On Saturday, November 7, 2020, Health Live @ Seniors Today invited leading eye specialist Dr Anand Shroff to speak to readers and address questions on Glaucoma, Diabetic Retinopathy, Age-related Macular Degeneration. Dr Noor Gill captures the key takeaways from the session.
On Saturday, November 7, 2020, leading eye specialist Dr Anand Shroff spoke to Seniors Today readers and addressed questions on Glaucoma, Diabetic Retinopathy, Age-related Macular Degeneration. This was part of the weekly Health Live @ Seniors Today series.
Dr Anand Shroff is a leading eye specialist and surgeon with specialisation in ReLEx Smile, Lasik, Bladeless EpiLasik, C3R, Glaucoma and Corneal disorders, Cataract including accommodative and toric implants. Dr Shroff had also addressed a Health Live session in July 2020 (Link: https://seniorstoday.in/webinar/takeaways-from-health-live-seniors-today-with-dr-anand-shroff).
An experienced Anterior Segment and Refractive Surgeon and a reputed educator and researcher, he has trained several ophthalmologists from all over the world during LASIK workshops in India and Europe. Dr Shroff is one of the most experienced refractive surgeons having over 17 years of experience as a LASIK and Cataract surgeon. He has performed over 20,000 cataract surgeries and 20,000 LASIK procedures and continues. Also a Glaucoma specialist; he runs the Glaucoma Clinic at Shroff Eye, performing various laser treatments and filtering surgeries with implants.
In India, he is one of the first ophthalmologists to use advanced accommodative and multifocal lens implant technology and methods. He is the pioneer of wavefront guided and topography-guided LASIK in the country. He is the first in India and one of only few in the world to use the ‘Concerto 500 Hz laser’. A former consulting surgeon of Bombay Hospital, he currently works at Shroff Eye Hospital in Bandra and Shroff Eye Clinic on Marine Drive, both in Mumbai.
As your age advances, glaucoma becomes a rising concern with the elderly, because
- It is a silent disease, which means that it causes no symptoms in the early stages of its onset
- It is irreversible
- It is a hereditary disease, which simply translates to a genetic disorder, which it is caused by an abnormality in the DNA.
Which is why you should be very careful and meet up with your ophthalmologist for regular check=ups, especially if you have a positive history of glaucoma in the family.
Don’t drink too much water: Everybody today is a graduate from the WhatsApp University, and one message chain that is going around passing false medical advice is: drinking four glasses of warm water in the morning can help prevent glaucoma. Though drinking water has its advantages, you should not drink too much water in one go. Doing so, raises the intraocular pressure which is the fluid pressure inside the eyes. The usual range for the intraocular pressure is 10-20 mm of Hg; it varies from person to person. For some people it can be adjusted to 15-20 mm of Hg for some it might be 8-18 mm Hg, but typically it is 10-20 mm Hg, it is adjusted per case or patient.
Coming back to the point, in the earlier days, when the medical technology was not as advanced as it is today, we performed a water drinking test to diagnose patients with glaucoma. This test required is to check the intraocular pressure of the patient to determine their range, then ask the patient to drink one litre of water in the morning which is followed by testing the pressure of the inside of the eye again. It was deduced that patients who showed a spike in the level of pressure were diagnosed with glaucoma. And those who did not have glaucoma would show a slight rise in the levels. So, if you have a positive history of glaucoma or are a diagnosed patient of glaucoma, please do not drink that one-odd litre of water in the morning. Instead restrict your intake to 200-250 ml of water per hour. And that should include everything, all the liquids you take should not exceed the 200-250 ml per hour mark, this includes your tea, coffee, milk, lassi, juice, etc.
Glaucoma changes are irreversible : The changes caused by glaucoma are unfortunately irreversible. Glaucoma affects the optic nerve. The optic nerve is located at the back of the eye and transfers visual information from the retina to the vision centers of the brain via electrical impulses. The optic nerve essentially links the eyes with the brain. And we don’t see with the eyes, we see because of and with the brain. So what happens in patients with glaucoma is that the rise in the pressure compresses the optic nerve, and it is the nerve that links the eyes and the brain, so the greater the damage, the higher will be the grade of loss of vision. Typically, your side vision is the first one to be affected since that is the art that is compressed first.
Another mistake that people tend to make is, get their check ups done only at the optician store, and what happens at the optician store is that they only check your central vision and they don’t check your peripheral vision, your intraocular pressure or the optic nerve. And in glaucoma, your central vision is the last to go; this is what we call “tunnel vision”. Because of that, when you go to the optic store and your central vision is fine, you get a false sense of security and because of that one ends up going to the optician often enough, thinking that everything is alright instead of meeting up with an ophthalmologist. And buy the time you make it to the eye doctor, you are already suffering from severe, irreversible vison loss.
