Ophthalmology

Ophthalmology is the medical branch that deals with the disease, anatomy and physiology of the eye. The term is derived from the Greek language. It literally means the Science of Eyes. Without a doubt the human eye is among the most sensitive of organs and needs to be taken care of. Emirates Hospital realizing this fact brings forth tertiary eye care services which are among the best eye surgeries Ophthalmology in Dubai and Abu Dhabi, UAE.

Eye problems can arise due to a number of issues starting from dust in our every day environment to inappropriate lenses and staying in the air conditioner for lengthy hours. In case you are encountering any sort of eye problem then visit our clinics across the UAE for a complete and thorough eye checkup Ophthalmology. Clients from across the region come to us as we offer a wide spectrum of expertise and equipment enabling the treatment of a panorama of eye diseases. No matter how grave the situation is, our team of expert doctors won’t let you down.

Emirates Hospital is proud to render services to the UAE. Our doctors can assist and treat you with Uveitis, Tonometry, Myopia, visual field test, hyperopia, Presbyopia and Diabetic Retinopathy. Our clientele spread across the region speaks for our performance and reputation. We take great pride in stating that we have provided exemplary services in the field of Ophthalmology. Our highly qualified staff plays a catalytic role in the speedy recovery of patients. Don’t believe us? Then try us and book your appointment, remember we are just a call away!


Uveitis

Uveitis is inflammation of the uvea, the middle layer of the eye between the retina and the sclera (white of the eye).
The eye is shaped like a tennis ball, with three different layers of tissue surrounding the central gel-filled cavity. The innermost layer is the retina, which senses light and helps to send images to your brain. The outermost layer is the sclera, the strong white wall of the eye. The middle layer between the sclera and retina is called the uvea.
The uvea contains many blood vessels — the veins, arteries and capillaries — that carry blood to and from the eye. Because the uvea nourishes many important parts of the eye (such as the retina), inflammation of the uvea can damage your sight.
There are several types of uveitis, defined by the part of the eye where it occurs.

  1. Iritis affects the front of your eye. Also called anterior uveitis, this is the most common type of uveitis. Iritis usually develops suddenly and may last six to eight weeks.
  2. If the uvea is inflamed in the middle of the eye, it is called pars planitis (or intermediate uveitis). Episodes of pars planitis can last between a few weeks to years. The disease goes through cycles of getting better, then worse.
  3. Posterior uveitis affects the back of your eye. Posterior uveitis can develop slowly and often lasts for many years.
  4. Panuveitis occurs when all layers of the uvea are inflamed.

Uveitis Causes

The specific cause of uveitis often remains unknown. In some cases, however, it can be associated with other disease or infection in the body
Uveitis may be associated with:

  1. A virus, such as shingles, mumps or herpes simplex;
  2. A fungus, such as histoplasmosis;
  3. A parasite, such as toxoplasmosis;
  4. Disease in other parts of the body, such as rheumatoid arthritis, gastrointestinal disease like Crohn’s disease or ulcerative colitis, or collagen vascular disease such as lupus;
  5. A result of injury to the eye.

If you smoke, stop. Studies have shown that smoking contributes to the likelihood of developing uveitis.

Uveitis Symptoms

Uveitis may develop suddenly with eye redness and pain, or with a painless blurring of your vision. In addition to red eye and eye pain, other symptoms of uveitis may include light sensitivity, blurred vision, decreased vision and floaters. There may also be a whitish area (called a hypopyon) inside the lower part of the iris.
A case of simple “red eye” may in fact be a serious problem of uveitis. If your eye becomes red or painful, you should be examined and treated by an ophthalmologist (Eye M.D.).

Uveitis Diagnosis

A careful eye examination by an ophthalmologist is extremely important when symptoms occur. Inflammation inside the eye can permanently affect sight or even lead to blindness if it is not treated.
Your ophthalmologist will examine the inside of your eye. He or she may order blood tests, skin tests or X-rays to help make the diagnosis.
Since uveitis can be associated with disease in other parts of the body, your ophthalmologist will want to know about your overall health. He or she may want to consult with your primary care physician or other medical specialists.

