On 24th November 2020, we, the students of Mushtifund Aryaan Higher Secondary School, had the privilege of interacting with a former student of MAHSS, a highly accomplished and brilliant woman, Dr. Tanvi PoyRaiturker.
Dr. Raiturker completed her MBBS from Goa Medical College in 2014. She also went on to obtain her MS in Opthalmology from Goa Medical College and was the gold medalist at the university level in 2017. She was also awarded the Best Postgraduate of the Year 2017, proving herself to be the best amongst her peers. She also did her training in cataract and phacoemulsification from the Center for Sight, Vadodara, in 2017. She completed her medical retina fellowship in 2018 at the HV Desai Eye Hospital Pune. She also has a DNB in Ophthalmology, FICO from the UK, and a MRCS from Edinburgh. Supplementing these numerous degrees, Dr. Raiturker is also an academic scholar and has 23 research publications in national and international medical journals.
Currently, she is a working consultant in Ophthalmology at Heathway Hospital, Old Goa, and also has her own clinic, D. Tanvi’s Eye Care, in Panjim.
Dr. Raiturker spoke about a topic that resonated with everybody in the audience – Computer Vision Syndrome. As per her definition, CVS is a complex of eye and vision problems caused by overexposure to computer activities. An unpleasant fact she mentioned was that the category of people most prone to this syndrome were children up to the age of 8 who have over two hours of daily screen time, exceeding the recommended pediatric guidelines of limiting screen time to 1 hour per day. She also rightly mentioned the fact that though cases of Computer Vision Syndrome have always existed, the situation has considerably worsened in recent times due to the COVID-19 pandemic. She explained all of the various symptoms of this syndrome – eye strain, blurred vision, headaches, temporary nearsightedness, dry eyes, itchy eyes, and musculoskeletal syndrome.
Dr. Tanvi further went on to explain the potential causes of Computer Vision Syndrome, the major one of them being lack of good contrast on computer screens. The characters or pixels on a computer screen are heavily flawed, especially in comparison to the good contrast on printed papers. This makes it difficult for our eyes to maintain focus and leads to problems with the eye’s accommodative mechanisms, since the constant attempt to maintain focus leads to the weakening of the ciliary muscles. In addition, there is dysfunction in the ocular surface mechanism of the eye, since the normal blink rate (16-18 blinks per minute) gets reduced to 6-8 blinks per minute. This can cause tear film evaporation and dryness, which are major factors contributing to Computer vision syndrome.
Dr. Tanvi also mentioned that other causative factors include glare from background lighting, uncorrected refractive errors, environmental factors like dry air, ventilation, static build-up, and building contaminants, contact lens use (if the ocular surface of the eye is dry, then the contact lenses dry and adhere to the upper eyelid during blinking), Meibomian gland diseases, etc…
After explaining the pathophysiology of the syndrome, and its various causes, Dr. Raiturker gave us the ways to manage it – she dubbed it as ‘The 5 E’s’ – Eye examinations, Ergonomics, Exercises, Effective breaks, and Eyewear. She then explained each one in a clear and concise manner.
For eye examinations, she mentioned that as students, we require at least one eye examination every 3 years, dry eyes should be treated, all symptoms have to be reported to your ophthalmologist, and all refractive errors should be corrected.
Everybody likes good ergonomics. She explained that screens and documents should be kept at a distance of 20-28 inches from our eyes, with the center of the screen approximately 20° below eye level. She further explained how much of a difference improving your posture using adjustable pads and other equipment to reduce strain can make. We were then given various tips to maintain a good posture, like sitting with your knees bent at 90 degrees angle with feet flat on the ground, sitting straight against a backrest with elbows at right angles and forearms resting on armrests, and using the keyboard at a level lower than the elbow and within easy reach of the hands. She also mentioned various ways of minimizing screen glare using anti-glare filters, directing overhead lights away from the screen, and sitting with windows on the sides rather than in front or behind the screen.
For exercises, she introduced the 20-20-20 rule where you take a break every 20 minutes, find an object 20 feet away, and stare at the object for 20 seconds. Acknowledging the practical limitations of such practices, she offered a more feasible solution of taking a break whenever possible and staring at a distant object for 10 to 15 seconds, and then gazing at a nearby object for 10 to 15 seconds, repeating this 10 times. We learned that this helps prevent accommodative spasms due to constant near-focusing. She also advised us to blink voluntarily frequently.
For effective breaks, we learned that short breaks of 5 minutes every hour will help reduce symptoms caused by prolonged near-focusing and accommodative spasm.
