Tag Archives: ophthalmology

Diabetes and Diabetic Retinopathy – Dr Rahul Shroff

27 Dec

The past two decades have seen an explosive increase in the incidence of diabetes mellitus worldwide, making it one of the most common non-communicable diseases today. According to the World Health Organization (WHO), there were an estimated 135 million diabetics in the world in 2000, and this number is expected to increase to 300 million by 2025.

What is of more consequence is that India has the largest number of diabetics in the world. In 1994, 19.4 million suffered from diabetes mellitus, 32 million were diabetics by 2000 and the number is expected to increase to 57.2 million by 2025. Moreover, according to current estimates, diabetics will increase by 42 per cent in developed nations and by 170 per cent in developing nations. According to an ICMR study, prevalence of diabetes mellitus, which was 2.3 per cent in urban population in 1970, increased to 12.1 per cent in 2001.

The increase in incidence of diabetes mellitus and its complications has been attributed to change in life style caused by increased urbanization, high calorie diet, decrease physical activity and stress. Other important factors are genetic factors, family history and increased longevity. And what is worrying that diabetes is striking at an early age among the urban population.

 

Types of Diabetes:

Diabetes mellitus occurs in two forms:

Type 1 (Insulin dependent) – Also called juvenile diabetes, this is seen in younger people and is characterized by absolute insulin deficiency due to which these patients are completely dependent on insulin treatment. The incidence of this form of diabetes is doubling every decade.

Type 2 (Non-Insulin dependent) – This is seen in older people and is characterized by insulin resistance or abnormal insulin secretion. These patients can be treated with tablets or may require insulin. This form accounts for 90 per cent of all cases seen globally, but its increasing incidence in India is due to changing diet, from traditional Indian food to modern diet caused by a more stressful life-style and increased urbanization. This type is being seen in younger people due to obesity. Moreover, type 2 diabetics have a greater tendency to develop hypertension and heart disease.

It’s not just the disease itself that is a cause for concern. Diabetics are more prone to develop systemic complications. They are also 25 times more likely to develop blindness, twice as likely to have a stroke, 2-4 times more likely to have myocardial infarction and much more likely to develop kidney disease or undergo amputation.

 

Effect of diabetes on the eye:

Diabetes can cause eye complications such as:

1. Diabetic Retinopathy: This is the most common complication and it has been seen that 25 per cent of all diabetics develop this complication after 10 years of diabetes and 50 per cent develop it after 20 years of diabetes. Diabetic Retinopathy is also more common in the upper socio-economic group.

 

Diabetic Retinopathy has two types –

Non-Proliferative Diabetic Retinopathy – This is the early stage in which tiny blood vessels in the retina get damaged and leak blood or fluid, which cause the retina to swell or form deposits called exudates. 90 per cent of Diabetic Retinopathy cases are of this type. This stage often has no symptoms.

Proliferative Diabetic Retinopathy – This is the advanced stage. Abnormal new blood vessels grow on the surface of the retina and often bleed into the jelly in front of the retina, giving rise to floaters, dots or lines or sometimes loss of vision. These new vessels can eventually pull the retina causing a traction retinal detachment. 10 per cent of Diabetic Retinopathy is of this type.

Maculopathy – Leaking fluid collects in the centre of the retina called the Macula giving rise to blurring of vision.

Studies have shown that there has been a 3-fold increase in the incidence of Diabetic Retinopathy in India in the last 10 years.

 

2. Cataract – This is more commonly seen in diabetics at a younger age and more commonly in the lower socio-economic group. Important causes are exposure to ultraviolet light and oxidative stress.

 

3. Glaucoma – This involves increase in intra-ocular pressure within eye and is more commonly seen in persons afflicted with diabetics.

