Articles on inborn errors of purine pyrimidine metabolism

Top 5 Myths About Gout

Dr. Sharath Kumar, Rheumatologist
Myth no 1:- Eating vegetables such as tomatoes, lettuce as well as consumption of dal can cause you to develop gout. Actually though purines in these vegetables and dals can be converted into uric acid, research has shown that this generally does not happen inside the human body. In fact the american college of rheumatology, and arthritis foundation (USA) handouts regarding diet in gout clearly state that patients can have all vegetables as well dals as the only purines which are to blame for gout are animal purines. So enjoy those veggies without guilt. Myth no 2:- Gout can cause pain all over the body Gout is a very painful arthritic condition. It can cause pain in several joints and sometimes causes pain in areas outside the joint called bursae as well. However gout generally causes severe pain and swelling and redness in a single joint which lasts for one to two weeks . Since uric can be elevated in many people without gout (see Myth number 3) many patients who have pain due to other reasons when tested for uric acid are found to have high uric acid. Their pain is totally unrelated to the "normal elevated uric acid" (see Myth number 3) but unfortunately the uric acid gets blamed for their pain. Myth no 3:- A high uric acid causes pain High uric acid IN THE BLOOD is found in many people. However it is only when this uric acid exceeds a certain level (generally 6.5mg/dl) does the uric acid sort of spill out from the blood into the joints. Now uric acid when it first spills into the joints does not cause any problems. In fact scientist estimate that the uric acid has to be elevated and continue to spill into the joints and keep accumulating in the joints FOR ATLEAST 10 to 20 years to ultimately cause pain and swelling  in the joints. Uric acid goes up AFTER puberty in MEN and AFTER MENOPAUSE in women. Thus most men develop gout in their late 30s (puberty = 16 years + 20 years)  and in their late 70s in women ( menopause = 45 + 20 years ). During these 20 years when uric acid is accumulating silently without causing problems if you test the blood you may get a high uric acid in many people who do not have any problem. This is called asymptomatic hyperuicemia or "normal elevated uric acid". During this time you can have other problems causing pain which can be falsely blamed on uric acid.Myth no 4:- Once my uric acid has come down I can stop the treatment for gout. High uric acid in the BLOOD spills over and accumulates in the joint and causes gout as explained in myth number 3. Thus to treat gout and make sure you are cured of gout (see myth number 5) we need to treat the uric acid which has accumulated in the JOINT and not the uric acid in the blood. Thus a low uric acid in the blood does not tell us the level of the uric acid in the joints and may be a false reassurance. Hence patients should continue to take medications for their gout even when their blood uric acid is normal. They should trust their rheumatologist who will be scientifically estimate the uric acid in their joint better and them to guide them regarding how long and at what dose they need to take their medications. Myth no 5:- Gout is not curable This is the worst myth of all. I have had many patients who are scared to start medications since they feel that they will be on the medications life long once they start. However gout if treated properly it is a potentially curable disease. However since patients do not start medications and continue taking medications for a few years they have to live with decades of intermittent painful gout. In addition what is not known is gout can also increase your risk of developing heart disease and kidney failure. Thus even if you are superman and can bear the pain that gout brings, you will not be able to bear heart attack or kidney failure. So you should take treatment and cure gout. You owe that much to your body. 

