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Your
Questions Answered
Cyrus Mehta
Q)Dear Doctor Cyres, my mother and I would like to know what really
is Glaucoma, how is it formed, what is the best way to keep it in
control, - no, my mum is not diabetic - I say this because many
people insist that it is caused due to diabetes - my mum has undergone
cataracts in both her eyes and then pressure had formed in one of
her eyes which was treated by a very good doctor, and now suddenly
this glaucoma has occurred. Could you please enlighten us on this,
doctor?
A) Glaucoma is a disease where three things happen to put it simply
1.Pressure in the eye rises beyond 21 millimeters of mercury
2.The side or peripheral vision reduces
3. The nerve at the back of the eye when examined by an eye surgeons
shows a typical change called CUPPING
If one of these 3 changes is not there ,then it is probably not
glaucoma. However in some cases loss of peripheral vision and cupping
can occur even if pressure is normal .This is called Normal Tension
Glaucoma.
There is a natural filter in the eye like a tea strainer(like a
‘channi’).Fluid made inside the eye flows out of it and normalizes
the pressure.If this meshwork gets blocked,then,the pressure in
the eye rises.
In diabetes 2 changes occur:
1.The lens in the eye swells and begins to form a cataract earlier
than normal.This can block the normal outflow channel of the eye
2.The meshwork itself develops degeneration and does not flow as
well as before So yes even though diabetes does not itself cause
pressure to rise it can indirectly lead to glaucoma. Once cataract
surgery is performed,implants are injected into the eye and open
into the capsular bag.Glaucoma has probably developed due to one
of 3 reasons
1. Some patients have a reaction to the steroid eyedrops after surgery
.This occurs in 10-20% of patients which are known as ‘steroid responders’.
2. Glaucoma has simply arisen as age has progressed. Whatever the
cause ,glaucoma today with modern medication and advanced surgical
techniques can be effectively managed in most cases before the vision
is affected.
Q) My eye doctor has diagnosed me as a case of Fuchs endothelial
dystrophy.The cells of the inner lining of my cornea are weak he
says.He fears that if I have cataract surgery I will not be able
to see after surgery and may need a corneal graft.I cant see now
as my cataract is very mature.What should I do?
A) Fuchs dystrophy is very common in Parsis. In the older days when
cataract was operated in the eyes with very weak endothelium ,or
bad Fuchs dystrophy ,in 8 out of 10 cases the cornea suffered during
surgery and sometimes needed to be replaced.This meant getting a
new donor cornea from the eye bank and a lot of procedure expense
and headache .
Today we have new generation machines (like the Infinity OziL) which
give less that one hundredth the power inside the eye than old machines.Also
we use newer protectants in the eye which protect the cornea .Still
1 out of 10 cases with a very weak cornea may need a transplant
a few years after surgery.This depends on how weak the cornea is
and how hard the cataract is.If you wait too long the cataract will
get harder and the cornea will suffer more during surgery.
I would advise you to go ahead with cataract surgery ,only if your
surgeon uses very modern technology and is sure of the outcome.
Q) My daughter aged 17 has a lazy eye.She is -7 in one eye and -3
in the other eye.The eye with minus 7 number also has a small squint.The
doctor has advised laser vision correction for her.Please advise.
A) The American Academy of Ophthalmology the most influential association
of eye surgeons worldwide has stated that doing LASIK in these cases
almost always improves the vision and must be considered to treat
the lazy eye.
First get LASIK done.Then after 3 months get the squint corrected.This
method yields the best improvement in how the eyes look and function
To know more contact Dr Cyres Mehta at 9819850971/65261579/9892736692
Email at cyresmehta@yahoo.com
Website www.cyreseye.com
Attachment-Director-
Mehta International Eye Institute Masina Hospital –
Tuesday and Saturday 10 am.
Parsi general hospital 8.30 am Tuesdays.
Breach Candy Hospital-Wednesdays 2 p.m.
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