Patient experience after 6 Years of Lasik Surgery, ICARE Eye Hospital Noida

Time flies!! I clearly remember the day when I was being examined for my eligibility for a Lasik surgery. I wanted to get rid of my glasses that gave me a clumsy look and handling the contact lenses was combersome. Once a close friend of mine had undergone Lasik. His happiness, looks and attitude altered for the better after the Lasik surgery. The results were informed to me by the consultant at ICARE, I was declared fit to undergo the surgery. On & before the surgery day, I was a bit nervous but this evaporated at the first sight of my Doctor, I knew I was in safe hands.

It is now over six years since I got rid of my glasses; and I have had no problems whatsoever related to my eyes in these six years. I am also convinced, like my Doctor, that I would not have to use glasses again.

This decision has been a life changer. I shifted to Mumbai from Noida for a job, met my soon to be husband there. I took my own time, saying yes and finally marrying him and am now a mother of a 3 year old little girl. He now and again teases me on my ‘with glasses look’ these are photographs of me with my rather trendy specs! How happy I am (as is my husband) of having got rid of the glasses. All the new friends I made in Mumbai as well as my daughter’s classmates mothers who I often met when I left her at nursery school would have thought me to be a bit drab and uniformed if I had not taken this life changing decision of getting Lasik procedure done. I am indebted to Dr. Saurabh Choudhry for explaining the steps of the surgery so patiently and for the marvelous job done. Besides being thankful to my friend Jasmine who advised me to seek this solution to rid myself of the glasses.

Electrophysiology Services at ICARE Eye Hospital, Noida

Occasionally a person experiences visual changes that are difficult to completely understand with only a clinical eye exam. These changes may be due to abnormalities in the function of some of the cells in the retina, or there may be changes in the nerve connections between the eye and the brain. Sometimes it is difficult to find out the exact point of damage in the pathway of vision. Furthermore, there are several diseases according to which the eye is displayed normal during eye examination, while the eye cell function is impaired. Young infants and children are often unable to communicate or describe in detail any problems they might have with the way they see. The recording of visual function is difficult in these patients, and clear information on the visual function maybe impossible to obtain. All these situations call for alternative methods of testing the visual function.

Electrophysiology testing includes a battery of tests which can be used to provide information about the visual system beyond the standard clinical examination of the eye. Each image we see is interpreted to an electrical sign. It is possible to detect this electrical response each time a light flashes or a stimulus moves or suddenly appears. This response comes either from retina, the light-detecting part of the eye (electro-retinogram, ERG) or the region of the brain that is responsible for vision (visual evoked potentials, VEP). We have the ability to detect these responses through electrodes placed at specific parts. Full electrophysiologic testing is required to detect damage to any part of the visual pathway.

ICARE eye hospital is one of the few eye care centers in India that has set up comprehensive clinical visual electrophysiology services and provides a full complement of electrophysiological tests for visual function assessment in the diagnosis, prognosis, and treatment of eye diseases.

Tests offered

• Electroretinogram (ERG)  Full field ERG, Pattern ERG.

An ERG is useful in evaluating inherited (hereditary) and acquired disorders of the retina such as retinitis pigmentosa, Leber's congenital amaurosis, cone dystrophies, Stargardt disease, congenital stationary night blindness, juvenile X-linked retinoschisis, achromatopsia, etc. It is often ordered if there is a complaint of night blindness. Pattern ERG consists of a specialized examination in cases where it is necessary to evaluate the central vision, ie the function of the macula. The visual stimuli that are commonly used are consisted by "boards" (black squares) of alternating form. The measurements are performed separately for each eye.

• Multifocal ERG (mfERG)

One of the recent advances in ERG technology is the multifocal electroretinogram (mfERG). The mfERG provides a detailed assessment of the health of the central retina (macula). It can hint towards the diagnosis in certain disorders where the retina examination maybe near normal. It can also be used to follow up and compare pre and post treatment in disorders such as diabetic retinopathy, age related macular degeneration, retinal vascular occlusions, central serous retinopathy, macular hole  where it provides additional information about the function of the retina.

• Visual Evoked Potentials (VEP)  Flash VEP, Pattern VEP.

