Laser iridotomy (iris hole)


A laser iridotomy is generally performed either to lower the eye pressure in chronic narrow angle glaucoma, or to prevent and treat acute angle closure glaucoma (both of which can cause severe and irreversible vision loss if not treated). The treatment is only recommended if the risks to vision from glaucoma outweigh any risks from the treatment itself.

The procedure is done as an outpatient and it is best to have someone along to take you home, as your vision in one or both eyes might be poor for driving or walking, though it isn’t usually badly blurred. We can treat one or both eyes at one sitting. There is no extra preparatory medicine needed on the day before or morning of, but you should take any usual eye drops that were prescribed for daily use. After the preliminary exam, an eye drop of pilocarpine is put into the eye to make the pupil small and the iris thinner. This takes 15-30 minutes. You will get a sensation like sinus pressure, often felt in the eyebrow, and your vision can blur temporarily. The eye is numbed with anesthetic eye drop or ointment and a lens is put on the eye, held by the doctor’s fingers to keep your eyelids out of the way and to magnify the view. You will be sitting up at the instrument called the slit lamp with a chin rest and bright light shining from binoculars that the doctor looks through. You help by keeping the other eye open and staring straight ahead between blinks. It’s OK to blink, since the eye getting treated can’t close with the examining lens in place.


The most commonly used laser is the neodymium: YAG type, which treats the eye so fast that you won’t have a chance to move your eye during laser applications. When the laser fires, you get a sensation that something happened. It’s typically not unpleasant, just a little startling if the doctor doesn’t warn you first. We often need to make several deliveries of laser to produce a hole about one half a millimeter in size, about the size of a ball point pen tip. That’s all it takes to let aqueous flow from behind to in front of the iris and fix the problem. It’s pretty uncommon that you or someone else will see where the hole was made, though if you look closely you’ll later possibly see a black dot where it is. Because the laser is focused down to a point at the iris inside the eye, it doesn’t have concentrated power anywhere in the eye except there, so it doesn’t damage the wall of the eye or anything behind the iris. You won’t have a hole in the outer wall of the eye.

A small number of persons after iridotomy previously reported that they saw an additional line of light around street lights, or, that they see more glare in general. Even those who experienced this glare effect found that it goes away with time. Widely accepted locations for placement of the iridotomy such that the incidence of glare is minimized include at the 3, 9 or 12 o clock positions. Very rarely, debilitating glare may require an operation to close the iridotomy using a stitch.

For the first hour after iris hole treatment, vision is blurred, but it clears quickly. Half an hour after treatment the pressure is checked, since occasionally it rises substantially and needs treatment for a while with drops to make it safe again. No eye patch is used. Some eye surgeons give anti-inflammatory eye drops for a few days. The next visits are one day, one week and one month later. If the laser hole is not open at 4 weeks after the initial treatment, it is retreated, which is typically pretty quick and easy. Making a hole is harder in thicker, brown irises, such as in African- or Asian-derived persons. In these eyes, we can treat with two separate types of lasers in sequence, the first being a continuous wave laser (diode) to thin down the iris, followed by the neodymium:YAG to punch through. About one in ten times in this kind of patient it can take two sessions to make a full hole of the right size, and sometimes the iridotomy may have to be placed at any suitable location to minimize the much higher risk to vision from glaucoma.

Once a laser iris hole is made, it’s open for good. The iris doesn’t heal as do other body tissues, probably because the aqueous fluid that surrounds it contains chemicals that prevent healing under normal circumstances. The exceptions to the no-healing rule are eyes that have new blood vessels growing in them or eyes with inflammatory diseases (neovascular and inflammatory glaucoma). Because the normal situation of no-healing is changed by these processes, laser iris holes in those eyes can close up and are watched more closely.

There is some limited evidence that making a hole in the iris speeds the development of cataract, perhaps because the movement of aqueous is re-routed through the hole and doesn’t uniformly bathe the lens as it normally does. Of course, if the eye develops an acute angle closure crisis because the hole wasn’t made, a cataract is pretty much guaranteed to develop soon. An iris hole, on balance, may wind up preventing more cataract than it might cause if angle closure crisis is avoided.

Depending on the type of glaucoma, laser iridotomy may help facilitate control of the eye pressure, but you may still need to use glaucoma drops long term. In some cases further laser or surgical treatment may be required to control glaucoma, as the iridotomy may be one step in the long term management of the condition. It is important to remember that a laser iridotomy is not done to improve vision or to gain independence from glasses.

Abu Dhabi based UEMedical Group adopts Okadoc solution for appointment booking and telemedicine across eight facilities

Abu Dhabi, UAE – November 23, 2020: United Eastern Medical Services (UEMedical), a leading healthcare group in the UAE, joins the growing list of healthcare providers who have adopted Okadoc’s white label booking and telemedicine solution. In an effort to digitize its healthcare services, UEMedical Group has successfully implemented the Okadoc solution for two of subsidiaries in UAE – HealthPlus Network of Specialty Centers and Danat Al Emarat Hospital and Clinics.

The Okadoc solutions enables patients to book and manage their in-person or video consultation appointments with doctors at HealthPlus Centers and Danat Al Emarat hospital and clinics easily through their respective websites. Patients can view availability of doctors in real time, both on the hospital or clinic’s website as well as through the Okadoc app. Even those with prior bookings via the call center can manage their appointments online.

