Membrana Epiretiniana

Beyond the everyday common diagnoses of dry eye, viral conjunctivitis, stye and cataract, there are certain ophthalmologic conditions that can be difficult to explain in plain language to a patient, regardless of the formal language in which the doctor and patient communicate. During the March through June period of 2014, my blog entries focused on some of these common, often-diagnosed eye problems. With this new series I am starting: “Cómo explicar conceptos complicados de oftalmología en español” I hope to create a series within a series, so to speak, this time around addressing less common diagnoses, many of which fall under the umbrella of subspecialty, and require more in-depth explanations and efforts at breaking down the information so a lay person can comprehend.  My goal is to help the non-native Spanish speaking doctor easily tackle the deconstruction of these often complicated medical concepts in English and fluidly relay this information in Spanish. My first subject: the concept of Epiretinal Membrane – Membrana Epiretiniana Macular.

Aviso Legal:  La información que está incluido aquí representa información general de los ojos -- no está aquí para diagnosticar o tratar una condición. Si Usted ve algunos cambios en la visión o en los ojos en general, debe visitar su oftalmólogo inmediatamente por un examen completo. La información aquí no se debe utilizar en lugar de un reconocimiento médico.

Legal Notice: The information included here represents general information of the eyes – it is not here to diagnose or treat a condition.  If you see changes in your vision or in the eyes in general, you should visit your ophthalmologist immediately for a complete exam. The information here should not be used in place of a medical examination.

La serie <Cómo explicar conceptos complicados de oftalmología en español> les presenta:

¿Qué es una “Membrana Epiretiniana” (Epiretinal Membrane)? 

¿Qué es una membrana epiretiniana macular?

Para comprender qué es una membrana epiretiniana, usted tiene que comprender las estructuras del ojo. Dentro del ojo, hay una capa fina que cubre el interior entero del ojo, se llama: la retina. Este tejido funciona para permitirle al ver. Imágenes se enfocan en la retina central: la macula, y esta información se envía al cerebro. Si la retina no funciona, por una razón u otra, usted no puede ver.

En algunas personas, las células debajo del tejido de la retina migran sobre la retina y forman una membrana en la superficie de la retina. Esta membrana provoca una arruga en la macula, y, con eso, hay distorsión y pérdida de la visión.

What is an epiretinal membrane?

To understand what an epiretinal membrane is, you have to understand the structures of the eye.  Inside the eye, there is a thin layer that covers the entire inner part of the eye, called: the retina.  This tissue works to allow you to see.  Images focus on the central retina, the macula, and this information is sent to the brain.  If the retina is not functioning, for one reason or another, then you cannot see.

In some people, the cells underneath the retinal layer migrate above the retina and form a membrane on the most superficial part of the retina.  This membrane causes a wrinkle in the macula, and as a result, there is distortion and loss of vision.

¿Qué causa la membrana epiretiniana?

Esta membrana se puede formar de estados varios del ojo: cuando hay inflamación, por ejemplo, después de algún tipo de cirugía del ojo, o un episodio de uveítis. También, después de la separación del vítreo de la retina (un proceso normal y esperado con envejecimiento) se puede formar la membrana. Si hay un hueco o abierto de una parte de la retina, hay la posibilidad de membrana. Y si hay una membrana en un ojo, hay riesgo de 20% para desarrollar dentro del otro ojo.

What causes epiretinal membrane?

This membrane can form as a result of various conditions of the eye: when there is inflammation, for example, after some type of eye surgery, or an episode of uveitis.  Also, after the vitreous separates from the retina (a normal process expected with age) a membrane can form.  If there is a hole or opening in a part of the retina, there exists the possibility of membrane formation.  And if there is a membrane in one eye, there is a 20% risk of a membrane developing in the other eye.

¿Qué son los síntomas?

Cuando la membrana crece sobre la retina central, se afecta la visión central. Si la membrana se contrae, suceden distorsiones o visión ondulada. En tiempo, es más difícil hacer actividades tal como leer y escribir.

What are the symptoms?

When the membrane grows on the central retina, it affects the central vision.  If the membrane contracts, distortions or wavy vision develop.  In time, it becomes more difficult to do activities such as reading and writing.

¿Cuál es el tratamiento – hay un tratamiento?

Si tiene un membrana epiretiniana, es importante consultar con un especialista de la retina. Él o ella puede determinar si la condición exige una cirugía para sacar la membrana y mejorar la visión. Afortunadamente, la mayoría de casos de membrana retiniana se estabiliza con tiempo y no necesitan cirugía, sólo observación. Su médico le puede dar una rejilla de ‘Amsler’ para vigilar los cambios en la visión.

