Detached / Dislocated Retina

What is Detached Retina?

A detached retina occurs when the retina becomes separated from its underlying supportive tissue. The retina sends visual images to the brain through the optic nerve. When detachment or dislocation occurs, vision is blurred. A detached retina is a very serious problem that almost always causes blindness unless it is treated.

Symptoms

If you suddenly notice spots, floaters and flashes of light, you may be experiencing the warning signs of a detached retina. Your eyesight might become blurry, or you might have poor vision. Another symptom is seeing a shadow or a curtain descending from the top of the eye or across from the side.

These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately. Retinal detachment can occur at any age, but it is more common in midlife and later. Conditions that can increase the chance of a retinal detachment are:

• Nearsightedness
• Previous cataract surgery
• Glaucoma
• Severe trauma
• Previous retinal detachment in your other eye
• Family history of retinal detachment
• Weak areas in your retina

Procedure

Retinal tears are usually treated with laser surgery or cryotherapy (freezing), to seal the retina to the back wall of the eye again. These treatments cause little or no discomfort and may be performed in an ophthalmologist's office. This treatment will usually prevent progression to a retinal detachment.

To return the retina back to its proper position in the back of the eye surgery may be needed. There are several ways to fix a detached retina. Type of surgery and anesthesia (local or general) required depends upon the characteristics of the retinal detachment. In each of the following methods, your ophthalmologist will locate any retinal tears and use laser surgery or cryotherapy (freezing) around them to seal the tear.

Types of Procedure

Pneumatic retinopexy is a procedure in which a gas bubble is injected into the vitreous space inside the eye. The gas bubble pushes the retinal tear back against the wall of the eye and closes the tear. Laser or cryo-surgery is used to secure the retina to the eye wall around the retinal tear. Your ophthalmologist will ask you to maintain a certain head position for several days. The gas bubble will gradually disappear. Sometimes this procedure can be done in the ophthalmologist's office.

An ophthalmologist may also perform a procedure called scleral bucking to reinforce the protective sclera. Often the ophthalmologist will drain the fluid from under the detached retina allowing the retina to return back to its normal position against the back wall of the eye. This procedure is performed in the operating room, usually on an outpatient basis.

Vitrectomy may also be necessary to remove any vitreous gel which is pulling on the retina. This may also be necessary if the vitreous is to be replaced with a gas bubble. Your body's own fluids will gradually replace this gas bubble, but the vitreous gel does not return. Sometimes a vitrectomy may be combined with a scleral buckle.

Glaucoma Surgery

Summary

Filtration surgery or trabeculectomy is done to help patients with open angle glaucoma. The surgery is done when medicines or laser surgery fail to alleviate eye pressure. If left untreated glaucoma can cause blindness.

Length of the procedure: 30 to 60 minutes

Hospital Stay:Patients are released from care the same day or within 24 hours of their procedure.

Recovery before traveling home:Patients seeking a filtration surgery through medical tourism can return home 2 to 3 days of their procedure.

Travel Tip:After filtration eye surgery you will need to have a follow-up appointment within 24 hours. Find a comfortable handicap accessible hotel room to recover in during this time.

Procedure Details

The filtration procedure begins with the administration of anesthesia to help you relax. Your eye will also be numbed with local anesthetic. In most cases you will be awake, but comfortable during this procedure.

Once you are fully relaxed the surgeon will make a small hole in the top part of your eye lid so they can make a hole in your sclera. Then, they will take a piece of the clear skin that covers your eye and use it to cover the hole they made in sclera. Fluid from the eye will flow from the hole and form a pocket. The pocket is called a bleb. This allows the pressure of your eye to maintain a healthy level.

After the Procedure

After the filtration surgery you will be taken to recovery. Your vitals and surgical wound will be closely monitored. If all goes well you will be released from care or moved to a regular hospital room for continued hospital recovery.