Uveitis Treatment

Uveitis is a serious eye condition that may scar the eye. It needs to be treated as soon as possible. Eyedrops, especially corticosteroids and pupil dilators, can reduce inflammation and pain. For more severe inflammation, oral medication or injections may be necessary.
If left untreated, uveitis may lead to:

  1. Glaucoma (increased pressure in the eye);
  2. Cataract (clouding of the eye’s natural lens);
  3. Neovascularization (growth of new, abnormal blood vessels); or
  4. Damage to the retina, including retinal detachment.

These complications may also need treatment with eye drops, conventional surgery or laser surgery. If you have a “red eye” that does not clear up quickly, contact your ophthalmologist.


Diabetic Retinopathy

Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.

The retina is a thin layer of light-sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see. The macula is a very small area at the center of the retina. It is the macula that is responsible for your pinpoint vision, allowing you to read, sew or recognize a face. The surrounding part of the retina, called the peripheral retina, is responsible for your side-or peripheral-vision.

Diabetic retinopathy usually affects both eyes. People who have diabetic retinopathy often don’t notice changes in their vision in the disease’s early stages. But as it progresses, diabetic retinopathy usually causes vision loss that in many cases cannot be reversed.

Who Is at Risk for Diabetic Retinopathy?

People with diabetes are at risk for developing diabetic retinopathy. Diabetes is a disease that affects the body’s ability to produce or use insulin effectively to control blood sugar levels.
There are three types of diabetes.

  1. Type 1 diabetes: usually diagnosed in children and young adults and previously known as juvenile diabetes, where the body does not produce insulin.
  2. Type 2 diabetes: the most common form of diabetes. Either the body does not produce enough insulin or the body’s cells ignore the insulin.
  3. Gestational diabetes: blood sugar levels (glucose) become elevated during pregnancy in women who have never had diabetes before. Gestational diabetes starts when the mother’s body is not able to make and use all the insulin it needs during pregnancy.

People with any type of diabetes can develop hyperglycemia, which is an excess of blood sugar, or serum glucose. Although glucose is a vital source of energy for the body’s cells, a chronic elevation of serum glucose causes damage throughout the body, including the small blood vessels in the eyes.

Diabetic retinopathy risk factors

Several factors can influence the development and severity of diabetic retinopathy, including:

  1. Blood sugar levels
  2. Controlling your blood sugar is the key risk factor that you can affect. Lower blood sugar levels can delay the onset and slow the progression of diabetic retinopathy.
  3. Blood pressure
  4. A major clinical trial demonstrated that effectively controlling blood pressure reduces the risk of retinopathy progression and visual acuity deterioration. High blood pressure damages your blood vessels, raising the chances for eye problems. Target blood pressure for most people with diabetes is less than 130/80 mmHg.
  5. Duration of diabetes
  6. The risk of developing diabetic retinopathy or having your disease progress increases over time. After 15 years, 80 percent of Type 1 patients will have diabetic retinopathy. After 19 years, up to 84 percent of patients with Type 2 diabetes will have diabetic retinopathy.
  7. Blood lipid levels (cholesterol and triglycerides)
  8. Elevated blood lipid levels can lead to greater accumulation of exudates, protein deposits that leak into the retina. This condition is associated with a higher risk of moderate visual loss.
  9. Ethnicity
  10. While diabetic retinopathy can happen to anyone with diabetes, certain ethnic groups are at higher risk because they are more likely to have diabetes. These include African Americans, Latinos and Native Americans.
  11. Pregnancy
  12. Being pregnant can cause changes to your eyes. If you have diabetes and become pregnant, your risk for diabetic retinopathy increases. If you already have diabetic retinopathy, it may progress. However, some studies have suggested that with treatment these changes are reversed after you give birth and that there is no increase in long-term progression of the disease.

Diabetic Retinopathy Diagnosis

The only way to detect diabetic retinopathy and to monitor its progression is through a comprehensive eye exam.
There are several parts to the exam:

VISUAL ACUITY TEST

This uses an eye chart to measure how well you can distinguish object details and shape at various distances. Perfect visual acuity is 20/20 or better. Legal blindness is defined as worse than or equal to 20/200 in both eyes.

SLIT-LAMP EXAM

A type of microscope is used to examine the front part of the eye, including the eyelids, conjunctiva, sclera, cornea, iris, anterior chamber, lens, and also parts of the retina and optic nerve.

