Overview
About 40 million Americans depend upon contact lenses for temporary solutions to vision problems. Contact lens intolerance (CLI) is a term that indicates the stage at which the eye cannot tolerate the lens that we have been using for years. The eyes treat the contact lenses as foreign particles, and inflammation begins to occur in the eyes, and there may also be signs of rejection of the lens. If the person suffering from this condition uses any contact lenses, he/she may not be able to use them for a long time. If the lenses are used for a long time in such conditions, then the wearer may experience discomfort, pain, and in some cases, injury also. Most contact lens users who use it to correct the different forms of refractive disorders might have experienced one or the other form of contact lens intolerance. It is a common eye condition and the chances of getting affected by its increase with age.

What Are The Symptoms Of Contact Lens Intolerance?
Some people experience the symptoms once or twice a year, while others may feel it daily. It means that they would not be able to wear the contact lenses anymore. Some of the symptoms of the contact lens intolerance are given below:-

Redness.
Irritation.
Inflammation.
Dryness and itching.
Feeling of stinging pain at the time of applying contact lens.
Development of ulcers in the cornea (the clear outer layer at the front of the eyes)
Abrasion in the cornea

Risk Factors Associated With Contact Lenses.
Some of the risks with the use of contact lenses are:-

About 30 to 40 Percent of people who use contact lenses do not follow the care instructions required to use the contact lenses. Due to this, the lenses may irritate the eyes after some use.
Improper cleaning techniques and replacing contact lenses more often can also lead to a serious eye infection.

What Are The Solutions To Contact Lens Intolerance?
Several ways can be used to get rid of these contact lens intolerance and symptoms of Contact lens intolerance.
Eliminating the symptoms and signs of contact lens intolerance is also important because of the pain and discomfort caused by it.
If you face any signs and symptoms of contact lens intolerance, you should visit the doctor. He/she will first try to correct it by changing the brand and quality of the lens. If it is still not treated, the doctor may advise some surgical methods to treat the condition.
The best way to terminate the problem of contact lens intolerance is to undergo laser vision correction surgery called SMILE eye surgery.
Small Incision Lenticellate Extraction (SMILE) is a minimally invasive surgery known as keyhole surgery. It is done by using a VisuMax femtosecond laser.
It is a bladeless and flapless surgery. However, it is less invasive than any other laser vision correction option.
Since the incision made is so small and no flap is created in this surgery, the chances of flap complications are also reduced to a greater extent.
The recovery time is the least in this procedure. Also, theduration of this surgery is very short. Small Incision Lenticellate Extraction (SMILE) eye surgery is used to correct the different refractive errors of the eyes like near-sightedness (a person can see near objects but may find it difficult to focus on far placed objects), far-sightedness (the person can see the far object but near objectsmay seem to be blurry), and astigmatism (in this condition the shape of the cornea of the person is changed).
Therefore, reducing the requirement of any eyeglasses or contact lenses. In addition, this surgery method is suitable for people who are not a good candidate for other laser eye surgery like LASIK or PRP surgery.

Conclusion
Contact lens intolerance is caused by several factors like carelessness in using contact lenses and not following the safety and care instructions about the use of contact lens use. It can cause day-to-day variations in the person’s daily life. Usually, after long term use of the contact lens, this condition may occur. In this condition, the eye starts showing the signs of rejection of contact lenses and may cause pain and discomfort. Numerous methods can be used to prevent it. SMILE surgery is a good method to cure contact lens intolerance.

Skull Base Surgery In India

What to expect from Skull Base Surgery in India?
The greater part of the tumors of the skull base may involve the sinuses or the ear or surrounding vascular structures. Modern Skull Base Surgery in India is carried out in association with ENT and Head Neck surgeon, Neurosurgeon, Vascular Surgeon, Interventional Radiologist.

Endoscopic Pituitary tumour removal
This is a minimially invasive surgical procedure carried out through the nose and sinuses using endoscopes, to treat and remove tumours of the pituitary gland of the brain. This is a procedure carried out jointly with the the Neurosurgeon. An insignificantly intrusive method, called endoscopic endonasal surgery, utilizes a little entry point at the back of the nasal cavity and causes little disturbance of the nasal tissues. The ENT specialist works through the nostrils with a minor camera and light called an endoscope. In both systems, openings are made in the sphenoid sinus, and sella to reach the pituitary. Once the pituitary is uncovered, the neurosurgeon expels the tumor.

