The retina is a very delicate, but extremely complex structure that lines the inner wall of the back of the eye. It contains the light sensitive elements – the rods and cones that allow us to see in dim and bright lighting conditions. It also contains numerous other cells and nerve fibers that are required for information processing. The vitreous is a jelly-like mass that fills up the back of the eye and has shock absorbing and nutritional functions.

• Horseshoe retinal tear

• Tear surrounded by laser treatment

• Retina

What can go wrong with these structures?

In premature children with low birth weight, retinal changes affecting sight can develop – retinopathy of prematurity. These and other developmental abnormalities of the retina and vitreous can also affect vision and need early care. Some infections can also affect these structures in children. The most serious lesion however, is a tumor termed retinoblastoma, arising from the retinal cells, threatening the eye and life of the baby.

In young adults, injuries can cause significant changes that affect sight. Sometimes however, there can be changes in the structure of the vitreous gel that are seen as floaters in front of the eye. These are usually harmless, although it is wise to have an eye exam to rule out serious retinal problems.

In older people, changes in the vitreous can result in pulling forces on the retina that can cause either a vitreous bleed, or a retinal detachment. A sudden increase in floaters without flashes of light is a matter for concern. Other aging changes can affect the center of the retina – the macula, an area needed for fine vision – changes in this zone result in black shadows in central vision, blurring or distortion of straight lines metamorphopsia.

The retina is affected in other systemic diseases-notably, diabetes mellitus and systemic hypertension. Blockage of the retinal vessels can result in vision threatening changes unless treated promptly. Infections of the structures within the eye are a very serious problem – endophthalmitis, and may occur after eye surgery. Prompt care is often successful in restoring sight in these eyes.

How will I know if I have these problems?

Since the primary function of these structures is to provide vision, most diseases affect sight – blurring, loss of field, floaters, flashes, central black shadows, and total loss of vision may occur. However, changes in the peripheral retina can be silent and require a detailed eye exam for detection.

What are the common causes of these diseases?

Genetic causes, injuries, infection, tumors, systemic

conditions, high refractive errors, and ageing changes account

for most of these diseases.

How can these conditions be detected?

A detailed evaluation of the back of the eye after dilation of the pupil, using an instrument called the indirect ophthalmoscope is required. In patients with diabetes, an imaging of blood flow in the retinal vessels is helpful- fundus fluorescein angiography. In age related changes of the central retina, two other examinations coherence tomography may be needed. If there is bleeding in indocyanine green angiography and optical the vitreous, ultrasonographic examination can help identify retinal changes.

How can these conditions be treated?

In changes of the blood vessels, the use of retinal lasers is often helpful, and these are also used to prevent serious eye disease in diabetics. In patients with infections, antibiotics; and in those with inflammation, steroids can be used. If there is serious vitreous bleeding or retinal detachment, surgery is required to restore vision. In age related central retinal disease, in addition to laser therapy, the injection of medications into the eye can be helpful.

Recent advances in vitreous and retinal diseases

Instruments are now available that allow the diagnosis of these diseases at a very early stage. Newer treatment option include photodynamic therapy for subretinalneovascularization, the use of intravitreal triamcinolone injections for diabetic macular edema, and anti VEGF agents for age related macular degeneration, all of which have improved our ability to treat retinal diseases.

General information

High myopes may be prone to central and peripheral retinal changes and should have a routine yearly eye exam. Similarly, diabetics and hypertensives should have a yearly eye exam in addition to good control of the systemic condition to protect their eyes and sight.

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only

Glaucoma is a leading cause of blindness especially for older people. It is a disease of the optic nerve. When damage to the optic nerve occurs, Blind spots in the field of vision develop, and usually go undetected until the optic nerve is significantly damaged. Early detection and treatment are the keys to preventing optic nerve damage.

What causes glaucoma?

Clear liquid called aqueous humor circulates inside the front portion of the eye and flows out through a drainage system (located in the angle of the anterior chamber). If the drainage angle is blocked or inefficient, the aqueous humor cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve and causing damage.

What are the different types of glaucoma?

