Jabalpur Eye Care

OPD Hours:
P.M. to P.M.
Sunday Closed

Contact:
9009101571, 9111451846
jabalpureyecare.com

Behind Sunil Hosiery
Krishna Hotel Road, Bhawartal
Garden, Jabalpur-482002

Eye Conditions

This section is a resource for those who wish to understand a little more about specific eye conditions.

Although there are numerous eye conditions, here is a list of some of the more commonly encountered eye conditions.

  • Why do I need glasses?
  • Myopia (Shortsight)
  • Hyperopia (Farsight)
  • Astigmatism
  • Presbyopia
  • Cataract
  • Keratoconus
  • Dry Eye
  • Flashes & Floaters
  • Glaucoma
  • Fuchs Endothelial Dystrophy
  • Limbal Stem Cell Deficiency

Why Do I Need Glasses

This page briefly describes the various conditions that result in the need for glasses or contact lenses.

How does the normal eye work ?

The eye is very similar to a camera and it will be useful to refer to the diagrams below. The cornea and lens are similar to the lens in the camera. Both the eye and camera has an iris which controls the amount of light that enters the eye.

Light rays enter the eye and 60 to 70% of the focus is performed by the front clear part of the eye, the cornea. The remaining 30 to 40% of focus is by the lens inside the eye. The retina is similar to the film of the camera and light rays need to come to point of focus on this structure at the back of the eye. Information from the retina which has photoreceptors (rods and cones) is passed to the optic nerve and then on to the brain where information is processed very much like a computer and the information is turned into vision. To see well light rays must be at a point focus in the eye.

If the eye is too long or short or the cornea too flat or steep, light rays focus in a place other than the retina and the information transmitted to the brain is poor and interpreted as a blur. This is called a refractive error of which there are 4 types:

  1. Shortsightedness (Myopia)
  2. Farsightedness (Hyperopia / Hypermetropia)
  3. Astigmatism
  4. Need for reading glasses (Presbyopia)

There are a number of options available to treat all kinds of eye conditions, but they generally fall into 3 categories.

  • Laser Eye Surgery
  • Laser Refractive Lens Exchange
  • Implantable Contact Lenses

Shortsight (Myopia)

This is where vision without glasses is quite good up close (sometimes very close) but poor at distance.

Shortsight is relatively common. Most people use glasses or contact lenses to cope, but there are many vision correction options available including:

  • Laser eye surgery
  • Implantable contact lenses
  • Laser lens replacement surgery

Patients who are shortsighted have a steep cornea and/or a long eye. This means that the point of focus falls short of the retina and the patient will struggle to focus on things in the distance.

The longer the eye and/or steeper the cornea the higher the level of shortsightedness. Shortsightedness can be corrected by flattening the cornea and making it less powerful. This moves the point of focus backwards to fall onto the retina.

Higher prescriptions require a higher correction and removal of more tissue - suitability is thus dependent on adequate corneal thickness to perform the correction safely. IntraLASIK has been effective for a wide range of shortsightedness up to -12.00 diopters.

Farsight (Hyperopia / Hypermetropia)

This is where vision is clear at distance and often clear at near. Farsighted people often report having fantastic vision when they were young and then with advancing age, near vision become blurry and in time distance vision also becomes worsens with the need for glasses for both near and distance.

Farsightedness or Hyperopia is a common form of visual imparment. When the eye recieves an image it focuses this behind the eye rather than on the back of the eye. Farsighted individuals typically have excellent vision when young but find they need glasses to read in their 30's and eventually need glasses for all activities. Strong glasses or contact lenses are required to help bring the rays upstream to focus on the retina.

Correction options include:

  • Laser eye surgery
  • Implantable Contact Lenses
  • Laser Refractive Lens Exchange

Correcting Hyperopia

If the cornea is flat, then IntraLASIK with the Zyoptix Wavefront algorithm is a good option for correction. Plus 5.00 Dioptres and in selected cases more can be treated and the advantage of the Wavefront treatment is the ability to create wide zones with less tissue removal - bespoke and personalised for the individual eye.

