GLAUCOMA

Over the recent years, more awareness has been made about eye conditions throughout our state and nation due to social media and general improvement in education. Yet, glaucoma remains to be an enigma which is particularly troubling due to the silent nature in which damage occurs without the patient’s knowledge.

Early diagnosis and management is absolutely vital in the long run as glaucoma, like so many chronic diseases, requires treatment for life-time . Initial stages of glaucoma may be missed if the necessary tools are not available. At Aradhana, we have obtained all the necessary machines in order to make this screening as easy and comprehensive as possible.

The management of glaucoma has come a long way as technology has improved, producing more accurate and reproducible reports. The gold standard test- the HFA field analysis provides time – tested precise results for both diagnosis and prognostication.

OCT- Spectralis with its unique features of confocal scanning laser imaging and ray-tracing technology to strengthen precision is a cut above the rest, giving reliable and reproducible OCT results in glaucoma analysis, enabling your doctor to confidently measure possibility of and extent of disease.

1. Phacoemulsification (Ultrasound) and MSICS

Zeiss HFA, pachymetry, high definition fundus photography, Hiedelberg OCT Spectralis- glaucoma.

2. Medical management

Most glaucoma patients will require medicines for their eyes. Your clinician will advise you on which option is best for your eyes. Regular visits with the doctor is advisable particularly for this disease as patients will not be able to realize if his condition is worsening or improving until severe damage to the optic nerve.

Remember , glaucoma is not a curable disease but medicines will delay progression if used regularly as per your doctors advise.

3. LASER for angle closure glaucoma

Treatment for one particular type of glaucoma – the angle closure variant- involves making a small hole in the iris to allow fluid inside the eye to get easy access to the outside of the eye. This LASER treatment may cure some patients high eye pressures. Even then, yearly or more frequent reviews may be needed as per individual cases.

4. Surgical management- trabeculectomy

Rarely, surgical treatment may be required for glaucoma management.

5. FREQUENTLY ASKED QUESTIONS BY OUR PATIENTS: 5.1 What is glaucoma? Why is it called a “silent killer of vision”?

Glaucoma is a group of diseases in which there is progressive irreversible optic nerve damage. Primary Open Angle Glaucoma is the most common variant causing progressive optic disc cupping and characteristic field loss. It may affect both eyes simultaneously or one eye first. There are NO symptoms initially and when symptoms occur, usually the disease is advanced. In this disease , like many neuro-degenerative diseases, damaged brain tissue/ nerve tissue does not recover in adults. This is why it is called a silent killer of vision.

5.2 How can I know if I have glaucoma?

Unfortunately, there are no symptoms or self- tests which is possible for diagnosing this disease. In angle closure glaucoma, there may be pain and eye redness , but angle closure is relatively rare compared to open angle glaucoma. Eye pressure testing is usually not possible without visiting the eye clinic. Home - testing eye pressure tools are extremely expensive and not freely available in India. In addition to this, glaucomatous neuropathy may progress when the eye pressure is totally normal, making diagnosis even more complicated. We advise yearly eye pressure check-up even if you have no eye related problems.

5.3 Is there more than one kind of glaucoma?

Broadly, there are two kinds of glaucoma- open and closed angle glaucoma. In closed angle glaucoma, there may be symptoms such as pain and headaches. In the more common open angle variant, there are no symptoms until eye pressure reaches more than 50mmHg or so. There are many eye diseases which can cause secondary open or closed angle glaucomas in which part of the treatment would be to treat the root cause.

5.4 How is this disease diagnosed?

Your doctor will do a thorough examination of your eyes. Once they have done that, some additional tests need to be done- eye pressure measurements at different times of the day, field testing, OCT scan of the nerve fibre, corneal thickness, fundus photography, anterior chamber angle imaging, as the case may present. Not all tests are necessary for all patients. Your doctor would be the best person to advise you on the matter.

