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Cornea is the outer most transparent layer of the eye that appears black or brown due to the colour of the Iris behind it and can be transplanted from a dead person to that of a living host.

Keratoprosthesis simply means artificial cornea. It is a new technology and a very good option for patients whose previous corneal grafts have failed or have been rejected. It is also an option for patients who have severe dry eyes where the normal grafts cannot survive. Finally it is an option for patients who are not able to find donors for a corneal transplant.

However being an artificial cornea it has its limitations. The most important being integration with the host tissue. This may lead to gaping or melting at the edges leading to infections and permanent damage to the eye. For this antibiotic drops are put throughout life and intermittent antiseptic washes are need for the eyes along with regular monitoring.

There have been various options for this problem including semi integrated and fully integrated keratoprosthesis which are fixed with the help of the person’s tooth and inner layers of the cheek. This process is tedious, expensive and cosmetically less appealing. However if it succeeds then a totally blind person is able to lead a decent life.

The various keratoprosthesis available today are Boston krpro, Aurokpro, Lucia, Boston type 2, MOOKP etc. Each one has its specific indications, advantages and disadvantages and the selection of those are decided by the corneal surgeon based on the patients eye condition, the cause and his experience.

There are a few other newer advances including synthetic corneas, liquid corneas, porcine tissue matrix and stem cell therapies all of which form part of regenerative medicine and offer further hope to corneal blind patients.

Also corneal transplantation has become more advanced with better techniques including lamellar surgeries where individual layers of cornea can be transplanted and hence the results are getting better with lesser rejections.

Considering all these options and their limitations, a keratoprosthesis is indicated only when a patient is corneal blind in both eyes. Also it should be done only in one eye at a time. The choice about whether to go for it or not and which type usually remains with the clinician based on set protocol and his experience. Also due to chances of melts and infections where ever possible natural corneal transplants still remain the first choice and if they fail repeatedly then an artificial cornea can be considered.

However with newer safer options becoming available, this may change in the near future and we may opt for artificial corneas as the first choice.

Glaucoma is the second most common cause of irreversible blindness worldwide, after Cataract, says the World Health Organization (WHO) 2020 report. It is estimated that the global burden of Glaucoma was around 79.6 million until last year, with almost half of them being Asian. In India particularly, blindness due to Glaucoma is a growing cause of concern. It has affected around 11.9 million Indians. It is a multifactorial condition resulting from progressive Optic Neuropathy and visual field loss. These changes are often slow, and many Glaucoma patients do not know about their underlying glaucomatous eye.
Glaucoma is a disease that involves damage to the optic nerve of the eye, causing permanent blindness due to rising pressure within the eye. The rise in pressure is gradual and the damage is slow. There may be some early signs and symptoms like pain & heaviness of eyes, haloes around lights in the evening, regular change of glass power and redness of eyes. Therefore, it is imperative to get your eyes checked each year after the age of 40yrs, to detect Glaucoma. It involves checking vision, optic nerve examination, measurement of eye pressure, and in suspicious cases, tests like perimetry & OCT.
Well, those with a family history of Glaucoma, people with minus power, those above the age of 40yrs, those with a history of eye injury like tennis ball hit in the past, people on steroids for other diseases, and also those who have Diabetes & Hypertension are people more at risk. Sometimes certain eye diseases like inflammations can also cause Glaucoma.
At times, children can also be affected with Glaucoma. This happens when there is a development-related issue called Congenital or Juvenile Glaucoma. Also, sometimes in adults, it may be present as an acute rise in pressure called ‘acute angle-closure Glaucoma’ where the patient may suffer acute pain, redness and blurred vision. In most cases, this remains undetected unless seen by an eye doctor and therefore poses a higher risk of blindness. Hence, a periodic examination is a must, especially with the above risk factors.
Treatment options: Control of eye pressure is the only way we can halt the progress of Glaucoma. However, the damage which has already occurred cannot be reversed. For controlling the pressure, we have eyedrops which can be given as single or as combinations. If it remains uncontrolled. then a laser procedure can be done. As a last resort, surgical control with filtration surgery or tube shunt procedures is employed.
What food to avoid: While most people may not know this, but food that we eat can affect our eyes greatly. It can cause direct or indirect harm to the optic nerve and raise intraocular pressure:
Trans-fats can harm blood vessels, which can damage the optic nerve. Avoiding fried foods and processed foods high in trans-fats (such as French fries, fried Chicken, and potato chips) can help
Saturated fats cause weight gain, which raises the Body-Mass Index (BMI). A high BMI has been linked to intraocular pressure and Glaucoma. It’s best to avoid foods high in saturated fats such as Butter, Cheese, and whole Milk, and such fatty meats as Salami and Bacon
Caffeinated Coffee may increase the eye pressure, so avoid over consumption
Also in narrow angles of the eye, too much and too long near work can cause intermittent rise in eye pressure. It is important to catch the thief before it steals your vision! Regular eye checkups, eating healthy food and early control of eye pressure is the key to fight this blinding disorder.
Inputs Dr Harshavardhan Ghorpade, Cataract, Cornea & Refractive Surgeon, Fortis Hiranandani Hospital, Vashi

~Authored by Dr. HarshavardhanGhorpade, Director, DOVS Eye Institute, Hiranandani Hospital, Vashi-A Fortis Network Hospital~

Cataracts by popular understanding are the prerogative of the old. However, Cataracts are quite common in infants and children as well, except that the causes are different and it is even more critical for surgery to be performed early! The various causes of Cataracts at birth include hereditary causes, part of Genetic Syndromes, intrauterine infections like Rubella, and birth trauma. They are also caused due to nutritional deficiencies in the mother during pregnancy. Later, injury to the eyes can be the cause of childhood Cataracts. These are usually detected before the age of 2yrs and sometimes by the age of 5yrs.

This lockdown we all have been wondering how much loss we had to sustain. How much finances, jobs, business, and lives were lost! The lost lives will never come back but the lockdown has opened our eyes to a new perspective that we may never have got otherwise.

If you look at the overall picture we realize that the gains have been much more than the losses. After all, life is not only about material gains. It is also about overall development as a person. So let me enumerate what I feel have been the best gains of this lockdown which otherwise wouldn’t have been possible in our ‘previous’ lives!