Protect your eyes from Uveitis

If you suffer from redness, pain, watering, inability to see bright light, floaters, and/ or decreased vision in your eye, you could be suffering from Uveitis.

Uvea is the middle part of the three coats of the eye. This further consists of the iris, ciliary body and the choroid. Inflammation of any of these parts is termed uveitis. Based on the part of the uvea involved, uveitis may be Anterior (involving the iris), Intermediate (involving the ciliary body), Posterior (involving the choroid) or Panuveitis (involving all the parts). 

Uveitis occurs as a result of an immune reaction by our body to substances which our body treats as foreign.  This reaction may occur against infectious agents such as bacteria, fungi, viruses and even parasites. It may also occur in patients with existing autoimmune diseases such as Rheumatoid arthritis, Systemic lupus erythematosus etc. In some patients, uveitis can also occur due to undeterminable causes.

Uveitic patients often require a whole series of investigations in order to identify the cause of uveitis and appropriate treatment to begin. These investigations usually include blood and urine tests and/ or X rays. At times, a sample of the fluid from the patients’ eye may have to be checked.

Steroids are an important part of Uveitis treatment. Depending on the location and the severity of the inflammation, they are used in the form of eye drops, eye ointment, injections around/ in the eye or injectable / oral medications. Anterior (and intermediate) uveitis is treated with topical steroids along with dilating eye drops which help in reducing the pain associated with inflammation. These drops are to be used until the inflammation has completely subsided. The dose, strength and duration of the drops are determined by your Ophthalmologist who decides the treatment based on the amount of inflammation.

Injection of the steroid around the eye is used in certain cases of intermediate uveitis (or in macular edema as a consequence of uveitis). This results in slow release of the drug over a period of three to four weeks.

Besides steroids, the other group of drugs used in the treatment of uveitis is immunosuppressives. These are especially used for patients who show resistance to steroids, inflammation not resolving with only steroids and patients with certain systemic conditions like rheumatoid arthritis. The commonly used immunosuppressives include Methotrexate, Azathioprine, Cyclosporine ,MycophenolateMofetil, Cyclophosphamide and Biological agents.

Sometimes people get worried about the side effects of the drugs used in the treatment of uveitis, but both steroids and immunosuppressives have side effects that are often not serious and reversible following the discontinuation of the drugs. These drugs should always be taken as per your Ophthalmologists instructions and one should never start or stop these drugs at their own will.

Topical steroids may cause cataract or an increase in the intraocular pressure (glaucoma). Oral steroids may cause acidity, increase in weight and rarely diabetes, hypertension, osteoporosis and nervousness/ depression.

Immunosuppressives may cause bone marrow depression that is reflected as a decrease in your blood counts. Some of them also interfere with the normal functions of the liver, cause mouth ulcers, rarely sterility and secondary malignancies. Thus, periodic blood counts or liver function tests may be required.

Women in the reproductive age group are advised not to become pregnant when on treatment with immunosuppressives/ steroids. If any infection develops while on treatment one needs to take appropriate antibiotics immediately after consulting with the Ophthalmologist.

It is important to remember that Uveitis is a recurrent condition and hence requires a prolonged and regular follow up with the Ophthalmologist. Consult your ophthalmologist at the earliest signs of a recurrence, which will make the treatment easier and speedier.

DIABETES AND YOUR EYES

Most of us read about Diabetes leading to Obesity, High Cholesterol and Cardiovascular Diseases among others, but candiabetes affect our eyes?

Yes.  Diabetes can affect our eyesight in many ways.In the eye the most common and important part affected is the retina.If an eye is to be compared to a camera, retina is like the film of the camera which captures the images. The manifestations of diabetes in the retina is known as diabetic retinopathy (DR).

In 2013, according to International Diabetes Federation, an estimated 382 million people had diabetesworldwide. The UAE is ranked 15th worldwide, with 18.98% of the UAE population living with diabetes.Globally the number of patients with diabetic retinopathy was 126.6 million in 2011.Diabetic retinopathy is a disease which can cause blindness in later stages. Timely detection and treatment along with good control of diabetes can prevent visual loss. The number of patients with vision threatening diabetic retinopathy globally was 37.3 million in 2011.

Diabetes causes damage to the walls of the blood vessels supplying blood to the retina of the eye. LaterDiabetic Retinopathy can cause haemorrhages (bleeding), swelling and closure of blood vessels in the retina which can affect eyesight. In late stages it can cause bleeding into the vitreous (a jelly in front of retina) or retinal detachment which can result in profound loss of vision. Diabetes can also cause cataracts and (recurrent) infections in various parts of the eye.

