Say No to Glasses

What is LASIK Eye Surgery?

‘Laser Assisted in situ Keratomileusis’ or LASIK is the most common type of eye surgery using a laser to correct nearsightedness, farsightedness & astigmatism. In most cases it is a pain-free procedure and is completed in about 15-20 minutes for both eyes.

What is Astigmatism?

Astigmatism is blurry vision that is caused by the cornea having an asymmetric shape. The precision laser used in LASIK surgery can correct the shape, thereby restoring proper vision. Even higher amounts of astigmatism can be corrected, but it may require a follow-up LASIK enhancement procedure for complete correction & it may also affect the overall cost of surgery.

What is a LASIK Consultation?

Prior to surgery, a comprehensive eye examination is carried out to ensure that you are a suitable candidate for LASIK and also the different procedures and their costs are discussed. In case LASIK is not recommended for you, then alternative procedures like PRK, refractive lens exchange or phakic IOL implantation may be discussed.

The eye examination will usually involve

• Dilation of the pupils to relax the focusing mechanism of the eye to get the most accurate Refractive Error measurement & allowing thorough investigation of the interior of the eye.
• Corneal Topography - Measurement of the shape & thickness of the cornea as it will be reshaped by laser.
• Wavefront Measurements determine whether a custom LASIK procedure is advisable.
• Tear Film Analysis detects possible dry eye & related complications after surgery.
• Inspection of Eyelids to detect & treat any blepharitis that could increase the risk of LASIK complications.
• Dominant Eye Test- important if you have presbyopia and are considering Monovision LASIK to reduce the need for reading glasses after surgery.

Is There a Minimum Age for LASIK?

Yes. The reason for a minimum age is to try to ensure that your vision is stable & unlikely to worsen after surgery.

Usually suitable candidates are 18 years and above, who have had a stable prescription for at least a year.

How Long before Surgery should I stop wearing Contact Lenses?

Most surgeons will recommend that contact lens use should be stopped at least 2-3 weeks prior to surgery, but individual surgeon may have different preferences.

Contact lenses reduce the amount of oxygen that reaches the cornea, potentially causing swelling that can affect the accuracy of important eye measurements taken before surgery. They also cause dry eyes & affect corneal healing post-surgery.

Does LASIK Hurt?

The eye drops that are put in before surgery thoroughly numb the eyes throughout the procedure, making it pain-free. Parts of the procedure may feel unusual, but it is quicker and more comfortable than many patients believe it to be. When the eye drop wear off, it is common to feel mild to moderate discomfort, slight itching & watery eyes due to increased sensitivity to light & colour for a few hours.

How Long Does LASIK Last?

In most cases, the improved vision after LASIK is permanent. In rare cases, due to changes that can occur in the lens, nearsightedness, farsightedness or astigmatism may be caused.

If a regression does occur, it can be corrected by a follow up procedure called LASIK enhancement. Night vision is also improved after LASIK.

Can I Get LASIK in Pregnancy?

It is not advisable as hormonal changes experienced during and after pregnancy may make the outcome of the procedure less predictable & may also affect the healing of the eye.

How Soon after LASIK Can I Resume Normal Daily Activities?

Although different surgeons may have different recommendations, generally:

• Driving:- You cannot drive yourself home immediately after the procedure as even after the drops wear off & vision is clear, you may experience more sensitivity to light & colour, as well as watery eyes. The next day you should ask someone to drive you to the post-operation examination & your doctor can suggest when to resume driving.
• Bathing:- You should wash your hair with shampoo the night before & thoroughly wash your face with soap the morning of surgery, removing all traces of make-up. After the procedure, it is safe to bathe the next day, taking care not to let soap & water get into the eyes.
• Work:- You can resume work within a day or 2, with appropriate eye-shield/eyeglasses to protect from dust & infection. Also use artificial tear drops to avoid dry eye, especially if you spend significant time in front of a computer screen.
• Exercise:- You can resume exercising within a few days, taking care to prevent getting sweat in the eyes & not rubbing them for at least 2 weeks.
• Swimming :- It is recommended that you avoid swimming for at least 2 weeks post-surgery to avoid infection.
• Eye Make-up:- Throw out old make-up and wait at least a week before using eye make-up.

What is a Cataract?

The lens of the eye is made up of water and proteins which gives it a clear appearance. When the proteins are damaged due to trauma or other factors, their structural changes cause the lens to become cloudy. Depending on the extent of the damage & placement, it can lead to decrease or loss of vision.

They develop slowly & may affect one or both eyes.

Cataracts are the cause of 50% of blindness and 33% of visual impairment globally.

What are the Symptoms?

