Blogs

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.

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

Glaucoma occurs when the pressure in our eye becomes high leading to damage to the optic nerve (nerve that connects our eye to the brain and helps us see). It is important to lower the eye pressure urgently to protect the nerve.

This can be done with eye drops, lasers and surgical techniques. Usually eye drops and lasers are used as first line treatment, but if these are not effective we have to intervene surgically.

What is the Presserflo MicroShunt?

The MicroShunt is an 8 millimetre long tube that is inserted into the eye to help lower eye pressure in glaucoma and reduce the need for medication. It is made entirely of a synthetic and biocompatible material called SIBS.

The MicroShunt won’t be rejected by the body and will not disappear or disintegrate with time. As it is not metallic, it will not set off airport scanners and is safe if you need to have an MRI or CT scan.

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. Like trabeculectomy surgery, the MicroShunt drains fluid from inside the eye to outside, under a thin skin-like membrane covering the white of the eye called conjunctiva. The fluid is drained and pooled under conjunctiva forming what is called a bleb.

What are the benefits?

The MicroShunt will lower your eye pressure and prevent further damage to the optic nerve caused by eye pressure (intraocular pressure).

Compared to other glaucoma procedures such as a trabeculectomy, MicroShunt has the advantage that the procedure is shorter, less invasive, and requires fewer post-operative visits. In addition, the drainage bleb created by the MicroShunt is usually less obvious than after a trabeculectomy and contact lens wearers are often still able to continue contact lens wear afterwards.

Are there any alternatives?

The closest alternatives to the MicroShunt will be a traditional trabeculectomy or aqueous shunt implant (Baerveldt, Ahmed or Paul Glaucoma Implant). We aim to always individualise treatment options to your unique needs and will suggest the MicroShunt to you only if we feel it offers the best chance of controlling your eye pressure using a minimally invasive approach.

Whilst sun exposure is an excellent source of vitamin D, not taking the necessary protective measures during the summer can have damaging effects on the eyes.  Spending a lot of time under direct sun light and heat may accelerate the aging process of the eyes and lead to conditions such as cataracts and macular degeneration.

With temperatures reaching as high as 48°C in the UAE, our eyes are at risk of developing corneal burns, also known as photokeratitis. Therefore, it is extremely important to take the necessary precautions while enjoying summer activities in the sun.

Our Ophthalmologists share six effective tips to protect your eyes in the summer.

1. Wear sunglasses with full UV protection – Increased exposure to UV radiation can damage the macula, a central part of the retina at the back of the eye, which gives us the ability to have the perfect, colored vision. UV radiation may also harm the front part of the eye (cornea and lens) leading to cataracts (clouding of lens), macular degeneration, pterygium (benign growth on the white of the eye) and corneal sunburn, which is painful and might cause temporary vision loss. Thus, medical grade tinted glasses that can block up to 100% of the sun’s UV radiations are essential for protecting your eyes in the summer.
2. Lubricate your eyes – High temperatures and dry winds outdoors can lead to increased dry eye. Air conditioning use increases during summer which also leads to dry eye symptoms worsening. The best and most immediate way to address eye dryness is by using artificial tears to keep the eyes moist and refreshed.
3. Nourish your body with antioxidants – Constant exposure to the sun’s rays can produce free radicals, roaming atoms in the body that can oxidize and damage the retina. Hence, consuming a diet that is rich in antioxidants will help cancel out the effects of free radicals. Antioxidants such as Lutein, zeaxanthin, and vitamins C can be found in oranges, berries and leafy vegetables and can be easily integrated into your diet.
4. Stay hydrated – In general, drinking water is extremely important to maintain healthy functioning organs. Considering that the summer heat can make us lose more water through sweat, we need to drink more water to compensate for this loss. Also, if you drink diuretics such as coffee, consider drinking at least 2 litres of water per day. Dehydration is a leading cause of dry eye and irritation, so it is imperative to maintain balanced hydration levels during the summer months.
5. Always wear swimming goggles – summer is synonymous with swimming. If you enjoy swimming, consider investing in goggles to protect your eyes. Pools are often disinfected with harsh sanitizers such as chlorine. Thus, using goggles can protect your eyes from coming in contact with potent sanitizers and reduce the likelihood of contracting an eye infection such as conjunctivitis, which leaves the surface of the eye red and dry.
6. Avoid swimming with contacts – Another important precaution to take is to remove your contact lenses before swimming. In fact, swimming with contacts can have sight-threatening effects such as ulcers and infections. Additionally, pool or beach water is home to many microbes such as Acanthamoeba, which can result in infections in the eye and serious complications.

