General Eye Exam FAQs
Why is an eye test done?
An eye exam helps detect eye problems at their earliest stage, when they're most treatable. Regular eye exams give your eye care professional a chance to help you correct or adapt to vision changes and provide you with tips on caring for your eyes. And an eye exam might provide clues to your overall health.
When to have an eye exam?
Several factors can determine how frequently you need an eye exam, including your age, health and risk of developing eye problems. General guidelines are as follows:
Children 3 years and younger
Your child's pediatrician will likely check your child's eyes for healthy eye development and look for the most common childhood eye problems — lazy eye, cross-eyes or misaligned eyes. A more comprehensive eye exam between the ages of 3 and 5 will look for problems with vision and eye alignment.
School-age children and adolescents
Have your child's vision checked before he or she enters kindergarten. Your child's doctor can recommend how frequent eye exams should be after that.
Adults
In general, if you are healthy and you have no symptoms of vision problems, the American Academy of Ophthalmology recommends having a complete eye exam at age 40, when some vision changes and eye diseases are likely to start. Based on the results of your screening, your eye doctor can recommend how often you should have future eye exams.
If you're 60 or older, have your eyes checked every year or two.
Have your eyes checked more often if you:
Wear glasses or contact lenses
Have a family history of eye disease or loss of vision
Have a chronic disease that puts you at greater risk of eye disease, such as diabetes
Take medications that have serious eye side effects
Is it necessary to get my eyes dilated at every exam?
Whether eye dilation during an exam is necessary depends on the reason for your exam, your age, your overall health and your risk of eye diseases.
The eye drops used for dilation cause your pupils to widen, allowing in more light and giving your doctor a better view of the back of your eye. Eye dilation assists your doctor in diagnosing common diseases and conditions, possibly at their earliest stages. They include:
Diabetes
High blood pressure
Macular degeneration
Retinal detachment
Glaucoma
Eye dilation also makes your vision blurry and your eyes more light sensitive, which, for a few hours, can affect your ability to drive or work. So if eye dilation is greatly inconvenient, ask your doctor about arranging another appointment.
What are some common eye ailments that can be detected by a regular eye exam? What symptoms would they have?
You Could Be Having Cataract If You Have
Cloudy or foggy vision
Double vision or multiple images
Changes in the way you see colors
Glare from bright lights causing difficulty in bright sunlight or during night driving
Better near vision for a while only in farsighted people
Frequent changes in your eyeglass prescription
Glaucoma
As this disease is typically asymptomatic in a majority of patients, if you are 40 years of age, or have a family history of glaucoma you should have your eyes tested regularly.
In certain cases, you may notice a decrease in vision which may maybe accompanied by redness or pain in the eye.
If you have glaucoma, regular eye tests for pressure and the visual field, and taking your eye treatment properly can prevent permanent irreversible blindness.
Diabetic Retinopathy
An eye with marked changes of diabetic retinopathy can have good vision and be totally free of symptoms.
Hence it is important for all diabetics to undergo regular eye check-up including retinal examination through dilated pupils especially for people who have been diabetic for a number of years.
Retinal Tears & Detachment
If you notice the sudden appearance of light flashes, or a large number of floaters in your vision, it may be suggestive of a tear in your retina and you should visit your ophthalmologist immediately.
Myopes (near sighted persons), aphakics (people who have undergone cataract surgery), those with a family history of retinal detachment are more prone to developing retinal degeneration, holes and tears, and subsequently retinal detachment. These groups of patients must undergo regular and thorough retinal examination by indirect ophthalmoscopy at least once annually.
What is the correct technique to use eyedrops?
First, wash and dry your hands thoroughly.
Check you have the correct bottle, and make sure you know which eye the drops are to go in.
Turn the bottle cap anticlockwise to pierce the dropper.
Stand in front of the mirror, sit in a chair, or lie down, which ever is best for you.
Take the top off the bottle, lean your head back, and look up at the ceiling.
Pull down your lower eyelid and squeeze a drop into you eye, taking care not to ouch the eye with the tip of the bottle.
Close your eyes for 2 minutes, and wipe gently with a clean tissue, if necessary.
Put the top on firmly back on the bottle and put in a safe place.
Finally, wash your hands again.
Remember:
Do not share your drops with anyone else.
Do not use needles or safety pins to pierce the dropper, as these may introduce infectious agents within the bottle.
Bottles of eye drops should only be used for four weeks after opening.
It may help to write on the label, the date you open the bottle.
It may also help to identify different drops by sticking a colored label on the bottle.
Your drops can be kept in the fridge but do not freeze them.
You can get more drops on prescription of your eye doctor.
Use drops in the frequency and for the duration recommended by your eye specialist.
Cataract FAQs
Why does a cataract develop?
A cataract develops as a part of the normal ageing process. It is usually present in varying degrees in all people above 50 years, although it can occur at an earlier age also.
In some people cataract development is aggravated by an eye injury, diabetes mellitus, use of certain medications or as a result of other eye diseases. Rarely cataract may be present in the newborn as a developmental defect.
What are the symptoms of a developing cataract?
Most people notice that objects may begin to look yellow, hazy, blurred or distorted. They may also find that they need more light to see clearly, or that they experience glare or haloes from lights at night. A common problem encountered is increasing nearsightedness. In advanced cases, the cataract may be visible as a whitish-looking pupil.
Can a cataract be prevented or treated with medication?
Age related cataracts cannot be prevented. Using the eyes for reading and similar activities has nothing to do with cataract formation. There is no reliable medical cure for a cataract of any form. A cataract once formed can only be cured with surgical correction.
The development of secondary cataracts can be slowed down by medically controlling the causative disease like controlling blood sugars in diabetics, etc.
If I have a cataract, do I have to have surgery?
Surgery to remove the cataract is the only treatment available. Surgical removal is considered only when the cataract begins to interfere with a person's daily activities-driving, reading, watching TV and recognizing faces. With modern microsurgical techniques of stitch-less cataract surgery it is not advisable to wait for the cataract to mature.
When should I undergo cataract surgery?
A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
Sometimes a cataract may need to be removed even if it does not cause significant vision problems. For example, a cataract should be removed if it prevents examination or treatment of another eye. problem, such as age-related macular degeneration or diabetic retinopathy or if it is causing other complications like a lens induced glaucoma.
What are the benefits of cataract surgery?
Cataract removal will assure a greater clarity of vision after surgery.
Reduced incidence of accidents that may occur as a result of poor vision.
Vision improvement helps people resume driving, reading, writing, watching television, sewing, household work and using a computer immediately after. Even when retinal diseases or other problems prevent a total restoration of vision, the remaining vision is usually improved by cataract surgery.
Improved confidence and quality of life.
How is a cataract surgery performed?
Cataract surgery is a quick outpatient surgical procedure. An ultrasound device is inserted through a very small opening in the eye to break the cataract into small pieces, which are removed from the eye. An artificial intraocular lens is then inserted. This lens is permanent and allows the vision to be restored.
Will I be able to see immediately after cataract surgery?
You will see after the procedure but it will take anywhere from 2 days to 3 weeks for your vision to stabilize. It is not unusual to have blurry vision for a few days after your surgery as your eye is healing.
Is clear vision guaranteed after surgery?
No surgery can be performed with guaranteed results. However, almost all the patients regain good vision following cataract surgery.
Blurred vision may be present immediately after surgery which improves gradually and most patients get normal vision with in 1-2 days after cataract surgery.
Any problem in the cornea, retina or optic nerve may limit the potential for clear vision even after a successful cataract surgery.
Will I need glasses after cataract surgery?
Measurements are done prior to cataract surgery to determine the correct intraocular lens (IOL) power for your eye. The most common form of IOL’s for cataract surgery are monofocal, designed to correct vision at one distance. Advanced IOL’s like Toric IOL, MFIOL, Trifocal IOL, EDOF IOL, Toric MFIOL can provide excellent spectacle independent vision for routine daily activities. Though glasses may be required by some patients for limited activities.
With modern cataract surgery, the surgical procedure can now be combined with refractive surgery to correct any residual power that may remain after cataract surgery.
A proper assessment and counselling is done by an ophthalmologist to help you decide the best IOL option for you.
Can all patients having a cataract undergo phaco surgery?
With Latest advances in technology like, now its possible to do phacoemulsification surgery in more then 99% patients.
But there may be rare situations where phacoemulsification may not be advisable such as poor endothelial counts, subluxated cataracts, poor view for surgeon as in corneal scars etc. Your ophthalmologist may suggest a manual small incision surgery in such cases.
Are there Any Problems With An Intraocular Lens (IOL) implantation?
The technological advancements in IOL manufacturing have making it an integral part of all cataract surgeries.
Complications are rare and similar ones can occur with conventional surgery without an IOL implantation. All patients irrespective of other general illnesses like diabetes, hypertension etc., can undergo IOL implantation after cataract removal.
IOL implantation is very rarely , if at all, not implanted. In the unlikely event that an IOL implantation is unsuitable for you, your ophthalmologist will inform you about the same. An IOL if not implanted in primary procedure, can be implanted later.
What Are The Possible Complications That Can Occur With Cataract & IOL Surgery?
Modern cataract microsurgical techniques have a high success rate and hence the few complications that exist are becoming even more remote.
Some minor complications that can occur include a redness, swelling around the eye, corneal haze, reflections or slight distortion from the lens implant, which are usually temporary.
Possible serious complications which are relatively rare include infection, severe inflammation, corneal edema and intraocular. In a majority of cases these complications can be treated successfully with a good final restoration of vision. The above list is however not exhaustive.
What Are The Latest Advances In Intraocular Lens (IOL) Technology?
Advanced IOL technologies are available as options for implantation after cataract suregery. These include:
Blue-light blocking IOLs that filter out harmful ultraviolet radiation
Aspheric (Aberration-free) IOLs which greatly improves image quality by enhancing contrast, eliminating glare and halos, and improving night vision
Toric IOLs are help to correct high cylindrical spectacle numbers
The newer Bifocal/EDOF / Trifocal IOLs provide good unaided distance, intermediate and near vision with less dependence on glasses. These are an advancement over the traditional monofocal IOLs which provide only good unaided distance vision.
Toric Multifocal IOL’s combine the advantages of toric and multifocal IOLs and hence help correct high cylindrical powers over a range of distances
Can a Cataract Be Treated With Lasers?
A cataract cannot be removed with lasers though modern phacoemulsification surgery has a common misnomer of " laser eye surgery". The procedure involves no big incision, ultrasound energy to emulsify the catarct and no stiches at the end of surgery.
Femtolaser Laser Assisted Cataract Surgery (FLACS) has been wrongly popularised as Bladefree or Robotic Cataract surgery. The misconception here is that though the cut made is with a help of a laser, the step of emulsification of the cataract is done by the surgeon (not a "robot").
In a certain number of patients undergoing cataract surgery, the back part of the lens capsule may become thick or opaque over a period of time causing blurred vision.
This is known as a posterior capsular opacification or secondary cataract. This is not a complication. The condition is treated with a “YAG laser capsulotomy” with full restoration of patient’s best vision.
What is Monovision?
Monovision means one eye is fully corrected for distance while the non-dominant eye is left a little under corrected to see things up close. The brain integrates the visual information from both eyes and adjusts either immediately or within a few weeks to having each eye focus at a different distance. Most people tolerate this very well and can function most of the time without glasses. This can be selected as an option for spectacle independence in case a monofocal IOL is selected for implantation.
What is a refractive lens exchange (RLE)?
A Refractive Lens Exchange is the same procedure as modern cataract surgery. RLE changes the focusing power of the eye by removing the eye’s natural lens and replacing it with an intraocular lens that can provide good distance vision, good reading vision or both. A multifocal intraocular lens has the potential to give excellent distance and reading vision in both eyes.
Glaucoma FAQs
Why is early detection of glaucoma necessary?
Glaucoma is a chronic, often progressive disease which may cause irreversible damage to vision if undetected. Damage due to glaucoma is preventable, not curable. It is therefore necessary that the disease should be detected and treated at its earliest stage to prevent blindness.
How does a person come to know that he/she is suffering from glaucoma?
Glaucoma is usually asymptomatic in early stages or is associated with very mild symptoms which the patient often tends to ignore. Some of the early symptoms may include:
Mild eye ache or headache towards the evening time.
Seeing colored haloes of light around lights with slight decrease in vision.
Inability to adjust one’s vision on entering a dark room and reduced contrast in the dark.
In advanced cases, there is a loss of side vision, while the central vision remains good. The patient becomes more prone to accidents as he/she is unable to see vehicles coming from the sides.
It is therefore advisable to undergo an annual routine eye examination after the age of 40 years to screen for glaucoma (earlier if you have a family history of glaucoma).
Which age group does glaucoma affect?
Although glaucoma is most common above the age of 40 years, it may affect any age group. There are variants of glaucoma which may affect newborns (congenital), infants (infantile) and even young children and adults (juvenile).
Who all are at high risk of developing glaucoma?
Those having a family history of glaucoma.
Increasing age – Above 40 Years
Co-morbidities like diabetes mellitus, hypertension, hyperlipidaemia, etc.
Patients who are on chronic steroid therapy for conditions such as bronchial asthma, rheumatoid arthritis ,etc.
Previous injury to the eye or history of eye surgery.
High hypermetropia (farsightedness) or high myopia (nearsightedness).
What are the types of glaucoma in adults?
There are different varieties of glaucoma :
Open-angle Glaucoma
Closed-angle Glaucoma
Mixed mechanism Glaucoma
Normal Tension Glaucoma
Secondary glaucoma, which develops due to systemic diseases like prolonged diabetes, complicated high blood pressure, thyroid disease, bleeding disorders etc. It may also occur as a complication of associated eye disorders such as vascular blocks, bleeding inside the eye, uveitis, swollen lens, injury to the eye, etc.
What are the types of glaucoma in children?