VEP tests are used to evaluate optic nerve disorders such as optic neuritis, optic tumors, demyelinating diseases such as multiple sclerosis and intracranial lesions, including brain tumors.

• Electro-oculogram (EOG)

Ordered in inherited retinal dystrophies (especially Best disease). ERG and VEP may be ordered together in cases with unexplained visual loss, infants with questionable vision, toxic drug exposure (for eg, hydroxychloroquine, ethambutol), opaque media or trauma including intraocular foreign bodies.

All these electrophysiological tests are conducted according to the standards of the International Society for Clinical Electrophysiology of Vision (ISCEV) by specially trained staff and are interpreted in conjunction with the entire clinical picture, by an ophthalmologist specialized in this field. These tests not only help to diagnose the cause of a visual problem but are also useful for monitoring the progression of a visual disorder or the effects of any treatment.

Procedure

Electrophysiological testing is completely non invasive. Local anesthesia with drops is only required. ERG examinations require dilation of the pupil. In case of children the support and cooperation of parents is very important and helps to perform these tests quickly and with the least possible inconvenience.

For ERG, a thin wire with an electrode is placed on the eye after topical anaethesia, while for VEP electrodes are attached to the head. Before inserting the electrodes, we clean the skin with a cotton swab with a gel that has a slightly grainy texture. This gel improves contact with the skin and helps to take good quality signals. All the electrodes are easily removed at the end of the examination. The patient then watches a screen with different lights to stimulate the retina. The electrical impulses from the retina are recorded. To get useful readings, the patient must first sit in the dark for a period of time to become completely dark-adapted. For this reason, this test usually takes about two hours.

In young children, vision problems often go undetected

In the first few months of life, infants can only see clearly objects that are 8 to 10 inches from their faces. It is not until 12 to 16 weeks that their eyesight begins to improve, and they start seeing things more clearly and further away. Over the next year, kids develop depth perception, eye-body coordination, eye-hand coordination, and the ability to judge distances. It's rare for children to have vision problems at this age.

Silent Symptoms: Vision Problems in Children

Vision problems in kids tend to emerge between 1½ - 4 years. The two most common issues are:

1. A crossed or wandering eye, which troubles 3 - 5% of children. Symptoms include an eye that drifts or appears crossed in respect to the other eye, though "it isn't really the eye that's the problem," says Dr. Geeta Srinivasan, M.S., DNB, Paediatric Ophthalmology.

2. Uneven focus, where one eye is more farsighted than the other, affects 2 - 3% of kids. This vision problem is the hardest to detect, because young children don't know that their vision is compromised. "Seeing that way, it's all they've ever known," says Dr. B.S. Goel, MD, Ph D and HoD Pediatric Ophthalmology, ICARE eye Hospital, "so they won't say anything about it.”

Most of the eye problems go unnoticed in children, as they are too young to understand that something is wrong with their vision. It is for the parents to take the child for an eye checkup to a Doctor. ICARE Eye Hospital's Pediatric Ophthalmology Department has special faculty, equipment ambience and sensitization for the children problems.

Glaucoma awareness prevents blindness by ICARE Eye Hospital Noida

Over 90% of the blindness caused due to glaucoma in developing countries could have been avoided, had these people been aware of this eye disorder. An internalization of the brief paragraph below and regular eye checks will help spread Awareness on Glaucoma.

There are several types of glaucoma. Some may occur as a complication of other visual disorders ("Secondary" Glaucomas) but the vast majority is "primary", i.e. they occur without a known cause. It was once believed that the cause of most or all glaucomas was high pressure within the eye (known as intraocular pressure - abbreviated as IOP). It is now established however, that even people without an abnormally high IOP may suffer from glaucoma. Intraocular pressure is therefore considered today as a “Risk Factor" for glaucoma, together with other factors such as racial ancestry, family history, high myopia and age.

Some forms of glaucoma may occur at birth (congenital) or during infancy and childhood (juvenile). In most cases however, glaucoma appears after the 4th decade of life, and its frequency increases with age. There is no clearly established difference in incidence between men and women.

