Services

Computerised Eye Testing

Computerised Services

Computerised eye testing only provides a guide based on which eye specialist or optician can make further tests for glasses which will be most appropriate depending on your circumstances. It is not always necessary to dilate the pupils to examine your eyes. This computerised eye testing is not very accurate either and every reading on this will be slightly different. This is also only for glasses prescription and not for checking the health of the eyes.

The gimmick of Computerized eye testing

Do you have a computerized eye testing? A very common question asked at our clinic. Eye testing on a computer really gives the satisfaction to a large chunk of population who refuse to even step in a clinic who don’t advertise about eye testing being computerized.

Is computerized eye testing accurate?

Personal computer is accurate but is it the same as eye testing computer? Is it a must for every clinic? To start with, let me tell you it is actually known as Auto-refractometer. This machine throws light in the eye and measures the reflecting light, giving us a good starting point to test your vision

The men behind the machines are important

This power has to be refined depending on the age, condition of the eye muscles, nature of work and other eye problems. This is known as subjective testing wherein you are made to read the letters on the chart at a fixed distance. Here your responses are assessed.

Can eye testing be done without a computer?

Practitioners, who do not have an auto refractometer, use retinoscope to arrive at the starting point for subjective testing. Retinoscope is perhaps the most important instrument in an Eye care practitioners arsenal. If a person is an experienced retinoscopist then he can be most accurate.

So does that mean eye testing on Auto refractor is a sham?

The reason why eye care practitioners prefer to have the autorefrator, is that retinoscopy needs lot of skill and is time consuming in untrained hands. For kids especially it is very difficult to keep them co-operating for retinoscopy. Here the auto-ref. comes to help. On few occasions it could be the other way round.

Confused about should eye testing be computerized or not?

So next time you want to have an eye check up, do not ask if it is computerized but ask if the person behind the machine is qualified and institutionally trained to examine eyes. This will get you the most accurate prescription.

Suturless Cataract Surgery

Suturless Services

I am an Ophthalmic Surgeon with 10 years experience in general Ophthalmology. I have detailed clinical and surgical knowledge of General Ophthalmology and have sound experience in sutureless cataract surgeries under topical anaesthesia (without injection).

A key issue in converting to sutureless cataract surgery is training. This article first describes the main surgical steps and complications of sutureless cataract extraction and their management.

Surgical Steps and Intra-operative Complications

Construction of a self-sealing wound
Opening of the anterior capsule
Hydrodissection
Nucleus delivery

a. Construction of a self-sealing wound

A stable, self-sealing wound of appropriate size is the precondition for sutureless cataract extraction. To create a valve-like incision, the tunnel has to be prepared 1 to 2 mm into clear cornea before the anterior chamber (AC) is entered. The required tunnel size can be anticipated by the appearance of the cataract and patient age. Deep brown nuclei in older patients will need very large tunnels, whereas cataracts in younger patients may require incisions just as large as the IOL. Use of sharp instruments and good catching forceps (Paufique or Pierce type) for scleral fixation help to achieve the desired results. In deep set eyes, where the operating field is difficult to access, the tunnel should be prepared temporally or supero-temporally rather than superiorly.
Premature entry: Dissection of the sclera is too deep and the AC is entered in the AC angle. The iris will easily prolapse and the wound will leak.
Button hole formation: The dissection of the sclera is too superficial.
Descemet's membrane injury or stripping: The keratome tip may be blunt or the angle at which the AC is entered may be too shallow.
A more shallow dissection can be started at the other end of the tunnel. Suturing of the wound is required at the end of the surgery.
Usually, this can be corrected by making a deeper frown-incision and dissecting the tunnel in a deeper plane, starting at the opposite side of the button hole. Injection of an air bubble at the end of surgery usually results in reattachment of Descemet's membrane. Accidental removal of Descemet's membrane and overlying endothelium will result in irreversible corneal decompensation.

b. Opening of the anterior capsule

The anterior capsule can be opened either by capsulotomy or capsulorhexis. Capsulotomies are easy to perform. A capsulorhexis is more difficult, but will guarantee long term IOL centration.
Linear capsulotomy: Rarely, an incomplete or oblique capsular tear will result, which makes mobilisation of the nucleus difficult.
Capsulorhexis: Peripheral extension of a capsulorhexis is the most common complication.
Extension of the capsulotomy with scissors solves the problem. Anterior capsule staining and the use of capsule forceps (Utrata type) can reduce this risk. For a controlled rhexis, sufficient visco-elastic has to be injected to deepen the AC. The capsule flap should be gripped close to the advancing tear while pulling it centrally and slightly upwards. A failed capsulorhexis can be converted to a can-opener capsulotomy.

c. Hydrodissection

Hydrodissection separates lens cortex with nucleus from the capsule. In conditions such as posterior polar, traumatic or hypermature cataracts with risk of pre-existing posterior capsular dehiscence, hydrodissection should be avoided.
Incomplete hydrodissection
Hydrodissection is most effective if the fluid is injected directly under the capsule.

d. Nucleus delivery

A variety of techniques can be used for nucleus delivery (see previous articles in this issue). However, similar complications may be encountered with all these techniques, especially when large nuclei have to be extracted.
Small capsulorhexis: The nucleus cannot be tilted or prolapsed out of the capsular bag.
Small tunnel: Inadequate size of the tunnel will create unnecessary trauma during nucleus delivery.
The rhexis has to be enlarged by radial relaxing incisions.
After mobilisation of a big nucleus, it is wise to re-check the size of the inner tunnel opening. If the wound seems to be small compared to the nucleus size, it should be enlarged before nucleus removal is attempted. In techniques where the nucleus is prolapsed into the AC before delivery, sufficient visco-elastic has to be injected above the nucleus to prevent endothelial touch.