There are different varieties of glaucoma :
Open-angle Glaucoma
Closed-angle Glaucoma
Mixed mechanism Glaucoma
Normal Tension Glaucoma
Secondary glaucoma, which develops due to systemic diseases like prolonged diabetes, complicated high blood pressure, thyroid disease, bleeding disorders etc. It may also occur as a complication of associated eye disorders such as vascular blocks, bleeding inside the eye, uveitis, swollen lens, injury to the eye, etc.
How often should one get an eye check up?
After the age of 40 years, one should get an eye check up for glaucoma every 3 to 4 years even if there are no symptoms.
If a family member has glaucoma, if you have diabetes, if you are on long term systemic steroids for some other disease, or if you have suffered a blunt eye injury in the past, you must get your eyes checked every 1 to 2 years.
How is glaucoma diagnosed?
Glaucoma is detected through a systematic series of eye tests that include: –
Visual acuity testing
It is important to remember that a good central (straight ahead) vision test may mislead a glaucoma patient about the severity of glaucoma, as it usually affects the side vision in early stages. Even patients with advanced glaucoma may retain very good visual acuity.
Evaluation of optic nerve damage
This is done by slit-lamp bio-microscopy and further documented by an optic nerve photograph.
Eye pressure measurement (Tonometry)
This helps to determine how high your intraocular pressure (IOP) is and how well the medicine is controlling it.
Assesment of anterior chamber angles (Gonioscopy):
Assessment of Angle of Anterior chamber of eye . Closed angles may need a Nd:YAG laser iridotomy
Visual field examination (Automated perimetry)
This test helps detect defects in your central and peripheral field of vision.
OCT examination of retinal nerve fibre layer+ ganglion cell layer
These special tests measure the thickness of the nerve fibre layer and ganglion cell layer of your retina. This helps in early diagnosis and to assess progression of glaucoma.
Corneal thickness measurement (Pachymetery)
Thick Corneas can show false high IOP reading , while thin corneas can show false low IOP.
Can someone suffer from glaucoma inspite of having good vision?
In glaucoma the central vision is not lost till the very late stages. It starts with damage to your peripheral vision and gradually comes to the centre. When the central vision is affected it is too late and nothing can be done to restore vision. In a way, a good vision is misleading as far as severity of glaucoma and extent of damage is concerned.
How is glaucoma treated?
As damage to nerve caused by glaucoma is irreversible, the aim of the treatment is to prevent further damage to the optic nerve. The first step to do that is to lower the eye pressure.
The three modalities of treatment are:-
Medical Treatment
Certain medication (eye drops and tablets) can be used to lower your eye pressure. ” you must use the medicines regularly with follow-ups at regular intervals as directed by your ophthalmologist. You should not stop medicines even if you do not have symptoms.
Laser Treatment
There are various types of lasers that are used in the treatment of glaucoma.
They include:
Nd:YAG Laser Peripheral Iridotomy
This is a modality used in the treatment of early angle closure glaucoma. It involves creation of a small opening in the iris so that the stagnant fluid finds a way to the front portion of the eye (anterior chamber), and subsequently drained off. This is an OPD procedure, done under local anesthetic drops and takes only a few minutes to be completed.
Selective Laser Trabeculoplasty (SLT)
This is a treatment option which can be used successfully in open angle glaucomas. It stimulates the autoimmune system of the eye to clear the block in the drainage area without damaging the surrounding delicate tissues. SLT is a painless OPD procedure, which takes a few minutes to be completed.
Diode Laser Cycloablation
This treatment option is generally used in advanced cases of glaucoma, wherein more conservative treatments have failed to provide adequate success. In this the laser is applied on the area which produces fluid (aqueous humour) in the eye, thus helping reduce this fluid production.
Surgical treatment
There are a variety of glaucoma surgeries that can be prescribed by your operating surgeon depending on the type of glaucoma you are affected by. These are generally advised when medical or laser treatment options have not provided adequate control of the intraocular pressure.
Is glaucoma preventable?
Yes, damage due to glaucoma is preventable if detected early, however, it is not curable. Whatever damage that is already there cannot be restored, however further damage can be arrested or at least slowed down by appropriate treatment. It is a life-long treatment and needs regular followup.
What is the normal pressure for an eye?
Normal pressure for an eye is one which does not cause any damage to the optic nerve. In most normal people the eye pressure is around 17 to 20 mm of mercury. Some people have higher pressure than this, but that does not cause damage to the nerve for years. However, such patients need careful monitoring so that damage to the nerve is detected at its earliest stage. On the other hand some patients have a much lower eye pressure, say 12 or 14 mm hg, but this low pressure is not tolerated by the eye and the nerve is damaged. This is a special type of glaucoma and needs more careful monitoring and treatment.
What precautions must one with glaucoma take?
One must remember that glaucoma treatment is life long, and one should use the medicines regularly and should come for follow-up as and when advised. Persons who are at the risk of developing glaucoma (as listed previously) should undergo regular eye examinations. Diabetics should ensure good control of blood sugar levels avoid smoking, avoid excessive forcible water drinking.
Is glaucoma hereditary?
Yes, blood related family members of glaucoma patients are likely to develop glaucoma more often than the general population. It is advisable that family members of glaucoma patients should get their eyes review to rule out glaucoma.
Can I get back my side vision after treatment?
Unfortunately the vision loss caused by glaucoma is permanent and cannot be regained.
Do I need to come for follow up after laser/ surgery?
Treatment of glaucoma is life-long. Even after laser or surgery one may need additional medication and a lifetime of follow up to monitor the progress of the disease.
Diabetic retinopathy FAQs
What are the symptoms of diabetic retinopathy?
Not every person with diabetes needs to have diabetic retinopathy. Conversely an eye with marked changes of diabetic retinopathy can have good vision and be totally free of symptoms.
Hence it is important for all diabetics to undergo a regular eye check-up including retinal examination through dilated pupils especially for people who have been diabetic for a number of years. Diabetes is often detected in a person, when some changes of retinopathy are seen on routine examination of the eye.
Reduced central vision can occur if the macula gets edematous (swollen). Black spots (floaters) and cobwebs in vision of sudden onset often point to a minor bleed inside the eye. Sudden total loss of vision may occur due to a large bleed into the vitreous.
Can diabetic retinopathy be prevented?
Early detection of diabetic retinopathy is the best protection against sight loss. This is possible by having a complete eye examination including a retina check-up once a year or more frequently if advised. In most cases the ophthalmologist can then begin treatment before sight is affected.
Excellent control of diabetes and associated conditions like hypertension, increased blood lipids & cholesterol and renal (kidney) disease, is strongly recommended. However, good control in itself does not guarantee freedom from diabetic retinopathy.
What eye investigations are advised for diabetic retinopathy?
If diabetic retinopathy is noted, color photographs of the retina may be taken.
A fundus fluorescein angiography (FFA) may also be performed. This involves dilating the pupils and injection of a fluorescent dye into a vein in the arm.
Quick sequential photographs of the retina are taken rapidly as the dye passes through the retinal blood vessels. This test helps in determining if laser photocoagulation treatment is necessary. If treatment is to be done, it helps in identifying what structures and areas need treatment with laser.
Optical coherence tomography (OCT), which is newer non-invasive diagnostic modality provides a cross-sectional view of the retina and helps in quantifying the amount and type of swelling and guides the treatment.
How is diabetic retinopathy treated?
Laser photocoagulation
Photocoagulation involves the use of a laser beam to seal leaking blood vessels and prevent growth of abnormal blood vessels. This procedure does not require hospitalization. In background retinopathy, if blood vessels are leaking fluid into the macula, laser treatment stops the leakage and may improve or stabilize vision. In proliferative retinopathy, laser photocoagulation is done to reduce and reverse the growth of abnormal leaky blood vessels, which significantly reduces the chances of severe vision loss.
Vision may improve or stabilize within several weeks to a year. It is important to remember that laser treatment is not a one-time procedure. Regular follow up is extremely important.
Intravitreal/ Subtrenon injections
Certain medication (antiVEGF/ steroids) when injected into the eye (intravitreal) or just outside the eye (subtenon) has shown encouraging results in reducing swelling in the retina and also reducing the growth of new abnormal blood vessels. These medicines are however to be used cautiously and judiciously.
Vitrectomy
If the vitreous is too clouded with blood or there is traction retinal detachment, laser treatment will not work. In this situation, a surgical procedure called vitrectomy needs to be performed. In this operation, opaque vitreous gel is removed from within the eye by a special instrument that simultaneously sucks and cuts the vitreous.
AMD FAQs
What are the different types of age related macular degeneration (AMD)?
Age related macular degeneration (AMD) is a eye disease associated with aging, characterized by damage to the central part of the retina called macula. It has broadly divided in to two major subtypes:
Dry AMD
It is the most common form found in 90% of eye patients. Dry AMD occurs when the macular tissues get thin and slowly lose function. Visual deterioration is slow but usually not profound. About 10-20% of people with dry AMD advance to the wet form.
Wet AMD
It is the less common but more aggressive form of AMD. If it is not treated it may get worse rapidly. Wet AMD is caused by proliferation of abnormal blood vessels under the retina which may exude or leak out fluid, or bleed and ultimately lead to the formation of a scar under the retina.
What are the symptoms of AMD?
Diminution of vision in an important symptom of macular degeneration.
Straight lines may appear crooked or wavy
A dark area may appear in the centre of vision e.g. Words in the central part of the page look smudged
Having one or more of these symptoms may not necessarily mean that one has AMD, although it warrants an immediate eye check up.
What are the risk factors for AMD?
Age – The risk increases with increasing age. Although AMD can occur during middle age, studies show that people over 60 years of age are at a greater risk.
Family history of AMD increases the risk.
Race – white populations are more predisposed to suffer vision loss from neovascular AMD than Asian or African populations
Smoking has a definite correlation
History of hypertension, heart disease, or lung infection adds to the risk.
How is AMD detected?
Early detection is of paramount importance as smaller lesions have a better recovery and chance of maintaining reading vision than advanced cases with larger lesions and fibrotic changes.
To establish a diagnosis a comprehensive eye checkup including the following needs to be done.
Visual Acuity Test – this eye chart test measures how well you see at varying distances.
Amsler Grid – this test checks for any area which is distorted, blurred, discolored or not visible. It is a useful test to detect early changes and can be done routinely by the patient at home.
Dilated Eye Examination – To look for signs of the disease your doctor will use drops to dilate or widen the pupil, and using a special magnifying lens and a light source your doctor will examine your retina. Dilating drops hamper close vision for around 4-5 hours.
If on the above examination your doctor suspects AMD, other confirmatory tests to learn more about the structure and functioning of the retina could be advised.
Fluorescein Angiography (FA)
A special dye (sodium fluorescein) is injected into your vein and serial photographs of the retina are taken. The photographs may reveal leaking new vessels (choroidal neovascular membrane), define its location in reference to the centre point and determine any associated finding i.e. Hemorrhage, exudates.
Fluorescein angiography is an important tool in planning treatment and a recent angiogram is essential at the time of treatment. Repeat angiograms after treatment are indicated to confirm the status of the lesion.
Indocyanine Green Angiography (ICGA)
ICGA gives a better study of the deeper (choroidal) circulation. It is indicated in certain cases where the fluorescein angiography is inconclusive e.g. Cases with ill-defined membranes, presence of hemorrhage, or polypoidal vasculopathy.
It takes longer than fluorescein angiography as photographs are taken till 20 minutes after injection of dye.
Optical Coherence Tomography (OCT)
This is a noninvasive test, which gives an accurate structural analysis of the retina. It is helpful in diagnosis and most importantly in follow-up of the disease.
How is dry AMD treated?
There is no definite treatment for the dry form but the AREDS (Age-Related Eye Disease Study) found that a specific high dose formation of antioxidants and zinc significantly reduces the risk of advanced AMD and its associated vision loss.
Regular amsler grid monitoring to detect conversion of dry form to wet form is important. Smokers should ensure that the formulation they take does not contain beta-carotene as that may increase their risk of developing lung cancer.
How is wet AMD treated?
Wet AMD can be treated with laser photocoagulation, photodynamic therapy, intravitreal injections or a combination of these. The aim of treatment is to slow the rate of vision decrease or stop further vision loss but the disease some times may progress despite treatment.
Laser Photocoagulation
This out patient procedure uses the conventional laser to destroy fragile, leaking blood vessels. A high energy beam of light aimed directly on the new blood vessels, destroys and inactivates them, preventing further loss of vision.
However, this may also destroy some surrounding healthy tissue. Only a small percentage of patients where the membrane is away from the centre (fovea) can be treated by this modality.
Photodynamic Therapy (PDT)
(PDT) has been found to be an effective treatment for patient for patients with new vessels (choroidal neovascular membrane or CNVM) secondary to AMD, myopia, etc. It reduces the risk of moderate and severe vision loss. A light stimulated drug called verteporfin is injected intravenously.
It travels through out the body including the new vessels in the eye. The drug tends to “stick” to the surface of new blood vessels. Next a low intensity laser beam (689nm) is directed into the eye for about 83 seconds to activate the drug.
The activated drug selectively destroys the abnormal blood vessels without damage to surrounding healthy tissue. Because the drug is activated by light the patient must avoid exposure of skin or eyes to direct sunlight or bright indoor light for 5 days after treatment.
Intravitreal Injections (Anti-VEGF Agents)
Abnormally high levels of vascular endothelial growth factor (VEGF) occur in eyes with wet AMD which promotes the growth of abnormal new blood vessels. Anti- VEGF agents block the effects of this growth factor.
Treatment by this agent helps slow down vision loss from AMD and in some case improves vision. Multiple injections are often required for complete inactivation of the disease process.
The commonly used anti-VEGF's include bevacizumbab (Avastin), ranibizumab (Lucentis) and aflibercept (Eyelea).
When used in the eye as an intravitreal injection its dose is miniscule and risk of adverse systemic reactions like gastrointestinal perforation, thrombo-embolic reactions, hypertension and proteinuria is negligible.
