Oculoplastic Surgery: Enhancing Vision and Appearance

This blog on Oculoplastic Surgery has been contributed by Dr. Rafic Antonios, Specialist Oculoplastic Surgeon. 

Oculoplastic surgery, often known as eyelid surgery, is a specialised field of medicine focusing on the areas around the eyes and the face. This includes the eyelids, orbit (eye socket), and lacrimal (tear) system. The purpose of these procedures ranges from aesthetic enhancements to significant functional improvements, including improvements in vision.

 

The Interplay Between Oculoplastic Surgery and Vision

Generally, the eyes and the surrounding structures work harmoniously to deliver clear, uninterrupted sight. However, droopy eyelids (ptosis) or eyelid malposition can disrupt this equilibrium, impairing vision. That’s where oculoplastic surgery steps in.

Addressing Common Concerns Through Surgery

Droopy eyelids, a common age-related condition, can obstruct the field of vision, making daily activities like reading or driving challenging. Oculoplastic surgery corrects this by tightening the muscles that lift the eyelid, thereby widening the visual field. Similarly, conditions like entropion (inward-turning eyelid) or ectropion (outward-turning eyelid) can cause discomfort, tear overflow, and blurred vision. Surgery to reposition the eyelid reinstates normalcy, relieving the symptoms and restoring vision clarity.

The Transformative Potential of Oculoplastic Surgery

In conclusion, oculoplastic surgery is not just about cosmetic enhancement. It’s a field aimed at restoring or maintaining the eye’s optimal functionality, significantly impacting vision. While the thought of surgery can seem daunting, understanding its potential benefits can provide reassurance.  Consulting with an oculoplastic surgeon could be a transformative step for your vision if you are experiencing vision disruption due to eyelid or surrounding orbital structure issues.

If you are considering oculoplastic surgery in Dubai or want to learn more about how these procedures can enhance your vision and appearance, we are ready to help you by providing personalised care tailored to your unique needs and goals.

Stages of visual development in Children

Orthoptist Sehar Mann has contributed to this blog on Stages of visual development in Children.

We are all born with blurry vision, and our vision develops in the first 7-8 years of life but is most important when we are babies and toddlers.

Understanding the stages of visual development in babies and toddlers and how they perceive colours can help you provide the correct visual stimulation in their early months of life.

 

Stages of Visual Development

  • The Newborn Stage (0-2 months): Newborn babies can only see objects about 8 to 12 inches from their face – roughly the distance between your face and theirs during feeding or cuddling. They are drawn to high-contrast patterns, like black and white since their eyes are still developing.
  • The Infancy Stage (2-4 months): During this period, your baby’s vision starts to improve gradually. They follow moving objects and show interest in colourful toys and pictures. It is normal for their eyes to cross or wander as their muscles strengthen occasionally.
  • The Exploratory stage (4-6 months): At 4 to 6 months, babies reach for objects and have better depth perception as they can see more colours more clearly. This is an ideal time to introduce more colourful toys and books with large, bold pictures to stimulate their developing vision.

How Toddlers Perceive Colours

Understanding how toddlers perceive colours can help you create an engaging and stimulating environment for them. Here are some tips to help them:

  • High Contrast is Key: In the early months, your baby is drawn to high-contrast colours, such as black and white because they are easier for their developing eyes to distinguish. Consider incorporating these colours into your baby’s nursery decorations or toys.
  • The world of Pastels: As babies grow, they will notice more subtle colours like pastels. Soft blues, pinks, and yellows can be soothing and visually appealing for them.
  • Vibrant Colours: Babies can see a broader range of colours in the toddler stage. Bright and vibrant colours like red, green, and blue can capture their attention and stimulate their visual development.

