Presbyopia

What is Presbyopia?

When you look at a nearby object your lens curvature changes accordingly and alters the focusing power forming an image. But aging causes a refractive error wherein the ciliary muscle fibres around the lens of the eye lose its flexibility. Further the lens capacity to reshape gets rigid and causes difficulties in changing the focus from far and near vision known as Presbyopia (age related long sight) or aging eye condition. The exact causes are under research and debate.

Sometimes one gets imperative to change presbyopic prescriptions for glasses quite often.

Spectacle independence and presbyopic correction has now become an enhanced vision experience with better refractive satisfaction owing to advancement in ophthalmology and wide array of options.

What are the causes?

One of the major risk factor causing presbyopia is increasing age and it normally occurs around 40 yrs although diabetes, multiple sclerosis or cardiovascular disease can have an early onset prematurely.

What are the symptoms?

You begin to experience difficulty to read small print or sometimes see with blurred vision at normal reading distance, headaches and strain in the eyes to read small print. Normally the need to hold the reading material at one arm length to read is another common symptom. It needs to be identified if these symptoms are due to presbyopia or some other reason.

How is Presbyopia Diagnosed?

Presbyopia is diagnosed through a comprehensive eye examination including the Visual acuity exam, Refraction test and Slit lamp exam according to the suitability of your eye.

What are the Treatment options?

Reading glasses, eye glasses with bifocal lens having variable focusing power and multifocal contact lens are the simplest options. Other common options are surgeries either to enable clear vision at all distances by using presbyopia correcting IOL’s (Intraocular lenses) or to maintain near vision for one eye and distance vision for the other eye using monovision lenses.

What are the commonly available surgical options for Presbyopia correction?

  • Laser Assisted Stromal In-situ Keratomileusis (LASIK) – This is a wavefront guided refractive surgery by excimer lasers where the correction is done by reshaping the cornea by creating a flap. It is a customized procedure wherein one eye is reserved for near vision and the other for distance vision enabling you to make the best use of monovision. It is a safe, painless and effective procedure.
  • Lens implant– IOLs are implanted according to the suitability of your eye and life style requirement.
  • Refractive lens exchange (Clear Lens Exchange) – This procedure is advisable if you have high refractive error. It takes care of near and distant vision as well as cataract occurrence. Here the natural lens is removed and replaced by intraocularlens which provides multifocal vision. The concept is similar to a cataract surgery to remove the cataract but here it’s for refractive purpose. It is suitable in case you are suffering from dry eyes or have thin cornea.

Presbyopia is not a disease but an inevitable part of aging.

It has no cure but it is correctable.

Hence prudent to have a timely eye check up in case you find any of the presbyopic symptoms affect your vision.

Some procedures are undergoing research and trials while some are more frequent and effectively conducted.

To avoid presbyopia complications do get in touch with us for a comprehensive eye examination and obtain the best treatment suitable for your eyes.

Posterior Capsule Opacity

What is Posterior Capsule Opacity?

Let’s imagine an analogue of an egg wherein eggshell as lens capsule with its egg white plus egg yolk as natural lens. If the anterior or front portion of the egg is carefully cut through incisions to extract the egg white and yolk then the back portion or posterior end is retained intact.

In a similar manner during a cataract surgery your natural lens are removed from the anterior position of the lens capsule and further implanted with IOL. The posterior position of the lens capsule is kept purposely kept intact to hold the IOL in its position. The opacity or blurring of the posterior capsule which holds the lens is called Posterior Capsule Opacity. This could occur as the outer cells of the natural lens remain in the membrane and grows on the capsule making it progressively thick and opaque. It is commonly known as ‘secondary cataract’ or ‘after cataract.

The commonly known two forms are fibrous and pearl or a combination of both. Posterior Capsule Opacity is a known complication after a cataract surgery. Some symptoms are pretty similar to that of cataract and apparently you may feel like the re-occurrence of cataract.

Symptoms:

  • Vision becomes hazy and blurred.
  • Glares occur.
  • Difficulty in reading small print.
  • Gradual decrease in vision.

