Special Services
Cataract Services
Phacoemulsification is the technique, which is being used for more than a decade. The cataract procedure and its techniques have evolved dramatically improving vision in up to 99% of cases and saving millions from cataract-induced blindness.
No injection, no stitch & no pad Phacoemulsification Cataract Treatment with Multifocal Intra Ocular Lens {IOL} implantation is the technique, which is being used. This technique is the most advanced technique for cataract management.
Cataract Treatment with phacoemulsification is performed on an outpatient basis under topical or regional anesthesia. Paracaine eye drops are used to numb the eye. No injection is given to numb the eye. No patch is required after surgery. The patients can see and move their eyes after surgery. Topical anesthesia has innumerable advantages.
There are no risks which are sometimes associated with regional anesthesia.
There is improved vision almost immediately after surgery.
This type of anesthesia is most helpful to cataract patients with sight in only one eye.
A small incision, less than 3mm, incision is made. Special microsurgical instruments are used to break up and suck the lens fragments from the eye (phacoemulsification). The back portion of the lens capsule is left in place and polished for clarity.
A small foldable intraocular lens is inserted through the wound and unfolded in place of the natural lens. The incision is self-sealing so that no stitches are needed. The no stitch incision is used because it can seal itself after Cataract Treatment without stitches, which allows the eye to heal more naturally and with greater symmetry.
The phacoemulsification technique is carried out as an outpatient procedure in stress free environment. The patients are informed about the details of the procedure. This helps in making the patient more comfortable. The patient is encouraged to bring the friends & relatives so that the apprehensions get allayed.
Cataract surgery has come of age. Drishti Eye Care Centre offers the best customized treatment for each patient. This helps in improving patients’ quality of life they deserve.
The customized cataract surgery involves the following aspects.
Every patient has different visual requirements. These requirements are based on the professional & personal visual goals of the patient.
We at Drishti Eye CareCentre strive to give to the patient quality and quantity of vision keeping in mind the individual goals. This is possible because of the state-of-the-art capacity of the centre to raise the bar in cataract surgery. We tailor our surgical capability to help the patient achieve any of the following goals:
Spectacle free eye after cataract surgery.
Attaining post operative spectacle power of the eye as per the requirement of the patient.
Implanting Intra ocular Lenses having different qualities like:
Image Quality
Blue light protection to mimic a natural lens of a 20 year old
Multifocality provides patients with freedom from glasses
Toricity delivers precise astigmatic correction & distance vision spectacle freedom.
Protection of the weak Retina by not allowing the posterior capsule to opacify.
Using different Phacoemulsification techniques according to the type of the cataract.
Instant & planned appointment for cataract surgery as per the convenience of the patient.
Cataract
Described as a natural clouding of the eye lens, cataracts are pretty common, affecting about 20 million people worldwide.
Cataracts are actually considered an inevitable part of aging and are widespread among people ages 55 years and older.
What's worse, if left untreated, cataracts can lead to blindness. Cataracts are already the leading cause of vision loss in adults over age 55 and the most common cause behind blindness worldwide.
The good news, however, is that treatment for cataracts is successful; more than 97 percent of the 3 million-plus cataract surgeries performed each year in the United States are considered successful.
In fact, about 95 percent of patients are able to restore their full pre-cataract distance vision after undergoing the standard intraocular lens (IOL) procedure
Causes of Cataract
Many things can cause a cataract to form, including diabetes, but it is believed that natural aging is the main culprit—at least for 99 percent of cataract sufferers (the other 1 percent are born with congenital cataracts, sometimes due to metabolic disorders or intrauterine infections). For the majority of people with age-related cataracts, age-related cataracts : A clouding of the eye's lens that blocks passage of light to the retina, resulting in impaired vision. Often a result of normal aging, cataracts form when protein clumps cloud areas of the eye's lens. As the cataract progresses, vision worsens and often requires surgical replacement of the damaged lens with an artificial one. or acquired cataracts, these develop very slowly and painlessly over the years and are often initially discovered by an eye doctor during routine exams, but may not be treated until your cataract impedes upon daily activities.
Types of Cataracts
To understand exactly how and why a cataract forms, you first need to know what kind of cataract it is. Following is a breakdown of the 3 most common.
Nuclear cataracts
The most common type, nuclear cataracts are associated with nearsightedness, blurry vision, and faded colors. As a nuclear cataract develops, the eye's lens Lens: The transparent disc behind the pupil that brings light into focus on the retina. becomes more curved and worsens nearsightedness, sometimes temporarily improving farsightedness but not for long
Attributed as a consequence of natural aging, there are several reasons why nuclear cataracts form.
