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Netradeep Eye Hospital,
7- Chitrakut , Gorwa Refinery Road , Vadodara-390016, Gujarat, India.
"If you are suffering from any problem related to eye, eye lids or areas around eye like dimness of vision, watering, spectacles, cataract, lid deformities, loss of eye or any other then contact Dr. Shailesh Mehta"
1. Children's Eye Care:
  1. Vision check up- It is vital to get vision tested at preschool age i.e. 3-5 years. If there is any abnormality it is best corrected soon. Next check up should be at school entry. It should be mandatory like vaccinations, height or weight measurements
  2. If child is not focusing to objects well, not following light or lighted toys with each eye by the age of  6 months (approximate age )  ,  if eyes have a squint (crossed eyes) or if two eyes look different – consult your eye doctor.
  3. Photograph of a child may be helpful for a third person to notice if there is difference in two eyes or crossed eyes.
  4. Care to avoid injuries.
  6. Nutritional care – especially vitamin A.  
  7. Basis for Early vision check ups and care - Visual development and development of binocular vision takes place highest in first 2 year of age. 
  8. Then to less extent up to 4 years of age .And still less up to 8 or 9 years of age. 
  9. If during this time any one or two eyes are not developed due to any   reason, it may remain so for ever resulting in to Lazy Eye or Amblyopia. For which no satisfactory treatment is available till date. So timely check up and prevention is the only answer. It is an easily preventable condition. 
There is lack of awareness regarding early vision check up.
  • In school vision check up programs in city like Vadodara – about 8-10 % children are found who need some attention.
  • In case of Squint or crossed Eyes- please do not delay treatment and follow advice of your doctor. If vital age is passed binocularity would not develop.

2. Eye numbers- (Refractory error) -  Spectacles, contact lenses  and Lasik Surgery for removal of spectacle numbers.

Mis conceptions and facts- 
let us seek answers to some common questions like - 
  • Is it some defect or shortcoming 
  • Can numbers be eliminated or reduced 
  •  Can wearing spectacles remove numbers  
Most people feel that eye numbers or refractory error is some defect and they have psychological effect. If kids get it, parents get worried.  In some societies it is a social stigma especially for girls of marriageable age.
But scientific fact is that it is a natural variation in size, shape or length of eye ball. Eye works like a camera where rays coming from an object to be seen need to be focused on retina. Cornea serves as first convex lens/mirror with focusing power in the range of average 42- 46 or 47 Diopters.  Crystalline lens serves as second convex lens with power of 18-20 Diopters. After first 2-3 years of life these two remain constant but length of Eye ball changes till our body growth continues. So In case of girls it may become long till age of 18-19 whereas in case of boys till 21-22 years of age.  
If some one has a shorter eye one gets plus number or needs converging glass. If some one has a longer eye, retina is farther away and one needs minus or diverging glass. As every one can not be 5 ft 6 inch if it is taken as normal, here also some eyes would be shorter and some longer; leading to plus or minus numbers. It also explains that plus numbers get reduced whereas minus number increases till the above mentioned age. Also wearing spectacles or normal contact lenses do not reduce numbers as it can not alter length of eye ball. Can a person’s height be changed by wearing a hat, certainly not. 
So it is vital to understand that it is a natural occurrence and not a disease or defect unless it is high minus number with retinal problems. In medical terminology high or progressive Myopia with retinal problems is a worrisome disease 
Should I wear spectacles or contact lenses 
Spectacles are first option and carries  no risk except for injury . It may provide additional protection against dust, heat or UV rays.
Contact lenses have two purposes. One is cosmetic where a person does not like to wear a spectacle and so wears contact lens. Another is Optical. In high or irregular numbers; contact lens provides better quality of vision. Main thing is one should maintain good hygiene and care of contact lens. Otherwise one may invite corneal infection. 
Lasik surgery to remove numbers - It is laser assisted in situ keratomileusis. Here corneal flap is opened up and Eximer laser used to ablate the corneal stroma.   People who do not want either spectacles or contact lens go for surgical option. It is an optional thing and a personal decision.  By and large it is being considered a safe surgery. With modern technology it is becoming more and more reliable and safe.   Even it has been approved by FDA and also for astronauts. But any surgery would carry a small risk. Here there may be risks like under correction, over correction, infection or ectasia.  Though rate or possibility of complications is in very small percentage like possibility of an accident while driving a car or flying in a plane.  One should make an informed decision.
  • Can yoga, Exercise remove numbers    - Any exercise or yoga may lead to healthy tissues or muscles and to that extent may have some benefit. But it is not likely to alter length of eye ball and hence can not significantly change numbers for good.
Should one not select a girl with spectacles as life partner  -  It is said that beauty lies in the eyes of a viewer. It is more of a social misdirected belief to associate spectacle with beauty or no beauty. When it is a natural phenomenon one should not consider it a negative feature unless it is high minus number with retinal problem. Rather other virtues should be given importance. Yes, one should know that as of now myopia or minus numbers are transmitted by heredity.   
Your may post your further queries and we will try to answer.    