Frequently asked questions on Lasik Surgery ICARE Eye Hospital, Noida,

Frequently asked Questions on LASIK

Q.        What is LASIK ?

A.        LASIK is an acronym for "Laser Assisted In Situ Keratomileusis". It involves reshaping of the cornea to get rid of spectacles.

Q.        How does it work ?

A.        In myopia, (common refractive error treated with laser) parallel rays of light are focused in front of the retina (part concerned with perception of image) i.e. the eye has a higher refractive power. This is corrected with the help of laser by decreasing the refractive power of cornea (the major refractive surface).

Q.        How safe is LASIK for Indian eyes ?

A.        Globally the scientific studies the have confirmed the safety of Lasik in myopia as high as 12 dioptres. The same is true for Indian eyes. The procedure though simple, requires a careful evaluation. In few the complications are seen in persons with high myopia.

Q.        What are the chances of weakening of cornea ?

A.        The Lasik involves ablation of corneal tissue decreasing its thickness. Studies have shown that no damage to structural integrity of cornea occurs if a residual thickness is of 250 microns or more. Lasik should not be done on individuals whose cornea is thin.

Q.        Can I get rid of my spectacles ?

A.        Yes, if you are above 21 years of age, your spectacle number is constant since the last two years, and your corneal thickness is sufficient to allow ablation.

Q.        What if I am wearing contact lenses ?

A.        You can undergo Lasik surgery after 4 weeks of stopping use of contact lenses.

Q.        What are my chances of spectacle free life ?

A.        The chances of your getting rid of glasses depend on the degree of myopia. There is almost total freedom from glasses in myopia upto 10 diotres - where maximum number of patients belong. In high degrees of myopia, it may not be feasible to correct the refractive error entirely.

Q.        Is the procedure painful ?

A.        No. The laser is done after locally anaesthetizing the eye with eye drops. You may experience a pressure sensation but no pain during the procedure.

Q.        What postoperative precautions do I have to take ?

A.        You will have to use eye drops for 4 weeks. It is advisable not to splash water on your open eyes or rubbing them for at least 2 weeks. Dusty conditions are to be avoided for the same duration. You may have to use lubricating eye drops for a period of time. There is no restriction in reading, bathing, watching TV or eating any food.

Annual Glaucoma Awarness Walk by ICARE Eye Hospital

ANNUAL GLAUCOMA AWARENESS WALK BY ICARE

Glaucoma Awareness Walk was organized on March 9th to mark the starting of World Glaucoma Week in Noida. The walk, organized by ICARE Eye Hospital, started from Sector 21 Stadium to ICARE Eye Hospital, Sector 26 Noida. A large number people participated in the walk. The participants included Ophthalmologists from Noida, staff, patients of ICARE Eye Hospital and volunteers etc. The objective of the walk was to generate glaucoma related awareness among general public so that blindness caused due to Glaucoma may be avoided. An enthusiastic group of cyclists participated in this program, starting cycling from Sector 18 Gurudwara to the Stadium and thereafter, accompanying the walkers. Caps & T-shirts were distributed to walkers.

The walk ended with a health talk on Glaucoma by Dr. Reena Choudhry, attended by journalists from media and patients. She explained that there are several forms of glaucoma the two most common forms are primary open-angle glaucoma (POAG) and angle-closure glaucoma (ACG). Open-angle glaucoma is often called "the sneak thief of sight" because it has no symptoms until significant vision loss has occurred. There are typically no early warning signs or symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years. Most people who have open-angle glaucoma feel fine and do not notice a change in their vision at first because the initial loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is maintained until late in the disease. By the time a patient is aware of vision loss, the disease is usually quite advanced. Vision loss from glaucoma is not reversible with treatment, even with surgery. Because open-angle glaucoma has few warning signs or symptoms before damage has occurred, it is important to see a doctor for regular eye examinations. If glaucoma is detected during an eye exam, your eye doctor can prescribe preventive treatment to help protect your vision. Function finished with soft drinks & snacks.

What is Lasik Surgery? Best Eye Hospital, Noida, Delhi

What is Lasik Surgery Explained By Dr. Saurabh Choudhry at ICARE Eye Hospital, Noida.

