The back bears a heavy load; it supports the weight of the body, sustains the weight of objects that are lifted or carried, and absorbs the stresses that result when parts of the body move. The back is a complex combination of muscles, ligaments, tendons, and bones-all attached to the backbone. The backbone is a series of interconnected blocks of bone called vertebrae. They form a tube-like “vertebral canal” that contains and protects the spinal cord and its bundles of nerves.

Causes of Low-Back Pain:

Low-back pain may be caused by abnormal development of the backbone, excessive stress on the back, injury, or any one of a number of physical disorders that affect the bones or the discs in the spine. The following are among the most common:

1. Ruptured or Herniated Disc. This is a frequent cause of low-back pain, and is sometimes called a “slipped” disc. Actually, an intervertebral disc cannot “slip” out of position. It can rupture, however, and when it does, some of the disc’s fragments push backward (prolapse posteriorly) into the spinal canal and press on nearby nerves, causing pain, numbness, tingling, and sometimes weakness in the leg or foot. A disc may rupture after a relatively minor stress, such as bending over to pick up an object. Pain may occur immediately after the rupture occurs, or it may grow steadily worse over the next few minutes or hours. Pain from a ruptured disc may involve the center or one side of the back, and it spreads gradually to the leg. This leg pain, which may be accompanied by numbing or tingling sensations, may affect the thigh, the back or outside of the calf, or the edge or top of the foot. Called Sciatica, leg pain or numbness is caused by the pressure that the ruptured disc’s fragments exert on the components of the sciatic nerve, which runs from the spinal cord down the thigh to the calf and foot. Each vertebra has a cylinder-shaped body, a vertebral arch, and several bony protuberances. The body of the vertebra rests on a cushion of tissue, known as an intervertebral disc that can act as a shock absorber. The vertebral arch extends from the body of the vertebra up and over the spinal cord to safeguard the spinal nerves. The bony protuberances are the places at which muscles, ligaments, tendons, and other bones join the backbone; they allow for normal flexibility of spinal movements.

2. Degeneration of the Vertebrae or Discs. Low-back pain occurs when parts of the vertebrae or the intervertebral disc deteriorate. When vertebral joints begin to wear down, the condition is called osteoarthritis. When the intervertebral discs start to degenerate, the spinal canal may become narrow and bone spurs can develop, a condition known as Spondylosis. Osteoarthritis and spondylosis produce intermittent aching or stiffness in the low back. Such low-back pain may spread into the buttocks and the thighs and may be aggravated by exercise or poor posture. People with osteoarthritis or spondylosis often feel stiff when they try to bend forward or stretch backward, because with these diseases, the backbone loses its mobility.

3. Spinal Stenosis. Narrowing of the vertebral canal is known as spinal stenosis. It may be due to overgrowth of vertebral joints associated with backward bulging of the discs or to degenerative diseases such as osteoarthritis or spondylosis (accompanied by thickening of the normal spinal ligaments). Pain from spinal stenosis, which typically occurs during walking or other exercise, develops after a few minutes of activity, accompanied by numbness, tingling, or cramps in the legs, and eases after a few minutes of rest

4. Sprains. Just as a sudden twist of the foot can cause a sprained ankle, an abrupt movement of the spine can sprain the muscles and ligaments of the back. A sprain is a partial tear of a ligament that has been overstretched. The pain from a sprain is located over the damaged ligament.

5. Infection. An infection in one part of the body, such as tuberculosis, can spread to the backbone and produce an inflammation of the bone or, occasionally, an abscess. Back pain from an infection develops slowly and eventually becomes severe. In addition to the back pain, a spinal infection raises the patient’s temperature and brings on an overall feeling of weakness and bouts of chills. The pain is often associated with severe spasms and stiffness of the back.

6. Tumors. Spinal tumors are uncommon. They may arise in the vertebral column or within the spinal cord or nerve roots, or they may spread to the spine from cancer elsewhere in the body. Spinal tumors cause pain in the back and may produce weakness or numbness

7. Ankylosing Spondylitis. Ankylosing Spondylitis is an inflammation of the backbone that causes stiffness. It occurs mainly in men between the ages of 15 and 25. In the most severe form of the disease, the backbone becomes completely rigid. Initially, the low back is stiff and painful, and the pain is aggravated by rest. A person with Ankylosing Spondylitis will often awake with an aching and stiff back and will gain relief only by exercising.

Before an Operation is considered:

Many of the conditions that bring about low-back pain (ankylosing spondylitis, sprains, osteoarthritis, and even a prolapsed disc) can be treated through rest, appropriate medication, and mild exercise. An operation is not considered, in fact, until these and sometimes other conservative measures have proved unsuccessful. If a trial period of conservative therapy produces unsatisfactory results and low-back pain continues to interfere with a person’s day-to-day activities, an operation may be considered.

