Good morning friends.
I’m Dr. Harshavardhan Ghorpade from the department of visual sciences DOVS from Fortis hospital Vashi, Mumbai and Saroj Speciality Eye Clinic Vashi, New Mumbai. I have done my MS. FRCS and I m a cataract, cornea and a refractive eye surgeon practicing here in New Mumbai. You can get back to me on lybrate.com and know more about me.
Today I’m going to talk to you about very interesting topic about recent advances in corneal surgeries. Now first of all let me start by telling you what is cornea. The Cornea is the front surface of the eye, the black thing you see at the center of the eye. It is actually very transparent and the black color comes from behind i.e. from the iris. This transparent structure is responsible for most of our vision. The other organ or other part which is responsible for most of our vision is the lens that lies behind the iris. So the cornea helps us to focus light on the retina which then transmits it to the brain. If this cornea is opaque then the light will not be transmitted and you will not see clearly. As a result of which we need to do something about it and the most important thing is to do is to replace the cornea with another cornea which comes from a donor and, therefore, donation of eyes after death is a very important act because you helped the next person who is blind to see again. But you should remember that while doing a corneal surgery we only replacing the front part of the eye and not the entire eye. So, now talking about the recent advances corneal surgery we thought that only one cornea could be used per person but today we are doing microsurgery in the cornea as well we are dissenting the cornea into multiple parts and therefore one single eye can help three other eyes. How is that? So, we have three parts of the cornea: the front, the middle and the back. The front part is called Epithelium the middle is Trauma and the inner is Endothelium. Periphery to these are stem cells which are called as limbal stem cells. Now if you have one donation we can dissect the cornea into the front and the back part. The back part can be use for replacing the back part of a damaged cornea and this called as DSEK Descemet Stripping Endothelial Keratoplasty which is a surgery where the inner part is replaced. In other cases where you have the front part involved where there is opacity because of say infection then we removed only the front part of the cornea and it is called as DALK Deep Anterior Lamellar Keratoplasty where we use only the front part of the donated cornea and then use the back part to some other person. Now the third part of the cornea is the Limbal stem cells, these limbal stem cells are responsible for growing a new layer on the cornea. however if they are damaged e.g. in acid injuries or alkali injuries or any other chemical injury then they don’t grow and this front part of the cornea gets completely opaque now we need to replace these stem cells from where do we get them. We get them from the other eye if it is normal or we can take it from a donor may be a relative or a dead person. Once you get these stem cells they can then be implanted into the eye which called as stem cell transplant and then they grow back on the surface leading to clear and very crystal clear front surface of the eye. These stem cells are very much important for overall health of the cornea. So as I have discussed the various advances i have now helped us to donate cornea and makes you full use of it for three different persons; the front part, the back part and the stem cells. So what are you waiting for? Go to the eye bank and get yourself registered for eye donation and remember eye donation can only be made after death so you don’t have to worry. After that you make other person see and you will also see the world through them.
Thank you very much.read more
Good morning friends.
I’m Dr. Harshavardhan Ghorpade from Fortis hospital Vashi, department of visual sciences. And Saroj Speciality Eye Clinic Vashi. I have done my MS. FRCS and I m a cataract, cornea and a refractive eye surgeon. You can contact me and know more about me through lybrate.com.
