It is a condition of clouding of natural lens leading to decreased vision.
Clouded lens does not allow light to pass normally and fall on the nerve layer of the eye [retina] . When light rays are not focused on the retina the vision gets blurred.
It is a condition that normally occurs as a process of ageing, but still can be seen in any age group due to various reasons. For example,in a child there may be congenital cataract, trauma may lead to traumatic cataract and in diabetics there is “sugar” cataract .
Cataract is a very common cause of preventable blindness in India. It affects more than 50% of the adult population in India .
It can be detected on a routine eye test without the need of advanced gadgets, which is why routine eye test is advised for any patient above 40 years of age.
The process involves a vision and eye pressure test before slit lamp examination of the eye followed by dilatation of eyes that requires instillation of dilating eye drops a minimum of two times [ diabetics do take a longer time for dilatation] . Normally it takes 15 – 20 min for dilating after which a retinal examination is performed to know the health of the nerve layer of the eye. After dilatation patients will develop blurring of vision which remains for a minimum period of 2 – 3 hours. After through retinal evaluation , which may not be possible if the cataract is very dense obscuring retinal view, B-scan may be required.
Cataract surgery is a simple procedure involving a small cut of about 2-3mm for removal of the denatured lens with use of high frequency ultrasonic waves that emulsifies the cataract , falsely named “ laser” eye surgery by many.
Following the removal of the natural lens”[god given”], implantation of a “man made” lens known as intraocular implantable lens is done.
Nowadays, micro incision cataract surgery(incision size less than 2mm) is also available with several options to implant high end foldable intraocular lenses.
Glaucoma is a group of eye diseases causing optic nerve damage. The optic nerve carries images from the retina, which is the specialized light sensing tissue, to the brain so we can see.
In glaucoma, eye pressure plays a role in damaging the delicate nerve fibers of the optic nerve. When a significant number of nerve fibers are damaged, blind spots develop in the field of vision. Once nerve damage and visual loss occur, it is permanent. Most people don’t notice these blind areas until much of the optic nerve damage has already occurred. If the entire nerve is destroyed, blindness results. Glaucoma is a leading cause of blindness in the world, especially in older people. Early detection and treatment by your ophthalmologist are the keys to preventing optic nerve damage and vision loss from glaucoma.
Although high eye pressure sometimes leads to glaucoma, many people can also develop glaucoma with “normal” eye pressure.
Chronic open-angle glaucoma is the most common form of glaucoma. The “open” drainage angle of the eye can become blocked leading to gradual increased eye pressure. If this increased pressure results in optic nerve damage, it is known as chronic open-angle glaucoma. The optic nerve damage and vision loss usually occurs so gradually and painlessly that you are not aware of trouble until the optic nerve is already badly damaged.
Angle-closure glaucoma results when the drainage angle of the eye narrows and becomes completely blocked. In the eye, the iris may close off the drainage angle and cause a dangerously high eye pressure. When the drainage angle of the eye suddenly becomes completely blocked, pressure builds up rapidly, and this is called acute angle-closure glaucoma. The symptoms include severe eye pain, blurred vision, headache, rainbow haloes around lights, nausea and vomiting. Unless an ophthalmologist treats acute angle-closure glaucoma quickly, blindness can result. When the drainage angle of the eye gradually becomes completely blocked, pressure builds up gradually, and this is called chronic angle-closure glaucoma.
Not all types of glaucoma are characterized by eye pressures. In normal-tension or low-tension glaucoma, the optic nerve suffers damage with the resulting visual field loss even though normal eye pressures are maintained. Eyes afflicted with this condition are far more susceptible to optic nerve damage with any increase in the intraocular pressure compared to other eyes.
Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. Your ophthalmologist will measure your eye pressure (tonometry); inspect the drainage angle of your eye (gonioscopy); evaluate your optic nerve (ophthalmolscopy); and test the visual field of each eye (perimetry). Optic nerve evaluation and visual field testing are performed at regular intervals to monitor the effects of glaucoma. Nowadays, the retinal nerve fibre layer thickness using the OCT gives valuable information as to the amount of structural damage that has occurred due to glaucoma.
The treatment for glaucoma depends upon the nature and severity of each case. In general, glaucoma cannot be cured, but it can be controlled. Eye drops, pills, laser procedures, and surgical operations are used to prevent or slow further damage from occurring..”
Staring at your computer screen, smartphone, video game or other digital devices for long periods won’t cause permanent eye damage, but your eyes may feel dry and tired. Some people also experience headaches or motion sickness when viewing 3-D, which may indicate that the viewer has a problem with focusing or depth perception.
Extended reading, writing or other intensive “near work” can also cause eyestrain.
