Health Reveal

Eye Care For every age

2009-07-04T08:49:00.000-07:00

All You Need To Know About Eyes and Eye Care -- The Right to Sight!

The eyes may be the mirrors of the soul but they're also one of the most misunderstood parts of the body.

There are some common conditions in the eye which are called 'refractive errors' or simply put the errors which require the use of glasses or spectacles. The most common one amongst them is 'Myopia'.

Myopia: When the person needs to use glasses for seeing clearly for far vision and the errors are minus numbers on the prescription card eg. -2.00 D [Dioptres]

Hypermetropia: When the person needs to use glasses for seeing clearly for far vision but the spectacle errors are plus numbers eg. + 2.00 D.

Presbyopia: When the person needs glasses for near reading, such as reading books, etc. These are also plus numbers but different from the plus numbers of hypermetropia as these plus numbers come after the age of forty and are only necessary for near vision.

Astigmatism: When errors occur in a certain axis. These will read as numbers such as -0.75D @ 180 ? .They are also termed 'cylindrical errors'.

A person having myopia or hypermetropia before the age of 40 years will also get presbyopia after 40 years as this is an age related process which is inevitable.

Besides the above conditions which are mainly spectacle errors there are many conditions in the eye which need to be addressed depending on the age group

School Going Children
Two to four percent of India's children develop a squint [cross-eyed] and/or amblyopia [lazy eye]. Early detection and treatment of these disorders during childhood is essential for preventing permanent vision loss".

In many cases the child doesn't see well out of one eye, as there may be a refractive error [spectacle number] in just that one eye. Here the eyes do not work as a team to see. If your child's brain doesn't receive visual images from that eye, eventually the brain will "shut off" that eye and vision could be permanently impaired. This condition is often undetected because the child has learnt to read from the good eye. During an eye examination, where each eye is separately checked, one can diagnose this condition.

Examination of vision among pre-school and primary school-going children is very rarely practiced in India unless an obvious problem is noted. Often the problem is dealt with too late. It is possible to check the vision in children who cannot read alphabets. All children attending kindergarten must be checked at admission.

What to do to detect these common eye problems:

Basic eye examination for every newborn by the pediatrician.
First detailed eye examination for all children age of 6 months. Again at 2 years, and then annually. Screenings at school are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye doctor. One study found that 11.3 percent of children who passed a vision screening were found to have a vision problem in need of correction.
Detailed eye examination by a pediatric ophthalmologist in the presence of visual impairment.
Follow-up annual examination by a pediatric ophthalmologist is recommended to stay on top of your child's visual needs, as well as ensure that your child's prescription for eyeglasses is still correct. The visual system is developing along with your child, so annual prescription changes are common.

A higher risk of eye problems at an early age in today's times

"Many pediatric eye doctors believe that heavy computer use among children puts them at risk for early myopia [short sightedness]" The average child now spends one to three hours per day on the computer doing homework, talking online with friends, and playing games. Parents encourage children as young as two or three years old to use the computer. Several recent studies have evidence that computers can have a negative impact on a child's vision. They have found that 25% to 30% of computer-using children need corrective eyewear to work comfortably and safely at the computer at home or in school. See below in tips how to prevent Computer Vision Syndrome in children.

Tips on daily eye care for children:

Diet:
A healthy diet with emphasis on green leafy vegetables, drumstick, carrots, beetroot, fresh fruits including mango and papaya are particularly rich in Vitamin A.
Lighting:
Light source should be positioned behind your child while reading. Avoid direct glare by using shielded light. Reading material should ideally be placed 12- 14 inches away.
VDU's or Visual display
units include TVs and computer screens. Headaches, eyestrain, burning, watering, blurring of vision, double vision and nausea can all be caused by prolong work on the VDUs.
Avoid watching TV
in a dark room. A well-lit room with white light [tubelight] is ideal. Preferred viewing distance for watching TV is 4 metres or more.
Place the computer screen at eye level
or slightly lower and in such a way to minimize reflection and glare. The recommended distance between the monitor and the eye for children is 18-28 inches. By viewing the computer screen closer than 18 inches, children risk straining their eyes. Parents and teachers should be aware of any behaviour that indicates potential problems, such as eye redness, frequent rubbing of the eyes, head turns and other unusual postures, or complaints of blurriness or eye fatigue. Avoidance of the computer may also be an indication of discomfort. Do not let the child sit for more than 40 minutes continuously in front of a computer monitor.
Swimming:
Water tight swimming goggles prevents irritation due to chlorine and reduces the chances of infection.
Sports:
If your child is involved in ball games and /or contact sports protective eye wear made of polycarbonate is recommended.
UV light:
Exposure to sunlight is healthy in moderation and helps in the making if Vitamin D by the body. Too much exposure to bright sunlight is harmful and can cause damage. Wide brimmed hats and UV filtering sunglasses provide adequate protection.
Application of 'kajal'
to newborns, washing the eyes with normal water, rose water etc is an absolute NO-NO. The normal circulation of tears is enough to adequately cleanse the eye of any extraneous material.

The gift of vision is very precious. Give your child the best start in life by visiting your eye doctor today.

Common Myths in Kids

Myth:
Squint in a child should wait till they grow up.
Generally speaking squints in children should be corrected before age 9 years. This is because later though a cosmetic treatment may be possible, the child after 9 years of age will continue to have a poorly developed vision from lazy eyes due to squint.
Myth:
'Children do not need eye examinations until they are in school'
False: It is recommended that every child's eyes be examined regularly starting at birth. Some eye problems such as crossed eyes or amblyopia (lazy eye) can result in permanent loss of sight in the affected eye if not detected and treated before the child is five or six years old.

Care Of Eyes During Examinations

2009-07-04T08:46:00.000-07:00

FOR STUDENTS

The most important reason why most students come to us is headaches and eye strain. This could be because of a probable spectacle number. But most of the times these symptoms are aggravated during school or college examinations.

Care of Eyes during Examinations
If your eyes water, eyelids twitch, and part of your forehead around your eyebrows seems to ache, you may be suffering from eyestrain. It's a common affliction that can occur after the eyes are taxed for a prolonged period - for example, after hours of close work. But you can reduce eyestrain by taking simple precautions.

Good lighting
Hold the reading material about 30 to 40 centimetres away from your eyes. Ensure you have adequate soft light coming from a source behind or beside your left shoulder [to avoid a shadow] -use a lamp with a 60-watt bulb. Good lighting does make reading easier and prevents eye fatigue. Use a tubelight if it's for general room lighting and a bulb for a table lamp.

Periods of rest
Take a break every half an hour or so by looking at distant objects for three or four minutes. Rest usually alleviates eyestrain.

Proper posture
Do not read while lying down, as it will strain the muscles of your eyes, neck and back. While sitting and reading don't slouch and make sure that you sit in a comfortable chair with good low back support. Headaches, neck aches, backaches and muscle spasms result from holding the body in awkward positions in trying to maintain a desirable angle between eyes and the book.

Good nutrition and hydration

Eat a healthy diet with emphasis on fresh vegetables and fruits, whole grains, beans, seeds, and nuts. The nutrients that they provide are important for overall as well as eye health. For non-vegetarians, add eggs and fish. Avoid addictive sweets, sodas, cookies and junk food, which is a prescription for disaster not just for eyesight but overall health. Staying with a mostly vegetarian diet of unprocessed, natural foods will help preserve the circulation to the retina, the rods and cones, and the lens.

Wear the correct spectacle number and do not read for long time with contact lenses.
If you have a refractive error or need spectacles, then wearing the correct prescription reduces eyestrain, which would have otherwise impeded your work. Contact lenses are meant to float on the tear film of your eyes. When we do near focus work such as on the computer, we tend to blink less than normal and this dries up our tear film. The contact lens then sticks on the eye and also causes contact-lens-induced allergies. If we wear contact lenses and read for a long time, then we are only worsening the situation. Try and avoid contact lenses while studying, spectacles are a better option.

Common Eye Problems Amongst Older College Students

2009-07-04T08:43:00.000-07:00

Common Eye Problems Amongst Older College Students
Also seen in those professions requiring long hours of computer use

Dry Eye A collection of symptoms that make up an eye condition due to imbalance in the quantity or quality of tears. What you may feel is gritty eyes, pricking or burning sensation, irritation or a feeling of a foreign body in the eyes. What you need to do is avoid contact lens wear, use a lubricating eye drop and reduce the time of work on computers. Draught from a fan or air conditioner directed on the face could worsen the symptoms.

Computer Vision Syndrome

It is common for computer users to have dry eyes. This is because we don't blink much and we keep our eyes wide open when working at the computer, resulting in drying up of the tear film. Many reasons can result in this condition.

Poor position in relation to the computer.
Lighting that produces glare or reflections, fuzzy images or images that are too dim or too bright;
Failure to blink often enough to moisten the surface of the eyes;
Use of glasses that are inappropriate for the user's position and distance from the screen;
Minor visual defects such as astigmatism that might go unnoticed unless intense computer use exaggerates them.

The following steps can help alleviate your symptoms:

Lower your computer screen so that the center of the screen is 4-8 inches below your eye level and at a viewing distance of 20-28 inches.
Use artificial tears as recommended by your doctor to re-wet and lubricate your eyes.
If you are seated in a draught or near an air vent, try to change your seating or position and direct the draught away from your eyes.
Low humidity or fumes aggravate a dry eye condition.
Concentrate on blinking whenever you begin to sense symptoms of dry or irritated eyes.
Take frequent breaks. Follow the 20-20-20 rule. This simply means every 20 minutes, look away beyond 20 feet and blink 20 times.

Red Eye - Typically caused by:

Fatigue and eye strain- reading in poor light, lack of sleep
Poor Contact Lens Hygiene/ Contact lens allergies
Infections- conjunctivitis- bacterial (infections) or allergic (eg. Dust).

If you suffer prolonged discomfort or notice a marked change in your vision, you should immediately have an eye examination.

Computer Vision Syndrome

2009-07-04T08:41:00.000-07:00

Computer Vision Syndrome

Many Hours at Your Computer Will Worsen Your Vision - - Unless You Know These Secrets

Computers are now a way of life, something that you cannot do without. As the number of people working on computers continues to grow each year, the number of people encountering temporary vision problems due to computer use also increases. Computers do not harm your eyes, but often cause temporary problems.

Human eyes were meant for hunting and farming and even I we have moved far ahead with technology, our bodies still have to catch up on the metamorphosis from far work to fixed close work. When you look in the distance, your eyes are relatively relaxed and at rest. But while doing near work, such as reading your computer screen, muscles in your eyes have to work harder to keep a clean near focus. These muscles get tired after extended use, resulting in eyestrain, neck pain, blurry near vision, headaches or difficulty changing focus. Dry eyes can also occur because we tend to blink less as we concentrate on our computer screen and keep our eyes wide open when working at the computer, resulting in drying up of the tear film.

Squinting while looking at a computer screen is not only uncomfortable, it can lead to dry eye. This is because squinting causes people to blink less often, and the less you blinked, the more you experience aches, burning and sensations of dryness, irritation and tearing in your eyes.

In fact, squinting even cuts your blink rates in half -- from 15 blinks a minute to 7.5 blinks a minute. Only four blinks per minute.

Many reasons can result in this condition:

Poor position in relation to the computer.
Lighting that produces glare or reflections, fuzzy images or images that are too dim or too bright;
Failure to blink often enough to moisten the surface of the eyes;
Use of glasses that are inappropriate for the user's position and distance from the screen;
Minor visual defects such as astigmatism that might go unnoticed unless intense computer use exaggerates them.

The following steps can help alleviate your symptoms:

Lower your computer screen so that the centre of the screen is 4-8 inches below your eye level and at a viewing distance of 20-28 inches.
Use a document holder placed next to your computer screen. It should be close enough so you don't have to swing your head back and forth or constantly change your eye focus.
Change your lighting to lower glare and harsh reflections. Glare filters over your computer screen can also help.
If you are seated in a draught or near an air vent, try to change your seating or position and direct the draught away from your eyes.
Low humidity or fumes aggravate a dry eye condition.
Concentrate on blinking whenever you begin to sense symptoms of dry or irritated eyes.
Take frequent breaks. Follow the 20-20-20 rule. This simply means every 20 minutes, look away beyond 20 feet and blink 20 times.
Use artificial tears as recommended by your doctor to re-wet and lubricate your eyes.

