Treatments

Glaucoma is an eye condition in which the optic nerve of the eye is progressively affected due to a rise in the pressure of the eye (called intra ocular pressure).

The risk for glaucoma is more in patients with high spectacle number (both plus and minus number). Also if a close blood relative is affected by it, there is a risk as it may run in families. Advanced age is also a risk factor.

Glaucoma can be kept under control with medications, usually eye drops. However the patient has to regularly put the eye drops all his life.

Broadly, glaucoma is of 2 types: angle closure type and open angle type. Angle closure type is more common in young and middle age and is usually associated with a small eye and plus spectacle number. Open angle type is found in elderly and  may be associated with a minus spectacle number.

In most cases, glaucoma causes no symptoms till there is significant optic nerve damage as the central vision is spared even in advanced cases. The patient has progressive loss of peripheral vision. In angle closure type of glaucoma, the patient sometimes gets acute attacks in which there is redness of eye, blurring of vision and eye pain and headache. These need immediate medical treatment to prevent permanent vision loss.

No, the vision loss in glaucoma is permanent. Hence routine annual eye check up that includes checking eye pressure is very important to detect such a problem in the early stages.

The cases in which eye pressure cannot be controlled with medications, surgery is sometimes required.

In cases of angle closure glaucoma, treatment with YAG laser may be necessary to create a separate channel for the aqueous (liquid inside the eye) to drain to the front portion of the eye. Also sometimes in open angle glaucoma laser trabeculectomy may sometimes be performed to increase drainage of aqueous.

Whenever the eye has to look at a near target, the ciliary muscle in the eye contracts and this makes the natural lens in the eye to bulge
and become more convex. This increases the refractive power of the lens. This process is known as accommodation.

Light from a distant target is almost parallel and the convexity of the lens in the relaxed state is sufficient to focus the light on the retina. Hence no accommodation is needed in a normal eye while looking far. However light from a near target is divergent and hence requires more power to focus its image on the retina. A point focus on the retina produces clear image.

So whenever a person works on a computer, he is actively using his accommodation to keep the image clear. However, continuous near work tires the ciliary muscle. The fatigued ciliary muscle can no longer maintain the required accommodation. This is known as accommodative asthenopia. The result is visual distortion which includes blurring, double vision, etc. This is also responsible for the resultant headache.

20-20-20 Rule
It is advised that a person who is continuously working on the computer should after every 20 minutes of work, take a break to relax the eyes. This involves looking at a distant target at least 20 feet away for about 20 seconds. Looking at the distant target relaxes the accommodation and prevents fatigue of the ciliary muscles of the eye. Alternately, one can close the eyes for 20 seconds, since cubicle spaces at offices may not give a convenient visual target 20 feet away. This is a simple but vastly effective way of giving the eye a break in order to relax and replenish its power to accommodate.

Remember to Blink
Normally the rate of blinking of eyelids ranges from 10 to 16 times per minute. However when we are working on the computer, we stare while concentrating on the task at hand. Due to this, the rate of blinking is reduced to 5 to 6 times per minute. Blinking acts like a wind-shield wiper of a car. It evenly distributes the tears over the eye surface. The moisture provided by the tears helps in maintaining the clarity of the cornea and thus keeps the image clear and sharp.

Reduced rate of blinking exposes the tear film to air for a longer time with no even distribution of tear. Thus dry spots are formed on
the eye surface which exposes the cornea directly to air. This may reduce image clarity causing further strain to the eyes. Also due to
dryness of the eyes there is pricking sensation and irritation of the eyes. The eyes may look red due to resultant congestion of blood vessels of the conjunctiva.

So it is advisable to remember to blink frequently while working on the computer. This is a very effective way to prevent dry eyes arising
out of computer use.

Avoid Air Blast
Avoid facing a direct blast of air from an air-conditioner vents, fan, etc. The blast of air will easily dry the tear-film of the eye and aggravate the symptoms of dry eyes. However a cool environment is better than a hot one as the rate of evaporation reduces. In an extremely dry environment, one can also use humidifiers to increase the ambient humidity in air.

Keep Proper Lighting
Proper lighting of the room plays a very important role in preventing C.V.S symptoms. The lights in the room should be above the computer and should fall on the face of the person using the computer. This position ensures that the light does not fall directly on the computer/ laptop screen, thus preventing glare. Also as the room light falls on the eyes of the user, the pupils of the eyes constrict (reduce in size). Pupil is the central aperture in the eye which regulates the amount of light entering the eye. Asmall pupil causes reduced glare and also helps to focus at a near target.Also the light of the room should be bright enough to constrict the pupil.

