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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.

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.

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.

This blog has been contributed Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery. 

Cataracts are a common age-related eye condition where the eye’s lens becomes cloudy and opaque, affecting vision. The lens is a clear, elastic structure that helps focus light onto the retina, which sends visual signals to the brain. As we age, the lens becomes less flexible and loses its transparency, leading to cataracts.

There are several types of cataracts, including congenital cataracts (present at birth), traumatic cataracts (caused by injury), and secondary cataracts (caused by other eye conditions or diseases). However, the most common type is age-related cataracts, which occur naturally with age.

Cataracts can cause various symptoms, including blurred or hazy vision, glare or halos around lights, double vision in one eye, frequent changes in eyeglass or contact lens prescriptions, fading or yellowing of colours, and difficulty seeing at night. If left untreated, cataracts can eventually lead to vision loss.

Cataracts are usually managed through surgery. In cataract surgery, the cloudy lens is removed and replaced with an artificial lens called an intraocular lens (IOL). Cataract surgery is a safe and effective way to restore vision and improve quality of life.

Before deciding on cataract surgery, an eye doctor will perform a comprehensive eye exam to determine if cataracts cause the patient’s vision problems. If cataracts are diagnosed, the eye doctor will evaluate the extent of the cataract and recommend the best course of treatment.

After cataract surgery, patients typically need eye drops for a few weeks to help prevent infection and inflammation. It is also important to protect the eyes from injury, such as by wearing sunglasses outside. However, most patients experience improved vision within a few days or weeks after surgery.

In conclusion, cataracts are a common age-related eye condition that can cause vision problems. Cataract surgery is a safe and effective way to treat cataracts and restore vision. If you are experiencing cataract symptoms, you must see an eye doctor for a comprehensive eye exam and evaluation. With advances in surgical techniques and technology, cataract surgery has become a highly effective way to improve vision and quality of life.

This blog on glaucoma awarness month has been contributed Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery. 

Glaucoma occurs when there is high pressure in the eye, which can lead to reduction or loss of vision due to damage to the optic nerve (the nerve that transmits signals from our eye to the brain). It is one of the leading causes of blindness worldwide, with nearly 60 million people already affected. This number is projected to increase by almost fifty percent over the next ten years.

January is Glaucoma Awareness Month and is an opportunity for us all worldwide to highlight this blinding condition (also known as the “silent thief of sight”).

Early detection and prompt treatment are essential. The campaign aims to increase awareness of the importance of annual eye examinations to diagnose and treat the condition early before vision is harmed for our loved ones and us.

Typically, your eye specialist will conduct the following very specialised and precise tests to screen for glaucoma:

• Eye pressure check
• Clinical evaluation of the optic nerve
• Visual Field testing
• Optical Coherence Tomography (OCT) scan of the nerves

If a diagnosis of glaucoma is made, treatment can be done with easy-to-use eye drops, gentle lasers or, in more advanced cases, with the latest surgical techniques. However, the treatment decision can vary from person to person, and your eye specialist will recommend a bespoke treatment plan keeping in mind your individual requirements.

For more information, please visit www.glaucoma.org”

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

What is neuro-ophthalmology?

Neuro-ophthalmology is an ophthalmic subspecialty that addresses the relationship between the eye and the brain.  The optic nerve acts as a cable that connects what we see through our eyes to the brain.  The brain then changes the visual signals into images and helps us know what we are seeing.  If the optic nerve is damaged, these visual signals are impaired, which leads to decreased visual perception.  The field of neuro-ophthalmology deals with such neurological conditions that affect the eye and causes problems with vision.  Some neuro-ophthalmic disorders can cause permanent damage if not diagnosed and treated adequately.

What are the most common symptoms of neuro-ophthalmic diseases?

Some common Neuro-ophthalmology symptoms include reduced vision, double vision, headaches, impaired colour vision, and visual field cuts.  These symptoms are not to be ignored, if you face any of them, you must immediately seek advice from a neuro-ophthalmologist

What are common types of neuro-ophthalmic diseases?