A word about Presbyopia

If you are over 42 and your near sight is gradually being lost and you require READING GLASSES, it is probably caused by increasing hardness of the lens in your eye - the lens can no longer change shape enough to focus.

For those over 50, a good option for vision correction is Laser Lens Exchange also known as Lens Replacement surgery with implantation of high performance Trifocal lens implants.

There are a number of other criteria that a suitable candidate requires:

  • Healthy eyes with no disease
  • No abnormalities in corneal shape (e.g. keratoconus)
  • Prescription within the range of correction
  • Do not have a profoundly lazy eye (amblyopia)
  • Are not pregnant or nursing
  • Are in good general health

There are a number of options available to treat farsightedness, but they generally fall into 3 categories.

  • Laser Eye Surgery
  • Laser Refractive Lens Exchange
  • Implantable Contact Lenses

Astigmatism

Astigmatism is often found in combination with shortsightedness and farsightedness. In this condition there is a defect in the shape of the cornea which contributes to blurry vision.

There are two focal points of the eye and this occurs because of defect in the shape of the cornea. This occurs because the cornea is shaped like a rugby ball rather than a soccer ball. There are two powers on the cornea and light rays in one or both areas of the cornea may focus inside or outside the eye. This means the retina picks up a blurred image.

Options for Correction of Astigmatism

There are many options available for permanent correction of astigmatism and these include:

  • Laser eye surgery
  • Laser astigmatic keratotomy
  • Laser Limbal relaxing incisions
  • Toric Implantable Contact Lenses
  • Toric Intraocular Lenses

Presbyopia (need for readers)

Beyond the age of 40 the lens inside the eye becomes larger and harder and less able to change shape. This ability of lens to change shape is necessary for near focus and if it cannot change shape, near focus becomes a problem. Glasses or bifocals are needed with extra power to compensate for this loss of lens function.

Reading glasses are something many of us will end up depending on as we get older. This is called 'presbyopia'. The good news is that surgeons at Jabalpur Eye Care can permanently correct this condition.

Why are reading glasses needed ?

With advancing age, (beyond the age of 40) the lens in our eye becomes larger and harder and less able to change shape. The ability to change shape decreases over time and as the lens hardens, reading glasses are required. Vision at near gets poorer and poorer with age and stronger glasses are required every few years. Eventually the crystalline lens becomes cloudy and this is known as a cataract.

What options are available to correct Presbyopia ?

At Jabalpur Eye Care two main options are available, the choice of which depends on age and health and power of the individual eye. These are assessed at a very detailed consultation performed by a Jabalpur Eye Care consultant. Corneal implants, such as Kamra and Raindrop are a newer options. Our Medical Advisory Panel is not completely comfortable with these options having had extensive experience with this type of technology many years ago.

Options available at Jabalpur Eye Care are selected based on multiple variables including the health of the eye, optical correction required, visual needs and patient expectations. Supracor Lasik is a laser vision correction option for those in their early forties to early fifties. For those older, in most cases where suitable, Laser Lens Exchange (replacement) may be recommended with either an accommodative lens, trifocal lens or the new WIOL (polyfocal) lens are options which may be considered.

Supracor LASIK

Presbyopia

This is a laser eye surgery option for correction of presbyopia that has been performed regularly at Jabalpur Eye Care. Both eyes are corrected for Distance, Intermediate and Near vision. Supracor is available for those who are farsighted and nearsighted.

Victus Laser Lens Exchange

For those in their 50s and above, and depending on the amount of correction, this is an alternative and highly reliable option. This involves the use of the Victus femtosecond laser to remove the hardening and poorly functioning lens in the eye and replacing this with an Accommodative, Multifocal or Trifocal lens implant providing Far, Intermediate and Near vision.

