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The department of ophthalmology is dedicated to providing state of the art medical and surgical care in all aspects of adult and pediatric ophthalmology. We provide patient oriented management of ophthalmic problems by integrating and leveraging our combined expertise. The center performs advance surgical procedures which include most current surgical and reconstructive techniques. We have a team of highly experienced surgeons which are supported by most advanced medical equipment and techniques. At Apollo Hospital, ophthalmology is the branch of medicine which deals with the diseases and surgery of the visual pathways, including the eye, Brain and areas surrounding the eye such as the lacrimal system and eyelids.
- Cataract
- Squint
- Glaucoma
- Cornea
- Neurophthalmology
- Paediatric Ophthalmology
Cataract
- Phacoemulsification & foldable lens implantation surgery with no stiches
- Refractive cataract surgery
- Small incision cataract surgery
- Pediatric cataract surgery
Squint
- Occuloplasty
- Complete evaluation of eye deformities
- Ptosis Surgery
- Occuloplasty corrective surgery
- Reconstructive orbital surgery
- Orbitotomy for orbital tumor
Glaucoma
- Glaucoma surgery
- Pediatric Glaucoma surgery
- Laser Glaucoma treatment ( trabeculoplastyiridotomy & cyclophotocoagulation)
- Retina And Vitreous:
- Specialty diagnostics and tests (retina imaging)
- Diabetic retinopathy management
- Age related macular degeneration management.
- Retinal detachment surgery
- Retinal laser photocoagulation
Cornea
- Complete corneal diagnostics
- Corneal ulcer treatment
- Dry eye management
Neurophthalmology
- Evaluation of neurological disorders of eye.
- Electrophysiology
- Optic nerve disease evaluation and management
- Ocular motility disorders & nerve paralysis
- Diplopia management
Paediatric Ophthalmology
- Retinopathy of prematurity screening & treatment.
- Developmental cataract
- Developmental glaucoma
- Childhood blindness
- Congenital and hereditary disorders
The department of ophthalmology at Indraprastha Apollo Hospital health increasing advances in the field of healthcare provides high end services in term of all the specialties as far as the holistic health care is concerned. Eyes as we know form an important part of our body and this is one organ which helps us see through all the colors of life. The hospital has specially trained technicians for assisting in the office and surgical procedures.
Out patient Facilities:
- Optometry and OrthropticsOccular ultrasounds (A & B Scan)
- Spectacles
- Synaptophore
- Contact Lenses
- Auto refractometer
- Refraction
- Keratometer
- Low vision aids
- Indirect/Direct ophthalmoscopy
- Eye muscle exercises
- Gonioscopy
- Fluorescein angiography
- Applanation tonometry
- OCT
1
What is cataract?
Cataract is clouding of the lens in the eye that affects vision. Most cataracts are related to ageing and are common in older people. It can occur in either or both eyes and cannot spread from one eye to the other. The lens is a clear part of the eye that helps to focus light, or an image, on the retina which is the light-sensitive tissue at the back of the eye. In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.
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What are the types of cataract?
Types of CataractAlthough most cataracts are related to aging, there are other types of cataract:
- Secondary cataract. Cataract can occur after surgery for other eye problems, such as glaucoma, in people who have diabetes and use of steroids.
- Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
- Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
- Radiation cataract. Cataracts can develop after exposure to some types of radiation.
3
What are the causes and risk associated with cataract?
- The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and let the light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens and result in cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see. Protein in the lens may also change from the wear and tear it takes over the years.
- Smoking and diabetes may also cause cataract formation.
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What are the symptoms of cataract?
- Cloudy or blurry vision.
- Colors seem faded.
- Glare( Headlights, lamps, or sunlight may appear too bright). A halo may appear around lights.
- Poor night vision.
- Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
- Frequent prescription changes in your eyeglasses or contact lenses.
5
How cataract could be detected?
Cataract is detected through a comprehensive eye exam that includes:
- Visual acuity test. This eye chart test measures how well you see at various distances.
