Month: June 2019

This week’s blog on ‘Importance of Sunglasses for Children’ has been contributed by Dr. Namir Kafil-Hussain, Consultant Paediatric Ophthalmologist, Specialist in Children’s Eye Diseases, Strabismus (Squint) and Paediatric Cataract Surgery
As children are in a dynamic active state of growth, it is estimated that 50% of total sun exposure occurs in the first 18 years of age, since children are more active outdoor during this age. Another important factor is the deletion of the ozone layer, a protective filter layer of atmosphere, leading to increased exposure to UV radiation which can negatively affect children’s skin and eyes. UVA rays may cause harm to the central vision, causing damage to the macula, a central part of the retina at the back of the child’s eye. UVB may cause harm to the front part of the eye (cornea and lens), which absorb UVB rays. The other well-known side effects of UV radiation include: cataract (clouding of lens), macular degeneration, pterygium (benign growth on the white of the eye) and corneal sunburn which is painful and might cause temporary vision loss. Additionally, blue rays may cause digital eye strain due to the high energy light that is emitted by computer and mobile phone screens. Another important fact is that children’s eyes are more susceptible to the harm caused by excessive exposure to UV rays than adults because the young clear lens inside the eye is less capable of filtration of these harmful rays.
To put things in perspective, normal light is between 400 nm (on the blue end of the spectrum) to 760 nm (on the red side). However, the sun emits other electromagnetic waves in addition to light. The sun emits two types of ultraviolet rays (UV) radiation, UVA (ranges between 320-400 nm) and UVB (ranges between 290-320 nm). UVA accounts for about 95% of the UV radiation that reaches the skin and eyes. UVA rays are considered to be more harmful than UVB since they penetrate farther into skin and eyes than UVB. Also UVA rays penetrate glass while UVB rays do not. Both UV rays are reflected from sand, water and snow (80% of UVB rays reflect from snow).
In conclusion, it would be very wise for parents to ensure that their children wear protective tinted sunglasses outdoors, especially in snowfields, sandy beaches and near pools and sea. The color of sunglasses is not correlated with the level of UV protection, thus special tinted glasses with certification that will block up to 100% of the sun’s UV radiations is needed. However, before buying these sunglasses, it is advisable to arrange an eye examination with Paediatric Eye Doctor for a thorough eye examination and to provide a prescription for the glasses, if needed.

This blog on Minimally Invasive Glaucoma Surgery (MIGS) was authored by Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery.

What is MIGS?

Minimally Invasive Glaucoma Surgery, or MIGS, has shown formidable results in mild or moderate glaucoma. MIGS is designed to improve the safety of surgical intervention for glaucoma cure. While coined minimally invasive, micro is a more appropriate term, truly differentiates these microscopic ophthalmic procedures from other minimally invasive surgical procedures (i.e., general surgery). MIGS can be considered as an alternative to medical therapy in an effort to address adherence challenges, adverse events, and quality-of-life (QOL) issues with topical medications.

The iStent

The iStent is the smallest implantable device approved by the FDA to be used on the human body. The iStent can reduce the need for daily use of glaucoma eye drops. A small (1mm) titanium drainage stent is inserted into the eye’s natural drainage channel to lower intraocular pressure.

The iStent is not visible in the eye, and shows no physical evidence of its presence. Nor does it appear in the vision of the person with the stent.

XEN Glaucoma Implant

The implant is a soft, collagen derived, gelatin that is known to be non-inflammatory. The Xen Gel Stent aims to reduce intraocular pressure by inserting a small drainage tube into the eye. The stent allows fluid to drain from the anterior chamber into a reservoir (bleb) under the conjunctiva. The goal of implantation is to create an aqueous humor outflow path from the anterior chamber to the subconjunctival space.

Similar to the iStent, the implant also has no physical appearance. However, occasionally a shallow bleb can be seen in extremes of gaze, where the eye is looking very far down and outwards.

The Surgery

Successful MIGS surgery takes much less time than many other types of Glaucoma surgery, typically lasting 30 minutes at the most. At Moorfields Eye Hospital Dubai/Abu Dhabi, MIGS implantation is usually performed under local anaesthesia, although general anaesthesia is also possible under certain circumstances.

Typically a drug called Mitomycin C (anti-scarring medication) is also used at the time of surgery if indicated to suppress healing.

It is extremely rare for complications to occur at the time of the surgery. When the complications do occur, they occur usually within 2 weeks of the surgery.

Postoperative Period

The blurring is usually worst for the first 1 to 2 weeks after surgery, and improving slowly afterwards. It takes about 1 month for the eye to feel completely normal though vision would stabilise much earlier.

Eye drops and tablets to lower the eye pressure are not normally required for the operated eye during the first night after surgery. The following day, the postoperative eye drops are usually started after removal of the eye patch and cleaning of the eye. The postoperative eye drops will usually consist of an antibiotic and anti-inflammatory steroid eye drops to use for the first month after surgery.

