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Globally, Age Related Macular Degeneration (AMD) Is The Third Most Common Cause Of 'legal' Blindness (WHO 2002) Whilst In Most Western Countries It Is By Far The Commonest Cause Of Blindness. Macular Degeneration Usually Manifests After 50 Years Of Age. With The Rapid Rise In The Geriatric Age Group, Which Is The At Risk Group, The Disorder Could Take Epidemic Proportions And Become A Major Public Health Consideration.

 

Learn About Age-related Macular Degeneration

 

Definition Of Age Related Macular Degeneration

Age Related Macular Degeneration (AMD) Is A Disease Associated With Aging, Characterized By Damage To The Central Part Of The Retina Called Macula. Before We Talk About What Can Go Wrong, It Is Important To Understand How The Eye Works When It Is Working Properly.

 

How The Eye Works

The Eye Is Like A Camera. The Lens In A Camera Allows Light To Pass Through And Focuses That Light On The Film At The Back Of The Camera For A Clear Picture.

 

The Eye Works In A Similar Way. The Front Parts Of The Eye (the Cornea, The Pupil, And The Lens) Are Clear And Allow Light Through. The Cornea And Lens Focus That Light On The Retina, Which Lines The Back Inside Wall Of The Eye. The Retina Is A Delicate Layer Of Nerve Fibers And Acts Like The Film In The Camera. It Is The Seeing Tissue. When Focused Light Hits The Retina, An Image Is Formed. This Message Is Transmitted To The Brain Via The Optic Nerve Enabling Us To See.The Retina Can Be Further Divided Into Two Regions: The Central (macula) And The Peripheral

 

The Macula (Latin Word Meaning Spot) Is A Very Small Area, About The Size Of A Pencil Eraser, In The Centre Of The Retina And Is The Most Important Region Of The Visual Anatomy. This Is The Area Upon Which Light Rays Are Focused By The Cornea And The Lens Of The Eye. The Macula, Which Is Loaded With Photoreceptors, Is The Most Sensitive Portion Of The Retina And Is Responsible For Acute (sharp) Vision - That Is For Reading, Writing, Threading A Needle And Other Fine Tasks. The Periphery Of The Retina Gives Us Vision To The Side, Which Is Called "peripheral Vision". This Is What We Refer To When We Say, "I Saw Something From The Corner Of My Eye."

 

When The Macula Is Damaged, The Central Vision Blurs Or Darkens. Tasks Like Reading, Watching TV, Driving Sooner Or Later Become Impossible. However, The Side Or Peripheral Vision Does Not Usually Change And Most People Keep Enough Useful Vision To Live On Their Own.

 

Dry AMD

It Is The Most Common Form Found In 90% Of Patients. Dry AMD Occurs When The Macular Tissues Get Thin And Slowly Lose Function. The Most Common Symptom Of Dry AMD Is Blurred Vision Which Causes Difficulty In Recognizing Faces, Increases Light Requirement For Reading And Other Tasks. Visual Deterioration Is Slow But Usually Not Profound. About 10-20% Of People With Dry AMD Advance To The Wet Form.

 

Wet AMD

It Is The Less Common But More Aggressive Form Of AMD. If It Is Not Treated It May Get Worse Rapidly. Wet AMD Is Caused By Proliferation Of Abnormal Blood Vessels Under The Retina Which May Exude Or Leak Out Fluid, Or Bleed And Ultimately Lead To The Formation Of A Scar Under The Retina. The Various Treatment Options To Stall Progress To The Wet Form And To Restrict Vision Loss Will Be Discussed.

 

Symptoms Of AMD

  • Diminution Of Vision In An Important Symptom Of Macular Egeneration. This Lack Of Ability To See Objects Clearly Affects Ones Ability To Read, Drive And See Details.
  • Straight Lines Appear Crooked Or Wavy
  • A Dark Area Appears In The Centre Of Vision E.g. Words In The Central Part Of The Page Look Smudged

Having One Or More Of These Symptoms May Not Necessarily Mean That One Has AMD And It Warrants An Immediate Eye Check Up (early Detection Is Important).

 

Risk Factors For AMD

Age - Is The Greatest Risk Factor. Although AMD Can Occur During Middle Age, Studies Show That People Over 60 Years Of Age Are At Great Risk. The Risk Increases With Increasing Age.

  • Family History Of AMD Increases The Risk.
  • Race - White Populations Are More Predisposed To Suffer Vision Loss From Neovascular AMD Than Asian Or African Populations
  • Smoking Has A Definite Correlation
  • History Of Hypertension, Heart Disease, Or Lung Infection Adds To Risk.

 

Detection Of AMD

Early Detection Is Of Paramount Importance As Smaller Lesions Have A Better Recovery And Chance Of Maintaining Reading Vision Than Advanced Cases With Larger Lesions And Fibrotic Changes.

 

Your Ophthalmologist May Suspect AMD If You Are Over 60 Years Of Age And Have Recent Changes In Central Vision. To Establish A Diagnosis A Comprehensive Eye Check Up Is Done.

 

Visual Acuity Test - This Eye Chart Test Measures How Well You See At Varying Distances.

 

Amsler Grid - In This Test The Patient Wearing His Reading Glasses, Covers The Opposite Eye And Looks At The Black Dot In The Centre Of The Test Page (checker Board Pattern) To Check For Any Area Which Is Distorted, Blurred, Discolored Or Not Visible. It Is A Useful Test To Detect Early Changes And Can Be Done Routinely By The Patient At Home.

 

Dilated Eye Examination - To Look For Signs Of The Disease Your Doctor Will Use Drops To Dilate Or Widen The Pupil. With A Special Magnifying Lens And A Light Source Your Doctor Will Examine Your Retina. Dilating Drops Hamper Close Vision For Around 4-5 Hours.
If On The Above Examination Your Doctor Suspects AMD, Other Tests To Learn More About The Structure And Functioning Of The Retina Could Be Advised.

 

Fluorescein Angiography (FA)

A Special Dye (Sodium Fluorescein) Is Injected Into Your Vein And Serial Photographs Of The Retina Are Taken. The Photographs May Reveal Leaking New Vessels (choroidal Neovascular Membrane), Define Its Location In Reference To The Centre Point And Determine Any Associated Finding I.e. Hemorrhage, Exudates. Fluorescein Angiography Is An Important Tool In Planning Treatment And A Recent Angiogram Is Essential At The Time Of Treatment. Repeat Angiograms After Treatment Are Indicated To Confirm The Status Of The Lesion.

 

Indocyanine Green Angiography (ICGA)

ICGA Gives A Better Study Of The Deeper (choroidal) Circulation. It Is Indicated In Certain Cases Where The Fluorescein Angiography Is Inconclusive E.g. Cases With Ill-defined Membranes, Presence Of Hemorrhage, Or Polypoidal Vasculopathy. It Takes Longer Than Fluorescein Angiography As Photographs Are Taken Till 20 Minutes After Injection Of Dye.

 

 Optical Coherence Tomography (OCT)

This Is A Newer Noninvasive Test, Which Gives An Accurate Structural Analysis Of The Retina. It Is Helpful In Diagnosis And Most Importantly In Follow-up Of The Disease.

 

Treatment Of Wet Age-Related Macular Degeneration

Wet AMD Can Be Treated With Laser Photocoagulation, Photodynamic Therapy, Intravitreal Injections Or A Combination Of These. The Aim Of Treatment Is To Slow The Rate Of Vision Decrease Or Stop Further Vision Loss But The Disease Some Times May Progress Despite Treatment. With The Advent Of Anti-VEGF Treatment There Are Greater Numbers Of Patients Who Are Showing Visual Improvement.

 

Laser Photocoagulation

This Out Patient Procedure Uses The Conventional Laser To Destroy Fragile, Leaking Blood Vessels. A High Energy Beam Of Light Aimed Directly On The New Blood Vessels, Destroys And Inactivates Them, Preventing Further Loss Of Vision. However, Laser Treatment May Also Destroy Some Surrounding Healthy Tissue. Only A Small Percentage Of Patients Where The Membrane Is Away From The Centre (fovea) Can Be Treated By This Modality. Re-treatments May Be Necessary. Recently In Some Cases We Combine It With An Anti-VEGF Agent So As To Decrease The Chances Of Recurrence.

 

Photodynamic Therapy (PDT)

(PDT) Has Been Found To Be An Effective Treatment For Patient For Patients With New Vessels (choroidal Neovascular Membrane Or CNVM) Secondary To AMD, Myopia, Etc. It Reduces The Risk Of Moderate And Severe Vision Loss. A Light Stimulated Drug Called Verteporfin Is Injected Intravenously. It Travels Through Out The Body Including The New Vessels In The Eye. The Drug Tends To "stick" To The Surface Of New Blood Vessels. Next A Low Intensity Laser Beam (689nm) Is Directed Into The Eye For About 83 Seconds To Activate The Drug. The Activated Drug Selectively Destroys The Abnormal Blood Vessels Without Damage To Surrounding Healthy Tissue. Because The Drug Is Activated By Light The Patient Must Avoid Exposure Of Skin Or Eyes To Direct Sunlight Or Bright Indoor Light For 5 Days After Treatment. The Treatment Is Relatively Painless And No Major Side Effects Have Been Reported. PDT Slows The Rate Of Vision Loss. Re-treatment May Be Required But Usually Not Before 3 Months.

 

Intravitreal Injections (Anti-VEGF Agents)

Abnormally High Levels Of Vascular Endothelial Growth Factor (VEGF) Occur In Eyes With Wet AMD Which Promotes The Growth Of Abnormal New Blood Vessels. Anti-VEGF Agents Block The Effects Of This Growth Factor. Treatment By This Agent Helps Slow Down Vision Loss From AMD And In Some Case Improves Vision. Multiple Injections Are Often Required For Complete Inactivation Of The Disease Process.


 
Avastin (Bevacizumab) Is An Anti-VEGF Agent Approved For Use In Colorectal Cancer. Ophthalmologists Are Using It "off Label" In AMD And Other Vascular Conditions For Its Anti-angiogenic Property. When Used In The Eye As An Intravitreal Injection Its Dose Is Miniscule And Risk Of Adverse Systemic Reactions Like Gastrointestinal Perforation, Thrombo-embolic Reactions, Hypertension And Proteinuria Is Negligible. There Are No Formal Clinical Trials With Avastin But Recent Experience With This Drug Has Been Encouraging With Most Patients Getting Stabilized And Some Improving.

 

Macugen (Pegaptanib Sodium) is The First Selective VEGF Inhibitor Which The FDA Approved To Treat The Pathologic Process Underlying All Subtypes Of Neovascular AMD. In Clinical Studies Macugen Was Given Every 6 Weeks For Upto Two Years And Was Found To Preserve Visual Acuity Of All Subtypes Of Neovascular AMD. Its Advantage Lies In Its Selective Systemic Inhibition Of VEGF, Thereby Making It Possible For Use In Patients With Recent Cardiac History.

 

Lucentis (Ranibizumab) Is A Recently FDA Approved Anti-VEGF Agent That Neutralizes All Active Forms Of Vascular Endothelial Growth Factor. It Is A Recombinant Homogenized Monoclonal Antibody. Clinical Trials With Lucentis Have Shown Not Only Stabilization But Also Improvement In Visual Acuity. In The Multicentre Trial Comparing Effectivity Of Lucentis To Sham Injection For Minimally Classic Or Occult CNVM, It Was Found That 94.5% Of The Group Given 0.3 Mg And 94.6 % Of Those Given 0.5mg Had Stable Vision Compared With 62.2 % Of Those Receiving The Sham Injection. Visual Acuity Improved In 24.8 % Of The 0.3 Mg Group And 33.8% Of 0.5 Mg Group As Compared With 5% Of The Sham Injection Group. The Benefit In Visual Acuity Was Maintained At 24 Months. Lucentis Was Also Found To Be Superior To Vertporfin (Photodynamic Therapy) In Predominantly Classic Neovascular Age Related Macular Degeneration With Low Rates Of Serious Ocular Adverse Effects.
 

Triamcinolone Is A Slow Releasing Steroid Preparation Which Helps In Reducing The Swelling Associated With The Disease And Also Has Some Anti-angiogenic Action. The Risk Of Increased Intraocular Pressure Is Its Major Disadvantage. Since It Is A Suspension It Is Visible As A Floater In The Upper Field Of Vision For A Few Weeks After Injection.


 
Intravitreal Injections Are Given With Aseptic Precautions In An Operation Theatre. The Eye Is Numbed With Anesthetic Drops And Then The Injection Is Given. The Procedure Is Relatively Atraumatic But Carries A Small Risk Of Post Injection Infection, Raised Or Low Intraocular Pressure, Cataract Formation, Vitreous Hemorrhage, Retinal Detachment. Systemically Anti-VEGF Agents Are To Be Used With Caution In Patients With A Recent History Of Cardiac Ailment, Uncontrolled Hypertension And Severe Proteinuria.

 

Combination Therapy

Treatment Of Wet ARMD With Photodynamic Therapy (PDT) Alone Has Very Limited Chances Of Visual Improvement While Anti-VEGF Agents Have The Problem Associated With Repeated Injections. Combination Therapy Of PDT With Anti-VEGF Agents Or Triamcinolone Makes The Treatment More Finite, With The Advantage Of Improvement In Visual Acuity In Some Cases And Reduced Requirement For Repeated Injections

 

Transpupillary Thermotherapy (TTT)
In TTT, A Large Spot Of Diode Laser (810 Nm) With Relatively Low Energy Is Applied To The Area Of New Vessels. The Treatment Is Non Specific And There Is Concomitant Damage To Normal Retinal Tissue Though Less Then In Conventional Laser Photocoagulation.

 

Surgical Treatment
The Following Surgical Procedures Have Been Tried But With Limited Benefit:

 

Excision Of Subfoveal CNVM - The Technique For This Has Been Fairly Well Perfected But Visual Recovery Is Limited By The Fact That Normal Retinal Pigment Epithelial Cells Are Also Removed In The Process.
 

Macular Translocation - In This Procedure The Retina Is Detached To Be Able To Shift The Fovea Away From The Subfoveal Choroidal Neovascular Membrane. Thereafter The Membrane Is Lasered Without Damaging The Fovea. Drawbacks Of This Procedure Are A High Complication Rate, Inadequate Shift Of Macula, Formation Of Retinal Folds And Double Vision.

 

Treatment Of Dry Age-Related Macular Degeneration
There Is No Definite Treatment For The Dry Form But The AREDS (Age-related Eye Disease Study) Found That A Specific High Dose Formation Of Antioxidants And Zinc Significantly Reduces The Risk Of Advanced AMD And Its Associated Vision Loss. Regular Amsler Grid Monitoring To Detect Conversion Of Dry Form To Wet Form Is Important. Smokers Should Ensure That The Formulation They Take Does Not Contain Beta-Carotene As That May Increase Their Risk Of Developing Lung Cancer.

 

Low Vision Aids
Patients Who Have Lost Fine Vision In Both Eyes Can Consult A Low Vision Specialist Who Helps Patients Learn To Use Their Remaining Vision To Its Fullest. Low Vision Specialists Can Fit Magnifying Lenses For Close Up Vision And Telescope Lenses For Seeing At A Distance. CCTV Devices Provide An Enlarged Image On A TV Screen. There Are Other Visual And Mechanical Devices Such As Filters, Increased Illumination And Special Reading Aids That Can Help Patients To Live Their Life To The Fullest Even With Reduced Vision. Special Books And Other Items Available In Large Print Offer Further Help.
Precautions And Life Style Changes

  • Yearly Complete Eye Check Up
  • Regular Amsler Monitoring Once Patient Is Diagnosed To Have AMD.
  • Anti-oxidants To Decrease Progression Of AMD.
  • Healthy Diet Rich In Green Leafy Vegetables And Fish.
  • Avoid Smoking.
  • Maintain Normal BP
  • Exercise And Avoid Obesity.
  • If You Have Lost Sight From AMD Do Not Be Afraid To Use Your Eyes For Reading, Watching TV.

 

Research
Scientists Are Studying The Possibility Of Transplanting Healthy Cells Into A Diseased Retina, And Are Evaluating Families With A History Of AMD To Understand The Genetic And Hereditary Factors That May Cause The Disease. They Are Also Looking At Certain Anti-inflammatory Treatments For The Wet Form Of AMD.


This Research Should Provide In The Future, Better Ways To Detect, Treat And Prevent Vision Loss In Patient With AMD


Sight Is Our Most Precious Sense Enabling Us To Enjoy The Beauty Of The World In Which We Live. Blindness Has Been Recognized As An Important Public Health Problem In India, A Country That Is Now Home To A Billion Inhabitants. A Nationwide Survey, Undertaken In 1999-2001, Revealed The Prevalence Of Blindness To Be 8.5%. Over 60% Of Blindness Has Been Attributed To Cataract Alone.

 

For Centuries, Developing Cataract Doomed A Person To Blindness. Today Modern Microsurgical Techniques Utilizing State-of-the-art Equipment, Lenses And Surgical Material, Allow People To Enjoy Good, Clear Vision After Their Cataracts Have Been Removed. We At Shreya Eye Centre Believe That Giving Up Favorite Activities And Suffering Through Years Of Poor Vision Due To Cataract Is No Longer An Inevitable Part Of The Ageing Process. Our Centre Is Dedicated To Provide The Best Possible Care To Patients Suffering From Cataract.

 

Learn About Contact Lenses

 

How The Eye Works

Before Understanding Cataract, It Is Important To Know How A Normal Eye Works. The Eye Is Like A Camera. The Lens In A Camera Allows Light To Pass Through And Focuses That Light On The Film At The Back Of The Camera For A Clear Picture.
The Eye Works In A Similar Way. The Lens Of The Eye Is Normally Clear And Allows Light To Pass Through. The Light Is Focused On A Thin Film-like Retina, Which Is Situated At The Back Part Of The Eye. This Is How We See.

 

What Is A Cataract?
It Is A Cloudiness Of The Normally Clear Lens In The Eye. It Prevents The Lens From Focusing Light Onto The Retina And Hence Causes Unclear Vision. As The Cataract Advances, This Cloudiness Of Vision Increases Over A Period Of Time Until The Vision Is Completely Impaired.

 

Why Does A Cataract Develop?
Cataract Development Is Part Of The Normal Ageing Process. Almost All People Above The Age Of 60 Years Have Cataract Of A Variable Degree, Although It Can Occur At An Earlier Age Also. In Some People Cataract Development Is Aggravated By An Eye Injury, Presence Of Diabetes, Use Of Medications Or Other Eye Diseases. Rarely Cataract May Be Present In The Newborn As A Developmental Defect.

 

What Are The Symptoms Of A Developing Cataract?
Because Cataracts Form In Different Ways, The Symptoms Of Cataracts Are Variable. Most People Notice That Their Vision Gradually Deteriorates - Objects May Begin To Look Yellow, Hazy, Blurred Or Distorted. Many People Also Find That They Need More Light To See Clearly, Or That They Experience Glare Or Haloes From Lights At Night. A Common Problem Encountered Is Increasing Nearsightedness. In Advanced Cases, The Cataract May Be Visible As A Whitish-looking Pupil.

 

Can Cataract Be Prevented Or Treated With Medication?
Cataracts That Occur Due To The Ageing Process Cannot Be Prevented As The Ageing Process Itself Cannot Be Prevented. Using The Eyes For Reading And Similar Activities Has Nothing To Do With Cataract Formation. Avoiding The Use Of Eyes Will Not Prevent Cataract.


Till Date As Per All Authentic Medical Research No Medication Exists To Prevent Or Cure A Cataract. The Only Known Treatment For Cataract Is Surgery.

 

When Can One Undergo Cataract Surgery?
Cataract Surgery Can Be Performed As Soon As The Patient Feels Handicapped In Performing Routine Activities At Work And Leisure. With Modern Microsurgical Techniques Of Stitch-less Cataract Surgery (phacoemulsification And MICS) It Is Not Necessary To Wait For The Cataract To Mature.

 

What Does Cataract Surgery Entail?
It Is One Of The Oldest, Safest And Most Successful Forms Of Surgery. It Requires A Very Short Hospital Stay And Is Generally Performed Under Local Or Topical Anesthesia. The Patient Is Awake During Surgery But Does Not Feel Any Discomfort Or Pain. Patients Are Ambulatory Immediately After Surgery And Are Discharged On The Same Day.

Step 1 :The Eye Operation Is Performed With The Help Of A Sophisticated Operating Microscope. A Small Incision Of 2.0-2.5 Mm Is First Made In The Eyeball

Step 2 :A Smooth Round Opening Is Then Made In The Front Part Of The Lens Capsule, Which Is A Thin Membrane Enclosing The Entire Lens.

Step 3 :All Cloudy Lens Material Within The Lens Capsule Is Then Removed Through The Same Incision By The Procedure Of Phacoemulsification Using A Thin Titanium Probe That Emits High-speed Ultrasound Waves, Vibrating At 40,000 Times Per Second. This Breaks The Cataract Into Tiny Pieces, Which Are Then Suctioned Out Of The Eye Through The Same Probe.

Step 4 :In The Final Step, A Foldable Intraocular Lens (IOL) Is Introduced Through The Small Incision, And Placed Within The Capsule Of The Lens Where It Unfolds And Stays In Place Securely.
One Of The Most Recent Advancements Has Been The Ability To Perform Cataract Surgery Through Even Smaller Incisions (as Small As 1.8 Mm). Small And Micro Incisions Such As Those Used In Phacoemulsification Seal Themselves Immediately After Surgery And Heal Very Quickly. Compared To Non-phaco Cataract Surgery, The Postoperative Rehabilitation For Stitch-less Phacoemulsification Is Faster And One Can Return To Normal Work And Activities Within A Few Days. This Is Currently The Most Effective Method For Removing Cataracts.

 

Are There Any Problems With An Intraocular Lens (IOL)?
Fortunately, The Technological Advances In IOL Manufacture And Surgery Have Made It Quite Safe. Complications Are Rare And Similar Ones Can Occur With Conventional Surgery Without An IOL Implantation. All Patients Irrespective Of Other General Illnesses Like Diabetes, Hypertension Etc. Can Have IOL Surgery. If There Is Any Reason Why You Should Not Have An IOL Your Ophthalmologist Will Explain.

 

Does One Need Glasses After IOL Surgery?

The Improvement In Quality Of Life After Cataract Surgery Is Extraordinary, And Most Patients Are Not Dependent On Their Distance Glasses For Daily Activities. Some Patients However, May Need Glasses Of Small Plus Or Minus Power To Obtain The Best Possible Distance Vision.

 

IOL Power Calculations Are Done By Trained Personnel Using A Computerized Ultrasound Biometer For Measuring The Eye Before The Operation, And Every Endeavor Is Made So As To Get Very Minimal Post-operative Power In The Distance Glasses. However, Since These Calculations Are Based On Certain Theoretical Formulae, It Will Vary On A Person-to-person Basis, And Some People May Have A Slightly Larger Postoperative Refraction Than Others. Unlike The Natural Human Lens, Which Can Change Its Shape To Focus For Various Distances, The IOL, Since It Is Made Of Plastic, Cannot Do So. Hence, Majority Of Patients Undergoing Routine Phacoemulsification With IOL Implantation, Typically Require Reading Glasses After Cataract Surgery.

 

What Are The Latest Advances In Intraocular Lens (IOL) Technology?

Advances In IOL Technology Have Made Available Various State-of-the-art IOLs. These New Lens Designs Include

  • Blue-light Blocking IOLs That Filter Out Harmful Ultraviolet Radiation As Well As Blue Light,
  • Aberration-free IOLs Which Greatly Improves Image Quality By Enhancing Contrast, Eliminating Glare And Haloes, And Improving Night Vision, And
  • The Newer Multifocal IOLs Which Provides Good Unaided Distance And Near Vision With Less Dependence On Glasses.
  • Toric IOLs Are Also Available For The Correction Of High Cylindrical Spectacle Numbers.
  • MIL (Micro Incision Lens) Can Be Inserted Through Incision  Smaller Then 2mm.
  • Recently Accomodative IOL’s Have Been Introduced Which Have The Property To Change The Focusing Power For Near Work And Provides Good Unaided Vision For All Distances. Depending On The Patients' Personal Visual Needs, The Surgeon Decides The Most Appropriate Lens To Implant In The Eye.

 

Can All Patients Having A Cataract Undergo Phaco Surgery?
Your Eye Surgeon Will Be The Best Judge To Decide Whether You Can Undergo Phaco-surgery. Each Patient Undergoing Cataract Surgery Is Examined In Detail To Assess The Health Of The Cornea. With The Availability Of Newer Technologies Almost All The Patients With Cataract Can Be Operated With Phacoemullsification. But There May Be Situations Where Phacoemulsification May Not Be Advisable Such As Poor Endothelial Counts, Subluxated Cataracts, Poor View For Surgeon As In Corneal Scars.

 

Is Clear Vision Guaranteed After Surgery?

  • No Surgeon In The World Can Perform A Surgery With Guaranteed Results. However, Almost All The Patients Regain Good Vision Following Cataract Surgery.
  • The Calibre Of Vision Obtained After A Successful Cataract Surgery With IOL Depends Upon The Health Of The Retina Behind. Eye Disease Or Problems In The Cornea, Retina Or Optic Nerve May Limit The Potential For Clear Vision Even When The Cataract Surgery Itself Has Been Successful.
  • However, It Might Not Be Possible To Evaluate The Condition Of The Retina, Optic Nerve, In Advanced Cataracts.
  • Cataract And IOL Surgery Is Not A Magical Procedure And Need Not Necessarily Restore Normal Vision Immediately. Blurred Vision May Be Present Immediately After Surgery. As The Eye Heals Over A Period Of Time, Vision Improves Gradually.

 

What Are The Possible Complications That Can Occur With Cataract & IOL Surgery?
Modern Microsurgical Techniques For Cataract Removal Are Highly Successful Procedures. The Few Complications That Exist Are Becoming Even More Remote, With Newer Developments In Surgical Techniques And Anesthesia.


Some Minor Complications That Can Occur Include A Slight Drooping Of The Eyelid, Swelling Around The Eye, Corneal Haze, Reflections Or Slight Distortion From The Lens Implant, Which Are Usually Temporary. The Chances For Serious Complications Are Negligible. Possible Serious Complications Include Infection, Severe Inflammation, And Hemorrhage. In A Majority Of Cases These Complications Can Be Treated Successfully Or May Resolve On Their Own With A Good Final Restoration Of Vision. The Above List Is However Not Exhaustive.

 

Can Cataract Be Treated With Lasers?

Contrary To A Popular Myth Cataract Cannot Be Removed With Lasers. Surgery Done By Phacoemulsification Is Commonly Termed "Laser Surgery" By Many People.


However, In A Certain Number Of Patients Undergoing Cataract Surgery, The Back Part Of The Lens Capsule May Become Thick Or Opaque Over A Period Of Time Causing Blurred Vision.


This Is Known As A Secondary Cataract. This Is Not A Complication. The Condition Is Treated With A "YAG Laser Capsulotomy" With Full Restoration Of Vision.

 

Benefits Of Cataract Surgery:
There Are Numerous Benefits Of Cataract Surgery, Many Of Which Cannot Be Measured Statistically. These Include: -
Improved Colour Vision - Colours Are Brighter And More Vivid After Cataract Surgery.

  • Greater Clarity Of Vision - Vision Is Crisper And Sharper After Cataract Surgery.
  • Improved Quality Of Life - Studies Have Repeatedly Shown That People Enjoy An Improved Quality Of Life After Successful Cataract Surgery. Many People Can Resume Driving, Reading, Writing, Watching Television, Sewing, Household Work And Using A Computer Immediately After. Even When Retinal Diseases Or Other Problems Prevent A Total Restoration Of Vision, The Remaining Vision Is Usually Improved By Cataract Surgery.

