Advances In Eye Care

The commonest eye problems that we face as we age are Age Related Macular Degeneration and Cataract. Even today, there are few who know of the advances that science has made in these two fields.

ARMD (Age Related Macular Degeneration)

Age-related macular degeneration (ARMD) is the one of the most common cause of vision loss in people over the age of 50 and its prevalence increases with age. It is caused by the degeneration of the Macula, the central and most sensitive part of the retina at the back of the eyes. This disorder results in the loss of central vision only — peripheral fields are always clear. Many people develop macular degeneration as part of the body’s natural aging process. The high risk factors identified are smoking, uncontrolled hypertension and prolonged exposure to direct bright sunlight.

There are two main types of ARMD: the “dry” form and the “wet” form. Most people with ARMD have the dry form.

• “Dry” Macular Degeneration (atrophic) -This is caused by the aging and thinning of the tissues of the macula. Vision loss is usually gradual.
• “Wet” Macular Degeneration (exudative) – Accounting for about 10% of all ARMD cases, Wet ARMD results when abnormal blood vessels form underneath the retina at the back of the eye leak fluid or blood and blur central vision. Vision loss may be rapid and severe.

People with macular degeneration notice that straight lines in a landscape – such as electricity poles, the sides of buildings or streets, appear wavy. Other symptoms include blurring of type or a page of print, with dark or empty spaces that may block the centre of the field of vision. You can detect early stages of macular degeneration by using a simple vision test using a chart called the Amsler grid.

Reduce Risks of ARMD by:

• Increasing intake of fruits and vegetables
• Consuming fish (like tuna) more than once per week may be beneficial
• Reducing alcohol consumption (alcohol depletes antioxidants and carotenoids in the body)
• STOP or NEVER START smoking.
• Wearing UV-blocking glasses/sunglasses
• Control high blood pressure

Advanced Treatment of ARMD

Laser surgery and medications can be used to treat certain types of ARMD. Furthermore, certain types of “wet” macular degeneration can be treated with Anti-VGEF injections. These injections target a specific chemical – vascular endothelial growth factor (VEGF) – in your body. Recent development of anti-VEGF medications have become an exciting advance in the treatment of wet AMD helping many patients who were believed to be ‘hopeless’. Bevacizumab (Avastin) and Ranibizumab (Lucentis) are two effective drugs. Most patients will retain the vision they have and some will regain some of the lost vision after these treatments.

CATARACT is one of the most commonly known eye conditions causing visual impairment. People who remember when cataract removal involved general anesthesia, days in the hospital, weeks immobile at home and the subsequent need to wear thick glasses may find it hard to believe how much the procedure has changed. While in the past people waited until a cataract was fully “ripe” and nearly blinding before having it removed, the current recommendation is to have the surgery as soon as a cataract interferes with normal activities, including driving, watching television, climbing stairs, playing games, cooking and reading. In fact, the more advanced a cataract becomes; the more difficult it is to give the desired result.

Evolution of Cataract Surgery- “No-Stitch” “No Stress” Customized Cataract Surgery The fundamental aim of cataract surgery, the removal of the opacified natural lens to improve vision, has remained the same for hundreds of years. However, the way in which this is achieved and the expectations of people undergoing the procedure have changed drastically. Advances allow cataract surgery to be customized for every patient.

Today, cataract surgery is nearly always performed under local or topical (eye drops) anesthesia and takes less than 15 minutes.

Microsurgical Techniques

Today the surgery is done through a very small stitch-less, self-sealing incision in the cornea. Earlier this incision used to be 6 mm, then 3 millimeters and now a very tiny incision of 2 mm called Micro Incision Cataract Surgery (MICS). MICS (Micro Incision Cataract Surgery) with stable advanced Intra Ocular lenses helps patients resume work early.

Foldable Advanced Lens Implants

Standard intraocular lenses are monofocal—that is, focused for one distance, usually far. These patients still need glasses for near and intermediate distances. The development of multifocal intraocular lenses offers a further option for patients

Now, one can reduce drastically, if not eliminate, nearsightedness and farsightedness without the need for glasses or spectacles after the surgery. Patients now have different options and their surgeries can be tailor-made for them, called ‘Customized Cataract’ surgery, which is customized based on their needs, desire to be free from spectacles and their need to get back to work as soon as possible. Customized matching of lenses covers the entire range of requirements and results in highly satisfied patients.

Many people now do not want to wait for a cataract to occur, but start looking for options to correct both, their reading and distant vision. They opt for ‘PRELEX’ or Presbyopic Lens Exchange even before the cataract starts to interfere with their daily activities. Such options look after all focal points of vision: near, intermediate and distance.