Posterior capsule rupture (PCR)

PCR may occur during hydrodissection, nucleus delivery or cleaning of cortex.
Once a PCR is noticed, irrigation should be stopped and vitreous integrity should be checked. If the anterior vitreous face is not disturbed, remaining lens cortex can be aspirated, using as little irrigation as possible. In case of any vitreous disturbance, anterior vitrectomy has to be done. In settings with limited resources, a simple, battery operated vitrectomy machine can be used for managing PCR (Figure ​(Figure1).1). If the cutter is immediately flushed with water and air after use, it can be re-sterilised and used many times.

RETINA Evaluation

Diabetic and Hypertensive retinopathy

Diseases And Conditions Of The Retina

Age-Related Macular Degeneration
Diabetic Retinopathy
Retinal tear
Retinal Detachment

Age-Related Macular Degeneration

During normal aging, yellowish deposits, called drusen, form under the retina, which is the light-sensitive layer of tissue at the back of the eye that provides clear, sharp images.
As drusen increase in size and number, they can interfere with proper functioning of the retina, damaging or killing the light-sensitive cells of the macula.
Because the macula’s light-sensitive cells provide the ability to have sharp, detailed vision, the results can be blurring of central vision and a devastating impact on the ability to enjoy activities of daily life, such as reading, driving, or even recognizing the face of a friend or family member.
This form of age-related macular degeneration is called dry AMD. Dry AMD can be a precursor to wet AMD.
Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These blood vessels often leak blood and fluid, damaging or killing light-sensitive cells—loss of vision occurs quickly.
Although approximately 80 percent of patients with age-related macular degeneration have dry AMD, wet AMD is responsible for 80 to 90 percent of severe loss of vision with this disease.
Many people ask if age-related macular degeneration can be prevented. Like most things in life, there is no easy answer.
The primary risk factor for AMD is age—the older you are, the greater your risk. Also, people with a family history of AMD are at higher risk, as are women and people of European descent.

DIABETIC RETINOPATHY:

The cells in persons with diabetes mellitus have difficulty using and storing sugar properly. When blood sugar gets too high, it can damage the blood vessels in the eyes. This damage may lead to diabetic retinopathy.

TYPES OF DIABETIC RETINOPATHY:

Background or nonproliferative diabetic retinopathy - blood vessels in the retina are damaged and can leak fluid or bleed. This causes the retina to swell and form deposits called exudates.
Many patients may not notice any change in their vision when they develop this early form of the disease, but it can lead to other more serious forms of retinopathy that severely affect vision. Fluid collecting in the macula is called macular edema and may cause difficulty with reading and other close work.

Glaucoma Evaluation

Glaucoma SERVICES

What Is Glaucoma?

Glaucoma is the term used to describe a group of eye diseases which damage the optic nerve, the nerve that connects the eye to the brain. If left untreated glaucoma can result in blindness.
In the more common forms of glaucoma there is increased pressure in the eye which presses on the optic nerve and causes a gradual loss of peripheral vision.
In the more common forms of glaucoma there is increased pressure in the eye which presses on the optic nerve and causes a gradual loss of peripheral vision.

What Are The Types Of Glaucoma?

There are two main types of glaucoma:

Open-angle glaucoma.Also called wide-angle glaucoma, this is the most common type of glaucoma. The structures of the eye appear normal, but fluid in the eye does not flow properly through the drain of the eye, called the trabecular meshwork.
Angle-closure glaucoma.Also called acute or chronic angle-closure or narrow-angle glaucoma. Poor drainage is caused because the angle between the iris and the cornea is too narrow and is physically blocked by the iris. This condition leads to a sudden buildup of pressure in the eye.

For most people, there are usually few or no symptoms of glaucoma. The first sign of glaucoma is often the loss of peripheral or side vision, which can go unnoticed until late in the disease. This is why glaucoma is often called the "sneak thief of vision."
Detecting glaucoma early is one reason you should have a complete exam with an eye specialist every one to two years. Occasionally, intraocular pressure can rise to severe levels. In these cases, sudden eye pain, headache, blurred vision, or the appearance of halos around lights may occur.
If you have any of the following symptoms, seek immediate medical care:

Seeing halos around lights
Vision loss
Redness in the eye
Eye that looks hazy (particularly in infants)
Nausea or vomiting
Pain in the eye
Narrowing of vision (tunnel vision)

Squint Evaluation

Squint SERVICES

How do You Evaluate a Person with Squint?

Visual acuity measurement- Visual acuity is usually abnormal. It may be normal if it is an intermittent or a squint...
Cycloplegic refraction: It is an objective determination of the true refractive error, by elimination of the effect
Slit lamp exam- This test checks for any diseases or abnormalities in the anterior portion of the eye
Fundus (retina) examination- It is also referred to as fundoscopy, and is used to view the eye's interior portion

Types of squint

Comitant:: Deviation not change with direction of gaze or fixing eye
Incomitant. :Deviation varies with direction of gaze or fixing eye
Paralytic or restrictive
Alternating
Monocular
Congenital
Acquired