Even when an operation becomes a possibility, it will not be attempted until the spine has been carefully assessed. Before performing a surgical procedure, the surgeon must know the exact nature of the problem in the back. Consequently, he or she will study the back by means of X-rays or other tests, such as myelography, computerized axial tomography (CT), or magnetic resonance imaging (MRI).

In myelography, a radiopaque material is injected into the vertebral canal to outline any disorders that may be found in the vertebrae or discs. Usually, the patient is placed on a special table that makes it possible to change his or her position, thereby distributing the injected material up and down the vertebral canal. Because myelography may cause headaches, which can be aggravated by sitting up or standing, patients may be asked to remain in bed for a day after the test.

During CT, a patient is placed in a large, circular device that projects X rays through a cross-section of the body. The X-rays outline the densities of various tissues, and by analyzing these densities, a physician can detect abnormalities.

Magnetic resonance imaging (MRI) is a relatively new technique for showing the bones and other tissues of the body. MRI scans do not involve the use of X-rays, and they may or may not include the injection of a contrast agent in the vertebral canal to enhance the images seen by the physician. An advantage of this method is that soft tissues (such as ruptured discs) show up much better on an MRI scan than they do on an X-ray or a CT scan. The test takes a longer time to perform than an X-ray or CT, and the patient must lie quietly in a large magnetic tube for the time of the examination. However, this type of examination is proving to be a safe and highly effective way to diagnose spinal disorders.

In addition, electrical studies of the muscles and nerves may be useful in diagnosing and managing spinal disorders.

About Operations on the Back:

The type of operation a surgeon performs depends on the nature of a patient’s back problem. However, most procedures involve a Fenestration, which may require the partial removal of the vertebral arch to gain access to the cause of the patient’s low-back pain. If a disc has ruptured, a surgeon will perform a Microdiscectomy to investigate the vertebral canal, identify the ruptured disc, and remove a good portion of the degenerated disc material, especially those fragments that press on the nerve roots.

The surgeon may consider a second procedure-Spinal Fusion-if he or she feels that stabilization of the spine is necessary. A spinal fusion is performed by fusing the vertebrae together with bone grafts; sometimes, the grafts are combined with metal plates or other types of instruments.

Some types of herniated discs are suitable for treatment by microsurgery or by a technique known as percutaneous discectomy, in which the disc is repaired through the skin without making a surgical incision. For this technique, the surgeon uses an X ray as a guide for inserting a large bore needle into the center of the disc; the central portion of the disc is then removed by using fine instruments that are placed through the needle. You should discuss with your surgeon the various treatment options to determine which is the most appropriate for your specific problems.

To treat spinal stenosis, the surgeon makes an incision that is long enough to allow inspection of all of the vertebrae that have contributed to narrowing of the vertebral canal. After performing a limited laminectomy, the surgeon performs a decompression operation by entering the vertebral canal and removing the material that is pressing on the spinal nerve roots. Occasionally, some form of spinal fusion or other type of stabilization may be indicated.

When a patient has a spinal tumor, the physician may opt to treat the patient with radiation or chemotherapy rather than a surgical operation. If an operation is needed, the surgeon performs a laminectomy, locates the tumor, and removes it from the spine, the spinal cord, and the nerve roots. Some tumors require that the operation be approached from the front of the spine, followed by spinal stabilization. Following the removal of a spinal tumor, the surgeon decides if further radiation therapy and/or chemotherapy should be given.

When a patient has a spinal infection with an abscess in the back part of the spinal canal, the surgeon removes the vertebral arch, locates the abscess, and drains away the pus. If the abscess is toward the front (anterior) in the disc space, the surgeon may make an anterior approach to the vertebral bodies. Appropriate antibiotics will be given to cure the infection.

Recovering from the Operation:

Recovering after back surgery varies with the type of operation that was performed. Following ordinary disc removal, most patients are able to get out of bed and move about on the same day after surgery and get discharged on the very next day. Patients who have undergone a spinal fusion or an operation for stenosis take longer to become mobile (upto 12-24 hours), and these patients may remain in the hospital for longer periods of time (48-72 hours) after the operation. In addition, they may be required to wear a brace or cast for a few weeks to months after surgery.

The length of stay for patients with spinal tumors depends on the type of tumor. Patients who have had an operation to drain an abscess of the spine stay in the hospital until the infection has been controlled.