DILATED EXAM

Drops are placed in your eyes to widen, or dilate, the pupil, enabling your Eye M.D. to examine more thoroughly the retina and optic nerve for signs of damage.
It is important that your blood sugar be consistently controlled for several days when you see your eye doctor for a routine exam. If your blood sugar is uneven, causing a change in your eye’s focusing power, it will interfere with the measurements your doctor needs to make when prescribing new eyeglasses. Glasses that work well when your blood sugar is out of control will not work well when your blood sugar level is stable.
Your Eye M.D. may find the following additional tests useful to help determine why vision is blurred, whether laser treatment should be started, and, if so, where to apply laser treatment.

Fluorescein angiography

Your doctor may order fluorescein angiography to further evaluate your retina or to guide laser treatment if it is necessary. This is a diagnostic procedure that uses a special camera to take a series of photographs of the retina after a small amount of yellow dye (fluorescein) is injected into a vein in your arm. The photographs of fluorescein dye traveling throughout the retinal vessels show:

  • Which blood vessels are leaking fluid;
  • How much fluid is leaking;
  • How many blood vessels are closed;
  • Whether neovascularization is beginning.

OPTICAL COHERENCE TOMOGRAPHY (OCT)

OCT is a non-invasive scanning laser that provides high-resolution images of the retina, helping your Eye M.D. evaluate its thickness. OCT can provide information about the presence and severity of macular edema (swelling).

Ultrasound

If your ophthalmologist cannot see the retina because of vitreous hemorrhage, an ultrasound test may be done in the office. The ultrasound can “see” through the blood to determine if your retina has detached. If there is detachment near the macula, this often calls for prompt surgery.

When your diabetic retinopathy screening is complete, your ophthalmologist will decide when you need to be treated or re-examined.
If you have diabetes, you should see your ophthalmologist right away if you have any visual changes that affect only one eye, last more than a few days, and are not associated with a change in blood sugar.

When to schedule an eye examination

Diabetic retinopathy usually takes years to develop, which is why it is important to have regular eye exams. Because people with Type 2 diabetes may have been living with the disease for some time before they are diagnosed, it is important that they see an ophthalmologist (Eye M.D.) without delay.
The American Academy of Ophthalmology recommends the following diabetic eye screening schedule for people with diabetes:
Type 1 Diabetes: Within five years of being diagnosed and then yearly.
Type 2 Diabetes: At the time of diabetes diagnosis and then yearly.
During pregnancy: Pregnant women with diabetes should schedule an appointment with their ophthalmologist in the first trimester because retinopathy can progress quickly during pregnancy.

Diabetic Retinopathy Treatment

The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.

Laser surgery

The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema, proliferative diabetic retinopathy (PDR) and neovascular glaucoma.

Laser surgery is usually performed in an office setting. For comfort during the procedure, an anesthetic eyedrop is often all that is necessary, although an anesthetic injection is sometimes given next to the eye. The patient sits at an instrument called a slit-lamp microscope. A contact lens is temporarily placed on the eye in order to focus the laser light on the retina with pinpoint accuracy.

With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.

A few people may see laser spots near the center of their vision following treatment. They usually fade with time, but may not disappear completely.

In PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment.
Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

Vitrectomy surgery

Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is often performed on an outpatient basis or with a short hospital stay. Either a local or general anesthetic may be used.
During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again.
Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.
To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist’s instructions so your eye will heal properly.

Medication injections

In some cases, medication may be used to help treat diabetic retinopathy. Sometimes a steroid medication is used. In other cases, you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.

After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve how well you see.
Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.


Tonometry

Tonometry is a method of measuring the pressure in the eye. Tonometry is used to determine the pressure in the eye by measuring the tone or firmness of its surface.

What is the intraocular pressure?

Tonometry is very useful to doctors for detection of the pressure in the eye, or the intraocular pressure (IOP). An elevated IOP can be dangerous because people with varying degrees of IOP elevation may develop damage to the optic nerve. The optic nerve collects all of the visual information from the retina of the eye and transmits that information to the brain, where the signals are interpreted as vision. When changes occur in the optic nerve leading to decreased peripheral vision and loss of the nerve tissues, a diagnosis of glaucoma can be made.