5.5 My sibling / parent has this disease. Am I at higher risk of developing glaucoma?

The risk of developing primary open angle glaucoma increases nine times if your parent has this type of glaucoma. You must check your eyes periodically to rule out glaucoma as this disease can develop at any age , though commonly after 40 years of age.

5.6 One of my relatives had LASER for glaucoma after which their glaucoma got “cured”. Is there such a cure?

As mentioned above, some variants of glaucoma can be curable if diagnosed at an early age. The most common of these is angle closure suspect, where the disease can be brought to a halt at times by simply making an additional path ( via LASER peripheral iridotomy) for the drainage of the aqueous fluid. Your doctor will explain this in detail if you have angle closure related problems. In other cases, with synechiae or plateau iris, even after LASER , medicines or surgery may be needed. Primary open angle glaucoma is not curable with LASER.

5.7 Will medicines or surgery cure my glaucoma?

Eye Drops are available for control of eye pressures, which is essentially the treatment for most types of glaucoma. Medicines can only slow the progression of glaucoma to a level where it does not affect the vision in an adverse way throughout most of your active life. Primary open angle glaucoma cannot be cured as of 2022. Without medicines, irreversible blindness is guaranteed in a high-pressure glaucoma. Surgery in essence does the same thing as drops, it reduces the eye pressure to a stable level where glaucomatous optic nerve damage occurs at slowest possible rate. Making the eye pressure below a certain level ('<'6mmHg) causes other complications in the eye , therefore , there is a limit to how much eye pressure control can be done.

RETINA

Retina is a thin layer of tissue on the inside back wall of our eye. It contains millions of light-sensitive cells (rods and cones) and other nerve cells that receive and organize visual information. Retina sends this information to brain through the optic nerve. Based on the light impulses sent through the nerve, brain creates the images enabling us to see.

Symptoms of retinal disorders;

Floaters (like flying insects/ moving clouds/ in form of dots and lines etc.)
Flashes (as in lightning)
Blurred or distorted vision
Black spot of vision
Sudden loss of vision, like a curtain dropping

Common disorders affecting retina, choroid and vitreous;

Diabetic/ hypertensive retinopathy
Retinal vascular occlusions
Macular degeneration
Macular hole/ Epiretinal membrane
Trauma related injuries
Retinal tear/ detachment
Central serous chorioretinopathy (CSCR)
Retinitis pigmentosa and other fundus dystrophies
Papilloedema

Many of these diseases do not have any early warning signs, especially diabetic retinopathy. The retina cannot be replaced, only reattached, so it is very important to prevent damage to the retinal tissue. The only way to do this is to have periodic yearly check-ups for retinopathy to make sure your eyes stay safe without further damage.

Risk factors for retinal disorders;

Systemic diseases like Diabetes Mellitus, Hypertension, Dyslipidemia etc., Trauma, Certain drugs, Aging, Smoking, Obesity can affect retina in different ways.

Tools to diagnose retinal and choroidal disorders;

If any of the above symptoms develop, consult ophthalmologist or retina specialist and undergo dilated fundus examination of both eyes. Fundus photography, retinal scan (OCT scan), Fundus Fluorescein Angiography (FFA), are the investigative options available to diagnose retinal diseases, all of which are available at Aradhana Eye Institute, Manacaud.

Treatment for retinal diseases;

• Control systemic diseases
• Regular follow–ups
• Non- surgical treatment : Lasers Intravitreal injections
• Surgical treatment

Surgeries done in Aradhana Eye Institute:

• Retinal detachment surgery
• Diabetic retinopathy related tractional retinal detachment
• Vitreous hemorrhage
• Macular hole surgery
• Epi- retinal membrane peeling
• Silicon oil removal

Our experienced surgeons predominantly use sutureless micro-gauge (25g) instruments to reduce the post- operative pain and inflammation with a vitrectomy system which is one of the best – in – class the world over- the Alcon Constellation machine. Consult our Vitreo-retinal consultant to know more about surgery options. In spite of all this, being a charitable institution, the costs are very nominal.

What to expect on a routine retina check up?

