Wonders and Concerns of Modern Eye Care


Technological interventions of a multidisciplinary nature have improved methods of eye care for more refined, precise and precise results.

Consulting eye surgeon Dr Champa Banagala spoke at length about the new era of eye care, including its wonders and concerns, during the 30th Susan George Pulimood Prayer recently organized by the Visakha Vidyalaya Old Girls Association. The prayer is held annually in honor of the beloved former director of Visakha Vidyalaya, Susan George Pulimood.

Technology

Regarding modern eye care, Dr Banagala said that technological integration and medical breakthroughs over the past decades have enriched ophthalmology and have helped people with different types of vision problems tremendously. Stem cell therapy, gene therapy, and microchip and signal processing (artificial eyes) have shown rewarding results, especially for patients with low vision problems.

Dr Banagala said that small incision surgery with shorter operating time and shorter hospital stay has benefited many patients around the world. Most of these technological interventions were primarily through innovative applications in lasers, biomaterials, and ultrasound technology.

“The era of digital health and artificial intelligence (AI) in ophthalmology has already begun. The digital age has provided new tools that improve the efficiency and availability of eye care services through digital health and telemedicine. In telemedicine, the electronic transmission of care data is transmitted to the ophthalmologist for efficient service. Such action will particularly help those living in rural and remote areas of many countries, ”said Dr Banagala.

Artificial intelligence

Artificial intelligence-based systems can identify the difference between normal and abnormal images after an eye exam within seconds, enabling ophthalmologists to act early and effectively.

Regarding lasers and eye care, Dr Banagala said it has revolutionized modern ophthalmic surgery, be it for the cornea, cataracts, retina or any other related condition.

“The beauty of the Fem to Second laser is that it can be used for precise cuts, without damaging surrounding tissue, as the energy is focused on a particular point,” she said.

Biomaterial, a substance designed to interact with biological systems for medical – therapeutic or diagnostic purposes, is used therapeutically to treat, augment, repair or replace tissue function in the body. Biomaterials are used in the manufacture of various intraocular lenses and contact lenses, she said.

Corneal diseases

Regarding corneal disease, Dr Banagala said it is one of the leading causes of visual impairment, ranking as the fourth leading cause of blindness in the world: after cataracts, glaucoma (often associated with excessive pressure in the eye) and age-related eye conditions, and macular degeneration.

She said that it is now possible to replace only the damaged layers of the cornea with a donor transplant, while leaving the healthy part of the cornea intact.

The amniotic membrane taken from the placenta is considered an important medical device with many applications in regenerative medicine. When there is severe damage to the outer surface of the cornea, the amniotic membrane transplant helps cleanse the cornea. Amniotic membranes are now commercially available. In Sri Lanka, it is available at the Sri Lanka Eye Donation Society, she said.

Limbal stem cell transplant has been developed for the treatment of many corneal diseases such as corneal scarring, chronic inflammation and so on to restore damaged corneal surface. Dr Banagala said that one of the recent surgical techniques to reshape the cornea is known as laser assisted LASIK. This is to correct the refractive error of the cornea to avoid wearing glasses.

In a condition known as keratoconus, the cornea thins, weakens, and protrudes. One of the treatments involves inserting transparent crescent-shaped polymer rings called “INTACS” to reshape the cornea. “INTACS” will make the cornea flattened and closer to its original dome shape, she added.

Corneal transplantation is another important surgical treatment for many common corneal diseases.

Cataract

Cataract surgery is commonly performed in Sri Lanka. Dr Banagala said that in other parts of the world laser surgery is being adopted. This is done more precisely with focused light where less energy is needed to break down the cataract. However, laser-assisted surgery is not currently performed in Sri Lanka.

Over the past decade, a variety of intraocular lenses with special designs have been produced: improved in both corrective power and the quality of vision provided.

Glaucoma

“Glaucoma can damage the optic nerve and reduce the field of vision. It is known as the silent killer of vision because the disease progresses over the years without any symptoms until the later stages. By the time the patient notices changes in the visual field, the disease has progressed. The final step is tunnel vision. Patients experience it as if they are looking through a tunnel. The danger of glaucoma is that it is irreversible.

