Eyes are the window to the soul and certainly the window to the body. There are many conditions that can affect our vision such as Cataract, Glaucoma, Diabetic retinopathy and Age-related macular degeneration. Some of these diseases are preventable, others treatable. Thus care of the eyes is important at all ages, at all times.
WHAT IS REFRACTIVE SURGERY?
It is the surgery, which is done to correct the refractive errors like Myopia, Hypermetropia, Astigmatism or Presbyopia.
WHY DO WE GET REFRACTIVE ERRORS?
Refractive errors are due to changes in the length or curvature of the eyeball. It may be:
•Myopia (near-sightedness) when the patient can see for near but not for far. This is corrected by minus powered glasses or contact lenses.
•Hypermetropia (long sightedness): The patient requires a plus power for correction both for far and near vision.
•Astigmatism: (Cylindrical): In this, the light is focused only in one meridian. The corrective spectacles or lenses are usually required for constant use.
WHEN DO WE GET REFRACTIVE ERRORS?
Usually refractive errors arise during school years, between 6-18 years. In a rare case, one may be born with an error.
HOW ARE REFRACTIVE ERRORS TREATED?
Refractive errors may be treated with Spectacles, Contact lenses or Refractive surgery.
WHAT ARE THE SURGERIES AVAILABLE TO REMOVE SPECTACLES OR CONTACT LENSES?
•Laser Vision Correction: LASIK
•Implantable Collamer Lens (ICL)/ Phakic IOL
•Phaco with Multifocal IOL
WHAT IS LASIK?
LASIK (Laser Assisted In-Situ Keratomileusis) is a surgical procedure that can benefit patients with near-sightedness, farsightedness, and astigmatism by reducing dependence on spectacles and contact lenses. The procedure involves permanently reshaping the cornea (the transparent part of the eye in front) with Excimer laser.
HOW IS LASIK DONE?
During LASIK, the eye surgeon creates a thin surface flap of the cornea, exposing the underlying tissues (stromal bed) to which the Excimer laser beam is applied to reshape the cornea and change its power. Once the laser ablation is completed, the surgeon gently replaces the corneal surface flap.
WHAT ARE THE RISKS AND SIDE EFFECTS OF THE PROCEDURE?
LASIK is a relatively safe procedure with very low chances of complications. Most of the complications are minor and include over or under correction, temporary development of red spots over the eye, dry eyes, decreased contrast sensitivity and glare. The patients are carefully screened before the surgery to exclude patients who have more than normal chances of developing complications.
Am I a candidate for LASIK?
Yes you are if
•You are above 19 years of age
•Your refractive error (power of glasses) has been stable for 6 months
•The power of your glasses is
1.Myopia more than -1.5D
2.Hypermetropia more than +1D
3.Astigmatism more than +/- 1D
HOW DO I KNOW LASIK IS SAFE FOR ME?
All potential LASIK candidates are screened for risk factors and suitability for the procedure. The LASIK work-up entails a thorough eye examination especially the cornea for corneal thickness (Pachymetry) and corneal shape (Topography), the eye pressure and the retina. Patients who are found unfit are then counseled for other modalities such as PRK, ICL etc.
WHAT HAPPENS DURING THE PROCEDURE?
The lasik eye surgery procedure is typically performed under topical (eye drop) anesthesia. During the surgery you will be asked to lie down on the operating table and focus on a light above. The entire LASIK procedure lasts only 20 minutes and the laser delivery itself takes less than a minute. You can return home a few hours after the surgery and go back to work after one to three days.
HOW TO PREPARE FOR THE PROCEDURE?
You will be asked to undergo a few tests for evaluation of your fitness for the procedure which requires a period of one week. Also:
•Discontinue using contact lenses 1 to 2 weeks before the investigations
•Inform your doctor about medical problems and allergies
Arrange for someone to drive you home on the day of surgery. Bring along a pair of dark glasses for use after the procedure.
WHAT IS WAVEFRONT OR CUSTOMIZED LASIK?
CustomVue LASIK is a new innovation in LASIK surgery which allows the procedure to be customised to each particular patient. While routine LASIK corrects the refractive error Wavefront LASIK also attempts to correct finer irregularities in the eye. Correction of these finer irregularities means a better quality of vision with reduced symptoms of glare, haloes, ghost images and improved contrast sensitivity.