Majd Abu Zant, Chief Operating Officer at UEMedical Group, UEMedical Group, said, “The COVID-19 pandemic has changed the world in many ways, of which digitization is at the forefront, especially in the delivery of healthcare. At UEMedical Group, we have always adopted the latest technologies to provide the highest standard of care to our patients. With Okadoc’s solution implemented across two of our healthcare subsidiaries, we seek to enhance the patient’s healthcare journey, making it seamless and effortless.”

On benefits of Okadoc’s white-labelled solution, Mr. Abu Zant added, “The platform is directly and fully integrated into our existing hospitals information system, ensuring that we deliver top patient care without interruption. It also helps us with reduced no-shows and optimized bookings, which positively impact our operational efficiencies.”

Healthcare providers can easily embed and deploy Okadoc’s white label booking and telemedicine solution into their websites and mobile applications within a matter of a few hours. It then allows patients to view doctors’ availability in real time, book, reschedule, and cancel an appointment with a practitioner at the hospital. Once patient bookings are made, an automatically generated confirmation and booking reminder is sent to the patients enabling them to connect online to access the information they need easily and effectively. 

“We are excited to be partnering with UEMedical Group, marking our first tie-up with Abu based healthcare providers. Okadoc was founded with the aim of providing convenient and hassle-free access to healthcare. Our white label solution is an important evolution of our solutions to help healthcare providers digitise and optimize their patient care process, especially during the current pandemic when patients are reluctant to visit hospitals”, said Fodhil Benturquia, Founder & CEO, Okadoc.

Okadoc has successfully implemented its white label solution across the UAE’s prominent healthcare groups including the Emirates Hospital Group (EHG) and Medcare hospitals and clinics.

Okadoc’s cloud-based platform connects the patients with their physicians via text or video calls at mutually convenient times. Either party can share or send documents pertinent to the consultation session and send and receive payments without any delay. The system ensures that all transactions, whether financial or informational, shared between the two remains confidential and secured.

Okadoc’s telemedicine platform is TRA (Telecommunications Regulatory Authority) approved, using end-to-end encryption with the cloud data hosted in the UAE, and compliant with UAE regulations.

Top 10 Eye Conditions Affecting Children

This  blog has been contributed Dr. Alaa Bou Ghannam , Specialist in Neuro-Ophthalmology, Paediatric Ophthalmology & Glaucoma, and Adult Strabismus

Children have their own set of eye diseases that are at times different from what we see among adults. Below is a list of ten of the most common pediatric eye problems seen in a paediatric ophthalmologist’s clinic.

  1. Refractive errors: This is by far the most common paediatric eye condition. Usually, it is easily treated with glasses. It can be myopia, hyperopia or astigmatism. Children sometimes cannot verbalize their inability to see, so they might squint, blink, turn their heads or just give up on seeing all together which might affect  their school performance.
  2. Strabismus: This happens when the eyes are not aligned together, with one or both eyes drifting or crossing. This can be congenital or acquired; it is usually treated with glasses or surgery. In some cases we can just observe but sometimes systemic workup is needed to rule out underlying conditions.
  3. Viral conjunctivitis: Eyes are red, watery and have purulent discharge. Typically, it involves one eye and then spreads to the other. Observation is usually the rule as most will resolve uneventfully within 4-10 days. It is highly contagious.
  4. Allergic conjunctivitis: Presents with itching, blinking, red and watery eyes. Typically involves both eyes simultaneously. It can be seasonal or related to a specific allergen. Severe condition is called vernal catarrh. Treatments include lubrication, antihistamine drops, steroids or cyclosporine drops in severe conditions.
  5. Amblyopia/ lazy eye: It happens when the brain favors one eye over the other, causing further decrease in vision in the weaker eye. This might be caused by a difference in refractive error between the two eyes, strabismus, or media opacification preventing clear images from reaching the retina. It must be treated early on with patching of the stronger eye or with atropine drops.
  6. Nasolacrimal duct obstruction: It is usually congenital. Infants have excessive tearing and discharge, treated with nasal massage to open up the nasolacrimal duct. Most resolve by the age of one.
  7. Chalazion/ stye: It is a benign growth on the eyelid caused by a blockage of the meibomian gland due to lid inflammation. Treatment is usually through lid massage. In most cases it resolves uneventfully. Sometimes, it gets infected and will need antibiotics. If it does not resolve in a month then incision and drainage is recommended.
  8. Congenital cataract: Infants are born with unilateral or bilateral opacification of the lens. Parents will see a white reflex in the pupils. It is recommended to remove the lens early on to prevent amblyopia.
  9. Congenital glaucoma: A condition where the pressure in the eye is elevated. Infants with glaucoma will have large eyes (buphthalmous) with tearing and light sensitivity. Surgery is the treatment of choice as drops might not be helpful.
  10. Retinoblastoma: It is a malignant cancer of the retina.  Parents will notice a white reflex in the pupil. It needs urgent diagnosis and treatment that includes chemotherapy, laser therapy and/ or removal of the eyeball (enucleation).

Annual comprehensive eye examinations are recommended for all young children, as many eye conditions may be managed or treated more effectively with early screening and detection.