• Faded Colours
• Blurry, hazy or Double Vision
• Increased sensitivity to light & glare
• Halos seen around lights
• Difficulty seeing at night
• Changes in eyeglass prescription or number
• Trouble with driving, reading or even recognizing faces.

What are the Causes of Cataract?

Most cataracts develop due to age-related changes in the lens, in people over 50, but sometimes can occur at younger age due to risk factors such as:

• Diabetes
• Smoking
• Prolonged exposure to UV light (Sunlight)
• Alcohol
• Nutritional deficiency
• Injury/trauma to the eye

How is Cataract Treated?

If cataract causes vision impairment that affects daily life, then surgery is the best option. Over 98% of cataract surgeries are completed without any complications & 95% patients report improved vision post-surgery.

There are generally 2 types of surgery that may be performed :

1. Phaco/Phacoemulsification

   A smaller incision of 2-3mm is made & the affected area of the lens is emulsified by ultrasound energy from a hand-held probe. The emulsification is then sucked out & an artificial intraocular lens replaces the old lens in the same manner.

2. Femtosecond Laser Assisted Cataract Surgery

   A laser is used to make the incision & fragment the cataract, which can then be removed & artificial intraocular lens fitted by the surgeon.

   Additionally, the laser can also correct pre-existing astigmatism (poor vision not caused by cataract).

   Laser assisted surgery is an automated & more precise process, and is a safer option for complex cataracts.

Types of Intraocular Lenses

1. Monofocal:- Single zone clear focus lenses – usually for distance vision, and reading glasses are required for near tasks.
2. Toric:- Reduce the residual refractive cylinder thereby reducing the effect of pre-existing astigmatism, and consequently improving vision further.
3. BIfocal:- Both distance & near powered correction. Multifocal IOLs minimize/eliminate the need for eyeglasses or contact lenses after surgery.
4. Trifocal:- Distance ,near and intermediate vision is corrected. Patient is 99% spectacle free.

Potential Complications

While cataract surgery is one of the safest surgical procedures to be carried out, rarely, complications may occur:

• Swelling of Cornea/Retina
• Increased pressure in the eye
• Droopy eyelid
• Infection, bleeding or retinal detachment may cause loss of vision – extremely rare.
• Sometimes vision may not improve fully due to other diseases such as diabetic retinopathy or glaucoma. However, your doctor will already have checked for these conditions before recommending surgery, therefore chances are minimal of complications.

What to expect after cataract surgery?

You may experience some mild symptoms post-surgery:

• Itching & Mild discomfort
• Fluid discharge (1st day)
• Increased sensitivity to light, colour& touch.

What is an After-Cataract?

The lens capsule, which is left to support the artificial lens, may sometimes become cloudy years after cataract surgery, creating an After-Cataract.

It can be easily treated with a laser in a simple & painless Outpatient Procedure, using a laser beam to make a tiny hole in the lens, allowing light to penetrate.

Pre-operative Care

• Wash your hair with shampoo the night before surgery, do not wash it on the morning f surgery.
• Wash your face properly with soap the night before & the morning of surgery.
• Remove all traces of make-up from face & eyes.
• Do not eat any food after midnight the night before surgery.
• Drink plenty of fluids on the day of surgery, but stop 3 hours before.
• Take blood pressure medicine on the morning of surgery.
• DO NOT take diabetes medication or insulin on the morning of surgery.

Post-operative Care

The recovery period is short (usually 4 weeks), but it is advisable to avoid heavy lifting & strenuous activities for about 4 weeks post-surgery.

• No water should go near the eyes for up to 4 days after surgery.
• Wear an eye-shield or eyeglasses to protect from dust & infection.
• Do not rub/press your eyes.
• Don’t lift heavy objects.
• Try not to bend from the waist for a few days.
• You can do light household chores, walking & climbing stairs.
• Use the eyedrops as prescribed (usually upto 3 months) to prevent infection & assist healing.

FAQ

Is surgery the only option to treat a cataract?

Just because you have a cataract does not mean that you have to have it removed. Cataract surgery only becomes necessary if you are not happy with your vision and want to see better and are not able to achieve adequate improvement with a change in glasses. Talk to your doctor if you have any questions or concerns about your vision.

Does cataract surgery hurt?

Thanks to numbing drops and medications to help you relax, this procedure involves minimal discomfort.

Will I be asleep during cataract surgery?

Since this procedure does not take very long, it is unnecessary to put you completely asleep with general anesthesia. Instead, your surgeon will use a local/topical anesthetic to numb your eye and you will remain awake during the surgery.

I have cataracts in both eyes. Will the doctor treat both at the same time?

Typically, doctors will perform surgery in the second eye one to four weeks after the first eye. All patients are different, so talk to your doctor about what is right for you.

