Eye Treatment

The term `cataract&rsquo` is used to describe the clouding of the natural lens of the eye. The vision dims because the cataract prevents light from passing beyond the lens and focusing on the retina.

Common symptoms of a cataract:

• Painless blurring of vision
• Glare or light sensitivity
• Frequent changes in eyeglass prescription
• Poor night vision
• Needing a brighter light to read
• Double vision in one eye
• Fading colours

Common misconceptions cleared:

• Cataract is not a film over the surface of the eye
• It is not caused by overusing the eyes
• It is not infectious and will not spread from one eye to the other
• It is not a cancer
• It is not a cause of irreversible blindness

What causes a cataract?

• The most common cause is due to aging and referred to as a `senile cataract`.
• Other common causes are:
• Family history
• Medical problems, such as diabetes
• Long-term use of medications, such as steroids
• Injury to the eye
• Congenital, since birth
• Previous eye surgery
• Long-term unprotected exposure to sunlight

How is a cataract detected?

A thorough eye examination by an ophthalmologist detects the presence and the extent of a cataract. Other conditions that could additionally compromise vision can also be detected, particularly problems involving the cornea, retina or the optic nerve.

How fast does a cataract develop?

Cataract development varies among individuals and may even vary between the two eyes. Most cataracts associated with the aging process develop over years. Cataracts in younger patients and in those with diabetes may develop more rapidly.

How do you treat a cataract?

Surgery is the only way a cataract can be treated. No dietary supplements, medications, exercises or optical devices have been proven to prevent or cure cataract.

When should surgery be done?

Surgery should be considered when the cataract causes visual disturbance enough to interfere with daily activities. Based on these needs and the examination findings, the patient and the ophthalmologist should decide together when surgery is appropriate. Cataracts need not be mature or `ripe` before removal.

What should you expect from a cataract surgery?

Cataract surgery is a day care, microscopic surgery performed under anaesthesia eye drops or local anaesthesia. The cloudy lens is removed leaving its capsule behind, within which a permanent, artificial intraocular lens is implanted. Today, there are a wide range of intraocular lens implants available, which not only replace the cataract, but also give visual advantages with better near vision, improved night vision and also can reduce or eliminate the need for spectacles post surgery.

After cataract surgery, you can return immediately to almost all routine activities. Medication must be administered as per the instructions of your cataract surgeon or ophthalmologist.

Can a cataract be treated with medicines or a laser?

No. Since the cataract occurs within the lens matter of the eye, no medication stops the progress of or treats the cataract. There is no medical or laser treatment for cataract other than replacing this lens with a surgery.

However, in layman terms today`s modern cataract surgery is called `laser cataract surgery` as there are no stitches, although there is no actual use of the laser. The cataract is dissolved using ultrasound waves from an equipment and is medically termed `phacoemulsification`.

Today`s procedures are quick, not taking more than 20 minutes of surgical time, pain free under topical (only eye drops) or local anaesthesia. Ask your ophthalmologist if you are eligible for topical aneasthesia.

Are there any complications of cataract surgery?

At our centres, we follow the highest standards of healthcare and strict protocols of infection control. We understand your fears regarding an eye surgery, but you stand a greater risk of not doing cataract surgery when required, as the longer you wait the more difficult it becomes to treat the cataract easily and there is a greater chance of surgical complications.

Standard Vs Premium Lens Implants?

Multifocal and Accomodative Implants are a new technology in cataract treatment wherein you can gain additional benefit of reducing your dependence on reading glasses.

Standard Lens Implants

• 1. Single focus- usually distant
• 2. 100% need for reading glasses
• 3. Insurance usually covers the cost

Premium Lens Implants

• 1. Multiple focuses- near, intermediate and distant
• 2. Reduces or eliminates need for reading glasses

RETINA

What is the retina?

The retina is a nerve layer at the back of the eye that senses light and sends images to the brain.

What is a retinal detachment?

The retina is attached to the inner back surface of the eye. Detachment is the pulling away of the retina from its normal position. The separation of the retina from the wall of the eye impairs its normal functioning, resulting in blurred vision.

What causes retinal detachment?

The vitreous is a clear gel that fills most of the space in the eye. It is located in front of the retina. With age, the vitreous pulls away from its attachments to the retina, usually without causing problems. Sometimes the vitreous pulls hard enough to tear the retina. Fluid may then pass through the retinal tear and lift the retina off the wall of the eye.

