ARMD is degeneration of the most sensitive part of the retina (sensory part of the eye) called macula. It is mostly seen in people over the age of 50. Initially it is a silent disease and can affect one eye. At this stage it might be detected by an ophthalmologist on routine retina evaluation. Gradually vision loss increases mainly in the centre allowing better vision at the sides, but making reading or close work difficult without use of special low vision aids.

ARMD is of two types: dry and wet. Dry type is more common and leads to a slow atrophy of the macula. Wet type of ARMD is the less common form and leads to the formation of abnormal blood vessels and haemorrhage beneath the macula.

The dry form, which is the more common variety, generally does not lead to blindness but can lead to a decrease in vision. The wet form, which is the less common variety, can lead to a marked fall in vision and blindness. The loss of vision occurs because of damage to the most sensitive part (macula) of the retina by blood and exudation.

The exact cause of macular degeneration is not known, though, the following risk factors have been identified: age, heredity, sex (women are more affected than men), light ocular pigmentation, hypertension, cardiovascular diseases, diabetes, photo toxicity and cigarette smoking.

If only one eye is affected to begin with, the symptoms are not noticeable in early stages. Early symptoms are metamorphopsia, i.e., straight lines appear to be wavy and the appearance of a black patch in front of the eye. The patient says that he/she can perceive well around the patch but cannot see within the dark circle. There may also be a sudden or gradual painless loss of vision.

Since ARMD is a silent disease in the initial phase, it is picked up mostly in a routine examination by an ophthalmologist. The retinal examination done by an ophthalmoscope will show the findings of this disease process. To assess the condition in detail, certain other tests are done.

Amsler Grid: It is a test paper with graphic picture to be used at reading distance with near glasses on. This is used to check the extent of sight loss, dark spot, distortion or missing of straight lines. It is also given to the patient to take home so that he can monitor his symptoms at home and report immediately if there is any worsening.

Fluorescin Angiography (FA): The photographs of macula are taken after injecting a dye in the patient's arm. The dye on reaching the eye helps to clarify the type and extent of disease, including details of abnormal vessels, leaks and membrane formations.

Optical Coherence Tomography (OCT): This is like an optical ultrasound of the eye. It gives the doctor information about the exact location and type of abnormal membranes that form beneath the retina. OCT and FA are also good tools for following up the progress of a case of ARMD.

There is no permanent cure for ARMD. In some cases ARMD may be active and then slow down or even stop progressing for many years. The aim is to keep a check on progression of the disease and take measures to improve functional capability of the patient.

Yes, it is the safest and one of the most advanced surgeries in the world.

No, the patient does not experience any pain. The procedure is safe and painless and the patient only experiences a slight pressure sensation. The procedure itself is very comfortable for the patient.

The recovery is very fast owing to the simplicity of the procedure. One can resume normal activities as early as after 24-48 hrs of the surgery with only a few precautions.

No, the power never comes back. Only in very rare cases where the refractive power is very high to begin with, a minimal residual power may remain, which can be corrected by what is known as enhancements, (which again can be assessed only after 1-2 months of the operation) depending on the patient's need.

No, there has been no reported case of blindness so far.

The chances of the complications happening are rare but in the event of any such complication occurring, our surgeons are very competent to take care of them.

One can get the surgery done after the age of 18 years with stable power of glasses for the last 1-2 years.

Yes, the treatment is designed to last a lifetime. Only after the age of 40 years, does a person require reading glasses.

Invention of spectacles was a great achievement at a time when patients with refractive error were severely handicapped or practically blind. Spectacles enjoyed a high degree of popularity for a long time, but now their disadvantages such as, cosmetic blemish, restricted field of clear vision, aberrations, obstruction in sports and physical discomfort, etc. are apparent. However, this does not mean that spectacles are to be condemned. There are still many situations where spectacles are the only alternative available for restoration of vision and also a respectable visual device.

The lens is the part of the eye that along with cornea helps focus light onto the retina. The retina is the eye's light-sensitive layer that sends visual signals to the brain. The lens is located just behind the iris, the coloured (brown, blue or green) part of the eye. In focusing (accommodation), the lens changes shape. It becomes more convex (curved) when you look at nearby objects and flatter for distant objects.

The lens is made mostly of water and protein. The protein is arranged to let light pass through and focus on the retina. Sometimes some of the protein clumps together and starts to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it hard to see.

Although researchers are learning more about cataracts, no one knows for sure what causes them. Scientists think there may be several causes, including smoking and diabetes. Or, it may be that the protein in the lens just changes as it ages. There is also some evidence that cataracts are linked to certain vitamins and minerals. Exposure to ultra-violet light has a definite role in the formation of the cataract.

