BEST EYE HOSPITAL€¦ · 8 Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India...

Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India Since A Decade www.narayananethralaya.orgNarayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India Since A Decade www.narayananethralaya.org2 3

Ranked once Again the BEST EYE HOSPITAL

in Karnataka

Proudly Presents

Happy Reading

VISIONFIRST

A FULL-FLEDGED ONLINE EYE CARE MAGAZINE FOR THE FIRST TIME IN INDIA

Vision First is a Narayana Nethralaya initiative to bring to you the latest in eye health and research, in an informative and informal way. Our aim is to spread awareness on how to maintain the health of your eyes and give you the knowledge to care for diseases which can affect your vision. This online magazine will cover various aspects of common eye conditions and keep you abreast of all the scientific and technological advancement in the field of ophthalmology.

It also endeavors to be a platform to bring together a community of Narayana Nethralaya patients to share their ideas and experiences and contribute to the society to empower and encourage the visually impaired.

(Times Health survey 2016) CONTENTS

DIALY NEWS

STRAIGHT TO YOUR DESK

STRAIGHT TO YOUR PHONE

www.narayananethralaya.org

narayananethralaya.org/online-magazine

SCAN to see the latest hospital and healthcare news

@NNethralaya

/NNethralaya

Life with glaucoma made easier

Glaucoma and ExerciseWomen and Eye Health

Glaucoma medications

Impact of Glaucoma on

driving

Accomadation for outstation

patients

Who is at risk for

retinal detachment?

How will I know if I have diabetic

retinopathy?

Published quarterly, The Narayana Nethralaya Vision first is an independent voice for the hospital, health and aged-care professional, containing regular features on major projects, health care disciplines, eHealth, news, conferences and events.

20

08 14

18

1001

07 29


#2565

Impact of Glaucoma

on DrivingDr Monika Soni

Driving gives us independence and a sense of control over our lives. Being able to drive means one is not dependent on family members, friends or society. However, an unsafe driver poses a huge risk to himself and to others. A

glaucoma patient with poor vision contributes to potential hazards on the road, and this becomes an important issue.

What is the impact that glaucoma has on driving?To understand this we need to understand the effects that glaucoma has on a patient’s vision. Patients suffering from glaucoma can have loss of vision that ranges from mild to very severe.

Loss of vision in glaucoma usually starts from the periphery or the sides. As the disease progresses the loss of vision progresses from the periphery towards the center.

Peripheral loss of vision that patients with glaucoma suffer from makes it difficult for them to see objects that lie in their outer field of vision, such as pedestrians and vehicles coming in from the sides.

For anyone who is driving, peripheral vision or its loss becomes a major concern since a person in the driver’s seat needs to be well aware of his environment. For this, good peripheral vision is a must, especially for the safe changing of lanes. Along with compromised vision, if a person has reduced cognitive ability and slower reflexes, driving becomes even more dangerous. A visual field test, which is a diagnostic test done routinely for glaucoma patients, can help assess the extent of a patient’s horizontal visual field loss.

To be eligible for a driving license, most foreign countries have driving standards, which include certain criteria for vision that a person applying for a driver’s license should fulfill. The United Kingdom follows 2 standards (UK guidelines 2013) which include one for visual acuity and the other for field of vision.

Unfortunately, in India, people applying for a driving license are not made to undergo a field of vision test and many a time, people with defective vision are not aware that they have compromised vision. This further increases the risk of accidents on the road.

Drivers with perfect vision can also have accidents. If you find yourself in a situation where you have had an accident which you know is your fault or if you find yourself having near misses then you should re-evaluate your ability to drive.

FROM THE CHAIRMAN’S DESK

Glaucoma is one of the leading causes of irreversible blindness in our country. As it has no symptoms in the early stages and can go unnoticed, people may realize that they are suffering from glaucoma only after the disease has

reached an advanced stage. Though it’s not curable, if detected early, the progression of the glaucoma can be halted and total blindness can be prevented.

Since patients who better understand their disease and its treatment have better success in managing their medical condition, we believe that patient education is an important part of long-term outcomes for glaucoma patients. This issue of Vision First provides a detailed explanation of glaucoma, its consequences, and the nature and importance of treatment, so that glaucoma patients and their family members have a better knowledge of the disease and how to manage it.

