It's something important you want to know.

R Vision Eye Hospital is a tertiary eye care centre, founded in 2019, for the visual rehabilitation of people in and around Iritty.

At R Vision Eye Hospital, we respect the unique and individual needs of our patients and hence strive to provide the utmost quality of care, with the best infrastructure and technology, for their life long health and vision.

The aim of the hospital is to provide state of the art treatment options to the entire gamut of eye diseases, with a focus of affordability and efficiency. Modern equipments in the outpatient and operation theatre complex, innovative treatment strategies, provided by a team of experts form the backbone towards the success strategy of R Vision Eye Hospital.

R Vision Eye Hospital is equipped to handle all eye ailments, ranging from refractive error correction to complex ocular diseases, with its plethora of instruments, experienced team of professionals, exclusive work stations, spacious cabins, a dedicated operation theatre complex with all facilities, and above all, the mindset to be the 'best' in what we do.

Rest assured, we will do the best, for your 'right' vision. WHAT WE OFFER

• 1) Outpatient services - optometry stations and consultation rooms.
• 2) Opticals - for refractive error management, with precise measurements and correction.
• 3) Pharmacy - quality medicines dispensed for eye ailments.
• 4) Scans & Lasers - for convenient diagnosis and management of eye diseases, so that your treatment is not delayed.
• 5) Operation Theatre Complex - state of the art operation theatre equipped with HEPA filter with recovery room.
• 6) CSSD - central sterilization unit to ensure a sterile and completely safe working environment.

FOR YOUR EYES !

R Vision Eye Hospital is equipped with the latest technology and paraphernalia, since it is our firm belief that there should be no compromise, when it comes to our patients' vision.

• 1) Digital visual acuity chart.
• 2) Auto-refractokeratometer.
• 3) Lensometer.
• 4) Retinoscope - Keeler, USA.
• 5) Slit lamp.
• 6) Applanation tonometer - the gold standard in intraocular pressure measurement.
• 7) Indirect Ophthalmoscope - Keeler, USA.
• 8) Colour vision chart - Ishihara.
• 9) Amsler Grid chart.
• 10) A scan / Digital Biometry Reader (DBR) - for accurate measurement and calculations during cataract and refractive surgery.
• 11) B scan.
• 12) 3D Optical Coherence Tomography and Fundus photography - for accurate diagnosis of retinal diseases and glaucoma management.
• 13) Nd YAG laser.
• 14) Phacoemulsification - Oertli, Switzerland.
• 15) State of the art Operation Suite, equipped with AHU and HEPA filter, to ensure the safest working environment in terms of sterility.
• 16) Electronic Medical Records - eliminating unnecessary paper trails.

An in-house opticals provides modern eyewear options at nominal costs, with precision, double checked by our expert doctors.

An in-house pharmacy ensures that quality medicines for eye ailments are dispensed, with minimal inconvenience to our patients.

Dr. Ramesh Hariharan

A dynamic ophthalmologist with varied interests and pursuits !

As an ophthalmologist, he takes a keen interest in improving the health and well being of his patients, and pursues it as his prime motive.

His clinical expertise focuses on comprehensive management of ocular pathologies and diseases with particular emphasis on anterior segment, corneal and ocular surface diseases. His clinical interests include a wide array of diseases especially managing corneal infections, keratoconus, dry eyes and diabetic retinopathy. His clinical research and papers have been well received and appreciated at numerous national and international podiums and symposiums.

With specialty training under the mentorship of Prof. Dr. Srinivas.K.Rao (former President, Cornea Society of India and a renowned clinician in management of corneal disorders) and Prof.Dr.Navin Jayakumar (an eminent neuro-ophthalmologist and cataract surgeon par excellence), he is adept at managing various ocular diseases with use of clinical and adjunctive investigations to provide effective treatment strategies for complex ocular conditions.

He truly believes and follows the adage - 'Coming together is a BEGINNING, staying together is PROGRESS and working together is SUCCESS'.

You can find him analysing science and spirituality in his free time, when not busy restoring vision to his patients.

R Vision Eye Hospital functions to provide eye care across all the segments.

