Ocular abnormalities in patients with beta thalassemia on transfusion and chelation therapy: Our experience

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Ocular abnormalities in patients with beta thalassemia on transfusion and chelation therapy: Our experience
Dear Editor, We read with interest the article by Taneja et al. [1] We believe that it was a great effort considering the number of studies on this particular group and no such study in our population group. There is relatively low awareness about these ophthalmic manifestations of thalassemia and this article would go a long way to create awareness about the same.
We want to share our own experience (presented as a free paper in AIOC 2009, Jaipur) which is different from their findings, especially in the untreated and treated group with desferioxamine. A total of 112 children (224 eyes) with beta thalassemia were taken for the study. Ninety-five children (190 eyes, 84.8%) not on desferioxamine therapy were termed as case group and 17 children (34 eyes, 15.2%) were on desferioxamine and called control group. Out of 95 children, 62 (65.2%) were male. All children were under the age of 15 years (4-15 years) who had received multiple blood transfusions.
Conjunctival blanching and isolated cataractous changes in the lens were the most common anterior segment findings in the untreated group. Both were found in 12 (6.3%) eyes. The rest of the findings are listed in Table 1. In the group on desferioxamine, none of these children had any opacity in the lens. Four (11.8%) had tessellated fundus in the control group.
The ocular manifestations were compared in the untreated group with respect to serum ferritin [ Table 2]. We compared our data with other studies and found lens opacities were commoner in our study (14 eyes 7.3%).
Goldberg et al. [2] did not find a single case with lens opacity. However, his patients were mainly with sickle cell hemoglobinopathy and not beta thalassemia patients. Degeneration of retinal pigment epithelium (RPE) and tessellated fundus were common in our study as has been noted in a previous study by Gartaganis et al. [3] Letters to Editor  We could not find a single case with angioid streaks even when our case series was larger. We saw untreated cases and therefore, could see that the effects on the eye were mainly because of the iron overload and not secondary to chelating therapy as has been thought.
We could not find a single case of lens opacities in children (small sample size) with reduced serum ferritin levels. All these children were on chelating therapy. Ocular manifestation in control group was significantly lower and it was comparable to other studies. This suggests that serum ferritin levels and iron load may not be actually responsible for the ocular manifestations of beta thatlessemia. Our study absolves desferioxamine of any role in causing ocular surface disorders. Rather, it is the disease itself which may be responsible for any such disorder. Desferioxamine may be considered safe so far as the eye is concerned. However, since our sample size was small, such results should be interpreted with caution.

As a member of the All India Ophthalmological Society
Dear Editor, As a member of the All India Ophthalmological Society (AIOS), a reviewer of the Indian Journal of Ophthalmology (IJO), and a member of the editorial board for a number of years, I admire and appreciate your tireless and efficient work. Your efforts have remarkably elevated the standard of the Journal .
I was interested to read the editorial, "On being editor of (Indian) medical journal: A steeple chase" [1] wherein, you have unambiguously and thoughtfully laid out a path for the future editors to follow, and have clearly spelt out the hurdles a future editor is likely to encounter. You have spelt out the unnecessary and unavoidable tasks the editor of our journal has to contend with, besides the editor's job. There are many historical and cultural reasons for that. It would be imprudent to go into the details of the reasons.
The quality of a journal is decided mostly by the quality of the articles appearing in the journal. The design of the cover pages adds to the attractiveness of the journal and the advertising pages certainly add to the coffers of the journal. The quality of printing, the timing of the journal, the regular appearance of the journal in pristine condition, in the hands of the members, and so on, all add to the value of the journal, albeit to a small extent. It is the impression of many of the readers that you have achieved a right balance of these variables and that is what has made the quality of the IJO go up a few notches.
We cannot always blame the members of AIOS for sending the article to foreign journals as a priority and this again has a historical reason, which is beyond the purview of the IJO or the AIOS.
I can only empathize with you when you state that there is no formal training of research at the undergraduate or even postgraduate level. It is preposterous, but true. What can an editor of a journal do about the medical education policy? He can, as an opinion maker, create awareness and draw the attention of the policy makers.
In many of the medical colleges, the postgraduates being guided by the misguided guides may not be universally true and I have many reasons to disagree. Our guides during our postgraduate days were, Prof. LP Agarwal, Prof. Madan Mohan, Prof. N.N. Sood, Prof. Premprakash, and many other stalwarts who ignited our brains. Maybe a few guides in some medical colleges, in some states, are incapable of guiding. I agree to an extent with Dr. SS. Hayreh when he states that, "what matters in India is whom you know than what you know!" [2] However, to tar all the guides with the same brush, is doing a great injustice to the yeoman and selfless service many of our teachers and guides have been rendering and have rendered. I am most certain that the guidance you received during your postgraduate days, has certainly contributed to your professional achievements.
It is difficult to categorically state that there is lack of knowledge about ethics in publication among all the Indian authors. Maybe a few, but not necessarily among all. I understand your consternation, but truth is not what is opined in the editorial.
Many authors have no clue about the Helsinki declaration. Perhaps true, but then the Helsinki declaration itself has undergone a number of revisions and is mainly subservient to the medical and industrial interests of the powerful and rich countries. I cannot see how a declaration with no legal tooth can stop a rich country carrying out human experiments in poorer countries, with the connivance of the local, but corrupt government/s. What matters is not the awareness about some non-enforceable declaration, but conscientious attempts at finding a cure for the problem. I would rather have an Indian author conscientiously refuse to use a medication on a patient and be completely unaware of the Helsinki declaration, than injudiciously use a medication on a patient and be completely aware of all the declarations! The editor's office has to shift as the editor's change every 3