PATIENT CARE

15 must know facts about Typhoid fever

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Typhoid fever is a serious condition. These are 15 must know facts about the disease Typhoid.

1. What are symptoms of Typhoid Fever ?

The classic symptoms of Typhoid Fever is sustained fevers as high as 103 F – 104 F (37.5C-38C). The fever is minimal in the first few days of the illness and increases over time to high fevers. Other common symptoms include

  • weakness
  • Generalized malaise (exhaustion and fatigue)
  • Headache
  • Relatively slow heart rate compared to the high fever.
  • Diarrhea
  • constipation
  • Loss of appetite

  Some patients will also have a distinctive rash on their chest and abdomen, which is rose – colored and flat (rose spots). Some patients will have an enlarged liver and spleen. If left untreated, the illness last approximately one month and carries a 10%-30% mortality rate. Which is usually due to intestinal hemorrhage or perforation.

More details

2. Is Typhoid a communicable disease?                               

 Yes, It is a communicable disease. The Germ-negative bacterium that causes typhoid fever is Salmonella Typhi, also known as Salmonella enterica serotype Typhi. Salmonella Typhi is spread through the fecal oral route from individuals that are currently infected and from asymptomatic carriers of the bacteria.

3. How long can typhoid bacteria live?

It depends on how many bacteria you have swallowed. It is usually between 7-14 days, but can be as short as three days, or as long as 30 days. Untreated, the illness usually lasts for three to four weeks, but may be longer in a small number of cases. Symptoms very from mild to severe and life-threatening.

4. How can measure a typhoid fever?

Salmonella antibodies or antigens support the diagnosis of typhoid fever, but these results should be confirmed with cultures or DNA evidence. The Widal test was the mainstay of typhoid fever diagnosis for decades. It is used to measure agglutinating antibodies against H and O antigens of S typhi.

5. What are the causes of Typhoid Fever?

Typhoid Fever is an acute illness associated with fever caused by a bacterium, Salmonella typhi. These bacteria adhere to ileal tissue,survive in macrophage cells, are carried to mesenteric lymph nodes and reach the lymphatic system. They are further carried to the liver, spleen and bone marrow.It can also caused by Salmonella peratyphi,a related bacterium that usually causes a less severe illness.The bacteria are deposited in water or food by a human carrier and then spread to other people.

 6. Is typhoid fever serious?

  Typhoid fever is a serious condition. The most common complication of typhoid fever is bleeding in the gastrointestinal tract,as the infection damages the lining of the intestine. Other complications that can occur as a result of the severe dehydration , bacteria spreading throughout body, include kidney failure inflammation of the abdominal wall lining ,inflammation of the heart muscle and lungs.  

7. What meal should be given to a typhoid patient?

  • Soft cooked vegetables, mashed potatoes and fruits like apple, banana and oranges.
  • Sufficient fluids like coconut water, lassi, fruits juices and glucose water.
  • High intake of carbohydrates which are easily digestible like soft rice, porridge and fruits custards.
  • Have small frequent meals.
  • Light biscuits, bread and jam, thin vegetable soups and thin dals can be had.
  • Avoid spicy, fried food, meats, butter and ghee.
  • Avoid high fiber diet and whole grains.

8. Can we drink milk while having typhoid?

Yes milk can be taken during typhoid. Typhoid is usually transmitted by faeco-oral route.So avoid outside food and always carry your own drinking water. Complete the course of antibiotics .

Typhoid fever is caused by bacteria (Salmonella typhi). The bacteria are passed on by eating food or drinking wate that has been contaminated by someone with the disease. You can also get the disease if water used for drinking or washing food is contaminated with sewage contanining the bacteria.

