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Q: Can cataract be cured by medicines?
A: As of present no medical treatment, proven by scientific clinical trials, exists for the reversal of cataract development in any system of medicine.

Q: Can I see well after cataract surgery?
A: Cataract surgery is extremely high tech and very standardized. Most patients have excellent vision after surgery provided they do not have any other eye disease which limits vision. These conditions would usually be detected and mentioned to you by your surgeon prior to surgery.

Q: What is the best surgery to undergo for my cataract?
A: The standard procedure the world over today is Phacoemulsification with different types of lenses as per the patient’s need. Rarely some other procedure may be required for a specific indication.

Q: Do you use laser for cataract surgery?
A: Laser is not used for cataract surgery anywhere in the world. Lasers for cataract surgery are still experimental prototypes. Phacoemulsification uses ultrasound to pulverize the cataract and remove it through a micro incision.

Q: What sort of an intraocular lens should I have implanted in my eye?
A: A wide spectrum of lenses is available in terms of design, function and cost. Your surgeon will help you make the best choice depending on your visual needs.

Q: How soon can I join back to work after cataract surgery?
A: Theoretically you could go back the next day, but we recommend you take a week off to ensure you put your eye drops properly and do not expose yourself to infections

Q: While I had excellent vision after cataract surgery, over the years it has become progressively hazy?
A: A thorough examination is essential to determine the cause but commonly it is due to thickening of the capsule on which the artificial lens is supported. This can easily be treated by YAG laser capsulotomy without any surgery.

Q: How do I know that my cataract is ready for removal?
A: No longer do you have to wait for the cataract to be ripe as in earlier years. Modern surgical techniques and instrumentation permit removal of the cataract at any stage that it interferes with the patients visual requirements.

Q: How urgently do I require to under go cataract surgery?
A: You generally have the flexibility to plan your surgery as per your convenience in the next 2/3 months. However, rarely mature, hyper mature cataracts or cataract induced raised intraocular pressure may require urgent surgery.

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Q: Can diabetes affect the eyes and vision?
A: Diabetes prominently affects the eye manifesting as diabetic retinal disease. Ignored it can result in irreversible blindness.

Q: How does diabetes affect the retina?
A: Diabetes causes decrease in blood supply to small vessels resulting in microangiopathy affecting the eyes, kidneys, heart, and nervous system. Decreased blood supply of the retina manifests as swelling of the central retina (macular edema) and/or development of abnormal new vessels (proliferative retinopathy) resulting in bleeding into the vitreous gel- both of which cause severe visual loss.

Q: In spite of being a diabetic my vision is good; do I still need to show a retina specialist?
A: Vision can be good until advanced state of the retinopathy, when the damage may be irreversible .All diabetics must have their retina examined once a year after dilatation.

Q: What is retinal laser treatment and what is its purpose?
A: Retinal laser treatment does not involving any cutting or breach of ocular tissues. The laser beam enters the eye like normal light. It can be used to ablate retinal tissue not receiving proper blood supply, hence making the limited supply available to the central area where maximum vision resides. It can also be used to seal leaking vessels. Laser treatment is the gold standard for treatment of diabetic retinopathy with high risk characteristics and has been validated in multiple trials internationally. The aim of retinal laser treatment is to stabilize and retain existing vision.

Q: What is the role of intravitreal injections in diabetic retinopathy?
A: A variety of intravitreal injections can be used. They can reduce the swelling on the central retina (Macular edema) and also cause temporary regression of new vessels.

Q: What is the surgical treatment of diabetic retinopathy?
A: Surgery for diabetic retinopathy is called pars plana vitrectomy. It can be used to clear bleeding into the vitreous gel and also repair tractional retinal detachments or both. Laser is also performed during the procedure with fibre optic laser delivery called endolaser. The procedure though complicated requiring advanced instrumentation and specially trained surgeon: is done under local anesthesia and is comfortable to the patient.

Q: What other care can I take about controlling my diabetes if I am detected with diabetic retinopathy?
A: Tight control of diabetes and use of insulin are two key factors to control progression of the retinopathy. This has been amply proved by two large multi centre clinical trials (DCCT and UKPDR).Control of coexistent raised blood pressure or deranged lipid profile is advisable. Smoking is an absolute no-no.

Q; Can Diabetes affect the eye in other ways?
A: Diabetic patients have a tendency to earlier development of cataract and have a higher prevalence of glaucoma.

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Q: What causes a retinal detachment?
A: retinal detachment is serious sight threatening condition resulting from displacement of the retina from its normal location. This is due to development of a retinal break or tear.

Q: Is there any group of people particularly susceptible to retinal detachment?
A: Patients with high minus glasses (myopia), patients who have undergone cataract surgery, people indulging in contact sports and rarely those with connective tissue disorders (Marfan’s syndrome) are more at risk. Such people should report to retina doctor immediately if they develop suspicious symptoms.