Cataract

A cataract is a loss of transparency or clouding of the normally clear lens of the eye. This lens is a part of the eye that helps focus light on the retina. It is located behind the iris. With age it becomes harder and leads to difficulties reading or Presbyopia. As time progresses the lens becomes cloudy and affects vision. Cataracts are a natural part of ageing that develop over time.

What causes Cataracts?

The lens of the eye is located immediately behind the iris and is responsible for 33% of the eye's focusing power. The cornea is a clear structure at the front of the eye and provides the remaining 67%.

The function of the lens is to provide fine focus, especially up close. The lens changes shape to alter the power of the eye (accommodate) and adjusts focus for near and intermediate objects. At birth it is like jelly but unfortunately with age it gradually hardens and loses its ability to change shape. Evidence of this hardening normally starts to affect us in our mid-forties when many require reading glasses for close work. This is called Presbyopia.

Those requiring glasses or contact lenses most of their life (i.e. before their 40's) for shortsight, longsight and/or astigmatism usually have what is called a Refractive Disorder. This is where the length of the eye in relation to the shape of the cornea causes the point of focus at the back of the eye to fall short of or beyond the retina. Many with a refractive disorder find that laser eye surgery is a good option. However it can be limited in its ability to treat Presbyopia.

With further increase in age, the lens continues to harden and starts to become more compact and cloudy, reducing initially quality of vision and later obstructing vision and interfering with day to day activities. A cloudy opaque lens is called a cataract and unfortunately is inevitable should we live long enough.

What are Cataract symptoms?

The typical symptom of cataract formation is a slow, progressive and painless decrease in vision of variable degrees. The loss of transparency of the lens may be so mild that vision is hardly affected, or so severe that no shapes or movements are seen, only light and dark. Other symptoms are:

  • Blurring of vision
  • Poor night vision
  • Glare, particularly at night
  • Frequent eyeglass prescription change
  • A decrease in colour intensity
  • A yellowing of images
  • Double vision (in rare cases)

Who can be treated?

  • Those with visually significant lens cloudiness
  • People of any age

A comprehensive eye examination including visual acuity test, tonometry (measurement of the pressure inside the eye), pupil dilation, cornea measurements and tests to measure the size of the eye will determine your suitability for the procedure.

How is a cataract treated?

Cataracts can be treated easily using micro-incision cataract surgery along with Lasers. This laser has enhanced the precision and safety of Cataract surgery.

Cataract surgery in combination with Premium or added value lenses such as Trifocal implants provides patients with independence from optical aids - Visual Rejuvenation.

Can I become completely free of glasses following cataract surgery ?

Yes this is possible if your surgeon uses a multifocal or trifocal intraocular lens. However not all patients are suitable for this option. Your surgeon at Jabalpur Eye Care will at the time of consultation indicate to you whether this type of lens is suitable in your case.

Fuchs Endothelial Dystrophy

Fuchs' dystrophy, also known as Fuchs' endothelial dystrophy, is a relatively common condition which is inherited. It is a condition where the cells on the back of the cornea drop out. These endothelial cells are important for keeping the cornea clear and as a result of loss, the cornea fills with fluid which in turns affects corneal transparency.

At Jabalpur Eye Care our area of special expertise is the Cornea. A Descemet's Stripping Automated Endothelial Keratoplasty is a small incision procedure that results in rapid visual rehabilitation.

Fuchs' dystrophy is a slowly progressing corneal disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs' dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s.

With Fuchs' dystrophy the cells on the innermost layer of the cornea called the endothelium drop out. The endothelial cells are responsible for pumping the water out of the cornea. Without the cells the cornea fills up with water and swells and is particularly bad on awakening. This is because the closed eyelids during sleep prevents evaporation of fluid from the cornea. Symptoms are worse first thing on awakening and vision clears after a few hours. This duration until the vision clears increases as the disease progresses. Eventually vision does not recover and a corneal transplant is required.

