Dr. Harshavardhan Ghorpade

Corneal Transplantation is a surgical procedure wherein a diseased or damaged cornea is replaced by donated corneal tissue . Such surgeries are performed by ophthalmologists, physicians who specialize in eyes.

While both may seem similar , there is a difference in both surgeries. We can fix what is broken with cataract surgery , however we can restore the ability of an ageing eye , which will further help a person to get rid of their reading glasses.

The eyes are such a complex structure that even minute changes in the extremely complicated internal structure affects the most important function of the eye, vision. And anyone with a vision problem can vouch for the extent of effect it has on the quality of life. Whether you are able to see only things at a close distance or far off, it is definitely difficult.

The good news, however, is that with the thorough understanding of the eye’s structure, these abnormalities can be corrected and absolutely normal vision can be restored. While surgery was the only mode of correction a few decades ago, but laser has come to rescue, especially in intricate structures like the eye.

LASIK is an abbreviation for laser in-situ keratomileusis. This is the most common and popular method to correct vision in errors of refraction. In all these conditions (as below), the cornea which is the clear portion in the front of the eye is affected.

The light passes through the cornea, lens and falls on the back of the eye ( retina), where an image is created, sent to the brain where it is reversed, and this is what we ‘see.’ Each of these parts have to be in perfect condition in order to produce this proper sight. Errors of refraction fall into three main categories.

1. Nearsightedness: There is difficulty in seeing far off objects, so road signs and boards are difficult to follow. Seeing objects that are closer is not affected. Most important cause is excessive staring into computer monitors.
2. Farsightedness: The person has difficulty seeing things that are nearby and has to hold them at a distance for clarity.
3. Astigmatism: Light rays merge to focus on multiple points either in front of or behind the retina. Normally, however, they should focus on a single point on the retina. There could be blurred vision, squinting, and eye strain.

What is done?

During the laser surgical procedure, ultraviolet laser beam is directed at the cornea. It is reshaped - made thinner in nearsightedness, elongated in farsightedness, and restoring the normal shape in astigmatism. This ensures that light is focused properly on the retina, producing sharp images and restoring vision.

Benefits:

1. Success rate as high as 96% - most patients no longer need the glasses or contacts they were using earlier
2. Minimal pain
3. Immediate correction of vision
4. No stitches required
5. Further adjustments to vision using glasses or contact lenses can be made if required

While errors in refraction are extremely common, there is no reason to panic. Corrective measures are also available, which can restore an almost normal vision.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Amblyopia or Lazy eye is the eye condition in which vision is reduced and cannot be corrected with glasses or contact lenses. All the images seen by the amblyopic eye are not fully acknowledged by the brain. It always affects only one eye, but may be accompanied with reduction of vision in both eyes. It can cause loss of vision, including loss of depth perception and two-eyed 3D vision. It's treatment can yield improvements at any age, but early detection can offer the best chances for a cure. Recent research has proven that lazy eye treatment can be successful in older children and adults. Comprehensive vision examinations are required for infants, toddlers, and pre-school children for the detection of lazy eye or amblyopia.

When the brain parts related with visual processing do not function properly, problems arise with such visual functions as the perception of movement, depth perception and fine detail (acuity, clear eyesight and sharp vision). Amblyopia is the most prevalent neurological defect of vision in children and adults resulting from developmental problems in the brain. Any interference with clear vision in either eye during the first six years or 'critical' period of visual and brain development can cause a lazy eye.

Constant strabismus or the constant turn of one eye in any direction, be it inward turn or crossed eye is one of common causes of amblyopia. The differences in vision or it's prescription between the two eyes leads to refractive amblyopia. Sometimes congenital disorders or a physical blockage of an eye due to trauma, drooping lids, cataract or a blocked tear duct can also lead to amblyopia. Many parents and children are not aware of any symptoms, as amblyopia usually occurs in one eye only and a lazy eye condition can exist without a noticeable eye turn. The visual acuity tests in addition to the 20/20 eye test charts and eye examination with cycloplegic drops by ophthalmologists are necessary to detect lazy eye.