Today I’m going to talk to you about one very important topic which is of interest to one and all i.e. cataract and refractive surgeries, the recent advances in these surgeries. Let me first start by telling you what is cataract surgery? In cataract surgery the procedure is to remove the opaque lens of the eye which is called a cataract and replaced it by a nice clean artificial lens so that a patient can see again. While refractive surgery is something where we do refractive correction i.e. correction of power of the glasses either by the laser or by a surgical procedure. Both the things can be combined to ultimately give clear vision to the patient. So let’s start by starting with the recent advances in the cataract surgery. Well today cataract surgery has been sophisticated by doing procedures using ultrasound phaco probe which is about 2.2mm in size and it can be lesser of up to 1.8mm as well. We can do microincision cataract surgery through these probes. As a result of which we don’t require any anesthesia, any stitch and any blood coming out during surgery. During surgery we enter the eye with a very small opening and with the help of this ultrasound probe the emulsify or break the cataract into small pieces and then it is absorbed into the system of the machine, this is then replaced by a very small foldable lens. The lenses are of various types. They are usually monofocal, multifocal, or cylindrical. When we use monofocal lens we try to give you correction for distance so that most of the vision is good without glasses. When we use multifocal lens which is necessary to be put in both the eyes we can give you distance as well as near vision and when we use a toric lens we try to correct your cylindrical power as well. So ultimately by doing cataract surgery we not only remove the cataract but we also correct the glasses power of the patient so the patient can see very well without being too much dependent on the glasses. Apart from the various types of lenses we have now different types of machines which do the surgery. As I said micro-incision surgery is possible by using phaco probe but nowadays we are using laser as well to do the surgeries. Laser was a common term used in public to know or to talk about phacosurgery but today actual laser can also be used to do the surgeries. Although it is very expensive as well as time consuming. So ultimately if we have a good surgeon or experience surgeon micro incision phaco surgery is the surgery of choice even today and with the various type of lenses that available we can get rid of glasses as well apart from removing cataract. Now coming to the refractive surgery. Refractive surgery means removal of power of glasses doing a procedure on the eyes, this is usually done on the surface of the eye using a laser. What we do over here is laser surface ablation of the cornea which can lead to removal of glasses without doing any type of incision any cut or any kind of trauma to the patient or lots of tissue. So this a bladeless procedure and the patient is absolutely comfortable during the procedure and he may have some discomfort in first three or four days but overall at the end of the week he is absolutely normal as he was before without his glasses. This is one of the recent advances of bladeless procedures in laser surgeries. The other advances that we are doing nowadays is in very high refractive power say a power of more than seventeen and eighteen we introduces a special lens which is called as ICL which is put inside the eye without removing the cataract. This lens is like a contact lenses that sits on the lens i.e. given to us by nature. As a result of which the power which is there say e.g. patient with minus eighteen end up with the power which is close to zero and he would be again not dependent on his thick glasses. So this is another advanced that is occurred so that we can correct even the higher refractive errors. So overall if you look at the cataract and the refractive surgeries today we are doing very good sort of very advanced sort of treatments to all our patients which start with the removal of cataract, putting a lens of different types, we can do laser procedure over it to get rid of glasses. We can also put intraocular contact lenses, called ICL, which helps in removal of numbers with high powers and so at the end of the day our patients seems very happy and satisfy with all these results that are coming with modern advancements in cataract and refractive surgeries.
I hope you have understood the topic and if you have any more queries you can get back to me on lybrate.com.read more
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Many people gave very positive feedback for this Harshavardhan Ghorpade. I owe him him a big thanks for making me fine again. The guidance Harshavardhan Ghorpade gave me has helped me immensely with my situation. The entire Saroj Speciality Eye Clinic was spotlessly, clean. I was amazed that other doctors before him were not able to even diagnose my problem, but Harshavardhan Ghorpade did it immediately and started the red eyes treatment for it. Saroj Speciality Eye Clinic had all the amenities, a patient requires. He is very courteous and behaves very aptly with elder patients. I was having this red eyes, but the symptoms were not very visible. I thought that post treatment it won't happen again, but then after sometime, the symptoms re appeared.
My problem was such that it required a number of sessions, and I must say after all the sessions, I am feeling much better now. So many doctors I consulted, but his treatment was the best. It was getting very difficult for me to cope us with my poor eye sight. I was admitted to the Saroj Speciality Eye Clinic in case of emergency, but not once did any of the nurses panicked. Never once that I felt that he is getting impatient, rather he has always responded to my each and every doubt with immense patience. I searched this Harshavardhan Ghorpade online and saw his reviews. In order to diagnose my problem completely he asked me a number of questions. I am so much benefitted with his treatment, that i am perfectly fine now.
Harshavardhan Ghorpade guidance has helped me immensely and has helped gain confidence. I was quite concerned, as my health was degrading day by day, but due to my Harshavardhan Ghorpade and the weakeyes treatment I didn't lose hope. The entire Saroj Speciality Eye Clinic was spotlessly, clean. In order to diagnose my problem completely he asked me a number of questions. The Saroj Speciality Eye Clinic is designed in such a way that every patient feels at ease. I was panicked, because I never thought I will suffer from weakeyes like this. He ensures that he gives enough time to each patient.