NYU Abu Dhabi Signs a Memorandum of Understanding with United Eastern Medical Services

October 28, 2020, Abu Dhabi: NYU Abu Dhabi (NYUAD) signed a Memorandum of Understanding (MoU) with United Eastern Medical Services (UEMedical) in Abu Dhabi, the parent organization of Danat Al Emarat Hospital for Women & Children, HealthPlus Network of Specialty Centers, and Moorfields Eye Hospital Abu Dhabi. A major outcome of the MoU is establishing the HealthPlus Diabetes & Endocrinology Center in Abu Dhabi as one of the main clinic sites for the UAE Healthy Future Study (UAEHFS) set to accept participants from November 1, 2020.

The collaboration will also offer support on current and future research, education, innovations, and workshops in the field of health sciences. 

The MoU was signed by NYUAD Vice Chancellor Mariët Westermann and Chief Operating Officer at UEMedical Majd Abu Zant; in the presence of UEMedical’s Chief Medical Officer Dr. Sadoon Sami Sadoon; and Diabetes & Endocrinology Consultant and Director of Academic Affairs at HealthPlus Network of Specialty Centers Dr. Huda Ezzeddin Mustafa. Mandatory health and safety protocols including testing, face masks, and physical distancing were in place throughout the event.

The UAE Healthy Future Study is the first cohort study aimed at understanding the source and cause of the rising cases of obesity, diabetes, and heart disease among Emiratis. The study invites all UAE nationals, between the age of 18 and 40, to participate. Currently, the study clinics are located in Abu Dhabi Blood Bank, Cleveland Clinic Abu Dhabi, Healthpoint, UAE University, and Latifa Hospital- Dubai Blood Donation Center.

Westermann said, “Across the disciplines, NYU Abu Dhabi is investigating and investing solutions to some of the world’s most pressing challenges, including public health concerns such as obesity, diabetes, and heart disease. The UAE Healthy Future Study is mobilizing the scholarly and scientific capabilities of our university along with great local partners such as United Eastern Medical Services towards building a healthier UAE. We are excited at the possibilities afforded by this new partnership and how we might advance our local contributions towards the health sciences.”

Abu Zant stated, “We hope this MoU paves the way to a successful and collaborative partnership that will benefit our community. UEMedical delivers world-class medical services through its various Centers of Excellence, underpinned by a strong medical education and research framework. As accredited research centers by the Department of Health Abu Dhabi (DoH), Danat Al Emarat Hospital, HealthPlus and Moorfields Eye Hospital Abu Dhabi have taken part and have initiated multiple integrated clinical research projects and studies in the past 18 months, and we are truly excited to participate in the UAE Healthy Future Study. We are confident that HealthPlus Diabetes & Endocrinology Center will provide insightful data for the study. The MOU also opens the door for further collaboration with NYUAD in research, education and innovation particularly in the fields of woman and child health, fertility, eye diseases and genomics.”

NYUAD, in association with its Abu Dhabi partner, Tamkeen, is funding and leading the UAE Healthy Future Study in collaboration with the Department of Health – Abu Dhabi,  Dubai Health Authority alongside SEHA – The Abu Dhabi Health Services including Sheikh Khalifa Medical City, Al Ain Regional Blood Bank, Abu Dhabi Blood Bank, Zayed Military Hospital, UAE University, Zayed University, Khalifa University, EBTIC, Higher Colleges of Technology, Healthpoint, Cleveland Clinic Abu Dhabi, Oasis Hospital, Capital Health Screening Center, Daman, and NYU Langone School of Medicine

NYUAD Public Health Research Center Associate Director Abdishakur Abdulle stated, “Given the importance of the UAE Healthy Future Study for the nation, we have developed a partnership with various national institutions in both the public and private sectors. Today marks yet another great milestone which will enable us to work with a key partner in healthcare, namely UEMedical. In part, this collaboration will facilitate accessibility for even more public participation among the nationals of the UAE. We will continue our efforts to engage with the public and ensure that participation in the UAE Healthy Future Study is smooth and easily accessible. Results from this study will not only help improve the health of the community, but will also be in line with national objectives to build a world-class healthcare system through scientific research in understanding the causes and consequences of chronic diseases in the UAE. It is anticipated that results from this study will also help the development of better prevention and treatment strategies.”

In April 2020, UAEHFS shifted to online recruitment in response to the precautions set out by the UAE Government to protect public health and limit the spread of COVID-19. To register, study volunteers now have the opportunity to participate through an online-based platform instead of physically visiting clinics.

Dr. Huda Ezzeddin Mustafa said, “We believe that the partnership between NYUAD and UEMedical is fundamental to build strong bridges between public health and healthcare providers within a framework of academics and clinicians. The collaboration will no doubt nurture community-based medical research through our multispecialty medical services. We are truly proud to open our doors to the landmark UAE Healthy Future Study, and we trust that the UAE population have the vision and understanding of the importance of clinical research. We have learnt from the phenomenal participation of our population in COVID-19 trials that the Emirati community is capable of making informed decisions to participate, with much enthusiasm, in well-designed medical research for building a healthier future for the generations to come.”