Vision therapy for the eyes and brain is a highly effective non-surgical treatment for lazy eye. It is a progressive program of vision exercises customized to fit the visual needs of each patient. It is conducted at the clinic and occasionally supplemented with exercises to be done at home or workplace. It improve visual comfort, ease, and efficiency and change how a patient processes or interprets visual information. When considering treatment options, it is important to understand that lazy eye results from neurological deficit or problems in the brain and surgery for lazy eye is performed on the muscles on the outside of the eye. Most of the cases, lazy eye surgery provides cosmetic benefits and does not improve the patient's vision, hence options for vision improvement should be exhausted before eye muscle surgery is considered.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Any patient who needs to undergo cataract surgery must be evaluated in a thorough manner so as to establish the requirement, appropriateness, expected surgical problems, expected benefits and co-morbid conditions having an influence on cataract surgery.

The preoperative assessment consists of--

A test for your existing glasses prescription:

It is useful for your cataract surgeon to know your existing glasses prescription in cases where there is a high refractive error (people who are very short or long sighted), in order to plan to correct this error after cataract surgery.

A full ocular examination: This includes looking at-

• The eyelid anatomy and inflammation.
• The state of the tear film, dry eye changes could make surgery difficult
• The presence of abnormalities in the cornea that could make visualisation of the cataract difficult during surgery.
• The amount of dilation the iris undergoes with dilating drops.

The type of cataract. Soft cataracts can be aspirated. Hard cataracts need more ultra-sound energy and surgical time to break up and remove. White cataracts may need trypan blue staining to visualize the capsule.

The measurement of intra-ocular pressure. With this test, we aim to exclude glaucoma and ensure optimal control of immediate pre-operative and intra-operative eye pressures often with extra eye drops that temporarily lower eye pressure.

Biometry Tests

This is a simple pre-operative measurement. It calculates the correct power of artificial intra-ocular lens. They will be implanted into your eye once your cataract is removed.

Corneal Topography

This is a test to map out the corneal curvature in greater detail. It is used prior to premium IOL Implantation like Toric IOLS either monofocal or multifocal , to ensure avoid postoperative refractive errors. This extra test is only required if the biometry readings show larger than normal differences in keratometry readings.

Optical Coherence Tomography (OCT)

This test allows detailed visualisation of the macula (the central sensitive part of the retina used for fine vision). If the ophthalmologist suspects any macula changes that may prevent a patient from visual improvement after cataract surgery, he always suggest optical coherence tomography.

Blood Pressure Measurements

It is very important to know your blood pressure measurements before your cataract operation. The risk of having a bleed at the back of your eye during cataract surgery (supra-choroidal haemorrhage) is very small (1 in 10000). But is higher if you have uncontrolled blood pressure.

Blood Sugar Measurements in Diabetic Patients

Cataract surgery itself does not affect your blood sugar measurements if you are diabetic. A routine checkup of blood sugars in diabetics before cataract surgery is done and the surgery if often delayed if the levels were greater than 20mmol/L as the risk of post-operative infection is higher. In case you have a concern or query you can always consult an expert & get answers to your questions!

Dry eyes are a common phenomenon that develops when the tears do not provide sufficient moisture to your eyes. This may also be the result of inadequate production of tears by the tear ducts. This condition cannot be cured permanently; however, treatments usually help.

Signs and symptoms of dry eyes:

1. A scratchy, burning and a stinging sensation in the eyes
2. Mucous surrounding the eyes
3. Sensitivity to light
4. Redness of the eyes
5. A feeling that something is stuck in the eyes
6. Problems in wearing contact lenses
7. Vision problems, especially while driving at night
8. Watery eyes caused due to the irritation that stems from dry eyes
9. Blurred vision

What are the causes?
1. Tears are a mix of fatty oils, water and mucus. This combination safeguards your eyes from any sort of infection in addition to keeping your ocular surface (the cornea surface) clear and smooth. Your eyes dry up if the tear ducts do not produce enough tears; medically, this condition is termed ‘keratoconjunctivitis sicca’. It can occur due to:

