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Glaucoma – The Silent Thief of Sight

Vision with GlaucomaGlaucoma is a group of diseases that can damage the eyes optics nerve & result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eye slowly rises.  However, with early treatment, a person can often protect his eyes against serious vision loss.  If you have one or more of the following risk factor for glaucoma, talk to your doctor about scheduling more frequent eye examinations.

  • Family history of glaucoma
  • Advancing age
  • Near-Sightedness (Myopia)
  • Any Injury to eyes
  • Secondary to other ocular conditions (thin cornea, cataract, inflammation, tumors)
  • Long-Term Medication (Cortisone)
  • Diabetes, Hypertension
  • Glaucoma in other eyes.

Be aware that a severe headache or pain In your eye or eyebrow, nausea, blurred vision or rainbow halos around lights may be symptoms of narrow-angle glaucoma.

  • If you experience two or more of these symptoms together, sick immediate care at an a emergency room or an eye doctor.

Sab acute (Intermittent) angle closure occurs in a predisposed eye with on occludable angle.

  • Attacks may be precipitated by physiological mydriasis (watching television in-darkroom), or by physiological shallowing of the anterior chamber when the patient assumes the prone or semi-prone position.(when sewing or reading)
  • Emotional stress may be a precipitating factor

The routine screening eye examinations (once in a year) are mandatory since glaucoma usually causes no symptoms (asymptomatic) in its early stages.

Once damage to the optic nerve has occurred it cannot be reversed thus in order to preserve vision glaucoma must be diagnosed early and followed regularly.

Patients with glaucoma need to be aware that it is a lifelong disease and
ophthalmologist decides the schedule for follow up visits depending on the
individual’s progress of the disease and associated risk factors.

Compliance with scheduled visits to the eye doctor with prescribed medication regimens offers the best chance of maintaining vision.

What is Buphthalmos and How can it be Treated

This essentially means a large eye as a result of stretching due to elevated IOP prior to the age of 3 years.

Primary congenital glaucoma:-

Is rare with an incidence of 1:10,000. Boys are more commonly affected.
Involvement is usually bilateral but may be unilateral as well. It is classified as:-

  1. True congenital glaucoma.
  2. Infantile glaucoma (manifests before 3 years)
  3. Juvenile glaucoma ( between 3-16 years of age)

The child usually presents with watering photophobia and blepharospasm noticed by parents.  The child is evaluated under short G.A. to check parameters like IOP, Anterior chamber evaluation, gonioscopy, optic disc evaluation, corneal diameter, Fundoscopy, and Retinoscopy.

Treatment:-

Management is essentially surgical

  • Goniotomy
  • Trabeculotomy
  • Trabeculectomy
  • Tube shunt implantation
  • Ciliary body ablative procedures
     

Long-term IOP monitoring with visual rehabilitation is a must to prevent
Amblyopia.

What Choroidal Melanoma?

Malignant melanoma of the eye can develop when pigment cells in your eye grow out of control.  Pigment cells are responsible for your eye color.  The cause of uncontrollable cell growth isn’t usually known.  Exposure to ultraviolet radiation has been identified as one potential cause of the disease.  Choroidal melanoma is cancer that affects the inner part of the eye. It develops in the choroid, the sponge-like membrane at the back of the eye between the sclera (the white of the eye) and the retina.  (The retina is the light-sensitive structure at the back of the eye.  It sends visual information to the brain).  The choroid is rich in blood vessels and supplies nutrients to the retina.

Over time, many choroidal melanomas enlarge and cause the retina to detach.  This can lead to vision loss.  The tumors also can spread (metastasize) to other parts of the body.  The liver is the most common site for metastasis.  If it spreads, this cancer can be fatal.
Melanomas usually occur in the skin.  But they can also develop in places where certain cells contain the pigment melanin.  The choroid is one such example.

Symptoms:-

This cancer often doesn’t cause any symptoms in its early stages.  The tumor may grow for some time before the problem becomes noticeable. When symptoms occur, they include

  • having blurry vision
  • seeing spots
  • seeing flashing lights
  • having severe eye pain

Having these symptoms doesn’t mean you have choroidal melanoma.  These symptoms can be caused by other conditions that are more common—and noncancerous.  In fact, seeing spots and flashing lights are very common symptoms.  And they are rarely related to choroidal melanoma.

Diagnosis:-

Most cases of choroidal melanoma are detected during a routine, dilated eye exam.  During this exam, an eye specialist (ophthalmologist) dilates the pupils to examine the back of the eye.  Most of the time, no other tests are needed.  But specialized tests can confirm the diagnosis.  

These tests include:-

  • ultrasound. A small probe placed on the eye directs sound waves toward the tumor. A machine records the patterns the waves make as they bounce off the tumor.
  • fluorescein angiography. A fluorescent dye is injected into an arm vein. A rapid sequence of photographs is taken through the pupil as the dye passes through the veins in the back of the eye.

