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NETHRADHAMA EYE HOSPITAL IN BANGALORE BEST EYE HOSPITAL IN INDIA

 

Patient Care Services

 

Nethradhama gives importance to Patient Expectations, those aspects of care most appropriately identified by the patient. These include consideration for a patient’s rights, comfort, culture, dignity, privacy, security, and individuality. Collectively, how these patients interests are allowed to affect patient treatment show our respect and care for the individual. We believe the patient has the right to expect that these needs will be coordinated in an atmosphere, which supports quality, interdisciplinary respect, and professionalism. Here are some details about each procedure and patient guidelines.

 

• Guide to Eye examination
• Outpatient procedures
• Daycare procedures
• Guidelines for patients with Medical Reimbursements, Mediclaim or Health Insurance

Cataract Eye Surgery

WHAT IS CATARACT ?

The human crystalline lens, which is clear and transparent is part of the focusing mechanism of the eye. With age,

the lens becomes cloudy and opaque, thereby hampering normal vision. Any opacity in the crystalline lens, which leads to decreased vision is cataract.

 

 

The early cataractous lens bends light irregularly, so the images formed are blurred and unclear. When opaque,

the cataract may cut off light nearly in total, causing blindness (reversible).

 

What causes Cataract ?

Ageing is the most common cause. With age, proteins of the eye lens get altered and opacified leading to

cataract. Other causes include congenital and developmental anomalies, trauma, inflammation of the eye,

metabolic diseases like Diabetes, Hypothyroidism etc.,

What are the common symptoms of Cataract ?

Cataract makes simple tasks difficult and in some cases impossible to perform.

This happens on account of :

• Cloudy or Blurred Vision
• Changes in one’s perception of colours
• Sensitivity to bright lamps or sunlight
• Poor night vision
• Difficulty in driving especially at night
• Frequent changes in eye glass prescription

What are the treatment options for Cataract ?

Surgery is the only course of treatment for cataract. There are two options available for cataract surgery :

Conventional Cataract surgery or Extra Capsular Cataract Extraction (SICS/ECCE)

 

• Injections are given near the eye
• Requires an incision of 7-8 mm
• The cloudy eye lens is removed in one piece
• A hard plastic lens is implanted
• Multiple Stitches are required in ECCE
• Final glass prescription could take even upto 10 weeks

 

Microincision Cataract Surgery (PHACOEMULSIFICATION)

 

• Requires a very small incision of 1.5 – 2.8mm
• Cataract Extraction with Phacoemulsification is followed by
• foldable lens implantation
• Walk-in Walk-out procedure
• Stitchless, bloodless, painless surgery
• Chances of infection are very low
• Minimum post surgery precautions
• Quicker healing and recovery

When to go for Cataract removal ?

 

Cataract should be removed as soon as it begins to affect daily activities. With any of the above mentioned symptoms setting in, it is the right time to go for Cataract removal. DO NOT WAIT FOR THE CATARACT TO GET MATURE as unnecessary delay can lead to avoidable complications and more difficult surgery. Cataract surgery can be undertaken successfully in any season. Summer or rainy season have absolutely no effect on the outcome of the cataract surgery.

 

What is the recommended treatment for cataract ?

 

With phacoemulsification and implantation of foldable Intra Ocular Lens (IOL), treatment of cataract has

become very simple and sophisticated. The procedure is safe, accurate and leads to rapid recovery. Thus

phacoemulsification with foldable lens implant is the most recommended treatment for cataract.

What is phacoemulsification with foldable IOL ?

In phacoemulsification, ultrasound power is used to break the hard cataract into minute pieces, which are then

sucked out through a small 1.5-2.8mm incision. A foldable lens (IOL) of the required power is then implanted.

The soft construction allows the lens implant to be folded for insertion through a 1.5 to 2.8mm micro incision.

Once in place, the lens unfolds to its regular size of 6 mm.

 

PHACOEMULSIFICATION FOR CATARACT

Phaco Incision		Phaco In Progress
IOL Insertion		Post IOL

What are the advantages of phacoemulsification with foldable IOL over conventional cataract surgery ?

• It allows for a injectionless, stitchless, painless, no bandage surgery
• Drops of local anaesthetic agent are used instead of an injection in the eye, thus leading to a walk-in
• walk out procedure
• Early visual rehabilitation for the patient
• Minimum curvatural changes occur in the eye following surgery
• Post surgery, the wound is very secure
• Final glasses can be prescribed within two weeks

How soon after phaco surgery, will I be able to see ?

