Q. I went for a checkup and my doctor said I have cataract in my eyes and it needs surgery. What does it mean?
Answer :

Every human being has a natural lens in their eye which helps them to see. With age, this lens gradually becomes opacified, and vision becomes blurred. This condition is known as cataract.

In cataract surgery, this damaged lens is removed and in its place, a new artificial intraocular lens (IOL) is implanted, which helps the patient to see clearly again.

Answer :

At the Himalayan Eye Institute, 3 types of cataract surgery are availabe:

a) Micro-Phaco - Surgery is performed through a 2.2 mm incision, and a foldable IOL is implanted. It has the most rapid recovery time and minimal post-operative pain.

b) Phaco - Surgery is performed through a 2.8 mm incision, and a foldable IOL is implanted. It also has rapid recovery time and minimal post-operative pain.

c) Manual SICS - Surgery is performed manually with a 6-7 mm incision and a rigid/foldable IOL is implanted. It has a slower recovery time.

Answer :

A wide variety of lenses are available at the Himalayan Eye Institute:

a) Monofocal lenses - These lenses give clear vision for the distance after surgery. However, glasses will be required for near vision. They are available from both Indian and foreign manufacturer companies.

b) Trifocal lenses - These are advanced lenses which provide clear vision for distance, intermediate (eg. computer use) and near vision (eg reading) after surgery.

c) Toric lenses - These lenses are suitable for patients who have pre-existing high cylindrical power (astigmatism), which can be corrected by this lens.

d) EDOF lenses - Extended depth of focus lenses are the newest lenses available which give clear vision for the distance, as well as an extended range of vision from distance to intermediate. Glasses will be required for near vision after surgery.

Your doctor and cataract counsellor will discuss in detail with you the best suitable lenses for you after your eye's full checkup and understanding your daily activities and vision requirements. However, the final choice of lens lies with the patient after fully understanding all available options.

Answer :

Foreign lenses usually come with additional features like better contrast sensitivity, crisp vision, higher clarity (like higher megapixel of camera), better lens stability, UV-absorbing and blue-light-filtering IOLs etc. However, Indian lens of high quality are also available with the above mentioned features. At the Himalayan Eye Institute, we use only those lenses which are time tested and widely used.

Once lens is put inside the eye, it is usually not removed or replaced during lifetime like we frequently change our spectacles. Hence, it is always advisable to opt for better quality lens, especially if patients do more outdoor activities, drive at night, spend significant time on computers, watching TV and mobile etc.

Answer :

The most common cause of cataract formation is increasing age. Almost every human being will develop cataract in both their eyes in their lifetime. Poor nutrition, increased oxidative stress, smoking, co-existing eye disease, history of eye surgery, traumatic injury to the eye, co-existing systemic disease such as diabetes, may cause earlier formation of cataract.

Answer :

The retina is the sensory membrane which lines the inner surface of the back of the eyeball. It converts light into electrical signals which are then transmitted to the brain through optic nerve, which helps us to "see". A healthy retina is necessary for good vision.

The common diseases affecting the retina are:

  • Retinal vascular diseases e.g. Diabetic retinopathy, Hypertensive Retinopathy, Venous occlusions, Arterial occlusions.
  • Macular disorders e.g. ARMD, CSCR, CNVM, macular dystrophies, macular hole
  • Retinal detachment
  • Vitreous Haemorrhage
  • Retained intraocular foreign body after trauma
  • Anterior segment complications e.g. Subluxated lens, Dropped Nucleus, Dropped IOL, Endophthalmitis etc.
Answer :

It is recommended for anyone above the age of 40 years to get their full eye checkup, including retina examination, once in a year. Apart from this, individuals who have the following risk factors are at a higher risk of retinal disorders:

  • Diabetes mellitus
  • Hypertension
  • High myopia
  • Family history of retinal disorders

Retina checkup is mandatory for such individuals.

Answer :

A retina examination takes a little more time than a routine eye exam. It involves dilation of your pupils, examination by the retina specialist and diagnostic testing if required. It may take about 2-3 hours for the complete examination. Dilation enlarges your pupils to allow the doctor a better view inside your eye. It is important to know that your vision will be blurred and you will be sensitive to light (photophobic) for several hours following this. Therefore, we recommend that you bring sunglasses and not drive after your appointment. It is better to have an attendant with you for this test.