 


Keratoconus Is A Condition Where The Cornea Becomes More Cone-shaped And Undergoes Progressive Thinning. The Vision Gradually Blurs And Becomes Distorted, And Is Often Not Satisfactorily Corrected With Glasses. Shreya Eye Centre Now Offers You Corneal Collagen Cross Linking Of The Cornea (C3R), Which Is A New And Promising Treatment For This Condition.

 

Learn About Keratoconus And Its Treatment.

 

The Normal Cornea
The Eye Is Like A Camera In Which Lenses Focus The Picture On A Light Sensitive Film. In The Human Eye, The Transparent Cornea And Lens Focus Light On The Retina, Which Changes It Into Electrical Signals, Which Are Then Transmitted To The Brain By The Optic Nerve To Be Perceived As Images.

 

The Cornea Is The Front Transparent Window Of The Eye And Forms The Outermost One-sixth Of The Eyeball. It Is Lamellar In Nature (like Plywood) And Is Made Up Of 5 Layers, Each Of Which Has A Definite Function. In Order To Be Effective It Must Remain Transparent. Freezing, Heating, Molding, Lathing, Tattooing, Excising, Incising And Transplanting Are All Means By Which The Delicate And Sensitive Cornea Has Been Altered For Optical, Therapeutic And Cosmetic Purposes. Due To Absence Of Blood Vessels In The Cornea, Much Of Its Oxygen Requirement Comes From Atmospheric Oxygen Dissolved In The Tear Film. When The Eyelids Are Closed, Oxygen Enters The Cornea From The Superficial Conjunctival Vessels. Nutrients Needed For The Cornea Pass Into It By Diffusion. Hence, Carbon Dioxide And Waste Products Are Also Removed Across The Tear Film. Hence, Any Deficiency Of The Tear Film Will Directly Or Indirectly Affect The Cornea.

 

What Is Keratoconus?
Normally The Cornea Is Nearly Spherically Shaped Thus Allowing Light To Be Focused Clearly On The Back Of The Eye (retina). However In A Condition Called Keratoconus, The Cornea Begins To Thin, And This Allows The Normal Pressure Of The Eye To Make The Cornea Bulge Forward Taking On A Cone-shape. As The Cornea Gradually Becomes More Cone-shaped, The Vision Blurs And Becomes Distorted Due To A High Degree Of Astigmatism. Initially Vision May Be Correctable With Spectacles, But As The Condition Progresses, And The Cornea Becomes More Irregular Causing Distorted Vision, Spectacles Become Less Effective. In Such A Situation, Contact Lenses Not Only Provide Better Vision, But Also Help To Retard The Progress Of The Disorder. A Rigid Contact Lens (RGP / "semi-soft" Contact Lenses) Must Be Used, So That It Can Hold Its Shape, As A Soft Lens Would Simply Mould To The Existing Shape And Thus Not Allow Complete Correction Of The Problem. Sometimes The Patient Is Fitted With Soft Lenses (for Comfort), Over Which Semi-soft Lenses Are Fitted ("piggy-back" Lenses).

 

Fitting Contact Lenses For Keratoconus Requires Expertise. Well-fitting Contact Lenses Dramatically Improves Such A Patient's Vision To Nearly That Of A Normal Person's, And Significantly Improves His Or Her Quality Of Life. Any Excessive Pressure Of A Poorly Fitting Lens On The Cone Apex Can Cause Permanent Scarring Within Months Or Years (This Scarring Can Also Occur Naturally). For This Reason It Is Important For Regular Follow-up Visits To Be Made So That Any Corneal Changes That Have Occurred Can Be Compensated For In The Design Of A New Lens. It Is Quite Common For Patients To Be Refitted At Irregular Intervals As The Condition Progresses. Rarely, Scarring Is So Severe That A Corneal Graft (transplant) Is Necessary.


A Recent Promising Treatment Modality For Keratoconus Is C3R (Corneal Collagen Cross-linking

 

What Is Corneal Collagen Cross-linking (C3R)?
Cross Linking Of Cornea Collagen (C3R) Is A Process To Increase The Mechanical Stability Of Corneal Tissue. The Aim Of This Treatment Is To Create Additional Chemical Bonds Inside The Corneal Stroma By Means Of A Highly Localized Photo Polymerization.
The Indications For Cross Linking Today Are Corneal Ectasia The Disorders Such As Keratoconus And Pellucid Marginal Degeneration, Iatrogenic Keratectasia After Refractive Lamellar Surgery And Corneal Melting That Is Not Responding To Conventional Therapy.

 

The History Of Corneal Cross-linking
The Procedure Was Developed From 1993 Till 1997 By Prof. Theo Seiler And Prof. Eberhard Spoeri At The University Of Dresden, Germany. The First Patients Were Treated In 1998. Today Corneal Cross-linking Is Performed In More Than 300 Centers Around The World. Corneal Cross-linking Has The Potential To Become The Standard Treatment For Keratoconus Thus Preventing The Need For Penetrating Keratoplasty!

 

The Principle Of C3R
Photo-polymerization Using UV-light Was Found To Be The Most Promising Technique To Achieve Cross-links In Connective Tissue. Photo-polymerization Is Activated By Means Of A Non-toxic And Soluble Photomediator And A Wavelength Which Is Absorbed Strongly Enough To Protect Deeper Layers Of The Eye (riboflavin-UVA Technique).

 

UV-A Radiation With Concomitant Administration Of Riboflavin Solution Leads To Physical Cross Linking Of The Corneal Collagen Fibers.
Thus Progressive Corneal Thinning Is Slowed Down Or Even Stopped And The Bio-mechanical Strength Of Corneal Tissue Is Improved.

 

The Device For C3R
For C3R We Need Riboflavin Dye And A Special Device Called Cross-linker. Cross Linker Is A Device To Deliver UV-A Light Of Specific Wavelength Of 365 Nm , At Controlled Energy Level Of 3 MW/cm.sq.

 

The C3R Procedure
After Removal Of The Corneal Epithelium, Riboflavin Solution Is Instilled For 30 Minutes On To The Cornea. Then The Corneal Penetration Of This Is Checked By Establishing That The Anterior Chamber Is Slightly Yellow. Pachymetry Is Performed To Make Sure That Minimum Corneal Thickness Is Maintained.

 

UV-A Radiation Starts Under Continued Administration Of Riboflavin Solution. After 30 Minutes Of Radiation Treatment Is Finished And The Patient Receives Post-operative Treatment Like After A PRK Procedure. A Bandage Contact Lens Is Inserted In The Operated Eye And The Patient Is Administered Oral And Topical Antibiotics, Steroids, Anti-inflammatory Medication As Well As Lubricant Eye Drops.

 

Clinical Experience With C3R

  • Today, More Than 1,400 Eyes Have Been Cross-linked World Wide In Controlled Clinical Studies With A Follow Up To 5 Years.
  • Clinical Studies Have Shown A Significant Increase In Best Corrected Visual Acuity (BCVA) In More Than 85% Of The Treated Eyes.
  • Six Months After Corneal Cross-linking The Refractive Cylinder Was Reduced In Over 80% Of The Eyes.
  • The Steepest K-value Was Usually Decreased By 1 Diopter And The Percentage Of Eyes That Had A Clinical Relevant Reduction Exceeds 86%.

 

Safety Of C3R
Corneal Cross-linking Is Considered To Be A Safe Procedure, Provided The Recommended Safeguards Are Observed. Up Until Today No Sight Threatening Side Effects Have Been Reported.


At Shreya Eye Centre, We Have A Dedicated Team Of Eye Specialists Committed To Provide You With The Best Possible Care To Protect Your Vision. For A Routine But Comprehensive Eye Check Up Make An Appointment With One Of Our Consultants.

Here Are Some Eye Care Tips:

 

1. ROUTINE EYE TESTING

  • Children Should Undergo Routine Eye Examinations Once A Year, Especially If He Or She Complains Of Symptoms Such As Headache, Tired Eyes Or Inability To See The Blackboard Clearly.
  • Glasses For Children Should Be Made Of Shatterproof Plastic Or Case Hardened Material. Children Should Wear Their Prescribed Glasses Constantly.
  • Any Pre-school Child With A Squint (eyes Appearing To Be Crossed) Needs To Be Urgently Examined By An Ophthalmologist.
  • Adults Should Have Their Eyes Tested Completely Every One To Three Years.

 

2. TO PREVENT EYE INJURIES:

  • Make Sure All Spray Nozzles Are Directed Away From You
  • Read Instructions Carefully Before Using Cleaning Fluids, Detergents, Ammonia Or Harsh Chemicals. Wash Your Hands Thoroughly After Use.
  • Pay Attention To Your Child's Age And Responsibility Level When You Buy Toys And Games. Avoid Projectile Toys Such As Darts, Pellet Guns, Etc., Which Can Hit The Eye From A Distance.
  • Supervise Children When They Are Playing With Toys Or Games That Can Be Dangerous.
  • Teach Children The Correct Way To Handle Items Such As Scissors And Pencils.
  • Never Allow Children To Ignite Fireworks.
  • Do Not Stand Near Others When Lighting Fireworks

 

3. YOU COULD BE HAVING CATARACT IF YOU HAVE:

  • Cloudy, Fuzzy, Fogging, Or Filmy Vision
  • Changes In The Way You See Colors.
  • Problems Driving At Night Because Headlights Seem Too Bright
  • Problems With Glare From Lamps Or The Sun.
  • Frequent Changes In Your Eyeglass Prescription.
  • Double Vision Or Multiple Images.
  • Better Near Vision For A While Only In Farsighted People.

These Symptoms Also Can Be Signs Of Other Eye Problems. See Your Eye Doctor To Find Out What You Have And Ho It Can Be Treated.

 

4. GLAUCOMA:

  • If You Are 40 Years Of Age, Or Have A Family History Of Glaucoma You Should Have Your Eyes Tested Regularly. See Your Eye Doctor To Arrange A Test.
  • If You Have Glaucoma, Regular Eye Tests For Pressure And The Visual Field, And Taking Your Treatment Properly Can Prevent Blindness.

 

5. DIABETES:

  • An Eye With Marked Changes Of Diabetic Retinopathy Can Have Good Vision And Be Totally Free Of Symptoms.
  • Hence It Is Important For All Diabetics To Undergo Regular Eye Check-up Including Retinal Examination Through Dilated Pupils Especially For People Who Have Been Diabetic For A Number Of Years.
  • It Is Also True That Diabetes Is Often Detected In A Person, When Some Changes Of Retinopathy Are Seen On Routine Examination Of The Eye.

 

6. RETINAL TEARS & DETACHMENT:

  • If You Notice The Sudden Appearance Of Light Flashes, Or If You Suddenly Notice A Large Number Of Floaters, You Should Visit Your Ophthalmologist Immediately To See If Your Retina Has Been Torn.
  • Myopes (near Sighted Persons), Aphakics (people Who Have Undergone Cataract Surgery), Those With A Family History Of Retinal Detachment Are More Prone To Developing Retinal Degeneration, Holes And Tears, And Subsequently Retinal Detachment. These Groups Of Patients Must Undergo Regular And Thorough Retinal Examination By Indirect Ophthalmoscopy.

 

7. WHAT IS COMPUTER VISION SYNDROME?

Computer Vision Syndrome (CVS), A Relatively New Condition, Is The Complex Of Eye And Vision-related Problems Associated With Computer Use Affecting Millions Of People. The Primary Symptoms Are Eyestrain, Blurred Vision, Dry And Irritated Eyes, Tired Eyes, And Headaches. Neck And Backaches Can Also Be Related To The Way That We Use Our Eyes At The Computer.


This Happens Because Staring At A Computer Screen Causes A Significant Reduction Of The Normal Blink Rate. Hence Washing Of The Corneal Surface Of The Accumulated Dust, Debris And Tear Waste Products Is Delayed; Instead They Have A Longer Contact Time With The Cornea Producing Ocular Surfacing Problems And Eye Fatigue.

 

The Following Steps Can Help Alleviate Your Symptoms:

 

To Ensure Comfort While Working On The Computer:

  • Lower Your Computer Screen So That The Center Of The Screen Is 4-8 Inches Below Your Eyes.
  • Ensure Correct Posture, Adequate Room Lighting And Convenient Placement Of The Mouse And Keyboard.
  • If You Are Seated In A Draft Or Near An Air Vent, Try To Eliminate The Flow Of Air Past Your Eyes. Low Humidity Or Fumes Aggravate A Dry Eye Condition. If You Have These Conditions In Your Work Place, Fix Them If Possible.
  • Concentrate On Blinking Whenever You Begin To Sense Symptoms Of Dry Or Irritated Eyes.
  • Every Once In A While (especially When You Sense The Symptoms) Close Your Eyes And Roll Them Behind Your Closed Eyelids.
  • Take A Short Break Of A Few Minutes From Your Work, Every Half An Hour.
  • Use Artificial Tears To Re-wet And Lubricate Your Eyes As Recommended By Your Doctor.

 

You Should Seek Professional Eye Care If Symptoms Persist. Many Computer Users Need A Pair Of Glasses For Their Computer Work That Is Different From The Glasses They Use For Their Other Common Visual Needs. They Either Have A Different Prescription Or A Different Lens Design From Their Usual Glasses. A Thorough Check Up By An Ophthalmologist Is Essential To Identify And Treat The Factors Contributing To The Problem.

 

8. HOW TO USE EYE DROPS:

  • First, Wash And Dry Your Hands Thoroughly.
  • Check You Have The Correct Bottle, And Make Sure You Know Which Eye The Drops Are To Go In.
  • Stand In Front Of The Mirror, Sit In A Chair, Or Lie Down, Which Ever Is Best For You.
  • Take The Top Off The Bottle, Lean Your Head Back, And Look Up At The Ceiling.
  • Pull Down Your Lower Eyelid And Squeeze A Drop Into You Eye, Taking Care Not To Ouch The Eye With The Tip Of The Bottle.
  • Close Your Eyes For 2 Minutes, And Wipe Gently With A Clean Tissue, If Necessary.
  • Put The Top On Firmly Back On The Bottle And Put In A Safe Place.
  • Finally, Wash Your Hands Again.

 

Remember

  • DO NOT Share Your Drops With Anyone Else.
  • Bottles Of Eye Drops Should Only Be Used For Four Weeks After Opening.
  • It May Help To Write On The Label, The Date You Open The Bottle.
  • It May Also Help To Identify Different Drops By Sticking A Colored Label On The Bottle.
  • Your Drops Can Be Kept In The Fridge But Do Not Freeze Them.
  • You Can Get More Drops On Prescription Of Your Eye Doctor.

Important: Use Drops In The Frequency And For The Duration Recommended By Your Doctor.


About 125 Million People Around The World Wear Contact Lenses As An Alternative To Glasses For The Correction Of Refractive Errors (spectacle Numbers). Shreya Eye Centre And Its Dedicated Staff Offers You Various Contact Lenses Options.

 

Learn About Contact Lenses

 

What Are Contact Lenses?

Contact Lenses (CL) Are Small, Thin, Curved Transparent Discs That Are Designed To Rest On The Cornea, The Clear Front Surface Of The Eye. Contacts Cling To The Film Of Tears Over The Cornea Because Of Surface Tension, The Same Force That Causes A Drop Of Water To Cling To The Side Of A Glass. Contact Lenses Are Mostly Used To Correct Near-sightedness, Far-sightedness And Astigmatism. Contacts Provide A Safe And Effective Way To Correct Vision When Used With Care And Proper Supervision. They Can Offer A Good Alternative To Eyeglasses, Depending On Your Eyes And Your Lifestyle. However, One Must Remember, They Are Health Devices, Not Commodities Or Beauty Aids, And Not Everyone Can Wear Them. Also, Their Use Can Affect The Well Being Of Your Eyes And Only An Optometrist Or An Ophthalmologist (eye Surgeon) Is Qualified To Assess The Health Of Your Eye. Your Healthy Vision Is The First Priority.

 

What Are The Types Of Contact Lenses Available?

There Are Basically Two Types Of Contact Lenses:

  •  Rigid Gas-permeable (RGP) Contact Lenses Which Are Also Known As "semi-soft Lenses"
  •  Soft Contact Lenses Hard Contact Lenses Have Become Obsolete Now.

 

Soft Lenses Can Be Further Classified Depending On The Type Of Wear:

  • Daily Wear
  • Extended Wear
  • Disposable (Quarterly, Monthly, Fortnightly, Weekly And Daily)

 

What Are The Advantages And Disadvantages Of Each Type Of Contact Lens?

RGP (Semi-soft) Lenses: RGP Lenses Are Made Of Special, Firm Plastics Combined With Other Materials, Such As Silicone And Fluoropolymers, Which Allow Oxygen In The Air To Pass Directly Through The Lens. These Lenses Are Very Durable And Typically Last Longer Than Soft Lenses. RGP Lenses Provide Excellent Quality Of Vision, Have A Long Life, And Can Correct Astigmatism As Well As Uneven Curvature Of The Cornea. The Disadvantages Are That These May Take A Little Longer To Get Used To, It Is Easier For Dust To Get Behind RGP Lenses, Causing Irritation And Discomfort, And One Can't Switch Back And Forth With Glasses As Easily. However, Regular Wearers Find Them Comfortable And The Visual Acuity Outstanding.

 

Soft Lenses Are Made Of Flexible Water-absorbent (hydrophilic) Material Having Water Content Between 30-80%. These Lenses Are Comfortable The Moment They Are Inserted In The Eye. They Are Less Likely To Dislodge And Can Be Worn For Longer Periods. However, Their Biggest Disadvantage Is That They Cannot Correct Higher Degrees Of Astigmatism. They Also Need To Be Changed More Frequently.

 

Which Type Of Contact Lens Is Best For Me?

Each Individual Is Different, Although There Are Some Broad Guidelines That May Be Followed. If You Are Interested In Initial Comfort, Soft Contact Lenses May Suit You Better Than Rigid Gas Permeable (RGP) Lenses. On The Other Hand, RGP Lenses Tend To Last Longer. A Soft (hydrophilic) Lens Is More Appropriate For Occasional Wear (at Most Once Or Twice A Week).

 

Not Everyone Can Wear Both Types. Only After Thoroughly Examining Your Eyes And Vision, Can One Advise Whether You Can Wear RGP Lenses, Soft Lenses Or Both. In Your Initial Consultation, A Number Of Tests And Measurements Will Be Performed, Usually Following A Full, General Visual Examination. This Evaluation Will Determine The Optimum Contact Lenses For Your Specific Needs. Additionally Any Other Factors That Determine Your Ability To Wear Lenses Successfully Will Be Explained To You.

 

Various General Health Factors, Including Medication, Ocular, Medical And Family History Will Be Assessed. A Number Of Prescription Medications, Drugs And Allergic Factors Can Influence The Ability To Wear Contact Lenses Successfully. Additionally Your Work And Social Environments Can Affect Lens Choice For Example Air-conditioning, Computer Use, Dusty Environments And So Forth Will Affect The Lens Choice.

 

What Is The Difference Between Daily-wear And Extended-wear Lenses?

Daily-wear Contact Lenses Are Designed To Be Removed Each Day For Cleaning, And Should Be Taken Out Before You Sleep Or Nap.

 

Extended-wear Lenses Can Be Worn Continuously For Up To Seven Days Before They Are Removed For Cleaning, Depending On How Oxygen-permeable The Lens Material Is. Extended-wear Lenses Can Also Be Prescribed To Be Removed Each Day For Cleaning And Slept In Occasionally When Special Circumstances Arise. Many Variables Are Considered In Deciding Between Daily-wear And Extended-wear Lenses For Each Person's Needs. Since The Risk Of Serious Eye Infections Is Higher In Extended Contact-lens Wearers, They Are Generally Prescribed In Carefully Selected Individuals Who Are Frequently Monitored By Eye Care Professionals.

 

Daily-wear Lenses Should Never Be Worn As Extended-wear Lenses. Misuse Can Lead To Temporary And Even Permanent Damage To The Cornea. People Who Wear Any Type Of Lens Overnight Have A Greater Chance Of Developing Infections Of The Cornea. These Infections Are Often Due To Poor Cleaning And Lens Care. Improper Over-wearing Of Contact Lenses Can Result In Intolerance, Leading To The Inability To Wear Contact Lenses.

 

What Are Disposable Lenses, Frequent And Planned Replacement Lenses?

Disposable Contact Lenses And Frequent Replacement Contact Lenses Are Designed To Be Worn For A Specific Period Of Time, Thrown Out And Replaced With A Fresh Pair Of Lenses. "Disposable" Refers Specifically To Lenses That Are Replaced Every Two Weeks Or Less Depending On The Wear Schedule Prescribed By Your Optometrist Or Doctor. Disposable Lenses Are Usually Prescribed In Multi-packs, Providing Several Weeks Supply At A Time. "Frequent & Planned" Replacement Lenses Are Lenses That Are Replaced On A Planned Schedule, Most Often Either Every Two Weeks, Monthly Or Quarterly.

 

The Purpose Of Replacing Contact Lenses On A Frequent Basis Is To Prevent Discomfort, Dryness, Blurred Vision And Allergic Reactions That Can Result From A Build-up Of Protein And Lipid Deposits On The Lenses. As The Deposits Age And Chemically Change On The Lens, They Contribute To These Irritations. The Changes In The Chemical Composition Of The Deposits Also Increase The Probability That Bacteria May Adhere To A Contact Lens, Increasing The Risk Of Serious Eye Infection Even Without Any Subjective Deterioration In Comfort. "Disposable Lenses" And "Frequent & Planned" Lenses Should Be Discarded After The Recommended Replacement Time Even If They Are Still Comfortable Thereafter.

 

Your Eye Care Practitioner Will Determine The Lens Replacement Frequency That Is Most Appropriate For You. Lenses Should Not Be Worn For Longer Than The Recommended Wearing Period.

 

If I Only Wear My Fortnightly-disposable Contact Lenses Part Time, Do I Still Have To Replace Them Every Two Weeks?

No, The Two Weeks Refers To The Actual Amount Of Wearing Time So They Can Last Longer Than Two Weeks If You Are Not Wearing Them Full Time.

 

Do People Experience Discomfort Or Pain When Using Contact Lenses?

Most First Time Wearers Are Delighted With The Level Of Comfort That Contact Lenses Provide. Initial Contact Lens Fittings By Professional Eye Care Practitioners Can Minimize Or Eliminate Any Irritation Associated With New Lenses. After A Brief Adjustment Period, Most People Report They Can No Longer Feel Contact Lenses On Their Eyes.

 

Can Contact Lenses Be "blinked" Out?

With Normal Use, Contact Lenses Will Stay Firmly In Position. However, They Can Come Out Under Certain Conditions. High Winds Can Cause The Eyes To Water And Pull The Eyelid Tight Against The Eye, Increasing The Chance Of Lens Loss. A Sharp Blow To The Head May Dislodge Rigid Gas Permeable Lenses. And Rubbing Your Eye Carelessly May Result In A Lost Lens.

 

Describe To Your Eye Care Practitioner All Of The Circumstances In Which You Are Likely To Wear Your Contact Lenses. This Will Help Him Or Her Prescribe A Type Of Lens That Is Less Likely To Be Dislodged Given Your Activities.

 

What Are The Basics Of Daily Contact Lens Care? What Are My Options?

Your Eyes And Your Vision Are Precious, And Good Contact Lens Care Can Help Assure A Lifetime Of Healthy Eyes. It's Important To Follow The Instructions For Daily Or Weekly Lens Care Prescribed By Your Eye Care Professional For Your Type Of Lenses. The Basic Steps Include Cleaning, Rinsing, And Disinfecting (for Storing).

  • Cleaning Solutions Remove Dirt, Protein, Oils, Mucus, And Debris That Get On The Lens During Wear.
  • Disinfecting Solutions Kill Bacteria And Other Germs On The Lenses. Disinfection Is Necessary To Help Prevent Serious Eye Infections.
  • Rinsing Solutions Remove Other Solutions From The Lenses. They Also Prepare The Lenses For Wear.
  • Enzyme Solutions Remove Protein And Other Deposits That Accumulate On The Lenses Over Time.
  • Rewetting Solutions Are Used To Wet (lubricate) The Lenses While You Are Wearing Them, To Make Them More Comfortable.

These Steps Can Be Performed Using Separate Solutions. However, Recently, There Has Been A Strong Movement To "one-bottle" Systems. These All-in-one Solutions Are The Easiest And Quickest To Use. You Should Not Make Your Own Lens Care Solutions, Nor Should You Mix Different Brands Of Solutions Unless Instructed By Your Eye Care Practitioner. However, If You Are Particularly Sensitive To Chemicals, It May Be Better To Use A Hydrogen Peroxide System. One Must Remember That All Contact Lens Cases Need Frequent Cleaning, Including Disposable Lens Cases. As A Rule Never Bring Any Contact Lenses In Contact With Tap Water As It Can Be Source If Serious (sight-threatening) Eye Infection

 

Is It Necessary To Use Protein Remover Tablets In Additions To My Normal Daily Cleaning Procedure?

The Need To Use Protein Remover Tablets Depends On The Amount Of Protein Deposits Your Eyes Produce And How Often You Replace Your Lenses. Protein Deposits Are Normal. But As They Age, They Can Change In Chemical Composition, Contributing To Discomfort And Poor Vision Or Leading To Allergies. Regardless Of Your Lens Replacement Schedule, However, Daily Cleaning Is Important For Eye Health. Consult Your Eye Care Practitioner For The Best Advice Regarding Your Replacement And Cleaning Schedules

 

Weekly Enzyme Cleaning Helps Keep Soft Lenses Free From Deposits Of Protein Naturally Produced In Your Eyes And Carried By Your Tears. Lately, Solutions Are Available, Which Eliminate The Need For Enzyme Cleaning As Well. Soft Extended-wear Contacts Are The Most Likely To Have Protein Build-up And Cause Lens-related Allergies. Soft Daily-wear Lenses Are Less Likely To Create Problems. Rigid Gas-permeable Lenses May Be Good Choices For Someone With Allergies, As Less Protein Is Deposited On The Lenses. If These Deposits Become A Problem, Your Eye Care Practitioner May Recommend A Type Of Contact Lens That You Replace More Frequently. Depending On The Replacement Frequency, Using A Protein Remover In Addition To Your Daily Cleaning Regimen May Not Be Necessary

 

The Type Of Care Contact Lenses Require, And How Long They Should Be Worn, Is Something Each Eye Care Professional Will Prescribe For Each Patient. Personal Wear And Care Regimens May Depend Upon The Type Of Contact Prescribed, The Nature Of The Vision Problem Being Corrected, And The Individual's Unique Eye Chemistry. Regardless Of The Type Of Lens You Wear, You Will Find That Lens Care Is Now Easier And More Convenient Than Ever Before.

 

Cosmetics And Contact Lenses

While Some Cosmetics May Interfere With Contact Lens Performance And The Wearer's Tolerance For Contacts, Others Are Safe. Some Rules Should Be Followed When Using Cosmetics:

  • Insert Lenses Before Applying Eye Makeup And Take Them Out Before Removing Cosmetics.
  • Use Hair Spray And Other Aerosols Before Lenses Are Inserted. Allow Time For The Aerosol Mist To Settle From The Air Or Go To A Different Area Before Handling Lenses.
  • Completely Remove Residual Cosmetics From You Hands With Mild, Additive-free Soap Before Handling Lenses.
  • Use Cream Shadows Instead Of Powders And Avoid Using Shadows With Glitters.
  • Use Water Based Cosmetic Formulations.
  • Use Hypo-allergenic Cosmetics.
  • Avoid Using Mascaras Containing Fibers For Extra Lash Length.
  • Avoid Using Saliva To Wet Applicators.
  • Don't Apply Eyeliners And Pencils Inside The Upper Or Lower Eyelid Margin.