At the start of the new academic year, we would like to reiterate the importance of good vision for the educational, physical and social development of children. Given a choice, many kids would prefer to spend all day indoors, glued to their digital screens. Fresh air, sunshine, and exercise benefit not only the body, but also the mind. Children who spend time playing outdoors can prevent myopia (short-sightedness) from developing and progressing, get better sleep, get relief from stress and anxiety, prevent childhood obesity, improve their imagination and develop good social skills. Encourage your children to eat healthy and spend more time outdoors this summer.

Best Regards,

Dr. K. Bhujang Shetty,Chairman and Managing Director,Narayana Nethralaya Hospital Bangalore


Constriction of the field of vision in a glaucoma patient

Blurred vision in a patient with glaucoma

So, what should you do if you have glaucoma and are concerned that you might not be driving safely? Ask a family member to accompany you on a drive and evaluate the situation. Discuss any concerns that you may have with your doctor.

Be open to suggestions that friends and family and your health care providers give you. It might mean a compromise on your freedom and independent commute, but safety should always come first. We must remember that we share the roads with others, so our own safety and the safety of others should be of prime concern to us always.

Glare that a patient with glaucoma might experience


Women and Eye Health

April is women’s eye health and safety month. Research shows that more

women than men suffer from visual impairments. Therefore, it’s very important for women to take better care of their eyes.

Here are some reasons why women could be more prone

to eye problems than men:

1. Longer lifespan - Statistics show that women usually have a longer lifespan than men. Many eye diseases such as cataract, glaucoma, AMD and diabetic retinopathy are related to advancing age.

2. Hormonal fluctuations - Women experience serious ups and downs in hormone levels during puberty, menstruation, pregnancy and menopause. Hormonal changes have been linked to dry eye and other vision problems such as blurred vision, trouble focusing, and watery eyes.

3. Autoimmune diseases - Women are more susceptible to develop autoimmune diseases such as Sjögren’s Syndrome, Lupus, Multiple Sclerosis, Rheumatoid arthritis, Hyperthyroidism and Scleroderma. Vision can be greatly impacted by these conditions.

4. Medications - Compared to men, women generally take more prescription and non-prescription drugs such as birth control pills and medication for hormone replacement. Many of these drugs can have serious side effects which can affect vision.

5. Lifestyle choices - Eye health is affected by poor lifestyle choices such as smoking, drinking alcohol, lack of proper nutrition and physical activity, which can lead to medical conditions such as diabetes, strokes and high blood pressure. Obesity due to lack of exercise and poor diets are on the rise among the adult female population. More women are also smoking and drinking as compared to earlier.

6. Socio-economic factors - Vision loss can be prevented with early detection and treatment of eye problems. In many parts of the world, women are still unable to access quality eye health care due to various social or economic factors. Women have to juggle the demands of a job, children, households and aging parents, and tend to neglect their own health.

The risks to eye health in women can be prevented with regular eye exams, avoiding smoking, wearing sunglasses when outdoors, and by following a healthy diet and exercise regimen. Your sight is precious and the power to prevent vision loss is in your hands.

When was the last time you had an eye exam?


Who is at risk for

prevent AMD?

AMD detected?retinal detachment?

How can I

How is

Though it is more common in people over age 40 and affects men more

than women, retinal detachment can occur at any age to anyone.

Risk factors for retinal detachment include severe myopia, retinal tears, a serious eye or head injury, family history, previous retinal detachment in the other eye, complications from an ocular surgery (especially cataract surgery), as well as eye conditions such as uveitis, retinoschisis, degenerative myopia, or lattice degeneration (peripheral retinal thinning).

The Four Stages Of

Diabetic Retinopathy

Mild nonproliferative retinopathy-At the early stage of this diseasemicroaneurysms( small areas ofballoon-like swelling in the retina’s tiny blood vessels) occur

Moderate Nonproliferative Retinopathy-During this stage, some blood vessels that nourish the retina are blocked.

Severe Nonproliferative Retinopathy - In the third stage, more blood vessels are blocked, depriving several areas of the retina with blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy-At this advanced stage, new bloodvessels grow, but they are abnormaland have thin, fragile walls. If they leakblood, it could lead to vision loss.

1 2

34

While some factors like age, family history and genetics is not in your control,

you can reduce your risk of AMD or slow its progression by taking preventative measures such as avoiding smoking, exercising regularly to maintain a healthy weight, keeping your blood pressure and cholesterol levels in check, and eating a diet rich in green, leafy vegetables, whole grains, yellow and orange fruit, and fish.

When AMD is in its early stages, it can be detected during a comprehensive eye examination, generally

before any of the symptoms are noticed by the patient. Changes in vision such as distortion or blurring should be reported to an eye doctor who can detect AMD with a dilated eye exam. The earlier the disease is detected, the more responsive it is to treatment.