What is the treatment – is there a treatment?

If you have an epiretinal membrane, it is important to consult with a retinal specialist.  He or she can determine if the condition requires a surgery to remove the membrane and improve the vision.  Fortunately, the majority of cases of epiretinal membrane stabilize in time and don’t require surgery, only observation. Your doctor may give you an Amsler grid to watch for changes in your vision.

¿Hay riesgos con esta cirugía?

Todas cirugías tienen beneficios y riesgos. Con el procedimiento para sacar la membrana epiretiniana, hay riesgo de formar catarata, desprendimiento de la retina, u infección del ojo—cualquiera de estas cosas puede resultar en ceguera.

Are there risks with this surgery?

All surgeries have benefits and risks.  With the procedure to remove an epiretinal membrane, there is a risk of cataract formation, retinal detachment or eye infection—any one of these conditions can result in blindness.

Para más información de membrana retiniana y otras enfermedades de los ojos, visite usted el sitio en la red: www.ojossanos.org . Es información médica patrocinado por la Academia Americana de Oftalmología (AAO). 

Ladybug invasion, van Cortlandt Manor

Dios le bendiga

Doctor: “Está bien. Siéntese atrás. Primero, quiero decirle que tenga ojos muy sanos.”

Paciente: “¡Ajj, Gracias a Dios!”

Doctor: “No hay signos de diabetes, y la presión del ojo es estable. Ahora, es importante que continue usted controlar el azúcar, para mantener una retina sana.”

Paciente: “O, sí, gracias a Dios por sus bendiciones, todo esté bien.”

Doctor: “Aquí, lleve este papel a la frente, hacemos una cita  para otro examen en un año.”

Paciente: “Gracias, doctor, pase buen día, Dios le bendiga.”

This conversation at the end of  a visit with my Spanish-speaking patients is quite typical. In this particular case, I am telling a diabetic patient that his eye exam is normal. He shows no signs of diabetic changes in his eyes. The patient expresses happiness and relief by thanking God for this good result. Though I reiterate during the exam that it’s his good blood sugar control that has kept his retina healthy, the patient continues to speak as if it’s not good blood sugar control that equals a healthy retina, but that garnering God’s many blessings equals a healthy retina.

There are many articles that chronicle the topic of “fatalismo”,  a particular concept of Latino culture where a person’s fate determines his outcome in any given situation. In the piece, “Cultural Values of Latino Patients and Families”, author Marcia Carteret, M. Ed. discusses how Latinos “... have a strong belief that uncertainty is inherent in life and each day is taken as it comes.” The term “fatalism” refers to the belief that because we are all assigned a pre-determined fate, there is little that can be done to alter the natural course of things.

When applying the idea of fatalismo to health care, Latino patients are less likely to seek out preventative care or continue a particular treatment. They may not follow up on testing or treatments or even want to know that they have a particular diagnosis like cancer because they believe the disease to be a punishment by God. In the case of my patient above, his good eye health was the direct result of God’s blessings. For others, conversely, diabetic retinopathy is the end result of someone’s fate, not poor blood sugar control.

For people who believe their fate is out of their hands, there is less emphasis on trying to control things in their environment. Time, for example, is flexible in the minds of many Latino immigrants. Being punctual for medical appointments is not necessarily valued and tardiness, in fact, is the societal norm. The author goes on to remark how in US American culture, there is a sense of discomfort that goes along with uncertainty in life. As a result, US born non-Latinos seek control of the natural chaos in life by tightly managing time: setting appointments, keeping them, multi-tasking. Non-Latinos focus on the individual when it comes to decision making, thereby putting “...little faith in fate or karma.”

Through my own experiences with my patients, I was about to conclude that only foreign-born or immigrant Latinos surrender to fatalismo, but an article by Amanda Machado says otherwise. In her piece, “Why Many Latinos Dread Going to the Doctor”, Ms. Machado writes how generations of Latinos in the United States still struggle with relying on Western medicine for their health care needs. They prefer turning to natural remedies used by family members to address any health ailment. She states that, though many of these plant and herbal remedies can be ineffective or even dangerous, Latinos still feel more at ease using them because “..“There’s greater trust for what has worked for your family or what you’ve heard has worked for others in your community.”