Visual Stimulation in the First 6 Months

Visual stimulation is essential for development during the first six months. Here are some simple ways to provide the correct visual experiences:

  • Face-to-Face Interaction: Spending quality time making eye contact and talking to your baby can help develop their vision. They love to gaze at your face, and this helps strengthen their visual focus.
  • Colourful mobile Toys: Hang a colourful mobile above the crib. The gentle movement and bright colours will intrigue your baby and encourage them to track the objects.
  • Picture Books: Choose picture books with large, bold images and vibrant colours. Reading to your baby fosters bonding and enhances their visual recognition skills.
  • Tummy Time: Give your baby plenty of tummy time. This helps them develop strong neck and shoulder muscles, which are essential for visual exploration.
  • Mirrors: Babies are often fascinated by their reflection. A baby-safe mirror can provide endless entertainment and help with self-recognition.

Watching your toddler’s visual development is an exciting journey that requires your support and engagement. By understanding the stages of visual development and how your baby perceives colours, you can create a stimulating environment that encourages healthy growth and curiosity. Remember, every baby is unique, so enjoy the discovery process together and celebrate each new milestone.

At Moorfields Eye Hospital Dubai, our dedicated paediatric department is staffed with expert ophthalmologists, optometrists, and orthoptists, all passionately dedicated to the eye care needs of children.

Myopia atropine treatment

Myopia, or short-sightedness, is an eye condition where distant objects appear blurry due to improper light focusing on the retina. While there is no cure, glasses or contact lenses can help.

Recent studies highlight Atropine 0.01% eye drops as an effective myopia treatment to decelerate progression in children. Originally, Atropine 1% is utilised for pupil dilation during eye exams. However, the myopia treatment uses a concentration of 100 times weaker. The exact way Atropine 0.01% hinders myopia progression remains uncertain, but international studies report high success rates. Notably, side effects, less frequent than the clinical dose, can include minor irritation, light sensitivity, and dilated pupils.

This treatment is not a myopia cure but aims to decelerate its advancement. It is essential to wear glasses and administer the drops nightly consistently. There’s no absolute assurance of its efficacy; missed doses might compromise the treatment.

Day of Surgery instructions

If you are scheduled for a day-case surgery with us, it is crucial to be well-prepared to ensure a smooth and safe surgical experience. From understanding the fasting guidelines to knowing what attire is appropriate, being informed can ease your anxiety and prepare you for a successful procedure.

We strongly recommend downloading our detailed leaflet for a comprehensive set of instructions. It covers everything from when to arrive, what to wear to post-operative care, and what to do in special circumstances like pregnancy or illness. Click the button below to download the full leaflet and prepare for your upcoming surgery.

Your well-being is our priority, and we are here to guide you through every step of your surgical journey. Thank you for entrusting us with your care.

Strabismus in Children: Crossed Eyes and Vision Development

This blog on Strabismus in Children has been contributed Dr. Ayesha Khan, Consultant Paediatric Ophthalmologist.

Strabismus, commonly called ‘crossed eyes,’ impacts approximately 2% – 4% of children worldwide. This condition results in the misalignment of the eyes, causing them to point in different directions and disrupting binocular vision.

Strabismus is primarily seen in infants and young children and is not just a cosmetic concern. It can significantly impact vision development and depth perception, essential for numerous activities, from catching a ball to crossing a street. When the eyes do not align properly, the brain may start to ignore the image from the eye that is not aligned to prevent seeing double, causing ‘amblyopia,’ also known as a lazy eye.

Emphasising early detection is crucial with strabismus, as the initial years of a child’s life are vital for visual development. Any signs of the condition, such as squinting, tilting the head while looking at objects, or noticeable misalignment of the eyes, should prompt an immediate medical consultation.

The treatment journey for a child with strabismus often involves a team of specialists. An optometrist performs regular eye exams and prescribes glasses if necessary. An orthoptist specialising in strabismus and amblyopia devises personalised eye exercises to improve eye coordination. Lastly, a paediatric eye consultant oversees the child’s treatment, deciding when surgical intervention is necessary and ensuring the various treatments align to maximise visual development and overall quality of life.

In essence, strabismus affects not only the physical appearance but also the functional vision of a child. Therefore, recognising and addressing strabismus in its early stages is crucial for optimal eye health and developmental growth.

If you notice any of the signs or symptoms of Strabismus, please seek care from a specialised ophthalmologist to help your child’s vision develop correctly.

