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As per proper diagnostics, proper treatment will start, here we have various types of modern technologies those are helpful for various types of serious eye problems. We have numerous surgical treatments those are very much helpful for treating severe eye diseases. Here you can get some idea about the diseases and the treatments.

Retina Problem & Treatment

What is medical retina?

Any disease that affects the retina or the optic nerve and thereby vision and are mostly treatable with medicines or outpatient procedures like lasers etc fall under this subspecialty.

The common diseases that fall under this category are as follows:

Age related macular degeneration - a disease poorly understood and treated till a few years back also has acquired almost epidemic proportions. The most sensitive area of the eye from which we see best degenerates with age thereby reducing the sensitivity. One of its variants called the wet type has blood vessels growing into this area and leaking or hemorrhaging leading to loss of central vision both for distance and near. Better imaging machines and techniques as seen with spectral domain OCT and high definition angiography have gone to the extent of picking up these problems even at a hidden (occult) stage thereby preventing catastrophic vision loss. Treated with injections and lasers a large proportion of these CNVM's as technically called can be controlled/cured.

Diabetic retinopathy- having almost 65 % of the national population as diabetics or prediabetics has put a huge burden on the average health of the population. As awareness has grown over the years more and more patients seek early medical opinion and almost invariably the Diabetologist asks the patient to go far an eye checkup. Perhaps not known to many eyes are the windows to the rest of the body especially the kidneys. Any changes, like swelling up of the blood vessels/leakage of retinal vessels/ hemorrhages from the vessels / ischemia areas, seen in the retina and blood vessels are also likely to be present elsewhere in the body, especially kidneys where it may indicate a failure. Yearly eye checkups with detailed photographs of the retina are a must now. In the event of a diseased retina a patient may have to undergo angiography, OCT etc to decide on the severity of retinopathy. These also aid the physician to plan the treatment with lasers, injections, surgery to help the patient retain his vision to the maximum possible limit till the last.

Vascular accidents - Diseases like venous thrombosis result in severe hemorrhages in the retina and cause the retina to swell up. This causes loss of vision and early diagnosis is very important in helping the patient to regain their vision. Left alone sometimes, especially if it is of the ischemic type new blood vessels grow and can lead to a painful type of glaucoma also.

Other Diseases - Besides these there are many other diseases like parasitic cysts growing inside the retina, tumors in the blood vessel layer of the eye, swelling up of the retina in various places, traumatic injuries of the eye, inflammation of the optic nerve etc. which need quick diagnosis and treatment to preserve vision.

Glaucoma - the silent killer

Glaucoma is a disease of the eye in which fluid pressure within the eye rises. Untreated, the patient may lose vision, and eventually become blind. The disease usually affects both eyes, although one may have more severe signs and symptoms than the other.

There is a small space in the front of the eye called the "anterior chamber". Clear fluid produced inside a tissue in the eye flows in-and-out of the anterior chamber. This fluid nourishes the nearby tissues. In someone with glaucoma, the fluid does not drain properly or it drains too slowly out of the eye. This leads to fluid build-up inside the eye thereby increasing the pressure inside the eye. Unless this pressure is brought down and controlled, the most vital nerve for sight- the optic nerve and other parts of the eye may become damaged progressively leading to loss of vision

There are two main types of glaucoma, open angle and closed angle (angle closure) glaucoma.

(1)Closed Angle Glaucoma (acute angle-closure glaucoma) this can occur suddenly. The patient commonly experiences pain and rapid vision loss. Fortunately, the symptoms of pain and discomfort make the sufferer seek quick medical help, resulting in prompt treatment which usually prevents any permanent damage from occurring to the most vital optic nerve of the eye.

(2) Primary Open Angle Glaucoma (chronic glaucoma) this progresses very slowly. The patient usually does not have any symptoms and even a slight loss of vision may go unnoticed. In this type of glaucoma, most people don't get medical help until significant permanent damage has already occurred sometimes till a point of no return.

Apart from the above there two more sub-types of Open angle glaucoma :

Low-tension glaucoma this is another form that most experts have still not fully understood. Even though eye pressure is normal, optic nerve damage still occurs. Perhaps the optic nerve is over-sensitive or there is there is narrowing of the blood vessels that supplies the optic nerve. There is a school of thought which also thinks that people with cardiac problems are more prone to this type of Glaucoma.

Pigmentary glaucoma this type generally develops during early or middle adulthood. Pigment granules, which arise from the back of the iris (the shutter like tissue which controls entry of light into the eye), are dispersed within the eye. If these granules build up in the fluid exit areas of the eye, they undermine the fluid dynamics in the eye, leading to a rise in eye pressure.

What are the signs and symptoms of glaucoma?

A symptom is something the sufferer experiences and describes, such as pain, while a sign is something others can identify, such as a rash or a swelling.