Most likely your eye will be taped shut right after the procedure. You may also have a protective covering placed over your eye. You will be required to wear the bandage for 24 hours after the procedure.

Self care after cataract surgery:

• Take antibiotics
• Take corticosteriods as prescribed
• Wear eye shield when sleeping for 1 month
• Light activity may resume in 48 hours
• Vigorous activity, heavy lifting and straining should be avoided for 8 weeks
• Do not strain when going the bathroom
• Avoid hot tubs or pools
• Avoid eye make up for 1 week
• Try not to sneeze or cough
• Return to work in 1 week

Result

For most people filtration surgery prevents visual field loss and lessens the build up of pressure in the eye. However, it is not uncommon for people to need a second filtration surgery or additional glaucoma treatments done the line. What’s more, is that certain demographics are less likely to respond favorably to filtration surgery including:

• Kids with congenital glaucoma
• African Americans
• People with glaucoma that has caused blood vessel growth on the iris
• People who have diabetes
• People who had eye surgery in the past

It is also important to note that filtration surgery does not cure glaucoma.

Risks and Complications

As is with any procedure there are risks associated with filtration surgery. The following is a list of the most common risks and complications:

• Scarring of the opening
• Severe blurring
• Bleeding in the eye
• Low eye pressure
• Clouding of the lens or cataract
• Fluid build up under the nerve
• Central vision loss
• Infection
• Droopy eyelid

Contact your physician if any of the following occur

• Sudden severe eye pain develops
• Sudden change in vision
• Fever that is 100.4 degrees or higher
• Chills
• Cold or flu develops
• Allergies develop or get worse
• Sinus infection develops
• Any question or concern regarding your glaucoma or surgery
• Redness or swelling
• Yellow drainage from eye
• Complete loss of vision

Hypermetropia With LASIK Surgery

What is Hyperopia?

Hyperopia is known by its more common name, farsightedness. People who are farsighted are able to see fine at a distance, but have trouble with close up viewing, such as is necessary for reading. These people require reading glasses for close viewing to avoid squinting or experiencing fatigue and headaches when trying to view things up close.

Normal sight works when light enters the eye and focuses directly on the retina. In a person with hyperopia the eyeball is too short, so the light ends up focusing behind the retina, resulting in problems with near viewing.

How Can Hyperopia Be Treated?

At one time, hyperopia was only treatable with corrective lenses such as glasses or contact lenses. However, it's now possible to have surgery to correct hyperopia. The most popular procedure used to correct hyperopia is LASIK surgery.

How does LASIK Surgery Treat Hyperopia?

LASIK surgery works by reshaping the surface of the cornea, enabling it to better focus light. The surgeon cuts a flap into the epithelium, the outer layer of the cornea. Tissue underneath is removed, or ablated with an excimer laser. The goal in farsighted people is to create more of a slope in the cornea, making it easier to focus light on the retina.

Is LASIK safe?

In the hands of a good surgeon LASIK is extremely safe if the following criteria are met:

• Stable hyperopia under 6 diopters. (Hyperopia usually stabilizes at around 16 years of age).
• Absence of Glaucoma and other eye conditions (which your ophthalmologist should rule out before surgery).
• Adequate corneal thickness (this measurement should always be performed using a pachimeter).
• Refractive surgery is not recommended for pregnant women.

Just as any other surgical procedure, LASIK has risks. One out of a hundred persons operated on with this technique has some sort of complication. In almost every case there is a solution to the problem. Severe complications are extremely rare.

How should I prepare for LASIK?

No special preparation is needed for LASIK. Your ophthalmologist should make sure there are no associated pathologies which can interfere with the prognosis. An extensive examination of your eyes including pupil dilation (which will determine the exact degree of hyperopia) should be performed. A topography and pachimetry are mandatory since theses exams show the surgeon the exact shape, curvature and thickness of the cornea. With this data he can plan the procedure and discard pathologies not detected in the initial evaluation.

What should I do during surgery?