Triamcinolone is a slow releasing steroid preparation which helps in reducing the swelling associated with the disease and also has some anti-angiogenic action. The risk of increased intraocular pressure is its major disadvantage. Since it is a suspension it is visible as a floater in the upper field of vision for a few weeks after injection.
Intravitreal injections are given with aseptic precautions in an operation theatre. The eye is numbed with anesthetic drops and then the injection is given.
The procedure is relatively atraumatic but carries a small risk of post injection infection, raised or low intraocular pressure, cataract formation, vitreous hemorrhage, retinal detachment. Systemically anti- VEGF agents are to be used with caution in patients with a recent history of cardiac ailment, uncontrolled hypertension and severe proteinuria.
Combination Therapy
Combination therapy of PDT with anti-VEGF agents or triamcinolone makes the treatment more finite, with the advantage of improvement in visual acuity in some cases and reduced requirement for repeated injections
Transpupillary Thermotherapy (TTT)
In TTT, a large spot of diode laser (810 nm) with relatively low energy is applied to the area of new vessels. The treatment is non specific and there is concomitant damage to normal retinal tissue though less then in conventional laser photocoagulation.
Surgical Treatment
The following surgical procedures have been tried but with limited benefit:
Excision of subfoveal CNVM
Macular translocation
How can low vision aids (LVA) help in cases of advanced AMD?
Patients who have lost fine vision in both eyes can consult a specialist who helps patients learn to use their remaining vision to its fullest. This can involve fitting magnifying lenses for close up vision and telescope lenses for seeing at a distance.
CCTV devices provide an enlarged image on a TV screen. There are other visual and mechanical devices such as filters, increased illumination and special reading aids that can help patients to live their life to the fullest even with reduced vision. Special books and other items available in large print offer further help.
Can precautions and lifestyle changes help in AMD?
Annual complete eye checkups.
Regular Amsler grid monitoring once a patient is diagnosed to have AMD.
Anti-oxidants to decrease progression of AMD.
Healthy diet rich in green leafy vegetables and fish.
Avoid smoking.
Maintain normal blood pressure.
Exercise and avoid obesity.
If you have AMD do not be afraid to use your eyes for reading, watching TV.
Paediatric ophthalmology FAQs
What Are The Common Eye Problems Seen In Pediatric Age Group?
Children can have variety of eye problems. Some of the relatively common disorders are refractive errors, redness of eyes (conjunctivits – infective or allergic), watering of eyes, strabismus (deviation of eyes), amblyopia (lazy eyes), lid abnormalities (ptosis), congenital cataracts, congenital glaucoma, developmental abnormalities of the eyes (microphthalmos), vitreous hemorrhage, retinopathy of prematurity, persistent fetal vasculature syndrome (phpv), chorioretinal coloboma, tumors (retinoblastoma) , foveal hypoplasia and optic disc abnormalities (coloboma, hypoplasia, optic atrophy, swollen optic discs).
How Early Does My Child Need An Eye Check Up?
Some common indirect pointers to the presence of vision problems in children are repeated watering of eyes, squeezing of eyes, frequent rubbing of eyes, habit of keeping visual targets at close distance, headaches, adoption of abnormal head postures. In very young children, gross discrepancy of vision between the two eyes can be tested by covering one eye at a time, in a subtle manner.
Observation of delayed visual milestones should prompt an early eye check up. Presence of deviation of eyes, nystagmus (to and fro movements of the eyes), abnormal head postures, roving eye movements are often associated with amblyopia.
These conditions require an urgent consult. In the absence of any of the above problems, we still recommend that every child should have a routine eye check up at around 3 years of age. Vision screening should be made mandatory at the time of school admission. It should be followed by annual routine check ups.
What Are The Common Causes Of Red Eye In Children?
Red Eye,” or conjunctivitis, is a non-specific finding that simply indicates conjunctival inflammation. The vast majority of children who present with “pink eye” will have a simple conjunctivitis. Other causes of a “red, teary eye” in a newborn include congenital glaucoma and nasolacrimal duct obstruction.
The most common causes for pediatric pink eye are allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, and blepharitis (inflammation of lid margins).
What Is Normal Binocular Vision?
Normally, both eyes are aligned on the same visual target and the images from each eye are merged in the brain to form a single three-dimensional image, or binocular vision. The brain’s process of merging or “fusing” images from each eye into one image is called binocular fusion.
The perception of three-dimensional depth is called stereoscopic vision. Binocular vision develops during early infancy, and proper alignment during this time is necessary for normal binocular development to occur.
What Is Strabismus (Deviation Of Eyes)?
Misalignment of eyes is called strabismus and can lead to disruption of the visual development process. Not all strabismus occurs at birth. It can be acquired throughout a person’s life for a variety of reasons. A problem affecting any of the six extra ocular muscles in either eye will cause misalignment and hence can cause some disruption in binocular vision. Depending on the cause for the disruption and the severity of the problem, visual symptoms will vary.
What Are The Common Types Of Strabismus And Their Management Options?
The two most common types of strabismus are esotropia, where an eye turns in and exotropia, where an eye turns out.
Infants developing esotropia within the first six months of life (congenital or infantile esotropia) usually have a large inward turn, which is easily noticed. The chances of developing normal binocular vision with normal depth perception are not good and the child may not develop full vision in the weaker eye. However, the best chance is with early surgery (before 18 months of age). Both the parent and surgeon have to be committed to multiple procedures to obtain perfect alignment.
Another common form of esotropia that occurs in children usually after age two is caused by a need for glasses (accommodative esotropia). These children are farsighted (hypermetropia or plus power in spectacles).
These children excessively strain their eyes when they focus, which causes one eye to turn in. Wearing glasses equal in strength to their farsightedness reduces the need to focus and straightens their eyes. Sometimes the addition of bifocals is necessary to further reduce the need to focus when looking at objects up close.
Exotropia or an outward turning of an eye is another common type of strabismus. Often the exotropia will occur intermittently, particularly when the child is daydreaming, ill, or tired or focusing at distant objects. Although glasses and prism therapy may reduce the amount of outward turning in some patients, surgery is usually needed. Rarely, special eye exercises (orthoptics) are necessary to help older children control the eye misalignment.
What Is Pseudo-strabismus?
Pseudo-strabismus is a common condition that needs to be distinguished from deviation of eyes (true strabismus). With pseudo-esotropia, the infant usually has a wide nasal bridge and wide, prominent lid folds, giving the appearance of eyes crossing. But, in fact, the eyes are straight. When the child looks to either side, the eye hides behind the eyelid folds or wide bridge and looks like they are crossing. It is important to document proper eye alignment in these cases by an orthoptic examination.
Comprehensive ocular examination and follow-up is important in patients diagnosed with pseudo-strabismus, as a small percentage of these patients will develop a true esotropia.
What Is Amblyopia (Lazy Eyes) And What Are Its Important Causes?
Amblyopia or ‘lazy eyes’ is simply defined as binocular or uniocular decrease in best corrected vision (even after spectacle correction), for which no apparent organic cause is found on eye examination. It is commonly caused from conditions that produce blurred image on the retina (e.g. Media opacities like congenital cataract, which obstruct the light from entering the eye; high refractive errors) or abnormal binocular coordination of the two eyes (deviation of eyes) or combination of both (unequal refractive errors between the two eyes, astigmatic refractive errors).
Amblyopia occurs during the critical or sensitive period of development and maturation of the visual system, which is estimated to be 0-8 years in children. It has to be remembered that the patient has to undergo a complete ocular examination to rule out any organic cause of loss of vision before the diagnosis of lazy eyes is established
How Amblyopia Is Commonly Diagnosed?
Subnormal best corrected vision (even after spectacle correction) points towards the possibility of amblyopia. Vision can be tested in children by many innovative picture/letter acuity/symbol charts. It can be done in a child as young as 2-3 years. In a very young child, the ability of an eye to take up and maintain fixation is an indirect sign of the presence or absence of amblyopia. In children with eye deviation, strong fixation preference of one eye indicates amblyopia.
What are the management options for amblyopia?
Amblyopia is treatable in appropriate cases. Early treatment of amblyopia is critical for best results. The first step is to clear the retinal image by giving appropriate glasses or by removal of media opacities like cataract or corneal opacities. The second step is to correct ocular dominance, if present, by forcing fixation to the weaker eye and thereby stimulating it.
This is achieved either by covering (patching) the good eye or by blurring the image in the good eye (by some drugs or by altering the spectacle number). Once amblopia is diagnosed, it has to be managed by strict vigilance and monitoring of therapy.
What are the common causes of watering of eyes in infancy and how is it managed?
Infants with a nasolacrimal duct obstruction present with a watery eye and an increased tear lake, mattering of the eyelashes, and mucus in the nasal corner of the eyelids. This is due to improper canalization of the nasolacrimal duct pathway (which drains tears from the eyes to the nose). Congenital nasolacrimal duct obstruction is common and occurs in 1 to 5% of the population, with approximately 1/3 occurring in both eyes.
Medical management during the observational period (initial six months of age) is a combination of nasolacrimal sac massage and intermittent topical antibiotics. In case the lacrimal massage fails to open the obstruction, syringing and probing is done. Under sedation or general anesthesia, a small steel wire is passed through the punctum into the nasolacrimal system, and down out into the nasal cavity. This does not hurt, nor does it create any problem in the nose.
The success rate for a single nasolacrimal duct probing is approximately 90%. It might need repeat sittings to relieve the nasolacrimal obstruction. In cases where nasolacrimal duct probing fails, intubation with silicone tubes is indicated to establish a working system. In case the above procedures don’t provide relief, the child may require a dacryocystorhinostomy (DCR) procedure at around 3.5 to 4 years of age. This involves making an alternate bypass between the tear drainage system and the nasal cavity
How are cataracts managed in children and what is the visual prognosis?
Pediatric cataracts can occur in one eye (unilateral) or both eyes (bilateral). They can be complete or partial and can be present at birth or occur sometime after birth. Cataracts can be partial at birth and later progress to become visually significant. In contrast to adults, cataracts in children present a special challenge, since early visual rehabilitation is critical to prevent irreversible amblyopia. The earlier the onset, and the longer the duration of the cataract, the worse the prognosis.
Children born with cataracts are also at risk for developing glaucoma, strabismus, nystagmus, and poor stereopsis, further complicating successful outcomes. Patients with acquired progressive cataracts have less amblyopia and a much better visual prognosis than patients with cataracts that cover the visual axis since birth.
Unilateral infantile cataracts are rarely caused by a systemic disease, except in some cases of intrauterine infections such as rubella. Generally, monocular congenital cataracts have a relatively good prognosis if surgery and optical correction is provided by two months of age. Beyond this age, there is a possibility of having dense amblyopia in the operated eye.
Bilateral cataracts are often inherited. The work-up for bilateral congenital or infantile cataracts should include a careful pediatric examination and special tests. Dense bilateral congenital cataracts require urgent surgery and visual rehabilitation. In general, bilateral cataracts operated prior to two months of age have a good visual prognosis.
Cataract surgery in children is done under general anesthesia. It involves removal of the cataractous (opaque) crystalline lens. This is often accompanied by surgical measures (primary posterior capsulorrhexis /anterior vitrectomy) to ensure the clarity of the central visual axis in the postoperative period, which can otherwise get obscured by the ‘after cataract’ (collection of inflammatory cells and fibrous tissue) formation.
We currently consider IOL implantation in patients who are one year or older, and IOL implantation is the procedure of choice in children 2 years and older. The use of aphakic glasses or contact lenses continues to be the treatment of choice for congenital cataracts in neonates, while an IOL is preferred for children over one year of age. Postoperatively, the child will still require glasses after the IOL implantation. The child may require occlusion therapy for the management of amblyopia.
My child has learning difficulties. Could this be related to their eye or vision?
Each child learns in different ways. Poor vision can certainly be a cause for learning delay and a thorough eye assessment would be recommended to all children with learning difficulty.
Improving vision with glasses or patching can help to improve a child’s learning and development.
What is the common cause of watering of eyes in infancy and how is it managed?
Infants with a nasolacrimal duct obstruction present with a watery eye and an increased tear lake, matting of the eyelashes, and mucus in the nasal corner of the eyelids. This is due to improper canalization of the nasolacrimal duct pathway (which drains tears from the eyes to the nose). Congenital nasolacrimal duct obstruction is common and occurs in 1 to 5% of the population, with approximately 1/3 occurring in both eyes.
Medical management during the observational period (initial six months of age) is a combination of nasolacrimal sac massage and intermittent topical antibiotics. In case the lacrimal massage fails to open the obstruction, syringing and probing is done. Under sedation or general anesthesia, a small steel wire is passed through the punctum into the nasolacrimal system, and down out into the nasal cavity. This does not hurt, nor does it create any problem in the nose.
The success rate for a single nasolacrimal duct probing is approximately 90%. It might need repeat sittings to relieve the nasolacrimal obstruction. In cases where nasolacrimal duct probing fails, intubation with silicone tubes is indicated to establish a working system. In case the above procedures don’t provide relief, the child may require a dacryocystorhinostomy (DCR) procedure at around 3.5 to 4 years of age. This involves making an alternate bypass between the tear drainage system and the nasal cavity.
Can you examine my child without putting drops in their eyes?
The only way that we can check a child’s focussing and possible need for glasses is to ensure their natural lens is completely relaxed.
Unfortunately, the only reliable and effective way we have is to instil drops which do sting temporarily. We generally only have to do this once a year. Sometimes this experience is not pleasant for the child and parents.
Having specialised expertise and many years of experience in dealing with children, my staff have specific techniques to reduce the anxiety and unpleasantness associated with this process.
Strabismus (Squint) FAQs
How is strabismus caused?
Strabismus is caused by misaligned eye muscles. However, the exact reason for the misalignment of the eyes leading to strabismus is not fully understood. Many factors can be responsible for strabismus.