ROUTINE OPHTHALMIC EXAMINATION

What does a routine ophthalmic examination entail?

A routine ophthalmic examination, after mandatory registration formalities, begins with the recording of the detailed history of the eyes and systemic ailments, relevant family history and current medication history, optometric assessment of your uncorrected and best spectacle corrected visual acuity, assessment of ocular movements and pupillary responses.

Your ophthalmologist will see you next and assess the general condition of the eye, following which your doctor may recommend dilation and follow it up with the examination of your retinae and nerves, in detail. The necessary prescriptions shall be handed over by the doctor and you will be guided towards the requisite stations.

A routine ophthalmic examination may take up to 30 minutes, while dilation may require an additional 45 minutes. Your visit at the hospital may require an overall time estimate of 1 to 1.5 hours, not including the time for investigations.

When is an eye examination required?

Any change in vision or ocular comfort warrants an immediate eye exam, as does an injury to the eye. Other indications for an eye exam are abnormal head postures or squinting eyes in children, or a tendency to hold objects very close to the eyes. Even in asymptomatic children, a routine screening evaluation at the time of schooling can help detect conditions like a 'lazy' eye, small degrees of squint, color deficiency, and loss of 3-dimensional perception. In adults, a routine evaluation at the age of 40 years, allows the detection and correction of presbyopia, and monitors the intraocular pressure to ensure that glaucoma does not exist. Periodic eye exams after the age of 50 years at yearly intervals, or when systemic conditions like hypertension or diabetes are detected, as necessary.

Are specialised tests done during a routine ophthalmic examination?

Apart from the routine procedures described above, if problems are detected, then your ophthalmologist may decide to order special investigations and procedures, after discussing their need with you. These could include investigational procedures like photography of the optic nerve for glaucoma, ocular ultrasonography for evaluating the posterior segment of the eye, optical coherence tomography for retinal disease, keratometry and eyeball length measurement for determining the power of the intraocular lens required during cataract surgery, or laser procedures using the Nd:YAG or Argon lasers for other eye problems.

Investigations can be done during the primary visit itself, at R Vision Eye Hospital, as the center is equipped for TOTAL VISION CARE.

REFRACTIVE ERROR

What are refractive errors?

In a normal eye, light is focused onto the retina, a light-sensitive tissue lining the back of the eye, for clear vision. Refractive errors exist when the curvature of the eye is mismatched to the length of the eye and light rays cannot focus properly on the retina. Myopia (near sightedness) is the most common refractive error, and occurs when the eye is too long or the cornea is too steep. Near vision is possible but distant objects appear blurred. Patients with hyperopia are farsighted; they can focus on more distant objects, but close-up objects appear blurry. This occurs when the eye is shorter than normal or the cornea is too flat. In astigmatism the curve of the cornea, and sometimes the lens, is uneven - steeper in one direction than the other - like a football or the back of a spoon. Presbyopia is the age-related loss of close-up focusing ability.

Who can get refractive errors?

Refractive errors can occur as part of the development of the eye in children, when they are usually of a mild to moderate degree, or they can be inherited from the parents, when they are moderate to severe in degree. In adult life, refractive errors can become manifest as the muscles in the eye weaken - this is usually seen with hyperopia. Refractive errors can also occur at any age due to pathological changes in the structures of the eye.

How do I decide which modality of refractive correction is suitable for me?

A variety of refractive options are now available that will fulfil the needs of all patients. It would be best to discuss your needs and requirements with your ophthalmologist - after a detailed evaluation of your eyes, the doctor would help you decide the most suitable option for your eyes.

What are the different types of spectacles and what are their advantages?

In general, spectacles form a safe and effective form of correction for most visual needs. A variety of options exist for this - both in the form of frames which can be light and hardy - shell frames; rimless and semi-rimless for a more stylish appearance; metal frames in various colours and designs; and designer wear for the fashionable. Lenses for refractive correction can be single vision - and with the advent of the high refractive index lenses, these can be made quite thin, both in glass and plastic to allow an acceptable cosmetic appearance.

What are 'progressive' lenses and when are they indicated?