Human eye has a natural lens, which is normally transparent and forms a clear image of the outside world in the eye. When this lens develops haziness/opacity, the sight is decreased or may be even completely lost. This is called cataract.

Cataract may develop at any age - right from birth to old age - but is most commonly seen in the elderly, after the age of sixty. By the age of 90, almost 98% of the people have had some degree of cataract.

In the old age, cataract may be caused due to the normal aging process, but, at a younger age, it may occur due to a number of reasons, e.g. some eye diseases like uveitis, general diseases like diabetes, heredity, injury, radiation, infections and many more.

The most important symptom of cataract is a decrease in vision for distant and/or near objects. Other features can be decreased vision in bright or low light, decreased contrast, altered colour appreciation, seeing many images of one object, rapid changes in the number/power of glasses, or sometimes pain, redness and watering. In advanced cases there is a complete loss of vision and the pupil becomes pearly white in colour. However, none of these symptoms are seen exclusively in cataract.

Age-related cataract: Most cataracts are related to aging.

Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.

Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.

Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.

A comprehensive eye examination usually includes:

Visual acuity test: This eye chart test measures how well you can see at various distances.

Pupil dilation: The pupil is widened with eye-drops to allow us to see more of the retina and look for other eye problems.

Tonometry: This is a standard test to measure eye pressure. Increased pressure may cause glaucoma.

Ultrasound (biometry) of the eye to calculate the power of the lens to be implanted. Other eye and general tests may be required to establish complete diagnosis and fitness for cataract surgery.

The treatment of cataract is essentially surgical and the timing is decided by the patient's visual needs. A cataract needs to be removed only if it affects one's vision so much that it interferes with one's daily activities. The patient needs to make this decision. If you have cataracts in both eyes, the operation on the eyes is performed preferably in an interval of one month (unless there is any emergency).

Problems after surgery are uncommon, but they can occur. These can include infection (in severe cases endophthalmitis), bleeding, higher pressure inside the eye (glaucoma), inflammation (pain, redness, swelling), haziness of the cornea and detachment of the retina. Any such problem should be immediately reported to the eye surgeon especially in the event of unusual pain, loss of vision, or flashing lights.

After the surgery, you can read and watch TV almost right away, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. This healing period may take many weeks. With an Intraocular Lens IOL, for example, you may notice that colours have a blue tinge, and that after you've been in bright sunlight, everything is reddish for a few hours. It doesn't take long to adjust to these changes.

Sometimes people after cataract surgery develop an opacification of the lens capsule on which the lens is placed. This is called after-cataract. This can easily be treated by a Laser called YAG Laser which makes a small opening in the capsule - YAG Capsulotomy.

Regular eye examinations after the age of 50 years are mandatory to detect eye diseases early and to institute timely treatment. Prevention of exposure to UV rays by regular use of UV protective sun glasses may confer certain degree of protection. However, any research or studies do not support this conjecture.

Today, cataract removal is one of the most common operations performed in India. It is also one of the safest and most effective. More than 90 percent of the people who have cataract surgery have better vision afterwards.

Currently, phacoemulsification with a foldable intraocular lens implantation through a 3 mm incision is the most preferred method of cataract surgery and has the best results, all over the world. Other types of operations are performed in special circumstances.

Currently, lasers are not commonly used to remove cataract (although some patients mistakenly use the term laser for phacoemulsification). Research is under way to use lasers - Dodick in cataract surgery and some success has been reported.

An IOL is a clear, polymer (Silicone or Acrylic) lens that is placed in the eye during cataract surgery. It does not need any after-care. With IOL one does not need to wear glasses for most of their work and moving about. Moreover, the area of clear vision is much wider.

Before surgery, some tests are performed including tests to measure the curvature and the length of the eye ball by a special ultrasound machine. This helps in calculating the power of the IOL to be implanted. Some other tests e.g., blood, urine, ECG, etc. may have to be performed to establish general fitness of the patient.

Most people after a cataract surgery can go home the same day. It's normal to feel itching, sticky eyelids, and mild discomfort for a while after the surgery. Some fluid discharge is also common. In most cases, reasonable amount of healing will take about four weeks. Mild pain, irritation, redness and watering is a common occurrence after cataract surgery but subsides in a few days.

Also known as "strabismus", squint is a condition where the eyes are not aligned in the same direction. The squinting eye may turn in (converge), turn out (diverge) or sometimes turn up or down. These can be present all or only part of the time, in one or alternating between two eyes.

It can arise because of an incorrect balance of the muscles that move the eyes, faulty nerve signals to muscles, refractive errors, childhood illnesses, etc.

