Doctor, Please can you talk about COVID . Also COVID and eyes.?

 

COVID infection as you all know is a viral infection.

It is spread through contact with an infected person.

And yet all of us have to go on with our normal activities.

So firstly wear mask, wear face shield and wash hands frequently.

Bcos severity of infection also depends on viral load (amount) coming at you.

Interact only with people who are wearing mask.

Avoid crowded places.

 

 Yet, if you do get infected , do not stress out. Not everyone requires hospitalization.

But get your eyes tested. COVID infection is presenting with very rare eyes conditions.

 

Also due to wearing on mask, a lot of simple lid infections are on the rise.

Wash your eyes , especially lid margins, with mild soap water.

Wash the eyes.

Moisturize the eyes.

And if infected by a simple eye infection, see a eye doctor.

Also due to increased screen time, the children will have a lot of eye complains and maybe rapid increase in spectacle power.

See your Kids Eye Doctor.

 

Screen Time during #COVID #Lockdown

At a time like this, #Lockdown due to COVID,  when all of us are indoors, our screen time has increased.

The use of TV, computers, I pads, mobile phones is way more than the recommended time for any age, especially young ones and teenagers.

This is turning out to be a good way to continue education, learn new and fun things, keep in touch with friends and family in these difficult times but it also comes with its own set of problems.

What bad things can increased screen time do?

1.    Can cause eye strain resulting in a feeling of discomfort, eye pain, watering, blinking, headaches and rarely double vision.

2.    Can cause dry eye resulting in again a feeling of discomfort, rubbing , pink or red eye and frequent blinking

3.    Can cause eye muscle balance problems  especially for near work, like accommodation and convergence issues.

4.    May aggravate some kinds of squint.

5.    Excessive near work associated with small screen use may cause existing myopia to increase in predisposed children.

6.    Can cause mental and physical fatigue to some extent with neck pain, back pain etc.

Recommendations to reduce the bad effects of screens.

1.    Frequent breaks from screens. Follow the 20-20 rule. Every 20 minutes there should be a break of atleast 20-40 seconds maybe more for children.

2.    Use larger screens which can be viewed  at a distance versus smaller screens. The TV is better then the laptop which is better than the mobile phone.

3.    For children who wear prescription glasses, they  should keep glasses on while using screens

4.    Preferably use screens in day light in a well lit room where some sunlight  also comes in.

5.    Reduce personal screen time involving games.

6.    Most newer electronic devices have an inbuilt UV protection screen and extra glasses for the same are not required.

7.    Correct upright posture will reduce fatigue. No lying down.

8. To teach children to view distant objects or just look out of the window or close their eyes intermittently

For symptomatic children. (Children exhibiting some complaints)

For mild symptoms of some discomfort off and on, some blinking, feeling of tired eyes etc

a.     Begin by taking frequent breaks

b.    Practice distance viewing

c.      Can do cold compresses

d.    Can use lubricating eye drops after discussing with your Kids Eye Doctor

For moderate to severe symptoms: Consult your Kids eye doctor.

Recommendations for online learning:

1.    Schools should be encouraged to not have online learning for very young children ( maybe less then 10 years of age) If still needed it should be at a minimum time of 1or 2 sessions of 20-30 minutes each

2.    For older children it is preferred that the school uploads the teaching videos and the children be allowed to view them at their convenience over the day

3.    If continuous session necessary for evaluation purposes etc frequent  and adequate breaks recommended.

4.    Self or guided book learning be an integral part of education as well.

Stay home. Stay safe. Reduce your screen time. Keep your eyes healthy.

Can I buy some drops from the Pharmacy for my kids red eye and watering in an emergency. ?

No.

Absolutely No.

You are playing with danger.

The commonest causes of Red eyes and watering are Bacterial Infection or  Allergic Conjunctivitis or mild allergy or foreign body in eye or injury or  Stye or Chalazion ……. Or even need for glasses.

There are the common causes. There could be hundreds of uncommon causes.

The young boy at the Pharmacy counter did not spend 5 years in a Medical School learning about the above conditions and their treatment.

The treatment of each is vastly different and wrong treatment could cause worsening and prolonging your kids condition.

The Pharmacy for business reasons will give you the drops which give them best profit margins.

And as a Kids Eye Doctor we have noticed absolutely wrong drops and harmful drops being given.

Also do not use any old drops that are lying around in your house.

The reasons are the same as above.

