Refractive Surgery & lasik laser

Refractive errors are a common cause of visual impairment. They cause blurred vision due to incorrect focus of light. It can be in the form of:

• Myopia: Also called nearsightedness where near objects are clear and far objects are blurred

• Hypermetropia: also called as far sightedness, where near objects are blurred and far objects are more clear

• Patients can see clearly within hours of surgery. 

• Astigmatism: caused due to altered curvature of the eye leading to blurred vision for near and far objects

These errors can be corrected with spectacles or contact lenses. But for those who want freedom from the hassle of using these, refractive surgeries can offer a permanent solution

What are Refractive Surgeries?

These surgeries aim to focus light correctly on the retina. This can be done by resharing the cornea or implanting a lens

they can be:

• Photorefractive Keratectomy: laser is applied directly to the cornea after removing its outermost layer. A contact lens is placed to support the healing of the eye after the procedure. It is suitable for individuals with thin corneas

• LASIK: A flap of the superficial layer is created and lifted, laser is then applied to the underlying part of the cornea and the flap is placed back into position

• Zyoptix: This laser eye treatment offers correction customized to the individual eye. It uses wavefront technology to measure and correct aberrations that cannot be detected with standard methods or older laser systems.

Implantable Collamer Lens(ICL): an artificial lens of the corrective power is placed in front of the natural lens

IS IT A GOOD CHOICE FOR ME?

You can consider refractive surgery if

• Have an appropriate refractive error. Initial testing scans will be required to determine eligibility and the best choice of procedure

• Want to decrease the dependence you have on glasses or contact lenses

• Do not have eye diseases

WHAT YOU CAN EXPECT

Before the Procedure: You will be properly evaluated to see if you are a good candidate for surgery Contact lenses can alter the shape of the cornea and you will have to stop wearing them for a few weeks before the check-up and surgery. After the check up, scans will be done to help study the parameters of the cornea, determine eligibility and plan how much tissues must be ablated with the laser.

During the Procedure: Numbing drops will be placed in your eyes which will be held open with an instrument. You will be asked to focus on a light and a suction ring will be placed on the eye following which the procedure will start. It is completed in 30 minutes or less

Side Effects and Recovery Time

• Possible side effects are dry eye, glare and halos which are usually temporary and resolve in a few weeks to months.

• Recovery time varies based on the procedure and the individual. Most surgeries allow return to routine work in a few days to a week.

CATARACT

what is it ?

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging and are very common in older people. People can have an age-related cataract in their 40s and 50s and usually it is after age 60 that most cataracts cause problems with a person's vision.

Symptoms you experience

• clouded, blurred or Dim vision

• Trouble seeing and Driving at night

• Need for brighter light for reading and other activities

• Seeing "halos" around lights.

• Sensitivity to light and glare

• Double vision in one eye

• Frequent changes in eyeglass or contact lens prescription

• Fading or yellowing of colors.

diagnosis

To determine whether you have a cataract your doctor may do several tests, including:

• Vision test: Using an eye chart to measure how well you can read a series of letters to determine if you have trouble seeing.

• Eye structure exam: Also called a slit lamp, allows your doctor to examine the structure of your eye under magnification in small sections and to determine the stage of cataract.

• Retinal exam: To prepare for a retinal exam, your eye doctor puts drops in your eyes to dilate the pupils. This makes it easier to see the retina and determine its status.

• Fluid pressure test. This test, also called tonometry, measures fluid pressure in your eye.

Treatment

The most effective treatment for cataracts is surgery. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

What happens before surgery? Tests that measure the curve of the cornea and the size and shape of your eye will be done to help choose the right type of intraocular lens (IOL)

The most effective treatment for cataracts is surgery. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

What happens during surgery? At the hospital, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed. The operation usually lasts less than half an hour and is almost painless. After the operation, a patch may be placed over your eye. You will rest for a while and can go home the same day.

Surgical Options Available

• Conventional: A relatively large incision is used to remove the lens manually. Takes around one month to fully recover. Spectacles are usually required after surgery.

• Minimally Invasive: Smaller incisions are used and the lens is removed with ultrasonic energy. Recovery time is faster, normal activities can be resumed within days. Specatcle requirement post surgery is lesser.

• Laser Assisted: A laser is used to create precise incisions. There is a shorter recovery time and lower risk of complications. Specatcle dependency is least after surgery.

lens potions available

• Monofocal: Standard lens that corrects far vision. Glasses will be needed for near vision

• Toric: Corrects astigmatism, but glasses will still be required for reading.

