Articles on eye health

Common Eye Investigations Explained!

Dr. Quresh Maskati, Ophthalmologist
Pachymetry: Measurement of the thickness of the cornea – a test done to determine if your cornea is suitable for LASIK or collagen cross linkage procedure in patients with keratoconus or conical corneaKeratometry: Measurement of corneal curvature, usually done in the centre of the cornea. This measurement is handy to add to other measurements to calculate amount of LASIK laser required to bring your spectacle number to zero; also one of the measurements required to calculate the Intra-ocular lens power suitable for your eye in case you have a cataract.AS-OCT: Anterior Segment Optical Coherence Tomography. Something like a CT scan of the front portion of the eye. Comes in handy for a variety of diseases of the cornea and anterior segmentUBM – Ultra Biomicroscopy: This is an ophthalmic ultrasound using a special probe, to view in detail structures in the anterior segment, up to and including the crystalline lens of the eye and an inserted IOL. Also useful to examine the angle of the eye (UBM Gonioscopy) to find out if it is narrow, closed or open. This may influence decision making about glaucoma surgery in some cases.B-scan: An ultrasound test to examine structures in the back of the eye, especially if the view of the back of the eye is hampered due to opacities in the normally clear media, such as a cataract or haemorrhage in the posterior compartment(vitreous haemorrhage), so that ophthalmoscopy examination is not possible. Also useful in lesions of the extraocular muscles and any space occupying lesions in the orbit, outside the eye.A-scan: Also called A scan biometry. In this the examiner determines the front to back measurement of the eye using ultrasound. He then feeds in the keratometry reading obtained from the keratometer. An inbuilt computer in the A- scan biometry machine, using one of several complex formulae, then calculate the power of the intra-ocular lens implant required for your eyeOCT: Exactly like the AS-OCT talked about earlier; it gives you colour coded pictures of the back of the eye including individual layers of the retina. Therefore , if there is bleeding into the back of the eye or fluid collection in the retina, the OCT can tell you in which layer of the retina or whether it is just in front of or just behind the retina. It can also measure retinal thickness .This is helpful in planning treatment  in conditions like diabetic macular oedema or monitoring efficacy of intravitreal injections given for wet age related macular degeneration.Corneal Topography: This gives you several ‘maps’ of the cornea; an invaluable tool in assessing suitability of the cornea for LASIK and useful in detection of keratoconus and in fitting of contact lenses. It provides information on the curvature of the cornea at various points of the cornea, the ‘power’ of the cornea etc.Aberrometry: This is often used by the LASIK surgeon in patients unhappy after a successful LASIK – it detects minute flaws called “higher order aberrations” in your eye’s optical system which prevents you from enjoying ‘super’ vision after LASIK. Some LASIK machines which are “wave-front guided” routinely use data from aberrometers to fine tune the LASIK treatment to reduce these aberrations post LASIK surgery.Visual Field Analysis:  Mechanical devices that measured your field of vision were called perimeters. They have been largely replaced by Visual Field Analysers (VFA). These have inbuilt computers for storing and analysing your visual fields. They can compare fields done over a period and analyse whether the patient’s field is worsening or remaining the same. The routine test is a little cumbersome and requires your co-operation, lasting around 30-40 minutes, though for simple screening faster tests are available in the same machine. VFA is ordered in cases of glaucoma both for diagnosis and for judging efficacy of treatment. They are also invaluable in some neurological disorders causing drop in vision like in stroke etc.Fluorescein Fundus Angiography (FFA): In this test a dye, fluorescein Sodium is injected into the vein of your forearm. It takes around 10 seconds for the dye to spread into your retinal vasculature. This can be viewed by the observer using an ophthalmoscope, though more commonly, a digital camera called a fundus camera is used to take multiple photos of the retina shortly after dye injection.Depending on the areas of perfusion (dye seen) or non-perfusion (dye not seen) or leakage of dye from the vessels into the retina, decisions are made in cases of diabetic retinopathy, age-related macular degeneration etc. about whether to do laser or give some injections or treat with medications .HRT/GDX : These are fancy names for computer software in which images of the optic disc and retina are analysed. Accurate measurements are made of optic  nerve size, cup/disc ratio, retinal nerve fibre thickness. This is a useful adjunct to diagnose glaucoma and monitor its progression.Electro-retinography (ERG):  This test is used to find out the function of the retina. This comes in useful when the retina appears normal on ophthalmoscopy but patient has poor vision and also when the retina is not clearly seen due to media opacities. If the ERG is poor or absent, the eye surgeon may decide that the visual prognosis is poor and further surgery to clear the media opacities like a corneal transplant for corneal opacities or a cataract extraction for a mature cataract is not warranted.M-ERG or Multifocal ERG. This is the newest version of the ERG. In this a colour map is generated with the area of maximum cone function (macula) showing a steep elevation while the area with no cones (optic nerve ) showing up as flat and blue in colour. In diseases like macular degeneration, the central hill is considerably flattened, making diagnosis a ‘no-brainer’.Visual Evoked Potential (VEP):  In this test, either a very bright light (Flash VEP) or a checker board pattern is shone into the patient’s eye. The time taken for this to be perceived by the visual area of the brain (situated at the back of the head) and the intensity of the signal is recorded by sensitive electrodes placed at the back of the scalp. This measures the integrity of the visual pathway from the eye right up to the brain. In conditions like optic neuritis, where the optic nerve which carries signals from the eye to the brain is inflamed, the VEP will be reduced. On the other hand, a patient who is feigning blindness will have a normal VEP.Can a person who has undergone one or more of these tests donate their eyes?None of these tests is life threatening. However, it is proved that every patient who undergoes any of these tests will die some day, maybe months, years or decades later! If a patient were to die due to natural or accidental causes years after any of these tests were performed, the author does recommend donation of the eyes!