For older persons, who need bifocal corrections, the advent of the progressive lenses has proved a boon, and not only are these cosmetically better in appearance, they also provide enhanced functionality. The absence of a separately powered inferior segment - as in the traditional bifocal - allows a seamless change in power from that for distance vision, to that for near vision - and this also incorporates the effective correction for intermediate distance - which is especially useful for those who work with computers for their daily activities. These glasses are also more suitable for those who spend time outdoors and indoors as the lack of a bifocal segment enables them to adjust easily to all activities.

Where can I get these spectacles made?

R Vision Eye Hospital has an in-house optical service for the needs of its patients. Spectacle frames and a variety of lens choices are available to ensure that patients have their needs met in a scientific and cost effective manner.

CATARACT

What is cataract? What are its associated symptoms?

Cataract is defined as the loss of transparency of the human crystalline lens. As we grow older, the lens proteins lose their clarity and elasticity. Thus, less light passes into the eye and we are unable to see clearly - this change is what we call a cataract. As the lens becomes more rigid it is not able to change shape and hence we are unable to see near objects (presbyopia). A gradual loss of clear vision is the main symptom of a cataract. Vision - for distance or near or for both may be blurred, objects may have fuzzy edges, lights at night may have coloured haloes, and there can be changes in colour perception. Sometimes, doubling of images may occur. Depending on the type of cataract, some of these changes are worse at night, some in daytime, and some - all the time. Cataractous changes in the lens often progress gradually, and are painless.

What are the major causes of cataract?

Apart from ageing, a number of other factors can influence cataract formation - injuries, inflammation in the eye, other eye diseases, diabetes, use of some medications, and so on. Sometimes, they are genetic and can be seen at birth.

What are the treatment modalities of cataract?

There is unfortunately no proven treatment to prevent, slow or reverse the progression of age- related cataract. At present the definitive treatment for a cataract remains surgery. The surgeon will remove the opaque lens through a very small opening in the eye wall in a fast, painless manner. The small opening made closes on it own without any need for stitches. The operation can be done either using anaesthetic eye drops or an injection to anaesthetise the eye. A foldable lens (intraocular lens or IOL) is inserted through the small opening. The new lens inside the eye allows a greatly improved quality of vision and minimises the need for glasses.

What are the advances available in cataract surgery?

With current technology, cataracts can be removed with a high degree of success and safety. There are a number of choices for IOLs. Yellow-tinted IOLs reduce the entry of blue light into the eye - as this may be harmful to the retina. Toric IOLs allow excellent unaided vision in people with corneal astigmatism. Prior to the availability of these lenses, such patients needed ancillary surgical procedures or glasses after surgery for clear vision. Multifocal IOLs try to reduce the need for reading glasses after surgery. Aspheric IOLs improve the contrast and quality of night vision. It is best to discuss with your doctor about the appropriate choice of lens for your eye.

Can cataract recur after surgery?

No. However, the surgeon retains a part of the natural crystalline lens - the capsular bag. The posterior surface of the capsular bag may thicken after cataract surgery and lose its transparency. This may sometimes cause blurred vision many months to years after the cataract operation. If a patient experiences significant difficulty due to this, a simple laser procedure (done in the consultation room itself - Nd YAG laser) clears the membrane to quickly restore clear vision.

General health information

Although cataracts are often due to ageing, exposure to ultraviolet light may hasten these changes. Wear the right type of dark glasses when you are outdoors in bright sunlight. This will reduce ultraviolet light exposure and may help protect your eyes. Good control of diabetes also helps to reduce the rate of progression of cataract. And stop smoking - that helps as well!

CORNEA & OCULAR SURFACE DISEASES

What can go wrong with my cornea?

Infections - A variety of microbial agents can infect the exposed corneal surface, especially if there is injury. Contact lens use is a known risk factor for corneal infections. Unless treated promptly, severe vision loss can occur.

Injuries - Despite the protection of the lids, due to its exposed position, the cornea can be injured easily. This can result in corneal tears or if chemicals are involved, extensive burns of the entire ocular surface.

Inflammations - The cornea is affected in a number of conditions affecting the lids, conjunctiva, or other parts of the body. These can result in significant corneal inflammation and damage unless prompt, expert care is provided.

