Clouding of the natural lens with age is called cataract. Early symptoms are Glare, Double vision, intolerance of light, blurred vision and difficulty in reading eventually leading to reversible loss of vision. Eye pain, headaches and watering are not the symptoms of cataract.
Cataracts cannot be treated by drops or tablets although some doctors prescribe Cinnereria drops and Renolen drops to buy time.
Phacoemulsification with foldable intraocular lens implantation is the best way to get rid of symptoms and enjoy good quality vision. The procedure is short and is done on an out patient basis under local anaesthesia but it does need careful after care for 2 weeks to avoid infections. Bed rest is not necessary and patient can do almost anything as long as the drops are instilled on time. It is safe to travel 4 days after the surgery if one has to.
LASIK Surgery
It the most common eye operation in the world. Over a million Laser Vision Corrections of refractive errors are done in the US every year and a similar number in India.
What happens in LASIK
This is a procedure where in a cornea is made flatter to focus the external light rays on the retina. It involves making a thin cut in the cornea and applying precise laser energy to make the central cornea flatter and thereby changing the focal point of the eye. It has no effect on the lens or retina.
How does lasik Vison differ from Normal Vision
Following Lasik most patients are able to read 6/9 or better. However the quality of their vision is not the same as spectacle vision. Most patients who have refractive errors which make them spectacle dependant don’t mind that as a trade off for not needing to wear glasses to see distant objects. The main complaint that they have are
- Slight blur/ ghosting to their vision.
- Glare of head-lights at night
- Slight decreased contrast sensitivity
- Feeling of dryness in eyes
- Near vision difficulty
- Over and under correction by 0.50D
All of these improve over a period of time, some people get used to the new situation earlier than others. One must understand that these problems are due to the splitting of the cornea that has become a 2 piece tissue as against the single piece existing naturally. Over a period of time the 2 pieces blend and the brain also adapts to minimise the disability.
In some patients halos appear. This happens when the treatment zone is smaller than the pupil diameter especially in dim light. Therefore measurement of pupil diameter is always done before operating on any patient.
The above vision compromise happens in a successful lasik. Lasik is not a complication free procedure. Rare complications like infection and inflammation (DLK) can occur.
Infections are very rare and caused by rare organisms and need lengthy treatment by drops. It usually affects the eventual visual outcome by scarring the cornea.
Inflammations are usually controlled by intensive steroid drops for a period of 4- 6 weeks and do not affect the visual outcome
Flap related complications can happen in very steep or very flat corneas. These are also rare and do not affect the visual outcome of surgery.
A patient can actually help in getting a good result by focussing on the fixation light throughout the procedure. The slight over or under correction is because each eye behaves differently and each individual has different healing rate.
ARMD (Age Related Macular
Degenraration)
This stands for Age Related Macular Degeneration. As the name indicates the disease affects elderly people and damages the central vision. People very rarely go blind with this disease. Here abnormal blood vessels grow and bleed or leak in the centre of the retina and damage it.
Early symptoms are distortion of vision and need urgent evaluation and treatment with either Laser or with Intraocular injections. The aim of the treatment is to save the remaining vision. A fluorescein angiogram is necessary before doing laser treatment to accurately deliver the laser energy. Patients are advised to monitor their vision at home for distortion by using Amsler Chart and report to the Ophthalmologist if they notice any change in the vision.
The treatment options for wet ARMD are
Argon laser Treatment
Photodynamic Laser treatment
Intravitreal Avastin injections
Intravitreal Lucentis injections
Squint Correction
There are a lot of myths relating to squinting of the eye. A child can be born with squint or it can develop a few months to 2 years after birth.
A child born with squint needs thorough examination to rule out abnormalities of eye as soon as possible because some rare retinal problems can also manifest as squints. Once we ensure that there are no abnormalities of the eye and there is no need for glasses, surgical correction is usually advised at around 18months to 2 years of age.
Usually a squint appearing at around 18months of age can be corrected by giving glasses. However some need surgical correction which is planned before the child is admitted in school to avoid trauma to the child caused by teasing by other children
A squint operation does not affect the vision and also doesn’t alter the appearance of the eye other than straightening of the eyes
Amblyopia-Causes
Uncorrected Refractive error
Presence of Squint.
Mechanical obstruction to entry of light like Ptosis, Cataract, Corneal opacity
This is a condition where the eyeball looks normal but doesn’t have normal vision. This is where vision screening is most important. It detects which child needs glasses for improving the vision and thus prevent the onset of Amblyopia. If a sharp image is not focussed on retina, the patient will not be able to read all the lines on the chart. The brain ignores the defocused image on that side and then the depth perception of the child suffers.
How do you treat Amblyopia(Lazy Eye)
Prevention is the best way to treat Amblyopia. The other method is
Patching the good eye for variable period of time depending on the degree of Amblopia in order to stimulate the vision in the bad eye.
Patching treatment needs a lot of encouragement and motivation from parents who themselves need to understand the problem.
Unfortunately there are no drugs that will help the lazy eye. Laser treatment doesn’t correct the amblyopia
Glaucoma
This is a condition where the Intraocular pressure increases because the fluid doesn’t drain out of the eye and damages the optic nerve permanently. It is the most under diagnosed eye condition because very often it doesn’t affect the vision till there is advanced nerve damage. The damage in Glaucoma starts from periphery of the visual field and therefore goes unnoticed till it affects the centre of the vision. Unfortunately the damage is irreversible unlike in cataract.
How is it treated
The aim of the treatment is to prevent further damage. If diagnosis is made at an early stage drops are able to control the pressure and prevent further damage. Some patients need laser treatment to avoid severe attack and some need operation to control the pressure.
Who are at risk for glaucoma
Patients with family history of Glaucoma
Myopic patients
Diabetic patients
Age above 50 years
Patients suffering from Migraine
Patients who have had blood loss in an accident or major surgery.
A complete Glaucoma evaluation involves measuring IOP, Gonioscopy, Visual field assessment, Nerve fiber layer analysis, Pachymetry and Fundus examination.
Diabetic Retinopathy
This is another common eye disease of elderly diabetic patients that can affect the vision, in addition to Cataract, Glaucoma and ARMD. Very often it is difficult for an Ophthalmologist to see the retina in the presence of cataract. Presence of Diabetic retinopathy is also one of the common reasons for a disappointing result after successful Cataract Surgery. Hence it is crucial not only to diagnose but also to counsel the patient about the possibility of less than satisfactory visual result if retinopathy is present. In addition Diabetics are more prone for infection and inflammation after cataract surgery and hence good diabetic control is advised before undergoing cataract surgery.
Who is likely to have Diabetic retinopathy
Any person who is diabetic for more than 7-8 years is likely to have retinapathy , even when the control of diabetes has been good. Good control of Diabetes certainly has a role in prolonging the development of retinopathy, but it is no guarantee against it. The best way to know if someone has retinopathy is to have dilated (Fundus) retinal examination by a competent Ophthalmologist on a periodic basis. The general rule is once a year if you don’t have retinopathy and more often as advised by Ophthalmologist if there is retinopathy.
Oculoplastic clinic
It is a branch of Ophthalmology where in lid and lacrimal dissorders are
treated. It involves mainly the cosmetic aspects of Ophthalmology like
correction of droopy and baggy lids(Ptosis crrection and Blepharoplasty),
Enucleation with orbital implants, surgery for watery eye (DCR) and removal of
little cysts and swellings aorund the lids. Dr Milnd Bhide has had trainig for
these procedures in Moorefields Eye Hospital, London, under Mr J R O Collins who
is a authority on this subject.
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