Ophthalmology

• Glaucoma

Key Features of Glaucoma

There are three key features of Glaucoma:

Increased IOP:

The pressure inside the eye is measured with NCT (Non-Contact Tonometer) Goldmann applanation tonometer. A prism with blue lights touches the eye to accurately check IOP.

Cupping and Atrophy of the Optic Nerve:

It is the drying up of the nerve of sight as it suffers damage due to high pressure inside the eye. It is assessed by examination of fundus of the eye.

Symptoms:

Unfortunately, there are no symptoms. Disease may effect 80% of the vision before a person realizes feels effect on the vision. A person with chronic Glaucoma is unaware of the disease. It is the silent killer of vision. On the other hand, Acute Glaucoma, in which pressure rises rapidly, causes severe symptoms that force patient to consult the doctor.

Some Symptoms suggestive of Glaucoma are:

1. Poor Night Vision
2. Appreciation of Blind area
3. Headaches during dusk and dawn
4. Pain in eyes associated with smoky vision
5. Halos around light
6. Frequent change in number of reading glasses

RISK FACTORS

People with high Intraocular Pressure have a higher risk of developing optic nerve damage. Other important risk factors include advancing age, high myopia (near sighted), family history of Glaucoma, presence of Diabetes, past injury to the eye, surgery, or history of severe anaemia or shock. We will weigh all these factors before deciding whether the patient need treatment for Glaucoma or not. If your risk of developing Glaucoma is higher than normal but there is no damage as yet, you will be monitored periodically as a “Glaucoma Suspect”.

High end Technology for Diagnosis

The slow death of nerve fibers is the earliest change to occur in Glaucoma. This nerve fiber layer damage is picked by an instrument called OCT. Visual Field defects are missing as are in the field of sight, though the person may be seeing well otherwise. This is measured with an instrument called perimeter(HVF). The modern perimeter is computerized to evaluate, self analyze, compare and report the defects.

EARLY DETECTION

Regular eye examination at WecareSecurex Clinique is the best place to detect Glaucoma. During a complete work up for Glaucoma, we will measure the Intraocular Pressure (Tonometry), the central corneal thickness (Pachymetry), inspect the drainage angle of the eye (Gonioscopy), evaluate for optic nerve head damage (Ophthalmoscopy), test the visual field of each eye (Perimetry), evaluate for retinal nerve fibre layer OCT.

TYPES OF GLAUCOMA

The drainage portion of the eye, called the “angle” is like a sieve and can get blocked in different ways.

Open Angle Glaucoma-It gets suddenly blocked by the iris closing off the angle. Eye pressure increases rapidly, resulting in sudden blurring of vision, severe eye pain, headache, rainbow halos around light, nausea and vomiting. It is an emergency and if not treated immediately leads to blindness. A small hole in iris with laser prevents attack of “Primary Angle Closure Glaucoma”.

Closed Angle Galucoma- In the second type of Glaucoma, the out flow sieves get slowly blocked. This leads to insidious rise in pressure, known as “Primary Open Angle Glaucoma”. It damages vision so gradually and painlessly that a person is unaware of the trouble until the optic nerve is badly damaged. It has no symptoms. This type of Glaucoma is much more common.

• Glaucoma can also occur secondary to injury, inflammation of eye, drugs, cataract etc. Glaucoma may rarely be present at birth. The parents may notice their baby’s eye enlarging and hazy(since a baby’s eye is more elastic than an adult). The infant or child should be taken to an ophthalmologist immediately.

TREATMENT

Medical Treatment

Eye drops are the first line of treatment. They act to decrease eye pressure either by reducing the production of aqueous fluid within the eye or by improving the outflow through the drainage angle. Instill drops properly and regularly at prescribed timings. Tablets may be required at times. Medication should never be stopped or changed without consulting your ophthalmologist. Frequent eye examinations and tests are crucial to monitor any changes in your Glaucoma.

Laser Treatment

Laser surgery is effective for some types of Glaucoma. In chronic open angle Glaucoma, the drain itself is treated (trabeculoplasty), and the laser helps to reduce the medications to control the pressure. In angle-closure Glaucoma, a hole is made in the iris (Laser iridotomy) to restore the free flow of aqueous fluid.

