Monday 29 December 2014

Cataracts From Statins ????


CATARACT

Cataracts From Statins? More Signals Emerge in Analyses

Statins are a class of medicines that are frequently used to lower blood cholesterol levels. The drugs are able to block the action of a chemical in the liver that is necessary for making cholesterol. Although cholesterol is necessary for normal cell and body function, very high levels of it can lead to atherosclerosis, a condition where cholesterol-containing plaques build up in arteries and block blood flow. By reducing blood cholesterol levels, statins lower the risk of chest pain (angina), heart attack, and stroke. 
By  Steve Stiles
VANCOUVER, BC — Statin therapy significantly elevates the risk of developing cataracts severe enough to warrant surgery, suggests analyses of two distinct cohorts, one from Canada and another from the US, that add to a hazy landscape of prior studies variously concluding for or against such a risk for the widely used drugs.
For now, the possibility of such a risk from statins and its potential mechanisms should be explored in prospective trials, “especially in light of increased statin use for primary prevention of cardiovascular disease and the importance of acceptable vision in old age, when cardiovascular disease is common,” according to the report, published in the December 2014 issue of the Canadian Journal of Cardiology with lead author Dr Stephanie J Wise (University of British Columbia, Vancouver).
“However, because the relative risk is low and because cataract surgery is effective and well tolerated, this association should be disclosed but not be considered a deterrent to use of statins when warranted for cardiovascular risk reduction,” they write.

Saturday 27 December 2014

And Another one

http://m.bbc.com/news/world-asia-30614627


An AirAsia flight travelling from the Indonesia to Singapore has lost contact with air traffic control with 162 people on board.
Flight QZ8501 lost contact at 07:24 (23:24 GMT), Malaysia-based AirAsia tweeted.
Search and rescue operations are under way.


Sunday 21 December 2014

Winter Bliss

Wonderful walk at the beach today morning. 
Nice to see so many people enjoying the weather and lots of fitness freaks of all ages frolicking in this winter mornings 

Sunday 14 December 2014

Life Changer

A simple squint surgery can change the the whole outlook of life. 
Here divergent squint since many years was treated with horizontal muscle correction. 

Successfully



Sunday 30 November 2014

Conjunctivitis After Effects

The recent bouts of conjunctivitis, if miss treated leads to keratoconjunctivitis. It affects the outer transparent layer of the eye known as Cornea. It heals with scars, sometimes May take six months to a year to go away.
Continous use of Lubricants is recommended.
The patient may see halos around the lights.

Saturday 30 August 2014

Pterygium With Grafting

Pterygium operated with conjunctival autologous grafting.
4 interrupted stitches taken. 
Picture taken at end of surgery 

Saturday 16 August 2014

Membraneous Conjunctivitis:

Bathia Hospital & Eye Clinic

Dr.Jigar Bathia, M.S(Ophthal), F.C.P.S, D.O.M.S.
Consulting Eye Surgeon
Mobile : +91 9820322664

Friday 13 June 2014

Cornea

Cornea is the transparent front surface of the eye. Normally, when looking straight on at the eye, you look right through the cornea and see the coloured iris and black pupil of the eye.
The cornea is avascular i.e. contains no blood vessels to nourish or protect it against infection, unlike other tissues in the body. Instead, it receives its nourishment from the tears and aqueous humour which is present in the anterior chamber. It is mainly composed of cells and proteins.
There are a lot of corneal disorders and diseases seen in routine practice. Enumerating below are a few of the common ones:
  1. Refractive errors
    • Hyperopia or farsightedness - If the cornea is flatter than normal or the eye is short, rays of light are focused behind the retina and causes  where close objects appear blurred. 
    • Astigmatism is a condition in which the uneven curvature of the cornea blurs and distorts both distant and near objects. The cornea is more curved in one direction than in the other. 
    • Myopia or Near Sightedness - If cornea is more steeperm than rays of light focus in front of the retina.