A routine retina check-up would take anywhere between 2 to 4 hours, depending on the number of tests ordered by your doctor and the number of patients at the clinic on that day. As all patients require dilation of the eyes after being checked for other problems in the eye, it takes a minimum of two hours for completion of a consult for a routine retina problem.

PEDIATRIC OPHTHALMOLOGY

Pediatric Ophthalmologists specialize in diagnosing and treating eye disorders in children. Young children often have difficulty in expressing their eye problems which can make diagnosis difficult. Pediatric ophthalmologists are trained to make children feel comfortable and co-operative. They use vision tests specially designed for the child’s developmental stage and special equipment that is appropriately sized for children.

Types of eye problems children can have

• Infections/Allergies/Injuries
• Refractive error (Vision problem)
• Squint (Crossed eye/Strabismus)
• Amblyopia (Lazy eye)
• Abnormal eye movements (Nystagmus)
• Drooping of eyelids (Ptosis)
• Blocked tear ducts (Watering/Epiphora)
• Pediatric glaucoma

General precautions and instructions

In our fast growing modern world, the habit of taking children for annual eye check-up must become an important duty of the parents/guardians . Small children cannot express their eye problems and so it is upto the Pediatric Ophthalmologist to examine and diagnose it on time. If parents notice any symptoms earlier , then they can be brought in OPD for evaluation as early as possible. If there is family history of wearing glass in parents or siblings , the children can be brought in for check-up too.

REFRACTIVE ERROR

Myopia/nearsightedness, is a condition in which an image of a distant object becomes focused in front the retina, either because the eyeball axis is too long or because the refractive power of the eye is too strong. Myopia is the most common refractive error requiring correction seen in children.

Hyperopia/farsightedness,is the refractive error in which an image of a distant object becomes focused behind the retina, either because the eyeball axis is too short or because the refractive power of the eye is too weak.

Astigmatism is a condition in which an abnormal curvature of the cornea can cause two focal points to fall in two different locations – making objects up close and at a distance appear blurry. It may cause eye strain and may be combined with nearsightedness or farsightedness.

Squinting, eye rubbing, lack of interest in school and difficulty in reading are often seen in children with refractive error. Eyeglasses or contact lenses may help to correct or improve refractive error by adjusting the focusing power to the retina. Refractive error can start in childhood or in adulthood. This condition makes close objects appear out of focus and may cause headaches, eye strain and/or fatigue.

SQUINT/STRABISMUS

Squints can be classified according to the direction of the turn of the eye:

If you have any of these common challenges, our expert team of Specialists would be glad to assist you. Please visit us for a review

• Esotropia (convergent) refers to an eye that turns inwards towards the nose;
• Exotropia (divergent) refers to an eye that points outwards;
• Hypertropia is when the eye is in an upward direction.
• Hypotropia is when the eye is in a downward direction

The squint may be present all or only part of the time, in only one eye or alternating between the two eyes.

Causes for squint:

• Refractive (focusing) abnormality/Eye muscle imbalance/ Injury
• It can run in families
• Illness can make it obvious
• Fatigue, stress or extended work load
• Rarely, it can be due to other diseases or illness

Early detection and treatment especially in children is important to prevent the development of "lazy eye".

Treatment options for squint

Non-surgical options- Not all patients require surgery for squints. Other methods such as: Prisms, refractive lenses, vision therapy, eye patching and certain medications have been used to help patients achieve fusion (alignment of the eyes) and minimize double vision.

Surgical options- The type and amount of surgery to perform for a particular squint is dependent on each individual's presentation and severity. This requires a thorough assessments and may require several follow-ups for accurate measurement and monitoring of the condition, prior to surgery.

What to expect on day of surgery?

Surgery can be planned under Local Anaesthesia or General Anaesthesia. General anaesthesia is preferred for children less than 18 years of age. Neurologist , Cardiologist and Pediatrician’s fitness is required pre-operatively. Chances of more than one squint surgery, diplopia(seeing double), over-correction, under-correction , infection ,may need to continue occlusion exercise and continue wearing glass post surgery is expected.

