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Shroff Eye Hospital

Shroff Eye Hospital is India's First Eye Hospital accredited by the Joint Commission International (USA) since 2006. Shroff Eye is also India's first and only Wavelight Concerto 500 Hz LASIK center. Shroff Eye has stood for excellence in eye care since 1919. A firm commitment to quality is at the heart of all services provided at our centers at Bandra(W) and Marine Drive, Mumbai.

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Amblyopia or Lazy Eye Can be Successfully Treated in Older Children and Adults

New studies show that Amblyopia or Lazy Eye Can be Successfully Treated in Older Children and Adults

There is still a general belief amongst ophthalmic professionals that amblyopia or Lazy Eye can be treated only up to a certain age, usually below 10-12 years and works only when treated at such young ages. New scientific research contradicts popular beliefs and typical medical practice regarding age limits for the successful treatment of lazy eye. These doctors and their staff continue to offer outdated treatment programs to patients, rather than providing the newly proven treatment programs which give the best outcomes. Eye patching or atropine drops and/or corrective lenses continue to be the most popular cure, but supervised visual training activities, known as Vision Therapy are not widely available or frequently recommended. Did You Know Most Vision Takes Place in the Brain? The eye takes the picture of what we see. Our brain helps us decode what it is.Vison is a three-step process involving (1) the eye, which captures the image, (2) the visual pathway within the brain (which delivers the image from the eye to the brain) and (3) the visual cortex (which interprets or gives meaning to the images). Children and adults with 20/20 vision can experience symptoms such as visual fatigue, headaches, or difficulty with visual tasks because of disturbances along the neuropathways of the vision system within the brain. These patients experience struggles in school or the inability to enjoy regular activities. What is Lazy Eye? As the name suggests, a “lazy eye” is one that does not take part fully in the seeing process, or sees ‘less’ than normal. Bodily, a person with a lazy eye, looks the same as anyone else, as in there is no physical deformity. The vision or sight in the affected eye is less than what a normal eye sees, but not due to any pathological cause, but is more functional. The images the lazy eye sends to the brain are ignored (suppressed). As a result, only the better eye is used for sight by the brain. If not treated, vision can stay impaired. There are a number of reasons why an eye might shut down, all of which involve an imbalance in performance between the eyes. Here are some of the reasons:

Constant eye turn (strabismus) in one eye
High prescription (blurry vision) in one eye
Reduced vision in one eye from trauma, lid droop or cataract