    Refractive errors are usually corrected by eye glasses or contact lenses. Although these are safe and effective methods for treating refractive errors, refractive surgeries are becoming an increasingly popular option.
  2. Infections
    A breach in the normal epithelial surface of the cornea associated with necrosis of surrounding corneal tissue is termed as corneal ulceration They usually cause pain, redness, watering, discharge, photophobia i.e. intolerance to light and blurred vision. It can be caused by bacteria, fungi, viruses, acanthamoeba and many other organisms. They cause painful inflammation called keratitis. These infections can reduce visual clarity, produce corneal discharge and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant. As a general rule, the deeper the corneal infection, the more severe the symptoms and complications. It should be noted that corneal infections, although relatively infrequent, are the most serious complication of contact lens wear. Minor corneal infections are commonly treated with anti-bacterial or anti-fungal eye drops. If the problem is severe, it may require surgical intervention.
  3. Dry eye
    Dry eye can be caused due to any of the following reasons:
    1. Aqueous tear deficiency
    2. Mucin deficiency
    3. Lipid deficiency
    4. Impaired eyelid function
    5. Corneal epithelium abnormalities.
    In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.The main symptom of dry eye is usually a scratchy or foreign body or sandy feeling as if something is in the eye. Other symptoms may include stinging, irritation, itching, burning or nonspecific ocular discomfort of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and pain and redness of the eye. Sometimes people with dry eye experience heaviness of the eyelids or blurred, changing, or decreased vision, although loss of vision is uncommon.
    Dry eye is more common in women, especially after menopause. Surprisingly, some people with dry eye may have tears that run down their cheeks. This is because the eye may be producing less of the lipid and mucin layers of the tear film, which help keep tears in the eye. When this happens, tears do not stay in the eye long enough to thoroughly moisten it.
    Dry eye can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs. People with dry eye should let their health care providers know all the medications they are taking, since some of them may intensify dry eye symptoms.
    People with connective tissue diseases, such as rheumatoid arthritis, can also develop dry eye. It is important to note that dry eye is sometimes a symptom of Sjogren’s syndrome, a disease that attacks the body’s lubricating glands, such as the tear and salivary glands. A complete physical examination may diagnose any underlying diseases.
    Artificial tears, which lubricate the eye, are the principal treatment for dry eye. They are available over-the-counter as eye drops. Sterile ointme
  4. Dystrophies
    Corneal dystrophies affect vision in widely differing ways. Some cause severe visual impairment, while a few cause no vision problems and are discovered during a routine eye examination. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision. The dystrophies are classified according to the anatomic site involved:
    Epithelial dystrophies: Epithelial basement membrane dystrophy, Reis Buckler’s dystrophy, Meesman’s dystrophy
    Stromal dystrophies: Granular dystrophy, Macular dystrophy, Lattice dystrophy, Schnyder’s crystalline dystrophy
    Endothelial dystrophies: Fuch’s endothelial dystrophy, Posterior polymorphous dystrophy, Congenital Hereditary endothelial dystrophy.
    Some of these dystrophies do not cause a lot of visual impairment. However most of them require surgery in the form of corneal transplantation for visual restoration.
  5. Keratoconus
    Keratoconus is characterized by progressive thinning and ectasia which results in deterioration of the quality of vision and also the quality of life. As the disease begins in young adults, it affects the most productive years of life. So far there has been no effective way to stop the progression of keratoconus. Current methods such as rigid contact lens, & intracorneal ring segments only the refractive error can be corrected without any effect on the progression of keratoconus. It is estimated that eventually 21% of the keratoconus patients require surgical intervention to restore corneal anatomy and eyesight. A new modality of treatment, based on collagen crosslinking with the help of Ultraviolet A (UVA, 365nm) and the photosensitizer riboflavin phosphate has been described which changes the intrinsic biomechanical properties of the cornea, increasing its strength by almost 300%. This increase in corneal strength has shown to arrest the progression of keratoconus in numerous studies all over the world.
    Topography guided C3R (Crosslinking) with Topolink
    This is done only if you are in early stages and if fit for the same as examined by our doctors as we can additionally also smoothen the shape of the cornea with our laser (PRK), besides strengthening it (C3R).
    Accelerated C3R or KXL
    The accelerated cross-linking mirrors the traditional cross-linking procedure but differs and benefits patients in 3 ways:
    1. Reduces cross-linking time from one-hour to a few minutes, adding to patient comfort and experience.
    2. More importantly, accelerated cross-linking allows thinner corneas to be cross-linked with greater precision, potentially decreasing the risks associated for cross-linking. In effect those patients outside current treatment criteria can be cross-linked and receive the benefits.
    3. The new Riboflavin solutions can penetrate the epithelium and this procedure is called “Transepithelial Corneal Collagen Cross-linking”.  