Squint is not just a cosmetic problem. It is always associated with certain degree of functional defect, which makes it important to treat squint as early as possible. It can be associated with decreased vision (amblyopia or lazy eye) or double vision (diplopia). Loss of binocular vision (ability to use two eyes together) can lead to loss of fine depth perception (stereopsis) and peripheral visual field.

The child is thoroughly assessed to establish the type of squint. It is very important to note the vision and fixation pattern in both eyes. Treatment varies according to the type of squint and can be in the form of spectacles, occlusion, eye-drops (rarely) or surgery.

Some squints, especially those that arise from hypermetropia (long sightedness) respond well to treatment with wearing of spectacles. The child will be seen from time to time to note the change in spectacle power and degree of squint till he grows up. Any residual squint not corrected by spectacle can than be corrected by surgery.

Amblyopia / Lazy eye: This is treated by patching/occluding the good eye. The weaker eye is encouraged to work harder with visual activities such as colouring and reading while patch is on. It should be noted that amblyopia can be treated only before the age of about 9 years after which the visual system of the eye becomes fixed and fails to respond to occlusion therapy.

Surgery: Sometimes this is the only choice to straighten the eye. If done at appropriate time results can be very good and 3D vision can develop. One or both the eyes may have to be operated and one or more operations sometimes may be required to achieve perfect functional results (cosmetic correction is usually easier to obtain).

When an adult presents with squint it is not only imperative to establish the type and amount of squint but also to establish and treat the cause of squint. There are two main types: non-paralytic or paralytic squint.

'Squint can present at any age. The cause is not always known, but if squint is suspected, then the baby should be seen for accurate assessment at the earliest opportunity. Sometimes a "pseudo or false squint" may be present due to wide gap between the eyes, flat nose bridge etc. where the eyes appear to be misaligned but do not actually have squint. Newborn child may have a certain degree of misalignment of the eyes which usually disappears by about 6 months of age but if it persists beyond 6 months then the child should be immediately examined by an eye surgeon.

There are six muscles attached to the outside of each eyeball, which move the eye in various directions. During surgery one or more (commonly two) muscles are weakened or strengthened (by moving their attachment backward or forward) to make the eye straight. The procedure is done under local anaesthesia in adults and general anaesthesia in children.

It is not uncommon for more than one operation to be necessary. This does not mean that something has gone wrong but that fine-tuning is needed to obtain the best straight alignment. Sometimes the squint is too large and hence a two-stage surgery is planned. The world over average is 2.3 operations to achieve ideal correction of squint.

It is a day care surgery with no hospitalisation (unless general anaesthesia is used). The eye pad is removed the next day and eye drops are instilled for a couple of weeks. Since it is an external surgery there is no effect on the vision. Most of the times external stitches are absorbable and do not have to be removed. The person can join back his office in a couple of days although a certain amount of redness and irritation continues for a few days.

Glaucoma is a disease where pressure of the eye becomes damages the nerve fibres that form the optic nerve. This nerve carries the visual information from eye to the brain and therefore, any damage to the nerve fibres causes defects in the visual area and results in decreased vision. If not treated in time, this may even lead to blindness.

Normally an eye has a certain pressure - 11 to 21 mm Hg (like a balloon filled with water), which is required for the eye to function in a healthy way. This pressure is created by a fluid called aqueous humor, which is continuously formed and drained out from the eye throughout life. Any disturbance in maintaining this delicate balance leads to high pressure, which in turn damages the nerve fibres.

Glaucoma is a common cause of blindness across the world. In our country alone the prevalence of glaucoma is estimated to be 4% in people of over 30 years of age. The main reason behind many people acquiring this disease is that it is SILENT and mostly does not have symptoms in early stages. By the time patients report with visual complaints, the damages which have already occurred in the eye are irreversible. Most of the cases are picked up on a routine eye examination by an eye surgeon. Though the disease is blinding, it is treatable if detected early.

The cure of glaucoma means keeping the eye pressure within normal range and stop further deterioration by means of eye drops, laser or surgery. This literature will help you in understanding the disease better.

The symptoms of glaucoma vary, depending on the type of glaucoma. These broadly depend on the exit channels for fluid inside the eye situated at the angle of anterior chamber of the eye.

Open Angle Glaucoma is the silent chronic variety. It does not have any symptoms in early stages and is mostly picked up during a routine eye examination by the eye surgeon. Later there can be a feeling of heaviness in and around the eyes, headache, and frequent change in spectacle number or even inability to see certain areas in the field of vision around us.