In some cases, the patient is able to see almost immediately following the surgery, although most patients experience clear vision after one or two days

Will I need glasses after phaco surgery?

You may need to wear glasses only to fine -tune your vision. These spectacles have normal lenses unlike

thick lenses used in the past. If unifocal IOL is used, near vision glasses are almost always required.

Will activities have to be restricted after phaco surgery ?

Normal activities including walking, reading, writing, watching television etc. may be resumed soon after the

surgery. However, during the first week after the surgery, it is better to avoid strenuous activities & avoid

exposing the eye to water or dust.

Is there any diet restriction after phaco surgery?

There are absolutely no diet restrictions after phaco and you can continue with your normal diet. However, diet

regulation advised for other diseases like Diabetes, High blood pressure, etc must continue.

 

Can I have phaco surgery on one eye even if the other eye had been operated upon by the conventional surgery ?

Yes, you may have micro incision Phaco surgery on your “Second Eye” provided there is no specific

contraindication for Phaco.

 

 

How long will the procedure take ?

With the advanced technique of the cataract surgery, removal of the cataract takes just about 2 minutes and the entire procedure would take about 5-8 minutes. All procedures are done with advanced operating microscopes form Carl Zeiss (Germany) & Signature

phacoemulsification system with ellips Technology and Sovereign phacoemulsification system with ICE Technology

Multifocal IOL :

The latest multifocal IOLs are designed to provide good distance vision, intermediate and near vision. They reduce the patient’s dependence on glasses for routine activities. Unlike conventional IOL it has multiple zones of different focal lengths that bring everything from near to far into clear focus. These lenses can be used only for suitable patients.

 

The Signature / Sovereign Advantages

Signature / Sovereign are the latest generation phacomachines as of now. Working on microprocessor based

technology, they allow the use of high vacuum during surgery. The use of vacuum of upto 650mm Hg helps reduce the energy required for phacoemulsification. This leads to reduced surgery time, less trauma to the eye tissues, less post operative reaction leading to faster visual recovery and allows even very advanced cataract to be removed by phaco itself. These machines also have non-contaminant tubings which reduce the incidence of infection. Nethradhama Superspeciality Eye Hospital has opted for the latest techonologies in phaco keeping in mind the extraordinary procedural safety it offers.

The Signature / Sovereign Advantages

Nethradhama Super Speciality Eye Hospital is a High-tech Eye hospital offering comprehensive eye care facilities with the state-of-the art technology to treat various eye disorders. Nethradhama is an icon of dynamic progress in the field of Ophthalmology. The hospital has the distinction of being the First Super speciality Eye hospital in India to be accredited by the National Accreditation Board for Hospitals & Healthcare providers (NABH), a constituent board of Quality Council of India (QCI) which focuses on patient safety & quality of care.

 

Equipment and Facilities Available in Phaco Refractive Department :

• Phacoemulsification & Foldable IOL Implantation
• Signature Phacoemulsification System With Ellips Technology
• Sovereign Phacoemulsification System with Ice Technology
• Sovereign Compact Phacoemulsification System
• Operating Microscope-Zeiss Visu-200, Zeiss-Lumera Microscope & Topcon 610
• IOL Master
• Diagnostic B Scan
• Multifocal IOL’s
• High Contrast Aspheric IOL’s
• Toric IOL’s
• State of the art operating suites for daycare Cataract surgery
• Monitored Anaesthesia Care

International Patients

 

Nethradhama Super Speciality Eye Hospital with its Mission “Vision care par excellence” and Vision “Leadership in the Eye care domain”, strives to live up to the expectations of its patients. We are committed to provide specialized eye care treatment with the best of technology and skills. We achieve excellence through continuous quality improvement and upgrading ourselves to serve our patients beyond their expectations.

 

Nethradhama has always been a forerunner in the technology front and provides the best of equipment, surgical techniques and skills for patients. The doctors are credentialed for various procedures and surgeries. Nethradhama is an icon of dynamic progress in the field of Ophthalmology. We are happy to announce that Nethradhama Super Speciality Eye Hospital is the first eye hospital in India to be accredited by National Accreditation Board for Hospitals & Healthcare providers (NABH), a constituent board of Quality Council of India which focuses on patient safety and quality of care. We are also the first hospital to get certification for the ISO 9001:2008 standards. We are committed to comply with the requirements of ISO 9001 and NABH Standards for continually improving the Quality Management system requirements. We respect patient rights and education. Patient information is one of the main focus areas through which we achieve excellence in our results. Every patient at Nethradhama irrespective of nationality is cared for by our team of doctors, counselors and coordinators offering personalized care and catering to the information needs of our patients. We want our patients to be comfortable knowing the treatment modalities of various eye disorders.