 

4. Diabetics are also more prone to develop paralysis of the nerves of the eyes due to obstruction of the blood supply.

 

Incidence of vision loss:

The following categories of individuals are at a higher risk of losing vision in diabetes:

  • Those who have had diabetes from a younger age
  • Those who have had diabetes for many years
  • Those who have poorly controlled blood sugar
  • Those who have poorly controlled blood pressure
  • Those who smoke

 

Improving diet:

Diet plays an important role in the control of diabetes and diabetic retinopathy. Studies have shown a much lower incidence of diabetic retinopathy in persons who follow a healthy diet. A good diet consists of

 

  • Ghee as the cooking medium
  • Fish and fish-oil capsules, which are rich in selenium and zinc. Fish is considered to be one of the best foods for diabetics
  • Green leafy vegetables
  • Vitamin A rich foods like carrot and green leafy vegetables

·         Vitamin C rich foods such as citrus fruit like orange, lemon

  • Vitamin E rich foods like cereals and grains

 

Diabetics must avoid fried food, animal food (except milk and fish), processed food and preserved food.

Regular eye examination

All diabetics must have the eyes examined regularly with dilated pupils. Juvenile diabetics must have their eyes examined at least once a year after the age of 12 years because diabetic retinopathy is rarely known to occur before puberty. Those with diabetes at an older age must have the eye examination done once at the time of diagnosis and then at least every 6 months to one year thereafter.

If Diabetic Retinopathy has been diagnosed, they should have the eyes examined as often as recommended by their eye doctor.

 

Laser treatment:

A special test called fluorescein angiography may be required to identify areas that require laser treatment. If leakages or new vessels are detected, laser treatment must be promptly given. Sometimes there is leakage of blood from the retina of the eye into the jelly in front of the retina, which may cause blurring of vision. An operation called vitrectomy may be required to remove the bleeding and replace it with clear fluid.

Studies have shown that vision can be preserved in 90 per cent of diabetics if laser treatment in done in time.

 

Newer treatment modalities:

 Anti-VEGF Injections for Diabetic Retinopathy

 Injection treatments (Lucentis™, Avastine™) used commonly for macular degeneration have also proven to be effective for diabetic eye disease, in some cases better than laser treatment.

Results from a large clinical trial conducted by the Diabetic Retinopathy Clinical Research Network, or DRCR.net, demonstrated that patients receiving a combination of anti-VEGF treatments and laser treatments had greater gains in visual acuity as compared to others.

 

A newer injection viz. EYLEA™ (aflibercept), known in the scientific literature as VEGF Trap-Eye, is also being used as an injection into the eye to provide a therapeutic effect in patients suffering from various eye disorders including in some cases of diabetic retinopathy.

Prevention of complications:

All diabetics must adhere to the following to prevent complications:

 

  • Avoid obesity and have regular physical exercise
  • Control the blood sugar and blood pressure at all times
  • Avoid self-medication. It is better to follow the advise of a physician
  • Maintain a healthy diet. Insulin or pills is not a substitute for a proper diet
  • Have your eyes examined at least once every 6 months to a year by an eye doctor

Being a diabetic does not mean that you cannot enjoy a happy and healthy life. Follow the above-mentioned simple rules with a positive attitude, and you will see the change in your life.

Issued in public interest by Shroff Eye Hospital, Mumbai, India

 India’s first LASIK Centre to launch the 500 Hz Wavelight Concerto laser

India’s first Eye Hospital to be awarded the JCI- Joint Commission International certification (USA), the Gold standard of Healthcare Internationally.

 Open your eyes…to a whole new world

 

Shroff Eye Hospital

222 S V Rd,

Bandra West,

Mumbai – 400050.

Ph: 66921000/ 66939372/ 26431006

 

Shroff Eye Clinic,

Gobind Mahal,

Marine Drive,

Mumbai – 400002.

Ph: 22814077 / 22811863/ 22029242

 Helpline: 98211-63901

Age-related macular degeneration (ARMD)

25 Apr

Age-related macular degeneration (ARMD) is the one of the most common cause of vision loss in people over the age of 50 years. Its prevalence increases with age. It is caused by the degeneration of the Macula, the central and most sensitive part of the retina at the back of the eyes.