A common problem after major back surgery is difficulty with urination. This problem usually subsides in three to four days. The insertion of a tube (catheter) into the bladder that will drain the urine may be necessary until the patient is able to void normally. After discharge from the hospital, most back surgery patients will need some time to recuperate before returning to their usual activities. The types of activities the patient can safely resume should be outlined by the operating surgeon and should be followed carefully by the patient. The period of recuperation varies, but it may range from weeks to months, and a back brace or physical therapy program may be recommended

Lifestyle Package for Women

According to studies, an unhealthy lifestyle can age a woman’s skin by more than 10 years and deteriorate the health faster than compared to men due to the weak physical specification. A lifestyle health checkup not only can help detect the risk factors but also improve a healthy lifestyle in order to live longer.

Benefits of the Package:

• Checkups especially designed to detect major health issues such as liver function test, cardiac risk evaluation and mammogram

• Use of latest technology for perfect assessment of the health

• Consultations with our medical experts

INVESTIGATIONS

• CBC

• ESR

• Blood grouping & RH typing

• Urine routine & microscopy

• Stool routine

• Peripheral Smear

• Audiometry

• PSA(Prostate Specific Antigen)

• Chest X ray

• Ultrasound abdomen & pelvis

• Sonomammogram(Less than 40 yrs)/Mammogram (Above 40yrs)

DIABETES EVALUATION

• Fasting Blood Sugar

• Post Prandial Blood Sugar

• HbA1C (Glycalated Haemoglobin)

Lipid Profile

• Total Cholesterol

• HDL

• LDL

• VLDL

• Triglycerides

Liver Function Test

• Alkaline Phosphatase

• SGOT

• SGPT

• GGPT

• Albumin

• Globulin

• Total Protein

• Total & Direct Bilirubin

KIDNEY PROFILE

• SR CREATININE

• SR Uric Acid

• Calcium

• Phosphorus

• BUN

Thyroid Profile

• T3

• T4

• TSH

CARDIAC RISK EVALUATION

• ECG

• ECHO Screening/Tread Mill Test

Other Investigations

• Vitamin B12

• Vitamin D

• Iron with TIBC

• Ferritin

CONSULTATIONS

• Physical examination

• Opthalmology Consultation

• Dental

• Diet Consultation

• Physician Consultation

• Gynecology Consultation

Alma (Harmony-XL) laser technology is used to treat peri-orbital pigmentation (dark circles), peri-orbital wrinkles, acne, acne scars, wrinkles on the face, pigmentation on the face, removal of unwanted facial hair, skin rejuvenation, skin tightening, vascular lesions, stretch marks, nevus, tattoo removal, warts, skin tags and scars. Laser is a safe and non-invasive, office procedure and is performed around the eyes using an eye shield.
The other procedures available include Chemical peeling, Microdermabrasion, Derma roller, Ellman radio surgery, Botox & Dermal fillers.

FACILITIES AVAILABLE:

1.Laser (Alma Harmony-XL platform)
2.AFT pulsed Light 570 – Pigmentation, Freckles, Melasma, Rosacea.
3.Infrared- Oculo facial Skin tightening, Scar, Stretch marks.
4.Erbium- YAG/Pixel-Post-Acne Scar, Skin rejuvenation, venous lake.
5.Q-switched Nd-YAG – Tattoo removal, Birth mark.
6.SHR (Super hair reduction)- Unwanted hair removal.
7.Chemical peeling-Pigmentation, Skin rejuvenation.
8.Microdermabrasion- Pigmentation, Skin rejuvenation, Post- Acne scars.
9.Derma roller-Post-Acne scars.
11.Ellman Radio-surgery-Skin tags, DPN, Warts.
12.Botox -Wrinkles.
13.Dermal fillers- Facial Rejuvenation.
14.Cosmetic Dermato-surgery-Scar revision.
15.Blepharoplasty-Cosmetic eye lid surgery.
16.Eyebrow surgery (Brow Lift).
17.Ptosis-Droopy eye lid correction.
18.Eyelid scar revision.
19.Radio frequency skin tightening.

AFT (ADVANCED FLUORESCENCE TECHNOLOGY):

AFT is the next generation of intense pulsed light for superficial vascular and pigmented irregularities to improvet patient’s skin colour with less discomfort and minimal skin damage. It requires approximately 5 to 8 sittings.

FILLERS:

Injection of hyaluronic acid for soft tissue augmentation used for wrinkles, scars, deep folds ( Naso-labial folds ,Peri-orbital folds) and to correct fat loss.

INFRARED – SKIN TIGHTENING:

Deliver deep dermal heating that induces neo collagenesis . A series of three to six treatments produces a tighter, fresher appearance – without pain or invasive procedures.

