Dr. Neeraj Sanduja is a reputed eye specialist with 18 years of rich experience as a Vitreoretinal Consultant. Dr. Sanduja completed his MBBS degree from PGIMs Rohtak and MS in ophthalmology from the same institute. Currently, Dr. Sanduja works as a Senior Consultant-Ophthalmology (Vitreoretinal) in Paras Hospitals, Gurgaon. His previous experience includes a stint at William Beaumont Hospital, Michigan, the USA as a Visiting Fellow in Paediatric Retina.
Dr. Sanduja has been involved in the organisation of various national and international conferences on subjects such as Diabetic Retinopathy, AMD and Retinopathy of Prematurity. Dr. Sanduja has always excelled in his profession as well as academics. He has multiple fellowships like FICO (UK), FRCS (Glasgow) & FAICO (Retina). He was awarded the Best Ophthalmologist in Delhi/NCR (2015) by the IMA. He has published numerous papers in various national and international publications. His area of expertise includes Vitreoretinal Laser Surgery, Disease of Retina and UVEA, Diabetic Retinopathy, Retinal Detachment, Ocular Trauma, Retinopathy and Macular Hole.
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A child’s sense of vision is constantly developing through infancy and childhood. At the same time, there are a number of diseases and eye conditions that may affect a child’s vision. The more common amongst these affect the child’s ability to focus and the alignment of the eyes. These include:
- Amblyopia or lazy eye: This condition refers to underdeveloped vision in one eye. It is a fairly common condition and may be caused by the misalignment of eyes. In such cases, both eyeballs look in different directions and are unable to focus on one object.
- Ptosis: In such cases, the upper eyelid droops and partially covers the eye thereby obstructing vision.
- Conjunctivitis or pink eye: This refers to a bacterial or viral infection that causes inflammation of the conjunctiva. It is highly contagious and characterised by an itchy discharge in one or both eyes and the reddening of the white part of the eye.
- Chalazion: Chalazion is characterised by the development of a small lump on an eyelid. This typically occurs as a result of the clogging of the meibomian gland.
- Stye: Styes are a common childhood occurrence. It is usually caused by an infected eyelash and appears as a sore, red lump on the eyelid edge.
- Preseptal or orbital cellulitis: Orbital cellulitis usually develops as a result of an eyelid infection or upper respiratory infection. It could also be the result of trauma. Some of the typical symptoms of this condition include redness of the eyes, swelling and pain around the eyes. The swelling may even keep the eye from opening completely.
- Blocked tear duct: If the tear duct is blocked, the risk of eye infection is greatly increased. As a result, the child’s eyes may water excessively.
In almost all cases of eye infection, the earlier it is diagnosed, the easier it is to treat and the less permanent damage it can cause. Hence, it is important to get your child’s eyes checked regularly by an ophthalmologist. Ideally, a child’s eyes should be screened at least once between the ages of six months to a year and between three to three and a half years.
Once they start going to school, their eyes should be checked at the slightest complaint of vision problems. This is because refractive errors such as near sightedness or far sightedness and astigmatism may develop at this age. In many cases, if a child wears corrective glasses in the early stages of such refractive problems, the condition may resolve itself.
While we usually consider the eye to be a single element, it does, in fact, have a number of smaller parts each which play a distinct role in helping us see. The retina covers more than half the interior surface of the eye and can be described as the light sensitive layer that converts light into optic signals that are then carried to the brain. Retinal detachment is a serious condition that causes the retina to be separated from the supportive tissue. If not treated immediately, it could lead to permanent blindness.
Retinal detachment can be passed down from one generation of a family to another and hence if someone in your family has suffered from this condition, you have a high risk of suffering from it as well. People who are severely near sighted or those who have suffered from an eye injury are also at a high risk of suffering from retinal detachment.
Retinal detachment is not a painful condition and may have no warning signs. Some of the symptoms of this condition include seeing flashes of light, floaters and darkening of the peripheral vision. An early diagnosis can help prevent blindness caused by retinal detachment. To diagnose this condition, the doctor will dilate the patient’s eyes and use a special tool to get a closer look at the retina.
The method best suited to treating retinal detachment depends on the condition of the retina and advancement of the detachment.
- Laser or cryotherapy: This may be used in the early stages of retinal detachment as an outpatient procedure. Laser therapy may also be used to treat retinal tears.
- Pneumatic retinopexy: This form of treatment can be used in cases where the retinal tear is small and can be closed easily. It involves injecting a small gas bubble into the eye. This gas then rises and presses itself against the retina thus closing the tear. Pneumatic retinopexy may be followed by laser therapy to seal the tear in place.
- Scleral buckle: This is a surgical procedure where the doctor will sew a sclera or silicon band around the white of the eye. This is invisible and gradually will push against the torn edges closer together till they heal. This may also be followed by laser therapy.