While complaints of eye fatigue and discomfort are common among computer users, these symptoms are not caused by the computer screen itself. Computer screens give off little or no harmful radiation (such as x-rays or UV rays). All levels of radiation from computer screens are below levels that can cause eye damage such as cataracts. Fatigue, dry eyes, bad lighting, or how you sit in front of the computer can cause eyestrain. Symptoms of eyestrain include sore or irritated eyes and difficulty focusing. You may also have symptoms of eyestrain if you need glasses or a change in your glasses.

Talk to your ophthalmologist if you suffer from any of these symptoms as you may benefit from a simple prescription.

Conjunctivitis & Summer

2009-07-04T08:38:00.000-07:00

Summer Woes: The Red Eye
Don't let those dark glasses fool you?read on to learn more

Summer is India's hottest season. This season starts in March with daytime's temperatures exceeding 30?C. When things begin to heat up many suffer from itching, burning, and watering of the eyes. This 'red eye' can either be due to allergens, called 'allergic conjunctivitis', or due to infections- 'infectious conjunctivitis'.

Conjunctivitis - is an inflammation of the conjunctiva of the eye. A clear, thin membrane called the conjunctiva covers your eyeball and the inside of your eyelids. If something irritates this covering, your eyes may become red and swollen. Your eyes also may itch or even hurt, and they may water.

Causes
Some common allergens include pollen from trees and grass, weed pollens and moulds; animal skin, fur and secretions such as saliva; perfumes and cosmetics and eye make up; skin medicines; air pollution and smoke. Grass pollens tend to cause symptoms in early summer. Various other pollens and moulds may cause symptoms later in the summer. In our city construction dust is a major cause of allergic conjunctivitis. The perennial form persists throughout the year and is usually triggered by dust mites. In some cases, use of mosquito-repellant liquids used in a closed room throughout the night can cause allergies and puffy eyelids.

Other causes of conjunctivitis are viral and bacterial infections.

Another form of conjunctivitis is Giant papillary conjunctivitis.
It occurs in some people who have a 'foreign body' on the eye - most commonly a contact lens. The exact cause of the inflammation is not known - it is possibly an allergic reaction to 'debris' on a contact lens or to poor lens hygiene. About 1 in 100 contact lens wearers develop this type of conjunctivitis.

What are the symptoms of conjunctivitis?

The eyes are usually itchy, and the whites of the eyes look red or pink.
A burning feeling may occur and it may be painful.
The eyelids tend to swell.
The eyes can water as in allergic conjunctivitis or become 'gluey' as in infective conjunctivitis.
Vision is not usually affected.
In severe cases the conjunctiva under the upper eyelids may swell and look lumpy.

Will conjunctivitis damage my eyesight?

Allergic conjunctivitis is irritating and uncomfortable, but it will not hurt your eyesight unless very severe. Infectious conjunctivitis however needs urgent attention as the symptoms can worsen and become difficult to treat.

Can I wear my contact lenses?
It's not a good idea to wear contacts while you have conjunctivitis. Instead, wear your glasses until your eyes feel better.

What can I do to avoid getting the above symptoms?

It is a myth if you think that by staring into a red eye you will get one yourself!
It is also a myth that a person wearing dark glasses when he/she has a red eye is enough protection from spreading the condition!
When one person rubs the eyes, the germs get on the hands. From there, they spread to someone else's hands while sharing things such as doorknobs, towels etc. Hence the most important precaution whenever you are outdoors is never to rub your eyes since your hands have been all over the place! Wash your hands frequently, even a hand sanitizer will do.

Try to identify and avoid the allergens that cause your symptoms. For example, if you are allergic to pollen or mould, stay indoors when pollen and mould levels are high. Close windows, wear 'wrap around' sunglasses when out and use an air conditioner during the summer months.

What you can do when you have conjunctivitis to prevent spreading it?

Conjunctivitis can also spread from one eye to the other, especially when you rub your eyes.
Hence good hygiene of hands and face is important.
There should be no sharing of face towels, especially if someone has conjunctivitis. People who suffer from conjunctivitis should have a special towel that only they use.
Pus and crust should be removed by bathing the eye with lukewarm salt water that can also lessen the symptoms.
Use disposable tissues when you dry the eyes and throw them away after use. This will limit the contamination.
Dispose of any antibiotic eye drops after the treatment is over.

The person suffering from infective conjunctivitis must refrain from rubbing the eyes. If the urge to itch is strong, first the hands must be washed, then the eyes cleaned and the hands washed again with soap. It is important not to share soaps, towels etc.

Treatment

Bathing the eyes with a cloth soaked in cold water soothes the eyes.
Depending on the type of conjunctivitis, eye drops that reduce inflammation and treat infection [antibiotic] are prescribed by your eye doctor.
Steroid eye drops are rarely needed or used. Steroids are good at reducing inflammation. However, they should only be used under the supervision of an eye specialist as infection and other causes of conjunctivitis need to be definitely ruled out. Steroids can make some other eye conditions worse.
Antihistamine tablets. You can take these in addition to the eye drops to ease the general symptoms of allergies.
In general, do not wear contact lenses until symptoms have gone, and for 24 hours after the last dose of any eye drop or ointment.
Lubricating eye drops (called artificial tears) may also make your eyes feel better. You can buy these drops without a prescription.

Contact Lens Use And Misuse

2009-07-04T08:37:00.000-07:00

Contact Lens -- Use and Misuse

The disposable contact lens has joined other commodities as a personal care item with a very short life. But don't think disposable contact lenses (or any other type) are free of troubles and maintenance just because they're so convenient. Any lens can become contaminated and cause severe infections and damage delicate areas.

Here are some Do’s and Don’ts with contact lenses.

Do not sleep with contact lenses in.
Even if you have contact lenses that are labelled ‘extended wear’ it doesn't mean you should leave them on through the night. The reason: Continuously worn contacts rub away the cornea (the covering of the eyeball). This causes tiny abrasions that invite infection and may lead to vision loss. Also, covering the cornea for extended period blocks out oxygen which provide an ideal breeding ground for harmful bacteria.

Do clean the contact lenses with every use.
Whenever you take out your lenses, they must be cleaned well as per the instructions. If you wear the disposable kind, be sure to throw them away at the time prescribed and not stretch it out to cut costs.

Do clean the lens case, too.
Scrub the case with hot water with a toothbrush that's used only for that purpose.

Do not use homemade saline solutions.
Use a fresh solution each day, and use only commercial contact lens preparations. That's because homemade salt solutions might harbour bacteria that can scar the cornea and cause partial or complete blindness. And since tap water and mineral water are not sterile, they may harbour infection-causing impurities.

Do one lens-care regimen.

A disinfecting/cleaning regimen is always specified for your lens type and that shouldn't be changed. Whatever the recommended procedure, be sure to stick with it and not cut corners!

Do not wet your lenses with saliva even in emergencies.
Saliva is teeming with bacteria. If you give your lenses a spit bath, you might as well rub your lenses on the floor!!

Do remove the makeup first, lenses second.
Use water-based, not oil-based, cosmetics, and apply makeup and hair spray before you put in your lenses. Around the eyes, use water-resistant mascara and apply to lash tips only.

Do not wear your lenses while swimming.
The risk of wearing hard lenses in a pool or tub is that they may float out if your eyes get wet. With soft lenses, impurities in the water might be absorbed, which could cause infection, so if you need to see underwater, get goggles.

Do remove your contacts if your eyes turn red.
Do not take your eyes for granted and abuse them! If your eyes become irritated, remove your contacts. If the irritation doesn't go away after two to three hours, contact your eye doctor.

Tears, discharge, redness around the eyes and a change in vision are all indications of eye allergy or infection.

Dry Eye : Non Invasive Machine To Diagnose Dry Eyes

2009-07-04T08:36:00.000-07:00

When your eyes are red and scratchy, it could be, they’re dry. The right treatment is important.

While most dry eyes are not severe, some can be. Any eye irritation is a warning sign that something has changed in the normal functioning of your eye, and it needs proper attention. Not all eye drops are the same. Make sure you contact your ophthalmologist if discomfort persists.

What is dry eye?

Dry eye is a condition when your eyes either produce too few tears, or produce tears that are weak in the ingredients that lubricate and protect the surface of your eye.

Why are tears important?

Tears are one of the body’s natural defense mechanisms. They are produced by glands around the eye, and released to coat, protect and nourish the surface of the eye.

What cause dry eye?

Age: The most common reason for dry eye is aging because both the tear flow rate and effectiveness of your tear film decrease with age. By age 40, you have about half the tear production you had at age 10. Lastly, these days most common reason is Lasik or i lasik , refractive surgeries to remove glasses

Environment: Many factors in your surroundings can also lead to Dry Eye such as:

1.Staring at computer terminals or television screens
2.Air conditioning or heat in homes and offices.
3.Air pollution.
4.Driving over long distances.
5.Extremes in humidity.

Contact lenses: Dry eye symptoms are experienced by many contact lens wearers around about 25-32%. This is mainly because soft contact lenses are “hydrophilic”, i.e. they attract fluids and float on top of the tear film. If not enough tear film is produced; irritation and redness may result from the contact lenses rubbing against the surface of the eyes.

Other factors: Certain medications taken for eye disorders or other conditions can cause Dry Eye if they affect the glands (lacrimation glands) around the eye.

Dry eyes often occur in patients suffering from arthritis. Dry eyes are common with women, especially during menopause or pregnancy.

Lastly, these days most common reason is Lasik or i lasik , refractive surgeries to remove glasses

What are typical symptoms?

Dry eye symptoms include one or more of the following :

Dryness Burning
Grittiness
Scratchiness
Watery Eyes Tiredness
Feeling of "something's in eye"
Sensitivity to light.

Is there a cure for Dry Eyes?

If you are suffering from dry eyes or other eye discomforts, you should obtain a complete eye examination from your ophthalmologist. If left untreated Dry eye can lead to other more serious conditions including corneal ulcers, infections and conjunctivitis. There is no cure for this condition. If Dry Eye is cause by environmental or occupational factors, i.e. staring at computers computer vision syndrome or being exposed to hot air, you could help your Dry Eye condition by simply reducing or eliminating the cause. In most cases, i.e. age or disease related, the condition is chronic and must be constantly treated. It is therefore important in all cases to follow your practitioner’s recommendation.

How Do Tear Substitutes Help?

The first line of treatment and relief for Dry Eye is the use of Tear Substitutes solutions. These solutions supplement natural human tears and provide a substitute coating to protect and nourish the surface of the eye. Ointments are also effective, but are usually applied only at bedtime due to blurring of vision. Tear as frequently as needed.

Latest machine (NON INVASIVE) for DRY EYES [First time in Asia]

Special non-invasive diagnostic instrument available only at G.G.S.I.EYE RESEARCH & CURE CENTRE which can detect the dry eyes in 5 secs which is never picked up other dry eye tests, it is very useful in early treating & diagnosing dry eye.

Dry Eyes What Is It ?

2009-07-04T08:32:00.000-07:00

Human eye is one of the most important vital sense organs of the body. Just close your eyes and imagine how life would be without proper eyesight. Well everything would come to a standstill. The front part of the eye contains a glass like structure called the cornea that allows light to enter the eye and get focussed on the light sensitive layer of the eye ie the retina. Any factor that affects the health of the cornea leads to degradation of its clarity and thereby directly affects the quality of vision.

The health of the ocular surface is maintained by the tear film, normal functioning eyelids, and healthy population of corneal stem cells. The tear glands continuously produce a watery secretion that moistens and lubricates the ocular surface, allowing smooth movement of the eyelids and the eyeball. The tear film also washes away any debris that accumulates on the surface of the eye, and provides a smooth refracting surface of the cornea. Any deficiency of a stable tear film, directly affects the quality of vision, besides producing a variety of symptoms. These range from dryness, burning sensation, irritation, foreign body sensation, itching, and redness etc.

I am sure as you read this article, you will recall experiencing some of these symptoms in the past. Well with the advent of 24 hours television channels, and usage of computers in day to day work, dry eye syndrome has become quite common, and is often referred to as ?Computer Vision Syndrome?. While watching television or working long hours on computer, people tend to blink less frequently. This leads to drying of the ocular surface in between blinks, making the surface rough, with resultant symptoms of irritation and burning etc. Moreover sitting in an air conditioned environment leads to faster evaporation and drying of the eyes. Hence it is important to realize this and consciously blink more frequently, or take a break after an hour, and keep the eyes closed to allow the surface to recover.