How long will I be in the hospital or surgery center?

Patients commonly spend only a few hours at the hospital or surgery center, and are allowed to go home the very same day.

How long before I can see after surgery?

Every patient and every eye is different, but patients commonly see well shortly after surgery. Ask your doctor how quickly he or she expects you to recover.

How long until I can return to normal activities?

Most patients can resume normal basic activities like reading and watching TV by the next day, and return to work within one to seven days. However, results vary for different patients, so you should ask your doctor what is best for you.

After surgery, will I be able to drive at night?

Your ability to drive at night should be much enhanced once your cataract is removed. Patients with a Multifocal IOL may notice a ring of light around headlights and other point-light sources. These are typically mild, rarely bothersome, and tend to diminish with time.

Will I need glasses after cataract surgery?

It depends on what type of intraocular lens you elect to have implanted. Most patients do not need glasses or contacts for distance tasks following cataract surgery with a standard distance vision lens, but still rely on glasses for reading, sewing, computer work and other close up activities.

Can my cataract come back?

No, once a cataract has been removed it cannot return. However, over time, patients may complain that their vision has once again become cloudy. This sometimes-common condition, which may occur with any type of lens, is caused by scar tissue behind the implant and can be easily treated by a painless laser procedure performed in the office.

Who do I call if I have a problem?

Consult your doctor immediately if you have any problems, especially if you experience decreased vision or pain.

What is Glaucoma?

One of the most common causes for irreversible visual loss is glaucoma. Glaucoma is damage to the nerve fiber layer of the retina that is typically caused by an elevation in the intraocular pressure. It can go undetected until extreme visual loss has taken place. That's why it is crucial for an individual to undergo an annual eye examination, especially if there is a risk factor for such a blinding disease.

Who are at risk for glaucoma?

• Family history
• Diabetes
• Migraine
• Myopic patients
• Eye injuries
• Blood pressure
• Steroid users

What are the symptoms?

Symptoms are:

1. Frequent change of glasses (none of which is satisfactory)
2. Difficulty in dark adaptation.
3. Bumping into things at unfamiliar places.
4. Blurred or foggy vision.
5. Coloured halos (rainbow coloured rings) around lights.

What kind of treatment do we offer?

The Humphrey Compurerized Field analyzer

An instrument which evaluates what you can see with your “fields” of from the periphery of your eye while keeping the eye fixated in the middle. It evaluates the extent of loss. In gluacoma the fileds progressively decrease till only a central island is left, which if untreted, extinguishes leading to blindness. The Humphrey Analyzer is the Gold standard all over the world. Fields are normally done twice a year.

Intraocular pressure evaluation

Non Contact Pneumotonometer: Acts as an analyzing tool and excellent as a survey instrument. Reasonably accurate when kept properly gradted.

These are some examples of the progression of glaucoma

This is an example of normal vision. This is also an example of how someone sees during the beginning stages of open-angle glaucoma. Because there are no symptoms initially, regular eye examinations are very important.

Early symptoms may include a gradual and often imperceptable failing of peripheral (side) vision.

As the disease progresses, the center of vision may still be clear, however peripheral vision begins to fail.

During the advanced stages of glaucoma, only a small central area of vision remains. If the entire optic nerve is destroyed, then total blindness will result.

TREATMENT OPTIONS

Treatment

The damage caused by glaucoma can't be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery or a combination of any of these.

Eyedrops

Glaucoma treatment often starts with prescription eyedrops. These can help decrease eye pressure by improving how fluid drains from your eye or by decreasing the amount of fluid your eye makes.

Surgery and other therapies

Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:

• Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you have open-angle glaucoma. It's done in your doctor's office. Your doctor uses a small laser beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the full effect of this procedure becomes apparent.
• Filtering surgery. With a surgical procedure called a trabeculectomy , your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork.

Tips for good eye health

1. Eat Well

• Green leafy vegetables like spinach, kale, and collards
• Salmon, tuna, and other oily fish
• Eggs, nuts, beans, and other nonmeat protein sources
• Oranges and other citrus fruits or juices
• Oysters and pork

2. Smartphone usage is a representative of near work. Nearly one-fourth of the young population is addicted to cellphone. Blame the use of smartphones for accommodative spasm.

People have a habit of using their phones while they are about to go to bed, which is usually in a dark room. Is the bright light from the telephone screen bad for one’s eyes?

It is a well-established fact that the blue light emitting from mobile devices can suppress the production of melatonin, which normally helps to regulate sleep. Thus, heavy cellphone users would have difficulty sleeping at night.Radiation from the handset can also cause headaches and early cataract.

