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Esotropia (inward turning of the eyes) occurs in four types. They are as follows
1. Congenital Esotropia
2. Infantile Esotropia
3. Accommodative Esotropia
4. Partially Accommodative Esotokropia
1. Congenital Esotropia -
Congenital esotropia, or childhood esotropia, is a specific sub-type of primary concomitant esotropia. It is a constant esotropia of large and consistent size with onset between birth and six months of age. Only 23% of infants are born with straight eyes. In majority of cases, one eye or the other actually turns outward during the neonatal period. Within the first three months the eyes regularly come into more steady alignment as coordination of the two eyes together as a team develops.
The cause of the situation is unidentified, and its early onset means that the affected individual’s potential for developing binocular vision is limited. The appropriate treatment approach remains a matter of some debate. Some ophthalmologists support an early surgical approach as offering the best prospect of binocularity at the same time as others remain uncertain that the prospects of achieving this result are good enough to justify the increased complexity and risk associated with operating on those under the age of one year.
Factual congenital esotropia is an inward turn of a large amount, and is present in very few children, but the newborn will not grow out of this turn. Right immature esotropia frequently appears between the ages of 2 and 4 months.
2. Infantile Esotropia –
The baby with infantile esotropia frequently cross fixates, which means that he or she uses either eye to look in the opposite direction. The right eye is used to look towards the left side, and the left eye is used to look towards the right side. By description, they interchange which eye they are looking with. It is further not easy to help this kind of strabismus with non-surgical methods, such as vision therapy and glasses. At times, clear tape applied to the inner third of each lens is able to decrease the tendency to turn inward. Prisms may aid alignment if the turn is not too large.
If the inward turn of the eye is constant, and of a large amount, surgery may be indicated. Both the parent and surgeon have to be committed to multiple procedures to obtain perfect alignment. Improved alignment may look better cosmetically, but it does not necessarily enable the brain to utilize information from both eyes together. Stereopsis, or two-eyed depth perception, is often poor following surgical treatment. The best chance for visual success occurs when the surgeon works with an Optometrist who is comfortable in prescribing glasses and exercises to encourage perfect alignment of the eyes with proper mixture. The possibility of developing binocular vision with surgery on your own diminishes with age. Older children with infantile esotropia might require both surgical interventions, if the turn is large, and vision therapy. Smaller turns can only require vision therapy. Getting the eyes to work together requires a lot of time and effort, but is usually worth it!
3. Accommodative Esotropia -
If excessive inward turning of an eye is first noted around 2 years of age, it may be due to complexity integrating the focusing system with the eye alignment system. Usually when we look across the room or beyond, our eyes are parallel, or straight. Though, when we look at things up close, two things happen. We need to converge more (aim both eyes inward at the same time) and we have to input more focus, or accommodate to keep things clear. Children have large amounts of focusing power, and sometimes in getting things clear, inward turning or esotropia results. If the inward turning only occurs up close, as when playing with small objects, making eye contact, coloring, looking at picture books and so forth, the child may just need glasses for near activities to reduce or eliminate the esotropia.
However, if a child is significantly farsighted (hyperopia), an inward turn of the eye may even occur when focusing to look further away, such as television. If the amount of turn is greater at near than far, your optometrist may prescribe a multifocal lens. For children this could be a traditional bifocal with a line, or a form of no-line bifocal or progressive lens.
"Congenital" means from birth and, using this strict definition, most infants are born with eyes that are not aligned at birth. Only 23% of infants are born with straight eyes. In the majority of cases, one eye or the other actually turns outward during the neonatal period. Within the first three months the eyes gradually come into more consistent alignment as coordination of the two eyes together as a team develops.
Patients with Accommodative Esotropia must never have eye muscle surgery to get rid of the need for glasses. If they do, they will have important focusing troubles when they get older. In the future, these patients might be excellent candidates for refractive surgery or contact lenses. This should be coordinated with the developmental Optometrist and Lasik surgeon.
4. Partially Accommodative Esotropia -
In some instance, part of the inward turn is due to basic esotropia, and an additional amount due to the effect of accommodation. Glasses might decrease the amount of eye turn, but it is not completely compensated. At first, the eye doctor possibly will recommend prism to reimburse for the amount of turn. Office-based vision therapy is frequently desirable. Surgery remains an alternative to address the non-accommodative portion of the esotropia. Remember that surgery on your own hardly ever enables a patient to learn how to use both eyes together as a team, and regularly leaves the patient with poor stereopsis.As vision is a learned process, some form of therapy is often helpful in learning new binocular vision patterns, or restoring normal pathways that have been lost or underutilized. Binocular vision occurs in the visual centers of the brain, not in the eye muscles.
