Tag Archives: glaucoma

Dr S.S. Gill - opthalmologist

World Glaucoma Week 2013

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Resident Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S.S. Gill

Eye Health

Dr S.S. Gill - opthalmologist

In conjunction with the recent World Glaucoma Week 2013, Ipoh Echo talks to  Consultant Eye Surgeon Dr. S.S. Gill about this “SILENT THIEF OF SIGHT”.

World Glaucoma Week 2013 - 2What is Glaucoma?

Glaucoma is a group of eye diseases that result in progressive damage of the optic nerve (the “main cable” that carries visual information from the eye to the brain). If glaucoma is not treated, it permanently damages vision in the affected eye(s) and results in blindness. It is often, but not always, associated with increased pressure of the fluid in the eye (aqueous humour).

Glaucoma has been nicknamed the “silent thief of sight” because the vision loss normally occurs gradually over a long period of time without significant symptoms until you eventually lose significant vision. In other words, it means that one will only notice poor vision when the disease is serious and the damage to the optic nerve is advanced.

Dr S.S. Gill - opthalmologistWorldwide, glaucoma is the second leading cause of blindness after cataracts. Glaucoma affects one in 200 people aged fifty and younger, and one in 10 over the age of eighty. As many as 6 million people are blind in both eyes from glaucoma today. Most of these people were once unaware they had this disease until they lost significant vision in one or both eyes.

One reason why a person may not realise that he or she is losing vision is because the vision loss involves the peripheral part of a person’s vision. This peripheral vision loss is the reason why it goes unnoticed by the patient until the very late stage when the central vision starts being affected. Rarely, in some patients there may be symptoms of slight eye discomfort, mild headache and haloes around lights.

Any person who is 40 years and above should go for glaucoma screening. More so, if you have a family history of glaucoma and have never been screened for glaucoma yourself, you should go for an eye check as soon as you can. Don’t wait for vision problems before you do. It may be too late.

For more information, call  05-5455582  at  Hospital Fatimah  or  email  gilleyecentre@dr.com.

Eye Health – Glaucoma (Final Part)

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

In conjunction with World Glaucoma  Awareness, Ipoh Echo talks to Consultant Eye Surgeon Dr. S.S. Gill about this “silent thief of sight” – Final Part.

Glaucoma as you know has been nicknamed the “silent thief of sight”. This disease results in permanent irreversible blindness in the affected eye(s) that often goes without symptoms until the loss of vision is significant or the patient is blind. Early diagnosis means early treatment and therefore prevention of major loss of vision.

Glaucoma treatment may either involve eye drops instillation, pills, laser surgery, conventional surgery or a combination of these methods. The ultimate goal of treatment is to prevent optic nerve damage that results in irreversible loss of vision. Taking medications regularly as prescribed, is crucial to prevent vision-threatening nerve damage.

1. Eyedrops

The first line of treatment is often instillation of special eye drops that can reduce eye pressure. These will have to be instilled daily without fail in order to prevent loss of vision. Sometimes doctors will prescribe a combination of eye drops in order to lower the eye pressure adequately. There are many patients on eyedrops for years who have their vision preserved. Always be diligent with the instillation of any eyedrops that have been prescribed for glaucoma.

ipoh echo issue 143,  Dr. S.S. Gill, glaucoma, ipoh opthalmologist2. Oral Medication

Oral medication usually has quite a few side effects that may include skin rash, tingling in the hands or feet, nausea or upset stomach, kidney stone formation, altered taste (especially with carbonated beverages), weight loss, fatigue, and decreased energy. So, they are generally not used long term. They are generally only used to treat acute eye pressure increase.

ipoh echo issue 143, Dr. S.S. Gill, glaucoma, ipoh opthalmologist3. Laser Surgery

Depending on the condition of your eyes, laser treatment may be recommended if suitable. Laser surgery is performed on an outpatient basis in an eye doctor’s office or clinic after the eye has been numbed. A laser is directed toward the trabecular meshwork which is the area that drains the fluid (aqueous humor) from the eye into the blood. There are many kinds of laser surgery and they are usually recommended based on the type of glaucoma.

ipoh echo issue 143, Dr. S.S. Gill, glaucoma, ipoh opthalmologist4. Surgery

Surgery is usually recommended if the eye pressure cannot be controlled by all of the above treatments. Surgery involves creating means for the eye fluid (aqueous humor) to drain in order to relieve the eye pressure.