Narrow Angle Glaucoma can cause acute pain, redness, headache or seeing coloured rings around light bulbs. These symptoms are more during evening or in dim-light because the pupil dilates, leading to compromised exit channels for fluid to drain out and results in high pressure inside the eye. Secondary Glaucoma can occur due to various causes like injury, inflammation, tumours of eye, haemorrhage, drugs like steroids etc. They can present with any of the above symptoms.

Congenital Glaucoma is a condition where the exit channels are poorly formed since birth. Due to high pressure the cornea becomes opaque and eye may gradually become large. The child might complain of a decreased vision, glare, watering or enlarged eye. This requires immediate treatment.

High pressure leads to poor blood circulation, damaging nerve fibres that form the optic nerve, which carries visual impulses from the eye to the brain. Initially there are corresponding areas of loss in visual field and gradually it progresses to marked decrease in vision. Rarely, even the normal pressure level may adversely affect the eyes in some people who are susceptible to optic nerve damage due to abnormal blood flow. This is called "normal tension glaucoma". Here it is the nerve-head-disc and visual field changes which decide the course of treatment and what pressure is normal for you.

Cataract is caused due to the opacity in the lens of the eye, which does not allow image to be properly focussed on the retina while glaucoma is due to the rise in pressure of the eye, which damages the optic nerve fibres. Loss of vision is recovered in cataract by surgery (phacoemulsification with intra-ocular lens implantation) while visual loss in glaucoma is permanent. Sometimes a patient can have both cataract and glaucoma.

Mode of treatment includes eye drops, medicines, laser or surgery. These do not cure the disease but treat the condition by preventing further damage. Hence, the importance of early detection. It is a condition that needs long term follow-up, mostly life long. The treatment is modified based on time to time evaluation of the disease status.

The treatment is aimed to keep eye pressure in normal range. For any individual the normal or "target pressure" is different, which is decided by the eye surgeon after studying the reports of all above mentioned tests. The lowering of eye pressure is achieved by eye drops or medicines alone or in combination with a laser procedure.

If the eye pressure is not controlled by the above, surgery is required. The modality of treatment is decided by factors like type & stage of glaucoma, damage already done at the time of presentation, response to prior treatment, patient's ability to put medication regularly etc.

The first attempt to control glaucoma is made with eye drops alone or in combination with oral pills. These medicines act by lowering the eye pressure either by decreasing the production of aqueous fluid within the eye or by improving the flow through drainage channels.

Various combinations of eye drops may be given to control the eye pressure depending on the type of glaucoma and systemic condition. These medicines should be put at regular intervals as advised by the doctor and should not be stopped without consulting him. A time-to-time evaluation of eye pressure and other tests are crucial to monitor the status of glaucoma.

Laser surgery may be effective for some types of glaucoma. In open angle variety, trabeculoplasty is done where the drainage angles are treated by laser to increase the outflow of aqueous fluid and lower the eye pressure. In narrow angle glaucoma, a hole is made in the iris - peripheral iridotomy, to restore the flow of aqueous fluid to drainage angles.

It is a microscopic filtering surgery-trabeculectomy where a small drainage channel is created for the fluid to leave the eye and thus lower the eye pressure. It is done under local anaesthesia and the patients need to be in the hospital for a couple of hours only.

Usually the surgery is done when eye pressures are not controlled by medicines and laser. In few situations, surgery can be the primary mode of treatment. For eg. inability to put the eye drops regularly, advanced glaucoma, combined cataract & glaucoma etc.

Whatever may be the approach, the objective of the treatment is to lower eye pressure to a level at which optic nerve damage and loss in vision & visual field does not develop or worsen.

Maintaining normal eye pressure means that present treatment is adequate but does not mean glaucoma is cured. The success of the treatment depends on early diagnosis, timely intervention and regular follow ups. People over forty years of age should get their eye pressures checked once every two years.

We at Max Eye Care, advice all our patients to maintain the glaucoma file comprising of periodic check-ups, as the future treatment depends on closely monitoring the changes occurring in your eye. The key to preventing blindness from glaucoma is regular treatment and follow-up.

Yes. Severe loss of vision can occur due to bleeding within the eye or a retinal detachment (detachment of the sensory part of the eye). Moderate loss of vision can occur due to oedema (swelling) of the retina.

A simple dilated eye examination by a retina specialist can help to determine the amount and severity of the disease.

LASER can help to prevent a bleed in the eye and also decrease swelling of the retina. However, it cannot usually restore vision lost due to the retinal damage. LASER, in this case, has to be appropriately timed.

Periocular or Intraocular injection of steroids can also help reduce swelling of the retina (macular oedema).

Advanced cases with non-resolving bleed in the eye or retinal detachment require advanced microsurgery. Today with highly advanced technology, good visual results can be achieved in a large number of advanced cases also.