Causes of Strabismus
Inappropriate development of the “fusion center” of the brain, problems with the “eye movement” centers of the brain, and injury to or disease of the eye muscles or nerves. This explains why children with cerebral palsy, down’s syndrome and hydrocephalus often have strabismus. Even a brain tumor may cause strabismus.
Another factor is genetics, and it is known that strabismus may run in families. However, in many patients there are no relatives with the problem. The condition occurs equally in males and females.
Associated eye conditions may also give rise to strabismus. In cases of cataract, injury or tumor within the eye, the eye may frequently turn in or out.
What are the symptoms of strabismus?
Constant and Intermittent Strabismus
The primary symptom of strabismus is an eye that is not straight. The misalignment may be permanent and always noticeable (constant strabismus), or it may come and go, appearing normal at times and abnormal at others (intermittent strabismus).
Alternating Strabismus
One eye may be directed straight ahead while the other eye is turned inward, outward, upward, or downward. In other cases, the turned eye may straighten at times, and the straight eye may turn (alternating strabismus).
Sometimes, poor tolerability to bright light may be noticed. Faulty depth perception may be present. Some children turn or tilt their heads in a specific direction in order to use their eyes together.
Up to the first 6 months of age, intermittent strabismus is a normal developmental milestone. After 6 months, it needs to be evaluated.
How is strabismus (squint) detected?
A child should be examined by the family doctor, pediatrician, or an ophthalmologist during infancy and preschool in order to detect any potential eye problem, particularly if a relative has had strabismus or amblyopia. Even the most observant parent may not discover strabismus without a doctor’s help.
It is often difficult to determine the difference between eyes that appear to be crossed and true strabismus.
Young children usually have a wide, flat nose and a redundant fold of skin at the inner eyelid that tends to hide the eye during side gaze and cause concern about strabismus. An ophthalmologist can readily distinguish this from true strabismus.
Why is early detection of squint important?
It is never too early to have a child’s eyes examined. Fortunately, an ophthalmologist can test even a newborn infant’s eyes. In general, research suggests that the maximum “critical period” in humans for the development of binocular vision with resultant depth perception is from just after birth to 2 years of age.
Any disruption of binocular vision in this period will therefore result in strabismus and/or amblyopia. If the eye examination is delayed until the child enters school, it may be too late to properly correct strabismus and amblyopia.
Occasionally, a misaligned eye may be caused by a cataract or tumor within the eye, as mentioned earlier. It is important to know about such conditions as early as possible, so that both the underlying condition and resulting strabismus can be corrected.
Parents often get the false impression that a child may “outgrow” the problem. Though fatigue or illness may worsen strabismus, children do not outgrow strabismus. Once a child has a suspected turning of an eye, an examination by an ophthalmologist is necessary to determine the cause and to begin treatment.
Why is early detection of squint important?
It is never too early to have a child’s eyes examined. Fortunately, an ophthalmologist can test even a newborn infant’s eyes. In general, research suggests that the maximum “critical period” in humans for the development of binocular vision with resultant depth perception is from just after birth to 2 years of age.
Any disruption of binocular vision in this period will therefore result in strabismus and/or amblyopia. If the eye examination is delayed until the child enters school, it may be too late to properly correct strabismus and amblyopia.
Occasionally, a misaligned eye may be caused by a cataract or tumor within the eye, as mentioned earlier. It is important to know about such conditions as early as possible, so that both the underlying condition and resulting strabismus can be corrected.
Parents often get the false impression that a child may “outgrow” the problem. Though fatigue or illness may worsen strabismus, children do not outgrow strabismus. Once a child has a suspected turning of an eye, an examination by an ophthalmologist is necessary to determine the cause and to begin treatment.
When is it too late to treat strabismus or lazy eye?
It is often asked at what age should treatment no longer be attempted. The answer is, everyone deserves a chance. Age should not be a deterrent, though treatment under 6 years of age (especially before 2) is ideal and allows better results than later treatment.
After age 6, age is not important. However, every attempt should be made to improve strabismus and lazy eye, even though treatment might not be as effective after the age of six, and definitely requires more work.
What are the goals of treatment?
The goals of treatment are to preserve vision, straighten the eyes, and restore binocular vision. Treatment of strabismus depends upon the exact cause of the misaligned eyes. It can be directed towards unbalanced muscles, cataract removal or other conditions that are causing the eyes to turn.
After a complete eye examination, including a detailed study of the inner parts of the eye, an ophthalmologist can recommend appropriate optical, medical or surgical therapy. Covering or patching the good eye to force use of the amblyopic eye may be necessary to ensure equal vision.
Constant strabismus must be dealt with immediately if one wants to re-establish proper use of the eyes. Treatment for this condition needs to be early and aggressive. If the eye turn is constant and simple things like patching, glasses (bifocal, prismatic, etc) do not eliminate the eye turn, surgery needs to be considered.
With intermittent strabismus, the eye does not turn in all the time, so the brain is probably receiving appropriate stimulation for the development of binocular vision. Children with intermittent eye turns should be handled with judicious patching, special glasses, and/or orthoptics (special eye exercises designed to encourage binocular vision). Surgery, if considered at all, should be a last resort.
What are the other causes of strabismus (squint) in adults?
These include:
Thyroid Disease
After Cataract Surgery
After Retinal Detachment Surgery
Myasthenia Gravis
Paralysis Of Eye Muscles Due To Diabetes And Hypertension
Orbital Fracture
What are the treatment options of inturning of the eye (Esotropia)?
Infants developing esotropia (inward turning of eyes) within the first three months of life (congenital or infantile esotropia) usually have a large inward turn, which is easily noticed. The chances of developing normal binocular vision with normal depth perception are not good and may lose vision in the weaker eye.
Esotropia Surgery
The aim of eye surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight. In surgery for esotropia, the tight inner muscles are placed further backward which weakens their pull and allows the eyes to move outward. Sometimes the outer muscles may be tightened by shortening the muscle length, which further pulls the eye outward.
Sometimes patients may require the use of prisms or glasses following eye muscle surgery. Over-corrections or under-corrections can occur and further surgery may be needed.
One or both eyes may be operated upon. General anesthesia is required in children. Some adults may prefer local anesthesia. Recovery time is rapid and the patient is usually able to return to normal activity within a few days. As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.
Accommodative Esotropia
Another common form of esotropia that occurs in children usually after age two is caused by a need for glasses (accommodative esotropia). These children are farsighted (hypermetropia or plus power in spectacles). They have the ability to focus their eyes enough to adjust for the farsightedness, which allows them to see well for both distance and near.
Some children excessively cross their eyes when they focus, which causes one eye to turn in. Wearing glasses equal in strength to their farsightedness reduces the need to focus and straightens their eyes. Sometimes the addition of bifocals is necessary to further reduce the need to focus when looking at objects up close.
Occasionally, eye drops and special lenses, called prisms, can be used to help the eyes focus properly. Rarely, special eye exercises (orthoptics) are necessary to help older children control the eye misalignment.
What are the treatment options of inturning of the eye (Esotropia)?
Infants developing esotropia (inward turning of eyes) within the first three months of life (congenital or infantile esotropia) usually have a large inward turn, which is easily noticed. The chances of developing normal binocular vision with normal depth perception are not good and may lose vision in the weaker eye.
Esotropia Surgery
The aim of eye surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight. In surgery for esotropia, the tight inner muscles are placed further backward which weakens their pull and allows the eyes to move outward. Sometimes the outer muscles may be tightened by shortening the muscle length, which further pulls the eye outward.
Sometimes patients may require the use of prisms or glasses following eye muscle surgery. Over-corrections or under-corrections can occur and further surgery may be needed.
One or both eyes may be operated upon. General anesthesia is required in children. Some adults may prefer local anesthesia. Recovery time is rapid and the patient is usually able to return to normal activity within a few days. As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.
Accommodative Esotropia
Another common form of esotropia that occurs in children usually after age two is caused by a need for glasses (accommodative esotropia). These children are farsighted (hypermetropia or plus power in spectacles). They have the ability to focus their eyes enough to adjust for the farsightedness, which allows them to see well for both distance and near.
Some children excessively cross their eyes when they focus, which causes one eye to turn in. Wearing glasses equal in strength to their farsightedness reduces the need to focus and straightens their eyes. Sometimes the addition of bifocals is necessary to further reduce the need to focus when looking at objects up close.
Occasionally, eye drops and special lenses, called prisms, can be used to help the eyes focus properly. Rarely, special eye exercises (orthoptics) are necessary to help older children control the eye misalignment.
What are the treatment options of inturning of the eye (Esotropia)?
Infants developing esotropia (inward turning of eyes) within the first three months of life (congenital or infantile esotropia) usually have a large inward turn, which is easily noticed. The chances of developing normal binocular vision with normal depth perception are not good and may lose vision in the weaker eye.
Esotropia Surgery
The aim of eye surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight. In surgery for esotropia, the tight inner muscles are placed further backward which weakens their pull and allows the eyes to move outward. Sometimes the outer muscles may be tightened by shortening the muscle length, which further pulls the eye outward.
Sometimes patients may require the use of prisms or glasses following eye muscle surgery. Over-corrections or under-corrections can occur and further surgery may be needed.
One or both eyes may be operated upon. General anesthesia is required in children. Some adults may prefer local anesthesia. Recovery time is rapid and the patient is usually able to return to normal activity within a few days. As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.
Accommodative Esotropia
Another common form of esotropia that occurs in children usually after age two is caused by a need for glasses (accommodative esotropia). These children are farsighted (hypermetropia or plus power in spectacles). They have the ability to focus their eyes enough to adjust for the farsightedness, which allows them to see well for both distance and near.
Some children excessively cross their eyes when they focus, which causes one eye to turn in. Wearing glasses equal in strength to their farsightedness reduces the need to focus and straightens their eyes. Sometimes the addition of bifocals is necessary to further reduce the need to focus when looking at objects up close.
Occasionally, eye drops and special lenses, called prisms, can be used to help the eyes focus properly. Rarely, special eye exercises (orthoptics) are necessary to help older children control the eye misalignment.
Cornea FAQs
What steps need to be followed after common corneal injuries?
A twig of a tree, a piece of paper, or a fingernail can produce corneal abrasions. If not attended to immediately, secondary infection can occur which could lead to vision threatening complications.
Contact lenses also can produce an irritable eye from a corneal abrasion. Until an ophthalmologist can be consulted, the contact lens should be removed and the eye patched.
Injuries to the eye with sharp or blunt objects require urgent attention of an ophthalmologist.
Acid or alkaline chemical solutions splashed into the eye may be potentially sight threatening. Symptoms such as pain, redness, watering and light-sensitivity occur immediately after exposure to the chemical and may be severe in nature. Chemicals in the eye need to be thoroughly washed out immediately with water. Thereafter, an immediate consultation with an ophthalmologist should be scheduled.
What infections commonly affect the cornea?
Inflammation of the cornea, or keratitis, may be secondary to conjunctivitis, blepharitis (inflammation of eyelid margins), or injury. Keratitis is characterized by a painful red eye, sensitivity to light, and an occasional scratching sensation upon blinking.
An ulcer may develop in the cornea after a bacterial, viral, fungal, or other infectious organism invades its outer layer.
A marginal ulcer is a corneal infection that occurs near the outer edge of the cornea. Central corneal ulcers due to bacteria, viruses, or fungi can be severe and serious; they may even cause loss of the eye. With these severe ulcers, the eye sets up a defense reaction to help fight the infection. This disease requires the immediate attention of an ophthalmologist.
With intensive medical treatment, the infection is brought under control. Sometimes drastic surgical intervention has to be undertaken. Often after elimination of the infection, there is residual scarring of the cornea, which requires corneal transplantation for restoration of vision.
What is a pterygium? How is it treated?
A pterygium is a grayish elevated growth of elastic and connective tissue containing blood vessels that invades and grows over the cornea. It may result from irritation to the eye from wind, heat of the sun, dust, or smoke.
If the pterygium progresses to grow over the center of the cornea, sight may be impaired or even lost. Before this occurs, the pterygium should be removed surgically.
Surgical correction of a pterygium involves a specialized technique called conjunctival autografting, where, the pterygium is excised, and a conjunctival graft, taken from a healthy part of the same eye is used to cover the defect. This technique prevents recurrence of the pterygium, which would normally occur after conventional pterygium removal without grafting.
How is keratoconus treated?
Contact Lenses
In such a situation, contact lenses not only provide better vision, but also help to retard the progress of the disorder. A rigid contact lens must be used, so that it can hold its shape.
Sometimes the patient is fitted with soft lenses (for comfort), over which semi-soft lenses are fitted (“piggy-back” lenses).
Fitting contact lenses for keratoconus requires expertise. Well-fitting contact lenses dramatically improves such a patient’s vision to nearly that of a normal person’s, and significantly improves his or her quality of life.
Corneal Collagen Cross-Linking with Riboflavin
A recent promising treatment modality for keratoconus is C3R (corneal collagen cross-linking with riboflavin), which is a new curative approach to increase the mechanical stability of corneal tissue.
Collagen Crosslinking is done with the help of Riboflavin and Ultraviolet A(365nm). This treatment brings biochemical changes in cornea, increasing its strength upto 300% by highly localized photo-polymerization. Strengthening of cornea leads to arrest of progression of Keratoconus and other ectatic conditions of cornea.
Surgical correction
Almost 21% of these patients eventually require surgical intervention like Corneal transplant to restore the corneal curvature and anatomy. So early diagnosis and treatment is mainstay of treating Keratoconus.
What degenerative changes commonly affect the cornea?
Dystrophies or degenerative aging processes may develop in the cornea and interfere with vision. They are slowly progressive, non-inflammatory, and usually affect or involve both eyes. They may produce a haziness or cloudiness of the cornea.
If the vision is markedly impaired, contact lenses may be prescribed to improve vision. If they do not help, a corneal transplantation may be performed to restore useful sight.
What is corneal transplantation?
Cornea transplantation or keratoplasty, is an operation designed to correct blindness resulting from corneal disease. When the cornea is involved by degenerative change, infection, or injury, scar tissue may form as healing occurs.