Therefore, it is important that all family members of a person receiving eye pressure treatment have regular eye screening, Dr Banagala said. The first changes in glaucoma are seen in the blood supply to the optic disc in optical coherence angiography or OCTA, a test done for imaging of blood vessels.

When nerve fiber changes occur, they can be diagnosed early with optical coherence tomography, she said. Glaucoma is usually treated with eye drops; laser or surgery are the other options.

“Micro-implants are recent advances in glaucoma surgery. These are made of biomaterials and are known as stents. They will drain the fluid into the eyes to reduce eye pressure.

Diabetes

Diabetic retinopathy is a complication of diabetes that affects the eyes. It is caused by damage to the blood vessels in the retina.

“Diabetic patients should watch for changes in retinopathy every year. Otherwise, it will progress to hemorrhages and exudates in the retina. It can reduce vision if it happens in the center of the eye. When new vessels form in the retina and optic disc, it leads to bleeding in the eye. At this point, the patient will feel black particles moving in front of the eye. For this, laser therapy or the injection of drugs called anti-vascular endothelial growth factor (anti-VEGF) therapy to regress the vessels is needed, ”she said.

The terminal stage, known as proliferative retinitis, requires surgery that takes long hours and the prognosis is grim.

Global myopia is expected to increase and it is estimated that more than 50 percent of the world’s population will be nearsighted by 2050, especially children.

For many years, myopia was corrected either with glasses or with contact lenses. Currently, there are many different new treatments available depending on a person’s condition and age, Dr Banagala said.

Laser surgery can only be done when myopia stabilizes. Until then, new methods are being used to prevent the progression of myopia. “There are two types of therapeutic contact lenses that control the progression of myopia: nighttime orthokeratology lenses and daytime multifocal soft lenses. The other option is myopilux multifocal-lens glasses or executive bifocal glasses.

Recent research has found that dilute atropine eye drops can be used to prevent the progression of myopia in school-aged children. Currently, these drops are used in other countries. Recent research has shown that children should be exposed to the sun to prevent the progression of myopia. They should be encouraged to play outdoors every day and limit the use of tabs, computers and cellphones, ”said Dr Banagala.

With presbiopia (inability to see up close), you have several options such as wearing glasses and contact lenses. Other options are Lasik, called Presby Lasik or corneal encrustation placed inside the cornea to change the refractive power of the cornea.

Genetical therapy

Gene therapy and genetic engineering are two closely related technologies that involve the modification of genetic material. This is applied in an incurable genetic disease that causes blindness in men (known as choroideremia) and transmitted by women. The disease is caused by a defect in the X chromosome. Treatment involves injecting a harmless virus that carries choroideremia directly into light-sensitive cells in the retina.

Dr Banagala also warned of the dire consequences the digital revolution would have on the eyes.

“The unprecedented use of the digital screen by people over the past two years (due to the pandemic situation) has made this situation worse,” she said.

Blue light exposure – Digital eye strain, eye strain, or computer vision syndrome occurs when a person stares at a screen for a long time, whether it is a computer, television, or computer. ‘a phone or tablet.

Blue light scatters more, making it more difficult to focus, which will reduce your visual contrast. This is why you experience eye strain, said Dr Banagala.

Numerical revolution

While there is no evidence that blue light from computers will directly lead to eye disease, there are concerns that it could lead to sleep problems.

Symptoms of computer vision syndrome involve eye strain, itchy eyes, dryness, blurred vision, double vision, and headache.

She said one of the easiest corrective measures for this is to follow the 20-20 rule.

The rule is to relax the eyes, looking beyond 20 feet, for 20 seconds after 20 minutes of use.

“What’s more, correct posture will also help reduce eye strain as it will lead to correct focus. The desk should measure 45 cm. at 75cm and your eyes should be looking towards the center at an angle of about 20 degrees, ”she said.

Dr Banagala added that the global need for eye care is expected to increase dramatically and advances in science and technology have opened up a wide range of clinical and research opportunities that have the potential to accelerate future eye care. “We hope that the Sri Lankans can also reap the fruits of these revolutionary developments without delay,” she added.

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