Professional Documents
Culture Documents
The Sight Vol 4
The Sight Vol 4
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Financial Aspect:
Funds collected for The Sight a major source (ads from optical +aids from Campus +BPKLCOS) Sale: B. Optom entrance preparation guide, Brock-string vision therapy kits as prescribed from orthoptic unit of BPKLCOS, NOSS T-Shirts, Low vision bold line copy, Pinholes. Membership levies from new comer optometry students. Plan: Megabucks can be collected from school screenings and entrance crammer classes, selling CDs about handle and care of contact lens from CL unit, BPKLCOS to interested patients, selling Dristi magazine, from the advertisements in our official website, public awareness program and eye health campaigning collaborating with NGOs, INGOs.
Invited Article LEARNING PROBLEMS ARE BRAIN PROBLEMS: WHAT NEUROLOGY, OPTOMETRY, EDUCATION, PSYCHOLOGY AND PSYCHIATRY HAVE IN COMMON. Merrill D. Bowan, O.D.
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One failure of many professionals is in recognizing that the phenomenon of perception is as much or more a neurophysiological process as it is a psychological process, though it has elements of both. As will be discussed later, a persons environment has an impact on not only their learning, but surprisingly, also on the brains anatomy. Visual therapy specialists have informally speculated this upon for years, and current neural research and clinical investigations support this clinical impression. Further research will elaborate the mechanisms, many of which appears to center around stress and coping. Perceptions affect cognitive associations, which in turn affect relationships in the brains understanding of its environment both the physical world and the social/emotional one, as well. Social relationships help to mold much of our ego concepts. Virtually all rational problem solving will suffer when perceptual problems exist. Because of the central nervous system interactions, perceptual problems wind up creating not only learning problems but interpersonal and ego problems as well. This is not to say that all psychological problems are the result of perceptual difficulties. However, A.M. Skeffington, the patriarch of behavioral optometry, often said in his lectures: A person insecure in his visual state will be a person insecure in his ego state. HOW CAN THE BRAIN BE CHANGED? There are five ways by which we can influence the brain to make it change:
1.
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Vyvanse, Prozac, Valium, antipsychotics, etc.). This is the most common avenue of deliberate intervention.
3.
instruction. This is the basis of daily change in our brains. It is normally a slow, deductive and inductive, often random process that can be applied in a structured, directed way. Thats when we call it teaching. (All educational strategies are rehabilitative, shaping brain circuitry.)
4.
modification of signals in response to real-time information. (This is actually a retraining, but it is a self-generated, conscious neurophysiological reorganization.)
5.
Change the visual-motor responses to ones space world; Change the ratio of action between the voluntary and Change the ratio of action between the sympathetic and Change the signal quality, which may alter the rate at
which the brain processes visual input (like changing the clock speed in a computer). Optometrists, approaching the individuals visual problems behaviorally, routinely employ three of the five avenues of brain change. They train and retrain, use optics, and develop biofeedback skills. Understand that visual problems do not cause learning problems as such. No credible authority has ever said so.2 Yet, visual problems can create functional difficulties that can become a collateral part of learning problems. Most of the time when there are visual problems, the effect is an indirect one the student cannot sustain learning activities because of visual distress and in this way, visual problems can mimic attentional problems. (ADD/ ADHD).
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TV interview for Dana Corporations Exploring Your Brain, 1998. Wold, R; Vision and Learning Update, Tape Series, Am. Optom. Bowan MD. The Visual Aliasing Syndrome: addressing the pattern
Assn., 1973.
3.
Bowan MD. Visual Convergence Therapy as a Vagal Maneuver: an Helveston, E; The Draw-a-Bicycle Test, J Ped Ophthalmol & Strab Rosner J, Rosner J; The Relationship Between Moderate Hyperopia
and Academic Achievement: How Much Plus is Enough?, J Am Optom Assoc, 1997 Oct; 68(10):648-650.
7.
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Masked and Matched Comparative Study of Orthoptic Treatment Versus Conventional Reading Tutoring Treatment for Reading Disabilities in 62 Children, Binoc Vis Eye Musc Surg Qtrly 1993; 8:91-108.