Genetic conditions - A variety of inherited diseases manifest at birth or in later life and can affect the size, shape or clarity of the cornea. Some of these may be a part of a wider syndrome with other eye and systemic changes.

Surgical damage - Although cataract surgery is a safe and effective procedure, it can sometimes produce corneal damage - especially in eyes with inherited corneal pathology. In these eyes, fluid collection in the cornea reduces sight.

Miscellaneous - Tumours can involve the cornea, and damage can result from improper contact lens fit and use. The cornea can be affected in dry eyes, improper lid closure, and if there is damage to the nerves supplying the eye.

What can go wrong with my sclera?

As with the cornea, the sclera can be involved in infections, injuries, inflammations, in some genetic conditions with extreme scleral thinning - resulting in a 'blue' appearance of the eye, and surgical damage.

How can I know if my cornea or sclera is involved?

Since the primary function of the cornea is to provide clear sight, most conditions affecting this structure will result in altered visual function. However, small, peripheral changes may not initially affect vision, but may produce pain, irritation, redness or discharge. Many scleral conditions can result in severe pain in and around the eye. Persistent eye pain is often a sign of serious eye disease and should not be ignored.

How can these be treated?

Infections and inflammations of the cornea and sclera can often be treated medically in the early stages, although some surgical treatment may be needed if the condition is advanced. While very minor injuries can be carefully observed, most need to be treated. Similarly, early tumours can be treated with medications, while large extensions need surgery. Many of the conditions affecting the clarity of the cornea will need surgical therapy.

Recent advances in the management of these diseases?

Newer antibiotics help eradicate most of the infections in these structures. Chemical injury to the cornea can be effectively managed by limbal stem cell transplants, and in end-stage disease, by the use of an artificial cornea, keratoprosthesis. Corneal transplantation for scarring can now be done in a limited, lamellar manner, increasing the safety of the procedure. Similarly, for corneal fluid collection, a limited replacement of the posterior layers of the cornea dramatically improves the safety and outcomes of the procedure.

General information

If chemicals splash into the eye, it is important to promptly and thoroughly irrigate the eye with clean water. Especially in one-eyed people, the use of a shatterproof polycarbonate glass would reduce the risk of eye injuries.

GLAUCOMA

What is glaucoma?

Glaucoma is a leading cause of blindness especially for older people. It is a disease of the optic nerve. When damage to the optic nerve occurs, blind spots in the field of vision develop, and usually go undetected until the optic nerve is significantly damaged. Early detection and treatment are the keys to preventing optic nerve damage.

Who is at risk for glaucoma?

The most important risk factors include age, elevated eye pressure, family history of glaucoma, ? farsightedness or nearsightedness, past eye injuries, thinner central corneal thickness, systemic health problems,? including diabetes, migraine headaches, and poor circulation.Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a glaucoma suspect.

How is glaucoma detected?

Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. The only sure way to detect glaucoma is to ? have a complete eye examination.During your glaucoma evaluation, your ophthalmologist will: measure your intraocular pressure (tonometry); inspect the drainage angle of your eye (gonioscopy); evaluate whether or not there is any optic nerve damage (ophthalmoscopy, optical coherence tomography).

How is glaucoma treated?

As a rule, damage caused by glaucoma cannot be reversed. Eye drops, laser surgery, and surgery in the operating room are used to help prevent further damage. In some cases, oral medications may also be prescribed. Periodic examinations are very important to prevent vision loss. Because glaucoma can progress without your knowledge, adjustments to your treatment may be necessary from time to time.

General information:

Regular medical eye exams help prevent unnecessary vision loss. Recommended intervals for eye exams are:? Ages 20 to 29: Individuals with a family history of glaucoma should have an eye examination every 3 to 5 years. Others should have an eye exam at least once during this period.

Ages 30 to 39: Individuals with a family history of glaucoma should have an eye examination every 2 to 4 years.? Others should have an eye exam at least twice during this period.Ages 40 and older: Every year.

DIABETIC EYE DISEASE

How can diabetes affect the eye?

Diabetes mellitus, characterised by raised blood sugar levels can cause a myriad of eye diseases, ranging from simple refractive errors to inflammation of the ocular surface (blepharoconjunctivitis) to potentially vision threatening diabetic retinopathy and optic neuropathy.