How to Increase Metabolism

Ms. Swati Kapoor, Dietitian/Nutritionist
Metabolism is the rate at which our body burns calories. Various factors influence metabolism such as age, gender, height, weight, genes, etc. But there are some day to day practices which affect the metabolic rate of the body. A high metabolic rate helps lose weight faster.Here are some tips shared to increase the metabolism:Don’t Starve: Due to lesser calorie intake the body automatically slows down the metabolism to maintain proper body functioning and to conserve energy.Proteins will boost: Proteins need more energy to metabolize. Hence consuming protein rich foods such as lean meat, fish, egg, beans, legumes, etc. keeps up the metabolic rate even after meals.Ice cold water: Drinking Ice cold water increases the metabolism as compared to room temperature water because the body uses up calories to heat up the water to normal body temperature.Small amounts of caffeine also work: Caffeine increases our heart rate and hence the metabolism is increased. So 1-2 cups of coffee a day is safe to consume to boost metabolism.Iron for transportation: Iron rich foods like fish, poultry, lentils, chickpea, spinach, kale helps in oxygen transport which is needed for energy production.Get enough amount of sleep: It is recommended to get atleast 8 hours of sleep everyday for adults. Lack of sleep leads to a slower metabolism and an increased appetite, which further increases the risk of weight gain and obesity.Exercise: It is considered one of the most effective ways of boosting metabolism especially when you are dieting. The slower metabolism due to lower calorie intake can be recovered by an exercise routine.Frequent meals will speed up: Along with all other benefits, consuming small frequent meals boosts the metabolic rate, since every time we eat we trigger our metabolism for a short period of time.Vitamins and Minerals also act as elevators: Calcium deficiency is found to slow down metabolism, so calcium rich sources such as dairy products should be consumed in appropriate amounts. Vitamin-D consumption should also be taken care of, as it is required for calcium absorption in body. So you need to get out in the sun and consume salmon and fortified products to get Vitamin D.

Gout - Gouty Arthritis

Dr. A Mohan Krishna, Orthopedist
Description of gout:Gout is a medical condition, a metabolic disease in which crystals of Uric acid (Monosodium urate) gets deposited in joints and tissues. These crystals are the by-product of body’s Protein degradation.Causes:The proteins that we consume in our diet get digested and undergo various steps of degradation in our body. Uric acid is produced during this process is usually excreted from intestine and kidneys.High levels of Uric acid can be produced due toIntake of protein rich diet- high purine dietAbnormalities in chemical pathways that leads to excessive production of uric acidCertain drugs like Aspirin (Salicylates), Diuretics (Kidney drugs) interfere with the excretion of uric acid thereby raising its level in blood.The body’s own overproduction of uric acid is an inherited condition and is present from birth.Symptoms :Uric acid is deposited in the form of crystals (Monosodium urate) in joints and tendon. This result in intense irritation, inflammation and pain in the joints and tendon tissues. The joint becomes hot, red and swollen.Classically the big toe joint of the foot is affected, but ankles, knees, elbows and joints of hand and feet can be involved. Large joints like hip and shoulder joints tend to be spared.Predisposing factors:Men are more likely to be affected than women.The commonest age for the first attack is between 30 and 60.Risk factors include.A high alcohol intake. Alcohol by itself  does not cause gout, but it will stimulate gout attacks in those who are affectedA protein rich diet.Certain races, like Maoris and Polynesian- who have higher blood levels of uric acid are more susceptible to goutObesity,Conditions that cause high cell turnover, such as polycythaemia (increased red cells), lymphomas and various other cancers can increase blood uric acid levels.A family history of gout,Drugs like Diuretics (drugs increasing urine flow) or low dose salicylates,Kidney diseases,Some percentage of patients suffering from Gout can have renal colic due to deposition on uric acid crystals in the kidneys.Diagnosis:History and complaintsSudden onset of severe pain, swelling and redness of joint in great to of the foot.Sometimes swelling of joints of foot, ankles and handsHistory of similar episodes in the past.Examination:Red, tender, swelling of joint of great toe or other involved joints.Long standing cases uric acid crystals deposit in tendons, tissues appear as swellings called Gout tophi. More common around the elbow, wrists, finger and toe joints and sometimes on the earlobe.Investigations:Blood tests: Raised blood uric acid levelsDoubtful cases: Fluid examination from Gout swelling for Uric acid crystals.X rays: in long standing cases shows joint destructionTreatment:Acute attack:Acute attack of gout is characterised by hot, swollen, red and painful joint of great to of foot.Non-steroidal anti-inflammatory drugs in acute attacks help in reducing the pain and swelling. They should be given in high doses initially.Colchicine is one of the oldest known drugs and can be taken during acute painful phase.New drugs are available that can be given during acute attacks which can reduce blood levels of Uric acid.Drug treatment:Drugs in the treatment of gout are given to control the levels of uric acid in blood and to prevent long term complications. Drug dosage should be adjusted according to the levels of uric acid in the blood.Allopurinol is one of the oldest and common drug used to control the levels of uric acid in blood. This drug inhibits xanthine oxidase which converts xanthine into uric acid.Probenicid and Sulphinpyrazone – Promotes excretion of uric acid through kidneys.Prevention:Once you are diagnosed with Gout, you’re a patient of gout for your life.Avoid Protein rich diet – High Purine foodsAvoid Dehydration: especially in hot weathersAvoid unaccustomed strenuous exercise.Care should be taken in patients on long term diuretics and low dose aspirin.Regular medications to control the uric acid levels by the advice of physician or orthopedician.Complications of untreated Gout:Long term complications of uncontrolled gout can causeJoint damage (Arthritis),Formation of gout tophi (swellings around the joint) andRare complication of chronic kidney disease.