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Bachara, G, Zaba, J; Psychological effects of visual training, Walzer S, Richman J,; The Epidemiology of Learning Disorders, Abrams J; An Analysis of Learning Disabilities and Childhood
Weisbard J, Carmody, D; Visual Perceptual Dysfunction in Patients with Schizophrenic and Affective Disorders Versus Control Subjects, J Neuropsych, 1992, Fall, 4(4) 422-427.
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BCVA:
Then
It happened about fifty years ago. I was in charge of the eye unit at the Bir Hospital and also had my private clinic at Basantapur. On occasion I had a VVIP patient visit my clinic for consultation. I had to refract and prescribe a new pair of glasses. I went through the routine examination and made out a prescription for a new pair of glasses16 | P a g e
And now
Things have changed a lot since. Today there are educational institutions for training in most of the medical specialties including allied ophthalmic medical courses. Now there are eye hospitals and clinics scattered all over the country. Doctors study MD in Ophthalmology and pass out in less numbers every year and almost all the eye hospitals and clinics are manned by specialists qualified from our own universities and trained in the ophthalmic subspecialties. Medical graduates from countries abroad come here for MD in ophthalmic speciality. Things have indeed changed a lot for better. Optical shops are available in every corner of the streets. Prescription glasses are filled and dispensed in hundreds every day. Computerized eye examinations- auto refractor are offered by some of these establishments. People are impressed by the mention of computerized examination .Graduate optometrists pass out and also quite a few ophthalmic assistance qualify every year. It is the high time to improve the quality and standard of prescription and lens dispensing. In these days of Laser refractive surgery services available in the country. Phacoemulsification s with home made foldable intraocular lens implants are routine procedures in almost every eye hospitals of the country. And 17 | P a g e
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Refractive and Primary Eye Care Services: Burden and the Solution
Prakash Paudel, B.Sc., B.Optom., FIACLE, FLVC School of Optometry and Vision Science University of New South Wales Sydney, Australia The astounding facts came up regarding the global magnitude of refractive error once the World Health Organization revealed that beside 161 million people who are visually blind from eye diseases[1], another 153 million people have significant vision impairment due to uncorrected refractive error[2]. At least another 517 million people are visually impaired as a result of uncorrected presbyopia[3]. It is also estimated that 300 million people who are in need of spectacles are not wearing spectacles[4] because refractive services are not easily accessible to them or they are not willing to pay or afford a pair of glasses. The interesting fact is that 75% of all blindness is either avoidable or treatable[5] and 90% of avoidable blindness occurs in developing countries[6]. This is ten times more likely for people in developing countries than those in the developed world[4]. There is direct or indirect link between blindness and poverty. Blindness or a visual impairment can keep people from going to school, working, and providing support for their families. Blindness, known as disability, often leads to unemployment which in turn leads to loss of income, higher levels of poverty and hunger and low standards of living. Frick and Foster estimated the costs of global blindness and low vision at $42 billion in 2000 with projected rise up to $110 billion by 2020 if estimated with the same prevalence[7]. The economic burden of blindness in India was estimated at US$4.4 billion using the cost-of-illness methodology and was estimated at US$77.4 billion using the cumulative loss over the lifetime of the blind[8]. As the magnitude of blindness due to refractive error is significant in developing nations, any strategies to combat avoidable blindness must take into account the socio-economic conditions within which people live. As South-East Asian countries contribute nearly one fourth population of the world[9], the economic burden of blindness and visual impairment is significantly high in this region. Almost one-third of total blind people in world live in South-East Asia region[10]. The burden is highest in India where one-fifth of the worlds visually impaired people (i.e. nearly 6.7 million people) are blind[1]. As of 1981 national blindness survey, Nepal 19 | P a g e
References:
In Nepal, Census Bureau (2006) reported that there are 12.5 million (40%) children under 18 years of age of which 3.6 million are below 5years. Vision and vision related disorders are the common disability and the most prevalent handicapping condition during childhood. A refractive error study from the Mechi Zone of Nepal conducted in 1997 showed 2.9% children had visual morbidity of which 56% was due to refractive error.1 21 | P a g e
