The influence of technology in ophthalmology

in Tetovo and Skopje

-Biotechnology-

Author:Prof.Festim Halili
Co-Authors:Diturim Xheladini ; Yllza Nesimi ; Besmir Ollomani

Abstract: We have chosen this topic to referee the I. Introduction

researches of statistics in ophthalmology field, we will
mention some of the most important subjects that will
lead us to a good and correct conclusion of the situation
in Tetovo & Skopje. We will tell the cause of some eye
Our features: We are three students currently
diseases that come through technology, early diagnosis as studying general medicine here in state university of
a result of technology so positive and negative sides of Tetovo, Macedonia. We like doing researches for
technology, also one of the most important facts to anything that is needed to help people prevent
mention is of course genetics for it is the major reason of
the cancer inheritance, we will mention the prevention of some of the most dangerous diseases that can lead
eye cancer and treatment of it if caused, we will tell how to fatal outcome and this time we have chosen
the diabetes affects the retina which leads to blindness as ophthalmology, its technology and statistics from
a result of high levelled glucose in blood. Our scientific
2014 to 2017. Ophthalmology is a very voluminous
work includes cases that come from our family members
that we have been able to pursue the signs, treatments field, knowing the sensitivity of the eye and how
and psychological statements of the cases, we won’t perfect it is, makes it more attractive to study. In
forget to mention devices that are important for fact, Ophthalmology is the branch of medicine that
diagnosing a certain eye disease and how the evolution of
technology has changed the life of many people around
deals with the anatomy, physiology and diseases of
the world but most importantly here in Tetovo & Skopje. the eyeball and orbit. An ophthalmologist is a
specialist in medical and surgical eye disease.
Keywords: ophthalmology, technology, statistics,
ophthalmological codes, genetic disorders, treatments.

With this scientific work we as medical students

want to raise awareness of the danger that comes
through technology e.g. monitors. If you are
addicted to your phone or laptop and you can’t get
at least 15 minutes of rest then this is the perfect
topic to read. We will start from statistics, cancer
cases, the affection of diabetes and as a conclusion
a guidance to prevent the danger is involved.
 With the Presbyopia (long – sightedness caused
II. Statistics by the loss of elasticity of the lens of the eye)
diagnosis, in 2014 there are 1498 patients
diagnosed, while in 2015 we have 1200 patients,
State Hospital of Tetovo (2014-2017) in 2016 there are 1300 and in the last year (2017)
we have 2040 patients diagnosed with
CODES 2014 2015 2016 2017
Year Year Year Year presbyopia, we can see the ups and downs but in
the current year (2017) there is a big number of
H520 1216 1303 1427 1000 patients with that diagnosis.

H521 831 901 822 559 In 2014 there are 640 patients diagnosed with
Diabetic Retinopathy (diabetes complications
H522 1426 1324 1200 1300 that affects the eye) while in 2015 we have 452
patients, in 2016 there are 460 patients and in
H524 1498 1200 1300 2040 the last year (2017) we have 316 patients
diagnosed with this diagnosis, we can clearly
H36 640 452 460 316
notice that 2014 was the year that held the
Cataract (Tetovo) biggest number of patients.

Zg61 383 326 391 305 CATARACTA – “Zg.61” (the medical code for
cataract). The number of the patients with this
diagnosis increases over the years, so from 2014
we have 305 patients, in 2015 we have 326, in
A. Results of the statistics in state 2016 we have 383 patients and in the last year
Hospital of Tetovo. we have 391 patients.

State Hospital of Skopje (2014-2017)

In 2014 there are 1216 patients with CODES 2014 2015 2016 2017
Hypermetropia (long – sightedness) meanwhile Year Year Year Year
in 2015 we have got 1303 patients, in 2016 –
1427 patients and in the last year there are 1000 H520 3819 3420 2904 2015
patients, we can see that in 2016 there are more H521 1997 1500 1250 985
patients diagnosed with Hypermetropia.
H522 2146 2000 2630 1963
The number of patients diagnosed with Myopia
(short – sighted, lack of foresight) in 2014 is 831, H524 954 995 2500 1200
then in 2015 we have 901 patients, in 2016 there
are 822 patients and in the last year (2017) we H36 760 850 1010 743
have 559 patients, as we can see there are more
patients with this diagnosis in 2015. Cataract (Skopje)

