Basketball, Baseball and Air/Paintball Guns Top the List of Leading Causes of Eye Injuries
More than 40 percent of eye injuries that occur every year are related to sports or recreational activities. A recent study found that about 30,000 people in the U.S. went to an emergency department with a sports-related eye injury, a substantially higher estimate than previously reported. Three sports accounted for almost half of all injuries: basketball, baseball and air/paintball guns.
Basketball was the leading cause of injury in males, followed by baseball/softball, and air/paintball guns. Baseball or softball was the leading cause among females, followed by cycling and soccer. In support of Sports Eye Safety Month in April, Acuity Eye Center Lahore Pakistan and the American Academy of Ophthalmology are offering athletes of all ages guidance on how to protect their eyes.
The good news is that simply wearing protective eyewear can prevent about 90 percent of eye injuries.
Follow these tips to save your vision:
Wear the right eye protection:
For basketball, racquet sports, soccer and field hockey, wear protection with shatterproof polycarbonate lenses.
Put your helmet on:
For baseball, ice hockey and lacrosse, wear a helmet with a polycarbonate face mask or wire shield.
Know the standards:
Choose eye protection that meets American Society of Testing and Materials (ASTM) standards. See the Academy’s protective eyewear article for more details.
Throw out old gear:
Eye protection should be replaced when damaged or yellowed with age. Wear and tear may cause them to become weak and lose effectiveness.
Glasses won’t cut it:
Regular prescription glasses may shatter when hit by flying objects. If you wear glasses, try sports goggles on top to protect your eyes and your frames.
“Virtually all sports eye injuries could be prevented by wearing proper eye protection,” said ophthalmologist Dianna L. Seldomridge, M.D., clinical spokesperson for the Academy. “That’s why I always strongly encourage athletes to protect their eyes when participating in competitive sports.”
Here is the message from our lead consultant Professor Dr. Zia Ul Mazhry,
" Protection of your eyes from eye injury is your own hands mostly. The most important thing you can do to protect your vision at work is to always wear appropriate protective eyewear, which can prevent more than 90 per cent of serious eye injuries."
Anyone who experiences a sports eye injury should immediately visit an ophthalmologist, a physician specializing in medical and surgical eye care.
MCI recommendations regarding issuing medical certificate.
A medical certificate or doctor's certificate is a written statement from a physician or other medically qualified health care provider which attests to the result of a medical examination of a patient. It can serve as a "sick note" (documentation that an employee is unfit for work) or evidence of a health condition.
The guidelines relating to the issuing of valid medical certificates as a doctor are shared in this article.
1. Never give it for more than 15 days.
2. See Patient again after 15 days and re issue.
3. Even in repeat case's, make sure that he or she are the patient , identify the pt. By photo I. D. Card , and then issue. *Not to the attendants.*
3. Avoid issuing certificate for diseases which you are not treating / or trained to treat. (Other Disciplines)
4. Describe the disability at best as you can even if you don't know how to grade it.
5. MOST IMPORTANT
*It is a legal document*
Even if you print otherwise, it is admissible in court & you can't say , " that it was not intended for legal purposes"
6. Certificate must address a particular person...."like Principal of school, employer etc.
*Don't write whomsoever it may concern.*
7. Never give from back date
8. Never give without your OPD days.
9. Never give fitness on advanced date or back date.
10. Never give fitness, if Rest given by somebody else.
11. Give if you can justify the disease or ailment and duration also for that particular disease.
12. If there is no disease, then always ask purpose why are you want to take medical, then only give 2- 3 days If someone's family member in severe life threatening to attending him on humanity ground, please verify it before giving, because opinion can differ person to person.
13. Physical presence is must because pt. May be at abroad or heavenly abode. So never write down PNB (Patient NOT Brought)
14. You are responsible class one gazetted officer verifying the physical presence and attendance.
Legally and valid document in court to justify the presence and absence of accused and deceased at the scene of crime.
*📲Pls.Share In ALL Drs Groups or DrFriends Whom You Know Immdly As Much As Possible Without Any Hesitation or Delay.*
Take reasonable steps to keep the certificates and patient records in a safe place.