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Clinical Diagnosis of Microbial and Viral keratitis. Why is the clinical diagnosis of infectious keratitis crucial? Even wellestablished laboratories can grow up to 60-70% of ocular pathogens from the material sent for culture. So, the management of rest of 30-40% of patients with corneal ulcer solely depends on clinical diagnosis. Infective keratitis developing after LASIK poses a problem to make clinical diagnosis due to the level of the lesion and steroid use. Clinicians should be aware of the commonly reported microbes from these patients (e.g., Nocardia, mycobacteriae and filamentous fungi). The clinical diagnosis of microbial keratitis often relies on a thorough history, especially history of infectious exposure, epidemiological trends and the morphological features of corneal inflammation. Ophthalmologists use clinical clues to recognize ocular surface infection. Some distinctive, though not pathognomonic, signs unique to the causative organism may help to differentiate bacterial, fungal and amoebicpathogens of the cornea. Bacterial keratitis
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Nystagmus
is
an
eye
anomaly
manifested
by
involuntary
eye
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Visual Rehabilitation
Some children with nystagmus are mistakenly thought to have learning difficulties because the real problems caused by their poor vision are not addressed. The role of proper eye check ups, low vision assessment and the use of appropriate low vision aids (LVAs) are crucial. Often children prefer large print over LVAs, however, it is important that they are encouraged to use LVAs as there will be situations in life where large print is not available and LVAs may be the only option. LVAs are more useful when the print can't be enlarged and there isn't a CCTV e.g. when in a shop, at a friends house, science laboratory in school, reading comics and magazines etc. Some possible visual rehabilitation options that may be useful to improve visual function in children with nystagmus are discussed below If the reduced vision is associated with refractive error (long or short sight), it is likely that simple prescription for glasses will help lessen the effect and significantly improve visual function. Glasses, however, do not cure nystagmus. Plenty of stimulation in the early years does seem to help them make best use of the vision they have. Toys which encourage the child to follow a moving object, such as bright colored marbles or train sets, are helpful to develop hand-to-eye coordination Low power but large field magnifiers like bright field (dome) magnifiers, which allow longer working distance can be beneficial. The small size hand held magnifiers that fit in a pencil case or a pocket or on a string around the neck for 31 | P a g e
Electronic magnifiers like CCTV, laptops with magnifying software, portable CCTV are often better accepted by children than magnifiers.
Timed tests may create emotional stress that can cause the nystagmus to increase and the childs vision to
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Nystagmus is neither painful nor does it lead to progressive loss of vision. Problems resulting from congenital nystagmus tend to improve until vision stabilizes around the age of five or six. Accurate information and support during the early years does make a big difference. Proper visual rehabilitation can reduce the effects of nystagmus to ensure that children have the same access to the same opportunities as fully sighted children. Parents and teachers should seek assessment from local low vision services where LVAs are freely available and if they dont work they can be easily swapped. Nowadays low vision practitioners should able to provide LVAs that look acceptable to children; which are small and look cool. The new portable CCTVs can even be envy of classmates. If required, specialist teachers or rehabilitation workers can provide training in the use LVAs in school. With the support of teachers trained in visual impairment, an
understanding school and the help of parents, most of the difficulties presented by nystagmus can be overcome. It is crucial that the teacher understands how to help a child with nystagmus and associated vision loss. The teacher must understand the need for the child to turn his eyes or head in a specific manner. Allowing the child to sit at the front of the classroom and the preferred location can help to maximize childs visual potential. The parents and the teachers should particularly conscious 34 | P a g e
References 1. Dr.Kathy Osborn and Jane Veys, Acuvue oasys research, Eye Zone, Arab Optical Magazine, Issue 18, March-April, 2008. 42-43. 2. Chalmers R, Begley C. use your ears (not your eyes) to identify CLrelated dryness. OPTICIAN, 2005;229,6000. 3. Brennan NA. Corneal oxygenation during contact lens wear: comparison of diffusion and EOP-based flux models. Clinical and experimental optometry, 2005 Mar,;88(2):103-8 4. Naim J, Jiang T. Measurement of the friction and lubricity properties of contact lenses: 1995. 5. Marc B Taub OD. Ocular effects of VU radiation. Optometry Today, June 18, 2004. 6. Troy E. Fannin, Theodore Grosvenor; Effects of radiation on the eye, Absorptive Lenses and Lens Coatings, Clinical optics, second edition.