Dry eye condition, also leads to poor lid hygiene, due to which there may be recurrent episodes of lid margin infections, painful boils in the eye lids. These often tend to recur if the dry eye condition is not properly treated. But it is extremely important to remember that all dry eyes may not be a result of infrequent blinking....

There may be an actual reduction in tear production, leading to all the symptoms described earlier. A proper assessment of the ocular surface status by a well trained corneal surgeon is essential to diagnose the exact etiology, and then provide correct treatment to resolve the same.

Frequently dry eye symptoms may be the first indicator of systemic connective tissue disorders or rheumatoid arthritis, so it is important that your corneal surgeon does a proper evaluation to rule out the same. The routine ophthalmologist (eye specialist), may not be able to assess the surface changes in a detailed manner, as compared to a well trained corneal surgeon.

At the cornea clinic ? Apollo Hospitals, Hyderabad, a detailed history is recorded, followed by clinical tests in a logical sequence, to assess the correct etiology, and severity of the surface damage secondary to dry eye condition. Proper counselling of the patient is done, following which appropriate dry eye therapy is started. Follow up visits are essential to assess the extent of recovery of the health of the ocular surface. Patients often tend to skip these visits as they get symptomatically better with the medications. Due to this, often it leads to inadequate treatment, and recurrence of symptoms after some time.

Newer medications, such as ?Restasis? can help reduce surface inflammation and improve surface sensitivity, which tends to improve tear secretion. This is essential to restore the health of the ocular surface and reduce patient symptoms, and dependence on artificial tear drops.

Eye Problems Amongst Older People

2009-07-04T08:29:00.000-07:00

Eye Problems amongst Older People

The commonest eye problems which we see are decrease in vision due to cataract or a retinal condition like retinopathy due to uncontrolled diabetes or hypertension or age related macular degeneration. Some often complain of flashes and floaters.

Risk factors for eye diseases

Smoking - increases the risk of cataract and macular degeneration by more than 3 times
Alcohol - More than 1 alcoholic drink per day can increase cataract risk
Bright UV light / not using sunglasses - increases the risk of cataract and macular degeneration
High Blood pressure and cholesterol - increases the risk of macular degeneration
Lack of protective eyewear - risk of eye injury and loss of sight

Flashes and Floaters

Floaters appear as grey or black specks, lines, or "cobwebs", worms, rings or dots in front of the eyes. As the eyes move, the floaters move too. They do not follow your eye movements precisely, as they usually drift when the eyes start or stop moving. Floaters are caused by clumping of pre-existing vitreous fibers in the eye or bits of material suspended in the vitreous jelly that fills the back of the eye.

Flashes are sensations of light, when no light is really there. They may appear as many tiny bright lights (like "sparklers") or like flashes of lightning. Flashes occur when the vitreous jelly pulls on or tears the retina. These flashes usually last for only a second or so, but typically occur repeatedly. They may be more obvious with eye movement or in a dark room.

Some people with migraine headaches may experience a different type of flash. These are usually shimmering, jagged lights that are present constantly for a period of ten-fifteen minutes or so. They typically appear in the center of your field of vision, and progress slowly towards the edges of the visual field. A headache that is commonly throbbing, and on one side of the head, may follow the disappearance of the flashes.

Many people have floaters. This happens in over 70% of the population as part of the normal aging process. Floaters that you have had for years, and that show little change, are usually not serious. It is the sudden onset of one or more new floaters that may be serious. The onset of flashes may also be serious.

Anyone with flashes or the sudden onset of a new floater (or floaters) needs a dilated fundus examination (looking at the vitreous and retina with specialized equipment after putting drops to enlarge the pupils).

Myths

Flashes and floaters cause total blindness
The Answer is - No, Floaters cause only a slight blockage of the vision at worst and are usually not detectable by visual testing unless they are very severe.
Importantly, floaters can be related to retinal detachment or a variety of vascular conditions such as diabetic retinopathy, while flashes can be related to retinal tears (breaks) or detachment. These can result in blindness if not treated.

If one eye develops flashes or floaters the other will develop them as well
It is very common for the same condition to occur in the second eye. For this reason, and because flashes and floaters are sometimes caused by retinal breaks, both eyes should have a dilated fundus exam as soon as possible when flashes or floaters develop in either eye.

CATARACT:

Cataract is the most prevalent age-related eye disease in the world, and according to the World Health Organization, the leading cause of reversible blindness. There are currently close to 10 million Indians age 40 and older with cataract.

A cataract is a condition wherein the otherwise clear nature of the human lens becomes opaque. Surgery should be considered when the cataract causes enough visual disturbances to interfere with daily activities, such as job requirements, safe driving and household activities. Based on these needs and examination findings, the patient and the ophthalmologist should decide together when surgery is appropriate.

It is not true that cataracts need to be 'ripe' before they can be removed. In fact advances in the field of cataract surgery have made it easier to remove an immature cataract than a mature ['ripe'] cataract.

Common misconceptions cleared:

Cataract is not a film over the surface of the eye
It is not caused by overusing the eyes
Not infectious [will not spread from one eye to the other], nor a cancer
Not a cause of irreversible blindness

Myths

Cataract can be prevented by taking drugs!

As per todays scientific knowledge the cataract coming with age cannot be prevented by any drugs.

Cataract Surgery is Done with Lasers
The Answer is - Never, Lay men talk of the word 'laser' actually refers to the latest technique called phacoemulsification. No actual laser is used. The surgeries now are stitchless, very quick and with speedy recovery. Due to this short, stitch less procedure, cataract removal is often a misnomer as a laser procedure.

A cataract must be ripe before it can be removed.
With modern cataract surgery, a cataract does not have to ripen before it is removed. When a cataract keeps you from doing the things you like or need to do, consider having it removed.
In fact the phacoemulsification surgery as well as the post- operative period is much easier for the patient and surgeon.

GLAUCOMA

Glaucoma is one of the leading causes of blindness in the world, especially for older people. However visual loss is preventable or stabilized with early diagnosis and treatment.

Glaucoma is a condition of the eye where the optic nerve is damaged. The optic nerve carries images to the brain, which are then perceived as vision. Minute nerve fibres from various parts of the retina join to form the optic nerve. Glaucoma results when the pressure within the eye is high enough to be detrimental to the normal functioning of these nerve fibres, some of which stop functioning. Non-functional nerve fibres result in a loss of retinal function in the area from where they originate, leading to defects in the field of vision.

The disease is called the `sneak thief of sight? because it is painless, symptomless and irreversible. Therefore, the person with glaucoma is usually unaware of it until much loss of vision has occurred. In fact, half of those suffering damage from glaucoma do not know it. Currently, damage from glaucoma cannot be reversed and if the entire nerve is damaged, blindness results. Early detection and regular treatment are the keys to preventing optic nerve damage and blindness from glaucoma.

Myth
Glaucoma can happen to you only if someone in the family has it.
The Answer is - False, Glaucoma though seen as a hereditary trait can also occur in sporadic cases, those on long term steroid use

Anti-Glaucoma Diet?
It cannot be cured by a special diet. This disorder is characterized by increased pressure in the eyeball and can lead to blindness. One important thing to remember is not to drink a lot of fluids in one go if you have Glaucoma

Glaucoma is blinding in all cases!
In modern ophthalmology glaucomas are nearly always prevented from losing vision by using the appropriate drugs or surgery and regular follow ups with eye care professionals. Hence a regular eye examination is a must.

DIABETIC RETINOPATHY

Diabetes mellitus is a condition which affects millions of Indians. It impairs the body's ability to use and store sugar. Elevated blood sugar levels and excessive thirst and urination are the indicators of diabetes. It can affect vision by causing damage to the blood vessels of the retina, or a higher incidence of cataract and glaucoma. Changes are also seen in blood vessels all over the body

It is an advanced stage of the diabetic disease process in which the blood vessels in the retina are damaged and leak fluid or blood. The longer a person has diabetes, the more the risk of developing diabetic retinopathy. People with type I diabetes [diabetes since childhood] are more likely to develop diabetic retinopathy at a younger age.

The symptoms of diabetic retinopathy:
Early diabetic retinopathy usually has no symptoms. Gradual blurring of vision may occur if fluid leaks in the central part of the retina [the macula]. In late diabetic retinopathy [proliferative stage], new abnormal blood vessels begin growing on the surface of the retina or the optic nerve. These vessels have weak walls and leak blood out into the retina and vitreous [jelly that fills most of the eye]. Presence of blood in the path of light entering the eye blocks vision.

Myth
Diabetic patients do not need an eye checkup till they have visual symptoms !
Diabetic patients must have an annual eye checkup. This can help detect early involvement of the eyes. At that stage a rigorous control of diabetes and preventive actions such as laser photocoagulation of the retina might help to prevent severe visual loss later.

AGE-RELATED MACULAR DEGENERATION
The macula is a small area at the center of the retina that allows us to see fine details such as central vision, activities such as reading and writing and appreciating colour vision.
Sometimes the delicate cells of the macula are damaged and stop functioning. The exact cause is not known although it tends to happen as people get older. This is called age-related macular degeneration. The most common types of macular degeneration are the dry [atrophic] and the wet [exudative].

The dry type is caused by aging and thinning of the tissues of the macula. The wet type results from the formation of abnormal blood vessels under the macula which leak fluid or blood and blur the central vision. Children and young people can also suffer from an inherited form of macular degeneration called macular dystrophy, which can sometimes affect several members from the same family

Some Helpful Tips for older people

Eat a balanced diet, including fresh fruits and vegetables, Greens and fruits provide vitamins, minerals and antioxidants to boost your body's immune system.
Commit to Exercise regularly (check with a doctor before starting an exercise program). Go for the great outdoors. Nature rambles are good for fresh, oxygenated air. This improves blood circulation.
Get regular health check-ups and annual eye examination.

SOME COMMONLY ASKED QUESTIONS

"What can I do with nutrition to improve my vision"

Start with a well balanced diet
Add Exercise for Circulation
Ultraviolet protection
Supplements that help the eyes like Selenium, Vitamin A

Care of eyes during examinations-

Good lighting
Taking breaks or periods of rest
Proper posture
Good nutrition and hydration

Food for the Eyes?

Some people believe poor eyesight can be corrected by following certain diets or taking vitamin supplements. This is true only if your problem is caused by a vitamin deficiency. Vitamin A, for instance, is needed for night vision. People who lack this vitamin - which is found in dark green leafy and yellow vegetables and fruits - can't see well in dim light because of night blindness. This is a common problem in developing countries like the Philippines.
But gorging on carrots and other sources of vitamin A won't spare you the trouble of wearing eyeglasses if you need them later. Rather than help you, too much vitamin A can cause blurred vision, itchy skin, loss of appetite, hair loss, joint pains and irregular menstruation.
Poor eyesight, which is helped by wearing eyeglasses, has nothing to do with nutrition. Only if you are short of vitamin A, then carrots would enable you to see better in dim light.

Dim Fears

Will reading in dim light harm your eyes? Of course not! This is another myth that refuses to die.
Reading in the dark, in a moving car or in bed won't damage your eyes. The worst you can expect is a headache or nausea. This comes from strained muscles which have to work harder since you're reading in an awkward position.

All Red Eyes are Infections and wearing dark glasses prevent its transmission to others.
It has been our experience in our hospital that most red eyes are due to allergies. However transmitting infection does not take place by looking or staring at the red eyes, but by hand to eye spread.

It is good for the eyes to look directly at the sun.
False. Ultra-violet light is harmful to your eyes, damaging the cornea, lens and retina. Also, never watch welding without wearing the proper protection. Never look directly at an eclipse.

You do not need to have your eyes checked until you are in your 40s or 50s.
There are several asymptomatic, yet treatable, eye diseases (most notably glaucoma) that can begin prior to your 40s.

I Believe Eye Can Fly!!

2009-07-04T08:25:00.000-07:00

I Believe Eye Can Fly!!

How airplane travel can affect your EYES and Tips on avoiding problems

Temperatures are warming up across the country and before you know it, it'll be time for summer vacation again. As soon as school lets out for the summer, Indians are expected to start heading to the airports in record numbers; but unless you plan ahead especially being health wise, you may run into some unexpected and unpleasant surprises.

The dry air in the cabins of modern jets causes rapid evaporation of tears from the eyes surface. Without sufficient moisture the cornea, which is the transparent "watchglass" that lies over the iris (coloured part of the eye) can be deprived of oxygen and cause your eyes to become irritated.