Endoscopic CSF leak closure
If there is a hole in the bone and lining (dura) along the floor of the brain, CSF (cerebrospinal fluid) can leak into the nose. A minimally invasive proceure can be performed through the nose to repair this hole, stop the leak and thus prevent infection. Normally performed under general anesthesia, a specialist will work endoscopically through the nose to recognize the break and repair it utilizing muscle and other tissue from the body. CSF leaksurgery does not include cutting through the skin, as it is performed totally through the nostrils. Most patients should remain in the hospital for one to three days after surgery. A few patients may require a lumbar drain that is removed before going home.

Endoscopic Orbit and Optic nerve decopression
An endoscopic procedure carreid out through the nose to decompress the eye ball or the optic (eye) nerve. This is sometimes required to reduce pressure on the eyeball or optic nerve and help treat certain types of visual loss. The objective of optic nerve decompression is to remove a bit of the hard optic channel, in this way removing pressure on the optic nerve. This method is finished with the utilization of endoscopes (little inflexible telescopes), enabling your specialist to experience the nose and sinuses to work in this sensitive surgery with no cuts to the face.

Microscopic Facial nerve decompression
The facial nerve that controls the muscles of the face travels through the ear bone. In certain types of facial paralysis, microscopic decompression of the facial nerve is performed to remove pressure on the nerve and allow recovery. By and large, facial nerve decompression is performed through the mastoid bone behind the ear. Bits of the bone are evacuated so that the compressed facial nerve can expandand the pressure that might bring about the loss offacial motionis removed. Contingent upon the individual case, the specialist may carry out the procedure through the middle cranial fossa technique or a mastoidectomy, or both.

Glomus tumour excision
These are slow growing benign vascular tumours of the ear and skull base. Of the various options available for their treatment, surgical removal may be one such. These operations are often carried out along with a Neurosurgeon. Fruitful removal of the tumor may likewise require delicateisolation of the tumor from the carotid supply route. This bit of the methodology is to a great degree sensitive and requires the nearby collaboration of the head and neck specialist, ear specialist and, now and again, vascular and neurosurgeons.

Acoustic Neuroma removal
These are slow growing benign tumours of the hearing and balance nerve. Of the various options available for their treatment, surgical removal may be one such. These operations are carried out along with a Neurosurgeon. A neurosurgeon or neuro-otologist can remove acoustic neuromas. The suboccipital approach is performed by a neurosurgeon and the translabyrinthine approach by the Neurotologist. Since every patient and every acoustic neuroma is unique, it is imperative to discuss the treatment that offers the full scope of alternatives, including surgery, radiation, and hearing and facial nerve preservation.

What is corneal blindness?
Cornea is the transparent, outermost layer of the eye and is used as a refractive medium for image formation. Tears on the other hand nourishes cornea by keeping eyes clean and moist. With age corneal clouding and corneal scar can be caused by inflammatory diseases, trauma or infection and may result in blindness eventually.

In general we believe that eye diseases like cataract or glaucoma are more of concern but if we check the facts with WHO, corneal blindness constitutes as much as 5% of total blindness. Ocular trauma and ulcerations are also cause of 1.5 to 2.0 million new cases every year.

You may suffer corneal blindness at any age and the common causes are eye trauma, vitamin A deficiency, as an after effect of bacterial, viral, fungal infections and congenital diseases or sometimes home remedies causes more eye damage then benefit.

Patients often experience symptoms like tearing, photosensitivity, eye pain, blurred vision, glare, redness and a feeling that something is in the eye.

Regular eye examination can prevent us from vision loss. In routine visit, your eye doctor takes complete medical history and diagnostic aids like slit lamp, keratometry and corneal topography helps in diagnosing corneal defects.

Corneal blindness can be prevented by reducing or eliminating exposure to harsh conditions. Wearing hats and eye glasses to reduce UV rays exposure. Use of lubricating eye drops in case of dry eyes and regular visit to eye doctor in case of symptoms persist.

With recent advances corneal blindness can be treated with corneal transplantation/grafting. Corneal transplant is a surgical procedure where the damaged cornea is removed and replaced by a healthy cornea from a deceased donor.

There is little awareness among population about cornea transplant and cornea donation. Initiatives to educate people regarding eye donation, treatment modalities, rehabilitation centers and eye banks plays an important role to balance the need of cornea transplant and eye donation.

What Is Lasik Surgery?
LASIK is the acronym for Laser-Assisted in Situ-Incision Keratomileusis. It is a type of refractive surgery used for vision correction. It is one of the effective, safe, and popular laser-based refractive surgeries. LASIK is carried out as an alternative for glasses and contact lenses. It permanently changes the changing the shape of the cornea. It helps in treating Near-sightedness, Farsightedness, and astigmatism eye defects. When the eye does not refract (bends) the light correctly, it leads to blurry vision.

