| What
are the common eye ailments?
1. Cataract
Clouding of crystalline lens, a
part of the eye is cataract, usually
in people above 60 years. An age
related ailment cannot be ruled
out in young children and infants.
Cataract can also occur due to eye
injuries, diabetes, kidney disease
or from certain medications.
2. Retinal
Detachment
Vision is impaired due to holes,
tears or detachment of retina with
the chloroid.
Impairment of vision caused by diabetes
is called diabetic retinopathy.
3. Vitreous
haemorrage
Retinal bleeding may leak into vitreous,
which if not absorbed develops floaters
leading to obscure vision.
4. GLAUCOMA-
The Silent Thief
The eye is a fluid filled structure.
The fluid inside the eye is constantly
being produced and drained out.
This production and drainage of
the intra ocular fluid gives rise
to a pressure inside the eye known
as intra ocular pressure [lOP].
The normal intra ocular pressure
is usually between 12 and 18 mm
of Hg. The intra ocular pressure
is measured by your eye doctror
using an instrument known as tonometer.
There are many types of tonometers,
the most sophisticated machines
can measure the intra ocular pressure
even without touching the eye [Non
contact tonometer / air puff - tonometer]
What is Glaucoma?
Glaucoma is a disorder of the eye
where there is a rise in the intra
ocular pressure. This rise in the
internal pressure causes slow weakening
of the optic nerve which in turn
reduces vision, finally leading
to blindness. Glaucoma is not a
single entity, over 20 types of
glaucoma exist, all of them have
one thing in common, increased intra
ocular pressure leading to weakening
of the eye nerve [ which in turn
causes reduction of vision].
Why is Glaucoma
considered a silent thief of vision?
Most often the rise in pressure
is slow and insidious. There is
no overt sign or symptoms in the
early stages. The rise in pressure
causes gradual weakening of the
nerve. The weakening starts from
the sides and the reduction of vision
is at the sides. This is not easily
noticed by the patients. It is only
when the vision is grossly reduced
and the disease is very advanced
that the patient notices the vision
problems. The seriousness of glaucoma
is that once vision - is reduced
or lost, it cannot be recovered.
Whatever is lost is lost for ever.
Glaucoma should be diagnosed and
treated before there is any loss
of vision.
How can glaucoma be diagnosed early?
If glaucoma is diagnosed after the
patient has already noticed problems
of vision, it is already too late.
This disease should be diagnosed
by routine examination. Since glaucoma
is common after the age of 40, all
persons over 40 should undergo a
routine eye examination by an eye
doctor at least once a year. The
eye doctor examines the patient's
eye not only to find out the glass
power, but he also measures the
intra ocular pressure and examines
the retina to assess the optic nerve.
Thus glaucoma can be diagnosed early
just by undergoing regular eye examination
by an eye doctor [ Ophthalmologist].
What causes
Glaucoma?
Galucoma is a disorder which is
inherited. If there is a person
is diagnosed as having glaucoma,
all persons in the family should
be periodically examined by an eye
doctor as they run an higher risk
of developing the disease. Diabetic
persons have a higher risk of developing
glaucoma and they too should be
regularly examined. Persons wearing
high minus or high plus glasses
too are at a higher risk of developing
glaucoma, so they too should be
examined regularly by an eye doctor.
What are
the signs and symptoms of glaucoma?
One of the earliest symptoms of
glaucoma is frequent changes of
glass power. Normally glass power
changes once in one or two years.
Frequent changes in glass power
in the space of few months could
be an early indicator of glaucoma.
Eye strain particularly for near
work such as reading or computer
work could be an early sign of glaucoma.
Frequent head ache associated with
blurred vision and eye strain is
also an early sign of glaucoma.
Severe eye pain with red-ness, headache
and vomitting can occur if the intra
ocular pressure inceases suddenly
at very high levels. Seeing coloured
halos around bright lights is a
sign of glaucoma. Loss of vision
in the sides, i.e not being able
to see objects at the sides is sign
of glaucoma. If you have any of
the above symtoms you should have
your eyes examined by an eye doctor,
at his/her clinic.
How is glaucoma
diagnosed?
The eye doctor will :- examine your
vision, glass power if any, intra
ocular pressure and he will examine
the inside of your eye to evaluate
the retina and optic nerve. If there
are any positive results your eye
doctor will do a computerised visual
fields examination. The latest way
of monitoring glaucoma is to photograph
the optic nerve with the fundus
camera. Photographs taken over a
period of time are used to analyze
the progression of the disease.
This is specialised test to evaluate
the condition of your retina and
optic nerve. This test will dignose
glaucoma even before vision is badly
affected. With these tests your
eye doctor will be able to diagnose
glaucoma very early.
What happens
after diagnosis?
