Dress-down Friday is all washed up

It is divided the following kinds of acquired cataracts: senile, traumatic, radiational (thermal, X-rays), toxic, complicated.

Senile cataract. Last thirty years its level has grown 6 times as much (4-6 cases in one thousand of population). 30-40% of op­erations on the eyes are operations due to cataracts. Usually it aris­es at the age over 50, but last years cataract is met in younger age.

Etiology. Cataract is caused by topical and systemic disorders of metabolism. The cataractogenic factors are:

a) decrease of antioxidative enzymes activity with the age;

b) defects of microcirculation of the eye caused by diseases of cardiovascular system (hypertention, atherosclerosis);

c) defects of metabolism in liver and kidneys diseases, diabetes mellitus, a deficiency of vitamins C and B2.

Clinical course of the senile cataract. In the beginning of the dis­ease patients complain to:

— "flies" which move together with the eye. In fixed eye "flies" are immovable (opacity of the vitreous is mobile, in motionless eye it falls down);

— myopia in elderly age, often change of glasses for near dis­tance;

— monocular diplopia, polyopia.

Gradually a decrease of the visual acuity, mist before the eyes appears.

The visual acuity decreases from 1.0 up to a right perception of light.

Due to cataract only one visual function (visual acuity) is im­paired. The visual field, light sensitivity remain normal.

It is distinguished cortical and nuclear senile cataract. Cortical cataract is divided into four stages:

I. The incipient stage. At the periphery of the lens there appear
radial opacities ("spokes in a wheer). At the centre of the lens un­
der the capsule there are the transparent vacuoles, eye fundus can
be seen clear. The visual acuity is equal 1.0-0.3. The complaints
are "flies", "mist" before eyes.

II. Immature, intumescent cataract. Considerable opacities of­
ten have the form of sectors or "spokes in a wheel" which reach
the centre. There is the iris shadow in lateral illumination, there is
a reflex from eye fundus on periphery, but its details are not visi­
ble. The visual acuity is less than 0.2. The anterior chamber is shal­
low. There is complication — phacogenic (phacomorphic) glauco­
ma.

III. Mature cataract. The entire lens becomes opaque, there is no the iris shadow at lateral illumination, pupil is white or grey, there is no reflex from eye fundus, visual acuity is right percep­tion of light.

IV. Hypermature cataract. Fibre of the superficial layers of the lens break, cortex of the lens becomes white like milk liquid and partially resorlves. Therefore the anterior chamber becomes deep, tremulousness of the iris arises. The reflex from eye fundus and even low visual acuity may appear. The heavy nucleus falls downwards on the bottom of the anterior chamber. Complications: phacolytic secondary glaucoma, phacolytic iridocyclitis.

In nuclear cataract the opacity begins in the centre of the lens' nucleus. By lateral illumination the gentle opacity like a cloud is visible in the centre. In examination by a passage light the reflex is absent in the centre. It develops slowly, at once the visual acui­ty considerably decreases. It can be atypical form of the age cat­aract, i.e. brown or brunescence cataract. The pupil has a dark col­our, the reflex from eye fundus is absent. Lens is firm, brown, it has only nucleus, cortex is absent.

Treatment of cataract. The conservative treatment is carried out only in I stage with the purpose to delay the cataract progressing. It is used topically tauphon, vitamin drops (catachrome, sancata-lin, vita-iodurol, vitaphacol etc.).

Beginning with the II stage the surgical treatment is carried out, and the condition of the second eye is taken into consideration. If the visual acuity of the other eye is high, the operative treatment is used in decrease of visual acuity of the ill eye less than 0.3. If the visual acuity of a other eye is low or it is absent, the cataract is operated in visual acuity less than 0.1.

History of cataract surgery. Up to the middle of XVIII century there was carried out reclination of cataract. So-called reclinators made it. This operation caused blindness from glaucoma in 40%. The founder of modern methods of lens removal was Jacques Dav-iel, which has removed cataract through the cornea incision in Marseilles in 1745. At that time about 10% of the patients lost vi­sion due to intraocular infection.