If required, the patient’s eye is then examined using advanced diagnostic technologies such as OCT, angiography, and fundus photography. A photographic documentation of the retina helps to make an accurate diagnosis and keep a track of the improvement in the eye.

Answer :

Retinal laser or photocoagulation is a process by which laser is applied through a binocular indirect ophthalmoscope or slit lamp laser delivery system for treatment of leaking blood vessels (diabetic retinopathy/retinal venous occlusion) or peripheral retinal holes and lattice degenerations.

Answer :

Intravitreal injection involves using a very fine injection to deliver a medicine directly into the vitreous cavity of the eyeball. They can be of the following types:

a) Anti-VEGF injections: These injections are given in patients of diabetic retinopathy, retinal venous occlusion, wet age related macular degeneration, CNVM and retinopathy of prematurity. These drugs allow rapid resolution of fluid inside the retina, as well as prevent growth of new leaky blood vessels, hence preventing bleeding inside the eye. Following anti-VEGF injections are available at the Himalayan Eye Institute:

  • i) Accentrix (RANIBIZUMAB, Novartis)
  • ii) Razumab/ Ranieyes/Oceva (Indian Biosimilar Ranibizumab)
  • iii) Eylea (AFLIBERCEPT, Bayer)
  • iv) Pagenax (BROLUCIZUMAB, Novartis)
  • v) Avastin (BEVACIZUMAB, Roche) - (off-label drug)

*anti-VEGF injections are not suitable for any patient who has a history of a heart attack or stroke in the last 3 months, or in pregnant women.

b) Steroid injections: In certain patients (diabetic retinopathy/retinal venous occlusion) for whom anti-VEGF injections are not suitable, or are not giving adequate results, intravitreal steroid may be used, if suggested by your doctor. The following injections are available:

  • i) Ozurdex implant (Dexamethasone implant, Allergan) - implant slowly releasing medicine upto 3-4 months
  • ii) Triamcinolone

*Intravitreal steroid may cause increase in intra-ocular pressure and cataract formation, and requires regular monitoring for the same.

c) Antibiotic Injections - In endophthalmitis cases, intravitreal antibiotic injections are required.

*It is pertinent to note that intra-vitreal injections may need to be repeated multiple times for adequate treatment, depending on the stage of the disease. They help to stabilise the disease progression, and may provide limited visual gain.

Answer :

Glaucoma, also known as "Kala Motia" is an eye disease in which there is an increase in pressure inside the eye. Just as some people have high blood pressure, in the same way a glaucoma patient has high eye pressure.

If the eye pressure remains high for a long time it damages the optic nerve which carries the light sense from the eye to the brain. This damage to the nerve is irreversible and leads to permanent and incurable blindness. Glaucoma is the second leading cause of blindness in the world with 70 to 105 million people affected worldwide (WHO).

Answer :

Glaucoma is often referred to as "silent thief of vision" as it can strike without any symptoms. However, some glaucoma patients may suffer symptoms like:

  • Severe eye pain in case of angle closure glaucoma
  • Blurred vision
  • Frequent changes of reading glasses
  • Difficulty in seeing side vision
Answer :

Your doctor will discuss with you the stage of your cataract and the need for immediate or delayed surgery. Currently, the only treatment for cataract is by surgery, and no medicine is known to reverse or prevent cataract formation. In very early stage of cataract, the doctor may recommend to use glasses, and be on regularcheckup. However, ultimately, a surgery needs to be planned for the same.

Answer :

Waiting for "maturity" of cataract is an old concept associated with older generation of surgery. Modern cataract surgery is best performed at an appropriate stage decided by the doctor, much before maturity. In fact, maturity is often associated with higher risk of complications during surgery. The correct stage for modern cataract surgery is a mutual decision between the doctor and the patient, depending on the grade and type of cataract, and the patient's visual requirements.

Answer :

Gradual, painless of dimness in vision, not fully improving with glass, is the hallmark of a progressing cataract. Some patients may also experience double vision, difficulty in night vision, or difficulty in bright light conditions.

Answer :

Cataract surgery is one of the safest and most painless procedures, with high success rate in expert hands; however it should not be considered a minor procedure. Like any surgical procedure, it is associated with certain risks, which will be discussed by your doctor and cataract counsellor, as well as explicitly mentioned in consent form.