Q: Is seeing a doctor urgent?
A: Retinal detachment of recent onset can be considered an ophthalmic emergency.

Q: Is retinal detachment an incurable condition?
A: Vast strides have been made in the last few years and surgical treatment is available. The recovery depends on the duration and extent of the retinal detachment as also the superadded changes.

Q: Are there different types of surgeries for retinal detachment?
A: Different surgeries are possible for retinal detachment depending on the case and surgeon’s expertise.

Q: Is there anything that can be done to prevent a detachment in the good eye?
A: A proper retinal evaluation with full pupillary dilatation using an indirect ophthalmoscope. Retinal laser may be required in patients if predisposing lesions are present.

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Q: What is age related macular degeneration?
A: Aging and exposure to ultraviolet radiation over the years results in chronic changes in the deeper layers of retina .These can progress to scar formation and disruption of the club sandwich like structure of the retina resulting in visual loss.

Q: What are the possible symptoms of ARMD?
A: Patients can complain of reduced vision and distortion of objects. These are often missed if the other eye is normal.

Q: Are there different types of ARMD?
A: Two forms of ARMD: Dry and Wet can cause visual loss.

Q: How can I monitor my disease at home to detect deterioration?
A: Check the vision in each eye separately by looking at a familiar object (calendar on the wall) and by checking any distortion on the Amslers grid provided to you by your retina specialist.

Q: How urgently should I see a doctor if I suspect change in status of ARMD?
A: As soon as possible. Irreversible deterioration could occur within days or weeks.

Q: What are the treatment options available?
A: The last five years have seen a sea change in therapies for ARMD. Timely detection can help patients with wet ARMD. Treatments with AntiVEGF agents can help achieve visual improvement. Lucentis (Novartis) and Macugen( Pfizer) are approved by the US FDA for the purpose. PDT (photodynamic treatment) with Visudyne (Novartis) can be used singly or in combination with anti VEGF. TTT(trans papillary laser thermotherapy) is a good low cost option for patients with poor visual prognosis.

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Q: What are the symptoms of glaucoma?
A: Unfortunately glaucoma is a silent disease becoming manifest only when irreversible damage to vision has already occurred. A simple test for intraocular pressure can diagnose this condition early. Some types may manifest with eye pain, and haloes around light

Q: Are there different types of glaucoma?
A: to put it simplistically there are two sub groups open and narrow angle glaucoma the treatments of which are different. Gonioscopy, a non invasive test must be done to differentiate

Q: What is the role of automated field analysis in glaucoma?
A: Automated field analysis helps to identify, plan treatment for and follow up patients with glaucoma.

Q: Are there different methods to take intraocular pressure?
A: We use the Non contact tonometer and Schiotz tonometer for screening and the Goldmann applanation tonometer which is the gold standard for detailed evaluation.

Q: Do all patients with glaucoma need surgery?
A: Today most patients can be controlled with eye drops and some cases and/ or laser.

Q: Can glaucoma be cured?
A: Glaucoma can only be controlled. Hence eyedrops may have to be continued lifelong. Arbitrarily stopping drops without medical supervision could be dangerous.

Q: Who can be considered at risk of glaucoma?
A: Individuals with family history, diabetes and advancing age need to undergo regular screening.

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Q: What is the Cornea?
A: It is the transparent front portion of the eyeball. To give an analogy it is like a lens of a camera. It is responsible for about 70% optical power of the eye.

Q: Why does the cornea become hazy?
A: Cornea is transparent because the collagen fibrils which form it are arranged in parallel & orderly fashion. In certain diseases of the cornea e.g. infections, injuries etc, this parallelism is lost and they are replaced by fibrous tissue (scar). The cornea loses its transparency & becomes hazy, with decrease in vision.

Q: What are the diseases commonly affecting the cornea?
A: Allergies-are commonly due to hot, dry, dusty weather, contact lenses & certain eye cosmetics. Allergic conjunctivitis called Vernal Catarrh is very common in young boys between the ages of 5-15 yrs. It can lead to itching, watery discharge, redness & reduced vision if not treated properly.
Infections-can occur due to a foreign body going in eye, after vegetative trauma etc. They can be bacterial, fungal, and viral. Certain tests are required to diagnose these infections. Intensive antibacterial, antifungal or antiviral eye drops are needed, as ocular penetration of oral drugs is poor.
Keratoconus- in this there is progressive thinning & bulging of the cornea forming a conical shape. It can cause severe loss of vision due to an abnormal curvature. In the early stages vision can be improved by spectacles; Later, Rigid Gas Permeable lenses or special lenses like ‘piggyback’, Rose K are required. In very advanced stages corneal grafting surgery is needed.