Never work on a computer/laptop/smartphone in a dimly light room or dark room. The dim light causes the pupil to dilate (increase in size). The light of the computer typically does not effectively constrict the pupils. So there is glare, dazzling and eye strain.

While working near a window, position your desk such that the light does not fall on the screen of the computer. While working outdoors, with mobile computing devices like smartphone and tablet remember to prevent sunlight from directly falling on the screen to prevent reflection of sunlight from the screen which impedes clear viewing.

Keep the Screen at Optimum Brightness
Modern electronic display devices have adjustable brightness. The amount of brightness required is subjective and depends on the comfort of the user and the overall lighting in the room. If the brightness is very low, the eyes may need to strain to see clearly. If the brightness is very high, there can be dazzling of light and glare. So keep the brightness just enough to see clearly.Also as a general rule, dimmer the light in the room, dimmer should be the brightness of the screen and vice versa.

Correct Position
Your computer should be at an arm’s length away from your eyes. The ideal distance is about 20 inches (50 cm). The center of the screen should be about 5 inches (12 cm) below eye level. The target point of vision is thus about 15 to 20 degrees below eye level which is considered as optimum for the eye and neck. In order to avoid other posture related problems, it is also advisable to remember the following points:

• Be seated in a comfortable, adjustable chair with good back support.
• Have a comfortable, upright posture.Avoid hunching, slumping and forward bending.

Wear Your Glasses
Remember to wear your glasses as advised by your ophthalmologist. The problems of C.V.S are especially acute in individuals with hypermetropia and presbyopia, both of which require convex (plus) lenses to see clearly. Not using the glasses causes additional burden on your eyes and aggravates the eye fatigue. Glasses are also needed for near work if there is astigmatism, in which the cornea (front portion) of the eye is not evenly smooth. This needs cylindrical lenses.

Individuals with Myopia (those using concave or negative lenses) may or may not need glasses for near work, depending on their spectacle number. All myopes below the age of 40 years should continue using spectacles at all times. But those above 40 years, having a spectacle number ranging from -1 D to – 2 D may not see with their glasses (meant for distance) and may need to remove them to see clearly.

Those needing glasses and above 40 years may either require a progressive lens or a separate lens for near work. The distance for computer use is slightly farther than for reading. Hence glasses meant for reading are not ideally suited for computer use. The user may have to come close to the screen to see with the reading glasses. Use glasses adjusted for computer use. Your eye specialist will guide you as to the best option for you.

Limit Contact Lens Use
Those using contact lenses may have aggravated symptoms of C.V.S. The cornea gets part of its oxygen from the air. The oxygen dissolves in the tear-film and is absorbed by the cornea. Use of contact lens hinders the free flow of tear over the cornea, thus limiting its access to oxygen. The fitting of the contact lens needs to be checked. Too tight and it reduces oxygen access further. Too loose and it moves over the eye more easily and may shift or dislodge and blur the vision.

Limit the use of contact lenses to less than 8 hours in a day. Avoid contact lenses, if there are is severe dry eye and if there is allergic reaction on contact lens use.

Other Screen Adjustments
Remember to keep the contrast and resolution at optimum levels so that you see clearly. Also use the font size that is best suited to give you clear focus.

Use Anti-glare Protection
Glare due to light reflected from the computer screen can cause strain on the eyes. Apart from the proper lighting, one can use anti-glare screen protectors to further reduce glare. These protectors are even compatible with touch screens. One can also use anti-glare coating on the glasses to reduce reflection at the level of spectacle lens. Keep the screen clean An unclean screen will distort and blur the images and cause your eyes to strain more. So remember to keep your screen surface clean and clear.

Use a Stand for Books/papers
Use a stand or document holder for books/papers if you have to type from them. Place the stand next to the screen. If you can type without looking at the keyboard, you can keep looking at the book and reduce your time spent looking at the screen.

Change Your Monitor
If you are using the old-styled cathode ray tube (CRT) monitor change it to a modern LCD screen. CRTs flicker and can strain the eyes. Choose LCD screen with high resolution for best clarity.

Use Lubricating Eye Drops
Some individuals are prone to having dry eyes. Such individuals may be advised by the doctor to use moisturising eye drops. The type of eye drops and frequency depends on the ocular surface condition.

Eat Well
Yellow, orange, red coloured vegetables (e.g. carrot) provide the eye with Vitamin A which is needed by both the retina to see well and the outer eye surface for proper lubrication. Also dry fruits like walnuts and sea foods, supply minerals essential for eye and health.