- Vitrectomy: Large tears may be treated with a surgical procedure known as a vitrectomy. This involves the removal of vitreous matter from the eye and its replacement with saline solution. This procedure may often be used in combination with any of the above forms of treatment.
Diabetes is a pervading disease as it does not spare any system of your body. The increased sugar level affects everything from circulation to vision to kidneys. Diabetes is the leading cause of blindness in the eyes in the age group of 25 to 75.
Some of the common eye problems caused by diabetes are listed below
- Blurred vision: Increased sugar levels can cause blurred vision. While most people might jump to getting a corrective lens, it may not be needed in all cases. Try getting the sugar levels to normal levels and see the vision improve. It may take up to 3 months, but it is definitely possible to do away with the lens.
- Cataracts: Clouding of the lens which is known as cataracts can set in early when there is diabetes. Worsening of cataracts also is at a quicker pace with diabetics. The blurring of vision and glare can set in, which would require removal of the clouded lens and placement of an artificial lens.
- Glaucoma: There is always a certain amount of pressure on the eyes, known as intraocular pressure. This pressure increases significantly in diabetics, leading to vision changes and damage to nerves and blood vessels. Glaucoma can cause dryness in the eyes, as there is less amount of liquid that the eye makes. There could also be headaches, eye pains, blurred vision, and vision loss. In addition to eye drops, surgery and laser can also be used for correction.
- Diabetic retinopathy: The retina is a layer on which image of an object falls, and from there, a message is sent to the brain to identify an object. However, in people with increased sugar levels, the blood vessels in the retina can be damaged, leading to vision problems and even blindness. Greater the sugar levels, greater the damage. There could be people who have lost vision due to this condition. Periodic checkups are advised to ensure that the vision is constantly monitored. There could be black spots or holes in the vision, flashes of light, and even blurring of vision gradually resulting in a complete loss.
Some eye care tips:
Now that we know diabetes affects the eyes adversely, the following are some effective tips to ensure good eye health is maintained.
- If sugar levels are not well controlled, more frequent checkups are advised, else, annual checkup should suffice.
- Monitor and control the blood sugar and A1c levels
- Monitor and control blood pressure levels, as combined with higher blood sugar levels, the damage is exponential
- Quit smoking
- Monitor and control cholesterol levels
- Healthy diet with lots of vitamins, minerals, and protein
- Exercise to help in improving overall quality of life. If you wish to discuss about any specific problem, you can consult an Ophthalmologist.
The most common vision problems are shortsightedness and farsightedness. Shortsightedness is when a person sees close objects clearly while distant objects appear blurry. It is more common than farsightedness and affects about 70% of the Asian population.
When there is a refractive issue, the prescription usually has a plus/minus with it and also a number. A ‘minus’ symbol is used to represent shortsightedness; the greater the number of the glasses, the higher the shortsightedness. High myopia is a more severe form of shortsightedness where the power is -6.0 or higher.
As mentioned, the person will be able to see nearby objects but will have difficulty seeing far off objects.
- Difficulty reading signs and boards
- Straining to reduce the strain on the eye
- Tired and fatigue due to this eye strain, especially when in constant move like playing sports or travelling
How it happens?
Vision can be explained by a physical process where light passes through a lens and falls on the retina in the posterior portion of the eye where it forms an image. This is then sent to the brain where it is read and interpreted as a particular object. When the lens becomes elongated, the image that is formed is distorted in that it is formed in front of the retina and not on the retina. Though it gradually settles down with adulthood, in most cases, it progresses and requires corrective lenses. The corrective lenses ensure the image falls on the retina and visual perception is improved.
- Corrective glasses are the most commonly used measure for nearsightedness. The lenses could be used either as spectacles or as contact lenses.
- Laser surgery can also be used to correct the problem. A thin layer of the cornea is removed and the image formation is corrected.
- Artificial intraocular lenses are also being used to treat this condition. They work like contact lenses and may need periodic replacement.
- The most common technique, especially for high myopia is the use of surgery to correct the problem. This is a one-time correction and is a more durable solution than the earlier mentioned options.
- Appropriate calculations are done to identify the lens to be used so that proper vision is restored.
- Though not common, retinal detachment and variable postoperative refractive error can occur during the surgery.
- It is very important to set realistic expectations with the patient in terms of what to expect before, during, and after surgery. If only one eye is going for repair, the chances of mismatch in vision could be present in the early stages. Being clear about what to expect will help in successful correction. If you wish to discuss about any specific problem, you can consult an Ophthalmologist.
Age-related macular degeneration, also known in brief as AMD or ARMD is one of the most common age-related causes for vision loss. It causes “blind spots” in vision, causing difficulty in activities requiring central vision like reading, sewing, driving, watching TV, computer usage, etc.
How it happens?