In some people vision is further impaired by rather severe astigmatism, an irregularity of the cornea which makes it difficult for the eye to bring light to a point focus on the retina, no matter how good the glasses you use. So, at the same time that the cataract is removed, the astigmatism can be corrected using new implants called ‘Toric IOLs’.

‘Wavefront Implants’ have taken the cataract lens market by storm. These are Aspheric Optics which mimic the optics of a ‘young eye’ and give exceptional contrast and night vision.

As we get older we generally accept that our eye sight will get worse, but in many cases poor vision can be treated by wearing the correct glasses or contact lenses, although some eye problems are more serious and may require medication or surgery.

Keynote:

As we age we become more at risk of eye problems, but many of these can be successfully treated today with advances in this field if detected in the early stages.

Eye sight changes over time, so it is important to have regular ‘dilated’ eye examinations with the ophthalmologist so that any problems can be picked up and treated early.

The Right to Sight!

SCHOOL GOING CHILDREN

“Vision problems affect one in 20 preschoolers and one in four school-age children” (Shroff Eye Vision Screening Program, Mumbai, 2003-4).

“Two to four percent of India’s children develop a squint [cross-eyed] and/or amblyopia [lazy eye]. Early detection and treatment of these disorders during childhood is essential for preventing permanent vision loss”.

In many cases the child doesn’t see well out of one eye, as there may be a refractive error [spectacle number] in just that one eye. Here the eyes do not work as a team to see. If your child’s brain doesn’t receive visual images from that eye, eventually the brain will “shut off” that eye and vision could be permanently impaired. This condition is often undetected because the child has learnt to read from the good eye. During an eye examination, where each eye is separately checked, one can diagnose this condition.

Examination of vision among pre-school and primary school-going children is very rarely practiced in India unless an obvious problem is noted. Often the problem is dealt with too late. It is possible to check the vision in children who cannot read alphabets. All children attending kindergarten must be checked at admission.

How to detect these common eye problems?

• Basic eye examination for every newborn by the paediatrician.
• All premature babies need an eye examination by an ophthalmologist
• First detailed eye examination for all children age of 6 months; again at 2 years, and then annually.
• Screenings at school are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye doctor. One study found that 11.3 percent of children who passed a vision screening were found to have a vision problem in need of correction.
• Detailed eye examination by an ophthalmologist in the presence of visual impairment.
• Follow-up annual examination by the ophthalmologist is recommended to stay on top of your child’s visual needs, as well as ensure that your child’s prescription for eyeglasses is still correct. The visual system is developing along with your child, so annual prescription changes are common.

A higher risk of eye problems at an early age in today’s times

“Many pediatric eye doctors believe that heavy computer use among children puts them at risk for early myopia [short sightedness]” The average child now spends one to three hours per day on the computer doing homework, talking online with friends, and playing games. Parents encourage children as young as two or three years old to use the computer. Several recent studies have evidence that computers can have a negative impact on a child’s vision. They have found that 25% to 30% of computer-using children need corrective eyewear to work comfortably and safely at the computer at home or in school. See below in tips how to prevent Computer Vision Syndrome in children.

Tips on daily eye care for children:

• Diet: A healthy diet with emphasis on green leafy vegetables, drumstick, carrots, beetroot, fresh fruits including mango and papaya are particularly rich in Vitamin A.
• Lighting: Light source should be positioned behind your child while reading. Avoid direct glare by using shielded light. Reading material should ideally be placed 12- 14 inches away.
• VDU’s or Visual display units include TVs and computer screens.

• Headaches, eyestrain, burning, watering, blurring of vision, double vision and nausea can all be caused by prolong work on the VDUs.

  Avoid watching TV in a dark room. A well-lit room with white light [tubelight] is ideal. Preferred viewing distance for watching TV is 4 metres or more.

  Place the computer screen at eye level or slightly lower and in such a way to minimize reflection and glare. The recommended distance between the monitor and the eye for children is 18-28 inches. By viewing the computer screen closer than 18 inches, children risk straining their eyes. Parents and teachers should be aware of any behaviour that indicates potential problems, such as eye redness, frequent rubbing of the eyes, head turns and other unusual postures, or complaints of blurriness or eye fatigue. Avoidance of the computer may also be an indication of discomfort. Do not let the child sit for more than 40 minutes continuously in front of a computer monitor.