Once glaucoma is diagnosed treatment
is started immediately. In most
patients the treatment is in the
form of drops to be applied once
or twice a day. With application
of these drops the intra ocular
pressure will come down to normal
levels. This will have to be verified
by your eye doctor. If the pressure
remain at normal levels the patient
should be reexamined at regular
intervals of six months or one year
to make sure that the retina and
optic nerve are healthy. So once
daignosed medicines should be applied
regularly and the regular reviews
should be done. Eye drops should
not be stopped or changed without
the advice of your eye doctor.
In some patients
laser treatment such as YAG laser
iridotomy, Argon laser trabeculoplasty
or iridoplasty will cure the glaucoma.
These treatments are done at the
eye doctor's clinic, and does not
require any hospitalisation. A small
number of patients will require
surgical treatment to control glaucoma.
Whatever the treatment, early diagnosis
is necessary to get the best results.
With the appropriate treatment glaucoma
can be easily controlled. Regular
follow up is very necesary during
the treatment and in most patients
treatment is life long.
What are
the mistakes done by patients?
Many patients even when diagnosed
as having glaucoma, apply eye drops
irregularly or they some times discontinue
the medication. Most patients do
not understand the importance of
regular followup. Many persons wearing
glasses do not visit an eye doctor
once in one or two years as required,
and run the risk of not having their
condition diagnosed early. Regular
eye check up by an eye doctor once
a year will go a long way in diagnosing
this blinding disorder early and
will prevent loss of vision.
If you
are above 40, if you are a diabetic,
if you have family history of glaucoma,
if you wear glasses, or if you have
any of the symptoms mentioned above
see your eye doctor at his / her
clinic and have your eyes examined
once a year and insure your vision.
5. Diabetes
and the eye
Diabetes is a metabolic disorder.
Persons affected by diabetes have
increased levels of sugar in their
blood Treatment is by a three pronged
approach of diet control, exercise,
and drugs. Uncontrolled diabetes
causes deleterious effects on almost
all parts of the body. The eye in
particular is very vulnerable to
the effect of diabetes. It can affect
all parts of the eye from the lids
to the retina. All diabetics are
more prone than normal individuals
to have allergic responses in the
eye. This manifests as itching and
swelling of lids along with stickiness.
Dust and pollen cause this allergy.
This allergy will be greatly reduced
if the blood sugar levels are kept
under strict control. Many anti
allergic drops are available which
will give relief from the symptoms.
A word of caution is that these
medications must be used only under
medical supervision.
Diabetics
are more prone to developing lid
infections such as styes [lid boils].
Increased blood sugar and tissue
sugar levels make these tissues
less able to ward off infections.
Uncontrolled sugar levels can change
glass powers rapidly and drastically.
So much so that a person needing
frequent change of glasses is routinely
checked for blood sugar. Strict
control of diabetes will prevent
this complication.
All diabetics in spite of good
sugar control tend to develop cataract
slightly earlier than in normal
persons. If the blood sugar is not
controlled properly they tend to
develop cataract much earlier. In
very poorly controlled diabetics,
cataract can develop in a matter
of weeks. Whatever the cause of
cataract it can be treated by surgery
and implantation of an intraocular
lens. The new modality of sutureless
small incision surgery with foldable
intraocular lens is very suitable
for diabetic individuals. All the
above disorders can be treated at
any stage and normalcy restored,
though it would be better to prevent
them from occurring. Diabetic affliction
of the retina, which is known as
diabetic - retinopathy, is far more
serious. This condition is irreversible
and treatment is always directed
at prevention and containment,
In persons with diabetes the blood
vessels tend to thicken and the
internal passage become narrow.
With narrowing of the blood vessels
blood flows sluggishly. These problems
are more in the retina than any
other part of the body. With reduced
blood flow the retina gets. less
oxygen than necessary. This caused
blood products to leak from the
blood vessels into the retina and
causes swelling. Swelling of the
retina results in slow reduction
of vision. If left untreated further
leak of blood itself occurs and
vision is further reduced. This
reduction of vision cannot be rectified.
Any treatment will only maintain
vision at the same level. Thus it
is very important that this condition
be diagnosed very early even before
reduction of vision occurs and proper
treatment is started. Treatment
for this condition is by Argon laser.
This laser treatment is applied
to the leaking areas and the leak
is stopped. First a test called
FFA [ fundus fluorescein angiography]
is done to find out the leaking
areas and then laser is applied
to treat these areas. Early treatment
is necessary to prevent loss or
reduction of vision.
The important part of treatment
for diabetic retinopathy is regular
examination and proper follow up.
Any diabetic needs a yearly eye
examination. Persons with early
diabetic retinopathy need eye examination
twice a year. Even after laser treatment
[photocoagulation] the patient should
be examined every six months.
Diabetic individuals tend to develop
glaucoma more commonly than others.
Glaucoma is not caused by increased
sugar but is inherited along with
diabetes. All diabetic persons should
be routinely screened for glaucoma
and treated if necessary.
Golden
rules for diabetics -
1. Good diabetic
control
2. Yearly / half-yearly eye examination
3. Laser treatment as and when necessary
4. No self medication.
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