 

 

Know your Eye

The human eye has 3 coats, the outermost of which is protective fibrous layer, the sclerocorneal layer. The sclera is the white of the eye. Placed in the front of the sclera, like a watch glass, is the CORNEA

The cornea is a transparent structure and the window through which we see the world. It accounts for a major part of the refractive power of the eye and is primarily responsible for focusing light rays on to the retina of the eye.

 

God has blessed us with a number of mechanisms to maintain the transparency and clarity of the cornea. Any modification by disease process or abnormal stress can cause loss of transparency of the cornea leading to blurring or loss of vision.

The diseases which affect the cornea and cause loss of transparency include Corneal Infections, Corneal degenerations and dystrophies )opacification of cornea caused due to genetic disorders or heredity( and corneal thinning disorders like Keratoconus. Injuries ( mechanical trauma / surgery or chemical/ acid / alkali burns) are also one of the most common causes for Corneal blindness.

 

When the eye is too long, light focuses in front of the retina causing myopia (Short Sight). When the eye is too short, light rays focus behind the retina causing hyperopia (long sight). When the cornea is shaped like the back of a spoon, light focuses on more than one point and a blurred image is formed on the retina and this is known as astigmatism (Cylindrical power) and is often associated with short sight or long sight.

 

Corneal Infections

A corneal ulcer is an open sore in the cornea. It is usually produced by an infection, commonly bacterial, fungal or viral. The ulcer can either be located in the centre of the cornea and greatly affect the vision or be placed in the periphery and not affect it so much. There are at least 25,000 cases of bacterial and fungal corneal ulcers each in India every year.

 

Infections that develop in the cornea are frequently associated with trauma, contact lens overuse and dry eyes. It causes pain, redness and watering in the eye which can be quite severe. Ulcers frequently require 2-3 months of intensive treatment with eye drops and / or tablets and heal by corneal scarring. If visual loss occurs, this may require corneal grafting later in future. If medical treatment fails; intense suppuration )pus formation( often ensues, and the cornea can eventually perforate. Hence non healing ulcers may require therapeutic corneal grafting to save the eye

 

Corneal ulcer

Fungal corneal infections frequently occur because of trauma with vegetable matter. Viral corneal infections often occur spontaneously or in immunocompromised patients.

Collagen vascular disorders like rheumatoid arthritis and systemic diseases like tuberculosis, leprosy, syphilis, diabetes and AIDS can also cause corneal ulcers.

 

Corneal Degenerations

various degenerative conditions like band keratopathy, spheroidal degenerations, lipid keratopathy etc, can cause decrease in vision and require corneal grafting

 

corneal dystrophies

These are hereditary disorders of cornea which cause excessive production of materials which get deposited in the cornea. If excessive, they can cause visual impairment requiring corneal grafting/ laser treatment )PTK( for vision improvement

 

bullous keratopathy & fuch’s endothelial dystrophy (fed)

These are diseases of innermost layer of cornea, which can require corneal grafting for visual improvement.

 

keratoconus

Keratoconus is a disease where the cornea becomes thinner than normal, and subsequently starts bulging forwards. This causes a blurring of visual images and is a known progressive condition. It is a disease of youngsters, starts in the second decade and is commoner with childhood eye allergy and rubbing habit. It causes frequent change of glasses with increase in cylindrical power. Keratoconus is treated in earlier stage with semi-soft contact lenses, but such lenses would not slow the disease process.

Now, there are a lot of advances in keratoconus treatment. One of the recent treatments is Corneal Collagen Cross-linking with Riboflavin )C3R(, which is a procedure that aims to stabilize a keratoconic cornea. Kerarings are implantable rings inserted into the cornea to flatten the corneal cone, and thus, also helps to improve vision of the patient. We can even put special Implantable contact lenses called Toric ICL to improve vision further in these cases.