 

Is It OK To Play Sports While Wearing Contact Lenses?

Wearing Contact Lenses For Sports Is A More Flexible And Stable Form Of Eye Correction Than Eyeglasses, And Athletes Of All Kinds Have Discovered The Advantages Of Wearing Contact Lenses When Participating In Sports Or Working Out. Contacts Don't Steam Up From Perspiration, Don't Smudge And Don't Get Foggy If You Go From Cold To Warm Temperatures. They Provide Better Depth Perception And Complete Peripheral Vision. Today's Close-fitting Contacts Stay On Your Eyes, Even During Vigorous Activity. If Your Sport Involves Vigorous Exercise, A Soft Contact Lens Is An Appropriate Choice. Your Eye Care Practitioner Can Help Determine The Best Type Of Lenses Based On Your Sport Or Activity To Help Protect Your Eyes And Your Contacts, Goggles Should Be Worn When You Swim.

 

Is It OK To Swim While Wearing Contact Lenses?

Pool Water Can Cause Discomfort Due To Chlorine. It Is Best To Avoid Swimming With Your Contact Lenses On Because It Exposes Your Contacts To Bacteria And Other Microorganisms In The Water. These Can Adhere To Your Lenses And Place You At Risk Of Eye Infections.


If You Do Swim With Your Lenses, You Should Wear Goggles With A Firm Seal. If You Don't Wear Goggles, The Contact Lenses May Float From Your Eyes. They May Also Absorb The Pool Water, One Consequence Of Which May Be That They Adhere Quite Firmly To The Eye. If This Occurs, It Is Advisable To Leave The Lenses Alone For 10-15 Minutes Until Your Natural Tears Have Replaced The Water In Them, Before Trying To Remove Them. You Should Then Disinfect Them Immediately Afterwards.

 

I Have Dry Eye Problems. Can I Wear Contact Lenses?

You're Less Likely To Have Success With Contact Lenses Than Someone Who Does Not Have This Condition. This Does Not Mean That You Cannot Wear Contact Lenses At All. It Simply Means You May Have A Shorter Contact Lens Wearing Period Than Normal Or That You May Choose To Wear Your Lenses Only Occasionally. You Can Increase The Comfort Of Your Lenses By Inserting Eye Lubrication Drops.


For The Same Reason, Wearing Contact Lenses While Traveling By Plane Can Be Uncomfortable. The Low Humidity In Aircraft Cabins Contributes To Dry Eye Symptoms And Contact Lens Discomfort. It May Be Helpful To Put Lubrication Drops In Your Eyes Before You Enter The Aircraft, Or During Flight. If Symptoms Persist Or Become Severe, It Is Probably Easiest And Best To Wear Eyeglasses When Flying. As Always, It Is Best To Consult Your Eye Care Practitioner For The Best Advice Regarding Whether You Should Wear Contact Lenses And What Type Of Lenses May Be Suitable For Such A Condition.

 

My Doctor Told Me I Couldn't Wear Regular Contact Lenses For Presbyopia. Why Not?

Presbyopia Is A Vision Condition (generally After The Age Of 40 Years) In Which The Eye Cannot Focus On Near Objects. In Most Cases, Reading Glasses Or Bifocal Glasses Are Prescribed To Correct Presbyopia. In Order For A Contact Lens Wearer To Read, He Or She Has To Wear Reading Glasses Over The Contacts. But Contact Lenses Can Be Prescribed Also. Special Bifocal Contact Lenses Are Also Available In Both Rigid Gas Permeable Or Soft Lens Designs.


As An Alternative, Many Practitioners Prescribe A System Called Monovision Where One Eye Is Fitted With A Distance Lens And The Other With A Reading Lens, With The Brain Automatically Switching To The Eye More Clearly In Focus. Monovision Is A Good Solution For Some People, But Not Everybody Can Successfully Adapt To The Arrangement.

 

I Have Astigmatism And Was Told I Couldn't Wear Contacts. Is That True?

No. Most People With Astigmatism Can Wear Contact Lenses. In Astigmatism, The Curvature Of The Cornea Varies In Different Axes And Spectacles With A Cylindrical Number Are Prescribed For Its Correction. For Those Wishing To Wear Contact Lenses, The Fitting Procedure Takes More Time, And Certain Lenses Don't Provide Vision As Good As Glasses, But Only In Special Circumstances Can A Person With Astigmatism Not Be Fitted With Contact Lenses.

 

In Astigmatism, RGP ("semi-soft" Lenses) Provide Sharper Vision. This Is Because Rigid Lenses Retain Their Shape And Placement On The Cornea Better Than Soft Lenses, And Helps The Eye To Conform To The Shape Of The Contact Lens, Thus Masking The Need For An Astigmatic Correction. If You Have A Small Amount Of Astigmatism, Between Zero And 1.00 (either +1.00 Or -1.00), You May Still Be Able To Wear A Regular Spherical Soft Lens, Although With Not As Good Quality As RGP Lenses. In Higher Degrees Of Astigmatism, Only RGP Lenses Will Provide Sharp Vision; Regular Soft Lenses Will Not Help.



If You Have A Significant Amount Of Astigmatism, And Still Wish To Wear Soft Contact Lenses, You Can Wear A Special Type Of Soft Contact Lens Called A Toric Lens, Which Will Correct Your Astigmatism. Properly Fitting A Toric Lens Takes More Of Your Time And Requires More Expertise Than Regular Contacts. However, These Lenses Are Typically More Expensive.

 

What Are Therapeutic Contact Lenses?


Advances In Materials Technology And Better Understanding Of The Eye's Needs In Health And Disease Have Enabled The Development Of Soft And Rigid Lenses To Aid In Protecting And Helping A Sick Eye (especially Certain Corneal Disorders) To Heal. This Acts As A Transparent Bandage Which Protects The Injured Or Diseased Cornea, And Acting As A Reservoir Of Medication Inserted Into The Eye. A Variety Of Conditions May Be Treated And In Some Cases, Even Cured In This Manner. These Unique Lenses Are Frequently Combined With Precise Medication Delivery Schedules To Help Heal The Eye.

 

What Is KERATOCONUS? How Can Contact Lenses Help?

Normally The Cornea Is Nearly Spherically Shaped Thus Allowing Light To Be Focused Clearly On The Back Of The Eye (retina). However In A Condition Called Keratoconus, The Cornea Begins To Thin, And This Allows The Normal Pressure Of The Eye To Make The Cornea Bulge Forward Taking On A Cone-shape. As The Cornea Gradually Becomes More Cone-shaped, The Vision Blurs And Becomes Distorted. Initially Vision May Be Correctable With Spectacles, But As The Condition Progresses, And The Cornea Becomes More Irregular Causing Distorted Vision, Spectacles Become Less Effective. In Such A Situation, Contact Lenses Not Only Provide Better Vision, But Also Help To Retard The Progress Of The Disorder. A Rigid Contact Lens (RGP / "semi-soft" Contact Lenses) Must Be Used, So That It Can Hold Its Shape, As A Soft Lens Would Simply Mould To The Existing Shape And Thus Not Allow Complete Correction Of The Problem. Sometimes The Patient Is Fitted With Soft Lenses (for Comfort), Over Which Semi-soft Lenses Are Fitted ("piggy-back" Lenses). Recently Special Contact Lenses Called Rose K Lenses Have Been Devised Which Can Be Tailor-made To Fit The "cone" In Patients Suffering From Keratoconus. Fitting Contact Lenses For Keratoconus Requires Expertise. A Well-fitting Contact Lens Dramatically Improves Such A Patient's Vision To Nearly That Of A Normal Person's, And Significantly Improves His Or Her Quality Of Life. Any Excessive Pressure Of A Poorly Fitting Lens On The Cone Apex Can Cause Permanent Scarring Within Months Or Years (This Scarring Can Also Occur Naturally). For This Reason It Is Important For Regular Follow-up Visits To Be Made So That Any Corneal Changes That Have Occurred Can Be Compensated For In The Design Of A New Lens. It Is Quite Common For Patients To Be Refitted At Irregular Intervals As The Condition Progresses. Rarely, Scarring Is So Severe That A Corneal Graft (transplant) Is Necessary.

 

What About Contact Lenses As A Vision Treatment For Young Children?

Certain Children Who Are Born With Cataracts, Or Develop Them In Early Childhood, Need To Undergo Cataract Surgery. However They May Be Too Young To Be Implanted With Intraocular Lenses (IOL). While Surgery Can Protect Their Vision, This Procedure Often Leaves Them Very Farsighted. Contact Lenses Can Provide Them The Best Vision Possible And Even Help Their Own Vision Develop Better, Since Spectacles Are Not A Practical Alternative For This Group.
When Contact Lenses Are Prescribed For Infants And Toddlers, Parents And Other Family Members Can Learn How To Insert, Remove And Clean The Lenses. Children Of All Ages Can Adapt Easily To Wearing The Lenses

 

Can Contact Lenses Be Fit If I Have Had Refractive Surgery And Have A Residual Spectacle Number?

Yes, But The Refractive Surgery Will Have Altered The Contour Of Your Eyes, Requiring A More Specialized Lens Than Normal. It Is Best To Consult Your Eye Care Practitioner Who Will Advise You Based On The Details Of Your Specific History And Requirements.

 

Why Is It Necessary For Contact Lens Wearers To Have Regular Eye Exams Even If Their Prescription Hasn't Changed?

eye Exams Are Important Not Only To Check Your Prescription But Also To Evaluate The Health Of Your Eyes. This Is Especially Important For Contact Lens Wearers Because The Contacts Could Be Causing Damage To Your Eyes Without Necessarily Causing Any Obvious Symptoms. Sometimes, One May Experience Symptoms Such As - Redness Of Eyes, Stinging, Burning Or Itchy Eyes, Excessive Tears, Unusual Eye Secretions, And Changes In Vision. Such Symptoms Could Be Due To Many Reasons. On Feeling Of Any Discomfort, You Should Remove And Examine Your Contact Lenses Immediately. If Your Lens Appears Damaged, Torn Or Ripped, Do Not Put The Lens Back On Your Eye. Put On A New Lens Or Contact Your Eye Care Practitioner To Order A New Lens. If Your Lens Is Not Damaged, But The Irritation Persists, Contact Your Eye Doctor Immediately.

 

Who Should NOT Wear Contact Lenses?

Most People Who Need Vision Correction Can Wear Contact Lenses, But There Are Some Exceptions. Some Of The Conditions That Might Keep You From Wearing Contact Lenses Are: Frequent Eye Infections, Severe Allergies, Severe Dry Eye (improper Tear Film), A Work Environment That Is Very Dusty Or Dirty, And Inability To Handle And Care For The Lenses Properly.
Whether Or Not Contact Lenses Are A Good Choice For You Depends On:

  • Individual Needs And Expectations.
  • Patience And Motivation During The Initial Adjustment Period To Contact Lens Wear.
  • Adhering To Contact Lens Guidelines For Wear, Disinfecting And Cleaning.
  • Diagnosis And Treatment Of Conditions That May Prevent Contact Lens Wear.

orneal Blindness Accounts For 0.52% Of Total Blindness In The Indian Subcontinent. The Cornea Can Be The Site Of Various Disorders. At Shreya Eye Centre, We Have A Dedicated Team Of Cornea Specialists Committed To Provide You With The Best Possible Care To Protect Your Vision.

 

Learn About Common Corneal Disorders And Their Treatment.

 

The Normal Cornea

The Eye Is Like A Camera In Which Lenses Focus The Picture On A Light Sensitive Film. In The Human Eye, The Transparent Cornea And Lens Focus Light On The Retina, Which Changes It Into Electrical Signals, Which Are Then Transmitted To The Brain By The Optic Nerve To Be Perceived As Images.

 

The Cornea Is The Front Transparent Window Of The Eye And Forms The Outermost One-sixth Of The Eyeball. It Is Lamellar In Nature (like Plywood) And Is Made Up Of 5 Layers, Each Of Which Has A Definite Function. In Order To Be Effective It Must Remain Transparent. Freezing, Heating, Molding, Lathing, Tattooing, Excising, Incising And Transplanting Are All Means By Which The Delicate And Sensitive Cornea Has Been Altered For Optical, Therapeutic And Cosmetic Purposes. Due To Absence Of Blood Vessels In The Cornea, Much Of Its Oxygen Requirement Comes From Atmospheric Oxygen Dissolved In The Tear Film. When The Eyelids Are Closed, Oxygen Enters The Cornea From The Superficial Conjunctival Vessels. Nutrients Needed For The Cornea Pass Into It By Diffusion. Hence, Carbon Dioxide And Waste Products Are Also Removed Across The Tear Film. Hence, Any Deficiency Of The Tear Film Will Directly Or Indirectly Affect The Cornea.

 

Foreign Bodies, Corneal Abrasions & Injuries

Since The Abundant Nerve Supply Of The Cornea Makes It One Of The Most Sensitive Parts Of The Body, It Serves As An Excellent "watchdog" For Foreign Material Entering The Eye. Dirt Or Specks Lodging In The Eye May Produce Scratching, Knife-cutting Sensations That The Sensitive Corneal Nerves Transmit To The Brain. If The Cornea Loses This Sensitivity Due To In- Jury Or Impairment By Disease, It Loses Its Protective Function. Foreign Bodies May Embed In The Cornea. A Foreign Body On The Cornea Needs Urgent Attention By An Ophthalmologist. One Should Not Attempt To Remove It By Rubbing The Eye

 

A Twig Of A Tree, A Piece Of Paper, Or A Fingernail Can Produce Corneal Abrasions. If Not Attended To Immediately, Secondary Infection Can Occur Which Could Lead To Vision-threatening Complications. Contact Lenses Also Can Produce An Irritable Eye From A Corneal Abrasion. Until An Eye Specialist Can Be Consulted, The Contact Lens Should Be Removed And The Eye Patched.


Injuries To The Eye With Sharp Or Blunt Objects Require Urgent Attention Of Your Ophthalmologist, Especially To Rule Out Corneal Injuries, Which Can Be Sight-threatening.

 

Chemical Burns

Acid Or Alkaline Solutions Splashed Into The Eye May Be Potentially Sight Threatening. Symptoms (such As Pain, Redness, Watering And Light-sensitivity) Occur Immediately After Exposure To The Chemical And May Be Severe In Nature. Chemicals In The Eye Need To Be Thoroughly Washed Out Immediately With Water. THEREAFTER, URGENT CONSULTATION WITH AN EYE SPECIALIST IS NECESSARY.

 

Infections Of The Cornea

Inflammation Of The Cornea, Or Keratitis, May Be Secondary To Conjunctivitis, Blepharitis (inflammation Of Eyelid Margins), Or Injury. Keratitis Is Characterized By A Painful Red Eye, Sensitivity To Light, And An Occasional Scratching Sensation Upon Blinking. An Ulcer May Develop In The Cornea After A Bacterial, Viral, Fungal, Or Other Infectious Organism Invades Its Outer Layer. Herpes Simplex, A Virus Can Invade The Cornea After Injury, Producing Keratitis. Herpes Zoster, Another Viral Agent, Produces Inflammation Of The Cornea, Especially If The Skin Of The Nose Is Involved. A Marginal Ulcer Is A Corneal Infection That Occurs Near The Outer Edge Of The Cornea. Central Corneal Ulcers Due To Bacteria, Viruses, Or Fungi Can Be Severe And Serious; They May Even Cause Loss Of The Eye. With These Severe Ulcers, The Eye Sets Up A Defense Reaction To Help Fight The Infection. This Disease Requires The Immediate Attention Of An Ophthalmologist. With Intensive Medical Treatment, The Infection Is Brought Under Control. Sometimes Drastic Surgical Intervention Has To Be Undertaken. Often After Elimination Of The Infection, There Is Residual Scarring Of The Cornea, Which Requires Corneal Transplantation For Restoration Of Vision.

 

Pterygium

This Grayish Elevated Growth Of Elastic And Connective Tissue Containing Blood Vessels Invades And Grows Over The Cornea. It May Result From Irritation To The Eye From Wind, Heat Of The Sun, Dust, Or Smoke. If The Pterygium Progresses To Grow Over The Center Of The Cornea, Sight May Be Impaired Or Even Lost. Before This Occurs, The Pterygium Should Be Removed Surgically. At Our Centre, Pterygium Is Removed By A Specialized Technique Called Conjunctival Autografting, Where, The Pterygium Is Excised, And A Conjunctival Graft, Taken From A Healthy Part Of The Same Eye Is Used To Cover The Defect. This Technique Prevents Recurrence Of The Pterygium, Which Would Normally Occur After Conventional Pterygium Removal Without Grafting. Some People Confuse A Cataract With A Pterygium By Calling A Cataract A "skin Growing Over The Eye." A Cataract, However, Is A Clouding Of The Lens, Which Is Located Inside The Eyeball.

 

Degenerative Or Aging Changes Of The Cornea

Dystrophies Or Degenerative Aging Processes May Develop In The Cornea And Interfere With Vision. They Are Slowly Progressive, Non-inflammatory, And Usually Affect Or Involve Both Eyes. They May Produce A Haziness Or Cloudiness Of The Cornea. If The Vision Is Markedly Impaired, Contact Lenses May Be Prescribed To Improve Vision. If They Do Not Help, A Corneal Transplantation May Be Performed To Restore Useful Sight.

 

What Is Dry Eye Syndrome?

Dry Eye Syndrome Is A Leading Cause Of Ocular Discomfort Affecting Millions Of People. Dry Eye Conditions Are A Spectrum Of Disorders With Varied Etiology Ranging From Mild Eyestrain To Very Severe Dry Eyes With Sight Threatening Complications.

 

Although The Typical Patient Of Dry Eyes Is Elderly, Or Suffers From Autoimmune Disease, Increasing Numbers Of Patients Do Not Fit This Profile. Younger Patients Who Work With Computers Can Suffer From Dry Eyes More Often Than Elderly Patients. Dry Eye Condition Is Also Aggravated In Polluted Conditions, Dry Weather, Decreased Ambient Humidity As Seen With Air Conditioning And Indoor Heaters. It May Also Result From The Abnormalities In One Or More Of The Tear Film Components, Ocular Or Systemic Diseases, And Various Drugs.


Dry Eye Syndrome Is Usually Treated With Tear Supplements And Lubricants. However, If These Do Not Help, The Insertion Of Microscopic Plugs (temporary Or Permanent) Can Be Inserted To Help Conserve Tears And Prevent Them From Draining Away. In Severe Cases, Surgical Intervention May Be Essential

 

Keratoconus

Normally The Cornea Is Nearly Spherically Shaped Thus Allowing Light To Be Focused Clearly On The Back Of The Eye (retina). However In A Condition Called Keratoconus, The Cornea Begins To Thin, And This Allows The Normal Pressure Of The Eye To Make The Cornea Bulge Forward Taking On A Cone-shape. As The Cornea Gradually Becomes More Cone-shaped, The Vision Blurs And Becomes Distorted Due To A High Degree Of Astigmatism. Initially Vision May Be Correctable With Spectacles, But As The Condition Progresses, And The Cornea Becomes More Irregular Causing Distorted Vision, Spectacles Become Less Effective. In Such A Situation, Contact Lenses Not Only Provide Better Vision, But Also Help To Retard The Progress Of The Disorder. A Rigid Contact Lens (RGP / "semi-soft" Contact Lenses) Must Be Used, So That It Can Hold Its Shape, As A Soft Lens Would Simply Mould To The Existing Shape And Thus Not Allow Complete Correction Of The Problem. Sometimes The Patient Is Fitted With Soft Lenses (for Comfort), Over Which Semi-soft Lenses Are Fitted ("piggy-back" Lenses).

 

Fitting Contact Lenses For Keratoconus Requires Expertise. Well-fitting Contact Lenses Dramatically Improves Such A Patient's Vision To Nearly That Of A Normal Person's, And Significantly Improves His Or Her Quality Of Life. Any Excessive Pressure Of A Poorly Fitting Lens On The Cone Apex Can Cause Permanent Scarring Within Months Or Years (This Scarring Can Also Occur Naturally). For This Reason It Is Important For Regular Follow-up Visits To Be Made So That Any Corneal Changes That Have Occurred Can Be Compensated For In The Design Of A New Lens. It Is Quite Common For Patients To Be Refitted At Irregular Intervals As The Condition Progresses. Rarely, Scarring Is So Severe That A Corneal Graft (transplant) Is Necessary.

 

A Recent Promising Treatment Modality For Keratoconus Is C3R (Corneal Collagen Cross-linking With Riboflavin). Shreya Eye Centre Now Offers You Cross Linking Of The Cornea With Riboflavin (C3R), Which Is A New Curative Approach To Increase The Mechanical Stability Of Corneal Tissue. The Aim Of This Treatment Is To Create Additional Chemical Bonds Inside The Corneal Stroma By Means Of A Highly Localized Photo Polymerization.


The Indications For Cross Linking Today Are Corneal Ectasia The Disorders Such As Keratoconus And Pellucid Marginal Degeneration, Iatrogenic Keratectasia After Refractive Lamellar Surgery And Corneal Melting That Is Not Responding To Conventional Therapy.

 

What Is Corneal Transplantation?

Corneal Transplantation, Or Keratoplasty, Is An Operation Designed To Correct Blindness Resulting From Corneal Disease. When The Cornea Is Involved By Degenerative Change, Infection, Or Injury, Scar Tissue May Form As Healing Occurs. If The Scar Involves The Center Of The Cornea Or The Entire Cornea, Vision Is Impaired. Depending Upon The Degree Of Involvement, The Person May Not Be Able To See To Perform His Daily Tasks. Contact Lenses Rather Than Spectacles May Partially Improve Vision, But Often They Are Ineffective And A Corneal Transplant Is Required. Eye Tissue From One Person Is Transplanted Into The Eye Of Another Person Who Has Been Blinded By A Corneal Scar Or Disease.

 

Many People Are Under The False Impression That One Good Eyeball Is Transplanted For Another Eyeball Which Is Diseased. Some Mistakenly Believe That A Blue-eyed Person's Eyes Cannot Be Used For Transplantation In A Brown-eyed Person. Neither Of These Statements Is True. The Only Tissue Used In The Transplant Is The Cornea, Which Has Nothing To Do With The Colored Part Of The Eye. Since The Eye Is Connected To The Brain By The Optic Nerve, Which Is A Part Of The Central Nervous System, The Eye Is Not And Cannot Be Transplanted.


If The Eye Were Compared To A Watch, The Crystal Of The Watch Would Be Synonymous With The Cornea Of The Eye. The Face Of The Watch Would Be Equivalent To The Iris And Lens. If The Watch Crystal Is Clean And Transparent, The Face Of The Watch Will Be Seen Clearly. However, If Paint Is Smeared Over The Crystal Of The Watch, The Face Of The Watch Will Not Be Seen And The Paint Cannot Be Wiped Off. To See The Watch Face Clearly Again, The Crystal Must Be Removed And Replaced With A New Clean Crystal.

 

How Is A Cornea Transplanted?

A Corneal Transplantation, Like A Cataract Operation, Is Usually Performed Under Local Anesthesia. General Anesthesia Is Used For Children And Apprehensive Or Nervous Patients. The Operation Is Completely Painless And Takes About One Hour To Perform.

 

The Diseased, Cloudy, Opaque Cornea Is Removed From The Recipient's (living Patient's) Eye Using A Special Blade, And Replaced By A New Clear Cornea (graft) From The Donor's (deceased Person's) Eye. Earlier We Transplanted The Entire Thickness Of The Cornea (Penetrating Keratoplasty). Today Depending On The Extent, Location And Type Of The Corneal Disorder, We Can Selectively Transplant Either The Front Part (Anterior Lamellar Keratoplasty), Or The Back Portion (Endothelial Lamellar Keratoplasty). The New Cornea Is Then Sutured Or Stitched Into Place. As Few As Eight And As Many As 20 Or More Sutures May Be Used, According To The Size Of The Graft, To Hold The Border Of The Graft To The Border Of The Recipient. If The Operation Is Successful And The Graft "takes" And Remains Clear, The Patient Should See Well Again, Provided The Lens And The Retina Behind The Cloudy Cornea Are Normal. The Patient Is Usually Hospitalized For One Day But Requires Rest For The Next One Month Although Returning To Light Work Is Not A Problem. However Frequent Follow-ups Are Required Over The Following Six Months To One Year.

 

How Successful Is Corneal Transplantation?

In Favorable Subjects The Rate Of Success Of Corneal Transplantation May Be As High As 60%, With Good Final Visual Acuity With Glasses. In Unfavorable Subjects, The Rate Of Success May Be Around 10 To 20%. Each Patient Is Evaluated Individually Before Definite Results Can Be Predicted. The Most Important Factors In Determining The Final Results Are:

  • Basic Corneal Disease (some Types Of Corneal Disease Respond Better To Corneal Transplantation Than Others).
  • State Of The Donor's Cornea.
  • Surgical Technique And Skill.
  • Healing Ability Of The Recipient Cornea.
  • Sensitivity Reactions Between Donor And Recipient Cornea May Lead To Transplant Rejection.

 

The Advantages Of Lamellar Keratoplasty (newer Techniques) Are Better Visual Outcome, Quicker Rehabilitation And Lower Rates Of Transplant Rejection.

 

A Corneal Transplantation Will Not Help Every Blind Person To See Again. If A Person Is Blinded By Glaucoma, A Detached Retina, Or Degenerative Change And The Retina Has Been Damaged Or Destroyed, Nothing Can Restore Lost Sight. Corneal Transplantation Restores Vision Only In Eyes That Have Been Partially Blinded By Corneal Disease. Some Vision Must Be Present Before Transplantation Is Even Contemplated.

THE OCCURRENCE OF PAIN, REDNESS, WATERING, LIGHT-SENSITIVITY AND DIMINISHED VISION, ANY TIME (EVEN MONTHS OR YEARS) AFTER CORNEAL TRANSPLANTATION SURGERY, REQUIRES IMMEDIATE ATTENTION OF YOUR OPHTHALMOLOGIST.


DIABETES MELLITUS Is A Condition That Impairs The Body's Ability To Use And Store Sugar (glucose). Sugar Is Excreted In The Urine And The Blood Sugar Is Abnormally High. It Causes Changes In Small Blood Vessels In Various Organs Of The Body. Diabetes Can Cause Various Changes In The Eye As Well, Particularly In The Retina. Diabetic Eye Disease Can Cause Severe Vision Loss Or Even Blindness.

 

Learn About DIABETIC RETINOPATHY

 

How The Eye Works

The Eye Is Like A Camera In Which Lenses Focus The Picture On A Light Sensitive Film. In The Human Eye The Transparent Cornea And Lens Focus Images On The Retina, A Thin Light Sensitive Film Which Receives Light And Changes It Into Electrical Signals Which Are Then Transmitted To The Brain By The Optic Nerve. Just In Front Of Lens Lies The Iris ('colored Portion Of The Eye') With A Central Opening - The Pupil. This Is Just Like The Shutter Or Diaphragm Aperture Of The Camera And Helps Regulate The Amount Of Light Entering The Eye. The Sclera ('white Of The Eye') Is The Protective Outer Coat Of The Eye. Between The Sclera And The Retina Lies The Choroid, Which Has A Chiefly Nutritive Function. The Space Between The Lens And The Retina Is Filled With A Clear Jelly Called The Vitreous Body.