After a choroidal melanoma has been diagnosed, an MRI (magnetic resonance imaging) scan may be ordered. This can help doctors further evaluate the tumor’s characteristics.

Prevention:-

Because the causes of choroidal melanoma are not well understood, there is no known way to prevent it.

Treatment:-

Management and treatment of choroidal melanoma depend on the tumor’s size. If the tumor is small, it may simply be monitored. If it grows, treatment would start.

Medium and large choroidal melanomas usually are treated with radiation or surgery. Radiation therapy may be given in different ways. Local radiation is delivered via a small, metal, dish-shaped device containing radioactive iodine. The device is stitched to the sclera so that the radiation can target the tumor precisely. In some institutions, external beam radiation therapy may be used. Beams of radiation target the tumor from outside the body.

In some cases, the eye has to be removed. This is called enucleation. Most ophthalmologists recommend removing the eye if the choroidal melanoma is large. After the eye is removed, a prosthetic eye is placed into the socket. Cosmetically, the fake eye can look almost real. However, it often does not move as well as a natural eye.

If you are treated for choroidal melanoma, you will need to be monitored for the rest of your life. This helps doctors determine whether the cancer has spread to other parts of the body.

Treatment of choroidal melanoma that has already spread beyond the eye has had very limited success. There is little evidence that radiation or surgery to remove the eye affects the outcome in these cases. Researchers are studying whether chemotherapy given after the eye is removed can reduce the risk of death from metastatic choroidal melanoma. Newer biological therapies are also being tested.

Prognosis:-

The outlook depends on the size of the tumor when it’s diagnosed. The prognosis is better if the cancer is contained within the eye and has not spread to other parts of the body.

LET’S NOT BE LAZY ABOUT LAZY EYE

As the name implies, a “lazy eye” is one that does not take part fully in the seeing process. The images the lazy eye sends to the brain are ignored (suppressed). As a result, only the better eye is used for sight by the brain. If not treated, loss of vision can occur in the lazy eye.

Amblyopia commonly develops in infancy and early childhood and affects about 3% of children.  It may develop due to vision conditions such as a crossed or wandering eye (strabismus).  Or, it can occur because of unequal vision in the two eyes caused by astigmatism, farsightedness or nearsightedness.

A key to successful treatment of lazy eye is to encourage its use whenever possible.  Corrective eyeglasses or contact lenses can sometimes encourage the use of the lazy eye by providing it with the clearest possible vision. Occlusion of the better fellow eye with either patching or blurring eye drops (atropine) can also force the use of the lazy eye.  In addition, doing near visual activities with the occlusion, such as reading, using a computer, and playing video games, will stimulate greater use of the lazy eye.

The time period for which patching is recommended depends on the age and vision at presentation.  Older age (greater the 8 years) and greater difference in visual acuity (more than 4 lines difference on distance vision testing) warrant longer (6 – 8 hours/day) hours of patching.  Hence early intervention is the key to the successful outcome.

Every new patient diagnosed with amblyopia, however, should undergo few months of patching therapy before being declared as refractory.

Oculoplastic Treatment and Surgery Hospital in Mumbai

NLDO
Oculoplastic Treatment

Oculoplasty is a specialized branch of Ophthalmology that deals with injuries around the eye, lid related problems, tear drainage related problems, cancers of the eye and around the eye and all the cosmetic concerns around the eyes.

Rushabh Eye Hospital in Mumbai has a specialized department for Oculoplastic Treatment and Surgery at the Hospital.  If you are suffering from any of these problems you may need an oculoplastic treatment.

  1. Watering from Eyes or Tear EyeIn a normal eye, there is a sac that drains tears from our eyes to our nose. This is called the nasolacrimal sac. Blockage of this sac is among the commonest causes for watering from the eyes.  If this blockage is left unattended, tears collect in the sac. They can get infected, causing pain, swelling, and redness in the area of the sac and the lower lid. Sac syringing is a test to confirm this blockage in which saline is injected through the opening of the sac near the eyes (punctum).  If this fluid easily and completely empties in the nose, the path is considered a patent. Amount of regurgitation of fluid can be documented by the doctor to determine if there is a partial or complete blockage and to determine the site of blockage. Surgical correction by creating an alternative passage for drainage of the fluid from the sac to the nose is the definitive treatment.
  2. Chalazion in the EyelidThis is a localized swelling of the eyelids.  It occurs due to obstruction to the opening of glands that are present in the eyelids.  Treatment could be conservative in the form of ointment and hot fomentation.  Surgical removal can be done at any point in time.  Surgical removal is essential in long-standing cases.  This removal is done by taking an incision on the conjunctival aspect so that there is no skin incision or scar.  In cases of repeated chalazia at the same location, it is mandatory to see an oculoplastic surgeon.
  3. Wrinkles

Are facial wrinkles troubling you?
Crow feet, forehead lines, bunny lines, frown lines… these are all easily treatable.   Injection Botulinum Toxin A is a simple, quick and safe way to improve facial lines.
So what are you waiting for? Here at Rushabh Eye Hospital, we have a specialized department to manage all kinds of aesthetic eye problems.