Answer :

Modern cataract surgery is a very safe and painless procedure. It is a daycare procedure, and you do not need to be admitted overnight for the same. Even though the procedure only takes 15-20 minutes, you are advised to keep 4-6 hours in hand for entire hospital stay, from pre-operative medication to post operative recovery period. The surgery is performed with topical (using drops) or local (using injection) anesthesia. You will be awake during entire procedure, and even able to communicate with the surgeon, but you will not experience any pain.

Answer :

Post operative recovery is usually rapid and painless. Certain restrictions such as avoiding head bath and use of dark glasses will be explained to you in detail by our counsellor. Glasses are usually prescribed 1-2 weeks after surgery.

Answer :

Myopia or short sightedness is a type of refractive error in which the light rays come to focus in front of, instead of on, the retina. This makes distant objects blurry, while near objects are seen clearly.

It is most commonly due to abnormal elongation of the eyeball (axial myopia). Most commonly, a child's myopia is diagnosed when the school teacher notices that the child is not able to read the blackboard from back benches, or the child is noticed to move too close to television or other objects to read things.

Answer :

As the child's height increases through his growing age (6-16 years), the length of his/her eyeball also may increase, resulting in increasing minus power. Usually this process becomes stable between 16-18 years. Increasing power >0.50 D in 6 months or >0.75D in one year is considered to be rapid progression.

Answer :

Family history of myopia, excessive near work (especially screen time), limited outdoor activities increase the risk of increasing myopia. For young children, using too much phone/tab from a very short distance is one of the most important causes of rapidly increasing minus power.

Answer :

Myopia can be corrected by glasses and/or contact lenses.

Answer :

Rapid progression of myopia may need myopia control therapy in the form of eyedrops (low dose atropine), specially designed myopia controlling glasses or contact lenses, exercises, and lifestyle modifications (increased outdoor activities, limited near work with adequate breaks, proper posture).

Answer :

The progression of myopia as well as certain measurements of the eye are recorded to identify the type of myopia, as well as monitor its progression once myopia control therapy has been started. This test measures the length of the eyeball, as well as curvature and thickness of the cornea, among other parameters. It is completely painless, and feels just like clicking a photograph.

Answer :

A comprehensive myopia oriented eye checkup at the myopia clincic includes detailed history taking (to detect risk factors for myopia development), measuring the eye's vision, power, accomodation/ focussing capabilities by our senior optometrist. A precision measurement of the eyeball length and corneal curvature are noted. A retina examination is performed to rule out any developing retinal pathology. After this detailed checkup, the doctor and optometrist suggest a myopia control plan tailormade for the child.

Answer :

A growing child's power should be checked every 6 months till his/her power becomes stable.

Answer :

Sometimes, if refractive error remains uncorrected from an early age, the vision may remain low in one or both eyes even after wearing glasses at a later period. This is known as lazy eye or amblyopia. If detected early, it can be corrected with the help of glasses as well as certain exercises such as occlusion therapy.

Answer :

High myopia (> -6 D) increases the risk of retinal problems such as retinal detachment, myopic maculopathy. Periodic retina checkup is recommended for the same. Myopia control therapy from an early age prevents the child's eye from becoming highly myopic.

Answer :

Wearing glasses constantly is essential for myopic children in order to see clearly, as well as for better visual and neurological development. For older children, contact lenses is also an option. Once power becomes stable and the age is more than 18 years, removing the power with the help of laser (LASIK) or implantable contact lenses (ICL) is also an option.

Answer :

Intravitreal injection is a very fine injection given inside the OT. The eye is anesthetized using eyedrops, making the injection painless. It is a day care procedure, and the patient is discharged soon after.

Answer :

Vitrectomy is a surgery done to repair or prevent retinal detachment, especially when it threatens to affect the macula. Vitrectomy is also carried out to clear bleeding inside the eye i.e, vitreous haemorrhage which can occur  in cases of  diabetics, trauma or venous occlusions. Advanced macular surgeries for macular hole, epiretinal membrane, vitreo-macular traction, are also available. We have the most advanced vitrectomy machine and the expertise to deal with complex retinal problems.

Answer :

In fundus angiography, a small amount of yellow fluorescein dye is injected which travels to the eye, where it highlights the blood vessels. It is particularly useful in showing leaking blood vessels and highlighting where the blood supply in the eye is poor. After this, photographs of the eye are taken.