LASIK is performed under topical anesthesia (anesthetic eyedrops). No injections or general anesthesia are required. The patient is awake during the procedure feeling no pain at all. LASIK takes about 5 minutes per eye. Once finished, you will go home without need for hospitalization.

During surgery you will be lying on an operating bed specially designed for the excimer laser. The operating microscope is an integral component of the system and will be in front of you at all times. This microscope will continuously generate a bright light. Your face will be covered with sterile drapes and oxygen will be provided under them. You should never touch these drapes. A small device will hold your eyelids open. As the initial cut is performed with the microkeratome you will feel some pressure in your eye. This is due to the suction ring needed to hold the device in place. As the microkeratome creates the flap it must pass directly in front of your eye. For this reason you will not see the light during this step of the procedure. At this point your ophthalmologist will ask you to look at a blinking light inside the laser. At this point you can really help with your treatment: better results are obtained if you hold your head and eye completely still during the laser ablation. Finally the surgeon will put back into place the superficial layers of the cornea and will tell you the procedure is completed. You will occasionally feel cold water over your eye that may even go down your cheek. This is the solution needed to keep your eye properly hydrated.

What should I do after surgery?

It is important not to squeeze your eye the first 5 days after surgery. Normally there will be some foreign body sensation, similar to having an eyelash in your eye. No bandages are required so the patient walks out of the operating room by his own means even though vision will be blurry for 2 or 3 days. Eyedrops will be prescribed for 2 to 3 weeks. Two weeks after surgery you will be able to perform any activity without risk.

Is LASIK the Best Option for Treatment of Hyperopia?

While patients with hyperopia have reported a great deal of success with the LASIK procedure, it is a surgery and patients should consider it carefully. There are many options for sufferers of hyperopia. 30-day extended wear contact lenses can restore vision without the inconvenience of regular contact lenses or an invasive procedure. Individuals should consult with their eye care professionals to determine whether LASIK is the right option.

Implantable Collamer Lens

What is ICL?

ICL is a new technology that involves using small, foldable lenses that are implanted inside the eye, between the colored portion of the eye and the natural lens to correct nearsightedness. These small lenses are capable of correcting large amounts of nearsightedness and may be better surgical solutions for those with high corrections or corneas that are too thin to safely allow laser treatment.

How is ICL performed?

Your surgeon will make a small incision in the front part of the eye through which they will place the lens behind the iris. The procedure takes minutes to perform and is typically done under mild anesthesia. If needed, the lens can be removed in a similar fashion.

What are the risks and side effects of ICL?

As ICL implantation is an intraocular surgery, there exists a risk of infection inside the eye. Several steps are taken to reduce this risk. Other complications that may require more surgical intervention would be development of a cataract and problems related to the cornea. The side effects are generally mild and include a dry sensation, some discomfort in the first 24 to 36 hours and fluctuating vision as the lens stabilizes.

What are the results of ICL technology?

After implanting ICL, 99 percent of patients were "satisfied/very satisfied" with their results. 98.3 percent of patients had uncorrected visual acuity of 20/40 or better. Once vision was corrected, the correction was stable and did not change over the follow up period. Additionally, the incidence of glare, halos, double vision, night vision problems, and night driving difficulties decreased or remained unchanged from before surgery.

Who is a candidate for ICL?

Currently, ICL is only approved for those with nearsightedness.

IntraLASIK

What is IntraLASIK?

During traditional LASIK surgery, the surgeon first creates a flap in the cornea with a microkeratome blade, and then reshapes the cornea in a way that improves the patient’s vision. IntraLASIK is an innovative new method in which the surgeon programs the desired depth and position of the corneal flap into a computer system prior to actual surgery, making the creation of the flap an incredibly safe and accurate procedure.

How IntraLASIK works ?

IntraLASIK alters the shape of the cornea to correct the eye’s focusing power. The way the cornea is reshaped depends on the condition of the eye.