• Multifocal and Trifocal: Provides distance, near and intermediate vision. Reduces the requirement for glasses

• Extended Depth of Focus: Corrects distance and intermediate vision with excellent clarity. Near glasses may be required for very small letters.

What happens after surgery? Itching and mild discomfort are normal aftercataract surgery. Watering and sensitivity to light and touch is also common. You will have to use eyedrops to help healing and decrease the risk of infection for a few weeks and eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye. You can walk, climb stairs, and do light household chores. In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress

GLAUCOMA

Glaucoma is a condition that damages your eye's optic nerve. As time goes on, it gets worse. A buildup of pressure inside your eye often causes it. There is a tendency for glaucoma to run in families. Usually, you don't get it until you're older.Your optic nerve, which transmits images to your brain, can be damaged by increased intraocular pressure. Within a few years, glaucoma can cause permanent vision loss or even total blindness.

Glaucoma Causes

The fluid within your eye, called aqueous humour, usually flows out through a mesh-like channel. In the event that this channel becomes blocked, or if the eye produces too much fluid, the liquid builds up. The cause of this blockage is sometimes unknown to experts. Nevertheless, it is inherited, meaning it is passed from one generation to the next.

Glaucoma Risk Factors

Generally, it affects adults over the age of 40, but can also affect young adults, children, and even infants. 

• Family history of glaucoma

• Have near-sightedness or far-sightedness

• Having trouble seeing

• Diabetes

• Prednisone and other steroid medications drugs for bladder control or seizures, or some over-the-counter cold remedies

• Have had an injury to your eye or eyes

• Have corneas that are thinner than usual

• Have high blood pressure, heart disease, diabetes, or sickle cell anaemia

• Have high eye pressure

Symptoms of Glaucoma

The majority of people with open-angle glaucoma don't experience symptoms. In most cases, symptoms appear at a later stage of the disease. The main sign of glaucoma is usually a loss of peripheral vision. Glaucoma is often referred to as the "sneak thief of vision. "When angle-closure glaucoma is present, the symptoms usually appear faster and are more obvious. Damage can happen quickly. If you have any of these symptoms, get medical care right away:

• Seeing a halo around lights

• Loss of vision

• Eye redness

• A hazy eye (especially in infants)

• Upset stomach or vomiting

• Eye pain

Treatment for Glaucoma

In order to lower your eye pressure, your doctor may prescribe eye drops, oral medications, laser surgery, or microsurgery.

• Eye drops.

• Oral medication.

• Laser surgery

• Microsurgery.

DIABETIC RETINOPATHY

Does diabetes Damage the Eye?

Yes, people with Diabetes are more likely to develop a number of visual disorders than people who are free of the disease. This is especially true for people who have had Diabetes for ten years or more. They are more likely to develop a number of diseases like Cataract, Glaucoma and Diabetic retinopathy.

 Are the eyes of all diabetics affected?

No, The eyes of about 80 % of the diabetes patients are affected. But the longer the duration of diabetes,  greater are the chances of eye disorders.

 What are all the ways in which diabetes can affect the eye?

•  Diabetic Retinopathy

• Cataract formation ( ie., clouding of the lens of the eye)

• Glaucoma (ie., Increased pressure inside the eye)

What is diabetic retinopathy?

In this condition, the blood vessels of the retina deteriorate and can no longer supply all the oxygen and nutrients needed by the retina to remain healthy. There are bleeding spots and deposits of fatty material with swelling of the retina. Thus the retina is unable to transmit visual messages to the brain resulting in low vision or blindness.

How does it cause low vision or blindness?

In moderate cases, the visual loss is due to swelling of the retina and few blood spots. In many cases there is severe bleeding into the vitreous from the abnormal blood vessel in the retina.

What are the symptoms by which diabetic retinopathy can be identified?

Usually diabetic retinopathy is symptomless. Some have slight decrease of vision or foggy vision. Some may have normal vision till they develop sudden blindness due to bleeding. There are few early symptoms of diabetes retinopathy which warn that the disease is progressing and that vision is threatened. Hence it is essential that diabetic patients undergo a routine check up by an eye specialist every six months. Fundus Fluorescein imaging which involves taking photographs of the eyes after a dye injection are necessary to identify the stage of diabetic retinopathy and start appropriate treatment.

How is diabetic retinopathy treated?

Laser photocoagulation :

• It is a total painless procedure

• The laser is low-energy, highly concentrated light that is beamed through a special lens into the eye.

• The light passes freely through the transparent structures of the eye and continues on through the transparent layers of the retina.