SHR (SUPER HAIR REDUCTION):

Hair removal is the most popular light-based aesthetic procedure in the world. SHR offers virtually pain-free hair removal procedure with no downtime.

ERBIUM- YAG/PIXEL:

Gives more youthful appearance with the High Power Pixel skin-resurfacing . A series of 4 to 6 virtually pain-free treatments will gradually stimulate new cells to replace aged and photo-damaged skin, with little patient downtime. It offers excellent reduction of post-acne scars.

High Power Q-Switched module is used for the non-invasive removal of various colored tattoos, birthmarks and benign pigmented lesions, providing deep penetration.

CHEMICAL PEELING:

Chemical peeling is a non-invasive procedure used to improve the skin’s appearance by applying a chemical solution to the skin, causing the top layers of skin to separate and peel off. Chemical peeling is done to reduce fine lines, treat mild acne scar, to diminish skin discoloration, such as sun tanning ,melasma, freckles, post-acne spots and to refresh skin texture and color using one or more chemical solutions, such as glycolic acid, trichloroacetic acid, salicylic acid. Around 6 to 8 sittings are required to achieve desired results.

MICRODERMABRASION:

Microdermabrasion is non-invasive mechanical exfoliation that removes the uppermost layer of dead skin cells from the face .For best results, it is recommended you get a series of 6 to 8 treatments. Microdermabrasion leaves skin with a fresher more glowing look,diminishes the appearance of fine lines ,wrinkles, enlarged pores, and coarse textured skin.

DERMAROLLER:

Derma roller is a device which has steel micro needles and are able to part pores on the top layer of the skin without damaging it. Derma roller reduces wrinkles, acne scar and stretch marks by increasing the levels of collagen and elastin in the skin.3 sittings are required to achieve desired results.

ABOUT THE DISEASE
It is an inflammatory bowel disease (IBD) causing long lasting swelling and inflammation of the colon (large intestine). There are tiny ulcers and small abscesses in the colon and rectum that flare up periodically producing symptoms, with periods of remission in between. It is closely related to another condition of inflammation of the intestines called Crohn’s disease. But unlike Crohn’s disease, it does not affect the esophagus, stomach or small intestine. It is a disease that can last years to decades. Men and women are affected equally. It most commonly begins during adolescence and early adulthood.

Ulcerative Colitis:

SYMPTOMS
• Rectal bleeding
• Abdominal pain or cramping
• Diarrhea
• Fever
• Tiredness
• Weight loss
• Night sweats
• Rectal pain
• Feeling the immediate need to have a bowel movement -Rectal urgency
• Joint pain or swelling

CAUSES:

The exact cause of ulcerative colitis is unknown, but it is likely caused by an abnormal response of the immune system in the gastrointestinal tract to something in the gut — food or bacteria in the intestines, or even the lining of the bowel — that causes uncontrolled inflammation. Risk factors include a family history of ulcerative colitis.

DIAGNOSIS:

– Endoscopy, such as colonoscopy or proctosigmoidoscopy
– Blood tests
– Stool samples
– Barium X-ray
– Other X-ray procedures, such as magnetic resonance imaging (MRI), or computed tomography (CT scan).
Colonoscopy needs to be repeated after every 1-2 years just to rule out colon cancer as the chances for the same increase in patients suffering from IBD.

TREATMENT METHODS:

There is no cure for this disease, medicines / immunomodulators / corticosteroids are used to control the immune system and reduce the inflammation. Hospitalisation might be required after every serious attack.
Dietary restrictions – small helpings, proper water intake (spread throughout the day) and stress management go a long way in containing the disease.
Surgery to remove the entire large intestine (colectomy), or both the colon and rectum (proctocolectomy) removes the threat of colon cancer. Surgery is usually recommended if you have:
– Colitis that does not respond to complete medical therapy
– Changes in the lining of the colon that are thought to be precancerous
– Serious complications such as rupture (perforation) of the colon, severe bleeding (hemorrhage)
If the entire colon is removed, the operation may create an opening, or stoma, in the abdominal wall, to which a bag is attached (permanent ileostomy). The tip of the lower small intestine is brought through the stoma. Stools pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times.

PEDIATRIC RETINA SERVICE:

Pediatric Retina is a nascent subspecialty in Ophthalmology world over. Truly, it is Ophthalmology’s newest ‘baby’. In the current scenario in India today, this niche specialty is evolving and only a handful of institutes have awarded it the status of a stand-alone department.

Over half of the world’s blind children live in India alone. Approximately 24% of childhood blindness in India is attributable to retinal causes. Whereas cataract and malnutrition related blindness have received the attention of both governmental and non-governmental eye-care providers, retinal causes are not a priority issue. This is despite the fact that perhaps the most devastating causes of blindness stems from retinal diseases.
The growing numbers of premature infants surviving in India today have resulted in an epidemic rise of diseases such as Retinopathy of Prematurity (ROP).This needs urgent attention.

