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Questionable Medical terms in Ophthalmology

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Dr. Katta S.V., D.O.F.R.F.

Retina Eye Clinic,Opp : Balaji Temple,Chikkadpally,Hyderabad – 500 020. Andhra Pradesh, India, Ph : 0091-40-27668867.

Email : drkattasv@gmail.com

Introduction:          

Retrospective study of ophthalmic literature shows for the last hundred years, imprecise medical terms like ‘retinoscopy’, ‘syringing’, ‘retinal detachment’, ‘intracapsular cataract’ have been in existence. Phaco emulsification came approximately 28 years ago, 10 years ago small incision cataract surgery and 5 years ago computer vision syndrome.  These less precise terms are being added to the medical literature.  No attempt has been made in the past to restore precision and greater accuracy to the terminology in current use.  Perhaps none took cognisance of the problem or the need for such correction was not taken seriously. 

Methods:          

From September 2001 to July 2002, we interacted with and interviewed 394 eye specialists in and around Hyderabad and ascertained their views on the scientific terms in respect of the meanings conveyed by them.  Those who were interviewed included speakers and the audience of the Andhra Pradesh State Ophthalmic conference at Sarojini Devi Eye Hospital in September 2001 and the guest lecturers from Bangalore and Mumbai at Hotel Viceroy during the continuous medical education programme on Dry eye Syndrome.  We also discussed with the honarary delegates from Chennai, Mumbai, Delhi, Ahmedabad and the foreign delegates from UK & USA at the L.V. Prasad Eye Institute, Hyderabad during the Cart Zeiss Symposium period in July 2002.  When verbal, letter, e-mail, and telephonic discussions too were made, a good number of them, who were interested in improving things had responded.

Our collective study results:

Above 55 years: 76 (40.6%) do not want change, 56 (30.2%) are silent and 55 (29.2%) want change but do not know how to bring it about.

Below 55 years: 145 (77.3%) want change but do not know how? 62 (32.7%) opine that nothing can be done at this stage, nil %: silent.

Discussion:


The well known Indian scripture BHAGAVATHAM says:
“Jivasya tattva-Jignasa”= Human being is meant for inquiry about the Absolute Truth.

Steth + G.algos= Chest; G.Skopeo to view= View through chest devised by Laennac.  After many generations, when ‘phone’ was invented, ‘stethophone’ = a term proposed as a more accurate name (Ref.1) “Steth-oscope” is still under common use even after finding a more precise word “Stethophone”

Pre-microscopic era:

Retinoscopy: The method of noting refractive condition of the eye by projecting a beam of light into the eye and observation of the movement of illuminated area on the retina surface.
Discussion: 1)Retina – scopie: View: Are we viewing the retina?  - No –The word is improper since the retina is invisible.  More precise terminology was suggested but  not in use, because of habituation.

Pupilloscopy’, Shadow test: More precise terms (Ref.2)

Syringing: Investigatory procedure by which fluid is injected  through the punctum andobserved for regurgitation to assess lacrimal canal patency.

Discussion :  VL test (Voie lacrimal) = Route lacrimal is used by French people, but in English, Syringing is in common use. Lacrimal patency test is more precise

Retinal detachment (RD) :A separation of the sensory retina from retinal pigment epithelium (RPE) by subretinal fluid (SRF) – (Refer.3)
Discussion: a) RD shows as if retina is detached from choriod but, as RPE is part of the retina, separation from RPE is not equal to detachment.  So, sensory retina separation (SRS) is more proper.
            b) The word RD is correct when RPE is not part of retina, as per Butterworth’s Medical Dictionary II edition, which says retina is having only 9 layers.  In such case, eye is covered with 4 layers.

Intra-capsular Cataract extraction: Removal of the whole lens with its capsule (Ref.4)
Discussion: ICCE expresses “within the capsule cataract extraction”.  Instead, WCCE=with capsule cataract extraction or TCE= Total cataract extraction or the term “catarectomy” is more precise.

In Microscopic era:

Extra-capsular cataract extraction (ECCE) Removal of the lens leaving part of the capsule in place (Refer:5)
Discussion:ECCE shows outside the capsule cataract extraction. RPCCE Retained posterior capsule cataract extraction is proper.Whenever ECCE fails, people are in the habit of calling it ICCE, instead of CEPCB."Cataract extraction with posterior capsule break” which is more suitable.

Phaco emulsification:(Ref: 6) GK. Phakos: Crystalline lens: L. emilgere: to mix out
Phacoemulisification: A method of emulsifying and aspirating cataract with a low frequency ultrasonic needle.
Discussion
a) Are we doing crystalline lens emulsification?b) If phaco expresses cataract, are we allowed to call it mature phaco or immature phaco?.c) Many doctors express phaco emulsification as phaco for easy communication; but on the stage, it shows something related to crystalline lens.d) Cataract emulsification is more precise & CE is more appropriate than phaco.e) Posterior capsule is intentionally not emulsified. So are we calling it partial phaco emulsification?f) Depending on the country, some surgeons may classify a lens in different categories of opacification (Ref.7)
(+)_ Opacification: Still a crystalline lens
(++) Opacification: a formated cataract.In such conditions, cataract emulsification is more precise.g) The person who originally coined the word perhaps preferred to describe the process rather than the result (Ref: 8)


Small incision cataract surgery (Sics): Sufficiently sized incision is found to remove the nucleus and implant the IOL.
Discussion:   a) How can we call it “Small” when we are bound to do the optimum incision to facilitate the nucleus and the IOL to go out and to go in?
                        b) Is there any big incision?
                        c) The word  “Small” is relative.
                        d) Instead, tunnel incision cataract surgery (Tics) is more appropriate.