Does diabetic retinopathy affectall diabetics?

The chances of diabetic retinopathy increases with the duration of the disease. At least 50% of the diabetics suffering from diabetes for over 10 years will have diabetic retinopathy at some stage in life. Poorly controlled Diabetes will hasten the onset and progression of diabetic retinopathy. Hyperlipidemia, obesity, hypertension(high blood pressure), smoking, anemia are other common risk factors which worsen diabetic retinopathy.

What are the symptoms of diabetic retinopathy?

Most common symptom is blurring or drop in the clarity of vision. Other symptoms include seeing floating clouds in the visual field or sudden profound drop in vision due to vitreous haemorrhage or retinal detachment. But symptoms often appear late in diabetic retinopathy.

When should I consult an ophthalmologist regarding diabetic retinopathy?

If you are diabetic you should consult an ophthalmologist or a retina specialist once a year to check for diabetic retinopathy. If you have any form of diabetic retinopathy; depending on the stage of the disease, you will be advised regarding more frequent follow ups and if necessary; treatment also. Diabetic retinopathy may progress rapidly during pregnancy; hence quarterly or more frequent follow ups may be required.

Are there any tests to evaluate diabetic retinopathy?

Most common investigations performed in diabetic retinopathyinclude

Slit lamp and indirect ophthalmoscopic eye examination – Ophthalmologist can detect Diabetic Retinopathyby this examination

Optical coherence tomography scan -   This scan detects and quantifies the retinal edema. This test takes less than 5 minutes and it does not involve radiation. It helps in deciding the treatment and in evaluating its effect.

Fundus photography (Wide field) – It includes taking a photo of the retina completely; creating a baseline to compare during follow ups and helping in early detection of progression

Fundus fluorescein angiography – In this test a dye is injected into the vein and serial photos of the retina are taken and evaluated. It gives information about presence of abnormal vessels which may bleed or leak, areas of the retina lacking blood supply etc.It helps to confirm the stage of the diabetic retinopathy in doubtful situations and helps in deciding the most appropriate treatment

Most of these tests are done after dilating the pupil with eye drops which may cause blurring for 3-4 hours

How is Diabetic Retinopathy treated?

Once Diabetic Retinopathy develops,it progresses through various stages like mild, moderate, severe, proliferative, high risk, vitreous haemorrhage, tractional retinal detachment etc. Treatment depends on the stage of the disease.. Initial stages require only tight control of diabetes and other risk factors.The treatment can be laser, intravitreal injection, surgery or often a combination.Proper control of diabetes and other modifiable risk factors are the key steps in the treatment at any stage

What is laser treatment in Diabetic Retinopathy?

Laser is used mainly for reducing the swelling in the retina and avoiding chances of vitreous haemorrhage and retinal detachment. This is an outpatient procedure and takes around 15 minutes. It may need two or more sessions for each eye. It is done after dilating the pupil with eye drops which may cause blurring for 3-4 hours.

What is the role of intravitreal injections in Diabetic Retinopathy?

Drugs like Ranibizumab, dexamethasone implantetc.are injected into the vitreous of the eye, to reduce the swelling in the retina and toreduce the chance of vitreous haemorrhage. Depending on the severity of the conditions multiple injections may be required.

What is the role of surgery in Diabetic Retinopathy?

Surgery is performed in the late stages of Diabetic Retinopathy when there is severe or recurrent bleeding into the vitreous or retinal swelling caused by traction on the retina by membranes or when there is retinal detachment reducing the vision. The purpose is to remove vitreous haemorrhageas well as membranes and to reattach the detached retina. Surgery is known as vitrectomy and is usually performed by a vitreoretinal surgeontrained in this specialization. Vitrectomy is done through three, less than 1mm diameter tunnels in the white part of the eye. Laser treatment is also done during the surgery as required. Most of the patients can go home on the same day after surgery.

How to prevent Diabetic Retinopathy progression?

Controlling diabetes is the most important step in preventing Diabetic Retinopathy. Proper medicine, diet and regular exercise can delay the onset and reduce the progression of Diabetic Retinopathy substantially. Risk factors like hypertension, anemia and hyperlipidemia should be treated. Smoking should be avoided and obesity should be controlled as they can worsen Diabetic Retinopathy. Annual consultation with an ophthalmologist or retina specialist will ensure early treatment, which will avoid loss of vision due to complications of Diabetic Retinopathy.

A child’s eyes are the windows to the future

A good vision is crucial for a child’s physical development, and well-being. Before we discuss the problems a child faces from eye conditions we need to understand that children’s eye problems often differ from those seen in adults and are often different from those of a fully grown individual.