3. Wear Sunglasses

The right pair of shades will help protect your eyes from the sun's ultraviolet (UV) rays. Too much UV exposure boosts your chances of cataracts and macular degeneration.

Choose a pair that blocks 99% to 100% of UVA and UVB rays. Wrap around lenses help protect your eyes from the side. Polarized lenses reduce glare while you drive.

4. Use Safety Eyewear

If you use hazardous or airborne materials on the job or at home, wear safety glasses or protective goggles.

Sports like ice hockey, racquetball, and lacrosse can also lead to eye injury. Wear eye protection. Helmets with protective face masks or sports goggles with polycarbonate lenses will shield your eyes.

5. Look Away From the Computer Screen

To protect your eyes:

• Make sure your glasses or contacts prescription is up to date and good for looking at a computer screen.
• If your eye strain won’t go away, talk to your doctor about computer glasses.
• Move the screen so your eyes are level with the top of the monitor. That lets you look slightly down at the screen.
• Choose a comfortable, supportive chair. Position it so that your feet are flat on the floor.
• If your eyes are dry, blink more.
• Rest your eyes every 20 minutes. Look 20 feet away for 20 seconds. Get up at least every 2 hours and take a 15-minute break.

 

MEET YOUR OPHTHALMOLOGIST ONCE A YEAR

Dry Eye

Dry eye is a condition in which a person doesn't have enough quality tears to lubricate and nourish the eye. People with dry eyes either do not produce enough tears or their tears are of a poor quality:


Causes of dry eye:

• Inadequate amount of tears. Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation.
• Poor quality of tears. Tears are made up of three layers: oil, water and mucus. Each component protects and nourishes the front surface of the eye. A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

Signs and symptoms, which usually affect both eyes, may include:

• A stinging, burning or scratchy sensation in your eyes
• Stringy mucus in or around your eyes
• Sensitivity to light
• Eye redness
• A sensation of having something in your eyes
• Difficulty wearing contact lenses
• Difficulty with nighttime driving
• Watery eyes, which is the body's response to the irritation of dry eyes
• Blurred vision or eye fatigue

What causes dry eyes?
Dry eyes can develop for many reasons, including:

• Age. Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
• Gender. Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
• Medications. Drugs such as isotretinoin,sedatives,diuretics,tricyclic antidepressants, antihypertensives, oral contraceptives, antihistamines, nasal decongestants, beta-blockers, phenothiazines, atropine, and pain relieving opiates such as morphine can cause or worsen this condition.
• Medical conditions. People with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation
• Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes.
• LASIK. can decrease tear production and contribute to dry eyes.

Investigations

• MMP-9
• Stressed epithelial cells on the ocular surface can produce matrix metalloproteinases (MMP). MMP-9 has been shown to be elevated in the tears of patient with dry eye disease, and levels correlate with examination findings in patients with moderate to severe dry eye.
• The normal range of MMP-9 levels in human tears is 3 to 40 ng/ml. MMP-9 levels can be elevated in other inflammatory conditions, such as graft-versus-host disease, Stevens-Johnson syndrome, and following corneal surgery.

How are dry eyes treated?

• Adding tears. Mild cases of dry eyes can often be managed using over-the-counter artificial tear solutions. These can be used as often as needed to supplement natural tear production.
• Punctal plug. Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes. This can be done by blocking the tear ducts through which the tears normally drain.
• Increasing tear production. Taking an omega-3 fatty acid nutritional supplement may also help.
• Treating the contributing eyelid or ocular surface inflammation eye drops or ointments, warm compresses and lid massage, or eyelid cleaners to help decrease inflammation around the surface of the eyes. Also eye drops advised by the doctor is to be applied.
• Scleral contact lenses are latest modalities.

Lipiflow

• Lipiflow is the upcoming machine which helps to get rid of dry eye caused by meibomian gland disease.

Self care

• Avoid air blowing in your eyes. Don't direct hair dryers, car heaters, air conditioners or fans toward your eyes.
• Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
• Consider wearing wraparound sunglasses or other protective eyewear. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air. Ask about shields where you buy your eyeglasses.
• Take eye breaks during long tasks. If you're reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eyes.
• Be aware of your environment. The air at high altitudes, in desert areas and in airplanes can be extremely dry. When spending time in such an environment, it may be helpful to frequently close your eyes for a few minutes at a time to minimize evaporation of your tears.
• Position your computer screen below eye level. Spending long periods looking at computer, phone, or tablet screens can strain the eyes. Using the 20-20-20 rule can help to prevent this problem.The rule says that for every 20 minutes spent looking at a screen, a person should look at something 20 feet away for 20 seconds.Following the rule is a great way to remember to take frequent breaks. This should reduce eye strain caused by looking at digital screens for too long.
  
• Stop smoking and avoid smoke.