4. Eyebags 

Eyebags in lower or upper lid is a common occurrence. It occurs due to the forward protrusion of normal fat which is present around the eye. These do not cause any harm to the eye but certainly, change the appearance of the face. Eyebags are commonly confused with water retention around the eyes. So a detailed checkup from you Cosmetic Eye Doctor (Oculoplasty Surgeon) is warranted.

5. Thyroid Eye Disease

Thyroid can have varying effects on eyes.
Thyroid Eye Disease has two phases: active and chronic.
The active phase is characterized by recurrent episodes of pain, redness, swelling, large looking eyes, double vision, diminished vision, etc. Treatment in this phase is to reduce the complaints of the patient and protect vision.   Chronic phase is when symptoms stabilize.  At this stage, a definitive correction can be done.   Do visit Rushabh Eye Hospital to consult with one of our Oculoplasty doctor for further details.

 

 

 

Why early Cataract Surgery is Possible?

Vision with cataract causes blurred vision, distorted images, haloes around light etc.  Advanced cataracts may cause a complete blackout of vision.  We usually do not wait for any more for cataracts to ripen, since the newer techniques of removal are laser based. In the olden days, manual techniques required us to wait so the cataract would become hard and would be easy to hook out from the eye from large incisions which then required to be stitched.  Healing was slow and unpredictable. These days, phacoemulsification cataract surgeries have changed the scenario. The incisions are hardly 3 mm in size and require no stitches. The healing is quick and results extremely predictable. The cataract can be removed at any stage, but requires more laser energy to break down the harder cataracts, which may occasionally delay healing. Hence, we no longer advise patients to postpone surgery.  Once diagnosed with a cataract, you can plan the surgery as per your logistics at an early stage itself.

WHAT ARE TORIC LENSES?

Astigmatism is the cylindrical component of the shape and number of the eye.  If you are planning a cataract surgery and have high astigmatism, you may require correcting this in addition to the conventional spherical power intraocular lens. These lenses are called toric lenses.

They correct the cylindrical power in addition to the spherical power
of the eye, thus giving more clarity in vision to the patient. If the
cylindrical power is left uncorrected, the person may require glasses to
improve clarity in vision even after removal of the cataract.

Hope for Macular Degeneration Patients

A treatment for the commonest cause of blindness could be available within five years, scientists believe, after revealing the first two patients given a revolutionary stem cell therapy have regained enough vision to be able to read.

The two patients have advanced AMD – age-related macular degeneration – which destroys the central vision.  Both were losing their sight.  They were, said their surgeon, unable to see a book, let alone the printed letters.

But an implanted “patch” of stem cells over the damage at the back of the eye has restored the central vision enough not only for reading but to see faces that used to be a grey blur.

In the future, the scientists behind the breakthrough anticipate the procedure could be as common as cataract surgery, helping large numbers of the 600,000 to 700,000 people in the UK who are losing their sight because of AMD.

The breakthrough comes from the London Project to Cure Blindness, a collaboration between Prof Pete Coffey of University College London and Prof Lyndon da Cruz, a retinal surgeon at Moorfields Eye Hospital.

They aimed to treat 10 people who had the “wet” form of AMD, caused by sudden leakage from blood vessels in the eye that can destroy the macula, a key part of the retina.  The retinal pigment epithelial (RPE) cells in the macula are crucial to the functioning of the light-sensitive photoreceptor cells, which die without RPE support.

The two patients, a woman in her 60s and man in his 80s, are the first in the UK to have the treatment, and were chosen because of their advanced disease – they would have gone blind within six weeks of the blood vessel leakage.  Each had one eye implanted with the patch, which consisted of a membrane covered with human embryonic stem cells engineered to differentiate into RPE cells. The results are published in the journal Nature Biotechnology.

Coffey said the improvement in vision – often measured in lines on a reading chart – was much greater than they had hoped for: “We said we’d get three [out of the proposed 10] patients with vision recovery of three lines.  They probably wouldn’t get reading vision back.

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“The first patient has got six lines improvement, which is astounding, and the second has five lines and he seems to be getting better as the months go by.  They are both really reading.  At best [the woman] could read about one word a minute with magnification.  She is now reading 80 words a minute and [the man] is reading 50.”

The male patient was Douglas Waters, 86, from Croydon. His case was severe and the doctors were not especially hopeful when they gave him the treatment in autumn 2015.  But the results have been remarkable.

