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"Dr. Smita Dheer is the One Of The Best Eye Specialist in Ahmedabad. Dr. Smita Dheer is Top Eye Surgeon Doctors in Ahmedabad. Dr. Smita Dheer Provide Best Eye Care Solution in Ahmedabad at affordable Cost.<br><br><br>Born to doctor parents, state rank holder in HSC and SSC, Dr. Smita Dheer received scholarship for meritorious performance from the government, which she gave up to help the needy students.<br><br>After finishing her MBBS from Gandhi medical college BHOPAL, she perused her Master of surgery (M.S) from REGIONAL INSTITUTE OF OPHTHALMOLOGY BHOPAL in 2000. She did her fellowship in SMALL INSCISION CATARACT SURGERY from B.A.B.T EYE HOSPITAL Mumbai. She gathered working experience under renowned surgeonSPITAL run by Lions Club Sight Savers in AHEMDABAD. She served in the organisation for a decade as CHIEF SURGEON from 2007 TO 2016. During her tenure, she handled complicated cases and polished her administrative and surgical skills. She did her post graduate diploma in hospital and health care management (PGDHHM) from SYMBIOSIS PUNE in 2005, and did a certificate course in clinical research (CCCR) in 2008. Now she is associated with CIMS HOSPITAL as CONSULTANT OPHTHALMOLOGIST."<br>
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Primary Care Practitioners • See variety of eye problems • Discuss treatment options • Facilitate referrals • Positioned to explain optometry's role as primary eye care providers
Outline • Anatomy • Optics • Turned Eyes • Lazy Eye • External Conditions • Internal Conditions • Diabetic Retinopathy
Basic Anatomy Choroid Sclera Retina Cornea Fovea Pupil Lens Optic Nerve Iris Ciliary Body
Lids • Lashes—protection from foreign material • Glands—lubricate anterior surface • Meibomian glands • Glands of Zeis • Glands of Moll
Conjunctiva • Thin, transparent, vascular layer lining • Backs of eyelids • Fornices • Anterior sclera
Sclera • Tough outer shell • Composed of collagen bundles • Protects from penetration
Cornea • Composed of regularly oriented collagen fibers • 5 layers
Anterior Chamber • Space between cornea and iris • Filled with aqueous humor produced by ciliary body
Iris • Iris gives eye color • 2 muscles: • Dilator—opens • Sphincter—constricts
Pupil • Allows light to enter • Enables view to back of eye and eye health evaluation
Lens • Located behind iris • Focuses light on retina • Allows for accommodation • Normally transparent • Where cataracts form
Ciliary Body • Primary functions • Pulls on lens for accommodation • Epithelium secretes aqueous fluid that fills anterior chamber
Red Reflex • Light reflection off retina • Useful for assessing media clarity • Affected by any opacity of cornea, lens, vitreous • White reflex = leukocoriaRefer immediately!
Vitreous Humor • Gel-like fluid that fills back cavity • Serves as support structure for blood vessels while eye formed—before birth • After birth, just ‘hangs out’ in there • Where floaters are located
Fundus • Interior surface of eye • Includes • Optic nerve • Retina • Vasculature
Optic Nerve Head • Collection of nerve fibers and blood vessels from retina • Transfers info to brain’s visual cortex • Slightly yellow-pink when healthy • White ‘full moon’ appearance can mean trouble!