Surgeons create an ultra-thin corneal flap (usually 90 to 100 microns or 0.1-mm thick) using a femtosecond laser. The laser creates this flap by producing thousands of miniature (1 micron or 1/1000th of a millimetre) bubbles in the cornea with micro-accuracy. The bubbles expand join together to separate a layer of the cornea, which becomes the flap. Then a second set of bubbles creates the side of the flap, leaving a gap at the top to act as a hinge.

The excimer laser (Bausch & Lomb Z100) is used to reshape the cornea depending on how the focusing power of the eye needs to change. The flap is replaced and allowed to settle without stitches, and because the eye is fooled into thinking that no surgical procedure has occurred, visual recovery is extremely quick.

Short-sightedness

The cornea in short-sighted patients is flattened once the flap has been created and lifted. Our excimer laser changes the shape using one of several algorithms: Zyoptix Tissue Saving, Zyoptix Wavefront or Zyoptix Aspheric.

The suitability of each will depend on a thorough examination of your eyes. Your Centre for Sight consultant will advise on which is most suitable for you. This will be based on a number of factors including a very thorough eye examination.

Far-sightedness or Long-sightedness

The cornea in long-sighted patients is steepened by removing tissue from the periphery of the cornea. This is done using Zyoptix Wavefront, a highly personalised treatment which suits patients with higher levels of long-sightedness, including astigmatism, and those who have large pupils and problems with night vision.

Astigmatism

Astigmatism IntraLASIK results are highly predictable, especially when using Iris Recognition and Registration technology . Our Advanced Control Eye Tracker (ACE), UK’s first installation has improved accuracy further and we have treated extremely high astigmatism (7 to 8 D using Zyoptix Wavefront combined with ACE... To accurately treat astigmatism, it is vital that treatment is delivered at a precise angle, and if the eye is rotated by even a few degrees, the amount of correction can be reduced significantly.

Presbyopia

After the age of 40, the crystalline lens in our eye that enables us to focus and read becomes larger, harder and less adaptable. This can make reading small print difficult, especially in dimly lit rooms. When this happens, most people head to the pharmacy or their optician to buy a pair of reading glasses.

An alternative option and suitable for those in their 50s or older are Intraocular lens implants, either the ACCOMMODATIVE Crystalens or Multifocal, Acri.LISA, ReSTOR or Tecnis Multifocal.

IntraLASIK Risks and Benefits

As with any surgical procedure, IntraLASIK has both risks and benefits that should be discussed fully with your LASIK surgeon. Generally, the IntraLASIKprocedure takes more time than with the traditional microkeratome blade, about 15-20 seconds per eye, compared to about three seconds per eye. Your eyes may be red for a few days, and your visual recovery can be slower than with the microkeratome.

The benefits of bladeless LASIK are that the flap thickness and diameter are pre-programmed into the IntraLASIK software by your surgeon, and are therefore very predictable. This greater accuracy and control is especially beneficial to those patients with particularly thin corneas. The IntraLase® laser also has the lowest occurrence of flap complications, such as partial flap, buttonhole flap, or wrinkling.

IntraLASIK Statistics

The IntraLase® laser was approved by the FDA in 2001 and has since been used to treat more than 250,000 eyes. Studies show that 81 percent of patients choose bladeless LASIK over traditional LASIK with a microkeratome when given the choice. Many doctors feel IntraLASIK is the best choice for treatment in certain cases.

LASIK

Summary

LASIK surgery is an eye surgery that changes the shape of your cornea permanently. The cornea is the clear covering on the front of your eye. When the shape of the cornea is changed it helps improve your vision and reduces or eliminates your need for corrective eye wear.

LASIK surgery is predominately performed on patients who require corrective eye wear because they are nearsighted. However, in some cases it can be used to correct farsightedness and astigmatism. A patient must 18 years of age or older to have LASIK eye surgery.