About the UAE Healthy Future Study

The UAE Healthy Future Study is the first long-term study aimed at understanding and providing substantive evidence for environmental, lifestyle, and genetic determinants of common diseases in the UAE population, such as obesity, diabetes, and heart disease. All UAE Nationals between the ages of 18 and 40 are invited to volunteer by participating in a confidential health assessment and future follow up that will contribute to a healthier future in the UAE.

Glaucoma: Why early diagnosis is important, and what treatments are available to maintain quality of life

This  blog on Glaucoma and treatment options has been contributed Dr. Salman Waqar, Consultant Ophthalmic Surgeon, Specialist in Adult Glaucoma and Cataract Surgery.

Glaucoma is a term used to describe a group of conditions in which the eye pressure is high, leading to damage to the optic nerve (the nerve that connects our eye to the brain). This can lead to permanent damage to the field of vision. In severe cases can cause tunnel vision and blindness. Even in less severe forms, glaucoma can interfere with independent living and can even affect our ability to drive.

Prevention is the key.

Regular eye exams with your eye specialist, particularly if there is a family history of glaucoma, can detect the condition early.

Fortunately, we now have many very sensitive tests that can diagnose the condition well before it causes any perceptible damage to your vision. These include Visual Field tests and Optical Coherence Tomography scans. Both are done in clinic and only take a few minutes with no discomfort.

Once the diagnosis is confirmed, the key is to lower the eye pressure and preserve vision. While searching for an eye care facility and a Glaucoma specialist, it’s best to look for a location that can offer the comprehensive treatment options shown below and an experienced Glaucoma Consultant, for long term relief and peace of mind.

  • Eye drops: There are a wide variety of eye drops which can be used to lower the eye pressure. They are usually taken once or twice a day but do need to be instilled regularly for the rest of your life.
  • Lasers:
  •  Selective Laser Trabeculoplasty: This is a simple and painless laser treatment that only takes a few minutes to perform and you can go home the same day. It can be done either to supplement the effect of eye drops or to replace them completely. At the time of your consultation, your consultant will discuss how this can help you.
    •  Laser Peripheral Iridotomy: In a particular type of glaucoma (narrow angle glaucoma), a very small channel is created in the iris (the coloured part of your eye) using a special laser. This can not only help lower the pressure but can also prevent future attacks of very high pressure (called acute angle closure glaucoma)
    •  Cyclodiode: If the eye pressure is not being controlled despite best efforts with all other treatment options, this laser can be performed to stop production of fluid in the eye (this is done by a part of the eye called the ciliary body).
  • Surgery: I am trained in all the latest surgical techniques for the treatment of glaucoma. These include:
    •  Cataract Surgery: For some, simply removing a developing cataract can not only lead to improvement in vision but can also lower the eye pressure.
    •  Cataract Surgery with iStent inject implantation: At the time of cataract surgery a very tiny titanium stent can be implanted into the eye which helps to drain fluid out of the eye thus lowering the pressure. This is part of an exciting new type of surgery called minimally invasive glaucoma surgery (MIGS).
    • Cataract Surgery with goniosynechialysis: Sometimes an iStent cannot be safely placed as the drainage angle of the eye is narrow. In such circumstances the drainage area can be opened with a technique known as goniosynechialysis.
    •  Trabeculectomy with antimetabolite injection: This involves creating a flap on the surface of the eye which allows fluid to drain out. A special anti-scarring medication is used to ensure success.
    •  Aqueous Shunt Devices: These devices comprise of a soft footplate connected to a plastic tube. The tube is inserted into the eye whilst the footplate is secured to the surface of the eye and drains fluid out.  Performing either a trabeculectomy or aqueous shunt device insertion is reserved for cases that are not responding to other suitable treatments as listed above.

Early detection and prompt treatment of glaucoma is essential to preserve vision. An ongoing and strong support system surrounding you can make all the difference in living a fulfilling life despite glaucoma.

Choose a location and a doctor that consider individualised treatments to suit your personal needs. This will help you and your family understand and manage the condition whilst also maintaining your quality of life.

Keratoconus and its Modern Treatments

This blog on ‘Keratoconus and modern treatments’ has been contributed Dr. Osama Giledi, Consultant Ophthalmologist, Specialist in Cornea, Cataract and Refractive vision correction surgery.

The cornea is the eye window which controls and focuses the entry of light into the eye, and in cases of keratoconus, there is a pathological decline in the thickness and rigidity of the cornea, which leads to irregular bulging of the cornea to a cone-like shape, which causes reduced vision from irregular astigmatism.

Corneal keratoconus usually affects both eyes and each eye may be affected differently, and usually occurs in people between the ages of 10 to 25 years. The condition may progress for 10 years or more and then slow down or stabilize.  As the condition progresses, vision becomes distorted and blurred, with an increased sensitivity to light and glare.

Keratoconus presents itself in more certain ethnic groups, such as the Arab countries, southern Europe, and southern Asia. Environmental and genetic factors are potential causes, but the exact cause is uncertain.

Eye rubbing is a major risk factor. It is associated with some disease such as atopy and asthma. Also associated with some syndromes such as Down syndrome. If you have a family history of keratoconus, you have a greater chance of developing keratoconus. Pregnancy can make keratoconus progress more.

New corneal scans especially the 3 dimension scan such as pentacam help to diagnose Keratoconus at early stage.