CATARACT: Act Now!

Diagnosis:
There are chances that you might have cataract if you experience any of these symptoms:

• Blurred Vision. One might also experience foggy or filmy vision.
• Increased and frequent changes in the glasses prescription.  An increase in the negative reading with a reduction in positive reading is observed
• Difficulty driving in the night
• Changes in the color perception
• One doesn’t feel the need for reading glasses
• Appearance of spots in vision when facing bright light at night time
• Double vision

Once you think you experience any of these problems, contact our eye care experts for a confirmed diagnosis. A timely diagnosis of cataract can prevent a lot of further damage to your eye and help you restore an optimum vision on time.
Diagnosing Cataract:
Our ophthalmologists use different examinations for diagnosing cataract. There are various tests used to make a clear diagnosis. A clinical eye examination is supported by glare sensitivity tests, night vision, contrast sensitivity; side vision tests are also performed.  Besides these, a snellen eye chart, macular evaluation and corneal evaluation may also be needed.
Treatment for Cataract:

   Treatment for cataract is decided based on the extent to which it affects one’s daily functioning and activities.  Cataract can sometimes be corrected by a change in the glasses prescription or by the use of contacts. However, if the doctor feels that it is affecting your daily activities, then a cataract surgery is the only solution.

 Cataract surgery- simple step to a clear vision

   Cataract surgery is a completely safe and painless procedure which is performed in day care. The eye surgeons use local anaesthesia or topical anaesthesia (eye drops) which makes the procedure free of any pain or discomfort.  

One should not delay getting the procedure done as the delay might worsen the cataract and cause unnecessary complications.

Phacoemulsification –Stitch less Cataract Surgery
     The most common and safest cataract surgery is Phacoemulsification. Phacoemulsification is a procedure which makes use of a small microscope which uses ultrasound energy to remove deposits from eye lens and a foldable intraocular lens is placed in capsule of the eye.
Phacoemulsification makes use of a microscopic probe. A small incision (about 2-2.5mm) is made in the eye ball. A circular opening is made in the anterior part of the capsule (a membrane that encloses the eye lens). The probe removes the deposits on the eye lens using ultrasonic energy.  A foldable ocular lens is then placed in the capsule.  This lens can remain in the eye for a lifetime and does not cause any problem. The incision is self-healing and requires no stitches. This stitch less procedure is completely safe and provides faster post-operative healing. The healing time is minimized because of the absence of any stitches.
  Cold Phaco: Our latest and top-of-line Phacoemulsification machines are capable of performing Cold Phaco. One such machine is the ‘The WhiteStar Sinature with Ellips "Transversal Phaco" These machines minimize the intensity and amount of the ultrasound energy that is used for the procedure.  Use of   lesser ultrasound energy enhances safety and comfort of the procedure.
Intraocular lenses (IOLs) used in Phacoemulsification
     There are different types of intraocular lenses used in the cataract surgery. The new decade IOLs come with better contrast sensitivity and glare correction. These are categorised as:
Micro incision IOL: These are ultrathin IOLs designed for micro incision cataract surgery.
Monofocal IOL: These IOL implants provide a good distant vision but will need reading glasses for near work. They come with a regular or aspheric surface. The aspheric design IOL gives better night contrast. 

Multifocal IOL: These IOLs have different optical zones for different distances. They have various advantages over the monofocal lenses. They have been designed to give good functional distant, intermediate and near vision. They reduce the patient's dependence on glasses for routine activities. 

Toric Lenses: These lenses have rapidly gained popularity for correction of astigmatism. These have different power incorporated in different part of the lens. They can correct the cylindrical power up to 4 dioptres in glasses. They reduce the dependence on glasses post-operatively. However spectacles may still be needed for reading, writing etc.


Accommodative IOL: Accommodative IOLs (Crystalens) simulate the movement of the natural eye lens. These lenses are able to move within the eye and are thus able to provide vision at different distances.

