SQUINT AND BINOCULARITY

When we talk of binocularity we refer to the use of both the eyes together. This means that the two eyes can work together as a single unit and relay images to the brain. The direct result of this is depth perception - which is the judgment of the distance a person or object is from us.

Squint needs to be rectified at an early age as this can improve our depth perception and there is no permanent loss of this function.

What happens when one operated at an older age, maybe once a person is an adult ? Research has shown us that even in an older age, the depth perception can be preserved and improved. So when we operate on a squint at an older age, when he or she is an adult there are two benefits of the surgery - not only does the individual have better cosmetic appearance, the person also regains most of the depth perception. 

So it is worth correction of the squint at any age.

ADVANCES IN SQUINT SURGERY

Squint surgery has become one of the most technically uncomplicated surgeries now. The outcome is mainly dependent on the careful planning and assessment of the patient before surgery. This needs a lot of knowledge and understanding on the part of the clinician and surgeon. Only an experienced and well trained surgeon can perform and give a good result.

Understanding the nature of the squint, the extent and severity and the possible future outcomes need to be understood before embarking on the squint surgery. It is easy to understand this based on tests performed in the clinic. Sometimes it is best to observe the squint for some months in an effort to understand the nature of the squint.

Surgery is technically simple especially for the patient. The patient walks in and walks out of the clinic after surgery. There is no need for special rest, the patient can watch TV, read and work on the computer.

The precautions would be not wetting the eyes for a month, so no swimming for a month and no head bath for a week.

Squint surgery has become technically simple to perform, scarless, and cosmetic in nature. Cosmetic because there is no scar of the surgery. There are no tell tale signs of surgery.

RESURGERY IN SQUINT

Most people wonder if operating again in a patient with squint is going to be successful. It is interesting to note that this is possible and one must realize that there are various ways by which one can increase the success rate of surgery.

Adjustable suture technique is a very useful method of ensuring that the results of squint surgery are good. The muscle is out on a shoe lace kind of knot and the same can be adjusted with the patient awake in the evening. This ensures excellent outcome and this can be shown to the patient also with the use of a mirror. 

Muscle surgery is quite forgiving and one can definitely operate again on muscles to ensure good outcome. Operating on the second eye can also give good results in patients.

Repeat surgery or a second or third surgery is definitely possible in squint and can give excellent results with the proper techniques....

SQUINT ---- TIMELY INTERVENTION

Time is crucial in the management of squint.....

It is important to understand that time is crucial in the management of squint. Time lost is going to cost the patient a lot and maybe include loss of vision. Hence it is important that one consults a pediatric ophthalmologist or squint specialist as soon as possible.

Many a times parents come with the complaint or doubt that the child seems to have a squint especially in the photographs. More often than not, there is no squint or there is a pseudo squint due to the exaggerated folds of the skin near the eyes. But sometimes there is a true squint which is actually present and can be treated. 

One must not forget that squint can itself lead to amblyopia or lazy eye. This can be a reason for vision loss or impairment in children. The earlier this is detected the better it is for the patient. 

Again the squint detected earlier is more amenable to treat with exercises or glasses and most cases may not need surgery or one can avoid surgery altogether. 

Many reasons you will agree to get the eyes checked and to rule out the possibility of a squint....

ALL ABOUT MYOPIA

v  Myopia, also called nearsightedness or shortsightedness, is the eye condition where objects nearby or a short distance away are clear but objects that are far away are blurred. It is caused by the eye being slightly too long.

v  One can stop the eyes from becoming myopic or progression of myopia.

v  Myopia is getting worse around the world, even to the point of being called an epidemic by some. In some parts of Asia, 80% of the girls in high school are myopic. In the United States, myopia has increased 66% in thirty years so that now 42% of people aged 12-54 are myopic.

v  Myopic parents have more myopic children than non-myopic parents.

v  People in urban environments have more myopia than rural or primitive societies.

v  The amount of reading or near work a person does is not predictive of whether they will become myopic.

v  People who spend more time outdoors, even if they have myopic parents and even if they read a lot, are less likely to become myopic. We don't know why exactly - it may be the sun, it may be focusing on distant objects or some other factor.

v  Spending too much time on the tablets and mobile games can accelerate the progression

v  ­­­­Your child needs an eye exam every year starting at age five. (Check-ups before then.) The goal is to actively start treatment within a few months of myopia starting. In general, you can slow or stop it, you can't make it better. 

Treatment options……

v  Atropine: reviews - the ATOM study. - 77% myopic progression reduction

v  Pirenzepine: approximately 50% reduction; not available easily.

v  Bifocals: No slowing of myopia

v  Progressive Addition Lenses(COMET study): PALs are "not clinically meaningful"

v  Contact lenses (RGP): "not effective for myopia control"

v  Orthokeratology: "...no evidence for long-term efficacy of orthokeratology in reducing myopia progression...A gold standard randomized controlled trial is needed .."

v  Undercorrection: makes things worse. "This means that myopes may have an abnormal mechanism for detecting the direction of optical defocus of the retinal image."

v  Part time lens wear: No effect seen. Larger study called for.

v  NeuroVision: A commercial internet based system of training. Preliminary results compared to age matched normals of another study showed slowing of myopia.

v  EyeRelax: "a microscope-like device". No evidence it can retard myopia.

v  Pinhole Glasses: No evidence it can retard myopia.

v  Bates Method: "Bates' anecdotal reports of improved vision have not been evaluated in trials.

ALLERGIC EYE DISEASE IN CHILDREN

ALLERGIC EYE DISEASE

·        

         There are 4 main types of allergic eye disease – seasonal, perennial, vernal and atopic allergic conjunctivitis

·         Main symptoms are itching, burning, watering and redness of the eyes

·         Seasonal allergic conjunctivitis

o   Usually these are a part of hay fever and the cause is usually pollen

o   The triggering agent is usually histamine

o   Allergy tests are not usually helpful

·         Perennial allergic conjunctivitis

o   Similar to seasonal allergic conjunctivitis

·         Vernal keratoconjunctivitis

o   Severely allergic children

·         Atopic keratoconjnctivitis

o   Occurs in adults

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