Traditional treatment of keratconus was through glasses, hard contact lenses and corneal grafts. However, modern treatments for keratconus is used to stop the progress of Keratoconus, improve the shape of the cornea, and improve vision as well as avoiding the need for corneal graft.

Glasses or contact lenses can be used to correct nearsightedness and astigmatism in the early stages of keratoconus. As the Keratoconus progress, the patient needs a special solid contact lens.

Corneal collagen crosslinking

It is a procedure designed to halt the progression of keratoconus. The modern approach of accelerated pulsed crosslinking is used to ensure an easier procedure for the patient. We use ultraviolet A (UVA 360 nm), Riboflavin( vitamin B2) to stiffen and harden the cornea about four times and this stops the deterioration of keratoconus. The process is carried out under topical anesthesia and several drops of riboflavin are placed in the eye for about 15 minutes and activated by ultraviolet (UVA) rays for eight to thirty minutes. The corneal cross linakge is considered one of the safest and most successful operations used to stop keratoconus degradation and may lead to some improvement in some cases.

Intracorneal rings ( Ferrara, Kerarings or Intacus)

Intracorneal rings are plastic inserts that are implanted into the cornea to alter the shape of the cornea. It used to restore the regularity of the cornea again or at least reduce the irregularity; it will flatten the steepened section of a keratoconic cornea to achieve better unaided and better corrected vision. This often allows for a reduced prescription of spectacles and/or contact lenses and in some cases, satisfactory vision without glasses or contact lenses.

It is recommended to implant cornea rings in cases where the eyeglasses or contact lens are not able to clearly improve vision.

There ring can add strength to the cornea and it can be removed easily if it does not improve vision much.

The installation of rings using a femtosecond laser (intralase) added a new dimension to this type of operation. The process became safer and more effective and the femtosecond laser enabled the ophthalmologists to place these rings in the most accurate depth and diameter possible within the cornea with great accuracy and are way better than old Manual surgery. There are different sizes and thickness of rings depending on the shape of the keratoconus.

topography-guided laser surgery (TG-PRK).

Using topography guided eximer laser to improve the irregularity for the cornea surface in keratconus is a new method, where the patient who cannot tolerate contact lenses and has bad vision with glasses. The aim is to remove very little tissue so the patient can see clearly with glasses. There is a risk of weakening the cornea with this procedure, so we need to do a corneal cross linkage and minimize the amount of tissue removed by the eximer laser. Patient should be aware it is not to get rid of the glasses.

Implantable contact lens inside the eye.

It is used in patients with very high astigmatism and myopia who can see reasonably with glasses but the glass prescription are very high or has imbalance between the two eyes.  These are placed inside the eye and have the ability to correct high degrees of short-sightedness and astigmatism. It is safe and effective procedure in selective patient, but the daily hard lens often provides for better vision than this lens as it corrects all the irregularity of the cornea.

Treatment with corneal cross linkage and intra corneal ring and topo guided laser all requires a minimum level of thickening of the cornea. Here the role of early diagnosis and treatment is highlighted, and that when the cornea becomes very thin these treatments become not possible, which makes corneal transplantation the only remaining treatment for such cases.

Corneal transplantation

It is recommended in advanced cases of keratoconus.

Out of all types of organ transplant surgeries (heart, lung, and kidney), corneal transplantation is the most widespread and successful of these.

We use modern ways to prepare the cut of both the donor and recipient cornea including using femtosecond laser.

There are various methods used for corneal transplant surgery. The old method includes removing the full thickness of diseased cornea and fixing the healthy cornea with stitches. As for following modern methods, the diseased frontal layers (DALK) is replaced and the patient retains the posterior portion of the cornea, thereby reducing the percentage of corneal transplants complications, especially the rate and severity of the corneal graft rejection.

Future treatment for keratoconus is prevention. Molecular genetics are currently being studied and we hope to identify people who are predisposing for the condition in an attempt to discover early and apply preventive treatment.


Blocked Tear Duct. The tear ducts start at the inner corner of the eye with two small holes in the corner of the eyelids. Each hole is known as a punctum, they lead into small tubes known as canaliculi, which in turn drains into the lacrinal sac. This lies between the corner of your eye and your nose which has a duct at the bottom, which drains into your nose, which drains nasolacrimal duct. They continue into small channels that join up and reach the lacrimal sac, which leads into the nasolacrimal duct. The tear ducts do not have much spare capacity and this is why we cry. The channels tend to become narrower with age, especially if there has been nose or sinus disease. An obstruction of the tear ducts will give you a watery eye. Syringing of the lacrimal system with a blunt cannula will determine the type and the site of the blockage. Occasionally a special radiograph is necessary. Called a dacrocystogram, which visualizes the locrimal duct at the eye following the injection of an x-ray dye into the duct.

Redefining Best Practices in an Eye Care setting

Moorfields Eye Hospital Dubai shares applied measures for long term patient benefit and sustainability

While best practices were once considered as generally accepted and set based on experience and outcomes, in today’s environment, what may have been considered best practices in a healthcare environment or setting as recently as a few months ago, may need to be reassessed and adapted to the current and the future healthcare landscape.

Over the past several months, we have periodically changed the way we practice eye care, as part of both the short and long term strategy to help our patients and in order to help sustain our organization as a whole.