 

 

For advanced Keratoconus, we can perform Deep Lamellar Keratoplasty or Penetrating Keratoplasty. (Corneal Grafting)

Lasik cannot be done in Keratoconu

 

Corneal Trauma

Injury to the cornea is potentially blinding, and may be minor such as a small superficial foreign body, or major, such as acid / alkali )lime( burns or penetrating injury. emergency treatment is mandatory in any kind of injury to the eye. for chemical injuries, one should immediately wash eyes thoroughly with plenty of water for half an hour and immediately see an eye doctor.

 

Wavefront Lasik or Customized Lasik

Wavefront Lasik or Customized Lasik is the result of a quantum leap in technology of sight restoration and enhancement. This Wavefront guided Lasik is a giant step forward from conventional Lasik. Optical aberrations (imperfections) inherent in the eye may adversely affect the visual acuity and the optical performance of the eye. Conventional Lasik can only correct the spectacle power & not these subtle optical aberrations. With Wavefront

guided Lasik, it is now possible to reduce these aberrations and enhance vision much above the normal levels. Custom Vue (VISx star S4 from AMO) is the procedure available for customized Lasik.

 

In severe cases, in addition to medical treatment, amniotic membrane grafting, limbal stem cell transplant and corneal grafting may be required

 

Ocular Surface Tumors

Ocular surface squamous neoplasia )OSSN( is a frequently misdiagnosed eye cancer. If neglected for too long can spread to other parts of body. It requires early detection and surgical excision. Limbal dermoid is a benign tumor which frequently requires excision.

 

keratoplasty

Corneal grafting, medically termed Keratoplasty, is an operation where a diseased cornea is replaced by a clear cornea donated by another person after death. Keratoplasty is of 2 types, Full-thickness and Partial-thickness )lamellar(.

Full thickness Penetrating Keratoplasty gives satisfactory results but requires a lot of care after surgery. Stitch removal starts after 5-6 months and visual rehabilitation takes between 6 months to 1 year. Strict follow-up is required for first 6 months. Rejection and infection needs to be guarded against. Glasses or contact lenses are required after stitches removal for visual improvement.

Of late, the results of full-thickness keratoplasty also have undergone vast improvement, due to the arrival of the Intralase equipment )Femtosecond laser( which is able to create a precise cut in both donor and recipient )patient’s( cornea. This is called IEK, i.e. Intralase Enabled Keratoplasty .It helps in faster visual rehabilitation, better fitting of graft, stronger healing and lesser glass power post operatively.

IELK )Intralase enabled lamellar Keratoplasty( is a sutureless topical procedure performed with the same laser machine, which in cases of corneal dystrophies and superficial corneal opacities gives gratifying results.

Deep lamellar Keratoplasty is a recent method of corneal grafting where the superficial corneal layers are only replaced, and the endothelium of the patient is retained. The rejection rate of DLK is lesser than conventional full-thickness keratoplasty and success rate is higher.

Decemet’s stripping automated endothelial keratoplasty (DSAEK) with fentosecond laser is suture less & quick alternative for the penetrating keratoplasty for endothelial diseases.

Unlike PK, preoperative glass power of patient’s eye does not deviate much postoperatively in DSAEK.

 

Investigations

Investigative modalities to help in diagnosis of corneal conditions include specular microscopy, which gives a clear picture of the innermost layer of cornea called endothelium. Specular microscopy is especially important in corneal grafting.

 

 

Miscellaneous

Dry eye syndrome is a very common condition affecting many people. It can manifest in numerous ways, such as burning sensation, pricking sensation, redness, feeling of heaviness in eyes, intolerance to contact lenses etc. Dry eyes are diagnosed by examining the tear film of the eye, and with a test called Schirmer’s test. Schirmer’s test is a test in which the production of tears is measured, and depending on the results, dry eye is treated. Dry eye patients may have associated general diseases, like arthritis, thyroid disease, Diabetes, chronic backache, chronic acidity and Polycystic Ovarian Disease etc. Severe dry eye cases like Steven Johnson’s syndrome, Ocular pemphigoid etc. can have corneal opacification and visual loss, which may require immuno suppressive agents and keratoprosthesis.

 

Facilities Available in the cornea department of Nethradhama:

• Specular microscopy
• Anterior segment digital photography
• Orbscan II Corneal topography
• Ultrasound pachymeter
• Pentacam ( oculyser )
• Intralase enabled keratoplasty (IEK / IELK)
• Artificial anterior chamber
• maintainer enabled endothelial
• Keratoplasty)DSAEK(
• C3R
• Smart plugs for dry eyes
• Corneal tattooing.
• Eye Bank )24 Hrs Services

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