Next, we got a crash course on good eyewear habits. Dr. Tanvi emphasized on the importance of screening and correcting any refractive error immediately. She also threw some light on the benefits of using near-vision glasses to reduce strain on the eyes, and blue light-blocking glasses with a special tint that reduces the monitor’s glare and intensity of light. Dr. Tanvi finally illustrated the use of artificial tears to address dry eye-related symptoms of CVS along with the benefits, which included the lack of side effects and relief from grittiness, burning sensations, irritation and redness.
This concluded the talk and opened the stage for questions from students and faculty alike, a transition welcomed by students who were hungry to get their curiosity satisfied.
The first question asked was regarding the career expectations of most medical students – “When is the best time to decide which field to specialize in?”. Dr. Tanvi took us through her past decision-making process, how she initially dreamed of orthopedics, later finding a fascination for gynecology, and finally, after her internship, discovered that surgery gave her the highest satisfaction. This conveyed an important message – that only when one has completed their education, can they accurately decide what they want to specialize in.
In line with questions regarding her journey through medicine, the next question was about how she found time to juggle between her clinic and research. She cleared the field by explaining how most of her research was conducted during her senior residency, because as a senior resident you do not engage in most ground jobs, they are done by junior residents. You make the decisions, but you do have free time. She also gave tribute to her mentor, Dr. Jagadeesh Kakodkar who was pivotal in her success.
Apart from personal and career-oriented questions, there were a plethora of questions pertaining to her specialty.
“For an eye with a spherical error, are blue lenses important?”
Dr. Tanvi explained that blue lenses reduce the blue light reaching the retina, which consequently reduces the strain on the eye. Hence, ideally, blue lens glasses should be worn.
“What are the causes for muscle twitch?”
She attributed this to the malfunctioning of the tear-secreting accessory lacrimal glands that serve to keep your eyes moist. With this, the eyes dry up, leading to twitching. Lack of sleep and emotional stress were also said to be causative factors.
The next question addressed a very common and popular adult ophthalmological disease faced by millions of Indians. Cataracts. Dr. Tanvi explained that the most common age for cataracts is above 50 years. She further explained that a cataract causes the vision to become cloudy or misty. Misconceptions were resolved when we were told that although most patients with cataracts are above 50, it could also arise at a younger age due to factors such as diabetes, emotional stress, trauma.
“Does the eye have a good factor of safety?”
Referring to whether we get warnings indicating an eye problem, her answer to this was that the eye has some safety mechanisms in place: the eyelashes curve upwards and downwards in order to keep dirt out; the conjunctiva has lymph nodes that give immunity. She emphasized the fact that any eye related concerns should never be ignored.
Numerous other questions were asked, such as questions regarding laser eye surgery, treating eye defects in newborns, and the effectiveness of phone features to increase eye comfort. For laser surgery, we got an insight into how technology has dominated the world of ophthalmologic surgery and how recent advancements have made the benefits of eye surgery a permanent solution. As for phone comfort, myths were debunked when we learned that phone features do in fact help reduce eye strain by modulating the backlight, font and contrast.
An interesting and important discussion came by when Dr. Tanvi was asked about the process of eye donation. She explained that within 6 hours of death, the eye is retrieved and all healthy and salvageable components are grafted. One eye can potentially give vision to three people. As for the limitations of donations, pre-existing conditions such as HIV were cited to be grounds for dismissal of a potential donation.
Resonating with most of the teenagers in the class, the next question asked was about dark circles. Revealing the science behind this all-too-familiar nuisance, she explained that dark circles are caused due to strain, emotional stress, lack of sleep, or even heredity. She mentioned that although there isn’t much that could be done about dark circles, hot water treatment before bed may be beneficial.
Lastly, she was asked the question for the ages: “How do you deal with stress?”. Dr. Tanvi explained how stress is variable and individualistic. Different specialties present different levels of stress. She described how junior residency and night duties in particular can be highly stressful – with long working hours in residency, to uncertain levels of incoming emergencies in the middle of the night.
Dr. Tanvi’s brilliant session was not only informative, but also inspirational and motivational. The ambition, passion and drive reflected in her talk, combined with her ability to educate while inducing fascination to the facts inspired not only the medical aspirants in the class, but even the ones who once felt that Biology was uninteresting. We were truly privileged to interact with Dr. Tanvi Raiturker, who taught us by example that hard work, determination, and humbleness are the keys to success.