Answer :

Watery Eye (Lacrimation / Epiphora)

A watery eye is caused by over production of tears due to irritation by in-growing lashes, infection, eyelid disease or an obstruction in the drainage of tears in the eye. The treatment depends on the cause of the disease. For example, if the lower eye lid is sagging away from the eye, eyelid will be repositioned through surgery. If the drainage pathway of tears is blocked, a DCT/DCT surgery may be required.

Answer :

Ptosis or ‘Drooping’ of the eyelid can be present from birth or develop later in old age. It is a cosmetic blemish but if severe, it restricts vision as well. The treatment in majority of cases consists of surgical correction. Surgery involves either strengthening the muscle, which elevates the lid, called LPS resection, or lifting up the lid with the help of a graft.

When ptosis occurs in adults, it may be the result of a systemic disease, such as myasthenia gravis, which can be treated medically. It can also follow muscle or nerve damage in other parts of the body, or tumors of the lid. When ptosis occurs suddenly in one eye, disease of the brain itself must be considered, and the patient should be seen at once by a neurologist.

Answer :

Smiling, frowning, squinting and even chewing - basically any facial movement can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of Botox.

Botulinum toxin can be used as a wrinkle treatment to smoothen:

  • Frown lines
  • Crows feet
  • Forehead furrows
  • Skin bands on the neck

Botulinum toxin can be combined with other cosmetic skin procedures such as chemical peels, dermal fillers or microdermabrasion to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

Answer :

The Ocular Prosthesis service is available at The Himalayan Eye Institute, for the management of patients with eviscerated, enucleated socket (removed eye) and phthisical eye (shrunken eye). These problems are managed cosmetically by prosthesis.The institute offers both Customized Prosthesis, i.e., preparing eye shells for the patients according to their socket dimensions; and also, there are Stock Eyes of readymade eye shells.

Answer :

For Eyelids:

  • Ptosis correction
  • Entropion correction
  • Ectropion correction
  • Lid retraction
  • Lid construction
  • Epiblepharon correction
  • Trichiasis management

For Lacrimal Gland (Tear Gland)

  • External DCR (with silicon intubation)
  • Canalicular repair
  • Syringing and probing
  • Punctal occlusion for dry eye

For Eye Socket

  • Enucleation with implants
  • Evisceration with implants
  • Exenteration
  • Dermis fat graft
  • Socket rehabilitation
  • Contracted socket repair
  • Anophthalmic socket rehabilitation
  • Customised prosthesis

Cosmetic procedures:

  • Botox
  • Upper and lower lid blepharoplasty
  • Epicanthus correction
Answer :

Blepharoplasty is a surgical procedure that removes excess tissues (skin, muscle or fat). It can be performed on the upper eyelid, lower eyelid or both. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid tiring the eyes. The procedure is also used to improve facial appearance by making the area around the eyes firmer and eliminating sagging skin under the eyes.

Answer :

Apart from being cosmetically unacceptable, any irregularity of the lid margin is functionally detrimental to the eye, as lid defects may fail to cover the cornea fully and provide adequate lubrication. Our oculoplastic surgeon repairs the injury in a way to make the lid as close to normal as possible.

Answer :

Normally tears from the eye drain to the nose through the lacrimal passage. In case of any blockage in this passage, watering results. The causes can be incomplete development, seen in young children, or infection, which occurs in adult life. Treatment varies from performing a relatively simple procedure like ‘probing’ the pathway to open it, to more complex surgery of fashioning an alternative pathway to drain the tears to nasal cavity. This procedure is known as dacryocystorhinostomy (DCR). Sometimes, when an alternate pathway creation is not possible, the infected lacrimal sac may need to be removed by dacryocystectomy (DCT) to prevent repeated infections of the sac (dacrycystitis).

Answer :

Lid margin abnormalities - Entropion

In a condition known as entropion there is inward turning of the eyelids, causing the eyelashes to scratch the cornea and produce irritation. Tearing and secondary infections as well as an unpleasant looking eye cause the patient to seek medical care. Entropion may be the result of spasm or secondary contracture or strictures from burns, injury or trachoma infection. It may involve the upper or lower lids. An adhesive tape applied to the skin of the lid temporarily may straighten the lid and relieve the annoying symptoms. Corrective surgery is usually required for a permanent cure.