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.

This blog on the importance of early diagnosis for glaucoma was authored by Dr. Salman Waqar, a Consultant Ophthalmologist in Cataract and Glaucoma 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.

What are the treatment options?

• 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: We 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.

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.

This blog on ‘Presbyopia surgical treatments: How do we remove progressive glasses?’ has been contributed Dr. Miguel Morcillo, Consultant Ophthalmologist, Specialist in Cornea and Refractive Surgery.

What is Presbyopia?

When you have difficulty in focusing on near objects, usually as we head into our 40s & 50s, you probably are developing presbyopia. It is a condition that affects everyone as they get older.

Why presbyopia happens is not clear. When we are young we have a crystalline lens that is very flexible and the muscles within the eye can manipulate it so that it changes its shape, and therefore its power, so we can focus over a range of distances. This is a reflex and is done automatically without thought or effort. As we age, the lens becomes a stiffer, more rigid structure and it becomes harder for the muscles to get the lens to increase in thickness to become more powerful. As such, focusing up close becomes more problematic.

How does Presbyopia occur?

Presbyopia happens gradually. First, people start to put near objects a bit far, or increase the size of the font at the computer. It can work for few years but finally, the need for glasses to perform near activities appears. These glasses are magnifiers that can be used only for near in case the patient has good far vision, or may be added to the far glasses if the uncorrected far vision is not good. Presbyopia has been long time corrected with glasses but for those who don’t want to wear glasses, we have some surgical techniques available to correct this problem.

Treatment options for Presbyopia

Presbyopia surgery is not new. Monovision techniques are long time performed. They can be done either with laser or with intraocular lenses. The aim of monovision is to use the ability of the brain to process both eyes’ individual images to create the image we see. We call it binocularity. One eye is focused in far distance and the other eye is focused in near distance. Depending on the distance we focus, the brain chooses the best image as the principal image and uses the other eye as supporter of the main image. This combination is very useful in most of the daily activities and only in extreme far or small near activities, occasional use of glasses may be required. Monovision works quite well in myopic patients.
For those patients where monovision doesn’t match their expectations, we have multifocal intraocular lenses. These lenses are implanted after removing the natural lens. This is called refractive lens exchange. The multifocal intraocular lenses have different focuses to see in the most used near distances (mobile, books or computer screen) and also for far distances. They can be used in only one or both eyes, depending on the case. They can be implanted in cataract patients as well. Hypermetropic patients are most frequently implanted.
There are also some other techniques as corneal inlays, extended focus lenses or accommodative lenses. They may be used in some other cases but less frequently.
We select the technique depending on the age of the patient, the kind of glasses they are wearing, the current visual performance and the visual requirements. A complete eye check must be done to rule out any other pathology so the best results are obtained in healthy eyes. The results are excellent and most of the patients need no glasses at all. In few cases, it is possible some occasional use of glasses for specific activities. Even in these cases, we can provide high satisfaction levels to our patients and a change in their quality of life, where the continuous use of glasses before the surgery was very annoying for them.

This week’s blog on ‘Can astigmatism be cured?’ has been contributed Dr. Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery.

What is astigmatism?