What is an Implantable Collamer lens?
Implantable Collamer lens is a special lens that is inserted into the eye to correct the refractive error. This eliminates the need for spectacles and contact lenses and unlike contact lenses, does not require to be applied and removed.
HOW IS ICL DIFFERENT FROM A CONTACT LENS?
The ICL is made from CollamerT, a hydrophilic, collagen copolymer. This is a highly specialised material which ensures that the lens is thin enough and inert enough to not create any disturbance to the other structures of the eye. Since it is placed inside the eye, this is a onetime procedure and there is no daily application and removal, no need for any special care as it is with contact lenses.
Who are the candidates for ICL?
You are a candidate for ICL if
•You are above 19 years of age
•Your refractive error (power of glasses) has been stable for 6 months.
The power of your glasses is
•Myopia more than -3D upto 20D
•Hypermetropia more than +2D to + 10D
•Astigmatism upto + 4D
Or, even if you are unfit for LASIK due to abnormal corneal curvature or thin cornea.
HOW DOES ONE PREPARE FOR THE PROCEDURE?
First a complete evaluation is done to determine suitability. Once the patient has been found suitable, a preparatory Laser iridotomy needs to be done. The actual procedure of ICL insertion can be then scheduled after one week.
WHAT DOES LASER IRIDOTOMY ENTAIL?
In this, a small opening is created in the iris by using YAG laser. This is an OPD procedure and takes 10-15mins. Eyedrops are then prescribed for a week. This procedure should be done at least 1 week before the ICL implantation.
IS THE PROCEDURE OF ICL IMPLANTATION PAINFUL?
No, it is not. This procedure is done in the operation theatre, under topical anaesthesia. Eye drops are applied to anaesthetise the eye, a micro-incision is made in the cornea and then the lens is inserted. The procedure takes around 10 minutes.
ARE BOTH EYES DONE TOGETHER?
Usually both eyes are not done on the same day. There is a gap of one or two days or even more depending on the patient.
IS ICL, A RISKY PROCEDURE?
We take a lot of precautions to ensure that it is not risky. The ICL is custom made for the patient taking all the specific parameters into consideration. It is made of very fine quality, ensuring that it doesn’t cause irritation to any of the other parts of the eye. Iridotmy is done in all cases to prevent pupillary block and glaucoma. In the remote case of the ICL not suiting or causing reaction in the eye, it can be taken out very easily.
WHAT IS CATARACT (SAFED MOTIABIND)?
Cataract is a clouding of the natural lens of the eye. This prevents the passage of the light and makes everything look blurred and hazy.
WHO GETS CATARACT?
Cataract is usually a disease of old age, but anyone can get it, especially after trauma or along with some other disease. Sometimes children may be born with a cataract (congenital cataract) or it may present in adolescence or early adulthood (developmental cataract).
WHAT ARE THE SYMPTOMS OF CATARACT?
Cataract can lead to decreased vision, glare, double vision, altered colour perception, haloes around lights and decreased contrast sensitivity. Cataract rarely causes pain or redness unless there is a complication.
IS CATARACT TREATABLE?
Yes, Cataract is treatable by surgery. There is no known medical treatment for cataract.
WHEN SHOULD CATARACT BE TREATED?
In the early stages, the vision can be improved by a change in glasses. Anytime the patient feels that glasses are no longer adequate and feels hampered in their activities, surgery can be undertaken. Maturity of cataract is NOT a criterion. One should not wait for it to “ripen”!!
DOES WAITING TOO LONG CAUSE ANY PROBLEM?
Yes, the longer we wait, the cataract becomes mature and hardens. This makes the surgery more difficult later on. Also mature cataract can lead to secondary conditions like glaucoma, inflammation etc.
WHAT ARE THE SURGICAL OPTIONS?
Surgical Options are: Extra capsular Cataract Extraction (ECCE) or Phacoemulsification (Without Stitches) known as cataract surgery.
WHAT IS PHACOEMULSIFICATION?
