EYE CARE in India is in the process of acquiring the latest technologies, techniques and pharmaceuticals to bring the best to our people. Of the world’s 37 million blind people, 15 million are in India and we desperately need to reduce cases of treatable blindness.
The most common cause of treatable blindness is cataracts followed by corneal blindness, which is a kind of black circular structure in front of the eye, treatment for eye complications of diabetes and uncorrected refractive errors.
The femtosecond laser
EYE CARE has seen a dramatic improvement in safety, efficiency and accuracy with the introduction of “femtosecond” laser technology.
The femtosecond laser creates more precise cuts without damaging surrounding tissue than a blade, creates fewer complications for faster healing after surgery. A femtosecond laser has greater coherence and greater versatility. It causes 106 times less collateral damage than other lasers used in ophthalmology.
Femtosecond means one quadrillionth of a second. The femtosecond laser causes photo-disruption of tissue through a process known as photoionization. This causes the tissue to vaporize with the formation of bubbles and a split is created inside. It is much more precise than a knife cut. The femtosecond laser was introduced to create precise flaps in LASIK eye surgery. Since the femtosecond laser is a versatile system, it has quickly become popular in various other eye surgeries like cataract and corneal transplant. The femtosecond is an infrared laser that can cut transparent tissue with precision. He can cut and divide at will for thinner corneal grafts and for creating pockets in the cornea. In addition to fabricating flaps for LASIK, he has the ability to perform CLEAR (Corneal Lenticule Extraction for Advanced Refractive correction) “flapless” corneal refractive surgery also known as SMILE (SMall Incision Lenticule Extraction). With the introduction of the femtosecond laser for cataracts, the cuts in the cornea are finer and the surrounding tissues are not damaged. It cuts the cataract into several small pieces which are very easy to remove thanks to a small opening. Precisely centered and circular removal of the anterior capsule aids in precise placement of the intraocular lens. In fact, the benefits of femtosecond laser-assisted cataract surgery (FLACS) are a decreased need for ultrasound energy for removal of cataract pieces and better astigmatism control through simultaneous arcuate cuts on the cornea. Due to these unique properties, the femtosecond laser is now widely accepted and has increased advancements in cataract surgery.
Diabetic eye disease
Diabetes is a lifestyle disease that can be effectively managed through regular exercise, diet control, and medication. Uncontrolled diabetes affects the eyes, kidneys, nerves and heart, thus involving several organs in the body.
In uncontrolled diabetes, the condition worsens and if not managed properly, a serious condition called diabetic retinopathy, caused by damage to blood vessels in the light-sensitive tissue at the back of the retina , may occur. If not managed properly, it can lead to blindness.
The disease burden of diabetic retinopathy and diabetic macular edema has increased significantly in India. New drugs like anti-VEGF, which target new blood channels, have shown promising results and can be used. These new agents are also used in the treatment of wet age-related macular degeneration (AMD), which is one of the leading causes of legal blindness worldwide.
Diabetes combined with high blood pressure (hypertension) is more damaging to the body as a whole and more to the eyes.
Diabetes has a strong association with glaucoma where it is twice as common in diabetics compared to the normal population.
Retinal examinations and surgery
The diagnosis of retinal diseases has also improved considerably thanks to advanced investigative tools such as optical coherence tomography (OCT) and OCT-angiography (OCTA). Angiography can now be performed non-invasively, without dye injection, and all retinal and choroidal layers can be analyzed easily within minutes.
Significant progress has been made in laser therapy also for various retinal diseases due to diabetes, uncontrolled hypertension, retinal vein occlusions. The laser now proceeds to the selective ablation of the ischemic retina and prevents collateral damage to the healthy retina. Various laser designs also speed up the laser procedure and cause less pain to the patient.
Retinal surgery is safer and results are better with small gauge instruments (25 gauge and 27 gauge), which now makes retinal surgery without sutures possible. In addition, the success rate has increased due to better high-end machines and excellent visualization systems. More controlled surgery is now possible with these modern instruments.
In addition, 3D visualization systems have improved surgical quality and surgeon comfort. It allows the surgeon to have an upright posture with their head held high during surgery and prevents long-term neck problems in retina surgeons, who operate for long hours.
GLAUCOMA is the leading cause of irreversible blindness worldwide. In India, the estimated number of glaucoma cases is 12 million and almost 1.2 million people are blind due to the disease.
Intraocular pressure (IOP) reduction is thought to be the only treatment option in glaucoma, however, recent research suggests that cerebrospinal fluid pressure is emerging as a potential modifiable risk factor. Biomechanical characteristics, as to how the eye responds to a given pressure, are also at the center of current research into the diagnosis of glaucoma.
Current research in pharmacotherapy has led to the development of new drug formulations such as Rho-associated coiled protein kinase (ROCK) inhibitors. Additionally, the development of other preservative-free, self-preserved anti-IOP drugs has improved efficacy, compliance, and duration of action. In surgery, the emergence of minimally invasive glaucoma surgery offers a safe alternative to traditional surgical techniques beyond traditional trabeculectomy and insertion of glaucoma drainage devices.
Current Eye Care Setup Scenario in India
Eye care in India has seen tremendous progress over the past decade. On the one hand, in the metropolitan cities, the system is comparable to the best in the world, on the other hand, the services and configuration are in a primitive state with little or no advanced facilities for diagnosis, treatment or surgery. This is the reason why our country has nearly 40% of the world’s blind population.
The population has very low health awareness and information about eye care. The need is to use print, television, internet radio and p2p campaign to raise awareness and bust myths.
By Dr. Sudhank Bharati, Bharti Eye Hospital, Delhi
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