Astigmatism is a common kind of refractive error. It is not an eye disease, it means the surface of the cornea is not spherical, or not completely round “the eye is shaped like a Rugby ball, not a football ball.” With astigmatism, the eye does not focus light evenly onto the retina causing blurring of the image formed at the back of the eye.

Causes of astigmatism?

The specific cause is normally unknown although genetics can play a part. Sometimes astigmatism can develop after an eye injury, surgery or because of an eye disease Astigmatism is not caused by reading in bad light, using a PC or watching a lot of TV.
Astigmatism can affect both children and adults, it is usually non progressive and associated with myopia or hyperopia. If the astigmatism is getting worse, then it is very important to see a corneal specialist to a have corneal scan in order to rule out the weaker cornea (Keratoconus) as it is a progressive disease and there is treatment to stop it, especially if detected early, to save the vision.

What are symptoms of astigmatism?

Patients with astigmatism notice a blurred/distorted vision especially at night driving or have frequent headaches, increased eye fatigue, eye strain and squinting.

How is astigmatism diagnosed?

Astigmatism is usually found during eye glasses examination. Most of astigmatism are regular, however some astigmatism are irregular and caused by diseases affecting the cornea such as Keratoconus or corneal scar. Eye examination and a corneal scan is needed to rule out disease causing the astigmatism

Can you have astigmatism and not know it?

It is possible to have mild astigmatism and not know about it. This is especially true for children, who are not aware of their vision being other than normal. Some adults may also have mild astigmatism without any symptoms. Also many people wear glasses for myopia or hypermetropia and have mild astigmatism but were not informed about it.

Treatment: How is astigmatism corrected?

Astigmatism can be rectified with eyeglasses, contact lenses, or surgery.
Multiple ways of correcting astigmatism are:

• Eyeglasses are the simplest and safest way to correct astigmatism.
• Contact Lenses; need special Toric soft contact lens or hard contact lens.
• Refractive Surgery aims to correct astigmatism permanently in association usually with myopia or hypermetropia. There are various types of refractive surgeries to treat astigmatism using:
  • Femto LASIK to change the shape of the cornea permanently
  • Toric intraocular implant which we use in severe cases who is not suitable for laser vision correction or patient with weak cornea such as Keratoconus eye.

Astigmatism can also be corrected during cataract surgery by using toric intraocular implant so patient does not need to wear glasses after the procedure.
For astigmatism caused by corneal diseases, the treatment can be by different options depending on the disease and level of astigmatism. Options can be surgical cuts in the cornea (now by using femtosecond laser instead of knive), Eximer laser removal of irregular corneal surface and scar, insertion of specific intracorneal rings and lastly by replacing the diseased cornea with corneal graft

This week’s blog on ‘What your eyes tell you about your health’ has been contributed by Dr. Luisa Sastre, Specialist Ophthalmologist in Medical Retina.
“Do you have sleep problems?” the doctor asked while examining my eyes. “Yes, I do. How can you know that? “I replied in amazement.
Even though I slept well last night and my eyes were white and quiet, I still had that mild discomfort in my right eye that feels like a pricking sensation, right after I woke up.

The Doctor replied “I know because you have some very subtle punctate erosions on the surface of your inferior cornea. The pattern suggests that your eyelids could be open while you are sleeping and so the surface of your eye would be exposed to the environment and get dry”.
Then the doctor held my eyelashes and pulled a little bit. “You have loose elastic upper eyelids. They can easily open while you are asleep, causing the surface of your eye to get dry. That’s why you are getting this pricking sensation in your eyes, right when you wake up. As the day goes on, normal blinking will spread your natural tear over the surface of the eye, reducing the discomfort. Nonetheless, we would need to start a treatment plan to help treat this condition”.
The doctor knew very well the association between obstructive sleep apnea, floppy eyelid syndrome and the patient’s profile ; overweight, middle-aged male. The treatment recommended included not only eye lubricants, but a referral to the pulmonologist expert in sleep apnea and to the oculoplastic surgeon.
This is just an example of an association between eye conditions and other problems in any part of your body. Some of these classical associations are diabetes and hypertension. The eye doctor can tell how good or bad your sugar or blood pressure control has been, just by looking inside the eye, through that little window called the pupil. Indeed every diabetic person should have regular eye examinations, with dilation of the pupil, to assess the retina’s health.
In the same way itchy red eyes can come along with flare ups of certain skin conditions, like atopic dermatitis or rosacea.
People under a lot of stress and those with sleep disturbances like insomnia or type A behaviour (aggressive and competitive personalities) are more likely to develop a condition in the eye called central serous chorioretinopathy (CSC). CSC can significantly impair your vision. So your eye doctor once again, will not only give you appropriate advice for your eyes, but also refer you to a sleep expert or to a psychologist, in order to have a comprehensive approach to your problem.
Examples of common associations:

• If you suffer a sudden drop in your vision and you are diagnosed with a vascular occlusion in your retina, you could be found to have high cholesterol and other cardiovascular conditions. So a prompt correction of your cholesterol levels can save you from future threats such as a heart attack and brain stroke.
• Not being able to see in a certain part of your visual field could mean a tumor might be compressing certain structures in your brain.
• If the whites of your eyes get yellow, you could have liver problems.
• If your eyes are red, painful and your vision is impaired and you are diagnosed with a condition called uveitis, you could also be found to have rheumatic diseases.

The list can go on, hence the Conclusion is; visit your eye doctor regularly as he/she is much more, than just an eye doctor!!

This  blog on ‘Amblyopia (lazy eye)’ has been contributed by Dr. Suhair Twaij, consultant ophthalmologist in Adult & Paediatric Strabismus Surgery, General Paediatric Ophthalmology, Adult Cataract Surgery & General Ophthalmology

What is Amblyopia?

The most common cause of a visual deficiency in children is amblyopia or lazy eye. It occurs when the eye fails to work with the brain properly.

Although the eye may appear normal, the brain prefers the other eye. This can happen in the critical period of eye development, which is from birth until about age 7, when children’s eyes and the brain form vital connections. These connections can be blocked or prevented by anything that obstructs or blurs vision in one or both eyes, leading to lazy eye. Sometimes both eyes may be affected.

Causes

A number of things can interfere with normal brain–eye connections and lead to amblyopia;

• Strabismus (squint): a disorder in which the two eyes don’t line up in the same direction.
• Refractive errors: when one eye cannot focus as well as the other. This includes nearsightedness, farsightedness and astigmatism.
• Cataract: a clouding in the lens of the eye.
• Droopy lid.
• Genetics play a role, too. Amblyopia tends to run in families. It’s also more common in children born prematurely or those with developmental delays.

Unfortunately, most children with amblyopia won’t complain of vision problems. Often, a parent or teacher might realize that a child is struggling with a vision problem, maybe noticing crossed eyes, frequent squinting, or tilting the head to see better. Some kids have poor depth perception (trouble seeing in three dimensions), difficulty with sports and clumsiness.

Diagnosis

Regular vision examinations by medical specialists are crucial for identifying any issues in children. To detect issues before a kid reaches visual maturity, these assessments should begin in the toddler and preschool years.

Treatment

As soon as possible, treatment should begin. The purpose of the treatment is to have the child use the eye with poorer vision. This is accomplished with eyewear, surgery, eye drops, eye patches, eye patches, or a combination of these.

This week’s blog on ‘Bell’s palsy’ has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery

What is Bell’s palsy?

Bell’s paralysis known as Bell’s palsy is a temporary weakness or lack of movement affecting one side of the face. It is the most well-known type of facial paralysis

Symptoms

Bell’s palsy affects the function of facial muscles, as well as tears, saliva, taste and the middle ear. It appears as droopiness on one side of the face from weakness or total paralysis of the facial muscles and it develops within two days.

