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EYE HEALTH
In India, as many as 550 million people almost half of India’s population estimated to be suffering from vision problems and correction…. The most common eye problem in people above 60 years of age – with Intra Ocular Lens (IOL) using blade-free femtosecond laser technology,” said Mahipal Sachdev (chairman of scientific committee, Intra Ocular Implant and Refractive Society of India (IIRSI) and chairman of Centre for Sight group of eye hospitals or CFS)
Eye disorders are conditions that impair the sense of vision in the eyes. Most people develop minor eye problems as they age, but these usually are resolved. Eye disorders are more severe and do not go away easily without specialist care.
Causes of Eye Disorders
The leading causes of common eye disorders are Infections, allergies, irritants and pollution in the air. Genetics, UV rays from the sun, blue light from devices like laptop and mobiles and deficiency of the Vitamins E,C,B are also known to cause eye disorders such as Cataract.
Symptoms of Eye Disorders
The following symptoms can indicate potential eye disorder:
- Eye pain, often severe pain.
- Watery/Red Eyes
- Blurry Vision
- Sudden narrowing or loss of vision
Glaucoma
According to a 2020 study, the prevalence of Glaucoma in India was reported to be 11.9
Million people, mostly affecting people aged above 40 years. The more prevalent type is known as ‘Open Angle Glaucoma’ which affect approx. 6.48
million people. The lesser prevalent is ‘Closed Angle Glaucoma’ affecting nearly 2.54 million
people. Glaucoma is caused when optic nerves of the eyes are damaged. Glaucoma results in loss of
vision and sudden blindness. Most often this is associated with increased pressure of fluid within
the eye socket (called Intra Ocular Pressure or IOP); but Glaucoma also happens with normal
IOP. Thus, it is caused by many reasons. Glaucoma appears two different ways:
Open Angle
Open Angle Glaucoma silently progresses, and becomes worse over a period of time. It is a chronic condition that results in severe pain. An affected person often does not notice the loss of vision until Glaucoma is at a very advanced stage. In this type of Glaucoma, fluid continue to drain through the angle between cornea and iris; but, ‘the trabecular meshwork’ gets partially blocked. Hence, fluid pressure inside eye keeps rising creating pressure on the optic nerve.
Closed Angle
Closed Angle Glaucoma manifests in the patient in a short period of time. Vision loss can be sudden and the pain and discomfort experienced by the patient is severe. This prompts them to seek medical attention before permanent damage, so it is more treatable than Open Angle Glaucoma.
Cataract
Cataract is the leading cause of blindness in India; it accounts for a whopping 62.6% of all blindness cases in India - affecting 9 to 12 million people. 20 lakh new cases of Cataract are added to the disease burden every day in India. Studies have shown that Cataract cases rise steeply as age increases - 0.5% cases from the 30 year old age group and 94.5% of cases are reported in the age group of 70 years and above.
Cataract refers to the clouding of the lens (clumping of the lens protein) of the eye. The light has to pass through the lens to reach the Iris, both of which work together to form an image in the brain. Due to the clouding on the lens, the light cannot pass through resulting in partial or total loss of vision.
It usually emerges as the person ages, however, a person can be born with cataract. Thus, cataract can occur at any age. The clouding caused by cataract makes vision blurry or even blindness! Often it begins with the trouble seeing at night, seeing colours as faded, very high sensitivity to glare and even seeing halos around light source with or without double vision; even the eye power numbers get frequently changed.
Cataract can be caused by high level of oxidants grown due to many reasons like, heavy smoking, drinking, excessive air pollution, exposure to UV radiation, long use of some medications like steroids, and also due to trauma, disease like diabetes and family history of cataract etc. Surgical removal of the lens is a widely sought after treatment for which restores the vision completely in nearly everyone. In mild cases of cataract, even eyeglasses can clear the clouding of the lens.
Refractive errors of the eye
Refractive errors happen when the eyes (the lens) fail to focus the light-rays correctly on a
particular point on retina (a specialised layer of tissue at the rear of the eye, which can
convert light energy to nerve signal to send to the brain); thus, a blurred image is formed. This problem affect a person as they age, or they don’t take proper care of their eyes.
India, along with China, accounts for 50% of the global Refractive Error cases. Interestingly,
half of all blindness caused by uncorrected Refractive Errors are from India! Refractive
errors can be resolved by eyeglasses, surgery or even contact lenses.
Refractive Errors includes four kinds of disorders, such as:-
Near-Sightedness or Myopia
(i.e. blurring / unclarity of vision at short distances)
Far-Sightedness or Hyperopia
(i.e. blurring / unclarity of far vision)
Astigmatism
Astigmatism happens due to faulty curvature of the eye apparatus (unequal curvature of cornea to lens) resulting in blurred near and far vision. Astigmatism, though correctable, poses problem to focus on small objects like writing etc.