Contact Our Team:
If you are looking for any of below services, please fill the form below, one of our team member will get in to provide you with full facilitation:
A laser is an intense, focused beam of light that can heat and destroy human tissue. Since the 1960’s, focused, carefully controlled lasers have been used for the treatment of human eye diseases. By carefully selecting the type and strength, a beam of laser can be fired into the eye to destroy diseased tissue or to prevent degenerative eye conditions from worsening.
Argon Laser photocoagulation to treat Diabetic and other retinopathies.
Yag Cutting laser to cut intra ocular tissues like opaque capsules after cataract surgery.
Excimer Laser treatment for refractive errors and to remove glasses.
Femto laser is used to raise flaps and place incisions during cataract and Refractive Surgery.
Diode laser is used to treat glaucoma in advanced cases resistant to medical and surgical treatments.
Laser trabeculuplasty for Glaucoma
Argon laser Marks on RetinaFemtosecond Laser being applied to raise a corneal flap
(C) parafoveal pattern of hydroxychloroquine retinal toxicity.
(A) Top to bottom: Superior field loss is located peripherally in pattern deviation plot (10-2 visual field). FAF image shows a broad range of hyperautofluorescence in inferior retina. SD-OCT image shows loss of photoreceptor layer in the pericentral area (arrow).
(B) Top to bottom: 10-2 visual fields (threshold and pattern deviation plot) are showing full ring scotomas. FAF image shows ring-shaped hyperautofluorescence in the parafoveal area (dashed curves) with diffuse hyperautofluorescence in the pericentral area (dashed curves). SD-OCT image shows disruption of the photoreceptor layer with loss of outer nuclear layer in both parafoveal and pericentral retina (arrows). RPE damage is combined in the extrafoveal region.
(C) Top to bottom: 10-2 visual fields (threshold and pattern deviation plot) are showing patchy parafoveal scotomas. Hyperautofluorescence is shown at a region just inferior to macula on FAF image. SD-OCT image shows parafoveal disruption of photoreceptor layer with loss of outer nuclear layer (arrow). RPE damage is suspected within the parafoveal retina. FAF: fundus autofluorescence; SD-OCT: spectral domain optical coherence tomography; RPE: retinal pigment epithelium.
Retinal Toxicity Progression
Severe HCQ retinopathy often progresses even after drug cessation Researchers used multimodal imaging to study retinal and vision changes after hydroxychloroquine (HCQ) cessation in 22 patients with HCQ retinal toxicity.
Their analysis revealed that eyes with HCQ retinopathy experience progressive changes in retinal structure and function after discontinuing treatment, and the magnitude of these changes reflects the severity of retinopathy.
Eyes with subtle, localized retinopathy, however, tend to remain stable and may gain functional improvement. Early detection of HCQ retinopathy is needed to stop retinopathy progression and improve long-term outcomes. Retina, March 2019
OPHTHALMIC PEARLS by AAO Article
Hydroxychloroquine-Induced Retinal Toxicity
Written By: Mark S. Hansen, MD, and Stefanie G. Schuman, MD Edited by Ingrid U. Scott, MD, MPH, Sharon Fekrat, MD, and Michael F. Marmor, MD
This article is from June 2011 and may contain outdated material.
Many systemic medications may cause retinal toxicity. One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine (Plaquenil), a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus.
Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. And before treatment is initiated with hydroxychloroquine, a complete ophthalmic examination should be performed to determine any baseline maculopathy.
Ophthalmologists should also follow the most current screening guidelines established by the Academy,1 recently revised in light of new findings.
Symptoms and Signs of Chloroquine Toxicity
Symptoms. Patients in earlier stages of hydroxychloroquine retinal toxicity usually do not experience symptoms, though the rare patient may note a paracentral scotoma that causes trouble with reading as well as diminished color vision. However, most patients usually notice symptoms only after scotomas have become severe. When allowed to advance, hydroxychloroquine retinal toxicity leads to loss of up to three visual functions: acuity, peripheral vision and night vision.
Signs. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful.
In early toxicity there are no visible signs, but field, OCT and mfERG changes can be detected. If abnormalities are present only unilaterally, investigate other causes besides hydroxychloroquine toxicity (see “Differential Diagnosis of Bull’s-Eye Maculopathy”).
