Dr Bakula Kashyap, a leading ophthalmologist in Bangalore who runs her own clinic and also consults at NIMHANS, answers basic questions on eye health.

Interviewed by Sheela Krishnaswamy, Director - Wellness, ChiHealth.

Sheela Krishnaswamy - It is said that regular users of computers / television / cell phones screens need to take ‘vision breaks'. Can you tell us the highlights of such breaks?

Bakula Kashyap - Evolutionally, the eye is designed for distance vision. Hence any activity where the eye has to focus on a near target results in some effort by the internal focusing mechanism of the eye. So long periods of such activity naturally tires the eye muscles resulting in eye fatigue. Rest breaks help to rejuvenate the eyes, hence the 20:20:20 rule as well as resting the eyes for 15 minutes after 2 hours of computer usage is beneficial.

SK - What are the possible reasons for eyes to become red?

BK - Red eyes can occur in several situations, the commonest among them being infective conjunctivitis, allergic conjunctivitis, foreign body in the eye and dry eye. More serious eye conditions such as intra ocular infections, inflammations, trauma and glaucoma can also cause a red eye. Occasionally a small bleed on the surface of the eye can also present as a red eye. A medical consultation is advised and it is best not to self medicate.

SK - Do diabetes or high blood pressure affect eyes? If yes, how?

BK - Diabetes and Hypertension (high blood pressure) are systemic diseases which affect the medium sized blood vessels in the body. Both Diabetes and Hypertension can cause considerable damage to the retina if left undetected. There may be blockage of circulation resulting in lack of blood supply or bleeding due to rupture of blood vessels inside the eye. This, in turn, may lead to further complications like Glaucoma or Retinal Detachment.

It is mandatory to have a complete eye evaluation once in 6 months in all patients who are diabetic, hypertensive or both. If retinopathy (involvement of the retina due to these diseases) is detected then the patient has to be monitored once in 3 months.

SK - Your thoughts on Lasik treatment to correct vision.

BK - Lasik treatment to correct refractive errors is a relatively new treatment modality which has freed millions of people around the world from wearing glasses or contact lenses. This procedure has a strict protocol which has to be followed - a Pre Lasik evaluation is done first to ascertain whether the person is a good candidate for the procedure. A thorough examination of the eyes is performed following which the procedure is carried out. It is an out patient procedure which takes a few minutes to perform. The patient is then sent home with instructions regarding usage of eye drops and asked to come for a follow up on the following day. He or she can resume work a day or two later.

There is a " Wow" factor to this procedure and people are very happy with the results.

SK - Any simple steps to prevent stye and conjunctivitis?

BK - The best way to prevent stye and conjunctivitis is to avoid touching the eyes. Our fingers are often soiled and transfer infection to the lid margins and the eyes. Touch your eyes only after washing the hands or use a tissue interface. Contrary to general opinion, conjunctivitis does not spread by looking at a person suffering from this condition. Hence wearing dark glasses does not prevent the spread, but only makes the patient feel comfortable. It is spread by ‘fomite' contact which means that if the patient touches his eyes and then touches other things around him like door handles, keyboard, currency notes, taps etc, then these become soiled. Another person may unknowingly touch these articles and then touch their eyes thus transferring the infective organisms from their fingertips to their eyes. To avoid catching these infections during an epidemic, be scrupulous about washing your hands before touching your eyes.

SK - How important are sunglasses? Do tinted glasses protect eyes? If yes, is there a minimum amount of tint that should be used to prevent harsh sunlight?

BK - Sunglasses and some types of tinted glasses protect the eyes and the skin around the eyes from UV glare. UV radiation is made up of invisible rays from the sun. The three bands of UV light are: UVA, UVB and UVC. UVB rays are the most worrisome. They burn the skin and cause damage to the eyes. UVA rays are absorbed primarily within the eye's lens, and research suggests that they are not as harmful as UVB. UVC rays are not a problem because they are absorbed by the upper atmosphere and do not reach the earth's surface.

UV rays contribute to the development of cataracts and are thought to be a factor in diseases such as macular degeneration as well. Good UV protection doesn't have to be expensive. Look for sunglasses that offer 99-100 percent UV protection. Wondering what color lenses to choose? Gray lenses don't modify colors. Green and brown are also good choices.

SK - At what age should a person get his/her retina checked?

BK - Myopes (people with short sight) need retinal checks every year, most are diagnosed in childhood. People diagnosed of Diabetes, Hypertension, Glaucoma etc require check up as advised by their doctors. An adult with no specific eye problems needs to get his/her retina checked annually after 40 years of age.

SK - At what age does cataract develop?

BK - Age related cataract usually develops in the 6th to 8th decade of life. In some cases there is a familial tendency to develop cataracts even earlier, in the 4th & 5th decade of life. Children can be born with cataracts too or develop them in infancy. Sometimes cataracts develop secondary to trauma or other problems in the eye.

SK - What is glaucoma and who is at risk?

BK - Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently impacting vision in the affected eye(s) and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye.

Glaucoma has been nicknamed the "silent thief of sight" because the loss of vision normally occurs gradually over a long period of time and is often only recognized when the disease is quite advanced. Once lost, this damaged visual field cannot be recovered. Worldwide, it is the second leading cause of blindness.

At risk - Asians, family members with glaucoma, people over 60; but checking for glaucoma commences at 40 yrs of age. Steroid users, people with eye injuries and high myopia (short sight)

SK - Who can donate eyes, and who should not?

BK - Anyone can be a donor, irrespective of age, sex, blood group or religion. Eyes should be donated within 6-8 hours of death. One cornea is grafted to one person. Eyes can be donated even if the deceased had not formally pledged their eyes during their lifetime. Spectacle wearers, people who have undergone cataract surgery, hypertensive and diabetics can also donate.

The eye bank team will immediately reach the donor's home to collect the eyes. This service is free. Eyes are never bought or sold. All religions endorse eye donation. There is no disfigurement of the donor's face.

People suffering from the following diseases cannot be donors :
Active viral Hepatitis
Acquired immunodeficiency syndrome (AIDS) or HIV
Active viral encephalitis or encephalitis of unknown origin
Creutzfeldt - Jakob Disease
Rabies
Subacute sclerosing panencephalitis
Active septicemia (bacteremia, fungemia, viremia)
Retinoblastoma
Laser photo ablation surgery
Leukemia and Lymphoma

With deep gratitude to -

Dr Bakula Kashyap, MBBS, MS
Consultant Ophthalmologist - Kashyap Eye Clinic
Consultant in Neuro-Ophthalmology - NIMHANS
Kashyap Eye Clinic
Address - 410, 5th Main, 18th Cross, 3rd Block, Jayanagar, Bangalore - 560011
Phone - 080 26649593 / 26651212
Email - drbakula_kashyap@yahoo.co.in