The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. Macular degeneration refers to the breakdown of the macula. This disorder results in the loss of central vision only. Degeneration results from the partial breakdown of the Retinal Pigment Epithelium (RPE) that is the insulating layer between the Retina and the Choroids and acts as a selective filter to determine what nutrients reach the retina.
Elaborating on the symptoms of this disease, Dr Rahul Shroff, vitreo-retinal surgeon, Shroff Eye Hospital, Mumbai says “Some people with macular degeneration notice that straight lines such as electricity poles, the sides of buildings or streets, appear wavy.
Macular degeneration cannot be reversed. Its impact, however, can be reduced. Timely laser surgery and medications can be used to treat certain types of macular degeneration.”

Newer Treatments for ARMD

Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage. THE RECENT DEVELOPMENT OF ANTI-VEGF MEDICATIONS HAVE BECOME AN EXCITING ADVANCE IN THE TREATMENT OF WET AMD. Bevacizumab (Avastin) and Ranibizumab (Lucentis) are two very useful drugs. Most patients will retain the vision they have and some will regain some of the lost vision after these treatments. These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, most people with macular degeneration still experience some vision loss. There should be no delay in taking the treatment advised by the retinal surgeon. Many older people develop macular degeneration as part of the body’s natural aging process. Exactly why it develops is not known, and no treatment has been uniformly effective. All the above treatments for ARMD are offered at Shroff Eye, Mumbai.

We will be happy to assist you with any further information that you may need. Assuring you of our best services always.

About:
Shroff Eye Hospital and LASIK Centre,
222 S V Rd, Bandra West,
Mumbai –400 050
Ph: 66921000/ 66939372/26431006

Shroff Eye Clinic,
Gobind Mahal, Marine Drive
Mumbai -400002
Ph: 22814077 / 22811863/ 22029242
LASIK Helpline: 98211-63901

http://www.shroffeye.org
http://www.lasikindia.in
http://www.pathologylabindia.com

Shroff Eye Hospital is India’s First Eye Hospital that is accreditied by Joint Commission International (International Division of JCAHO, USA) for excellence in patient care and health care delivery. Shroff Eye is also India’s first and only Wavelight Concerto 500 Hz LASIK center- The Worlds Safest and Fastest LASIK.

Disclaimer: All the contents of this Article is provided “As Is”. That means there is no warranty of any kind. Indianhealthjournal makes no claim that the Article’s information is appropriate in any jurisdiction or that the products described in the Article will be available for purchase in all jurisdiction.

Are You At Risk of Silently Losing Your Vision?

14 Mar


“Just like your Blood Pressure is checked regularly, the Intra Ocular Pressure or IOP should be checked for every person undergoing an eye examination to screen for an eye condition called ‘Glaucoma’ since it can occur in the absence of any symptoms.

Further, Persons With Family History of Glaucoma can undergo a sensitive test- SWAP Test which detects changes in eye when glaucoma is suspected well before the optic nerve shows the effects of Glaucoma”, says Dr. Anand Shroff, Glaucoma Specialist at Shroff Eye Hospital

Glaucoma is one of the leading causes of blindness in the world, especially for older people. However, visual loss is preventable or can be stabilized with early diagnosis and treatment.

This disease is called the ‘Thief of Sight’ because it is painless, symptom less and irreversible. Therefore, persons with glaucoma are usually unaware of it until much loss of vision, especially the peripheral vision has occurred. In fact, half of those suffering damage from glaucoma do not know it!! Glaucoma damages the optic nerve because of high pressure within the eye, leading to defects in the field of vision. If the entire optic nerve is damaged, it results in irreversible blindness. Early detection and regular treatment are the keys to preventing optic nerve damage and blindness from glaucoma.