I see a large community of Latino patients in my practice. I have to admit that when I first started working there and noted how many of the patients came 15, 20 even 30 minutes late, -and regularly so- I felt frustrated because  1) I took it as a sign of disrespect for me, my time, and my other patients’ time and 2) I had to struggle to rush and squeeze in their exams so I didn’t make the other patients who came on time wait to be seen. However, after reading this information on fatalismo, and understanding the meaning behind it, I now see that the lateness of these patients is not a sign of disrespect. It’s part of a natural belief about life, that there are many things outside our control and that perhaps there’s no point in stressing about every minute, second or microsecond.

This laxity about time does have its benefits. I’ve rarely if ever had a Latino patient complain about waiting to see me. I’ve never had them start screaming at me in the exam room like some of my non-Latino patients, about how time is money and time is everything and I’ve wasted theirs. If time can’t be controlled and fate is out of our hands, then I can breath a little easier. I can give my patients the attention they deserve without rushing. And I can do my doctorly duty and explain a disease and how to prevent it. But if my patient chooses to believe that God and not lifestyle guides his health status, who am I to disagree? I happen to believe in something I’ll call ‘fatalismo plus’: that some of our life is scripted and some of it we write on our own. If we take the extra time to listen to, respect and help one another, then indeed we’ll find ourselves in a world of many blessings.

References

Carteret, Marcia, M. Ed. “Cultural Values of Latino Patients and Families.”http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/

Machado, Amanda. “Why Many Latinos Dread Going to the Doctor.” http://www.theatlantic.com/health/archive/2014/05/why-many-latinos-dread-going-to-the-doctor/361547/

Adirondack Balloon Festival, Queensbury, NY

El acrónimo

I am in the process of translating a consent form for the glaucoma laser procedures Argon laser trabeculoplasty and selective laser trabeculoplasty.  When we speak of these laser surgeries in English, we often use their acronyms, ALT and SLT, simply for ease of use and flow of the text. We usually introduce the acronym along with their corresponding words when they are first mentioned in the text. For example:

“Indications. The Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) surgeries are used for patients with open angle glaucoma. The laser is utilized to treat the drainage system of the eye.”

But what happens when this is translated for the Spanish reader?

“Indicaciones.  La trabeculoplastía con láser de árgon y trabeculoplastía selectiva con láser son procedimientos los que se usan para los pacientes con el glaucoma de ángulo abierto. El radioláser se utiliza para tratar el sistema de drenaje del ojo.”

Do I shorten “trabeculoplastía con láser de árgon” to TLA, which is the acronym corresponding to the Spanish words, or do I use the familiar ALT which is how this procedure is known by a U.S. audience?

In my own research of acronym translation, I have seen this situation handled differently. On the website TrustedTranslations.com an article posted by Scott J addresses these different approaches.

First, you can always write the acronym as it corresponds to the text in your target language, but then add in parenthesis something to the effect of “for its acronym in language of origin”.  I did this with a recent translation I did for an MTA (Metropolitan Transportation Authority) in Spanish:

 MTA – Metropolitan Transportation Authority ( la Autoridad Metropolitana de Transporte – en adelante MTA en inglés) A su servicio

Second, world-renowned organizations will have their own translation in each language:

            NATO=OTAN

Third, acronyms related to health and medicine usually have their own default translation. As seen above:

trabeculoplastía selectiva con láser (TSL – en adelante SLT en inglés)

Síndrome de Inmunodeficiencia Adquirida (SIDA – en adelante AIDS en inglés)

Lastly, the article emphasizes that it is always important to do some investigations for a potential acronym in the target language. Especially for job titles, country names, political parties, “some acronyms have a standardized translation and others do not.”

But going back to my ALT/SLT translation from English to Spanish, another important fact to consider is, who is your reading public? For whom are you writing this? In the case of this particular consent form, the reading public includes a small immigrant population of Spanish-speakers living in an English-predominant area. The majority of these people did not have access to medical care in their home country, and if they did it was limited. Therefore for these people, I think the best approach is to write the name of the procedure in Spanish, add the Spanish acronym, but clarify what the English acronym would be, too, so they could recognize it should they come across print ads or informational brochures written in English.

Remembering the audience- knowing who your reader is- is almost as important as knowing the translation itself.

References

Trusted Translations: Translating Acronyms and Abbreviations  http://translation-blog.trustedtranslations.com/translating-acronyms-and-abbreviations-2012-06-07.html\

Purple Heron, Kopački Rit, Slavonia, HR