When you get less sleep than you need, your eyes may become irritated. During sleep our eyes rest for an extended period and are replenished by nutrients. Ongoing eye irritation can lead to swelling and infection, especially if you wear contact lenses.
If you wear contact lenses, it’s important that you use and care for them properly — especially if you use a computer and other digital-screen devices often. This helps avoid eye irritation, swelling, infection and vision problems.
Stop wearing your contact lenses and see an ophthalmologist right away if you develop any of these problems: Eyes that are red, blurry, watery, sensitive to light, or sore; eye swelling or discharge.
A common vision problem in children is amblyopia, or “lazy eye.” It is so common that it is the reason for more vision loss in children than all other causes put together. Amblyopia is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then “learns” to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it
Strabismic amblyopia develops when the eyes are not straight. One eye may turn in, out, up or down. When this happens, the brain “turns off” the eye that is not straight and the vision subsequently drops in that eye.
Deprivation amblyopia develops when cataracts or similar conditions “deprive” young children’s eyes of visual experience. If not treated very early, these children can have very poor vision. Sometimes this kind of amblyopia can affect both eyes.
Refractive amblyopia happens when there is a large or unequal amount of refractive error (glasses strength) in a child’s eyes. Usually the brain will “turn off” the eye that has more farsightedness or more astigmatism.
With amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “re-learn” how to see and the vision may increase. Remember, glasses alone do not increase the vision all the way to 20/20, as the brain is used to seeing blurry with that eye. For that reason, the normal eye is treated (with patching or eyedrops) to make the amblyopic (weak) eye stronger.
Early treatment is always best. If necessary, children with refractive errors (nearsightedness, farsightedness or astigmatism) can wear glasses or contact lenses when they are as young as one week old. Children with cataracts or other “amblyogenic” conditions are usually treated promptly in order to minimize the development of amblyopia.
Recommended by the American Academy of Pediatrics (AAP) over the course of childhood to detect amblyopia early enough to allow successful treatment. Pediatricians check newborns for red reflex to find congenital cataracts. Infants are checked for the ability to fix and follow and whether they have strabismus. Toddlers can have their pupillary red reflexes tested with a direct ophthalmoscope (Brückner Test) or by photo screening, or by remote auto refraction to identify refractive errors that can cause amblyopia. When children can consistently identify objects either by reading, or by matching, the acuity of each eye (with the non-tested eye patched or covered) is screened to identify amblyopia.
One of the most important treatments of amblyopia is correcting the refractive error with consistent use of glasses and/or contact lenses. Other mainstays of amblyopia treatment are to enable as clear an image as possible (for example, by removing a cataract), and forcing the child to use the non dominant eye (via patching or eyedrops to blur the better-seeing eye).
Patching should only be done if an ophthalmologist recommends it. An ophthalmologist should regularly check how the patch is affecting the child’s vision. Although it can be hard to do, patching usually works very well if started early enough and if the parents and child follow the patching instructions carefully. It is important to patch the dominant eye to allow the weak eye to get stronger.
The classic patch is an adhesive “Band-Aid” which is applied directly to the skin around the eye They are available in different sizes for younger and older children. For children wearing glasses, both cloth and semi-transparent stickers (Bangerter foils) may be placed over or onto the spectacles. “Pirate” patches on elastic bands are especially prone to “peeking” and are therefore only occasionally appropriate.
Sometimes the stronger (good) eye can be “penalized” or blurred to help the weaker eye get stronger. Blurring the vision in the good eye with drops will penalize the good eye This forces the child to use the weaker eye. Ophthalmologists use this treatment instead of patching when the amblyopia is not very bad or when a child is unable to wear the patch as recommended. For mild to moderate degrees of amblyopia, studies have shown that patching or eyedrops may be similarly effective. Your pediatric ophthalmologist will help you select what treatment regimen is best for your child.
In many instances, school is an excellent time to patch, taking advantage of a non parental authority figure. Patching during school hours gives the class an opportunity to learn valuable lessons about accepting differences between children. While in most instances, children may not need to modify their school activities while patching, sometimes adjustments such as sitting in the front row of the classroom will be necessary. If the patient, teacher, and classmates are educated appropriately, school patching need not be a socially stigmatizing experience. On the other hand, frequently a parental or other family figure may be more vigilant in monitoring patching than is possible in the school setting. Parents should be flexible in choosing when to schedule patching.
Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, etc. Children will often throw a temper-tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period.
Surgery on the eye muscles is a treatment for strabismus – it can straighten misaligned eyes. By itself, however, surgery does not usually or completely help the amblyopia. Surgery to make the eyes straight can only help enable the eyes to work together as a team. Children with strabismic amblyopia still need close monitoring and treatment for the amblyopia, and this treatment is usually performed before strabismus surgery is considered.
