Eye errors and diseases

Nearsightedness (Myopia)

Is most commonly caused by the patient’s eye being longer than it should be. This causes the picture of distant objects to fall in front of the retina, thus the picture is blurred. Less commonly is this problem caused by illnesses, which increase the refraction of lens and cornea (cataract, diabetes, keratoconus). Nearsighted people see objects in their immediate vicinity clearly, distant objects are blurred. The scale of myopia is in negative diopters. Mild myopia (to -3,0 diopters), moderate (from -3,25 to -6,0 diopters) and high (above -6,0 diopters). Myopia is one of the most common eye issues, and affects up to 30% of our population. This issue is genetically dependent. Usually, the issue starts in childhood or puberty and is getting worse during the whole growing up period. Myopia stabilizes itself after the transition from child to adult, between the 20th and 25th year of life. Glasses and contact lenses are correcting myopia, focusing the picture on retina. To get rid of myopia completely, the patient must undergo a surgery. During this surgery, the cornea of the eye is honed ( can be performed utill the 35th-40th year of life). If the patient is older, myopia is treated by replacing the inner lens with a multifocal prosthetic one (surgery Prelex).

Far-sightedness (hyperopia)

Is most commonly caused by the eye of the patient being shorter than it should be. Due to this, the picture of distant objects falls behind the retina, thus is blurred. Less commonly is this issue caused by illnesses, which lower refraction of lens and cornea (e.g. cataract). All people, when born, are suffering from hyperopia, during the development and growth of the eye the problem disappears. When a person has eye development anyhow hindered, hyperopia prevails. Hyperopia is genetically dependent. Far-sighted person sees distant objects better than objects in immediate vicinity. This issue, same as myopia, affects about 30% of human population. During the childhood period, mild levels of hyperopia (up to +3,0 diopters) have no effects, for the eye is able to compensate for the diopters its missing. Consecutively, near objects become blurry, and first signs of hyperopia appear in early 40’s of person’s life. During this period of life, symptoms of hyperopia connect to those of presbyopia - lowering of the ability to focus vision. Most common symptoms are headache connected to unbearable issues to look at close objects. Higher degrees of hyperopia (moderate +3,25 to +6,0 diopters, high above +6,0) appear in childhood and are connected to amblyopia and squinting. To cure hyperopia, glasses and contact lenses are used. Should that not be enough for the patient, surgical methods are used. Laser operations are limited only to +3,25 diopters and do not cure problems to come in patient’s 40’s. To cure the problem completely, it is more efficient to replace patient’s lens with multifocal prosthetic one (surgery Prelex).

Presbyopia

Presbyopia is not a real optic disease, rahter than natural physiological loss of the ability to focus on near objects. This issue affects people between 40th and 45th year of life, and also affects people, who never had to wear glasses. Presbyopia appears sooner for far-sighted people. At the beginning, this issue can be solved by increasing the distance between eye and text by extending arm. Unfortunately, the issue is not resolved and reaches its maxim at 60 years of age, when accomodation is completely lost. This stops presbyopia from any further development. Presbyopia is caused by loss of elasticity in lens, which causes the eye to not be able to focus on near objects (accomodation). Presbyopia is treated with reading glasses, which number of diopters increase over time. This disease can be treated with a surgery (corneal implants), unfortunately its effect are only temporal. Similar is the PresbyLasik surgery, when the cornea is shaped to see well both distant and close objects. The most effective way to get rid of presbyopia is a surgery Prelex. During this surgery, the not working lens is replaced with multifocal prosthetic lens. Effects of this surgery are permanent, and the surgeon can get rid of both far and short sightedness to free the patient from glasses forever.

Astigmatism

Is mostly genetically dependent refractive error in the eye, caused by irregular flexure of the cornea. Cornea has usually regular, spheric shape and refracts light rays in all levels in the same way, to one focal point. Astigmatism causes the cornea to be more flexed in one level, which refracts more rays than the non flexed level – thus, the rays do not connect in the focal point, but create more focal points. This causes blurred vision, making the picture the eye sees shadowy (ghostly). Astigmatism causes problems when distinguishing numbers, the eye continuously refocues, leading to eyes being sore and headaches. A person might suffer from astigmatism after eye illnesses, injuries or surgeries. The irregular flexure of the coronea might be treated with glasses, contact lenses, but with surgery as well.Depending on the age of the patient and degree of astigmatism and its combinations with other refractive errors(myopia, hyperopia) there are two options: Corneal laser surgery or internal surgery with implantation of prosthetic toric lens.