• The light is stopped by the pigment layer of the retina, where it is converted into heat. The heat coagulates, or conceals the retinal layer.

• The light is stopped by the pigment layer of the retina, where it is converted into heat. The heat coagulates, or conceals the retinal layer.

But photocoagulation may not be appropriate for everybody. If the condition is too advanced, laser treatment is not possible. In such cases a method called vitrectomy is resorted to.

Vitrectomy

In this surgical procedure, the blood and scar tissue is removed from the centre of the eye and replaced with a clear artificial solution. Following vitrectomy, patients can often see well enough to move around on their own.

A word about self care

• Take insulin and other medications as prescribed by the physician.

• Inform each physician of medication prescribed by other doctors.

• Follow a controlled diet recommended by your doctor.

• Have annual eye examinations by a qualified ophthalmologist.

remember

• Diabetic retinopathy is symptomless.

• When marked visual impairment is present, it maybe too late for effective treatment.

• Early detection of these changes is possible only by periodic examination of the eye by an eye specialist.

Facilities available for Diabetic retinopathy:

Diagnosis:

• Fundus Digital imaging system - Carl Zeiss (Fundus Fluorescein Angiography)

• OCT -Optical Coherence Tomography - Carl Zeiss.

• OCT -Optical Coherence Tomography - Angio Vue.

• B-Scan Biometry – Alcon.

treatment:

• Argon laser photocoagulation -Coherent.

• Double Frequency Yag - Green laser- Carl Zeiss.

surgeries:

• Vitreo - retinal Surgical unit-Constellation -Alcon.

• Carl Zeiss - visu 210 microscope with Biom

SQUINT

Squint or strabismus is a condition where the eyes point in different directions. One eye may turn inwards, outwards, upwards or downwards while the other eye looks forward. This condition usually develops before a child turns five years old, but can appear later. Adults can also develop squint.

what causes them ?

The exact cause of a squint is not always known.
Some people are born with a squint and others develop one later in life. Sometimes they run in families.

In children, a squint is often caused by the eye attempting to overcome a vision problem, such as:

• Myopia or short-sightedness –difficulty seeing things that are far away

• Hyperopia or long-sightedness –difficulty seeing nearby objects

• Astigmatism – where the front of the eye is unevenly curved, causing blurred vision.

Rarer causes of a squint include:

• certain infections, like measles

•  some genetic conditions, such as Down's syndrome

• developmental delays

• cerebral palsy

• other problems with the brain or nerves

• A squint can also sometimes be a symptom of a rare type of childhood eye cancer called retinoblastoma

How do squints affect vision?

Squints can cause symptoms like

• double vision

• lazy eye(amblyopia) in young children where the vision is poor in the eye with the squint

• abnormal position of the head.

If a squint is left untreated in young children it can lead to lazy eye or amblyopia. Vision in the affected eye gradually deteriorates because the brain ignores messages from that eye. A lazy eye can only be treated successfully up until about six or seven years of age, hence it is important that it is treated as soon as possible.

Treatment for Squint

The main treatments for a squint are:

• Glasses – can be used of the squint is caused due to a problem with a child’s eyesight, such as farsightedness. Glasses with prisms may also be required.

• Eye exercises – these work on the eye muscles that control eye movements to improve their coordination and work together better.

• Surgery – this involves shifting muscles that control eye movement so as to align the eyes correctly. It may be required if glasses alone are not fully effective to correct the quint.

• Injections – these are given into the eye muscles to weaken them and help the eyes align  better. The effect is temporary(3 months).

If your child has developed lazy eye that will need to be treated as well.

Treatment for a lazy eye requires wearing a patch over the unaffected eye to help improve vision in the affected eye.

CORNEAL TRANSPLANTATION

The cornea is the clear layer on the front of your eye that helps focus light so you can see clearly. If it gets damaged, you might need to have it replaced. This involves removal of part or all of the cornea and its replacement with a healthy tissue from a donor.

why is it done ?

It is most often used to restore vision to a damaged cornea. It can also relieve pain or other symptoms associated with corneal diseases.

A number of conditions can be treated with a cornea transplant, including:

• A cornea that bulges outward, called keratoconus.

• Degenerations and dystrophies of the cornea

• Cornea scarring, caused by infection or injury.

• Swelling of the cornea.

• Corneal ulcers not responding to medical treatment.

• Complications caused by previous eye surgery.