Symptoms

Redness
Scratchy feeling in the eyes
Vision can get blurred

What makes symptoms worse?

Reading on the plane adds to the problem because you tend to blink less frequently when you read, leading to more evaporation of moisture from the eyes.

Wearing your contact lenses during a long flight can result in symptoms ranging from mild discomfort to severe pain. This problem can occur with all types of contact lenses: hard, soft, gas permeable, or extended-wear.
When contact lenses are worn, oxygen reaches the cornea either through the lenses or dissolved in tears that flow under the lenses. The dry air in the cabin also evaporates the water from the contact lenses

Hence, if you are a contact lens wearer, it is better to wear spectacles in flight.

How can you avoid problems?
It is a good idea to put moisture-containing eye drops in your eyes during a flight as often as you feel they are necessary. The drops may be artificial tears or the lens lubricant or saline solution that you use.
Airline personnel who wear contacts and have discomfort should always use these drops routinely.

It may be wiser to remove the contacts and wear your eyeglasses when flying.

SNOW CAN BE BLINDING
If you are escaping the summer heat and heading towards a snowy region, there is extra care you have to take as far as eyes go! We've all heard the expression "a blinding snowstorm". Though that refers to whiteout conditions where visibility is reduced, make no mistake, the snow can be blinding too. Bright sun reflecting on a blanket of fresh white snow can reflect damaging rays into unprotected eyes. The casualty may not be aware of the damage at the time - not feeling the effects for up to several hours.

Symptoms of snow blindness:

Sensitivity to light
Pain in the eyes or forehead
Gritty feeling in the eyes

Precaution:
Use good ultra violet protected eyewear.

Other Eye Care Tips

Carry a spare pair of spectacles especially if you have high numbers.
Carrying your spectacle prescription may also be handy.
Most airports are equipped reading glasses for those above forty; also available are contact lens cases and solutions.
Speak to your eye doctor to prescribe you a simple and safe antibiotic eye drop in case of red eyes due to infection.
Avoid putting spectacles in pockets, as is commonly a habit, carry a pouch instead for safekeeping.

Other Health Tips While Travelling

Drink plenty of non-alcoholic, non-caffeinated beverages. A glass of water every hour is good.
Put a pillow behind the small of your back to avoid backaches.
Take an occasional stroll around the cabin. This is especially for those who are overweight or have high-risk conditions such as high blood pressure. By moving around you will decrease the risk of deep venous thrombosis, which in simple terms is blood clotting in the lower limbs.
Bring a sweater, shawl or jacket - airplane cabins are usually cool.
Use lip-balm, moisturiser and eye-drops/contact lens lubricant to combat the effects of cabin dryness.
The relatively low air pressure in your aircraft can cause discomfort. If your ears bother you during takeoff and landing, try yawning, chewing gum or doing this: pinch your nostrils shut, inhale, close your mouth and try gently to blow your nose. Children should be encouraged to drink or suck on sweets.
If you have a cold, the dry air will make your sinuses feel worse. If you are taking medications, carry them with you in the cabin. See your physician to rule out infection. Also, your fellow passengers will appreciate it because everyone is more susceptible to catching a cold in dry air than in moist due to the effect.
Comprehensive travel insurance is one of the best investments you can make when planning a vacation. Let's face it; no one likes to spend money on insurance. But the consequences of not having travel insurance can be so significant as to warrant the inclusion of a good policy in every vacation you take

JET LAG
Solutions:

Drink plenty of water. Don't drink too much alcohol, as it tends to dehydrate your body.
Do stretching exercises in your seat to avoid cramped muscles.
Walk around the cabin during your flight.
Wear comfortable clothes and shoes.
Be well rested before you leave.
Make sure your pre-flight diet contains plenty of starch, carbohydrates and greens.
Set your watch to your destination time as you take off. Then start programming your body to it.
Allow a day for each time zone to get over the jet lag.

Medical option?
There is a drug called 'Melatonin' for jet lag problems. It helps to control the body's sleep/wake cycle. However, your physician should advise it.

LASIK - Is It Safe For My Eyes ?

2009-07-04T07:38:00.000-07:00

LASIK stands for LAser in SItu Keratomileusis, a procedure that painlessly reshapes the cornea to correct various refractive errors of the human eye. Millions of people have successfully undergone this treatment worldwide, since its introduction in the early 1990?s.

Cornea refers to the clear glass like structure in the front part of the eye. In myopia or short sightedness the light rays come to a focus in front of the retina, and in hyperopia or long sightedness the light rays come to a point focus behind the retina, and in astigmatism no single point focus is achieved. All these errors can be perfectly corrected using the laser beam to remove tissue from the cornea in a precise manner and altering its power, so as to allow the light rays to get focused on the retina. This results in perfect unaided vision and freedom from glasses.

But the key question still remains ? Doc , is this treatment safe for my eyes ??, what are the long term results ?, people say that the power comes back ? will I go blind after the treatment ? etc etc..

This is something that I hear from my patients wanting to undergo the LASIK procedure. I do not blame my patients for asking these questions, for there is enough negative information available on the internet to scare an individual from this wonderful procedure. The basic reason why this procedure is viewed with caution, is that 90% of the surgeons performing this procedure are not corneal surgeons, nor have had any basic formal training in corneal surgery. They just invest money in a laser machine and start performing treatments on anyone who comes to their clinic wearing glasses. Not everyone who wears glasses is a suitable candidate for LASIK treatment. In my practice (www.corneaclinic.com) almost 25% of the patients are rejected for this procedure as the cornea is not ideal for LASIK treatment. Either the corneal thickness is not sufficient, or there is some abnormality in the corneal shape that may affect the final outcome of LASIK treatment. This is what plays a key role in having satisfied patients following the LASIK procedure. Having performed over 5000 procedures till date, I am yet to have a patient who is unhappy with the LASIK procedure.

I think it is important for patients to realize that the most popular eye specialist, may not be the most ideal LASIK surgeon. As recommended by the FDA, USA patients should look at the experience of the surgeon with the laser treatment procedure, whether any formal training received, and also speak to others who have had treatment earlier at the same center. This is essential, as a corneal surgeon can detect abnormalities in corneal shape or contour preoperatively, handle the corneal tissue better intraoperatively, and in the unfortunate event of some unforeseen complication manage the situation better than a general ophthalmologist. I have had several instances, wherein the treating general ophthalmologist has referred patients with complications following LASIK for further management. All of these patients recovered good vision once the complication was managed successfully. But would it not have been better if these patients were under the care of a corneal surgeon to begin with ?

Decision for LASIK treatment should not be made by the treating doctor, but by the patient himself or herself. The doctor should provide enough information that would help the patient in deciding whether to go in for the treatment or not.

LASIK procedure gives excellent results if performed on the right patient, by a well trained experienced corneal surgeon. So if you are planning on LASIK treatment, do ask yourself?am I in safe hands ?

LASIK Or Laser Eye Surgery

2009-07-04T07:35:00.000-07:00

What you need to know about recent advances

In Laser Vision Correction [ LASIK] and why?

Imagine waking up and seeing clearly without having to reach for your glasses or contact lenses. Laser Assisted Stromal In-situ Keratomileusis (LASIK) is making this dream a reality for millions of people worldwide. LASIK is a method of re-shaping the external surface of the eye [the cornea] to correct low, moderate and high degrees of nearsightedness, astigmatism and far-sightedness.

Some of the common reasons why people undergo LASIK are because of contact lens intolerance, cosmetic reasons, social (marriage), tired of wearing glasses, and lifestyle activities that are inhibited due to glasses or lens wear such as outdoor sports like golf, football, water sports or hiking. Spectacles are cosmetically unappealing for some. There is a degree of distortion when looking through the periphery of the glasses, the field of vision is reduced and on leaving a cold room moisture can fog the glasses and blur vision for a few minutes. Hence glasses are unacceptable for certain careers such as the Army, Merchant Navy, Airlines, Air Force, Railways and professional sports. In respect to this, one of the pre requisites for such careers is good eyesight of 6/6. Contact lenses require repeated motivation with fastidious attention to hygiene during insertion and removal failing which sight-threatening infections may result. LASIK overcomes all these disadvantages hence; many consider this permanent method of correction of vision. It is therefore most important for our youth to understand where the safety and accuracy of these methods lie. Most youth go into the cost of LASIK, without understanding the details of technology and its advances especially in this field. Not all LASIK centres will be the same in this aspect primarily because not all have updated technology. This is one field where the doctor is not working on the eyes with his hands alone it is through technology! So, it is of utmost importance that one learns more on this procedure and the advances that it has made till date in order to make the correct informed decision.

LASIK is SAFE when performed on a suitable candidate with most of the new generation Excimer lasers. LASIK has been practiced in our country for the last 6 to 7 years and was started in Mumbai in 1995.

The latest advancement in the LASIK procedure is wavefront-guided or custom LASIK. Wavefront-guided LASIK compatible lasers use high-speed sensitive eye trackers to ensure perfectly accurate and well-centred treatments. Wavefront procedures very often leave patients with eyesight better than normal. These procedures have been developed not only to enhance visual acuity but also to improve on contrast sensitivity especially in dim light conditions. Wavefront-ready lasers are also far more refined in their laser beam profiles and eye-tracking capabilities.

Patient expectations have increased over the years and with the new amazingly accurate excimer lasers, so-called 'super vision' is becoming a reality. However, only a thorough examination by a LASIK specialist can evaluate whether or not you are medically suited for LASIK.

Dr Anand Shroff, who has been a pioneer in Wavefront technology in India, says, ? With Wavefront guided LASIK it has now become possible to treat a larger spectrum of patients. This procedure particularly helps to have clear vision in dim light, which would have otherwise been difficult with the older procedures.

It is very important to do a complete eye assessment and certain specialized tests to determine a patient?s suitability for LASIK with sophisticated instruments like the aberrometer, topography etc. The assessment helps the surgeon to understand the patient?s visual requirements and to develop a customized treatment plan. With this technology of the WaveLight Allegretto Eye Q 400 Hz, the newest generation Excimer laser, we can now offer the highest degree of accuracy and utmost safety.

Permanent Treatment For Keratoconus

2009-07-04T07:33:00.000-07:00

CORNEAL COLLAGEN CROSSLINKING WITH RIBOFLAVIN (C3R) for PERMANENT TREATMENT FOR KERATOCONUS, CORNEAL MELTING, IATROGENIC KERATECTASIA, EXTENDED PRK/EPI/LASEK, MARGINAL PELLUCID DEGENERATION, KERATOGLOBUS

The latest revolutionary Keratoconus treatment is C3R (Corneal Collagen Crosslinking with Riboflavin) available at G.G.S.I.Eye Research & Cure Centre , Delhi,India that has been proven to strengthen the weak corneal structure by increasing collagen crosslinking, which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular, consequence of advanced Keratoconus.

Keratoconus (ker-ah-to-ko’-nus) means to have a ‘coned-shaped cornea’. It is a relatively common and non-inflammatory progressive disorder whereby the normally round cornea becomes thin and irregularly conically shaped.

Symptoms

In its earliest stages, keratoconus can be difficult to detect as nearsightedness, sensitivity to light, astigmatism and blurred eyesight can occur with the illness. As keratoconus progresses, however, the cornea becomes more distorted and symptoms more apparent. These include:

* Blurred vision
* Distorted images, especially at distances
* Seeing halos of light around objects, especially at night
* Sensitivity to glare or light
* Disproportionate watering of the eyes

The Procedure

The C3R treatment is performed in just 20 TO 30 minutes. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light.

The cornea which is the front transparent structure of the eye is first anaesthetized using drops. . The mucous surface of the cornea (epithelium) is disrupted and then Riboflavin, (Vitamin B2) drops are placed in the eye every few minutes. The yellow pigment of the Riboflavin absorbs the Ultraviolet A light , increases the amount of collagen cross-linking in the cornea and strengthen the cornea.. Once the procedure is completed, a soft bandage contact lens will be placed in the eye and antibiotics will be instilled. The contact lens will be removed in one or two days.

The cornea increases in rigidity soon after the procedure although the process of cross linking continues on for a period of a few days afterwards. The effect on corneal shape takes longer but flattening does not occur in all eyes that have had treatment. A satisfactory result will be arresting the progress of keratoconus.