Surgical Treatment

Surgery for Glaucoma would be recommended only if the medicines fail to prevent damage to the optic nerve. Whatever may be the approach, the objective of the treatment is to lower the eye pressure to a level at which optic nerve damage does not develop or worsen.

In advanced cases, surgery (trabeculectomy) is necessary to control Glaucoma. Miniature instruments are used to create a new drainage channel for fluid to leave the eye, thus lowering the pressure in advanced cases. If surgery fails, special Glaucoma valves can be implanted. Fortunately, serious complications of modern Glaucoma surgery are rare.

• Vitreo-Retinal Diseases

Diabetic Retinopathy

Diabetic Retinopathy, a complication of diabetes, is caused by changes in the blood vessels of retina, the light sensing nerve layer at the back of the eye. These damaged blood vessels leak fluid, lipid and blood which get deposited in the retina. As a result, the images which the retina sends to the brain become blurred, distorted or partially blocked.
Diabetic Retinopathy is the leading cause of blindness among adults in our country. The risk of developing diabetic retinopathy increases with the age of diabetes. About 80% of population with diabetes of more than fifteen years, will have some damage to the blood vessels of their retina. Besides, uncontrolled diabetes, fluctuating blood sugar levels, hypertension (high blood pressure), high blood cholesterol, anemia, effect of diabetes on kidneys and pregnancy aggravate Diabetic Retinopathy.

Types of Diabetic Retinopathy

1. Nonproliferative Diabetic Retinopathy (NPDR): This is an early stage of diabetic retinopathy. Fine blood vessels leak fluid and lipids causing the retina to form deposits called exudates. This problem is called Diabetic Macular Edema. Sight can be restored if treated in time. If left untreated, macular edema can worsen and vision is lost. Reading and close work may become more difficult: In some diabetic patients, vision may be permanently impaired due to reduced blood supply to the central part of retina – a condition called macular ischemia.

2. Proliferative Diabetic Retinopathy (PDR): Proliferative Diabetic Retinopathy is the advanced stage and more serious form of diabetic retinal disease. It affects up to 20% of diabetics and can cause severe loss of sight, including blindness. Abnormal blood vessels may rupture and bleed into vitreous. This leaking blood blocks the light, causing severe impairment of vision. These abnormal blood vessels frequently grow scar like tissue with them which may pull the retina away from its normal position at the back of the eye (retinal detachment).

Diabetic Retinopathy is a painless condition. One can have Non-proliferative Diabetic Retinopathy for a long time without any symptoms. Thus changes in the eye can go un-noticed unless detected by an eye examination. Gradual painless blurring of vision suggests onset of diabetic retinopathy. A sudden loss of vision points to bleeding inside the eye due to proliferative diabetic retinopathy. This severe form of diabetic retinopathy requires immediate medical attention or surgery.

Treatment of Diabetic Retinopathy

Anti-VEGF therapy

Latest advances in the treatment of diabetic retinopathy has been the introduction of anti-VEGF therapy. Inj-Bevacizumab (Avastin) is one of such drugs which is injected directly into the eyeball and has shown promising results in management of Diabetic Macular Edema and Diabetic Vitreous Hemorrhage.

Supportive Treatment

Besides control of diabetes, management of any associated condition like;

• Hypertension,
• High cholesterol levels
• Anemia
• Nephropathy (effects of diabetes on kidneys) is very important to prevent aggravation of diabetic retinopathy.
• Steroid injections given in the outer layer of eye ball prevent leakage of fluid for 6-8 weeks.

Medication

Lipid or cholesterol lowering drugs (Atorvastatin) also help in reducing the Diabetic Retinopathy.

• Paediatric OPHTHALMOLOGY and STRABISMUS (SQUINT)

Paediatric ophthalmology is a subspecialty of ophthalmology that concerns vision care in children. Since the visual system is in a developing phase in childhood, hence it is imperative that any eye disorder in children be identified and rectified, as early as possible. paediatric ophthalmologists treat eye defects in children through medication, therapies, and complex eye surgeries. Due to their expertise in handling eye movement disorders, paediatric ophthalmologists also treat squint in adults.

WHY YOUR CHILD NEEDS AN EXPERT PAEDIATRIC OPHTHALMOLOGIST?

Children experience a variety of eye problems, which are relatively distinct from adult eye diseases.