Length of the procedure:10 to 15 minutes per eye

Hospital Stay:Patients are released from care the same day as their LASIK procedure.

Recovery before traveling home:Patients seeking a LASIK surgery through medical tourism can return home 48 hours after their procedure.

Travel Tip:After LASIK eye surgery you will need to have a follow-up appointment within 24 to 48 hours. Find a comfortable handicap accessible hotel room to recover in during this time.

Procedure Details

The LASIK procedure begins with a complete examination of your eyes. Your eyes will also be measured for cornea size, pupil position, shape and thickness of cornea. You will receive anesthetic eye drops to numb the surface of your eyes.

Once your eye is numb the surgeon will use a special knife called a microkeratome to cut a corneal flap. The flap will be lifted away carefully and a laser is then used to reshape the underlying tissue of the cornea. When the surgeon has reshaped the cornea he will carefully put the flap back in place. No stitches are required and the flap will heal its self.

After the Procedure

After the LASIK surgery you will have an eye patch or shield in place to protect the flap. The shield also prevents you from rubbing or touching your eye. You will also be given dark glasses to wear outside.

Immediately following LASIK surgery your eyes may burn, itch or it may feel as if there is something in your eye. You may also have a small amount of discomfort. You will be given pain medication to alleviate this discomfort.

Your vision may be blurry immediately following the procedure. However, the next day that should subside. You will also be give antibiotic eye drops to prevent infection. Make sure you use these eye drops as prescribed.

Self Care after LASIK surgery:

• Keep follow up appointment after procedure
• Avoid swimming, hot tubs and whirl pools for 2 weeks
• Avoid eye make-up and creams for 2 weeks
• Avoid contact sports for 2 to 4 weeks
• Do not drive until vision is completely back to normal

Result

Most people heal completely within 3 to 6 months of the LASIK procedure. Some people may require an additional procedure to achieve the desired results. After LASIK many people have problems with visual halos, glare and night driving. These problems subside with 6 months in most cases. Even with LASIK most people require reading glasses after the age of 45.

Risks and Complications

As is with any procedure there are risks associated with LASIK surgery. The following is a list of the most common risks and complications:

• Corneal infection
• Corneal scarring
• Misshapen cornea
• Inability to wear contact lenses
• Decreased distance vision at high altitudes
• Decrease in contrast sensitivity
• Dry eyes
• Light sensitivity
• Glare or halos
• Night driving difficulty
• Red or pink patches on the white of the eye
• Vision loss
• Scratchiness

Contact your physician if any of the following occur

• New problem with eye develops
• New eye symptom develops
• Severe eye pain develops
• Reported symptoms
• Vision gets worse
• Any visual concerns
• Any sign of infection

PHACO and IOL (Intra Ocular Lens)

What are Phaco and IOL (Intra Ocular Lens) ?

Phacoemulsification, or phaco, is method of cataract surgery in which the eye’s internal lens is emulsified using ultrasonic energy and replaced with an intraocular lens implant, or IOL.

How is Phaco and IOL done?

Phaco surgery is performed with a small ultrasonic probe that is inserted into the eye via a two-to-three millimeter incision. This probe breaks the cloudy lens into tiny pieces and sucks the fragments out of the eye. Your doctor will place a permanent artificial lens (called an intraocular lens or IOL) where the natural lens used to be. Surgery is performed under a local anesthetic, which prevents movement of the eye. Or topical anesthetic may be used to numb the area. Most procedures take between 15 minutes and one hour.

Why is Phaco and IOL done?

A cataract clouds the lens of the eye causing vision loss that interferes with daily activities. The only effective means of restoring full and clear vision that has been compromised by cataracts is to perform surgery to remove and replace them with permanent artificial lenses.

Risks & complications

Complications are infrequent and usually minor. However, as with any surgery, there are risks, including the possibility of:

• Infection requiring antibiotics and in some cases hospitalization
• Inflammation (redness, swelling) of the eye
• Corneal swelling
• Vision loss
• Retinal detachment
• Development of secondary cataracts

Risks can be reduced by following the surgeon's instructions before and after surgery.