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The primary therapeutic goal is comfortable, single, clear; normal binocular vision at all distances and directions of gaze. Early treatment in infancy can reduce the chance of developing amblyopia and depth perception problems. Initially proper refractive correction should be made. Amblyopia if associated can be treated with use of of an eye patch on the dominant eye with active vision therapy. Optical treatment: For any accommodative esotropia, full cycloplegic correction without making any tonus allowance for the cycloplegic used should be given. An under correction of hypermetropia is recommended to reduce the degree of consecutive exotropia. A slight overcorrection of myopia helps in controlling intermittent exotropia. Bifocal glasses are useful in controlling deviation of patients having non refractive accommodative esotropia. Prism therapy: For vertical deviation=Fresnel press-on prisms in patients with small(less than 12 PD) comitant vertical deviation. For horizontal deviation=for relief of diplopia in visually nature patients. Pharmacologic treatments Miotics: In cases of non refractive type of accommodative esotropia, for e.g. DFP 0.1% and Echothiopate 0.03% solution. Similarly, in cases of residual esotropia and consecutive esotropia. Atropine: For therapy of accommodative esotropia. Botulinum toxin=It blocks release of acetylcholine and paralyze the muscles for several weeks. It is use in the short term treatment o infantile esotropia and paralytic strabismus. Orthoptic treatment: For convergence insufficiency: Pencil push up test, physiological diplopia exercises along with base out prisms and on synaptophore. For overcoming suppression: Diplopia exercises, macular massage on synaptophore and occlusion therapy should be performed. Surgical treatment of squint: It is carried out to correct squint cosmetically as well as functionally. Patients with marked asthenopic
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GDx is based on the principle of scanning laser polarimetry and provides comprehensive information of the damage to the retinal nerve fiber layer. Scanning laser polarimetry utilizes polarized light to scan the retinal nerve fiber layer. The polarized light is made up of two orthogonal components when this passes through the RNFL (a birefringent medium), one component is changed. This change called retardation is directly proportional to RNFL thickness. The scan captures an image with a field 400 horizontally by 200 vertically and includes both peri-papillary and macular region. Total scan time is 0.8 seconds. Apart from RNFL, anterior segment structures such as cornea and lens also are birefringent media and hence affect the final measurement of the RNFL thickness. GDx VCC compensates for this factor by individually calculating the birefringence contributed by these structures for each measurement in its corneal measurement hence this is called Variable corneal compensation (VCC). Earlier GDx such as GDx NFA and GDx 44 | P a g e
Figure: GDx report: The correlation between the Deviation Map (bottom), visual fields (top right), and the Thickness Map (top left) is shown for a normal, pre-perimetric, moderate, and advanced glaucoma eye. The red 45 | P a g e
Background
To define Optometry and Optometrist in Nepal is not a new thing. Every time whoever writes about Optometry/Optometrist, the author seems to be unsatisfied without quoting the definition of Optometry/Optometrist. Short history of Optometry (here in Nepal) may be the reason behind this need of repeated reminders. World Council of Optometry (WCO) defines Optometry as a healthcare profession that is autonomous based on professional education and regulated (licensed/registered). Optometrists are primary healthcare practitioners of Eye and Visual system, who provide comprehensive Vision care including Refraction and Dispensing of lenses, Detection/ Diagnosis and Management of Eye Diseases and 47 | P a g e
Discussions There are similar cases of low vision patients with similar complaints. The education system still lags behind their needs of improvement. The patients are still not aware of special privileges given to the low vision patients during exams and in their academics. The information about low vision and the advantages have to propagate to various corners of this
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LITTLE
Rajendra Gyawali B. Optom, 8th Batch Introduction Screening is the process by which unrecognized disease or defects are identified by tests that can be applied rapidly on a large scale. Screening tests sort out apparently healthy people from those who may have a disease. Screening is not usually diagnostic and it requires appropriate investigative follow up and treatment.1 It is a public health intervention measure which has to fulfill certain criteria but which may not always be possible in practice.2 According to Wilson and Jungner (1968), the disease should be one that would prove serious if not diagnosed early such as phenylketunaria and amblyopia in children. The cost of screening program must be balanced against the number of cases detected and the consequences of not screening. The screening test itself must be cheap, easy to apply, acceptable to the public reliable