Ophthalmology

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SOME APPLICATIONS DONE IN OUR EYE CLINIC:

OCT (Eye Tomography)
SLT Laser (Painless, Nonsurgical Treatment of Eye Pressure)
Argon Laser (Diabetes and Other Retina Diseases)
YAG Laser (Secondary Cataract and Glaucoma)
FFA (Eye Angio)
Phaco (Seamless Cataract Operation)
Computerized Visual Field Test
Computerized Eye Examination and Contact Lens
Eye Biometer and Pacimeter Measurements
Pterjum Grafted Operation
Squint and Amblyopia Treatment
Intravitreal Medications
Ceratoconus follow-up and treatment

INFORMATION ABOUT THE MOSTLY SEEN EYE DISEASES

CATARACT:

Cataract is an eye disease resulted from the fact that the lens which is in the eye as hyaline, loses its transparency because of variable reasons, and as a result, there is a low vision. It emerges 90% depending on the age. The secondary cataract, even it is rarely seen, can be observed depending on the use of some medicines such as steroid or trauma, some systematic diseases, eye diseases like uveitis.

The congenital cataract can also be seen in the infants congenitally because of the rubella during the pregnancy or antiviral medicines etc.

THE SYMPTOMS OF THE CATARACT

  • Shapeless and cloudy sight
  • Diplopia
  • Perception of the colors as pale and with difficulty
  • Difficulty of sight in the evening
  • Frequent changes of eye numbers and contact lens
  • The loss of the depth feeling
  • Eyestrain and headache

WHAT FACTORS CAUSE THE CATARACT?

Old age (the reason mostly seen)

Harmful solar rays
Some medicines like Cortisone
Eye traumas
The eye diseases gone through before (uveitis, glaucome) and operations
Radiotherapy
Diabetes
Congenital

HOW RAPIDLY DOES IT GROW?

The growth rate of the cataract changes from person to person, even between the two eyes. While the cataract slowly grows in some people, it rapidly grows in some, especially in diabetic patients; it even grows in both eyes.

HOW IS THE CATARACT DETECTED?

The existence of the cataract, the degree of low sight it causes and the timing of the operation can be presented with a detailed examination applied by the oculist.

Except for the cataract, if you have a glaucoma or retina disease which affect your sight, your doctor will inform you about how much you will gain sight with the cataract operation.

WHEN SHOULD THE TREATMENT BE APPLIED?

If you have a sight loss which begins to negatively affect your daily life, glare or a difference between the two eyes, it means the operation time has come. If you drive or work actively, the operation can be made earlier. It is no longer necessary to wait for maturing of the cataract as it was in the past. It is suitable for both the patient and surgeon to operate the cataract when it is just soft so that the modern operation methods can be applied and the wanted intraocular lens can be used.

HOW IS THE TREATMENT OF THE CATARACT MADE?

The single treatment method of the cataract is surgical. It has no drug treatment. The decision for the surgery can be made from the time that the patient has insufficient sight and the cataract is diagnosed. To wait for the maturation and hardening of the cataract is not a true decision. Since the operations of the cataracts that have matured and hardened are more difficult than others are, the recovery periods may be longer.

PHACO METHOD

It is the method that is valid for today, and has the most successful results. Its greatest advantage is that it can be applied in a very short time and it can work without making a very big section to the eye. Postoperatively, the sight is gained rapidly and the operation is made seamlessly by using the special lenses. The patient is operated in a very short time with the drops only anesthetizing the eye without using any narcosis; and in a few days he/she can slowly return to his/her daily life.

THE THINGS THAT SHOULD BE PREOPERATIVELY KNOWN

  • You can eat before the operation on condition that the food is not indigestable.
  • The medicines used for the systematic diseases such as diabetes, tension, and asthma should be continued to be used in the operation day, too.
  • You should come without any make-up in the operation day; you should avoid using a deodorant or perfume.
  • You will wear the special operation clothes during the operation in terms of sterility.
  • You should not move your head or eye for a short time during the operation.
  • You can go to your home after a short time when the operation is finished.
  • Your doctor will call you for the examination again in the first 36 hours.

THE THINGS THAT SHOULD BE POSTOPERATIVELY KNOWN

  • Do not rub your operated eye in any way, avoid the movements pressuring.
  • Do not rest on the side of your operated eye.
  • Avoid hard body movements.
  • Do not get your eye in touch with water and soap for the first week.
  • Consult your doctor when you can swim, dive, and do other water sports.
  • The most important thing is that you should use the medicines advised by your doctor in time after the operation, and come to the controls.

OPERATION AND RECOVERY PERIOD

The cataract operation is completed in approximately 15-20 minutes after the pupil is anesthesized and grown. After the operation, the time of the patient’s gaining the normal sight changes depending upon the difficulty of the operation and the solidity of the cataract.