 

The Retina

The Retina Can Be Divided Into Two Regions: The Central (macula) And The Peripheral. The Macula Is A Very Small Area In The Centre Of The Retina Upon Which Light Rays Are Focused By The Cornea And The Lens Of The Eye. The Macula Being The Most Sensitive Portion Of The Retina Is Responsible For Acute (sharp) Vision, - That Is For Reading, Writing, Threading A Needle And Other Fine Tasks. The Periphery Of The Retina Gives Us Vision To The Side, Which Is Called "peripheral Vision". This Is What We Refer To When We Say, "I Saw Something From The Corner Of My Eye."

 

What Is Diabetic Retinopathy?

When The Retina Is Affected By Diabetes, Weakened Blood Vessels May Leak Fluid Or Blood, Causing Damage To The Retina. This Is Called DIABETIC RETINOPATHY.

 

There Are Two Forms Of Diabetic Retinopathy. In BACKGROUND RETINOPATHY, Blood Vessels Within The Retina Become Abnormally Permeable And Allow Substances Like Fluid And Lipid To Leak Out. This Results In Water Logging Or Edema Of Retinal Tissue And Deposition Of Yellowish Material Called Exudates. If The Leaking Fluid Collects In The Macula (the Central Part Of The Retina Responsible For Reading Vision And Other Fine Tasks), Vision Gets Affected, Often To A Marked Degree.


The Second Form Is PROLIFERATIVE RETINOPATHY. Abnormal Fragile 'new' Blood Vessels Grow On The Surface Of The Retina Or Optic Nerve And Sometimes Into The Vitreous Cavity. These Fragile Vessels May Rupture And Bleed Into The Normally Clear Vitreous Gel, Blocking Light From Reaching The Retina. Subsequent Scar Formation In The Vitreous May Pull On The Retina, Detaching It From The Back Of The Eye (traction Retinal Detachment). Severe Loss Of Sight, Blindness, And Even Painful Glaucoma Can Result From These Conditions.

 

What Are The Symptoms?

Please Note That Every Person With Diabetes Need Not Have Diabetic Retinopathy. Conversely An Eye With Marked Changes Of Diabetic Retinopathy Can Have Good Vision And Be Totally Free Of Symptoms. Hence It Is Important For All Diabetics To Undergo REGULAR EYE CHECK-UP INCLUDING RETINAL EXAMINATION THROUGH DILATED PUPILS Especially For People Who Have Been Diabetic For A Number Of Years. It Is Also True That Diabetes Is Often Detected In A Person, When Some Changes Of Retinopathy Are Seen On Routine Examination Of The Eye.


Reduced Central Vision Can Occur If The Macula Gets Edematous (swollen). Black Spots (floaters) And Cobwebs Of Sudden Onset Often Point To A Minor Bleed Inside The Eye. Sudden Total Loss Of Vision May Occur Due To A Large Bleed Into The Vitreous

 

Investigations For Diabetic Retinopathy

If Diabetic Retinopathy Is Noted, Color Photographs Of The Retina May Be Taken And FLUORESCEIN ANGIOGRAPHY Performed. This Involves Dilating The Pupils And Injection Of A Fluorescent Dye Into A Vein In The Arm. Photographs Of The Retina Are Taken Rapidly As The Dye Passes Through The Retinal Blood Vessels. This Test Helps In Determining If Laser Photocoagulation Treatment Is Necessary. If Treatment Is To Be Done, It Helps In Identifying What Structures And Areas Need Treatment With Laser.


OPTICAL COHERENCE TOMOGRAPHY (OCT), Which Is Newer Non-invasive Diagnostic Modality Provides A Cross-sectional View Of The Retina And Helps In Quantifying The Amount And Type Of Swelling And Guides The Treatment.

 

 

Treatment Of Diabetic Retinopathy

PHOTOCOAGULATION Involves The Use Of A LASER Beam To Seal Leaking Blood Vessels And Prevent Growth Of Abnormal Blood Vessels. This Procedure Does Not Require Hospitalization. In Background Retinopathy, If Blood Vessels Are Leaking Fluid Into The Macula, Laser Treatment Stops The Leakage And May Improve Or Stabilize Vision. In Proliferative Retinopathy, Laser Treatment May Involve One Or More Sessions Depending On The Type And Severity Of Retinopathy. Laser Treatment Significantly Reduces The Chances Of Severe Visual Loss By Destroying The Abnormal Blood Vessels And Preventing Growth Of More Such Vessels. Vision May Improve Or Stabilize Within Several Weeks To A Year. It Is Important To Remember That Laser Treatment Is Not A One-time Procedure. Regular Follow Up Is Extremely Important. Your Doctor Will Tell You When To Return For A Check-up.


Recently, Along With Laser Treatment, Certain Medication When Injected Into The Eye Or Just Outside The Eye Has Shown Encouraging Results. These Medicines Are However To Be Used Cautiously And Judiciously. If The Vitreous Is Too Clouded With Blood Or There Is Traction Retinal Detachment, Laser Treatment Will Not Work. In This Situation, A Surgical Procedure Called VITRECTOMY Needs To Be Performed. In This Operation, Opaque Vitreous Gel Is Removed From Within The Eye By A Special Instrument That Simultaneously Sucks And Cuts The Vitreous.

 

Prevention Of Diabetic Retinopathy

LOSS OF VISION FROM DIABETIC RETINOPATHY IS LARGELY PREVENTABLE.

 

EARLY DETECTION Of Diabetic Retinopathy Is The Best Protection Against Sight Loss. This Is Possible By Having A Complete Eye Examination Including Retina Check-up Once A Year Or More Frequently If Advised. In Most Cases The Ophthalmologist Can Then Begin Treatment Before Sight Is Affected.
Excellent Control Of Diabetes And Associated Conditions Like Hypertension, Increased Blood Lipids & Cholesterol And Renal (kidney) Disease, Is Strongly Recommended. However, Good Control In Itself Does Not Guarantee Freedom From Diabetic Retinopathy.


Implantable Contact Lens (ICL) / Phakic IOL For The Correction Of High Myopia, High Hyperopia And Astigmatism

If Your Glass Power Is Too High, Or If Your Corneas Are Too Thin, Then You Are Probably Unsuitable For LASIK Or Even Epi-LASIK. Shreya Eye Centre Offer You A Safe Alternative. The Implantable Contact Lens (ICL) Is A New And Safe Treatment Option For Patients With Extremes Of Myopia (near-sightedness) And Hyperopia (far-sightedness).

 

Learn More About The Implantable Contact Lens (ICL) - THE ULTIMATE CHOICE IN VISION CORRECTION.

 

What Is An Implantable Contact Lens (ICL)?

The Implantable Contact Lens (ICL) Is Indicated For Patients Unsuitable For LASIK With Extremes Of Myopia (near-sightedness), Hyperopia (far-sightedness) And/or Astigmatism (cylindrical Powers).

 

They Are Designed To Correct Visual Problems Much The Same Way As An External Contact Lens. Unlike External Contact Lens, Implantable Contact Lenses Are Placed Inside The Eye Behind The Iris (colored Part Of The Eye) And In Front Of The Eye's Natural Lens. Unlike LASIK, The ICL Is A Reversible Procedure.


It Is An Artificial Lens Made From Material Similar To The Type Used For Intraocular Lenses Currently Being Implanted In Cataract Surgery That Is Placed Inside Your Eye In Addition To Your Natural Lens.

 

How Does The ICL Work?

The Implantable Contact Lens Is A Very Thin, Foldable Lens, Which Is Inserted Into The Eye Through A Tiny Sutureless Corneal Incision During A 30-minute Local Anesthetic Procedure. Each ICL Is Specially Designed And Custom-made To Fit The Patient's Own Unique Anatomy. It Lies Behind The Iris And In Front Of The Lens, Without Touching The Central Lens. The ICL Is Reversible And Can Correct Near-sightedness, Far-sightedness And Astigmatism.

 

Who Should Consider The ICL / Am I Suitable For The ICL?

Because Each Person's Eyes Are Different, Your Surgeon Must Choose The Best Treatment For Your Specific Disorder. The Implantable Contact Lens (ICLTM) Is Capable Of Correcting Most Refractive Disorders As Well As Those Where Conventional Laser Treatment (LASIK, PRK, Etc.) May Not Be Advisable. Implantable Contact Lenses Are Best Suited For Patients With High Nearsightedness Or High Farsightedness With Problems Wearing Contact Lenses. More Specific Guidelines Of ICL Eligibility Could Include:

  • Extreme Nearsightedness (especially If Thin Corneas Would Raise The Risk Of LASIK-induced Problems)
  • Extreme Farsightedness
  • Corneas Too Thin To Have Safe LASIK Or Even Epi-LASIK
  • Older Than 21 Years With A Stable Refraction For 2 Years Or More And Not Pregnant
  • Dry Eyes Or Large Pupil

 

The Consultation

ICL Work-up And Treatment At Shreya Eye Centre Is Performed By Our Experienced Staff And Surgeons. An Initial Consultation Will Confirm Suitability. Each Patient Then Goes Through A Comprehensive Series Of Eye Tests And Examinations (including Manifest, Cycloplegic And Post-mydriatic Refraction, Corneal Topography, Pachymetry, And Thorough Retina Check-up) Before Consulting With The Surgeon To Discuss And Plan The Specifics Of Personal Vision Correction. If One Decides To Go Ahead With The Treatment, The Lenses Will Be Made To The Exact Specifications And Will Be Ready In Two Weeks. If You Wear Contact Lenses, You Will Be Required To Stay Off Them Prior To Your Check-up (Soft Lenses For 2 Weeks And Rigid Lenses For 4 Weeks).

 

The ICL Procedure

As Part Of The Pre-operative Work-up Your Surgeon Will Perform YAG Laser Iridotomy Before The Actual Procedure, Which Consists Of Making Two Holes In Your Colored Portion Of The Eye (Iris) To Help Ensure That Intraocular Fluid Does Not Build Up Behind The ICL

 

Prior To The ICL Procedure You Will Be Started On Pre-operative Medication Including Antibiotic Drops, As Per The Surgeon's Requirements. The ICL Implantation Procedure Is Performed In A Specialist Ophthalmic Theatre. Local Anesthetics Will Be Used To Numb The Eye.

 

The Lens Is Inserted Through A Small Incision In The Side Of The Cornea And Sits In Front Of The Eye's Natural Lens, Just Behind The Cornea. Antibiotic And Anti-inflammatory Drops Are Then Administered To Avoid Infection And The Whole Procedure Takes Around 30 Minutes. As A Precautionary Measure, The Lenses Are Implanted One At A Time, Allowing A Minimum Recovery Time Of One Week Between Treatments. Once The First Has Fully Settled, The Second Eye Receives Its ICL.

 

After Treatment

You Will Be Able To Go Home On The Same Day And It Is Essential That You Have Someone To Accompany You. You Are Free To Leave The Clinic As Soon As You Feel Able, With Padding Over The Eye To Prevent Infection. Although You May See Some Improvement In Your Vision As Early As The First Postoperative Day But Visual Recovery May Take Several Weeks To Stabilize. You Will Be Able To Return To Normal Activities Within 2-3 Days Following Surgery And Should Be Able To Drive And Be Back To Work Within Two Weeks Of The Procedure. You Will Need To Be Seen Again By Your Surgeon On The Day After Surgery. Aftercare Visits Are Required After One And Three Months, Then As Directed By The Surgeon.

 

Limitations Of ICL / Phakic Implant Surgery

Results Of Surgery Cannot Be Guaranteed And Sometimes Glasses May Be Required For Sharpest Vision, For Night Driving Or Other Activities Performed In Low Light, And For Prolonged Reading Etc. Implantable Contact Lenses Are Designed To Provide As Close To Normal Vision As Possible. People With Normal Distance Vision Benefit From Wearing Reading Glasses For Near Work At Some Stage In Their 40s. ICL Patients Experience This Aging Change Just The Same As Normal People.

 

What Problems Have Been Encountered With ICLs?

There Is A Small But Unavoidable Risk Of Infection But This Is Minimized By The Full Sterile Theatre Conditions. There Is Also A Small Possibility Of Damage To The Structure Of The Eye, Which Could Lead To Cataracts, Glaucoma, Retinal Complications, Corneal Decomposition And Rejection.

 

Severely Short-sighted People Often Have Other Eye Problems Such As Damaged Retinas And Progressively Deteriorating Eyesight. The ICL Cannot Help Or Stop These Associated Conditions. In The Event Of Complications, Lens Implants Are Potentially Reversible.

 

No Procedure Can Be Risk-free. Ultimately, The Patient Needs To Make Up Their Mind About The Risk/benefit Balance For The Various Options Available To Them To Correct Their High Myopia Or High Hyperopia. Some Patients Need Surgical Correction Of Their Severe Focus Error For Safety Reasons. Theoretically, The Proximity Of The ICL To The Iris And Lens Raises The Possibility Of Late Onset Lens Opacities Or Pigment Dispersion. Both These Rare But Potential Problems (occurred In 0.4% Patients In The FDA Study Group) Are Much More Easily Fixed Than Corneal Complications Following LASIK Surgery. Current Evidence Supports ICLs As Being A Very Effective And Safe Option For These Patients.


The Implantable Contact Lens Is Designed To Be Placed In Your Eye And Remain There Permanently, But With Increasing Age If You Develop A Cataract Significant Enough To Cause Visual Problems, Then Cataract Removal With Intraocular Lens Implantation Can Be Done With Removal Of The ICL.

 

The Advantages Of ICL Implantation

  • The ICL Is Tiny And Soft - The ICL Can Be Folded So Small That It Can Be Injected Painlessly Into Your Eye In Seconds Through A Tiny Opening In Your Cornea So That It Unfolds Into Position In The Liquid Between Your Iris And Your Natural Lens And Is Easily Accepted By Your Body
  • The ICL Is Invisible - The ICL Is Placed Inside Your Eye, Rather Than On The Surface. The Lens Is Invisible. The Only Way That You Or Anyone Else Will Know That It Is There, Is The Improvement In Your Eyesight.
  • ICL Is Removable - The Lens Is Meant To Remain Permanently In The Eye. However, It Can Be Removed If Necessary, Since The Lens Does Not Alter Any Structures Within The Eye Or The Cornea.
  • The ICL Works Beyond The Limits Of Laser Treatment - The ICL Is Useful In Cases Beyond The Limits Of Laser Treatment (high Minus And Plus Spectacle Powers) And Is The Treatment Of Choice If You Have Thin Corneas, Dry Eyes, Or Large Pupils
  • The Toric ICL Treats Two Vision Disorders In One Procedure - The Toric ICLTM Corrects You Nearsightedness As Well As Your Astigmatism In One Single Procedure. Each Lens Is Custom Made To Meet The Needs Of Each Individual Person.
  • The ICL Provides High Patient Satisfaction - The ICLTM Provides High Quality Of Vision, And Is A Highly Precise And Predictable Treatment Providing Exceptional Patient Satisfaction.

 

The ICL - The Ultimate Choice, Even For Doctors Themselves

Surgeons Around The World Have Made The ICLTM Their Procedure Of Choice More Than 65,000 Times - Not Only For Their Patients, Staff And Family, But Even For Themselves.

 

FREQUENTLY ASKED QUESTIONS

Q Am I A Candidate For The ICLTM?
A Yes, If You Have Nearsightedness, And / Or Astigmatism And No Eye Disease. ICL For Farsightedness Is Also Available.

Q What Are The Advantages Of The ICLTM?
A Lens Is Small, Foldable, And Injected Through A Tiny, Pain Free, Self Healing Incision In Your Eye. ICLTM Provides Highly Predictable Outcomes, Excellent Quality Of Vision And Can Be Removed If Necessary.

Q How Quickly Can I Go Back To My Daily Routine & Activities?
A Due To The Quick Recovery After This Treatment, You Can Leave The Centre After A Couple Of Hours. You Will Be Able To Enjoy Your New Sight Almost Immediately And Go Back To Your Active Lifestyle. Your Surgeon Will Give You Detailed Advice.

Q What If My Vision Changes?
A Though Unlikely, If During Your Annual Eye Exam A Major Change In Your Vision Is Observed, The ICLTM Can Be Removed Or Replaced. With The ICLTM You Can Still Wear Glasses Or Contact Lenses If Necessary. The Lens Does Not Treat Presbyopia Or Eliminate The Need For Reading Glasses Due To Age.

Q What Is The Long-term Experience With ICLTM?
A The ICLTM Has Been Available Internationally For Over 12 Years. More Than 65,000 Lenses Have Been Implanted Since Then.
The ICL Thus Provides A High Quality Of Vision, And Is A Highly Precise And Predictable Treatment Providing Exceptional Patient Satisfaction For Patients Unsuitable For LASIK


LASIK (or Laser Assisted In Situ Keratomilieusis) Is Currently The Most Popular Method In The World For The Correction Of Refractive Errors (spectacle Powers). Shreya Eye Centre Offers You Laser Vision Correction To Reduce Your Dependence On Glasses Or Contact Lenses.

 

Learn About Refractive Errors And Laser Vision Correction.

 

What Are The Causes Of Focusing Problems?

Focusing Problems Of The Eye, Which Require Correction By Glasses Or Contact Lenses, Are Called Refractive Errors. These Are:

  • Myopia, Also Called Shortsightedness Or Nearsightedness
  • Hypermetropia (Hyperopia) Also Called Or Longsightedness Or Farsightedness
  • Astigmatism - Those Using Cylindrical Correction In Their Glasses

 

Nearsightedness, Or Myopia

It Is The Most Common Focusing Problem, Affecting A Significant Proportion Of The Indian Population. Nearsighted People Can See Various Ranges Of Near Objects Clearly But Not Distant Objects. Nearsightedness Usually Results From An Eyeball That Is Too Long. Because Of This Extra Length, Light From Distant Objects Converges To A Focal Point Before It Reaches The Retina At The Back Of The Eye. Beyond The Focal Point, The Light Then Begins To Diverge. Since The Retina Only Captures The Quality Of The Image That Reaches It, The Brain Receives A Blurred Image Of What The Eye Is Trying To See.


Nearsighted People Need To Wear Minus-powered Spectacles Or Contact Lenses To See Clearly.

 

Farsightedness, Or Hyperopia

This Is A Focusing Problem Caused By An Eyeball That Is Shorter Than Normal. Due To The Reduced Length, The Lens Fails To Bring Light Rays To A Focal Point By The Time They Reach The Retina. The Effects Of Farsightedness Vary With Age Because Of The Diminishing Flexibility Of The Lens. Young People May Not Notice Any Effects. But As The Eyes Begin To Age, Near Objects Become Increasingly Difficult To See. Later In Life Nearly All Focal Ranges May Be Unclear. Farsighted People Need To Use Plus Powered Spectacles To See Clearly.

 

Astigmatism

Astigmatism Is The Result Of The General Inability Of The Eye To Clearly Focus Images From Any Distance. It Results From Uneven Curvatures Of The Cornea. Instead Of Being Spherical, It Is More Similar To The Side Of An Egg. This Focusing Problem Usually Occurs In Combination With Nearsightedness, Or Farsightedness. People With Astigmatism Need To Use Cylindrical Correction In Their Glasses.

 

What Are The Life-style Benefits Of Laser Vision Correction?

LASIK Eye Surgery Offers Multiple Benefits To Most People With Refractive Errors:

  • Clear Vision Without The Hassles And Inconvenience Of Corrective Lenses - No More Fears About Being Incapacitated In An Emergency If Lenses Are Lost Or Glasses Are Broken
  • Expanded Career Opportunities (police Officers, Firefighters, Pilots, Air Hostesses And Professional Athletes).
  • Better Vision For Recreational Sports, Especially Water, Winter And Contact Sports
  • Wider Scope Of Peripheral Vision Than What Glasses Provide
  • May Be Safer For Eye Health Than Wearing Contact Lenses For An Extended Period Of Time.
  • New Visual Freedom For All Aspects Of Life

 

Do You Qualify For Laser Vision Correction?

To Qualify For Laser Vision Correction, You Should

  • Be At Least 18 Years Of Age
  • Have Had Stable Vision For The Past One Year (slight Prescription Changes May Not Disqualify You.)
  • Have Corneas Of Adequate Thickness As Measured By Corneal Pachymetry And Normal Shape (determined By Corneal Topography).
  • Be Free From Systemic Illnesses, Collagen Vascular Disorders Such As Rheumatoid Arthritis, Sjögrens Syndrome, Systemic Lupus Erythematosus, Etc.
    Not Be Pregnant Or Nursing
  • Be Off Contact Lenses For 1-3 Weeks Prior To The Surgery (this Varies With The Type Of Contact Lens - Soft Or Semi-soft).
  • Your Expectations From LASIK Should Be Realistic. Patients With Un-realistic Expectations Generally Have Low Levels Of Satisfaction. Detailed Patient Counseling Is Important In This Regard

 

How Does Laser Vision Correction Work?

Laser Vision Correction Works By Using A High Precision Laser Beam To Reshape The Front Surface Of The Cornea And Allow Light Rays To Focus Precisely On The Retina. This High Precision Laser Known As Excimer Laser Involves The Use Of 193 Nm UV Light, Which Is A Unique Type Of "cold" Laser That Does Not Burn Or Cut Tissue. Instead, It Gently Breaks The Molecular Bonds Between The Cells So That Controlled Amounts Of Tissue Can Be Literally Vaporized Away, One Microscopic Layer At A Time. Central Tissue Is Removed To Reduce The Corneal Curvature And Correct Nearsightedness. Peripheral Tissue Is Removed To Increase The Corneal Curvature And Correct Farsightedness. Astigmatism Can Be Corrected By Removing Selected Tissue To Even Out The Curvature Of The Cornea.

 

What Is LASIK?

For People Wishing To Have Less Dependence On Glasses Or Contact Lenses, An Excimer Laser Procedure Called Laser Assisted In Situ Keratomileusis (LASIK) Is Currently The Best Way To Achieve Clear, Natural Vision. This Procedure Had Its Origins Back In The 1960s, And Has Evolved Over The Years Into A Safe And Effective Operation. This Procedure Was FDA Recognized In September 1998.

 

In Performing LASIK, The Surgeon First Uses A Special Oscillating Blade To Make A Partial Cut Through One Fourth To One Third Of The Front Surface Of The Cornea, Creating A Flap Of Clear Tissue On The Central Part Of The Eye.

 

he Patient Is Then Positioned Under The Excimer Laser, Which Is Programmed To Vaporize Some Of The Internal Corneal Tissue Under The Flap. After The Laser Has Removed The Selected Tissue, The Flap Is Closed Over The Eye. The Cornea Has Extraordinary Natural Bonding Qualities That Allow Effective Healing Without The Use Of Stitches.


In The Latest Technique Of I-LASIK Or Blade-free LASIK, This Flap Is Created Not By An Oscillating Blade, But By An Advanced Technology Called The Intralase Method Utilizing A Special Laser (femtosecondlaser).

 

What Is Customized LASIK (Advanced CustomVue Treatment)?

Customized LASIK Is An Advanced Form Of Laser Vision Correction, Which Further Enhances The Precision Of Excimer Laser Surgery. This Is Based On The Fact That The Human Eye Suffers Not Only From Sphero-cylindrical Errors, Which Can Be Corrected With Glasses Or Contacted Lenses, But Also From Numerous, Minute Optical Imperfections Or Aberrations, Other Than Sphero-cylindrical Refractive Errors, Which Are Not Correctable With Glasses Or Contact Lenses.

 

The LASIK Procedure

Each Patient Goes Through A Comprehensive Series Of Eye Tests And Examinations (including Corneal Topography, Pachymetry And Wavefront Analysis) Before Consulting With The Surgeon To Discuss And Plan The Specifics Of Personal Vision Correction. To Ensure A Painless Experience The Eye Is Anaesthetized With Drops (No Injections Are Necessary). For The Surgery, The Patient Lies Under The Laser Machine And Concentrates On A Flashing Light For A Few Seconds. The Patients Are In The Surgery Suite For About 15-20 Minutes And Can Walk Away After The Surgery. No Hospitalization Is Required. In LASIK, Both The Eyes Are Generally Operated At The Same Time; No Patch Is Applied Post-operatively. However, If You So Desire, You May Undergo The Procedure One Eye At A Time.

 

What Happens After LASIK?

The Vision May Be Blurry For The First Few Hours After Surgery But It Gradually Improves. Few Patients May Have A Mild Discomfort In The First Two Hours After The Procedure. However, This Is Easily Relieved By Pain-killing Medication. Patients Are Encouraged To Rest For A Day After The Surgery. The Precautions, Which Need To Be Taken Post-operatively, Are To Avoid Rubbing And Squeezing The Eyes. Avoid Splashing Water To The Face Or Directly Into The Eyes. Instillation Of Eye Drops Would Start Immediately After The Surgery And Will Continue For Approximately Two Weeks. Most Patients Have Functional Vision And Can Resume Normal Activities And Work Within A Few Days. In LASIK, Good Vision Is Attained In 2-3 Days. You Will Have Follow Up Examinations On The Day After The Surgery, After The First Week, One Month, 2 Months, 3 Months And 6 Months Later

 

Risks And Side Effects Of LASIK

As With Any Surgical Procedure, LASIK Surgery Has Some Possible Risks And Side Effects That Must Be Taken Into Account. A Specific End Result Cannot Be Guaranteed, Although It Can Be Closely Predicted Based On Data From Thousands Of Previous Cases. Side Effects Are Usually Minimal Following LASIK Surgery. During The First Few Days After Surgery, Most People Can Expect To Experience At Least Some Of These Effects:

  • Increased Sensitivity To Light Or Glare.
  • Gritty And Burning Sensation In The Eyes
  • Slightly Drier Eyes
  • Decreased Visual Clarity In Dim Light

In Most Cases, These Effects Decrease And Eventually Disappear As The Eye Heals. Occasionally, Somemay Persist.

 

Serious Complications Are Fortunately Very Rare. Some Of These Include Infection, Wrinkles In The Flap, Epithelial In Growth And Increased Or Decreased Response To Correction. These Complications Are Treatable With Medication Or Further Surgery.

 

Epi-LASIK Eye Surgery

Epi-LASIK Is A Relatively New Procedure That Is Technically A Variation Of LASIK, And Is Also Called Epithelial LASIK Or E-LASIK. Epi-LASIK Is Used Mostly For People In The Higher Refractive Range Where Corneas Are Too Thin Or Too Flat For LASIK. In This Procedure, A Very Thin Flap Is Made Consisting Of The Most Superficial Layer Of The Cornea (the Epithelium). This Is Followed By The Excimer Laser Treatment To Correct Your Refractive Error As In LASIK. At The End Of The Procudere The Epithelial Flap Is Put Back And A Transparent Protective Shield (bandage Contact Lens) Is Placed Over The Cornea. The Epithelium Takes A Few Days To Heal Following Which The Bandage Lenses Are Removed. In The Epi-LASIK Procedure Although The Visual Outcome Is The Same As That Of LASIK, Recovery Of Good Vision Takes 8-10 Days. Your Surgeon Will Be Your Best Judge To Decide Which Procedure You Should Undergo.

 

QUESTIONS & ANSWERS

Q. Are Both Eyes Treated At The Same Time?

Literature Has Shown That LASIK Is An Extremely Safe Procedure And Sight-threatening Complications Are Rare. Patients Normally Prefer To Have Both Eyes Treated At One Sitting And Get Back To Work Faster. This Practice Is Followed Worldwide. However If The Patient Feels More Comfortable Getting Only One Eye Treated At Each Session, This Can Be Done Without Any Additional Cost To The Patient.

 

Q. Will My Number Get Fully Corrected At The Time Of LASIK?

The Laser Is Set So As To Reshape Your Cornea To Eliminate Your Number Completely. However During The Healing Process The Eyes Of Each Person May Heal Slightly Differently. Thus It Is Possible That You May Have A Small Residual Number. Usually This Does Not Make It Necessary For You To Wear Glasses For Routine Work.

