EYE CARE in India is in process of acquiring the latest technology, techniques and pharmaceuticals for providing the best to our people. Out of 37 million blind people all across the world, 15 million are in India and we are in desperate need of reducing the cases of treatable blindness.
The most common cause of treatable blindness is Cataract followed by Corneal blindness, which is a sort of black circular structure in front of the eye, Treatment of eye complications in Diabetes and uncorrected Refractive errors.
The Femtosecond Laser
EYE CARE has seen a tremendous improvement in safety, efficacy, and accuracy with introduction of “Femtosecond” laser technology.
Femtosecond laser creates more precise cuts without damage to surrounding tissue than by a blade, creates fewer complications for a faster healing after surgery. A Femtosecond laser has a greater consistency and is greater versatility. It causes 106 times less collateral damage as compared to other lasers that are used in Ophthalmology.
Femtosecond means one quadrillionth of a second. The femtosecond laser causes photo-disruption of the tissue by a process known as photoionization. This causes the tissue to get vaporized with formation of bubbles and there is split created within. This is much more precise than a knife cut. The femtosecond laser was introduced to create precise flaps in the LASIK eye surgery. Femtosecond laser being a versatile system, soon got popular in various other eye surgeries like Cataract and Corneal transplant. Femtosecond is an infrared laser which can cut the transparent tissue with accuracy. It can cut and split as desired for finer corneal transplants and for creation of pockets in cornea. Besides making flaps for LASIK, it has capability to perform “flap less” corneal refractive surgery CLEAR (Corneal Lenticule Extraction for Advanced Refractive correction) also known as SMILE (SMall Incision Lenticule Extraction). With the introduction of femtosecond laser for cataract the cuts in the cornea are finer and there is no damage to the surrounding tissue. It cuts the cataract into multiple small pieces which are very easy to remove through small opening. The precisely centered and circular removal of anterior capsule helps in the accurate placement of the Intraocular lens. In fact, the benefits of Femtosecond laser assisted cataract surgery (FLACS) is decreased need of ultrasound energy for removal of cataract pieces and better astigmatism control by simultaneous arcuate cuts on the cornea. Because of these unique properties, the Femtosecond laser has now a wide acceptance and increased the advancements in cataract surgery.
Diabetic Eye Disease
Diabetes is a lifestyle disease which can be efficiently managed with regular exercise, diet control and drugs. Uncontrolled diabetes leads to effects on Eye, Kidneys, Nerves, and Heart thereby involving multiple organs of the body.
In uncontrolled diabetes the situation gets worse and if not taken care of this properly then a serious condition named diabetic retinopathy which is caused by the damage to the blood vessels of the light sensitive tissue at the back of the retina can occur. If it is not managed properly then it can lead to blindness.
The disease burden of Diabetic Retinopathy and Diabetic Macular Edema has increased tremendously in India. Newer drugs like anti- VEGF’s which targets new blood channels, have shown promising results can be utilized. These newer agents are used in the treatment of wet age-related macular degeneration (AMD) also, which is one of major cause of legal blindness world-wide.
Diabetes in combination of high blood pressure (Hypertension) is more damaging to the body as a whole and more to Eye.
Diabetes has strong association with Glaucoma where it is twice as common in diabetics as compared to normal population.
Retina Investigations & Surgery
Diagnosing retinal diseases has also improved significantly with advanced investigative tools like Optical Coherence Tomography (OCT) and OCT- Angiography (OCTA). Angiography can now be done non-invasively, without injecting any dye, and all the retinal layers and choroidal layers can be analyzed easily within minutes.
Significant advances have been made in laser therapy also for various retinal diseases due to diabetes, uncontrolled hypertension, retinal vein occlusions. The laser now selectively ablates the ischemic retina and prevents collateral damage to healthy retina. Various patterns in laser also quickens the laser procedure and causes less pain to the patient.
Surgery of Retina is safer, and results are better with small gauge instruments (25 gauge & 27 gauge) making suture less retina surgery possible now. Also, the success rate has increased due to better high end-machines and excellent viewing systems. More controlled surgery is now possible with such modern instruments.
Also 3-D visualization systems have improved surgical quality, and surgeon comfort. It allows the surgeon to have a straight posture with heads up position during surgery, and prevents long term neck problems in retina surgeons, who operate for prolonged hours.
GLAUCOMA is the leading cause of irreversible blindness worldwide. In India, the estimated number of cases of glaucoma is 12 million and nearly 1.2 million people are blind from the disease.
Reducing intraocular pressure (IOP) is believed 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 is also the focus of current research in glaucoma diagnostics.
The current research in pharmacotherapy had led to the development of new drug formulations like Rho-associated coiled-coil-forming protein kinase (ROCK) inhibitors. Also, the development of other preservative-free and self-preserved IOP-lowering medications have 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 the insertion of glaucoma drainage devices.
Current Scenario of Eye Care Setup in India
Eye care in India has seen tremendous advancement in last decade. At one side in the metropolitan cities the system is comparable to the best in the world, on the other side the services and setup is in a primitive state with no or poor facility of advanced diagnostic, treatment, or surgical facilities. That is the reason of our country having nearly 40% of world’s blind population.
Lack Of Awareness
The population has a very poor health awareness and eye care information. The need is to use print, television, radio internet and p2p campaign to increase awareness and remove myths.
By Dr. Sudhank Bharati, Bharti Eye Hospital, Delhi
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly.)