Managing High Uric Acid Levels With Proper Diet

Ms. Ankita Gupta Sehgal, Dietitian/Nutritionist
Gout Symptoms & DietIn the middle ages, gout was known as the disease of the wealthy. Nowadays, it is one of the most common metabolism illnesses among adults that are associated with nutrition. Gout results from excessively high uric acid levels in the blood. There are two types of gout, primary gout, which is congenital and secondary gout, which is an acquired disease. Primary gout is the result of a metabolism problem associated with insufficient removal of waste by the kidneys. In the case of the second form, the gout is caused by illnesses such as tumours, anaemia, and diabetes with kidney function problems.Nutrition-related causes include total fasting and the increased consumption of meat and alcohol. But what causes excessive uric acid in the blood? Organic compounds called Purines are changed into uric acid by the metabolic activity of the body. Uric acid is then eliminated from the body through the kidneys. If this function is disrupted, as in the case of primary gout, the uric acid will remain in the body. This means that the uric acid level in the blood will increase. We also absorb uric acid from our food, particularly from animal products.How does uric acid cause gout?Increased uric acid levels usually remain unnoticed for many years due to the lack of symptoms. Ultimately, however, permanently increased uric acid levels will result in gout. These increased levels cause the formation of uric acid crystals. These crystals tend to gather in the large toe, in bursae, tendon sheaths, and ear cartilage or in the kidneys as stones. Acute gout attacks typically involve the sudden onset of severe pain, accompanied by extreme redness and swelling in these areas. There is no reason to get to this stage if countermeasures can be taken at the right time, and symptoms can be avoided with a balanced diet.How to diagnose gout? Uric acid levels can be determined through a blood test. Men are much more frequently affected by raised values and gout than women. However, the risk for women also increases at the beginning of the menopause period, as the protective effect of oestrogen will no longer be provided. During a longer fasting period or in the case of extreme diets, the increased breakdown of body cells can increase uric acid levels. And the opposite is also true: if you eat too much meat and drink excessive amounts of alcohol, the levels will increase. Uric acid:                                         Normal values in the blood: Men                                                           3.5 to 7.0 mg/dlWomen                                                     2.5 to 5.7 mg/dlWhat is the treatment?If uric acid levels are too high, the first preferred treatment is a change of eating habits. If uric acid levels remain high over a long period of time and the change of diet makes no positive difference, medication will need to be used. This will either reduce the production of uric acid in the body or increase the elimination of uric acid through the kidneys. In the case of acute gout attacks, anti-inflammatory pain medication combined with cold compresses can provide significant relief in just a few hours. Discuss the treatment with your doctor and ensure that you have your levels checked on a regular basis.Tips for increased uric acid levels and goutWatch your weight.Try to lose weight slowly.Eat fresh fruit, vegetables, whole wheat products, and some pulses (high in purine) every day.Enjoy low-fat milk and dairy products daily.Keep an eye on the purine content of food. Avoid offal, shellfish, and crustaceans and tinned fish such as sardines in oil.Eat no more than 100g of meat, sausages, fish and poultry a day.Drink alcohol only occasionally, as it affects the elimination of uric acid.Eat low-fat food. The consumption of high-fat foods encourages weight gain.Drink at least two litres of low-calorie fluids a day. Recommended fluids are water, tea and fruit juice.

What Is Gout?