- Dilated eye exam. Drops are put in your eyes to widen, or dilate, the pupils. Your doctor uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
- Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
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How cataract can be treated?
- The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
- A cataract needs to be removed only when vision loss interferes with everyday activities, such as driving, reading, or watching TV. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult.
- Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as diabetic retinopathy. By having your vision tested regularly, you and your doctor can discuss if and when you might need treatment.
- If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.
- Many people who need cataract surgery also have other eye conditions, such as glaucoma.
7
How is a macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session in some cases. Further treatment may be needed. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart. Simultaneously with the laser treatment Blood Pressure, Blood Sugar, serums and lipids should be well controlled.
8
What are the key safety points of diabetic retinopathy?
- Annual eye exam or earlier.
- Regular check up of IOP.
- Control of Blood Sugar value (HbA1c<6.5).
- Control of Blood Pressure.
- Lowering of lipids.
- Even after laser treatment, follow up with your eye specialist is must which should be 3-6 monthly.
- The aim of laser treatment is to prevent the patient from blindness or from sight threatening complications. It does not usually improve the existing vision.
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1
How cataract problem occurs?
Cataract occurs when the natural clear lens inside the eye, located behind the iris, becomes cloudy over time and the clouding of this lens during cataract formation distorts our vision. Cataracts are usually a very gradual process of normal ageing.
2
Who is the candidate for cataract surgery?
An eye specialist may mention during a routine eye exam that you have early cataract development even if you are not yet experiencing visual symptoms. Although your doctor will be able to tell when you first begin to develop cataract, you will generally be the first person to notice changes in your vision that may require cataract surgery. Clouding of the lens may start to be seen at any age, but it is uncommon before the age of 40. However, a large majority of people will not begin to have symptoms from their cataract until many years after they begin to develop. Cataract can be safely observed without treatment until you notice changes in your vision.
Surgery is recommended for most individuals who have vision loss and are symptomatic from a cataract. If you have significant eye disease unrelated to cataract that limits your vision, your doctor may not recommend surgery. Sometimes after trauma to the eye or previous eye surgery, a cataract may make it difficult for your doctor to see the retina at the back of the eye; in these cases, it may still be appropriate to remove the cataract so that further retinal or optic nerve evaluation and treatment can occur. The mode of surgery can be tailored to individuals based on coexisting medical problems. Cataract surgery is generally performed with minimal sedation and generally takes less than 30 minutes. Therefore the surgery does not put significant strain on the heart or the lungs.
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What are the different types of cataract surgery?
- Phacoemulsification: With the use of an operating microscope, your surgeon will make a very small incision in the surface of the eye in or near the cornea. A thin ultrasound probe, which is often confused for a laser, is inserted into the eye and uses ultrasonic vibrations to dissolve the clouded lens. These tiny fragmented pieces are then suctioned out through the same ultrasound probe. Once the cataract is removed, an artificial lens is placed into the thin capsular bag that the cataract occupied. This lens is essential to help your eye focus after surgery. In this most modern method, cataract surgery can usually be performed in less than 30 minutes and usually requires only minimal sedation and numbing eye drops, no stitches to close the wound, and no eye patch after surgery
- Extra capsular cataract surgery: This procedure is used mainly for very advanced cataracts where the lens is too dense to dissolve into fragments. This technique requires a larger incision so that the cataract can be removed in one piece without being fragmented inside the eye. An artificial lens is placed in the same capsular bag as with the phacoemulsification technique. This surgical technique requires a various number of sutures to close the larger wound, and visual recovery is often slower. It usually requires an injection of numbing medication around the eye and an eye patch after surgery.
- Intra capsular cataract surgery: This surgical technique requires an even larger wound than extra capsular surgery, and the surgeon removes the entire lens and the surrounding capsule together. This technique requires the intraocular lens to be placed in a different location, in front of the iris. This method is rarely used today but can be still be useful in cases of significant trauma.
4
What should one expect prior to and on the day of cataract surgery?