9. Can drinking alcohol reduce a fever?

No

10. Does typhoid occur only once in a lifetime?

No, typhoid fever can be recurrent. It is a strict human pathogen and colonise the small intestine of the infected human hosts. Asymptomatic long-term colonization occurs commonly in infected hosts. Infected typhoid patient and more frequently carriers are important reservoirs of infections for typhoid fever. Food handlers or cooks who become carriers are potentially dangerous to the community. Food, vegetables or water contaminated human faeces by S. typhi are the common sources of infection S. typhi infections occur when food or water contaminated by infected food handlers or due to poor personal hygiene is ingested. The infectious dose for S. typhi infections is low, so person-to-person spread is common. Relapse due to typhoid can occur, but it is not that common. Relapses are common if antibiotics are not taken for full 15 days.

11. How do I treated Typhoid?

Typhoid fever is treated with antibiotics and fluids. It consists of supportive care through iv fluids (delivering fluids, medication or blood directly into a vein) and oral rehydration therapy giving fluids by mouth to treat dehydration caused by Diarrhea.

     Medications include antibiotics, which stop the growth or kills bacteria and penicillin antibiotic stops growth of or kills specific bacteria.

Generally,

     Ampicillin and trimethoprim-sulfamethoxazole frequently prescribed antibiotics.

     Ciprofloxacin is often prescribed for pregnant patients.

12. Can Typhoid be cured in 2-3 days is diagnosed the first day?

If Typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed for patients. Most people need to take these for 7 to 14 days. Your symptoms should begin to improve within 2 to 3 days of taking antibiotics.

         Salmonella antibodies or antigenssupport the diagnosis of typhoid fever, but these results should be confirmed with cultures or DNA evidence. The Widal test was the mainstay of typhiod fever diagnosis for decades. It is used to measure agglutinating antibodies against H and O antigens of S typhi.

Are any side effect associated with Typhoid Fever Vaccines?

As with any medication, the vaccine could cause a serious problem (for example, an allergic reaction). However, side effects from typhoid vaccine are generally mild and self-limited. Side effects of the shot include redness and soreness at the injection site, fever and headache. Side effect of the oral vaccine (the pill form) include fever, headaches,nausea,vomiting and rash.

Further details

http://www.who.int/immunization/diseases/typhoid/en/

13. I’m done taking antibiotics for typhoid but symptoms persist?

Drug resistant typhoid may be the reason.

consult your doctor for further advise.

14. Is typhoid (1GM positive) contagious?

Yes

15. Prevention of typhoid fever

A. Safe water

Typhoid fever is a waterborne disease and the main preventive measure is to ensure
access to safe water. The water needs to be of good quality and must be sufficient to
supply all the community with enough drinking water as well as for all other domestic
purposes such as cooking and washing.

B. Food safety

Contaminated food is another important vehicle for typhoid fever transmission.
Appropriate food handling and processing is paramount and the following basic hygiene
measures must be implemented or reinforced during epidemics:

C. Sanitation

Proper sanitation contributes to reducing the risk of transmission of all diarrhoeal
pathogens including Salmonella typhi.
Appropriate facilities for human waste disposal must be available for all the
community. In an emergency, pit latrines can be quickly built.
Collection and treatment of sewage, especially during the rainy season, must be
implemented. In areas where typhoid fever is known to be present, the use of human excreta as fertilizers must be discouraged.

D. Health education

Health education is paramount to raise public awareness on all the above mentioned
prevention measures. Health education messages for the vulnerable communities need
to be adapted to local conditions and translated into local languages. In order to reach
communities, all possible means of communication (e.g. media, schools, women’s groups, religious groups) must be applied.
Community involvement is the cornerstone of behaviour change with regard to hygiene
and for setting up and maintenance of the needed infrastructures.
In health facilities, all staff must be repeatedly educated about the need for :

  • Excellent personal hygiene at work;
  • Isolation measures for the patient;
  • Disinfection measure.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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PATIENT CARE

Water purification at home : Must know facts for everyone

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The WHO estimates that 94% of these diarrheal disease cases are preventable by access to safe water. Simple techniques for treating water at home, such as chlorination and filters  could save a number of lives each year. These are some  must know facts about water purification at home .