• Age
• Certain medical complications such as Sjogren’s Syndrome (a medical condition marked by dry eyes and a dry mouth) arthritis, diabetes, thyroid disorders and deficiency of Vitamin A among a few others
• Side effects of certain medications such as anti-depressants, acne medications, birth control medications and medicines to control high blood pressure
• Laser eye surgery or damage caused to the tear gland due to exposure to radiation or inflammation

2. Increased drying up or evaporation of the tears caused due to exposure to various kinds of smoke, dry air or wind, less of blinking while focusing on any particular activity or an object and eye lid problems such as in-turning of the eyelids (entropion) and out-turning of the eyelids (ectropion) can contribute to this irritating condition.

3. Imbalance in any of the layers constituting a tear film (made of oil, mucus and water) might lead to this condition.

In case you have a concern or query you can always consult an expert & get answers to your questions!

• Hello all. Its smog everywhere. And so is allergic conjunctivitis, symptoms are itching redness eyelid swelling and eye discharge,
• Do not worry, do not rub, just apply ice compresses. Wash with clean cold water and use lubricating eye drops. If very severe then visit an eye doctor.

Amblyopia is commonly known as 'Lazy Eye'. It is a vision development disorder, which affects eyes and the brain during infancy and childhood. It signifies that the eye does not achieve a normal visual acuity even with refractive correction in form of glasses or contact lens. During normal visual development, the eye and brain learns to 'see' and develop binocularity, that is the ability to perceive depth (Stereoacuity). This occurs in the first 8 to 10 years of life. 

Each eye transmits a clear and identical image from retina to the brain, which fuses the two images into a single image with 3 dimensions ( adding depth). When the image is formed on the retina of two eyes is too dissimilar, the brain cannot fuse the two images and suppresses the more blurred image. As a result, the worse eye does not learn to 'see' and becomes 'lazy'. This condition is seen in 1-4% of population.

The common causes for dissimilar images or Amblyopia are:

1. Misalignment of the eyes or squint: It is the primary reason for Amblyopia is misalignment of the eyes. In case, both your eyes are not aimed in the same direction, the image captured by each eye is different , resulting in diplopia. The brain will see from the dominant eye and suppress image from the other eye. Over a prolonged period of time, the eye dissociates from the visual cortex of the brain.

2. Refractive Amblyopia:

• Unequal refractive error in both eye. When the eye power of both eyes differ by more than 1.5D of spherical equivalent, which results in dissimilar images between the two eyes. As a result, the visual development in restricted in the worse eye.
• High refractive error or astigmatism in both eyes, since there is a blurred image in both eyes, the normal vision development does not occur in either eyes resulting in bilateral lazy eyes.

3. Cloudiness in visual system or visual deprivation Amblyopia: Any kind of obstruction or cloudiness in the normal visual axis of the eye tissues can lead to Amblyopia. Disorder of any kind, which blocks a clear image from being focused blocks the formation of a clear image on your retina. Commonly due to congenital or developmental cataracts or corneal opacities or prolonged closure of one eye in early childhood( drooping of one eyelid, eyelid swelling, patching of one eye).

Treatment for Amblyopia: For treatment of Amblyopia, a child must be compelled to utilize his affected, weaker eye. This can be done by correction of causative factor such as, treating refractive error with glasses, surgical correction of misalignment of eyes followed by patching and vision therapy, cataract surgery.

Patching or occlusion of the good eye: This is done to force the brain to pay attention to visual input from the worse eye. This allows nerve connections between affected eye and brain to develop due to, which the eye 'learns to see'. Eye drops such as atropine are also used for blurring the vision of the good eye. Some form of vision therapy may also be required to train both eyes to see together and develop some degree of depth perception.

To be effective, treatment should be implement as early as possible , within the period of normal visual development best within first 8 years of life. Some visual gain has been seen in selected patients up to age of 14 to 18 years. This also highlights the importance of a comprehensive eye examination as a routine in young children.

In case you have a concern or query you can always consult an expert & get answers to your questions!