Eyes have an important structure called lens, which helps focus the rays of light on to the retina. Clouding or opacification of the lens is cataract. This may be present at birth or occur due to injury but the most common variety is related to age (Senile Cataract). This is the most common cause of visual disability in the aged population.
Cataract is the commonest cause of preventable blindness in the world. The treatment is surgical with replacement of the opacified lens with an artificial intraocular lens. The current method of performing suture less surgery with a small incision by using the phacoemulsification machine and the introduction of a foldable lens results in early visual rehabilitation.
CEHC is equipped with the latest microscopes and phacoemulsification machines and the surgeries are done in modern operating theatres with standards as defined by NABH and with disposable consumables from companies of repute for optimal results.
The options of cataract removal are, manual or by phacoemulsification.
Manual cataract removal is now days done by a large sutureless self-sealing wound, where the nucleus of the cataract is removed manually and the remaining cortical matter is aspirated and then a lens is placed. The healing time is slower and the chances of inducing a higher postoperative power is more.
Phacoemulsification, on the other hand uses ultrasound energy to cut, emulsify and aspirate the cataract through a self-sealing small incision. Current technology advancements and newer techniques helps the surgeon perform phacoemulsification in nearly 100% of the cataracts. Visual rehabilitation is rapid. It is a however a highly skilled procedure and the experience of the surgeon counts as it amounts to working in a 6mm area with a phaco probe vibrating at 60000 MHz
Femtosecond cataract surgery or “Laser” cataract surgery is the current method where the entry to the eye, the opening in the capsule and dividing the nucleus is done with the help of laser thereby avoiding the use of blade, therefore it is also called “bladeless surgery”. After opening the capsule the rest of the surgery is done by phacoemulsification.
Following cataract removal, visual rehabilitation occurs with placing of the lens in the eye. In today’s world, all eyes must have an intraocular lens(IOL).
The best lens material in use today is acrylic which makes the lens foldable and can therefore be inserted through a The best lens material in use today is acrylic which makes the lens foldable and can therefore be inserted through a small incision. Intraocular lens (IOL) could be monofocal, extended depth (EDOF) or trifocal and toric or non toric. Some of these lenses like trifocal or EDOF IOLs significantly decrease the dependency on glasses for good vision, most patients are spectacle independent. Toric lenses, while they do not promise spectacle independence, significantly lower the cylindrical power in the eye thereby improving the quality of vision tremendously.
There are many cataract scenarios where additional gels are needed to protect the surrounding structures while emulsifying the nucleus of the cataract or hooks are needed to dilate the pupil or rings are used to stabilize the capsular bag before placing the IOL.
Often the surgeon can predict the need, sometimes the need to use these are taken preoperatively.
The cataract surgeon sometimes suspects or observes a lack of adequate support for placing the type of IOL initially discussed and changes the model while doing the surgery, for better stability and long term safety of the eye. Such spontaneous decisions are best left to the operating surgeon. Rarely, the cataract cannot be removed in its entirety or sinks into the vitreous cavity and calls for a second sitting to remove it and place a IOL. These situations are less commonly encountered.
This article is intended to increase awareness of Glaucoma, a potentially blinding eye
condition, which is mostly symptomless and hence neglected.
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids. The fluids in the eye are divided by the lens into the vitreous humour (behind the lens) and the aqueous humour (in front of the lens).The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind the coloured part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle, which acts as a drain for the eye. This forming and draining of the fluid (aqueous) is a continuous process and also is a fine balance maintaining a certain pressure in the eye called intraocular pressure.
What is Glaucoma?
The increased pressure causes compression of the optic nerve which can eventually lead to nerve damage. Glaucoma can cause partial vision loss, with blindness as a possible eventual outcome.
Glaucoma refers to the condition of increased intraocular pressure causing nerve damage at the back of the eye which can be detected clinically and/or by a set of specialized investigations called visual fields and Retinal nerve fibre analysis. Increased pressure alone does not constitute glaucoma but must raise an alarm, similarly normal pressure may also cause nerve damage.
THIS nerve loss causing VISION LOSS IS IRREVERSIBLE, hence the need to detect and arrest progression of nerve loss in the early stages.