Chronic open-angle glaucoma: This is the most common form of glaucoma. The drainage angle becomes less efficient over time, and pressure within the eye gradually increases, which can damage the optic nerve. Typically, open-angle glaucoma has no symptoms in its early stages, and vision remains normal. As the optic nerve becomes more damaged, black spots begin to appear in your field of vision. Closed angle glaucoma: Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can block the drainage angle completely. The pressure inside the eye builds rapidly and causes an acute closed-angle attack. Symptoms may include: blurred vision, severe eye pain headache, rainbow-colored halos around lights, and nausea and vomiting. This is a true eye emergency -call your eye doctor immediately. Unless this type of glaucoma is treated quickly, blindness can result.

Who is at risk for glaucoma?

The most important risk factors include age, elevated eye pressure, family history of glaucoma. farsightedness or nearsightedness, past eye injuries, thinner central corneal thickness, systemic health problems, including diabetes, migraine headaches, and poor circulation. Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect.

How is glaucoma detected?

Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. The only sure way to detect glaucoma is to have a complete eye examination. During your glaucoma evaluation, your ophthalmologist will: measure your intraocular pressure (tonometry); inspect the drainage angle of your eye (gonioscopy); evaluate whether or not there is any optic nerve damage (ophthalmoscopy); and test the peripheral vision of each eye (visual field testing, or perimetry.)

How is glaucoma treated?

As a rule, damage caused by glaucoma cannot be reversed. Eye drops, laser surgery, and surgery in the operating room are used to help prevent further damage. In some cases, oral medications may also be prescribed. Periodic examinations are very important to prevent vision loss. Because glaucoma can progress without your knowledge, adjustments to your treatment may be necessary from time to time.

General information:

Regular medical eye exams help prevent unnecessary vision loss. Recommended intervals for eye exams are: Ages 20 to 29: Individuals with a family history of glaucoma should have an eye examination every 3 to 5 years. Others should have an eye exam at least once during this period. Ages 30 to 39: Individuals with a family history of glaucoma should have an eye examination every 2 to 4 years. Others should have an eye exam atleast twice during this period.

Age 40 and older: Every year

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only

Tips for choosing the right spectacles:

Although nature ensures that most people see well, in some eyes a mismatch between the “Power” and “length” of the eyeball, results in poor vision. This is termed as refractive error. These can be classified as myopia, hyperopia, or astigmatism depending on whether the power is too high, too low, or different in different axes. Presbyopia is the term used to describe the need for reading glasses. Traditionally, refractive errors have been treated with spectacles, and while these work well in the majority of patients, some simple rules have to be followed when selecting them. These include

Choose the right frame:

Since spectacles are usually worn throughout the day, having a comfortable frame is very important. A good fit is as important as a trendy look. The Most important aspect of a frame is that the eyes should see through the center of the lens. Hence, please wear the frame and look at yourself in the mirror to ensure this. Since the shape of each face is different, this can sometimes be a challenge. Once this is done, make sure that the length of the side stem is appropriate. The loop of the stem should fit securely around your ear. If it is too long, the frame will tend to slide forwards when the head is tilted. However, if too short or too tight, the pressure exerted by the frame will result in a headache. A shell frame distributes the weight of the spectacles on the bridge of the nose and is less likely to leave unsightly pressure marks on the nose, unlike frames with nose pads.Rimless frames look nice, but are quite delicate and should be chosen only if proper care will be exercised, as they tend to get bent and distorted quite easily.

The optician will ensure that the power and centration of the lens are appropriate. However, there are other choices that you can make when choosing your spectacles and it is important to be aware of them. In general, glass lenses are heavier than plastic lenses and this is especially true for higher refractive errors. Plastic lenses are also the best choice when choosing spectacles for children, as they do not break and are hence safer. Similarly, when choosing a delicate frame, be sure to use a plastic lens to lessen the weight of the spectacles. To reduce the thickness of the lens in higher refractive errors, choose a high index material both in glass and plastic. Choosing a frame with a smaller eye segment will also help in achieving a better cosmetic appearance in such cases. Tints in the lens help reduce glare, and do not interfere with vision in indoor lighting conditions. For those who spend a lot of time outdoors, a photo chromatic lens, which darkens on exposure to sunlight, can be helpful. Antireflective coatings help to reduce glare at night. Scratch resistant coatings will reduce the risk of damage to the lens surface.