The centre portion of the eye is known as retina which has a screen in the posterior portion. For proper vision, light falls on this screen and is then processed to enable ‘vision.’ When this screen is not clear, blurred vision results. It may not cause total blindness but impairs vision including double vision and loss of central vision.
Types: There are two types of AMD, wet and dry.
- Dry: There are yellow deposits known as drusen which form in the macula, and as they grow in size, they impair vision, specifically the central vision. This is the common variant and can lead to the wet form.
- Wet: There are abnormal blood vessels which are formed in the retina. There is leaking of blood and fluid which makes it ‘wet.’ There could be scarring of these leaked substances, which again leads to loss of central vision. Further studies have shown that retina produces a protein knows as vascular endothelial growth factor (VEGF) which promotes the generation of new blood vessels, normally required for the production of new blood vessels. However, increased VEGF causes excessive proliferation of blood vessels, leading to macular degeneration.
Risk factors: Though age related, there are definitely some factors which put one at a higher risk for AMD
- Genetics: AMD is hereditary and runs in families
- Gender: Females are more prone to develop AMD than males
- Ageing: People above 60 are at greater risk
- Smoking: Direct and passive smoking contribute to AMD.
- Obesity: Accelerates the pace of AMD and severity of complications.
- Hypertension: Increases the chances of developing AMD
- Ethnicity: Caucasians are more prone to develop AMD as their lighter skin and eye color is more prone to sun damage
- Sun exposure: Increased sun exposure accelerates the onset of AMD
- No symptoms in the initial stages
- Gradually, there is impaired central vision, affecting activities like reading, driving, and computer usage
- Color perception is impaired
- A routine eye exam will reveal the yellow deposits which actually cause the condition.
- An angiography may be done after injecting a dye to detect blood vessel growth.
There is no cure, but progress can be delayed
With everything requiring a computer to execute, more and more people end up looking at the computer screen for hours on end. This could range anywhere from a couple of hours to really long hours like 16 to 18. The effect of is a group of symptoms, which are collectively known as computer vision syndrome or CVS (syndrome means a collection of symptoms). The cause of this is the strain and pain resulting from constant staring at the monitor.
It is a type of repetitive stress injury, where a particular organ, the eye here, is subjected to repeated action (staring at a monitor) resulting in a group of symptoms. This is also compounded by age, where the flexibility to adjust to near and far vision is gradually reduced.
Symptoms of CVS:
There is no damage per se, but a constant strain on the eyes leads to:
- Blurred vision
- Double vision
- Dryness of the eyes
- Redness of the eyes
- Irritation of the eyes
- Headaches and neck/back aches
This could be a progressive condition, where the symptoms get worse with time. Treatment is definitely an option once the problem sets in, but this is a condition which can be definitely prevented with some simple, effective steps.
- Desk arrangement: Make sure the desk or monitor is slightly below eye level, about 30 inches away from the face. If you are straining the neck or the back to look at the monitor, it requires a change. The chair also can be changed in height to suit the seating. Also, prints can be pinned to the workstation when something is being typed, so constantly looking up and down while typing is avoided.
- Screen type: Move away from the older tube-style monitor with an LCD screen, which is easier on the eye. Check the computer settings so that brightness, contrast, and font size and shape and contrast are altered to suit your convenience. Ensure you are not requiring to strain to read.
- Alter the lighting: Look around you, and ensure there is adequate lighting with no glares on the monitor from surrounding windows or bright lights. A glare filter on the monitor is an effective way to manage this.
- Rest your eyes: Follow the 20-20-20 rule, with a 20-second break every 20 minutes where you look at something 20 feet away.
- Keep them moist: Blink your eyes constantly to ensure there is enough moisture. Eye drops can be used if required additionally.
- Frequent breaks: Not just your eyes, this also reduces strain on the neck and the back.
- Regular eye checkups: An annual visit, especially after 40, is a must for optimal eye health. If you wish to discuss about any specific problem, you can consult an ophthalmologist.
Cataracts are a common eye problem experienced by the elderly. In some cases, babies may also be born with cataract as a congenital defect or it may develop as a result of conditions such as diabetes. Cataracts can affect one or both eyes and is characterized by the clouding of the lens in the eye. This can make it difficult to see clearly and if not treated in time can lead to blindness.
Common symptoms of cataract include:
- Blurred vision
- Changes in the perception of colour
- Night blindness
- Increased sensitivity to glares
- Double vision
An eye examination is the first step to diagnosing cataracts. To confirm a diagnosis the doctor will also dilate the pupil to check the lens. Most cataracts can be easily treated with surgery. This surgery involves the separation of the cataract from the lens and its removal after which an intraocular lens implant is placed in the eye. In cases where this cannot be used, corrective contact lenses or glasses will need to be used. One of the most popular methods of cataract surgery is known as phaco surgery or phacoemulsification.