- Prior to the day of surgery, your eye specialist will discuss the steps that will occur during surgery. You should discuss with your ophthalmologist which, if any, of your routine medications you should avoid prior to surgery. Prior to surgery, several calculations will be made to determine the appropriate power of intraocular lens to implant. A specific artificial lens is chosen based on the length of the eye and corneal curvature (the clear portion of the front of the eye).
- It is important to remember to follow all of your preoperative instructions, which will usually include not eating or drinking anything after midnight the day prior to your surgery. Mostly cataract surgery is done with only minimal anesthesia and numbing drops without having to put you to sleep. While cataract surgery does not involve a significant amount of pain, medications are used to minimize the amount of discomfort. The actual removal of the clouded lens will take approximately 20 minutes. You may notice the sensation of pressure from the various instruments used during the procedure. After leaving the operating room, you will be brought to a recovery room where your doctor will prescribe several eye drops that you will need to take for a few weeks postoperatively. While you may notice some discomfort, most patients do not experience significant pain following surgery.
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What should one expect after the cataract surgery?
Following surgery, you will need to return for visits within the first few days and again within the first few weeks after surgery. During this time period, you will be using several eye drops which help protect against infection and inflammation. Within several days, most people notice that their vision is improving and that they are able to return to work. During the several office visits that follow, your doctor will monitor for complications, and once vision has stabilized, he will fit you with glasses if needed. The type of intraocular lens you have implanted will determine to some extent the type of glasses required for optimal vision.
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What are the potential complications of cataract surgery?
- While cataract surgery is one of the safest procedures available with a high rate of success, rare complications can arise. The most common difficulties arising after surgery are persistent inflammation, changes in eye pressure, infection, or swelling of the retina at the back of the eye, and retinal detachment. If the delicate bag the lens sits in is injured, then the artificial lens may need to be placed in a different location. In some cases, the intraocular lens moves or does not function properly and may need to be repositioned, exchanged, or removed. All of these complications are extremely rare but can lead to significant visual loss; thus, close follow-up is required after surgery.
- In some cases, within months to years after surgery, the thin lens capsule may become cloudy, and you may have the sensation that the cataract is returning because your vision is becoming blurry again. This process is termed posterior capsule opacification, or a “secondary cataract.” To restore vision, a laser is used in the hospital to painlessly create a hole in the cloudy bag. This procedure takes only a few minutes , and vision usually improves rapidly.
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1
What is diabetic retinopathy?
Diabetic retinopathy is the most common diabetic eye disease which may lead to blindness. It is caused by changes in the blood vessels of the retina (which is the light sensitive tissue at the back of the eye). A healthy retina is necessary for good vision.In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In others, abnormal new blood vessels may grow on the surface of the retina.If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. It usually affects both eyes.
2
How does diabetic retinopathy cause vision loss?
- Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision.
- Fluid can leak into the center of the macula, the part of the eye where sharp,straight-ahead vision occurs. The fluid makes the macula swell (macular edema) causing blurring of vision. It is more likely to occur as the disease progresses.
3
Who are at risk for diabetic retinopathy?
- All people with diabetes–both type 1 and type 2–are at risk. That’s why everyone with diabetes should get a comprehensive eye check up at least once a year. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.
- During pregnancy, diabetic retinopathy may be a problem for women with diabetes.
- Persons having high blood pressure or abnormal blood cholesterol levels are more prone to develop diabetic retinopathy.
4
What are the symptoms of diabetic retinopathy?
- You may have diabetic retinopathy for a long time without noticing any symptoms.Typically, retinopathy does not cause noticeable symptoms until significant damage has occurred and complications have developed.
- Symptoms of diabetic retinopathy and its complications may include:
- Blurred or distorted vision or difficulty in reading.
- Floaters(shadows or dark objects that float across your field of vision).
- Partial or total loss of vision .
- Pain in the eye.
5
What type of exam and test need to detect diabetic retinopathy?
- Visual acuity test. This eye chart test measures how well you see at variousdistances.