If the scar involves the center of the cornea or the entire cornea, vision is impaired. Depending upon the degree of involvement, the person may not be able to see to perform his daily tasks. Contact lenses rather than spectacles may partially improve vision, but often they are ineffective and a corneal transplant is required. Eye tissue from one person is transplanted into the eye of another person who has been blinded by a corneal scar or disease.
What is keratoconus?
Normally the cornea is nearly spherically shaped thus allowing light to be focused clearly on the back of the eye (retina). However in a condition called keratoconus, the cornea begins to thin, and this allows the normal pressure of the eye to make the cornea bulge forward taking on a cone-shape.
As the cornea gradually becomes more cone-shaped, the vision blurs and becomes distorted due to a high degree of astigmatism. Initially vision may be correctable with spectacles, but as the condition progresses, and the cornea becomes more irregular causing distorted vision, spectacles become less effective.
How is a a cornea transplanted?
A corneal transplantation is usually performed under local anesthesia. General anesthesia is used for children and apprehensive or nervous patients.
The diseased, cloudy, opaque cornea is removed from the recipient’s (living patient’s) eye using a special blade, and replaced by a new clear cornea (graft) from the donor’s (deceased person’s) eye. Earlier we transplanted the entire thickness of the cornea (penetrating keratoplasty).
Today depending on the extent, location and type of the corneal disorder, we can selectively transplant either the front part (anterior lamellar keratoplasty), or the back portion (endothelial lamellar keratoplasty).
The new cornea is then sutured or stitched into place. As few as eight and as many as 20 or more sutures may be used, according to the size of the graft, to hold the border of the graft to the border of the recipient.
How successful is corneal transplantation?
In favorable subjects the rate of success of corneal transplantation may be as high as 60%, with good final visual acuity with glasses. In unfavorable subjects, the rate of success may be around 10 to 20%.
Each patient is evaluated individually before definite results can be predicted.
Lamellar keratoplasty provides the advantages of better visual outcome, quicker rehabilitation and lower rates of transplant rejection.
Corneal transplantation restores vision only in eyes that have been partially blinded by corneal disease. Some vision must be present before transplantation is even contemplated.
Uveitis FAQs
Are there different kinds of uveitis?
When any part of the uvea becomes inflamed, the condition is labeled as uveitis. This may be further subdivided depending upon the exact structures involved in the inflammation. Thus, if only the iris is inflamed it is called iritis. Similarly cyclitis is inflammation of the ciliary body. Anterior uveitis or iridocyclitis is inflammation of both the iris and ciliary body.
Choroiditis or posterior uveitis is inflammation of the choroid. Intermediate uveitis is inflammation of the middle part of the uvea and is commonly also referred to as pars planitis. If all structures (iris, ciliary body and choroid) are inflamed then it is called panuveitis.
What causes uveitis?
Uveitis may result from hypersensitivity to various infective organisms including viruses (such as shingles, mumps, or herpes), fungi (such as histoplasmosis), parasites (such as toxoplasmosis) and bacteria (such as tuberculosis, lyme disease, and syphilis). In the Indian scenario, infectious causes account for a large proportion of uveitis cases.
Uveitis can also be related to disease in other parts of the body (such as sarcoidosis, arthritis & ankylosing spondylitis) or come as a consequence of injury to the eye. Rarely, inflammation in one eye can result from a severe injury to the fellow eye (sympathetic uveitis).
Additionally, uveitis may occur if an adjacent ocular structure is inflamed (like a corneal ulcer or rarely a swollen hypermature cataract). In a few patients there may be genetic predisposition to inflammation that can be detected by HLA typing.
Despite thorough investigations, in a significant proportion of cases, the cause remains undetermined and is called idiopathic uveitis.
How is uveitis diagnosed?
An ophthalmologist will conduct a detailed eye examination and often make a diagnosis on that basis.
In some circumstances, blood tests, skin tests (mantoux test), x-rays, and CT scans, and sometimes, even specimens taken surgically from the eye, may assist in establishing the diagnosis and finding its cause.
Since uveitis can be associated with disease in some other part of the body, an evaluation and understanding of the patient’s overall medical health is important. This may involve consultation with other medical specialists, including pulmonologists, immunologists or rheumatologists.
What are the symptoms of uveitis?
Depending on which part of the eye is inflamed in uveitis different combinations of symptoms may be present. These include redness of the eye, pain, light sensitivity, blurring of vision and floaters.
Uveitis may come on suddenly with redness and pain, or it may be slow in onset with little pain or redness, but gradual blurring of vision. These symptoms may also come on suddenly, and you may not experience any pain.
The symptoms described above may not necessarily mean that you have uveitis. However, early detection and treatment is necessary, as inflammation inside the eye can permanently affect sight due to glaucoma (high pressure in the eye), cataract (clouding of the lens of the eye), or retinal damage, and rarely, lead to blindness.
How is uveitis treated?
Medical treatment of uveitis must be aggressive to prevent glaucoma, to prevent scarring of the structures inside the eye and to prevent possible blindness.
Different medications are used to control the original cause of the uveitis, if detected, and to minimize the inflammation itself. Eye drops, especially steroids (to reduce inflammation and pain) and pupil dilators (to widen the pupil and relax the muscles within the eye), are the main medications used to treat uveitis.
For deeper inflammation, oral medication or injections around the eye may be necessary, especially sub-tenons’ injection of depot steroids. Sometimes if the inflammation is more prolonged or vision threatening then systemic steroids may be required.
These drugs quickly control inflammation in a large proportion of patients. However, if used for longer periods these drugs cause weight gain and water retention, acne formation, osteoporosis and gastric ulcers, and require to be minimized during treatment.
Rarely if very prolonged systemic steroid treatment is required it may not be possible to do so because of the enumerated side effects. In such a situation, a patient may be switched over to special medicines called immunosuppressive agents. When given in low doses, these drugs decrease the number of white cells, which are the mediators of inflammation.
These drugs, such as, methotrexate, azathioprine and cellcept have different side effects including decreasing blood counts and mild liver and kidney dysfunction, which are partially reversible on stopping treatment. These can be detected by frequent blood tests and being under the care of a physician or immunologist.
Complications of uveitis such as glaucoma, cataracts, or new blood vessel formation (neovascularization), also may need treatment in the course of the disease. If complications are advanced, conventional surgery or laser surgery may be necessary.
Neuro-ophthalmology FAQs
What are the common symptoms of neuro-ophthalmic diseases?
Symptoms that are more common in neuro-ophthalmic disease include visual loss, visual disturbance, diplopia, unequal pupils and eyelid and facial spasms.
What are the types of Neuro-ophthalmic diseases?
A few of the most common neuro-ophthalmic conditions are optic neuritis, ischemic optic neuropathy, compressive optic neuropathy (including pituitary tumors), papilledema, inflammatory and infectious optic neuropathies, cerebrovascular disorder involving vision, tumors involving vision, blephrospasm & hemifacial spasm, thyroid eye disease, myasthenia gravis, ocular motor disorders (including cranial nerve palsies), pupillary abnormalities, hereditary optic neuropathies and patients who have unexplained visual loss.
What is ischemic optic neuropathy (AION)?
This is the most common cause of sudden decreased vision in patients older than 40 years.
Each of the optic nerves receives blood supply from branches of the ophthalmic artery within each eye socket. The optic disc has a unique blood supply (the posterior ciliary arteries). Loss of blood supply within the posterior ciliary arteries deprives the optic nerve tissue of oxygen and results in damage to part or all of the optic nerve. This is a small “stroke” in the optic nerve. It is painless.
Patients may become aware of decreased vision or difficulty seeing above or below the center of gaze.
Loss of the blood supply results in swelling of the optic disc, often associated with hemorrhages. The hemorrhages and swelling will go away leading to the development of a pale disc (optic atrophy). As the swelling resolves, some of the axons will be permanently lost. We do know that this happens more often in patients who are born with small optic discs.
These episodes may occur when there is a sudden drop in blood pressure (following an operation or associated with blood loss after an accident). Patients who smoke, or who have diabetes or high blood pressure, may be at higher risk for AION.
What is the treatment for AION?
Unfortunately, at this time there is no proven treatment for patients with AION. It has been suggested that aspirin may decrease the chance of an episode in the opposite eye.
It is important that the blood pressure and elevated lipid levels be controlled by your doctor (elevated pressure increases risk). On the other hand it is important that there be no sudden drop in blood pressure. Smoking should be stopped.
What are the symptoms and tests for AION?
Most patients with AION notice a sudden painless disturbance in their vision. Because of the decreased optic nerve function, however, the pupils may not react as well when light is directed into the affected eye.
Swinging a flashlight between the two eyes will then show an “afferent pupillary defect.” Visual field testing (perimetry) can identify the area of optic nerve dysfunction.
Blood pressure should be checked and if there are any unusual features other blood studies may be done. In elderly patients a blood test (sedimentation rate or c-reactive protein) can help assess the risk of giant cell arteritis.
What is a ophthalmic cranial nerve palsy?
This is one of the most common causes of acute double vision in the older population. It occurs more often in patients with diabetes and high blood pressure. These will get better and essentially always resolve without leaving any double vision. However, compressive masses, infections, inflammation and injury can also cause cranial nerve palsy.
The eyes are moved by 6 extra-ocular muscles which are controlled by three cranial nerves (oculomotor, trochlear, abducens).
Pressure on or interruption of the blood supply to one of the cranial nerves causes it not to work.
The patient will be aware of double vision that will be worse when the patient looks towards the affected side.
The nerves are usually not permanently injured and over a period of 6 to 12 weeks the function should recover.
Will vision improve after an episode of AION?
Most patients with ischemic optic neuropathy will have relatively stable vision. A recent study suggests that 40% of patients may expect to have some improvement in central vision. A very small number of patients can have worsening of vision.
In patients who have had AION there is a possibility of this happening in the other eye. Fortunately, this is not common (approximately 20% chance). Probably the best news is that it is very rare for a second episode of ischemic optic neuropathy to occur in the same eye.
What tests are done for nerve palsies?
While it is possible for multiple cranial nerve palsies to have a microvascular cause all patients with more than a single nerve palsy or with other neurologic findings must have a work up (neurologic examination and imaging study) before the diagnosis is accepted. If the cranial nerve palsy fails to resolve completely over 3 months additional work-up is indicated.
All patients with presumed microvascular cranial nerve palsies should have their blood pressure and blood sugar checked to make sure they do not have diabetes or hypertension. Additional work up such as CT or MRI scans or even an angiogram may be necessary.
How do I know that I have a cranial nerve palsy?
Dysfunction of one cranial nerve will produce weakness in one or more muscles. If the eyes aren’t moving together the patient will experience blurred or double vision. The extent and direction of double vision in gaze will vary depending on the cranial nerve involved.
What is the outcome of nerve palsies?
There is no known means of accelerating the natural recovery characteristic of microvascular cranial nerve palsy. It is important to make sure that blood pressure and blood sugar are adequately controlled.
The double vision may be treated acutely with patching either eye. It is very important that patients report any new symptoms or failure of the double vision to resolve.
What is optic neuritis?
This is the most common cause of sudden visual loss in a young patient. It is often associated with discomfort in or around the eye, particularly with eye movement.
In the most common form of optic neuritis, the optic nerve has been attacked by the body’s overactive immune system or a viral infection that may have occurred years, or even decades, earlier may have set the stage for an acute episode of optic neuritis.
What do I do about the double vision?
Since we expect the double vision to clear up on its own any treatment will hopefully be necessary for only a few weeks or months. The easiest way to get rid of the double vision is to wear a patch. Alternatively one lens of your glasses may be fogged using frosted cellophane tape on the inside
What are the symptoms of optic neuritis?
The most common symptom of optic neuritis is sudden decrease in vision. In mild cases, it may cause reduced contrast or reduced colour differentiation. This may vary and, not infrequently, will progress from the time it is first noticed.
The second most common symptom associated with optic neuritis is discomfort in or around the eye often made worse by movement of the eye.
How does an ophthalmologist diagnose optic neuritis?
A few patients with optic neuritis have swelling of the optic disc at the back of the eye. This is referred to as papillitis. One sign usually detected by your eye doctor is the presence of an afferent pupillary defect. This is found by swinging a bright light back and forth between your two eyes while observing how your pupil reacts. There may also be a defective colour vision that can be detected with a special chart.
Optic neuritis can recur involving the same eye, the other eye or other parts of the central nervous system (brain and spinal cord). This may result in recurrent episodes of decreased or loss of vision or problems with weakness, numbness or other signs of brain involvement. An MRI scan can give us a rough guess as to the likelihood of recurrence.
Other testing techniques include visual evoked potentials (a test where you are shown a checkerboard of light and signals are recorded from electrodes on your scalp) that can show a delay in conduction due to the damage to the myelin.
How will the vision loss improve after the initial episode of optic neuritis?
The pain will go away, usually in a few days. The vision problems will improve in the majority (92%) of patients. There are rare patients who have continued progressive loss of vision. Frequently colors look different or “washed out.” visual recovery usually takes place over a period of weeks to months, although both earlier and later improvement is possible.
How is optic neuritis linked to multiple sclerosis?
Multiple sclerosis (MS) is a disease process where the body’s immune system attacks multiple areas in multiple episodes. An episode of optic neuritis may be the first indication of multiple sclerosis. With a single episode, without other evidence of involvement, we usually cannot make the diagnosis at that time.
An MRI scan may be helpful in dividing those patients into high and low risks. Finding evidence of other areas of inflammation on MRI scanning suggests you may be at higher risk for recurrent episodes and thus MS.
How is optic neuritis treated?
Patients treated with oral (pills) steroids seem to have a higher chance of recurrent episodes. Therefore, steroid pills alone are not recommended as treatment. Patients who were treated with intravenous steroids did have a slightly more rapid recovery of their vision, although the final visual outcome was not better than in those who were not treated.
Thus, iv steroids can be recommended for patients with severe involvement or involvement of both eyes.