In all of these cases, the brain uses the two eyes very differently. Early in vision development, the brain compensates for the imbalance by shutting down the weaker eye, resulting in a single, clear image in the other eye. The basic treatment of lazy eye is to encourage its use whenever possible. Corrective eyeglasses or contact lenses can stimulate or push the eye to see well. Occlusion of the better fellow eye with either patching or blurring eye drops (atropine) can also force the use of the lazy eye. In addition, doing near visual activities with the occlusion, such as reading, using a computer, and playing video games, will stimulate greater use of the lazy eye. All of these approaches are currently in practice. Vision therapy or visual training exercises support the development of improved vision in patients with lazy eye. They stimulate the eye-brain connection and force the lazy eye to take a more active part in seeing. Concept of Vision Rehabilitation Neuroplasticity has been shown to be active in many regions of the brain. The brain is not static. It consists of a dynamic system of neural networks that have the capacity of significant growth following repeated stimulation. For example, it is possible that new synapses can be created to counter a deficit acquired within the visual field Eye Patching or Atropine Drops Are Often Not Enough While occlusion (eye patching) or atropine may enhance visual acuity in the amblyopic eye, these techniques do not enhance the patient's ability to use the two eyes together (binocular vision). If the patient does not learn to combine input from the lazy eye and the fellow eye simultaneously, then the beneficial effects of eye patching may be lost. This may explain why 25% of patients, who are successfully treated with eye patching, experience a regression in vision after the patching treatment has ended. Treatment with Eye Muscle Exercises or Orthoptics Are Not Enough Eye muscle exercises called orthoptics are employed with or without eye patching to fix a lazy eye. Orthoptists practice eye muscle exercises (convergence, etc.) but this remains limited in its scope as it almost exclusively focuses on eye muscles only (convergence) and excludes the relation with the human brain (neuroplasticity). Lazy Eye or amblyopia is a neurological condition, so treatments that address the eye muscles only is not effective. Vision Therapy Treats Both Eyes and the Entire Visual System Vision therapy provides additional treatments for all aspects of vision impacted by amblyopia. With vision therapy, the patient engages in visual activities which require the simultaneous use of both the lazy eye and unaffected eye at all distances (near, middle and far range). Through a series of steps, vision therapy retrains the brain to use both eyes together, showing a way to allow the adult brain to rewire itself and form new connections. Vision Therapy is Physiotherapy for the Lazy Eye It has long been accepted that our ability to move and coordinate can be enhanced with training and practice. No one would question the benefits of physical therapy for a patient who has sustained a leg injury. However, for most of the last century, therapy for a lazy eye has been discouraged because it was thought that improvements in vision could not be made past the "critical period." Recent studies show that we have the ability to change, enhance, and develop many perceptual and visual skills throughout life. Optometric vision therapy is effective in treating people with amblyopia AT ALL AGES. No one should be denied treatment simply on the basis of age. At Shroff Eye Vision Therapy Clinic After regular use of the Vision Rehabilitation Program over a six month period, patients have reported an improvement in their sight Vision Therapy sessions develop efficient visual-motor and visual perceptive-cognitive processing skills. Initial sessions focus on enhancing the brain’s ability to control many functions of the eye including eye alignment, eye teaming ability and coordination, focusing, movement accuracy as well as visual speed and integration. Then, the program develops visual-motor skills and endurance through the use of specialized computer and optical devices, including therapeutic lenses, prisms, and filters. During the final stages of therapy, patient’s newly acquired visual skills are reinforced and automated through repetition and integration with their motor and cognitive skills References: Neurobiologist Susan R. Barry, Ph.D. and Rachel Cooper, Adult Patient Who Overcame Lazy Eye with Therapy