The signs and symptoms of primary open angle glaucoma and acute angle-closure glaucoma are quite different.

Signs and symptoms of primary open-angle glaucoma

  • Peripheral field of vision is gradually lost. This almost always affects both eyes.
  • Sometimes frequent change in glasses and bumping into objects especially in low light could be valuable indicators to an underlying problem.
  • In advanced stages, the patient ends up with tunnel vision

Signs and symptoms of closed angle glaucoma

  • Usually severe eye pain.
  • Blurring of vision
  • The eye pain may be accompanied by nausea, and sometimes vomiting. Almost akin to some one having gastroenteritis
  • Lights appear to have extra halo-like glows around them
  • Intense congested eyes

What risk factors are linked to glaucoma?

A risk factor is something that raises the risk of developing a condition or disease. (eg: obesity is a risk factor for diabetes type II - obese people have a higher risk of developing diabetes.

  • Old age - people over the age of 60 years have a higher risk of developing the disease.
  • Family history of glaucoma.
  • Old age - people over the age of 60 years have a higher risk of developing the disease.
  • Ethnic background - East Asians, because of their shallower anterior chamber depth, have a higher risk of developing glaucoma compared to Caucasians. Females are more likely to develop glaucoma as males.
  • Some illnesses and conditions - people with diabetes or thyroid problems have a much higher chance of developing glaucoma.
  • Eye injuries or conditions - some eye injuries, especially severe ones, are linked to a higher glaucoma risk. Retinal detachment, eye inflammations &thrombosis, eye tumors can also end up causing Glaucoma.
  • Eye surgery - some patients who have undergone eye surgery may also have a higher risk of glaucoma.
  • Myopia - people with myopia (nearsightedness) have a higher risk of glaucoma.
  • Corticosteroids - patients on long-term steroids have a raised risk of developing glaucoma. The risk is even greater with eye drops containing steroids. There is a particular group of patients called steroid responders where pressures may rise even with mildest use of steroids.

Diagnosing glaucoma

Eye-pressure test - the doctor uses a tonometer, a device which measures the pressure inside the eye. Some anaesthetic and a dye is placed on the cornea, and a blue light is held against the eye to measure the pressure. This test can also diagnose ocular hypertension; a risk factor for open angle glaucoma.

The doctor also measures the corneal thickness, because it affects how the pressure inside the eye is interpreted. (Factoring this gives an accurate estimate of the eye pressure.)

Gonioscopy this examines the area where the fluid drains out of the eye. It helps determine whether the angle between the cornea and the iris is open or blocked (closed).

Perimetry test - also known as a visual field test. It determines which area of the patient's vision is missing. The patient is shown a sequence of light spots and asked to identify them. Some of the dots are located where the person's peripheral vision is; the part of vision that is initially affected by glaucoma. If the patient cannot see those peripheral dots, it means that some vision damage has already occurred.

Optic nerve damage - the ophthalmologist (eye doctor) uses instruments and special lenses to magnify and look at the back of the eye, to look for any slight changes which may also point towards glaucoma.

OCT- this new age imaging device gives us quantitative estimates of the nerve inside the eye which when added on to the qualitative report of perimeter gives a very accurate picture of the status of glaucoma if present . Serial examinations give an accurate estimate of progression of glaucoma.

What are the treatment options for glaucoma?

Treatment involves either improving the flow of fluid out of the eye, reducing its production or sometimes both. Damage caused by glaucoma is irreversible. Though the disease itself cannot be cured, regular check-ups and proper treatment can considerably slow down the progression of the disease, and even prevent further loss of eyesight.

Eye drops - in the majority of cases, initial treatment includes eyedrops. Compliance is vital for best results and to prevent undesirable side effects - this means following the doctor's instructions carefully.

Surgery - if drugs don't work, or if the patient cannot tolerate them, surgical intervention becomes an option. The aim of surgery is usually to bring down the pressure inside the eye. Examples of surgery may include:

Acute angle-closure glaucoma - this condition is treated as a medical emergency. Pressure reducing medications are administered immediately. A laser procedure is usually carried out which creates a tiny hole in the iris, allowing fluids to pass out of the eye. This procedure is called an iridotomy. Even if only one eye is affected, the doctor may decide to treat both, because this type of glaucoma often affects the other eye too (so as a preventive measure the other eye also needs laser).

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Pediatric Ophthalmologists - The Best Care For Children

Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination. Pediatric ophthalmologists know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, pediatric ophthalmologists use equipment specially designed for children. Most pediatric ophthalmologists' offices are arranged and decorated with children in mind. This helps create a comfortable and non threatening environment for your child.

What Kind of Training Do Pediatric Ophthalmologists Have?