Just as skin sheds, so does the eye. But since cells can’t be lost into the air inside the eye, they deposit into the lens, causing it to thicken and yellow.
Likewise, with aging, fewer nutrients reach the inner eye, contributing to the formation of an opaque nucleus.
Overexposure to ultraviolet light can also contribute, especially as the lens becomes harder, less resilient, and more opaque over time.
Several studies have also linked alcohol and exposure to cigarette smoke as cataract contributors.
Some systemic disorders, such as hypothyroidism (an underactive thyroid disease), diabetes, and in rare cases, glaucoma, can lead to cataracts as well.
Cortical cataracts
Often associated with farsightedness and natural aging, cortical cataracts are less common and tend to develop in their own unique way.
They form when the shell, or cortex, of the lens becomes hard after developing post-birth and grows, usually till around age 60, when nearly 16 percent of the lens has become cortex.
Cortical production makes the lens more compact and hard, or sclerotic. Sclerotic: Relating to sclerosis, the hardening of tissue.
Posterior subcapsular cataracts Posterior subcapsular cataracts are even less common but affect vision more than any other type and tend to affect people under age 40 more often.
Since light converges at the back of the lens, extreme sensitivity to bright lights normally develops and reading can be extremely difficult. Causes include:
Chronic intraocular inflammation due to overuse of medications such as corticosteroids. Corticosteroids: A class of steroid hormones used to treat a variety of conditions. Chronic use may lead to the formation of posterior subcapsular cataracts.
A penetrating injury to the lens, eye surgery, concussion, or the use of irradiation to treat an eye tumor, which can cause any type of cataract but typically result in posterior subcapsular cataracts
Cataract prevention
While many doctors believe that nothing prevents most cataracts from forming, there is some promising research and things you can start doing now for possible cataract prevention (if you don’t have them already) or to slow down the development of a cataract. Such as:
Wear sunglasses to block out the harmful ultraviolet (UV) rays from sunlight. Too much exposure has been shown to contribute to the development of cataracts. Look for a label from the American National Standards Institute (ANSI) that says that the lenses block both UVA and UVB rays.
Eat foods containing high amounts of antioxidants, meaning fruits and vegetables. People who eat large amounts of green, leafy vegetables, such as kale and spinach, which are rich in the nutrients lutein and zeaxanthin, show lower risk for cataracts.
Have your cholesterol checked by your doctor. It could be that there is a link between high cholesterol levels and cataracts, as some studies suggest that the use of statins, a class of cholesterol-lowering drugs, may help prevent the formation of nuclear cataracts. Anyway, it doesn’t hurt to get your cholesterol levels tested by a doctor at least every 5 years, or more often if you have had high levels in the past or are a man over age 45 or a women over age
Different intraocular Lens
Most patients experience significantly improved vision after the full recovery period from cataract surgery, but some do still require glasses to achieve their best vision. This depends mainly on the lens chosen by the patient for implantation.One of the most important aspects of your cataract surgery will be choosing your new intraocular lens (IOL.) In order to choose the ideal IOL for your vision and lifestyle needs.
Monofocal IOLs
Monofocal IOLs are designed to create a patient’s clearest possible vision at one distance. The distance chosen can be near, intermediate, or far. Most of our patients who choose monofocal IOLs go with far-distance focusing and then occasionally wear reading or magnifying glasses when the need arises. We, at Drishti eye care centre provide the wide range of most advanced monofocal IOLs available.
Aspheric IOLs
Traditional intraocular lenses have a spherical optical design, meaning the front surface is uniformly curved from the center of the lens to its periphery. This design does not mimic the shape of the natural lens inside the eye, which varies in curvature from center to periphery. In other words, the eye’s natural lens is aspheric (“not spherical”).
A spherical intraocular lens can induce minor optical imperfections called higher-order aberrations (HOAs), which can affect quality of vision, particularly in low-light conditions such as driving at night.
Premium aspheric IOLs, on the other hand, match more closely the shape and optical quality of the eye’s natural lens, and thereby can provide sharper vision — especially in low light conditions and for people with large pupil size.
Toric IOLs
Toric IOLs are premium intraocular lenses that correct astigmatism (cylindrical power) as well as nearsightedness or farsightedness.
Toric IOLs can correct astigmatism (Cylindrical power) because they have different powers in different meridians of the lens. They also have alignment markings on the peripheral part of the lens that enable the surgeon to adjust the orientation of the IOL inside the eye for optimal astigmatism correction.