See a Kids Eye Doctor.

What is NLD obstruction, that my 2 month old child has ?

Tears are continuously produced in our eyes.

For lubrication and vital health of the eyes.

There has to be some passage to take away these tears.

That passage is called NLD.

Nasolacrimal  duct.

There is a tube connecting the nose side of the eye with the nose.

Your tears travel through this tube, into nose, then into your throat and eventually your stomach.

In very young babies, sometimes (in a very small percentage) this passage is blocked or rather has not opened up yet.

You will notice continuous redness in the eyes of the baby and watering.

In majority of such babies the passage will eventually open up.

No major treatment or surgery will be necessary.

But you have to show your Kids Eye Doctor.

The doctor will suggest some drops and a nose massage. The block will eventually open up in about a month or two.

If it doesn’t we are looking at a minor surgery or a major.

But this is required only in a very minor percentage.

See the Kids Eye Doctor immediately.

Is it necessary to test the eyes of “Special Children” ?

Yes ……. Absolutely yes.

Special  Children have the same Eye Problems, Errors and needs as enumerated in the other blog topics.

But they are different in 2 ways.

1.    They are unable to recognize their errors or express them. Hence it takes detailed and special exminations to check them.

2.    The Special Children are usually born with various Syndromes. The Eye is involved in multiple ways in majority of those syndromes. So it takes special examination to specifically look for those errors and to treat them regularly or in a planned fashion.

So a detailed, regular, quarterly examination of the Special Children is absolutely necessary.

50 % of the patients at Kids Eye Clinic are Special Children, since we are trained specialists.

Please do inform us while taking an appointment if your child is a Special Child. That way we can plan to give them more time

Squint

Can you explain to us what is Squint ? And what is the treatment.

When you look at something both your eyes are looking together.

Therefore this requires three or four assumptions for good vision.

One, your eyes are aligned in same direction.

Two, they have to move in conjunction.

Imagine a chariot, that is your brain, the 2 horses are the eyes and the multiple 8-10 reins are the muscles. The horses have to be of same strength, same speed and to turn together on pull of reins.

Thirdly your eyes have to be seeing clearly (means they have NO refractive errors).

Fourthly your brain has to be able to mix all the images (messages) from both eyes and show you one picture (with depth, 3 Dimension).

To understand how 2 eyes are different and yet brain mixes and show you one Picture, do this experiment.

Close your left eye and look at a scene with right eye, now close right eye and look at same scene with left eye. This is how 2 different pictures are then mixed by the brain and you see a single picture.

Now, when the 2 eyes are not aligned straight , in simple words it is known as Squint. (Your horses are not in synchronicity)

The commonest cause in children is Refractive error, and hence the treatment is right correction, that is Glasses/ Spectacles.  Therefore every child, should be seen by a Kids Eye Doctor , at the latest by four years of age. Especially Kids with Squint should be seen as early as possible..

There are other causes of Squint too : Birth Trauma, Infection, Paralysis, Weakness of Muscle, Weak eye, Lazy eye, etc etc.

Everything can be treated. But how much treatment is necessary, when to treat, how to treat, whether to delay is the decision of the Kids Eye Doctor.

The next common treatment for Squint is Surgery. Where the muscle is shortened, lengthened or position is changed. This sounds easy, but is a delicate surgery, as you have to adjust the 8-10 reins of your horses, so that the horses align perfectly.

Trust your Kids  Eye Doctor and ask as many questions as need be.

The other treatments of Squint are dependent on the specific cause.

What if we do not treat the Squint, as per the instructions of Kids Eye Doctor?

Then you stand to definitely have one of these, or more:

Permanent Squinting Eyes.

Weak Eyes.

Double Vision.

Impaired mobility for lifetime of the child.

Abnormal head posture, leading to it becoming permanent.  .

Can you please talk a bit about Cataract, Children and Treatment.

Can you please talk a bit about Cataract, Children and Treatment.

There is a clear lens hanging in the eye, when this lens gets dirty it is called cataract, and the lens has to be changed.

Imagine a window, when it gets dirty, this simple process prevents you from seeing things clearly, you have to replace the window.

Now Cataract is usually an age related problem.

Hence seen in Children in a very small percentage.

But when seen in Children it is a Medical Emergency.

If this is not treated urgently, and with utmost knowledge and precision, it will surely lead to Weak eyes, Blind Eye, Squint, Glaucoma and many other problems.