Risk factors for retinal detachment:

• Myopia or near-sightedness
• Injury to the eye
• Previous retinal detachment in the other eye
• Family history of retinal detachment
• Areas of thin/weak retina
• Complicated cataract surgery

Warning symptoms of retinal detachment:

• Flashes of light
• New, or increase in, floaters [black dots in your vision]
• A gray curtain noticed in the field of vision

How is retinal detachment diagnosed?

The retina is examined with an instrument called the indirect ophthalmoscope after dilating the pupil. Holes and tears are carefully looked for in the periphery of the retina.

Treatment

Retinal tears without detachment – Laser photocoagulation or cryotherapy is performed around the tear to seal the retina to the back wall of the eye.

Retinal tears with retinal detachment – Requires surgery as soon as possible to put the retina back in its proper position. The longer the retina stays detached, the less the visual improvement after surgery. Scleral buckle surgery – A flexible silicone band is placed around the eye to counter the force pulling on the retina after removing the fluid under the detached retina.

Vitrectomy – The vitreous gel pulling the retina is removed from the eye and replaced with a special gas or silicone oil.

Visual recovery

The more severe the retinal detachment and the longer its duration, the less is the visual improvement after surgery. For this reason it is very important to see an ophthalmologist at the first sign of any trouble. If the condition is left untreated it results in loss of useful vision.

LASIK

Now you can lose your glasses…. on purpose!!

Remember how your life changed when you had to get glasses? Now you can change it back and see naturally again. All this is possible now thanks to laser vision correction. We know you need more information to make an informed decision; so we would like to answer some of the questions you may have while considering this procedure.

What is LASIK ?

Laser Assisted Stromal In-situ Keratomileusis [LASIK] is a method of re-shaping the external surface of the eye [the cornea] to correct low, moderate and high degrees of nearsightedness, astigmatism and far-sightedness. During the treatment, an instrument called the microkeratome creates a corneal flap to make it a painless procedure. The computerized Excimer laser then uses a cool beam of light to gently reshape the cornea so as to alter its curvature to the desired extent. The flap when replaced on the new corneal curvature allows images to be sharply focused on the retina. The goal is to eliminate or greatly reduce the dependence on glasses or contact lenses.

Who is a candidate ?

Is LASIK safe ?

Yes. When choosing this method to improve your vision safety should be your first concern. It`s ours too. New generation Excimer lasers and advances in technique offer the highest degree of accuracy and utmost safety. Recent studies conducted internationally and by us show it to be a very safe and effective procedure.

Is LASIK successful ?

Yes. LASIK is a permanent treatment. However, patients who are 40 years and above may require reading glasses. Millions of patients worldwide and thousands at our centre have had an Excimer laser refractive procedure done on them successfully. During your consultation we will give you an idea of the procedure and the level of vision you can expect.

Are there other refractive procedures ?

You may have heard about PRK [photo refractive keratectomy]. You may have also heard about the surgery known as RK [radial keratotomy]. You need to understand that these are two completely different procedures from LASIK with less predictable results.

Is this the latest technology ?

The latest and most reliable procedure is wavefront-guided LASIK, a customized treatment for each eye. Our excimer lasers use high-speed sensitive eye trackers to ensure perfectly centered treatments. Wavefront procedures even often leave patients with eyesight better than normal. We are committed to providing our patients with the best that technology and technique has to offer. This is one of the best laser in Mumbai, India

Does this procedure hurt?

No. There is no pain during the procedure. There may be mild discomfort for a few hours after the procedure.

I need to know what to expect the day of treatment ?

This is an outpatient procedure. The laser treatment usually takes less than a minute. The entire procedure usually takes 5-10 minutes per eye. First you will lie on a motorised bed to which the laser is attached. Anesthetic drops will be placed in the eye. The head is positioned under the laser and the eyelids are gently and comfortably kept open during the treatment with the help of a soft clip by our doctor. You will be asked to look at a blinking light during the entire procedure. Once the procedure is completed, a soft corneal protective shield is sometimes placed on the eye. A post-procedure eye examination is performed and eye drops are prescribed. We will inform you about the follow-up schedule.

How soon can i return to work ?

You will notice an improvement in vision within 4-6 hours and a restoration of functional vision by the next morning. However, complete recovery may take up to 48 hours. Some people get back to work the day after treatment. Two or three days are suggested.