C3R causes the collagen fibrils to thicken, stiffen, and crosslink & reattach to each other, making the cornea stronger and more stable & halting the progression of the disease

Is Ultraviolet light harmful ?
Ultraviolet A light used in this procedure is not harmful to the eye in measured doses. Ultraviolet C light (in sunlight) is potentially harmful. The Light emitting diodes used in the C3R device is of a wavelength that is not harmful. Furthermore, light emission is carefully measured and calibrated prior to each treatment. There is also a self diagnostic check on the device which prevents use in case of a malfunction. There have been concerns about toxicity to the retina (at the back of the eye) however the Riboflavin pigment in the cornea and front of the eye, absorbs the Ultraviolet light and in effect stops the light from being transmitted to the retina.

Adavantages of C3R

* Simple non invasive treatment
* Halts the progress and causes some regression
* No handling of lenses every day
* No stitches
* No incisions
* Quick recovery

Presbyopia Surgery : Get Rid Of Reading Glasses

2009-07-04T07:24:00.000-07:00

People wearing near vision glasses can read or write or pass thread through a needle hole without wearing glasses. It seems difficult for one to believe. The technique developed at G.G.S.I. Eye Research &Cure Centre claims so far no where in world such an eye surgery is performed.

Ques. What is Presbyopia ?
Ans. In simple words, it is a defect of accommodation which comes with age at 40 years.

Ques. What is accommodation?
Ans. This is the mechanism by which the natural lens of the eye adjusts it self to see objects at various distances. The adjustment is brought about by lens, zonules and ciliary body muscle of the eye.

Ques. Where lies the defect in presbyopia ?
Ans. All the three that is lens, zonules and ciliary body muscle contributes to it.

Ques. Who all develop this eye condition?
Ans. It generally people at the age of 40 or above start suffering from presbyopia or the deficiency of accommodation.

Ques. How much time it takes to perform new eye surgery for presbyopia?
Ans. It takes about 15 minutes to perform the surgery by which the deficiency of accommodation which in medical term is called as presbyopia, in the eye is corrected and the patient can does his work without using contact or conventional lenses.

Ques. After operation, does the glasses number returns
Ans. No.

Ques. Is this eye operation is safe?
Ans. The operation is 100% safe without any side effects and the patient is discharged the same day.

Ques. Is there any other means to correct presbyopia?
Ans. There are many ways to correct presbyopia ,like use of convex lenses, bifocal contact lenses, bifocal glasses, separate glasses for near & distance and multi focal glasses,conductive keratoplasty or multifocal intraocular lens implantation. But people suffer a lot of inconvenience in using above treatment.

But the new surgery of correcting the accommodation gives great relieve to the patient when he is saved from the botheration of using glasses.

Reading Glasses ? Can I Get Rid Of Them ?

2009-07-04T07:21:00.000-07:00

With aging, the natural lens inside the human eye gradually starts losing its elasticity. As a result of this change, the lens is unable to change its shape while focusing at near objects and it becomes progressively difficult to read small prints, read sms messages on mobile phone etc. This phenomenon is referred to as presbyopia, and usually starts around the age of forty, and affects all individuals. (Myopic individuals ie people using minus power lenses, may not experience this change as their far point of focus is situated close to the eye. Hence the tendency to read fine prints at near, without distance glasses) Presbyopic individuals have to strain to focus at near objects, and this often results in eye symptoms such as blurred vision, & eye pain, often associated with headache.

So how is presbyopia corrected.

Most commonly, reading glasses are prescribed, which can be used alone or in addition to the distance correction. Bifocal glasses have the upper segment correcting sight for distance vision, and the lower segment correcting for near vision. Progressive addition lenses, have gradual increase in power from the upper to lower segment of the glasses. Hence there is a gradual increase in power, which allows an individual to focus at all distances from distance to near, unlike bifocals wherein there are only two focal points ? distance and near. Computer users may require a reduced addition for near, for intermediate vision.

Monovision is a situation, wherein one eye is corrected for distance vision, and the fellow eye for near vision. However in this situation the binocular vision ie depth perception is affected hence not every individual is comfortable with this option of treatment for presbyopia. An initial trial with contact lens is usually attempted for monovision, and if an individual is comfortable with this situation, permanent correction can be attained using laser refractive surgery or conductive keratoplasty. However, these procedures need to be repeated over a period of time.

So is there a permanent solution to this condition?.
Well the answer is ?Yes?. Newer intraocular lens implants have been developed that when placed inside the eye, allow images to be focused both for distance and near allowing more functional vision. This is a permanent correction, wherein the natural lens that has lost its elasticity is replaced with a sophisticated intraocular lens implant to restore the function of the natural lens. This surgery is a day care procedure and takes only 10 -15 minutes to perform. One can return home the same day. Can I have this surgery even if I do not have cataract ? Well yes, you can. This surgery not only improves the ability to focus both at distance and near, it also improves the quality of vision, and contrast sensitivity. However it is slightly expensive compared to the intraocular lens implant used in routine cataract surgery. There are two companies that manufacture these lenses, one is called Restor from Alcon USA, and the other is called Technis Multifocal from AMO USA. The approximate cost of this surgery is 45 ? 50,000 rupees per eye.

Refractive Errors - Glasses, Contact Lens, Or Laser Treatment

2009-07-04T07:19:00.000-07:00

Refractive errors affect approximately 20 - 30% of the normal population. Blurred vision, headache, and eyestrain are common symptoms of uncorrected refractive errors. Glasses or contact lenses are usually prescribed for correction of refractive errors. Recent advances in technology, have made it possible to permanently correct refractive errors using Laser treatment. In USA, about 2 million refractive laser treatment procedures are performed every year.

What are refractive errors?
Refractive errors refer to condition of the eye wherein the rays of light do not get focused on the retina, the light sensitive layer of the eye. In Myopia (short-sightedness) rays of light fall short of the retina, hence require minus power glasses, whereas in Hyperopia (far-sightedness) rays of light come to a focus behind the retina, hence require plus power glasses. In Astigmatism the rays of light come to focus at two different points, and therefore require cylindrical power glasses for better vision.

What are the options for correction of refractive errors?

Refractive errors can be corrected using glasses (spectacles) or contact lenses. Permanent correction can be achieved by reshaping the cornea using laser treatment (LASIK).

Glasses or contact lenses have the advantage that they are economical, and can be replaced whenever there is a change in refractive error. However, with higher refractive errors, glasses become thicker, heavy and uncomfortable to wear, besides poor cosmesis. The field of vision is also smaller and restricted with glasses as compared to contact lenses. Contact lenses need to be worn on the eye, and provide good quality of vision compared to glasses. However with contact lens wear, there is a potential risk of infection, which if severe can result in loss of vision. Hence good hygiene needs to be maintained, along with proper care of the contact lens to prevent infections. In comparison, laser treatment although expensive, provides a permanent correction of refractive error, with better unaided vision following treatment.

What is LASIK ?

LASIK (laser in situ keratomileusis), is a laser procedure, wherein the shape of the cornea is altered using the Excimer laser to painlessly correct refractive errors. A specialized instrument called the microkeratome, is applied on the cornea to lift up a thin flap prior to applying laser treatment. The procedure takes only 10 minutes to perform, and good visual improvement is noted the next day.

Who is eligible for LASIK?

Well not everyone who wears glasses or contact lens is eligible for LASIK. It is usually performed in individuals above the age of 18 years, with stable refractive error. There should not be any other associated eye disease. Preoperative evaluation of the corneal shape and measurement of corneal thickness is essential to rule out corneal abnormalities.

How are the results of LASIK?

The results of LASIK are quite satisfactory. In experienced hands, with modern laser machines, 98% patients are within 1 diopter of refractive error following treatment, with unaided visual acuity of 6/12 or better. 85 ? 88 % patients achieve unaided 6/6 or normal vision following LASIK. There is a significant improvement in unaided visual acuity, and patients are able to carry out their normal daily activities with greater confidence. Tiger Woods, the golf champion underwent LASIK in both eyes, in 1999 and has been playing active golf since then winning several championships

What is customized LASIK?

Besides the normal refractive errors measured routinely, the total optical imperfections of the eye can now be measured using a special instrument called the aberrometer. When this data is used to correct the optical imperfections using laser treatment, it is called customized LASIK. Different laser manufacturers have given specific names to this customized LASIK treatment with their machines, such as zyoptix, custom vue, custom cornea etc. To perform customized LASIK, the laser should have smaller laser spot size, active eye tracker, and high speed of treatment. Customized LASIK is useful in patients with significant amount of higher order aberrations.

What are the complications of LASIK?

LASIK procedure is quite safe if performed by well trained corneal surgeons. Undercorrections and overcorrections are usally minimal, and if present can always be corrected by laser re-treatments. There is usually a transient phase of dryness in the eyes, with mild glare while looking at bright lights. Infections are extremely rare if the procedure is performed in an operation theatre like environment, with sterile precautions.

Should I undergo LASIK?

The key question in everybody?s mind who wear glasses or contact lens. Excimer laser treatment for correction of refractive errors has been present for over 15 years now, and millions of people have undergone this procedure with good results. The procedure has been proven to be safe, if performed by an experienced surgeon. It is important to have a good discussion with the treating surgeon prior to undergoing laser treatment for correction of refractive errors. Your surgeon will examine your eyes and then decide if you are a suitable candidate for laser treatment.

If I am not a suitable candidate for LASIK are there other options?

Yes there are other options for correcting refractive errors not amenable to LASIK. There are special intraocular implants called ?Phakic IOL?s? which can be placed inside the eye to correct higher refractive errors. In some patients, the natural lens can be replaced with an implant to correct higher refractive errors. Suitability for these procedures require detailed evaluation of the eye.

Ultraviolet Protection For Your Eyes

2009-07-04T07:15:00.000-07:00

Ultraviolet Protection for Your Eyes

UV radiation in sunlight, including both UV-A and UV-B, has been shown to be harmful to the eye. UV-A penetrates deep into the eye and may injure the macula, the part of the retina responsible for sight in the centre field of vision as well as cause cataract. External eye conditions are a result of intense exposure to UV-B. It is most common among individuals that spend long hours outdoors without proper eye protection. This is one precaution one can take to avoid many eye conditions later in life.

Eye damage caused by UV Radiation:

Cataract: Cataracts are opacities formed in the natural lens often caused by long term exposure to UV radiation. Lens opacities can potentially decrease vision.

Macular degeneration: chronic UV exposure may contribute to the aging processes in the retina, including the sensitive centre of the retina, called the macula, leading to macular degeneration and poor vision.

Pterygium: is a fleshy growth on the white part of the eye that may extend onto the clear cornea where it can block vision. It presents most commonly in people who work outdoors in the sun and wind, and is correlated to the amount of UV exposure.

Cancer of the skin, including the eyelids and facial skin, is a well-known consequence of excessive UV exposure.

Photokeratitis is reversible sunburn of the cornea resulting from excessive UV-B exposure. It occurs from spending long hours on the beach or snow without UV sun protection. It can be extremely painful for 1-2 days and can result in temporary loss of vision.

Ways to protect your eyes from UV Radiation:

Protection from sunlight can be obtained by using a brimmed hat and UV absorbing eyewear. Ultraviolet absorbing eyewear provides the greatest measure of UV protection, particularly if it has a wraparound design to limit entry of peripheral rays.

Ideally all types of eyewear, including prescription spectacles and some contact lenses should absorb most of the UV spectrum. Labels should be examined carefully to insure that the lenses purchased absorb at least 99-100% of UVA and UVB light.

Look for sunglasses that are close-fitting or wrap-around sunglasses to prevent light from entering in.

Don't be misguided by price -- higher priced sunglasses usually reflect fashion or durability, not UV protection. Dark-colored sunglasses don't necessarily provide better protection. A chemical coating applied to the lens is responsible for UV protection, not the lens color.

Children are more prone to sun damage to the eyes because their lenses are clearer.

What's New In Corneal Transplantation Surgery?

2009-07-04T07:06:00.000-07:00

Cornea refers to the clear glass like structure in front part of the eye. This structure allows light to enter the eye, and also helps focus image on the light sensitive retina inside the eye. The cornea is composed of five layers. The outer four layers maintain the shape of the cornea and the innermost fifth layer contains active cells that help maintain the clarity of the cornea. Damage to the anterior layers following infection, or trauma leads to scarring and reduces the clarity of cornea, thereby affecting vision. In certain conditions like Keratoconus, there is progressive thinning of the cornea, due to which the shape of cornea becomes abnormal. This abnormal corneal contour results in distortion of images, thereby affecting vision. The innermost layer of the cornea can become dysfunctional with aging, or following trauma etc. This leads to accumulation of water within the corneal layers resulting in loss of corneal clarity and hazy vision.