World Health Organization (WHO) reports that  1.1 billion people lack access to an improved drinking water supply. Ninety percent  of the 4 billion annual cases of diarrheal disease are attributed to unsafe water and inadequate sanitation and hygiene, while 1.8 million people die from diarrheal disease each year.  Simple techniques for treating water at home, such as chlorination, filters,and storing it in safe containers could save a huge number of lives each year.[2] Reducing deaths from waterborne diseases is a major public health goal in developing countries 

 

As per wikipedia ” Water purification is the process of removing undesirable chemicals, biological contaminants, suspended solids and gases from water. Purifying water may reduce the concentration of particulate matter including parasitesbacteriaalgaevirusesfungi, as well as reducing the concentration of a range of dissolved and particulate matter. The goal is to produce water fit for for human consumption (drinking water).”

 

1. Sediment Filtration

Fit for household having water supply having lot of sand, dirt and other solid waste. It is seen in those locations where the water supply is derived from larger , open water storage tanks, which in turn receive water from polluted stream, or lakes.

This filter traps relatively large particles which may be present in the water-like dirt, sand, slime and grit. It is meant to filter large volume of water entire home.

It filters in two stages

1st Stage: — removes dust, particles, and rust. 
2nd Stage: gets rid of unpleasant chlorine, tastes and odours, cloudiness and colours

2. Water “softening,” ion exchange

Fit for household having water supply which is hard. Hard water results in deposition of calcium scales in the pipes utensils.

Ion exchange provides  removal of the metals responsible for pipe scaling and deposits. The process also removes various heavy metals, such as lead, mercury, iron, and cadmium, which have been associated with health concerns.

3. Granular Activated Carbon adsorption: 

Fit for household having smaller amount of  requirement and filtration is possible without electricity.

a form of activated carbon with a high surface area, adsorbs many compounds including many toxic compounds. Water passing through activated carbon is commonly used in municipal regions with organic contamination, taste or odors. Household filters for drinking water sometimes contain silver as metallic silver nanoparticle. If water is held in the carbon block for longer periods, microorganisms can grow inside which results in fouling and contamination. Silver nanoparticles are excellent anti-bacterial material and they can decompose toxic halo-organic compounds such as pesticides into non-toxic organic products.

4. Ultraviolet disinfection

Ultraviolet light (UV) is very effective at inactivating cysts, in low turbidity water, or low concentration of solid particles. UV light’s disinfection  is not effective as turbidity increases.

 

Ultraviolet light acts as a powerful sterilizing agent which destroys the genetic material within microorganisms, eliminating the possibility of bacterial or viral reproduction and proliferation . The dead organisms  are captured and removed during the prefiltering before the reverse osmosis purification process.

5. Reverse Osmosis

It is most preferred method of household water purification.

In reverse osmosis, high pressure is used to force water across a membrane while impurities are left behind. . Only the pure water is able to cross the membrane; even the dissolved impurities which cannot be removed by conventional filtration are captured and eliminated by reverse osmosis purification system.

Chlorine disinfection

The most common disinfection method involves some form of chlorine or its compounds such as chloramine or chlorine dioxide. Chlorine is a strong oxidant that rapidly kills many harmful micro-organisms. Because chlorine is a toxic gas, there is a danger of a release associated with its use. All forms of chlorine are widely used, despite their respective drawbacks. One drawback is that chlorine from any source reacts with natural organic compounds in the water to form potentially harmful chemical by-products. Although chlorine is effective in killing bacteria, it has limited effectiveness against protozoa that form cysts in water (Giardia lamblia and Cryptosporidium, both of which are pathogenic).

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Medical practice

Medical Abortions in India : Need for a policy change

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In a study published in the prestigious journal,  Lancet Global Health, 2018, Kirti Iyengar and Kristina Gemzell Danielsson have called for need for overhaul of policy on contraception and abortion in India. 

The problem estimate

It points to the huge burden of unintended pregnancy in India as India’s family welfare programme has been sterilisation-focused and the contraceptive needs of a large proportion of people are largely ignore.

Authors report that in 2015, half of the all pregnancies in India were unintended and that 15·6 million (14·1–17·3 million) pregnancies ended in abortions. It is surprising to note that more than 75% of abortions were obtained outside of facilities. Medical abortion drugs sold off the counter by chemists and informal vendors without prescriptions were main sources how these abortions were conducted.