The first step of treatment of Cataract is removal of the cataract.

In the past it was deferred to a further age as the Anaesthesia and its equipment for very small babies could not guarantee the safety of the childs life. Not so now. Therefore Cataract removal is taken as soon as Pediatrician gives clearance.

The further treatment plans may differ depending upon age and eye size of the child :

Lens to be implanted or at a later date.

Treatment with glasses, follow up every 4 months.

Contact lenses.

Glaucoma surgery.

Glaucoma treatment.

Eventually Lens implantation.

Yes the journey will be long.

But the Child will get back very good workable vision.

Your Pediatric Ophthalmologist will be with you all through this journey.

MYOPIA

What is myopia ?

It is a Refractive error of the eye which is corrected by minus number glasses (eg -2.25 D spherical).

In very layman terms, near objects are seen clearly and distant are seen blurred.

What is the best treatment ?

Myopia can  easily and commonly corrected with (a) glasses (b) contact lenses. There are also newer surgeries for Myopia but they have to be taken up only after a certain age of the patient , after thorough assessment and after reviewing the side effects.

How does age affect myopia ?  or

Why do numbers increase ?

Normally every one is born with a little plus (+) numbers and as we grow (till  10-12 years) due to changes or growth in the eye this becomes zero (emmotropia).

But suppose you are detected with minus numbers (myopia) at age 4-10 then these numbers will increase till you grow to 18-21 years of age and then they will stabilize. Usually there is no change in numbers after this.  

Why should a myopia patient get a Retina check regularly ?

Retina, as it is is a very thin and delicate , innermost layer to the eyeball. In myopia it is extra thin. Further more there are some extra thin, frayed areas, called as Lattice found majorly in Myopes. These have to be specially looked for by a Retina Specialist.

These make a myope more prone or liable to Retina Problems (especially Retinal Detachment).

Cautions or Self Tests in Myopia ?.

Decrease in vision

Decrease in field of vision

Sudden increase in floaters (black spots)

Flashes of lightening

Curtain of darkness (Retinal Detachment)

The above 2 ** are an Emergency and you should contact and see your eye doctor immediately.

Why do I see these Black spots (Floaters) or Wiggly lines ?

In certain conditions the jelly that fills your eye (vitreous) it starts converting to liquid. The strands that float in the pockets of liquid formed, you see them as black flecks (floaters)  or wiggly lines. They will not harm you. You will learn to ignore them.

What is Laser therapy sometimes advised to a Myopia patient, even children?

When the thin areas, Lattice, seem likely to produce a potential to damage, they are welded more firmly to the eye by Laser. It is a very painless, OPD procedure.

Can Myopia be cured by “Special medicines” / Yoga / exercises ?

Myopia can be treated, it can not be cured. Patients can lead a normal life with the aid of glasses and contact lenses and should enthusiastically do so.

Updated February 2019: American Academy of Paediatric Ophthalomology has published that the new figures for Myopia in USA are 40% of kids below 15 years of age. Use of iPads, Phones and TV being the main culprit again.

What is this new "Atropine to prevent Myopia" ?

This "New Treatment" of "Atropine drops to prevent progression of Myopia" has originated from a Study being done in Singapore, SNEC. 

Treatment: Atropine drops are instilled daily to prevent the progression of Myopia in Children.

100% of the Children of Singapore are Myopic (also a high percentage in Chinese).This is an alarming factor, as a statistic and a health concern for a nation.

When Atropine was used for other purposes, the progression of Myopia was arrested.

So a prospective study was started. 1% atropine drops were instilled once a day in eyes of Kids. This definitely arrested the myopia progression. But it got along with it, a dilated pupil, allowing much extra light to enter the eye, hence discomfort and unknown long term ill effects. It also brought along difficulty in near vision, where Kids had to be given glasses for near vision or progressive glasses. Plus logically, the treatment has to stop at some time, when the myopia came back, known as rebound myopia, in a much severe progression. So it did not serve the purpose.

So the next prospective study was done with 0.5 %  Atropine drops. Again same results. This definitely arrested the myopia progression. But it got along with it, a dilated pupil, allowing much extra light to enter the eye, hence discomfort and unknown long term ill effects. It also brought along difficulty in near vision, where Kids had to be given glasses for near vision or progressive glasses. Plus logically, the treatment has to stop at some time, when the myopia came back, known as rebound myopia, in a much severe progression. So it did not serve the purpose.