At present there are applied the following methods of removal of cataract (only with microscope):

1. Extracapsular cataract extraction. The posterior capsule is not removed. It prevents loss and hernia of the vitreoum, ditach-ment of the retina. Due to microsurgical technique in the most cases it is possible to prevent the main defect of this method — develop­ment of a secondary cataract. Secondary cataracts are carried out by laser or knife discission.

2. Phacoemulsification is the most modern and effective meth­od. It is distinguished with a small incision, not very traumatic ope­ration, fast rehabilitation of the patient. Due to the new achieve­ment in phacoemulsification technique quality of the cataract sur­gery is very high. The main components of the method is automatic aspiration-irrigation system which supports constant intraocular pressure during the operation, high quality of coaxial microscope, viskoelastics for prevention of the cornea damage, small tunnel in­cision, adapted to a small incision of intraocular lens.

3. Intracapsular cataract extraction. It is carried out by means of a cryoprobe (cryoextraction) or with capsule forceps. This meth­od frequently gives complications: hernia of the vitreous, glauco­ma, ditachment of retina. Now it is carried out only in subluxa­tion of the lens.

Aphakia

Aphakia is absence of the lens. One of aphakia causes is opera­tion of cataract extraction. Clinical signs of aphakia: — the visual acuity is less, than 0.05;

— absence of accommodation;

— high hypermetropia — 10-12 D;

— deep anterior chamber;

— iridodonesis;

— absence of the lens complex at ultrasound examination.

Methods of aphakia correction

1. The intraocular lens (IOL). The first experimental implanta­
tion of IOL in rabbits was made by A. Kh. Mikhailov in 30s in
Sukhumi. In people the first implantation of IOL was carried out
by Ridley (England, 1949).

Now it is impossible to imagine cataract surgery without im­plantation of the intraocular lens. IOL are implanted almost to all patients after extraction of cataract. Contraindications are only diseases of the cornea, severe cases of diabetes mellitus. The mo­dels of the intraocular lens, its material are permanently improved. Now the posterior camera lens with intracapsular fixation are usu­ally applied. They are made from polymethylmetacrelate, silicon, hydrogel, acril. In our department the new models of intraocular lens with a carbon covering, has been worked out due to which trauma of eye tissue during implantation and excudative reaction have decreased, toxic effect of PMMA and damage effect of ul­tra-violet rays of light on retina were removed.

Last achievement in development of new models of intraocular lenses is multifocal lenses, which ensure the high vision at long and short distances.

2. Keratophakia — interlammelar refractive keratoplasty.

3. Contact lenses.

4. Iseikonia glasses (in monocular aphakia).

The old method. In binocular aphakia it is used glasses from + 10 to +12 D for a long distance and glasses from +13 to +15 D for a short distance (the eye refraction before operation will be ta­ken into account).

Dress-down Friday is all washed up

It's official - wearing casual clothes to work makes people rude, lazy and flirtatious. No wonder bosses are demanding that staff dress up again

Kathryn Hughes

The Observer, Sunday 22 April 2001

Dress-down Friday has not worked out. In fact, it is about to be let go. A slew of new surveys from the States shows employers increasingly concerned that staff who turn up in 'smart casual' (or should that be 'casual smart'?) are up to 50 per cent more likely to act rude and silly.

Lateness, sluggishness or just not being there at all have all become hallmarks of the last day of the working week, according to a study for American Corporate Trends Magazine. So much so, that many bosses are now returning Friday to its previous strict and sober incarnation. They include George W. Bush, who has decreed that henceforth all White House staff must be formally suited and booted whenever they report for work. And in Britain the Institute of Directors has also detected signs of an end to the recent custom of greeting the weekend one day early with a sludgy medley of soft trousers and endless, endless fleeces.

Friday first went casual in Britain in the late 1980s, but the practice didn't really catch fire until the mid-Nineties. By then, the economy was booming and new sources of income and prestige - IT, biotechnology, dotcom - were emerging. The people who worked for these firms may have been rich (in fact, they were getting richer all the time), but they liked to think that they were sufficiently self-confident not to need to rely on someone else's idea of a status symbol. Bowler hats and umbrellas represented an older - now ailing - economy, one that had been founded aeons ago in the mid-nineteenth century on a formal distinction between work and home.