• It is crucial to be attentive to children’s eye care when their eye-brain connections are still developing and strengthening. All of these reasons demand an additional emphasis on their requirements.
• Any problem at this stage has the potential to hinder their future visual capabilities permanently Children’s eye care issues may not always be apparent, and the child may not complain. Hence, the need to objectively assess the needs, if any.

Common Eye Related Symptoms in Children

The most commonly noticeable sign in children is the challenge in reading the content written on blackboards in school. Sometimes, they even struggle to write in their notebooks.

• It is easy to recognise a physical symptom such as misalignment of the eyes, a squint in the eyes, drooping eyelids, or any other physical deformity around the eyes that may appear to affect the vision. Timely detection and diagnosis are essential for treatment for squint eyes.
• Children often feel more discomfort as compared to adults who have a higher tolerance for pain or irritation. Any signs of frequent headaches along with watery or red eyes, recurring inflammation or irritation in the eyes, should not be dismissed easily.
• Easy susceptibility to different types of eye infections is also a very visible indicator that a detailed eye check-up is a must for the child.
• Some of the disorders regarding the sense of sight are also hereditary. If one has a family history of eye-related disorders or needs corrective glasses, the same problems may manifest in children.

Common Eye Disease in Children

The most common eye diseases seen in children are squint, refractive errors (spectacle requirement), lazy eye disease, congenital or paediatric cataract, retinopathy of prematurity (ROP), and rarely tumours.

Understanding Squint (Strabismus)

Strabismus or squint is an eye condition in which the eyes are not aligned in the same direction. This eye disorder may or may not manifest in children. They usually develop before five years of age but can appear later too.

Strabismus may also occur in adults due to residual childhood strabismus. Treatment for squint eyes becomes unmissable if you notice one eye of your child turning inwards, upwards, downwards, or outwards, while the other one focuses on one spot.

Depending on the type of strabismus, the expert surgeons perform squint surgery or strabismus surgery. We have some of the most reliable names in the field of ophthalmology, eye procedures, and squint treatment.

If ignored or left untreated, squint, or strabismus may lead to further severe problems like persistent blurred or double vision, and lazy eye- an early childhood eye condition in which the eyesight does not develop properly in one eye. This eye condition is also known as amblyopia.

Other Paediatric Ophthalmology Services Available:

• Blocked tear ducts
• Ptosis
• Abnormal vision development
• Retinopathy of prematurity
• Amblyopia
• Convergence insufficiency
• Congenital malformations
• Refractive errors such as myopia, hyperopia, astigmatism, etc

Squint eye treatment (Cross-eyed Treatment)

The paediatric ophthalmologists’ team offers all forms of treatment for strabismus. Based on the patient’s condition, our team provides correct consultation and the treatment that will go with the specific eye condition. With more than two decades of experience in eye care and squint correction surgery, choosing for strabismus surgery is the right decision. The surgeon performing the squint correction surgery needs to know the exact cause of the misaligned eyes. Unbalanced muscles, Nerve defects,or any other condition could be the reason for eyes to turn.

After a thorough eye examination, including a comprehensive study of the inner parts of the eye, our surgeons advise appropriate optical, medical, or surgical therapy.
Strabismus treatment or cross-eyed treatment needs to be early and aggressive. If the eye turn is constant and patching, glasses (bifocal, prismatic, etc.) do not eliminate the eye turn; then, surgery needs to be considered.

Are squint eye exercises helpful in dealing with the condition?

Practising eye exercises, as recommended by the ophthalmologists, may help in aligning eyes in selected cases. There are many vision therapy programs that are customized according to the needs of the patient. Squint eye exercises in a vision treatment plan are advised only after a thorough eye examination.

Squint eye exercises aim to improve the coordination of the eyes and to delay the need for surgery. They can be done at home or as suggested by the expert.

Some of the widely known squint eye exercises are:
● Pencil exercise
● Brock string exercise
● Pencil push-ups
● Machine-based exercises

How to correct squint eyes in babies?