Eye Care Tips for Women

Dr. Charu Tyagi, Ophthalmologist
According to the World Health Organization (WHO) almost two thirds of blind people worldwide are women and girls. Women are also prone to develop dry eye problems more than men. There are several ways to keep the eyes healthy to prevent serious eye problems from developing.Hereditary eye problems An important thing to know is family history of any eye diseases. It is helpful to know which eye problems run in the family and whether these are hereditary. This will give a clear idea if one is at higher risk of developing a certain eye condition. Certain steps can then be taken to prevent its occurrence or minimize the complications that may be associated with it. To stay on the safe side, continue to consult your family ophthalmologist for regularly. Better safe than sorry, right?Eating RightEating right can help protect eyesight. Dark green leafy vegetables such as spinach, lettuce, peas, and broccoli are rich in lutein, an antioxidant that protects cells against damage. Lutein was found to be concentrated in the macula, a part of the retina of the eye responsible for central vision. Age related macular degeneration is the leading cause of blindness. Lutein acts as a natural eye shade that may protect the retina against sun damage.Antioxidants such as Vitamin C and Vitamin E can likewise help reduce the progression of age related macular degeneration. These antioxidants play a significant role in maintaining healthy cell membranes and other cell processes. A deficiency in Vitamin E has also been pointed to as one of the causes of dry eye syndrome, a condition that can lead to scarring of the cornea and vision loss.Eat protein rich food:When we’re discussing eating habits, we can’t rule meat proteins, can we? Research has also shown that eating fish high in omega 3 fatty acids can be beneficial to the eyes. Several studies suggest that omega 3 fatty acids may help protect the eyes from dry eye syndrome. Dry eye is a common complaint among middle aged women and this can cause severe eye irritation because of insufficient tear production. Dry eye in itself does not lead to blindness but it can increase the risk for eye infection. Fish rich in omega 3 fatty acids include salmon, tuna, and halibut. The retina has one of the highest concentrations of omega 3 fatty acids in the body and by simply increasing the dietary intake of omega 3, there is almost 50% decrease in the severity of retinopathy or damage to the retina. Vegetarians have an option of omega 3 fatty acid derived from algae.Across some regions, religions, socioeconomic strata, & level of education, girl child is neglected. Children are otherwise also prone to malnourishments because of their food preferences and frequent cough colds & post measles .Supplements of vitamin A & C is good when required.Contact lenses:Studies show that women wear contact lenses more, compared to men because of the fact that glasses tend to hide the natural (beautiful) look of the eye. Generally, more women than men wear contact lenses because of aesthetic reasons. Make sure that your contacts are appropriately fitting (on your corneal base curve) for your cornea, clean and disinfected so that no external body enters the eyes. When there is poor eye hygiene or extended wear of contact lenses, the eyes can become infected. The cornea is at risk of scarring and this can lead to blindness.  