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Micro Phaco

2011-10-09T19:16:00.000-07:00

Till a few decades back cataract surgery used to mean prolonged bed rest and absence from work. Phacoemulsification made cataract surgery very safe with fast recovery. It cut short admission and enabled a day care procedure with minimum disruption in a patient’s life. With the phacomachine we are able to make a small opening of 2.8 mm to extract the 9mm cataract and implant a 6mm intraocular lens. This small opening gave the name “key hole” to the surgery.

As in many things in life, smaller is better, is the dictum in most all surgeries and especially so in eye surgeries. The search for a safer, faster and easier surgery resulted in micro phaco cataract surgery. This has been aptly nicknamed “pinhole surgery” as the incision size was further reduced by 40%.

The main advantage of the much smaller incision is the faster healing and therefore quicker rehabilitation to the patient. Smaller incision means more control to the surgeon during surgery as the wound is more stable. Thus the patients safety and the surgeons comfort level is enhanced.

The surgery is ideally suited for people wanting to start working soon after surgery. As the procedure is safer than conventional phaco patients with higher risk profile like diabetics and nephrology patients should ideally opt for this procedure. This would be the best option for complicated and difficult surgeries. The only disadvantage of Micro Phaco is that it needs sophisticated, computerised, ultrasound machines which can give pulsed power to enable the entire lens to be pulverised and removed by a thin needle.

Microphaco has made the already painless and safe 15 minute phaco procedure into a much faster computer controlled ultra precision surgery with very predictable results.

Though the safety profile is greatly enhanced the procedure has the same complications as phaco surgery; a list of which can be found on http://divyaprabha.in/consent-for-cataract-surgery

Spectacles for Presbyopia

2011-05-18T08:49:00.000-07:00

Starting around the age of 40, we loose the ability to see objects at very close distances. We might first notice this when we have difficulty in reading the small print on our medicine bottles or legal documents. As we grow older near vision will slowly become progressively more blurry, but distance vision will not be affected. This inability to see near objects is called presbyopia.

We have two types of spectacles to help people with presbyopia see near objects. These are Bifocal and Progressive lens. The major physical difference between the bifocal lens and the progressives lens is the demarcation line between the area used to see far and area used to see near objects. The main functional difference is that bifocal has only two focal points, while progressive has many.

Bifocal as the name implies have two areas of focus- the top portion for distance and the bottom circle for near. The reading power can be titrated to the distance that the person requires. For a person who read books in his hand would need the focus to be at 20-30 cm, while if he reads with the paper on a desk while he leans back the focal distance would be 3-40cm. If he requires to see both near and intermediate objects/ print then he has to opt for a progressive lens.

The reading segment can be round, D shaped or a flat line as in executive bifocals. Round shape is most comfortable while D shape gives more area for distance. Executive bifocals have large area for near for people who read a lot.

Search Amazon.com for progressive lenses

Progressive glasses are also known as varifocal, graduated glasses and no-lines bifocals. These lenses have more than one focal point or lens power with different powers at different levels of the lens. At the top of the lens, the power is minimum, which gradually increases in the middle level and finally, the bottom part of the lens has the maximum power.

Commercially, progressive glasses are quite popular because of the absence of any line on the lens. The greatest advantage of progressive glasses is the ability to look at objects at varying distances with just a slight tilt of head. As the different levels have different powers, the top part can be used to view objects at a distance, the middle one at the objects at an intermediate distance and the bottom part while working on the nearby objects, like reading a book. They also avoid the discontinuities like image-jumps which occur in the visual fields created by bifocal and trifocal glasses.

Links

How to choose a spectacle frame

Computers and the Eye.

Choosing a Spectacle frame

2011-05-02T19:49:00.000-07:00

The most important factor to consider when choosing a new frame is the fit of the frame. It doesn't matter how good a frame looks if you always have to push it back up your nose. Make sure that the frame fits the bridge of your nose without slipping down, remembering that the finished spectacles will be heavier than the frame when you try it on.

The frame should not rest on your cheeks. Try smiling while you are trying on the frame - if it rides up, then it is sitting on your cheeks, not your nose.