If AMD is suspected, it can be diagnosed with the following tests:

Visual acuity test - A standardized eye chart (Snellen chart) is used to determine how well you see at distances.

Dilated eye exam - Eye drops are used to widen or dilate the pupils to provide a better view of the back of your eye. The ophthalmologist will then use a special magnifying lens to check for any abnormalities in your retina and macula.

Amsler grid - is a special grid that’s made up of horizontal and vertical lines and a dot in the centre. Changes in your central vision may cause the lines in the grid to disappear, appear wavy, look faded or distorted, which is a sign of AMD. This test will give your ophthalmologist a better idea of how damaged your macula is. Since damage to the macula affects central vision, usually the lines towards the centre of the grid appear broken or distorted.

Retinal Imaging - In order to determine the damage caused by macular degeneration, detailed images of your retina are used as part of the examination, using the following methods:

Fluorescein angiogram - In this test, a fluorescent dye is injected into a vein in your arm. As the dye passes through the blood vessels in your eye, detailed images are taken with a special camera. These images can point out leaking blood vessels or abnormal new blood vessels that may be growing under the retina. This procedure can identify the type of AMD you have.

Optical coherence tomography (OCT) - Similar to an ultrasound test, which uses sound waves to capture images of living tissues, OCT uses light waves to take high-resolution images of the retina and macula. This enables the ophthalmologist to establish whether any fluid has leaked through into the retina, or whether the macula is abnormal or thickened.

Fundus Photography - the inside of your eye is photographed with a special camera (a fundus camera), through which 3D images of your macula are captured. The ophthalmologist, with the help of these images can establish whether any damage has occurred to your retina.


Glaucoma is a condition which affects the optic nerve in the eye and this is usually due to an increase in the eye pressure. Some patients can be affected by glaucoma and develop weakness of the optic nerve even though their

eye pressure is normal. This generally occurs due to poor blood flow to the eye. Blood flow to the eye can decrease due to low blood pressure and poor circulation. While intraocular pressure (IOP) in glaucoma patients can be lowered with medication, laser treatment or surgery, there is some evidence that a regular moderate intensity exercise can help in decreasing the eye pressure. Most exercise or activity can improve blood circulation to the optic nerve and protect it from damage to some extent.

So which exercises are good for glaucoma patients and which are bad?

Glaucoma and Exercise Dr Monika Soni

The long term effect of exercise on glaucoma progression is not clearly known, but anything that improves overall health and helps in maintaining the integrity of the optic nerve is a positive benefit. Aerobic exercises, running, swimming and jogging are cardiovascular exercises which help increase blood flow to the heart and also to the optic nerve and are good for the eye. However, if you are a glaucoma patient and have recently undergone an eye surgery, you should avoid swimming for a few weeks after the surgery or until your doctor gives you the go ahead. Certain exercises like squat thrusts and lifting

very heavy weights can cause the eye pressure to rise for a short while during the exercise. It is not just the lifting of weights but also holding one’s breath as one exercises that can be bad. Patients with glaucoma can continue to exercise and even lift weights which are not too heavy but should avoid holding their breath while doing it.

Today yoga has a global presence and a lot of people worldwide are doing yoga as part of their fitness regimen. Some asanas in yoga are not advisable for glaucoma patients and it is important for those suffering from glaucoma to be aware of these asanas. Sheershasana is a yoga position in which the patient stands upside down or on his head. This asana is known to cause a temporary increase in the eye pressure and should be avoided in patients who have glaucoma.

Some types of glaucoma such as the closed angle type are not responsive to the effects of exercise and others such as pigmentary glaucoma may develop a temporary increase in IOP after vigorous exercise. Hence patients with glaucoma should always check with their doctor about which exercises are suitable for them. Glaucoma patients should follow a few instructions while exercising which can reduce the rise of eye pressure during exercise : One is to exhale during periods of maximum exertion such as when lifting weights and to inhale when lowering the weight. This will help avoid the Valsalva effect (which is when a person exhales forcefully with a closed mouth or held nose and the exit of air is blocked).

The Valsalva effect can increase eye pressure dramatically, sometimes up to 300% of the normal pressure. While doing yoga, avoid all inverted positions including headstands and inversions since all inverted positions raise IOP substantially.

Exercise, Running and Yoga

Sheershasana or Lifting heavy weights can increase the eye pressure briefly


changes that help lower IOP

In today’s world, people are quite aware about how lifestyle choices affect our overall health, and the same goes for glaucoma. Until now it was believed that lifestyle changes don’t play a role in glaucoma, but recent studies have shown

the role of lifestyle factors which influence eye pressure - the major modifiable risk factor for glaucoma.