Why Is Lasik Eye Surgery Performed?
LASIK surgery is carried out to correct the following eye disorders:

Near-sightedness: It is also known as MYOPIA. It occurs when the eye focuses the light in front of the retina. As a result, the far objects appear blurry, whereas nearby objects can be seen properly without any hassle. LASIK can be used when near-sightedness is up to the range of -1 dioptres
Farsightedness: It is commonly known as HYPERMETROPIA. It occurs when the eye focuses the light behind the retina instead of on it. As a result, the nearby objects appear blurry and unclear, and things far away can be seen clearly. LASIK can treat farsightedness up to the range of +6 dioptres
Astigmatism: It occurs when the focus of both near and far vision is affected.
Is There Some Eligibility Criteria One Needs To Meet To Get Lasik Done?
There are specific criteria which are needed to be met to get LASIK done. LASIK is not for everyone. Your doctor must be transparent and honest with you. Several conditions are taken into consideration while deciding the eligibility. Some of the points which determine the eligibility for LASIK are:

A person must be 18 years or above.
Should not be suffering from autoimmune diseases like HIVs, AIDS, Rheumatoid arthritis
Have stable vision
Should have an appropriate corneal thickness for surgery
Should have no history of any eye disease, scarring, or infection
The farsightedness is not age affected
Should not be pregnant or nursing
How Is Lasik Eye Surgery Performed?
LASIK is a two steps process. It takes almost 25-30 minutes to complete. In LASIK, the laser remains in contact with the cornea of the eye for 60 seconds. First, the doctor administers the anaesthetic eye drops in the eye to numb the eyes. Then the doctor places an eyelid to prevent it from blinking. The surgeon guides the femtosecond laser to create a thin “circular flap� on the cornea. The flap is then folded back. It allows the surgeon to access the stoma (underlying cornea). Later, using the computer-guided laser, the surgeon injects a beam of ultraviolet light to remove the small part of the cornea. It is done to reshape the cornea. Once done, the light is refracted accurately on the retina. Then optic nerves transmit the message to the brain to convert it into a clear image. Without proper optic nerve functioning, the image produced is unclear and blurry.

Are There Any Risks Or Side Effects Associated With The Process?
LASIK is an advanced technology with a high success and patient satisfaction rate. However, all surgeries have some or other risks associated with them. However, the risks associated with LASIK are generally mild. As per the reports, only 1% of patients are seen to have a complication. These were are also temporary ones and improved with time.

The significant risk associated with LASIK is flap complications which are flap wrinkling, flap breaking, displacing from its position, or debris trapped under the flap.

Some side effects associated with LASIK are:

Mild pain
Watery eyes or dry eyes
Blurry or hazy vision
Itching or burning in the eye
The white part of eyes may look bloodshot and red for some days
Sensitivity to light, glare, and haloes surrounding lights
The doctor may prescribe some eye drops for the side effects. Kindly take the eye drops prescribed as directed. These are common with LASIK and will go away within a week.

What Results Can You Expect After Lasik?
You may experience ocular discomfort few hours after the surgery. The doctor may also provide eye drops to relieve the symptoms and reduce the risk of infection. You may expect a significant improvement in the vision the next day after the surgery. An experienced eye surgeon performs the surgery. It has a high patient satisfaction rate. The results have been so wonderful that many people don’t consider the second LASIK. As per the latest report, more than 90% of patients have achieved perfect vision. It is important that to obtain the maximum benefit and perfect vision after LASIK eye surgery, you should strictly follow all the recommendations of your eye surgeon.

Age Related Macular Degeneration
Human eye has various important parts like Cornea, Pupil, Iris, Lens and Retina. The macula is located in the center of the retina, the light-sensitive tissue at the back of the eye. The retina instantly converts light, or an image, into electrical impulses. The retina then sends these impulses, or nerve signals, to the brain. When the cells of the macula deteriorate, images are not received correctly. In early stages, macular degeneration does not affect vision. Later, if the disease progresses, people experience wavy or blurred vision, and, if the condition continues to worsen, central vision may be completely lost. People with very advanced macular degeneration are considered legally blind. Macular Degeneration is the leading cause of vision loss, more than cataracts and glaucoma combined.

Macular degeneration is classified as:
Dry Age related Macular Degeneration
Wet Age related Macular Degeneration.
Pathophysiology
The dry form is more common than the wet form, with about 85 to 90 percent of AMD patients diagnosed with dry AMD. The less common wet AMD usually leads to more serious vision loss.