A frame should also suit your lifestyle. If you are very active, or wear your spectacles while exercising, then a smaller frame may be better, since your spectacles will be less likely to fog up than if they have a large, close-fitting frame.

Re-Using Your Frames

Re-Using your own frame can be a good alternative to searching for another frame that suits you, or spending a lot of money on a new frame when your budget is a little low.

But before considering this there are a few things you should bare in mind. Plastic frames must be heated and stretched to insert new lenses. Because the resins used in plastic frames tend to become hard and brittle with age, there is a high risk of breakage when you re-use an old plastic frame, regardless of how much the frame cost when you bought it, or which manufacturer made it.

A progressive lens requires perfect centration for an ideal fit. An old frame might have slight distortions and a perfect fit might not be possible. It is best not to reuse a frame to fit a progressive lens.

Contact Lens: Use and Care

2011-05-01T19:23:00.000-07:00

The contact lens is a plastic film which floats in front of the cornea on a thin film of tear. It corrects refractive errors of the eye. It is applied onto the eyes in the morning and removed at night.

It has several advantages over spectacles: The patient will have a wider field of view with contact lens. There will not be any steaming. There is no restriction of activity while using contact lens. Patients with high power glasses will have better and sharper vision with contact lens.
Disadvantages of contact lens

Once the Contact Lens are placed over the eyes, there will be increased tearing, lid irritation, excessive blinking. It is a matter of getting used to an unaccustomed set of sensations. By the end of one week the contact lens wearer is usually no longer aware of the lenses on his eye except when he thinks about it.

About the only real disadvantage in wearing contact lenses is the process of getting used to them. Once the wearer has become accustomed to all day use of contact lenses, he will find it difficult to name any disadvantage of importance.

Care of your Contact Lens

* Cleanliness cannot be over emphasized. Always wash your hands before putting on or taking off the Contact Lens.
* Do not rub your eyes when Contact Lens is in your eyes.
* When in doubt about anything contact us immediately.
* Insert the Contact Lens before shaving or applying facial creams or make-up.
* Remove contact lens before removing make-up.
* You can use a pencil eye liner. Apply it just above the upper lashes and just below the lower lashes. Never apply eyeliner to the inside rim of the eye.

CVS: Computer Vision Syndrome

2011-04-29T21:40:00.000-07:00

Computer Vision Syndrome (CVS) is commonly seen in persons working on computers for long hours. The symptoms of Computer Vision Syndrome involve not only the eyes but also the musculoskeletal system.

Eye problems consist of:

Eye strain, Watering
Irritation and Foreign body sensation
Headaches or pain in and around eyes
Blurred vision
Inability to concentrate after a while
Musculoskeletal problems consist of:
Pain in the neck
Pain in lower bac
Pain in the wrist

Working on computers, watching TV and driving a vehicle are strenuous jobs for our eyes. In all these situations the object of focus keeps moving from one position to other. Hence eyes have to move constantly to keep the object at the centre of the retina. Uncorrected refractive errors are the single most important factors that trigger off this disorder. Hence even a small refractive error need correction.

The CVS can be reduced by adjusting the computer monitor as follows

Adjust the height of the chair to keep the upper edge of the VDT screen below the level of your eyes so that you do not have to extend your neck or keep your eyes wide open to see the screen.
Background should be light & letters dark. Black letters on a white background are easiest to read and least strenuous on the eyes.
Keep the font size at least two points larger than the size you can read easily. Prefer scrolling on the screen rather than zooming down to have every thing in one view.
Viewing distance should be comfortable. Place monitor in such a way that there is no reflection of light on the screen. The source of light should be on your sides to avoid reflection on the screen. If a bright source of light e.g. a window is directly in front of your eyes, the glare will be highly disturbing. Some people feel comfortable working in a dimly lit room. Maintaining absolutely essential brightness is necessary to avoid straining eyes.
If you have to work for long hours, use support for the lower back. Position your key board, mouse and monitor in such a way that the body remains in a straight posture to see as well as handle these.

The eyes are constantly moving and accommodating while working on computers. To rest your eyes follow a 20:20:20 rule. It means that every 20 minutes take a break for 20 seconds and get up to look at a distance more than 20 feet. This will rejuvenate your eyes and make working more comfortable
Computer glasses make working on computers comfortable and are not needed otherwise, for distance or near vision correction. Computer glasses should ideally be UV protective and have a good quality anti-reflective coating to avoid the glare.