Mechanism of HCQ Toxicity
The mechanism of hydroxychloroquine retinal toxicity has yet to be fully elucidated. Studies have shown that the drug affects the metabolism of retinal cells and also binds to melanin in the RPE, which could explain the persistent toxicity after discontinuation of the medication. However, these findings do not explain the clinical pigmentary changes causing a bull’s-eye maculopathy.
HCQ Medication Dosage
Several factors have been associated with the risk of developing hydroxychloroquine retinopathy. One of the most important appears to be dosage—with debate over whether daily intake vs. cumulative dosage is most significant. Recent studies indicate that cumulative dosage may be a more important consideration than daily dosage.2 However, since higher daily dosage will obviously lead to the toxic cumulative dose more rapidly, daily dosage is still important to consider. Higher daily dosage also leads to higher concentration of the drug in the RPE, which could lead to more aggressive tissue damage. Previous reports indicate that toxicity is rare if dosing is less than 6.5 mg/kg/day.2 To avoid overdosage, especially in obese patients or those of short stature, dose should be based on height, which allows for an estimation of ideal body weight. (The drug clears slowly from the blood, so basing dosage on weight puts obese patients at risk.) The typical daily dosage for most indications is 200 mg to 400 mg per day. Daily dosage is recommended not to exceed 400 mg.
Risk for HCQ Toxicity
Although it is not possible to predict which patients will develop retinal toxicity, high-risk characteristics include the following:
daily dose greater than 400 mg (or, in people of short stature, a daily dosage over 6.5 mg/kg ideal body weight) or total cumulative dose of more than 1,000 g
medication use longer than five years
concomitant renal or liver disease (because the drug is cleared by both routes)
underlying retinal disease or maculopathy
age greater than 60 years.
Monitoring Guidelines for Chloroquine Toxicity
Guidelines on screening for retinopathy associated with hydroxychloroquine toxicity were initially published by the Academy in 2002. These guidelines were updated in February of this year, given the emergence of more sensitive diagnostic techniques and the recognition that risk of toxicity from years of hydroxychloroquine use is greater than previously believed.
The updated guidelines state that due to sensitivity, specificity and reliability issues, it is not recommended that Amsler grid testing, colour vision testing, fundus examination and full-field electroretinogram or electrooculogram be used for toxicity screening. Fluorescein angiography may assist in visualizing early subtle changes in the RPE, but it is not considered a screening tool for retinal toxicity.
It is critical to counsel patients about the benefits and limitations of screening, underscoring that it can catch toxicity at early stages and minimize vision loss but cannot necessarily prevent all toxicity and vision loss.
Baseline examination. At the initiation of treatment with hydroxychloroquine, the prescribing physician should refer the patient to an ophthalmologist. During the initial examination, it is recommended that the patient receive:
1) a thorough ocular examination documenting any preexisting conditions,
2) a Humphrey visual field central 10-2 white-on-white pattern, and
3) at least one of the following objective tests, if available:
fundus autofluorescence (FAF)
multifocal electroretinogram (mfERG) or
spectral domain OCT (SD-OCT).
In fact, mfERG—a test that is typically available in large clinical centers—objectively evaluates the function and can be used in place of visual fields. It’s also worth considering the use of colour fundus photographs to assist in documenting changes over time, especially if there is preexisting retinal pathology. However, the dilated fundus exam should not be considered a screening tool, as it only picks up relatively late toxic changes.
Ongoing monitoring. Encourage the patient to obtain an annual ophthalmic examination as part of the screening process. Since toxicity is rare within the first five years of treatment, ancillary testing is not necessary unless abnormalities are noted on baseline examination. However, earlier, more frequent screening may be prudent for those at higher risk for toxicity. After five years of treatment, perform annual screenings, including an ocular examination, 10-2 threshold field testing, and one of the objective tests. In practical terms, SD-OCT is most widely available and is very sensitive, so practitioners should look for subtle parafoveal abnormalities.
Toxicity: suspected and confirmed. Whenever you note abnormalities, obtain additional testing. Repeat visual fields promptly if you see central or parafoveal changes, even if these appear to be nonspecific. If these findings are reproducible, follow up with objective testing. If toxicity is suspected, perform more frequent and detailed examinations. Once toxicity is confirmed, the prescribing physician should be notified and hydroxychloroquine discontinued unless it is medically critical and the patient has been informed of the visual risk. Before discontinuation, inform the patient that the drug clears slowly from the body and therefore visual function may continue to slowly deteriorate.
