Procedures in eye care
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The eye is our window to the world. They are very precious and must be kept in perfect condition all the time. We must look after our eyes with great care and caution. Our eyes suffer from various diseases and conditions from time to time. With great advancements in technology, ongoing research and growing awareness, there has been a revolution in eye care procedures and eye disease treatments. Here is an insight into various current eye care practices.

Eyeglasses and contact lenses

To begin with, we have our good old, eye glasses or spectacles. They are the most common and cheapest means to correct focusing (refractive) errors of the eye, such as presbyopia, myopia, hypermetropia, astigmatism etc. Spectacles are made of lenses, the type and power of which depends on the degree of focusing error of the eye. Generally, there are two broad categories of lenses; a 'plus' lens is convex while a 'minus' lens is concave in shape. The power of a lens is measured in dioptres (D). The higher the dioptre count the stronger the lens, in either a plus or a minus direction.

As an alternative to glasses, contact lenses are now very popular. However, as well as soft contact lenses for shortsight, special types of contacts can be used in the treatment of other eye conditions including many of those listed below.

Corneal reshaping

Corneal reshaping, also known as orthokeratology and corneal refractive therapy, is a popular procedure in temporarily correcting myopia by the use of rigid contact lenses. Advancement in corneal reshaping contact lens designs and materials have made it a more convenient choice over refractive surgery and glasses. However, this therapy must involve proper education about its implementation for both the practitioners and patients to ensure optimum results and safety. Modern orthokeratology involves the overnight use of reverse-geometry gas-permeable lenses and is often referred to as OK, ortho-k, corneal reshaping and more commonly rigid contacts.

Cataracts

Cataracst are the opacification (clouding) of the lens and is one of the biggest threats to functional vision, affecting an estimated 16 million people worldwide. Though, there has been no major breakthroughs in prevention of cataracts, its cure has seen advancement with improved surgical removal procedures (including small-incision surgery), use of viscoelastics and the development of intraocular lenses for implantation.

Bilateral congenital cataracts are the commonest cause of curable infant blindness. Treatment involves immediate surgery in patients with dense congenital cataracts within 2 months of birth; simultaneous optical correction of the aphakia; and potent occlusion therapy with regular reviews. Intraocular lens can also be implanted safely in children aged over 1 year.

Ocular allergy treatment

Contact lenses have also revolutionized the treatment of anterior segment eye disorders like dry eye, blepharitis and ocular allergy. Prevention is better than cure as far as eye allergies are concerned. The most common eye allergies are:

  • Acute allergic conjunctivitis
  • Vernal keratoconjunctivitis
  • Atopic keratoconjunctivitis
  • Giant papillary conjunctivitis
  • Dry-eye syndrome (tear film dysfunction)
  • Contact dermatitis of the eyelids
  • Blepharoconjunctivitis
  • Microbial keratitis

The first line of treatment in allergies is to block the triggers. However, if allergy does occur there are pharmacotherapies with antihistamines, decongestants, nasal corticosteroids, mast cell stabilizers, anticholinergics and immunotherapy to fall back on.

Laser-based therapies

The development of medical lasers has opened yet new vistas in eye therapy. It has led to the following laser-assisted procedures:

  • Keratoplasty that corrects corneal curvature and hence is an effective therapy for hyperopia and hyperopic astigmatism
  • Lasik (laser in situ keratomileusis), Lasek (aser subepithelial keratomileusis) and Photorefractive Keratectomy (PRK) are laser-assisted surface ablation surgeries for vision correction.

Glaucoma treatment

The eye condition of glaucoma is a public health issue of global concern. An estimated 6.7 million people are blind from this disease worldwide. Moreover, blindness caused by glaucoma is irreversible, unlike cataracts. A lot more research needs to done about the pathogenesis of this ailment, but there has been satisfactory progress in its therapeutic approaches. The process of reducing intraocular pressure (IOP) has proved to be most effective mode of treatment.

INTACS

INTACS are polymethylmethacrylate segments that are surgically fitted into the core corneal stroma to smoothen the central cornea for the treatment of various eye conditions like keratoconus, ‘‘forme fruste’’ keratoconus with mild myopia, post-LASIK ectasia, pellucid marginal degeneration and cornea that is too fragile for supplementary uplift after undergoing a LASIK for myopia.

Diabetic retinopathy

Diabetic retinopathy is a visual threat among older people and individuals with poor diabetic control, hypertension and raised lipids. Loss of eyesight can be avoided with peripheral retinal laser photocoagulation, with preproliferative retinopathy and maculopathy. Macular laser photocoagulation helps in case of macular oedema plus low-to-moderate preproliferative and grid photocoagulation in case of diffuse maculopathy.

Uveitis treatment

Uveitis is a considerable cause of blindness among young people. Treatment regimes include sulphasalazine, systemic corticosteroids and/or immunosuppressive and infliximab in applicable cases. Medical therapy tends to be more testing in children with uveitis.

Choroidal neovascularization therapy

Choroidal neovascularization is an abnormal growth of blood vessels related to macular degeneration. It is associated with several other conditions like intraocular inflammation, angioid streaks, choroidal rupture, pathological myopia, chorioretinal scars, or chorioretinal dystrophy. Effective therapy involves action on the vessels with heat, light, ionizing radiation and photodynamic agents.

Cosmetic blepharoplasty

Cosmetic blepharoplasty is a surgical procedure for enhancing the look of the eye. Performed on the upper and lower eyelid, it is a cosmetic correction of the tired and ageing eyes.

These and several other eye care diseases and their treatments are described in more detail in the articles here.

 
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