I use bifocal glasses. But I am not comfortable. What can I do?

The placement of monitor is neither like a book in your hand nor like a long distance object. Hence both the segments of your bifocals will be of no use on computers. Either you choose multi-focal glasses or get computer glasses. Older reading glasses may prove to be more comfortable than the recently changed ones.

Is there any association between contact lenses and CVS?

Not really. If the fitting of the contact lenses is perfect and refractive error is completely eliminated, they should prove to be as comfortable as glasses. Sometimes, in an overenthusiastic move to use only contact lenses and not glasses, astigmatic errors are left unattended. In such cases, glasses should be preferred over contact lenses. Also if one has a little dryness in the eyes, contact lenses may add to the discomfort.

What is a dry eye? How does it lead to CVS?

Tears are constantly secreted in our eyes to keep the front surface of the eye wet. This wetness of front surface is absolutely essential for clear and comfortable vision. If there is tear deficiency, it will cause dry eyes and lead to CVS. Also due to extreme concentration, the blinking rate usually decreases. Hence tears dry up faster leading to a to false dry eye state. Such cases can be helped by artificial tears, available as Eye Drops. One should also try and blink as normally as possible.

UV Safety Awareness for Your Eyes

2011-04-26T07:48:00.000-07:00

Sunlight is one of the greatest threats to your eyes. Studies show that exposure to bright sunlight may increase the risk of developing cataracts, age-related macular degeneration and growths on the eye, including cancer. Unfortunately many people are unaware of the sun’s harmful rays.

Remember to always shield eyes from the sun’s damaging rays by wearing proper protection outdoors. Also remember to protect eyes from indoor UV light when using tanning beds.

“By wearing UV blocking sunglasses, you can enjoy the summer safely while lowering your risk for potentially blinding eye diseases and tumors.” The longer the exposure to bright light, the greater the risk is. Excessive exposure to UV light reflected off sand, water or pavement can damage the eyes’ front surface.

Tips to protect your eyes from the sun:

Don’t focus on color or darkness of sunglass lenses: Select sunglasses that block UV rays. Don’t be deceived by color or cost. The ability to block UV light is not dependent on the price tag.
Choose sunglasses that absorb at least 99 percent to 100 percent of both UV-A and UV-B rays. Avoid products with labels that do not state exactly how much UV the product blocks.
Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun’s rays can’t enter from the side.
Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your eyes.
Don’t rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.
Don’t be fooled by clouds: The sun’s rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year, not just in the summertime.
Protect your eyes during peak sun times: Sunglasses should be worn whenever outside and it’s especially important to wear sunglasses in the early afternoon and at higher altitudes, where UV light is more intense.
Never look directly at the sun. Looking directly at the sun at any time, including during an eclipse, can lead to solar retinopathy, damage to the eye’s retina from solar radiation.
Don’t forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun’s UV rays are the strongest.

Summer Safety for Children

2011-04-26T07:47:00.001-07:00

In Summer children spend more time outdoors – trips to the beach, cricket and playing in the yard. Research shows that children's eyes can be damaged from sun exposure, just like their skin. This damage may put them at increased risk of developing debilitating eye diseases such as cataracts or macular degeneration as adults. It is important to make sure your children are wearing 100 percent UV blocking sunglasses. Whenever you are outside with children, remember to put a hat and/or sunglasses on them just as you would yourself. Children should be taught at a young age to wear sunglasses and hats to protect their eyes from the sun, so they will grow up with healthy sun protection habits. Keep children out of the sun between peak times -10 a.m. and 2 p.m.-- when the sun’s UV rays are the strongest.

Here are some summertime safety suggestions for children.

Make sure your kids wear sunglasses - Sunglasses for children may be purchased inexpensively. Check for 100 percent UV protection when buying sunglasses: Make sure your sunglasses block 100 percent of UV rays and UV-B rays. Don’t focus on the color or darkness of sunglass lenses: Select sunglasses that block UV rays. The ability to block UV light is not dependent on the price tag. Look for glasses with a polycarbonate lens; children under six may need a pair with straps to keep them in place.

