging to different age groups, there must be some acceptance for change in opinions that comes with age as well as changed training etc.

Conclusion: If we can learn to live with our small differences and inequalities and enjoy variety, we must try to form groups with clear and well-discussed goals. If not, there is absolutely nothing wrong in going Solo and singing your own tune, for a group is worthwhile only if it can deliver a coordinated jugalbandi rather than an uncoordinated cacophony.