Phacoemulsification or Phaco is the most advanced technique of cataract extraction. In this method, the procedure is performed through a very small incision (2-3mm). The instrument uses ultrasound vibrations to break the cataract into small pieces and with the help of vacuum all the pieces of the cataract are sucked out. A new lens, which is an intra-ocular lens (IOLs) is inserted into the eye. The surgery is completed without any stitches. This minimal incision allows faster and safer healing, hastening the return to normal activity.
WHAT ARE THE POST-OPERATIVE CARE IS REQUIRED?
Since this is a sutureless operation, there are very few restrictions after the surgery. There is no need for bandages, green shades, dark glasses etc. There are no restrictions on bathing, eating and other activities. Eye drops are prescribed which need to be applied for 4-6 weeks.
WHAT IS INTRA OCULAR LENS (IOL)?
Intraocular lenses (IOLs) are different from contact lenses. During Phaco surgery, the IOL of appropriate power fitted inside the eye. The foldable IOLs can be inserted through very small. These are made of high quality material. They unfold in the eye and are permanent and Lifelong.
WHAT ARE THE TYPES OF IOLs?
•Non-Foldable & Foldable
•Aberration Free Aspheric IOL Foldable.
•Multifocal IOLs: Lens for both distance & near
•Toric IOLs: To correct preexisting cylindrical number
IS THE PROCEDURE PAINFUL?
No, most of the cases can be done under topical anaesthesia. In this, eye drops are instilled to anaesthetise the eye and the procedure is done. Sometimes, if the patient is unable to co-operate or the cataract is mature/hard an injection might be needed to anaesthetise the eye.
WHAT ARE THE ADVANTAGES OF PHACOEMULSIFICATION?
Since this is a minimally invasive surgery, the healing is very fast and thus there is almost immediate rehabilitation. There are no stitches, so no pain or irritation. There are no restrictions and the patient can quickly return to a normal life.
VITRO RETINAL SERVICES AT ARTEMIS
Digital Fluorescein Angiography, Green Laser Retinal Photocoagulation, Laser Indirect Ophthalmoscopy, Retinal Detachment Surgery, Vitreoretinal Surgery, Diabetic Retina Care, Diabetic Retinopathy
I HAVE DIABETES, HOW DOES IT AFFECT MY EYES?
People with diabetes may suffer from various eye related complications of diabetes which can cause severe vision loss or even blindness. Diabetic eye disease includes:
Diabetic retinopathy – This is most important eye complication of diabetes and results due to damage to the blood vessels in the retina.
Cataract – Clouding of the eye’s lens which occurs at an earlier age in diabetic patients.
Glaucoma – Increase in fluid pressure inside the eye that damages the optic nerve causing loss of vision. A person with diabetes is twice as likely to get glaucoma as other adults.
WHAT IS DIABETIC RETINOPATHY?
Diabetic retinopathy is a complication of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). If untreated, it may lead to blindness but if diagnosed and treated promptly, blindness is usually preventable.
WHO IS AT RISK FOR DIABETIC RETINOPATHY?
All people with diabetes (both type 1 and type 2) are at risk for diabetic retinopathy. The risk is highest if the person has poorly controlled blood sugar, high blood pressure, high cholesterol, pregnancy or habit of smoking.
Up to 45% of adults diagnosed with diabetes have some degree of diabetic retinopathy and the longer you have diabetes, the more likely you are to have it.
What are the stages of diabetic retinopathy and how does it cause visual loss?
Nonproliferative diabetic retinopathy (NPDR) is the earliest stage and the most common type of diabetic retinopathy. During this stage, the blood vessels become weak and balloon like (microaneurysms). As the disease progresses, some of the blood vessels become leaky or get blocked depriving the retina of important nourishment.
Damaged blood vessels can leak fluid into the most essential central part of the retina (macula) causing it to swell, blurring vision. This condition called macular edema can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses.
Proliferative Retinopathy (PDR) is the advanced stage when abnormal fragile blood vessels start forming on the retina. These fragile vessels can bleed inside the eye (vitreous hemorrhage) and even pull the retina out of its normal position (Tractional retinal detachment) causing severe vision loss.
What are the symptoms of Diabetic Retinopathy?
Symptoms are unusual in the early stages of the disease and often appear in the late stages without warning signs. It is therefore important NOT to wait for symptoms for an eye exam. A comprehensive eye test is a MUST for all diabetic patients at least once a year.