There are few conditions related to this disease that tend to put some people at greater risk. This may apply to you if:

a)   Someone in your family has a history of glaucoma, though not always necessary that it could be hereditary.

b)   If you are over 40 {could be earlier if you have a family member suffering from glaucoma} and have not had your eyes examined regularly by an ophthalmologist, not an optician.

c)    Near-sightedness {myopia}

d)   Any injury to your eyes

e)   Secondary to other ocular conditions (cataract, inflammations in the eye, tumours etc.}

f)     Long term medication {cortisone}. This holds for those who use eye drops injudiciously, particularly Pyrimon and other steroids, and repeat their prescription for red eye treatment with their chemists without consulting doctors. It is therefore, very important that youngsters who have contact lens-induced and other allergies, and those who repeatedly suffer from red eyes, to be very careful with their use of eye drops. They must visit the ophthalmologist urgently.

g)    Glaucoma is detected by regular eye examinations with an ophthalmologist (eye doctor).

You require annual examinations if you are at risk for glaucoma. Those with glaucoma need to have regular visual field tests done to monitor the progress of the disease. ‘Suspect’ cases with a family history of glaucoma may be required to additionally undergo a highly sensitive form of visual field analysis called short wavelength automated perimetry [SWAP], which detects changes in your eye well before the optic nerve shows the effects of glaucoma. It is also useful to monitor the progress of the condition.

The main treatment for glaucoma aims at reducing the pressure in your eye. Damage already caused by glaucoma cannot be reversed. Eye drops, tablets, lasers and surgical operations are used to prevent or slow further damage from occurring. There are different types of glaucoma, but with any type of glaucoma periodic examinations are very important to prevent loss of vision. Because glaucoma can irreversibly worsen without your being aware of it, your treatment may need to be changed from time to time during the periodic examination.

If you are diagnosed with glaucoma, the best treatment for you should be decided after a thorough examination and discussion with a glaucoma specialist.


Issued in public interest by Shroff Eye Hospital, Mumbai, India

India’s first LASIK Centre to launch the 500 Hz Wavelight Concerto laser India’s first Eye Hospital to be awarded the JCI- Joint Commission International certification (USA), the Gold standard of Healthcare Internationally.

Open your eyes…to a whole new world

Shroff Eye Hospital and LASIK Centre,

222 S V Rd, Bandra West,

Mumbai –400 050

Ph: 66921000/ 66939372/26431006

Shroff Eye Clinic,

Gobind Mahal, Marine Drive

Mumbai -400002

Ph: 22814077 / 22811863/ 22029242

LASIK Helpline: 98211-63901

www.shroffeye.org

www.lasikindia.in

www.pathologylabindia.com

YOR EYES IN THE SKIES: How to avoid eye problems while flying

3 Dec

Date: 3rd December 2010

Author: Dr Anand Shroff

About: Cornea and LASIK surgeon, Shroff Eye Hospital, Mumbai

Contact: Shroff Eye Hospital and LASIK Centre, 222 S V Rd, Bandra West, Mumbai –400 050 | Ph: 66921000

Shroff Eye Clinic, Gobind Mahal, Marine Drive , Mumbai -400002 | Ph: 22814077

LASIK Helpline: 98211-63901  | www.shroffeye.org |  www.lasikindia.in |  www.pathologylabindia.com

The dry air in the cabins of modern jets causes rapid evaporation of tears from the eyes surface. Without sufficient moisture the cornea, which is the transparent “watch glass” that lies over the iris (coloured part of the eye) can be deprived of oxygen and cause your eyes to become irritated.

There are many environmental reasons, which dehydrate the eyes’ tear film and cause dry eye symptoms. While most people think that this only occurs outdoor due to intense sunlight, many indoor conditions can be a much greater problem because of re-circulated air, artificial lighting, cleaning products, etc.

Symptoms of dry eye

  • Redness
  • Scratchy feeling in the eyes
  • Vision can get blurred

What makes symptoms worse?

  • Reading on the plane adds to the problem because you tend to blink less frequently when you read, leading to more evaporation of moisture from the eyes.
  • Wearing your contact lenses during a long flight can result in symptoms ranging from mild discomfort to severe pain.

This problem can occur with all types of contact lenses: hard, soft, gas permeable, or extended-wear due to less oxygen reaching the cornea. Dry air in the cabin evaporates the water from the contact lenses and contributes to the problem. Hence, if you are a contact lens wearer, it is better to wear spectacles in flight.