At Moorfields Eye Hospital Dubai, our dedicated paediatric department is staffed with expert ophthalmologists, optometrists, and orthoptists, all passionately dedicated to the eye care needs of children.

 

Selective Laser Trabeculoplasty for Glaucoma

This blog on Selective Laser Trabeculoplasty for glaucoma treatment has been contributed Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery.

Living with glaucoma often means meticulous eye drop management and close intraocular pressure (IOP) monitoring. Thankfully, advancements in eye care, such as Selective Laser Trabeculoplasty (SLT), offer a more refined to manage this condition.

What is SLT?
Selective Laser Trabeculoplasty is a minimally invasive procedure designed to help control glaucoma by decreasing IOP. One of its standout features is the potential to lessen, or in some cases, even eliminate, the dependence on glaucoma eye drops, especially beneficial for those with open-angle glaucoma.

How Does It Work?
Imagine the eye’s drainage system, the trabecular meshwork, as a sink’s drain. Over time, this drain can become less efficient, leading to increased IOP. During this procedure, a precision-targeted laser is applied to this drainage system. Unlike other methods, Selective Laser Trabeculoplasty ensures no thermal damage to the nearby tissue. The treatment encourages the drainage system to work more efficiently by promoting beneficial biological changes within its cells. As the drainage improves, the IOP naturally decreases.

Why Consider SLT?
Selective Laser Trabeculoplasty is revolutionary in its approach. Unlike more aggressive surgeries, it targets only specific cells, ensuring surrounding tissues remain untouched. This selectivity means a less invasive procedure, minimal risks, and quicker recovery times.

However, it’s essential to remember that while it is highly effective, it might not completely negate the need for glaucoma eye drops for all patients. For some, it can notably decrease the amount or frequency of medication, leading to improved comfort and better adherence to treatment.

In Conclusion
Selective Laser Trabeculoplasty is a promising option in glaucoma care. Potentially reducing our reliance on daily eye drops offers a more convenient yet effective way to keep glaucoma in check and safeguard our vision. If you are considering this procedure, discussing it with a glaucoma specialist is recommended to tailor the best care for your eyes.

 

Diabetes and Cataracts

This blog has been contributed by Dr. Luisa Sastre, Consultant Ophthalmologist in Medical retina and cataract surgery.

Cataracts, a common eye condition characterised by clouding of the lens, can affect individuals of all ages. However, people with diabetes are particularly susceptible to developing this condition. In this blog, we will explore the connection between them, understand the underlying mechanisms, and discuss the treatment of cataracts in diabetics.

The connection: Diabetes, a metabolic disorder affecting blood sugar regulation, increases the risk of complications, including eye-related issues such as diabetic retinopathy. Cataracts occur when proteins in the lens clump together, causing clouding and reduced vision. People with diabetes are more likely to develop cataracts at an earlier age and experience faster progression than those without diabetes.

Mechanisms Behind Cataract Formation in Diabetes: Diabetes can cause cataracts by increasing sugar levels in the body. This can lead to imbalances and changes in the lens structure, making it less transparent. Diabetes can also cause damage to lens proteins, which makes cataracts form faster.

Managing the Risks of Cataracts in Diabetes: Effective management of cataract risks in individuals with diabetes is crucial. Maintaining stable blood sugar levels through proper diabetes management helps slow cataract progression. In addition, regular eye examinations are essential for early cataract detection. Adopting a healthy lifestyle, including a diet rich in antioxidants, regular exercise, and avoiding smoking, can also reduce the risk of cataracts.

Cataract treatment options for people with diabetes: Surgery is the most effective treatment for cataracts. The procedure involves removing and replacing the clouded lens with an artificial intraocular lens (IOL). People with diabetes must work closely with their doctors to ensure stable blood sugar levels before, during, and after surgery, minimising the risk of complications and optimising visual outcomes.

Understanding the connection between those two conditions and managing the associated risks is crucial for maintaining good eye health. Individuals can effectively navigate this coexisting condition by controlling blood sugar levels, regular eye check-ups, and considering cataract surgery when necessary.