With Astigmatism (imperfection in the Zg61 1000 962 900 522

curvature of the cornea) there are 1426 patients
diagnosed in 2014, while in 2015 there are 1324
patients, in 2016 – 1200 patients and in the last
year (2017) there are 1300 patients, so we can
clearly see that 2014 was the year that held the
biggest amount of patients with astigmatism.
B. Results of the statistics in state
Hospital of Skopje
In 2014 there are 3819 patients diagnosed with
Hypermetropia, in 2015 we have 3420 patients
with this diagnosis, in 2016 there are 2904
patients and in the last year (2017) we have
2015 patients, as we can see, the year that
holds the biggest amount of patients diagnosed
with Hypermetropia is 2014.
In the year of 2014 there are 1997 patients
diagnosed with Myopia, in 2015 we have 1500
patients while in 2016 there are 1250 patients
and in the last year (2017) we have 985
patients diagnosed with this diagnosis, the
 results are pretty good, we can see that the CATARACTA – (“Zg.61”) with this diagnosis
number of patients with Myopia decreases in in 2014 we have 1000 patients, in 2015 there
years, so in 2014 we have the biggest number are 962 patients, in 2016 there are 900 patients
of patients. diagnosed with this diagnosis and in the last
year (2017) we have 522 patients. In 2014 we
The number of the patients diagnosed with can see the biggest number of patients. The
Astigmatism in 2014 is 2146 while in 2015 we cataract is cured with PHACO method.
have 2000 patients, in 2016 there are 2630
patients diagnosed with Astigmatism and in
the last year (2017) there are 1963 patients,
2016 was the year that held the biggest number
of patients.
In 2014 there are 954 patients diagnosed with
Presbyopia, in 2015 we have 995 patients
while in 2016 we have 2500, a huge growth of
the patients. In 2017 there are 1200 patients, as
we can see, 2016 was the year with the biggest
number of patients.
Figure 1: PHACO method

In 2014 there are 760 diagnosed with Diabetic

Retinopathy, in 2015 there are 850 patients
with this diagnosis while in 2016 we have
1010 patients and in the last year we have got
743 patients, in 2016 we have the biggest
number of patients diagnosed with Diabetic
Retinopathy.

Tetovo Skopje
7% 9%
9% 23% 9%
31%
14%
23%
14%
15%
24% 22%

Hypermetropia Myopia Hypermetropia Myopia

Astigmatism Presbyopia Astigmatism Presbyopia
Diabetic Retinopathy CATARACT Diabetic Retinopathy CATARACT

CODES NAME MEANING

 H520 Hypermetropia Long/far sightedness (blurred close up images).
H521 Myopia Short sightedness (blurred distant images).
H522 Astigmatism Focus problems (crooked images).
H524 Presbyopia Natural part of the aging process, blurred images.
H36 Diabetic Retinopathy Damage of the eye blood vessels, it can lead to
blindness.
Zg61 Cataract “Cloudy” and blurry visions, it can affect both eyes.

III. Genetic eye disorders

Some of the inherited eye diseases:

 Congenital cataract (present at birth)