Following are the corneal transplant options:

  • DSAEK / DSEK (Descemet's Stripping Endothelial Keratoplasty)
  • DMEK (Descemets Membrane Endothelial Keratoplasty)

Keratoconus

Keratoconus is a condition in which the shape of the cornea, which is usually round, is distorted, developing a cone-shaped bulge, resulting in harm to vision.

Keratoconus is a relatively common condition. Progression of the condition depends on the patient's age at the time of the onset. The earlier the onset, the faster keratoconus progresses. The condition affects both eyes, however one eye may be more affected than the other.

  • The cornea is a bit more elastic and tends to bulge
  • Eye rubbing worsens the condition
  • Associated with allergy, asthma and eczema
  • Best detected and treated early

Huge progress has been made in Keratoconus with treatments such as

  • Collagen Crosslinking (CXL) to stop progression
  • Intracorneal rings (Intacs, Kera-rings, Ferrara)
  • Toric ICL to correct vision
  • Laser Corneal Transplants

What causes Keratoconus?

Keratoconus is a condition that has many causes and is multifactorial. It can be inherited and it can be associated with allergic conditions (hay fever, asthma and eczema) its onset is usually during puberty and the earlier it occurs the more rapidly it progresses. It is also seen in contact lens wearers. The cornea is a bit more elastic than normal and tends to alter in shape and thin out becoming cone shaped. Rubbing the eyes can aggravate the condition.

Keratoconus treatment

Eye glasses / spectacles:

These can provide good vision in the early stages and often a moderate amount of astigmatism correction is required.

Rigid contact lenses:

Rigid contact lenses and Scleral lenses are required for good vision when glasses do not work.

CXL - Corneal Collagen Cross linking with Riboflavin

This technique increases the strength of the cornea to prevent progress.

Intracorneal rings (Intacs and Ferrara):

These ring inserts are useful and are used to change the shape of the cone on the cornea, flattening and making it more central. If patients are intolerant to contact lenses and the keratoconus is not excessively advanced, intracorneal rings can enable patients to obtain good vision with glasses and perhaps even consider Toric Implantable Contact lenses to eliminate the need for optical aids altogether.

Toric implantable Contact Lenses:

For those who have stable keratoconus and are able to obtain good vision with glasses, the Toric ICL can eliminate the need for glasses and in some patients provide improve vision.

Corneal transplants:

In advanced stages - either a partial thickness (Deep Anterior Lamellar or DALK) or full thickness (Penetrating graft or PK) is done. Considerable advances using lasers have been made and the preferred option for patients with Keratoconus is to have a Femtosecond Laser Deep Anterior Lamellar Keratoplasty.

Jabalpur Eye Care surgeons is renowned for their expertise in Keratoconus and Corneal disorders.

Dry-eye

Dry eye or Dry Eye Syndrome is a very common condition that increases with age and affects usually more women than men. Dry eye occurs when people don't have either enough tears, or the correct composition of tears, on the surface of their eyes to lubricate the eyes and keep them comfortable. For some this can be a maddening condition that can frustrate as much as it does irritate.

Tear Film

The tear film is composed of three layers. Each component layer is dependent on the other for proper function. The outer oily layer of the tear film is produced by the meibomian glands in the eyelids and reduces evaporation of the tears. The thick middle watery layer is made by the lacrimal gland above the upper eyelid and washes away irritants. The inner mucus layer is secreted by the goblet cells in the conjunctiva (mucous lining) of the eyelids and helps the tear film stick to the cornea.

Simplistically, there are three main components of Dry Eye and one individual may have one, two or all three components:

  • Underproduction - where there is poor production of fluid by the lacrimal glands
  • Evaporative - tears evaporate too quickly. Result of poor oil production by eyelid meibomian glands.
  • Inflammatory - seen in conjunction with dry eye and requires specific treatment

Symptoms and Signs

  • Persistently gritty
  • Itchy
  • Burning
  • Pain
  • Tired eyes

These symptoms worsen as the day goes on. Stringy mucus may appear in or around the eyes. Usually patients who have dry eye usually are aware of their condition. Patients with the most severe disease are at increased risk of developing corneal infection, scarring or ulceration. These conditions can cause permanent vision loss, so it is important to seek professional help if you have severe symptoms of dry eye.