Amblyopia

Is an ocular defect, which is manifested by decreased visual acuity most often in one eye, with high dioptric defects of both eyes, however, the sight can also be bilateral. In normal eyes, images from both eyes join in the brain into one spatial vision. However, if one of the eyes has a dioptric defect or congenital cataract or a shiver, it gives a poor image. In order for the vision of the better eye not to be disturbed by the poor image of the sick eye, the vision of the diseased eye will be discarded from the vision process. The effect is to reduce vision of the affected eye, loss of cooperation between both eyes, and thereby loss of stereoscopic (spatial) vision. The appearance of drowsiness can be frequent head tilting to one side, eye glancing and eye catching. However, obscuration often does not have to be exaggerated, because the child sees through the normal eye normally. Prevention is therefore important. If the family has had a high dioptric defect, shivering, and drowsiness, parents should have their child examined, preferably from 4 to 5 years of life. Amblyopia starts only when the eyes are formed. If an error is detected and treatment is started in time, it is possible to partially or completely eliminate the blur. Mostly, after 7 - 8 years of life, the development of visual function is terminated and if amblyopia has not yet been revealed, the condition remains permanent and virtually unaffected by the treatment. Therefore, therapy has significance for about the 6th year of the child's life and depends on the cause. If this is a dioptric defect (the most common cause), correct diopter is prescribed. If the cause is a cataract surgery is neccessary. To treat amblyopia, we try to make the brain stop favoring the one healthy eye and begin to perceive the image of the affected eye as well. This is used by temporarily patching a healthy eye (occlusion application) and to engaging the affected eye to work through various games aimed at the development of visual functions - so-called pleoptic treatment (drawing, point bonding, color differentiation). Amblyopia treatment is a long-term one and requires a great deal of patience.

Dry eye syndrome

Is a condition where not enough tears are produced and/or their quality is impaired (incorrect ratio of mucus, or other tears components - water and fat). As the surface of the eye (cornea and conjunctiva) is insufficiently moistened, unpleasant feelings such as cutting, burning, feeling of foreign object in the eye, redness, photophobia, and impaired vision occur. Small defects occur on the surface of the eye, due to the increased friction of eyelids around the surface of the eye, which often leads to inflammation. Eyes paradoxically excessively tear due to constant irritation, which reflectively stimulates tears formation. Dry eye syndrome occurs more often with increasing age (over 50 years), menopause, or after an eye surgery. However, environmental factors (dusty and damp environments, air-conditioned or overheated dry air spaces, long-term computer work), general diseases (autoimmune diseases), or drug use (antidepressants) also play a significant role. Easier forms of dry eye syndrome are treated with so-called artificial tears, which are ocular drops most often based on hyaluronic acid, which moisturise and protect the surface of the eye. It is also appropriate to adjust the environmental factors (stay in the fresh air), higher intake of fluids and omega-3 fatty acids to improve the quality of the tears. In heavier forms, eye gels are applied or tear canals are surgically seized with special implants to prevent drainage of the tears into the nose, to get more tears the surface of the eye.

Cataract

Is one of the most common ocular diseases of older people (so-called senile cataract). Cataract is a loss of eye lens purity. It is reflected by decreased visual acuity, fuzzy vision, change in eye diopter, change in color perception, dazzling. About a third of people over sixty years of age have a cataract on at least one eye. With an increasing age its incidence is rising steadily.

The only option for cataract treatment is an operation that is painless (thanks to the modern equipment and surgeon's experience) and fast (surgery takes about 10-15 minutes). Approximately, 45,000 cataract surgeries are performed in Slovakia every year. It is the most common, safest and most successful operation on the human body. Prior to the surgery, the patient performs anterior and posterior segment eye examinations as well as biometric eye measurements. During surgery, the blurred lens is removed from the eye and replaced with an artificial lens. The operation is performed under local anesthetic drops.