Artificial Intelligence and eye care

This blog has been contributed by Dr. Ammar Safar, Consultant Ophthalmologist and Vitreoretinal Surgeon and Chief Medical Officer.

Artificial intelligence (AI) has revolutionised various industries, and it’s making its way into ophthalmology. AI technologies are being viewed as valuable tools for diagnosing, managing, and treating eye diseases.

AI algorithms can analyse large amounts of data in a short time, making it easier to identify and treat eye conditions. One of the most significant applications of AI in ophthalmology is in detecting and diagnosing retinal diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma.

Diabetic retinopathy is a leading cause of blindness in adults. It is unfortunately very prevalent in our part of the world with a large number of patients affected. However, with the help of AI, ophthalmologists can now detect the disease early and provide timely treatment. AI-powered retinal imaging systems can analyse a large number of retinal images for early signs of the disease with an outstanding level of accuracy, providing ophthalmologists with a more accurate diagnosis and making it next to impossible to delay or miss a diagnosis.

Age-related macular degeneration is another eye condition that can lead to vision loss. AI algorithms can analyse the retina’s images to detect signs of the disease and track its progression, enabling ophthalmologists to provide appropriate treatment.

Glaucoma is a condition that damages the optic nerve, leading to vision loss. AI technologies can detect the disease in its early stages, allowing for early intervention to prevent further vision loss. AI algorithms can analyse visual field tests, imaging tests, and other data and compare them to previous tests detecting even the very minute variations providing a very powerful tool to determine the likelihood of developing glaucoma and its progression.

AI can also assist ophthalmologists in the management of cataracts, which is a common cause of vision loss in older adults. AI algorithms can analyse patient data, including medical history, to determine the appropriate surgical approach and intraocular lens power.

AI technology has the potential to revolutionise ophthalmology, enabling ophthalmologists to provide more accurate diagnoses and personalised treatment plans. While AI cannot replace human expertise, it can significantly enhance it, providing ophthalmologists with a powerful tool to improve patient care.

In conclusion, AI can transform ophthalmology by improving the diagnosis, management, and treatment of eye diseases. As technology advances, AI will undoubtedly become an increasingly essential tool for ophthalmologists.

Moorfields Eye Hospital in Abu Dhabi saves the vision —and the career— of future dentist

A Moorfields Eye Hospital ophthalmologist has performed a life-changing surgery on a 23-year-old patient after diagnosing him with a progressive eye disease that is prevalent in Middle Eastern communities.

Mogemad Osama, an Ajman University student from Palestine who plans to become a dentist, struggled for years with devastating vision loss which caused him to change his prescription glasses multiple times. After deciding that he needed to seek help, Mogemad was referred to Dr. Esmaeil Arbabi at Moorfields Eye Hospital, a Mubadala Health partner.

He feared he would not be able to realize his dream of practicing dentistry. “My career depends on two things: my eyes and my hands,” he said. “When I first started having problems with my vision, it was a huge disappointment for me. But I never give up.”

Mogemad was soon diagnosed with Keratoconus, which affects the structure of the cornea and gradually causes blurred vision that cannot be corrected with glasses. According to a recent study, while the disease affects only one in 2,000 people worldwide, the prevalence of the disease in the UAE is 2.7 percent, which is 54 percent higher than the global average.1 The condition also impacts both men and women and typically stabilizes by the time people reach their 30s, although by then serious damage could have been caused.

According to Dr. Esmaeil, who has treated a number of cases of Keratoconus, the cause of the disease is unknown, but genetics and environmental factors could play a role. Osama’s father had surgery several years ago for the same condition.

Instead of opting for a corneal transplant, Dr. Esmaeil performed a minimally invasive surgery, called cross-linking, combined with a sophisticated laser treatment on Mogemad’s left eye. The advanced laser reshapes the cornea and smoothens the irregularities caused by Keratoconus. This will then be immediately followed by the application of Vitamin B eyedrops and shining of an ultraviolet light on the eye. The procedure only takes just 15 minutes to complete and has a 95 percent chance in stopping the progression of the disease.