Pediatric ophthalmologists are medical doctors who have had

  • At least 4 years of medical school
  • One year of medical or surgical internship
  • At least 3 years of residency (post graduation) training in ophthalmology
  • At least 1 additional year of training in pediatric ophthalmology

What Types of Treatments Do Pediatric Ophthalmologists Provide?

Pediatric ophthalmologists can diagnose, treat, and manage all children's eye problems. Pediatric ophthalmologists generally provide the following services:

  • Eye exams
  • Perform surgery, microsurgery, and laser surgery (for problems like weak eye muscles, crossed eyes, wandering eyes, blocked tear ducts, retinal problems, and infections)
  • Diagnose problems of the eye caused by diseases of the body such as diabetes or juvenile rheumatoid arthritis (JRA) and other medical and neurological diseases
  • Diagnose visual processing disorders
  • Care for eye injuries
  • Prescribe eyeglasses and contact lenses

Eye problems in children

Children experience a variety of eye problems, many quite distinct from adult eye diseases. Pediatric ophthalmologists are specially trained to manage the following disorders:

  • Infections (Conjunctivitis).
  • Strabismus(Squint) is a misalignment of the eyes that affects 2-4% of the population; it is often associated with amblyopia or lazy eye. The inward turning gaze commonly referred to as "crossed-eyes" is an example of strabismus. The term strabismus applies to other types of misalignments, including an upward, downward, or outward turning eye.
    Squint or strabismus may be corrected by glasses or surgery or both. A squint is not only a cosmetic blemish but if not treated in time may cause severe visual disability which become permanent and cannot be rectified later on. It is not only poor vision but also lack of quality of vision such as depth perception possible only in aligned eyes and not in person with squint.
  • Amblyopia (aka lazy eye) occurs when the vision of one eye is significantly better than the other eye, and the brain begins to rely on the better eye and ignore the weaker one. Amblyopia affects 4% of the population and is clinically diagnosed when the refractive error of one eye is more than 1.5 diopters different from the other eye (anisometropia) or one of the eye is misaligned for a long period of time (Strabismus). The management of amblyopia involves correcting of significant refractive errors and using techniques that encourage the brain to pay attention to the weaker eye such as patching the stronger eye(occlusion therapy).
  • Blocked tear ducts. Many infants have tear duct block by birth. These babies will have watering and discharge since birth as complaint by the parents. Normally 90% of such babies will get their tear duct opened by one year of age without any intervention. If it doesnot then a simple probing under general anaesthesia can cure the condition but should be done before two years of age as success rate of probing after that age decreases.
  • Ptosis Droopy eye lids may present since birth. A droopy lid not severe enough to cover the pupil is not an emergency but if it covers the pupil it is an emergency to correct it surgically otherwise visual development of the child will not take place and severe amblyopia (lazy eye) with very poor vision and or squint(deviated eye) may develop.
  • Retinopathy of prematurity This happens in case of premature birth and low birth weight babies. As newborn care is developing a baby of 5-6 month gestation and babies of birth weight as low as 1000 gm are surviving, more and more babies are likely to have this condition. A routine screening and timely intervention by laser or surgery of such babies can save many eyes from becoming blind.
  • Nystagmus Involuntary movement of eye ball or nystagmus usually present since birth. Vision in such babies depends on severity of nystagmus. Some time very awkward head position may be present in such child to bring the eyes in such a position in which the movement is minimal so that better vision can be enjoyed in such face turn or head tilt position. If position of eyeballs can be changed surgically to bring it in a position of minimal movement the awkward head position can be removed or minimized.
  • Pediatric cataracts Cataract may not happen only in adult but may be present since birth. When such congenital cataract is of significant density it is an emergency to operate such babies as young as two month old. Operated late such babies will have poor fixation and may develop amblyopia A child may also develop cataract after infancy called as developmental cataract. Pediatric cataract can also be due to trauma and as result of many metabolic disorders .
  • Pediatric glaucoma Due to abnormal development of the internal drainage system of the eyeball an infant may develop high eye pressure due to accumulation of internal fluid of eye to cause damage to optic nerve(sight nerve) a condition known as congenital glaucoma in which eye appears very large also known as buphthalmos or bull's eye . Surgery is only solution to this condition which can save such eyes from blindness.
  • Genetic disorders often cause eye problems for affected children. Since approximately 30% of genetic syndromes affect the eyes, examination by a pediatric ophthalmologist can help with the diagnosis of genetic conditions. Many pediatric ophthalmologists participate with multi-disciplinary medical teams that treat children with genetic syndrome
  • Orbital tumours
  • Refractive errors such as myopia (near-sightedness), hyperopia (far-sightedness) and astigmatism can often be corrected with prescriptions for glasses or contacts lenses
  • Accommodative insufficiency This may cause near vision problem
  • Convergence insufficiency and asthenopia This is very common condition and is due to poor action of converging muscles of two eyes and it may lead to exotropia ( a outward deviation of eyeball)
  • Evaluation of visual issues in education, including dyslexia and attention deficit disorder. Pediatric ophthalmologists often work in conjunction with orthoptists in the treatment of strabismus.