BLADEFREE LASIK

Bladeless All Laser LASIK using the Femtosecond Laser from Carl Zeiss - VisuMax

The Bladeless LASIK option utilizes a precise, high-energy femtosecond laser instead of a microkeratome to create the flap of corneal tissue. The femtosecond laser we use is the VisuMax, which is one of the more advanced recent lasers today.

In general, patients who qualify for LASIK are also candidates for the VisuMax laser corneal flap treatment, and thus will benefit from its accuracy and gentleness.

Benefits of Blade-Free

• The Visumax laser provides more stability and greater flap precision when compared to LASIK.
• LASIK’s greatest complication is flap problems after surgery. Because blade free is so precise, this risk is significantly reduced.

The real benefits for some patients include:

• Decreased risk of flap complications.
• Decreased incidence of postoperative dry eye
• Unlike other alternatives to LASIK, it preserves many of the benefits of LASIK including a short and largely pain-free recovery.
• More accurate outcomes in terms of patients’ postoperative vision.
• Benefits of vision correction surgery are available to those who might have previously been poor candidates.
• Less pressure on the eye during the surgery.
• Reduced incidence of patients needing a second operation to correct their vision.
• Flaps created with a laser are less likely to become dislodged later

Glucoma

Silent thief of sight

Glaucoma is the most serious eyesight threatening condition of the eye. It usually manifests as a painless gradual loss of vision. The lost vision can never be recovered. However, medical or surgical treatment can prevent or retard further loss of vision.

Many a times it can be confused with a cataract which also manifests as a painless gradual loss of vision. The difference is that in the case of cataract, the loss of vision is fully recoverable by means of a simple surgery called Phaco. Our eyes contain a clear fluid called aqueous humour, which is continuously produced in the eye to bath and nourish the structures inside it. The fluid normally drains out of the eye through drainage canals in a fine mesh work located around the edge of the iris (the colored part of the eye that surrounds the pupil). In people with glaucoma the fluid fails to drain due to some defect and thus increases the pressure inside the eyes called raised Intraocular Pressure (IOP) (or Tension).

In most cases of glaucoma, the patient is not aware of the gradual loss of sight until vision is significantly impaired.However, if glaucoma progresses without adequate treatment, the following symptoms may occur in some individuals:

• Pain around the eyes when coming out from darkness (e.g., as soon as the person comes out of a cinema hall)
• Colored halo rings seen around light bulbs especially in the mornings and nights
• Frequent change of reading glasses, headaches, pain and redness of the eyes
• Reduced vision in dim illumination and during nights
• Gradual decrease of side vision with progression of glaucoma

Types Of Glaucoma

It happens when the eye’s drainage canals become clogged over time. The inner eye pressure (also called intraocular pressure or IOP) rises because the correct amount of fluid can’t drain out of the eye. With open angle glaucoma, the entrances to the drainage canals are clear and open. The clogging problem occurs further inside the drainage canals, similar to a clogged pipe below the drain in a sink. Most people have no symptoms and no early warning signs. If open angle glaucoma is not diagnosed and treated, it can cause a gradual loss of vision. This type of glaucoma develops slowly and sometimes without noticeable sight loss for many years. It usually responds well to medication, especially if caught early and treated. This form of glaucoma is more common in Caucasians.

This type of glaucoma is also known as acute glaucoma or narrow angle glaucoma. It is more common in Asian and is very different from open angle glaucoma in that the eye pressure usually rises very quickly.This happens when the entrance to the drainage canals are very norrow or covered over, like a sink with something covering the drain. Symptoms of angle closure glaucoma may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.

Low-tension or normal-tension glaucoma:

In this type of glaucoma, the optic nerve is damaged even though intraocular pressure (IOP) is not very high. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. A comprehensive medical history is important in identifying other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.

Congenital glaucoma:

Children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines may have unknown effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas:

These can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery.

Glaucoma Treatment

Glaucoma is a chronic (long lasting) progressive condition. Any vision loss that has occurred, before glaucoma was diagnosed, cannot be reversed. Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

• Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
• Glaucoma medicines may be taken several times a day .Since glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.
• Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you need to keep taking glaucoma drugs after this procedure. Laser trabeculoplasty is performed in your doctor’s office or eye clinic. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your doctor will hold a special lens to your eye. A high-intensity beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.
• Glaucoma Filtering surgery. Conventional surgery makes a new opening for the fluid to leave the eye. Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure. Before the surgery, you will be given medicine to help you relax. Your doctor will make small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye.

