Can we eliminate age related blindness? Is age the non modifiable risk factor?

Remain young & escape from death!

We know that prevention of eye disease is better than cure. The bulk of eye diseases is age related; cataract being the number one eye disease directly related to ageing process. The incidence of cataract and the number of surgeries done for cataract are increasing every day because the life expectancy is increasing and the indications for cataract surgeries are modified to suit the modern life style. The aggressive style of tackling cataract has created a situation where almost everybody will be going to the grave with two intra ocular lens in their eyes, like the ancient Romans going to the grave with two coins kept on their eyes for the boat man. The management of cataract has been revolutionized from a refined Indian couching to blade less refractive phaco surgery with accommodative intraocular lens.

Generally we doctors and health professionals work hard to eliminate diseases and if possible eradicate them from the surface of globe. We have eradicated small pox , polio etc and reduced the incidence of the killer diseases like plague, rabies, cholera, diphtheria, typhoid etc. As far as age related diseases are concerned all our attempts for good health care have increased life expectancy. The final result is the increase in diseases like cataract, diabetic retinopathy, age related macular degeneration, osteoporosis , adult cancers etc. This is a paradox in health care. Along with longevity , age related diseases also increase. We consider increased life expectancy as a good health parameter showing the progress of that country. A higher life expectancy in a country means, the population is more progressed and the country is more developed. In other words, a country having the higher incidence of age related diseases is considered as a more progressed state! Kerala is one such state in India now, progressed in health parameters with higher incidence of age related diseases! We go on increasing our life expectancy at any cost. We believe that the higher the life expectancy or longer we live, the better we are. We often wish people long life. Nobody says how long. There is no optimum life expectancy. Imagine a life expectancy of thousand years as envisaged by Mr. Aubrey de Grey. Even if we transplant and replace many organs the brain transplant shall be difficult. Same is true about visual pathways. The quality of life in this extended old age shall be often poor with dementia and degeneration of nerves tissue. Even with a life expectancy of below hundred years we are going to get an Alzheimer’s epidemic. Do we have an alternative to this extension of old age and resultant growth of age related diseases including eye diseases? As far as the major age related disease (cataract) responsible for avoidable blindness is concerned we can prevent blindness perhaps by removing the cataracts before they produce blindness. (We know that in olden days usually cataract surgery was done to cure blindness, but now- a- days often it is done for prevention of blindness.) But this is not possible in the case of diseases like age related macular degeneration. Appropriate nutritional support with anti oxidant agents and avoidance of use of tobacco and other toxic substances to some extend prevent the occurrence of age related macular degeneration. But those who have the genetic predisposition the disease do develop when age advances. Similarly now- a- days our diabetic patients are living longer than their predecessors of last century because of better facilities for sugar control. We know that the diabetic age is an important risk factor for diabetic blindness. We should remember that even if the eyes are functioning reasonably well, if the occipital cortex and visual pathways are not working well due to age related problems, the elderly person cannot see. The sure and certain remedy for these types of diseases is avoidance of the occurrence of old age itself. As it stands today the simple, certain and easy option for achieving it is to die before the old age diseases start appearing! But this is not acceptable. Do we have any other option to prevent the epidemic of senile dementia and growing number of other geriatric diseases including blindness?

Infant mortality rate is another important health parameter to assess the health and prosperity of a nation. All developed nations have low infant mortality rate. The lower the infant mortality rate the better that country is. When the infant mortality rate is reduced, we shall see that many premature children with multiple congenital anomalies are surviving. Many children with serious congenital heart & brain diseases survive because of excellent neonatology care. The hospitals compete to improve and upgrade the NICU to level four and are capable of even doing major surgery on these feeble infants for congenital heart disease etc. Their neonatal care facility is really advanced and a child born after 23 or 24 weeks of gestation with multiple developmental anomalies and organ defects can survive often with complications, at a huge expense involving lot of skilled manpower and sophisticated machines. With such advanced facilities soon we can reach a zero infant mortality rate! Nobody says how much is the optimum infant mortality rate. Let us see what happens if the infant mortality rate is zero. We will have many unhealthy, physically handicapped, mentally retarded and incurably deaf & blind children. Kerala is also moving in this direction with rapidly reducing infant mortality rate. Perhaps soon our blind schools authorities will start demanding good capitation fee for admission! Our infant mortality rate is reducing day by day. Do we really need a very low infant mortality rate with high number of invalid subnormal blind children ? How are we going to prevent multiple congenital anomalies in children ? Even with early detection and treatment of ROP many children with severe form of the disease remain severely visually handicapped. The easy solution is to allow the severely unhealthy infant to die. Many countries are making legislation for euthanasia not only in the elderly patients but also among young children & infants. But is it ethically acceptable ? Do we have an alternative option to have good healthy children and young population.