Causes:

  • Use of surgical techniques– Single piece lenses are used extensively compared to three piece lenses. The variation in sizes and certain surgical techniques can cause Posterior capsule opacity.
  • Intraocular lens optic edge designs– Comparatively Square and sharp edge designs in IOL aids In preventing Posterior Capsule Opacity as it arrests the movement of lens cells migrating behind the lens.
  • Intraocular lens materials- The biocompatibility of IOL materials usually made of silicone or acrylic polymers. Depending on the type of material the cell inflammation can increase or decrease leading to Posterior capsule opacity.
  • Other causes include the Use of therapeutic agents, Patients age, Inflammation in the eye after surgery, Duration of time since the surgery.

Diagnosis:

During a routine eye exam your eye pupils would be dilated to detect Posterior Capsule Opacity along with OCT (optical coherence tomography)). It could become severe if you have diabetes or uveitis. Risk factors are modifiable through surgical techniques. Based on the diagnosis you would be advised necessary treatment.

Treatment:

YAG laser capsulotomy: This is a safest, painless and effective outpatient procedure to restore vision. It is painless since the capsule bag does not have any nerves in it. Ensure that you remain still during the procedure which lasts for few minutes. In this procedure a small opening is created by using laser. Further the laser removes the affected portion of the posterior capsule from your line of sight. During this process no incision are made. Normally when laser is fired you may hear a clicking sound with a few light flashes. Owing to the absence of incisions the risks are minimal. Nevertheless in rare cases Retinal detachment (the retina loses connection with the inner back of the eye), movement of the lens implant or retina may develop swelling etc. are rare complications in YAG laser capsulotomy.

You are advised rest at the hospital for few hours to ensure that eye pressure is under control and to instill eye medication.

After undergoing YAG laser capsulotomy, your vision is expected to be normal after a day. You could resume normal activities quite immediately.

In case you experience no improvement in vision or any other discomfort like pain etc., do get in touch with us at the earliest.

New advances in IOL technology and surgical techniques, vision researchers are investigating on solutions to combat Posterior Capsule Opacity and optimize visual outcome.

What are the Causes for Cataract?

Most of the age related cataracts are caused when the natural lens in the eye becomes opaque due to clumping of certain proteins in the lens. This makes the passage of light difficult. In order to see clearly it is important that the lenses are transparent so that the light passes easily and captures a clear image on the retina. The cloudiness in the lens results in distorted vision or blurring causing cataract.

Distorted vision causes hurdles in the day to day activities and can result in accidents.

The cataract progression is a gradual process normally occurring after the age of 60 and may occur even early due to certain causes like diabetes or even by birth. Generally women are more affected than men.

Knowledge of the causes of cataract aids in safeguarding cataract as a precautionary measure to some extend but its occurrence cannot be completely stopped by medicines or therapy. Cataracts can occur in both the eyes simultaneously and sometimes in one eye it could progress rapidly. If cataract is left untreated it can cause blindness. Research is still in progress on understanding the exact cause of cataract.

The most known risk factor to cause cataract is the advancing age. This type of cataract is called senile cataract.

Other Causes:

Secondary cataract: Cataracts that are caused due to secondary effects of other diseases like diabetes, eye inflammations like uveitis, hypertension etc. called secondary cataract. These are not age related and can occur early.

Medications: Use of certain medications like steroids (corticosteroid) such as prednisone, antipsychotic medications, drugs used to treat glaucoma etc. can also cause cataract.

Genetic risk factors: Cataract could be inherited in the family though genes.

Environmental risk factors: Excessive exposure to X-rays and ultraviolet radiation as in the treatment for cancers may also cause cataract.

Eye Traumatic risk factors: The lens of eyes could get damaged due to eye injury, cuts or

punctures. It is necessary to protect the eyes with eye gear in case of high risk.

 

Congenital cataracts: Some children are born with cataract due to inborn abnormalities in the lens. This normally affects both the eyes and is not very common. Early eye check up at birth is hence important to rule out any possibility of cataract at birth.

Some suggestions:

  • Have a regular eye check up.
  • Protect your eyes with UV protected sunglasses as exposure to ultraviolet rays (UVB) from sun can damage the proteins in the lens of the eye.
  • Have a nutritious diet rich in antioxidant vitamins C and E, selenium, beta-carotene and lycopene.
  • Avoid smoking and excessive drinking as it affects the lens.
  • Maintain a regular healthy life style and keep a check on the cholesterol, sugar levels, blood pressure and obesity.

The causes of cataract depend on the various risk factors. The only effective treatment for cataract is cataract surgery although vision researchers have suggested the alternative treatments in cataract where surgery could be avoided.

Do get in touch with us for a through eye check up.