A very good sightpoint is reached in 7-15 days. The patient recovers completely between 15-30 days. The patient, who has come at the right time and has been operated, can recover even in 1-2 days.

DOES THE CATARACT REPEAT POSTOPERATIVELY?

After the cataract operation has been applied once, no cataract repeats. In the situation incorrectly expressed that “the cataract come into my eye again”, the ocular thickens the capsule part and reduces the sight. In this situation, the previous sight is provided by opening the capsule with “Yag Laser” in 1-2 minutes since the operation is not necessary.

GLAUCOMA:

What is Glaucoma?

Glaucoma is the increase of the eye pressure and the vision loss depending on it. It damages the optic nerve and may cause the permanent sight loss. There is no symptom which can be noticed by you. It is a silent and sly disease. The frequency of the glaucoma increases with the aging. However, it can be seen in yougn people, even in newborn babies. The best way to preserve from the damage of optic nerve and the blindness caused by the glaucoma is the early diagnosis and treatment. Thus, the eye pressure should be measured at certain intervals. For the adults above 35, the eye pressure should be measured in every eye examination, and the ones who have glaucoma in their families or relatives should measure their eye pressure at earlier ages.

How Does The Glaucoma Grow?

There is a clear fluid called “aqueous humor” in the eye. This fluid is produced daily in balanced quantities in order to keep the intraocular pressure at the normal level and it passes from the eye to the blood vessels through the discharge channels. Since the eye is a closed structure, if the exit of the intraocular fluid from the eye disrupts, the intraocular pressure increases. This pressure constrains on the optic nerve and leads to a damage in the nerve fibres transmitting what we see to the brain. Who is under the risk of the glaucoma?

  • The ones who have an eye pressure that is higher than the normal ones are under the risk of “the glaucoma” disease.
  • The growth rate of the glaucoma increases in everybody above 50
  • The ones who have glaucoma in their families and relatives
  • The ones who have a high myopy or hypermetrope
  • The ones who have an eye injury
  • The ones who have migraine headache
  • Diabetic patients
  • The ones using cortisones

Your oculist will review all these risk factors and decide whether you need the glaucoma treatment or not, or whether you should be closely followed up or not. All these accounted risk factors mean that your risk of growing the glaucoma is higher than the normal ones have and you need an examination at certain intervals for the early detection of the symptoms.

What are the Different Types of Glaucoma?

Chronic open-angle glaucoma: It is the most common type of glaucoma. It is seen in old people. The eye pressure slowly increases and the optic nerve may be damaged. At first, it does not give any symptoms and the sight is normal. Later, the black points begin to emerge in the visional field. When the optic nerve is damaged significantly, your vision is narrowed and you virtually look through a pipe.

Closed-angle glaucoma: It results from the organic difference of the eye. Generally, these eyes are smaller than the normal ones are, and they are hypermetrope. When the preparative conditions take place, “the sudden glaucoma attack” may emerge. The eye pressure increase rapidly, there are pain, nausea, and vomiting, and the sudden sight-deficit as well. This is an emergency situation and it should be immediately treated.

How is the Glaucoma Detected?

The regular eye treatment is the best way in the detection of the glaucoma. To measure only the intraocular pressure is not sufficient for the detection of the glaucoma. The single absolute way to detect the glaucoma is a complete and detailed eye examination.

The examinations that have this feature are the advanced tests such as “the computerized visual field test”, the optic nerve examination with “HRT”, “the optic nerve screening and photography”.

The ones who have the glaucoma in their families should be examined at earlier ages. An eye examination should be applied in every 2-4 years after the age of 40, for the ones above 65 in every 1-2 years.

How is the Glaucoma Treated?

As a rule, the damage caused by the glaucoma is not reversible. The glaucoma is not treated completely. However, it can be kept under control with the regular treatment.

The medical treatment (eye drops) is generally the first step in the treatment. The eye drops should be regularly used and not disrupted. The medication of the glaucoma lasts for life. There are “laser” or “operation methods” according to the phase of the patient, the function of the medicines, and the degree of the visual loss.

KERATOCONUS:

WHAT IS KERATOCONUS?

It is the deformation of the camberness of the transparent layer which is in the front of the eye and should be in the dome camberness, and have a conoid form. That is to say, the keratoconus means “the conical shaped cornea”. The sight diminishes with the taper of the cornea which is normally round.

WHY DOES THE SIGHT DIMINISHES IN KERATOCONUS?

The deformation of the cornea in the keratoconus disease makes the vision developing in the eye deform, causes to the spoiling of the visual clearness and quality, and the diminishing of the visual degree.

