Clear Vision Eye Centre

Hello,

This is Dr. Vinay Agrawal, I am a cornea and ocular surface specialist. Today we will try and talk about a problem which is affecting more and more of us with the changing lifestyle, increasing usage of computer screens, video units, mobile phones. A condition that is labeled as dry eye. Essentially this is a condition wherein the tear film in the eye is not able to do its normal job, leading to a condition of dryness and therefore patients usually would complain of either grittiness in the eye, foreign body in the eye, feeling of heaviness, pain, redness or a fluctuating vision. All of these or any of these symptoms can be a problem and can be a cause of dry eye, usually, precipitating factors would be, as I already mentioned, the whole lifestyle issues, in addition, certain diseases like arthritis, collagen vascular diseases can cause swelling or ocular surface inflammation and therefore a reduction in the amount of tear film that is produced in the eye both of these disease conditions though presenting similarly would require a very different approach in terms of management. So how do we diagnose or how do we understand that there is a problem? With the presence of all the history that I have mentioned previously, there are certain tests which an eye surgeon can perform in the clinic that will help the diagnosis and for the person to understand as to what kind of dry eye or what type of disease presentation is there in his given case. And according to that in her or his case, the concerned doctor can decide the kind of management that is required. Essentially we would breakdown the treatment into variety of things which is, for example, taking care of the meibomian glands or the lid glands which are present, which will take care of the outer tear film layer, or if there is a genuine loss of tear film, we can replace it with the help of artificial substitute like the tear substitutes that we have a variety of options and variety of drugs are now available. In a given case the suitability would be decided by the treating doctor.

In addition, the newer understanding of dry eye, have told us that inflammation or swelling inside the surface of the eye can be an important precipitating factor, therefore ocular surface inflammation management is becoming a more and more important tool in managing patients with dry eye. A variety of drug options are available right from corticosteroids to non-steroidal anti-inflammatories, each one of them has a role to be played depending on the severity of the disease and a given patient. So instead of doing any self-medication, it would be advisable that you approach a qualified eye doctor, who would be best placed to decide what would be the best treatment option as far as you are concerned. In addition to putting drops in the eyes and doing hot fermentations for lid diseases, there are other options which are existing for patients who have a more severe version. For example, there can be plugs which can be inserted in the area which helps in radiance of this tear film, thereby helping to retain a tear film for a longer period in the eye, and therefore helping a patient who has a reduction in the production to be more asymptomatic because more tear film is retained for a longer period in the eye. In addition, there have been a variety of other products that have been tried for example ocular inserts have been attempted though with limited success and there are a variety treatments which are now existing like for example the intense pulse light therapy photobiomodulation both of which work more on the lipids or lipids glands of this ocular surface or to be more precise the glands which are present in the lid margins, each one of these treatments is useful but we should understand that none of these treatments replaces others. All of these treatments are complementary and therefore taking an expert’s advice would be the right way to do and to understand as to what combination of therapy would be in your best interest. Thank you for your attention today and I hope we have cleared some of your doubts about dry eyes. If there are any further questions or if you have any doubts please feel free to contact me either on Lybrate.com I would be more than happy to answer any queries that may arise.

Thank You!

Hello,

I am Dr. Vinay Agrawal, I am a cornea and ocular surface specialist. Today we will be talking about keratoconus,a problem we are seeing more and more often in our clinics now. Keratoconus is a progressive disease that can cause thinning of the cornea, causing it to bulge in front and therefore leading to a variety of visual issues. Usually, it would present at around about 20 years of age. Generally, we see it in a zone between the early teens, say 15 years onwards and can be up to 35-40 years of age. Keratoconus, as the name suggests causes the cornea to become conical, as it progresses, it can cause more and more distortion of vision leading to increase in the numbers like for example, these patients would have a minus number which keeps on increasing and along with that these cylinders keep growing up and then comes a stage, where in spite of any change in the number because of the corneal irregularity, it causes a distorted vision may be the patient may have increased glare, increased starburst, increased signs and the usual complaint of these patients is, no matter what glasses they get made, they are not able to see well.

Let’s come to what is the cause of keratoconus? Recent research has suggested that there would be an abnormality of the enzymes in the cornea of patients who present with this disease and an abnormality of these enzymes can cause the oxidative stress to increase and therefore leading to thinning of tissue and that presents the bulging of the cornea over a period of time. The other aspect of keratoconus is that it is now being more and more understood that chronic eye rubbing, exposure to ultraviolet light and chronic eye irritation can be factors that can precipitate keratoconus in a genetically predisposed individual. So therefore, the commonest instruction given to all such presenting patients is to stop eye rubbing and that is becoming the most important function as far as the patient management is concerned. Let’s now move to how do we manage patients who have shown or are now diagnosed with having keratoconus. Till about a decade back, we couldn’t really stop the progression of this disease, however now for the last ten years we are in a position to stop the progression of the disease with the treatment known as corneal collagen cross-linking, this treatment, which has become popular worldwide, achieves a very good success rate in most patients and it essentially functions by causing the strengthening of the tissue in the cornea, it is done with the help of ultraviolet light and vitamin B6 or riboflavin. When used simultaneously of they work together to induce what is known as photo-oxidation and that causes and that causes the cornea to become more strong or enhances the strength of the tissue and therefore allowing it to withstand the pressures of day to day life. Another modality that is being used to help change the shape of the curve of the cornea is intracorneal rings. These rings are sometimes used in combination with corneal collagen cross-linking to help change the curvature of the cornea. And therefore reduce the numbers in a given patient and arrest the progression of the disease.

It has been there for a pretty long time but by itself, it can not arrest the progression of the disease and that is an important part to understand that corneal collagen cross-linking is the only treatment modality that can arrest the progression of this disease. How do we improve the vision in such patients is the next question that we look at. The best method which is being devised and now with very advanced modalities is the usage of contact lenses. Usually, in early patients of keratoconus or patients with mild disease, regular soft contact lenses and glasses might be a good option but in patients with a disease which is more progressed like the moderate or the severe version, there is a variety of options of customized contact lenses that are now possible. You can use hybrid contact lenses, mini sclera contact lenses, cornea sclera lenses, corneal lenses, and scleral lenses. All of these need expertise that is available in our country and can help improve the vision of a patient to almost that of a normal patient. In addition, a variety of contact lens options also help us in fitting a different kind of cone which is individualiseable to a given patient, so customization in the true sense is now a possibility to help improve vision in the eyes of keratoconus patients. With the advances in cornea transplant, we can now do layered transplants. The treatment option known as deep anterior lamellar keratoplasty or DALK is now a preferred choice for the treatment of advanced keratoconus patients. The advantage of this method is that only the layers which are weak are replaced, therefore the risk of rejection is low and also the recovery periods are reduced significantly. Overall the management of keratoconus has improved very significantly in the last decade or so. The main advantage being the availability of corneal collagen cross-linking as a treatment modality. A variety of customized contact lenses and advances in cornea transplants have all come together to make keratoconus manageable, controllable and treatable diseases. I hope this has helped clear some of your doubts of keratoconus. If you have any further questions, please feel free to contact me through Lybrate.com or cornea transplant.net, both of which will reach me and I would be very happy to more than able to answer your questions.

Thank You!