This unit provides a comprehensive structure to render Hi-Tech facilities as mentioned below,
A) Diabetic Eye Disease
B) Paediatric Ophthalmology
DIABETIC EYE DISEASE
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.
This section may include - Diabetic retinopathy
- Diabetic Cataract
- Diabetic Glaucoma
Diabetic retinopathy
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina.
There are two main stages of diabetic retinopathy:
1. Non-proliferative: When the blood vessels leak, macular edema may occur, thereby reducing vision.
2. Proliferative: When new, weak blood vessels grow or proliferate, bleeding into the vitreous may occur and cause severe visual loss.
Causes
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy.
2. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema.
Risk factors
All people with diabetes--both type 1 and type 2--are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes.
If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.
The level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease.
Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss.
Symptoms
Often there are no symptoms in the early stages of the disease, nor is there any pain. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema.
At first, you will see a few specks of blood, or spots, "floating" in your vision. Hemorrhages tend to happen more than once, often during sleep.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness.
Treatment (A) Non proliferative Retinopathy
During the non proliferative stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
(B) Proliferative retinopathy
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Scatter laser treatment may slightly reduce your color vision and night vision.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
(C) Macular Edema
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent.
Injection of Triamcinolone (steroid) into the eye helps to reduce the edema.
Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.
At Polio Foundation we have out-patient services, in-patient services, fully equipped OT with an operatingmicroscope included in the surgical instruments. We would be dealing in specialized needs of pediatricophthalmic problems- squints, corneal, retinal and vitreous diseases. Our ophthalmic unit has beenwell supported by high tech instruments from the world’s leader in the field - Carl Zeiss. Also, it has the unique privilege of being a CARL ZEISS OPHTHALMIC KNOWLEDGE CENTER – 3rd such center nationwide. Fellowship in Retinal diseases is also getting planned at this specialized center.
Diabetic cataract
Cataracts are changes in clarity of the natural lens inside the eye that gradually degrade visual quality. The natural lens sits behind the colored part of the eye (iris) in the area of the pupil, and cannot be directly seen with the naked eye unless it becomes extremely cloudy.
Cataract development is usually a very gradual process of normal aging but can occasionally occur rapidly. Many people are in fact unaware that they have cataracts because the changes in their vision have been so gradual. Cataracts commonly affect both eyes, but it is not uncommon for cataracts in one eye to advance more rapidly. Cataracts are very common, affecting roughly 60% of people over the age of 60,and more common in people with diabetes..
Causes
The lens is made mostly of water and protein. Specific proteins within the lens are responsible for maintaining its clarity. Over many years, the structures of these lens proteins are altered, ultimately leading to a gradual clouding of the lens. Rarely, cataracts can present at birth or in early childhood as a result of hereditary enzyme defects, and severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataracts to occur earlier in life. Other factors that may lead to development of cataracts at an earlier age include excessive ultraviolet-light exposure, diabetes, smoking, or the use of certain medications, such as oral, topical, or inhaled steroids. Other medications that are more weakly associated with cataracts include the long-term use of statins and phenothiazines.
Symptoms
Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dulled color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye.
Cataracts are usually gradual and usually not painful or associated with any eye redness or other symptoms unless they become extremely advanced. Rapid and/or painful changes in vision are suspicious for other eye diseases and should be evaluated by an eye-care professional.
Exams and Tests
To detect a cataract,.a comprehensive eye examination becomes necessary. It usually includes the following:
• Visual acuity test: Refraction: Glare testing: Potential acuity testing: Contrast sensitivity testing:
• Tonometry : Pupil dilation: Treatment
Surgery
Phacoemulsi fication
Diabetic Glaucoma
This is a condition that may occur in people with and without diabetes. It is usually caused by too much fluid pressing on the nerve at the back of the eye.
The optic nerve is the 'electric wire' of the eye, taking messages about what you see on towards the brain. In the main type of glaucoma the optic nerve is pressed on by extra fluid in the eye, and this may damage the sight in the eye.
Glaucoma is found by
- measuring your eye pressure
- looking into your eye at the optic nerve (the nerve can appear caved in)
- Testing the field of vision.
Treatment for glaucoma
- The basic treatment for glaucoma in diabetes is eye drops, and the commonest is one of the beta-blocker drops such as betaxalol, teoptic (cartelol), or timolol.
- Surgery involves either laser treatment or making a cut in the eye to reduce the intraocular pressure (IOP).
B. PAEDIATRIC OPHTHALMOLOGY
This refers to a group of diseases that occurred in children which may lead to blindness if not diagnosed & treated timely.
1 - Juvenile cataract
2 - Juvenile corneal opacity
3 - Juvenile Glaucoma
4 - Juvenile squint
5 - Juvenile retinal diseases including juvenile diabetic retinopathy
India shoulders the world’s largest burden of blindness. Of a total population exceeding 1 billion, as many as 15 million people are blind, with an additional 52 million visually impaired. Among those are 320,000 children under the age of 16, constituting one fifth of the world’s blind children. Fifty percent of these children could be cured if adequate facilities and trained staff were available.
Blindness can affect the young and old, rich and poor, educated and unaware - and people who live in Africa and South America are 5 - 10 times more likely to go blind than people who live in industrialized nations. Half of the world's blind people live in three regions: India (9 million), Africa (7 million) and China (6 million). The global statistics are sobering.
Corneal Blindness in India (Total aprox. 10 lacs) among them 1.9 lacs bilaterally blind & 5.9 lacs unilaterally blind. 20000 - 25000 children affected by corneal problem added every year.
Aims
- To recognize “Health for all” as a national goal and health right of all citizens
- To create awareness about gravity of blindness and its complications
- To provide early diagnosis and prevention of complications of Diabetic Eye
- To provide early diagnosis and prevention of complications of Cerebral Palsied Children Eye
- Restore eyesight
- Provide Eye to needy person
- To help enhance the quality of life
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.
Diabetic eye disease may include:
- Diabetic retinopathy: Damage to the blood vessels in the retina.
- Cataract: Clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.
- Glaucoma: Increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.
Squint or Crossed Eye, Squint eye usually develops during early childhood. Both the eyes of the child are abnormally aligned when looking at an object. A person with crossed eyes uses one eye at a time and is deprived of the depth perception. It affects binocular vision and co-ordination between the two eyes. The Squint is best corrected, if noticed during early childhood. In some cases, proper spectacles can achieve desired correction & long duration squints is corrected surgically.
Polio Foundation does provide surgery for pediatric ophthalmic diseases with Hi-Tech CARL -ZEISS equipments.
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