Reasons

The reasons cited were, a shortage of number of trained providers, legal impediments, lack of privacy and confidentiality, and insistence on specific contraception as a precondition for providing abortion services

The authors call for needed in India to improve access to safe abortion services, especially medical abortion. One of the steps suggested was the simplification of service delivery guidelines for medical abortion  would also help increase access, even in rural areas.

Conclusion

As emphasized by the authors, improved policies to increase access to contraceptive services is an urgent priority in India to help millions of women avoid unintended pregnancies.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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PATIENT CARE

Retinoblastoma ( cancer of eye): An ultimate patients guide

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India carries the biggest burden of Retinoblastoma globally, with an estimated 1500 new cases annually, which account for almost 20% of total Retinoblastoma population. Regular screening of the children at risk should be done , so that Retinoblastoma can be identified as early as possible.  Some guidelines to help parents understand disease and its management. 

What is Retinoblastoma ?

Retinoblastoma is an eye cancer, seen in children less than 5 years of age, though  it may present be later in some cases.  Early treatment has excellent results for survival, nearly 100%. The delay in treatment is the major reason why survival is poor and is is universally fatal if not treated.

Why Retinoblastoma occurs ?

The risk of developing retinoblastoma in the lifetime of  a newborn baby is 1 in 18,000 to 30,000 . In the United States, there are reported  3.6 cases for each million children under the age of 15 years. we do not have the exact data from Indian population.

Retinoblastoma gene RB1

Mutations in the Retinoblastoma gene RB1   causes most cases of Retinoblastoma.

TYPES

  1. Heritable Retinoblastoma these account for about 1 in every 3 patients of Retinoblastoma. it means that a mutation in the Retinoblastoma gene RB1 is present in each and every cell of the body including sperms and eggs. these cases often present in both the eye and patients may have the same disease in other relatives also.
  2. Non-heritable Retinoblastoma   These account for about 2 out of every 3 patients of Retinoblastoma. It means that the  Retinoblastoma gene RB1 inherited by the child are normal at birth but in early childhood, both copies of the RB1 gene in certain retinal cells acquire mutations. these cases often present in one eye only and is not seen in other relatives.

Distribution of the patients across the world. The majority of patients reside in low and middle income countries, while the majority of Retinoblastoma Centers are in high income countries.

Why should children be screened for Retinoblastoma?

It is a cancer and delayed identification and initiation of treatment causes loss of eyesight, eye or even death. if the disease is identified in early stage, it can be cure and sight as well as life of  child can be saved. At-risk children should be screened very early in life by regular eye examinations so as to diagnose the cancer in its initial stages. It has been scientifically proven that early identification of the disease is associated with less advanced disease and better outcome in terms of saving vision and the eye.

Does every new born child needs to be screened ?

No

Who should be screened?

All offspring, twins and siblings of Retinoblastoma patients should  complete retinal examination for earliest identification of the disease. Other relatives need not be screened.

Current recommendations were:

  • At-risk children should undergo genetic testing
  • The child’s age and risk level should determine the frequency of serial dilated fundus exams, which should be performed by a physician
  • Newborns at high risk should be screened every 2 to 4 weeks during their first 2 months of life, whereas newborns with intermediate or low risk should be screened monthly.
  • high risk means
    • Bilateral Retinoblastoma diagnosed in any of the parents.
  • intermediate risk means
    • siblings of a patient diagnosed with bilateral Retinoblastoma
    • children of a person whose one of the siblings has Bilateral Retinoblastoma
    • children of a patient of Unilateral Retinoblastoma
  • low risk means
    • siblings of a patient diagnosed with Unilateral  Retinoblastoma
    • children of a person whose one of the siblings has Unilateral Retinoblastoma
    • children of a person whose one of the siblings had a children with  Bilateral Retinoblastoma
  • Necessary exam frequency declines as the child ages and may be discontinued at age 7 for children without an RB1 mutation
  • Children who carry an RB1 mutation should be screened indefinitely, every 1 to 2 years.