However, it is not mandatory that factors which increase intraocular pressure (IOP) may cause glaucoma, and those that lower IOP may prevent the development of glaucoma. There are various factors which contribute to the development of glaucoma and modifications in one’s lifestyle are just supplementary to these.

This means that certain lifestyle factors that increase the intraocular pressure need not actually increase the risk of glaucoma and similarly certain factors which could reduce the intraocular pressure need not actually decrease one’s risk of glaucoma.

Exercise

Diet

Musical instruments

Sources rich in antioxidants

Habit forming substancesActivities which raise your pulse by 20 to 25, like walking briskly, can help reduce IOP. The more number of steps a person walks throughout the day, less likelihood of an increase in IOP. Aerobics is known to cause a temporary decrease in the intraocular pressure but it has not been tested in glaucoma patients. Swimming reduces vulnerability of the optic nerve to an increase in the intraocular pressure.

Lifting of heavy weights is known to cause a temporary increase in the intraocular pressure. Hence, patients who already suffer from glaucoma are advised to avoid lifting very heavy weights.

Yoga, which is a very popular form of exercise includes various ‘asanas’ or positions. Some of these asanas, particularly those with the head – down position (sheershasana) have been proven to cause an increase in the eye pressure. Therefore, patients with glaucoma are advised to avoid such positions.

such as caffeine, alcohol, tobacco and marijuana are known to have a negative effect on eye pressure.

Caffeine, which is consumed widely, is known to cause a temporary increase in the eye pressure.

Consumption of caffeine in small quantities is alright, but an excessive intake of caffeine is has been proven to increase the risk of glaucoma.

Alcohol is known to decrease the eye pressure for a short duration but a daily consumption of alcohol is supposed to increase the risk of glaucoma.

Smoking cigarettes is known to increase the risk of glaucoma.

Though marijuana is known to lower eye pressure, it is not recommended for treatment due to its side effects.

Various studies have been undertaken to study the role of diet in glaucoma. A diet rich in green leafy vegetables is supposed to lower the eye pressure. Dietary nitrates in green leafy vegetables lowers risk of developing open angle glaucoma.

DHA (docosahexanoeic acid) is an omega- 3 fatty acid and is helpful in preserving a healthy retina and lowering the IOP. Rich sources of DHA such as salmon, shellfish and tuna should be consumed twice or thrice a week. If natural addition to the diet is not possible, DHA supplements in the form of fish oil supplements can be taken.

A diet rich in lutein and zeaxanthin helps in lowering intraocular pressure. It avoids oxidative damage to the optic nerve. Spinach, broccoli and sprouts are rich sources of lutein and zeaxanthin.

Antioxidants provide nutrients and strengthen the muscles and nerves in the eye. Rich sources of antioxidants are blueberries, grapeseed extract, goji berries, pecan nuts and cranberries. Foods which are rich in trans-fats, the kind found in deep fried food, prevent the optimal functioning of omega 3- fatty acids and increases eye pressure. Such food should be avoided.

such as the trumpet and the saxophone are known to cause an increase in the eye pressure. Glaucoma patients are advised to avoid playing such high resistance wind instruments which can increase the intraocular pressure.

Lifestyle choices can, to some extent, influence eye pressure and affect the risk of developing glaucoma, but there aren’t enough proven studies about the same in glaucoma patients. However, a shift towards a healthier lifestyle makes for an overall positive change.

Lifestyle

- Dr Bhavin Tilva


Glaucoma is a disease in which the pressure inside the eye increases, and causes damage to the

nerve of the eye, leading to irreversible loss of vision. Usually, it has no symptoms in the early stages and can go unnoticed, only to be diagnosed later with severe vision loss. It is not surprising that glaucoma has been called ‘The silent thief of sight’!

How glaucoma affects vision

There is a small space within the eye called the anterior chamber. Clear liquid (called the aqueous humor) flows in and out of the anterior chamber. It is the aqueous humor that plays an integral part in maintaining the pressure in the eyes. In some people, due to various reasons, the pressure inside the eye rises. This increased eye pressure, if left untreated can damage the eye nerve and can cause permanent vision loss. The disease usually affects both eyes, though one may be more severely affected than the other. Unfortunately, the damage to the eye nerve due to glaucoma is irreversible and the loss of vision cannot be reversed. But, this condition can be halted and the remaining vision can be retained if glaucoma gets diagnosed on time and appropriate treatment is started.