Meetings , where the intellectuals, social activists , doctors and public health leaders assemble and actively discus current issues in health management are good venues to evolve solutions to these peculiar problems arising out of development of better health parameters, an agony of progress. The vision of the vision 20/20 group of health professionals and associates to eradicate avoidable blindness is great. The poor countries have one type of problem which can be solved with money and education. But the problems of the rich countries with better health parameters are more difficult to solve. Blindness can be avoided by eliminating the birth and survival of the blind child ! Blindness can be also avoided by reducing the ‘abnormally’ high life expectancy! Should we have an unhealthy population with good health parameters ? Should we have healthy population with not so good health parameters? Should we have a healthy population and good health parameters? What is the optimum life expectancy and what is the optimum infant mortality to prevent blindness and other physical and mental disabilities? There is a group of blindness related to prolonged life expectancy and zero infant mortality rate. How do we avoid this type of blindness?

We know that as time passes on, changes are inevitable . You and I have changed, and our thoughts have changed. Our right and wrong have changed. Our style of surgery and management of diseases have changed. Diagnostic techniques and protocols in disease management have changed. We have changed one living person’s blood with another living person’s blood, we have changed a living person’s cornea with a dead person’s cornea, and we have even changed a living person’s diseased heart , with a brain dead person’s beating healthy heart. Yet we need many more things to be changed. What we need today is to correct the paradoxes in life expectancy and infant mortality rates and changes in birth and death. The process of birth and death in humans have remained constant for such a long time that they need change. Many people think that nobody can change birth and death. People are in fact scared to think about change in birth and death because of the great influence of the religions sponsoring the imaginary souls to heaven after death and inducing souls to the new born infants heart before the children are born. More than fifty percentage of population believe that after death they can send their souls to heaven through the religious route. In this situation do you think birth and death can be changed without objections from religion? I do not ignore the fact that we have changed the natural birth by doing caesarian section and temporarily saved people from molecular death by reviving cardiac death patients. But we need some change beyond this for the people to live long with good quality of life.Retaining the old we can build a new method for by passing death. As you all know "the secret of change is to focus all of your energy not on fighting the old,but on building the new"

When we fix very high goals which are difficult to achieve, often ‘out of the box’ thoughts evolve, because conventional methods cannot achieve such goals. Solutions to many health problems are complex and not as easy as treating a bacterial infection or nutritional deficiency. Genetic manipulation is the latest treatment methodology evolving in health care domain and is being tried successfully in solving many recalcitrant health problems. There are several health problems still unsolved. When we find the solution is difficult the best method is to try again and again with different routes to reach the desired destination or solution. A pessimistic view that it cannot be solved is not acceptable and is a retrograde step in the progress of humanity. Many of our achievements in health science have evolved over a period of time because of the repeated attempts of intelligent committed persons. If you can enjoy science fiction and are receptive to out - of - the - box thinking there is an E. book for you ; named “ Eye doctor out of the box” ISBN: 9781301878284. In this book you may find unusual and unconventional answers to some of the questions raised.The Immortality series consists of Eye doctor out of the box and Why cancer? You may find a theoretical solution to the geriatric problem in these books . The books can be easily accessed through https://www.smashwords.com/books/view and can be downloaded to your PC or smart phone in a format of your choice.

Please just do not close your eyes when you face giant difficult problems like epidemic of Alzheimer’s disease & growing number of children with multiple congenital defects. Once these things happens we can perhaps derive satisfaction and relief in getting consoled by priests highlighting the old religious beliefs & faith. But we should realize that however difficult the problems are to solve , real solutions to the problems are much better than the consolation following the miserable outcome due to the present mode of procreation by birth and death. I feel that the time for the idea of asexual reproduction for humans has come.

“Whatever the mind can conceive and believe the mind can achieve” ( Napoleon Hill.)

*Published in the souvenir of vision 20/20 conference 2014 Angamaly.