Consult Your Eye Specialist
Finally don’t forget to consult your eye specialist. Even in the absence of symptoms it is advisable to have an annual eye check up. Your ophthalmologist is best suited to advise you on treatment options and to check for changes in refractive errors.

Exercise Your Hands and Neck:
Take small breaks. Use the 20-20-20 rule mentioned before to also relax the neck and back muscles and do small stretching exercises during the break. While working on the computer, one keeps the neck flexed (bent forward). Remember to extend (bent backwards) the neck and move it side-ways also. The fingers and wrist can be similarly exercised to stretch the muscles.All these exercises must be done slowly and after proper consultation with your doctor.

Tackling Psychological Problems:
People who work in small cubicles for long hours may face psychological problems like depression, mood swings, irritability, etc. These may arise due to isolated and cramped working place, work pressures, extended working hours, etc. Consult your psychiatrist for best assessment and proper treatment of your problem. As a general advice, it is advisable to regularly practice meditation techniques, yoga, breathing exercises to calm one self and control mood imbalance.

Lifestyle Modifications:
Sedentary lifestyle brings with it a whole host of disorders like diabetes, hypertension, obesity and their complications. The best way to prevent this is to eat moderately, exercise regularly and practice yoga/meditation to calm the mind.

Avoid Fast Moving Visuals:
Avoid flickering lights and fast moving visuals as found in some video games. They are not recommended in children as they can cause reduced attention span, cause irritability, impatience and sometimes rage. They also interfere with the normal mental and emotional development of a child.

Avoid Use on the Go
Though tablets and smartphones are mobile devices, they should not be used to see during motion. They should obviously not be used while driving. But also avoid using them while walking and when in bumpy rides on road, rail or air. Continuous jerky motion of the device can make focusing a tedious task for the eye which constantly has to adjust to minor changes of the visual target. It may also trigger vertigo (giddiness) in some.

Avoid Excessive Use of Computer at Night
Night time light exposure, particularly to short-wavelength or blue light suppresses the production of melatonin by the pineal gland. Melatonin maintains the sleep-awake cycle (circardian rhythm). Reduction in melatonin not only causes sleeplessness but also cardio-metabolic disorders and impairs immunity. There are programs available which change the light setting of mobile phones/tablets according to time of the day. Also blue-light filtering glasses are recommended by some. However the best thing is to avoid excessive use of these devices at night.

Bringing these techniques to practise and making them a habit will go a long way to ensure that eye problems and other health-related problems are kept at bay while one is using the latest gadget in keeping with the modern times.

Patient of uncontrolled/poorly controlled diabetes usually shows first signs of diabetic retinopathy after 5 years from onset of diabetes.

Diabetic retinopathy in early stages may show no visual symptoms. It is only when the central part of the retina critical for vision (macula), develops changes that the vision of the patient gets drastically affected.

Any treatment given for diabetic retinopathy only tries to prevent or delay further damage to the retina. The vision lost due to retinopathy is usually irreversible. Hence it is important to detect this condition in the early stages.

A diabetic patient needs eye check at least once in every 6 months. Patients with poor sugar control may need more frequent examinations.

Diabetic retinopathy occurs due to small blood vessels of the retina developing abnormal changes. These changes result in either leakage (microvascular leakage) which results in accumulation of fluids in the retinal tissue (retinal oedema) or occlusion (microvascular occlusion) which results in poor blood supply to regions of the retina and resultant low oxygen supply (hypoxia).

In a patient with advanced microvascular occlusion as mentioned above, there is release of certain chemical mediators (like VEGF or vascular endothelial growth factor) which result in formation of new blood vessels to try and restore the blood supply. However these new blood vessels are fragile and rupture easily, thus resulting in bleeding in the internal eye cavity (vitreous haemorrhage). Such repeated episodes of bleeding can result in formation of tractional bands and eventually retinal detachment which has poor prognosis and may need surgical intervention.

The best way to prevent it is to keep the blood sugar levels under control.

Laser treatment is used for 2 reasons: One if there is formation of new blood vessels. In this PRP laser treatment is done in 3 to 4 sittings to reduce the demand of oxygen from the peripheral retina and thus reduce the production of VEGF-like factors. In this treatment is given to only peripheral retina. Two, in patients who have central retinal oedema, grid laser treatment may be given to reduce the oedema.

In some patients intra-vitreal injections may be advised. These usually contain Anti-VEGF drugs which prevent or reduce formation of new blood vessels. However their effect may not last for more than 6 months. The patient needs to keep strict control of diabetes to prevent further damage.