A better understanding of your treatment and medications can make it easier to live with glaucoma

Q: I miss instilling my eye drops often. Will it affect my vision?

A: Missing your eye drops often leads to inadequate control of eye pressure. In order for them to help your eyes, you will need to use your drops every day. Make it a part of your daily routine, like brushing your teeth. Follow your doctor’s instructions properly.

Q: How important is it to put the drops at exactly the time stated?

A: It is important to get into a routine and to instil the eye drops at around the same time each day, but the exact time is less important.There are several ways to help yourself remember when to put your drops in:• A chart with tick boxes,• A box with compartments for the drop bottles,• A special timer can be set to ring several times each day as required

Q: Where should I keep the drops and for how long?

A: Read the storage instructions mentioned on the cover of your eye drops. Keep your drops in a cool place or in the door of the refrigerator. Do not place them in the freezer section. Check the expiry date on unopened bottles before using them.

Q: What happens if I forget to take my drops when I go out?

A: Do not worry unduly if you forget on the odd occasion, but try to get into the habit of taking your drops with you wherever you go. If you have forgotten a drop, just put it as soon as possible after the time it was due.

Q: Can I take other medicines at the same time as my glaucoma treatment?

A: Patients with angle closure or narrow angle types of glaucoma should seek advice before taking some types of tranquillizer or certain asthma and indigestion medicines. However, glaucoma eye drops are usually safe if you have had laser treatment (laser iridotomy) or glaucoma surgery.

Glaucoma medications

Dr Shivani Dixit

and easier for your doctor to control your disease. Here are answers to frequently asked questions by glaucoma patients regarding medications that are to be used:

Q: How do my glaucoma eye drops work and help save my vision?

A: The goal of glaucoma treatment is to lower the pressure in your eye. It often starts with prescription of eye drops. These can help decrease your eye pressure by improving how fluid drains out of your eye or by decreasing the amount of fluid your eye produces.

Q:What are the different types of medications available and do they have any side effects?

A: There are different types of medications available for glaucoma. They do have a few side effects so; feel free to ask your doctor when he is starting you on treatment.

Q: What precautions should I take while putting my eye drops?

A: Wash your hands before instilling your drops. While opening the cap of your eye drop, be careful not to touch the nozzle of the bottle. Gently pull your lower eyelid and put one drop into the eye. Gently close your eye for a few seconds. Do not squeeze the eye forcefully after putting the drop, as it may cause the medication to come out of your eye and get wasted.

Q: My doctor has prescribed more than one eye drop for glaucoma. Can I put them into the eye one after the other?

A: No, usually you should keep a gap of 5-10 minutes between two eye drops as it helps in better absorption of the drop and helps in better eye pressure control.

Q: Is it safe to put in an extra drop just to make sure?

A: Yes, if you are not certain that the first drop went in, it is safe to put in another drop. In general, it is best to avoid putting in more than one drop.

Steroid (cortisone-type) drops and tablets should be used with caution because they can increase the pressure in the eye.Always mention that you are on glaucoma medication when you visit a doctor for any other treatment.

Q: Why do I have to see the eye specialist or attend the glaucoma clinic regularly?

A: Even if your glaucoma is stable, it is important to attend the glaucoma clinic regularly. The purpose of your visits is to monitor your glaucoma (through optic nerve appearance, visual field and eye pressure tests) and to ensure that the treatment is working.

Q: Do I need to put the drops in before I come to the clinic?

A: Yes, always continue as usual unless requested otherwise. It helps the doctor to judge the effect of the treatment.

Timely instillation of glaucoma medications is of utmost importance

The medical treatment of glaucoma is usually in the form of eye drops

Know your medications and manage your glaucoma better


Financial constraints for consultation fees and investigations, to buy medications, and for transportation - to make regular visits to his eye doctor.

He has been an auto driver for 20 long years. It is challenging for him to change his profession as it is no longer safe for him to drive his auto.

Adherence to medications becomes difficult as he tends to forget to use the medications on time. Missing his medication is harmful for him since it can worsen his glaucoma and make him more visually handicapped.

Psychologically, he is stressed as he is the bread winner in the family and has to support his entire family.

This is just one example! There are many similar stories that have affected the lives of many people. So, what can a glaucoma patient do to make his life easier?

Glaucoma is one of the leading causes of irreversible blindness in our country. It has been aptly called the “silent thief of sight”. As it is a symptomless disease,

people usually do not realize that they are suffering from glaucoma unless they visit the ophthalmologist or have reached an advanced stage of disease.