How can diabetic eye disease be ascertained?

The patient and the doctor work together, wherein, the patient has to provide the details of his/ her glycemic profile and hypoglycemic agents, along with any recent blood reports. The doctor ensures a thorough ophthalmic examination, with dilated retinal examination, as a part of the routine visit. Ancillary investigations may then be discussed by your doctor with you, following which appropriate therapy with medications or surgery may be discussed by your doctor with you.

Recent advances in management of diabetic eye diseases?

Optical coherence tomography provides a non - invasive micro structural analysis of the retinal damage caused due to diabetic retinopathy.Therapy involves conventional laser photocoagulation, with intravitreal triamcinolone acetonide for diabetic macular edema and anti VEGF injections,which have been added to the existing armamentarium.

RETINAL DISEASES

What are the common causes of these diseases?

Genetic causes, injuries, infection, tumours, systemic conditions, high refractive errors, and ageing changes account for most of these diseases.

How can these conditions be detected?

A detailed evaluation of the back of the eye after dilation of the pupil, using an instrument called the indirect ophthalmoscope is required. In patients with diabetes and age related central retinal changes, optical coherence tomography may be needed. If there is bleeding in the vitreous, ultrasonographic examination can help identify retinal changes.

How can these conditions be treated?

In changes of the blood vessels, the use of retinal lasers is often helpful, and these are also used to prevent serious eye disease in diabetics. In patients with infections, antibiotics; and in those with inflammation, steroids can be used. If there is serious vitreous bleeding or retinal detachment, surgery is required to restore vision. In age related central retinal disease, in addition to laser therapy, the injection of medications into the eye can be helpful.

Recent advances in vitreous and retinal diseases?

Instruments are now available that allow the diagnosis of these diseases at a very early stage. Newer treatment options include photodynamic therapy for subretinal neovascularization, the use of intravitreal triamcinolone injections for diabetic macular edema, and anti VEGF agents for age related macular degeneration, all of which have improved our ability to treat retinal diseases.

General information

High myopes may be prone to central and peripheral retinal changes and should have a routine yearly eye exam. Similarly, diabetics and hypertensives should have a yearly eye exam in addition to good control of the systemic condition to protect their eyes and sight.

COMPUTERS & THE EYE

What is the Computer Vision Syndrome?

Most people who work constantly with computers tend to have some or all of the following symptoms - eyestrain, eye fatigue, dry eyes, light sensitivity, blurred vision, loss of focus, double vision, headaches, and neck and shoulder pains. This symptom complex has been termed the computer vision syndrome (CVS).

What causes this problem?

CVS is caused by our eyes and brain reacting differently to characters on the screen than they do to printed characters, which are usually dense black characters with well-defined edges. Healthy eyes can easily maintain focus on the printed page. Characters on a computer screen, however, don't have this contrast or well-defined edges. These characters (pixels) are brightest at the centre and diminish in intensity toward their edges. This makes it very difficult for our eyes to maintain prolonged focus on these images. Instead our eyes drift out to a point called the "resting point of accommodation", and then strain to regain focus on the screen. This continuous flexing of the eyes' focusing muscles creates fatigue and the burning, tired-eyes feeling.

What can I do about it?

The solution is to see a doctor who understands CVS and its treatment. Since a computer is usually viewed from a different distance (18"-28") than that for reading distance (16"-21"), your doctor can prescribe computer eyeglasses that will allow you to work comfortably and productively. These help in eliminating the constant refocusing effort, that your eyes will otherwise perform.

Place the computer terminal below the level of your eyes, so that you look down at it. Looking up at the screen causes your upper lid to ? lift and exposes more of the ocular surface to the drying effects of a low humidity air-conditioned environment.Concentrating on the screen is often associated with a reduced blink rate, and decreased comfort. Constant, conscious blinking when working on computers can therefore help. Another useful thing to remember is the 20-20-20 rule. Every 20 minutes, one should look away from the screen into the distance (20 feet), for 20 seconds to rest the eye muscles.

Will glare screens help?