Clean the lens case & change lens solution every day, if you are not wearing daily disposable contact lenses. Do not over wear your contact lenses, have a smart well corrected glasses option always with you. Those using colored contacts lenses, kindly ensure that they are of good quality & fitting. A routine visit to your eye specialist to ensure the health of your eyes is a must for all contacts users to check for eye infections, allergies, contacts intolerance & cornea changes (Remove contacts at least 24 -48 hours before an eye checkup)Cosmetics:Don’t mess up with your eyes by applying expired make-up! When eye cosmetics are not properly removed, makeup and dirt can become trapped at the base of the eyelashes. This is another cause of eye infection among women. Proper application and complete removal of eye makeup at the end of the day can help prevent the eye infections and eye damage. Some area have deep seated misbelieve that application of kajal, surma, kohl enhances eye beauty & enlarges the eye. This often leads to frequent chronic eye infections, scaring leading to lid deformities. Your eyes if properly taken care of can greatly enhance your overall beauty and can enable you to see the world in the clearest way possible.Sunglasses:When going outdoors, one must wear protective sunglasses. Constant and excessive exposure to the ultraviolet rays of the sun can damage the eyes. Common eye diseases like pterygium,macular degeneration have been linked to too much sun exposure. Choose sunglasses that block out 99 to 100 percent of both UVA and UVB radiation. Women and girls who are active in sports should also consider wearing protective eyewear, which can be easily bought at sporting goods stores. Post refractive surgery (post Lasik/PRK)Glasses removal by surgery is far more common in females than males. Glasses removal surgery does not change the configuration of your eye, so regular checkup of eye and retina once a year with your eye specialist is a must. Post surgery problems like dryness, decreased sensitivity and glare is commonly experienced for which you can consult your eye specialist. Be on look out, if you observe some floaters or increase in there number. Computer use and office eye syndrome -dry eye disease is found in higher prevalence among women office workers working on visual display terminal(VDT) users.PregnancyPregnancy is associated with lots of hormonal changes. This leads to water retention & some experience it as change in refractive error (glasses). Many patients become intolerant to contacts. Some pregnancies are associated with raised blood pressure & blood sugar levels; they too may affect pregnant lady’s vision. A good eye checkup with proper glasses correction during the second or third trimester is advised.Computer usersProper correction, posture, lubrication, lighting should be taken care...…Helpful eye care tips for computer users.Systemic Diseases (Diabetes/Thyroid/Hypertension/Arthritis/Autoimmune diseases/obesity)Women are prone to become overweight, especially with advancing age. This increases the risk for developing diseases such as diabetes. High blood sugar causes the lens of the eye to swell, impairing normal vision. Diabetes also increases the risk of developing other eye problems such as cataracts, glaucoma, and diabetic retinopathy. Maintain a healthy weight and have regular blood tests if diabetes runs in the family. Thyroid & arthritis too affect women more commonly, presenting with dryness, grittiness, foregn body sensation. Thyroid may be associated with raised intraocular pressure, or limitation of eye movements. Women are eight times more prone to suffer from various auto immune diseases and they too have associated eye symptoms.Oral contraceptives also are associated with increased incidence of dry eye symptoms:SmokingSmoking has been linked to an increased risk of developing dryness,cataracts, macular degeneration, and optic nerve damage. Girls should never start smoking and women who smoke should quit right away decreasing the risk of developing these eye conditions.MenopausalWomen entering menopause too suffer from various hormonal changes/imbalances .This can affect eye by presenting as dryness, foreign body sensation, redness, heaviness.Age associated diseasesCataract, Age related macular degeneration (ARMD), glaucoma prevalence of many diseases increases with age. Women over age of sixty should go for a comprehensive eye check up at least once a year. Early detection leads to better management.Suffering from eye problem? Book an appointment today!