Optic Nerve Head • Cup is natural depression in center of nerve • Cup size varies between people • Very large cup, or change in appearance over time, can indicate glaucoma Optic Disc Physiologic Cup Optic Nerve
Macula • Dense collection of cone photoreceptors • Fine detail and color vision • Macular degeneration affects this area
Retinal Vessels • Include arteries and veins • Only place in body where you can directly visualize blood vessels • Excellent indicators of systemic diseases • HTN • Diabetes • High cholesterol • Carotid disease
Peripheral Retina • Can only be evaluated with dilated pupil • Important to evaluate periodically to fully assess eye health
Optics Review • Myopia • Hyperopia • Astigmatism • Presbyopia
Myopia • Nearsightedness • See well up close but blurry in distance • Eye is too long • Light focuses in front of retina
Hyperopia • Farsightedness • See well in distance • Eye is too short • Focus point is behind retina
Hyperopia • Blurry image on retina • Lens focuses to compensate • Hyperopes often asymptomatic much their of lives • Can cause headaches or eyestrain with extended reading • These problems can get worse after age 40
Astigmatism • Surface of cornea isirregular or misshapen • Light focuses at various points causing distorted vision • Often combined with nearsightedness and farsightedness
Presbyopia • Normal, age-related change • Near vision becomes difficult • Mid-40s lens becomes less elastic and losesability to change focus • Time for bifocals…
Eye misalignment One or both turn in, out, up or down Caused by muscle imbalance 3 Kinds of Strabismus Esotropia Exotropia Hypertropia Turned Eyes - Strabismus
1. Esotropia • Eye turns in towards nose
3 Types of Esotropia • Infantile (congenital) • Develops in first 3 months of life • Surgery usually recommended—along with vision therapy and glasses • Accommodative • Usually noted around age 2 • Child typically farsighted • Focusing to make images clear can cause eyes to turn inward • Treated with glasses but vision therapy may also be needed
3 Types of Esotropia • Partially Accommodative • Combination of • accommodative dysfunction and • muscle imbalance • Glasses and vision therapy won’t completely correct eye turn • Surgery may be required for best binocularity
If you see Esotropia • Refer to pediatric optometrist or ophthalmologist • Sooner the better for best chance of good vision
2. Exotropia • Eye turns outward • Congenital—present at birth • Surgery usually needed to re-align • Many exotropias are intermittent • May occur when patient is tired or not paying attention • Concentration can force eyes to re-align • Vision therapy and/or glasses can help
2. Exotropia • When intermittent • Brain sometimes receives info from both eyes (binocular) • Less chance of amblyopia • However, important to be seen by eyecare provider when deviation noted
3. Hypertropia • One eye vertically misaligned • Usually from paresis of an extra-ocular muscle • Typically much more subtle for patient to describe and provider to diagnose
2 Types • Congenital • Most common type • Patients can compensate for years by tilting head • Can be discovered by looking at childhood photos
2 Types • Acquired • Trauma—Extra-ocular muscle ‘trapped’ by orbital fracture • Vascular infarct—Systemic diseases that affect blood supply to nerves can cause temporary nerve palsy • Diabetes and HTN most common • Palsies tend to resolve over weeks or months • Neurological—In rare cases a tumor or aneurysm can cause symptoms
Lazy Eye - Amblyopia • Decreased vision uncorrectable by glasses or contacts—not due to eye disease • For some reason, brain doesn’t fully acknowledge images seen
3 Types of Amblyopia Strabismic Anisometropic Stimulus deprivation Lazy Eye - Amblyopia
1. Strabismic Amblyopia • One eye deviates from other and sends conflicting info to brain • Brain doesn’t like to see double—so “turns off” info from deviated eye • Results in under developed visual cortex for that eye • Can usually be reversed or decreased if treated during first 9 years • Need to visit eyecare provider ASAP to determine cause
Treatment • If caught early, treatment can teach brain how to see better • Vision therapy/patching • Glasses • Surgical re-alignment • Early vision screenings are critical!
2. Anisometropic Amblyopia • Anisometropia—significant difference in Rx between eyes • Commonly one eye more farsighted • Farsighted eye works hard to see clearly—and sometimes gives up • Brain relies on info from other eye
2. Anisometropic Amblyopia • If not caught, one eye won’t learn to see as well as other • Vision therapy and glasses are both beneficial • Sooner the better
3. Deprivational Amblyopia • Any opacity in visual pathway can be devastating to developing visual system • Congenital cataracts • Corneal opacities • Ptosis (droopy eyelid) • Other media opacities
Blepharitis Hordeolum—stye Preseptal cellulitis Orbital cellulitis Pterygium Corneal ulcer Conjunctivitis Viral “pink eye” Adenovirus Bacterial Allergic Hyperacute Chlamydial Common External Ocular Conditions