Children who are born with cataracts may need surgery to take out the cataracts. After surgery, the child will usually need vision correction with glasses or contact lenses and patching.
|In all cases, the goal is the best possible vision in each eye. While not every child can be improved to 20/20, most can obtain a substantial improvement in vision. Although there are exceptions, patching does not usually work as well in children who are older than 9 years of age.
In some cases, treatment for amblyopia may not succeed in substantially improving vision. It is hard to decide to stop treatment, but sometimes it is best for both the child and the family. Children who have amblyopia in one eye and good vision only in their other eye can wear safety glasses and sports goggles to protect the normal eye from injury. As long as the good eye stays healthy, these children function normally in most aspects of society
Conjunctivitis: A Common Infection in Children
Conjunctivitis is the term used to describe inflammation of the conjunctiva — the thin, filmy membrane that covers the inside of your eyelids and the white part of your eye (known as the sclera). Often this condition is called “pink eye.” The three most common causes of conjunctivitis are: viral, bacterial, and allergic.
Bacterial conjunctivitis is a highly contagious form of pink eye caused by bacterial infections. This type of conjunctivitis usually causes a red eye with a lot of pus.
Viral conjunctivitis is caused by the same virus that causes the common cold and is also very contagious.
Allergic conjunctivitis is a form of conjunctivitis that is caused by the body’s reaction to an allergen or irritant. It is not contagious. The main symptom is itching.
Bacterial and viral conjunctivitis can be quite contagious. The most common ways to get the contagious form of pink eye include:
Children are usually most susceptible to getting pink eye from bacteria or viruses because they are in close contact with so many others in school or day care centers and because they don’t practice good hygiene.
Practicing good hygiene can help prevent the spread of conjunctivitis. If a child is infected, make sure to have them do the following to help prevent the spread of the illness:
Children who return to school or daycare before their conjunctivitis has cleared risk spreading the infection.
With viral conjunctivitis, pink eye symptoms can last from one to two weeks and then will disappear on their own. Antibiotic eyedrops do not cure viral conjunctivitis. Severe cases may last longer.
For bacterial conjunctivitis, an ophthalmologist (Eye specialist) will typically prescribe antibiotic eye drops to treat the infection.
Allergic conjunctivitis treatment often includes applying cool compresses to the eyes and using anti-allergy eyedrops and cool artificial tears.
Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina undergo changes due to diabetes. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.
Diabetic retinopathy usually affects both eyes. People who have diabetic retinopathy often don’t notice changes in their vision in the disease’s early stages. But as it progresses, diabetic retinopathy usually causes vision loss that in many cases cannot be reversed.
There are two types of diabetic retinopathy:
Nonproliferative diabetic retinopathy (NPDR) is the earliest stage of diabetic retinopathy. With this condition, damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Sometimes, deposits of cholesterol or other fats from the blood may leak into the retina.
NPDR can cause changes in the eye, including:
Proliferative diabetic retinopathy (PDR) mainly occurs when many of the blood vessels in the retina close, preventing enough blood flow. In an attempt to supply blood to the area where the original vessels closed, the retina responds by growing new blood vessels. This is called neovascularization. However, these new blood vessels are abnormal and do not supply the retina with proper blood flow. The new vessels are also often accompanied by scar tissue that may cause the retina to wrinkle or detach.
PDR affects vision in the following ways:
Diabetic retinopathy symptoms usually affect both eyes.
Your doctor may order fluorescein angiography to further evaluate your retina or to guide laser treatment if it is necessary. This is a diagnostic procedure that uses a special camera to take a series of photographs of the retina after a small amount of yellow dye (fluorescein) is injected into a vein in your arm. The photographs of fluorescein dye traveling throughout the retinal vessels show:
OCT is a non-invasive scanning laser that provides high-resolution images of the retina, helping your Ophthalmologist evaluate its thickness. OCT can provide information about the presence and severity of macular edema.
When your diabetic retinopathy screening is complete, your ophthalmologist will decide when you need to be treated or re-examined.
If you have diabetes, you should see your ophthalmologist right away.
The recommended diabetic eye screening schedule for people with diabetes:
The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema(ME), proliferative diabetic retinopathy(PDR), neovascular glaucoma(NVG).
Laser surgery is usually performed in an office setting. For comfort during the procedure, an anesthetic eyedrop is often all that is necessary, although an anesthetic injection is sometimes given next to the eye. The patient sits at an instrument called a slit-lamp microscope. A contact lens is temporarily placed on the eye in order to focus the laser light on the retina with pinpoint accuracy.