As with laser surgery, conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart. Conventional surgery is about 60 to 80 percent effective at lowering eye pressure

Cornea

The cornea is the transparent, dome-shaped tissue covering the front of the eye. Replacing the damaged or opaque cornea with a clear, healthy cornea from a donor is referred to as corneal transplant, corneal graft or Penetrating Keratoplasty (PK). There are many different types of Corneal transplants depending on the part of Cornea damaged. All types of Corneal transplants are performed routinely in our hospital. Of all issue transplants in a human body, corneal transplants are the most successful.

Keratoplasty / Corneal Transplant

A graft replaces central corneal tissue, damaged due to disease or injury, with healthy corneal tissue donated from a local eye bank. An unhealthy cornea affects your vision by scattering or distorting light and causing blurry or glary vision. A cornea transplant may be necessary to restore your functional vision.

An unhealthy cornea affects your vision by scattering or distorting light and causing blurry or glary vision. A cornea transplant may be necessary to restore your functional vision. Cornea transplants are performed routinely in our hospital n fact, of all tissue transplants, the most successful is a corneal transplant.

Are You a Cornea Transplant Candidate?

Corneal Transplant is done in various conditions:

• Hereditary factors or corneal failure from previous surgeries.
• Thinning of the cornea and irregular shape (such as with keratoconus).
• Chemical burns on the cornea or damage from an eye injury.
• Excessive swelling (edema) on the cornea.
• Corneal transplants are performed in order to protect the eye`s inner structures, relieve pain, and improve vision.

Tears are a combination of water for moisture, oils for lubrication, mucus for even spreading . These components are secreted by special glands. When there’s imbalance in this tear system, a person may experience dry eye.

How to recognize dry eye?

When tears do not adequately lubricate the eye, one may experience:

• Pain
• Light insensitivity
• Gritty sensation
• Feeling of foreign body or dust in eye
• Itching
• Redness
• Blurring of vision

Dry eyes cannot be cured but there are a number of steps that can be taken to treat them. Based on patient to patient ,management includes:

• Artificial lubricant eye drops and ointment
• Punctal occlusion: It is a procedure in which the channels through which tears flow out of the eyes are closed either temporarily or permanently.

Sometimes dry eye can be a result of medicine s the patient is already using or a manifestation of systemic diseases like rheumatoid arthritis. These conditions should be ruled out in the diagnosis of dry eye.

Its an allergic reaction on the surface of the eyes. Its a very common condition that occurs when any allergy causing substances comes in contact with your eyes. The allergic reaction sets in following contact of allergen with the ocular surface.

How to recognize allergic Red eye?

• Usually both the eyes are affected.
• The eyes a re itchy and the white of the eye looks red or pink.
• Feeling of burning sensation
• Tendency to rub the eyes frequently
• Watering of eyes
• Swelling of eye lids.

Treatment

• The best treatment of allergic conjunctivitis is to avoid contact with allergy causing substance.
• If you u
• se contact lens ,do not wear lenses until the symptoms have gone.
• Do not rub your eyes as it increases the inflammation.

Antihistaminic eye drops and mast cell stabilizer eye drops to keep symptoms at bay.

Keratoconus And C3R

Keratoconus is an eye condition where the clear front of the eye, the cornea, gets thin and bulges outward into a cone shape. This spoils the quality of the image projected into the eye, and the vision becomes progressively blurred. This usually begins in the teens or early twenties and affects mostly males Glasses may be sufficient in the early stages of keratoconus, but contact lenses are needed when the cornea becomes so misshapen that glasses are no longer effective in correcting vision. In some cases, the corneal shape becomes too distorted that contact lenses won�t fit. Also, scarring may develop, causing vision to become clouded. At this stage, a corneal transplant is usually needed.

C3-R is a non-surgical keratoconus treatment method that can stop keratoconus from progressing to the stage where contact lenses or corneal transplantation becomes necessary.

Corneal collagen crosslinking with riboflavin causes the formation of normal chemical links between the collagen protein strands in the cornea. This makes the cornea more rigid and can stop the keratoconus from progressing. The treatment may even cause the keratoconus to reverse to some extent.

Anyone with progressive keratoconus is potentially suitable. Patients with very advanced keratoconus or whose vision is already spoiled by scarring will usually not be good candidates for the procedure. The facility of C3R is available at our hospital.