Initiatives such as virtual consultations were introduced and rolled out in next to no time, as a short term measure to allow delivery of necessary eye care to patients without their physical attendance required. This initiative now helps us continue to provide an option to attend a consult with a visiting doctor for example that is otherwise still unable to travel to UAE, it also helps our overseas based patients consult with one of our permanent doctors.

Operationally, the challenges and regulatory changes have led us to assess our patient journey time (the time spent by a patient in the hospital), and improve on this without compromising the quality of care provided. The Paediatric Ophthalmology team for example reviewed the dilation protocol, and new criteria were set, lowering the age at which dilation is mandatory for certain conditions.

In parallel, more stringent infection control was a key priority for the hospital, with changes in policies and monitoring controls for hand washing and sterilizing, equipment cleaning, in addition to rearrangement of all seating areas for patients within the hospital to maintain safe distancing between all areas. Appointments have been spread out to avoid crowding, and while multiple family members were once welcomed to attend appointments, this has been reduced to only one accompanying escort to ensure safety of staff and other patients in the waiting areas, with masks to be worn as a mandatory measure by all. At check- in, pens are now single use only, until disinfection of each is completed, along with limited paper contact. 

During a time when, globally, investing in what would be regarded as an ‘unnecessary expenditure’ has been reduced, Moorfields Eye Hospital Dubai carefully considered the long term benefit and our ongoing commitment to patient and staff safety. In order to further improve infection control, Moorfields Eye Hospital Dubai has invested in more permanent additional protective measures for patients and staff.

Thermal body temperature scanners have been installed at the main entrance of the hospital, and all patients and staff temperatures are monitored daily, in addition to the investment and installation of new protective screens at all main patient facing areas including registration, cashier, pharmacy and all doctors’ offices, to maintain safe distance between staff and patients. The hospital has also invested in the addition of cameras complimenting the conventional method of examining patient’s eyes, which allows a magnified view of the eye safely from a distance.

Moreover, weekly disinfection with an approved third party is a key investment to be considered. The entire hospital premise disinfection is now completed by a Dubai Municipality approved and accredited company from top to bottom, the entire disinfection process may take up to 2 hours at a time, scheduled weekly.

The new normal and best practice for most clinical staff at the hospital are now to wear scrubs. These are changed into on arrival to and out of prior to departure from the hospital and sent out daily for professional cleaning.

Patients that require general anaesthesia now complete a wellness test by an external hospital before any procedure is confirmed, and sedation is recommended in some cases as an alternative. Full Personal Protective Equipment (PPE) is worn by all staff in theatre during general anaesthesia procedures, and deep cleaning is completed in the theatre area after each and every case. Will open plan offices and impressive conference rooms become obsolete and a thing of the past? Or will they slowly be reintroduced and in the future used as frequently as they once were not long ago? These are the types of questions many industries are being forced to ask recently and unfortunately cannot answer yet. However, what we know in the healthcare industry is that we are proficient at learning, adapting, and re-examining our best practices and adapting them for the long run. Through this practice we can all help keep one another as safe as possible and continue to improve on our quest to provide the best possible care to our patients.

Experts at MEHD Warn Residents of the Risk of Developing Cataracts

In line with Cataract Awareness Month (June 2020), Moorfields Eye Hospital Dubai’s expert team of ophthalmologist warn MENA residents of the two major risk factors for cataracts: age and diabetes.

Cataract, the leading cause of blindness in the world, affects roughly 25% of the population living in the MENA region. An ageing population combined with the high incidence of diabetes raises concerns and yields an environment with an elevated prevalence of cataracts across the MENA region.

Cataract is generally a slow age-related process where the transparent natural lens gradually loses its transparency resulting in cloudy or dull vision. The word ‘cataract’ comes from the Greek word meaning ‘waterfall’ – in Arabic it translates into ‘white water’ as with advancing severity, the lens appears white.


Initially, there may be no symptoms of cataracts, but over time the quality of the vision deteriorates. The sharpness of vision may be lost, and colours may appear washed out and lack definition. Glare, myopia (near-sightedness), and rapid changes in the spectacle prescription are key indicators a patient may be developing cataracts.


Intraocular lens implants a treatment for cataracts is a highly effective yet simple procedure that has become one of the most common and most successful procedures performed worldwide. The procedure causes minimal discomfort and takes about 15-20 minutes to be completed and often can be done under local anaesthesia. During procedure, the cloudy lens is removed, and an artificial lens is implanted.

While, modern medicine has provided a hassle-free solution to this condition, if left untreated cataract can become very dense and surgery becomes riskier. In severe cases, there can be inflammation and a rise in eye pressure, which can damage the vision. Therefore, it is advised that patients over 40 have regular screenings for cataracts so that the condition can be treated promptly.

Risk (Age & Diabetes)


Most patients become aware of cataracts after the age of 60. However, cataracts can develop much earlier and affect people of any age, including children and young adults. However, in adults, symptoms may not appear until the age of 40. The causes are not clear but could include hereditary factors, illness, eye trauma and smoking.

With this in mind, cataracts still disproportionally affect people over the age of 65. As the region’s naturally ageing population grows, it will lead to more age-related health issues, including cataracts. Although there is no way to prevent age-related cataracts, a healthy lifestyle – including healthy eating, not smoking and wearing sunglasses with proper UV blocking filters – can slow their progression.