Open-angle (chronic) glaucoma is the most common type of glaucoma. The cause is unknown. It is usually seen after the age of 40 years. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. This type tends to run in families, so the risk is higher if one has a parent, a grandparent or a sibling with open- angle glaucoma.
This type of glaucoma is symptomless and is usually detected on routine examination.
Angle-closure (acute) glaucoma occurs when the exit of the aqueous humour fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye. Acute angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment in the form of laser in the second eye.
Often during routine examination the angles are noted to be narrow, in such cases the intraocular pressure may be normal and the patient is otherwise asymptomatic but is still advised to undergo a laser treatment called YAG PI(peripheral iridectomy). This laser forms an alternative route for the aqueous to flow should the angles suddenly close. This is a preventive treatment done in persons having narrow angles (angles are the natural drainage system in the eye). This is an outpatient procedure and both eyes are done in the same sitting. This does not mean they have glaucoma.
Congenital glaucoma is seen in babies. It often runs in families (is inherited).It is present at birth. It is caused by abnormal eye development.
Secondary glaucoma is caused by drugs such as corticosteroids, certain eye conditions like uveitis, systemic diseases and trauma.
Normal-tension glaucoma – A type of Glaucoma in which eye pressure can be normal, but the nerve may get damaged.
What tests are done to detect Glaucoma?
A comprehensive (complete) eye examination is needed to diagnose glaucoma. The
examination will include vision, refraction, tonometry (eye pressure checkup), and
evaluation of the nerve and retina after dilatation. Some of the other tests may include
using a special lens to look at the angle (drain) of the eye (gonioscopy),visual field testing
and scanning of the nerve with the help of specialized equipments(OCT).
The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that one has. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. Tablets may also be given to lower pressure in the eye. Other treatments may involve Laser therapy. Eye surgery for glaucoma is reserved for those whose pressure doesn’t get controlled with drops or laser.
Open-angle glaucoma cannot be cured. However, you can manage your symptoms by closely following your doctor's instructions. Regular check-ups are needed to prevent blindness. Angle-closure glaucoma is a medical emergency. You need treatment right away to save your vision. Babies with congenital glaucoma usually do well when surgery is done early. How well a person with secondary glaucoma does depends on the disease causing the condition.
With proper use of medications and regular follow up with the eye specialist most Glaucoma patients will be able to lead a life with good vision.
All adults should have a complete eye exam from age 40 on a yearly basis, or sooner if you have risk factors for glaucoma or other eye problems. You are more likely to get glaucoma if have a family history of open-angle glaucoma, have diabetes or high blood pressure.
If you are at high risk for acute glaucoma, talk to your doctor about having eye surgery to prevent an attack.
Retina is the light sensitive layer at the back of the eye. It
receives the rays of light and sends it to the brain via the
optic nerve for interpretation.
The retina has 10 layers and has blood vessels running through it.Macula is the central and the most sensitive area of the retina.
The Centre has all the necessary and modern equipment and expertise to diagnose and treat retinal conditions like all stages of diabetic retinopathy, retinal vein occlusions, age related degeneration(dry and wet, macular conditions and many similar retinal conditions.
The current addition of OCTA has improved the
diagnosing ability of a lot of retinal conditions. The
OCTA or Optical Coherence Tomography Angiogram is
a new non-contact, non-invasive imaging technique that
generates volumetric angiography images in a matter of
seconds. It delineate the blood vessels across all the
layers of the retina and the choroid, so new blood
vessels and ischemic areas are seen.
This makes it easier to analyze and gives a better understanding of the pathology and hastens decision making.
FFA is used in select situations of retinal vascular conditions, it involves injecting a dye in the forearm followed by taking of photos of the retina in all gazes.
The Fundus imaging equipment can take images of the central 40 degrees of the retina and the optic nerve as well as front of the eye without dilatation, which helps in quick screening for conditions like diabetic retinopathy. It also helps in planimetry.
The Retina (green) laser is used in the treatment of many retinal conditions and this equipment has all 3 modalities of laser delivery system
Many retinal conditions warrant injections to be given in the eye and they are given in the operation room as it requires stringent sterilized areas, the Centre has a state of the art operating room with ambulatory beds which makes the entire experience comfortable for the patient especially since multiple injections are given in most conditions.