Glaucoma affects the quality of life of millions of people. In the early stage of glaucoma, patients experience compromised vision which affects their quality of life. This worsens as the disease progresses. Ocular discomfort, psychological factors, economic factors and social constraints contribute to the burden of the disease.

Glaucoma is not curable but if detected early, the progression of the disease can be halted and total blindness can be prevented.Here is an example to explain the difficulties a patient

diagnosed with glaucoma faces:

A 46 year old auto driver visited an ophthalmologist with complaints of difficulty in near vision. He was examined in detail and was diagnosed to have an advanced stage of glaucoma where he had significant loss of the peripheral field of vision.

He was started on multiple eye drops in both eyes. He was advised to use these medications and was also advised not to drive as his vision was severely compromised.On asking him for a detailed family history, he said his father had an eye disease for which he had consulted a doctor and was asked to get some investigations done. Unfortunately, before he could take him to the hospital, his father fell sick and passed away. It is possible that he had an unnoticed family history of glaucoma.

made easier

The problems that the

auto driver is facing are:

Here are some TIPS to make the life of a glaucoma patient easier

Before the disease is detected:

Prevention is better than cure

Ophthalmic consultation is a must for everyone over the age of 40, in an eye hospital rather than getting tested for near vision at an optical shop. Get glaucoma screening done if you have family history of glaucoma, diabetes, hypertension, heart disease, asthma, arthritis, migraine, thyroid disease, using minus or plus powered glasses, any history of trauma to eye. If detected in the early stage, the disease can be arrested and existing vision can be retained. Babies born with whitish coloured eyes or bigger than normal eyes, or babies with severe watering and difficulty in opening their eyes at birth, should be screened for congenital glaucoma.

Prevention is better than cure

If you have undergone any surgery or laser treatment for glaucoma, it is important to understand that these procedures are performed to reduce the intra-ocular pressure and are an attempt to restore the remaining vision.

Regular usage of medications –- keeping alarms on your mobile phones will remind you to put your medications on time - making a simple drug chart in a pocket diary as shown in the figure below so that it can be noted and showed to your doctor as well.

Date Morning 8 am Afternoon 1pm Night 8pm

RE LE RE LE RE LE

RE LE RE LE RE LE

RE LE RE LE RE LE

Follow the instructions of your doctor and attend follow up examinations as advised

Follow the technique properly while instilling the medication into the eye so that the desired effect of medication is attained.

If you have any difficulty in instilling the medication or if you have any discomfort with the medication, let your doctor know about it rather than stopping medication on your own.

Never stop the medications on your own - people usually think that there is no change in vision and stop the medication themselves. This can compromise your vision further.

After the disease is detected:

Dr Shruthi S

Life with glaucoma


Glaucoma risk factors

There are certain other types of glaucoma where there is an identifiable cause for increased eye pressure resulting in optic nerve damage and vision loss. These are called secondary glaucoma. It may be caused by prolonged, indiscriminate use of steroids, severe diabetic retinopathy, injuries to the eye, inflammation of the eye (uveitis) or advanced cases of cataract.

If you believe you have any of these risk factors get an eye examination done. Always remember to inform your eye doctor about the risk factors that you have. This will help your doctor decide how often you need to get your eyes examined. Glaucoma is a disease that can be easily controlled if it is diagnosed early. So encourage your friends and family to get regular eye examinations done.

Dr.Sruthi.P

Glaucoma is a disease that damages the eye’s optic nerve. In glaucoma the fluid pressure inside the eye increases, and this leads to progressive damage of the optic nerve, resulting in a gradual loss of vision. The front half of the

eye is filled with a fluid known as the “aqueous humor”.

This fluid is continuously produced and constantly flows out of the eye, maintaining a steady pressure inside the eye. If there is either reduced drainage or excessive production of this fluid, the pressure in the eye will increase, leading to glaucoma. Not everyone with high eye pressure will develop glaucoma, and some people with normal eye pressures may also develop glaucoma. There are several other factors which determine this.

Primary open angle glaucoma

Secondary glaucoma:

Angle closure glaucoma or closed angle glaucoma:

Normal tension glaucoma /Low tension glaucoma:

Primary open angle glaucoma is the most common type of glaucoma. In this type of glaucoma, the part of the eye through which the fluid of the eye flows out is open, permitting the outflow of fluid, but the patient still has high pressure. This type of glaucoma develops slowly without any symptoms. Initially it affects the peripheral or side vision and very gradually progresses to the centre. This is the reason why many people are not aware that they have the condition until they have significant vision loss affecting central vision. Glaucoma has been labelled as the “sneak thief of sight” because many people remain undiagnosed until irreversible loss of vision occurs. If left untreated it can even cause blindness.