IS EYE DILATION NECESSARY IN AN EYE EXAMINATION

IS EYE DILATION NECESSARY IN AN EYE EXAMINATION? All eye checks ups (unless they are post surgery checks or specified by Optometrist or your eye doctor) need to be completed with a dilated eye examination. Eye dilation during an eye examination means the use of dilating eye drops (called mydriatics) which widens the pupil (the black circular opening in the centre of your coloured portion of the eye (iris). This dilation is usually done with your eye doctor and not with the optician (at least not in India). How is it done? Dilating eye drops are used at short intervals, till the pupils enlarge or dilate. This can be achieved with just one dose in some, whereas others may require repetition of dilating eye drops to achieve satisfactory dilation. The dilation effect is checked with torchlight, and usually termed as ‘partially dilated’ or ‘fully dilated’. For some conditions or before procedures or surgeries a full dilation is necessary to be able to visualize the inside of the eye. Once the pupil is fully dilated (which takes approximately twenty to thirty minutes after application of the eye drops) one can easily examine or view the entire retina through a larger aperture. In adults we use Tropicamide eye drops and its effect lasts usually for 4 hours. In children (below age 12 years) we use Homide eye drops and its effect lasts usually for24 hours. Why is dilation necessary? The retina is the only place in the human body where blood vessels and nerves can be directly observed. It is very important at revealing the status of your optic nerve and retina, and critical to preventing and treating eye conditions that could potentially lead to vision loss. Several diseases and conditions can be detected in their earliest stages diabetes: 1. Diabetes- Diabetic Retinopathy 2. High blood pressure- Hypertensive Retinopathy 3. Age Related Macular degeneration- ARMD 4. Retinal detachment 5. Eye tumors 6. Glaucoma- by observing optic nerve changes Patients who visit with redness in their eye question the need for a dilated eye examination. All red eyes are not due to infection, and hence dilation is necessary to ensure that the redness is not due to any internal eye problem. Dilating drops are sometimes used in children to test accuracy of prescription) as this disables the child’s ability to use their eye muscles to “squeeze” their eyes or squint and try and read a line or two more. Hence, eye examinations for an accurate prescription, especially in children may need more than one visit to the doctor’s office (cycloplegic refraction or PMT post mydriatic test). In children we use Homide eye drops for the following reasons:- 1. To check the internal eye completely 2. To check the numbers with accuracy as the internal eye muscles are strong in children and sometimes the child can compensate the refractive error leading to erroneous prescription numbers 3. The answers sometimes are not reliable, so in order to reveal the refractive status (spectacle numbers) properly we need to dilate the eyes. dialated-pupil Is dilation necessary at every eye exam? The simple answer is no, not every exam requires a pupil dilation, BUT an annual examination or an examination in patients with retinal conditions; it is an important step for thorough eye examination. Each patient is different, and the absolute need for dilating your eyes may be different than for a different patient. In some cases of Glaucoma, one needs to be careful not to dilate the eye fully, that it could cause increase in eye pressure. Hence, it is best to allow your treating doctor to take the decision of whether to dilate or not. What to expect after the dilation? 1. It is difficult to focus on objects close up for a few hours after your exam. Hence, do not plan to head back to work immediately. 2. Eye dilation also makes your eyes more sensitive to bright light. 3. You may need to make arrangements to have a friend or family member drive you home or take a local transport as driving post a dilated examination is not recommended due to blurred vision. In our centre, patients reserve the right to refuse any test or diagnostic procedure, despite our recommendations. If a patient refuses a dilated eye examination, he or she assumes the risk for detection and diagnosis of related conditions; hence some centres such as ours request a signed waiver in these cases.

What is OCT Angiography

OCT Angiography: The Newest Frontier and Future for the Revolutionary Technology of Imaging in Eye Care What is OCT Angiography (OCTA)? Optical Coherence Tomography Angiography (OCTA) provides three-dimensional (3D) imaging of the anterior segment, retina, and optic nerve head (similar to a C T Scan of the eye) allowing early diagnosis and timely management of eye diseases. Indications: Used to diagnose and manage retinal diseases which are major causes of blindness such as: • diabetic retinopathy • age-related macular degeneration (ARMD) • artery and retinal vein occlusions (BRVO) • glaucoma Advantages over FFA • A high-speed device- produces images in 10-15 seconds; FFA takes over 10-15 minutes • Non invasive; FFA needs injections • No dye injected, instead uses motion contrast. Hence no leakage, staining and other side effects such as nausea and severe allergic reactions (anaphylaxis) • Can acquire different scan sizes in the macula and the optic disc in about 3 seconds • Can scan the other eye in same sitting, unlike FFA, which is one eye per sitting • Provides accurate size and localization. FFA results are highly variable and often obscured by subjective interpretation by doctors • Visualizes both the retinal and choroidal vasculature • Can be used for routine screening examinations for early diagnosis of vascular abnormalities, and for routine follow-up examinations to evaluate the efficacy of treatments such as intra-vitreal injections. "With OCT angiography, we now have a noninvasive, safe, and effective tool to visualize the earliest pathological changes in the most common diseases that cause blindness, leading to earlier diagnosis and more successful treatments”, says Dr Rahul Shroff, Vitreo Retinal surgeon at Shroff Eye, Mumbai.

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Shroff Eye provides ‘Quality Ophthalmic Care’ with the highest levels of skill, competence and concern, leading to effective care that meets patient needs and ensuring the prevention, diagnosis and treatment of various ocular conditions by adopting the latest technologies, techniques and practices in ophthalmology.

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