Toric IOLs decrease the likelihood of needing additional surgical procedures to reduce residual astigmatism
Multifocal IOL (Bifocal and Trifocal lenses)
Multifocal IOLs are a category of presbyopia-correcting IOLs that can decrease your need for reading glasses or computer glasses after cataract surgery.
Like multifocal contact lenses or progressive glasses, these premium IOLs contain added magnification in different parts of the lens to expand your range of vision so you can see objects clearly at all distances without glasses or contact lenses.
Your cataract surgeon can help you decide if you are a good candidate for multifocal IOLs at your preoperative exam and consultation. Laser cataract surgery often is recommended if you are a good candidate for multifocal IOLs, because precise alignment of these lenses is very important to give you the best visual outcome at all distances.
Traditional multifocal lenses have two foci,i.e. Bifocal which work for far distance and either intermediate or near distance. So effectively the spectacle independence with traditional bifocal IOLs is partial.
Newer generation multifocal IOLs, due to its’ innovative technologies, have provided the patients with option to go for complete spectacle free post cataract surgery vision. These are effectively trifocal lenses which provide patients with good near, intermediate and distance vision.
Paediatric Ophthalmology
Children experience a variety of eye problems, many quite distinct from adult eye diseases. Pediatric eye disorders are:
Infections (conjunctivitis).
Strabismus is a misalignment of the eyes that affects 2-4% of the population; it is often associated with amblyopia. The inward turning gaze commonly referred to as "crossed-eyes" is an example of strabismus. The term strabismus applies to other types of misalignments, including an upward, downward, or outward turning eye.
Amblyopia (aka lazy eye) occurs when the vision of one eye is significantly better than the other eye, and the brain begins to rely on the better eye and ignore the weaker one. Amblyopia affects 4% of the population and is clinically diagnosed when the refractive error of one eye is more than 1.5 diopters different than the other eye. The management of amblyopia involves correcting of significant refractive errors and using techniques that encourage the brain to pay attention to the weaker eye such as patching the stronger eye.
Blocked tear ducts.
Ptosis
Retinopathy of prematurity
Visual inattention
Pediatric cataracts
Pediatric glaucoma
Abnormal vision development
Genetic disorders often cause eye problems for affected children. Since approximately 30% of genetic syndromes affect the eyes,
Congenital malformations affecting vision or the tear drainage duct system can be evaluated and possibly surgically correction can be done.
Orbital tumours
Refractive errors such as myopia (near-sightedness) and astigmatism can often be corrected with prescriptions for glasses or contacts.
Accommodative insufficiency
Convergence insufficiency and asthenopia
Squint Services
The adjustment of the muscles of the eye to correctly align the eyes is the most common eye operation performed in children.Eyes can be straightened virtually at any age- from as early as 4-5 months and whenever necessary in adulthood. A squint operation may take from 15-40 minutes.
The procedure is relatively straightforward and the results are good but not perfect. In most patients there is an 80-90% chance of the eyes being correctly aligned postoperatively. This means more than one operation will sometimes be required. The phases of the operation are-
Preoperative Assessment
It is extremely important to accurately measure the angle of deviation preoperatively. This is performed using prisms to neutralise the turn. It is also necessary to know preoperatively whether there is any paralysis or restriction of function of the eye muscles as this can affect the outcome and limit chance of correction.
Anesthetic
In children a General Anesthetic is employed.Adults can in certain circumstances have the procedure performed under Local Anesthetic. This makes it possible to optimize alignment in the course of the procedure.
If this is not possible, in older children or cooperative adults an "adjustable suture" technique can be combined with a General Anesthetic so that alignment can be optimized postoperatively.
Operation
The loose lining (conjunctiva) of the eye is opened to allow the anterior end of the eye muscles to be viewed.
The eye muscles are approached, may be tightened by removing a small segment (resection) and reattaching it to the eye or conversely loosened by reattaching the muscle further posteriorly on the globe (recession). Other procedures may be utilized to vary the muscle's effect on movement- (eg transposing the muscle to affect rotation)
The lining is reapplied and sutured into place.
Post-operative Care
When fully awake the patient is allowed to go home. Eye-drops are normally prescribed. Some medication is also prescribed to minimize pain and discomfort. Severe pain is rare following these operations but the eye will be sore for 24hours and remain red for several days. Nausea and vomiting occasionally occurs but is minimized with appropriate pre-operative medication.
Review
On the first day, at 1 week and 1 month. The final result of surgery is usually known within one month. Children require follow-up until they are no longer at risk of developing amblyopia.