How is screening for Retinoblastoma done?

Complete eye examination is done  by a trained ophthalmologist / eye surgeon with or without anaesthesia.

Genetic testing of Retinoblastoma.

The test which can predict the occurrence of Retinoblastoma in future, can help to save the vision of the patient  and avoid unnecessary (and invasive) eye examinations for first person who develop disease (proband) in a facility and their close relatives.  The disease exhibits a hereditary and a non-hereditary occurrence. One third of all children which have Retinoblastoma had a heritable tendency to develop tumors. The mutation in Retinoblastoma gene RB1   predisposes the retinal cells to undergo to malignant transformation, resulting in the disease occurrence. A child born to a parent with mutation in Retinoblastoma gene RB1 has a 45% chance of developing Retinoblastoma. These patients, multiple tumors and often in both the eyes.  15% of the patients, who have tumor in one eye, are also heritable. Siblings (brother and sister of patients with bilateral or unilateral Retinoblastoma have a risk of 3% and 0.5%, respectively, to have Retinoblastoma.

Genetic testing services of Retinoblastoma, available in India.

There are many hospitals which are offering the genetic testing for Retinoblastoma. At Shankar netralaya, Channai, this test cost around 12000 INR for a family of four (parents and two children). There are few private labs, which are also offering at price of about 30,000 INR per person. Genetic screening  cost one sixth of the cost of clinical testing to rule out Retinoblastoma in a person.

Can we prevent  Retinoblastoma from happening in a child?

As per our present understanding of the disease, there are no known avoidable risk factors for Retinoblastoma. So there is no way to prevent it. If a child has developed Retinoblastoma, it’s important to realize that it is not his fault.some type of gene changes put the child at risk of developing Retinoblastoma. if any member in the family ever had Retinoblastoma, genetic screening  may help in identifying the child art greater risk of developing Retinoblastoma in life.

How does Retinoblastoma present in a child?

Credit : Dr. Santosh Honavar

Clinical presentation of Retinoblastoma in India.

Clinical presentation of Retinoblastoma in India is different from what is reported from developed world. it is primarily because of late identification of tumor in children.

The most common presenting signs of Retinoblastoma in  Indian population are

1. White color reflex in center part of eye ( 75-81%) (leukocoria ) can be seen in video above(Credit : Dr. Santosh Honavar).

2.Out ward protrusion of eye ball( 5-17%) (proptosis) ( can be seen in the boy featured video above at 44 sec (Credit : Dr. Santosh Honavar)

Some of the children may have skewed eye( strabismus ) ( < 10%) or red eye ( <10%) as presenting sign of disease.

in India,  the average age of presentation/diagnosis of a child with Retinoblastoma is around 2 years and 6 months. Out of all the children 55-60% are boys, and rest are girls. Around 35-40 % of children have tumor in both the eyes, and rest have it in one of the eyes.

Signs and Symptoms of Retinoblastoma in developed world is slightly different.

Also read : Retinoblastoma Screening : Indian Scenario. 

What is the treatment for Retinoblastoma?

The most common modalities of primary treatment are the cancer drugs ( systemic chemotherapy) which is used to manage two third of the patients.Unfortunately one third of the patient might need removal of their eye at some stage of the treatment.

Outcome of treatment ( survival)

EXCELLENT: In India, scientific studies report that more than 90 percent children are completely cured of the disease with the available treatment.

Also read

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Dengue

Dengue: Patient’s guide for Dengue fever

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At times when newspapers are filed with headlines of Dengue cases,  and its complications , how should one decide what to do when one develops fever. Its a step wise patient guide to take a informed decision at every cross road.