Signs of Eye and Vision Problems

A child may not tell you that he or she has a vision problem because they may think the way they see is the way everyone sees.

Signs that may indicate a child has vision problem include:

  • Frequent eye rubbing or blinking
  • Short attention span
  • Avoiding reading and other close activities
  • Frequent headaches
  • Covering one eye
  • Tilting the head to one side
  • Holding reading materials close to the face
  • An eye turning in or out
  • Seeing double
  • Losing place when reading
  • Difficulty remembering what he or she read

There are many visual skills beyond seeing clearly that team together to support academic success.

Vision is more than just the ability to see clearly, or having 20/20 eyesight. It is also the ability to understand and respond to what is seen. Basic visual skills include the ability to focus the eyes, use both eyes together as a team, and move them effectively. Other visual perceptual skills include:

  • recognition (the ability to tell the difference between letters like "b" and "d"),
  • comprehension (to "picture" in our mind what is happening in a story we are reading), and
  • retention (to be able to remember and recall details of what we read).
  • recognition (the ability to tell the difference between letters like "b" and "d"),

Every child needs to have the following vision skills for effective reading and learning:

  • Visual acuity the ability to see clearly in the distance for viewing the blackboard, at an intermediate distance for the computer, and up close for reading a book.
  • Eye Focusing the ability to quickly and accurately maintain clear vision as the distance from objects change, such as when looking from the blackboard to a paper on the desk and back. Eye focusing allows the child to easily maintain clear vision over time like when reading a book or writing a report.
  • Eye tracking the ability to keep the eyes on target when looking from one object to another, moving the eyes along a printed page, or following a moving object like a thrown ball.
  • Eye teaming the ability to coordinate and use both eyes together when moving the eyes along a printed page, and to be able to judge distances and see depth for class work and sports.
  • Eye-hand coordination the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball.
  • Visual perception the ability to organize images on a printed page into letters, words and ideas and to understand and remember what is read. If any of these visual skills are lacking or not functioning properly, a child will have to work harder. This can lead to headaches, fatigue and other eyestrain problems. Parents and teachers need to be alert for symptoms that may indicate a child has a vision problem.

When is a Vision Exam Needed?

Your child should receive an eye examination at least once every two years-more frequently if specific problems or risk factors exist, or if recommended by your eye doctor.

Unfortunately, parents and educators often incorrectly assume that if a child passes a school screening, then there is no vision problem. However, many school vision screenings only test for distance visual acuity. A child who can see 20/20 can still have a vision problem. In reality, the vision skills needed for successful reading and learning are much more complex.

Even if a child passes a vision screening, they should receive a comprehensive optometric examination if:

  • They show any of the signs or symptoms of a vision problem listed above.
  • They are not achieving up to their potential.
  • They are minimally able to achieve, but have to use excessive time and effort to do so.

Vision changes can occur without your child or you noticing them. Therefore, your child should receive an eye examination at least once every two years-more frequently if specific problems or risk factors exist, or if recommended by your eye doctor. The earlier a vision problem is detected and treated, the more likely treatment will be successful. When needed, the doctor can prescribe treatment including eyeglasses, contact lenses or vision therapy to correct any vision problems.

Sports Vision and Eye Protection

Outdoor games and sports are an enjoyable and important part of most children's lives. Whether playing catch in the back yard or participating in team sports at school, vision plays an important role in how well a child performs.

Specific visual skills needed for sports include:

  • Clear distance vision
  • Good depth perception
  • Wide field of vision
  • Effective eye-hand coordination

A child who consistently underperforms a certain skill in a sport, such as always hitting the front of the rim in basketball may have a vision problem. If visual skills are not adequate, the child may continue to perform poorly. Correction of vision problems with eyeglasses or contact lenses, or a program of eye exercises called vision therapy can correct many vision problems, enhance vision skills, and improve sports vision performance. (Link to Sports Vision)

Eye protection should also be a major concern to all student athletes, especially in certain high-risk sports. Thousands of children suffer sports-related eye injuries each year and nearly all can be prevented by using the proper protective eyewear. That is why it is essential that all children wear appropriate, protective eyewear whenever playing sports. Eye protection should also be worn for other risky activities such as lawn mowing and trimming.

Regular prescription eyeglasses or contact lenses are not a substitute for appropriate, well-fitted protective eyewear. Athletes need to use sports eyewear that is tailored to protect the eyes while playing the specific sport. Your doctor can recommend specific sports eyewear to provide the level of protection needed.

It is also important for all children to protect their eyes from damage caused by ultraviolet radiation in sunlight. Sunglasses are needed to protect the eyes outdoors and some sport-specific designs may even help improve sports performance.

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