Differential Diagnosis of Bull’s-Eye Maculopathy
Age-related macular degeneration
Benign concentric annular dystrophy
Central areolar choroidal dystrophy
Chloroquine/hydroxychloroquine retinal toxicity
Chronic macular hole
Cone and cone-rod dystrophies
Stargardt disease
Conclusion
Patients and their physicians prescribing hydroxychloroquine need to be keenly aware of retinal toxicity risks and the importance of regular screening, and ophthalmologists who see these patients should keep retinal toxicity in the front of their minds. Adhering to the Academy’s guidelines will help achieve the goal of identifying abnormalities with screenings and examination prior to the patient’s visual complaints. ___________________________
1 Marmor, M. F. et al. Ophthalmology 2011;118:415–422. 2 Mieler, W. F. New Monitoring Guidelines for Hydroxychloroquine. Presented at Retina Subspecialty Day, Oct. 16, 2010, Chicago.
We have guidelines here to screen these patients- consensus opinions from the MR specialists...it’s a good read for the trainees...
On-the-job safety goes well beyond avoiding slips, falls, and heavy lifting. Caring for your eyes should be a high priority and part of an overall workplace wellness routine. Each day, about 2,000 U.S. workers sustain a job-related eye injury that requires medical treatment. However, 90 percent of these accidents can be avoided by wearing eye protection. As part of an ongoing effort to stress the importance of workplace eye wellness, the Acuity Eye Center Lahore Pakistan and the American Academy of Ophthalmology, during the month of March, is encouraging the public to do right by their eyes and wear appropriate eye protection.
Protect your eyes
Workplace eye injuries cost more than $300 million a year in lost productivity, treatment, and compensation. These injuries range from simple eye strain to trauma, which may lead to permanent damage, vision loss, and blindness. This is particularly true for workers in construction, manufacturing, and mining. Approximately, 40 percent of eye injuries in the workplace happen in these three industries.
If an eye injury does occur, an individual should seek care from an ophthalmologist — a physician who specializes in the medical and surgical treatment of eye diseases and conditions — or go to an emergency room for immediate care.
Caring for your eyes on the job should not be limited to those who do physical labor, however. People who spend long hours working on a computer can experience eye discomfort. Focusing on small font type for hours on end can cause eye strain, fatigue, and headaches. Staring at screens for long periods can also leave eyes parched and red, causing eyes to become dry from lack of blinking. This happens frequently as computer screens or other digital displays reduce a person’s blink rate by as much as 50 percent.
The Academy provides tips to help avoid workplace eye injury or strain:
Wear protective eyewear:
Protective Eye Wear
Ensure that your eye protection is appropriate for the type of hazard that may be present in your workplace, such flying debris, falling objects, chemicals, intense light, and heat. Your eyewear must be American National Standards Institute ANSI-approved and OSHA compliant. You must use special-purpose safety glasses, goggles, face shield or helmet if you are near hazardous radiation welding, chemicals, lasers or fiber optics.For more info https://eyeacuity.com/uv-rays/
Position your computer 25 inches away:
Position your computer 25 inches away
If you are working on a desktop computer, try placing the monitor at an arm’s length away from your face. You may need to adjust the font size to appear larger at that distance.
Follow the 20-20-20 rule:
Follow the 20-20-20 rule
Eye strain and dry eye occur after long, continuous periods of viewing digital screens up close. To help alleviate this, take a break every 20 minutes by looking at an object 20 feet away for 20 seconds. Looking at a distance allows your eyes to relax and return to a regular rate of blinking again. Normally, people blink about 14 times a minute and with every blink, your eyes are lubricated with fluid that contains moisturizing elements, including oil.For more info click https://eyeacuity.com/eye-strain/
Reduce glare on your smartphone and digital screen:
Reduce glare on your smartphone and digital screen
While many new phones and digital devices have glass screens with excellent picture quality, they also produce a strong glare that can aggravate the eyes. If you use a glass screen device, adjust the low light filter setting to lower screen brightness or use a matte filter to reduce eye strain.