Dr. Sanjay kapoor, Orthopedist
What is Gout?Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history.‪What causes Gout?Gout results from abnormal deposits of uric acid crystals in the joint cartilage. The crystals are later released into the joint fluid.Gout was once incorrectly thought to be a disease of only the rich and famous, caused by consuming too much rich food and fine wine. Although diet and excessive drinking contribute to gout, they are not the main cause of the condition. We now know that heredity plays a role in the development of gout, and it's often associated with other medical problems like high blood pressure.Not everyone with high levels of uric acid will develop gout. The kidneys' ability to rid the body of uric acid is partly determined by heredity. And just because someone in the family suffers from gout does not mean everyone in that family will have the disease. This risk varies from person to person.What Are the Symptoms of Gout?Sudden, intense joint pain, which often can wake a person from sleepSwollen joint that is warm to touchRed or purple skin around the joint.The amount of uric acid in your blood can change depending on what you eat and drink, how hydrated or dehydrated you are, your overall health, how much alcohol you drink, and the medicines you are taking. It can change in response to a sudden illness..How Is Gout Treated?There is no cure for gout, but it can be treated and controlled. Symptoms often are relieved within 24 hours after treatment has begun.The type of treatment prescribed will depend on several factors, including the person's age, type of medications he or she is taking, overall health, medical history, and severity of gout attacks. Gout attacks are mainly treated with anti-inflammatory drugs. These include:NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen or naproxen, are generally prescribed to treat sudden and severe gout attacks. They usually reduce inflammation and pain within hours.Corticosteroids (also called steroids), may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills.Colchicine is often used to treat gout and usually begins working within a few hours of taking it. This drug is used less often due to concerns about its side effects.Dr. Sanjay Kapoor (Orthopedics & Joint Replacement Surgeon)For More DetailsVisit: www.drsanjaykapoor.in

Uric Acid and Joint Problems - Facts and Myths

Dr. Anuj Shukla, Rheumatologist
There is a lack of awareness and many myths related to uric acid and joint problems. This article is to increase the awareness regarding this topic in general public and among doctors.What joint problems can uric acid cause?The only joint problem related to high blood uric acid level is “Gout”Symptoms of Gout are episodes of severe pain, redness and swelling at the base of the great toe (Image). It can involve different joints in the foot and occasionally ankles and knees. The episode starts with severe pain in great toe base that increases rapidly within first 12-hours to maximum intensity. Pain and swelling that subsides gradually over a week or two, leaving behind the almost normal joint.In addition to joint problems, high uric acid is related to kidney stones and high blood pressure.You are more likely to get Gout ifYou have high blood uric acid levels (>7mg/dl)Are maleAre an older adultAre obeseYou are taking certain medicines to increase urine outputEat certain foods, like red meat and organ meat (liver)Drink alcohol and sugary drinks, like soda sugar-sweetened juiceHave certain health conditions, like kidney failure, high blood pressure, and diabetesHave had a kidney transplantWhat joint problems are not due to high uric acid?Uric acid related joint problems are not seen in young women and does not cause mild joint pain. Uric acid cannot lead to continuous joint pain and swelling for months (>45 days). Mild pain at the base with a gradual outward deviation of great toe over months to years is not due to high uric acid. Uric acid does not cause whole body pain. Uric acid also does not lead to lower back pain.How is gout diagnosed?Your doctor will diagnose gout based on your symptoms mentioned above and examination of joints. He may require X-rays, ultrasound, and sometimes joint fluid aspiration to confirm the diagnosis. Blood uric acid level is not necessary to diagnose Gout.How is gout treated?Treatment has two parts.  It starts with rest, ice pack application and use of painkillers to control the pain and swelling of the joint involved. Later in some patients medicines to decrease blood uric acid level below <6mg/dl are required. This medicines to lower uric acid levels once started needs to be taken regularly and will prevent further episodes of joint pain. Lifestyle changes like weight reduction, avoiding alcohol, taking water enough to avoid dehydrations also help to control gout.Do you need treatment for all high uric acid levels (>7 mg/dl)?No, there is no need to treat high uric acid levels that are not causing above joint problem or kidney stones.Treatment of high uric acid is required only in patients withRepeated attacks of Gout (described above)Patients with long duration kidney diseasesThose who have repeated kidney stones with high blood uric acidWhat diet precautions I should take if I have Gout?There is a wrong concept among doctors and public, that Gout patients should not take vegetarian protein diet for example pulses and whole grains. Uric acid and arthritis have nothing to do with high protein diet. Uric acid is the end product of purine metabolism and not protein.Diet to be avoided by patients with high uric acid and gout areNon-vegetarian diet for example red meat, liver, and kidney, artificially sweetened soda drinks and excessive alcohol intake. Most of the western literature recommends taking more of vegetarian sources of proteins, as they are low in purine. Increasing milk and milk products in the diet decreases blood uric acid.What if I don’t take any treatment for Gout?In the absence of appropriate treatment and care, over months to years, uric acid crystals get deposited in joints and can damage them forever. They can also get deposited below skin leading to multiple swellings in the body, medically termed as Tophaceous Gout.References for further readingRichette P et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2016;0:1–14.Neogi T. In the Clinics-Gout. Ann Intern Med. 2016;165(1):ITC1-ITC16.Jordan MK et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology (2007) 46 (8): 1372-1374.Khanna D et al. 2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care Res (Hoboken). 2012 Oct; 64(10): 1431–1446.Khanna D et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. 2012 Oct; 64(10): 1447–1461.