Later in the disease, diabetic retinopathy symptoms may include
•spots floating in vision,
•dark streaks or a red film that blocks the vision,
•poor night vision
I HAVE DIABETES. WHAT SHOULD I DO?
Early detection of diabetic retinopathy is the key to prevent severe vision loss. If you have diabetes, see your eye doctor for an yearly dilated eye exam even if there are no symptoms. Your doctor may ask for more frequent checkups in case of you have more advanced disease. If you become pregnant, you may require additional eye exams throughout your pregnancy. Contact your eye doctor immediately if you have sudden vision changes or your vision becomes blurry, spotty or hazy.
WHAT TO EXPECT DURING A TEST FOR DIABETIC RETINOPATHY?
Diabetic retinopathy is best diagnosed with a dilated eye exam. During the exam, your eye doctor will first dilate your pupils with eye drops which may cause blurring of your close-up vision for several hours. Make sure you have somebody to take you back home as you won’t be able to drive for a few hours. Your eye doctor uses a special magnifying lens to examine the inside of your eye for signs of damage. If your eye doctor finds features of retinopathy, he or she may suggest Fluorescein Angiography for further evaluation.
What is Fluorescein Angiography?
It is a test to pinpoint blood vessels that are closed, broken down or leaking fluid. In this test, a special dye is injected into your arm and multiple digital
Angiography with severe diabetic changes
photographs of your retina are taken. The test allows your eye doctor to plan further management of your disease.
MY DOCTOR TELLS ME THAT I NEED LASER TREATMENT. WHAT DOES IT MEAN?
Laser treatment is required when the eye has macular edema or PDR. You will be asked to sit facing the laser machine and a special lens is applied to your eye. During the procedure, you may see flashes of light. The laser procedure causes only minimal discomfort and is over in 10 to 15 minutes.
AFTER LASER WILL MY VISION BE RESTORED?
Laser treatment stabilizes vision and reduces the risk of vision loss by 50 percent. It may not be able to restore vision completely, hence the need for screening and early treatment.
WHAT ARE THE TYPES OF LASER TREATMENT?
•Focal laser spots
•For macular edema the laser treatment involves placing few hundred small laser burns around the macula. More than one treatment may be required to control the leakage.
•For PDR 1,000 to 2,000 laser burns are applied in the retina away from the macula. Two or more sessions may be required due to the large number of spots.
WHAT ARE THE SIDE EFFECTS OF LASER TREATMENT?
Side effects of laser treatment can include some loss of your side vision and reduction of color and night vision but it can save the rest of your sight.
WHAT IS ANTI-VEGF THERAPY FOR DIABETIC RETINOPATHY?
VEGF is a protein in the eye which has been found to play a central role in the development of diabetic retinopathy. Anti-VEGF therapy refers to the use of drugs to specifically inhibit this protein to control diabetic retinopathy. Few drugs such as bevacizumab, pegaptanib and ranibizumab are now available which can be used for this purpose. These drugs need to be given as an injection in the center of the eye (intravitreal injection). In some patients, the injections may need to be repeated at regular intervals.
WHEN IS SURGERY REQUIRED FOR PATIENTS WITH DIABETIC EYE DISEASE?
Surgery may be required in advanced cases with vitreous hemorrhage and/or tractional retinal detachment.
HOW DO I PREVENT DIABETIC RETINOPATHY?
•Monitor and control your blood sugar tightly. Keeping blood sugar levels close to normal slows the progression of disease and reduces the need for laser or surgery.
•Keep your blood pressure and cholesterol under control.
•Stop smoking or the use of other forms of tobacco.
•Yearly dilated eye exams are absolutely essential as early warning signs are typically absent. You can have the most severe forms of DR and still have no symptoms.
•Contact your eye doctor immediately if you notice sudden vision changes or your vision becomes blurry, spotty or hazy.
•Ptosis ( Drooping eyelid)
•Dacryo-cysto Rhinostomy ( DCR)
•Eyelid malpositions ( Entropion, Ectropion)
PIC1 AND PIC 2 ORBITAL SURGERY
•Repair of blow-out fractures of the orbit
•Orbitotomy: for biopsy/tumour removal
•Decompression of orbit for Thyroid Eye Disease