Adjust environmental lighting at your work:
Adjust environmental lighting at your work
If your computer screen is brighter than your office surroundings, your eyes need to work harder to see. You can reduce eye strain by adjusting the lighting in your surroundings.
"It takes only a few seconds to protect yourself from eye related issues that can cause vision problems," said Brenda Pagán-Durán, M.D., a clinical spokesperson for the American Academy of Ophthalmology. “I can’t stress enough the importance of incorporating eye wellness into your daily routine; whether it’s simply adjusting the setting on your computer monitor, or wearing appropriate protection to avoid serious eye injury. This is truly an ounce of prevention that can safeguard your vision.” Here is the message from our lead consultant Professor Dr. Zia Ul Mazhry,
" Your eyes are windows to the brain regularly eating good foods with nutrients like Omega-3 , Lutein zinc and Vitomen-c may help to take care of problems like Macular Degeneration and Cataract formation.Get your eyes examine regularly to find any eye decease that can be treated in early stages."
For more eye safety tips, visit eye injury prevention at work. For information on computers and eye strain in the workplace, visit www.eyesmart.org and www.eyeacuity.com
Since you are in 40s or 50s, you probably noticed that your vision is changing. Perhaps you need glasses to see up close or you have more trouble adjusting to glare or distinguishing some colors. These changes are a normal part of ageing process. These changes alone cannot stop you from enjoying an active lifestyle or stop you from maintaining your independence. In fact, you can live an active life well into your golden years without ever experiencing severe vision loss. But as you age, you are at higher risk of developing age-related eye diseases and conditions. These include: age-related macular degeneration, cataract, diabetic eye disease, glaucoma, low vision and dry eye.
Get a comprehensive dilated eye exam.
Everyone age 50 or older should visit an eye care professional for a comprehensive dilated eye exam. Many eye diseases have no early warning signs or symptoms, but a dilated exam can detect eye diseases in their early stages before vision loss occurs. Early detection and treatment can help you save your sight. Even if you aren’t experiencing any vision problems, visit your eye care professional for a dilated eye exam. He or she will tell you how often you need to have one depending on your specific risk factors.
Common Age-related Eye Diseases and Conditions:
Age-related Macular Degeneration (AMD) AMD is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. Learn more about AMD.
Photographer: Mariia Chalaya | Source: Unsplash
Cataract A cataract is a clouding of the lens in the eye. Vision with cataract can appear cloudy or blurry, colors may seem faded and you may notice a lot of glare. Learn more about Cataract.
Cataract
Diabetic Eye Disease Diabetic eye disease is a complication of diabetes and a leading cause of blindness. The most common form is diabetic retinopathy which occurs when diabetes damages the tiny blood vessels inside the retina. Learn more about Diabetic Eye Disease.
Diabetic Retinopathy
Glaucoma Glaucoma is a group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness. It is usually associated with high pressure in the eye and affects side or peripheral vision. Learn more about Glaucoma.
Glaucoma
Dry Eye Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly. Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time. Learn more about Dry Eye.
Dry Eyes
Low Vision Low vision means that even with regular glasses, contact lenses, medicine, or surgery, people find everyday tasks difficult to do. Reading the mail, Driving, shopping, cooking, seeing the TV, and writing can seem challenging. But, many people with low vision are taking charge. Learn more about Low Vision.
Low Vision
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1- Comprehensive Primary Eye Exam/ Consultation
Consultation ::: Adult Eye Examination and Consultation Consultation ::: Children Eye Examination Refraction Consultation Consultation ::: Infant Eye Examination Refraction Consultation 2-Secondary Follow up Eye Examination and Consultations
Followup ::: Examination under Sedation for Kids (After Initial Consultation) Followup ::: Dilated Fundus Examination(DFE) Followup ::: Cycloplegic Refraction and DFE 3-Diagnostic Eye Test
Diagnostic ::: OCT Diagnostic ::: Angio OCT Diagnostic ::: Anterior Segment OCT Diagnostic ::: Pachymetery Diagnostic ::: Perimetery/Visual Fields Diagnostic ::: Hess Chart/Digital Squint Assessment/Digital Diplopia Test Diagnostic ::: Digital Colour vision test