As a last resort, a special glaucoma drainage device may have to be implanted in the eye in order to relieve the eye pressure.

In summary, get an eye examination done annually. If you are diagnosed with glaucoma, it does not mean you will go blind. It only means that you will need to be treated intensively in order to prevent you from going blind.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Health – Glaucoma

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

In conjunction with World Glaucoma Week 2012, Ipoh Echo talks to Consultant Eye Surgeon Dr S.S. Gill about this “silent thief of sight ”  – PART 4

Glaucoma as you know has been nicknamed the “silent thief of sight”. This disease results in permanent irreversible blindness in the affected eye(s) that often goes unnoticed until the loss of vision is significant.

What Is Unnoticed Loss Of Vision?

In some types of glaucoma such as Primary Open Angle Glaucoma and Normal Tension Glaucoma, the visual loss occurs very slowly without the patient ever noticing until the disease is in its advanced stage. You may wonder how a person can be losing vision without noticing it. Well, this is because the visual loss is from the periphery.

This peripheral visual loss is typically described as tunnel vision. Starting in the peripheral most part of the field of vision, the visual loss slowly starts encroaching into the central vision. This slowly progressing loss of vision is often unnoticed by the patient until a substantial amount of peripheral vision has been lost. Furthermore, glaucoma is “silent” without any acute pain or symptoms.

Early Glaucoma

Early glaucoma tunnel vision - Eye Health - Dr S.S. GillThis picture simulates the early tunnel vision that a glaucoma patient may have and yet may not notice that there is peripheral loss of vision. A major part of the central vision is good and the patient is still able to see well. This peripheral loss of vision can only be detected by specialised testing called Perimetry or Visual Field Testing.

Advanced Glaucoma

Advanced glaucoma tunnel vision - Eye Health - Dr S.S. GillThis picture shows advanced glaucoma. Most of the peripheral vision has been lost here. Only a small tunnel of vision is left. At this stage, the patient usually experiences difficulty moving around in poorly lit places or outdoors at night. Most people end up seeking treatment at this stage when such a significant vision loss has already occurred.

I have had patients walk into my Consultation complaining of poor vision in one eye. Following examination, the patient was found to have Primary Open Angle Glaucoma. The shocking part for such a patient is that whatever visual loss has occurred cannot be reversed. In other words, the vision that has been lost in the affected eye is lost permanently. It is for this reason that those above 40 years of age should have their eyes checked routinely as part of their general health screening.

Dr Gill will elaborate on the eye checks that are done for glaucoma in the next issue of the Ipoh Echo.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Health – Glaucoma (Part 2)

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

In conjunction with World  Glaucoma Week  2012, Ipoh Echo talks to Consultant Eye Surgeon Dr S.S. Gill about this “silent thief of sight”  –  PART 2

Glaucoma as we know is a group of eye diseases that results in permanent blindness in the affected eye(s) that is irreversible. Glaucoma is the second leading cause of blindness in the world. The disease often goes unnoticed until the loss of vision is significant, hence the nickname “silent thief of sight”.

Who is at risk of glaucoma?

Everyone is at risk for glaucoma and should go for an eye check annually. However, certain groups are at higher risk of developing glaucoma. The following conditions and groups have a higher risk of glaucoma:

  • Aging
  • Family members of glaucoma patients
  • Diabetes Mellitus
  • Short sightedness (Myopia)
  • Long sightedness (Hyperopia)
  • High blood pressure (hypertension)
  • Past or Present use of steroids
  • Migraine
  • Eye injuries
  • Certain ethnic groups – Asians & Africans

People Over 60

Glaucoma is much more common among older people. You are 6 times more likely to get glaucoma if you are over 60 years old and that is why it is important to have your eyes checked as you advance in years.

Family Members with Glaucoma

The most common type of glaucoma is primary open-angle glaucoma (POAG). This glaucoma is hereditary. The risk of glaucoma increases by 5 to 9 times if you have a family member who suffers from glaucoma. This hereditary link has been confirmed by two studies, i.e., the Baltimore Eye Study and the Rotterdam Eye Study.

Glaucoma-Rubeosis - eye health - S.S. Gill
Glaucoma-Rubeosis

Diabetes

Several large studies suggest that people with diabetes are more likely to develop glaucoma. If diabetes and glaucoma are treated early, vision can be saved. Otherwise, abnormal vessels in diabetes may form resulting in bleeding in the eye and rubeotic glaucoma (picture on left).