 

Q. Are The Results Of The LASIK Procedure Permanent?

The Correction Of Vision Done By LASIK Is Permanent. However LASIK Has No Effect On The Natural Progression Of Your Number. This Is Why We Only Perform LASIK In Patients Whose Number Has Been Stable For At Least One Year.

Q. If Required, Can LASIK Be Performed Again?

If The Objectives Of Visual Correction Are Not Met With In The First Surgery, A Second, Or Enhancement Procedure Can Usually Be Performed To Provide Additional Correction. Most People Do Not Require Additional Surgery, But The Higher The Amount Of Correction Necessary, The Greater Is The Possibility Of Needing An Enhancement Procedure. The Surgeon And The Patient Together Assess This Need And Make The Decision About Further Surgery.

Q. Will I Require Reading Glasses?

After LASIK Surgery You Will Be Able To See All Distant Objects Clearly. Since LASIK Cannot Arrest The Normal Aging Process Of The Body, You May Require Glasses For Reading At Around 40-45 Years. Sometimes It May Be Possible To Correct One Eye For Distance And The Other Eye For Near Vision If You So Desire. This Is Called Monovision.

Q. Does LASIK Correct All The Problems Associated With Myopia ?

LASIK Will Only Correct The Refractive Power Of The Eye So As To Focus The Image On The Retina Without Need Of Glasses. However There Are Other Associations And Possible Future Risks In A Myope Like Higher Chances Of Retinal Detachment, Glaucoma ,cataract, Etc. LASIK Does Not Change The Risk Of Such Problems In Future. Therefore Patient Should Always Mention The Past History Of LASIK During Future Eye Check-ups. Because It's Difficult For Ophthalmologists To Detect The Past Occurrence Of LASIK If It Is Not Looked For. It Is Important That Patient Should Get Regular Eye Checkup With Special Emphasis On Retina And Glaucoma.


 

What Is 'Low Vision'?

A Person Is Said To Have 'Low Vision', If He Or She Has A Significant Visual Handicap In Spite Of Treatment And Best Correction With Standard Eyeglasses Or Contact Lenses. 'Low Vision' Should Not Be Confused With Blindness. People With 'Low Vision' Have A Significant Visual Handicap But They Also Have Significant Residual Vision. The Residual Vision May Be Insufficient To Meet The Patient's Routine Needs. But A Good Percentage Of These Patients Have Some Degree Of Usable Vision, Which Can Be Utilized For Their Day To Day Work Using Special Aids Or Devices. If Properly Motivated, These Patients Can Potentially Benefit With The Use Of Special Aids Or Devices Called 'Low Vision Aids'

 

What Are The Causes Of 'Low Vision'?

Although Most Often Experienced By The Elderly, People Of Any Age May Suffer From Low Vision. Low Vision Can Result From Birth Defects, Inherited Diseases, Injuries, Diabetes, Glaucoma, High Myopia And Aging.

 

The Commonest Cause Is Age Related Macular Degeneration (ARMD), A Degenerative Disease Of The Retina, The Innermost Layer Of The Eye That Perceives Light And Enables Us To See. Macular Degeneration Affects The Central Vision. Even When Advanced, It Does Not Lead To Total Blindness Because The Peripheral Vision Is Still Preserved, Even Though The Central Vision May Be Totally Lost.


Although Reduced Central Vision Is The Commonest Cause Of Low Vision, Extensive Loss Of Peripheral Vision As In Advanced Glaucoma, Can Also Produce Low Vision Due To Extremely Narrow Field Of Vision. Birth Defects Or Inherited Disease Producing Loss Of Color Vision Or Increased Glare Sensitivity (diminished Ability Of The Eye To Adjust To Light, Contrast Or Glare) Can Also Cause Low Vision.

 

Visual Handicap May Be Produced By Various Kinds Of Visual Impairments

Reduced Central Vision Produces Difficulty In Reading, Watching Television And Recognizing Faces. Loss Of Peripheral Vision Reduces Mobility. Increased Glare Sensitivity Causes Difficulty In Driving. Impaired Color Vision Results In Difficulty In Distinguishing Different Colors. Different Types Of Low Vision Require Rehabilitation With Different Kinds Of 'Low Vision Aids'.

 

What Are 'Low Vision Aids?'

A 'Low Vision Aid' (LVA) Is A Device Or An Apparatus That Improves Or Enhances The Residual Vision In Patients With Low Vision. There Is No Absolute Level Of Vision Above Which LVAs Will Be Useful, And Below Which They Will Not Be. Also There Is No One Device That Is Suitable For All Situations And All Patients. Different Devices Are Needed To Fulfill The Needs Of Various Patients. Various Low Vision Aids May Need To Be Tried Out Before The Most Suitable Device Or Devices Is Determined For A Particular Patient.

 

Types Of Low Vision Aids

There Are Broadly Two Types Of Low Vision Aids: Optical And Non-Optical.

 

OPTICAL LOW VISION AIDS

Optical Low Vision Aids Use Lenses, Or A Combination Of Lenses, To Magnify The Size Of Objects Of Regard At Distance Or Near. The Lowest Magnification Compatible With The Task To Be Performed Should Be Used By The Patient. The Main Types Of Optical Devices Available Are:

 

Magnifying Spectacles - They Have Stronger, High-powered Lenses Compared To The Usual Eye Glasses And Are Designed For Close Work. Patients Using Them Need To Hold The Reading Material Very Close To Their Eyes In Order To Keep The Print In Focus. One Needs Some Practice To Get Used To These Spectacles. They Have The Advantage Of Leaving Both Hands Free To Hold The Reading Material. The Hands Are Also Freed From Holding A Magnifying Lens, An Important Consideration In Old Patients With Shaky Hands.

 

Hand Magnifiers - They Are The Most Commonly Used Low Vision Devices. They Offer Greater Flexibility Because The Patient Can Control Their Position In Relation To The Eye Or The Object Of Regard. Also, The Reading Material Can Be Held At The Normal Distance. Some Of Them May Have A Self Contained Light Source Incorporated In Them

 

Stand Magnifiers Have The Magnifying Lens Mounted On A Stand That Rests On The Reading Material.

Sheet Magnifiers - These Are Essentially Plastic Sheets With Concentric Ridges On Their Surface. These Are Available As Small Size Pocket Magnifiers Or Large Size Book Readers. However They Provide Only Low Magnification

Paperweight Magnifiers - They Rest Directly On The Print Material, Which They Magnify.

Bar Magnifiers Are Useful For Reading Books Or The Telephone Directory

Telescopes - Telescopes Are Aids To Magnify Distance Objects. They May Be Hand Held Or Mounted On Spectacles. However They Have The Disadvantage Of Reducing The Field Of Vision.

 

NON-OPTICAL LOW VISION AIDS

These Include: -

  • Large Print Books And Magazines
  • Large Playing Cards
  • Large Dial Telephones
  • Enlarging Photocopiers
  • Talking Machines - Talking Watches, Talking Books, Talking Calculators, Talking Diaries & Talking Computers
  • Closed Circuit Televisions - These Can Provide High Magnification (up To 40 Times) In An Undistorted Manner. The Patient Can Get As Close As He Wishes To The Monitor, Which May Be A Small Or A Medium Sized Screen Of A TV Or A Computer Monitor. Contrary To Popular Belief, Sitting Close To The Screen Does Not Cause Eye Damage. Adjustable Magnification And Contrast Make It Easy To Use.

 

Illumination & Low Vision

Illumination Has An Important Role In Helping Patients With Low Vision. Even For A Normal Person With Advancing Age, Increased Illumination Is Needed To Perform The Same Task. Lighting Should Be Ample, Placed Close To The Reading Material And Be Properly Directed Towards It. Illumination Devices Like High Intensity Reading Lamps With Adjustable Arms Are Of Good Help.
Visors And Cap Brims Block The Dazzling Effect Of Overhead Light. Glare Control Filters Incorporated In The Spectacles Can Help Control Glare And Improve Function In Many Patients.

 

What Services Are Available For Patients With Low Vision At Shreya Eye Centre?

At Shreya Eye Centre, A Complete Eye Examination Of Patients With Low Vision Is Performed By Ophthalmologists (medical Doctors Educated And Trained To Provide Eye Care). Total Eye Care To These Patients Starts With Diagnosing The Cause Of Low Vision. Once The Cause Of Low Vision Is Determined, Patients Try Out Different Low Vision Aids. According To The Needs Of The Patient, The Most Suitable Low Vision Device Or Devices Are Determined And Then Prescribed For Him Or Her.

 

Low Vision Aids Assist Many Patients In Leading A Comfortable And Relatively Normal Life. With These Devices And Proper Motivation, People With Visual Loss Can Often Read, Do Modified Close-up Work, And Continue To Take Good Care Of Themselves.

 


What Is Neuro-Ophthalmology?

Neuro-ophthalmology Is An Ophthalmic Subspecialty That Addresses The Relationship Between The Eye And The Brain, Specifically Disorders Of The Optic Nerve, Orbit, And Brain, Associated With Visual Symptoms. Neuro-ophthalmologists Provide Comprehensive Clinical Care To A Broad Spectrum Of Patients With Visual Disturbance From Optic Nerve Diseases, Central Nervous System Disorders, Ocular Motility Dysfunction, And Pupillary Abnormalities. Over 50 Percent Of All Intracranial Lesions Involve The Visual Or Oculomotor Pathways. Shreya Eye Centre Offers You A Dedicated Neuro-Ophthalmology Service For The Diagnosis And Treatment Of These Neuro-ophthalmic Disorders.

 

The Neuro-Ophthalmology Service At Shreya Eye Centre

  • Learn About Neuro-ophthalmic Disorders.
  • What Are The Common Symptoms Of Neuro-ophthalmic Diseases?
  • What Are The Common Types Of Neuro-ophthalmic Diseases?
  • What Is Ischemic Optic Neuropathy (AION)? 

 

This Is The Most Common Cause Of Sudden Decreased Vision In Patients Older Than 40 Years. We Do Not See With Our Eyes. We See With Part Of Our Brain That Is Capable Of Interpreting Visual Signals Sent Back From The Eyes. This Is Located At The Back Of Our Head (the Occipital Lobes). Information Is Transmitted From The Eyes To The Brain Via The Optic Nerves. These Nerves Are Composed Of The Long Tube Extensions (axons) Of Cells (ganglion Cells) Located Within The Inner Lining Of The Eye (the Retina) That Exit The Back Of The Eye At The Optic Disc. Each Of The Optic Nerves Receives Blood Supply From Branches Of The Ophthalmic Artery Within Each Eye Socket. The Optic Disc Has A Unique Blood Supply (the Posterior Ciliary Arteries).


Loss Of Blood Supply Within The Posterior Ciliary Arteries Deprives The Optic Nerve Tissue Of Oxygen And Results In Damage To Part Or All Of The Optic Nerve. This Is A Small "stroke" In The Optic Nerve. It Is Painless. Patients May Become Aware Of Decreased Vision Or Difficulty Seeing Above Or Below The Center Of Gaze. Loss Of The Blood Supply Results In Swelling Of The Optic Disc, Often Associated With Hemorrhages. The Hemorrhages And Swelling Will Go Away Leading To The Development Of A Pale Disc (optic Atrophy). As The Swelling Resolves, Some Of The Axons Will Be Permanently Lost. We Do Know That This Happens More Often In Patients Who Are Born With Small Optic Discs. These Episodes May Occur When There Is A Sudden Drop In Blood Pressure (following An Operation Or Associated With Blood Loss After An Accident). Patients Who Smoke, Or Who Have Diabetes Or High Blood Pressure, May Be At Higher Risk For AION.

 

Learn About Neuro-ophthalmic Disorders

 

What Are The Common Symptoms Of Neuro-ophthalmic Diseases?
Symptoms That Are More Common In Neuro-ophthalmic Disease Include Visual Loss, Visual Disturbance, Diplopia, Unequal Pupils And Eyelid And Facial Spasms.

 

What Are The Common Types Of Neuro-ophthalmic Diseases?

A Few Of The Most Common Neuro-ophthalmic Conditions Are Optic Neuritis, Ischemic Optic Neuropathy, Compressive Optic Neuropathy (including Pituitary Tumors), Papilledema, Inflammatory And Infectious Optic Neuropathies, Cerebrovascular Disorder Involving Vision, Tumors Involving Vision, Blephrospasm & Hemifacial Spasm, Thyroid Eye Disease, Myasthenia Gravis, Ocular Motor Disorders (including Cranial Nerve Palsies), Pupillary Abnormalities, Hereditary Optic Neuropathies And Patients Who Have Unexplained Visual Loss.

 

What Is Ischemic Optic Neuropathy (AION)?

This Is The Most Common Cause Of Sudden Decreased Vision In Patients Older Than 40 Years. We Do Not See With Our Eyes. We See With Part Of Our Brain That Is Capable Of Interpreting Visual Signals Sent Back From The Eyes. This Is Located At The Back Of Our Head (the Occipital Lobes). Information Is Transmitted From The Eyes To The Brain Via The Optic Nerves. These Nerves Are Composed Of The Long Tube Extensions (axons) Of Cells (ganglion Cells) Located Within The Inner Lining Of The Eye (the Retina) That Exit The Back Of The Eye At The Optic Disc. Each Of The Optic Nerves Receives Blood Supply From Branches Of The Ophthalmic Artery Within Each Eye Socket. The Optic Disc Has A Unique Blood Supply (the Posterior Ciliary Arteries).

 

Loss Of Blood Supply Within The Posterior Ciliary Arteries Deprives The Optic Nerve Tissue Of Oxygen And Results In Damage To Part Or All Of The Optic Nerve. This Is A Small "stroke" In The Optic Nerve. It Is Painless. Patients May Become Aware Of Decreased Vision Or Difficulty Seeing Above Or Below The Center Of Gaze. Loss Of The Blood Supply Results In Swelling Of The Optic Disc, Often Associated With Hemorrhages. The Hemorrhages And Swelling Will Go Away Leading To The Development Of A Pale Disc (optic Atrophy). As The Swelling Resolves, Some Of The Axons Will Be Permanently Lost. We Do Know That This Happens More Often In Patients Who Are Born With Small Optic Discs. These Episodes May Occur When There Is A Sudden Drop In Blood Pressure (following An Operation Or Associated With Blood Loss After An Accident). Patients Who Smoke, Or Who Have Diabetes Or High Blood Pressure, May Be At Higher Risk For AION.

 

What Are The Symptoms And Tests For AION?

Most Patients With AION Notice A Sudden Painless Disturbance In Their Vision. Because Of The Decreased Optic Nerve Function, However, The Pupils May Not React As Well When Light Is Directed Into The Affected Eye. Swinging A Flashlight Between The Two Eyes Will Then Show An "afferent Pupillary Defect." Visual Field Testing Can Identify The Area Of Optic Nerve Dysfunction. Blood Pressure Should Be Checked And If There Are Any Unusual Features Other Blood Studies May Be Done. In Elderly Patients A Blood Test (sedimentation Rate Or C-reactive Protein) Can Help Assess The Risk Of Giant Cell Arteritis.

 

Will I Get Back My Vision?

Most Patients With Ischemic Optic Neuropathy Will Have Relatively Stable Vision. A Recent Study Suggests That 40% Of Patients May Expect To Have Some Improvement In Central Vision. A Very Small Number Of Patients Can Have Worsening Of Vision. In Patients Who Have Had AION There Is A Possibility Of This Happening In The Other Eye. Fortunately, This Is Not Common (approximately 20% Chance). Probably The Best News Is That It Is Very Rare For A Second Episode Of Ischemic Optic Neuropathy To Occur In The Same Eye.

 

What Is The Treatment For AION?

Unfortunately, At This Time There Is No Proven Treatment For Patients With AION. It Has Been Suggested That Aspirin (regular Size Or Baby Aspirin Once A Day) May Decrease The Chance Of An Episode In The Opposite Eye. It Is Important That The Blood Pressure Be Followed By Your Doctor (elevated Pressure Increases Risk). On The Other Hand It Is Important That There Be No Sudden Drop In Blood Pressure (overly Aggressive Treatment). Smoking Should Be Stopped

 

What Is Cranial Nerve Palsy?

This Is One Of The Most Common Causes Of Acute Double Vision In The Older Population. It Occurs More Often In Patients With Diabetes And High Blood Pressure. These Will Get Better And Essentially Always Resolve Without Leaving Any Double Vision. However, Compressive Masses, Infections, Inflammation And Injury Can Also Cause Cranial Nerve Palsy. The Eyes Are Moved By 6 Extra-ocular Muscles. Four Of These Are Rectus Muscles (superior, Inferior, Medial, And Lateral) That Attach To The Front Part Of The Eye (just Behind The Iris, The Colored Portion Of The Eye). Two Muscles (the Superior And Inferior Oblique) Attach To The Back Of The Eye. These 6 Muscles Receive Their Signals From 3 Cranial Nerves (the IIIrd [oculomotor], IVth [trochlear], And VIth [abducens]). These Nerves Originate In The Brain Stem (at The Base Of The Brain) And Enter The Eye Socket Through A Fissure In The Bone Of The Skull Behind The Eye.

 

Pressure On Or Interruption Of The Blood Supply To One Of The Cranial Nerves Causes It Not To Work. If There Is Interruption Of Signal To The VIth Nerve (which Innervates The Lateral Rectus Muscle) The Affected Eye Will Not Be Able To Move To The Outside. The Patient Will Be Aware Of Side-to-side Double Vision That Will Be Worse (further Separation) When The Patient Looks Towards The Affected SideWhen The IIIrd Nerve (which Goes To Multiple Muscles) Is Involved The Eye May Be Limited In Up, Down, And Gaze Toward The Nose. The Patient Is Usually Aware Of Combined Vertical And Side To Side Double Vision Although There May Be No Double Vision At All Since The Lid Droops And May Block The Second Image. The Nerves Are Not Permanently Injured And Over A Period Of 6 To 12 Weeks The Function Should Recover.

 

How Do I Know That I Have Cranial Nerve Palsy?

Dysfunction Of One Cranial Nerve Will Produce Weakness In One Or More Muscles. If The Eyes Aren't Moving Together The Patient Will Experience Blurred Or Double Vision. If Only The VIth Nerve (innervating The Lateral Rectus) Is Affected The Double Vision Will Be Side To Side. If The IIIrd Or IVth Nerve Is Affected There Will Most Commonly Be Some Vertical ("one On Top Of The Other") Double Vision. This Will Vary Depending On The Direction Of Gaze.

 

What Tests Are Done For Nerve Palsies?

While It Is Possible For Multiple Cranial Nerve Palsies To Have A Microvascular Cause All Patients With More Than A Single Nerve Palsy Or With Other Neurologic Findings Must Have A Work Up (neurologic Examination And Imaging Study) Before The Diagnosis Is Accepted. If The Cranial Nerve Palsy Fails To Resolve Completely Over 3 Months Additional Work-up Is Indicated. All Patients With Presumed Microvascular Cranial Nerve Palsies Should Have Their Blood Pressure And Blood Sugar Checked To Make Sure They Do Not Have Diabetes Or Hypertension. Additional Work Up Such As CT Or MRI Scans Or Even An Angiogram To Rule Out An Aneurysm May Be Necessary.

 

What Is The Outcome Of Nerve Palsies?

There Is No Known Means Of Accelerating The Natural Recovery Characteristic Of Microvascular Cranial Nerve Palsy. It Is Important To Make Sure That Blood Pressure And Blood Sugar Are Adequately Controlled. The Double Vision May Be Treated Acutely With Patching Either Eye. It Is Very Important That Patients Report Any New Symptoms Or Failure Of The Double Vision To Resolve.

 

What Do I Do About The Double Vision?

Since We Expect The Double Vision To Clear Up On Its Own Any Treatment Will Hopefully Be Necessary For Only A Few Weeks Or Months. The Easiest Way To Get Rid Of The Double Vision Is To Wear A Patch. Alternatively One Lens Of Your Glasses May Be Fogged Using Frosted Cellophane Tape On The Inside

 

What Is Optic Neuritis?

This Is The Most Common Cause Of Sudden Visual Loss In A Young Patient. It Is Often Associated With Discomfort In Or Around The Eye, Particularly With Eye Movement. The Optic Nerve Fibers Are Coated With Myelin To Help Them Conduct The Electrical Signals Back To Your Brain. In The Most Common Form Of Optic Neuritis, The Optic Nerve Has Been Attacked By The Body's Overactive Immune SystemA Viral Infection That May Have Occurred Years, Or Even Decades, Earlier May Have Set The Stage For An Acute Episode Of Optic Neuritis. The Inflammation Associated With Optic Neuritis Can Result In Discomfort (particularly With Movement Of The Eye).

 

What Are The Symptoms Of Optic Neuritis?

The Most Common Symptom Of Optic Neuritis Is Sudden Decrease In Vision. In Mild Cases, It May Look Like "the Contrast Is Turned Down" Or That Colors Appear "washed Out." This May Vary And, Not Infrequently, Will Progress From The Time It Is First Noticed. The Second Most Common Symptom Associated With Optic Neuritis Is Discomfort In Or Around The Eye Often Made Worse By Movement Of The Eye.

 

How Does The Ophthalmologist Know That I Have Optic Neuritis?

A Few Patients With Optic Neuritis Have Swelling Of The Optic Disc (the Beginning Of The Optic Nerve) At The Back Of The Eye. This Is Referred To As Papillitis. One Sign Usually Detected By Your Eye Doctor Is The Presence Of An Afferent Pupillary Defect. This Indicates That There Is Less Light Being Sensed By The Affected Eye Than The Opposite Eye. This Is Found By Swinging A Bright Light Back And Forth Between Your Two Eyes While Observing How Your Pupil Reacts.

 

What Will Happen To The Vision Over Time?

The Pain Will Go Away, Usually In A Few Days. The Vision Problems Will Improve In The Majority (92%) Of Patients. There Are Rare Patients Who Have Continued Progressive Loss Of Vision. Frequently Colors Look Different Or "washed Out." Visual Recovery Usually Takes Place Over A Period Of Weeks To Months, Although Both Earlier And Later Improvement Is Possible. Optic Neuritis Can Recur Involving The Same Eye, The Other Eye Or Other Parts Of The Central Nervous System (brain And Spinal Cord). This May Result In Recurrent Episodes Of Decreased Or Loss Of Vision Or Problems With Weakness, Numbness Or Other Signs Of Brain Involvement. An MRI Scan Can Give Us A Rough Guess As To The Likelihood Of Recurrence. Other Testing Techniques Include Visual Evoked Potentials (a Test Where You Are Shown A Checkerboard Of Light And Signals Are Recorded From Electrodes On Your Scalp) That Can Show A Delay In Conduction Due To The Damage To The Myelin.

 

How Is Optic Neuritis Treated?

Patients Treated With Oral (pills) Steroids Seem To Have A Higher Chance Of Recurrent Episodes. Therefore, Steroid Pills Alone Are Not Recommended As Treatment. Patients Who Were Treated With Intravenous (given By Needle) Steroids Did Have A Slightly More Rapid Recovery Of Their Vision, Although The Final Visual Outcome Was Not Better Than In Those Who Were Not Treated. Thus, IV Steroids Can Be Recommended For Patients With Severe Involvement Or Involvement Of Both Eyes.

 

Do I Have Multiple Sclerosis (MS)?

Multiple Sclerosis (MS) Is A Disease Process Where The Body's Immune System Attacks Multiple Areas In Multiple Episodes. An Episode Of Optic Neuritis May Be The First Indication Of Multiple Sclerosis. With A Single Episode, Without Other Evidence Of Involvement, We Usually Cannot Make The Diagnosis At That Time. An MRI Scan May Be Helpful In Dividing Those Patients Into High And Low Risks. Finding Evidence Of Other Areas Of Inflammation On MRI Scanning Suggests You May Be At Higher Risk For Recurrent Episodes And Thus MS.

 

 

What Is A Pituitary Tumor?

Pituitary Tumors Are Benign (non-cancerous) Overgrowth Of Cells That Make Up The Pituitary Gland (the Master Gland That Regulates Other Glands In The Body). Tumors That Grow Large Enough To Produce Symptoms Are Less Common But Still Are One Of The Most Common Tumors Occurring Within The Head. These Tumors May Often Be Present For Years Without Diagnosis Or Even Symptoms.

 

The Optic Nerves Coming From Each Eye Meet Just Above The Pituitary Gland In The Optic Chiasm. An Abnormal Growth Of Cells Within The Pituitary Gland May Produce An Excess Of Signal To The Other Endocrine Glands Leading To Overproduction Of Thyroid, Cortisone, Or Sex Hormones. If The Pituitary Tumor Extends Out Of The Sella It May Produce Symptoms Due To Compression Of Surrounding Structures Including The Optic Nerves, Chiasm, And Cranial Nerves In The Cavernous Sinus (controlling Eye Movement And Facial Sensation).

 

How Would I Know If I Have A Pituitary Tumor?

Patients With Pituitary Tumors Often Have No Symptoms At All. Occasionally These Tumors May Produce Headaches. Head Pain May Be Sudden And Severe If There Is A Bleed Into The Tumor. Endocrine Symptoms Are Most Common Including Alterations In Menstruation, Lactation (milk From The Breast), Impotence, Or Loss Of Sex Drive. Less Commonly, Tumors May Produce Growth Hormone Causing Gigantism In Young Patients Or Enlargement Of Hands, Feet, And Facial Features (acromegaly) In Older Patients. The Most Common Of These Symptoms Is Due To Compression Of The Optic Nerves Or Chiasm. Patients With Involvement Of One Optic Nerve May Notice Dim, Dark, Or Blurred Vision. If The Chiasm Is Affected, Vision Will Be Lost Off To The Outside In Both Eyes.

 

How Is A Pituitary Tumor Detected?

Pituitary Tumors Are Usually Suspected Based On Endocrine Changes But Are Confirmed With Imaging Studies. A CT Scan Can Reveal A Pituitary Tumor And May Be Especially Sensitive To Hemorrhage. MRI Scanning May Be More Sensitive And Better Define The Relationship Of The Tumor To The Optic Nerves And Surrounding Structures. Blood Studies To Check Pituitary Function Are Essential. Other Lesions Around The Sella And Pituitary May Produce Similar Symptoms And May Be Confused With A Pituitary Tumor. These Include Meningiomas, Craniopharyngiomas, Germ Cell Tumors, And Aneurysms.

 

How Is A Pituitary Tumor Treated?

When The Patient Is Symptomatic, Some Form Of Treatment Is Usually Indicated. The Most Common Approach Is Surgery Usually Performed Through The Nose (or Up Under The Lip). Occasionally (especially When The Tumor Is Larger Or Extending To The Side) A Surgical Approach May Be Best Through A Scalp Incision. With Large Tumors, Some Tumor Cells Are Almost Always Left Behind Following Surgery. Additional Treatment May Be Needed. This May Include Repeat Surgery Or Radiation Therapy. It Is Very Important That Hormone Levels Be Checked Periodically And Replaced As Necessary. It Is Also Important To Follow Vision, Visual Fields, And Imaging Studies (MRI Scan) To Make Sure That There Is No Re-growth Of The Tumor. These Should Probably Be Checked At Least Once Every One To Two Years.

 

Will My Vision Get Better?

In Patients With Visual Loss Due To Compression Of The Optic Nerve Or Chiasm By A Pituitary Tumor The Chance Of Visual Improvement Is Best Predicted By The Duration Of The Damage. The Presence Of Changes In The Back Of The Eye (optic Atrophy) May Suggest Long Duration. Surgery Also Can Result In Rapid Relief Of Compression

 

What Is Papilledema?