The risk of cataracts is much higher amongst the large community of people with diabetes in the GCC – those with type 2 diabetes statistically face a 60% greater risk of developing cataracts and research has also shown that people with type 2 diabetes who lower their HbA1c level by just 1% can reduce their risk of cataracts by 19%.

In a 2018 study published in the journal, Eye, research found that the risk of cataracts in diabetic patients is double that of individuals who do not have the disease. This relates to the connection between uncontrolled glucose and the impact it has on the nourishing properties of the aqueous humor (watery fluid located in the anterior and posterior chambers of the eye), which can cause lens opacity.

The good news is that cataracts can be treated very effectively with modern surgery to remove the cloudy lens and insert a high-quality lens implant and once treated, cataracts do not return. While many factors contribute to cataracts, age and diabetes are the most prominent. The best way to prevent early-onset cataracts is to monitor your blood sugar and have regular check-ups with your eye doctor.

The Effects of Smoking on Your Eyes

Why smoking-related eye ailments are rising in prevalence across the GCC  

By Dr. Ammar Safar, Consultant Ophthalmologist and Vitreoretinal Surgeon, Medical Director at Moorfields Eye Hospital

The World Health Organization (WHO) estimates tobacco use in the Eastern Mediterranean Region to be nearly 25%, compared to the worldwide prevalence rate of 22.7%. A number that is even higher when non-cigarette tobacco products like shisha and dokha are included. While these non-traditional tobacco devices are on the rise, so is the prevalence of smoking in the United Arab Emirates, as the country reigns in among the leading countries in the region in terms of Self-reported tobacco use. 

Most people are very aware that smoking in all forms can cause cancer, lung and heart disease, as well as many other chronic health ailments. But did you know that smoking is one of the most harmful habits for the eyes? A study by the British Medical Journal found that smokers are up to four times more likely to go blind in old age; however, many smokers are not aware of the risk. Below, I will discuss four eye-related risk factors that smokers and those frequently exposed to tobacco smoke should know.

Dry Eye Syndrome

Dry eye syndrome is a common condition, especially in the gulf area, where the dry climate can severely aggravate the eyes. Dry eye syndrome occurs when your eyes do not have enough amount, or the right kind of tears. Cigarette smoke is known to have over 7,000 chemicals, many of which can irritate and damage in the setting of dry eye syndrome. Symptoms of dry eye syndrome include burning sensation, scratchy eyes, redness, sandy sensation and severe irritation. Experts recommend that people prone to dry eye avoid smoking and contact with smoke all together as smokers are twice as likely to develop dry eye syndrome.


A cataract is clouding of your eye’s naturally clear lens. It causes blurry vision and makes colours look dull, faded, or yellowish.  Cataracts are the leading cause of blindness and moderate visual impairment worldwide. Therefore, preventing cataracts carries the potential for significant health benefits, removing the financial and clinical burden of the disease. Thus, identifying risk factors for cataracts is important and may help to establish preventive measures.

If you smoke, you are at an increased risk of developing cataracts. Smoking alters the cells of the eye lens through oxidation and aids the build-up of heavy metals on the lens, contributing to the formation of cataracts.

Age-Related Macular Degeneration (AMD)

AMD occurs when a part of the retina called the macula is damaged. You lose your central vision and cannot see fine details, but your peripheral (side) vision stays normal. In some cases, certain medical treatments can help reduce AMD complications, but there is no cure. 

While age is the number one risk factor for the disease, smoking is a close second. Smokers are four times more likely to get this condition than non-smokers, and people who live with smokers are two times as likely to develop it as well.

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.

Diabetic Retinopathy

Smokers who also have diabetes risk getting diabetic retinopathy. Diabetic retinopathy is when blood vessels in the eye are damaged. Smoking causes vasoconstriction or narrowing of the blood vessels, which reduces the blood supply to the eyes. The condition can lead to diabetic retinopathy, a disease characterized by symptoms such as blurry or distorted vision and possibly blindness. Treatment includes medication or surgery. Additionally, smoking raises blood sugar and can cause your body to become more resistant to insulin, which can lead to higher blood sugar levels. Uncontrolled blood sugar can lead to serious complications from diabetes, including diabetic retinopathy.

Smoking is the single most controllable risk factor that contributes to the development of many eye-related illnesses. The risk factors listed above are just a few of the many risks that smoking imposes. We advise patients to participate in programs to support them in their journey to quitting this harmful habit. Removing smoking from your lifestyle is one of the many healthy habits associated with optimal eye health. Quitting smoking will not only reduce the likelihood of patients developing eye issues throughout their lives, but it will also aid in the improvement of their overall lifestyle.

Everything You Need to Know About Diabetic Retinopathy

By: Dr. Luisa M. Sastre, Specialist Ophthalmologist in Medical Retina and Cataract Surgery

Sudden fluctuations in eyesight including blurred vision, double vision, and the appearance of floaters in the eye could go unnoticed as people maneuver complicated and unpredictable lifestyles. However, these minor ailments could be a sign of a more serious underlying disease. These symptoms are some of the key indicators of diabetic retinopathy, one of the leading causes of preventable blindness in the world.

