Prof. K,C. Garg was our teacher of Ophthalmology when we were doing our M.B.B.S in King George’s Medical College, Lucknow. He was an outstanding teacher, a very popular clinician and a wonderful human being. He inspired an entire generation of students to take up Ophthalmology as a career and his students went on to became Unit Chiefs and Directors of Ophthalmology in hospitals and medical institutions all over the world.
Prof. Garg MS, FRCS, DO was trained in the U.K. and was
the second in hierarchy in the department of ophthalmology, during a large part
of his tenure, a time when we had a head of the department with an
exceptionally towering demeanor in Prof. M.K. Mehra, about whom I have eluded
in one of my previous blogs. In case you have missed it, please click: https://surajitbrainwaves.blogspot.com/2025/01/remembering-prof-mk-mehra-with-his.html
Only in the last two years was Prof. Garg the head of the department. The postgraduate students in the department had much to learn from him, besides the subject. At times he would talk of the past, when he used to travel by bus, to neighboring towns, rendering service and earning a name, by providing professional specialist service to the people. The sympathy, empathy, and kindness for the patients, was there at all times, for all his residents to see and emulate. He was simple and humble at all times whether he was with the PG students or colleagues. It was because of the genuine person he was that even the head, never questioning his authority, even though was senior to Prof. Garg by two years. He was the only faculty with a personal chamber of his own, besides the HOD, in the department, yet most of the time, when not in the OPD or the OT, he would sit in the chamber where his colleagues, much junior to him, were having their seats.
During those days, the Chief Resident was responsible for preparing the OT
list, and as a principle, whenever the HOD went on a short leave, Prof. Garg
would take the rounds of the beds of the HOD, but never operate those
patients, requesting them to wait a day or two, for the HOD to return. He
always expected a reciprocal culture in working.
An incidence was recalled by my batch mate, Dr. Jaideep Datta, a prominent
ophthalmologist in Dehradun. In the absence of the Chief Resident one day, he,
the Senior Resident, was officiating and he took Prof. Garg, who had
returned from a short leave, for the rounds, along with the JR and HO's. On
seeing a patient on his side, operated just a day earlier by the HOD, an
oversight of the CR, Jaideep was witness
to a rare mortal rage, where the team members simply ran away for chores
not completed for last many days, leaving him to face the fury of the person who
valued principles. Within minutes, he was back to normal, and later, when he
was leaving the department, Jaideep was called. Prof. Garg, seated in his car, explained
painstakingly his point about morality and the correct ways of life. The next
day was their OT day, and he deputed Jaideep to operate three cases, even
though those senior to him and others were present. Justice and apology both being
delivered in the true tradition of Guru-Shishya parampara!
Today I recall a lecture on Glaucoma, delivered to
our MBBS class way back in 1978-79 by Prof. Garg. After retrieving my lecture notes I asked my batch mate and retired professor of Ophthalmology from Prof. Garg's department, Dr. Poonam Kishore to confirm that I have documented it correctly. She tells me that the understanding of glaucoma has changed over time, but this was an outstanding lecture for the late seventies!
What
is glaucoma?
Glaucoma
is an umbrella term for eye diseases that make pressure build up inside our
eyeball, which can damage the Optic Nerve at the back of our eye. Most of
these diseases are progressive, which means they gradually get worse. As they
do, they can eventually cause permanent vision loss and blindness. In fact,
glaucoma is the second-leading cause of blindness worldwide.
In
Glaucoma the optic nerve becomes damaged, and worsens over time. The build-up
of pressure inside the eye, known as intraocular pressure, is the eye's
inability to drain out the aqueous humor fluid properly. Optic nerve damage can
lead to loss of vision and permanent blindness within a couple of years, if
left untreated.
Causes
glaucoma
Glaucoma
can occur without any cause, but many factors can affect the condition. The
most important of these risk factors is intraocular eye pressure. Our eyes
produce a fluid called aqueous humor that nourishes them. This liquid flows from
the posterior chamber, through our pupil to the anterior chamber n the front of
our eye. In a healthy eye, the fluid drains through mesh-like canals (trabecular
meshwork), which is where our iris and cornea come together
at an angle.
With
glaucoma, the resistance increases in your drainage canals. The fluid has nowhere
to go, so it builds up in our eye. This excess fluid puts pressure on our eye.
Eventually, this elevated eye pressure can damage our optic nerve and lead to
glaucoma.
What
makes the fluid build up can vary, depending on the specific overall type of
glaucoma the patient has. Secondary glaucoma can be caused by:
• Blunt injury to the eye
• Chemical damage to the eye
• Severe eye infection
• Inflammatory conditions of the eye (Uveitis)
There are many different types of glaucoma:
- Primary open-angle glaucoma. “Open-angle” means that the drainage angle, where the inside of the sclera and the outer edge of the iris meet, is open wide. Aqueous humor flows into the drainage angle so it can drain out of the anterior chamber. This is the most common type of glaucoma.
- Primary angle-closure glaucoma. Aqueous humor fluid is supposed to flow from the posterior chamber behind our iris, through our pupil, and into the anterior chamber. But sometimes, the lens of our eye presses too far forward, blocking fluid from flowing through the pupil opening. The extra fluid in the posterior chamber forces the iris forward, narrowing or closing off the drainage angle.