Eye Care in the Monsoon

Dr. Hasanain Shikari, Ophthalmologist
After the heat of the summer, the monsoon is a welcome relief. Yet, the rains bring with them a host of bacteria, viruses and allergens, many of which disturb our delicate eye equilibrium. Let us identify the main eye-related complaints and then establish some easy tips to maintain your eye health this monsoon.Conjunctivitis, also known as pink eye, is the inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. This can be caused by irritants like dirt, bacterial or viral infections or may be allergic.Eye Allergies are also known as allergic conjunctivitis.  These are non-infectious and may be seasonal. It leads to red, watery or itchy eyes.Stye (Sty) is usually recognized as a “pimple” on the eyelid. Its an inflamed swelling on the edge of the eyelid and is usually due to bacterial infection.Personal hygiene is important. Prevention is better than cure!Some Eye Care Tips- Keep your eyes clean. Do not rub your eyes with dirty hands, or rather, do not rub your eyes at all.- Maintain hygiene. Wash your hands frequently. Wash your eyes with cold water 2-3 times a day.- Do not share personal items like towels with anyone.- Wear sunglasses to protect your eyes, especially while traveling.- Avoid getting wet in the rain or swimming in the monsoon. This can aggravate existing eye inflammation.- Eat healthy foods. This should include fresh fruits and vegetables. Anti-oxidants will boost your immune system.- Do not self-medicate or use medications given by pharmacists.Go for an eye check-up to an eye specialist if you have symptoms.Healthy diet, healthy body

Eye Donation: What you need to know and do.