Wear protective eyewear when playing sports. Tens of thousands of sports and recreation-related eye injuries occur each year. The good news is that 90 percent of serious eye injuries are preventable through use of protective eyewear. While helmets are required for many organized sports like cricket, protective eyewear unfortunately is not. For all age groups, sports-related eye injuries occur most frequently in basketball and racquet sports. Sports eye protection should meet the specific requirements of that sport; these requirements are usually established and certified by the sport's governing body and/or the American Society for Testing and Materials (ASTM).

If sand gets in your child's eyes, no rubbing. If a child gets sand blown or thrown into his eyes, an adult should immediately take him to a sink with running water. You should restrain the child from rubbing his eyes, as this can irritate the thin corneal tissue and make symptoms worse. Encourage the child to blink; also crying will help as the tears remove eye irritants. If the child’s eye still bothers him, it is important to seek medical attention from an Eye M.D.

Knowing Your Risks Can Stop the Sneak Thief of Sight

2011-04-26T07:46:00.002-07:00

Glaucoma is a silent illness; most people have no early symptoms or warning signs as their peripheral vision diminishes or blind spots occur. It affects more than 2.3 million Americans age 40 and older. Another 2 million do not know they have the disease. March is Glaucoma Awareness Month, and Divya Prabha Eye Hospital wants to remind people that knowing your risk for the disease can save your sight. If untreated, glaucoma ultimately results in blindness.

“Glaucoma can be a ‘sneak thief’ illness, and currently there is no treatment to restore vision once it’s lost,” said Prof. Dr. Suseela Prabhakaran. “But when we catch glaucoma early and closely monitor and treat people, we can significantly slow its progression and minimize vision loss.”

Those who have a family history of the illness are four to nine times more susceptible. Other glaucoma risk factors include aging, nearsightedness, previous eye injuries, steroid use and health conditions including cardiovascular disorders, diabetes and migraine headache.

For individuals with symptoms of or at risk for eye diseases like glaucoma, the Academy recommends that they see their ophthalmologist to determine how frequently their eyes should be examined. The Academy recommends that those with no symptoms or risk factors for eye disease get a baseline screening at age 40, when the signs of disease and change in vision may start to occur.

About Glaucoma

Glaucoma damages the optic nerve, the part of the eye that carries the images we see to the brain. As glaucoma worsens, cells die in the retina — a special, light-sensitive area of the eye — reducing the optic nerve’s ability to relay visual information to the brain. In the most common form of the disease, open-angle glaucoma, peripheral vision usually narrows, then other blank spots occur in the visual field. Symptoms of the less-common but more acutely dangerous form of the disease, closed-angle glaucoma, include blurred vision, severe eye pain and headache, rainbow-colored halos around lights and nausea and vomiting. Anyone with these symptoms needs to be seen by an Eye M.D. right away

Living with Glaucoma: It’s all in the Family

2011-04-26T07:46:00.000-07:00

Glaucoma remains a leading cause of preventable blindness. It affects more than 2.3 million Americans age 40 and older. Another 2 million do not know they have the disease. January is Glaucoma Awareness Month and knowing your risks for glaucoma can save your sight. Glaucoma can quietly damage the eye and optic nerve even before a person notices vision problems. Such damage cannot be reversed once it occurs.

Top risk factors for glaucoma are:

Age (65 years and older)
Elevated eye pressure
Family history of glaucoma
African, Asian or Latino ethnicity
Related health problems, including diabetes, low blood pressure, migraine headaches

For people of any age with symptoms or risks for eye disease, such as glaucoma, Divya Prabha Eye Hospital recommends seeing an Eye M.D. to decide on eye exam intervals and other needed care. For adults with no signs or risk factors for eye disease, a baseline screening is recommended at age 40—the time when the early stages of age-related eye disorders and vision changes may begin. Based on this screening information, the Eye M.D. will prescribe how often to return for follow-up exams.

Family support from the first diagnosis can make all the difference, as is true for many chronic illnesses. Family members can help an elder set up a medication schedule that fits his or her daily routine and help him or her learn to self-administer eye drops. Empathic listening and companionship are also important, as studies show depressed or isolated patients are less likely to adhere to treatment.