Besides Phacoemulsification, the other surgical options for the treatment of cataract include:
Extracapsular Cataract surgery: Extracapsular cataract surgery is performed in advanced cataract cases where the lens cannot be cleared using Phacoemulsification.  This procedure requires postoperative sutures and the postoperative recovery is slower.
 Intracapsular Cataract surgery: Intracapsular cataract surgery is rarely used. It is mostly used in cases of trauma.  The capsule is removed along with the lens and the lens is laced at a new location in front of the iris.
 Postoperative care: After the procedure you will be asked to come for a few follow up visits to monitor healing of the eye.  A few eye drops will be prescribed to keep the eye lubricated and infection free. A few instruction about avoiding to stoop or bend forward or lifting heavy objects will be given .You will find the vision improving within few days.
Cataract surgery provides a significant vision improvement post-operatively. Prescription glasses with a small power might still be needed in few cases. The defects of the optic nerve and retina can only be noticed postoperatively.

Is Lasik Safe for You?

‘I’m getting rid of my glasses!’ 20 years old Sanya announced to her parents one Sunday afternoon. ‘I have decided that I want to undergo LASIK,’ she said. ‘What rubbish.’ ‘It is a surgery after all. Not just something you decide on a whim’, ‘Do you know how unsafe it is?’ and ‘What is it that you are hiding behind your back?’ did her father. Sanya chuckled to herself. This is something she had anticipated. Out came a bunch load of papers that she had been holding behind her back, waiting for the right time.

‘It’s not just a whim Dad. I have done a lot of research on the internet on which is the best eye hospital in Mumbai, who is the best LASIK surgeon, which is the best type of LASIK. And Mom, millions of people undergo LASIK every year.’ She tried coaxing her parents. A week and lots of heated discussions later, Sanya triumphantly sought an appointment at an eye hospital. As they waited for their turn, her mother whispered, ‘Sanya, remember we just agreed to come check out the place. Only if we feel that it’s ok will we give it a thought.’ She just hugged her mother as her father sighed.

 Soon, they found themselves in the surgeon’s cabin. Sanya could hardly contain her excitement. But the LASIK Surgeon soon poured a bucketful of water over her enthusiasm, ‘Sanya, it’s your eyes after all. We would not like to jump in head first just like that.’

She was confused and irritated as she saw her father sink into his chair with a sigh of relief. ‘LASIK is one of the safest surgeries, only as long as you are the right candidate. There are a number of things that need to be considered like the thickness of your cornea, the surface of your cornea and various other factors. We will run a few tests for your eyes. If any of these show that you cannot undergo LASIK, I will not perform the procedure on you.’

Here are some tests Sanya underwent to check if she was eligible for the procedure:

Corneal Topography: This test studies the surface map of the cornea (the outer dome shaped layer of the eye). Those with corneal abnormalities are advised against LASIK.

Corneal Pachymetry and OCT: This test measures the thickness of the cornea. The thickness of the cornea is examined since those with abnormally thin corneas are at a higher risk of developing corneal weakness.

Aberrometry and contrast sensitivity: This is measured to rule out any major aberrations in the optical system of the eye as that can influence the type of technique used to perform the procedure.

Orthoptic Check Up: Some people tend to have minor muscle alignment troubles. Here the balance of one’s eye muscles and depth perception ability is checked before undergoing LASIK.

IOL Master to assess disparity in length between the two eyes if any as that can have a bearing on the kind of correction that can be performed safely.

Detailed Refraction: This is done to measure the exact prescription. One’s eyes are dilated so as to measure the true vision if one did not focus too hard.

Dry Eyes Tests: This is done to rule out pre-existing dry eye. Here Lid margins, tear film stability, surface of the eye and the amount of tear secretion (Schirmer’s Test) are evaluated

Evaluation of Eye Pressure:  This is done to rule out glaucoma, a disease where high pressures in the eye can lead to damage to the optic nerve.

Fundoscopy: This test is done for the evaluation of the retina or the photosensitive layer at the back of the eye and also the Optic Nerve head (Disc) to rule out pre-existing abnormality

Finally, after undergoing a battery of tests the LASIK surgeon was convinced that Sanya was eligible for the procedure. Also it convinced her parents that their daughter’s eyes were in excellent hands and she wasn’t being conned into undergoing the procedure.