A cataract treated in time, saves your sight.

Cataract Surgery Recovery

Cataract surgery is an inevitable treatment for cataract.

A successful cataract surgery recovery depends on:

  • Your co-operation in observation of medications, instructions and follow up meeting schedulewith us.
  • Type of cataract surgery conducted.
  • Freedom from related infections or complications.

Complications: Generally cataract surgery is the safest outpatient procedure but sometimes complications may occur although not common.

  • Posterior capsular opacification commonly known as secondary cataract (the back of the lens capsule which is retained to hold the IOL gets cloudy obstructing vision) could be easily corrected by a painless outpatient procedure called (YAG) capsulotomy.
  • Dislocation of the lens.
  • Retinal detachment -It is possible to re-attach on early detection.
  • Muscular edema – Swelling of the macular portion of the retina.
  • Corneal oedema- Excessive fluid in the cornea.
  • Raised intraocular pressure.
  • Others – Infection, bleeding, Inflammation like Uveitis in the eye.

Post Operative Instructions

  • Let you be driven back home instead of driving yourself.
  • A pair of sunglasses as instructed is best to avoid direct sensitivity with sunlight.
  • You need to use eye shield during naps or night.
  • Rubbing or touching eyes should be avoided.
  • Any activity that is likely to cause extra pressure on the eye should be avoided like bending to pick up objects or lifting heavy object, exposure to wind or any irritants.
  • Immediate swimming or head bath to be avoided.
  • Correct usage and dosage of antibiotic eye drops as prescribed at the right time. Ensure dosage is completed as instructed.
  • Avoid entry of soap, shampoo or foreign particles like dust etc.

(Post operative instructions vary according to the type of cataract surgery and gradually reduce according to the healing time)

What do I expect after the cataract surgery?

  • You would be given an instruction handout/checklist with the details.
  • You can expect a direct telecon from our surgeon enquiring about your condition.
  • You need to be relaxed and calm during the adaptation period as the first removal of the eye shield may have a blurred vision as the internal visual adjustments will take some time. Some persons may have redness or experience floaters which is normal and will heal within days.
  • It is necessary to take precautionary steps, follow up treatment and medication to ensure a speedy healing and best visual outcome.
  • You would need to meet the operating surgeon one day after the surgery and as indicated for post operative follow up.
  • Need to report dry eye or watery eyes, Pain after several days or No vision improvement. Do contact us in case you are facing any difficulties, we would be glad to assist you.
  • You would be informed when you can take your glasses after through check up and final prescription which is normally after 6 weeks.

Above all you can expect the joy of getting back your vision gradually. You would be able to enhance your routine life style and enjoy an improved health related quality of life. Moreover depending on your choice of IOLs implanted will make you least depend on eye glasses any more.

The complete healing time after surgery is gradual and normally approximately 1-2 months. There could be slight variation in the healing time between eye to eye, person to person and type of surgery conducted etc e.g. modern small-incision cataract surgeries have reduced restriction and heal faster.

With our surgeon’s expertise and advanced technology in its very best, we assure you the best treatment and will help you to have a speedy recovery after your cataract surgery

……….a successful journey on the path of recovery to a better vision.

Best Lens for Cataract Surgery

During the cataract surgery the natural lens is removed and replaced with IOL (Intraocular lens) and vision is restored. The selection on the type of IOL will support the necessary correction to be implemented whether it is cataract, astigmatism or presbyopia etc. Apart from the correction another decision would be the need to use glasses or go spectacle independent.

What are the types of lenses and implants?

Some of the types of lenses and implants are.

Traditional lens Implant:

  • Monofocal lens: This is the most commonly used lens since decades. They are called Monofocal lens because they give the sharpest focus only one distance. Depending on which vision is selected i.e. (near or distant) glasses would be required. These lenses are suitable if you are willing to wear glasses. If you have set the monofocal lens for distance vision then for near vision glasses would be required and vice versa. It assists Monovision (one eye can be set for distance vision while the other eye takes care of the near vision). It does not correct Astigmatism and Presbyopia.

Premium lens Implant:

  • GOAL: Astigmatism correction.
  • Toric lens- Toric lens is primarily used in the correction of distance vision and near vision would still need glasses. This is another option to correct Astigmatism rather than making extra incision in your cornea.
  • GOAL : Presbyopia correction.
  • Multifocal lens – Multifocal lens aid in Presbyopia correction. They have varied power which makes one see at varied distances. Vision without glasses is possible although visual outcome varies from person to person.