The key focus area of this service has been the KIDROP project. In addition, the department has active clinical and research projects in retinal vascular diseases, surgical retinal disorders of the infant retina and retinal imaging using high end OCT, FFA and ICG.

CLINICAL SERVICES:

Pediatric-Retina-Service3 Reaching the correct diagnosis is not always easy in pediatric retinal disorders. The department uses a combination of advanced imaging techniques using the RETCAM Shuttle (Clarity MSI, USA), electrophysiological testing (Electro-Retinogram and Visual Evoked Potential), India’s first hand held SD-OCT (Bioptigen) and a specially developed method to convert the Spectralis (Heidelberg) to perform multi-modal imaging to arrive at the appropriate diagnosis. Appropriate genetic and family counseling is administered in cases of inherited conditions while cases that would gain from surgical intervention are appropriately operated.

SURGICAL TREATMENT:

The department uses the latest micro-surgical instrumentation that makes advanced surgery for retinal detachment and other conditions in infants possible. Internationally trained surgeons perform surgical procedures using the latest techniques. The department is ably aided by an expert pediatric anesthesia team that is capable of providing safe and effective anesthetic care for infants only a few weeks old.

NEURO OPHTHALMOLOGY & ELECTROPHYSILOGY:

Neuro-ophthalmology is an ophthalmic subspeciality that addresses the relationship between the eye and the brain, specifically disorders of the optic nerve, orbit and brain associated with visual symptoms.

NEUROLOGICAL DISORDERS PRESENT WITH A VARIETY OF VISUAL SYMPTOMS INCLUDING:

1. Decrease in central vision.
2. Disorder of the visual field.
3. Double vision (seeing double due to misalignment of the eye with abnormal eye movements).
4. Abnormal drooping of the eyelids.
5. Severe headache, which may or may not be associated intermittent blurring of vision and vomiting.

The Neuro-ophthalmologists provide comprehensive clinical care to a broad spectrum of cases including optic neuritis, ischemic optic neuropathy, compressive optic neuropathy (including pituitary tumors), papilledema, inflammatory and infectious optic neuropathies, cerebrovascular disorder or tumors involving vision, ocular motor disorders (including cranial nerve palsies), hereditary and traumatic optic neuropathies and patients who have unexplained visual loss.

THE FACILITIES PROVIDED INCLUDE:

1. ELECTRORETINOGRAPHY (ERG).
2. MULTIFOCAL ERG
3. ELECTROOCULOGRAPHY (EOG)
4. VISUALLY EVOKED POTENTIAL (VEP)

What is Collagen Cross Linking?

Although many current treatments can improve vision in keratoconus, they do not treat the underlying cause of the corneal weakness and distortion i.e they do not stop the progression of keratoconus. Collagen cross linking with riboflavin (commonly known as C3R) is one such treatment modality which stops propressive weakening of the cornea that occurs in keratoconus.

The one hour C3-R treatment is performed in the hospital. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet A light(370nm). This amazingly simple process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In published European studies, such treatments were proven safe and effective in patients.

A pilot clinical study in humans evaluated the effect of the new cross-linking method in patients with keratoconus and showed that, in all treated eyes, progression of the condition was halted. To date there are over 700 patients with more than 5 years follow-up after cross-linking treatment and some eyes have been followed for 7 years with encouraging results.

HOW IS THE TREATMENT DONE?
The treatment involves removing the superficial layer (epithelium) from the surface of the cornea and then applying Riboflavin eye drops to the eye for 30 minutes. The eye is then exposed to UVA light for another 30 minutes. After the treatment, a bandage contact lens is worn for 1-3 days until the surface of the eye has healed. Antibiotic and steroid eye drops are also prescribed for a few weeks.

WHO CAN BENEFIT FROM THIS TREATMENT?
It is important to understand that collagen cross-linking treatment is not a cure for keratoconus. Rather, it aims to slow or even halt the progression of the condition. After the treatment, it is expected that it will continue to be necessary to wear spectacles or contact lenses (although a change in the prescription may be required). However, it is hoped that the treatment will prevent further deterioration in vision and the need for corneal transplantation.

Thus initially the treatment would be offered only to patients in whom there is clear evidence of progression of their keratoconus. A person whose keratoconus is already so bad that it cannot be corrected by contact lenses is unlikely to gain any benefit from this treatment. In this situation a corneal transplant is usually required.

WHAT ARE THE RISKS?
There are a number of potential risks associated with this treatment although very few complications have been reported so far.