Risk factors for primary open angle glaucoma are:

• Age more than 40 years• Race –African Americans• Family history of glaucoma • Systemic diseases such as diabetes mellitus, hypertension, heart disease• Injuries to the eye• High myopia

It is a less common type of glaucoma which occurs due to narrow drainage channels in the eye. Gradual closing of the angle is called chronic angle closure and if the drainage angle closes suddenly, it causes an acute angle closure attack. Acute angle closure glaucoma usually presents as an emergency. A patient who is in an acute angle closure attack will have symptoms of eye pain, nausea, vomiting, redness and blurred vision due to a rapid increase in the eye pressure. In such cases the patient needs immediate treatment by an eye specialist.

Risk factors for angle closure glaucoma:

• Age more than 40 years • Race - East Asians• Family history of glaucoma• Women• High hypermetropia or those with a high plus power

In this type of glaucoma the optic nerve can get affected even though the pressure in the eye is normal. Although its cause is not entirely known or understood, normal tension glaucoma is believed to occur either because of an extremely fragile optic nerve that can get damaged even though the pressure in the eye is normal, or because of reduced blood flow to the optic nerve. Because of its silent nature, people usually do not have any visual complaints until a very advanced stage of the disease.

Risk factors for normal tension glaucoma are:

• Family history of normal tension glaucoma • Race - Japanese ancestry• Thinner corneas• Heart disease• Migraine and peripheral vascular disease


World Glaucoma WeekWho is at high risk for glaucoma?

Glaucoma Treatment by Laser

What is Tonometry? Why is Gonioscopy important?

If you are more than 60 years old, have blood relatives with glaucoma, are on treatment with steroids (in the form of tablets, skin ointments, inhalers, eye drops), have diabetes or high blood pressure, are near sighted or have a history of trauma, your risk of developing glaucoma increases.

Glaucoma is a treatable disease that needs early detection as the damage is irreversible. Treatment can include eye drops, laser or surgery. Laser treatments such as Laser Peripheral Iridotomy and Selective Laser Trabeculoplasty are used to lower the intraocular pressure and increase the outflow of fluid from the eye.

Tonometry is a diagnostic test that measures the fluid pressure, known as intraocular pressure (IOP), inside your eye.

The tonometry test is important as it can help your doctor evaluate whether or not you may be at risk of glaucoma. Glaucoma is a serious eye disease that is characterised by increased fluid pressure within the eye which can damage your optic nerve.

Gonioscopy is a painless eye examination of the front portion of your eye (anterior chamber), to examine whether the area where fluid drains out of your eye (drainage angle) is open or closed.

This test is important as it helps your doctor to diagnose and monitor various eye conditions associated with glaucoma.

The Visual Field test is a method of measuring your peripheral or side vision (which is affected first by glaucoma), through which your doctor can diagnose and monitor glaucoma. The data from the test is used to determine the severity of your glaucoma, level of vision loss, damage to the visual pathways of the brain, and other optic nerve diseases.

What is a Visual Field test?

floaters?What are

Part of the natural aging process, floaters are black or white spots in our vision. They can appear as specks, strings, or cobwebs that drift about when you move your eyes and appear to shift away when you try to look

at them directly.

With age, the jelly-like substance (vitreous) inside your eyes begins to dissolve and becomes more liquid. Microscopic fibers within the vitreous tend to aggregate and cast tiny shadows on the retina as light passes through the eye. These shadows are called floaters.

Floaters can be distracting at first, but usually settle down at the bottom of the eye (below the line of sight), becoming less bothersome over time.

Symptoms of eye floaters may include:

Factors that can increase your risk of floaters include:

Contact your ophthalmologist immediately if:

Causes of eye floaters include:

• Small dark spots in the vision• Spots that move when you move your eyes• Spots that are more noticeable when you look at a white or light-colored background, such as a blue sky, a white wall or a computer screen with a background

A sudden increase in the number of floaters or flashes of light can be symptoms of detachment of the retina, which is the nerve layer of the eye.

• Age over 50• Nearsightedness• Eye trauma• Complications from cataract surgery• Diabetic retinopathy

• You see several floaters at once• See new floaters suddenly• Flashes of light along with the floaters• Darkness on any side of your visual field

The above symptoms are painless but require urgent attention.