“In the months before the operation my sight was really poor and I couldn’t see anything out of my right eye,” he said. “I was struggling to see things clearly, even when up close.

“After the surgery, my eyesight improved to the point where I can now read the newspaper and help my wife out with the gardening.  It’s brilliant what the team have done and I feel so lucky to have been given my sight back.”

Coffey and da Cruz intend to operate on one more patient to ensure the safety of the procedure.   One of the successes of the trial has been showing that there was no need for drugs to suppress the patient’s entire immune system to avoid rejection of the stem cells.  The eye is self-contained, so they were able just to inject pellets that release immunosuppressant drugs into the eye over the course of two to three years.

Coffey thinks they can have an off-the-shelf treatment available for NHS surgeons to use within five years, at the moment just for the 10% of AMD patients with the wet form of AMD.  Dry AMD develops more slowly and there is no treatment for it.  Coffey says, however, that there is no reason why the patch would not work for them too.

In due course, the team hopes the treatment could become as common and eventually as cheap as cataract surgery.

Dr. Carmel Toomes, associate professor at the Leeds Institute of Molecular Medicine, said: “These results give the many patients out there who suffer from AMD and other retinal degenerations real hope that stem cells replacement therapy may be a reality in the near future. While this is only a very early clinical trial, the results are positive and show that the technology is moving along. In the right direction.”

Double Vision (Diplopia) or Ghost Images

Double vision (also called diplopia) may be temporary, or long-lasting.  It is often visually disturbing and can limit day to day activities like driving, walking down the stairs, and working on the computer.  Diplopia may sometimes be misinterpreted as Ghost images and blurriness.

When two eyes correctly and accurately point and focus at the same time, we see only one image of the world. When two eyes point and focus differently from each other, double vision may happen.

Some people are born with strabismus.  They will see double if their brain allows it because each eye sees a different thing at the same time.  But the brain usually adapts by shutting down or ignoring the information from one eye.   This is called suppression.  Surgery or vision therapy can help many people with strabismus.

Other causes of double vision include:-

      1. Stroke, head injury, brain tumor, brain swelling or a brain aneurysm.  A head injury, tumor, stroke or related condition can cause double vision that comes on suddenly.
      2. Cranial nerve palsies.  Double vision also can be caused by paralysis or loss of coordination of one or more muscles that control the position and teaming of the eyes due to cranial nerve palsy.  Cranial nerve palsies can be caused by viral fever diabetes, head injury, tumor, multiple sclerosis, meningitis, high blood pressure, blockage of an artery or an aneurysm.

    The above two are causes of binocular diplopia, that is double vision with both eyes open.  There is relief from diplopia when one of the eyes is closed.

    3. Corneal irregularities.  Ghost images can be caused by such conditions
    as keratoconus (cone-shaped corneas) and corneal dystrophies (deterioration of the corneal structure).

4. Dry eyes. Severe dry eyes can cause ghost images due to insufficient or poor quality tears.  Many people who suffer from dry eyes can be helped by eye drops (over-the-counter or prescription), punctal plugs, lid hygiene techniques or a combination of all these treatments.

5. Refractive surgery. If you have had any refractive surgery to help you see better without glasses or contacts, you may experience some double or ghost imaging because of changes to your corneas. An irregular corneal surface, caused by the surgery itself or by dryness, may cause light rays to scatter instead of focusing properly.

This problem usually clears up within weeks or months. But you may need to use eye drops for a while.

6. Cataract or lens abnormality. Cataracts may cause ghost images, usually in one eye only.  This is because the clouding of the eye's natural lens and can cause light rays to scatter in different directions, creating multiple but incomplete images, especially when you look at lights. Sometimes severe blunt trauma to the eye can cause tilting of the
lens, causing monocular diplopia.

Lens surgery usually will eliminate this ghost image problem.

Diplopia Treatment:

Generally, treatments for double vision can include surgery, vision therapy, prism glasses or medications.

It’s important to have a comprehensive eye exam to help determine the cause of the double vision as soon as possible.

If you have a sudden double vision that you ignore and then it goes away over a long time period, this may mean your brain has tuned out one of the images(suppressed it). Although this is certainly more comfortable and bearable for you, it is not a good sign. Suppression could be masking a serious problem that needs to be solved.

 

 

My Life is Devastated, I have Glaucoma!!

This is what people feel when they have been diagnosed with glaucoma. Well although a lifetime disease early diagnosis of glaucoma is a boon.  Regular follow-ups and adherence to treatment are the keys.  A compliant patient helps himself/ herself to sail through successfully through glaucoma.  Hence adherence to treatment is the norm.  Just a few variations in lifestyle,  like putting eye drops regularly, going for follow-ups as advised by the treating glaucoma specialist will make the person’s life easier and hassle-free.