We continue with the second part of this article in which we are presenting the latest ophthalmologic advances that improve the visual quality of patients. In last month’s post we talked about femtosecond laser and collamer lenses to solve refractive problems and intraocular lenses as the most effective method to treat presbyopia and cataracts. In this month’s issue we will talk about the best technique to strengthen a thinned cornea, the latest in drugs against AMD and the most pioneering treatment to treat dry eye.
INTRACORNEAL RINGS
The cornea is the outermost structure of the eye, the most exposed. It is the transparent part of the eye and has many peculiarities. The first is that it is an avascular tissue, i.e. it has no blood supply. In addition, due to its composition, it is a rather rigid structure. This is because it must be able to withstand both the intraocular pressure and the pressure exerted from the outside by, for example, an impact.
One of the most serious conditions that can affect this tissue is called keratoconus. It consists of an extreme thinning of the cornea to the point that its resistance is in danger, which could cause it to break and the consequences would be fatal. Keratoconus is usually caused by the patient himself, who obsessively rubs his eyelids. This continuous rubbing ends up causing a thinning of the corneal tissue that causes it to adopt a conical shape, hence its name. There are different techniques to treat it, but the most effective is undoubtedly the intervention to implant the so-called intrastromal rings. The stoma is the central layer of the cornea and the aim is to reinforce it by implanting rigid semicircular rings that reinforce the cornea and prevent it from breaking, and at Clínica Oftalmológica Castanera we are very fortunate to have a great expert in this technique. Dr. Diego Castanera is one of our most experienced surgeons. He has been trained in this technique for a long time and is now one of the best surgeons in being able to perform it with maximum guarantees.
INTRAVITREAL INJECTIONS
To treat some diseases that affect the retina, such as AMD (age-related macular degeneration), drug infusion is used. Let us remember that AMD affects the macular, a tiny point of the retina but of utmost importance, since it is where the focus of what we look at is produced. In other words, central vision, sharpness, takes place on the macular, which occupies only 5% of the retina. The rest of the retina is responsible for peripheral vision.
Therefore, it is important to keep the macular in an optimal state of health. Any alteration in this structure will cause a severe distortion of vision and a significant decrease in visual acuity, and it is difficult to reverse the damage when it appears, efforts are focused on halting its progression. To do this, drugs are used that have the ability to prevent the macular tissue from further deterioration.
The main problem is that these drugs are quite expensive and need to be administered periodically to maintain their efficacy, but when faced with the possibility of losing vision, it is the only possible alternative. In recent years, much progress has been made in this type of drugs and there are currently some on the market, such as Eylea, Avastin or Lucentis, which are very effective, and the way to administer them is simple, but may cause some apprehension in some people. It involves injecting the drug directly into the eye.
Although it may seem uncomfortable and painful, it is not, since before the infusion a series of anesthetic drops are instilled to numb the area where the injection is to be made. In addition, the needle used is extremely fine and is barely noticeable when it penetrates.
The injection is performed through the sclera, the white part of the eye, so as not to put at risk any internal structure and because it is the most direct way to reach the retina, where the drug should act. It can also be performed in the same office, without the need to enter an operating room, and at Castanera Clinic we are fortunate to have one of the best retinologists. Dr. Danai Kyriakou is a great expert in this type of pathology and has a great track record of success in this type of treatment.
DRY EYE TREATMENT: IPL PULSED LIGHT
One of the main complaints of our patients is the sensation of dry eyes. This can be due to multiple factors. But the consequence is always that the quality of the tear is not adequate. When the tear does not have the correct composition, it evaporates very easily and this is what causes the sensation of dry eyes.
In order to solve this syndrome we must go to the root of the problem: correct the quality of the tear. It should be noted that the tear is composed of an aqueous part, which is what hydrates, and an oily portion, which is responsible for lubricating the eye and at the same time prevents the tear itself from evaporating so easily. The glands located in the eyelids, called Meibomian glands, are responsible for providing this oily part of the tear. When these glands become obstructed they cannot provide the tear with its oily portion and, therefore, the tear will be more liquid and easier to evaporate.
There are several alternatives to unblock these glands and restore their functionality, although the newest and most effective is through the action of a type of laser called IPL Pulsed Light. It consists of applying this type of laser directly on the eyelids. Thanks to its action it is able to unblock the Meibomian glands and make them able to provide the tear with the oily portion so necessary for the tear to perform its lubricating action and can also remain longer on the surface without evaporating.
The treatment is performed in the same office and lasts approximately 10 minutes per eye. Usually at least three sessions are required for maximum effectiveness. The patient does not feel any pain, only a slight sensation of heat, which is not unpleasant.
In Castanera Clinic we are committed to the latest technological advances, so we have this type of laser. Always having the latest technology is what allows us to remain one of the reference ophthalmology centers in Barcelona.