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Color blindness, in the formal medical term, color vision deficiency is any abnormality of the color vision system that causes a person to see colors differently than most people or to have difficulty distinguishing among certain colors.
Color vision deficiency is detected by tests that use special color plates under daylight conditions. The test usually is conducted during the childhood years. It is also performed when an adult applies for a job in which color vision is essential, such as airline pilot. The exact degree of color vision deficiency can be determined by a test that requires the arrangement of sequences of colored chips or by an instrument called an anomaloscope, which shines a mixture of red and green lights. The person being tested adjusts the mixture until it appears the same as a fixed spot of yellow light. An adjustment that yields a mixture that is too red or too green indicates the presence and severity of color vision deficiency.
Many people with color vision deficiency are not aware of the problem because it does not interfere with everyday living. It can be detected during employment tests for an occupation requiring normal color vision. Such positions include airline pilot, commercial artist, marine pilot, color photographer, or electrician, where the ability to distinguish color-coded wires is important. There is no treatment for the condition.
A person with color blindness is unable to distinguish some or all of the colors visible to a person with normal color vision.
Color blindness falls into three sub-categories:
- Monochromacy
Monochromacy, also known as “total color blindness”, is the lack of ability to distinguish colors; caused by cone defect or absence. Monochromacy occurs when two or all three of the cone pigments are missing and color and lightness vision is reduced to one dimension.
- Dichromacy
Dichromacy is a moderately severe color vision defect in which one of the three basic color mechanisms is absent or not functioning. It is hereditary and sex-linked, affecting predominantly males. Dichromacy occurs when one of the cone pigments is missing and color is reduced to two dimensions.
- Trichromacy
Anomalous trichromacy is a common type of inherited color vision deficiency, occurring when one of the three cone pigments is altered in its spectral sensitivity. This results in an impairment, rather than loss, of trichromacy (normal three-dimensional color vision)
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Eye surgery is also recognized as orogolomistician surgery or ocular surgery. It is a surgery performed on the eye or its adnexa by an ophthalmologist. Even though most eye surgery can be performed by an experienced general ophthalmologist.
There are four main types of eye conditions - myopia, hyperopia, Presbyopia and astigmatism.
Myopia – Also called as nearsightedness, is the problem of not being able to see what is far away without glasses.
Hyperopia – Also called as farsightedness, is the other way round or opposite of myopia.
Presbyopia – In this the eye exhibits an increasingly diminished capability to focus on near objects with age.
Astigmatism - It is little different, where the patients have irregularities in their cornea which as a result distorts the image formed on the retina of the eye.
After an Eye Surgery the need for glasses or contact lens will either be negated, or your dependency on them will be significantly reduced. But eye operation comes with its own set of risks and they should always be careful seriously before you actually sign-up for an operation.
You will not be suitable for the operation if you are suffering from diabetes, glaucoma, cataracts, arthritis, and lupus. Even pregnant women are not suitable. With these conditions, undergoing surgery can cause permanent damage to your vision. Other problems that might be caused due to surgery are double vision, glare, and halo. One’s nighttime vision can also be affected, particularly for certain operation procedures. Even permanent unclear vision and diminished contrast may be the effects of the surgery. Some patients experience discomfort in the first 24-48 hours after surgery. Other side effects, even if unusual, may include- Glare, Seeing halos around images, Difficulty driving at night, fluctuating vision.
Advantages of Lasik are -
- Most of the surgeons worldwide consider refractive surgery to be the preferred choice.
- Increases self-confidence
- Clarity of vision within hours of surgery
- Extremely predictable
- No more daily cleaning rituals or recurring costs as with visual aids
- Both eyes treated on the same day
- Greater convenience for playing sports
- Broad range of treatable prescriptions
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Similar to our fingerprints, each of our eyes is dissimilar and has its own exceptional shape and visual individuality. Having poor eyesight is a barrier that creates unnecessary challenges and sets pointless limits on what you can do in your every day life.
The three factors that create poor eyesight are:
- The curvature of the cornea
- The length of eyeball.
- The light that enters your eyes cannot focus at the proper place.
There are three ways to help out persons who go through from unclear vision or poor eyesight
Spectacles -
For centuries, mankind has well-known how to use eyeglasses to transfer the rays of light to their proper points. It is a not dangerous and accepted technique of correcting ones vision, but there can be limits, such as when playing sports, occupational hazards or limits and even self-consciousness that the eyeglass wearer might feel.
Refractive Surgery -
Researchers have developed Radial Keratectomy and PRK (Photorefractive Keratectomy) and LASIK (Laser In-situ Keratomileusis). For LASIK, this is the great revolution in ophthalmology innovation.