• Allergies and frequent colds: must be looked into and treated. Allergies of the eyes may make the child ‘knuckle’ his/ her eyes, which may become habitual and lead to permanent corneal abnormalities.
• Swimming: Water tight swimming goggles prevents irritation due to chlorine and reduces the chances of infection.
• Sports: If your child is involved in ball games and /or contact sports protective eye wear made of polycarbonate is recommended.
• UV light: Exposure to sunlight is healthy in moderation and helps in the making if Vitamin D by the body. Too much exposure to bright sunlight is harmful and can cause damage. Wide brimmed hats and UV filtering sunglasses provide adequate protection.
• Application of ‘kajal’ to newborns, washing the eyes with normal water, rose water etc is an absolute NO-NO. The normal circulation of tears is enough to adequately cleanse the eye of any extraneous material.
• The gift of vision is very precious. Give your child the best start in life by visiting your eye doctor today.

Common Myths in Kids

Myth about squint: ‘Squint in a child should wait till they grow up’

Generally speaking squints in children should be corrected before age 9 years. This is because later though a cosmetic treatment may be possible, the child after 9 years of age will continue to have a poorly developed vision from lazy eyes due to squint.

Myth about timing of eye examination:‘Children do not need eye examinations until they are in school’

False. It is recommended that every child’s eyes be examined regularly starting at birth. Some eye problems such as crossed eyes or amblyopia (lazy eye) can result in permanent loss of sight in the affected eye if not detected and treated before the child is five or six years old.

Issued in public interest by Shroff Eye Hospital, Mumbai, India

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Open your eyes…to a whole new world

Your child’s vision is the most important tool that he/she needs in order to succeed in school and improve IQ.

Most parents are under the impression that children cannot be tested till they enter main stream school-which is a Myth. It is possible to check the vision in children who cannot read alphabets as there are many child friendly visual charts

“Vision problems affect one in 20 preschoolers and one in four school-age children” [Shroff Eye Vision Screening Program, Mumbai, 2003-7].

“Two to four percent of India’s children develop a squint [cross-eyed] and/or amblyopia [lazy eye]. Early detection and treatment of these disorders during childhood is essential for preventing permanent vision loss”.

When should a child have his first eye examination and how often?

Once before Age 1

To examine for eye disease and normal eye development.

Early detection at this age can prevent vision problems that can have lifelong effects.

The American Optometric Association recommends a first eye exam at age six months.

At Age 3Children are checked for their general health of the eyes, eye movement skills, focusing, and the development of binocular vision skills. Visual conditions, like lazy eye

(amblyopia), are most responsive to treatment if diagnosed by the age of 3.

At Age 5
A child is examined to determine the readiness of vision skills for learning in the school setting. An estimated 25-30% of children have a significant need for eyeglasses or other correction for vision problems.

Yearly or every 2 years, till Age 9
Children’s eyes are fully developed by the time they are 8 years old so it is very important to have any problems detected before this.

Why do we see a higher occurrence of eye problems at an early age in today’s times

Many eye doctors believe that heavy computer use, Game Boy and Video Games among children puts them at risk for early myopia [short sightedness]. The average child now spends one to three hours per day on the computer doing homework, talking online with friends, and playing games. 25% to 30% of computer-using children need spectacles to work comfortably and safely at the computer at home or in school.

How to detect these common eye problems?

• First detailed eye examination for all children age of 6 months; again at 2 years, and then annually.
• Screenings at school are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye doctor.
• Screenings at school are designed to alert parents to the possibility of a visual problem, but not take the place of a visit to an eye doctor.

Tips on daily eye care for children:

Diet: A healthy diet with emphasis on green leafy vegetables, drumstick, carrots, beetroot, fresh fruits including mango and papaya are particularly rich in Vitamin A.

Lighting: Light source should be positioned behind your child while reading. Avoid direct glare by using shielded light. Reading material should ideally be placed 12- 14 inches away.

TV: Avoid watching TV in a dark room. A well-lit room with white light [tubelight] is ideal. Preferred viewing distance for watching TV is 4 metres or more.

Computers: Place the computer screen at eye level or slightly lower and in such a way to minimize reflection and glare. The recommended distance between the monitor and the eye for children is 18-28 inches. Do not let the child sit for more than 40 minutes continuously in front of a computer monitor.

Allergies: Common colds and allergies are common but it is important not to allow the child to knuckle or rub his or her eyes very hard as this can be habitual leading to corneal abnormalities like keratoconus. Hence always address the root cause of allergy.

Swimming: Water tight swimming goggles prevents irritation due to chlorine and reduces the chances of infection and allergies.

Sports: If your child is involved in ball games and /or contact sports protective eye wear made of polycarbonate is recommended.

UV light: Exposure to sunlight is healthy in moderation and helps in the making if Vitamin D by the body. Too much exposure to bright sunlight is harmful and can cause damage. Wide brimmed hats and UV filtering sunglasses provide adequate protection.