Dr Gill will elaborate more on glaucoma in the next issue of the Ipoh Echo.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Dr Lee Mun Wai - Glaucoma and Erectile Dysfunction

Glaucoma and Erectile Dysfunction

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Dr Lee Mun Wai - Retinal Surgeon’s Perspective
Dr Lee Mun Wai

Eye Chat – From A Retinal Surgeon’s Perspective

What has an eye disease like glaucoma have to do with a condition which is so physically remote from the eyes (you might ask)? A recent study was published (http://www.ncbi.nlm.nih.gov/pubmed/22036631) which described a possible link between glaucoma and erectile dysfunction (impotence) and has reported an almost 3 FOLD increased risk of glaucoma in individuals suffering from erectile dysfunction (ED).

Dr Lee Mun Wai - Glaucoma and Erectile DysfunctionWhat is glaucoma?

As World Glaucoma week nears (March 11-17), there has been much information put out there about how glaucoma is the 2nd leading cause of blindness worldwide and how the symptoms do not present themselves until a very advanced stage. There are many different types of glaucoma and I shall not elaborate too much into the diagnosis and treatment of this disease but suffice to say that glaucoma is a group of diseases characterised by progressive damage to the optic nerve and associated with pressure inside the eye.

What is erectile dysfunction (ED)?

Dr Lee Mun Wai - Glaucoma and Erectile DysfunctionThis is a particularly taboo subject (amongst the men at least) and not often discussed in the context of our society as well. It is defined as the inability to develop or maintain an erection for satisfactory sexual intercourse.

Causes of ED – Public education about this condition is very poor and there are many men who “suffer in silence” for fear of the stigma associated with this diagnosis. The main causes are divided into two main categories; psychological and physical. Little do people know that the physical causes account for over 50% of ED and these would include hypertension, diabetes, high cholesterol and heart disease just to name a few. All these diseases have a common ‘theme’ in that they are vascular disorders (i.e., problems with blood vessels). In actual fact, treatment of these vascular problems would also treat ED in such individuals.

What is the link between glaucoma and ED?

This study looked at data from over 4,600 men with ED and found that there was an increased risk of these men having glaucoma compared with a “control” group of men without ED. There has been evidence to show that vascular problems (as mentioned above) can lead to ED as there is chronic damage to the blood vessels throughout the body. Similarly, problems with vascular tone and blood flow have been implicated in glaucoma and it would not be surprising if the two conditions had common causative mechanisms.

What are the implications?

The results of this study have to be taken into context of course – a lot more research has to be done to evaluate this association between glaucoma and ED. Is there a true link or is this a chance finding?

What it would mean for physicians is that there is another aspect to look out for when managing a patient with ED – getting their eyes checked as well! For the layman, being armed with good health information is always a good start towards leading a normal life in spite of these problems. Nevertheless, this paper has raised some eyebrows and we shall continue to look hard for more information about these two conditions.

More about Viagra and risk of blindness in coming issues.

 

For more information about this topic or other eye health subjects, please visit my blog at: www.lec.com.my/youcare-eyecare. Or call Lee Eye Centre : 05-254 0095

What is glaucoma?

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

In conjunction with World Glaucoma Week 2012, Ipoh Echo talks to Consultant Eye Surgeon Dr S.S. Gill about this “silent thief of sight”.

What is glaucoma?

Glaucoma is a group of eye diseases that result in progressive damage of the optic nerve (the “main cable” that carries visual information from the eye to the brain). If glaucoma is not treated, it permanently damages vision in the affected eye(s) and results in blindness.  It is often, but not always, associated with increased pressure of the fluid in the eye (aqueous humour).

Glaucoma has been nicknamed the “silent thief of sight” because the vision loss normally occurs gradually over a long period of time without significant symptoms until you eventually lose significant vision. In other words, it means that one will only notice poor vision when the disease is serious and the damage to the optic nerve is advanced.

Worldwide, glaucoma is the second leading cause of blindness after cataracts. Glaucoma affects one in 200 people aged fifty and younger, and one in 10 over the age of eighty. As many as 6 million people are blind in both eyes from glaucoma today. Most of these people were once unaware they had this disease until they lost significant vision in one or both eyes.