Please note that this is not a full medical account but a simple to understand review for common people.

Laser vision correction -   Lasik surgery

Basic understanding-

Here power is adjusted -reduced or increased by reshaping part of Cornea.

For corneal reshaping – a thin flap with a hinge is opened out with a small instrument known as microkeratome.

Usually residual bed thickness of 275 or 300 microns is desirable after deducting flap thickness and ablation for correction of spectacle numbers. Higher the number more is the ablation.

Hence a microkeratome which creates a thin flap of 90 or 100 microns gives  more safety margin as it leaves behind more stromal bed thickness. Also it allows for correction of higher numbers.

Eximer laser is applied on corneal stroma and flap put back.

Success or result depends on many factors few of which are,

1.         Accurate pre operative examination – Exact Spectacle number which should be steady over 12 months or so, accurate corneal topography, corneal thickness measurement and factors like dry eye.

2.         Good microkeratome to take thin flaps

3.         Laser Machine which is perfect and delivers exact results.

4.         Calibration of machine with each case and maintaining environment.

 What can you expect

Usually it is precise and safe surgery. One may expect good spectacle free vision.

Though minor residual error like +/- 0.25 or 0.50 may remain.

What are likely problems -

Usually problems may be minor and correctable like

·        Over correction or under correction- as every cornea has different water content or hydration it may behave little differently. If significant it can be retouched and made exact.

·        Some glare at night which usually goes away or you get attuned.

·        Some dryness of eyes for which drops are given and over a period may get non bothering.

Serious problems- Occur in very  small percentage of cases or are rare.

·        Ectasia or irregular corneal ballooning. -  It leads to irregular numbers. Can be arrested by treatment like collagen cross linking. Even with adequate residual bed it may occur as corneal bio- mechanical strength may be different and it cannot be exactly measured pre operatively.

·        Corneal infections -  

·        Corenal inflammation or swelling- which can be treated .

On the whole it is safe surgery and done with proper care and caution –it gives excellent results.

Questions to ponder – Should I shop for cost  -------

It is our precious eye with whole life ahead. Can we calculate cost of our visionNULL Wisdom is to go for best quality and utmost care rather then cost or few rupees which really dose not matter in long run.
 Article 4 - Squint - non aligned eyes,  crossed eyes, deviated eyes.

Squint can be since early childhood or can be aquired at later stage of life.
How to recognise-  Simple ways for common people are as following

  •  take a simple photograph and if  eyes are mis aligned , white reflex of light falls out of pupil centre in any eye it is squint.
  • take a simple torch and ask person to look at it. If white light reflex falls outside pupillary centre of any eye ,it is squint.
  • sometimes it appears like squint but on torch light test ,it may not be so. 
How to manage- 
  • Please do not wait for child to grow old .Consult Eye specialist dealing with squint at earliest. In many cases it is essential to treat it right at early chidhood to avoid life long lazy eye.
  • Eye specialist would examine methodically - look for any sppectcle number, Retina and other aspects.
  • certain squints can be corrected only by glasses. and excersise.
  • Others would need surgery.
  • In chidhood - first effort is done to improve vision of  eye whic is lagging behind and later surgery is undertaken.
  • In childhood there are some chances of restoring binocular vision and vision of each eye.
  • In adulthood it is cosmetic purpose and binocularity or vision of amblyopic eye can not be improved .
  • Even cosmetic correction offers significant advantage by improved self esteem and socio economic aspects of life.

“ It’s made life much easier for me. Now I can play with my little boy….roll around on the ground, pick him up….without worrying about my glasses.”
Jignesh Patel
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