Glaucoma is a fairly common condition, with as many as 10 million sufferers in the United States. Many of these people have not been checked and therefore do not know that they have glaucoma. Thus, glaucoma screening efforts as well as regular eye examinations are essential to detect glaucoma at the earliest possible stages.
Glaucoma is usually, but not always, associated with elevated pressure in the eye. Actually, glaucoma is now considered a disease of the optic nerve, or optic neuropathy. Generally speaking, the vision loss in glaucoma usually occurs in both eyes, and is thus termed bilateral. As in many other disease states, the vision loss may not be symmetric, that is, one eye may be worse than the other. Vision loss due to glaucoma often begins with a subtle decrease in peripheral vision. If the glaucoma is not diagnosed and treated, it may progress to loss of central vision and blindness.

Vision loss in the chronic open-angle form of glaucoma generally occurs gradually over many years, while the vision loss of acute angle closure glaucoma may occur within a matter of days if not immediately treated. Since patients with open-angle glaucoma rarely notice their gradual peripheral visual field loss, they may not visit an eye doctor until advanced changes have occurred. Unfortunately, the visual field loss in glaucoma represents permanent damage to the optic nerve and is therefore irreversible. For this reason, glaucoma is often called the sneak thief of sight.


Presbyopia

Presbyopia (which literally means “aging eye”) is an age-related eye condition that makes it more difficult to see very close.
When you are young, the lens in your eye is soft and flexible. The lens of the eye changes its shape easily, allowing you to focus on objects both close and far away.

After the age of 40, the lens becomes more rigid. Because the lens can’t change shape as easily as it once did, it is more difficult to read at close range. This normal condition is called presbyopia.
Since nearly everyone develops presbyopia, if a person also has myopia (nearsightedness), hyperopia (farsightedness) or astigmatism, the conditions will combine. People with myopia may have fewer problems with presbyopia.
Your eye doctor can diagnose presbyopia as part of a comprehensive eye examination. In addition to checking for other eye problems, he or she will determine your degree of presbyopia by using a standard vision test.

Your doctor will use a phoropter, an instrument that the measures the amount of refractive error you have and helps determine the proper prescription to correct it. You will try out several corrective prescriptions to determine which one will offer the best presbyopia correction for you. He or she can also discuss presbyopia surgery as another method for treating your presbyopia symptoms.


Myopia

Myopia, or nearsightedness, is a refractive error, which means that the eye does not bend or refract light properly to a single focus to see images clearly. In myopia, close objects look clear but distant objects appear blurred. Myopia is a common condition that affects an estimated 25 percent of Americans. It is an eye focusing disorder, not an eye disease.

Myopia in children

Myopia is inherited and is often discovered in children when they are between ages eight and 12 years old. During the teenage years, when the body grows rapidly, myopia may become worse. Between the ages of 20 and 40, there is usually little change. Myopia can also occur in adults.

High myopia

If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. High myopia will usually stabilize between the ages of 20-30 years old. With high myopia, you can usually correct vision easily with glasses, contact lenses or sometimes with refractive surgery.

Patients with myopia have a higher risk of developing a detached retina. Ask your ophthalmologist (Eye M.D.) to discuss the warning signs of retinal detachment with you if you are in this risk category. If the retina does detach and it is discovered early enough, a surgical procedure can usually repair it. It is important to have regular eye examinations by an ophthalmologist to watch for changes in the retina that might lead to retinal detachment.

Nearsightedness: Causes of Myopia

In order for our eyes to be able to see, light rays must be bent or refracted by the tear film, the cornea and the lens so they can focus on the retina, the layer of light-sensitive cells lining the back of the eye. The retina receives the picture formed by these light rays and sends the image to the brain through the optic nerve, which is actually part of the brain.

Myopia occurs when the eye is longer than normal or has a cornea (clear front window of the eye) that is too steep. As a result, light rays focus in front of the retina instead of on it. This allows you to see near objects clearly, but distant objects will appear blurred.

Nearsightedness: Myopia Symptoms

Some of the signs and symptoms of myopia include eyestrain, headaches, squinting to see properly and difficulty seeing objects far away, such as road signs or a blackboard at school.