IS THE REASON OF THE KERATOCONUS KNOWN?

Besides the reason of the keratoconus is not known completely, it has a genetic aspect. In a sense, keratocanus is a degenerative disease of the cornea.

WHAT IS THE FIRST SYMPTOM IN THE KERATOCONUS?

At first, an eye deformation called astigmatic emerges in the eyes with the keratoconus. This is generally in the type of the myopy-astigmatic. With the growth of the disease, the eye gradually begins to be myopy and astigmatic further, especially the astigmatic develops very much; the cornea (the transparent layer) becomes conical toward the front, and gains an irregular form. There emerges an astigmatic which cannot be healed with eyeglass in parallel with this malformation.

IS THE KERATOCONUS A MOSTLY SEEN DISEASE? AT WHAT AGE IS IT SEEN?

Keratoconus is a disease in every approximately 2000 persons (1/2000) in society. Its emergence is generally at the ages of 15-20. It grows in a different way in every patient. It sometimes advances for 4-10 years; then, it may stop. Sometimes, it progresses rapidly; the sight may spoil in a short time.

CAN THE KERATOCONUS BE CURED?

Different treatment applications are done according to the phase of the keratoconus disease. In the early phase that there is a slight myopy and astigmatic, the patient can see clearly with the eyeglass. When the disease advances, the clear vision with the eyeglass is not available. The patient benefits from the special keratoconus lenses (gas permeable contact lenses) in this phase. There is no need for an operation on condition that the patients wear contact lenses and their visual degrees remain at the sufficient level.

The visual level reduces in the further phases of the disease and a contact lens becomes dismountable. The operation is necessary in this phase. Statistics show that only 20% of the eyes with the keratoconus require an operation. The operation mentioned is the transplantation of a healthy cornea instead of the central cornea deformed. This operation, medical name of which is keratoplasty or cornea transplantation, is incorrectly known as “eye transplantation” by the public. This operation is tissue transplantation, not organ transplantation. Since the cornea layer (the transparent layer of the eye) is a veinless tissue, the refusal of the tissue is lesser than the organ transplantations are.

DIPLOPIA:

The disability of the eyes to look paralelly is called diplopia. While one of the eyes looks properly, the other one may slip towards the inside, outside or down.

The slipping may be continuous or temporary. It may be continuously in one eye or in both eyes and may slip by turns. Diplopia is observed in 4% of children. It may emerge in further periods. It may be equally seen in girls and boys. It may be permanent, but no diplopia is observed in any relative of the child with a diplopia problem.

SIGHT AND BRAIN

In the normal sight (two-sided) both eyes are directed to the same target. The visual part of the brain transforms the two different pictures into the single 3 dimensional image. Since one eye slips in the squint, 2 different pictures come to the brain. The brain of a child ignores the image coming from the slipping eye, and learns to notice the image coming from the eye with the best sight. This leads to the loss of the depth feeling. If the squint grows in an adult, since the brain has learned to perceive the images coming from both of the eyes, it cannot ignore the image coming from the slipping eye and the complaint of diplopia emerges.

THE REASONS AND SYMPTOMS OF DIPLOPIA

The reason for the slipping of the eyes in the squint has not been known completely yet. 6 muscles covering the eyeball provide the eye movements. While 2 muscles pull the eye inside and outside in all eyes, other 4 muscles enable upper, lower, and rotational motions. It is necessary that the whole muscles in one eye are in balance with other muscles which do the same work, and they work together so that both eyes look to the target properly.

The brain controls the motions of the eye muscles. Diplopia is generally seen in the children who have an organic problem in their brains. Diplopia also grows in the situations that diminish the sight such as the cataract or eye injury.

The most significant symptom of diplopia is the cross-eye. The slipping can emerge in the shiny daylight. Sometimes the child has been observed that he/she has developed a head position by himself/herself in order to keep his/her eyes proper. The loss of depth feeling may be encountered as a complaint. In diplopia grown in the adults, the double vision is the mostly seen complaint.

DIAGNOSIS

The children should be examined by a pediatrician and oculists in terms of the possible eye problems in the neonatal and preschool period. Especially if there is a story of a diplopia or amblyopia in the family, this examination gains more importance. In the infants, it is difficult to distinguish whether the eyes look like slipping (pseudo diplopia) or it is a real diplopia. The pseudo convergent strabismus is a suspicious situation in the children who have a pug nose root and skin particles (epicantal remains) in the inner side of the eyelids or in the situations that the distance between both eyes is narrow and the eyes are in depth, in the positions of side view that the eyes slip inwards. As the child grows, the nose grows, and the skin convolutions regress and gain a normal appearance. The excess of the distance between both eyes or the eyes coming to the forefront is the reason of the pseudo squint. The types of diplopia mostly seen are the convergent strabismus and divergent strabismus.