What is a pituitary tumor?
Pituitary tumors are an overgrowth of cells that make up the pituitary gland. Tumors that grow large enough to produce symptoms are less common but still are one of the most common tumors occurring within the head. These tumors may often be present for years without diagnosis or even symptoms.
An abnormal growth of cells within the pituitary gland may produce an excess of signal to the other endocrine glands leading to overproduction of thyroid, cortisone, or sex hormones.
If the pituitary tumor extends out of the sella it may produce symptoms due to compression of surrounding structures including the optic nerves, chiasm, and cranial nerves in the cavernous sinus.
What is a pituitary tumor?
Pituitary tumors are an overgrowth of cells that make up the pituitary gland. Tumors that grow large enough to produce symptoms are less common but still are one of the most common tumors occurring within the head. These tumors may often be present for years without diagnosis or even symptoms.
An abnormal growth of cells within the pituitary gland may produce an excess of signal to the other endocrine glands leading to overproduction of thyroid, cortisone, or sex hormones.
If the pituitary tumor extends out of the sella it may produce symptoms due to compression of surrounding structures including the optic nerves, chiasm, and cranial nerves in the cavernous sinus.
Oculoplasty FAQs
How is ptosis treated?
Drooping of the eyelid or ptosis can be present from birth or develop later in old age. It is a cosmetic blemish but if severe, it restricts vision as well. The treatment in majority of cases consists of surgical correction.
Surgery involves either strengthening the muscle, which elevates the lid, called LPS resection, or lifting up the lid with the help of a graft. This graft can be taken from the patient’s thigh area or can be an artificial sling material. This procedure is known as ‘frontalis sling’.
When ptosis occurs in adults, it may sometimes be the result of a systemic disease, such as myasthenia gravis, which can be treated medically. It can also follow muscle or nerve damage in other parts of the body, or tumors of the lid. When ptosis occurs suddenly in one eye, disease of the brain itself must be considered, and the patient should be seen at once by a neurologist.
What are common lid margin abnormalities? How are they treated?
Trichiasis is a condition in which there is misdirection of eyelashes. If the eyelashes turn in toward the eyeball and scratch the cornea, they produce a sensation like a foreign body. This condition may result from trachoma (an eye infection), burns or injuries to the lids. Removal of the offending lashes or corrective plastic surgery on the lid relieves the symptoms.
Entropion is a condition where there is inward turning of the eyelids, causing the eyelashes to scratch the cornea and produce irritation. Tearing and secondary infection as well as an unpleasant looking eye cause the patient to seek medical care. Entropion may be the result of spasm or secondary contracture or strictures from burns, injury or trachoma infection.
It may involve the upper or lower lids. An adhesive tape applied to the skin of the lid temporarily may straighten the lid and relive the annoying symptoms. Corrective surgery is usually required for a permanent cure.
Ectropion is the opposite condition, and the lower lid usually turns away from the eyeball. Ectropion may be due to laxity of the tissue in elderly people or to paralysis of the seventh cranial nerve (the nerve which controls the facial expressions), which causes the weakness of the muscles of the lid.
It may also follow cuts, infections, or burns of the lids and face that heal poorly; the resultant scar tissue forms adhesions that cause the lids to turn out. Besides being cosmetically unpleasant, ectropion is accompanied by troublesome tearing and infection. Treatment is surgical rotation of the lid margin and its alignment with the eyeball.
What are some common lacrimal passage diseases?
Normally tears from the eye drain to the nose through the lacrimal passage. In case of any blockade in this passage, watering results. The causes can be incomplete development, seen in young children, or infection, which occurs in adult life.
Treatment varies from performing a relatively simple procedure like ‘probing’ the pathway to open it, to more complex surgery of fashioning an alternative pathway to drain the tears to nasal cavity. This procedure is known as dacryocystorhinostomy (DCR).
How are lid injuries treated?
Apart from being cosmetically unacceptable, any irregularity of the lid margin is functionally detrimental to the eye, as lid defects may fail to cover the cornea fully and provide adequate lubrication. An oculoplastic surgeon repairs the injury in a way to make the lid as close to normal as possible.
How are orbital diseases treated?
Orbital diseases involve the tissues lying in the bony socket. Generally the eyeball protrudes from its socket, producing a widening of the eyelids. Sometimes the patient does not blink frequently, developing a staring gaze.
This may be the result of an endocrine disorder (thyroid disease), inflammation in the orbit or a tumor. Generally these lesions require investigations including ct scan and MRI. Treatment varies from case to case and may involve medical treatment, surgery, radiotherapy, chemotherapy or a combination of these.
How are lid tumours treated?
A suspicious lid mass needs excision, examination under microscope and reconstruction of the resultant lid defect. Histopathological examination determines whether the lesion is cancerous or not, and the chances of its recurrence.
Reconstruction in the form of suturing, tissue flaps from neighboring areas & other lid, and grafts preserve the lid function.
When is socket surgery undertaken?
Any painful blind eye needs removal. The deep ‘socket’ left behind is not ideal for artificial eye fitting. Therefore, at the time of eye removal, an implant is placed in the orbit, which occupies the space taken by the normal eyeball. This reduces the hollowness of the socket seen with the artificial eyes placed without an implant.
In some people, the artificial eye fit changes with passage of time. Socket surgery aims at giving the best possible ‘bed’ for artificial eye fitting, with or without an orbital implant. The above-mentioned list of disorders is by no means exhaustive. Lack of space prevents description of all conditions seen by an oculoplastic surgeon. Do not hesitate to contact your eye specialist for further information
Refractive surgery FAQs
What are the life-style benefits of laser vision correction?
LASIK surgery offers multiple benefits to most people with refractive errors:
Clear vision without the hassles and inconvenience of corrective lenses.
Expanded career opportunities (police officers, firefighters, pilots, air hostesses and professional athletes).
Better vision for recreational sports, especially water, winter and contact sports.
Wider scope of peripheral vision than what glasses provide
May be safer for eye health than wearing contact lenses for an extended period of time.
New visual freedom for all aspects of life.
Are you a good candidate for laser vision correction?
To qualify for laser vision correction, you should
Be at least 18 years of age
Have had stable vision for the past one year (slight prescription changes may not disqualify you.)
Have corneas of adequate thickness as measured by corneal pachymetry and normal shape (determined by corneal topography).
Be free from systemic illnesses, collagen vascular disorders such as rheumatoid arthritis, Sjögrens syndrome, systemic lupus erythematosus, etc.
Not be pregnant or nursing
Be off contact lenses for 1-3 weeks prior to the surgery (this varies with the type of contact lens – soft or semi-soft).
Your expectations from LASIK should be realistic. Patients with un-realistic expectations generally have low levels of satisfaction. Detailed patient counseling is important in this regard.
What is the procedure for LASIK surgery?
The ophthalmologist first uses a specialized cutting instrument called a microkeratome or Femto laser to make a flap on the front surface of the cornea.
The patient is then positioned under the excimer laser, which is programmed to vaporize some of the internal corneal tissue under the flap. After lifting the flap , the laser is applied to remove the selected tissue. The flap is then replaced in its position. The whole procedure takes 5-7 minutes in each eye.
What precautions should be followed after LASIK surgery?
The vision may be blurry for the first few hours after procedure but it gradually improves. Few patients may have a mild discomfort in the first two hours after the laser procedure. However, this is easily relieved by pain-killing medication.
Patients are encouraged to rest for a day after the LASIK. The precautions, which need to be taken, are to avoid rubbing and squeezing the eyes. Avoid splashing water on the face or directly into the eyes. Instillation of eye drops would start immediately after the laser and will continue for approximately two weeks.
Most patients have functional vision and can resume normal activities and work within a few days. In LASIK, good vision is attained in 2-3 days. You will need follow up examinations on next day after the procedure, and after the 1 week.
What are the risks associated with LASIK?
As with any surgical procedure, LASIK procedure has some possible risks and side effects that must be taken into account. A specific end result cannot be guaranteed, although it can be closely predicted based on data from thousands of previous cases. Side effects are usually minimal following LASIK surgery.
During the first few days after LASIK surgery, most people can expect to experience at least some of these effects:
• Increased sensitivity to light or glare.• Gritty and burning sensation in the eyes• Slightly drier eyes• Decreased visual clarity in dim light
In most cases, these effects decrease and eventually disappear as the eye heals. Occasionally, some side effects may persist.
Serious complications are fortunately very rare. Some of these include infection, wrinkles in the flap, epithelial in growth and increased or decreased response to correction. These complications are treatable with medication or further enhancement procedure.
Are both the eyes treated at the same time during laser vision correction?
Patients normally prefer to have both eyes treated at one sitting and get back to work faster. This practice is followed worldwide. However if the patient feels more comfortable getting only one eye treated at each session, this can be done without any additional cost to the patient.
Are the results of the LASIK procedure permanent?
The correction of vision done by LASIK is permanent. However LASIK has no effect on the natural progression of your number. This is why we only perform LASIK in patients whose number has been stable for at least one year.
Will my number get fully corrected at the time of LASIK?
The laser is set so as to reshape your cornea to eliminate your number completely. However during the healing process the eyes of each person may heal slightly differently. Thus it is possible that you may have a small residual number. Usually this does not make it necessary for you to wear glasses for routine work.
If required, can LASIK be performed again?
If the objectives of visual correction are not met with in the first surgery, a second, or enhancement procedure can usually be performed to provide additional correction. Most people do not require additional surgery, but the higher the amount of correction necessary, the greater is the possibility of needing an enhancement procedure. The surgeon and the patient together assess this need and make the decision about further surgery.
Will I require reading glasses after laser vision correction?
After LASIK surgery you will be able to see all distant objects clearly. Since LASIK cannot arrest the normal aging process of the body, you may require glasses for reading at around 40-45 years. Sometimes it may be possible to correct one eye for distance and the other eye for near vision if you so desire. This is called monovision.
Does LASIK correct all the problems associated with myopia ?
LASIK will only correct the refractive power of the eye so as to focus the image on the retina without need of glasses. However there are other associations and possible future risks in a myope like higher chances of retinal detachment, glaucoma ,cataract, etc. LASIK does not change the risk of such problems in future.
Therefore patient should always mention the past history of LASIK during future eye check-ups. It is important that patient should get regular eye checkup with special emphasis on retina and glaucoma.
What is trans-PRK?
Trans PRK is a procedure which is advised for selected patients who have thin cornea. In this procedure, a corneal flap is not made. The Laser is directly applied on corneal surface in 2 stages. In the first stage, the epithelium is ablated. In the second stage, the stromal ablation is done. After the procedure a contact lens is applied for 3 days for epithelium to recover.
This procedure is safer in patients who have thin corneas.
Patient may experience pain , watering, irritation and blurred vision for few days.
In the Trans PRK procedure although the visual outcome is the same as that of LASIK, recovery of good vision takes around 8-10 days.
What is an Implantable Contact Lens (phakic IOL)?
The phakic IOL surgery is indicated for patients unsuitable for LASIK with extremes of myopia (near-sightedness), hyperopia (far-sightedness) and/or astigmatism (cylindrical powers).
They are designed to correct visual problems much the same way as an external contact lens. However, unlike an external contact lens, a phakic IOL is placed inside the eye behind the iris and in front of the eye’s natural lens. Unlike LASIK, however, the phakic IOL is a reversible procedure.
Am I a suitable candidate for a phakic IOL?
The phakic IOL (IPCL/ICL) is capable of correcting almost all types of refractive errors, including very high myopia & astigmatisms. Many patients who are declared unfit for conventional laser treatment (LASIK, PRK etc.) can also benefit from phakic IOL.
Implantable contact lenses are best suited for patients with high nearsightedness or high farsightedness with problems wearing contact lenses. More specific guidelines of Phakic IOL eligibility could include:
Extreme myopia (nearsightedness) >-8 diopters.
Extreme hyperopia (farsightedness) >+6 diopters.
Even low to moderate myopia – if cornea is too thin to have safe LASIK or even EPI-LASIK.
Older than 21 years with a stable refraction for 2 years or more and not pregnant.
Dry eyes or large pupil.
Contraindications for Laser refractive surgery.
What does the pre-operative workup for a phakic IOL entail?
Each patient goes through a comprehensive series of eye tests and examinations (including manifest, cycloplegic and post-mydriatic refraction, Pentacam topography, optical biometery, white-to-white diameter, and thorough retina check-up) before consulting with the surgeon to discuss and plan the specifics of personal vision correction.
If one decides to go ahead with the treatment, the lenses will be made to the exact specifications and will be ready in 1-2 weeks. If you wear contact lenses, you will be required to stay off them prior to your check-up (soft lenses for 5 days and rigid lenses for 2 weeks preferably).
What is the surgical procedure of the phakic IOL?
As part of the pre-operative work-up your surgeon may perform YAG laser iridotomy before the actual procedure, which consists of making a hole in your colored portion of the eye (iris) to help ensure that intraocular fluid does not build up behind the phakic IOL (IPCL/ICL). Though with newer generation phakic IOL’s with a hole in center of IOL it’s not mandatory to do YAG laser iridotomy
Prior to the procedure you will be started on pre-operative medication including antibiotic drops, as per the surgeon’s requirements. The PIOL implantation procedure is performed in a specialist ophthalmic theatre. Topical drops anesthetics will be used to numb the eye.
The lens is inserted through a micro incision in the side of the cornea and sits in front of the eye’s natural lens, just behind the Iris. Antibiotic and anti-inflammatory drops are then administered to avoid infection and the whole procedure takes around 10-15 minutes. As a precautionary measure, the lenses are implanted one at a time, with gap to 3-5 days for second eye.
Postoperatively patient need to take precautions for 1 week. Most patients can get back to routine work after 1-2 week
What does the pre-operative workup for a phakic IOL entail?
Each patient goes through a comprehensive series of eye tests and examinations (including manifest, cycloplegic and post-mydriatic refraction, Pentacam topography, optical biometery, white-to-white diameter, and thorough retina check-up) before consulting with the surgeon to discuss and plan the specifics of personal vision correction.