My boss referred me Dr Harshavardhan Ghorpade. I have consulted so many doctors but nobody till now was able to understand my concern properly, until i consulted him. The atmosphere in the Saroj Speciality Eye Clinic is always so positive and full of life. Overall eye infection treatment was very effective. The Clinic has all the latest technology in place to handle severe cases. He is not just friendly, but also is very motivating. I was shocked to experience the symptoms of eye infection
He is not just friendly, but also is very motivating. Even though it's been more than a year, still if I sometimes feel pain and call him, and Harshavardhan Ghorpade still takes my call in case of any emergency. I owe him him a big thanks for making me fine again. Due to my conjunctivitis i was feeling very depressed and had no hope. Harshavardhan Ghorpade has so much knowledge that for everything my family takes herreference. The nurses at the Clinic were really helpful.
All of sudden I developed therdark circles Issue and didn't know what to do. The staff at Saroj Speciality Eye Clinic in Mumbai was very attentive to my needs. drHarshvardhan Ghorpade is very talented and seasoned doctor. Someone from the office, referred him to us. My case was extremely serious, but he really handled it very nicely. With the help of hertreatment for dark circles I am feeling so great.
Due to my squint my daily activities were suffering. I read about Dr Harshavardhan on one of the social media platform. Never once that I felt that he is getting impatient, rather he has always responded to my each and every doubt with immense patience. I am really grateful as his squint treatment has give me a ray of hope. I am almost my normal self post the treatment
I started suffering from cataract due to sunlight. I consulted Dr Harshavardhan. He has great experience in the field of Ophthalmologist. He treated me so well and now it has been 4 months, my condition has improved to great extent. Thanks to him for treating me so well.
Cataract usually affects people who are above 40. It is a blurring of the eye’s lens, which lies at the back of pupil and iris. It is the most usual cause behind the loss of vision for people above 40. Research also states that it is a major cause of blindness in the world.
Types of cataracts:
- Subcapsular cataract: People who are diabetic and those are taking high steroids are more prone to subcapsular cataract. In this type, the cataract develops at the back of the lens.
- Nuclear cataract: A nuclear cataract is related to aging. It usually affects the central portion of the lens of the eye.
- Cortical cataract: It is a white opacity, which begins from the periphery of the lens and spreads up to the center of the lens in a spot-like manner. It usually affects the cortex of the lens.
- In the beginning, cataract affects a small portion of your eye and affects your vision.
- Your vision gradually gets blurred.
- Too much exposure to the light might cause glare.
- In nuclear cataract, you may notice a short-lived improvement of your near vision.
- In subcapsular cataract, you cannot notice any symptoms in the initial days.
Cause of cataract:
The lens inside our eyes acts like a camera and it is made of protein and water. The protein helps in keeping the lens clear. But with aging, the protein may start to form a lump, which causes cloudiness in the eye area. With time the cataract spreads all over the lens and creates more cloudiness, which ultimately leads to blindness. The factors which usually trigger cataract are
- UV rays from sunlight
- Consumption of high dosage steroids medicines
- Statin medicines
- History of eye inflammation or any eye injury
- History of eye surgery
- Too much consumption of alcohol
- Hormone replacement therapy
- Family history of cataract
Prevention of cataract:
It cannot be guaranteed whether cataract can be prevented or not. A study shows that cataract is caused due to the oxidative changes in the lens of the eye. Nutrition studies have shown that consuming vegetables and fruits, which are high in antioxidants, may help in preventing cataract. Dietary intake of vitamin E, carotenoids lutein, and zeaxanthin from supplements and food items can decrease the risk of developing a cataract. Sunflower seeds, spinach and almonds are good sources of vitamin E. Kale, spinach, other leafy green veggies are the good sources of zeaxanthin and lutein. Food items that contain Omega-3 fatty acids and vitamin C decrease the chances of cataract.
Last, but not the least, when you step out, always wear a sunglasses, which has the ability to block UV rays.
In case you have a concern or query you can always consult an expert & get answers to your questions!
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.
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.
- 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.
- Farsightedness: The person has difficulty seeing things that are nearby and has to hold them at a distance for clarity.
- 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.
- Success rate as high as 96% - most patients no longer need the glasses or contacts they were using earlier
- Minimal pain
- Immediate correction of vision
- No stitches required
- 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.
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.
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:
- A scratchy, burning and a stinging sensation in the eyes
- Mucous surrounding the eyes
- Sensitivity to light
- Redness of the eyes
- A feeling that something is stuck in the eyes
- Problems in wearing contact lenses
- Vision problems, especially while driving at night
- Watery eyes caused due to the irritation that stems from dry eyes
- 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:
- 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.
- 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.
Hi My eyes are itching very much and sometimes I am having too much sneezing. Is it cold or allergy? Thanks.
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.