Iron for Better Metabolism

Ms. Swati Kapoor, Dietitian/Nutritionist
We know how iron is important and its presence in the blood helps carry oxygen to the cells for energy production and good health of tissues. For a good metabolism oxygen is required in the cells. The iron helps carry the oxygen through blood to every cell. Do you remember how a good metabolism helps lose weight? 28-30  mg is the daily requirement of iron and is vital for a good immune system, build resistance and vital for brain development and concentration. Fainting, fatigue, rapid heartbeat are some of the common symptoms involved with iron deficiency. Iron has a low absorption rate in your body and can be increased with vitamin C.There are two forms of iron, Heme iron and non heam iron. The meats fall in the heam category which have a higher absorption in the body and non heme are plant food which have a low absorption rate. The oxylates and tannins present in plant food reduce the absorption of iron in the body. Especially caffeine, due to presence of tannins, when consumed with iron rich food can slow the rate of iron absorption?Traditionally the food was cooked in iron utensils which made the food rich in iron when prepared in them. The food absorbed iron from the iron handi and kadhai and other similar utensils. But with changing times the cooking utensils have changed too.Convenience and appearance  of non-stick utensils and plastic wares for micro waving,have soon replaced the iron utensils from the shelves. People consumed a decent amount of daily iron intake by just cooking the food in the utensil itself, but now with the paradigm shift one has to reach out to richer sources of iron to substitute for this change.Green leafy vegetables like spinach are good sources of iron. Dates, sprouts and green mint leaves provides a high amount of iron for the body. Nuts and seeds with fortified cereals and fish along with meat provide iron for metabolism. Add vitamin c for higher absorption of it.Here are some easy tips to increase your iron absorption in your body. Have sprouts with a squeeze of lime in it for higher iron absorption. Add citrus fruits which contain lots of vitamin C with iron rich foods to accelerate the absorption rate. Vegetables like tomato and broccoli are a good source of both vitamin C and iron.