Corneal transplantation is performed in this situation to restore corneal clarity and improve vision. Traditionally corneal transplantation refers to full thickness replacement surgery, wherein all the five layers are replaced with donor tissue. The results of this transplantation procedure are good, and most patients are able to maintain a clear graft for several years after surgery.

Over the past 2 -3 years, newer surgical techniques have evolved wherein selective replacement of the diseased layers of the cornea is performed to restore corneal clarity. These procedures have several advantages over conventional full thickness transplantation surgery.

In the presence of corneal scarring wherein the innermost layer is functioning normally, replacement of the anterior layers is performed using a technique called Deep Anterior Lamellar Keratoplasty (DALK). Here the surgeon surgically removes the affected corneal layers and replaces them with healthy donor tissue. This technique has been successfully used with good results in a variety of corneal disorders associated with corneal scarring or abnormal corneal shape. Keratoconus is a corneal disorder, wherein there is progressive thinning and ectasia of the cornea.

This results in poor vision, and is initially corrected using hard contact lenses. In advanced keratoconus, surgical replacement of the cornea is required. In traditional full thickness corneal transplantation surgery, the healthy innermost layer is also replaced with donor tissue. Following this corneal transplantation procedure, the body tends to recognize the innermost layer as non-self, and attempts to reject the donor tissue. To prevent such rejection episodes, long term therapy with steroids is necessary following surgery. Prolonged use of steroids can lead to formation of cataract or cause a rise of pressure within the eye. Both of which may require further surgical intervention and or medical therapy.

With the lamellar corneal surgical procedures such as DALK, the healthy innermost layer of the host is retained, and only the outer layers are replaced with donor tissue. In this scenario, the body is not able to detect the donor tissue, and therefore there is no risk of rejection episodes unlike full thickness corneal grafts. Hence steroid therapy is given only for a limited short term period following DALK procedure.

In conditions, wherein the innermost layer of the cornea is not functioning properly, full thickness corneal transplantation procedures provide healthy tissue to restore corneal function. The full thickness corneal graft, requires multiple stitches to keep the donor tissue in position. This results in abnormal corneal curvature and glass power following surgery. Moreover the stitches have the risk of becoming loose over a period of time, and this can lead to corneal infections, or invite blood vessels into the corneal graft, increasing the risk of damage to the corneal graft.

Newer methods of corneal transplantation procedure such as Deep Lamellar Endothelial Keratoplasty (DLEK), allow selective transplantation of the diseased inner layer without the need for surface incisions or stitches to keep the donor tissue in place. The results of this technique are encouraging and provide better quality of unaided vision following surgery, compared to the full thickness corneal transplantation procedure. (the author, was the first corneal surgeon in India to perform the DLEK procedure.)

Both DALK and DLEK allow better utilization of donor tissues in the eye bank. This ensures that more patients are able to undergo corneal transplantation surgery, as donor corneal tissues are always inadequate for the number of patients awaiting corneal transplantation surgery. Both the procedures are technically demanding, and therefore require special training. Experienced corneal surgeons, should perform both DALK, and DLEK procedures whenever possible to provide better long term benefit to the patients undergoing corneal transplantation procedures.

Constipation In Children

2009-07-02T06:20:00.000-07:00

Habitual constipation is a fairly common presentation in the day to day practice of a Pediatrician. There are no universal guidelines regarding the management of constipation. Each physician has his / her own way to deal with the problem. That causes a lot of confusion particularly among the parents, who are anyway, often in the habit of doctor shopping. In this article, I would like to sum up our understanding of this common, yet less understood problem. I shall intentionally leave out discussion on constipation in patients with anorectal malformation, colonic aganglionosis (Hirschsprungs’ disease) and intestinal neuronal dysplasia.

IDIOPATHIC / HABITUAL CONSTIPATION

It is the incapacity / difficulty to pass stool regularly and efficiently. Although many theories have been proposed, we know that the cause is yet unknown. In its most severe form, it is extremely incapacitating and may also cause overflow pseudoincontinence or encopresis. The most serious type of constipation cannot be differentiated from a very serious motility disorder called intestinal pseudo-obstruction that carries a significant mortality rate.

Proposed causes: A number of causes have been proposed to cause idiopathic constipation, but most explanations have no solid scientific basis.

Diet : We talk of constipating and laxative diet. Alteration of dietary habits / conents may help in milder forms but in severe, intractable constipation, diet has minimal role to play. Furthermore, the same diet may cause constipation for some but multiple motions for another (eg. Breast fed neonates).

Psychological basis: Many authorities have tried to explain constipation on the basis of psychological origin1. We believe that constipation can lead to psychological problems, but vice versa particularly in cases of the severe forms of constipation in patients with a giant megacolon, a megabladder, and serious nutritional and developmental disturbances are not self explanatory.

Voluntary stool holding: It is not easy to retain stool voluntarily when an otherwise autonomous rectosigmoid has normal peristalsis. Rather most often a constipated child lands up with a fissure causing enough pain to resent defecation, and hence the psychogenic component is secondary.

Achalasia of internal sphincter: A simplistic explanation is that there is a lack of relaxation of the internal sphincter, known as achalasia2,3. This is a diagnosis based on manometric findings 4. What are the pitfalls of rectal manometry in children? We assess rectoanal inhibitory reflex by dilating a rectal balloon. How can we guarantee that the apparent spasm of the anal canal is not due to sustained contraction of the voluntary sphincter mechanism? We normally do not use muscle relaxants during manometry. Secondly, the size of the rectal balloon remaining the same, in cases of megarectosigmoid, the balloon will hardly be able to generate enough pressure on the rectal wall and theoretically there is a high probability of a false negative result.

Ultra short segment Hirschsprungs’ disease 5,6 – We doubt the existence of this disease entity. Those who believe in this disease entity think that these children have a very short area above the anal canal with absent ganglion cells, which causes dilatation of the rectum all the way to the anal verge. But, normal children have varying areas of aganglionosis proximal to the pectinate line.Intestinal neuronal dysplasia. A study that determines the length of normal aganglionosis in premature infants, newborns, preschool children, adolescents, and adults has not yet been undertaken, and only if ever done, can bring to light the true picture. There is no reason why anorectal myectomy, which involves resection of a longitudinal segment of anorectal wall should cure this ailment.

Newer studies: More recently, we have learned about new potential explanations for colonic hypomotility. A deficiency of substance P immunoreactivity in the colonic nerve fibers of some children with severe constipation has been proposed7. Colonic abnormalities were also found when it was studied with monoclonal antineurofilament antibodies8. Another very interesting finding was an increased plasma level of pancreatic polypeptide and a decreased plasma level of motilin in children with encopresis9.

Anatomical problems – There may be true or aquired stricture of the anal canal ,congenital anal stenosis, improper positioning of the anus vis a vis the sphincter mechanism, and all of these require surgery.

Natural history and clinical manifestations:

The natural history of idiopathic constipation is well documented. The knowledge of natural history has a strong bearing on the management of constipation. Idiopathic constipation is a self perpetuating and self aggravating disease. If inadequately treated and the colon inadequately cleared, larger and larger amounts of stool collects in the colon and this leads to the creation of a megarectosigmoid. We know from basic Physics that pressure inside a tube varies inversely with the diameter of the tube. So formation of megacolon will effectively reduce the intraluminal pressure and cause poor peristalsis and hence fecal impaction which in turn will cause more rectal dilatation. It is this vicious cycle all physicians should constantly remind themselves. One flip side in this story is the mother’s depiction of the ailment. We know of children with fecal retention whose mothers had actually told us that they pass adequate amount of stools.

We believe that in most cases idiopathic constipation is incurable but manageable. So follow-up and treatment have to be long term. In most cases treatments are prescribed on a temporary basis. Then they are tapered or stopped leading to recurrence. The parents get frustrated and indulge in doctor shopping only to face the same cycle again.

When to start treatment ?

Most physicians believe that the symptoms start at the time of toilet training. It is true that symptoms become more evident then. But we believe that the motility disorder is present since birth. Breast fed babies do not show symptoms because of the laxative effect of human breast milk. The moment they are weaned off, they present with constipation. Actually the parents remember most vividly the day when fecal impaction caused some amount of bleeding as the day when constipation first started. So treatment of constipation should begin early.

Anal fissure is another worrisome sign. It is a tear in the anal mucosa caused by passage of hard stool. In turn, it causes painful defecation and makes the patient a stool retainer. Retention of stool in the rectum causes more water absorption and hardens the stool which when passed forcibly causes more aggravation of the fissure. This vicious cycle has to be broken somewhere. Fissure has to be carefully looked for and treated with emollients, local anesthetics, dietary fibres, laxatives and sometimes local steroids and one has to search for the actual cause of constipation.

Fecal impaction is another stressful event which is often overlooked. One should always do a per rectal examination before prescribing laxatives. If laxatives are given in presence of an impacted scybala, abdominal crampy pain gets exacerbated. Vomiting may also occur as the laxative increases colonic peristalsis in the face of a colonic obstruction. In such cases, the child may actually pass liquid stool that passes alongside the impacted stool. We call this spurious diarrhea.

There is another form of constipation where the child actually soils his / her undergarment. This phenomenon is known as encopresis. They behave as fecally incontinent individuals. When the constipation is treated adequately, most of these children again regain bowel control. If the child continues to soil and there are associated urologic symptoms one should assess the spine to rule out occult spina bifida, or a tethered cord or a serious psychological disorder.

Soiling is a socially incapacitating phenomenon. They continue to smell badly and people avoid their company. They are socially outcast and even dread to go to school. The patient is unaware of the smell as he/ she gets accustomed to it. The emotional interrelations in the family gets seriously affected. The child becomes shy, withdrawn, very unsure of himself/ herself.

So by the time a child comes to a surgeon for treatment it is not only a medical problem, but a social problem too. So one has to be careful to listen to the problems, get emotionally involved and bring him / her into confidence, before the treatment proper is started.

DIAGNOSIS

The diagnosis is usually straightforward. One should not think of Hirschsprungs’ disease if the child is healthy and thriving well. Secondly the patients with agangliosis never soil or have encopresis. The kids with idiopathic constipation may have occasional abdominal distension but never have episodes of frank enterocolitis as in H.D. They however have episodes of viral gastroenteritis due to stasis caused by impacted stool but that is never severe enough to cause toxicity, lethargy and death as in enterocolitis.

A contrast enema done with a water soluble dye is the first investigation. The characteristic image of contrast enema in chronically constipated children is that of a megarectosigmoid. The colonic dilatation goes all the way to the anal verge or extends to the level of the levator mechanism, which is recognized because it coincides with the pubococcygeal line. Normally the anal canal and the part of the rectum below the level of the levator mechanism stays collapsed by the effect of the striated muscle tone from the sphincter mechanism. This should not be mistaken as aganglionosis. In Hirschsprungs’ disease, the dilatation of the colon progresses variably from the level of aganglionosis. In habitual constipation only the rectosigmoid is dilated usually, these patients sometimes need localized resection of the rectosigmoid. But the kids with generalized dilatation of the colon belong to the bad prognostic group.

Another entity is a rectoperineal fistula, which may cause incurable constipation in children. This was referred to as “anterior ectopic anus” by some authorities10,11,12. Here, the external anal orifice is abnormally narrow, it is not surrounded by sphincter mechanism in its entire circumference, and does not have a normal pectinate line. We operated on these children and place the orifice in the center of the sphincter mechanism, thereby creating an anus with normal caliber.

Where the diagnosis is still in doubt, we perform rectal biopsy. This is valid particularly in those cases where the child is severely constipated but examination reveals an empty rectum. The child has multiple episodes mimicking enterocolitis but does not soil.

Anorectal manometry is very dubious and has its own limitations.

The entire pathogenesis of idiopathic constipation centers on colonic hypomotility. But unfortunately there are few studies to study colonic motility. Colonic manometry has been tried by placing balloons in different areas of colon recording the waves of contraction13,14. Others have performed recordings of the electrical activity of the colon15,16. It requires the active participation of a Gatroenterologist interested in Pediatric studies to get proper results. A proper colonic motility study can only guide us to the exact extent of hypomotile colon that may need resection to cure the ailment.

Histology of colonic tissue in patients with idiopathic constipation mainly show hypertrophic smooth muscle in the area of dilated colon. One would expect that hypertrophic smooth muscle would cause high power peristaltic waves, but actually the reverse happens. The dilated part of the colon is atonic and aperistaltic.