Glare screen filters may help somewhat, but they will not solve your computer vision problems because they only affect glare from the computer screen - not the visual problems related to the constant refocusing of your eyes when working at a computer. Only when your eyes can focus clearly at the plane of proper distance on the computer screen can they experience relief from the fatiguing effects of CVS. An anti-reflective coating (AR) is also highly recommended on all computer eyeglasses. An AR coating prevents glare and reflections on the front and the back of the lenses that would interfere with focusing on the screen.

How can CVS be treated?

Your doctor will need to perform a complete eye exam to determine the various factors that may be responsible for the CVS in your case. This will include an estimation of your vision and refractive error, and the need for glasses for the distance at which you view the monitor. If the ability of the eyes to move towards each other (convergence) is less, or the tone of the muscles inside the eye that allow the lens to change shape (accommodation), is reduced, then these need to be treated. The health of the lids and the tear film is also important and needs to be assessed. The work environment and the design ergonomics of the desk and chair will also need to be determined. Based on the above, your doctor would be able to help by providing the appropriate correction - glasses, eye exercises, suggestions about your work environment and posture, and help monitor your condition.

General information

CVS has multiple causes, and these suggestions are intended to increase your working comfort - working distance from eye to screen should be set between 20" and 26", viewing angle for the screen should be 10 degrees to 15 degrees below straight-ahead gaze position, room lighting should be free of glare, place computer screens at 90 degrees angles to windows whenever possible, reduce room lighting so that screen brightness and contrast can also be reduced to more comfortable levels.

NEURO - OPHTHALMOLOGY

The optic nerve is a cable of 1.2 million nerve fibres that convey vision in the form of electrical impulses from the eye to the brain. Damage to the optic nerve can result in loss of vision. Unlike other nerves, the optic nerve is actually an extension of the brain itself. Thus serious brain disorders can often present with vision related symptoms. The neuro-ophthalmologist is a specialist who deals with optic nerve and visual pathway problems.

What can go wrong with the optic nerve?

Involvement of the optic nerve is termed optic neuropathy and can be due to various causes. Injury: Trauma can permanently damage the optic nerve. Sometimes early treatment with high dose intravenous steroids can help recover some vision. Inflammation: Optic neuritis (optic nerve inflammation) can occur due to a variety of causes and is sometimes associated with a neurological condition called multiple sclerosis in which other nerves may also be affected at different times. An MRI scan is helpful in arriving at the diagnosis. Visual loss is sudden in onset. The visual outcome is generally very good and treatment with intravenous steroids is sometimes recommended.

Ischemia: The optic nerve can be damaged by lack of blood circulation (ischemia). This commonly affects middle-aged individuals with risk factors like diabetes, high blood pressure, or elevated cholesterol. Loss of vision is usually sudden in onset. The outcome is variable with 40% of patients having some visual improvement. Another more serious kind of damage can occur with a disease of blood vessels called temporal arteritis.Raised fluid pressure within the brain: This is a serious condition that can lead to blindness and even be life threatening if caused by brain tumours. The eye doctor is often the first person to detect this because one of the early signs is swelling of the optic nerves termed papilledema. Other causes: These include drugs like ethambutol (used in TB treatment), methyl alcohol poisoning, nutritional and vitamin B complex deficiencies. Tumours of the optic nerve cause gradual progressive loss of vision. Optic nerve disorders can occasionally be genetic in origin.

How will I know if I have these problems?

Visual loss - gradual or sudden in onset, temporary blurring of vision lasting a few seconds to minutes, and loss of side vision (visual field defects) are symptoms of optic nerve disease.

How can these conditions be detected?

A detailed evaluation of the eye with special attention to the reactivity of the pupil and the appearance of the optic nerve head at the back of the eye is required. Common tests done to evaluate optic nerve function include testing of colour vision and examination of the visual field. Sometimes additional testing to evaluate the thickness of the nerve fibre layer (Optical Coherence Tomography or OCT) and electrophysiological tests called VEP (Visual Evoked Potential) may be needed. Suspicion of intracranial (brain related) conditions requires imaging of the brain by CT or MRI scan.

How can these conditions be treated?