The patient will require two follow up visits two weeks apart, after the operation in order for a follow up.

Following surgery you are able to read and watch television as normal as these activities will not harm your eye. It is however important to avoid strenuous activity during the first few weeks after surgery.

Here is a table with the dos and don’ts:

With showing 80-90% success rates in most studies, MIGS is slowly becoming a well requested form of glaucoma correction, especially since it only takes around 1 month for the eye to feel completely normal in most cases.

This week’s blog on Are all LASIK procedures the same? Which one is the best? has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery
If you have been thinking about laser vision correction surgery and reading up on it, you may have come across many different procedure names. Some may say that it is very confusing to understand and compare them to one another, especially as there are different packages and prices offered for such procedures.
The two main types of refractive laser procedures are the LASIK procedure and the surface laser procedure.
The LASIK procedure is one in which the thin layer of the cornea (located in the front part of the eye) is created, called a flap. The flap is then lifted to allow for the application of excimer laser energy beneath it. The laser then reshapes the cornea for vision correction outcomes. After the laser treatment is completed, the protective flap is replaced back to its original place in order for it to heal.
With traditional LASIK, a mechanical instrument called a Microkeratome uses a moving blade to create a thin corneal flap. Traditional LASIK may cause complications such as torn flaps and free flaps which in some cases can unfortunately cause permanent reduced vision. It is also known as Ultra LASIK, SupraLASIK or Thin LASIK.
An alternate new method of creating a LASIK flap is through the use of a femtosecond laser, also known as “IntraLase,” “blade-free” or “all-laser LASIK.” This technology represents an innovative and highly sophisticated laser technique used to prepare the cornea for laser vision correction surgery. This allows extra safety for the laser procedure. Using laser technology to create the corneal flap, which is most important step in LASIK procedure, has made the procedure much precise, effective, eliminates serious flap creation risks and is arguably the safest LASIK technique to undergo. Femtosecond lasik allows the surgeon to choose a excellent centration of the flap, create precise diameter and thickness and edge design of the flap, so it improves both the quality and the accuracy of the procedure.
A result, this reduces the risk of surgical flap formation complication to almost risk free, also reducing the risk of post-surgery flap wrinkles and weaker cornea, and also reduces the risk of dry eye after the procedure.
LASIK was originally approved by the FDA in 1995. The first FDA-approved bladeless flap-making system in the United States was in 2007, so it is not a new procedure, but as technology has advanced over the years, it is now extremely precise, safer and easy to perform with predictable outcomes.
In conclusion, not all LASIK procedures are equal; if you are considering LASIK, ask your surgeon whether they will perform the blade or Femto laser LASIK flap. If price is a major concern for you, the blade procedure may provide an option, however you should also consider the safety and raised potential complication rates and risks associated with this. Using the femto laser flap technique, your risk of complications and outcomes are much better guaranteed to be in your favor and also remember that some facilities offer different packages and financing options.
The choice is yours, just make sure to ask your surgeon, and the facility you are seeking treatment from, enough questions, especially how the Lasik flap is created in order for you to make an informed decision.

This week’s blog on Smoking and the eyes has been contributed by Dr Ammar Safar, Medical Director, Consultant Ophthalmologist and Vitreoretinal Surgeon.
Most people are very aware that smoking in all shapes can cause cancer, lung and heart disease, as well as many other health problems but people are always surprised when I tell them that smoking can seriously affect the health of their eyes too. Here are some of the more important eye conditions affected by smoking:

• Dry eyes: This is a very common condition especially in the gulf area and it can be severely aggravated by smoking. Patients will feel burning sensation, scratchy eyes, redness, sandy sensation and severe irritation.
• Macular degeneration: this is a vision threatening condition that affects people over age 55 and can cause severe distortion or loss of central vision. Smokers are 4 times more likely to get this condition than non-smokers and people who live with smokers are 2 times as likely to get it too. Recent medical improvements have introduced a treatment for the severe form of AMD in the form of injections in the eye to restore vision loss. Research has proven that smokers are much less likely to respond to these injections than non-smokers.
• Cataract: This is clouding of the natural lens of the eye that obstructs vision. People who smoke are 2 times more likely to get cataract than those who do not.
• Diabetic retinopathy: People who are diabetic and smoke have much more risk of developing problems in the retina called diabetic retinopathy. This can be a serious condition and lead to blindness.
• Smoking while pregnant: If you smoke while being pregnant you could increase your child’s risk of bacterial meningitis by 5 folds. This condition causes swelling around the tissue of the brain and can seriously affect the eyes and the optic nerve. In addition to that, smoking during pregnancy increases the risk of early delivery. This can have direct effect on the eyes and especially on the retina. This condition is called Retinopathy of Prematurity (ROP) which is a serious condition, if left untreated can lead to permanent vision loss.

Patients are advised to engage in programs that lead to quitting this dangerous habit. Studies have shown that patients who quit smoking reduce their risks to pre smoking levels after 5 years of quitting.