If you have glaucoma, make sure you visit your eye doctor and get your eye pressure checked every two-three months. Same goes for, if you have a history of glaucoma in the family.
If you do not have glaucoma, get your intra ocular pressure checked once every year.
Symptoms of glaucoma
There are two types of glaucoma
- Open angle glaucoma
- Close or narrow angle glaucoma
Open angle glaucoma– it is a hereditary disorder.
In open angle glaucoma, the drainage of fluids from the angle (which is formed by the cornea-the transparent layer forming the front of the eye and the iris- the coloured part of the eye) remains open but the trabecular meshwork (responsible for draining the aqueous humour) is partially blocked. This causes a normal inflow but the outflow of the humor is reduced drastically, leading to collection of the fluid which causes the pressure in the eye to gradually increase. And it is this pressure that damages the optic nerve.
In most of these cases, there are no symptoms at all, hence a silent disease. Some patients however may complaint of slight heaviness in the eyes
- Constant change in the power of your glasses
- Patchy blind spots in your peripheral (or central vision), frequently in both eyes
- Tunnel vision is seen in advanced cases
Close angle glaucoma– those occurs when the iris bulges out or forward to narrow or completely block the drainage angle formed by the cornea and iris. An acute angle closure glaucoma attack is a medical emergency. The intraocular pressure shoots up to 40, 50 even 60 mmHg.
- You get blurring of vision
- Redness of the eyes
- Severe headache
- Nausea, vomiting
- Pain in the eye
- Halos around light
Precautions to take after the diagnosis of glaucoma
- Make sure you set up a regular appointment with your ophthalmologist every two-three months to see if the glaucoma has advanced or if it is controlled.
- Get your intraocular pressure checked frequently
- Make sure to ask your ophthalmologist to give you clear instructions on how to out the drops in the eye and how to use those eye drops correctly.
- Always wash your hands first
- Lie down and then out your drops.
- After you’ve out your eye drops, shut your eyes once only. If after putting your eye drops, you start blinking, the eye drops go down in your throat and they eye drops cause an E.N.T problems. It can enter into your throat and into your sinuses and can end up with a pain in your head and sinuses. They also tend to trickle down the side of the eyes, thus negating its purpose.
- Block the tiny opening also called the punctum for 60-90 seconds. So the drops don’t go into your throat.
Typically only 15-20% of the eye drops go into your eyes. And this percentage drops even further if you don’t put the drops correctly which decreases the efficacy of the drug.
We’ve started seeing a lot more cases of macular degeneration now, because we’ve started living longer. It is because the macula was never made to last as long as 70, 80, even 90 years of age.
Macular degeneration can occur either because of hereditary reason or is simply a result of increase in the average human expectancy age.
Important things to keep in mind to avoid early macular degeneration are:
- Avoid UV rays. Whenever you go out, you must always have your glares on.
- Have a well-balanced diet with leafy vegetables, fruits and salads. You can also take vitamin supplements
- Avoid excessive drinking and smoking because the chemicals can cause damage to the retina.
Diabetes, if uncontrolled, affects the eye, the kidneys, the brain and the nerves of the hands and legs. Diabetic patients must get their eye check-ups. The retina is one part of the eye where you can see l lth arteries and veins of the eye. Diabetes if not controlled well, leads to bleeding in the capillaries and the retina is the only place you can see it. So, if you can see it on the retina, there is a high chance that it is also on the other parts of the body.
Diabetes affects the eyes in the following ways
- It affects the capillaries. The capillaries get weak and an out-pouching of the capillaries is seen. This out pouching is what we call a micro aneurysm and these over time can bleed
- Retinal bleeds can also cause glaucoma.
- Ischaemia in the retia is also a common complication in patents with uncontrolled diabetes. Thus means that the oxygen supply to the retina is reduced. When the sugar is not controlled well, the hemoglobin in the blood is not able to pick up oxygen, when it cannot pick up the oxygen, some parts of the retina remain under or sometimes even de-oxygenated. But the human body is made in a way to help, so when some part of the retina is not recieving enough oxygen, the angiogenic factor is secreted out from the arteries which are close to the area if ischaemia or low oxygen supply. The angiogenic factor leads to new blood vessel formation, also known as neovascularization. But these new vessel, are only one cell layer thick and often tend to bleed.
- It can also cause vitreous hemorrhage. This can lead to sudden loss of sight.
- It can increase the risk of cataract.
And all these complications can be avoided by simply keep your blood sugar levels under control. If you’re diabetic get your HbA1c levels checked every three-four months, it is a good indicator of whether your blood sugar levels have been maintained well and controlled well over time.