Types of Corneal Transplant Surgeries

Penetrating keratoplasty: This operation involves replacement of entire thickness of the irregular or diseased cornea as a button-sized disk of corneal tissue. The donor cornea is sutured in place. The stitches might be removed ata later visit with your eye doctor.

 Endothelial keratoplasty: These operations replaces only the diseased tissue from the back corneal layers.  Descemet stripping endothelial keratoplasty (DSEK), uses donor tissue to replace up toone-third of the cornea. Descemet membrane endothelial keratoplasty (DMEK),uses a thinner layer of donor tissue.

Anterior lamellar keratoplasty (ALK): This removes diseased tissue from the front corneal layers, leaving the back endothelial layer in place. Healthy donor tissue is then attached to replace the removed portion of the cornea.

Your doctor will discuss which method of cornea transplant surgery is best for you, tell you what to expect during the operation and explain the risks of the operation.

PRIMARY EYE CARE

Primary eye care is integral to primary health care and includes promoting eye health, preventing and treating conditions that may lead to visual impairment, and rehabilitating the blind.  Primary eye care is the primary health care approach to the prevention of blindness and it should be an integral part of primary health care.

DRY EYE

Dry eye occurs when a person does not have enough quality tears to lubricate and nourish their eyes. Tears are necessary for maintaining the health of the eye's front surface and for providing clear vision.

Causes & Risk factors

• Ageing: Most common cause. Women often experience dry eye symptoms     after menopause

• Side effects of medications: antihistamines, beta blockers, anxiety     medications, drops for other eye conditions

• Medical conditions: Rheumatoid arthritis, SLE, Sjogren’s Syndrome

• Environmental Factors: Low humidity from central heating or airconditioning, or living in a hot dry climate can cause increased evaporation of tears

• Contact Lens usage

• Having a low blinking rate increases evaporation of tears often seen when spending long periods concentrating on computer screens

Symptom

Both eyes are affected by:

• Irritation in the eyes: gritty or burning sensation.

• Temporary blurring of vision from time to time.

• Discomfort when looking at bright lights.

• If you wear contact lenses, they become uncomfortable and intolerable

How are dry eyes diagnosed?

A doctor usually can diagnose dry eyes from the symptoms and examining your eye. Dry eyes can bea symptom of an underlying disease (such as Sjögren's syndrome), and your doctor may inquire about other symptoms.

Sometimes a tests are done to confirm the diagnosis; Schirmer's Tear Test: measures the quantity of tears; Further examination with a slit lamp can show up dry patches or ulcers on the surface of the eye.

treatment

Most treatments for dry eyes are aimed at moisturising and lubricating the eye.

• Artificial tears: come as eye drops and gels. You may need to use them regularly to keep symptoms away.

• Dietary changes: Fats from fish oils in the diet can improve dry eyes. Therefore, including oily fish in your diet once or twice a week may be beneficial.

Dry eye treatment can be aided by

• Trying to keep your environment less dry by using a humidifier.

• Wearing glasses or sunglasses to protect your eyes from wind and dust in a hot, dry environment.

• Resting your eyes by taking regular breaks if you spent long periods in front of a screen or staring down a microscope

LOW VISION AID

Severe vision impairment that cannot be fully corrected with glasses, contact lenses, medication, or eye surgery is called low vision.

causes

• Blurred or partially obscured central vision: Macular degeneration

• Blind spots, blurriness and visual distortions: Diabetic retinopathy

• Poor peripheral vision, or tunnel vision: Glaucoma

• Poor peripheral vision, and inability to see in the dark: Retinitis pigmentosa

• Eye injuries

• Poor central vision which may progress to no light perception: Optic neuropathies which may be inherited or acquired (toxic)

low vision aid devices

They are designed to improve visual performance in individuals with low vision, enabling social adaptation and providing improvement of daily experiences. They can be optical or optical and electronic.

• Magnifying spectacles

• Magnifying spectacles

• Telescopes

• Video magnifiers

Low Vision Techniques

Life style changes called low vision techniques can help with daily tasks

• Increase lighting in your home by using higher wattage bulbs and make sure all areas have adequate lighting to prevent falls and improve visibility.

• Reduce glare by adjusting the lighting to minimise it. Sunglasses and a wide-brimmed hat or a shawl can protect your eyes from glare.

• Special low-vision equipment: "talkback" clocks and remotes are also readily available and affordable

Our specialist team will examine, treat and guide you if you have low vision

RETINAL DETACHMENT

What is retinal detachment?

Retinal detachment is an eye problem that happens when your retina (a light-sensitive layer of tissue in the back of your eye) is pulled away from its normal position at the back of your eye.