If you do not have significant astigmatism and wish to have distance and near vision with limited intermediate vision needs then a multifocal IOL is best choice.

  • Accommodating Lens: Helps to correct Presbyopia allowing the focus at multiple distances

but likely to cause glare and halos.

What are the factors in the selection of an IOL for your eye?

  • Realistic Vision goal – Your need should be prioritised and must discuss with us on what exactly is your vision goal.
  • Present eye condition – An eye check up will reveal the present conditions based on which the IOL would be suggested.
  • Type of eye surgery / correction conducted – Previous and current history need to discussed for proper selection of your IOL.
  • Life style needs – Some require near vision more often depending on the type of job or daily tasks undertaken.
  • Cost – Premium lens are not covered by Insurance unlike Traditional lens. Premium lens are more expensive than Traditional lens.
  • Risk and complications – Enhancement surgeries may be required on case to case basis. Some IOLs can cause gare and halos after implant.
  • Spectacle Independence – If you do not wish to wear glasses after cataract surgery, you need to choose IOL that does not require glasses.

You need to discuss the risks, benefits and alternate options during the eye examination.

Each IOL is best in its relevant feature.

No IOL is perfect. We need to understand if your eye is suitable for a particular lens.

Each eye need is unique and the suitability of the best matching lens will optimize the ultimate visual outcome.

 

Astigmatism

What is Astigmatism?

Astigmatism is a common refractive error or vision condition mainly caused due to irregular shape in the eye lens or cornea. If caused to cornea wherein the cornea gets irregular shape it is called corneal astigmatism and if caused due to the lens it is called lenticular astigmatism.

Normally when light enters the eye it bends (refracts) uniformly forming a clear image. In case of an eye with astigmatism only a part of the object gets focused at time as light gets refracted to multiple areas of the retina. This makes it difficult to see causing blurring in vision.

It is also referred to as a ‘cylindrical number’

What are the causes?

It could be hereditary, due to eye injury, eye surgery causing scarring in the cornea or other eye conditions such as keratoconus where the structure of the cornea changes from a normal shape to a cone shape. Some are born with astigmatism while some have it along with other refractive errors like nearsightedness (myopia) or farsightedness (hyperopia). The exact cause is still unknown.

What are the symptoms?

The common symptoms are as noted below.

  • Blurred vision
  • Fatique
  • Headaches
  • Squinting
  • Eye irritation

These symptoms could be a cause for some other illnesses too.

How is Astigmatism diagnosed?

A comprehensive eye examination including tests in Visual acuity, Streak Retinoscopy, Keratometry, Refraction, Corneal topography helps to diagnose Astigmatism.

What are the correction options?

There are various corrections options where the main focus is to reshape your cornea.

The common correction options are as noted below.

  • Spectacles – Traditionally spectacles according to the prescriptions with the desired lens are used to correct astigmatism. These are best when surgery is not advisable. A cylindrical number corrects astigmatism.
  • Contact Lens – SoftToriclenses or gas permeable rigid contact lenses for high astigmatism are used to maintain the shape of the lens to correct astigmatism. Great care need to be taken in usage and maintaining them hygienically. Toric = astigmatism
  • Refractive Surgery – In case you are the right candidate for refractive surgery then Astigmatism could be corrected by vision correction procedures. Some of the common procedures are listed below.
  • Laser-assisted in situ keratomileusis (LASIK) – In this procedure the corneal flap is created using a microkeratome or a Femtosecond laser (bladeless LASIK). The shape of the anterior corneal surface is changed using excimer laser. It is a safe, quick and painless procedure if found suitable for your eyes.
  • Photorefractive keratectomy (PRK) – During this procedure, the laser is used to reshape the cornea and change its curvature. It is an old procedure compared to LASIK and is currently used only when the cornea has had previous eye surgery, scars etc and not commonly as a primary line of management.

Astigmatism is correctable not preventable. It may worsen gradually if unattended. It may get unnoticed in children if they are not subject to regular eye checkups.

Blurred vision is a common symptom both in cataract as well as Astigmatism. Both are correctable and treatable in a single procedure.

Enhance your vision to permanent correction and spectacle free life.

If you notice any vision problems do get in touch with us for an eye check up and get the best correction suitable for your eyes.