Dr. Quresh Maskati, Ophthalmologist
Q. Who can be an eye donor?A. Anyone can be an eye donor, irrespective of age, sex, religion, caste, creed or blood group.Q. Do religious authorities approve of eye donation?Yes, all religious faiths support this vital sight restoration programme.Q. Is the whole eye used for transplant?A. No, only the thin transparent layer in front of the iris, called the cornea is used for transplant, to replace the diseased or opaque cornea in the eye of the patient (recipient).Q. Do cataracts or the use of spectacles render the cornea unfit for donation?A. No, both these conditions relate to the lens of the eye and not the cornea. In fact, people who have been successfully operated for cataracts or glaucoma or even retinal detachments can also donate their eyes after death. In fact there have been instances of those who have received a corneal transplant themselves donating their corneas after death! All that is required is that the donor have a clear, transparent, healthy cornea at the time of death.Q. Does eye donation disfigure the donor’s face? A. No, the removal of the eyes does not produce disfigurement nor interferewith the customary funeral arrangements.Q. Does the human body reject the transplanted donor’s cornea? How successful are corneal transplants?A. The human cornea does not have any blood supply; hence the risk of rejection is very low. Rejection, if it does occur can be suppressed by timely medication. In general, the chances of success are greater than 80%. In deep anterior lamellar transplants, where the inner lining of the cornea called the endothelium, is not transplanted, the success rate is as high as 95%!Q. What conditions render the cornea unfit for donation?A. Corneas of patients suffering from AIDS, rabies, syphilis, tetanus, septicaemia and certain viral diseases are considered unfit for use for transplant purposes.Q. What about diabetes, hypertension or cancer?A. People with these conditions can also donate their eyes. Eyes from a cancer patient are not used for transplant only if the cancer had a blood borne spread.Q. Is there any use for corneas which are for some reason unfit for transplant?A. Corneas, which for some reason cannot be used for vision restoring corneal transplants, are invaluable for research and training programmes.Q. How will my donation be used?A. After the eyes are removed, they will be evaluated, processed, screened and then supplied to the eye surgeon for transplant.Q. Do corneal transplants guarantee sight to all blind people?A. No, transplants only help when the loss of sight is solely due to corneal defects and the rest of the eye mechanism is intact.Q. How quickly should eyes be removed after death?A. As soon as possible, but eyes can be removed up to 6 hours after death. However, in places where the climate is hot such as most parts of India, a shorter duration, preferably 2 to 4 hours after death is advisable.Q. Is it necessary to transport the donor to the hospital after death?A. No, eye banks have personnel who will come to the donor’s home or place of death and remove the eyes.Q. What is an eye bank?A. An eye bank is the link between the donor and recipient/eye surgeon. It is an organization recognised by the government to collect and distribute human eyes to those who require corneal transplants.Q. What is to be done when a relative expires?A. 1.Keep the death certificate or its copy to show to the eye bank team. They do not need to take it away. You do not need to look for a photocopier machine to make a photocopy in the middle of the night. The eye bank team only needs to look at the certificate to determine:a) The patient is really dead andb) The cause of death, to determine if the eyeball can be useful.    2. Contact your nearest eye bank – in India, most cities have 1919 as the eye bank contact number. Otherwise, check the local telephone directory – most eye banks are listed in the emergency numbers list. The eye bank team will arrive in the next 30-60 minutes, provided you have given them an accurate address with landmarks. The procedure will take only around 30-40minutes.    3. Close the eye lids, while waiting for the eye bank team and put off any overhead fan, to prevent drying of the cornea. However, if there is an air-conditioner, switch it on, if possible.    4. Cover the closed lids with moist cotton wool (if readily available in the house, otherwise do not bother).     5. Raise the donor’s head by 6 inches, by placing 2 pillows under it.Q. Is there any cumbersome paperwork or time consuming formalities?A. None whatsoever. The eye bank team will come with a form, which they will fill themselves. They will only need the signatures of 2 close relatives, giving consent. It does not matter whether the donor had pledged his eyes for donation during his lifetime or not.Q. I believe some blood is also collected?A. Yes, according to WHO guidelines, the team will also collect some blood from the donor, for testing for HIV, hepatitis etc. They will withdraw this from a large vessel or from the heart with a needle puncture.Q. Is there a real need for Eye Donation?A. Yes, in India there are lacs of patients awaiting corneal transplant.. in some eye banks patients wait over a year for their turn. Every year barely 30,000 corneas are donated, so the waiting list keeps growing!Q. Finally, is there any money to be paid?A. No, no monetary transaction is done. Most eye banks recover their running costs by charging a small processing fee to the recipients.Q. If it does not cost to donate eyeballs after death and the procedure is so easy, and encouraged by every religion, why are there such few donors?A. Good question. You tell me! You go around spreading the message of the nobility of eye donation and how easy and hassle free it is and maybe by the time I write next year, this question will need deletion!