  6. Pterygium
    Pterygia are more common in sunny climates and in the 20-40 age group. Scientists do not know what causes pterygia to develop. However, since people who have pterygia usually have spent a significant time outdoors, many doctors believe ultraviolet (UV) light from the sun may be a factor. In areas where sunlight is strong, wearing protective eyeglasses, sunglasses, and/or hats with brims are suggested. While some studies report a higher prevalence of pterygia in men than in women, this may reflect different rates of exposure to UV light.
    A fully developed pterygium has three parts: head, neck and body. Depending upon the progression it may be progressive or regressive pterygium. Progressive pterygium is thick, fleshy and vascular with a few infiltrates in the cornea, in front of the head of the pterygium. Regressive pterygium is thin, atrophic, attenuated with very little vascularity. Ultimately, it becomes membranous but never disappears.
    Visual disturbances occur when it encroaches the pupillary area or due to corneal astigmatism induced due to fibrosis in the regressive stage. Occasionally diplopia may occur due to limitation of ocular movements.
    Because a pterygium is visible, many people want to have it removed for cosmetic reasons. Other indications for surgery include continued progression threatening to encroach onto the papillary area or diplopia due to differential ocular movements. Pterygium surgery involves excision of the pterygium followed by covering the bare area with a conjunctival auto graft either from the same eye or the other one. Recurrence rates are the least when surgery is done with conjunctival auto graft technique.
  7. Ocular surface problems
    Patients with ocular surface diseases suffer from loss of vision, discomfort, infection, erosions, ulceration, and destruction with scarring of the eye surface. The most common cause of these problems is the imbalance in the neural regulation which leads to an “unstable tear film”. Ocular surface failure manifests in two ways – the first one is the Limbal Stem Cell Deficiency in which the corneal epithelium is replaced by the conjunctival epithelium. In the second one, the corneal or the conjunctival epithelium changes with keratinisation and loss of mucosal epithelial characteristics.
    Treatment of these conditions involve ocular surface reconstruction. This involves multidisciplinary approach to restore the normal ocular surface defense so that a stable tear film can be achieved, restore the epithelial stem cells and restore stem cell stromal niche. These treatment strategies combine medical and surgical modalities. Medical treatment includes the use of various topical drops. Surgical modalities include symblepharon release, pannus excision, amniotic membrane transplantation, conjunctival autograft, limbal stem cell transplant etc.
  8. Aphakic /pseudophakic bullous keratopathy
    1.Regular arrangement of the corneal collagen lamellae
    2.Lack of blood vessels, lymphatics and cellularity
    3.Relative state of dehydration which is maintained by the corneal endothelium
    4.Normal intraocular pressure
    Of these, the function of the corneal endothelial cells is of utmost importance. Failure of the corneal endothelial cells to maintain a relative state of dehydration of the cornea results in accumulation of fluid within the cornea known as “corneal edema”. As the corneal stroma swells, there is accumulation of fluid in the subepithelial and intraepithelial spaces which leads to the formation of bullae which causes a lot of discomfort, decreased vision, loss of contrast, glare and photophobia. If these bullae rupture, they cause a lot of pain and foreign body sensation. Bacteria can occasionally cause secondary microbial infection. This is known as Bullous Keratopathy. Most important causes include Fuch’s Endothelial Dystrophy and corneal endothelial trauma. Bullous keratopathy after cataract surgery is called PSEUDOPHAKIC BULLOUS KERATOPATHY (if intraocular lens implant is present) or APHAKIC BULLOUS KERATOPATHY (if intraocular lens implant is absent).
    Treatment includes topical dehydrating agents, intra-ocular pressure lowering agents, lubricating agents, bandage soft contact lenses for mild to moderate cases and treatment of any secondary microbial infection. For severe cases, corneal transplantation is usually required.
    Till recently, full thickness corneal transplantation was the treatment of choice for these cases. The surgical treatment of corneal endothelial dysfunction has been revolutionized with Descemet’s stripping with endothelial keratoplasty (DSEK). As an alternative to traditional penetrating keratoplasty (PK), DSEK has gained popularity because the selective transplantation of the endothelial layer avoids the potential complications of PK such as wound dehiscence, wound infections, and high postoperative astigmatism. Originally conceived as posterior lamellar keratoplasty by Melles et al, selective endothelial keratoplasty has evolved into deep lamellar with endothelial keratoplasty and now Descemet’s stripping with endothelial keratoplasty (DSEK). In DSEK the recipient Descemet’s membrane and endothelium are stripped and a posterior lamellar graft, or DSEK graft, then is inserted and allowed to unfold with subsequent recipient-to-donor stromal adherence. Adhesion of the DSEK graft allows for eventual deturgescence of the recipient cornea as the donor endothelial cells begin their pump action. Preparation of the posterior lamellar graft, containing the donor posterior stroma, Descemet’s membrane, and endothelium, has been simplified by use of a microkeratome on a corneoscleral button mounted on an artificial chamber. This variant in procedure has been termed Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Lasik