The New Economy, by contrast, liked to emphasise the continuity and even overlap between professional and domestic spaces. People brought scented candles to the office before returning home to a converted industrial site. In Frankfurt, workers could pop into 'nap rooms' after lunch, while in London the smartest new nightclub was called, quite simply, 'Home'. At the level of aesthetics, work and play had become infinitely swappable.

By the time the Millennium finally arrived, many firms, including the formerly pinstriped Merrill Lynch and Arthur Andersen, had decided to extend dress-down Friday to the other four days of the week. There were rules, of course - there always are. No jeans, naturally, and some other less obvious demarcations: shirts needed to have collars, and shoes laces. In America, apparently, staff had to be reminded to wear underwear, but that never seems to have been a problem in EC4 where it is always rather cold.

What has been a problem, though, for a lot of people is achieving the required look. 'I can never remember if I'm supposed to be going for smart casual or casual smart,' complains one Merrill Lynch employee, who has given up pondering the distinction and taken refuge in ubiquitous chinos. While American and French men have long had an alternative uniform to the business suit - polo shirt, unstructured jacket, brownish/fawn trousers - British men have mostly had to resort to that odd solution of teaming a formal, usually Harris tweed, jacket with jeans.

Several retailers have taken pity on the hordes of baffled men who arrive for work in the financial institutions of Canary Wharf each day knowing that they don't want to dress like Jeremy Clarkson but aren't quite sure who they do want to look like. Both Gap and Ted Baker have set up branches stuffed full of the kind of touchy-feely clobber that will take you inconspicuously through the day in a symphony of mushroom.

What is odd is the complaint by one third of employers polled in New York last year that dress-down Friday has led to a huge increase in flirtatiousness among their staff. There surely can be nothing less erotic than men and women swaddled alike in baggy fleeces and comfy cords. 'I sometimes feel as if I'm working in an office staffed by expensive teddy bears,' reports one female bank worker who looks back with fondness to the days of crisp suiting. She's right, of course.

Formal business wear is designed to give the illusion of sharp lines where none really exist. Waists are clinched, shoulders padded, large bottoms mercifully covered. In the case of men, the tie points urgently towards the genital area while, with women, obligatory skirts mean that legs are always on show. It's no surprise that a recent survey of more than 2,000 office workers carried out for Mills & Boon showed that a third of us, male and female, like to fantasise about the object of our office affections wearing a nice smart suit.

Dressing down has proved to be more of a worry, than getting decked out in a uniform ever was. Even in those companies that are casual every day, the understanding is that you wear a suit whenever appropriate - to meet a client, make an important presentation.

'As a result I spend more time matching up my clothes to my schedule than I ever did before,' says Sarah Smart, who works for a Swiss bank.

And, if America is anything to go by, the sartorial week is about to get even more complicated. To counter the negative effects of dress-down Fridays, some firms have instituted the weird corrective of Dress Up Thursdays. Soon, it seems, each day of the week could carry its own coercive dress code.

Where dress-down Friday got it wrong was not in overestimating the importance of clothing upon our psyches, but in underplaying it. Employers had the vague hope that allowing people to wear buff-coloured trousers to the office would signal a loosening up of mental boundaries which, in turn, would release a stream of 'beyond the box' thinking.

But clothing acts like a sharp trigger for sense memory. Wear casual clothes to work, and your brain thinks it's on holiday. It doesn't want to come up with left-field solutions to the problems in Product Development. Instead it makes you want to gossip with your friends, drink coffee, send loads of raffish emails and, if you can bear to fumble through all those layers of fleece, have sex with the person sitting next to you.

Asking people to pretend that work is fun, and then suggesting that they mark this state of affairs by wearing combat trousers, is the height of patronisation. As the economy slows down and recession begins to bite, these kinds of self-deceiving strategies are beginning to fall away. We know what work owes us - money, skills-training and a certain amount of status. It doesn't own our souls, and we wouldn't want it to. For that we have home, where we can dress exactly as we please.

Date: 2014-12-21; view: 999