Non-Phaco Sics: People mean non-phacoemulsification sics.
Discussion: a) The word “Non Phaco Sics” expresses nonlenticular cataract surgery.
b) The word “Phaco” is being sometimes used for lens and at other times for emulsification.
c) The coding of the word “Non phaco Sics” shows comparison with phaco. For discussion it may be good, but for naming the word “Non ICCE non phaco Sics” appears to be more suitable.
d) Non-emulsification Tics is more appropriate (NETICS) if we want to compare.

Manual cataract Surgery: People commonly use this word with the expression of “Non-phaco cataract surgery”.
Discussion: Are we not using instrumentation?In loose and informal communication, such words may be alright, but it is imprecise in formal use, especially in books.

Tunnel incision cataract emulsification (TICE):

            Some experienced surgeons want to convert from phaco to Sics because of varied reasons after entering into AC and some others during learning curve try phaco after doing scleral tunnel incision.In this context, TICE is proper

7. Computer Vision Syndrome (CVS)

Signs and Symptoms: a) Headache: due to saving more thoughts and making them fewer  in a short time and also thought storage capacity of the mind.b) Eye-strain: due to ciliary spasm caused by continuous maintenance of the shape of the crystalline lens for longer period to facilitate the convergence of the light rays from fixed distance object, i.e. computer.c) Burning: due to reduced blink-rate because of anxiety or apprehension while achieving the target, which inturn is capacity of the mind and also due to continuous exposure to the air-conditioner in the room.d) Stiffness of fingers: due to continuous use of “mouse”.e) Back ache: due to continuous sitting for longer periods.

Discussion:  

  1. Fixed distance, mind capacity, surrounding AC target achieving personality, behavioural posture are responsible for the discomfort.  The object (Computer) is not responsible.
  2. All these symptoms do occur with any fixed distance object viewed for a long time.  We do not call cinema vision syndrome, TV Vision syndrome, book vision syndrome, gold-smith vision syndrome, tailoring syndrome etc.
  3. Fixed distance object visual syndrome (FDOVS) The newly floated disease, under which all these object visual strains may be chaptered.
  4. CVS intermission: Total break down of all parallel computers for 5 minutes for every one hour is being suggested as one of the treatments of choice.  This system of intermission is being adopted in Cinema halls for many years.  But we never floated Cinema Vision syndrome.
  5. Unless physiology of light rays emanating from electronic material and pathophysiology of the eye tissues due to exposure of those rays proved, the word “Computer” is less precise.

Conclusion:

As stated earlier, by means of a survey conducted on the basis of a random sampling of 394 eye specialists of different age groups and analytical study and critical examination of the existing terminology with reference to authoritative dictionaries, books and journals, I tried to prove the unsuitability of the existing scientific terms and make out a case for their replacement. To provide precision and ease of communication in the use of scientific terminology, in my humble opinion it is desirable that there should be an International Standard Organisation (ISO) to serve as nodal agency (Ref:9).  However this concept is in scientific embryological state.  Let us watch its gestation period, as education is an ongoing process of  progressive discovery of our own mistakes and ignorance.  If we aim at excellence, we may reach atleast a reasonably high standard.

Acknowledgements:

  1. Deeply indebted to Dr. P.N. Nagpal, M.S., F.A.C.S..Aso-Palov eye research Centre, Ahmedabad for his support of the concept.
  2. I am grateful to the Indian Medical Association (IMA),Hyderabad Airport branch who extended their support to the concept.
  3. I am thankful to Prof. I.V.Chalapathi Rao, Registrar, Central Institute of English and Foreign Languages (Retd) who went through my paper and made valuable suggestions in respect of language.
  4. I am thankful to all contributors (394 eye specialists) who have responded to this concept by all means

 

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References :

  1. Douglas M. Anderson MA, Dornalds Illustrated Medical Dictionary 28th ed, 1994: 1579 and Marjory Spraycon, Stedman’s Medical Dictionary 26th ed, 1995 : 1677
  2. Macdonald critchley, Butterworth’s Medical Dictionary 2nd ed, 1989 : 1468
  3. Jack J. Kanski, MD, MS, FRCS Retinal Detachment Clinical Ophthalmology 2nd ed, 1989 : 262
  4. Macdonald Critchley., Butterworth’s Medical Dictionary  2nd ed, 1989 : 635
  5. Macdonald Critchley., Butterworth’s Medical  Dictionary 2nd ed, 1989 : 635 
  6. Marjory Spraycon, Stedman’s Medical Dictionary 26th ed, 1995: 1338.Douglas M. Anderson MA. Dornald’s Illustrated Medical Dictionary 28th ed,1994 : 1270, Macdonald Critchley, Butterworth’s Medical Dictionary 2nd ed, 1989 : 1289

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