Presbyopia
Presbyopia is an age related gradual loss of ability to focus on the nearby objects. It is actually a natural phenomenon of aging; usually begins by forties and becomes quite intense by late sixties.
India has nearly 55 million people affected by Refractive Errors. Among all the above issues, Presbyopia is estimated to be the max (33%) number of sufferers. Myopia accounts for nearly one-third of the cases, hyperopia is the next (slightly lesser) prevalent in India.
References:
Diabetic Retinopathy (DR)
Diabetes can lead to multiple complications and DR is one of them. It damages the blood
vessels of the light-sensitive tissue of the retina at the rear part of the eye. It
damages the retina over a period of time, and that is how the disease is
characterised by this slow progression of damage.
India is the Diabetic Capital of the world. Union Health Ministry conducted nation’s
first National Diabetic and DR from 2015-2019. Approx. 17% of India’s population is
affected by DR. Among them, approx. 4% are suffering from a loss of eyesight. All
India Ophthalmological Society found that patients suffering from DR were mostly
male (more than 60%. Nearly 90% of the DR cases found where between 40 and 80
years of age and over half of them had diabetes more than 5 years.
In its earlier stages it can only cause mild vision problems like blurry vision, but in its
later stages can cause complete loss of vision! DR is known to affect both the eyes.
It is caused when sugar is build-up to a high level in the blood and remains
uncontrolled for long. The blood vessels at the eyes get blocked which are supposed
to nourish the retina! Thus, retina gets damaged over time. The eyes sometimes try
to grow their own blood vessels but these are not efficient and can burst easily. This
entire condition of retina impacted by diabetes is commonly regarded as DR.
The usual symptoms of DR can range from:
A. Blurry Vision
B. Dark spots in the eye where there is no vision
C. Vision fluctuating in and out of focus
D. Loss of Vision
DR has four stages through which it progresses:
A. Mild non-proliferative retinopathy
B. Moderate non-proliferative retinopathy (blockage in some retinal vessels)
C. Severe non-proliferative retinopathy (most blood vessels are blocked and the eyes begin to grow their own blood vessels)
D. Proliferative retinopathy (Advanced Stages)
Good control of blood sugar, disease management of diabetes, early detection and treatment go a long way in reducing the effects of the disease and it's resolution.
References:
Age-Related Macular Degeneration (AMD / ARMD)
The loss of clear and focused vision that accompanies old age is due to an eye disorder
called Age-Related Macular Degeneration (AMD / ARMD). AMD affects the eyes’ Central
Vision, which is the sharp image that is needed to carry out day to day activities like cooking
and driving. With the onset of AMD, this central sharp vision is lost due to impact on Macula
(part of retina), which allows the eyes to see the finer details in the image that is captured.
Wet AMD
Wet AMD is caused when extra blood vessels grow behind the retina, directly under the Macula. These blood vessels are inefficient and can bleed or leak. This leakage can cause damage to the macula, which leads to loss of clear central vision. An early sign of the onset of Wet AMD is that straight lines appear to be wavy, appearance of eye floaters, glare and contrast sensitivity.
Dry AMD
Dry AMD is associated with aging; when the Macula thins as a result of aging it can cause loss of central vision. The progress of Dry AMD is very slow but eventually ends with very blurry vision. The onset of Dry AMD is characterised by the presence of Drusen (Small white or yellow deposits of dead cells found under the retina, - large amounts of this deposits cause the onset of AMD)
Age Related Macular Degeneration does not have a cure, but treatment can help to slow the disorder and prevent complete loss of vision.
Anti Angiogenic Drugs:
These are medications that are dropped into the eyes, that help prevent extra blood vessels from growing behind the retina. This can help to prevent AMD from progressing into worse stages, and has also been found to restore vision in people suffering from AMD.
Anti-VEGF Treatment
It is given as an injection into the white of your eye (the sclera). The drug is injected directly into the vitreous, the jelly that fills your eye. This is called an “intravitreal” injection. It works by blocking a protein called vascular endothelial growth factor (VEGF). This stops the growth and leakage of abnormal blood vessels in the eye(s) that may cause vision loss.
Supplementation for ARMD
Dietary supplements may help to delay the onset of AMD, and potentially progression of the disease. The Age-Related Eye Disease Study (AREDS) and AREDS2 were two major research studies done by the U.S. National Eye Institute. AREDS2 found that supplementing your diet with high levels of vitamins C, E, lutein, and zeaxanthin, which are all antioxidants, and the minerals zinc and copper may help slow the progress of advanced age-related macular degeneration (AMD) and delay vision loss if you already have moderate or severe AMD.
Laser Therapy:
High energy laser light are used to curb the growth of extra, abnormal blood vessels behind the eyes
Studies conducted in India to ascertain the number of AMD cases have found that 2%-3. 7% of people aged 70 and above suffered from AMD. This is comparable to western countries.
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