Dry eye does not frequently cause blindness, but as it is such an uncomfortable condition, it is a common reason for seeking assistance. Furthermore, dry eye syndrome can in additiona to discomfort, can impair vision with a decreased ability to perform activities that require visual attention, such as reading and driving a car.

Jabalpur Eye Care offers a fully comprehensive dry eye consultation inclusive of dry testing. Your consultant will perform a thorough eye examination and provide an explanation for the reasons why the eye is dry as well offer a course of treatment. Please note dry eye is often a chronic condition and can take a while before there is any percieved improvement.

Sjogren's syndrome

Severe dry eye is sometimes caused by Sjogren's syndrome, which is an uncommon chronic, multi-organ, autoimmune disorder that also results in dry mouth and often arthritis. You should be seen regularly by your doctor and ophthalmologist if you have Sjogren's syndrome.

Tests for Dry Eye

Several tests for Dry Eye are used by your doctor. The meniscus of tears, lid wiper action and distribution along with objective tests below provide information. Not all tests are always performed and are done where appropriate depending on symptoms and clinical findings.

Objective tests:

Tear Break Up Time (TBUT) - The speed at which tears break up reflects evaporation.

Schirmer's Test - A test to measure tear production where strips of sterile blotting paper are placed at the outer corner of the eye for 5 mins. The length of wetting reflects the level of tear production.

Jabalpur Eye Care doctors are all fellowship trained in Cornea and the Anterior Segment. In the course of their usual practice, they are often asked to see patients for second opinions and to manage dry eye. You can be confident that you will be evaluated by doctors with expertise in this area at the time of your consultation.

Flashes & Floaters

Floaters are something many will not need to worry about although they can be distracting. There is however the potential for a floater to be a warning sign of a more serious condition.

Eye floaters are small pieces of debris that float in the eye's vitreous humor. This debris casts shadows onto the retina (the light-sensitive tissue layer at the back of the eye). If you have eye floaters, it is these shadows that you see "floating" across your field of vision.

Types of floater

Fibrous Strand Floater:

Most common in young people, this thin, dense floater can appear as multiple dots and/or string-like cobwebs and is a result of clumping of the collagen fibers of the vitreous. Depending on size, and where it is located, it may be treatable with vitreolysis.

Diffuse Floater:

This cloud-like floater is caused by the natural aging process. Whilst this type of floater can sometimes be treated with vitreolysis, it often requires more overall treatment in order to obtain satisfactory results.

Weiss Ring Floater:

The ring-shaped Weiss Ring floater is a large, fibrous floater that is usually located safely away from the crystalline lens and the retina. Because of this, it can be treated safely and effectively with vitreolysis.

What do they mean?

Age

As you get older, your risk of developing floaters increases. Floaters tend to occur in people who are over 40 years of age and are most common in those who are in their 60s and 70s. However, some younger people may also develop floaters.

As you get older, the vitreous humour in the middle of your eyeball can become less firm and strands of a protein called collagen may become visible within it. The collagen strands may appear to swirl as your eyes move.

Normally, light travels through the clear layer of vitreous humour to reach the retina. The retina is the light-sensitive layer of cells at the back of your eye that turns what you are looking at into an image, and transmits this to your brain. Floaters can cause shadows as they float through the fluid in your eye.

Posterior vitreous detachment (PVD)

Floaters can be a symptom of posterior vitreous detachment. This is a common condition that occurs in about three-quarters of people over 65 years of age. PVD can occur as the result of changes to the vitreous humour as the eye gets older.

As we get older the central part of the vitreous humour becomes more liquid and the outer part, known as the cortex, starts to shrink away from the retina. Floaters are created as a result of the collagen clumping together.