• Age-related eye changes• Retinal detachment or tears• Inflammation in the back of the eye - due to the release of inflammatory material into the vitreous that are seen as floaters• Bleeding in the eye - Blood can be seen as floaters. Bleeding in the vitreous can be due to diabetes, hyper-tension and blocked vessels or injury• Eye surgeries and eye medications - Medications that are injected into the vitreous can cause floaters to de-velop till they are absorbed into the eye. Surgery of the retina involves adding silicone into the vitreous that can also be seen as floaters.

Dr Rwithuja Thomas


Diabetic retinopathy is a serious complication of diabetes where tiny blood vessels inside the retina are damaged, causing them to bleed or leak fluid, leading to vision complications or even vision loss.

What is Diabetic Retinopathy?

Glaucoma StatisticsGlaucoma is one of the leading causes of irreversible blindness, where damage to the optic nerve leads to loss of visual function.

Why is it important to know the statistics, percentages, proportions or the number of people affected with glaucoma?

How many people are affected by glaucoma?

How many people are affected by glaucoma in India?

What are the different types of glaucoma and what is the prevalence of different types of glaucoma?

The prevalence is the proportion of a population with the disease at a given point of time. Hence, the answer to this question is that the awareness about its prevalence alerts individuals to the disease. This is necessary as early diagnosis, and therefore early intervention, is crucial in delaying the progression of the disease process.

A recent systematic review estimated that the number of people aged between 40 - 80 years with glaucoma worldwide is 64.3 million, and that it will increase to 76 million in 2020 and 111.8 million in 2040. The number of people blind and visually impaired due to glaucoma worldwide will be 2.1 million and 4.2 million respectively.

In India, the estimated number of cases of glaucoma is 12 million. This is around one fifth of global burden of glaucoma.

There are different types of glaucomas like primary open angle glaucoma, angle closure glaucoma, congenital glaucoma and secondary glaucoma.

> Prevalence of primary open angle glaucoma ranges from 0.41 to 2.99%.

> Prevalence of angle closure glaucoma is between 0.88 to 7.24 %.

> Prevalence of congenital glaucoma in South India is one in every 3300 children.

> One of the risk factors for glaucoma known as the pseudoexfoliation is an abnormal material formed in the eye which can cause high pressures in the eye. The prevalence of pseudoexfoliation glaucoma is reported to be between 1.87 and 13.5%.

> Studies have reported the prevalence of secondary glaucomas to be 0.08 to 0.3%.

The highest rate of blindness in India is at least partially explained by the large proportion of the undiagnosed disease in the population based studies.So, get yourself screened for glaucoma and save your vision!

Dr Guddeti Praveena


Challenging the challengesNarayana Nethralaya in collaboration with National Federation of the Blind and Sthree Vani - A WhatsApp group

for visually impaired women, celebrated Women’s Day in a program exclusively for women with impairment. Ms. Rajani Gopal Krishna, the first visually impaired Chartered Accountant in India, was the chief guest who shared her journey and its challenges.

Health is wealth –a workshop on Gynecology was conducted by Dr. Shilpa Venkatesh, a renowned Obstetrician and Gynecologist. The 1st Anniversary of Sthree Vani was celebrated and their services to the visually impairment community was narrated. Prizes were distributed by Mrs. Naina Shetty and Ms. Priya Seshadri to the winners of two fun filled competitions.

Accommodation for

outstation patientsAt Narayana Nethralaya, the comfort of our patients is very important to us. We understand that outstation patients who consult with us often have issues with proper accommodation while undergoing treatment.

We are happy to announce that accommodation within the hospital premises is now available for outstation patients and their attender in a safe, clean and friendly environment. Services offered include AC rooms for Rs 2500 and non-AC rooms for Rs 2000, with an attached bathroom.

For room enquires, please contact Mr. Naveen at 08066121311.Working hours 8 AM - 6 PM.

Thanks for Reading

A Narayana Nethralaya Initiative

We invite your feedback & suggestions.Would you like to contribute Articles or Testimonials?

write us to [email protected]

Creatives & Photographs : Mr Najeeb Rahman, Mr Kallappa

Editorial board : Mrs Shilpa Rudra, Mr Praveen.I.M, Mrs Chitra Seshadri

visionFIRST

Ranked once Again the BEST EYE HOSPITAL

in Karnataka(Times Health survey 2016)

BEST EYE HOSPITAL€¦ · 8 Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India...

Documents

Transcript of BEST EYE HOSPITAL€¦ · 8 Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India...