TREATMENT

Dietary alteration, adequate fluid intake, regular physical exercise, stool softeners, active laxatives form the mainstay of first line treatment.

For the resistant variants, which form the objective of this article, many innovative methods have been tried. Psychotherapy, behaviour modification, biofeedback types of treatment have been tried. These are controversial modes of treatment whatsoever.

Disimpaction : The babies and kids who come to us are often impacted. Disimpaction is a painful but essential pre-requisite for treatment of constipation. We follow the regime of thrice daily enemas to clear the rectum and if it fails, administration of polyethylene glycol alongwith enema is tried. If this also fails, very rarely, disimpaction is done under anesthesia.

Following disimpaction we try medical treatment with gradually increasing doses of laxatives. Doses mentioned in Pharmacology textbooks sometimes are an underestimate for the amount actually required for proper evacuation. We rely on abdominal x-ray films to assess the amount of retained stool. That is the only objective way to assess the degree of fecal impaction.

Many children outgrow their constipation with growing age and changing dietary and activity patterns, but there are a few children with enema dependency. For these children, antegrade enema approach through an umbilical appendicostomy (Malone ACE procedure) can be offered. This gives them independence to evacuate themselves at their convenience.

CONCLUSION

We are yet to know the constellation of factors that cause idiopathic / habitual constipation. We sincerely hope that in the future, more serious scientific approach will be applied to this condition. There is a possibility of histologic abnormalities in this group of patients which we still do not know properly. In future colonic motility studies’ techniques may be perfected to make them more reliable. And, of course genetic engineering will have a role to play in the days to come.

Developmental Milestones

2009-07-02T06:17:00.000-07:00

Every child is unique. However, all children follow basic patterns of growth and development, from infancy and early childhood through middle childhood and adolescence. Most parents want to know if their baby or toddler is developing ?normally?. The following is a basic guide as to what you might expect for the first four years of life. Each heading gives an idea about what a baby or child will usually do at that age. There will be individual differences, and the differences in the way you care for your child can sometimes have an effect on what your child does. A delay in these areas does not always indicate a medical problem.

To support healthy growth and development throughout childhood and in later years, proper nutrition, adequate rest and physical activity are essential.

However, among the most important things parents and other caring adults can do as children grow and develop is to provide them with plenty of attention and unconditional support at every stage of their development.

0 - 3 months

Relationships and feelings (often called social and emotional development):

? can feel, but not yet able to think ? will pick up your feelings

? watches parent?s face when being talked to by 4-8 weeks

? smiles by 5-7 weeks

? starts to laugh aloud by 3 months.

Out of step?

No social smile by 8 weeks.
Does not usually calm down, at least for a little while, when picked up.

Doing, seeing and hearing (often called motor skills, vision and hearing):

when cheek is touched, turns to that side to suck from birth
blinks at sudden noises such as hand claps or door slamming from birth
may open eyes to normal speech sounds just as she is dozing off from birth
startled by loud sounds by 1 month
begins to notice sudden long sounds when they start and stop (eg vacuum cleaner) by 1 month
lifts head when lying on tummy by 4-8 weeks (do not leave baby alone on tummy)
kicks both legs strongly by 2 months
arms, fingers and legs automatically move, bend, straighten and bend again
follows a moving light with eyes by 1 month
both eyes move together most of the time by 6 weeks
watches a moving face by 2-3 months
sucks well at the breast or from a bottle

Out of step?

Baby is unusually stiff.
An arm and leg on one side is obviously different in muscle tone or strength to the other side.
Fingers are always held in a tight fist.
Baby is not watching faces by 3 months.
Baby is not startled by sudden noise.
Seems unusually ?good? and not demanding compared to other babies.

Learning to talk (often called speech and language development):

watches the face. makes other sounds besides crying by 2 months
starts to make sounds and ?talk back? by 7-8 weeks
appears to listen to parent?s voice and

Out of step?

Not watching the person?s face when being spoken to by 3 months.
Not making little sounds by 3 months.

3 - 6 months

Relationships and feelings:

laughs aloud by 2-4 months
enjoys being played with, laughs and kicks by 4 months
makes eye contact with you and you will be smiling at each other.

Out of step?

Doesn?t seem interested in things around him.
Doesn?t seem to show delight in being with people.
Doesn?t seem to recognize his parent or other familiar people.

Doing, seeing and hearing:

enjoys watching others doing things
makes eye contact
likes looking at people and bright objects
looks at hands and plays with own fingers by 3 months
can grasp an object when placed in his hand by 3-4 months
rolls over to his side around 5 months (range is 4-6 months)
lifts head and chest when lying on his tummy by 4 months ? never leave baby alone on tummy
begins to react to familiar situations by smiling, cooing and excited movements
begins to turn head slowly to moderate level of sound (eg normal speaking voice) by 3 months
should quieten or smile at sound of your voice, even if he cannot see you, by 4 months
may turn his head or eyes towards you if you speak as you come from the side or from behind by 4 months.

Out of step?

Does not open hands or straighten fingers.
Arms and legs are bent most of the time.
Is not kicking his legs.
Does not follow activities with his eyes.
Does not make eye contact with people.
Does not turn to look for you when you speak.
Is not looking to where there is a sound.
Is not startled by loud noises.
Unhappy or unsettled most of the time.

Learning to talk:

makes lots of little voice sounds
turns head towards a talking person by 5 months
begins babbling then listening, around 3-4 months
takes turn when ?talking? (making sounds) with parents.

Out of step?

Is not making many voice sounds.

6 - 9 months

Relationships and feelings:

knows familiar people and is unsure of strangers
at times might not go to people she knows well for a while ? but wants the main carer
may become distressed when separated from the main carer

Out of step?

Does not show pleasure when she sees people she knows well.
Does not make eye contact.
Cannot be comforted by parent or close carer.

Doing:

rolls over on to tummy and back again by 7 months
sits without support by 8 months
starts to move around more and can roll and creep on her tummy by 8 months
can move between positions, e.g. sitting to crawling to sitting by 8 months
can hold a bottle to drink
can start to drink from a cup which is held by an adult, by 8 months
holds a spoon, but cannot use it, by 7 months
shows interest in small objects and reaches out for them
starts to look at and feel objects before taking them to her mouth
looks in the right direction for things that have fallen down.

Out of step?

Not starting to move around by any means.
Not interested in and does not reach for objects by 8 months.
Does not recognise parent or main carer.
Does not show an interest in surroundings.
Not interested in new objects.

Hearing and learning to talk:

should turn immediately to very quiet sounds by 7 months
babbles with sounds like "da da" and then starts to put these babbling sounds together by 6-7 months
copies sounds made by other people.

Out of step?

Babbling has not developed further and she does not babble in ?conversation? with others.
Not turning towards you when calling her name.

9 - 12 months

Relationships and feelings:

knows familiar people and starts to withdraw from strangers by 9 months
begins to turn around when his name is called
starts to become anxious if main carer is out of sight
stretches up arms to be picked up
may give clues as to whether hungry or needing a cuddle
loves to be talked to and played with
copies gestures such as coughing, waving

Out of step?

Does not show pleasure when he sees people he knows well.
Is not making eye contact.
Cannot be comforted by parent or close carer.

Doing:

points with the index finger
drops and throws things on purpose
passes objects easily from one hand to the other
moves around by crawling by 10 months
pulls up to standing by 11 months
walks with hands held and feet wide apart and facing outward by 10-12 months.

Out of step?

Is not sitting by 9 months.
Holds his body stiff and cannot be put in a sitting position.
Is not starting to move around in any way.
Is not interested in new objects or reaching for them.

Hearing and learning to talk:

looks for quiet sounds made out of sight by 9 months
shows pleasure in babbling loudly by 9 months
conversation ?babble? develops further
knows the direction a sound comes from and turns to it immediately by 10-12 months
shakes his head for "no" and nods his head to signal "yes", by 10-12 months
knows and turns to his own name, by 12 months
likes to look at picture books and can say some sounds at certain pictures
there may be one or two single words.

Out of step?

If he does not babble or make other sounds when someone talks to him.

1 - 2 years

This is a time of rapid change. Your baby is on the move full of energy and curiosity discovering the world. Parenting becomes demanding because you have to think about safety and setting limits as well as caring for your toddler. In this year your toddler is learning to be a separate person from you. The one-year-old sees everything and everyone being there for them alone. This self-centredness will continue through this year. This is a year of firsts ? first steps, first words, moving freely, running, climbing and exploring actively.

By 18 months:

explores the environment around her, touching, pulling whatever she can see and reach
shows different feelings and easily moves from happy to sad to angry
is likely to be afraid of strangers
shows a strong attachment to parents or main carer
shows distress when left by a parent ? is often clingy when the parent returns.

Out of step?

Does not show a preference for people she knows well.
Does not seem to like cuddles.

By 2 years:

plays near other children, but not yet with other children (unless the other children are older and able to adapt their play to fit the 2-year-old)
unable to share or take turns
gets upset by separating.

Out of step?

Does not show awareness of different people.
Doesn?t seem interested in surroundings or in people.

Doing

By 12 months can usually:

pull self up on a lounge chair
side step around the chair whilst holding on
push a small trolley along in a straight line ? but can?t turn corners.

By 18 months can usually:

walk, at first with feet wide apart, but as her balance improves so her feet get closer and straighter
fall over if she tries to run
climb onto low furniture
push a wheeled toy such as a trolley
place one object such as a block deliberately onto another
start to scribble with a pencil
pick up small objects.

Out of step?

Not yet walking.
Cannot hold a spoon and get food to her mouth.
Cannot pick up small objects.

By 2 years a toddler can usually:

start to explore more widely, opening doors and drawers and pushing buttons
run fast without falling over when turning corners or stopping
squat steadily to pick up objects from the floor
bring a small chair to the table and sit on the chair at the table
walk backwards pulling a toy or trolley
get up without using her hands.

Out of step?

Not walking steadily by 2 years, especially if there is a limp.

Learning to talk

By 18 months a toddler can usually:

babble loudly to self and others, as though having a conversation
listen to things said and understand some things such as "No" or "stop"
follow a few simple instructions such as "Get your shoes"
identify a few familiar objects when they are named such as "Show me the ball" or "Where is the spoon?"
knows and uses 6 or more words (the words may be quite unclear, but the parent or carer can tell what is meant by the sound).

Out of step?

Not babbling much.
Not starting to use some meaningful words.
Not listening when others speak to him.

By 2 years a toddler can usually:

use 20 to 50 recognizable words
listen to things that are said to him
start to put 2 words together such as "Daddy?s car"
join in with familiar songs e.g. nursery rhymes
babble while playing, with a few recognizable words in the babble
tells you most of what he wants with words, e.g. "outside", "milk", "want more" or "go away".

Out of step?

Is still mostly silent while playing.
Does not respond when others talk to him.
Is not able to point to objects when they are named.
Uses signs, grunts or gestures but not words when he wants something.

2 - 3 years

This is a time of challenge ? when toddlers really want to find out about themselves and what they want and don?t want. Their determination, tantrums and struggle for independence are all part of normal development. They have new skills and behaviors to learn and remember, feelings to grapple with, and these can be overwhelming. They can wait a little while ? but not for long. They can hold strong feelings inside a little, but these can burst out in a rush. Losing control of such feelings can be frightening ? they need lots of physical contact and reassurance that they are lovable.

Relationships and feelings

By 2^1/2 years can usually:

try hard to be independent, say "No" a lot, or "Me do" (but still very dependent on parents)
not be able to control his feelings ? tantrums are common especially when tired or frustrated
not be able share with others or take turns
start to play imaginative games, such as putting a doll to bed, driving a car around on the floor or ?feeding? toys.

Out of step?

Is having tantrums very often.
Does not play with adults or older children.

By 3 years, children can usually:

try to copy adults, and may be able to be helpful eg help put toys away
play games using lots of imagination and start to join in with other children?s play.

Out of step?

Not playing imaginative games or using toys the way they are ?meant? to be used e.g. pushing a car along a road rather than just playing with the wheels.
Mostly ?in his own world? rather than interacting with others.

Doing

By 2^1/2 years can usually:

climb on and off furniture
run smoothly and climb on play equipment
kick a large ball gently but not necessarily where she wants it to go
throw a ball more or less where she wants it to go
climb up stairs
feed herself with a spoon and drink from an open cup
help to dress and undress

Out of step?