The symptoms of Bell’s palsy include:

• Sudden limitation or loss of motion on one side of the face
• Drooping eyelid or corner of the mouth
• Difficulty smiling or shutting the eyelid
• Ear pain
• Drooling
• Dryness in the eye and mouth
• Ringing in the ear or sensitivity to sound
• Impaired speech or taste
• Reduced tear production.

If you have any symptoms of Bell’s palsy, it is advised to consult your physician early.
However, if facial weakness is a symptom in a person who cannot lift up both arms and keep them there or have difficulty speaking (speech may be slurred or garbled) you need to go to emergency department as these can be signs of a more serious condition, like a stroke. In contrast to Bell’s palsy, the symptoms of a stroke are sudden.

Treatment

Bell’s palsy is usually treated by a General practitioner. Symptoms generally begin to diminish within two weeks of starting treatment, with complete recovery within half a year
Treatments for Bell’s palsy include:

• A Short 10-day course of Oral steroid (medication should be within 3 days of the symptoms starting to speed the recovery of bell’s palsy)
• Eye drops and eye ointment to protect the eye and to stop the affected eye from drying out
• Surgical tape to keep the eye shut at bedtime

Bell’s palsy is rare in kids, and most kids who are affected make a full recovery without treatment.

How long the Bell’s palsy lasts

Most patients recover fully within 6 months, but sometime it can take longer. In a small number of cases, the facial weakness can be permanent which can be treated by surgery.

Causes and Risk Factors

Bell’s palsy is caused by inflammation or compression of the facial nerve (Seventh cranial nerve), which controls face muscles. Infection by a virus is believed to cause inflammation and swelling of the nerve. Various viruses from the herpesvirus family are related with Bell’s palsy. Other Non-Viral causes such as: Headaches, chronic ear infection, tumors, diabetes and injury to the face.

You can’t prevent Bell’s palsy

Because it’s probably caused by an infection of several types of viruses, Bell’s palsy cannot be prevented.
You’ll normally just get Bell’s paralysis once, yet it can once in a while return. This is more probable in the event that you have a family history of the condition.

Retinoblastoma is an eye cancer that occurs most commonly in childhood under the age of 5. . Two thirds of children are diagnosed before the age of two and almost 95% by the age of 5.
It is estimated that 5000-8000 children develop retinoblastoma worldwide every year. The incidence rate of retinoblastoma in United States and Europe is approximately 1:15000 live births. However, the rate appears to be higher in Africa and India.

Its present in two forms, bilateral (hereditary) form (25% of all cases) and unilateral (75% of all cases, 90% of which are non-hereditary).
The most common presentation is leucocoria which is an abnormal white reflection in the eye (60%) and 20% as squint, the misaligned position of the eye).
The best approach to manage this condition is based on early detection and early diagnosis.

It involves Paediatric Ophthalmologist, Ophthalmic Oncologist and Paediatric Oncologist. The aim of the treatment is primarily to preserve the life of the child. Secondly, to preserve vision and finally, to preserve the eye. It is highly curable if identified in early stages; more than 90% of children survive in high income countries and up to 40% in less privileged countries. Treatment includes radiotherapy, chemotherapy and sometimes enucleation of the eye with tumor. Children with bilateral disease and gene mutation are at higher risk for secondary cancers. This increases with radiation therapy.

It is very important to for parents, Pediatricians, Ophthalmologists and other healthcare professional involved in childcare to detect abnormal white reflection (absence of red reflex) during routine checkups of the children. Leucocoria can be seen in the eye with the tumor due to the reflection of the white flash light from abnormal white retina in the back of the eye.

In the modern phone cameras, a red eye reduction feature is included so that the red reflex is prevented in the photos. There are few iPhone applications (apps) which are designed to detect the white reflex. However, there are certain limitations with these apps.

A thorough eye examination by a Paediatric Ophthalmologist is essential to detect the tumor in its early stages when concerns arise by parents with these apps or iPhone photos.