and valid.2 Launched on October, 2007, Little Optometrists is a part of eye screening and eye health education program of NOSS. This is training cum screening program intended to produce trained school students who can test vision and identify obvious abnormalities of eye and can refer to the eye care centre. Refreshment training and evaluation for their efficiency is done periodically. Secondary level students are trained in the presence to their school teacher to guide them. Necessary equipments and instruments were provided to them by NOSS. The screening and the follow up part is conducted by optometry students under the guidance of optometrists at the school itself. The screening is based on the Indiana school vision screening guidelines and modified clinical technique. The program is also intended to obtain the data about the magnitude of vision and eye related problems in school children. Little optometrists are involved in various awareness programs in schools and their society through Vision Club, under direct supervision of NOSS. Background The prevalence of blindness among children in different regions varies from 0.2/1000 children to over 1.5/1000 children with global figure estimated at 0.7/1000 children. This means that there are and estimated 1.4 million blind children worldwide .3 Many of the causes of childhood blindness are avoidable being either preventable or curable. Early detection is crucial and there is a greater urgency for the managing the 52 | P a g e
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Understanding Malingering
Baburam Bhattarai, B.Optom 10th Batch
Malingering is the classification of behavior but not an illness. For e.g. playing dead, like opossum, may save soldiers life. A case defendant may feign mental illness to obtain mental hospitalization rather than execution. A pilot may not report of syncope or migraine headaches, so that he could fly. Generally, malingerers pretend to be ill or injured in order to avoid work. It may be further inclusive of copy, imitation, feigning, simulation, imposture, artifice, counterfeit disease, goldbricking, scream shaking, factitious disorders and pathonomias. Malingerers seeking compensation often choose an event that commonly results in disability. They mainly express vague & ill defined symptoms. So, malingering is an intra-psychic & interpersonal behavior that includes care soliciting motive to obtain attention, love, sympathy, medial treatment & self punishment for guilty feelings. States of Malingering: 1. Simulation: Feigning of non existent disease 2. Exaggeration: Worsening of symptoms. 3. False-attribution: Assignment of other disease than original. 4. Dissemination: The pretending of non existent disease for insurance or job Hysteric patients are also malingerer but at their subconscious level. Hysteric doesnt exaggerate symptoms. Hysterical amblyopia is detected by charting of visual fields in which symmetrical (tubular) patterns are obtained with sharp margin. Psychological assessments of malingerers will reveal their aggressiveness, uncooperative nature and dramatizing abilities. Various vision tests can be assessed in which these persons will read every line hesitatingly. Treatment would get more complex with increasing number of visits, whereas placebos can make out. Different vision tests useful for the detection of malingering are: Binocular alignment, Objective prism, Prism stairs test, Bar reading test, Duanes method, Double prism test, Synaptophore test for one eye. Similarly, Jacksons convex & concave cylinder test, Special test cards, Mirror test, Amblyoscopic test, Cycloplegic test for partial blindness. On the other hand, Menace reflex & Optokinetic nystagmus test reveal malingering of blindness in both eyes. Hysterics enjoy the examination. Malingerer is aggressive, sulky & resentful of any tests.
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There is no universally accepted definition of ARMD. Age-related Eye Disease Study categorized ARMD into 5 groups.
4) HO T, Law N.M,Guh Luetal, Eye disease in Elderly in Singapore, Singapore Med Journal1997;38:144-146 5) Christopher patterson ,MD 6) Screening for visual impairment in elderly 7) Age related eye disease research group. Risk factors associated with age-related macular degeneration. A case control study in the age-related eye disease study. Age related eye disease study report number 3. Ophthalmology 2000; 107 : 222432.
8) . Frank RN, Puklin JE, Stock C, et al. Race, iris color, and age-related macular degeneration. Trans Am Opthalmol Soc 2000; 98 : 109-15 9) .Age related eye disease research group. Risk factors associated with age-related macular degeneration. A case control study in the age-related eye disease study.
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-inadequate drainage
2. Photophobia
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INTRODUCTION
Dacrocystography is a radiographic investigation of lacrimal system following the injection of contrast media. Dacrocystography is usually employed to demonstrate the site of obstruction in case of obstructive epiphoria. Tears produced passes into the lacrimal ducts via puncta and then into canaliculi. The ducts open into the lacrimal sacs and are connected to nasal cavity by naso-lacrimal ducts.