Reading glasses

For those who do prolonged reading, a separate pair of glasses in a regular frame, will provide greater reading comfort. However, for those who are mostly outdoors, with only occasional reading requirements, using half segment readers are more convenient as they can carry these small frames more. easily. For those whose work requires the constant use of both distance and near vision, as in an office environment, the use of bifocals is recommended. These lenses consist of two distinct segments an upper portion for distance viewing and a lower portion for near viewing. If the person has predominantly distance viewing requirements, a kryptok bifocal, with a smaller reading segment is helpful; while for those with more reading requirements, an executive bifocal, with a larger reading segment is helpful. The presence of two distinct segments with a dividing line can be disturbing in some individuals, due to the image jump when the eye traverses this line. In these individuals, and also in those who use computers a lot, the use of a progressive or transition lens in which there is no distinct separation of the distance and near segments of the lens, is helpful.

Looking after your spectacles is as important as making the right choice when ordering them. Carry the spectacles in the provided box to ensure that they do not get damaged. Clean the lens with soap and running water, and then shake them dry, before gently cleaning the surface of the lens with the provided cloth. Do not clean them when there is dust and grime on the surface as this can result in scratches. Be sure to regularly clean the hinges of the frame to ensure that they open and close smoothly.

We hope the above information has been helpful in making your use of spectacles a safe, comfortable, and rewardng experience. If you have any suggestions or comments, please do let us know at drkaushalshah@gmail.com

Please note the refractive errors can also be treated by contact lenses and by excimer laser corneal surgery (PRK and LASIK), if you desire not to wear spectacles. To check if these options are suitable and advisable for you, please consult your ophthalmologist, who will help you decide.

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only

Although structures in the child’s eye are similar to that in adults, the visual pathways continue to develop in a child. Hence, any obstruction to vision at a young age can cause permanent damage to the system that cannot be corrected later. Since small children often may not notice such changes, it is very important that all children undergo a screening eye exam at an early age.

Long sight (Hyperopia) Correction by a convex lens

What are the common problems in a child’s eye?

A common problem is a refractive error high myopia, hyperopia, or astigmatism may exist in one or both eyes, especially if these are also present in the parent. These may be associated with misalignment of the eyes, squint, which can however, also exist by itself. Other problems can be structural – cataracts, glaucoma, corneal or retinal disease, and these may be present from birth. A rare but very serious problem is a tumor of the retina retinoblastoma. If the normally black pupil appears white (white reflex) in the eye of a child, please arrange for an immediate eye exam, as also in the case of premature births.

What is a ‘lazy eye’?

Amblyopia, also known as ‘lazy eye’, is reduced vision that does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but rarely both eyes can be involved. A simple vision screening test can detect this-condition, and should be performed in all children since amblyopia is best treated in the early stages.

What is a ‘squint’?

Strabismus or ‘squint’ is a vision condition in which a child cannot align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time such as, under stressful situations or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. Children do not outgrow strabismus!

What is nystagmus?

Nystagmus is an involuntary rhythmic shaking or wobbling of the eyes. The eyes move constantly in various directions, although horizontal movements are the most common. The presence of nystagmus in a child is often an indication of vision problems. Treatment will depend on the cause. Sometimes, the presence of a nystagmus can indicate neurological dysfunction, and rarely, it can be a side effect of medication use.

How can these conditions be detected?

Children may not complain of problems, and a detailed examination is needed. In infants, the examination is done under general anesthesia. Parents may notice peculiar head posturing, constant side-to-side eye movement, squinting. sitting very close to the TV, or a white reflex in the pupil. The eye exam includes assessment of vision, special tests for stereopsis, (ability to use both eyes simultaneously), eye alignment, pressure and thorough examination of the front and back of the eyes.

How can these conditions be treated?

If a refractive error is detected early, simply providing the correct glasses will correct the problem. If detected late, and one both eyes are already ‘lazy’, then in addition to glasses, other measures may be required – these include eye exercises, and patching or occluding an eye to force the child to use the other eye, thereby ‘strengthening’ that eye.

If there is a squinting of the eyes, in some types, glasses may be corrective, although quite often surgery may be required.

For other problems, like cataract, glaucoma, corneal and retinal disease, the doctor will discuss in detail the options for treatment these could include the use of laser treatment or surgery. If a retinoblastoma (eye tumor) is present, early care is necessary to save the eye and life of the child.

General information

Your child should have his or her first eye exam done during the first year of the child’s life. The next eye exam will be at the age of 3, and once again before entering kindergarten, or by age 5. Thereafter, your child should receive a comprehensive eye exam at least every two years. Since prevention is better than cure, it is better to detect these problems at an early stage.

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only

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