- Slit Lamp Exam. This is to see interior of the eyeball under magnification.
- Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
- Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This is a special investigative test done for certain indications (after excluding contra indications). This allows the doctor to see more of the backside of your eyes to check for signs of retinopathy and presence of cataract. After the exam, your vision may remain blurred for approximately 6 hours. You will not be able to read and drive for 6 hours.
- Fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your doctor to identify any leaking blood vessels and recommend treatment. Your doctor checks your retina for early signs of the disease, including:
- Leaking blood vessels.
- Retinal swelling (macular edema).
- Pale, fatty deposits on the retina–signs of leaking blood vessels.
- Damaged nerve tissue.
- Any changes to the blood vessels.
- Presence or absence of diabetic retinopathy which is usually graded as mild,
- moderate and severe non proliferative.Diabetic retinopathy which is a serious one is called proliferative diabetic retinopathy and requires urgent attention.
6
How is diabetic retinopathy treated?
Annual dilated eye exam is mandatory even if you do not have any visual symptoms.DO NOT CONFUSE IT WITH SPECTACLE TESTING During the initial stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
In advanced retinopathy laser photocoagulation may be needed. This procedure is called scatter laser treatment which helps to shrink the abnormal blood vessels. Three or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, your color vision and night vision, scatter laser treatment can save the rest of your sight and prevents from blindness. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.
In a few cases, if the bleeding is recurrent in spite of laser treatment, you may need a surgical procedure called a vitrectomy in which blood is removed from the center of your eye.
7
How is a macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session in some cases. Further treatment may be needed. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart. Simultaneously with the laser treatment Blood Pressure, Blood Sugar, serums and lipids should be well controlled.
8
What are the key safety points of diabetic retinopathy?
- Annual eye exam or earlier.
- Regular check up of IOP.
- Control of Blood Sugar value (HbA1c<6.5).
- Control of Blood Pressure.
- Lowering of lipids.
- Even after laser treatment, follow up with your eye specialist is must which should be 3-6 monthly.
- The aim of laser treatment is to prevent the patient from blindness or from sight threatening complications. It does not usually improve the existing vision.
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1
What is glaucoma?
Glaucoma refers to a group of disorders that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain. Damage to the optic nerve causes vision loss, which may progress to blindness. Most people with glaucoma have increased fluid pressure in the eye, a condition known as increased intraocular pressure.
2
What are the types of glaucoma?
- Open angle (chronic) glaucoma
- Angle closure (acute) glaucoma
- Congenital glaucoma
- Secondary glaucoma
3
What causes glaucoma?
- The eye constantly produces aqueous, the clear fluid that fills the anterior chamber (the space between the cornea and iris). The aqueous filters out of the anterior chamber through a complex drainage system. The delicate balance between the production and drainage of aqueous determines the eye’s intraocular pressure (IOP). Most people’s IOPs fall between 8 and 21. All four types of glaucoma are characterized by increased pressure within the eyeball, and therefore all can cause progressive damage to the optic nerve.
- Open angle(chronic) glaucoma ( most common)-The front part of the eye is filled with a clear fluid called the aqueous humor. This fluid is constantly made in the back of the eye. It leaves the eye through channels in the anterior (front) chamber of the eye, and eventually drains into the bloodstream. The channels that drain the aqueous humor are in an area called the anterior chamber angle, or simply the angle.In this, the channels in the angle gradually narrow with time, making it hard for the fluid to drain properly. The buildup of fluid causes increased pressure in the eye. This increased pressure pushes on the junction of the optic nerve and the retina at the back of the eye, reducing the blood supply to the optic nerve. Peripheral (side) vision is affected first. This is usually not noticed until quite a bit of vision is lost. If the disease is not diagnosed and treated, a lot of vision may be lost before the person becomes aware of a problem.There may be redness and swelling in the affected eye. Nausea and vomiting may occur. Angle closure glaucoma is an emergency. This is very different from open angle glaucoma, which painlessly and slowly damages vision.