CREDIT: DengueInfo

Step one : DO NOT PANIC

  1. Every fever is not dengue. Even in the season when lots of Dengue cases are reported, it is not the only cause for fever. Fever is one of the most perplexing clinical signs which is seen in diverse clinical conditions  from infections, malignancy ,drug effect  to environmental toxicity. In many cases, cause of fever could not be established even after   after intensive search. So do not presume that you have Dengue, just because few other cases are been reported it.
  2. Every patient of dengue is not at risk of serious illnessDengue fever is a severe  and flu-like illness but seldom causes death. India in year 2017 a total of seen 28,702  cases of dengue  were reported  out of which  46 patients succumbed . It is less that 2  per one thousand patients.
  3. High risk patients
    1. Children
    2. Elderly ,
    3. Patients presenting with hemorrhagic manifestations.
    4. Patients presenting with altered sensorium / disorientation.
    5. Patients with associated diseases,  diabetes mellitus , hypertension, chronic anemia, congestive heart failure, other cardiovascular diseases,
      chronic obstructive pulmonary disease, asthma, renal disease .

Step two: Medical consultation with nearest health facility.

Dengue infection has no specific treatment, but it does not mean that consultation with the nearest health facility is not required. One must consult the nearest health facility available.

Clinical course

Dengue infection is dynamic disease involving whole of the body. It has a wide clinical spectrum that includes both severe and non-severe clinical manifestations .

  1. Phase of fever when patient typically develop high-grade fever suddenly usually last for 2-7 days.
  2. Critical phase when the temperature drops to 37.5–38 degree  C or less usually on days 3–7 of illness. During this period the decrease in platelet count is noticed.
  3. Recovery phase If the patient survives the 24–48 hour critical phase, patient slowly recovers in the following 48–72 hours.

Severe dengue  If one or more of the following is present: (i) plasma leakage (ii) severe bleeding, and/or (iii) severe organ impairment.

Step three:  Selecting correct health facility for management :

Since there is no specific treatment of Dengue, the only way to prevent death in  a case of Dengue is  early recognition of the disease, and its management by the health care personal. When it is not possible to manage that patients, than the referral to a higher center.

Step four: Prevention is better than cure. Ensure that other family members are protected from mosquitoes so that further spread of disease can be avoided.

Best Mosquito control methods for your home.

key points are

  1. Prevention is better than cure.

  2. Most dengue patients recover without requiring hospital admission.

  3. Only some may progress to severe disease.

  4. Patient with severe disease need hospitalization and/or  critical care management.

Also read

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Cataract Surgery

Cataract surgery: an ultimate patient’s guide

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What should you do if you are told that you have cataract. It’s a step wise guide to help you decide what to pick when you have multiple options to choose. The aim is to enable you to take an informed decision at every cross road of your treatment plan.

.

You had  problem in reading the fine print in the newspaper . You went to a doctor and he/she says you have cataract. You ask him why is it has happened, and he/she consoles you that it’s simply because of aging and not much you could have done. When you ask him/her, what should you do, the often the answer is “go for surgery”.

Such an experience leaves a patient with more question than any answer to his problem. here is the list of steps you should take to handle it.

Step one: Do not panic.

Cataract is a very common clinical condition and is treatable.

At any point of time, there are about 20 million people in whole world who have cataract, and about third of them are in India. Around half a million people undergo cataract surgery every year in India alone, which means that it is very much treatable. Internet has lot content on this topic, but I would recommend NIH and Wikipedia as reference sites for basic information about cataract. Do not correlate that information with your case as it will leave you more confused.  Ask you doctor the questions you have about yourself.

Step two: Confirm why you developed the cataract?

Usually its age, but there could be others reasons also. There are many types cataract, and many ways to classify it. Do not try to find the answers on internet because it require lot of professional expertise to decide the cause. Just because you have , diabetes, does not mean you are having a diabetic cataract.  Ask your doctor to explain. Its important to know the reason . discuss with your doctor, the other medical conditions , you have,  like diabetes, hypertension, asthma, thyroid dysfunctions etc.

Step three: Do you actually need surgery?

Just because you have the cataract, does not automatically means you immediately require surgery. Mostly it is the compromised vision resulting from the cataract that people decide to have the surgery. Sometimes there could be other reasons as well, which are decided by your doctor only. You should discuss with your doctor, the extent to which your vision is compromised due to cataract, in involved eye and with both the eyes open, and the likely visual gain after cataract surgery in these situations.