Optic nerve disease is difficult to treat since once an optic nerve fibre is damaged, it is difficult to restore it to normal function. Nevertheless, some optic nerve diseases such as optic neuritis have good outcomes with treatment. Even if the visual outcome is guarded, it is necessary to investigate the causes thoroughly to preserve existing vision and prevent further loss of sight.

Recent advances in vitreous and retinal diseases?

Optical Coherence Tomography (OCT) is a new investigation that allows us to measure nerve fibre loss as never before. This helps early detection of even subtle loss of nerve fibres. Early treatment intervention can thus preserve vision. MRI imaging has greatly increased our ability to detect and characterise brain lesions such as multiple sclerosis, tumours, and infarctions. Preventing damage in optic nerve injury and even regenerating a damaged human optic nerve will soon become realities in the near future.

General information

Patients with optic nerve disease should have periodic examinations as per the doctor's advice. Those with risk factors like diabetes, high blood pressure or cholesterol, those taking ethambutol tablets should also undergo periodic eye check-ups.

THE CHILD'S EYE - PEDIATRIC OPHTHALMOLOGY

What is different about a child's eye?

Although structures in the child's eye are similar to that in adults, the visual pathways continue to develop in a child. Hence, any obstruction to vision at a young age can cause permanent damage to the system that cannot be corrected later. Since small children often may not notice such changes, it is very important that all children undergo a screening eye exam at an early age.

What are the common problems in a child's eye?

A common problem is a refractive error - high myopia, hyperopia, or astigmatism may exist in one or both eyes, especially if these are also present in the parent. These may be associated with misalignment of the eyes, or squint, which can however, also exist by itself. Other problems can be structural - cataracts, glaucoma, corneal or retinal disease, and these may be present from birth. A rare but very serious problem is a tumour of the retina - retinoblastoma. If the normally black pupil appears white (white reflex) in the eye of a child, please arrange for an immediate eye exam, as also in the case of premature births.

What is a 'lazy eye'?

Amblyopia, also known as 'lazy eye', is reduced vision not correctable by glasses or contact lenses and is not due to any eye disease. The brain, for some reason, does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but rarely both eyes can be involved. A simple vision screening test can detect this condition, and should be performed in all children since amblyopia is best treated BEFORE 8 YEARS OF AGE.

What is a 'squint'?

Strabismus or 'squint' is a vision condition in which a child cannot align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time, such as, under stressful situations or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. Children do not outgrow strabismus!

What is nystagmus?

Nystagmus is an involuntary rhythmic shaking or wobbling of the eyes. The eyes move constantly in various directions, although horizontal movements are the most common. The presence of nystagmus in a child is often an indication of vision problems. Treatment will depend on the cause. Sometimes, the presence of a nystagmus can indicate neurological dysfunction, and rarely, it can be a side effect of medication use.

How can these conditions be detected?

Children may not complain of problems, and a detailed examination is needed at the earliest. Parents may notice peculiar head posturing, constant side-to-side eye movement, squinting, sitting very close to the TV, or a white reflex in the pupil. The eye exam includes assessment of vision, special tests for stereopsis, (ability to use both eyes simultaneously), eye alignment, pressure and thorough examination of the front and back of the eyes. In case of infants, your doctor will discuss about the need of examination under general anaesthesia with you.

How can these conditions be treated?

If a refractive error is detected early, simply providing the correct glasses will correct the problem. If detected late, and one or both eyes are already 'lazy', then in addition to glasses, other measures may be required - these include eye exercises, and patching or occluding an eye to force the child to use the other eye, thereby 'strengthening' that eye. If there is a squinting of the eyes, in some types, glasses may be corrective, although quite often surgery may be required. For other problems, like cataract, glaucoma, corneal and retinal disease, the doctor will discuss in detail the options for treatment - these could include the use of laser treatment or surgery. If a retinoblastoma (eye tumour) is present, early care is necessary to save the eye and life of the child.

General information

Your child should have his or her first eye exam done during the first year of the child's life. The next eye exam will be at the age of 3, and once again before entering kindergarten, or by age 5. Thereafter, your child should receive a comprehensive eye exam at least every two years. Since prevention is better than cure, it is better to detect these problems at an early stage.