How can you avoid problems?

  • Put artificial tears or lubricating eye drops in your eyes during a flight as often as you feel they are necessary.
  • Airline personnel who wear contacts and have discomfort should always use these drops routinely.
  • It may be wiser to remove the contacts and wear your eyeglasses when flying.

OTHER EYE CARE TIPS

  • Carry a spare pair of spectacles especially if you have high numbers.
  • Carrying your spectacle prescription may also be handy.
  • Most airports are equipped reading glasses for those above forty; also available are contact lens cases and solutions.
  • Speak to your eye doctor to prescribe you a simple and safe antibiotic eye drop in case of red eyes due to infection.
  • Avoid putting spectacles in pockets, as is commonly a habit, carry a pouch instead for safekeeping.
  • If you are escaping the summer heat and heading towards a snowy region, there is extra care you have to take as far as eyes go. Snow can blind you! So use good ultra violet protected eyewear.

 

OTHER HEALTH TIPS WHILE TRAVELLING

  • Drink plenty of non-alcoholic, beverages. A glass of water every hour is good.
  • Put a pillow behind the small of your back to avoid backaches.
  • Take an occasional stroll around the cabin. This is especially for those who are overweight or have high-risk conditions such as high blood pressure. By moving around you will decrease the risk of deep venous thrombosis, which in simple terms is blood clotting in the lower limbs.
  • Bring a sweater or jacket – airplane cabins are usually cool.
  • Use lip-balm, moisturiser and eye-drops/contact lens lubricant to combat the effects of cabin dryness.
  • The relatively low air pressure in your aircraft can cause discomfort. If your ears bother you during takeoff and landing, try yawning, chewing gum or doing this: pinch your nostrils shut, inhale, close your mouth and try gently to blow your nose. Children should be encouraged to drink or suck on sweets especially during take- offs and landings.

If you have a cold, the dry air will make your sinuses feel worse. If you are taking medications, carry them with you in the cabin.  See your physician to rule out infection. Also, your fellow passengers will appreciate it because everyone is more susceptible to catching a cold in dry air than in moist due to the effect.

  • Always wash your hands as soon as possible after contacting surfaces in the public domain such as handrails, counter tops and doorknobs.
  • Use a hand sanitizer after washing and when soap and water are not readily available.
  • Comprehensive travel insurance is one of the best investments you can make when planning a vacation

JET LAG

 

In spite of your zealous efforts of doing and packing everything, having done your hair, nails and just about everything before taking off on your vacation, you still look “black-eyed” with deep black rings under your eyes and puffy lids!!  Blame it on ‘jet lag’!  Your regular internal clock is rather topsy-turvy at the moment. Disrupted eating pattern, bowel pattern and irregular and interrupted sleep pattern is why we get jet lag.

 

Solution?

  • Drink plenty of water.
  • Don’t drink too much alcohol, as it tends to dehydrate your body.
  • Do stretching exercises in your seat to avoid cramped muscles.
  • Walk around the cabin during your flight, if possible.
  • Wear comfortable clothes and comfortable shoes.
  • Be well rested before you leave.
  • Make sure your pre-flight diet contains plenty of starch, carbohydrates and greens.
  • Arrange in-flight meals to reflect the time-of-day at your destination.
  • Set your watch to your destination time as you take off. Then start programming your body to it.
  • Allow a day for each time zone to get over the jet lag.

Medical option?

There is a drug called ‘Melatonin’ for jet lag problems. It is a hormone produced by the pineal gland in the brain. It helps to control the body’s sleep/wake cycle. By resetting the body’s internal clock, melatonin can treat the underlying cause of all jet lag problems, which is the disruption of the natural sleep/wake cycle. However, your physician should advise it.

 

Issued in public interest by Shroff Eye Hospital, Mumbai, India

India’s first Eye Hospital to be accredited by JCI- Joint Commission International (USA) for excellence in patient care and healthcare delivery.

SHROFF EYE

Open your eyes…to a whole new world


 

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