- Secondary glaucoma. This is when another condition or event increases eye pressure, which leads to glaucoma. Conditions that can cause it include eye injuries, pigmentary dispersion syndrome, uveitis, certain medications (especially corticosteroids and cycloplegics), eye procedures and more.
- Congenital glaucoma. Child is born with glaucoma because of abberation in fetal development of the eye. These include Aniridia, Axenfeld-Rieger syndrome, Marfan syndrome, congenital rubella syndrome and neurofibromatosis type 1.
Symptoms
of glaucoma
In
its early stages, glaucoma may not cause any symptoms. That’s why up to most of
the people in India with glaucoma may not know they have it. And symptoms may
not appear until this condition causes irreversible damage.
Some
of the more common glaucoma symptoms include:
- Eye pain or
pressure
- Headaches
- Red or
bloodshot eyes
- Blurred vision
- Gradually
developing diminution of vision
- Gradually
developing blind spots (scotomas) or visual field defects like tunnel
vision
Some
types of glaucoma, particularly angle closure glaucoma, can cause sudden,
severe symptoms that need immediate medical attention to prevent permanent
vision loss. Emergency glaucoma symptoms include:
- Blood gathering in
front of your iris (hyphema)
- Nausea and vomiting that happen with eye pain/pressure
- Rainbow-colored
halos around lights
- Sudden appearance
or increase in floaters (myodesopsias)
- Sudden vision loss of
any kind
- Suddenly seeing
flashing lights (photopsias) in your vision
- Sudden hazy or
blurred vision
Risk factors for glaucoma
Several
risk factors can contribute to glaucoma. They include:
- Age. Most types of
glaucoma affect people age 40 and older (congenital types are the biggest
exception to this). Experts estimate that 10% of people age 75 and older
have glaucoma.
- Race. Black people
have a much higher risk of developing primary open-angle glaucoma,
especially people of Afro-Caribbean descent. People of African descent are
15 times more likely to have blindness from open-angle glaucoma. People of
Asian and Inuit descent have a higher risk of angle-closure glaucoma.
- Sex. Women have
a higher risk of angle-closure glaucoma. Experts suspect this is mainly
because of sex-linked differences in eye anatomy.
- Refractive errors. People
with myopia have a higher risk of open-angle glaucoma. People
with hypermetropia have a higher risk of angle-closure glaucoma.
- Family history. There’s evidence
that a family history of glaucoma, especially a first-degree biological
relative (a parent, child or sibling), means you also have a higher risk
of developing it. And several conditions that cause secondary glaucoma
are genetic, too.
- Chronic conditions. Patients with hypertension and diabetes
have much higher odds of developing glaucoma. Patients on steroids are
also at a higher risk of developing glaucoma.
Preventative Measures
Against Glaucoma:
1)
Healthy Diet - Green leafy vegetables are high in chlorophyll, which is
a vital component that improves vision and protects against glaucoma. Spinach,
kale, beetroot, and carrots, are all useful. The omega-3 fatty acids of cold
water fish are also beneficial.
2) Eye
Exercises
- Eye exercises prevent strain and sharpen concentration.
(a)
The Pencil Exercise - Hold a
pencil at arm’s length and focus on it, slowly bring it closer to
your nose. Move the pencil farther from your eyes until you can no longer keep
it in focus. Perform this exercise about ten times a day.
(b)The
Eye Rolling Exercise - Roll your eyes in a clockwise direction for a few
seconds, and then counter-clockwise for a few seconds. Repeat the process four
or five times, and blink your eyes in between each set.
(c)
The Eye Blinking Exercise - Try blinking your eyes in quick spurts, 20
to 30 times without squeezing your eyes shut, which is known as eyelid
fluttering. Close your eyes and let them rest for a while after you are
done.
(d)The
Concentration Exercise - Focus your vision on a distant object for a short
period. Try staring at the moon outside for a few minutes to avoid straining of
the eyes.
3)
Sunning and Palming - The Bates Method of sunning and palming, helps
flex and reactivate the lens of the eye.
(a)The
Sunning Process - Let the sun shine directly onto your closed eyelids,
while breathing in deeply. You can sun in the morning for a couple of
minutes.
(b)
The Palming Process - Rub your palms together to generate heat and then
gently cup them over your closed eyes without applying any pressure. Keep your
eyes covered so that no trace of light can enter.
4)
A few other preventive measures
• Avoid long hours of watching television
• Maintain a working distance of 18 inches at least.
• Wear sunglasses with anti glare
• Insist on good lighting for reading books and newspapers to avoid strain to eye muscles.
• Correction of refractory error and wearing correct prescription glasses.
• Visual breaks every 20 minutes – rest to the eyes
• Good night sleep is a must
I
have to thank my batch mates, Dr. Jaideep Datta and Prof. Poonam Kishore for sharing the memories of their residency days in the Department of Ophthalmology and for scientifically validating the lecture for me. I personally know
Prof. Garg’s sons Vinay, an ophthalmologist and Sandeep, an orthopedic surgeon who are both
practicing in Lucknow and are keeping the proud and precious family banner flying high!
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