Dietary Guidelines for Lactose Intolerance

Ms. Swati Kapoor, Dietitian/Nutritionist
Lactose intolerance, also called lactase deficiency and hypolactasia, is the inability to digest lactose, sugar found in milk and to a lesser extent milk-derived dairy products. Lactose intolerance is caused by reduced or absent activity of lactase that prevents the splitting of lactose (lactase deficiency). When lactose moves through the large intestine (colon) without being properly digested, it can cause uncomfortable symptoms such as gas, belly pain, and bloating. Some people who have lactose intolerance cannot digest any milk products. Others can eat or drink small amounts of milk products or certain types of milk products without problems. Lactose intolerance is common in adults. It occurs more often in Native Americans and people of Asian, African, and South American descent than among people of European descent.The amount of lactose an individual can tolerate varies from person to person.  Many people with lactose intolerance can tolerate some lactose-containing foods by adjusting the type, amount and timing of these foods.  Some patients may need to (or may choose to) limit or eliminate these foods completely. If you wish to include lactose-containing foods in your diet, the following suggestions given by UVA nutrition services may help the one to deal with the lactose intolerance problem. Always consult with your health expert  before making changes to your prescribed diet.LIVING WITH LACTOSE INTOLERANCE1. Add new foods one at a time; decrease the amount, or eliminate the food, if symptoms occur.2. Most people with lactose intolerance do not need to avoid all dairy products, for example:Cultured yogurt contains live cultures that naturally help digest lactose. Many people with lactose intolerance tolerate cultured yogurt well.  Check labels to see if a yogurt contains live cultures or hard cheese is low in lactose and is usually well tolerated3. If you wish to drink milk, try taking small amounts (1/2 cup at a time). Many people can tolerate up to 2 cups of milk per day when taken in smaller servings spread out over the course of the day.4. Foods that contain lactose may be better tolerated if they are eaten with a meal.Foods made from certain dairy products (such as pudding, cream soups, cream or cheese  Sauces,  etc.)  also contain lactose.  The amount of lactose in a product will depend on the  amount of dairy products used. Other foods such as baked items, instant mixes, salad dressings , etc. may also contain lactose.  The following ingredients suggest a product contains lactose.Butter, Caseinates, Cheese, Cream, Curds, Dry milk solids, Lactose, Milk, Milk by-products, Milk solids, Milk sugar, Non-fat dry milk powder, Skim milk solids, Whey, Yogurt5. Lactose can also be found in medications:-Check for lactose on the label, although it does not have to be listed; if you are very sensitive to lactose and have persistent symptoms, ask your pharmacist to help you.  Ask your doctor to prescribe a lactose-free alternative if one exists.6. Specialty Products:-If you are not able to tolerate lactose-containing foods using the above suggestions, special products are available.  Keep in mind, not everyone with lactose intolerance needs special products; many people can tolerate regular dairy products by adjusting the type and amount consumed.- 100% lactose reduced milk is available in the dairy section of most grocery stores.- Available in nonfat, 1%, 2%, and whole milk varieties.- Lactose reduced milk contains the same nutrition, including calcium and vitamin D as regular milk.- Lactose reduced milk does cost a bit more than regular milk.- Lactose reduced milk may taste sweeter than regular milk.7. Lactase Enzyme SupplementsThese products contain the enzyme lactase, which is needed for the digestion of lactose. Available in tablet or chewable form.8.Other ProductsSoy milk, rice milk and almond milk are lactose free.  If you plan to use these products as an alternative calcium and/or vitamin D source, read labels carefully and choose a brand which specifically states it contains these nutrients and in what amounts.Calcium and Vitamin DIf you are on a low lactose diet, discuss your calcium and vitamin D intake with your physician or dietitian. Studies have shown that individuals with lactose intolerance often do not take in enough of these nutrients.  Inadequate calcium and vitamin D intake increases the risk of osteoporosis.  A dietitian can help you determine whether you are getting enough of these nutrients in your diet.PREVENTIONThere is no known way to prevent lactose intolerance. However, one can lead a healthy and normal life by managing their daily diet routine and incorporating products that are lactose free, yet with healthy nutrients. The key is to have balance of all vital nutrients and implementing guidelines that are meant for lactose intolerance condition.

Refractive Errors In Children

Dr. Brijinder Singh Rana, Ophthalmologist
Refractive error is the most common cause of visual impairment in children. Visual impairment can have a significant impact on a child’s life in terms of education and development. It is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.Children with such errorsFind difficulty in reading, writing and have difficulty to see distanceEye strain while reading for long or shrink eyes to see at a distanceMay have squint (crossed eyes)May hold book close while readingIn addition to the above condition,Child may rub the eyes or blink frequentlyHeadache in forehead regionRecurrent swelling in the eyelidsCorrection using the spectacles is the best option available .Though children may initially refuse to accept glasses, They will become fond of them once they realize they can see better with them on. The power of glasses may change depending on the growth of eyeballs. An eye checkup and change of glasses if necessary, has to be done once six months for children less than 5 years of age and once a year thereafter.Making a child wear glasses regularly is the duty and responsibility of the parents. Failure to wear glasses in childhood will retard the development of vision in that eye. Children older than 15 years can use contact lenses, if they don’t want spectacles. Those over 18 years of age with stable power have option of going in for lasik.“HELP YOUR CHILD SEE THE WORLD BETTER.WEARING GLASSES IS NOT A STIGMA”