As the name implies, diabetic retinopathy is directly linked to diabetes, a condition where the body’s inability to produce adequate insulin, the hormone that regulates glucose, triggers long term instability in blood glucose levels. Diabetes is a disease that can develop in two forms, Type 1 which is a congenital disease and Type 2 which is more common and is linked to obesity and lack of physical activity.

Diabetes is a significant public health issue in the region with several GCC countries including, UAE, Saudi Arabia, Bahrain, and Kuwait leading in numbers as part of the top 15 countries in terms of the prevalence of diabetes worldwide. In fact, according to the International Diabetes Federation, an estimated 32 percent of the adult population (age 20-79) in the UAE, including both UAE nationals and expatriates, may have or could develop diabetes or prediabetes over the next decade. 

As these numbers trend upwards health experts grow progressively concerned for the future of the nation. Studies show that as many as 50 percent of diabetes sufferers in the country do not know they have the disease and 74 percent of diabetics in the UAE may not be aware that they have diabetic retinopathy.

Caused by changes to the blood vessels of the retina, diabetic retinopathy is onset by poor glucose control which can cause damage to nerves and blood vessels.  As one of the most complex and vascular organs in the body, the eye is especially vulnerable to damage caused by diabetes. This impairment of the eye vessels causes new weak blood vessels to grow and leak fluid into the retina progressing the disease. For these reasons, almost all Type 1 and two-thirds of Type 2 diabetes patients will develop diabetic retinopathy within 20 years of diagnosis.

Diabetic retinopathy can be reversible only in the early stages of the disease if excellent diabetic control is achieved. In the advanced stages of the disease, diabetic retinopathy is not reversible. However, early detection and treatment plays an important role in the progression of the disease.

Treatment options are available, and sometimes a combination of procedures can manage and reduce the effects of the disease. These include intravitreal injection of medications (anti-VEGF and or steroids), panretinal photocoagulation (conventional peripheral laser therapy) and in more advanced cases, with proliferative retinopathy or with intravitreal hemorrhages, surgery is inevitable.

Anti-VEGF drugs reduce the new vessel formation and the leakage from these weak new vessels, helping to keep the macula and the peripheral retina dry. Intravitreal steroids aid in reducing the swelling in the macula. Panretinal photocoagulation improves the oxygenation of the retina and by doing so, decreases the stimulus to the growth of retinal and iris new vessels. When the above treatments are not enough, surgery helps restore the anatomy of the eye. During the procedure the surgeon removes non-clearing hemorrhages and fibrotic tissue that proliferates between the retina and the vitreous causing vitreous hemorrhages and traction retinal detachments.

There are key visual complications associated with the presence of diabetic retinopathy. However, it is common for the disease to start asymptomatic. Diabetic retinopathy can only be diagnosed by an ophthalmologist with a Fundus examination. Therefore, regular screenings are imperative in people with diabetes because early detection generally leads to better management and better outcomes. 

Moorfields Eye Hospital Dubai Introduces Virtual Consultations

In line with the recently announced, ‘Stay Home’ campaign by the UAE, Moorfields Eye Hospital Dubai (MEHD) has introduced the additional appointment option of virtual consultation appointments for both new and existing patients, to complement their current face to face appointment offering.

Launching on the 4th of April, Moorfields Eye Hospital Dubai’s world class team of ophthalmologists will be available to provide virtual consultations from 10 am to 10 pm, Saturday through Thursday, to consult with patients remotely for certain eye conditions. Face to face appointments will still be offered depending on the need of the patient.

While promoting the ‘Stay Home. Stay Safe’ campaign, Moorfields Eye Hospital Dubai is protecting the health of patient’s eyes from the convenience of their homes. The video consultation will be facilitated through a safe and secure video platform, approved by Dubai’s Telecommunications Regulatory Authority.

Video appointments will enable the team to engage promptly with patients and to ensure that they get the care they need in a timely manner. During the consultation, experts can assess and provide essential recommendations and follow up where necessary for patients.

For existing patients, the doctor will have access to their medical file and for new patients, the doctor will review the medical history with the patient as part of the virtual consultation process. After the consultation, a digital medical report will be provided to the patient as well as a prescription issued, if needed.

This service is to act as an extension of MEHD’s current service provision, to support and to keep people safe while still being able to protect the health of their eyes in a personalised manner, given the current global situation.

“Our patients’ health and safety are always a top priority for us. The use of telemedicine through the integration of video consultations makes it convenient for patients and doctors to remotely communicate with each other. With the introduction of such a solution, we will be able to help more patients while empowering our team to adapt and adjust to the UAE’s current precautionary measures,” said Dr. Ammar Safar, Medical Director, Moorfields Eye Hospitals UAE.

Whilst reducing face-to-face contact and tackling the challenges at hand, this program also enables the hospital to continue delivering high-quality care to the people who need it most. With this in mind, certain eye conditions and needs may still be done in-person, depending on the urgency of the condition or need. Patients experiencing ocular emergencies such as sudden vision loss of any kind are still recommended to seek in-person emergency care.

Online consultations are covered by select insurance providers. However, patients who are not covered have the option to self-pay for the service, which will be processed through a secure channel directly with the hospital. To book your remote virtual appointment with one of MEHD expert ophthalmologists from the comfort of your home, call +9714 429 7888