This Is A Condition In Which High Pressure Inside Your Head Can Cause Problems With Vision And Headache. In Papilledema Cerebrospinal Fluid Outflow Is Blocked. The Pressure Is Transmitted To The Back Of The Eye Via The Optic Nerve Sheath (surrounding Each Of The Optic Nerves) Producing The Swelling Seen At The Disc (papilledema).

 

How Will I Know If I Have Papilledema?

The Most Common Symptoms Of High Intracranial Pressure Are Headache And Visual Loss. The Headache May Be Located Anywhere; Frequently In The Back Of The Neck. It Is Usually Steady But May Be Pounding. It May Be Very Severe, And Unlike Migraine, It May Awaken The Patient In The Middle Of The Night. It Also May Worsen With Bending Or Stooping. The Optic Nerve Swelling May Eventually Lead To Loss Of Vision Seen As Dimming, Blurring Or Graying Of Vision. Patients May Be Aware Of Difficulty Seeing To The Side. Frequently Patients Notice Visual Disturbance Lasting For A Few Seconds (often Associated With Bending Or Stooping). High Pressure May Cause Damage To The Nerves That Move The Eyes Resulting In Double Vision. Patients May Also Be Aware Of A Rushing Noise In Their Ears. Nausea And Vomiting May Occur If The Pressure Is High And Especially With A Severe Headache. Peripheral Vision (detected On Visual Field Testing) Is Usually Abnormal And Is One Of The Most Important Means Of Judging Both The Necessity For And Effectiveness Of Treatment.

 

How Is The Cause For Papilledema Detected?

The Patient Requires A MRI Scan. The Diagnosis Also Requires A Spinal Tap. This Will Document Elevated Pressure Inside Your Head And Make Sure There Are No Other Abnormalities In The CSF. The Finding Of Abnormal Cells, Inflammatory Cells, Or Elevated Protein May Indicate A Previous Infectious, Inflammatory, Or Tumor Related Cause Of Elevated Intracranial Pressure. In Rare Cases, An Angiogram, Where A Catheter Is Placed In The Arteries And Veins Going To The Head, May Be Necessary To Exclude An Abnormality Of The Blood Vessels. To Determine Whether There Is Further Damage To The Optic Nerve Acuity And Visual Field Testing Is Necessary.

 

How Is Papilledema Treated?

Reduction In CSF Production Or Increase In Its Outflow May Reduce Intracranial Pressure. Weight Reduction Programs (in Overweight Patients) May Be Effective. Continuous Drainage May Be Surgically Accomplished By Placing A Catheter Between The Spinal Canal And The Abdomen (lumbo-peritoneal Shunt). In Patients With Worsening Visual Fields Or Decrease In Central Acuity, Who Do Not Have Severe Headaches, An Optic Nerve Sheath Fenestration May Protect The Optic Nerve From Further Damage. A Small Hole Or Multiple Slits Are Placed In The Optic Nerve Sheath Just Behind The Eye Using An Operating Microscope. 

 

What Is Thyroid Eye Disease?

This Is An Autoimmune Condition Where Your Body's Immune System Is Producing Factors That Stimulate Enlargement Of The Muscles That Move The Eye. This Can Result In Bulging Of The Eyes, Retraction Of The Lids, Double Vision, Decreased Vision, And Ocular Irritation. This Is Often Associated With Abnormalities In Thyroid Gland Function (either Too Much Thyroid (Graves' Disease) Or Too Little). The Eye Findings Of Thyroid Orbitopathy May Be Independent Of Treatment Of Your Thyroid Abnormalities And May Not Resolve In Spite Of The Fact That The Thyroid Is Now "controlled." These Symptoms May Be Present Even If Your Thyroid Has No Apparent Problems.

 

How Will I Know If I Have Thyroid Eye Disease?

With Muscle Enlargement The Globe (eyeball) Is Pushed Forward Leading To The Characteristic "stare." In Addition, The Muscles Become Stiff And The Upper Lid Tends To Retract, Pulling Away From The Colored Portion Of The Eye. The Eyes May Become Red Due To Difficulty Closing As Well As Increased Prominence Of The Blood Vessels. This Often Results In Double Vision With One Image Seen On Top Of The Other. If The Muscles Get Large Enough, They May Press On The Optic Nerve Causing Damage To The Nerve.

 

This Dysfunction Within The Optic Nerve, Which Transmits Information From The Eye To The Brain, Results In Decreased Vision. This, Fortunately, Occurs Only In About 5% Of The Patients With Thyroid Orbitopathy And May Be Reversible If The Pressure On The Optic Nerve Is Relieved.

 

What Tests Are Done To Detect Thyroid Eye Disease?

This Is Detected By Carefully Checking Vision, Pupillary Reactivity, Visual Fields, And The Appearance Of The Optic Nerve Head. Most Frequently This Makes The Thyroid Gland Over Produce Thyroid Hormone That In Turn Can Lead To Tremors, Shakes, Weight Loss, Rapid Heart Beat Or Palpitations, Nervousness, And Sensitivity To Heat. Less Commonly The Attack On The Thyroid Gland Leads To Low Thyroid Production Or Even Normal Thyroid Levels. We May See Antibodies In Your Blood That Can Be Identified As Attacking Thyroid Tissue.

 

What Is The Prognosis Of Thyroid Eye Disease?

Thyroid Orbitopathy, Like Other Autoimmune Diseases, Often Comes And Goes On Its Own. There Is Frequently Only One Acute Inflammatory Episode But Unfortunately The Effects May Persist For Years Or Even Permanently. Although There May Be Some Reduction Of The Prominence Of The Globe, Eye Movements Will Often Not Return To Normal. Lid Position Will Also Likely Remain Elevated, Possibly With Persistent Problems With Closure.

 

What Is The Treatment For Thyroid Eye Disease?

In Patients With Mild Involvement, Irritation And Foreign Body Sensation May Improve With Artificial Tears And The Use Of Lubricating Ointment At Night. If The Lids Are Not Closing Completely, They May Be Taped Closed At Night. With More Severe Corneal Problems, Lid Surgery To Help Partially Close The Lids Or To Raise The Lower Lids May Be Necessary. In Severe Retraction Of The Upper Or Lower Lid, Surgery To Reduce The Effects Of The Lid Retractors, Either Without Or With Spacer Placement (such As A Piece Of Tissue Removed From The Roof Of The Mouth) Can Help The Lids To Close. Smoking May Worsen Symptoms And Should Be Discontinued.

 

There Is No Medicine That Improves The Ability Of Muscles To Move (and Thus Relieves Double Vision). Covering One Eye Immediately Relieves Double Vision. It May Be Possible To Optically Realign Eyes With The Use Of Prisms Either Applied To Glasses Or Ground Into The Lens Although This May Not Be Effective Until Things Stabilize. When Double Vision Cannot Be Corrected With Prisms, Eye Muscle Surgery May Be Necessary. Often Multiple Muscle Operations Are Necessary. It Is Sometimes Not Possible To Completely Remove Double Vision, But The Goal Is To Remove Double Vision Looking Straight Ahead And In Reading Position, As These Are The Most Important Directions Of Sight.

 

Fortunately, Optic Nerve Problems Resulting In Decreased Vision Are Uncommon. When It Occurs, Treatment Is Aimed At Shrinking The Muscles, Usually By The Use Of High Dose Steroids (prednisone). For Those Patients Who Will Not Tolerate Steroids Radiation Therapy May Be Of Benefit. If The Muscles Cannot Be Made Small Enough To Relieve The Compression Of The Optic Nerve (resulting In Decreased Visual Acuity) Then The Orbit Can Be Made Larger. This Is Usually Done Surgically By Removing One Or More Of The Bony Walls Of The Orbit. Since The Optic Nerve Is Usually Compressed At The Very Back Of The Orbit, Removing The Posterior Medial Wall Of The Orbit Is Most Critical. This May Be Done Directly (through The Soft Tissues Or Skin Around The Eye), Through The Sinus Under The Eye, Or Through The Nose. To Further Reduce The Eye Bulge The Floor, Lateral Wall, Or Even The Roof Of The Orbit May Be Removed. One Of The Problems With Surgical Decompression Is That This Often Affects Eye Movements, Thus Changing The Pattern Of Double Vision (if It Already Exists) Or Potentially Producing Double Vision In Those Patients Who Don't Have It Before Surgery.

 

The Steroids Made My Eyes Much More Comfortable. Can't I Just Continue Taking Them?

Steroid Therapy May Be Effective In Halting The Inflammatory Phase Of Thyroid Orbitopathy And Partially Shrinking The Muscle Swelling. Steroid Side Effects Are Very Common With Continued Treatment. If There Are Still Problems With Eye Movements (double Vision), Exposure Problems (irritation And Foreign Body Sensation), Or Decreased Vision Then Surgery Should Be Considered.


The Orbit & Oculoplasty Subspecialty Is A Distinct Subspecialty In Ophthalmology, Which Deals With The Various Diseases Of The Eyelids And Orbits (sockets). .

 

Learn About Various Diseases Of The Eyelids And Orbits

 

Anatomy Of The Eyelids And Orbit

Before Some Of The Common Problems Are Discussed, It Is Important To Understand The Anatomy Of The Structures Around The Eyeball. The Delicate Structure Of The Eyeball Is Protected, Against Injury, On The Sides And In Front By Bony Walls Of The Orbit And Eyelids Respectively.


The Orbit Is The Bony Cage Or The Socket In The Skull, Which Houses The Eye. In Front Of The Eye, The Eyelids Open And Close By Reflex Or Voluntary Action To Distribute Tear Fluid So As To Keep The Cornea (the Front Surface Of The Eye) Moist, To Shut Out Light, And To Protect The Eyes From Foreign Bodies And Exposure. The Outer Surface Of The Lids Is A Layer Of Skin Continuous With The Skin Of Forehead Above And That Of The Cheeks Below. The Outer Layer Of The Lids Contain Muscles That Elevate And Lower The Lids, A Firm Tissue Plate, Or Tarsus, That Maintains Their Shape, And Eyelashes That Prevent Perspiration Or Small Foreign Bodies From Entering The Eye And Damaging The Transparent Sensitive Surface Of The Cornea. The Inner Surface Of The Lids Is Lined By A Mucous Membrane Called The Conjunctiva; This Is Continuous With The Conjunctiva Covering The White Of The Eyeball. The Conjunctiva Has A Rich Supply Of Blood Vessels, Which Accounts For The Bloodshot Appearance Of The Eye After Irritation. It Also Contains Lubricating Glands That Permit The Lids To Move Easily And The Eye To Rotate Smoothly. Behind The Upper Eyelids Are Present The Main Tear-producing Glands (the Lacrimal Glands).

 

The Orbit Contains, Apart From The Eyeball, Nerves, Blood Vessels, Fat, Eye-muscles (to Move The Eyes Freely And Harmoniously In Both Directions), And The Optic Nerve, Which Transmits Visual Sensation From The Eye To The Brain. The Orbit Also Forms The Wall To The Adjacent Sinuses, Which Are Air Spaces In The Skull Lined By The Same Kind Of Membrane As The Nose. Canals Connecting The Eyelids To The Sinuses (Lacrimal System) Allow Secretions And Tears To Drain Through The Nose. Some Of The Problems Frequently Encountered By An Oculoplastic Surgeon Include:

 

Ptosis

'Drooping' Of The Eyelid Can Be Present From Birth Or Develop Later In Old Age. It Is A Cosmetic Blemish But If Severe, It Restricts Vision As Well. The Treatment In Majority Of Cases Consists Of Surgical Correction. Surgery Involves Either Strengthening The Muscle, Which Elevates The Lid, Called LPS Resection, Or Lifting Up The Lid With The Help Of A Graft. This Graft Can Be Taken From The Patient's Thigh Area Or Can Be An Artificial Sling Material. This Procedure Is Known As 'Frontalis Sling'.
When Ptosis Occurs In Adults, It May Be The Result Of A Systemic Disease, Such As Myasthenia Gravis, Which Can Be Treated Medically. It Can Also Follow Muscle Or Nerve Damage In Other Parts Of The Body, Or Tumors Of The Lid. When Ptosis Occurs Suddenly In One Eye, Disease Of The Brain Itself Must Be Considered, And The Patient Should Be Seen At Once By A Neurologist

 

Lid Margin Abnormalities - Trichiasis

Trichiasis Is A Condition In Which There Is Misdirection Of Eyelashes. If The Eyelashes Turn In Toward The Eyeball And Scratch The Cornea, They Produce A Sensation Like A Foreign Body. This Condition May Result From Trachoma (an Eye Infection), Burns Or Injuries To The Lids. Removal Of The Offending Lashes Or Corrective Plastic Surgery On The Lid Relieves The Symptoms.

 

Lid Margin Abnormalities - Entropion

In A Condition Known As Entropion There Is Inward Turning Of The Eyelids, Causing The Eyelashes To Scratch The Cornea And Produce Irritation. Tearing And Secondary Infection As Well As An Unpleasant Looking Eye Cause The Patient To Seek Medical Care. Entropion May Be The Result Of Spasm Or Secondary Contracture Or Strictures From Burns, Injury Or Trachoma Infection. It May Involve The Upper Or Lower Lids. An Adhesive Tape Applied To The Skin Of The Lid Temporarily May Straighten The Lid And Relive The Annoying Symptoms. Corrective Surgery Is Usually Required For A Permanent Cure.

 

Lid Margin Abnormalities - Ectropion

Ectropion Is The Opposite Condition, And The Lower Lid Usually Turns Away From The Eyeball. Ectropion May Be Due To Laxity Of The Tissue In Elderly People Or To Paralysis Of The Seventh Cranial Nerve (the Nerve Which Controls The Facial Expressions), Which Causes The Weakness Of The Muscles Of The Lid. It May Also Follow Cuts, Infections, Or Burns Of The Lids And Face That Heal Poorly; The Resultant Scar Tissue Forms Adhesions That Cause The Lids To Turn Out. Besides Being Cosmetically Unpleasant, Ectropion Is Accompanied By Troublesome Tearing And Infection. Treatment Is Surgical Rotation Of The Lid Margin And Its Alignment With The Eyeball.

 

Lacrimal Passage Diseases

Normally Tears From The Eye Drain To The Nose Through The Lacrimal Passage. In Case Of Any Blockade In This Passage, Watering Results. The Causes Can Be Incomplete Development, Seen In Young Children, Or Infection, Which Occurs In Adult Life. Treatment Varies From Performing A Relatively Simple Procedure Like 'probing' The Pathway To Open It, To More Complex Surgery Of Fashioning An Alternative Pathway To Drain The Tears To Nasal Cavity. This Procedure Is Known As Dacryocystorhinostomy (DCR).

 

Lid Injury

Apart From Being Cosmetically Unacceptable, Any Irregularity Of The Lid Margin Is Functionally Detrimental To The Eye, As Lid Defects May Fail To Cover The Cornea Fully And Provide Adequate Lubrication. An Oculoplastic Surgeon Repairs The Injury In A Way To Make The Lid As Close To Normal As Possible

 

Lid Tumors

A Suspicious Lid Mass Needs Excision, Examination Under Microscope And Reconstruction Of The Resultant Lid Defect. Histopathological Examination Determines Whether The Lesion Is Cancerous Or Not, And The Chances Of Its Recurrence. Reconstruction In The Form Of Suturing, Tissue Flaps From Neighboring Areas & Other Lid, And Grafts Preserve The Lid Function.

 

Orbital Diseases

Orbital Diseases Involve The Tissues Lying In The Bony Socket. Generally The Eyeball Protrudes From Its Socket, Producing A Widening Of The Eyelids. Sometimes The Patient Does Not Blink Frequently, Developing A Staring Gaze. This May Be The Result Of An Endocrine Disorder (thyroid Disease), Inflammation In The Orbit Or A Tumor. Generally These Lesions Require Investigations Including CT Scan And MRI. Treatment Varies From Case To Case And May Involve Medical Treatment, Surgery, Radiotherapy, Chemotherapy Or A Combination Of These

 

Socket Surgery

Any Painful Blind Eye Needs Removal. The Deep 'socket' Left Behind Is Not Ideal For Artificial Eye Fitting. Therefore, At The Time Of Eye Removal, An Implant Is Placed In The Orbit, Which Occupies The Space Taken By The Normal Eyeball. This Reduces The Hollowness Of The Socket Seen With The Artificial Eyes Placed Without An Implant. In Some People, The Artificial Eye Fit Changes With Passage Of Time. Socket Surgery Aims At Giving The Best Possible 'bed' For Artificial Eye Fitting, With Or Without An Orbital Implant. The Above-mentioned List Of Disorders Is By No Means Exhaustive. Lack Of Space Prevents Description Of All Conditions Seen By An Oculoplastic Surgeon. Do Not Hesitate To Contact Your Eye Specialist For Further Information


SOME FREQUENTLY ASKED QUESTIONS

 

What Are The Common Eye Problems Seen In Pediatric Age Group?

Children Can Have Variety Of Eye Problems. Some Of The Relatively Common Disorders Are Refractive Errors, Redness Of Eyes (conjunctivits - Infective Or Allergic), Watering Of Eyes, Strabismus (deviation Of Eyes), Amblyopia (lazy Eyes), Lid Abnormalities (ptosis), Congenital Cataracts, Congenital Glaucoma, Developmental Abnormalities Of The Eyes (microphthalmos), Vitreous Hemorrhage, Retinopathy Of Prematurity, Persistent Fetal Vasculature Syndrome (PHPV), Chorioretinal Coloboma, Tumors (retinoblastoma) , Foveal Hypoplasia And Optic Disc Abnormalities (coloboma, Hypoplasia, Optic Atrophy, Swollen Optic Discs). Shreya Eye Centre Is Fully Equipped In Managing These Ocular Disorders.

 

How Early Does My Child Need An Eye Check Up?

Some Common Indirect Pointers To The Presence Of Vision Problems In Children Are Repeated Watering Of Eyes, Squeezing Of Eyes, Frequent Rubbing Of Eyes, Habit Of Keeping Visual Targets At Close Distance, Headaches, Adoption Of Abnormal Head Postures. In Very Young Children, Gross Discrepancy Of Vision Between The Two Eyes Can Be Tested By Covering One Eye At A Time, In A Subtle Manner. Observation Of Delayed Visual Milestones Should Prompt An Early Eye Check Up. Presence Of Deviation Of Eyes, Nystagmus (to And Fro Movements Of The Eyes), Abnormal Head Postures, Roving Eye Movements Are Often Associated With Amblyopia.

 

These Conditions Require An Urgent Consult. In The Absence Of Any Of The Above Problems, We Still Recommend That Every Child Should Have A Routine Eye Check Up At Around 3 Years Of Age. Vision Screening Should Be Made Mandatory At The Time Of School Admission. It Should Be Followed By Annual Routine Check Ups.

 

What Are The Common Causes Of Red Eye In Children?

Red Eye," Or Conjunctivitis, Is A Non-specific Finding That Simply Indicates Conjunctival Inflammation. The Vast Majority Of Children Who Present With "pink Eye" Will Have A Simple Conjunctivitis. Other Causes Of A "red, Teary Eye" In A Newborn Include Congenital Glaucoma And Nasolacrimal Duct Obstruction. The Most Common Causes For Pediatric Pink Eye Are Allergic Conjunctivitis, Bacterial Conjunctivitis, Viral Conjunctivitis, And Blepharitis (inflammation Of Lid Margins).

 

What Is A Chalazion?

Obstruction Of The Meibomian Gland Openings In The Eyelids May Result In An Acute Infection, But More Commonly Produces A Chalazion. A Chalazion Appears As A Lump Near The Eyelid Margin, Either On The Upper Or Lower Lid. Chalazia May Resolve Spontaneously Over Several Weeks; However, Applying Hot Fomentation Over The Closed Lid Helps The Drainage Of Lipid Material. Topical And Systemic Medication May Be Required To Decrease The Inflammation Around The Lump. If It Does Not Resolve, Incision And Drainage May Be Necessary.

 

What Is Normal Binocular Vision?

Normally, Both Eyes Are Aligned On The Same Visual Target And The Images From Each Eye Are Merged In The Brain To Form A Single Three-dimensional Image, Or Binocular Vision. The Brain's Process Of Merging Or "fusing" Images From Each Eye Into One Image Is Called Binocular Fusion. The Perception Of Three-dimensional Depth Is Called Stereoscopic Vision. Binocular Vision Develops During Early Infancy, And Proper Alignment During This Time Is Necessary For Normal Binocular Development To Occur.

 

What Is Strabismus (Deviation Of Eyes)?

Misalignment Of Eyes Is Called Strabismus And Can Lead To Disruption Of The Visual Development Process. Not All Strabismus Occurs At Birth. It Can Be Acquired Throughout A Person's Life For A Variety Of Reasons. A Problem Affecting Any Of The Six Extra Ocular Muscles In Either Eye Will Cause Misalignment And Hence Can Cause Some Disruption In Binocular Vision. Depending On The Cause For The Disruption And The Severity Of The Problem, Visual Symptoms Will Vary.

 

What Are The Common Types Of Strabismus And Their Management Options?

The Two Most Common Types Of Strabismus Are Esotropia, Where An Eye Turns In And Exotropia, Where An Eye Turns Out. Infants Developing Esotropia Within The First Six Months Of Life (Congenital Or Infantile Esotropia) Usually Have A Large Inward Turn, Which Is Easily Noticed. The Chances Of Developing Normal Binocular Vision With Normal Depth Perception Are Not Good And The Child May Not Develop Full Vision In The Weaker Eye. However, The Best Chance Is With Early Surgery (before 18 Months Of Age). Both The Parent And Surgeon Have To Be Committed To Multiple Procedures To Obtain Perfect Alignment. Another Common Form Of Esotropia That Occurs In Children Usually After Age Two Is Caused By A Need For Glasses (accommodative Esotropia). These Children Are Farsighted (hypermetropia Or Plus Power In Spectacles). They Have The Ability To Focus Their Eyes Enough To Adjust For The Farsightedness, Which Allows Them To See Well For Both Distance And Near. Some Children Excessively Strain Their Eyes When They Focus, Which Causes One Eye To Turn In. Wearing Glasses Equal In Strength To Their Farsightedness Reduces The Need To Focus And Straightens Their Eyes. Sometimes The Addition Of Bifocals Is Necessary To Further Reduce The Need To Focus When Looking At Objects Up Close.

Exotropia Or An Outward Turning Of An Eye Is Another Common Type Of Strabismus. Often The Exotropia Will Occur Intermittently, Particularly When The Child Is Daydreaming, Ill, Or Tired Or Focusing At Distant Objects. Although Glasses And Prism Therapy May Reduce The Amount Of Outward Turning In Some Patients, Surgery Is Usually Needed. Rarely, Special Eye Exercises (orthoptics) Are Necessary To Help Older Children Control The Eye Misalignment.

 

 

How Is Strabismus Surgery Done, And What Are The Risks Involved?

The Aim Of Strabismus Surgery Is To Adjust The Muscle Tension On One Or Both Eyes In Order To Pull The Eyes Straight. For Example, In Surgery For Esotropia, The Tight Inner Muscles Are Placed Further Backward Which Weakens Their Pull And Allows The Eyes To Move Outward. Sometimes The Outer Muscles May Be Tightened By Shortening The Muscle Length, Which Further Pulls The Eye Outward.

 

Strabismus Surgery Is Usually A Safe And Effective Treatment, But Is Not A Substitute For Glasses Or Amblyopia Therapy. During Surgery, The Eyeball Is Never Removed From The Socket. A Small Incision Is Made Within The Tissues Covering The Eye To Allow Access To The Eye Muscles. Selection Of Eye Muscles To Be Operated Upon Depends Upon The Direction The Eye Is Turning. One Or Both Eyes May Be Operated Upon. Despite A Thorough Clinical Evaluation And Good Surgical Technique, The Eyes May Be Closely Aligned After Surgery, But Not Perfect. In These Cases, Fine Adjustment Is Dependent Upon The Coordination Between The Eye And The Brain. Sometimes Patients May Require The Use Of Prisms Or Glasses Following Eye Muscle Surgery. Over-corrections Or Under-corrections Can Occur And Further Surgery May Be Needed.

 

General Anesthesia Is Required In Children. Some Adults May Prefer Local Anesthesia. Recovery Time Is Rapid And The Patient Is Usually Able To Return To Normal Activity Within A Few Days (2-3 Weeks). As With Any Surgery, Eye Muscle Surgery Has Certain Risks. There Is A Small Risk Of Infection, Bleeding, Excessive Scarring, And Other Rare Complications, Which Can Lead To Loss Of Vision.

 

What Is Pseudo-strabismus?

Pseudo-strabismus Is A Common Condition That Needs To Be Distinguished From Deviation Of Eyes (true Strabismus). With Pseudo-esotropia, The Infant Usually Has A Wide Nasal Bridge And Wide, Prominent Lid Folds, Giving The Appearance Of Eyes Crossing. But, In Fact, The Eyes Are Straight. When The Child Looks To Either Side, The Eye Hides Behind The Eyelid Folds Or Wide Bridge And Looks Like They Are Crossing. It Is Important To Document Proper Eye Alignment In These Cases By An Orthoptic Examination.

 

Comprehensive Ocular Examination And Follow-up Is Important In Patients Diagnosed With Pseudo-strabismus, As A Small Percentage Of These Patients Will Develop A True Esotropia

 

What Are The Latest Advances In Intraocular Lens (IOL) Technology?

Advances In IOL Technology Have Made Available Various State-of-the-art IOLs. These New Lens Designs Include 1) Blue-light Blocking IOLs That Filter Out Harmful Ultraviolet Radiation As Well As Blue Light, 2) Aberration-free IOLs Which Greatly Improves Image Quality By Enhancing Contrast, Eliminating Glare And Haloes, And Improving Night Vision, And 3) The Newer Multifocal IOLs Which Provides Good Unaided Distance And Near Vision With Less Dependence On Glasses. 4) Toric IOLs Are Also Available For The Correction Of High Cylindrical Spectacle Numbers. Depending On The Patients' Personal Visual Needs, The Surgeon Decides The Most Appropriate Lens To Implant In The Eye.

 

What Is Amblyopia (Lazy Eyes) And What Are Its Important Causes?

Amblyopia Or 'Lazy Eyes' Is Simply Defined As Binocular Or Uniocular Decrease In Best Corrected Vision (even After Spectacle Correction), For Which No Apparent Organic Cause Is Found On Eye Examination. It Is Commonly Caused From Conditions That Produce Blurred Image On The Retina (e.g. Media Opacities Like Congenital Cataract, Which Obstruct The Light From Entering The Eye; High Refractive Errors) Or Abnormal Binocular Coordination Of The Two Eyes (deviation Of Eyes) Or Combination Of Both (unequal Refractive Errors Between The Two Eyes, Astigmatic Refractive Errors).Amblyopia Occurs During The Critical Or Sensitive Period Of Development And Maturation Of The Visual System, Which Is Estimated To Be 0-8 Years In Children. It Has To Be Remembered That The Patient Has To Undergo A Complete Ocular Examination To Rule Out Any Organic Cause Of Loss Of Vision Before The Diagnosis Of Lazy Eyes Is Established

 

How Amblyopia Is Commonly Diagnosed?

Subnormal Best Corrected Vision (even After Spectacle Correction) Points Towards The Possibility Of Amblyopia. Vision Can Be Tested In Children By Many Innovative Picture/letter Acuity/symbol Charts. It Can Be Done In A Child As Young As 2-3 Year Old. In A Very Young Child, The Ability Of An Eye To Take Up And Maintain Fixation Is An Indirect Sign Of The Presence Or Absence Of Amblyopia. In Children With Eye Deviation, Strong Fixation Preference Of One Eye Indicates Amblyopia.