We perform the cataract surgery with most up-to-date and the safest phacoemulsification apparatus this age has to offer – the CENTURION VISION SYSTEM, which divides the lens into small parts which are then sucked out. Subsequently, a new, clear, artificial (acrylic) lens is permanently implanted into the eye. This replaces the dioptric force of the original turbid lens, even removing the original diopter of the patient (myopia or hyperopia). The patient may also choose to implant a special multifocal lens that will improve both long-distance and near-vision, and will no longer need glasses. We implant yellow intraocular lenses, which, thanks to the yellow filter, protect the eye's retina from the impact of the harmful blue part of the light spectrum.

The surgery technique itself is very gentle - the surgery is done through a very small incision (2.2mm), which reduces the amount of postoperative complications, speeds up vision recovery and shortens the duration of the surgery. Vision is refreshed very quickly after the surgery, usually on the second day. In some cases, vision may be blurred after surgery, but will clear out within a few days. Visual stabilization usually occurs 4 weeks after surgery. After this time, it is possible to prescribe new glasses (for patients who have not had a multifocal lens implanted, enabling them to see at all distances without eyeglasses).

In addition to cataract, there is a so-called "secondary cataract" that occurs after several years of cataract surgery. This is a blurring of a capsule in which an artificial lens is inserted. The vision then worsens, the patient sees it as if it were through a thick foil. However, the solution is very fast and involves laser surgery, where a special YAG laser creates an opening in the turbid lens capsule, and the patient immediately sees as before. After this procedure, the condition is permanent and will never be repeated.

Glaucoma

Is a visual impairment caused by dying of the optic nerve. Although multiple factors are to blame, such as age, genetic factors (occurrence of family glaucoma), smoking, diabetes, eye injury, refractive defects of the eye (myopia, long-sightedness), medications (corticosteroids), low blood pressure (so-called cold leg syndrome), it is crucial that high eye pressure is attributed. This arises as a result of an imbalance between permanent fluid formation in the eye and its ability to drain the eye out. Mostly, the problem is in the decreased discharge of the eye fluid (ventricular fluid) from the eye to the vessels, the eye pressure rises and leads to a nutrition disorder of the retina nerve cells, which begins to die. Glaucoma is a malignant illness, which is mostly symptomless, it does not hurt and the patient does not have to know at all about it at all (open-angle glaucoma). The exception is so-called narrow-angle glaucoma, which can be manifested by pain in the eye and the head, often associated with vomiting - the so-called glaucoma seizure. More often, it develops in a hyperopic eye due to their anatomical predisposition. It requires urgent treatment, otherwise the person may end up blind within 24 hours. A prerequisite for detecting glaucoma is its diagnosis during preventive eye examinations. The most sensitive examination when detecting glaucoma is OCT (optical coherence tomography) , which we also perform at our eye clinic. This examination uses a laser beam to measure the thickness of the retinal nerve fibers in μm (in glaucoma patients the thickness decreases) and the result is compared with the normal value of healthy people. The device maps the retina and creates sections showing its structure to diagnose other diseases of the retina (especially macular disease). This examination can detect glaucoma very early, before permanent visual impairment occurs - loss of peripheral vision, which may lead to blindness without treatment. Glaucoma cannot be completely cured, but its treatment can prevent its progression. Treatment is aimed at reducing eye pressure, especially by eye drops, which reduce the production of eye fluid or improve its drainage from the eye or a combination thereof. In more serious conditions, when conservative treatment fails, surgery is possible. Untreated glaucoma leads to blindness, so it is important not to neglect preventive eye examinations, especially for middle-aged people with glaucoma in the family or with other risk factors.