So now the latest study is on with 0.01% Atropine drops. It does stop the progression of Myopia. But the questions and ill effects still remain. 

So whenever my patients hear or read about these "New treatements" i talk to them in detail about this. Ask them to read about it. Then again discuss. Then ask them to get drops from Singapore . The 0.01 % drops are not available in India, and the doctors in India are diluting physically the 1 % drops and giving to their patients.

After all these deliberations , only a small % of my patients have opted for this treatment.  But as a researcher i am as yet not dismissing it, i am awaiting definite conclusions.

THESE  DROPS  ARE  NOW  AVAILABLE  IN INDIA  BY INDIAN COMAPNIES.

Updated February 2019: American Academy of Paediatric Ophthalomology has published that the new figures for Myopia in USA are 40% of kids below 15 years of age. Use of iPads, Phones and TV being the main culprit again.

My baby is born Premature. Do i need to know anything special about the eyes?

Your baby is premature.

The Vision of your baby depends upon the baby’s RETINA, which also is premature bcos your baby is premature.

You require a ROP check by a Retina specialist to prevent risk of blindness in your baby.

·        What is this ROP ??? (Retinopathy of Prematurity)

·        Why should I be worried about the eyes of my premature baby ?

The innermost layer of the eye (the retina) is not fully developed (it too is premature) in a premature baby due to early birth. This premature retina layer is further exposed to factors, which are aiding this condition called ROP.

This premature retina can develop abnormal blood vessels.  This can cause bleeding inside the eye and also a retinal detachment.  

This is called ROP (Retinopathy of Prematurity).

If developed and progressed, ROP surely leads to low vision and even blindness.

The sad part is that it is a condition exclusive to premature babies.

The sadder part is that it is a condition which progresses very fast. If not detected and treated at the crucial time, it can lead to irreversible low vision or even blindness.

·        How can I help detect ROP in my premature baby?

A Retina Specialist or a Pediatric Ophthalmologist or a trained eye surgeon can detect ROP by detailed examination of your premature baby’s eyes. All it requires is for you to remind your Pediatrician or directly request for a Retina Specialist.

This test is done inside your Neonatal Unit or the hospital, during a visit by the Retina Specialist or Pediatric Ophthalmologist. The pupils of the eye are dilated using drops and the Retina is examined by an Indirect Ophthalmoscope for any signs of ROP.  In fact, you can ask your Paediatrician to help you with an ROP Eye check.

·        Should all premature babies be examined for ROP?

ALL premature babies should be examined ……..at the soonest.

And after all it is a simple exam, done in the hospital without any inconvenience to your baby. And this one simple examination to detect ROP could mean the difference between normal vision and blindness.

Babies with a birthweight of less than 1700 gm or those born before 35 weeks of pregnancy are at the highest risk to develop ROP.

Any premature baby who has other problems after birth (oxygen line, blood transfusion, infections, etc) is also at a risk.

·        What is treatment for ROP?

ROP is best treated with laser rays. This treatment can be done in the Neonatal unit or the hospital, with the help of the Pediatrician and team. The treatment helps stop further growth of abnormal vessels, thus preventing complications.

The thing to remember is that ROP is a very fast disease. The time period between early detection and complications is just 2-3 weeks. The treatment has to be decided on at the soonest. ROP should be treated as soon as it reaches a critical stage called as threshold ROP. There is a 50% greater risk of vision loss if left untreated after this.

The treatment is successful in majority of the case. Only some rare, late diagnosed or complicated retina’s may go into further complications.

They may require advanced treatments like Injection Anti VEGF or Vitrectomy.

·        When should the eyes of my premature baby be examined.?

Follow the “Day – 30” strategy.

The eye exam should be done at soonest or atleast completed before “Day-30” of the life of a premature baby.

It is a simple exam, done in your hospital without any inconvenience to your baby.

ROP can progress rapidly and seriously in 2-3 weeks. Therefore it may require 2-3 check ups in that period.

·        What is the after Treatment or regular follow up schedule of a premature baby?

If treated on time, majority children will not go into complications.

Yet all premature babies require a yearly eye exam by a Pediatric Ophthalmologist.

All babies who have developed ROP will develop some other eye conditions. They may require treatment for glasses, lazy eye, cross-eyes, or even cataract, glaucoma  and retinal detachment. This again indicates a yearly eye exam by a Pediatric Ophthalmologist till atleast 15 years of age.