Alternatives

For less severe cataracts, vision may improve by changing eyeglasses, using a magnifying glass or increasing lighting. Beyond these measures surgery is the only effective treatment. The surgeon may discuss alternative surgical approaches to Phacoemulsification including direct surgical removal of the entire lens and/or lens capsule.

Candidate eligibility

Phacoemulsification and intraocular lens implant surgery is ideal for individuals with no other eye disease. Patients with diabetes are known to be at a high risk for worsening eye problems after this procedure. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.

Strabismus Surgery

General Information:

Eye muscle surgery involves making an incision in the conjunctiva, the outer cellophane like covering of the eye, and isolating one or more of the eye muscles that move the eyes in various directions. No incision is made on the skin. The eye is not pulled out of the socket. The eye is gently moved no more than one normally moves the eye when looking around. The incision is almost always made behind the eyelid so the incision itself is usually not visible unless one pulls the eyelid back.

Pre-OP Preparation:

It is important that the person undergoing surgery does not eat or drink anything after midnight the day prior to the surgery. Sometimes infants under age 1 year can drink milk or liquids until 4-6 hours before the surgery. The patient or the family will be called the day before surgery and informed when oral intake of all sorts should stop.

If the patient is taking any medications regularly, you should ask whether these medications should be taken the morning of the surgery. Most medications are not given until after the surgery but essential medications (for example, for seizures or high blood pressure) can be taken the morning of surgery with a small sip of water.

Success Rate:

The success of the surgery is dependent on the ability of the eyes to work together as a team, or the ability of the patient to FUSE or combine the image from each eye successfully into a single image. On average, one eye muscle operation has about an 80% success rate. Another operation may be needed a few weeks, a few months or a few years following the initial surgery.

If the patient has an eye muscle problem that is intermittent rather than constant, the chances of success are usually better than if one of the eyes deviates constantly. If extremely poor vision is present in one or both eyes, the chance of one operation being successful permanently is generally somewhat lower.

Day Surgery:

The surgery is almost always performed as "Day Surgery": that is, the patient comes into the hospital or day surgery facility the morning of the surgery and goes home the same day. Almost all patients can leave the hospital the same day the surgery is performed.

Vision and Surgery:

General anesthesia is used. The risk of losing vision from the surgery is extremely small, about 1 in 20,000 or less. If the patient wears glasses, there may be a small change in the prescription following surgery. It is usually best to wait six weeks following surgery to change the prescription in the glasses.

What about glasses? If you or your child wears glasses prior to eye muscle surgery, glasses will probably (not always) be needed after surgery. If you or your child does not wear glasses prior to surgery, glasses may be needed after surgery to help keep the eyes working together. If prisms are worn in the glasses, then a pair of glasses without prisms should be obtained prior to surgery to be used immediately following surgery.

Post OP Strabismus Surgery:

The amount of pain following surgery is variable. Some very young patients wake up with very little pain. Generally, a child with have some soreness in the eyes for 1-3 hours, during which time a cool rag on the eyes is helpful. All patients over age 2 years will receive one medication to prevent pain and one medication to prevent nausea in the IV during surgery. Usually these medications prevent much of the pain and nausea that once followed eye muscle surgery.

After 1-3 hours, the eyes are usually not extremely sore. There may be a foreign body sensation, like having an eyelash in the eye that may persist for 2-4 days.

The eyes normally stay red for 1-2 weeks or sometimes more following eye muscle surgery. If the redness in the eyes increases markedly, or if the eyelids become red and swollen, an infection on the outer surface of the eye may be present Antibiotics by mouth may be required.

Usually a change in the position of the eyes will be noted soon after surgery, but the final effect cannot be completely assessed for four to six weeks after the surgery.

Cataract Removal