Ultraviolet light is potentially harmful to the eye .However, the dose used is designed to prevent observable damage to the sensitive cells that line the back of the cornea (endothelium) or the other delicate structures within the eye eg lens and retina. No lens opacities (cataracts) have been attributed to this treatment in European trials.

The treatment involves the scraping away of the outer layer (skin or epithelium) of the cornea. There is therefore a risk that the surface of the cornea will be slow to heal. Infection may occur which could lead to the development of corneal scarring. Antibiotics are routinely used to prevent this complication. Corneal scarring might necessitate further surgical procedures (including corneal transplantation)though this is extremely rare.

OTHER LESSER BUT MORE COMMON RISKS INCLUDE:
Inability to wear contact lenses for several weeks after the treatment.
Changes in the shape of the cornea necessitating a refitting of a contact lens or a change in the spectacle correction.
As is the case with any experimental treatment, there may also be long-term risks that have not yet been identified.
The increased corneal rigidity induced by exposure to UVA and riboflavin may wear off over time and further periodic treatments may be required, raising the possibility of other side effects from repeat doses of the treatment.
A NEW FORM OF COMBINATION TREATMENT HAS BEEN INTRODUCED WHICH INVOLVES COLLAGEN CROSSLINKING AND INTACS AFTER 3-6 MONTHS. THIS TREATMENT IS KNOWN TO HALT THE PROGRESSION AND ALSO STABILIZES THE CORNEA.

The contact lens department at Narayana Nethralaya is well equipped to cater the requirements of all eye conditions.We provide basic and various speciality contact lenses. The basic contact lenses like Spherical soft lenses, Rigid Gas Permeable lenses and Toric lenses are available which can be given in patient’s who wish to avoid glasses due to cosmetic purpose or due to the profession itself. Also, the Cosmetic contact lenses, which enables one to enhance or change the eye colour are available with us.

The prosthetic Contact lenses, which can be used in patient’s who have corneal scarring(white spot) or abnormalities like loss of iris, large/ irregular pupil can be given these lenses which will mask the scars/other deformities at the same time will reduce glare and photophobia. The patient’s who require glasses for near and distance can be prescribed with Multi focal contact lenses, which will keep them free from glasses.

The patient’s who cannot tolerate RGP contact lenses, have an option of Hybrid lenses which provide comfort of Soft lens and vision clarity of RGP lens. We also have Refractive Surgery Specific(RSS) Contact lenses for patient’s who complaints of glare, distortions and ghosting of images/shadows after the refractive surgery. . Orthokeratology that uses contact lenses at night to provide a spectacle free day is also available with us.

The special focus of this department is on Keratoconus and all the currently available contact lenses for the management of this progressive condition such as Rose K lenses, Kerasoft contact lenses, Scleral and miniscleral lenses are provided here. Keratoconus is managed by many different contact lens designs. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the practitioner carefully evaluates the needs of the individual to find the lens that offers the best combination of visual acuity, comfort and corneal health.

Compliance is the key to long-term success for all contact lens wearers. It is even more important for keratoconus patients, since they are almost totally dependent upon contact lenses for all their visual tasks. After patients have been successfully fit with contact lenses, a high percentage of complications and adverse reactions are related to skipping or shortcutting the recommended procedure for cleaning, disinfecting, and storing their lenses. A study revealed that 27% of patients admitted that they don’t clean their lenses daily, and it is likely that an even higher percentage of lens wearers are non-compliant in some way. Some patients have used dishwashing liquid, baby shampoo, or even toothpaste instead of the recommended cleaners; stored their lenses dry, rather than in an FDA-approved disinfecting solution; and used saliva (which contains a host of sight-threatening microorganisms) instead of the sterile solutions that are readily available, to wet their lenses before inserting them in their eyes.

GLASSES:

In the early stages, vision can be corrected with glasses or regular soft contact but as KC progresses they are not able to correct the distortion caused by the irregular corneal surface and more complex contact lens designs are required.

SOFT LENSES:

Contact-Lens1The role of soft lenses in keratoconus is limited because the soft lens drapes over the irregular corneal surface and the front surface of the lens assumes the same irregular surface as the cornea without trapping a fluid reservoir so the effective refracting surface is no improvement over the original corneal surface. There are some specially designed thicker soft lenses retain more of a rigid shape and may contribute to the liquid lens effect to some extent. There are designs being used for keratoconus, and they are helpful in mild to moderate cases.

RGP CONTACT LENSES:

Rigid Gas Permeable (RGP or GP) contact lenses are primary option for correcting KC vision. The rigid lens masks the underlying irregular cornea and functions as the new refractive surface of the eye, with the tear film filling in the space between the back of the contact lens and the front of the eye. “Rigid” defines the type of lens. “Gas Permeable” describes the lens material. There are many different RGP lens designs.