Glaucoma Services
Glaucoma (Kala motia) is the most common cause of irreversible blindness, asymptomatic until advanced stages. It is rightly called the " Silent thief of sight" as most patient do not have any symptoms until the advanced stage and by that time only little can be done.
It is a chronic progressive optic neuropathy characterized by raised intra ocular pressure (IOP), optic nerve head (ONH) changes & visual field defects. But many patients have an IOP within normal range and a substantial proportion with normal IOP develops glaucomatous optic neuropathy. Besides raised IOP, other strongly associated factors include greater cup to disc ratio in ONH, thinner central cornea, shallow anterior chamber (A.C), increasing age, family history of Glaucoma, Hypertension and Diabetes are few of the risk factors.
Issues in the management of Glaucoma are diagnosing the case at the earliest, even before any substantial structural damage has occurred. As IOP is the only recognizable and controllable cause hence assessing target IOP and controlling it to prevent any subsequent structural/ functional damage is the main stay of therapy. Newer imaging techniques help us provide information that is reproducible and free of inter-observer variability.
A comprehensive eye check-up helps us catch the disease in unsuspecting cases even before the person is aware of symptoms like a frequent change of glasses, poor dark adaptation, headache mistaken to be migraine etc.
Management
Active participation of the patient is required in the form of compliance to the the treatment, regular check ups and investigations to keep the progression of Glaucoma under check.
Most of the patients can be treated with eye drops with convenient daily dosage. In few, where the target IOP can not be achieved with the maximum medical therapy, option of surgery (Trabeculectomy) is there.
oculoplastic survices
Most of us care how we look and how we feel. We use proper nutrition and exercise to enhance our health, appearance and well being. Some of us may have abnormal appearance of the eyelids and the surrounding structures. These abnormalities, like drooping eyelids, bulging eyes, watery eyes and many more may be present since birth or early childhood. Some of these may be acquired during various stages of life or as a result of any accidental trauma.
Over time, the upper and/or lower eyelids and/or eyebrows may become droopy, hooded, puffy or baggy, giving a tired appearance which distracts from the overall attractiveness of the face. The eyelid tissues stretch, the muscles thin and fat pockets bulge, becoming more noticeable. The cheek tissue descends a little and the chin line becomes "jowly". Eyebrows become drooping, the forehead furrows and deep tear troughs appear below our eyes.
These changes may be cosmetically unattractive and when severe, may also affect eye function. This includes discomfort from the weight of excess eyelid skin on the lashes, impaired visual field from overhang of upper eyelid skin, (or) difficulty wearing glasses because of lower eyelid bulges and tearing problems.
Both men and women are increasingly requesting plastic / cosmetic (aesthetic) surgery on the eyelids or face. They need to be fully informed about the surgical options for their eyelids and surrounding areas.
Cornea Services
At Drishti eye care centre , prayagraj we provide treatment for emergencies as well as care for more long-term conditions of the cornea.
Cornea is the clear tissue at the front and centre of the eye, it’s transparency allows light to pass into the eye through the pupil, lens and on the Retina.
The curvature of the cornea plays an important role in focusing.
Corneal Eye Diseases:
Corneal eye disease is one of the leading cause for avoidable blindness .
For a quality vision a healthy, clear cornea is most important, any injury, infection, or damage on the cornea can leave the cornea swollen, scarred or misshapen and with a distorted vision
Causes of corneal disease:
Infection: Bacterial, fungal and viral infections are common causes of corneal damage.
The cause of Keratoconus in most patients is unknown.
Age: Aging can affect the quality and health of the cornea
Cataract & Intraocular lens implant surgery: Bullous Keratopathy although seen in very small percentage of patients after these surgical procedures.
Heredity
Contact lenses
Eye trauma
Certain systemic diseases
Corneal Blindness: There are almost 1.5 to 2 million new reported cases every year due to Ocular trauma and ulcerations. Traditional and non-scientific diagnosis and medicines have also been a major risk factor in corneal blindness .
Some of the leading causes for Corneal Blindness:
The after-effects of bacterial, fungal, or viral infections
Eye trauma
Congenital disease
Traditional medicine or home remedies, which often harm the eye rather than relieve pain or improve eyesight
Infections
Bacterial, fungal, or viral Keratitis, as well as parasitic diseases
Trauma
Abrasions or exposure to toxic chemicals
Dystrophies and degenerative corneal disorders
Fuchs' dystrophy, map-dot-fingerprint dystrophy, or lattice corneal dystrophy
Autoimmune disorders, Wegener's disease, Rheumatoid Arthritis, or Lupus
Nutritional deficiencies
Treatment :
The only curative treatment available is a cornea graft or transplant
2.Keratoconus
The Cornea gets thin & conical causing distorted vision and high cylindrical power. More commonly seen in children with seasonal allergy and eye rubbing.