CONTRAST MEDIA
0.5 ml to 2 ml of water soluble contrast media per side is required, according to quantity necessary to fill the available space .The contrast injection is continued until reflux occurs from the upper punctum and patient tastes the contrast media in the pharynx.
EQUIPMENT REQUIRED
Skull unit. Silver dilator and cannula.
TECHNIQUE
Initially two preliminary films (scout films) in occipito-mental and lateral projection are taken so that we can compare these films with post contrast injection film and even to see any other pathological condition. The patient is asked to lie down in supine position and is asked not to blink during insertion of catheter or cannula. A drop of topical anesthesia can be placed into palpebral aperture if required for uncooperative patients. The lacrimal sac is massaged to express its contents prior to injection of contrast medium. Then the lower Sc: superior canaliculus punctum is diluted with silver lacrimal Ic: inferior canaliculus 76 | P a g e Ls: lacrimal sac ND: nasolacrimal duct VK: valve of Krause VH: valve of Hasner
AFTERCARE
Local anesthesia if used during dilution of Punta lacrimalia and blunt cannula insertion leave the eye temporarily unprotected. An eye pad or goggle can be recommended as they leave radiology department. OTHER MODALITIES 1. Computed Tomography Dacrocystography (CTD) CTD require cannulation of one of the lacrimal canaliculi as in dacrocystography, precluding adequate functional evaluation of the lacrimal drainage. Delivery of ionizing radiation occurs with this technique and absorbed dose to the lens has been calculated, as 1.8 to 2.6 mSv for CTD. This procedure is time consuming, expensive, and not widely available. 2. Magnetic Resonance Dacrocystography (MRD) It is done after topical administration of diluted contrast media (gadodiamide dimeglumine) into the conjunctiva. MRD can also use stationery or slowly flowing water injected into lacrimal drainage system as substitute for contrast media and acquisition of heavily weighted T2 images. This process is also time consuming, expensive and not widely available. Its only advantage is that it doesnt make use of radiation. 3. Lacrimal Scintigraphy It allows more physiological assessment of tear flow dynamics .In this procedure technetium lebelled celloid is instilled in the inferior fornix of the eyes with subsequent imaging to demonstrate drainage. The absorbed dose to the lens has been calculated as1.09 mGy/MBq. This procedure is not easily practicable everywhere because of unavailability of radionuclide. References: American Journal of Radiology (www.ajnr.org) A Guide to Radiological Procedure - Chapman Diagnostic Radiography Glenda. J Bryan
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Football and cricket are the most popular and mostly played sports. A footballer needs sharp static and dynamic vision to see the ball, friends, 79 | P a g e
References 1. Lectures by Vidyut Rajhans Lions NAB eye hospital, Miraj,India 2. Geraint Griffiths: Eye dominance in sport; a comparative study : The incidence of ametropia in elite sport : Visual performance in yachting 3. Donald F.C. loan: Sports eye wear; a survey of UK and USA practitioners
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HIV / AIDS & OPHTHALMOLOGY Dr Gyanendra Lamichhane Final Yr. Resident BPKLC OS 81 | P a g e
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In the first figure is the inner figure exactly circular? Are the two figures in second illusion of same length? Which one of the two monsters do you think is large? Can you say which man near the wall is taller? References: Sensation and perception, E. Bruce Goldstein, Fifth edition Visual perception, Steven Schwartz Vision and visual perception Pshycology, Gleitmann
The Physical effects of Psychological Stress Govinda Ojha Optometrist Tilganga Eye Center A quiet revolution is under way in medical science. Only relatively few years ago, the role of the psyche as a factor in physical disease was almost universally downplayed. Today, however, with the widespread recognition of the importance of the work of Walter Cannon and Hans Selye on the psychic causation of stress and its role in maintaining homeostasis; with the advent and success of holistic medicine as an alternative approach, the recognition of the importance of the mental and spiritual factors in fighting illness has grown into an imperative of medical treatment nearly everywhere in the world. The study of the role of stress in causing and healing disease cause into its own with the work of Cannon and Selye, who carefully studied what happens to the various organs of the body in the presence of stress (which Selye defined clinically as the nonspecific response of the body to any demand made upon it). A number of ailments have since then been identified (and the list gets longer every day) which have known stress related origins. Depending on ones constitution, the non-specific response to stress may affect almost any organ system in the body. Digestive System 86 | P a g e
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