Contact-Lens2
Contact-Lens3
“Piggy-backs”
This is a two system: an RGP lens worn on top of a soft lens. The RGP lens provides crisp vision and the soft lens acts as a cushion providing comfort.

Hybrid lenses
This is a lens combination that has an RGP center surrounded by a soft skirt.

Scleral lenses
These are large diameter lenses that rest on the white part of the eye, called the sclera, and vaults over the cornea. The size can be a scary prospect for some, but scleral lenses have many advantages. Because of their size, they do not fall out, dust or dirt particles cannot get behind them during wear. They are surprisingly comfortable to wear because the edges of the lens rests above and below the eye lid margins so there is no lens awareness. The introduction of rigid gas permeable (RGP) materials has made this design more readily available.

Contact Lenses
Eye infections, while infrequent, can be devastating, preventing patients from wearing their contact lenses for days or weeks and sometimes resulting in permanent corneal scarring and loss of vision. A thorough understanding of the role played by each of the rigid lens care products will help to keep lenses clean and eyes healthy.

CARE SYSTEM FOR RIGID LENSES:

They consist of:
A daily cleaner, to remove tear film oils, mucus, cosmetics, and other debris from lens surfaces. Cleaning solution containers have a red tip to warn patients that the solution should not be put in the eyes. If cleaner is accidentally instilled in the eyes, it should be flushed out immediately, preferably by dunking the entire face into a sink filled with water.
A combination wetting/soaking solution for lens storage and reinsertion in the eye, which kills bacteria and other microorganisms, keeps lenses from warping, and acts as a “cushioning agent” when the lenses are placed in the eyes.
An optional enzymatic cleaner (in either liquid or tablet form), for patients who build up a lot of protein on their lenses. Not all rigid lens wearers need an enzymatic cleaner.
A lubricating and rewetting drop, to instill in the eye while you are wearing lenses. This will help to flush debris from under the lenses and help the lenses to glide more smoothly and comfortably in the eyes.
Rub the lens between your fingers! It may warp or crack! If the lens curvature is too steep for your index finger to clean the inner lens surface, try using your pinkie or a cotton swab.
Rinse the lens with cool or lukewarm water. Hot water will warp the lens. Do not rinse your lenses over an open drain!
Replace the right lens in the case and repeat the steps for your left lens.
Soak lenses overnight or for at least 4 hours.
In the morning, wash your hands and insert your lenses directly from the wetting/soaking or conditioning solution. Do not rinse first! The solution will help to cushion the lenses as you insert them. In addition, if the lenses are rinsed with water after they have been disinfected, there is a chance that they may become contaminated from impurities in the water supply.

ABNORMAL SYMPTOMS

Pain: when placing lenses on the eyes, while wearing the lenses, or after removing them
Burning, a sensation of heat, redness, excessive tearing, or discharge
Inability to keep the eyes open
Extreme sensitivity to light
Severe or persistent haze, fog, or rainbows around lights
Severe irritation
White spots on the cornea.

DO’S AND DON’TS FOR RIGID LENS WEARERS

Clean your lenses at night, immediately after you remove them from your eyes. Leaving them in the soaking solution without cleaning until morning reduces the effectiveness of the disinfecting chemicals. In addition, rinsing the cleaner off with tap water just prior to replacing the lenses in your eyes might introduce bacteria or other microorganisms that would ordinarily have been killed while the lenses soaked overnight.

If your lenses ever dry out, soak them for at least 4 hours before you wear them again, since they may have warped or flattened in curvature when the liquid evaporated.
Do not mix and match solutions made by different manufacturers. Doing so may cloud your lenses, cause them to become gummy, or irritate your eyes. Make sure that the cleaning, soaking, disinfecting, and wetting/rewetting products you buy are all part of the same care system.

Always store your lenses in a case with ridges on the bottom. Lenses tend to suction onto smooth-bottomed cases and may chip if you try to pry them up at the edges.
Replace your case each time you buy a new bottle of wetting/soaking or cleaning/soaking solution. Cases tend to become contaminated. You can clean case with your contact lens cleaner using a brand new inexpensive toothbrush. Be sure to rinse the case well before using it again.

If the skin on your hands is rough, ask your contact lens fitter if you can use a manually-agitated device such as the Allergan Hydramat or a mechanical device such as the Clensatron. These devices work like miniature washing machines and may protect the lenses from becoming scratched from your rough skin.