An important reason for people to be unsatisfied with surgical outcome, is the lack of significant improvement in vision after surgery. You should also discuss what exactly is the room for improvement in your vision after surgery, in involved eye and with both the eyes open.

Step four: Can it be postponed?

Mostly it is not an emergency. Discuss with your doctor, about the duration for which it can be conveniently postponed. Cataract due to aging, unless contraindicated by the doctor, can be easily postponed for few months to accommodate more pressing employment and family matters.

Step five: when to get operated?

I think the two conditions mentioned below should be met before surgery is planned in age related cataract.

  1. Reasonable expectation of improvement in vision after surgery
  2. Stable associated diseases like, diabetes, hypertension, asthma etc.

Step six: where to get operated?

There are no rule of thumb to identify a good hospital from the rest, but certain general guidelines may be followed.

  1. Prefer a hospital/ facility which accredited by some accreditation agencies like NABH in India.
  2. Dedicated eye hospitals have better developed facilities for eye care that an eye department in a multi-specialty hospital.
  3. A facility with multiple eye surgeon practicing different eye specialties has better services than single surgeon facility.
  4. If you have personal acquaintance with the reputed individual surgeon, that’s the best choice.

Step seven: what type of surgery should you have ?

Most commonly surgical method for age related cataract is Phaco-emulsification with posterior chamber lens implantation, commonly known as Phaco. It’s neither required nor  possible in every patients.  There are other surgical methods also which are required in certain conditions in certain types of patients. You should discuss with your doctor which surgery is best in your situation. You should never insist for a particular type of surgery with your doctor.

Step eight: what type of anesthesia should you have ?

It’s same as surgery. Topical anesthesia in which the eye is anesthetized with a drop of anesthetic, is common way the age related cataract is operated, but there are other methods of anesthesia which are required in certain situations. You should discuss with your doctor which anesthesia is best in your situation. Insisting for surgery under topical anesthesia only, is a bad idea.

Step nine: what type of lens should be implanted ?

Posterior chamber lens are commonly used, unless it is not possible to implant that lens in eye due to medical reasons. They rigid and fold-able. Fold-able lens are better. They are available by different brands, and place of manufacturing (Indian /imported). Often the imported lens are expensive. I could not find a single scientific report which says that visual gain after surgery has any relation with the brand or the place of manufacturing of lens.

Monofocal and a multifocal lens

Other important issue is to decide between monofocal and a multifocal lens. The latter is supposed to provide functional vision for both near and distance, but lens are expensive. But that does not guarantee spectacle free life after the surgery. Some cases may still need glasses for certain type of task, even after an uneventful cataract surgery with multi-focal lens. Moreover it is associated with certain type of vision related complications like glare and reduced contrast of images. An article by Dr. Evans appropriately explain the pros and cons. If you want to know more, than there are many good scientific publications on this issue. Discussion with your doctor is the best way out. If you are still in doubt, gamble on mono-focal lens.

Robotic/Laser assisted cataract surgery

It’s a new technique in which some critical surgical steps are done using high precision laser. Other steps are common between laser assisted and traditional method. The down side is that it is more expensive that traditional method. The available scientific evidence by researchers (Popovic MDay AC) does not document any significant in the visual outcome after either of these techniques.

 Step ten: What are complications of surgery of surgery?

Complications during and after surgery are associated with every surgical procedure. Cataract surgery is no exception to this rule.

 Posterior capsular Rent ( PCR ) is (relatively common complication ) occurring during the surgery  and Endoththalmitis ( infection in the eye after cataract surgery) is uncommon complication happening after completion of the cataract surgery. These may require vitreo-retinal surgical support.  Discuss with your doctor regarding the availability of back up facility in hospital and its policy regarding the management of this complication.

Step eleven: Post operative care  after cataract surgery

Eye hygiene, protection and regular use of eye drops/medications constitutes the basic post operative care. But the care is individualized as per surgery and patient parameters. Its important to clearly understand it and follow the instructions issued.

share you opinion  on this issue in the comment section. Point out the issues i have left or you have a different take.

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Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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