“Early diagnosis and early treatment are absolutely essential,” said Dr. Esmaeil. “If we catch this early enough, we can treat it so that it’s like nothing has happened at all. But if you delay, there’s a risk of a lifetime wearing hard, rigid contact lenses, or ultimately requiring a corneal transplant. It could lead to a poor quality of life for the rest of your life.”

“Before the procedure I was experiencing double vision; it wasn’t clear at all,” said Mogemad. “But 10 days after, everything in my left eye was back to normal. I even returned to university and started to work again. It would be fair to say that my career has been saved by Dr. Esmaeil and the great staff at Moorfields.”

The main symptoms of keratoconus are gradual worsening of vision and frequent need for changing eyeglasses.

“If you have these symptoms, see a corneal specialist or ophthalmologist,” stressed Dr. Esmaeil, who is working to raise awareness about the disease as it can require a specialist familiar with the disease, rather than a general optometrist. He also warns anyone experiencing these symptoms against eye rubbing, which can make Keratoconus worse.

Glaucoma in Children

This blog has been contributed Dr. Mohamed Sayed, consultant ophthalmic surgeon in Cataract and Glaucoma in Children & Adults 

What you need to know about childhood glaucoma

When we hear the word “glaucoma”, the stereotype that comes to one’s mind is that of a middle-aged or older person, who has lost a considerable proportion of her or his sight, is using several types of eye drops on a regular basis, and who may have had one or more surgeries to lower their eye pressure. While it is true that glaucoma is generally a disease of old age, two points need to be elaborated upon. First, this stereotype may have been true a decade or two ago. Still, the recent advances in medical, laser, and surgical therapy have helped millions of glaucoma patients worldwide preserve their vision and enjoy a normal lifestyle with minimal or no disruption. Second, all age groups may suffer from glaucoma, including newborns and young children.

How do children get glaucoma?

The most common form of glaucoma in children, primary congenital glaucoma, is genetically determined. However, the disease is genetically distinct from glaucoma, which affects adults. Typically, the drainage system of the eye, which is responsible for draining the eye fluid and regulating eye pressure, is malformed or malfunctioning.

Childhood glaucoma may also result secondary to other eye diseases, following surgery for paediatric cataracts, after eye trauma, or associated with certain metabolic and systemic disorders.

Is it important that my newborn be tested for glaucoma?

When a baby is born, the neonatologist typically checks the eye for the size and clarity of the cornea. Typically, babies born with glaucoma have bigger than normal eyes, as the eye stretches due to the high pressure inside, asymmetric eye size, with one eye typically larger. The clear window of the eye, the cornea, would be lusterless and have a whitish or bluish hue that would make distinguishing their iris colour difficult.

Additionally, the mother may notice that the newborn is tearing excessively or is light sensitive. While these symptoms may result from other disorders in the eye, their presence warrants prompt and timely examination by a paediatric glaucoma specialist or a paediatric ophthalmologist.

Is paediatric glaucoma a serious condition?

Absolutely! If left untreated or discovered late, the visual prognosis can be very poor. Luckily, with timely diagnosis and prompt medical and/or surgical treatment, children with glaucoma typically retain functional vision.

My child has been diagnosed with (or is suspected of having) glaucoma. What should I do next?

You should visit a Consultant Ophthalmologist specialized in managing glaucoma in children. At Moorfields Eye Hospital Dubai, we have the expertise and the technology to diagnose and treat the full range of paediatric glaucoma.

Joint Commission International (JCI) Accredited Moorfields Eye Hospital Dubai highlights the importance of quality of care in a healthcare setting

Healthcare providers have a moral and professional responsibility to ensure that the care they provide to patients is safe and delivers results in line with internationally recognised outcomes.

As the first overseas branch of Moorfields Eye Hospital NHS Foundation Trust, Moorfields Eye Hospital Dubai continuously strives to maintain and further grow the positive reputation of its 200+ year-old parent hospital. A core priority for the hospital, and one of the ways of achieving this, is through frequent, quantifiable audits related to the quality of care provided.

The quality ambition of the hospital includes measurable targets for their patients, embodied by safe care, positive experiences, involvement, and, very importantly, outstanding surgical outcomes.