Dry AMD causes changes of the retinal pigment epithelium, typically visible as dark pinpoint areas. The retinal pigment epithelium plays a critical role in keeping the cones and rods healthy and functioning well. Accumulation of waste products from the rods and cones can result in drusen, which appear as yellow spots. Areas of chorioretinal atrophy (referred to as geographic atrophy) occur in more advanced cases of dry AMD. There is no elevated macular scar (disciform scar), edema, hemorrhage, or exudation.

Dry AMD has three stages, all of which may occur in one or both eyes:

Early AMD - People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are no symptoms and no vision loss.
Intermediate AMD - People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks.
Advanced AMD - In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This breakdown can cause a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or recognizing faces until they are very close to you.
Wet AMD occurs when new abnormal blood vessels develop under the retina in a process called choroidal neovascularization (abnormal new vessel formation). Localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment. Eventually, untreated neovascularization causes a disciform scar under the macula.

Symptoms
Dry macular degeneration symptoms usually develop gradually and without pain. They may include:

Visual distortions, such as straight lines seeming bent
Reduced central vision in one or both eyes
The need for brighter light when reading or doing close work
Increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant
Increased blurriness of printed words
Decreased intensity or brightness of colors
Difficulty recognizing faces
What causes macular degeneration?
Though macular degeneration is associated with aging, there is genetic component to the disease. A strong association between development of AMD and presence of a variant of a gene known as complement factor H (CFH) is observed. This gene deficiency is associated with almost half of all potentially blinding cases of macular degeneration.

Other investigators have found that variants of another gene, complement factor B, may be involved in development of AMD.

Specific variants of one or both of these genes, which play a role in the body's immune responses, have been found in 74 percent of AMD patients who were studied. Other complement factors also may be associated with an increased risk of macular degeneration.

Oxygen-deprived cells in the retina produce a type of protein called vascular endothelial growth factor (VEGF), which triggers the growth of new blood vessels in the retina.

The normal function of VEGF is to create new blood vessels during embryonic development, after an injury or to bypass blocked blood vessels. But too much VEGF in the eye causes the development of unwanted blood vessels in the retina that easily break open and bleed, damaging the macula and surrounding retina.

Risk Factors
The biggest risk factor for Macular Degeneration is age. Your risk increases as you age, and the disease is most likely to occur in those 55 and older.

Other risk factors include:

Genetics – People with a family history of AMD are at a higher risk.
Race – Caucasians are more likely to develop the disease than African-Americans or Hispanics/Latinos.
Smoking – Smoking doubles the risk of AMD.
Diagnosis
AMD is detected during a comprehensive eye exam that includes:

Visual acuity test - This eye chart test measures how well you see at various distances.
Dilated eye exam - Drops are placed in your eyes to widen the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry - An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
Both forms of age - related macular degeneration (AMD) are diagnosed by funduscopic examination. Visual changes can often be detected with an Amsler grid.
Color photography and fluorescein angiography are done when findings suggest wet AMD. Angiography shows and characterizes subretinal choroidal neovascular membranes and can delineate areas of geographic atrophy. Optical coherence tomography (OCT) aids in identifying intraretinal and subretinal fluid and can help assess response to treatment.
What Treatments Are Available for Macular Degeneration?
There’s no cure for macular degeneration. Treatment may slow it down or keep you from losing too much of your vision. Your options might include:

Lifestyle changes - like dieting, exercise, avoiding smoking, and protecting your eyes from ultraviolet light.
Anti-angiogenesis drugs - These medications – aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab (Lucentis) -- block the creation of blood vessels and leaking from the vessels in your eye that cause wet macular degeneration. Many people who’ve taken these drugs got back vision that was lost. You might need to have this treatment multiple times.
Laser therapy - High-energy laser light can destroy abnormal blood vessels growing in your eye.
Photodynamic laser therapy - Your doctor injects a light-sensitive drug verteporfin (Visudyne) into your bloodstream, and it’s absorbed by the abnormal blood vessels. Your doctor then shines a laser into your eye to trigger the medication to damage those blood vessels.
Low vision aids - These are the devices that have special lenses or electronic systems to create larger images of nearby things. They help people who have vision loss from macular degeneration make the most of their remaining vision.
Submacular surgery - This removes abnormal blood vessels or blood.
Retinal translocation - A procedure to destroy abnormal blood vessels under the center of your macula, where your doctor can’t use a laser beam safely. In this procedure, your doctor rotates the center of your macula away from the abnormal blood vessels to a healthy area of your retina. This keeps you from having scar tissue and more damage to your retina. Then, your doctor uses a laser to treat the abnormal blood vessels.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.


To schedule an appointment with our experts for Age Related Macular Degeneration Management please call us at +91 8451045935, +91-8451045934 or visit our clinic at Address.



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