As all things have the side effects, restrictions and complications of Refractive surgery. A balanced opinion of the advantages of Refractive surgery with the identified and unidentified risks. It is significant to recognize that it is not possible to perform any form of surgery without the patient accepting a definite amount of risk and responsibility.
Contact Lenses -
When Contact lenses were developed, public were given an additional technique to improve their vision. One benefit that contact lenses recommend over eye glasses is a wider field of vision, but the daily, required rituals of cleaning the lenses, inserting them into the eyes and taking them out and re-cleaning them another time at night causes some people to shy away from converting to contacts. In addition, if the lens are not taken proper care of and cleaned regularly, there is a risk of infection. For some people with high astigmatism, contact lenses just do not work.
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Refractive eye surgery is a type of eye surgery that is used to rectify refractive errors of the eye and decrease dependency on corrective lenses such as eyeglasses and contact lenses. Successful refractive procedures can reduce myopia or nearsightedness, hyperopia or farsightedness, and astigmatism or elongated corneas. A number of different procedures exist for refractive eye surgery depending upon the type and severity of the refractive error.
There are four main types of refractive eye surgery procedures: flap and photoablation procedures; corneal incision procedures; thermal procedures; and implants. Currently, the most common refractive eye surgeries involve the use of lasers to reshape the cornea. Flap procedures involve cutting a small flap in the cornea so that the tissue underneath can be reshaped to correct the refractive error.
LASIK, short for Laser Assisted In-Situ Keratomileusis, is the most popular refractive surgery and is used to correct myopia, hyperopia, and astigmatism. The LASIK procedure involves using a microkeratome or IntraLase to cut a flap into the stroma, moving the flap out of the way, removing excess corneal tissue with an excimer laser, then replacing and smoothing out the flap. LASEK is best suited for individuals with thin or flat corneas. The LASEK procedure uses a small trephine blade to cut into the shallow epithelium, after which the eye is bathed in a mild alcohol solution to soften the edges of the epithelium. The flap is gently moved out of the way so that an excimer laser can remove excess corneal tissue, after which the flap is replaced and smoothed out.
Epi-LASIK, like LASEK, involves a shallow cut into the epithelium, but makes use of epikeratome to create a thin epithelium sheet for removal instead of the harsher blade and alcohol. Photoablation, the second stage in flap procedures, makes use of ultraviolet radiation to remove excess corneal tissue. PRK, or photorefractive keratectomy, was the original laser eye surgery procedure. PRK involves numbing the eye with local anesthetic eye drops, and reshaping the cornea by destroying miniscule amounts of tissue from the surface of the eye. The laser used, an excimer laser, is a computer-controlled ultraviolet beam of light. It burns cool so as not to heat up and damage the surrounding eye tissue. Corneal incision procedures such as radial keratotomy and arcuate keratotomy use miniscule incisions in the cornea to alter its surface and correct refractive errors.
Radial keratotomy, or RK, uses a diamond tipped knife to make a number of spoke-shaped incisions in the cornea. The result of the incisions is that the cornea flattens out, minimizing the effects of myopia. Arcuate keratotomy, or AK, is very similar to RK. The diamond knife is used to cut incisions that are parallel to the edge of the cornea, as opposed to the spoke-shaped incisions of the RK procedure. These procedures have been much less common with the emergence of laser-assisted refractive eye surgeries.
Thermal procedures use heat to correct temporarily hyperopic refractive errors, or farsightedness. The thermal keratoplasty procedure involves putting a ring of 8 or 16 small burns on the eye immediately surrounding the pupil. The application of the heat increases the slope of the cornea, making it steeper, through thermal contractions. There are two main types of thermal keratoplasty. Laser Thermal Keratoplasty, or LTK, is a no-touch procedure that uses a holmium laser.
Conductive Keratoplasty, or CK, uses a high-frequency electric probe. The final type of refractive eye surgery involves the use of implants. Implantable contact lenses, or ICL, can be used to correct severe levels of myopia, hyperopia, and astigmatism. The implants are actually tiny contact lenses that are inserted through a small incision in the side of the cornea. Implants are seated so they sit immediately in front of the eye’s natural lens just behind the cornea. ICL works in conjunction with the eye? natural lens to refocus light on the retina and produce a crystal clear image. Each of these procedures has its advantages and disadvantages, and not all individuals are suitable candidates for refractive eye surgery. Individuals who are interested in learning more about surgical options should contact their ophthalmologist for more information about these procedures, as well as inquire about other new cutting-edge procedures. Since ophthalmologic surgery is constantly growing and changing with emergence of new technologies and methods, there are always new techniques in development. |
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