What to expect as part of squint evaluation?

Vision testing , cycloplegic refraction , Prism bar Cover test , Stereopsis testing, Binocular single vision check up and detailed fundus/retina evaluation.

Recovery & rest period after surgery?

Post squint surgery ,patient is expected to take complete rest for 2 weeks . Eyedrops and ointments are to be continued 6 weeks .

OCULOPLASTY

CONTACT LENS FITTING

Contact lenses are an excellent option for those who do not want to wear glasses all the time and also do not want to take any risks of undergoing any surgical procedure. There are many options available depending on your lifestyle, work and needs.

A typical contact lens fitting consult would require you to see the optometrist, then the doctor to rule out any other problems in the eye then the contact lens specialist who will assist you in selecting the lens which you suit you. The whole procedure may take one hour on a light day and two hours on a busy day.

What is a contact lens?

A contact lens is a thin synthetic circular piece of material which is shaped to fit onto the cornea ( the black portion of your eye). As different people’s cornea are shaped slightly differently, your contact lens specialist will test and make sure the fitting is just right before dispensing a lens to you.

How do i know if i am suitable for contact lens?

Not all people will be suitable for contact lens. Patients who have problems with their cornea, conjunctiva, eyelids, or with issues such as severe dryness of the eyes may not be suitable for this lens.Your consultant will look into that before prescribing a contact lens for you.

What are the types of lenses available?

The most common type of contact lens used by most people is the soft contact lenses. If your cornea has cylinder power, you may need what is called a Toric Contact Lens to correct the cylinder also. These are more expensive. For patients with other cornea related problems, RGP- rigid gas permeable lenses may be a better option.

What are the precautions i need to take?

IF you are using contact lenses , you would have been told about the necessary precautions to be taken. You mut always wash your hands with soap before touching the contact lenses. Always use the prescribed solution for cleaning the lenses. Segregate right and left eyes correctly every single time. DO Not leave the lens in the eye for more than 8 hours unless it is an extended wear type lens. DO NOT sleep with contact lens on.

Many medications cannot be put into the eye while your contact lenses are on. IF your contact lens falls off during any acitivity, do not attempt to put it back into the eye without first cleaning in the correct manner and inspecting for damage. DO NOT use expired contact lenses.

Which type of lens is suitable for me

Unlike common belief, all people cannot use the same type of lenses. Some may need slightly different curvature lenses, different material, cylinder correction lenses, presbyopia correction lenses. Easiest way to decide is to consult a doctor regarding the same. They will be able to help you choose what is best for you.

How long can i wear these lenses?

There are lenses available which are daily disposable, weekly disposables , monthly and even yearly basis. Daily disposables will be suitable only for people who rarely wear contact lenses since it cannot be reused.

What will happen if i sleep with these lenses on?

There is an increase chance of infection of the cornea when one sleeps with the contact lenses in. This could be because of the reduced oxygen supply to the cornea, reduced lid and eyeball movements and pollutants in the eye throughout the day. IT is always advisable to remove the lenses before sleeping.

Do i still need glasses after i buy contact lenses?

You would always need a pair of glasses because you cannot be wearing contact lenses all the time. In the nights, when your eyes feel particularly dry, during swimming, etc, you would be advised to wear glasses rather than using contacts.

PROCEDURE FOR CERTIFICATES

OPTOMETRY COURSE

Diploma in Optometry/ Ophthalmic Assistance:

This course grants a Diploma, which trains its students to specialize in ophthalmic techniques, making them competent to hold jobs in eye hospitals, clinics or optical shops. A high demand for ophthalmic assistants has given tremendous job opportunities for these graduates, both in India and abroad.

We run two courses.

• Diploma in Ophthalmic Assistance/Optometry: Recognized by the Govt of Kerala for Students of Kerala origin.
• Diploma in Optometry run Aradhana Eye Institute: OPEN TO ALL.