If you remove your lenses with a suction cup make sure you know exactly where the lens is before placing the suction cup on the eye. Suction cups should be cleaned with contact lens cleaner and rinsed after each use. They can also be soaked in wetting/soaking or cleaning/soaking solution.
If you drop a lens, do not drag it along a surface. Wet your finger with wetting/soaking or rewetting solution and touch it gently to the lens to lift it.

Article by

Narayana Netralaya

DACRYOCYSTORHINOSTOMY (DCR):

What is DCR?

Each eye has a fine pipe which drains the tears from the eye. This is a nasolacrimal duct (drain-pipe of the eye). If it gets blocked, the tears and stickiness come out of the eye. The treatment is by dacryocystorhinostomy (DCR). This is a technique by which a new passage is created from the eye into the nose, and the tears can drain out.

Is it necessary to undergo DCR?

When a nasolacrimal duct is blocked, the dirt and discharge accumulate in the lacrimal sac next to the eye. There is the risk of severe eye infection if the condition is left untreated. There may be swelling, pain, and watering. If a cataract surgery is planned, a blocked nasolacrimal duct increases the risk of dangerous infection; a DCR should be done before the cataract surgery.

How is DCR performed? What are the outcomes?

DCR can be performed in three ways- externally, through a small (less than half inch) line next to the nose; endonasally- through the nose; and trans-canalicular using Laser DCR.

The external DCR leaves a fine mark near the eye; it has the highest success rates, more than 95 out of 100 patients have the problem completely solved after external DCR. An endo nasal DCR is done through the nose, so there is no mark outside. The success rates are a little lower; all nose space inside is not suitable for endonasal surgery, and it can be done well in selected patients only. Trans-canalicular Laser DCR is a very rapid procedure, with hardly any pain and swelling. However, some of the DCR done with laser may close down again.

I have had a DCR done already. The eye is still watering. Why?
As mentioned, about 5 out of 100 patients find that their DCR has closed down again. This may particularly happen in a patient who had multiple attacked of infection earlier, with a history of injury near the nose, or a patient who has frequent nasal allergies and colds. The DCR can be repeated, with addition of silicone intubation to prop the passage open. A typical oculoplastic surgeon will often see patients sent over from elsewhere after the DCR did not work; most such patients can be re-operated successfully.

Article by

Narayana Nethralaya

PTOSIS
What is ptosis?
Ptosis is drooping of the eyelid. The eye appears smaller, there is difficulty opening th e eye. Ptosis may occur in one eye or both eye. There is obstruction of vision and a sleepy and tired appearance.

Why does ptosis occur?
There is a muscle in the upper lid, called the levator- the function the levator is the lift the eyelid open. If the levator is not working well, the eyelid droops.
In many patients who have ptosis since birth, the levator muscle is weak since birth.
In patients where ptosis starts later in life, there may be multiple causes : injury, age, use of contact lens for many years, some neurological diseases.

Do we need to consult a neurologist?
A small proportion of ptosis stems from neurologic diseases. Usually the oculoplasty surgeon is able to differentiate these on examination. They will then refer you to a neurologist.

How important is it to correct ptosis?
For an adult, a ptosis can block part of the visual field, obstructing the vision. There can be strain by lifting the brow muscles to compensate. More and more people opt for ptosis correction to avoid looking tired, sleepy and unhappy.

In a child, the ptosis may cause delay in the development of vision, and a lazy eye (amblyopia). This has to be corrected at a young age, and appropriate glasses and exercise started. Once the patient is older, vision correction cannot be achieved. It is extremely important to have an accurate assessment of vision in a child with ptosis.

What are the methods of correction of ptosis?
The oculoplasty surgeon assesses the measurements of the eye. If the natural muscle can be strengthened with stitches, that is the method of choice. If the natural muscle levator is too weak for correction, an implant (most commonly silicone) is places to connect the forehead muscles and the eyelids. The patient can then effectively use the forehead muscle to lift the eyelid.
Some neurologic diseases such as myasthenia can be treated by oral medicines.
Rarely, there are some ptosis patients where it is not safe to do surgery. These patients are recommended crutch glasses, spectacles which prop the eye open.

What are the outcomes with ptosis surgery?
After ptosis surgery, the final outcome is known at 6 weeks .This is because each person’s body heals in a slightly different way, and a small percentage of uncertainty remains. Eight of ten patients have the eyelid set exactly at the correct height, two may be little higher or lower.

Usually the eyelid height is equal when the patient looks forward, but some difference is seen when the patient looks upward or downward. In a few patients, when the patient sleeps after surgery, a small gap may remain open in the eyelids. A silicone sling when used, has greater flexibility, allows natural blinking, and can be re-adjusted if required.

Article by
Narayana nethralaya