Myopia symptoms may be apparent in children when they are between ages eight and 12 years old. During the teenage years, when the body grows rapidly, myopia may become worse. Between the ages of 20 and 40, there is usually little change.

Nearsightedness: Myopia Diagnosis

Your eye doctor can diagnose myopia as part of a comprehensive eye examination. He or she will determine if you have myopia by using a standard vision test, where you are asked to read letters on a chart placed at the other end of the room.

If the vision test shows that you are nearsighted, your doctor will use certain examination devices to learn what is causing the myopia. By shining a special light into your eyes, a retinoscope will be used to see how light reflects off your retina. As the light is reflected back from inside the eye, it can indicate whether a person is nearsighted or farsighted.

Your doctor will also use a phoropter, an instrument that the measures the amount of refractive error you have and helps determine the proper prescription to correct it.

Nearsightedness: Myopia Treatment

There is no best method for correcting myopia. The most appropriate correction for you depends on your eyes and your lifestyle. You should discuss your lifestyle with your ophthalmologist to decide which correction may be most effective for you.

Myopia Treatment

Eyeglasses or contact lenses are the most common methods of correcting myopia symptoms. They work by refocusing light rays on the retina, compensating for the shape of your eye. Eyeglasses can also help protect your eyes from harmful ultraviolet (UV) light rays. A special lens coating that screens out UV light is available.
In many cases, people may choose to correct myopia with LASIK or another similar form of refractive surgery. These surgical procedures are used to correct or improve your vision by reshaping the cornea, or front surface of your eye, effectively adjusting your eye’s focusing ability.

You may have heard of a process called orthokeratology to treat myopia. It uses a series of hard contact lenses to gradually flatten the cornea and reduce the refractive error. Improvement of sight from orthokeratology is temporary. After use of the lenses is discontinued, the cornea goes back to its original shape, and myopia returns. There is no scientific evidence to suggest that eye exercises, vitamins or pills can prevent or cure.


Hyperopia

About 1 in 4 people in the U.S. have hyperopia or farsightedness, but fortunately there are more ways to correct this eye disorder than ever before.

People with hyperopia or farsightedness have difficulty focusing on objects close up, such as print in a book. More severe hyperopia would also cause problems with seeing objects in the distance clearly, such as highway signs.
The occurrence of hyperopia increases with age; At least half of all persons over the age of 65 have some degree of farsightedness.

What Causes Hyperopia?
Hyperopia is a refractive error, like astigmatism and nearsightedness (myopia). Having a refractive error means that light rays bend incorrectly into your eye to transmit images to the brain. Farsightedness occurs when light entering the eye focuses behind the retina, instead of directly on it. An abnormally flat cornea or short eye can cause the light to enter the eye this way.

Hyperopia often runs in families. It is often present at birth; however, many children outgrow it.

What Are the Symptoms of Hyperopia or Farsightedness?
Symptoms of farsightedness may include:

  1. Headaches
  2. Eye strain
  3. Difficulty concentrating or focusing on nearby objects
  4. Fatigue or headache after performing a close task such as reading

If you experience these symptoms of hyperopia while wearing your glasses or contact lenses, you may need a new prescription.

Astigmatism is a common type of visual problem that partly blurs an image. This is because there is irregularity in the curve of the front surface of the eye (the cornea). The cornea is curved more like a football (an American football, that is) or a rugby ball rather than the normal shape of a spherical basketball.

Light rays entering the astigmatic eye are not uniformly focused on the retina. Rays going through the more-curved surface are focused in front of the rays coming through the less-curved surface.

The light is focused clearly along one plane but is blurred along the other. The result is blurred vision at all distances. Only part of what an individual with an astigmatism is looking at is in clear focus at any given time.

Astigmatism may be so slight that it causes no problems. Almost everyone has some degree of astigmatism.
Moderate astigmatism can cause headaches and eye strain. Severe astigmatism can seriously blur vision. Astigmatism can contribute to poor school performance but paradoxically it is usually not detected during routine eye screening in schools.

Astigmatism is a refractive error. It may be present along with other problems in refraction, such as near- sightedness or far-sightedness.

The word “astigmatism” comes from the Greek “a-” (without) + “stigma” (point) = “without a point.” This referred to the fact that there is no point of convergence for the light rays on the retina.


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