Primary Eye Care in 7 Emergency Situations

Dr. Manoj Rai Mehta, Ophthalmologist
Many People learn Basic Life Saving skills to save lives and render primary care to the sufferers in emergency situations.  Similarly, there can be "sight saving situations" where timely action can restrict damage and give sufficient time safely to reach a higher centre for further management.1. Sputtering of hot cooking oil into the eyes while frying.Rinse eyes immediately in running cold water or simply dip your head in a bucket full of water to bring down the temperature as soon as possible.  Apply cool patch/ice pack around the lids.  Instil only lubricating drops (if available), gently patch the eyes with a sterile eye pad or clean handkerchief and take the patient to an eye surgeon. 2. Squirting of glue in the eyes.This is not an infrequent occurring with people trying to squeeze tubes that have a blocked nozzle. Immediate action should be to rinse eyes in running water.  Luke warm water around 40 degrees is somewhat more effective.  Put an ointment (lubricant or antibiotic) in the eye, gently cover the eye and take the patient to an eye surgeon.3. Chemical Injury to the eyes (domestic).Diluted Hydrochloric Acid, phenols, diluted caustic soda are some of the common corrosive chemicals found in homes for cleaning purposes.  They are acidic or alkaline in nature. Accidental exposure is not uncommon.  Immediate action is again washing off of the chemical to dilute its damaging effect.  Wash should continue for several minutes before a patient is taken to a medical facility.  lubricating drops, gels, ointments or antibiotic ointment may be applied for relief.Carry the bottle or the container in which the chemical was stored, with a label, in case the exact nature of chemical is not known, it will help the treating doctor in carrying out specific treatment.4. Foreign Body (FB) in the eye (domestic)Foreign bodies of different kinds fall into eyes under various circumstances such as- dusting, blowing dust with a vacuum cleaner, using a screwdriver on rusted components, hammering a nail, splicing cables, cutting wires, gardening or simply going for a ride.  Do not rub the eyes or put pressure as the FB can go deeper into the cornea.  Rinse in running water for a while, cover the eye with a suitable patch and take the patient to a facility.  One can use lubricating drops or antibiotic drops on the way.  No ointment, please.   5.  Soap solution, shampoo, chlorine in water or face creams in the eyesThis is a common issue especially with young children and all it requires is thorough rinsing followed by a lubricating eye drop and some cool compresses.  Creams can be very irritating as they adhere to the cornea and take a while to get washed off.  Chlorine in the swimming pools can also cause a lot of irritation especially on the days when tipping is done.  Preservative free lubricating drops, cold compresses provide relief.    6. Blunt trauma around the eyesAccidental injuries from window panes, friendly boxing or grappling amongst children are also a frequent occurrence.  Apply gentle pressure on the bones to prevent swelling around the eyes and apply a cold patch with pressure.  Take the opinion of a doctor in due course.  At times a blue haematoma may occur after a few days.  Please take an opinion as some blunt traumas around the eyes can lead to retinal oedema (Berlin's Oedema) that needs to be tackled timely to prevent a loss of visual acuity. 7. Penetrating InjuriesPenetrating injuries are seen with pencil tips, pen tips, compass used in geometry, knives, scissors, sewing needles, screwdrivers etc. Do not try to examine the eye forcefully, prise the lids, put pressure on the eye or even touch it. All these actions can result in disastrous outcomes!  Prevent the child from pressing or touching the eye by firmly holding in lap. Patch the eye gently with a clean handkerchief or a sterile pad and reach a facility at the earliest.You may keep a special first aid kit ready with disposable sterile eye pads, clean bandages, one-inch plaster tape, scissors, preservative free lubricating gel drops and gel tubes, antibiotic eye ointment, antibiotic eye drops etc.  A plastic bottle with a bent tube at the opening may be useful for gentle irrigation of the eyes with water.  It is equally important to reduce the risk of injuries at home by keeping potentially harmful chemicals out of reach of children and supervise them when they are using sharp instruments.  Safety always Saves.   