 Congenital glaucoma
 Optic atrophy
 Eye malformations such as Myopia,
Astigmatism, Strabismus, etc.
Glaucoma is the condition that causes damage of
the eye’s optic nerve because of the intraocular
pressure, in adults, glaucoma and age-
related macular degeneration are two of the leading
causes of blindness, and both appear to be inherited
in a large portion of cases. Researchers have
mapped several genes for glaucoma and are starting Figure 2: Trabeculectomy (anti-glaucoma surgery)
to identify genes involved in macular degeneration.
They also are making very significant progress in The rare retinal dystrophy, Malattia Leventinese, is
identifying the genes that cause retinitis caused by a mutation of an arginine residue at the
pigmentosa, a degenerative disease of the retina 345th position in a protein called fibulin-3. Instead
that causes night blindness and gradual vision loss. of incorporating an arginine residue, a change in
Glaucoma can be treated with a special procedure, the DNA code results in the insertion of a large,
called Trabeculectomy. During a Trabeculectomy bulky tryptophan residue, thus the mutation is
an alternate channel is created through which fluid called Arg345Trp (R345W).
inside the eye can exit, when the usual pathways
This mutation site occurs in a specific region of the
become blocked, the fluid collects outside the eye
protein called an epidermal growth factor (EGF)
in a tiny pocket, where it is then reabsorbed by the
domain. The presence of this large tryptophan
body. This lowers the pressure of fluid inside of the
residue causes problems with fibulin-3 protein
eye which helps prevent further damage to the optic
folding and its eventual secretion from cells. As a
nerve from glaucoma. During the weeks following
result, the disease-causing mutant protein is poorly
surgery, eye drops must be used to prevent
secreted and has a tendency to activate the cell’s
inflammation and infection. Frequent follow-up
stress responsive signaling pathways.
visits are necessary so that the doctor can follow
your progress and determine if any further In healthy individuals, misfolded proteins are
treatment is required. normally recognized by the cellular quality control
machinery and targeted for degradation, effectively
removing them from the cell. However, an
interesting aspect of this R345W mutation is that it
is not effectively degraded within the cell. This
observation begs the question: Where is mutant
fibulin-3 located within the cell that renders it
resistant to degradation? Is it localized in vesicles?
Is it trapped in the Golgi apparatus? Can we
identify ways to target mutant, disease-causing
fibulin-3 for degradation?
The overall goal of this project is to determine the
intracellular localization of wild-type (normal) and
R345W (mutant) fibulin-3 in human retinal
pigmented epithelial cells. The student who
undertakes this study develops a skill set enriched
in molecular biology and cell biology techniques
including: aseptic cell culturing, mammalian cell
transduction, immune histochemistry,
epifluorescence microscopy, and confocal
microscopy.
Figure 3:R345W mutation
Figure 4: Eye dystrophy
Retinoblastoma is the commonest intraocular
childhood malignancy in the world. It affects
mostly children under 5years of age. It is a curable
cancer when detected early. Survival rate in
developed countries is at 90% compared with less
than 50% in developing countries. Delay in
presentation and management has been seen as a
major contributor affecting outcome.
IV. Cases
Case 1
The patient B.A in the age of 6 suffers from
retinoblastoma sin et dextri (left and right), he goes
in Germany and removes the right eye even though
in the left eye he has had small Adenomas (tumors)
which disappeared by radiation, the duration of
radiation was 6 weeks so once in a week, the
doctors couldn’t put a prosthetic in the eye cavity
because the eye cavity was shrunk because of the
high volume of high radiation. In the age of 11,
doctors tried to transform a skin layer from head
scalp to the eye cavity through the surgery but it
turned out unsuccessful.
Case 2
The patient V.A is the daughter of the B.A
(previous patient), so it is about genes but this girl
has suffered from many diagnosis, the first is
RETINOBLASTOMA DEX, SIN (right, left) the
second is OSTEOSARCOMA FEMORIS DEXTRI
(cancer of the right thigh bone) the third is
CAMPANACCI GENUS DEXTRI (non-ossified
knee bone, right) and the fourth is
KYPHOSCOLIOSIS TORACALIS (an abnormal
curvature of the spine). All the cancerous cells
were malign, these diagnosis were earned form the
eye cancer, so as a baby (7 months) she has had eye
cancer which cancer has been detected by her
mother who has noticed a reflection in her eye
pupil while taking a picture of her, when she goes
under surgeries, the left eye is completely removed,
fortunately the tumor has not had metastasis so the
cancer did not destroy the optic nerve but the
cancerous cells were still active but recessive
(hidden) the “active cancer cells”
appear in the age of 8 in the form of
OSTEOSARKOMA so she started 6 block
chemotherapy then she goes through surgery,
doctors remove the knee part along with 5-6 cm of
healthy bone shaft. Because of the high amount of
the body weight only on the left leg, she gained the
other diagnosis KYPHOSCOLIOSIS
TORAKALIS. She is 13 now and she lives a
healthy life. Below, we will show some of our
original pictures of the second case.
Psychological statements
Patient B.A /
Patient V.A – has been on depression as long as her
hair was falling out because of chemotherapy, she
has felt unloved and didn’t want anybody near her
but as soon as she finished 6 blocks chemotherapy
she started to be happy and more positive.
 Figure 5: the echography of the eye

Figure 8: Magnetic resonance of the knee

The prevention of Retinoblastoma, also known

as Eye cancer.
The eye cancer is unfortunately inherited (BAP1
gene). It is a cancerous growth to any part of the
eye but it can be treated if it is detected early, the
treatment includes removal of the total eye together
with radiotherapy (for killing other cancerous cells
left behind). How to find out if the cancer is
heritage to you?
You can discuss this topic with your doctor if one
of your parents has cancerous cells (no matter
Figure 6: Ocular prosthesis
where) but you also can check it by yourself in a
simple way.
1. We suppose that the father is healthy (BB)
but the mother is having or has had cancer
(bb), now we want to know if their
children will or will not have cancer
heritage.
♂ ♀
P: BB X bb

F1:
♂
B B
♀
Bb Bb
b

Bb Bb
b

Each box is counted as 25% so in this occasion we

Figure 7: Osteosarcoma dextri (right leg)
have 100% chances that children will carry the
cancer inheritance to their children but they
(second generation) won’t be affected by cancer.
 2. Now that we have seen the situation when
the mother is ill, we suppose that the
father is again healthy (BB) and the
mother is the carrier (Bb) (she carries the
inheritance from her parents) let’s see the
children’s situation.
♂ ♀
P: BB X Bb