A few of the most common neuro-ophthalmic conditions are optic neuritis, ischemic optic neuropathy, comprehensive optic neuropathy (pituitary tumours), papilledema, inflammatory and infectious optic neuropathies, cerebrovascular disorders involving vision, tumours involving vision, blepharospasm and hemifacial spasm, nystagmus, thyroid eye disease, myasthenia gravis, ocular motor disorders, pupillary abnormalities, hereditary optic neuropathies in patients who have unexplained vision loss

Some disorders that require immediate attention from neuro-ophthalmologists include;-

• Optic neuritis: It is an eye disorder that is caused by inflammation of the optic nerves. This inflammation can be caused by infection or autoimmune disorders like multiple sclerosis and neuromyelitis optica.  It is a disease that usually affects young adults in 1 eye but often affects 2 in children.  Patients with optic neuritis can develop nagging eye pain, pain with eye movements, blurry vision, and loss of colour perception.  These issues can be serious because it can lead to permanent vision loss.
• Papilledema : It is a condition in which optic nerves swell up due to increased intracranial pressure. It is often accompanied by headaches, dimming of vision and rushing noises in the ears.  Papilledema can lead to optic atrophy and blindness if not treated in a timely manner.  Sometimes papilledema can be a warning sign for a tumour or haemorrhage.  If papilledema is not traced to a particular problem, then it is called idiopathic cranial hypertension.
• Nutritional optic neuropathy: Toxic substances found in alcohol and tobacco can also damage the optic nerve. Certain vitamin deficiencies like folic acid and vitamin B complex can cause optic neuropathy
• None ischemic arthritic optic neuropathy (NAION): There are many risk factors for NAION, some of which include uncontrolled sugar levels in diabetics or high blood pressure in hypertensive patients. These systemic conditions can affect the blood vessels that supply the optic nerve, which can result in disabling vision loss.
• Strabismus (squints): It is a disorder when both eyes cannot align in one direction, which can cause double vision. Paralytic strabismus occurs when the muscles are unable to move the eye, disrupting the coordination between both eyes.  This could be due to a lesion compressing the nerves that connect to the ocular muscles or due to microvascular damage to these nerves

This blog on Dry eyes has been contributed by Dr. Alia Issa, General Ophthalmologist at Moorfields Eye Hospital Dubai 

Introduction 

Dry eye is one of the most common reasons to visit an ophthalmologist. It is estimated that around 75% of people worldwide suffer from dry eye at some point in their life.

What causes dry eye?

Environmental factors like air conditioning, air pollution, cigarette smoke, contact lens use, dusty and hot weather, and extended computer and smartphone use can contribute to dry eye and ultimately worsen symptoms. But also gender and age, systemic diseases, especially autoimmune diseases and medications play an essential role in developing dry eye disease.

What are the symptoms?

Symptoms can include foreign body sensation, pain, itchiness, tearing, redness of the eyes and blurry vision.

How do we diagnose dry eye?

When diagnosing a dry eye we differentiate between two main types of dry eye i.e. evaporative dry eye and aqueous deficient dry eye. Evaporative dry eye means that the tear film evaporates from the ocular surface faster than it should. In contrast, aqueous deficient dry eye describes a condition where tear production is reduced. Both have different underlying causes, which require different treatment approaches.

How do we treat dry eye?

Dry Eye is a complex disease; very often, it is not one but multiple factors that contribute to it. Therefore, a detailed history, slit lamp examination and special diagnostic tests are vital in finding the right individual treatment approach for each patient. Treatment options can vary from lifestyle changes, different types of artificial tears, and tear plugs to in-office treatments like Intense Pulse Light (IPL) , depending on the underlying causes of the dry eye.

At Moorfields Eye Hospital Dubai, we can tailor an individual treatment plan for each patient. If you feel you are experiencing dry eye symptoms, we recommend you visit a specialist to get a professional diagnosis and treatment if required.

This blog has been contributed by the Moorfields Eye Hospital Dubai Glaucoma Team (Dr. Salman Waqar and Dr. Mohamed Sayed), who were the first in Dubai to insert the PAUL Implants in adults and children.

Glaucoma affects a significant percentage of the population worldwide, and the risk increases with age. The non-surgical treatment options available for most patients are medications to reduce pressure in the eye and laser trabeculoplasty, which targets the drainage angle of the eye.

 

However, for many patients with advanced glaucoma or complex secondary glaucoma, medications and laser treatments alone are not sufficient to control eye pressure and preserve vision.

In these circumstances, aqueous tube shunts (also known as aqueous shunt devices or glaucoma drainage devices) have a much broader range of efficacy even in patients with the highest risk.