Children have eyes that are still developing and the impact of uncorrected eye problems during childhood may lead to visual loss for the rest of a person’s life

Babies are able to see as soon as they are born. For the visual system to continue to develop properly, children need clear input from both eyes to the brain. If there is some problem which interferes with vision in either eye or both, the connections from the eye to the brain can become weak or not develop properly. Crossed or turned eyes or imbalance in the way each eye focuses can interfere with this normal development of the visual system.

Ophthalmologists suggest that even healthy children without any known risk factors for eye disease should undergo age-appropriate screening examinations with their paediatricians.

Children with parents or siblings with certain eye conditions, such as strabismus or amblyopia, may be at increased risk for these problems, even if they do not appear to have any difficulty with their eyes or vision. These children would benefit from an assessment with a paediatric ophthalmologist.

Children with certain medical conditions, such as diabetes, blood problems, metabolic problems, and genetic diseases like neurofibromatosis, need to be examined regularly for eye problems.

Some serious eye problems have warning signs early in life. Poor vision, eye pain, changes in the shape or size of an eye, crossed or wandering eyes, or an abnormal appearance to the pupil of one or both eyes can all be signs of serious eye conditions and should be evaluated by a physician.

Most parents are unsure when to take their child to the Ophthalmologist, but the child can be taken to the doctor at any age, if there is a suspected problem. Otherwise an appropriate time can be between three and four years of age, with the examination including measurement of visual acuity, eye alignment, motility, refraction, and fundoscopy (an examination of the back of the eye). One of the most important aspects of the examination is to identify conditions that are only treatable at an early age.

Children below three years of age or those who cannot speak properly can also be taken to the Ophthalmologist. With special eye drops and equipment, the doctor can see into the eye and measure to see if the child needs glasses, even if they can’t read. The doctor will also check for any eye misalignment or other ocular problem.

Children may need glasses for several reasons—some of which are different than for adults. Because a child’s visual system is growing and developing, especially during the first 5-6 years of life, glasses may play an important role in ensuring normal development of vision. The main reasons a child may need glasses are:

• To provide better vision, so that a child may function better in his/her environment
• To help straighten the eyes when they are crossed or misaligned (strabismus)
• To help strengthen the vision of a weak eye (amblyopia or ‘lazy eye’). This may occur when there is a difference in prescription between the two eyes (anisometropia). For example, one eye may be normal, while the other eye may have a significant need for glasses caused by near-sightedness, far-sightedness or astigmatism.
• To provide protection for one eye if the other eye has poor vision

Some common eye disorders among children are:

Amblyopia -  It is a common vision problem in children and is also known as ‘lazy eye’. It is so common that it is the reason for more vision loss in children than all other causes put together.

Amblyopia develops in childhood when the connections between the yes and the brain are developing. The brain must learn how to put together information sent from the two eyes and make one picture. If the image from one eye is clear and the other blurry, or if the eye is misaligned and send two different pictures, the brain will ignore the picture sent from one eye. Amblyopia results when the brain consistently ignores the information from one eye, while the appearance of the eye may be perfectly normal yet its vision will be abnormal.

With early detections and treatment, visual loss from Amblyopia can be minimised or even completely reversed

Strabismus - It is one of the most common conditions seen by paediatric ophthalmologists and is a generic term for any misalignment of the two eyes

Eye misalignment can cause strabismus in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain may ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned.

The goal of strabismus treatment is to improve eye alignment which allows for better work together (binocular vision).Treatment may involve eye glasses, eye exercises, prism, and/ or eye muscle surgery.

Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

Paediatric cataract -  Paediatric cataracts often occur because of abnormal lens development during pregnancy. Cataracts can be genetic or they can occur spontaneously. These cataracts may be present at birth or may develop during childhood.  Some cataracts are small and/or off-center in the lens. These cataracts do not need to be removed because vision develops normally, even if the cataract is left in place.

Cataracts that interfere with vision should be removed as soon as is safely possible, especially if the cataract is present at birth.  A delay in cataract removal can interfere with normal development of the vision centers in the brain.

A few examples of warning signs of vision problems in children are:

Constant rubbing of the yes
White reflex in a photograph

Extreme light sensitivity

Poor ability to focus

Poor visual tracking

Chronic redness of the eye

Persistent tearing

Squinting (cross eyes)

Difficulty in reading

Covering or closing one eye

Looking at an object of interest with the head tilted or with a face turn

Wiggly eyes

Droopy eyes