One reason why a person may not realise that he or she is losing vision is because the vision loss involves the peripheral part of a person’s vision.  This peripheral vision loss is the reason why it goes unnoticed by the patient until the very late stage when the central vision starts being affected. Rarely, in some patients there may be symptoms of slight eye discomfort, mild headache and haloes around lights.

Any person who is 40 years and above should go for glaucoma screening. More so, if you have a family history of glaucoma and have never been screened for glaucoma yourself, you should go for an eye check as soon as you can.

More on Glaucoma in the next issue.

For more information, contact Gill Eye Specialist Centre at 05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

The Right To Sight

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Visual impairment is a term used to describe any kind of vision loss to the extent that even with conventional forms of correction or treatment, the person’s vision remains poor.

“Being visually impaired can be frightening, especially when it affects those who once had good vision,” says Dr. Gill, who is based in Hospital Fatimah in Ipoh. “In fact, just taking into cognizance the facts on visual impairment should send the message that we cannot take our eyes for granted”.

Dr. S.S. Gill Resident Consultant Ophthalmologist
What Causes Visual Impairment?
Many factors can cause visual impairment. “Cataracts, or the clouding of the eye’s lens preventing light from passing through to the retina, are common causes for loss of vision,” says Dr. Gill. “Because cataracts form slowly, causing gradual vision loss, it may not be noticeable to the patient”. Cataracts usually affect people in their 60s and 70s, but may sometimes appear earlier in people who are excessively exposed to sunlight.

“Many of my patients who present early are golfers and sports people who are not in the habit of wearing sunglasses. The general rule is that you should always wear good sunglasses whenever you go out during daylight hours.” Symptoms of cataract include double vision, cloudy or blurry vision, difficulty seeing in poorly lit spaces, and when colours seem faded. Early detection and replacement of the eye’s natural lens with an intraocular lens (IOL) implant through cataract surgery usually restores vision in these cases.

“If you have diabetes, you need to be screened regularly for Diabetic Retinopathy, which is a condition where the tiny blood vessels in the retina (back of the eye) are damaged due to diabetes. People with retinopathy may not have any problems seeing at first. But if the condition gets worse, they can become blind.” To help prevent retinopathy, people with diabetes should avoid smoking, keep their blood pressure under control, and keep their blood sugar at an even level.

Another common cause is Glaucoma, a condition where an increase in pressure inside the eye impairs vision by damaging the optic nerve. “Any damage to the optic nerve is irreversible so it is important to find out if there is any history of glaucoma in your family as the condition is hereditary. Early detection and treatment is crucial or the vision will gradually deteriorate over time to a small tunnel vision, and then blindness can occur,” emphasizes Dr. Gill.

Most people may also find it surprising to note that injury is one of the commonest causes for vision loss. Examples like getting hit with a hockey ball or a shuttlecock, or children playing with sharp objects, and injuries from car accidents are common factors. These incidents are potentially devastating and a drastic accident can cause blindness. “I always advise parents to avoid buying toys with sharp edges and prevent children from playing with chopsticks or pencils. Prevention is always better than cure!”

Macular degeneration is a gradual deterioration of the macula (centre point at the back of the eye), which is the most sensitive region of the retina. The condition leads to progressive loss of central vision (the ability to see fine details directly in front). Excessive exposure to sunlight and smoking can increase the risk for age-related macular degeneration. Symptoms may include increased difficulty reading or watching TV, as vision becomes distorted and straight lines appear wavy or objects look larger or smaller than normal.

In children, amblyopia or “lazy eye” in early childhood can drastically reduce vision in an eye if the weak eye is not corrected. It is important to detect and treat the lazy eye before the age of 7 or 8 years, before the “vision centre” in the brain completes development.

Preventing Visual Impairment
For a large number of people who develop visual impairment in their 50s and later, it usually begins with a preventable disease, unless vision loss is caused by cataracts which can be reversed with surgery. A disease like glaucoma for instance, has to be detected early and treated or damage is irreversible.

Some final words from Dr. Gill: “Many people will have some type of visual problem at some point in their lives. It is important that if you have an underlying condition like diabetes, hypertension or glaucoma that you visit your ophthalmologist regularly and comply with prescription medication and eye drops to prevent further vision loss.”

For more information, contact 05-5455582 or email gilleyecentre@dr.com or visit: www.fatimah.com.my.