 

What Are The Management Options For Amblyopia?

Amblyopia Is Treatable In Appropriate Cases. Early Treatment Of Amblyopia Is Critical For Best Results. The First Step Is To Clear The Retinal Image By Giving Appropriate Glasses Or By Removal Of Media Opacities Like Cataract Or Corneal Opacities. The Second Step Is To Correct Ocular Dominance, If Present, By Forcing Fixation To The Weaker Eye And Thereby Stimulating It. This Is Achieved Either By Covering (patching) The Good Eye Or By Blurring The Image In The Good Eye (by Some Drugs Or By Altering The Spectacle Number).Once Ambylopia Is Diagnosed, It Has To Be Managed By Strict Vigilance And Monitoring Of Therapy.

 

How Is Cataract Managed In Children And What Is Its Visual Prognosis?

Pediatric Cataracts Can Occur In One Eye (unilateral) Or Both Eyes (bilateral). They Can Be Complete Or Partial And Can Be Present At Birth Or Occur Sometime After Birth. Cataracts Can Be Partial At Birth And Later Progress To Become Visually Significant. In Contrast To Adults, Cataracts In Children Present A Special Challenge, Since Early Visual Rehabilitation Is Critical To Prevent Irreversible Amblyopia (lazy Eyes). The Earlier The Onset, And The Longer The Duration Of The Cataract, The Worse The Prognosis. With New Techniques And Material In The Treatment Of Congenital Cataracts And Improved Surgical And Clinical Management, Visual Prognosis Has Improved. Now Ophthalmologists Operate As Early As The First Week Of Life And Visually Rehabilitate The Child With Either Glasses Or Contact Lenses.

 

Children Born With Cataracts Are Also At Risk For Developing Glaucoma, Strabismus, Nystagmus, And Poor Stereopsis, Further Complicating Successful Outcomes. In Most Cases, It Is The Willpower And Resolve Of The Parents Or Caregivers To Follow Post-operative Management That Determines Visual Success For The Child. Patients With Acquired Progressive Cataracts Have Less Amblyopia And A Much Better Visual Prognosis Than Patients With Cataracts That Cover The Visual Axis Since Birth.

 

Unilateral Infantile Cataracts Are Rarely Caused By A Systemic Disease, Except In Some Cases Of Intrauterine Infections Such As Rubella. Generally, Monocular Congenital Cataracts Have A Relatively Good Prognosis If Surgery And Optical Correction Is Provided By Two Months Of Age. Beyond This Age, There Is A Possibility Of Having Dense Amblyopia In The Operated Eye.


Bilateral Cataracts Are Often Inherited. The Work-up For Bilateral Congenital Or Infantile Cataracts Should Include A Careful Pediatric Examination And Special Tests. Dense Bilateral Congenital Cataracts Require Urgent Surgery And Visual Rehabilitation. In General, Bilateral Cataracts Operated Prior To Two Months Of Age Have A Good Visual Prognosis With Approximately 80% Achieving Vision Of 20/50 Or Better.

 

Cataract Surgery In Children Is Done Under General Anesthesia. It Involves Removal Of The Cataractous (opaque) Crystalline Lens. This Is Often Accompanied By Surgical Measures (primary Posterior Capsulorrhexis /anterior Vitrectomy) To Ensure The Clarity Of The Central Visual Axis In The Postoperative Period, Which Can Otherwise Get Obscured By The 'after Cataract' (collection Of Inflammatory Cells And Fibrous Tissue) Formation. We Currently Consider IOL Implantation In Patients Who Are One Year Or Older, And IOL Implantation Is The Procedure Of Choice In Children 2 Years And Older. The Use Of Aphakic Glasses Or Contact Lenses Continues To Be The Treatment Of Choice For Congenital Cataracts In Neonates, While An IOL Is Preferred For Children Over One Year Of Age. Postoperatively, The Child Will Still Require Glasses After The IOL Implantation. The Child May Require Occlusion Therapy For The Management Of Amblyopia.

 

What Is The Common Cause Of Watering Of Eyes In Infancy And How Is It Managed?

Infants With A Nasolacrimal Duct Obstruction Present With A Watery Eye And An Increased Tear Lake, Mattering Of The Eyelashes, And Mucus In The Nasal Corner Of The Eyelids. This Is Due To Improper Canalization Of The Nasolacrimal Duct Pathway (which Drains Tears From The Eyes To The Nose). Congenital Nasolacrimal Duct Obstruction Is Common And Occurs In 1 To 5% Of The Population, With Approximately 1/3 Occurring In Both Eyes. Medical Management During The Observational Period (initial Six Months Of Age) Is A Combination Of Nasolacrimal Sac Massage And Intermittent Topical Antibiotics. In Case The Lacrimal Massage Fails To Open The Obstruction, Syringing And Probing Is Done. Under Sedation Or General Anesthesia, A Small Steel Wire Is Passed Through The Punctum Into The Nasolacrimal System, And Down Out Into The Nasal Cavity. This Does Not Hurt, Nor Does It Create Any Problem In The Nose. The Success Rate For A Single Nasolacrimal Duct Probing Is Approximately 90%. It Might Need Repeat Sittings To Relieve The Nasolacrimal Obstruction. In Cases Where Nasolacrimal Duct Probing Fails, Intubation With Silicone Tubes Is Indicated To Establish A Working System. In Case The Above Procedures Don't Provide Relief, The Child May Require A Dacryocystorhinostomy (DCR) Procedure At Around 3.5 To 4 Years Of Age. This Involves Making An Alternate Bypass Between The Tear Drainage System And The Nasal Cavity


Retinal Detachment And Related Vitreous Problems Affect One Out Of Every 10,000 People Each Year. It Is A Sight Threatening Eye Problem That May Occur At Any Age Although It Usually Occurs In Middle-aged Or Older Individuals. Surgery Is Often Beneficial, And If Done In Time, Can Restore Good Vision.

 

Learn About Retinal Detachment

 

How Does The Normal Eye Work?

The Eye Is Like A Camera In Which Lenses Focus The Picture On A Light Sensitive Film. In The Human Eye, The Transparent Cornea And Lens Focus Images On The Retina, A Thin Light Sensitive Film That Receives Light And Changes It Into Electrical Signals, Which Are Then Transmitted To The Brain By The Optic Nerve. Just In Front Of The Lens Lies The Iris ('coloured Portion Of The Eye') With A Central Opening - The Pupil. This Is Just Like The Shutter Or Diaphragm Aperture Of The Camera And Helps Regulate The Amount Of Light Entering The Eye. The Sclera ('white Of The Eye') Is The Protective Outer Coat Of The Eye. Between The Sclera And The Retina Lies The Choroid, Which Has A Chiefly Nutritive Function. The Space Between The Lens And The Retina Is Filled With A Clear Jelly Called The Vitreous Body.

 

What Is Retinal Detachment?

Retinal Detachment Is The Separation Of The Retina From The Underlying Choroid. This Results In A Profound Loss Of Vision And Requires Major Surgery To Re-attach It.

 

What Causes Retinal Detachment?

Most Retinal Detachments Are Caused By The Presence Of One Or More Tears Or Holes In The Retina. Normal Aging Can Sometimes Cause The Retina To Thin And Develop Holes, But More Often These Are Caused By Shrinkage Of The Vitreous Body (posterior Vitreous Detachment).

 

The Vitreous Is Firmly Attached To The Retina In Several Places Around The Back Wall Of The Eye. As The Vitreous Shrinks With Aging, It May Pull A Piece Of Retina With It, Leaving A Tear Or Hole In The Retina. Fluid From The Vitreous Body Then Passes Through The Retinal Tear Detaching The Retina From Its Normal Position (retinal Detachment).

Posterior Vitreous Detachment (vitreous Separation From The Retina) Is A Natural Process Of Aging And Usually Does Not Lead To Any Damage Of The Retina. It Is However More Common And Occurs Earlier In People Who: -

  • Are Abnormally Nearsighted (high Myopia);
  • Have Undergone Cataract Operations (aphakics);
  • Have Had YAG Laser Surgery Of The Eye;
  • Have Had Inflammation Inside The Eye.

 

It Should Be Noted That There Are Some Retinal Detachments That Are Caused By Other Diseases Of The Eye Such As Tumors, Severe Inflammations, Or Complications Of Diabetes. These So-called Secondary Detachments Do Not Have Tears Or Holes In The Retina And Treatment Of The Disease That Caused The Retinal Detachment Is The Only Treatment That May Allow The Retina To Return To Its Normal Position.

 

How Is A Person To Know Of The Presence Of Retinal Weakness, Holes Or Tears?

In Some Patients The Formation Of A Retinal Tear Is Preceded By Flashes Of Light, Which Are Indicative Of Pull (traction) On The Retina. In Others, The Tear May Break A Small Blood Vessel In Its Path Causing A Small Hemorrhage (bleeding), With Blurring Of Vision And 'floaters'.

 

However In The Majority, Retinal Holes Are Completely Asymptomatic, As They Usually Occur In The Periphery Of The Retina And Not In The Visually Important Central Part. They Therefore Do Not Cause Any Visual Problem At All, Unless They Have Led On To A Retinal Detachment. At This Stage, Profound Loss Of Vision Or Field Occurs.


It Should Also Be Noted That 'floaters' Are Very Commonly Seen By People Who Have No Eye Disease. They Are Seen As Small Specks, Circles, Lines, Clouds Or Cobwebs Moving In One's Field Of Vision. They Are Actually Tiny Clumps Of Gel Or Cells Inside The Vitreous And Cause No Harm.
Routine Examination By Binocular Indirect Ophthalmoscopy By A Person Proficient In This Method Is The Only Way Holes Or Tears May Be Detected Before They Can Cause Retinal Detachment.

 

What Can Be Done About Floaters?

Floaters Can Get In The Way Of Clear Vision, Which May Be Annoying When You Are Trying To Read. You Can Try Moving Your Eyes; Looking Up And Then Looking Down To Move The Floaters Out Of The Way. While Some Floaters May Remain In Your Vision, Many Of Them Will Fade Over Time And Become Less Bothersome. However You Should Visit Your Ophthalmologist If You Suddenly Notice New Floaters Because You Need To Know If Your Retina Is Torn.

 

What Causes Flashing Lights?

When The Vitreous Gel Rubs Or Pulls On The Retina, You May See Flashing Lights Or "lightning Streaks". If You Notice The Sudden Appearance Of Light Flashes, You Should Visit Your Ophthalmologist Immediately To See If Your Retina Has Been Torn.

 

Who Runs A Greater Risk Of Developing Such A Problem?

People More Prone To Developing Retinal Degeneration, Holes And Tears, And Subsequently Retinal Detachment Are Myopes (near Sighted Persons), Aphakics (people Who Have Undergone Cataract Surgery), Those With A Family History Of Retinal Detachment And People With Symptoms Like Light Flashes And Onset Of A Large Number Of Floaters.

 

These Groups Of Patients Must Undergo Regular And Thorough Retinal Examination By Indirect Ophthalmoscopy.

 

How Can Retinal Detachment Be Prevented?

A Careful Examination Of Your Retina By Binocular Indirect Ophthalmoscopy As Mentioned Above Will Be Done. For This Procedure, Your Pupils Will Be Dilated With Eye Drops. During This Painless Examination, Your Ophthalmologist Will Carefully Observe Your Retina And Vitreous And Look For Holes And Weak Areas. At This Stage (i.e. Retinal Detachment Has Not Yet Occurred), They Can Easily Be Closed Or Sealed By Producing Minute Scars In The Retina Around Them, Which "weld" The Retina To The Choroid And Prevent Fluid From Seeping Through The Hole. These Scars Can Be Produced By The Heat Of A Strong Light Source (laser Photocoagulation), Or By Controlled Freezing (cryotherapy). Which Of These Two Modalities Is Chosen, Depends On The Location Of The Hole And The Presence Or Absence Of Cataract And Vitreous Hemorrhage, And The Retinal Surgeon Decides Individually For Each Case After A Thorough Examination. Both Cryotherapy And Photocoagulation Are Usually Carried Out As An Outpatient Procedure. As The Treatment Is From The Surface Of The Eye, No Invasive Surgery Is Involved.

 

Symptoms Of Retinal Detachment

Some Retinal Detachments May Begin Without Noticeable Floaters Or Light Flashes. In Those Instances, Patients May Notice A Wavy Or Watery Quality In Their Overall Vision Or The Appearance Of A Dark Shadow In Some Part Of Their Side Vision. Further Development Of The Retinal Detachment Will Blur Central Vision And Create Significant Loss Of Sight In The Eye Unless The Detachment Is Repaired. A Few Detachments May Occur Suddenly And The Patient May Experience A Total Loss Of Vision In One Eye. Similar Rapid Loss Of Vision May Also Be Caused By Bleeding Into The Vitreous When The Retina Is Torn.

 

Detection & Diagnosis

A Detached Retina Cannot Be Viewed From The Outside Of The Eye. Therefore, If The Above Symptoms Are Noticed, An Ophthalmologist Should Be Visited As Soon As Possible. Again, Binocular Indirect Ophthalmoscopy Through Dilated Pupils Is Essential To Thoroughly Examine The Retina. Other Special Instruments Including Contact Lenses, Slit Lamp And Ultrasound May Also Be Used. 

 

Treating Retinal Detachment:

If The Retina Has Become Detached And The Detachment Is Too Large For Laser Treatment Or Cryotherapy Alone, Surgery Is Necessary To "re-attach" The Retina. Without Some Type Of Retinal Re-attachment Surgery, Vision Will Almost Always Be Lost.

 

Scleral Buckling

The Traditional Surgery For Retinal Detachment Is Scleral Buckling And Is Performed In The Operation Room Under Local Or General Anesthesia. In This Process, After Cryotherapy Is Done To Seal The Retinal Tears, A Piece Of Silicone Plastic Is Sewn Onto The Outside wall Of The Eye (sclera) Over The Site Of The Tear. This Pushes (buckles) The Sclera In Toward The Retinal Tear And Holds The Retina Against The Sclera Until Scarring From The Cryotherapy Seals The Tear. This Procedure Is Usually Combined With Placement Of An Encircling Silicone Band Around The Circumference Of The Eye To Lessen The Pulling Of The Vitreous On The Retina. The Surgeon May Also Drain Fluid From Underneath The Retina And Place A Gas Or Air Bubble Into The Vitreous Cavity. These Buckles And Bands Are Left Permanently And Are Not Visible From Outside. Success Rates For Re-attaching The Retina With Scleral Buckling Are Approximately 90-95%.

 

Pneumo-retinopexy

This Is Another Type Of Surgery For Re-attaching The Retina. Instead Of Placing A Buckle After Cryotherapy, The Surgeon Injects A Gas Bubble Inside The Vitreous Cavity Of The Eye. The Patient Is Instructed To Keep His Or Her Head In A Specific Position So That The Gas Bubble Seals The Retina Tear By Its Surface Tension Effect. Circulation Of Fluid Through The Tear Stops And The Retina Is Re-attached.



Vitrectomy Occasionally, Retinal Detachment Is So Complicated And Severe That It Cannot Be Treated With Either Standard Scleral Buckling Surgery Or Pneumatic Retinopexy. Moreover Scleral-buckling Surgery Fails Approximately 5% To 10% Of The Time Because Excessive Scar Tissue Grows On The Surface Of The Retina. This Scar Tissue Is Very Bad For The Eye. It Pulls On The Retina, Causing It To Re-detach. Retinal Re-detachment Usually Occurs Four To Eight Weeks After The Initial Surgery. The Vitreous Pulls On The Retina, Detaching It From The Back Wall Of The Eye. The Scar Tissue Also Puckers The Retina Into Stiff Folds, Like Wrinkled Aluminum Foil. This Condition Is Called Proliferative Vitreo-retinopathy (PVR).

 

The Only Way To Unfold And Re-attach The Retina Is To Cut Away The Vitreous And Remove The Scar Tissue With Vitrectomy Surgery And Then Re-attach The Retina. The Surgeon Uses A Fibre-optic Light To Illuminate The Inside Of The Eye And A Variety Of Instruments (scissors, Forceps And Laser Probes). The Vitreous Gel Is Removed As Well As Abnormal Scar Tissue, And Replaced With Fluid Or Air. Sometimes The Natural Lens Or A Previously Existing Intraocular Lens (IOL) May Have To Be Removed If The Case Is Complicated. The Holes And Tears Are Sealed With Laser, And Fluid Under The Retina Is Drained. At Times, Vitrectomy Is Combined With Placement Of A Scleral Buckle. Often Air, Gas Or Silicone Oil Is Placed In The Vitreous Cavity To Hold The Retina In Place. If Silicone Oil Has Been Used, It Has To Be Removed At A Later Date As A Separate Surgical Procedure.

 

Removing The Vitreous And Especially The Scar Tissue From The Surface Of The Retina Is A Delicate Process That Requires The Surgeon To Lift And Peel Strands Of Scar Tissue Away From The Retina. The Surgery May Take Many Hours In Severe Cases.


 
If The Retina Is Successfully Re-attached, The Eye Will Recover Some Sight, And Blindness Will Have Been Prevented. However, The Degree Of Vision That Finally Returns Up To Six Months After Successful Surgery Depends Upon A Number Of Factors. Unfortunately, Success In Re-attaching The Retina (anatomic Success) Does Not Always Translate Into Marked Visual Improvement (functional Success). This Is Because Of Permanent Damage To Fine Vision Cells Of The Macula. In General, There Is Less Visual Return When The Retina Has Been Detached For A Long Duration, Or There Is A Fibrous Growth On The Surface Of The Retina. It Should Be Clearly Understood That Often The Purpose Of Surgery For PVR Is To Give The Patient An Eye That Would Have Some Supporting Vision And Could Serve As A "spare Tyre", If The Other Eye Ever Loses Vision Entirely.

 

Vitreous Surgery For Primary Retinal Detachment

Vitreous Surgery Is Now Often Undertaken For Primary Detachments When The Tears Are Very Large Or Placed Very Far Back (posteriorly) On The Retina, When There Is A Macular Hole Causing Detachment, Or If There Is Blood In The Vitreous Blocking A Clear View Of The Retina. Success Rates For These Cases Are Much Better With Vitrectomy Than With Scleral Buckling Alone.

 

What Are The Complications Of Surgery?

Even Though The Surgery For Retinal Detachment Is Generally Successful, Certain Complications Can Occur. They Include Drooping Of The Upper Lid And Double Vision, Which Are Temporary. Serious Complications Include Infection, Bleeding Severe Enough To Interfere With Vision, Glaucoma And Cataract Formation. However, These Complications Are Very Infrequent. Retinal Re-detachment Is The Most Commonly Occurring Problem. If This Occurs, Your Surgeon Will Discuss The Chance That A Re-operation Will Successfully Re-attach The Retina. It Is Important For The Patient To Know That Surgery May Fail Due To Complications, Or Simply Due To The Progressive Nature Of The Retinal Disease.


STRABISMUS - SQUINT OR MISALIGNED EYES

Misalignment Of Eyes Is Called Squint Or Strabismus And Can Lead To Disruption Of The Visual Development Process. This Problem Is Often Detected In Childhood And Should Not Be Neglected. At Shreya Eye Centre, We Have A Dedicated Squint & Orthoptics Service Committed To Provide You With The Best Possible Care To Protect Your Child's Vision.

 

Learn About Squint Or Strabismus

 

What Is Strabismus?

Strabismus Or Squint Is A Misalignment Of The Eyes Where The Two Eyes Are Pointed In Different Directions. Though It Is A Common Condition Which Affects Children, It May Appear Later In Life.

 

Before Attempting To Understand Squint, Its Effects, And How It Is Treated, It Is Important To Understand The Function Of Eye Muscles And Their Role In Maintaining Eye Alignment And Binocular Vision.

 

Eye Muscles

Eye Movements Are Controlled By Eye Muscles, Much Like Reins Control A Horse's Head. There Are Six Eye Muscles Attached To The Outside Of Each Eye, Which Control Its Movement. In Each Eye, Two Muscles Move The Eye To The Right Or Left Side; The Other Four Muscles Move The Eye Up Or Down, And Control Tilting Movements. In Order To Line Up And Focus Both Eyes On A Target, All Eye Muscles Of Each Eye Must Be Balanced And Working Together With The Corresponding Muscles Of The Opposite Eye. When The Eye Muscles Do Not Work Together, Then Misalignment Of The Eyes Or Strabismus Results.

 

Binocular Vision & Depth Perception

The Eyes Are Designed To Focus Images Clearly On The Retina And Then To Relay That Image To The Brain. If Both Eyes Are Lined Up On The Same Target, The Visual Portion Of The Brain Can Fuse The Two Pictures Into A Single 3-dimensional Image. This Creates Binocular Vision And Depth Perception, Which Helps The Eyes Work Together To Transmit One "picture" To The Brain.

 

When One Eye Turns As In Strabismus, Two Different Pictures Are Sent To The Brain. In The Young Child, The Brain Learns To Ignore The Image Of The Misaligned Eye And See Only The Image From The Straight Or Better-seeing Eye. The Image Of The Worse Eye Is Suppressed. This Causes Loss Of Depth Perception. Adults Who Develop Strabismus Usually Have Double Vision Because Their Brain Is Already Trained To Receive Images From Both Eyes And Cannot Ignore The Image From The Weaker Or Turned Eye.

 

What Is Amblyopia ("Lazy Eye")?

Normal Alignment Of Both Eyes During Early Childhood Is Necessary To Allow Good Vision To Develop In Each Eye. Abnormal Alignment As In Strabismus May Cause Reduced Vision Or Amblyopia ("lazy Eye"), Which Is Not Correctable By Glasses Or Contact Lenses. Amblyopia Occurs In Approximately One-half Of Children With Strabismus. The Brain Will Recognize The Image Of The Better-seeing Eye And Ignore The Image Of The Weaker Or Amblyopic Eye. Amblyopia Often Can Be Reversed By Patching The Preferred Or Better-seeing Eye In Order To Strengthen And Improve The Vision Of The Weaker One. If Amblyopia Is Detected Before The First Few Years Of Life, Treatment Is Often Successful. If Adequate Treatment Is Delayed Until Later, Amblyopia Or Reduced Vision Generally Becomes Permanent. As A Rule, The Earlier Amblyopia Is Treated, The Better The Visual Result.

 

Amblyopia (lazy Eye) And Strabismus Are Not The Same Condition. Strabismus Is One Of The Causes Of Amblyopia. Other Causes Are Anisometropia (highly Different Spectacle Prescriptions In Each Eye), And Obstruction Of Vision In An Eye Due To Injury, Cataract, Lid Droop, Etc.

 

How Is Strabismus Caused?

Strabismus Is Caused By Misaligned Eye Muscles. However, The Exact Reason For The Misalignment Of The Eyes Leading To Strabismus Is Not Fully Understood. Many Factors Can Be Responsible For Strabismus. They Include:

  • Inappropriate Development Of The "fusion Center" Of The Brain, Problems With The "eye Movement" Centers Of The Brain, And Injury To Or Disease Of The Eye Muscles Or Nerves. This Explains Why Children With Cerebral Palsy, Down's Syndrome And Hydrocephalus Often Have Strabismus. Even A Brain Tumor May Cause Strabismus.
  • Another Factor Is Genetics, And It Is Known That Strabismus May Run In Families. However, In Many Patients There Are No Relatives With The Problem. The Condition Occurs Equally In Males And Females.
  • Associated Eye Conditions May Also Give Rise To Strabismus. In Cases Of Cataract, Injury Or Tumor Within The Eye, The Eye May Frequently Turn In Or Out.

 

What Are The Symptoms Of Strabismus?

The Primary Symptom Of Strabismus Is An Eye That Is Not Straight. The Misalignment May Be Permanent And Always Noticeable (constant Strabismus), Or It May Come And Go, Appearing Normal At Times And Abnormal At Others (intermittent Strabismus). One Eye May Be Directed Straight Ahead While The Other Eye Is Turned Inward, Outward, Upward, Or Downward. In Other Cases, The Turned Eye May Straighten At Times, And The Straight Eye May Turn (alternating Strabismus).

 

Sometimes A Youngster Will Close One Eye In Bright Sunlight. Faulty Depth Perception May Be Present. Some Children Turn Or Tilt Their Heads In A Specific Direction In Order To Use Their Eyes Together.

 

Up To The First 6 Months Of Age, Intermittent Strabismus Is A Normal Developmental Milestone. After 6 Months, It Needs To Be Evaluated.

 

Detection And Diagnosis

A Child Should Be Examined By The Family Doctor, Pediatrician, Or An Ophthalmologist During Infancy And Preschool In Order To Detect Any Potential Eye Problem, Particularly If A Relative Has Had Strabismus Or Amblyopia. Even The Most Observant Parent May Not Discover Strabismus Without A Doctor's Help. It Is Often Difficult To Determine The Difference Between Eyes That Appear To Be Crossed And True Strabismus.

 

Young Children Usually Have A Wide, Flat Nose And A Redundant Fold Of Skin At The Inner Eyelid That Tends To Hide The Eye During Side Gaze And Cause Concern About Strabismus. An Ophthalmologist Can Readily Distinguish This From True Strabismus.

 

Why Is Early Detection Important?

It Is Never Too Early To Have A Child's Eyes Examined. Fortunately, An Ophthalmologist Can Test Even A Newborn Infant's Eyes. In General, Research Suggests That The Maximum "critical Period" In Humans For The Development Of Binocular Vision With Resultant Depth Perception Is From Just After Birth To 2 Years Of Age. Any Disruption Of Binocular Vision In This Period Will Therefore Result In Strabismus And/or Amblyopia. If The Eye Examination Is Delayed Until The Child Enters School, It May Be Too Late To Properly Correct Strabismus And Amblyopia.


Occasionally, A Misaligned Eye May Be Caused By A Cataract Or Tumor Within The Eye, As Mentioned Earlier. It Is Important To Know About Such Conditions As Early As Possible, So That Both The Underlying Condition And Resulting Strabismus Can Be Corrected.


Parents Often Get The False Impression That A Child May "outgrow" The Problem. Though Fatigue Or Illness May Worsen Strabismus, Children Do Not Outgrow Strabismus. Once A Child Has A Suspected Turning Of An Eye, An Examination By An Ophthalmologist Is Necessary To Determine The Cause And To Begin Treatment.

 

When Is It Too Late To Treat Strabismus Or Lazy Eye?

It Is Often Asked At What Age Should Treatment No Longer Be Attempted. The Answer Is, Everyone Deserves A Chance. Age Should Not Be A Deterrent, Though Treatment Under 6 Years Of Age (especially Before 2) Is Ideal And Allows Better Results Than Later Treatment. After Age 6, Age Is Not Important. However, Every Attempt Should Be Made To Improve Strabismus And Lazy Eye, Even Though Treatment Might Not Be As Effective After The Age Of Six, And Definitely Requires More Work.

 

What Are The Goals Of Treatment

The Goals Of Treatment Are To Preserve Vision, Straighten The Eyes, And Restore Binocular Vision. Treatment Of Strabismus Depends Upon The Exact Cause Of The Misaligned Eyes. It Can Be Directed Towards Unbalanced Muscles, Cataract Removal Or Other Conditions That Are Causing The Eyes To Turn. After A Complete Eye Examination, Including A Detailed Study Of The Inner Parts Of The Eye, An Ophthalmologist Can Recommend Appropriate Optical, Medical Or Surgical Therapy. Covering Or Patching The Good Eye To Force Use Of The Amblyopic Eye May Be Necessary To Ensure Equal Vision.