- If you have had acute glaucoma in one eye, you are almost certainly at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment.Dilating eye drops and certain systemic medications may trigger an acute glaucoma attack if you are at risk.
- Secondary glaucoma is caused by other diseases, including eye diseases such as uveitis, systemic diseases, and drugs such as corticosteroids.
- Congenital glaucoma, which is present at birth, is the result of abnormal development of the fluid outflow channels of the eye. Surgery is required for correction. Congenital glaucoma is often hereditary.
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What are the symptoms of glaucoma
Open angle glaucoma-Most people have no symptoms but gradual loss of peripheral (side) vision may occur.
Acute angle glaucoma-Severe eye pain, facial pain ,decreased or cloudy vision, redness and swelling of the eye,nausea and vomiting .
Congenital glaucoma-Tearing ,sensitivity to light, redness and cloudiness of the front of the eye.
5
What type of exam and test need to detect glaucoma?
An examination of the eye may be used to diagnose glaucoma along with measurement of intraocular pressure. Tests may include:
- Retinal examination
- Intraocular pressure measurement by tonometry
- Visual field measurement
- Visual acuity
- Refraction
- Pupillary reflex response
- Slit lamp examination
- Optic nerve imaging (photographs of the interior of the eye)
- Gonioscopy- use of a special lens to see the outflow channels of the angle
6
How glaucoma will be treated?
The objective of treatment is to reduce intraocular pressure. Depending on the type of glaucoma, this is achieved by medications or by surgery.
Open angle glaucoma treatment:
- Most people with glaucoma can be treated successfully with eye drops and pills to lower pressure in the eye.
- Some patients will need additional forms of treatment, such as a laser treatment, to help open the fluid outflow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.
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What are prognosis?
- Open angle glaucoma: It can be managed and vision will almost always be preserved, but the condition cannot be cured. Careful follow up with doctor is important. With good care, most patients with open angle glaucoma will not lose vision.
- Angle closure glaucoma: Rapid diagnosis and treatment of an attack is the key element to preserve vision.
- congenital glaucoma: Early diagnosis and treatment is important. If surgery is done early enough, many patients will have no future problems.
8
When to contact a doctor?
Consult doctor if you have severe eye pain or a sudden loss of vision, especially loss of peripheral vision.
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Can glaucoma be prevented?
- There is no way to prevent glaucoma, but vision loss can be prevented with early diagnosis and careful management of the condition. All persons over 40 years should have an eye examination at least every 5 years, and more often if in a high-risk group.
- People at high risk for acute glaucoma may opt to undergo iridotomy before having an attack. Patients who have had an acute episode in the past may undergo the procedure to prevent recurrence.
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1
What is hypertensive retinopathy?
Hypertensive retinopathy is damage to the retina(which is the light sensitive tissue at the back of the eye) caused by high blood pressure.
2
What are the causes of hypertensive retinopathy?
High blood pressure can cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be. Your doctor can see narrowing of blood vessels, and excess fluid oozing from blood vessels, with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of I to IV. At grade I, no symptoms may be present. Grade IV hypertensive retinopathy includes swelling of the visual center of the retina (macula). Such swelling can cause decreased vision.
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What are the symptoms of hypertensive retinopathy ?
- Headache
- Visual disturbances
4
How could hypertensive retinopathy be treated?
Control of high blood pressure (hypertension) is the only treatment for hypertensive retinopathy.
5
What are the prognosis?
Patients with grade IV (severe hypertensive retinopathy) frequently also have heart and kidney complications of high blood pressure. The retina will generally recover well if the blood pressure is controlled, but some patients with grade IV hypertensive retinopathy will have permanent damage resulting in vision problems.
6
When to contact a doctor?
Go to the emergency room or call the local emergency number (such as 911) if you have high blood pressure and vision changes or headaches occur.
7
What are the prevention of hypertensive retinopathy?
Control of high blood pressure prevents changes in the blood vessels of the eye.
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