If one decides to go ahead with the treatment, the lenses will be made to the exact specifications and will be ready in 1-2 weeks. If you wear contact lenses, you will be required to stay off them prior to your check-up (soft lenses for 5 days and rigid lenses for 2 weeks preferably).
What are the limitations of phakic IOL surgery?
Though most patients are suitable for phakic IOL implant, some may not be suitable due to factors like inadequate Anterior chamber depth, ocular co-morbities like cataract, glaucoma, retinal diseases etc.
Though phakic IOL is very safe and results are very satisfying, the results of surgery cannot be guaranteed.
Some patients may need glasses with minor power for sharpest vision, for night driving or other activities performed in low light, and for prolonged reading etc.
Phakic IOL’s are designed to provide as close to normal vision as possible. People with normal distance vision benefit from wearing reading glasses for near work at some stage in their 40's. Phakic IOL patients experience this aging change just the same as normal people.
What are the advantages of phakic IOL surgery?
The phakic IOL is tiny and soft – It can be folded so small that it can be injected painlessly into your eye in seconds through a tiny opening in your cornea so that it unfolds into position in the liquid between your iris and your natural lens and is easily accepted by your body
The phakic IOL is invisible – It is placed inside your eye, rather than on the surface. The lens is invisible. The only way that you or anyone else will know that it is there, is the improvement in your eyesight.
The phakic IOL is removable. Though the lens is meant to remain permanently in the eye, it can be removed if necessary, since the lens does not alter any structures within the eye or the cornea.
The phakic IOL (IPCL/ICL) works beyond the limits of laser treatment (high minus and plus spectacle powers) and is the treatment of choice if you have thin corneas, dry eyes, or large pupils
The toric phakic IOL treats two vision disorders in one procedure i.e. it corrects your nearsightedness as well as your astigmatism in one single procedure. Each lens is custom made to meet the needs of each individual person.
What are the advantages of phakic IOL surgery?
The Phakic IOL (IPCL/ICL) is tiny and soft – It can be folded so small that it can be injected painlessly into your eye in seconds through a tiny opening in your cornea so that it unfolds into position in the liquid between your iris and your natural lens and is easily accepted by your body
The Phakic IOL (IPCL/ICL) is invisible – It is placed inside your eye, rather than on the surface. The lens is invisible. The only way that you or anyone else will know that it is there, is the improvement in your eyesight.
Phakic IOL (IPCL/ICL) is removable – the lens is meant to remain permanently in the eye. However, it can be removed if necessary, since the lens does not alter any structures within the eye or the cornea.
The Phakic IOL (IPCL/ICL) works beyond the limits of laser treatment – the Phakic IOL (IPCL/ICL) is useful in cases beyond the limits of laser treatment (high minus and plus spectacle powers) and is the treatment of choice if you have thin corneas, dry eyes, or large pupils
The Toric Phakic IOL (IPCL/ICL) treats two vision disorders in one procedure – the toric IPCL/ICL corrects you nearsightedness as well as your astigmatism in one single procedure. Each lens is custom made to meet the needs of each individual person.
The Phakic IOL (IPCL/ICL) provides high patient satisfaction – They provides high quality of vision, and is a highly precise and predictable treatment providing exceptional patient satisfaction.
What are the risks associated with phakic IOL surgery?
Though this procedure is considered to be very safe, the standard risks of any intraocular surgery are possible.
There is a small risk of infection but this is minimized by the full sterile theatre conditions. There is also a small possibility of damage to the structures of the eye, which could lead to cataracts, glaucoma, retinal complications, corneal decomposition and rejection.
Severely short-sighted people often have other eye problems such as damaged retinas and progressively deteriorating eyesight. The ICL cannot help or stop these associated conditions. In the event of complications, lens implants are potentially reversible.
No procedure can be risk-free. Ultimately, the patient needs to make up their mind about the risk/benefit balance for the various options available to them to correct their high myopia or high hyperopia. Some patients need surgical correction of their severe focus error for safety reasons.
Theoretically, the proximity of the ICL to the iris and lens raises the possibility of late onset lens opacities or pigment dispersion. Both these rare but potential problems are much more easily fixed than corneal complications following LASIK surgery. Current evidence supports phakic IOL as being a very effective and safe option for these patients.
The phakic IOL is designed to be placed in your eye and remain there permanently, but with increasing age if you develop a cataract significant enough to cause visual problems, then cataract removal with intraocular lens implantation can be done with removal of the phakic IOL.
How quickly can I go back to my daily routine & activities after a phakic IOL surgery?
Due to the quick recovery after this treatment, you can leave the centre after a couple of hours. You will be able to enjoy your new sight almost immediately and go back to your active lifestyle. Your surgeon will give you detailed advice.
What if my vision changes after phakic IOL surgery?
Though unlikely, if during your annual eye exam a major change in your vision is observed, the phakic IOL can be removed or replaced. With the phakic IOL you can still wear glasses or contact lenses if necessary. The lens does not treat presbyopia or eliminate the need for reading glasses due to age. Now presbyopic phakic IOL's are also available, which can correct presbyopia along with myopia or hyperopia, thus reducing dependency on reading glasses also.
Dry eyes FAQs
What is Dry eye syndrome?
Dry eye syndrome is a leading cause of ocular discomfort affecting millions of people. Dry eye conditions are a spectrum of disorders with varied etiology ranging from mild eyestrain to very severe dry eyes with sight threatening complications.
Although the typical patient of dry eyes is elderly, or suffers from autoimmune disease, increasing numbers of patients do not fit this profile. Younger patients who work with computers can suffer from dry eyes more often than elderly patients.
Dry eyes are also aggravated in polluted conditions, dry weather, decreased ambient humidity as seen with air conditioning and indoor heaters. It may also result from the abnormalities in one or more of the tear film components, ocular or systemic diseases, and various drugs.
Dry eye syndrome is usually treated with tear supplements and lubricants. However, if these do not help, the insertion of microscopic plugs (temporary or permanent) can be inserted to help conserve tears and prevent them from draining away. In severe cases, surgical intervention may be essential.
Can I wear contact lenses if I have dry eyes?
Generally, except in the most severe cases, patients with dry eyes can wear contact lenses. A variety of new lens materials and eyedrops—both prescription and over-the-counter—are available, allowing most patients to wear contacts.
Can something be done about the redness in my eyes?
Red eyes can be due to many treatable causes, including dry eyes, allergies and blepharitis (a problem originating in the oil-producing glands of the eyelids). In addition to oral anti-allergy medications, eyedrops are helpful in reducing the symptoms of allergy. Although blepharitis tends to be a long-term problem, there are many treatments available that can help with the symptoms it causes, including over-the-counter eyelid cleansers as well as topical and oral medicine.
What is blepharitis?
Frequently, bacteria on the skin and eyelashes can cause a condition known as blepharitis. Blepharitis is a persistent and common inflammation of the eyelids. This condition, if left untreated, may cause permanent damage and dysfunction to the natural glands of the eyelid that are meant to keep your eyes moist. Traditionally, this condition can be difficult to treat due to its recurrent nature.
What is a meibomian gland dysfunction (MGD)?
The meibomian glands of the upper and lower lids play one of the biggest roles in dry eye symptom management. These glands produce specific lipids that coat the tears and prevent them from evaporating. Studies show, that approximately 65 % of dry eye symptoms are caused by a dysfunction of these glands! Over years, these glands can get obstructed with bacteria, cholesterol, debris, allergens and even make-up. For years, patients have been treated with hot compresses to help loosen up this obstruction. However, in most cases, this treatment has provided minimal relief.
What is Lipiflow?
LipiFlow® is an advanced thermal pulsation treatment system that effectively relieves blockage of the eyelid glands during a comfortable in-office treatment. Opening the blocked eyelid glands allows the body to resume the natural production of lipids (oils) needed for the tear film. It reduces the need for drops, warm compresses and other cumbersome, time-consuming efforts for chronic Evaporative Dry Eye disease or Meibomian Gland dysfunction.
Contact lens FAQs
What are contact lenses?
Contact lenses (CL) are small, thin, curved transparent discs that are designed to rest on the cornea (the clear front surface of the eye). Contacts cling to the film of tears over the cornea because of surface tension, the same force that causes a drop of water to cling to the side of a glass.
Contact lenses are mostly used to correct near-sightedness, far-sightedness and astigmatism. Contact lenses provide a safe and effective way to correct vision when used with care and proper supervision. They can offer a good alternative to eyeglasses, depending on your eyes and your lifestyle.
However, one must remember, they are health devices, not commodities or beauty aids, and not everyone can wear them.
What are the types of contact lenses available?
There are basically two types of Contact Lenses:
Rigid Gas-permeable (RGP) Contact Lenses which are also known as “semi-soft lenses”
Soft contact lenses
Hard contact lenses have become obsolete now.
Soft lenses can be further classified depending on the type of wear:
Daily Wear
Extended Wear
Disposable (Quarterly, Monthly, Fortnightly, Weekly And Daily)
What are the advantages and disadvantages of each type of contact lens?
RGP (Semi-soft) Lenses
RGP lenses are made of special, firm plastics combined with other materials, such as silicone and fluoropolymers, which allow oxygen in the air to pass directly through the lens. These lenses are very durable and typically last longer than soft lenses. RGP lenses provide excellent quality of vision, have a long life, and can correct astigmatism as well as uneven curvature of the cornea.
The disadvantages are that these may take a little longer to get used to, it is easier for dust to get behind RGP lenses, causing irritation and discomfort, and one can’t switch back and forth with glasses as easily. However, regular wearers find them comfortable and the visual acuity outstanding.
Soft lenses
Soft lenses are made of flexible water-absorbent (hydrophilic) material having water content between 30-80%. These lenses are comfortable the moment they are inserted in the eye. They are less likely to dislodge and can be worn for longer periods. However, their biggest disadvantage is that they cannot correct higher degrees of astigmatism. They also need to be changed more frequently.
What is the difference between Daily-wear and Extended-wear lenses?
Daily-wear Lenses
Daily-wear contact lenses are designed to be removed each day for cleaning, and should be taken out before you sleep or nap. Daily-wear Lenses should never be worn as extended-wear lenses. Misuse can lead to temporary and even permanent damage to the cornea. People who wear any type of lens overnight have a greater chance of developing infections of the cornea. These infections are often due to poor cleaning and lens care. Improper over-wearing of contact lenses can result in intolerance, leading to the inability to wear contact lenses.
Extended-wear Lenses
Extended-wear Lenses can be worn continuously for up to seven days before they are removed for cleaning, depending on how oxygen-permeable the lens material is. Extended-wear lenses can also be prescribed to be removed each day for cleaning and slept in occasionally when special circumstances arise.
Many variables are considered in deciding between daily-wear and extended-wear lenses for each person’s needs. Since the risk of serious eye infections is higher in extended contact-lens wearers, they are generally prescribed in carefully selected individuals who are frequently monitored by eye care professionals.
Additionally your work and social environments can affect lens choice for example air-conditioning, computer use, dusty environments and so forth will affect the lens choice.
Which type of contact lens is best for me?
Each individual is different, although there are some broad guidelines that may be followed. If you are interested in initial comfort, soft contact lenses may suit you better than rigid gas permeable (RGP) lenses. On the other hand, RGP lenses tend to last longer. A soft (hydrophilic) lens is more appropriate for occasional wear (at most once or twice a week).
Not everyone can wear both types. Only after thoroughly examining your eyes & vision, can one advise whether you can wear RGP lenses, soft lenses or both. In your initial consultation, a number of tests and measurements will be performed, usually following a full, general visual examination.
This evaluation will determine the optimum contact lenses for your specific needs. Additionally any other factors that determine your ability to wear lenses successfully will be explained to you.
Various general health factors, including medication, ocular, medical and family history will be assessed. A number of prescription medications, drugs and allergic factors can influence the ability to wear contact lenses successfully.
What are disposable lenses, frequent and planned replacement lenses?
Disposable contact lenses and frequent replacement contact lenses are designed to be worn for a specific period of time, thrown out and replaced with a fresh pair of lenses. “disposable” refers specifically to lenses that are replaced every two weeks or less depending on the wear schedule prescribed by your optometrist or doctor.
Disposable lenses are usually prescribed in multi-packs, providing several weeks supply at a time. “frequent & planned” replacement lenses are lenses that are replaced on a planned schedule, most often either every two weeks, monthly or quarterly.
The purpose of replacing contact lenses on a frequent basis is to prevent discomfort, dryness, blurred vision and allergic reactions that can result from a build-up of protein and lipid deposits on the lenses. As the deposits age and chemically change on the lens, they contribute to these irritations.
The changes in the chemical composition of the deposits also increase the probability that bacteria may adhere to a contact lens, increasing the risk of serious eye infection even without any subjective deterioration in comfort. “disposable lenses” and “frequent & planned” lenses should be discarded after the recommended replacement time even if they are still comfortable thereafter.
Your eye care practitioner will determine the lens replacement frequency that is most appropriate for you. Lenses should not be worn for longer than the recommended wearing period.
If I only wear my fortnightly-disposable contact lenses part time, do I still have to replace them every two weeks?
No, the two weeks refers to the actual amount of wearing time so they can last longer than two weeks if you are not wearing them full time.
Do people experience discomfort or pain when using contact lenses?
Most first time wearers are delighted with the level of comfort that contact lenses provide. Initial contact lens fittings by professional eye care practitioners can minimize or eliminate any irritation associated with new lenses. After a brief adjustment period, most people report they can no longer feel contact lenses on their eyes.
Can contact lenses be “blinked” out?
With normal use, contact lenses will stay firmly in position. However, they can come out under certain conditions. High winds can cause the eyes to water and pull the eyelid tight against the eye, increasing the chance of lens loss. A sharp blow to the head may dislodge rigid gas permeable lenses. And rubbing your eye carelessly may result in a lost lens.
