Dr. Pattnaik's Laser Eye Institute New Delhi

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Eye Glasses For Kids

Most children who need eyeglasses are either near sighted or farsighted. Depending on the degree of visual correction necessary, your ophthalmologist will prescribe glasses for full- or part-time wear.
Here are some tips to ensure that your child gets the right glasses.
o Avoid frames that will not please your childs’ personality and make him look uncool.
o Plastic frames are a better choice for children because they are more durable, less likely to be bent or broken, lighter in weight and less expensive.
o Each frame must be evaluated individually to make sure it fits the bridge. If any gaps exist between the bridge of the frame and the bridge of the nose, the weight of the lenses will cause the glasses to slide, no matter how well the frame seems to fit before the lenses are made. It is important that the glasses stay in place, because kids tend to look right over the top of the lenses instead of the center of glasses.
o Temple that wraps all the way around the back of the ear help keep glasses from sliding down or dropping off a child’s face completely. Another option is a strap that goes around the head.
o Kids are not always careful when they put on and take off glasses, and spring hinges can help prevent the need for frequent adjustments and costly repairs. These special hinges allow the temples to flex outward, away from the frames, without causing any damage.
o Lenses should be made of polycarbonate because these are lightweight and more impact-resistant than other lens materials. In addition these can be made into thin lenses if your child has thick glasses by choosing the right refractive index, which your optician can guide you the best.

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Diabetic Eye Disease

WHAT IS DIABETIC EYE DISEASE?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

 

Diabetic eye disease may include:

  • Diabetic retinopathy—damage to the blood vessels in the retina.
  • Cataract—clouding of the eye’s lens. Cataracts develop at an earlier age in people with diabetes.
  • Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

WHAT IS DIABETIC RETINOPATHY?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

WHAT ARE THE STAGES OF DIABETIC RETINOPATHY?

Diabetic retinopathy has four stages:

  1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
  2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
  3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
  4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

HOW DOES DIABETIC RETINOPATHY CAUSE VISION LOSS?

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

  1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathyand is the fourth and most advanced stage of the disease.
  2. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

WHO IS AT RISK FOR DIABETIC RETINOPATHY?

All people with diabetes–both type 1 and type 2–are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

WHAT CAN I DO TO PROTECT MY VISION?

If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:

  • Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
  • Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
  • You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
  • Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

SYMPTOMS AND DETECTION

Does diabetic retinopathy have any symptoms?

Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema.

If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.

What are the symptoms of proliferative retinopathy if bleeding occurs?

At first, you will see a few specks of blood, or spots, “floating” in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.

Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.

If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

How are diabetic retinopathy and macular edema detected?

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

  1. Visual acuity test. This eye chart test measures how well you see at various distances.
  2. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  3. Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of the disease, including:

  • Leaking blood vessels.
  • Retinal swelling (macular edema).
  • Pale, fatty deposits on the retina–signs of leaking blood vessels.
  • Damaged nerve tissue.
  • Any changes to the blood vessels.

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram and OCT Macula. In this Fluorescein angiogram, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment. OCT quantifies the amount of swelling in the macula and identifies the layers involved.

 

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Dry Eyes

Lacrimation is the secretion of tears, which often serve to clean and lubricate the eyes in response to irritation of the eyes. Tears formed through crying are associated with strong internal emotions such as sorrow, awe and pleasure. Laughing and yawning also result in production of tears. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health.

DRY EYE SYNDROME

In dry eye syndrome, the eye doesn’t produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly. Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from subtle and constant irritation to inflammation of the eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

DRY EYE SYMPTOMS

Persistent dryness, scratchiness, red eyes and a burning sensation are common symptoms of dry eyes. These symptoms alone may prompt your eye doctor to diagnose dry eye syndrome.

Dry eyes can become red and irritated, causing a feeling of scratchiness.

But sometimes your eye doctor may want to measure the amount of tears in your eyes. A thin strip of filter paper placed under the lower eyelid, called a Schirmer test, is one way to measure tear production.

Another symptom of dry eyes is a “foreign body sensation,” which is a feeling that something is in your eye.

And it may seem odd, but dry eye syndrome also can cause watery eyes. This is because dryness on the eye’s surface sometimes will overstimulate production of the watery component of your tears as a protective mechanism.

CAUSES OF DRY EYE

Dry eye syndrome has several causes:

  • It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, or because a dry, dusty or windy climate. Home or office air conditioning or a dry heating system can dry out your eyes. Another cause is insufficient blinking, such as when staring at a computer screen or TV monitor all day.
  • Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, Sjogren’s syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis).
  • Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among long term contact lens wearers. Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and the rubbing of the lenses against the conjunctiva seems to be a cause of dry eyes.
  • Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

TREATMENT FOR DRY EYES
Dry eye syndrome is an ongoing condition that may not be completely and permanently cured (depends on the cause), but the accompanying dryness, scratchiness and burning can be managed.

  • Lubricants: Your eye doctor may prescribe artificial tears, which are lubricating eye drops that may alleviate the dry, scratching feeling.
  • Contact lens: If you wear contact lenses, be aware that many eye drops, cannot be used while your contacts are in your eyes. Your doctor can prescribe eye drops, which are safe and effective over contact lenses.
  • Blocked meibomian glands: Meibomian gland dysfunction (MGD) is now recognized as a primary cause and contributor to most cases of dry eye. Lid compresses and massages help in relieving from meibomian gland dysfunction.
  • Environment. If the problem is environmental, wear sunglasses when outdoors to reduce exposure to sun, wind and dust.
  • Nutrition and hydration. Doctors sometimes recommend special nutritional supplements for dry eyes. Studies have found that supplements containing omega-3 fatty acids can decrease dry eye symptoms. Good sources of omega-3s include cold-water fish, such as sardines, cod, herring and salmon. Some eye doctors also recommend flaxseed oil to get rid of dry eyes.
  • In case of persistent dry eyes, your doctor will recommend specialized tests and treatment for relief of symptoms like Punctal occlusion. Temporary or permanent silicone plugs can be inserted in the lacrimal (tear) drainage ducts in your eyelids to keep tears on your eye from draining away as quickly. Called lacrimal plugs or punctual plugs, they can be inserted painlessly while you’re in the eye doctor’s office and normally are not felt once inserted.
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