Retinal diseases

Age-related degeneration of the yellow spot (macula) - diseases affecting the retinal center of, mostly, both eyes. We recognize two forms of macular degeneration: the so-called dry (atrophic) form and so-called wet (exudative) form. In the dry form, luminescent cells (photoreceptors) and cells of the pigment epithelium in the macula die. It accounts for about 90% of age-related macular degeneration, and visual impairment is slow and subtle. On the contrary, the dramatic course with a sudden deterioration in visual acuity has the wet form of disease, when new, inferior vessels are formed under the macula of the retina. These blood vessels are of poor quality, fluid leaks through their walls, and macula is swollen and/or cracked, causing a bleeding of the yellow spot. The wet form represents about 10% of cases of age-related degeneration of the yellow spot. Since light is focused in the vision process just to the point of sharp vision, which is the macula, because it has the highest photoreceptor density, its damage will affect the quality of the central visual acuity. One can not recognize details when reading, does not recognize faces, colors, even perceives dark in the middle of his vision. Fortunately, the peripheral vision remains intact. Both forms of degeneration occur more frequently with increasing age, which is the major risk factor. Other risk factors include genetic burden, female gender (more common for women), light color of the iris (the disease is more common among blue-eyed women), smoking, cardiovascular disease and poor diet. Macular degeneration, unfortunately, belongs to diseases that can not be completely cured, and the disease stabilization is considered a success. Although there currently is no effective treatment for the dry form of the yellow spot degeneration, nutritional supplements containing lutein, zeaxanthin, zinc and antioxidants such as vitamin E are recommended. On the contrary the wet form we can at least stop by the repeated application of anti-VEGF injection. Patients who start the treatment early, before the appearance of scar-related changes in the maculae, (which can no longer be affected) have a better prognosis. Therefore, it is important to diagnose the disease at the beginning, during regular eye examinations and confirm the OCT exam..

Diabetic retinopathy - is one of ocular complications of diabetes, when fine retinal vessels are damaged. The vessels become clogged or dilated, resulting in ischemic, retinal zones without blood supply and leakage of fluid between individual layers of the retina. In the most severe cases, new vessels are formed on the basis of ischemia, often cracked, leading to bleeding inside the eye with sudden loss of vision. It is important to check the eye background regularly, annually at least, in order to intervene in time with laser treatment and to avoid a challenging surgical procedure.

Retinal detachment is caused by retina detaching from its underlying layer of the pigment epithelium, which is important for retinal metabolism (comparable it to liver function for humans). Retina may be dislodged as a result of eye trauma, eye inflammatory diseases and tumors, and retinal degeneration, myopia. Initially, it starts with flashes and flies in front of the eye, and later a failure occurs in some part of the field of view. This condition requires a surgery solution, otherwise leads to permanent blindness after several weeks.

Plastic surgery

We perform upper eyelids surgery (blepharoplasty), we deal with defects in the position of the eyelids (ectropion, entropion), pterygium and hordeolum surgeries.

Blepharoplasty removes excess, saggy skin of the upper eyelids, and possibly also fat cams. The need for a such correction increases with the advancing age, due to the loss of elasticity of the eyelid skin, but may also be inherited or caused by allergy. Excessive skin causes, in addition to aesthetic problems, the feeling of heavy and fatigue eyes, even in the most severe cases, narrowing of the field of view. The operation is done under local desensitization, and the patient leaves with a compressive bandage on the eyes, which is removed after 4 hours. 24 - 48 hours after the surgery, cold tiles are applied. The sutures are removed in 6th-7th postoperative day, with the swelling and bruises remaining for about 2-3 weeks. The blepharoplasty patient should not be exposed to sunlight for about 2 months due to the risk of darkening of scar. Immediately after the operation, the scar is first reddened, but it gradually fades, and after 2-3 months is almost invisible.

Entropion is a condition in which the eylid (usually the lower lid) folds inward to the eye, causing chronic irritation of conjunctiva and cornea. Ectropion , on the contrary, is a condition in which the lower eyelid turns outwards from the eye, which disturbs the natural function of the lid to spread tears along the surface of the eye. This condition leads to eye irritation and tearing. Both ectropion and entropion affect mostly the elderly and patients with chronic eyelids inflammation.

Pterygium is an overgrowth of a thick, pinkish conjunctive blot into the cornea. It has a triangular shape, contains a number of vessels and occurs mainly in the inner corner of the eye. It is manifested by reddening of the inner part of the eye globe (near the nose), in a more advanced condition as well as worsening of the vision for the induction of astigmatism, because the growth of the pterygium deforms the cornea with its pull force. Pterygium mostly affects people who are exposed to UV light or move in a dusty environment. The operation consists of pterygium removal and plastic operation of the produced defect, using the autotransplantation technique, thereby reducing the likelihood of recurrence which is relatively frequent in the pterygium.

Chalazion is an eyelid disease that is manifested by the appearance of a painful node in the eyelid. It is caused by clogging, inflammation and bacterial infection of the sebaceous gland of the eyelid, which is caused by staying in a dusty environment, drafts and reduced immunity. Chalazion is treated with antibiotic eye drops and ointments; in case of failure, sometimes a small surgical procedure is needed.