Q: What is Dry Eye?
A: The Cornea & ocular surface is bathed by the tears. Certain diseases can lead to decreased volume or impaired quality of tear film, causing symptoms like itching, grittiness, excessive watering. Long hours in front of a computer, air condititioned environs, certain drugs, aging, and connective tissue disorders can cause dry eye.

Q: What is corneal grafting? Is it safe & successful?
A: A corneal graft/ Keratoplasty involves replacing an opaque cornea of a patient with an healthy cornea of donor which is obtained from the Eye bank. To put it simply, it is like a kidney or liver transplant surgery, on smaller scale. It is very different from cataract surgery. Stringent care before and after surgery is required. The success rate depends on the type of disease. Conditions like Bullous Keratopathy and Corneal dystrophies have high success rate-80-90 %.

Q: What are complications of corneal transplant?
A: Since the transplanted cornea is not a part pf the patient’s own body, there is a chance that it may not be accepted well, resulting in an ‘immunological rejection’ in which the graft can become hazy. Certain other problems like glaucoma and astigmatism can also lead to poor vision. Regular follow up with corneal surgeon & putting drops religiously after surgery, is necessary.

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Q. How can I be sure that I am a suitable candidate for refractive laser procedure?
A: A complete assessment of eligibility is always undertaken prior to doing any Excimer laser procedure. After the patient has made up his mind there are three criteria which need to be fulfilled. The spectacle power should be correctable by the laser procedure being offered. The cornea should be suitable for undergoing the procedure both in terms of its thickness and absence of disease. The retina is evaluated to ascertain any weakness and to document any impediments to complete recovery of vision.
It is only after this that the patient is undertaken for the laser procedure.

Q: How are laser refractive procedures different from other eye procedures?
A: It is important to stress that Laser for removal of glasses is unlike other surgeries and procedures being conducted. All other surgeries are done in situations where they are the only option and failure to do them will not improve vision or cause visual loss. Excimer Laser for spectacle correction however is a matter of preference. Other options of continuing to wear spectacles or contact lenses exist. The person can plan the procedure as per his convenience both in terms of time and finance. It is because of the uniqueness of this procedure that it is important to choose the right centre. You are embarking on doing an irreversible procedure on an essentially normal eye and looking forward to improving your quality of life. Most people being young, this decision will impact the next fifty years of their life.

Q: What should be the key factor in opting to do my procedure with a particular centre?
A: In the back drop of what was mentioned above, the important factors to be considered are as follows:
Transparency - involving you in the decision making of your procedure is vital. You must be aware of the criteria of eligibility mentioned earlier. You must know which procedure is going to be done in your case. While you will be counseled by a trained counselor, usually a fully qualified optometrist, you must feel free to talk to the doctor if you have any specific doubts. Positive vibes with your treating doctor go a long way in making this a great experience.
Technology- All Excimer laser procedures are largely machine dependant. The hardware and software of these devices has been undergoing continuous improvement over the last ten years on the basis of feedback of patient clinical data. This has resulted in better ablation profiles, shorter treatment times, eye ball tracking systems and correction of internal focusing defects (optical aberrations). It is therefore important to know about the all important machine which will do your procedure. Is it a state-of-the-art machine being used in the US today or is it a refurbished machine manufactured when Excimer lasers just arrived. Most transparent establishments will give you the website of their Excimer laser company to find out in detail before you go ahead. Understandably a lot of this is rocket science to most patients but it is the willingness to freely exchange information that bolsters confidence.

Q: Different centers charge differently for laser correction of spectacle number?
A: Like in everything else pricing may be affected by the reputation of the surgeon, the city where the practice is located and the patient profile patronizing the establishment. However please make sure you are comparing apples with apples. If you have planned to undergo wave front guided LASIK (the procedure of choice the world over) don’t compare its expense with PRK a totally different procedure (from early years of excimer laser) and wonder why one centre is charging half of the other.
Fresh consumables for each case and better pre LASIK assessment tools also reflect in price differences.
Excimer laser treatments are not compulsory that you cut corners and make it fit in a budget: that is why medical health insurance does not cover them, just as it does not cover cosmetic surgery and orthodontic treatments. People who under go excimer do so as a matter of choice because they feel this will improve their prospects in life -- professional or personal. In such a scenario, opt for the best procedure or postpone it till you’re more comfortable with the expenses.

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Info Bytes

Age related Macular Degeneration

Modern day Ophthalmology has seen an explosive change in how we treat Age related Macular degeneration. 'Vascular endothelial growth factor inhibitors' allow arrest and even reversal of these changes helping to actually restore vision. International clinical studies like ANCHOR and MARINA proved this point.

At Specialty Eye Clinics we are routinely treating such patients from India and abroad using the entire spectrum of Pharmacotherapeutic armamentarium available internationally from leading companies like Novartis and Pfizer.





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