F1:
♂
B B
♀
BB BB
B

Bb Bb
b

The situation stands 50% - 50% (50% healthy

children, 50% carrier of the disease)

V. Ophthalmological
devices

Figure 9: Eye vision testing device (Tetovo)


Figure 10: Technology - European Eye Hospital (Skopje)
The diseases caused by modern
technology
Technology is really good for us, especially in
medical field. Modern technology is able to detect
not only eye deficiencies but all the failures that
can happen to a body, even at molecular levels.
However the modern technology has also its side
effects which can lead to different bad diseases.
Digital eye strain syndrome.
Our eyes have obviously not evolved to be used to
stare at a computer screen for extend periods of
time. However, in the modern technological
society, this is the reality for many of us. When
working with a computer screen, we tend to blink
less, and also move our eyes around less. Thus, the
eyes dry and the characteristic red-eye appears.
Other symptoms are eye strain, itching eyes and
swollen eye lids. While most symptoms are only
present temporarily and disappear when we start to
do something else, in the worst cases permanent
vision changes may occur.
Research has shown that 70% of the American
population has experienced digital eye strain.
Symptoms: Reddish eyes, itching eyes, eye strain,
swollen eye lids, headache, vision disorders (e.g.
double vision).
These symptoms may be caused by:
 poor lighting
 glare on a digital screen
 improper viewing distances
 poor seating posture
 uncorrected vision problems
 a combination of these factors
Remedy and cure: Remember that our eyes are not
adapted for screen work. Try to rest and look at
other objects during extended periods of time in
front of a screen.
There's no research that shows constant technology
use causes any permanent vision damage, but
staring at bright screens for hours on end can lead
to smaller-scale problems.
Many people will go to the ophthalmologist and
"complain about their eyes feeling uncomfortable,
thinking there's something wrong with their vision,
but they don't always realize ocular discomfort can
be a result of too much technology. Here is a
common eye ailment that can arise from too much
screen time:
Tension headaches
Extremely high contrast from lit screens can cause
headaches, reading dark print on an extremely
bright background can lead to spasms of the
muscles at the temples, which causes stress
headaches. That's why e-readers like the Amazon
Kindle or the Barnes & Noble Nook, which are
made for long reads, have black text displayed on a
grey background. Reading e-books made for e-
readers on a cell phone, where the screen contrast is
not made for long reads, can also produce
headaches. Black on grey is easier for reading
versus black on a brighter white, so it's important to
decrease the contrast if you find yourself
developing headaches from trying to read off a
screen.
How to protect our eyes from the damage?!
 Sit far enough away from the screen
stretch your arm, if your hand touches the
screen you are sitting too close.
 Blink often – In everyday life, we blink
about 15 to 20 times a minute. But that
rate drops by half when we’re viewing text
on a screen. Blinking is important because
the upper eyelid spreads tears over the
front of the eye, or cornea, just like a
windshield wiper works,
 Adjust the screen lightning.
 Take regular breaks to look around.
 Wear computer eyeglasses – Computer
glasses differ from regular eyeglasses or
reading glasses in a number of ways to
optimize your eyesight when viewing your
computer screen. Without computer
eyeglasses, many computer users often
end up with blurred vision, eye strain, and
 headaches — the hallmark symptoms of
computer vision syndrome.
As we are reaching the end, we would like to
recommend some of the greatest foods that prevent
eye blurriness or other eye diseases, so carrots may
be the food best known for helping your eyes. But
other foods and their nutrients may be more
important for keeping your eyesight keen as you
age. Vitamins C and E, zinc. Lutein, zeaxanthin,
and omega-3 fatty acids all play a role in eye
health. They can help prevent cataracts, clouding of
your eye lens. They may also fight the most-likely
cause of vision loss when you're older: age-related
macular degeneration (AMD).
VI. Closure (conclusion)
We believe that our scientific work and researches
helped you to understand more clearly the
sensitivity of the eye and its importance, even
though the researches has been made in two places,
(Tetovo & Skopje) there are so many people
suffering from the diagnosis mentioned earlier.
As medical students, we want to see you being
healthy and self-caring by following the guidance
we mentioned.
We want to thank our mentor Professor Festim
Halili for encouraging us and making this possible,
also we want to thank our colleagues (doctors) for
helping us to do the researches. We will conclude
this project with a very special quote “I opened
two gifts this morning, they were my eyes”
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