The devices in common use are the Ahmed Valve and the Baerveldt Tube.

Now, at Moorfields Eye Hospitals UAE, we also offer surgery with the latest device known as the PAUL implant.

What is the PAUL implant?

The PAUL implant is the latest generation of aqueous shunt devices. It has been designed to optimize efficacy with a higher safety profile. It is composed of a soft tube that is inserted into the eye and drains away excess fluid thereby controlling the eye pressure. The diameter of this tube is less than half a millimeter and this prevents complications such as low pressure or corneal damage. The tube is connected to a thin and soft end-plate which is placed under the skin of the eye. This end-plate is very comfortable and causes no erosion or discomfort. It also does not degrade and lasts for the duration of the patient’s lifetime.

How does it work?

Glaucoma is most commonly associated with a build-up of fluid pressure inside the eye. This build-up of fluid pressure is caused by partial blockage of the natural drainage channel of the eye. This pressure can damage the optic nerve which carries images from the eye to the brain affecting your vision. This fluid produced inside your eye is called aqueous humour, which is different from your tears. The PAUL implant drains fluid from inside the eye to an end-plate on the outside, which is placed under a thin skin-like membrane covering the white of the eye called the conjunctiva. The fluid is then absorbed into the bloodstream.

What are the benefits?

The PAUL implant will lower your eye pressure and prevent further damage to the optic nerve caused by eye pressure (intraocular pressure). Its design ensures less chance of complications such as low IOP (hypotony), corneal damage and tube erosion, and a more predictable eye pressure control from the very first day after the surgery.

Are there any alternatives?

The closest alternatives to the PAUL implant are the traditional aqueous shunt implants such as the Baerveldt or Ahmed Implants. We aim to always individualise treatment options to your unique needs and will suggest the PAUL implant to you only if we feel it offers the best chance of controlling your eye pressure compared to other techniques.

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This  blog has been contributed Dr. Fahd Quhill, Consultant Ophthalmologist in Medical Retina and Ocular inflammatory disease

Panretinal laser photocoagulation is gold standard for treating proliferative diabetic retinopathy; it is still the only available treatment that will provide a diabetic patient with long term regression of their diabetic changes and prevent further vision impairment.

What does laser treatment involve?

Dilating drops will be instilled on the day, to dilate your pupils with additional drops given by the nurse to numb the surface of the eye. Then the doctor will position you at the laser, whereby a contact lens will be placed on the front of the eye to keep the eyelids open and to allow the doctor to visualize the back of the eye and apply the required laser beams accordingly. It is important you keep still during the procedure and listen carefully and follow the instructions given by the doctor. It normally takes 10 to 20 minutes to complete a laser treatment, all dependent on the type of laser and number of laser burns the doctor needs to apply.

Is laser painful?

Some patient do feel some discomfort; it is normally a pricking sensation that they can perceive when certain areas of the retina are treated.

How long will it take my vision to recover?

Normally immediately after the laser, your vision will be dark, this is normal and not a cause for concern; it is due to the back of the eye being exposed to the light. Within a few minutes it will clear, but it will take up to 24 hours for your vision to return to its previous level where you will be able to resume your normal daily activities.

You may experience mild eye ache after laser, and there is no harm in taking mild painkillers to help with the discomfort.

You also may notice a few floaters within the vision, which do eventually improve and settle with time.

What are the side effects of panretinal laser photocoagulation for diabetic retinopathy?

Well for effective treatment, we need treat to the peripheral areas of the retina to regress the abnormal changes and stabiles vision. But within the peripheral retina, the cells that are important for your peripheral vision and night vision reside. So you may notice a reduction in your night vision, and perceive changes within the peripheral field, often this settles with time and you quickly adapt. However these side effects commonly occur in patients who have received multiple laser treatments for diabetic retinopathy.

Also occasionally if you have pre-existing diabetic maculopathy, leakage or swelling at the central vision, panretinal laser can worsen these changes leading to blurred vision. Often this is self-limiting and it will spontaneously resolve, but occasionally intravitreal injections into the eye are required to reduce leakage and rehabilitate your vision.

Don’t forget?

We cannot always guarantee stabilsation and regression of your diabetic changes with a single laser treatment, often patients will require multiple laser treatments to achieve this goal. Or patients ocular condition needs intravitreal injections to be combined with retinal laser for the best results and visual outcome.