What are the symptoms of retinal detachment?

If only a small part of your retina has detached, you may not have any symptoms.

But if more of your retina is detached, you may not be able to see as clearly as normal, and you may notice other sudden symptoms, including:

• A lot of new floaters (small dark spots or squiggly lines that float across your vision)

• Flashes oflight in one eye or both eyes

• A dark shadow or “curtain” on the sides or in the middle of your field of vision

• Retinal detachment is a medical emergency. If you have symptoms of a detached retina, it’s important to go to your eye doctor or the emergency room right away.

The symptoms of retinal detachment often come on quickly. If the retinal detachment isn’t treated right away, more of the retina can detach — which increases the risk of permanent vision loss or blindness

Am I at risk for retinal detachment?

Anyone can have a retinal detachment, but some people are at higher risk. You are at higher risk if you had:

• A serious eye injury

• Eye surgery, like surgery to treat cataracts

• You may need a laser or cryopathy to seal the tear.

• Diabetic retinopathy (a condition in people with diabetes that affects blood vessels in the retina)

• Extreme nearsightedness (myopia)

• You or a family member has had a retinal detachment before

What causes Retinal Detachment?

There are many causes of retinal detachment, but the most common causes are aging oran eye injury.

There are 3 types of retinal detachment: rhegmatogenous , tractional, and exudative. Each type happens because of a different problem that causes your retina to move away from the back of your eye.

how can i prevent retinal detachment ?

• Since retinal detachment is often caused by aging, there’s often no way to prevent it.

• If you experience any symptoms of retinal detachment, go to your eye doctor or the emergency room right away. Early treatment can help prevent permanent vision loss.

How will we check for retinal detachment?

• Check for signs of retinal detachment using Ophthalmoscopes

• B – Scan(Ultrasound based scan)

• Optical Coherence Tomography (OCT)

All these tests are painless and help in diagnosing Retinal detachment.

TREATMENT OF RETINAL DETACHMENT

Laser photocoagulation:

If you have a small hole or tear in your retina, your doctor can use a medical laser to seal any tears or breaks in your retina. This is a quick procedure done in OPD and does not require admission.

surgery:

• If a larger part of your retina is detached from the back of your eye, you may need surgery to move your retina back into place.

• It involves removing the fluid in the eye (Vitrectomy)along with any tissue that is tugging on the retina.

• Then Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina.

• Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.

•  After surgery your vision may take several months to improve.

what is uveitis ?

Uveitis occurs when the middle layer of the eyeball gets inflamed (red and swollen). This layer, called the uvea, has many blood vessels that nourish the eye. Uveitis can damage vital eye tissue, leading to permanent vision loss.

Three types of uveitis

There are 3 types of uveitis. They are based on which part of the uvea is affected.

• Swelling of the uvea near the front of the eye is called anterior uveitis. It starts suddenly and symptoms can last many weeks. Some forms of anterior uveitis are ongoing, while others go away but keep coming back.

• Swelling of the uvea in the middle of the eye is called intermediate uveitis. Symptoms can last for a few weeks to many years. This form can go through cycles of getting better, then getting worse.

• Swelling of the uvea toward the back of the eye is called posterior uveitis. Symptoms can develop gradually and last for many years

• In severe cases, all layers may be involved

what casues uveitis ?

You are more likely to get uveitis if you have or have had

• Infections such as shingles virus, herpes simplex virus, syphilis, Lyme disease, and parasites such as toxoplasmosis

• Diseases such as inflammatory bowel disease (IBD), rheumatoid arthritis or lupus

• An eye injury

• Smoking (cigarettes, cigars or pipes) also increases your risk of getting uveitis

symptoms

Uveitis can develop suddenly. Symptoms can include:

• having a red eye with or without pain

• being very sensitive to bright light

• having blurry vision

• seeing “floaters” (specks or moving clouds in your vision) all of a sudden

diagnosis

Eye doctors will give you some eye drops todilate (widen) your pupil and then check your eyes for uveitis using  a slit lamp microscope. It is a simple andpainless examination.

Since uveitis is often connected with other diseases or conditions, some other tests like blood or skin tests, imaging tests may also be needed

How Is Uveitis Treated?

• Uveitis needs to be treated right away to prevent lasting problems.

• Ophthalmologists often treat uveitis with eye-drop medicine that reduces inflammation (corticosteroids).

• They may also use an eye drop to widen (dilate) the pupil, which helps reduce pain and swelling. Sometimes medicine may need to be given by injection or taken by mouth.