With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.
A few people may see laser spots near the center of their vision following treatment. They usually fade with time, but may not disappear completely.
In PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment.
Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.
Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is often performed on anday care basis or with a short hospital stay. Either a local or general anesthetic may be used.
During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again.
Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.
To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist’s instructions so your eye will heal properly.
In some cases, medication may be used to help treat diabetic retinopathy. Sometimes a steroid medication is used. Steroid implants are a new modality of treatment that slowly release the drug over 16 to 24 weeks and control macular edema. In other cases, you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.
We realize the importance of your time and the multiple commitments that you have to honor every day, both professional and with family or friends. To enable you to plan your day better, we have provided below a comprehensive guide for your visit to the hospital, along with estimated average waiting and procedure execution times at each stage of the consultation process. Please be aware that all time durations mentioned assume average patient load and hence actuals might vary from the estimated time.
Please click on the relevant section below to start planning your visit.
Booking an Appointment
While booking an appointment is not mandatory, it is recommended that you do so in order to minimize waiting time or avoid conflicts with your preferred doctor’s surgery commitments.
Please click on “Book Appointment link” to find the most convenient way to book your appointment.
Please approach the reception desk on your arrival. You will be requested by our front desk management to fill out a simple form with your personal details along with any specific reason you might have for the visit. You will also be requested to pay the consultation fees in full at the time of registration.
Post your registration, you will be escorted to our ‘Diagnostics and Lasers’ chamber for an automated refraction test followed by an automated eye pressure test. The results from these tests would be attached to your file as our staff will guide you to the next station.
Post your automated diagnostics tests, our staff will seat you at the main waiting lounge till you’re called in to our optometry room for a detailed test by our qualified optometrists.
You will be seated either in the main waiting lounge or the waiting corridor till you’re called in to consult with your doctor. All the results from the earlier stations will be made available to the doctor before you’re invited for consultation. Aside from discussing your results, and any other complaints you might have, during this stage the doctor will also examine your eyes using the slit lamp each consultation room is equipped with. Depending on the observations, your age, existing conditions etc. you will be asked to undergo another consultation with the doctor post dilatation of your eyes.
Having examined your test results and eyes under normal conditions, in most cases your doctor will want to observe changes in your eye post dilatation. Dilatation is a process whereby our trained OPD assistants will apply dilatation drops to your eyes and will ask you to close your eyes and rest for a while.
They will keep checking your pupils at certain intervals and once found to be dilated adequately, will invite you for a final consultation session with your doctor.
Important: Please note that dilatation will result in blurred vision for 2-3 hours in adults. Activities like driving are not recommended during this time. Please make alternative arrangements or consider waiting at the hospital till normal vision is restored.
In kids, a period of 2-3 days might be required for normal vision to be restored. In case of any critical activities scheduled at school, please let your doctor know and re-schedule another visit for dilatation at no additional consultation charges.
In the dilated condition your doctor will be able to examine the inside of your eye, thus providing him a view of any important issues at the back of your eye including the retina, macula and the optic nerve.
Your doctor will convey all his findings to you in a simple yet clear manner, and will include the technical details in your final health report. If there are any findings that require further tests, then you will be explained further diagnostic options and corrective procedures.
You will be directed to our reception desk to collect your final report; and will be requested to provide feedback on your experience with us.
Procedures to be followed on the day of surgery would vary based on the nature of the operation and the patient profile.
In all surgical cases, your doctor and/or counsellor would have appraised you of all pre-op preparations and detailed instructions on the procedures to be followed on the day of surgery. Please ensure you are informed and have complied with the same.
If you are due for surgery at Akshara and have any questions for us, please Contact Us for clarifications.
If you are scheduled for a review with your doctor, please ensure you plan your day as per the routine consultation procedure (except registration).
While in all likelihood you will not go through all the stations (and hence spend much less time) during your review visit, the actual time would depend on the reason for review (post-surgery, routine etc).
Please Contact Us if you have any questions about your review visit.
Parking is available at the premises for 2 and 4 wheelers. Our security personnel will guide you to an available parking slot in front of the hospital or at the basement.
These are private resting wards equipped with comfortable bedding, air conditioning, attached washrooms and internet access on request.
This ward can accommodate up to 3 patients at any point in time and is equipped with comfortable beddings, air conditioning and a common washroom.
Overnight stay options are currently not available as most of the surgical procedures do not require long stays. However if you have travel constraints and need assistance with lodging, please let us know in advance, and we will do our best to ensure your comfort.
All billing processes will be carried out at the main reception. Payments can be made by cash as well as all major credit and debit cards.
We are currently empanelled for cashless services with the following insurance providers and TPAs