Constant Strabismus Must Be Dealt With Immediately If One Wants To Re-establish Proper Use Of The Eyes. Treatment For This Condition Needs To Be Early And Aggressive. If The Eye Turn Is Constant And Simple Things Like Patching, Glasses (bifocal, Prismatic, Etc) Do Not Eliminate The Eye Turn, Surgery Needs To Be Considered.


With Intermittent Strabismus, The Eye Does Not Turn In All The Time, So The Brain Is Probably Receiving Appropriate Stimulation For The Development Of Binocular Vision. Children With Intermittent Eye Turns Should Be Handled With Judicious Patching, Special Glasses, And/or Orthoptics (special Eye Excercises Designed To Encourage Binocular Vision). Surgery, If Considered At All, Should Be A Last Resort.


The Two Most Common Types Of Strabismus Are Esotropia, Where An Eye Turns In And Exotropia, Where An Eye Turns Out.

 

Treatment Of Various Kinds Of Strabismus - Esotropia

There Are Various Types Of ESOTROPIA (inward Turning Of Eyes). Infants Developing Esotropia Within The First Three Months Of Life (Congenital Or Infantile Esotropia) Usually Have A Large Inward Turn, Which Is Easily Noticed. The Chances Of Developing Normal Binocular Vision With Normal Depth Perception Are Not Good And May Lose Vision In The Weaker Eye. However, The Best Chance Is With Early Aggressive Surgery. Treatment After The Age Of 2 Decreases The Chances Of Improvement Of Vision, And The Ability To Use The Two Eyes Together. Additionally, The Cosmetic Defect Resulting From "crossed Eyes" Can Have A Negative Effect On A Child's Self-confidence. Both The Parent And Surgeon Have To Be Committed To Multiple Procedures To Obtain Perfect Alignment. The Aim Of Eye Surgery Is To Adjust The Muscle Tension On One Or Both Eyes In Order To Pull The Eyes Straight. In Surgery For Esotropia, The Tight Inner Muscles Are Placed Further Backward Which Weakens Their Pull And Allows The Eyes To Move Outward. Sometimes The Outer Muscles May Be Tightened By Shortening The Muscle Length, Which Further Pulls The Eye Outward.

 

Strabismus Surgery Is Usually A Safe And Effective Treatment, But Is Not A Substitute For Glasses Or Amblyopia Therapy. During Surgery, The Eyeball Is Never Removed From The Socket. A Small Incision Is Made Within The Tissues Covering The Eye To Allow Access To The Eye Muscles. Selection Of Eye Muscles To Be Operated Upon Depends Upon The Direction The Eye Is Turning. Despite A Thorough Clinical Evaluation And Good Surgical Technique, The Eyes May Be Closely Aligned After Surgery, But Not Perfect. In These Cases, Fine Adjustment Is Dependent Upon The Coordination Between The Eye And The Brain. Sometimes Patients May Require The Use Of Prisms Or Glasses Following Eye Muscle Surgery. Over-corrections Or Under-corrections Can Occur And Further Surgery May Be Needed.


One Or Both Eyes May Be Operated Upon. General Anesthesia Is Required In Children. Some Adults May Prefer Local Anesthesia. Recovery Time Is Rapid And The Patient Is Usually Able To Return To Normal Activity Within A Few Days. As With Any Surgery, Eye Muscle Surgery Has Certain Risks. There Is A Small Risk Of Infection, Bleeding, Excessive Scarring, And Other Rare Complications, Which Can Lead To Loss Of Vision.

 

Another Common Form Of Esotropia That Occurs In Children Usually After Age Two Is Caused By A Need For Glasses (accommodative Esotropia). These Children Are Farsighted (hypermetropia Or Plus Power In Spectacles). They Have The Ability To Focus Their Eyes Enough To Adjust For The Farsightedness, Which Allows Them To See Well For Both Distance And Near. Some Children Excessively Cross Their Eyes When They Focus, Which Causes One Eye To Turn In. Wearing Glasses Equal In Strength To Their Farsightedness Reduces The Need To Focus And Straightens Their Eyes. Sometimes The Addition Of Bifocals Is Necessary To Further Reduce The Need To Focus When Looking At Objects Up Close. Occasionally, Eye Drops And Special Lenses, Called Prisms, Can Be Used To Help The Eyes Focus Properly. Rarely, Special Eye Exercises (orthoptics) Are Necessary To Help Older Children Control The Eye Misalignment.

 

Treatment Of Various Kinds Of Strabismus - Exotropia

EXOTROPIA Or An Outward Turning Of An Eye Is Another Common Type Of Strabismus. Most Commonly This Occurs When A Child Is Focusing At Distant Objects. Often The Exotropia Will Occur Intermittently, Particularly When The Child Is Daydreaming, Ill, Or Tired. Parents Often Note That The Child Squints One Eye In The Bright Sunlight. Although Glasses And Prism Therapy May Reduce The Amount Of Outward Turning In Some Patients, Surgery Is Usually Needed.

 

Loss Of Vision Due To Amblyopia Is Preventable

Treatment For Strabismus Is Most Effective When The Child Is Young. It Becomes More Difficult To Treat Strabismus And Establish Binocularity As The Child Grows Older, But Cosmetic Straightening Of The Eyes Remains Possible At Any Age. There Is No Known Prevention For Strabismus, But Misaligned Eyes Can Be Straightened, And Loss Of Sight From Amblyopia Is Preventable If Treatment Is Begun Early.

 

In Summary:

  • Children With Strabismus Do Not Outgrow The Condition.
  • Treatment For Strabismus May Be Non-surgical And Include Eye Drops Or Glasses.
  • If Surgical Treatment Is Indicated, It Is Wise To Align The Eyes When The Child Is Young In Order To Allow More Normal Use Of The Eyes Together.

 

Besides The Conditions Mentioned Above In Children, There Are Certain Disorders In Adults Which Are Associated With Strabismus. These Include:

  • Thyroid Disease
  • After Cataract Surgery
  • After Retinal Detachment Surgery
  • Myasthenia Gravis
  • Paralysis Of Eye Muscles Due To Diabetes And Hypertension
  • Orbital Fracture

The Glaucoma Service At Shreya Eye Centre

Sight Is Our Most Precious Sense Enabling Us To Enjoy The World Around Us. One Of The Leading Causes Of Blindness Is Glaucoma. Unlike Cataract, Blindness Due To Glaucoma Is Permanent. While There Are No Known Ways Of Preventing Glaucoma, Blindness Or Significant Vision Loss From Glaucoma Can Be Prevented If The Disease Is Recognized In The Early Stages..

 

Learn About Glaucoma And Its Treatment.

 

What Is Glaucoma?

Glaucoma, Otherwise Known As "Kala Motia" Is An Eye Disease In Which There Is An Increase In Pressure Inside The Eye. Just As Some People Have High Blood Pressure, In The Same Way A Glaucoma Patient Has High Eye Pressure.


If The Eye Pressure Remains High For A Long Time It Damages The Optic Nerve Which Carries The Light Sense From The Eye To The Brain. This Damage To The Nerve Is Irreversible And Leads To Permanent And Incurable Blindness. That Is Why Glaucoma Is A Dangerous Disease Of The Eye And Has Been Labeled As "lurking Thief Of Vision". Glaucoma Is The Second Leading Cause Of Blindness In The World With 70 To 105 Million People Affected Worldwide (WHO).

 

Why Is It Important To Know About Glaucoma?

Damage Due To Glaucoma Is Preventable, Not Curable. It Is Therefore Necessary That The Disease Should Be Detected And Treated At Its Earliest Stage To Prevent Blindness.

 

How Does A Person Come To Know That He/she Is Suffering From Glaucoma?

 

Glaucoma Is Usually Asymptomatic Or Is Associated With Very Mild Symptoms Which The Patient Often Tends To Ignore. Some Of The Early Symptoms Include:

  • Frequent Change Of Reading Glasses.
  • Mild Eye Ache Or Headache Towards The Evening After A Day's Work.
  • Seeing Rainbow Colored Haloes Of Light Around A Bulb Associated With Slight Decrease In Vision.
  • Inability To Adjust One's Vision On Entering A Dark Room. " Difficulty In Focusing On Close Work.
  • In Advanced Cases, There Is A Loss Of Side Vision, While The Central Vision Remains Good. The Patient Becomes More Prone To Accidents As He/she Is Unable To See Vehicles Coming From The Sides.
  • It Is To Be Remembered, That Cataract ("Safed Motia") Also Starts Developing At The Same Age As Glaucoma. Many People May Think That They Are Losing Vision Due To Cataract Whereas It May Actually Be Due To Glaucoma, Which Is A Much More Dangerous Disease.
  • It Is Therefore Advisable To Undergo A Routine Examination Around The Age Of 40 Years To Screen For Glaucoma.

 

Which Age Does Glaucoma Affect?

Although Glaucoma Is Most Common Above The Age Of 40 Years, It May Affect Any Age Group. A Special Type Of Glaucoma Called Congenital Glaucoma May Affect Even A Newborn Or A Child. Any Eye That Appears Bigger Than Normal In A Child Should Be Shown To An Eye Specialist.

 

Who All Are At High Risk Of Developing Glaucoma?

  • Presence Of Glaucoma In Other Family Members
  • Increasing Age - Above 40 Years
  • Thyroid Disease O Patients Who Are On Long Term Steroid Therapy For Other Diseases Such As Asthma, Arthritis Etc.
  • Previous Eye Injury Or Surgery O Hypermetropia (farsightedness)

 

Damage Due To Glaucoma May Be More Severe In Those Patients Who Have Associated Diabetes, Widely Fluctuating Blood Pressure And Myopia.
 
What Are The Types Of Glaucoma In Adults?

There Are Three Main Varieties Of Glaucoma In Adults Which Concern Us:-

  • Chronic Glaucoma Or Open-angle Glaucoma
  • Acute Glaucoma Or Closed-angle Glaucoma
  • Secondary Glaucoma, Which Develops Due To Systemic Diseases Like Prolonged Diabetes, Complicated High Blood Pressure, Thyroid Disease, Bleeding Disorders Etc. It May Also Occur As A Complication Of Associated Eye Disorders Such As Vascular Blocks, Bleeding Inside The Eye, Uveitis, Swollen Lens, Blunt Injury To The Eye, Etc.

 

What Is The Difference Between Open-angle And Closed-angle Glaucoma?

Let Us Explain With The Simple Example Of A Kitchen Sink At Your Home. There Is A Tap Through Which Water Comes And There Is A Drain Through Which Water, After Cleaning Utensils, Is Drained Off. If The Drain Is Blocked, Water Accumulates In The Sink. Similarly, In Your Eye There Is An Area Which Produces A Clear Fluid Which Circulates Inside The Eye And Provides Oxygen And Nourishment To The Vital Parts. Likewise, There Is A Small Drainage Channel Through Which All The Waste Products From Inside The Eye Are Drained. In Glaucoma This Passage Or The Drainage Channel Is Blocked, Either At Its Entrance Or Beyond. When The Block Is At The Entrance It Is Called Closed Angle Glaucoma. When The Blockage Is Not At The Entrance, But Beyond, Somewhere Inside, We Call It Open Angle Glaucoma. The Blockage Results In More Fluid Accumulating Inside The Eye Than Can Be Drained Out. This Leads To A Buildup Of High Pressure Inside The Eye.

 

How Is Glaucoma Detected Or Diagnosed?

Glaucoma Is Detected Through A Comprehensive Eye Examination That Includes: -

 

Vision Testing

Since Glaucoma More Often Affects The Side Vision, The Central Vision May Be Retained Till A Very Advanced Stage. It Is Important To Remember That A Good Central (straight Ahead) Vision Test May Mislead A Glaucoma Patient About The Severity Of Glaucoma And The Extent Of Damage To The Optic Nerve.

 

Measurement Of Eye Pressure

This Is Done By Tonometry (non-contact/applanation). This Helps Your Doctor To Determine How High Your Pressure Is And How Well The Medicine Is Controlling It.

 

Evaluation Of Optic Nerve Damage

By Ophthalmoscopy And Optic Nerve Photography.

 

Evaluation Of Drainage Channels

A Special Magnifying Contact Lens Is Used On Your Eye To Help Your Doctor Determine Why The Fluid Is Not Draining Properly. This Examination Is Called Gonioscopy.

 

Visual Field Examination

This Test Detects Defects In Your Central And Peripheral Field Of Vision.

 

GDxVCC Retinal Nerve Fiber Layer Analyzer / HRT / OCT

These Special Tests Measure The Thickness Of The Nerve Fibre Layer And Helps Your Doctor Detect Glaucoma At A Very Early Stage

 

How Often Should One Get An Eye Check Up?

  • After The Age Of 40 Years, One Should Get An Eye Check Up For Glaucoma Every 3 To 4 Years Even If There Are No Symptoms.
  • If A Family Member Has Glaucoma, If You Have Diabetes, If You Are On Long Term Systemic Steroids For Some Other Disease, Or If You Have Suffered A Blunt Eye Injury In The Past, You Must Get Your Eyes Checked Every 1 To 2 Years.

 

How Is Glaucoma Treated?

As Damage To Nerve Caused By Glaucoma Cannot Be Reversed, The Aim Of The Treatment Is To Prevent Or Reduce Further Damage To The Optic Nerve. The First Step To Do That Is To Lower The Eye Pressure. The Three Modalities Of Treatment Are:-

 

Medical (Eye Drops And Tablets)  Laser Treatment Surgery

Medical Treatment: -

Your Doctor Will Prescribe You Certain Medication (Eye Drops And Tablets) So As To Lower Your Eye Pressure. " You Must Use The Medicines Regularly As Directed By Your Ophthalmologist.

You Should Not Stop Medicines Even If You Do Not Have Symptoms.

A Regular Follow Up, As Advised By Your Doctor, Is Mandatory.

 

Laser Treatment: -

If Glaucoma Is Not Controlled With The Help Of Medicines, If The Side Effects Of The Medicines Are Not Well Tolerated And The Patient Is Non Compliant, Or Cannot Afford The Cost Of The Medicines, The Second Option Is LASER TREATMENT. There Are Various Types Of Lasers That Are Used In The Treatment Of Glaucoma.

 

They Are: -

YAG Laser Peripheral Iridotomy

A Small Opening Is Made In The Iris So That The Stagnant Fluid Finds A Way To The Anterior Chamber, The Front Portion Of The Eye, And Subsequently Drained Off. This Is An OPD Procedure, Done Under Local Anesthetic Drops And Takes Only A Few Minutes To Be Completed. After The Laser, You Can Wash Your Eye With Water And Can Lead A Normal Life.

 

Selective Laser Trabeculoplasty (SLT)

This Is A New Type Of Laser, Which Does Not Cause Any Thermal Burn In The Eye And May Be Called "COLD LASER". It Stimulates The Autoimmune System Of The Eye To Clear The Block In The Drainage Area Without Damaging The Surrounding Delicate Tissues. SLT Is A Painless OPD Procedure, Which Takes A Few Minutes To Be Completed. One Can Resume Normal Activities Immediately After The Laser. If Necessary It Can Be Safely Repeated Without Damaging The Eye.

 

Argon Laser Trabeculoplasty
When Applied At The Drainage Area, The Laser Causes Small Burns, Which Contract To Open Up The Block.

 

Diode Laser Cycloablation
In This The Laser Is Applied On The Area, Which Produces Fluid In The Eye. It Can Be Used If The IOP Is Too High And Is Intractable.
Your Treating Doctor Will Decide Which Laser Is Suitable For You.

 

Operative Procedures (Glaucoma Filtering Microsurgery Or "By-pass" Surgery Of Eye)

Operation For Glaucoma Is The Only Option Left For Patients In Whom The Eye Pressure Is Not Controlled With Medication Or Laser. It Is Also The Treatment Of Choice In Non-compliant Patients, And In Infants And Children With Glaucoma. Filtering Microsurgery Involves Creating A Drainage Hole With The Use Of A Small Surgical Tool, To Bypass The Blockage In The Eye's Trabecular Meshwork (the Eye's Drainage System). This Opening Helps Increase The Flow Of Fluid Out Of The Eye And Thereby Reduce The Eye Pressure.

 

SOME COMMONLY ASKED QUESTIONS BY GLAUCOMA PATIENTS

 Q My Vision Is Good, Then Why Do You Say I Have Glaucoma?

In Glaucoma The Central Vision Is Not Lost Till The Very Late Stages. It Starts With Damage To Your Peripheral Vision And Gradually Comes To The Centre. When The Central Vision Is Affected It Is Too Late And Nothing Can Be Done To Restore Vision. In A Way, A Good Vision Is Misleading As Far As Severity Of Glaucoma And Extent Of Damage Is Concerned.

 

Q What Is The Normal Pressure For An Eye?

Normal Pressure For An Eye Is One Which Does Not Cause Any Damage To The Optic Nerve. In Most Normal People The Eye Pressure Is Around 17 To 20 Mm Of Mercury. Some People Have Higher Pressure Than This, But That Does Not Cause Damage To The Nerve For Years. However, Such Patients Need Careful Monitoring So That Damage To The Nerve Is Detected At Its Earliest Stage. On The Other Hand Some Patients Have A Much Lower Eye Pressure, Say 12 Or 14 Mm Hg, But This Low Pressure Is Not Tolerated By The Eye And The Nerve Is Damaged. This Is A Special Type Of Glaucoma And Needs More Careful Monitoring And Treatment.

 

Q How Serious Is My Glaucoma Problem?
It Depends Upon The Amount Of Optic Nerve Damage That Has Already Been Caused. The Damage Can Be Measured By Visual Field Analysis (VFA) And GDx (which Measures The Thickness Of Nerve). As The Damage Is Permanent, Appropriate Measures Are Taken To Prevent Or Slow Down Further Damage.

 

Q Is Glaucoma Preventable?
A Yes, Damage Due To Glaucoma Is Preventable, Not Curable. Whatever Damage That Is Already There Cannot Be Restored, However Further Damage Can Be Arrested Or At Least Slowed Down By Appropriate Treatment. It Is A Life-long Treatment And Needs Regular Followup.

 

Q Is Glaucoma Hereditary?
Yes, Blood Related Family Members Of Glaucoma Patients Are Likely To Develop Glaucoma More Often Than The General Population. It Is Advisable That Family Members Of Glaucoma Patients Should Get Their Eyes Review To Rule Out Glaucoma.

 

Q Can I Get Back My Side Vision After Treatment?
Unfortunately The Vision Loss Caused By Glaucoma Is Permanent And Cannot Be Regained.

 

Q What Precaution Must One Take?
One Must Remember That Glaucoma Treatment Is Life Long, And One Should Use The Medicines Regularly And Should Come For Follow-up As And When Advised.
Persons Who Are At The Risk Of Developing Glaucoma (as Listed Previously) Should Undergo Regular Eye Examinations.
Diabetics Should Ensure Good Control Of Blood Sugar Levels
Avoid Smoking
Avoid Drinking 2-3 Glasses Of Water At A Time.

 

Q Do I Need To Come For Follow Up After Laser / Surgery?
Treatment Of Glaucoma Is Life-long. Even After Laser Or Surgery One May Need Additional Medication And A Lifetime Of Follow Up To Monitor The Progress Of The Disease.


What Is Uveitis?

Uveitis (pronounced U'VE-I'TIS) Means "inflammation Of The Uveal Tract", Or The Middle Layer Of The Eye. It Is An Immunologically Mediated Reaction In The Uveal Tract Leading To Its Inflammation. It Is Important To Clarify That There Is No Infection In Uveitis. Uveitis May Be An Isolated Problem Or May Be Associated With Inflammation In Other Parts Of The Body. It May Be A Single Episode In Some Patients While In Others It May Have A Tendency To Be Chronic And Recurrent. We Therefore Thoroughly Investigate A Patient Of Uveitis To Find A Possible Cause For This Inflammation And Its Prognosis. To Understand About Uveitis And Its Seriousness, It May Also Be Helpful To Know The Basic Anatomy Of This Tissue Of The Eye

 

Normal Structure Of The Eye

The Eyeball Can Be Divided Into Three Coats Or Tunics. The Outer White Coat, Or Sclera, Forms A Dense, Fibrous Outer Covering. In The Front Part Of The Eye The Sclera Becomes Continuous With The Cornea, The Transparent Structure Through Which We See. The Innermost Lining Of The Eyeball, Is A Thin Layer Known As The Retina (image-gathering Tissue In The Back Of The Eye Much Like The Film In A Camera), Which Contains The Nerve Endings Whose Function It Is To Send Visual Impulses To The Brain. These Nerve Fibers Form The Optic Nerve, Which Exits Through An Opening In The Back Part Of The Sclera. The Eyeball Cavity Is Filled With A Jelly-like Substance Called The Vitreous

 

What Is The Importance Of The Uvea?

The Uvea Contains Many Of The Blood Vessels, Which Nourish The Eye. Inflammation Of The Uvea Can Affect The Cornea, The Retina, The Sclera, And Other Vital Parts Of The Eye. Since The Uvea Borders Many Important Parts Of The Eye, Inflammation Of This Layer May Be Sight Threatening And More Serious Than The More Common Inflammations Of The Outer Layers Of The Eye. Also, Due To Its Rich Blood Supply, The Uveal Tract Is A Natural Target For Diseases Originating In Other Parts Of The Body. Because The Cornea Is Normally Clear, Signs Of Disease May Be Seen Inside The Eye, Often Before Signs Develop Elsewhere In The Body

 

Are There Different Kinds Of Uveitis?

When Any Part Of The Uvea Becomes Inflamed, The Condition Is Labeled As Uveitis. This May Be Further Subdivided Depending Upon The Exact Structures Involved In The Inflammation. Thus, If Only The Iris Is Inflamed It Is Called Iritis. Similarly Cyclitis Is Inflammation Of The Ciliary Body. Anterior Uveitis Or Iridocyclitis Is Inflammation Of Both The Iris And Ciliary Body. Choroiditis Or Posterior Uveitis Is Inflammation Of The Choroid. Intermediate Uveitis Is Inflammation Of The Middle Part Of The Uvea And Is Commonly Also Referred To As Pars Planitis. If All Structures (iris, Ciliary Body And Choroid) Are Inflamed Then It Is Called Panuveitis. These Are Medical Terms But Are Helpful For You To Know.

 

What Causes Uveitis?

Uveitis Results From A Hypersensitivity To An External Or Internal Protein; Hence It May Have Many Different Causes. It May Result From Hypersensitivity To Various Infective Organisms Including Viruses (such As Shingles, Mumps, Or Herpes), Fungi (such As Histoplasmosis), Parasites (such As Toxoplasmosis) And Bacteria (such As Tuberculosis, Lyme Disease, And Syphilis). It May Be Due To An Underlying Autoimmune Disease. In The Indian Scenario Infectious Causes Account For A Large Proportion Of Uveitis Cases.


Uveitis Can Also Be Related To Disease In Other Parts Of The Body (such As Sarcoidosis, Arthritis & Ankylosing Spondylitis) Or Come As A Consequence Of Injury To The Eye. Rarely, Inflammation In One Eye Can Result From A Severe Injury To The Fellow Eye (sympathetic Uveitis).


Additionally, Uveitis May Becaused If Other Structures Of The Eye Are Inflamed Like A Corneal Ulcer Or Rarely A Swollen Hypermature Cataract. In A Few Patients There May Be Genetic Predisposition To Inflammation That Can Be Detected By HLA Typing Of Your DNA In Specific Conditions. Despite Thorough Investigations, In A Significant Proportion Of Cases, The Cause Remains Undetermined And Is Called Idiopathic Uveitis.

 

What Are The Symptoms Of Uveitis?

Depending On Which Part Of The Eye Is Inflamed In Uveitis Different Combinations Of Symptoms May Be Present. These Include Redness Of The Eye, Pain, Light Sensitivity, Blurring Of Vision And Floaters.


Uveitis May Come On Suddenly With Redness And Pain, Or It May Be Slow In Onset With Little Pain Or Redness, But Gradual Blurring Of Vision. These Symptoms May Also Come On Suddenly, And You May Not Experience Any Pain.


The Symptoms Described Above May Not Necessarily Mean That You Have Uveitis. However, If You Experience One Or More Of These Symptoms, Contact Your Ophthalmologist (eye Doctor) For A Complete Exam. Early Detection And Treatment Is Necessary, As Inflammation Inside The Eye Can Permanently Affect Sight Due To Glaucoma (high Pressure In The Eye), Cataract (clouding Of The Lens Of The Eye), Or Retinal Damage, And Rarely, Lead To Blindness.

 

How Is Uveitis Diagnosed?

An Ophthalmologist Will Use Instruments To Examine The Inside Of The Eye And Often Can Make A Diagnosis On That Basis. In Some Circumstances, Blood Tests, Skin Tests (Mantoux Test), X-rays, And CT Scans, And Sometimes, Even Specimens Taken Surgically From The Eye, May Assist In Establishing The Diagnosis And Finding Its Cause. Since Uveitis Can Be Associated With Disease In Some Other Part Of The Body, An Evaluation And Understanding Of The Patient's Overall Medical Health Is Important. This May Involve Consultation With Other Medical Specialists, Including Pulmonologists, Immunologists Or Rheumatologists.

 

How Is Uveitis Treated?

The Treatment Of Uveitis Requires Therapy To Halt The Inflammation Of The Uveal Tract Along With A Search For The Cause Of The Condition. Diagnostic Tests May Be Needed To Determine Possible Causes. The Results Of These Tests Are Very Important For Proper Treatment To Be Given. Medical Treatment Of Uveitis Must Be Aggressive To Prevent Glaucoma, To Prevent Scarring Of The Structures Inside The Eye And To Prevent Possible Blindness.


Different Medications Are Used To Control The Original Cause Of The Uveitis, If Detected, And To Minimize The Inflammation Itself. Eye Drops, Especially Steroids (to Reduce Inflammation And Pain) And Pupil Dilators (to Widen The Pupil And Relax The Muscles Within The Eye), Are The Main Medications Used To Treat Uveitis. For Deeper Inflammation, Oral Medication Or Injections Around The Eye May Be Necessary, Especially Sub-Tenons' Injection Of Depot Steroids. Sometimes If The Inflammation Is More Prolonged Or Vision Threatening Then Systemic Steroids May Be Required. These Drugs Quickly Control Inflammation In A Large Proportion Of Patients. However, If Used For Longer Periods These Drugs Cause Weight Gain And Water Retention, Acne Formation, Osteoporosis And Gastric Ulcers, And Require To Be Minimized During Treatment.


Rarely If Very Prolonged Systemic Steroid Treatment Is Required It May Not Be Possible To Do So Because Of The Enumerated Side Effects. In Such A Situation, A Patient May Be Switched Over To Special Medicines Called Immunosuppressive Agents. When Given In Low Doses, These Drugs Decrease The Number Of White Cells, Which Are The Mediators Of Inflammation.


These Drugs, Such As, Methotrexate, Azathioprine And Cellcept Have Different Side Effects Including Decreasing Blood Counts And Mild Liver And Kidney Dysfunction, Which Are Partially Reversible On Stopping Treatment. These Can Be Detedcted By Frequent Blood Tests And Being Under The Care Of A Physician Or Immunologist.

 

Complications Of Uveitis Such As Glaucoma, Cataracts, Or New Blood Vessel Formation (neovascularization), Also May Need Treatment In The Course Of The Disease. If Complications Are Advanced, Conventional Surgery Or Laser Surgery May Be Necessary.

 

Periodic Follow Up Is Essential

Follow-up Examinations Ensure Optimal Therapy Is Being Given And Guard Against Possible Complications. Uveitis, If Caught Early And Treated Diligently And Appropriately, Will Often Resolve Without Serious Consequences.