Cannot run smoothly, especially if there is a limp.
Cannot safely climb stairs or onto low furniture.
Is far more active or less active than other children of the same age.
Is not yet managing to feed herself most of the time.

By 3 years can usually:

push or pull large toys around to where she wants them
walk alone up and down stairs
push the pedals on a pedal toy
kick a ball forcefully
throw a ball and catch one with outstretched arms
undress and put on some simple clothes
eat with spoon and fork
manage toilet training (some children will not manage this until they are nearly 4).

Out of step?

Not able to run as smoothly as other children of the same age.
Not climbing skilfully.

Learning to talk

By 2^1/2 years can usually:

understand a lot more than he can talk about
use well over 100 recognisable words, but many of the words will be unclear, as he cannot say all of the sounds in the words
put the words into short sentences eg "Look Mummy dog"
talk during play
let people know what he wants using words rather than signs

My Child Is Not Growing

2009-07-02T06:10:00.000-07:00

This is the most common complaint of all the mothers. As a parent it is natural to be concerned about the child?s growth. During ?doctor shopping? some of the parents unfortunately fall prey to quacks with those colorful bottles claiming to boost up the child?s growth and appetite. As a child specialist I have seen many children landing up in the emergency ward in a serious state having no documentation of the medicine which was given to them previously as a tonic.

To make thing simpler for the parents I have summarized the various stages of growth. If your child is following these stages, you need not worry.

Infantile Stage (birth to 1year)
Most infants become triple of their birth weight at 1 year and roughly measure 75cm in length. This is the fastest phase of their growth.

Toddler Stage (2 to 4 years)
Growth is not as fast as it was before. They should have an average weight between 12 kg to 16 kg and height between 85 to 100 cms for ages 2 to 4 years respectively.

Slow Phase (Latent phase - 4 to 12 years)
The child gains only 2 kg per year. This is the phase when most of the mothers are unduly worried about the child?s appetite & weight gain and try all possible remedies.

Adolescent growth spurt (12 to 16 years)
Weight and height gain are dramatic during this phase due to sudden surge of hormones. This phase is slightly earlier in girls.

Final height
Depends on diet, hormonal, genetic and environmental factors.

If the parents have knowledge of these stages they will be satisfied that their child is growing normally and will not look for some ?magic potion? to accelerate their child?s growth.

Remember we all were fussy eaters and were choosy about foods when we were kids, still we grew up quiet well.

Fever Management At Home

2009-07-02T06:08:00.000-07:00

Any rise in temperature is a discomfort.. and above 101F it becomes intolerable... and hence requires treatment.

'Highest level of tolerable temp' has no clinical significance as some children show symptoms of hyperpyrexia even at 103 F. and it varies from person to person.

The question is whether do we need to treat the fever?
fever upto 101F should be watched.. as it may get cured spontaneusly and it can cure the disease at times.

High fever in children, can at times turn lethal; so observing without treatment is no wise.

How do we manage:

Switch on Fan /AC, not directed towards pt, air in room should be free flow.
take clothes off.. no blankets... a common question always asked is what to do if child is shivering...? The answer is child may shiver.. we may give blanket for 1o min only.. as shivering doesnt last longer and fever starts rising after shiver if a blanket is given. Also shivering is protective while fever may be harmful. SO do take the vlanket off by 10 min... can repeat same.
Give an oral antipyretic. In viral infections and malarial fever , the myalgia plays a significant role... so its better to use a combination with ibuprofen or only ibuprofen.. more symptomatic relief. wait for 10 min.
Fever coming down : observe. Fever not coming down: start sponging.
Sponging tricks : Keep fan on. dont get scared of shivering. Dont use ice or cold water (why? : its not required ! and it has a risk of ppting hypothermia in children.. children are scared of cold when febrile) use a wet hanky /turkish towel, make it wet.. remove excess water.. spread it over the trunk and tummy... cover maximum surface area, faster relief; till it dries off or becomes hot.. then change the towel, repeat same till temp comes down. Forehead sponging: Most of the times not reqd.. as it carries undue emphasis from movies.. and covers small area. Parents may restrict sponging only to forehead. TricK: make scalp wet, let the forehead towel cover eyes.. that avoids pricking sensation in eyes.
wait another 10 minutes.. temp same or falling... observer and continue. If temperature rising.. try injectable paracetamol... by this we are just increasing the dose of PCM, changing route is only bcos child wont be in a position to take oral; one may try rectal.. equally effective.
Treat the cause of fever !!

Why prompt relief of fever reqd?
Annoying symptom, discomfort, feb seizure... hyperpyrexic brain damage.

HYPOSPADIAS

2009-07-02T06:02:00.000-07:00

Little baby boys pass urine like a fountain. Small lads can stand and pass urine straight with an ability to point the stream where they want, like a fire-man’s hose. This is possible because the urine comes out of the opening at the tip of the penis. In boys with hypospadias, the opening is located on the under surface of penis. Because of this the urine is deviated downwards towards their feet.

How is hypospadias detected?

Hypospadias occurs in one in 300 male newborns. When the paediatrician checks out the baby, or when the parents bath the baby, the following features are there-

Abnormal spraying of urine
Penis being slightly bent downwards
Having to sit down to urinate
Malformed foreskin that makes the penis look "hooded"
Urethra opening on the underside of the penis
What are the consequences of Hypospadias?

When hypospadias is left uncorrected, the following consequences can develop

Hypospadiac lads have to sit; if they stand and pass urine, it goes down the leg.
When they get older, sexual activities become difficult.
Sometimes the urinary opening is also small, leading to blockage in urine stream. This leaves them at a risk of urinary infection.

Do they have other birth defects? Can the same problem recur in future children?

In general, hypospadiac children do not have other kidney abnormalities. However in 10% of these kids, the testis may not be descended normally. When the first child or the father has hypospadias, there is a slightly higher chance (7-10%) for the future boys in the family to have the same birth defect.

What is the right time to correct hypospadias?

From 6 months onwards, hypospadias can be corrected by an operation. Not having an appearance like other boys at school, can lead to emotional problems in these children.

What does the operation involve? What are the complications?

Most of the hypospadias can be operated by a single stage operation. When the opening is too far down from the tip, they might require two-stage operation. The operation is usually done under general anesthesia and a catheter/ dressing is left for 5-7 days. Three things are corrected during the operation.

The opening is brought to the tip
The penis is straightened
Excess foreskin is removed (circumcision).
Optical magnification (microscope) and fine suture materials are essential for a successful result. When extra care is taken there is a very good (95%) success rate. In 5% the following complications can occur.

The new opening gets small gradually (meatal stenosis)
Urine leaks at the original site (Fistula)
Both these can be corrected by another minor operation; so the parents need not have undue concern about this.

What are the chances of fertility after operation?

Straight penis and an opening at the tip are essential for a successful married life and fertility. When the problem is corrected by 1-3 years of age with a good outcome, there should be no problem in future for fertility.

Key Points:

1. In children with hypospadias, the opening is on the under surface of penis.
2. Because of this, these lads can’t stand and pass urine like normal children.
3. They can have infertility in later life, if left uncorrected.
4. By performing a corrective surgery at the right age, these can be avoided.

Laparoscopic Appendicectomy

2009-07-02T05:59:00.000-07:00

Some say why go for a laparoscopic appendicectomy, when you can have it removed by a micro(!) incision?

LAPAROSCOPIC APPENDICECTOMY has the following advantages over conventional appendicectomy:

1) It allows a proper inspection of the entire abdomen to rule out other pathologies, e/g/ if there is a lesion of the left ovary in a small girl, you can hardly palpate the left ovary with a small micro(!) incision in the right iliac fossa. Whereas with a laparoscope, you can see a magnified close up view of any abdominal organ and treat the pathology.

2) Sometimes, it happens that there is appendicular perforation or an abscess causing pus to accumulate in the abdomen. An open operation does not give you enough access to irrigate the entire abdomen or suck out th epus. With a laparoscope, you can suck out the last drop of pus anywhere in the abdomen and at the same time wash the area with saline.

3) In cases of abnormal positions of the appendix, you need to increase the incision if you opt for an open approach, which significantly adds to the morbidity. In laparoscopic appendicectomy, you can tackle the appendix wherever it is located. You can also treat associated pathology with this approach without any extra incision.

4) In our country, often Tuberculosis causes recurrent abdominal pain. With a laparoscope, you can see the tubercles and just do nothing, or can take a lymph node for biopsy to prove your diagnosis.

5) An open operation for appendicitis even if the skin incision is small, the fascia and the muscles need to be cut for the appendix to be taken out. So despite proper closure, there always remains a chance of development of an incisional hernia. For proper union of the muscles to take place, a period varying from 4 - 8 weeks of rest is mandatory post-operatively failing which there is a chance of development of hernia. But in laparoscopy, since we do not cut the muscles at all, chances of developing a hernia is minimal and the child can actually all normal activities immediately following his/her surgery.

SO LAPAROSCOPIC APPENDICECTOMY IS NOW A GOLD STANDARD FOR ALL VARIANTS OF APPENDICITIS.

Phimosis

2009-07-02T05:53:00.000-07:00

Phimosis is a common referral to any Pediatric Surgeon’s chamber.

What is phimosis?
Phimosis is a disorder in males when the prepuce cannot be retracted beyond the coronal margin.

Is Phimosis always pathological and require treatment?
The glans and the prepuce are intimately adherent to each other at birth. The layer gradually separates over the first couple of months after birth. The complete separation may take 3-4 years. So it is not advisable to retract the prepuce forcibly till the natural separation occurs. If one does so, usually advised by the Pediatrician or the local caregiver, minor or major tears develop in the prepucial skin which later on fibroses to create a scar. Then true phimosis develops which usually require surgery.

Whom should one consult for phimosis if the patient is an infant or a child?
Phimosis in children should be dealt with by a Pediatric surgeon as a General Surgeon usually does not have a proper understanding of the disease process as such. We have seen circumcised kids with hypospadias operated in Government Hospitals by senior General Surgeons whereas we all know that circumcision is contraindicated in kids with hypospadias, as the prepucial skin is used to cover the newly formed neourethra.

What are the signs and symptoms when the parents should think that their child may have phimosis?
The following signs and symptoms should prompt the parents to consult a Pediatric Surgeon.

Straining during passing urine
Poor flow (rarely occurs with phimosis, usually due to some intrinsic urethral obstruction)
Pus in the external urinary meatus
Redness or swelling of the prepuce (balanoposthitis)
Hardening / scarring of the prepuce (balanitis xerotica obliterans – usually a late sign).
Non reractibility of prepuce even beyond 3-4 years.

What is the treatment for phimosis?
Usually (70% of our patients) phimosis does not warrant surgery. There are some ointments which if properly applied locally, can improve the condition and may even cure the condition.

What are the surgical options? Is it painful? Does the child require admission?
The traditional operation for phimosis is circumcision. Circumcision is usually done as a day case unless required by the Insurance company or the child stays far. Then overnight admission is recommended. The child is operated under general anesthesia and is given a local anesthesia so that he does not have pain after surgery. The oral analgesics take over once the child can tolerate feeds. We usually do not use post-operative dressings as the children have severe pain during removal of the dressings. So the area looks ugly immediately afterwards for swelling, some natural secretion and scab formation but at the end of 2 weeks everything looks normal. The child can wear pants and go to school at the end of 1 week.
Nowadays there is another minimal invasive surgical option called Preputialplasty. In this procedure the prepucial ring that causes phimosis is widened. The pain is much lesser. The post-operative swelling is more than circumcision but the child is pain free, can wear pants from the next day and can go out from the third day. The only flip side is that the parents need to retract the skin and dilate once a day and apply some medicines as advised from the 10th or 11th day onwards for a period of around 2-3 months. At the end of 2-3 weeks the child will appear to be like a normal child who does not have phimosis, without any evidence of surgery. He needs to know that like any other child he needs to clean the prepuce daily during bath.

Does the surgery involves any complication?
Circumcision / Preputialplasty is an extremely safe and low-risk surgery. But like any other surgery the parents have to give an informed consent knowing fully well the possible complications. These are anesthetic complications, post operative bleeding, and wound infection. There are anecdotal cases of rephimosis which need to be fixed again. We have done a couple of them, primary surgery done by other surgeons. Sometimes the urinary opening can become pinhole (meatal stenosis). We have not faced any such problems but have done meatoplasty on kids operated elsewhere.