The Common Chalazion: Blocked Oil Gland on Your Eye

Dr. Aravind P. M., Ophthalmologist
This is the story of the common lump on the eyelid that most of us would have suffered from or at least seen somebody with, at some point in our life.This innocuous, mostly harmless — but sometimes painful and quite unsightly bump is known by many names — the Chalazion (kal-ey-sion in India, Shchal-ey-zion if its diagnosed in the west), Stye, Hordeolum, heat boil (even if heat has nothing to do it!), eyelid swelling.The swelling is quite benign in most circumstances and may even resolve by itself but it serves as a useful indicator for some underlying undiagnosed problems. Of course various home remedies are prescribed with the naamakattichalk being the most popular.The lump itself is a blocked eyelid oil gland. The Meibomian oil glands are neatly arranged in rows in both the upper and lower eyelids and produce the oily layer of our normal tear film. The oil prevents rapid evaporation of our tears and provides insulation for retaining the moisture on the surface of our eyes. The blockage could be because of dust, grime or pollution. A lid margin inflammation or infection could also precede a lid lump.Rubbing the eyelids introduces dust collected in the fingernails on these minute gland openings located at the eyelid margin. Needless to say, personal hygiene — keeping fingernails trimmed and clean — and avoiding rubbing the eyelids are basic steps in preventing these lid lumps in the first place.This is especially true for children. Children who develop lid lumps frequently need to be checked for their vision for any refractive error (spectacle power). Poor vision can cause eye fatigue, which induces the child to rub his/her eyes, resulting in an eyelid swelling.Adults who develop lid lumps also need to get their blood sugars checked, as underlying diabetes maybe the reason. The blocked gland can be infected from the bacteria of the skin resulting in a painful, red- hot lid swelling.Consult an eye doctor who will treat it with antibiotic tablets or ointments. In the case of a longstanding painless lid lump that doesn’t resolve with medical treatment, the doctor may drain the lump surgically. Children (and adults with poor immunity) are again susceptible to developing infections from these lumps that spread rapidly around the eyelids and face if not treated promptly.In rare cases the infection may spread behind the eye, a condition which requires intensive treatment with intravenous antibiotics and medications; sometimes even hospitalisation.In the elderly, an eyelid swelling may not be as harmless as it looks. It may mask a cancerous growth and requires an evaluation by an oculoplastic surgeon (an eye doctor who also specialises in plastic surgery).What to do:Keep fingernails trimmed and cleanWash hands after playAvoid rubbing the eyes.Treat it with a warm compressUse an analgesic in case of painSchedule a check-up to rule out underlying problems

How Do I Behave When I Am Undergoing Cataract Surgery?

Dr. Manoj Rai Mehta, Ophthalmologist
Cataract Surgery nowadays is usually performed under 'topical anaesthesia' that involves instillation of drops of the anaesthetic agent on the eye surface.  The patient retains the power to close the lids and move the eyeball during surgery, feel no pain but touch and pressure sensations are unaffected.  A peribulbar block anaesthesia may be used at times on surgeon's discretion that involves an injection of anaesthetic agent around the eyeball with a short needle.  This takes away lid and eye movements to a large extent but some control may remain with the patient.     Operating Surgeon expects the patient to follow the instructions for a smooth surgery.  It is important to have a surgical counselling session with the doctor to understand the procedure and expected sounds/conversation during the operative procedure.  The sequence of events should be understood and played in your mind while you move through the surgical suite.You should be wearing loose, comfortable hospital pyjama suit.  Do not hesitate to change it if it is tight around your neck.  Some hospitals have the policy to allow you to wear your own loose clothes and give you a hospital gown over them.  Please ensure you are not wearing tight fitting clothes and your neck is free.  Ladies to tie their hair in a ponytail with a band or a soft bun with no clips or claspsSit quietly in the pre-operative area and use the washrooms before going to the OR.  You may take sips of water if your mouth feels dry but do not hydrate yourself too much.You may be given a cap and eye marked for surgery.  The antiseptic solution will be painted around the eye.  Let the solution dry and do not touch your eye. OR assistant will help you lie down on the OT table with a rubber ring under the head to prevent rolling from side to side. You should be comfortable and be able to breathe rhythmically while lying down.  Ask for a head raise if neck extension is hurting you and get the ring adjusted to your comfort and if it is hard for you to ask for a softer ring.When you are comfortable allow the staff to put monitoring devices which could be a pulse oxygen meter alone or additional cardiac electrodes.  Breath rhythmically and try to relax.Sterile Drapes will be placed around your head and an adhesive eye drape on the eye to be operated upon.  Please maintain your head in a position as required and adjusted by the surgeon.  Do not move your head or lower your chin.  The surgeon works under a microscope and any movement shifts the focus and obstructs in smooth surgery.There will be several sounds in the OR that you should ignore-beep of monitors, hum of air circulation unit, trolley wheels, the doctor would be giving instructions to staff and asking for instruments etc.  Try to keep your attention focused towards surgery only.Coughing and snorting during surgery can create complications, always ask the surgeon to stop the surgery if you feel like doing so.  Do not try to suppress a cough or sneeze by holding breath.  Do not bear down or move.Follow instructions of a surgeon and do not start a conversation. Answer only when a question is directed towards you.  The surgeon may ask you to look in a particular direction.  You have to follow the command by moving your eyes and not head unless the specific instruction is made. The first touch of the instrument will increase your confidence.  Do not wince, squeeze your lids or make a jerky movement if you feel some pain.  Inform the doctor, who will reinforce anaesthesia.Cataract Surgery machines also produce different types of sounds during different phases of surgery and also have synthesised verbal outputs.  Do not get distracted by the same.You will see movements in front of the eye during surgery and also perceive vibrations.  Light intensity will increase towards the end of surgery.  A calm patient who is having a regular rhythmic breathing and a regular normal pulse rate makes a surgeon's job easy.(In case of specific problems additional monitoring and specialised anaesthetic cover may be required which the operating surgeon will discuss before hand).               