Flashing lights can also be another symptom of PVD. Flashing lights may occur when the outer vitreous humour pulls on the light-sensitive tissue of the retina. The pulling on the retina causes brain to interpret it as a light signal.

Retinal detachment

Floaters may be a sign of retinal detachment (when the retina separates from the wall at the back of the eye). If you have retinal detachment, you will usually have:

  • a large number of floaters
  • flashing lights
  • loss of vision

If you think that you may have retinal detachment, seek urgent medical attention from ophthalmologist.

If you are unsure about your loss of vision contact us to be seen by ophthalmic surgeons.

Macular Degeneration (ARMD)

A leading cause of blindness in people 60 and older. There are measures that can be taken to slow progression of the condition and newer treatments can help reduce irreversible blindness.

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is an eye condition that causes painless loss of central vision and is most common in people over the age of 50. It is estimated that at least 1 in 10 people over the age of 65 have some signs of AMD and that its incidence will continue to increase due to longer life expectancy and dietary changes.

Glaucoma

Glaucoma is the name given to a group of eye conditions which causes optic nerve damage and in turn can affect vision. Glaucoma damages the optic nerve at the point where it leaves the eye.

Glaucoma damage may be caused by raised eye pressure or a weakness in the structure surrounding in the optic nerve. Our eye pressures may be within normal limits but damage occurs because there is a weakness in the optic nerve which in turn affects blood flow to the nerve. NOTE: Eye pressure is not connected to your blood pressure.

Diagnosis of Glaucoma

A thorough consultation is required if there is any suspicion that you might have glaucoma. The examination involves measuring the intraocular pressure (IOP) as well as evaluation of the optic nerve, specifically the cup/disk ratio which provides an indication if there has been any damage.

Specific investigations are performed and includes a Visual field Test and an Ocular Coherence Tomographic (OCT) evaluation of the Retinal Nerve Fibre Layer (RNFL).

The visual field test is checked on a sophisticated machine that using patient feedback measures the the peripheral vision. Subtle changes can be picked up and monitored over time.

A RNFL OCT measures the thickness of the nerve fibre layer surrounding the optic disc. Nerve damage results in loss of nerve fibre layer thickness. Again the areas of damage which often match up with the visual field can be documented and followed over time.

Treating Glaucoma

Eye Drops.

Drops are usually the first line of treatment for Glaucoma. If the intraocular pressure cannot be reduced to an appropriate level, further drops may be added.

Laser Treatment for Glaucoma.

Some cases of glaucoma, e.g. narrow angle glaucoma can benefit from a Yag peripheral iridotomy. This is where the Yag laser is used to create a small opening in the iris to allow fluid to pass through from the back of the eye to the draining area (Trabecular meshwork) at the front.

Herpes simplex

Herpes simplex is a very common viral condition. The virus can also affect various areas of the eye including the cornea.

Herpes simplex keratitis is the name of the condition when the virus affects the cornea. The eye can become:

  • Red
  • Painful
  • Sensitive to light
  • Have visual loss

These symptoms are potentially serious and patients must be seen without delay. Herpes simplex disease can if untreated cause visual loss.

How is Herpes simplex treated ?

Herpes simplex eye infection can be a sight threatening condition but if the infection is treated promptly it is not usually serious.

Antivirals in an ointment or tablet form is used in the early stages to treat the condition. In those unfortunate enough to have frequent recurrences, tablets may be used long term to prevent a recurrent infection. Sometimes steroid eye drops are used in conjunction with anti-viral medication. Your ophthalmologist is the best person to decide the best course of treatment for you.

Retina

There are a number of retinal conditions that can lead to visual loss.

The Retina is a thin film of nerve tissue that fans out from the optic nerve and lines the back of the eye. The following symptoms require immediate attention:

  • Floaters - sudden onset
  • Flashing lights
  • Loss of vision (like a curtain closing)
  • Straight lines look twisted
  • Patches of loss of vision