Describe to your eye care practitioner all of the circumstances in which you are likely to wear your contact lenses. This will help him or her prescribe a type of lens that is less likely to be dislodged given your activities.
What are the basics of daily contact lens care?
Your eyes and your vision are precious, and good contact lens care can help assure a lifetime of healthy eyes. It’s important to follow the instructions for daily or weekly lens care prescribed by your eye care professional for your type of lenses. The basic steps include cleaning, rinsing, and disinfecting (for storing).
Cleaning solutions remove dirt, protein, oils, mucus, and debris that get on the lens during wear.
Disinfecting solutions kill bacteria and other germs on the lenses. Disinfection is necessary to help prevent serious eye infections.
Rinsing solutions remove other solutions from the lenses. They also prepare the lenses for wear.
Enzyme solutions remove protein and other deposits that accumulate on the lenses over time.
Rewetting solutions are used to wet (lubricate) the lenses while you are wearing them, to make them more comfortable.
These steps can be performed using separate solutions. However, recently, there has been a strong movement to “one-bottle” systems. These all-in-one solutions are the easiest and quickest to use. You should not make your own lens care solutions, nor should you mix different brands of solutions unless instructed by your eye care practitioner.
However, if you are particularly sensitive to chemicals, it may be better to use a hydrogen peroxide system. One must remember that all contact lens cases need frequent cleaning, including disposable lens cases. As a rule never bring any contact lenses in contact with tap water as it can be source if serious (sight-threatening) eye infection
Is it necessary to use protein remover tablets in addition to my normal daily cleaning procedure?
The need to use protein remover tablets depends on the amount of protein deposits your eyes produce and how often you replace your lenses. Protein deposits are normal. But as they age, they can change in chemical composition, contributing to discomfort and poor vision or leading to allergies.
Regardless of your lens replacement schedule, however, daily cleaning is important for eye health. Consult your eye care practitioner for the best advice regarding your replacement and cleaning schedules
Weekly enzyme cleaning helps keep soft lenses free from deposits of protein naturally produced in your eyes and carried by your tears. Lately, solutions are available, which eliminate the need for enzyme cleaning as well. Soft extended-wear contacts are the most likely to have protein build-up and cause lens-related allergies.
Soft daily-wear lenses are less likely to create problems. Rigid gas-permeable lenses may be good choices for someone with allergies, as less protein is deposited on the lenses. If these deposits become a problem, your eye care practitioner may recommend a type of contact lens that you replace more frequently. Depending on the replacement frequency, using a protein remover in addition to your daily cleaning regimen may not be necessary
The type of care contact lenses require, and how long they should be worn, is something each eye care professional will prescribe for each patient. Personal wear and care regimens may depend upon the type of contact prescribed, the nature of the vision problem being corrected, and the individual’s unique eye chemistry. Regardless of the type of lens you wear, you will find that lens care is now easier and more convenient than ever before.
What precautions must be taken while using cosmetics with contact lenses?
While some cosmetics may interfere with contact lens performance and the wearer’s tolerance for contacts, others are safe. Some rules should be followed when using cosmetics:
Insert lenses before applying eye makeup and take them out before removing cosmetics.
Use hair spray and other aerosols before lenses are inserted. Allow time for the aerosol mist to settle from the air or go to a different area before handling lenses.
Completely remove residual cosmetics from you hands with mild, additive-free soap before handling lenses.
Use cream shadows instead of powders and avoid using shadows with glitters.
Use water based cosmetic formulations.
Use hypo-allergenic cosmetics.
Avoid using mascaras containing fibers for extra lash length.
Avoid using saliva to wet applicators.
Don’t apply eyeliners and pencils inside the upper or lower eyelid margin.
Is it safe to play sports while wearing contact lenses?
Wearing contact lenses for sports is a more flexible and stable form of eye correction than eyeglasses, and athletes of all kinds have discovered the advantages of wearing contact lenses when participating in sports or working out.
Contacts don’t steam up from perspiration, don’t smudge and don’t get foggy if you go from cold to warm temperatures. They provide better depth perception and complete peripheral vision. Today’s close-fitting contacts stay on your eyes, even during vigorous activity.
If your sport involves vigorous exercise, a soft contact lens is an appropriate choice. Your eye care practitioner can help determine the best type of lenses based on your sport or activity to help protect your eyes and your contacts, goggles should be worn when you swim.
Is it safe to swim while wearing contact lenses?
Pool water can cause discomfort due to chlorine. It is best to avoid swimming with your contact lenses on because it exposes your contacts to bacteria and other microorganisms in the water. These can adhere to your lenses and place you at risk of eye infections.
If you do swim with your lenses, you should wear goggles with a firm seal. If you don’t wear goggles, the contact lenses may float from your eyes. They may also absorb the pool water, one consequence of which may be that they adhere quite firmly to the eye.
If this occurs, it is advisable to leave the lenses alone for 10-15 minutes until your natural tears have replaced the water in them, before trying to remove them. You should then disinfect them immediately afterwards.
I have dry eye problems. Can I wear contact lenses?
You’re less likely to have success with contact lenses than someone who does not have this condition. This does not mean that you cannot wear contact lenses at all. It simply means you may have a shorter contact lens wearing period than normal or that you may choose to wear your lenses only occasionally. You can increase the comfort of your lenses by inserting eye lubrication drops.
For the same reason, wearing contact lenses while traveling by plane can be uncomfortable. The low humidity in aircraft cabins contributes to dry eye symptoms and contact lens discomfort. It may be helpful to put lubrication drops in your eyes before you enter the aircraft, or during flight.
If symptoms persist or become severe, it is probably easiest and best to wear eyeglasses when flying. As always, it is best to consult your eye care practitioner for the best advice regarding whether you should wear contact lenses and what type of lenses may be suitable for such a condition.
My doctor told me I couldn’t wear regular contact lenses for presbyopia. Why not?
Presbyopia is a vision condition (generally after the age of 40 years) in which the eye cannot focus on near objects. In most cases, reading glasses or bifocal glasses are prescribed to correct presbyopia. In order for a contact lens wearer to read, he or she has to wear reading glasses over the contacts.
But contact lenses can be prescribed also. Special bifocal contact lenses are also available in both rigid gas permeable or soft lens designs.
As an alternative, many practitioners prescribe a system called monovision where one eye is fitted with a distance lens and the other with a reading lens, with the brain automatically switching to the eye more clearly in focus. Monovision is a good solution for some people, but not everybody can successfully adapt to the arrangement.
I have astigmatism and was told I couldn’t wear contacts. Is that true?
No. Most people with astigmatism can wear contact lenses. In astigmatism, the curvature of the cornea varies in different axes and spectacles with a cylindrical number are prescribed for its correction. For those wishing to wear contact lenses, the fitting procedure takes more time, and certain lenses don’t provide vision as good as glasses, but only in special circumstances can a person with astigmatism not be fitted with contact lenses.
In astigmatism, RGP (“semi-soft” lenses) provide sharper vision. This is because rigid lenses retain their shape and placement on the cornea better than soft lenses, and helps the eye to conform to the shape of the contact lens, thus masking the need for an astigmatic correction.
If you have a small amount of astigmatism, between zero and 1.00 (either +1.00 or -1.00), you may still be able to wear a regular spherical soft lens, although with not as good quality as rgp lenses. In higher degrees of astigmatism, only rgp lenses will provide sharp vision; regular soft lenses will not help.
If you have a significant amount of astigmatism, and still wish to wear soft contact lenses, you can wear a special type of soft contact lens called a toric lens, which will correct your astigmatism. Properly fitting a toric lens takes more of your time and requires more expertise than regular contacts. However, these lenses are typically more expensive.
What are therapeutic contact lenses?
Advances in materials technology and better understanding of the eye’s needs in health and disease have enabled the development of soft and rigid lenses to aid in protecting and helping a sick eye (especially certain corneal disorders) to heal.
This acts as a transparent bandage which protects the injured or diseased cornea, and acting as a reservoir of medication inserted into the eye. A variety of conditions may be treated and in some cases, even cured in this manner. These unique lenses are frequently combined with precise medication delivery schedules to help heal the eye.
What about contact lenses as a vision treatment for young children?
Certain children who are born with cataracts, or develop them in early childhood, need to undergo cataract surgery. However they may be too young to be implanted with intraocular lenses (IOL). While surgery can protect their vision, this procedure often leaves them very farsighted.
Contact lenses can provide them the best vision possible and even help their own vision develop better, since spectacles are not a practical alternative for this group.
When contact lenses are prescribed for infants and toddlers, parents and other family members can learn how to insert, remove and clean the lenses. Children of all ages can adapt easily to wearing the lenses.
Can contact lenses be fit if I have had refractive surgery and have a residual spectacle number?
Yes, but the refractive surgery will have altered the contour of your eyes, requiring a more specialized lens than normal. It is best to consult your eye care practitioner who will advise you based on the details of your specific history and requirements.
Why is it necessary for contact lens wearers to have regular eye exams even if their prescription hasn’t changed?
Eye exams are important not only to check your prescription but also to evaluate the health of your eyes. This is especially important for contact lens wearers because the contacts could be causing damage to your eyes without necessarily causing any obvious symptoms.
Sometimes, one may experience symptoms such as – redness of eyes, stinging, burning or itchy eyes, excessive tears, unusual eye secretions, and changes in vision. Such symptoms could be due to many reasons. On feeling of any discomfort, you should remove and examine your contact lenses immediately.
If your lens appears damaged, torn or ripped, do not put the lens back on your eye. Put on a new lens or contact your eye care practitioner to order a new lens. If your lens is not damaged, but the irritation persists, contact your eye doctor immediately.
Who should not wear contact lenses?
Most people who need vision correction can wear contact lenses, but there are some exceptions. Some of the conditions that might keep you from wearing contact lenses are:
frequent eye infections, severe allergies, severe dry eye (improper tear film), a work environment that is very dusty or dirty, and inability to handle and care for the lenses properly.
Whether or not contact lenses are a good choice for you depends on:
Individual needs and expectations.
Patience and motivation during the initial adjustment period to contact lens wear.
Adhering to contact lens guidelines for wear, disinfecting and cleaning.
Diagnosis and treatment of conditions that may prevent contact lens wear.
What is contact lens intolerance?
Contact Lens Intolerance is a situation which affects many long-time contact wearers. The eye tires of the foreign body (contact lens) that has been in place all these years and starts to show signs of rejecting it.
Are you becoming contact lens intolerant?
You may find that you need to remove your contacts by the end of the day; making it next to impossible to tolerate wearing contacts the next day.
Thw symptoms include:
Dry, itchiness setting in earlier in the day
Rationing your contact lens time
Frustration at the need to wear your glasses more
How do I deal with contact lens intolerance?
Some people can get relief from switching to a different hydrating solution. Sometimes the problem arises from keeping extended-wear lenses past their useful life. Be sure to follow package directions and the instructions of your doctor.
Clean your lenses often and practice good hygiene with your hands and eyes to minimize the possibility of infection.
The more permanent solution to contact lens intolerance is laser vision correction.
Low Vision aids FAQs
What is ‘Low Vision’?
A person is said to have ‘low vision’, if he or she has a significant visual handicap in spite of treatment and best correction with standard eyeglasses or contact lenses. ‘Low vision’ should not be confused with blindness.
People with ‘low vision’ have a significant visual handicap but they also have significant residual vision. The residual vision may be insufficient to meet the patient’s routine needs.
But a good percentage of these patients have some degree of usable vision, which can be utilized for their day to day work using special aids or devices. If properly motivated, these patients can potentially benefit with the use of special aids or devices called ‘Low Vision Aids‘
What are the causes of ‘Low Vision’?
Although most often experienced by the elderly, people of any age may suffer from low vision. Low vision can result from birth defects, inherited diseases, injuries, diabetes, glaucoma, high myopia and aging.
The commonest cause is age related macular degeneration (ARMD), a degenerative disease of the retina, the innermost layer of the eye that perceives light and enables us to see. Macular degeneration affects the central vision. Even when advanced, it does not lead to total blindness because the peripheral vision is still preserved, even though the central vision may be totally lost.
Although reduced central vision is the commonest cause of low vision, extensive loss of peripheral vision as in advanced glaucoma, can also produce low vision due to extremely narrow field of vision. Birth defects or inherited disease producing loss of color vision or increased glare sensitivity (diminished ability of the eye to adjust to light, contrast or glare) can also cause low vision.
Reduced central vision produces difficulty in reading, watching television and recognizing faces. Loss of peripheral vision reduces mobility. Increased glare sensitivity causes difficulty in driving.
Impaired color vision results in difficulty in distinguishing different colors. Different types of low vision require rehabilitation with different kinds of ‘low vision aids’.
How does controlling illumination affect low vision?
Illumination has an important role in helping patients with low vision. Even for a normal person with advancing age, increased illumination is needed to perform the same task. Lighting should be ample, placed close to the reading material and be properly directed towards it.
Illumination devices like high intensity reading lamps with adjustable arms are of good help.
Visors and cap brims block the dazzling effect of overhead light. Glare control filters incorporated in the spectacles can help control glare and improve function in many patients.
What are ‘Low Vision Aids?’
A ‘Low Vision Aid’ (LVA) is a device or an apparatus that improves or enhances the residual vision in patients with low vision. There is no absolute level of vision above which LVAs will be useful, and below which they will not be.
Also there is no one device that is suitable for all situations and all patients. Different devices are needed to fulfil the needs of various patients. Various low vision aids may need to be tried out before the most suitable device or devices is determined for a particular patient.
What are ‘Low Vision Aids?’
A ‘Low Vision Aid’ (LVA) is a device or an apparatus that improves or enhances the residual vision in patients with low vision. There is no absolute level of vision above which LVAs will be useful, and below which they will not be.
Also there is no one device that is suitable for all situations and all patients. Different devices are needed to fulfil the needs of various patients. Various low vision aids may need to be tried out before the most suitable device or devices is determined for a particular patient.