The 5 Myths About Eye Testing in Children

Dr. Siddharth Kesarwani, Ophthalmologist
Myth 1. All Children are born with normal eyes and all eye diseases start later in life.Truth: This is what most parents assume. Most Children are born with normal eyes. However some babies have problems in one or both eyes right at birth and unless detected in time, are likely to affect vision. All babies should get eye screening immediately following birth.Myth 2. Children should get eye checkups only when they complain of eye strain or headache or inabilty to see.Truth: Most small children with eye problems never complain of any symptoms. Infact they can appear to be leading a normal life inspite of having poor vision in one or both eyes. They need to be routinely checked at 1 year, 3 years and 5 years to detect any issues with vision and eye development.Myth 3. My child does not know how to read. How will the doctor test his eyes?Truth: Children off all ages right from infancy  can undergo a detailed eye check up. There are many different ways of testing vision in small children who cannot read.Myth 4. Me and my spouse do not have any eye problems, so our child doesn't need any eye testTruth: All children irrespective of positive family history of eye diseases need periodic eye check ups. Although it is true that children whose parents have eye problems have a higher risk of having the same problem, but, ant child can have the same eye problem.Myth 5: Eye testing is painful for the child and child wont co-operate.Truth: Pediatric ophthalmologists are trained to handle children delicately and will ensure that the experience is pleasant for the child. The pediatric eye clinics have a child friendly waiting area and play area where the child feels comfortable.

7 Benefits of a Regular Eye Check Up

Dr. Manoj Rai Mehta, Ophthalmologist
At the outset let me explain what a "Complete Eye Check UP" would generally comprise of:1) Visual Acuity Testing- This is done with the help of a standardised chart projected at 6 metres or 20 feet.  Standard size alphabets, a broken ring or the letter E are used to measure acuity of vision.Colour Vision Testing- Can be carried out routinely with Ishihara charts. 2) Intra Ocular Pressure (IOP)- This is done with a Non Contact Tonometer (NCT) and when indicated with an Applanation Tonometer.3) Torch Light examination for checking movements of eyes individually and together.  Pupilllary Reflexes4) Slit Lamp examination to look at the front lying structures of the eyes5) Dilated Pupil examination and Cycloplegic refraction for detailed look at the crystalline lens of the eye and retina.An annual Complete Eye Examination gives you the following benefits;(1) Objective Recording of change in visual acuity.(2) Variation of IOP ( Intra ocular pressure) at different times in a day which is important in diagnosis as well as treatment of Glaucoma.(3) Change in the power of 'corrective lenses'(4) Early detection of progressive diseases such as Cataract and Glaucoma and their susequent follow up(5) Detection of silent diseases such as macular degeneration(6) Diseases affecting on eye only are often missed as the normal eye covers up. Retinal vascular blocks, haemorrhages, retinal detachments are many a time diagnosed on a routine check up.(7) Breaks in the Retina and potentially dangerous degenerative changes are also detected and documented during routine examination.           People suffering from Hypertension, Diabetes, Rheumatoid Arthritis, Ankylosing Spondylosis and several other systemic diseases should be going for a regular eye check up as a part of their disease management programme.The age old adage comes true-"A Stitch in time saves Nine"