Lid margin abnormalities - Ectropion

Ectropion is the opposite condition, and the lower lid usually turns away from the eyeball. Ectropion may be due to laxity of the tissue in elderly people or to paralysis of the seventh cranial nerve (the nerve which controls the facial expressions), which causes the weakness of the muscles of the lid. It may also follow cuts, infections, or burns of the lids and face that heal poorly; the resultant scar tissue forms adhesions that cause the lids to turn out. Besides being cosmetically unpleasant, ectropion is accompanied by troublesome tearing and infection. Treatment is surgical rotation of the lid margin and its alignment with the eyeball.

Answer :

Lid margin abnormalities - Trichiasis

Trichiasis is a condition in which there is misdirection of eyelashes. If the eyelashes turn in toward the eyeball and scratch the cornea, they produce a sensation like a foreign body. This condition may result from trachoma (an eye infection), burns or injuries to the lids. Removal of the offending lashes or corrective plastic surgery on the lid relieves the symptoms.

Answer :

Everyone is at risk of getting affected by Glaucoma. But certain risk factors for the disease are:

  • High intraocular pressure
  • Age - risk increases with age, especially those beyond 40 years of age
  • Heredity - Primary open angle glaucoma risk is high if there is a family history of glaucoma
  • Ethnicity - Glaucoma is common among Asians, Africans, Americans and Hispanics.
  • Traumatic eye injury - in such cases, glaucoma can occur immediately after the injury or even in later years
  • High myopia (nearsightedness)
  • Diabetes
  • Thyroid disease
  • Hypertension
  • Steroids intake
Answer :

Periodic eye check-up is the best way to detect Glaucoma early. Glaucoma can be detected using following basic tests:

  • Visual acuity test
  • Tonometry, to measure the eye pressure
  • Gonioscopy, to assess angle of anterior chamber
  • Evaluation of optic disc damage by fundoscopy
  • Perimetry Test for visual field examination
  • OCT RNFL test to measure the thickness of the nerve fiber layer.
Answer :

Glaucoma can be of two types. In open angle glaucoma, the drainage pathway is wide open, still there is increased eye pressure due to increased formation of aqueous humour (fluid of eye). In closed angle glaucoma, eye pressure is raised due to blockage in the drainage pathway of the fluid due to narrow or closed angle of the eye. Apart from this, some people also have secondary glaucoma, i.e developing glaucoma as a result of some other disease in the eye eg diabetic retinopathy, venous occlusion in the retina, after trauma etc.

Answer :

Glaucoma cannot be cured, but it can be controlled. As damage to nerve caused by glaucoma cannot be reversed, the aim of the treatment is to prevent or reduce further damage to the optic nerve. The first step to do that is to lower the eye pressure. The three modalities of treatment are:-

Medical treatment:

  • Your doctor will prescribe you certain medication (Eye drops and tablets) so as to lower your eye pressure. You must use the medicines regularly as directed by your ophthalmologist.
  • You should not stop medicines even if you do not have symptoms.
  • A regular follow up, as advised by your doctor, is mandatory.

Laser treatment:
A laser peripheral iridotomy (PI) is required for patients with angle closure glaucoma to open up the drainage area for the fluid of the eye (aqueous humour). It is a simple outpatient procedure which can protect the eye from developing attacks of angle closure attack in the future.

Surgery (Glaucoma Filtering Microsurgery or "By-pass" surgery of eye - Trabeculectomy)

Operation for glaucoma is suggested for patients in whom the eye pressure is not controlled with medication or laser. It is also the treatment of choice in non-compliant patients, and in infants and children with glaucoma. Filtering microsurgery involves creating a drainage pathway with the use of a small surgical tool, to bypass the blockage in the eye’s trabecular meshwork (the eye’s drainage system). This opening helps increase the flow of fluid out of the eye and thereby reduce the eye pressure.

Answer :

Glaucoma surgery is a major surgery, and it requires regular checkup even after surgery. The surgery is performed under local anesthesia (injection), hence the patient does not feel any pain during the surgery. It is important to remember that life long checkup is mandatory even after surgery, and sometimes a patient may require medicines to control eye pressure after surgery.

Things to remember about Glaucoma:

  • Glaucoma, like diabetes, cannot be cured only controlled
  • Vision lost due to glaucoma cannot be recovered
  • Early detection and treatment of glaucoma will prevent further loss of sight and blindness
  • It is essential that people above the age of 40 and those with family history of glaucoma should have their eye examined periodically to detect glaucoma early
  • Once diagnosed as having glaucoma, the patient should be committed for life-long treatment and periodic eye check-up.
  • Drugs prescribed by the doctor should be regularly used at the specified time to ensure round the clock pressure control.