Surgical outcome measures monitor the safety and success of surgeries performed in a quantifiable way. This helps to ensure that the quality of care can be robustly measured and comparisons assessed from patient to patient, surgeon to surgeon and clinic to clinic.

The hospital has a vast range of vigorously monitored surgical outcome measures, covering services including cataracts, retinal detachments, paediatrics, strabismus, refractive eye surgery, ocular plastics, corneal transplants, and glaucoma. In addition, the hospital measures aspects such as vision after surgery, the occurrence of infection and the rate of requiring further surgery.

The data gathered is fed back to the parent hospital to ensure that clinical outcomes are in line with international guidelines and benchmarks.

An example of the above is cataract surgery outcomes, where over 98% of Moorfields patients in the UAE had a post-operative visual acuity better than 6/12, exceeding the target of 90% set.

Another instance is the hospital’s 98% success rate for retinal detachment surgery, far exceeding the 75% target for the highly complex surgery.

LASIK surgery and similar vision correction surgery targets of 80% and over were also surpassed, with over 95% success rate reported.

Accountability for outcomes is an aspect in which the London branch in Dubai takes much pride. The detailed surgical outcomes measured are not only communicated organisation-wide in Dubai and London but also to the patients; this helps relieve anxiety often associated with the decision to undergo a surgical procedure.

The hospital aims to publish such outcome data and urges all other healthcare providers to do the same, as such transparency is a patient right and a way of empowering patients to make the most informed choice about their healthcare needs.

Optic neuritis

This blog has been contributed by Dr. Salma Yassine, Consultant Ophthalmologist in Paediatric & Neuro-ophthalmology

What is optic neuritis?

Optic neuritis occurs when our immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin. This disrupts electrical impulses that travel from the eye to the brain, causing blurred or dark vision.

How does optic neuritis affect me?

Optic neuritis usually affects one eye. Symptoms might include:

  • Pain: Eye pain that’s usually worsened by eye movement. Sometimes it presents as a dull ache behind the eye.
  • Vision loss in one eye: Noticeable vision loss usually develops over hours or days and improves over several weeks to months. However, vision loss can be permanent in some people.
  • Visual field loss: Central or peripheral vision loss
  • Loss of colour: Colours appear less vivid

What causes optic neuritis?

The following autoimmune conditions often are associated with optic neuritis:

  • Multiple sclerosis: It is a disease in which the autoimmune system attacks the myelin sheath covering nerve fibres in your brain. The risk of developing multiple sclerosis after optic neuritis increases further if an MRI scan shows demyelinating brain lesions
  • Neuromyelitis Optica: In this condition, the inflammation affects the optic nerve and spinal cord. As a result, it often results in diminished visual recovery after an attack compared with MS.
  • Myelin oligodendrocyte glycoprotein (MOG) antibody disorder: Like neuromyelitis optica, recurrent attacks of inflammation can occur in the optic nerve, spinal cord or brain. However, recovery from MOG attacks is usually better than recovery from neuromyelitis optica.

When symptoms of optic neuritis are more complex, other associated causes need to be considered, including infections, rheumatological diseases, and drugs or toxins (ethambutol or methanol)

Why do I need to see a neuro-ophthalmologist?

  • Neuro-ophthalmologist is experienced in sorting out the differences between optic neuritis and other optic nerve diseases.
  • During your office visit, the doctor will check your visual fields and scan your optic nerves
  • Your doctor will order an MRI of the brain with special views of the orbits with contrast to confirm optic neuritis
  • Your doctor may order other tests, such as blood tests or a chest X-ray

What are the possible complications?

  • Optic nerve damage:  Most have permanent optic nerve damage after an episode of optic neuritis, but the damage might not cause permanent symptoms.
  • Decreased visual acuity: Most people regain normal or near-normal vision within months, but a partial loss of colour discrimination might persist.

Side effects of treatment: Steroid medications used to treat optic neuritis suppress the immune system, which causes your body to become more susceptible to infections. It can also cause mood changes and weight gain.