This surgery involves making two, small incisions on the eye where the cornea meets the sclera. This is then used to create a circular opening in the lens through which a probe is inserted into the eye. Sound waves or laser is then used to break the cataract into small pieces. This is then removed from the eyes and an intraocular lens implant is put in its place. Stitches are rarely required for this surgery and it is usually performed as an outpatient procedure while the patient is under local anaesthesia. When treating cataract, both eyes are usually not addressed simultaneously.
This surgery is usually pain free. The operated eye may be bandaged overnight and the patient will be given a protective eye shield to be worn for a week. The doctor will ask you to get a check up 2-3 days after the surgery where they can evaluate the clarity of the lens, overall health of the eye, eye pressure and visual acuity.
Cataract surgery is generally considered to be a safe surgery but like any other surgery there are risks involved. Some of the possible complications of this type of surgery include:
- Pain and redness of the eye
- Vision problems
- Swelling of the eye
- Discharge from the eye
- Flashes or floaters in the patient’s vision
If you wish to discuss about any specific problem, you can consult an ophthalmologist.
A cataract is defined as a clouding of lens in the eye where your vision gets blurred. A cataract affects the eyes, when light that passes through the lens prevents a clearly formed image from reaching your retina. The disease is very common and usually, develops as your eyes age or due to any injury caused to the tissues that cover your eye's lens.
Types of cataracts:
- Senile Cataract: This is the commonest of all. It is age-related clouding of the lens. It can affect the near or distance vision and can also cause glare and change in glasses power.
- Secondary Cataract: It can be developed after surgery for other eye problems like glaucoma and other health conditions such as diabetes.
- Traumatic Cataract: It can develop many years later after an injury caused to your eye.
- Congenital Cataract: As the term explains, the disease may be inborn or some children might develop it at a later stage which often affects both eyes.
- Radiation Cataract: It can form after you are exposed to some form of radiation.
A cataract surgery involves the extraction or cleaning of the cloudy lens, which is then replaced by a clear artificial lens.
Why does it happen?
There are lenses that lies behind our iris and pupil which act much like a camera lens. It helps concentrate light onto the retina at the back of our eye to form a sharply defined image. Besides, the lens also helps our eyes to adjust focus and allows us to see things clearly both far away and up close. The lens is composed of protein and water where the protein is arranged in a manner to keep the lens clear thereby letting light pass through it.
However, as we grow old, some of the protein starts to become thick and cloud a small lens area. This is known as a cataract. With the passage of time, it may inflate and cover more of the lens, making it difficult for us to see.
Besides, there are other causes of cataract such as smoking, addiction of alcohol, prolonged sunlight exposure, to name a few.
When should you opt for a cataract surgery?
Believe it or not, but till date no eye drop or medication has proven to reverse or prevent the formation of a cataract. If a cataract is affecting your nearsightedness or alteration in your prescription, then new prescription eyeglasses may help to better your blurred vision. However, the only treatment for a cataract is the surgical removal of your natural lens. And, most eye doctors recommend this surgery only when the problem becomes severe and starts hampering your day-to-day activities, such as studying or driving at night.
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Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear. A cataract causes the lens to become cloudy, which eventually affects your vision.
Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means you don't have to stay in the hospital after the surgery. Cataract surgery is very common and is generally a safe procedure.
How a cataract affects your vision
Cataract surgery is performed to treat cataracts. Cataracts can cause blurry vision and increase the glare from lights. If a cataract makes it difficult for you to carry out your normal activities, your doctor may suggest cataract surgery.
When a cataract interferes with the treatment of another eye problem, cataract surgery may be recommended. For example, doctors may recommend cataract surgery if a cataract makes it difficult for your eye doctor to examine the back of your eye to monitor or treat other eye problems such as age-related macular degeneration or diabetic retinopathy.
In most cases, waiting to have cataract surgery won't harm your eye, so you have time to consider your options. If your vision is still quite good, you may not need cataract surgery for many years, if ever.
When considering cataract surgery, keep these questions in mind:
- Can you see to safely do your job and to drive?
- Do you have problems reading or watching television?
- Is it difficult to cook, shop, do hardwork, climb stairs or take medications?
- Do vision problems affect your level of independence?
- Do bright lights make it more difficult to see?
Complications after cataract surgery are uncommon, and most can be treated successfully.
Cataract surgery risks include:
- Drooping eyelid
- Dislocation of artificial lens
- Retinal detachment
- Secondary cataract
Loss of vision
Your risk of complications is greater if you have another eye disease or a serious medical condition. Occasionally, cataract surgery fails to improve vision because of underlying eye damage from other conditions, such as glaucoma or macular degeneration. If possible, it may be beneficial to evaluate and treat other eye problems before making the decision to have cataract surgery.