Now you can lose your glasses…. on purpose!!
Remember how your life changed when you had to get glasses? Now you can change it back and see naturally again. All this is possible now thanks to laser vision correction. We know you need more information to make an informed decision; so we would like to answer some of the questions you may have while considering this procedure.
What is LASIK ?
Laser Assisted Stromal In-situ Keratomileusis [LASIK] is a method of re-shaping the external surface of the eye [the cornea] to correct low, moderate and high degrees of nearsightedness, astigmatism and far-sightedness. During the treatment, an instrument called the microkeratome creates a corneal flap to make it a painless procedure. The computerized Excimer laser then uses a cool beam of light to gently reshape the cornea so as to alter its curvature to the desired extent. The flap when replaced on the new corneal curvature allows images to be sharply focused on the retina. The goal is to eliminate or greatly reduce the dependence on glasses or contact lenses.
Who is a candidate ?
The treatment is for patients who have a refractive error and meet certain visual and medical criteria. In addition the best candidates tend to be those who are dissatisfied with their contact lenses or glasses and are motivated to make a change, whether it is due to occupational or lifestyle reasons. However, only a thorough examination by our LASIK team can evaluate whether or not you are medically suited for LASIK.
Is LASIK safe ?
Yes. When choosing this method to improve your vision safety should be your first concern. It’s ours too. New generation Excimer lasers and advances in technique offer the highest degree of accuracy and utmost safety. Recent studies conducted internationally and by us show it to be a very safe and effective procedure.
Is LASIK successful ?
Yes. LASIK is a permanent treatment. However, patients who are 40 years and above may require reading glasses. Millions of patients worldwide and thousands at our centre have had an Excimer laser refractive procedure done on them successfully. During your consultation we will give you an idea of the procedure and the level of vision you can expect.
Are there other refractive procedures ?
You may have heard about PRK [photo refractive keratectomy]. You may have also heard about the surgery known as RK [radial keratotomy]. You need to understand that these are two completely different procedures from LASIK with less predictable results.
Is this the latest technology ?
The latest and most reliable procedure is wavefront-guided LASIK, a customized treatment for each eye. Our excimer lasers use high-speed sensitive eye trackers to ensure perfectly centered treatments. Wavefront procedures even often leave patients with eyesight better than normal. We are committed to providing our patients with the best that technology and technique has to offer. This is one of the best laser in Mumbai, India
Does this procedure hurt?
No. There is no pain during the procedure. There may be mild discomfort for a few hours after the procedure.
I need to know what to expect the day of treatment ?
This is an outpatient procedure. The laser treatment usually takes less than a minute. The entire procedure usually takes 5-10 minutes per eye. First you will lie on a motorised bed to which the laser is attached. Anesthetic drops will be placed in the eye. The head is positioned under the laser and the eyelids are gently and comfortably kept open during the treatment with the help of a soft clip by our doctor. You will be asked to look at a blinking light during the entire procedure. Once the procedure is completed, a soft corneal protective shield is sometimes placed on the eye. A post-procedure eye examination is performed and eye drops are prescribed. We will inform you about the follow-up schedule.
How soon can i return to work ?
You will notice an improvement in vision within 4-6 hours and a restoration of functional vision by the next morning. However, complete recovery may take up to 48 hours. Some people get back to work the day after treatment. Two or three days are suggested.