The World Health Organisation (WHO) facts:
* Approximately 314 million people are visually impaired worldwide and 45 million of them are blind.
* Every 20 seconds, someone in the world becomes visually impaired.
* Most people with visual impairment are older, and females are more at risk at every age, in every part of the world.
* Cataract remains the leading cause of blindness globally, except in the most developed countries.
* Correction of refractive errors (short and long sightedness) could restore normal vision to more than 12 million children between the ages 5 to 15.
* About 85% of all visual impairment is avoidable.

Next Issue: Part 2 – Tips on How to Look After Your Eyes and Maintaining Good Eye Sight

Cataract Surgery – ‘More Than Meets the Eye’

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Introduction

There are an estimated 160 million people worldwide who are visually impaired and cataract accounts for almost 50% of this visual impairment. It is the leading cause of blindness and in the local context, a national eye survey found that cataract accounts for 39% of blindness.

Anatomy

The eye functions like a camera i.e. there is a lens which focuses light onto the ‘film’ (retina). In the eye, images from the retina are processed into electrical signals and sent to our brain which then interprets these signals as images.

With age, the lens becomes cloudy, hence, forming a cataract.

Causes of Cataract

The most common cause for cataract is age. However, in specific illnesses (such as diabetes) or in association with certain types of medication (steroids), there is an increased risk of cataract. Increased UV exposure can also lead to the development of cataract.

Symptoms of Cataract

The most common symptom is blurring of vision (Figure 1). Other symptoms may include colours appearing dull, glare and halos around lights, difficulty reading, watching TV or driving at night.

Treatment of Cataract

The only proven ‘cure’ for cataract is surgery. Contrary to popular belief, there is no eye drop or medication which can treat a cataract.

How Is Cataract Surgery Performed?

Modern cataract surgery is called phacoemulsification and involves the use of high frequency ultrasound (not laser) delivered through a handheld probe to break the cataract into little pieces and remove it. An artificial lens implant is then placed into the eye. The whole procedure is carried out through a wound of less than 3mm and no stitches are required. (Figure 2)

Advancements in Cataract Surgery

Cataract surgery is constantly changing and technological advancements in the machines as well as significant developments in the types of lenses have contributed to improved quality of vision as well as quality of life of the patient.

Challenging Cataract Surgery

There are many different types of cataract and to the ophthalmologist, the technical difficulties presented by the different types of cataracts during surgery is a very real issue and a challenging one.

Dense cataracts: A significant number of patients only seek help when they are almost blind from cataracts and in these cases, the cataracts would be very dense. In a dense cataract, more energy is required during surgery and there is an increased risk of damage to other structures within the eye.

Unstable cataracts: In certain circumstances such as in an inherited condition (Marfan’s syndrome) or following injury to the eye, the lens may be dislocated from its original position. Complicated manoeuvres to stabilize the lens will be required during surgery for these situations and should only be performed by an adequately experienced surgeon.

Small pupils: A dilated pupil is essential during cataract surgery but pupil sizes are variable and in certain conditions such as diabetes or glaucoma the pupil can be particularly small. The surgeon will be required to use various different techniques to mechanically ‘dilate’ the pupil in order to operate safely.

Cataract and Other Eye Diseases

Cataracts often co-exist with other eye diseases and in the appropriate hands, combined surgery can be carried out.

Cataract and glaucoma: Glaucoma is characterised by high pressure within the eye causing damage to the optic nerve. Patients lose peripheral vision first and eventually their central vision as well if left untreated. Glaucoma and cataract often co-exist and cataract surgery combined with trabeculectomy (a filtration procedure to lower eye pressure) can be carried out.

Cataract and diabetes: Diabetes can cause severe bleeding in the eye and this complication from diabetes is the leading cause of blindness in the working age group. Vitrectomy is a specialised microsurgical procedure which is often carried out in patients with severe diabetic eye disease. As cataracts are also more common in diabetics, combined cataract surgery and vitrectomy are often performed.

Conclusion

As illustrated above, there is a lot ‘more than meets the eye’ when it comes to cataract surgery. It is important that patients understand the options available to them when told they require cataract surgery. Discuss all visual requirements with your ophthalmologist to find out the best option for you.

It is also important that patients understand the potential complexity of cataract surgery. No doubt cataract surgery may be trivialised to be a simple procedure which takes minutes to perform, but patients should be aware that it is still an operation which carries with it certain risks and should not be taken lightly.

Finally, be aware of other conditions which may affect the eye as we age. Regular visits to your friendly ophthalmologist will go a long way in picking up problems early and nipping them in the bud.