Ask the Doc
Dr. Ravi Thomas, Consultant Ophthalmologist and Surgeon based in Hyderabad, replies to this week's queries:
MY brother, 25, suffers from retinitis prigmentosa from the age of 10. No treatment seems to work for him. Doctors have advised vitamin A capsules. Is there any remedy? Name withheld
Answer: If the diagnosis is correct, unfortunately, at this point in time, there is no CURE for retinitis pigmentosa. Vitamin A capsules have been found to increase the electrical responses from the retina, but have not been shown to have any effect on vision, or other functional measures.
Ask your doctor what type of retinitis pigmentosa your brother has. That is important for planning the future as well as ruling out any other associated conditions. Additionally, the type of inheritance is important, especially from the perspective of planning a family.
A diagnosis of retinitis pigmentosa is not incompatible with a full and happy life. If visual function is poor, consult an expert on low vision and rehabilitation. Depending on level of visual disability, this may have a major role to play, now as well as in the future. A diagnosis such as retinitis pigmentosa can certainly affect a person's psychological well being. Look after that too. He needs support; and judging from your letter, he obviously has it.
I AM 62 and a diabetic for the last 18 years. I was treated for Diabetic Background Retinopathy two years ago. After laser treatment I had hazy vision for a few days. Recently in July both eyes were treated for Peripheral Retinopathy. Now I have blurred vision in both eyes. I am on insulin for two years. Please clarify whether the eyes becoming hazy is normal after laser treatment despite good sugar control. Will it go in due course? I am a vegetarian and exercise in the morning and walk for an hour in the evening. K.N. Subba Rao
Answer: Laser is not usually undertaken for "background retinopathy". Perhaps you were at high risk, or the disease was at a more advanced stage. Blurred vision for a day or so after the laser is not unusual: it is caused by the drops used to dilate the pupil so as to perform the laser, as well as temporary effects of the lens used on the eye to deliver the laser. If you needed another laser treatment, it looks like the disease progressed. If you have blurred vision in both eyes, it is probably due to the retinopathy involving the central retina, which is more important for "vision" as we think of it, or another cause like cataract. A single blood sugar report doesn't mean very much, and you may want to get that checked again, but both the sugar and the HbA1c seem to be normal. Fluctuating blood sugar can produce fluctuating vision. I suggest you go back to your doctor for another exam and ask him these questions. If fluctuating blood sugar or cataract is the cause, there may be a good chance of helping you. Do ask about any other doubts you may have and participate in any decisions that might be taken, especially any decisions that may involve surgery.
I AM 20. For the last 5-6 years, I have `double vision'. Last year, I got it checked. Thinking it to be a muscle problem, they prescribed convergence exercise. I have done it regularly for more than a year but with very little improvement. Is surgery a viable option? I am an engineering student and this is creating trouble in my studies. I have done exercise on `Syanptophore' also and the angle is constant at 30 for six months. Name withheld
Answer: Is the double vision intermittent or constant? If intermittent, does it come after reading for a while or looking to one side or up or down or when you are tired or is it precipitated by some other situation? Do you tend to close one eye in the sunlight? If the double vision is constant, did it start after an injury or an illness? Have you noticed that your eye movements are limited?
Depending on the findings you may need further examination and investigations: there are some systemic conditions that may cause this. The treatment would depend on the final diagnosis and either glasses, special glasses with prisms built in, or surgery are all options. Surgery is always an option, especially if you are symptomatic and the condition interferes with your daily life: but you needn't rush into it unless you and your doctors concur that it is the only option. Have a full discussion with your doctor and ask about all the options, benefits and risks.
I AM 53 and suffer from pain in the eyes (just above the sclero corneal junction) to the top of the head, vertex for over 30 years. My fundus are normal and I have myopia, which increased over the years and is now minus five diopters in both eyes. Whether I strain my eyes or not, the pain is always there. I have been to several neuro physicians, surgeons and ophthalmologists and taken CAT scans, MRIs without any clinical evidence of the problem. I developed mild spondylosis both lumbar and cervical for the last two years. One neurosurgeon told me that the problem is in the neck and suggested some exercise. This helped a bit but did not consolidate. I have stiff sensation and pain in my eyes while looking up and turning the eyes sideward. I was on antidepressants for a long time and asked to do yoga, which also did not help. What is my problem? K.R. Dasharathi
Answer: Your symptoms do not seem to fit into any obvious syndrome or cause. As the symptoms are not related to the use of the eyes, it is unlikely to be due to the glasses or muscle balance. The pain over the sclero corneal junction may be a worry, but if an ophthalmologist has examined you and ruled out simple causes (something in the inner part of the upper lid), or inflammation in the front of the eye, that should be a relief.
How long do you keep your eyes in the sideways position before you get the stiff sensation and pain in the eyes? And does this happen to any particular side? If this happens on attempting to look sideways for a long time: that is probably "normal". It is however not normal to look sideways with your eyes for a long time: it is better to turn your head.
Look at the positive side. You have had neurological tests that have not shown up anything. I hope the tests were preceded by an examination. Tests are only good if directed by and ordered AFTER an examination. So there doesn't seem to be anything sinister. You were told that the problem was in the neck and exercises caused temporary relief. Was that investigated further? Perhaps you should pursue that. Yoga may be good, but watch your neck, and do tell your instructor about your medical condition.
It looks like you have been on anti-depressants for a long time. Depression can do strange things, and manifest in some strange ways, including physical symptoms. If other causes are excluded, perhaps we should pay a little more attention to and get another consultation for this aspect.
RECENTLY I underwent cataract surgery and was fitted with an intra ocular lens. The doctor never discussed the surgery specifics and after the operation I found that I was able to see objects far away clearly but need glasses for reading and see near objects. I am 75 and no longer go out or drive. I need the glasses now even to see things at home. Before the surgery I needed glasses only for long distance and never used glasses at home. Can my vision be corrected using some laser technology so that I can read without glasses. Sundararajan
Answer: Generally intra ocular lenses provide good "unaided" eyesight for either distance, or for near; or, reasonable "unaided vision" for both distances. Usually glasses are required to "top up" the vision, and for near tasks. There are intraocular lenses available that do provide correction for distance as well as near, but there are potential disadvantages like loss of contrast.
Generally before undertaking any surgery, it is our practice to discuss the objectives of the surgery with the patient and talk about the benefits as well as the occasional risks. We also talk about visual requirements. The fact that the objective cannot always be achieved is also discussed, as is the need for glasses to top up the vision and for reading. The availability, advantage and disadvantages of special Intra Ocular Lenses that are supposed to provide good vision for all distances are discussed if appropriate.
Having said that, the level and depth of discussion varies with the patient. I think it is important for the patient to convey what their expectations are too. Unfortunately, too many times patients feel the doctor knows, or should know what you need. If you ask a specific question about the procedure or desired outcome, the doctor will (usually) address it.
What we can do for you now depends on you. I would strongly suggest conservatism: that you get yourself a pair of glasses that can be used without too much discomfort or trouble. Since you have good vision for distance, all you need is probably a pair of good "readers". Within the familiar surroundings of your house, simple measures like adequate lighting may help you manage well (perhaps even without glasses). If you are still very unhappy and unable to adjust, surgical options are available. Surgery is invasive and usually beneficial, but there is always a small risk involved. Discuss your problem, your requirements, possible solutions as well as risks and benefits with your doctor and discuss them in detail.
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