The Cornea gets thin & conical causing distorted vision and high cylindrical powers.
More commonly seen in children with seasonal allergy and eye rubbing
Amniotic Membrane transplant
Amniotic membrane transplantation is currently being used for a continuously widening spectrum of ophthalmic indications. It has gained widespread attention as an effective method of reconstruction of the ocular surface.
3.Dry EyeDry eye usually occurs when tears are inadequate in quantity or quality. Commonly seen in computer professionals and with smartphone overuse. Other causes: Sjogrens syndrome
4.Chemical burns
Chemical & Acid injury of the eye is an ocular emergency and requires immediate intervention to save from severe damage to the eye if not chemical injuries to the eye can produce extensive damage to the ocular surface and anterior segment and which may also lead to visual loss and disfigurement of the eye.
5.Chuna injury
Once chuna enters the eye, it sticks into the eye under the eyelid, even through washing it with water it does not removes the particles the chuna particles leache onto the eyelids and gets into the cornea destroying its outer covering it's epithelium this can lead to vision loss .
Management : Treatment for emergency and Acute and chronic cases
6.Corneal Transplant
An unhealthy, damaged cornea affects your vision by distorting or scattering light and blurred vision a cornea transplant may be required to restore vision, A healthy corneal tissue donated from a donor from a local eye bank, the surgeon will replace central corneal tissue with a graft.
Pterygium Surgery: Pterygium surgery: The procedure involves removal abnormal tissue from the sclera and cornea of the eye.
Today Pterygium surgery technique has a higher success rate than conventional procedures, patient heals within two to four weeks with mild discomfort
Diagnosing corneal disease:
The Eye Surgeon will examine your eye for Trauma and Corneal disease through advanced diagnostic technology such as magnifying tools and Slit lamp, corneal topography, your doctor can detect signs of corneal infection, inflammation, scarring, and other problems associated with the front structure of the eye. A special dye may be used to determine the extent of the damage.
Treatment for corneal disease: Like other serious eye diseases, corneal infections/disease should be treated immediately. There are antibiotics and steroids that can be used topically, and occasionally orally.
Retina Services
The common disease affecting the retina are:-
Diabetic Retinopathy
Retinal Detachment
Age-related Macular Degeneration (ARMD)
Diabetic Retinopathy
Diabetic Retinopathy (DR) is a common vascular retina disease affecting about 40% of type 1 diabetics & 20% of type 2 diabetics. Duration of the diabetes is the most important risk factor for DR.
Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes.
Over time, diabetes damages small blood vessels throughout the body, including the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.
Treatment for diabetic retinopathy depends on the stage of the disease [Non-Proliferative or Proliferative]. The goal of any treatment is to slow or stop the progression of the disease.
Treatment options for DR include Laser photocoagulation, Intravitreal injections (Avastin, Accentrix, Eylea) and Surgical Treatment. Surgery is done with 25 Gauge Micro Incision Vitrectomy Surgery (MIVS) instruments .
Retinal Detachment
Retinal detachment (RD) is a disorder of the eye in which the retina peels away from its underlying layer of support tissue and can lead to sudden vision loss and blindness. It is a medical emergency. RD can occur due to a hole, tear, or break in the retina or inflammation and trauma.
Age related Macular Degeneration (ARMD)
Age-related macular degeneration (ARMD) is the most common cause of irreversible vision loss in people over age of 60 years.
The retina has two parts: The peripheral retina and central part called macula. The macula is the only part of the retina capable of producing a sharp and crisp image, which enables us to read, write, watch television and drive. There are two main types of macular degeneration, "dry" and "wet".
Normal VisionMacular Vision
Objects are obstructed and unclearObjects are unobstructed and clear
Macular Vision
Objects are obstructed and unclear
Dry age-related Macular Degeneration /Dry ARMD
This is the most common type of age-related macular degeneration. The round deposits called drusen (degenerated material) appear beneath the retina. A few small drusen cause no decrease in vision. However, if any large drusen develop, vision may be decreased. The dry type of macular degeneration presents with a slow, progressive loss of vision. In this type, the vision remains stable and good for a longer period of time. Unfortunately, there is no treatment for dry age-related macular degeneration.
Wet age-related Macular Degeneration /Wet ARMD Wet
In this type, abnormal blood vessels grow beneath the macula, they leak and bleed. The "wet" form of macular degeneration can cause more severe visual loss. Vision may suddenly become distorted or blurred