We offer regular check-ups, plan treatments, and provide a comprehensive diagnosis of your childs eye care needs. Get quality squint correction surgery. Our eye specialists for kids always make sure to lighten the environment in our paediatric ophthalmology department. Our paediatricophthalmologists ensure hassle-free treatment of your little ones.
Crossed-eye surgery or squint surgery is pretty common. Mild cases are managed with spectacles, wherever possible. However, significant eye deviations, not correctable by glasses alone, require surgery. Squint correction is a highly specialized surgery performed by our eye specialists for kids and is a common treatment for squints

·        Refraction errors/Refractive Errors

At a glance: Refractive Errors

Types: Nearsightedness (myopia), farsightedness (hyperopia), astigmatism, presbyopia

Most Common Symptom: Blurred vision

Diagnosis: Eye exam

Treatment: Eyeglasses, contact lenses, surgery

What are refractive errors?

Refractive errors are a type of vision problem that makes it hard to see clearly. They happen when the shape of your eye keeps light from focusing correctly on your retina (a light-sensitive layer of tissue in the back of your eye).

What are the types of refractive errors?

There are 4 common types of refractive errors:

• Nearsightedness (myopia) makes far-away objects look blurry
• Farsightedness (hyperopia) makes nearby objects look blurry
• Astigmatism can make far-away and nearby objects look blurry or distorted
• Presbyopia makes it hard for middle-aged and older adults to see things up close

What are the symptoms of refractive errors?

The most common symptom is blurry vision. Other symptoms include:

• Double vision
• Hazy vision
• Seeing a glare or halo around bright lights
• Squinting
• Headaches
• Eye strain (when your eyes feel tired or sore)
• Trouble focusing when reading or looking at a computer

Some people may not notice the symptoms of refractive errors. It’s important to get eye exams regularly — so your eye doctor can make sure you’re seeing as clearly as possible.

If you wear glasses or contact lenses and still have these symptoms, you might need a new prescription. Talk to your eye doctor and get an eye exam if you are having trouble with your vision.

Que: Am I at risk for refractive errors?

Anyone can have refractive errors, but you’re at higher risk if you have family members who wear glasses or contact lenses.

Most types of refractive errors, like nearsightedness, usually start in childhood. Presbyopia is common in adults ages 40 and older.

Talk with your doctor about your risk for refractive errors, and ask how often you need to get checked.

Que: What causes refractive errors?

Refractive errors can be caused by:

• Eyeball length (when the eyeball grows too long or too short)
• Problems with the shape of the cornea (the clear outer layer of the eye)
• Aging of the lens (an inner part of the eye that is normally clear and helps the eye focus)

Que: What’s the treatment for refractive errors?

Eye doctors can correct refractive errors with glasses or contact lenses, or fix the refractive error with surgery.

Glasses. Eyeglasses are the simplest and safest way to correct refractive errors. Your eye doctor will prescribe the right eyeglass lenses to give you the clearest possible vision.

Contacts. Contact lenses sit on the surface of your eyes and correct refractive errors. Your eye doctor will fit you for the right lenses and show you how to clean and wear them safely.

Surgery. Some types of surgery, like laser eye surgery, can change the shape of your cornea to fix refractive errors. Your eye doctor can help you decide if surgery is right for you.

Contact Lens Clinic

Contact lenses are thin, clear disks of plastic that float on the surface of the eye.

Contact Lenses for Vision Correction
Millions of people around the world wear contact lenses. When used with proper care and maintenance, contact lenses may provide a safe and effective alternative to eyeglasses. They correct vision like eye glasses and are safe when used with care. Contact lenses are used to correct the same conditions that eyeglasses do i.e.

• Myopia (nearsightedness),
• Hyperopia (farsightedness),
• Astigmatism (blurred vision due to the shape of the cornea)
• Presbyopia (inability to see close up).

Types of Contact lens
There are two general types of contact lenses: hard and soft.

1) The hard lenses most commonly used today are rigid, gas-permeable lenses (RGP). They are durable, resist deposit build up, and generally allow for clear, crisp vision. They last longer than soft contacts, and also are easier to handle and less likely to tear. However, they may take a few weeks of getting used to.
2) Soft lenses are the choice of most contact lens wearers. These lenses are comfortable and made of flexible plastic that allow oxygen to pass through the cornea. Daily-wear lenses are the least expensive, are removed every night and are replaced on an individualized schedule. They should not be used as an extended-wear lens.
3) Extended-wear lenses are worn overnight but are removed at least weekly for thorough cleaning and disinfection. They are recommended less frequently, since there is a greater risk of corneal infection.

Important Things to Know About Contact Lenses

Lens Care Tips:

Optical Store:

• Frames
• Goggles
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