Presbyopia Correcting Intra Ocular Lens

2011-04-23T08:51:00.001-07:00

Huge medical advances have been made in the medical treatment of cataracts. This has made cataract surgery one of the safest, most effective surgical procedures. It is also one of the most successful surgical procedure1. For patients, cataract surgery is generally a simple, outpatient procedure with little discomfort only requiring a few hours away from home. The operation is through a tiny 1-3mm incision through which the surgeon inserts an instrument the size of a pen tip. The instrument breaks the cloudy lens into pieces and removes them from the eye. Once the cataract is removed, a replacement lens is inserted through the same tiny incision.

The evolution of cataract surgery took a giant leap forward in 1949, when Dr. Harold Ridley developed and implanted the first intraocular lens. The intraocular lens is an artificial lens that is implanted in the eye during cataract surgery to replace the eye's clouded crystalline lens. IOL advancements over the years have made it possible for cataract patients to realize clearer, more youthful vision than they could have ever thought possible.

Until recently, life without reading glasses or bifocals wasn't an option after cataract surgery. Traditionally, the replacement lens implant used for cataract surgery is a monofocal IOL. A monofocal intraocular lens has only one focal point. These lenses only correct vision at one portion of the patients visual range (typically vision at a distance). Though this type of lens restores good functional distance vision, patients still need to continue wearing reading glasses.

A new option is the multifocal intraocular lens. FDA approved presbyopia correcting intraocular lens a few years back. Multifocal lens can improve vision in a full range of distances: near, far and everywhere in-between. Most patients after multifocal lens implantation can read a book, work on the computer, drive a car and other daily activities with increased freedom from glasses.

Does this mean freedom from glasses after cataract surgery? For many people, yes. In fact, in clinical trials, after having the multifocal IOL implanted in both eyes, four out of five patients reported never wearing glasses. However, there can be a trade-off – while the patient may gain clear vision throughout his visual range, he can also experience halos or glare around light at night. Most patients find these trade-offs tolerable, but each patient should still discuss the options with their doctor because every patient is different. In extremely rare cases, as is true with any intraocular lens and cataract surgery, the patient may experience permanent vision loss due to infections or other surgical complications.

Thus in conclusion after successful cataract surgery, it may be possible to regain clearer, brighter and sharper vision than the patient had in years!

1. Facts About Cataracts. National Eye Institute, National Institutes of Health, Department of Health and Human Services. June 2004.

Deepavali Fireworks

2011-04-23T08:45:00.001-07:00

Each Deepavali, thousands of people are injured from using consumer fireworks. Of the thousands of fireworks-related injuries each year, nearly half are head-related injuries, with nearly 30 percent of these injuries to the eyes. One-fourth of fireworks eye injuries result in permanent vision loss or blindness.

“Too many Deepavali celebrations are ruined because a child has to be rushed to the emergency room after a fireworks accident,” says Prof. Dr. Suseela Prabhakaran.

Children are the most common victims of firework accidents, with those 15 years old or younger accounting for half of all fireworks eye injuries. For children under the age of five, seemingly innocent sparklers account for one-third of all fireworks injuries. Sparklers can burn at nearly 2,000 degrees Fahrenheit, which is hot enough to cause a third-degree burn.

“Among the most serious injuries are abrupt trauma to the eye from bottle rockets,” according to Prof. Dr. Suseela Prabhakaran. The rockets fly erratically, often injuring bystanders. Injuries from bottle rockets can include eyelid lacerations, corneal abrasions, traumatic cataract, retinal detachment, optic nerve damage, rupture of the eyeball, eye muscle damage and complete blindness.

For a safe and healthy Deepavali celebration, Divya Prabha Eye Hospital urges observance of the following tips:

Never let children play with fireworks of any type.
View fireworks from a safe distance: at least 500 feet away for best viewing.
Respect safety barriers set up to allow pyrotechnicians to do their jobs safely.
Leave the lighting of fireworks to trained professionals.
Follow directives given by event ushers or public safety personnel.
If you find unexploded fireworks remains, do not touch them. Immediately contact your local fire or police departments.
If you get an eye injury from fireworks, seek medical help immediately.