Cataract

For most people with poor vision from cataract, the opportunities of regaining good vision and resuming normal daily activities are excellent.
What is a cataract?
The term ‘cataract’ is used to describe the clouding of the natural lens of the eye. The vision dims because the cataract prevents light from passing beyond the lens and focusing on the retina.
Common symptoms of a cataract:
  1. Painless blurring of vision
  2. Glare or light sensitivity
  3. Frequent changes in eyeglass prescription
  4. Poor night vision
  5. Needing a brighter light to read
  6. Double vision in one eye
  7. Fading colours
Common misconceptions cleared:
  1. Cataract is not a film over the surface of the eye
  2. It is not caused by overusing the eyes
  3. It is not infectious and will not spread from one eye to the other
  4. It is not a cancer
  5. It is not a cause of irreversible blindness
What causes a cataract?
  1. The most common cause is due to aging and referred to as a ‘senile cataract’.
  2. Other common causes are:
  3. Family history
  4. Medical problems, such as diabetes
  5. Long-term use of medications, such as steroids
  6. Injury to the eye
  7. Congenital, since birth
  8. Previous eye surgery
  9. Long-term unprotected exposure to sunlight
How fast does a cataract develop?
Cataract development varies among individuals and may even vary between the two eyes. Most cataracts associated with the aging process develop over years. Cataracts in younger patients and in those with diabetes may develop more rapidly.
How do you treat a cataract?
Surgery is the only way a cataract can be treated. No dietary supplements, medications, exercises or optical devices have been proven to prevent or cure cataract.
When should surgery be done?
Surgery should be considered when the cataract causes visual disturbance enough to interfere with daily activities. Based on these needs and the examination findings, the patient and the ophthalmologist should decide together when surgery is appropriate. Cataracts need not be mature or ‘ripe’ before removal.
What should you expect from a cataract surgery?
Cataract surgery is a day care, microscopic surgery performed under anaesthesia eye drops or local anaesthesia. The cloudy lens is removed leaving its capsule behind, within which a permanent, artificial intraocular lens is implanted. Today, there are a wide range of intraocular lens implants available, which not only replace the cataract, but also give visual advantages with better near vision, improved night vision and also can reduce or eliminate the need for spectacles post surgery.
After cataract surgery, you can return immediately to almost all routine activities. Medication must be administered as per the instructions of your cataract surgeon or ophthalmologist.
Low stress cataract surgery at Bathia Hospital and Eye Clinic
Phacoemulsification is a micro-incision technique of cataract surgery wherein an ultrasound probe breaks the cataract into tiny pieces and sucks them out. The foldable lens implant is inserted through a very small incision (2.8 – 3.0 mm) as compared to an approximately 5 mm incision to accommodate a non-foldable lens. The incision are self-sealing and needs no stitches. Your ophthalmologist will help you decide as to which lens implant is most suitable for you.
Benefits to you:
  1. Smaller incision resulting in faster healing and visual rehabilitation
  2. Reduced surgical time
  3. No stitch surgery.
  4. Painless or minimal post-operative discomfort
  5. A quick return to your normal routine.

Can a cataract be treated with medicines or a laser?
No. Since the cataract occurs within the lens matter of the eye, no medication stops the progress of or treats the cataract. There is no medical or laser treatment for cataract other than replacing this lens with a surgery.
However, in layman terms today’s modern cataract surgery is called ‘laser cataract surgery’ as there are no stitches, although there is no actual use of the laser. The cataract is dissolved using ultrasound waves from an equipment and is medically termed ‘phacoemulsification’.
 

Today’s procedures are quick, not taking more than 20 minutes of surgical time, pain free under topical (only eye drops) or local anesthesia. Ask your ophthalmologist if you are eligible for topical anesthesia.
Are there any complications of cataract surgery?
At our centre, we follow the highest standards of healthcare and strict protocols of infection control. 

We understand your fears regarding an eye surgery, but you stand a greater risk of not doing cataract surgery when required, as the longer you wait the more difficult it becomes to treat the cataract easily and there is a greater chance of surgical complications.
Standard Vs Premium Lens Implants?
Multifocal and Accomodative Implants are a new technology in cataract treatment wherein you can gain additional benefit of reducing your dependence on reading glasses.
Standard Lens ImplantsPremium Lens Implants
Single focus- usually distantMultiple focuses- near, intermediate and distant
100% need for reading glassesReduces or eliminates need for reading glasses
Insurance usually covers the costMay be reimbursed partially by insurance

Lens Implants available at  Bathia Hospital and Eye Clinic:
Standard IOLs
Monofocal: AMO Sensar / Akreos / Rycef /Matrix

Monofocal Wavefront : AMO Tecnis / Akreos AO / Zeiss ZO/Acrysof Alcon IQ
Monofocal Microincision: Bausch and Lomb MIL
Monofocal Toric: Alcon / Zeiss
Premium IOLs
Multifocal: Tecnis / Restor / Rezoom/ Zeiss
Multifocal Toric: Alcon / Zeiss
Accomodative: Crystalens