THE CONVERGENT STRABISMUS

It is the type of stabismus mostly seen in children. The type which emerges until 6 months after the delivery is called infantile type and its operation is advised until the baby is 1 year old. The convergent strabismuses are generally seen together with the hypermetropy. The hypermetropes adjust themselves to see the distant objects well. The adjustment pulls the eyes inwards. When the hypermetropy is healed with the eyeglass, the strabismus can be recovered completely. This accommodative type is the convergent strabismus. In this type of diplopia, as the child grows, the hypermetropic eye number diminishes and diplopia is controlled, and the operation becomes unnecessary. In some situations, although the hypermetropy is healed completely, some distinct diplopia may remain. This part is the nonaccomodative type. The part of the strabismus, which is not healed with the eyeglass, can be recovered with an operation. In some children, when he/she looks at a nearby place, the convergent strabismus increases very much.

In this situation biphocal glass, prismas, some eye drops and sometimes surgery enable the complete recovery. In the types of the convergent strabismus that do not depend on the hypermetropy and accommodition, the treatment is only surgical. If there is a need for an operation in the convergent strabismus, the surgery is planned in a short time. The main surgical principle of the convergent strabismus is to weak the muscle pulling the eye inwards from the adherence surface and to shorten and empower the muscle pulling the eye outwards.

DIVERGENT STRABISMUS

There are the types which emerge sometimes or which is continuous. There are two types which are seen sometimes. This type is called divergence redundancy in which there is a normal two-sided sight while looking at a nearby place and one of the eyes slips outwards while looking far away. In other type called the convergence insufficiency, while looking far is normal, the eyes slip outwards while looking at a nearby place. In this type of diplopias, firstly, the myopy and astigmatic are healed compeletly. It is benefited from the ortoptic (training the eye muscles) treatment and prismas. The last remedy is the surgery. The same treatment methods are valid in the continuous outward slippings seen while looking both nearby and far away, as well. Contrary to the surgical convergent strabismuses, the exodeviation depends upon the principle of the weakening the muscle pulling the eye inwards from the adherence surface and the shortening and empowering the muscle pulling the eye outwards.

DIPLOPIA OPERATION

It is generally made under the anesthesia. The local anesthesia can be suitable for some adults. The operation begins just by removing the tissue that covers the eyeball and reaching to the muscles that move the eye. Then, the required empowering and weakening applications are made in one or two eyes for the muscles. The postoperative recovery is quick. You can return to your daily life in a few days. An eyeglass or prisma may be required after the operation. Although the recovery response of everybody and every eye has been different, the operation may be repeated when the deviation has been healed less or excessively after the operation. In the squint, the early operation is very important. Since after the cross-eye is healed in the infants, the normal sight and the depth feeling with two eyes develops. As the child grows up, although the complete development of fort he depth feeling is not possible fort he sight, whent the squint is removed, there may be an increase in the periphery sight. The squint surgery is made to bring the eyes to their normal positions. The squint operation is not an alternative of the usage of the eyeglass and amblyopia treatment in any way. The eyeglass used preoperatively and the amblyopia treatment applied are maintained in the same way postoperatively.

DO NOT FORGET!

AMBLYOPIA

In the eyes which look properly, have no high refraction or organic deformation, there is a good sight in both eyes. With the result of the deviation of the one of the eyes in the squint, there is an amblyopia in the deviant eye. The brain perceives the image of the eye seeing well and ignores the one seeing weakly. Thus, the eye neglected does not learn the complete sight and there becomes an amblyopia. If the amblyopia is detected in the very early ages (till the ages of 7-8), its treatment is generally possible. If the treatment is late, the amblyopia gains continuity. The treatment of the amblyopia in adults is not possible for today.

SMD (Macular Degeneration):

Macula (yellow point) is a 1.5 mm diameter region in the center of the retina, and it enables the great part of the sharpness of the sight. Many diseases may prevent the sensitive tissues from working in this region.

EyeLid and Lacrimal Canal Defect:

The lacrima is carried to the lacrimal sac through the canals which begin in the inside of the eyeballs and end in the lacrimal sac settled in the neighbourhood of the nasal side wall. These canaliculuses may be rarely undeveloped during the infancy.

Amblyopia:

It is the disability to gain the functional sight beacuse of the hindrance of the vision during the childhood.

The Effects of Diabetes to the Eye:

There is an influence in the insufficient or excessive sight in the long diabetes. In the situation of the high continuity of the blood sugar, the contagion of the eye intensifies. There become deformations around the vessels in the retina or new vessels grow.


Doctors in this Department



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