New Al Shefa Ophthalmology Department aspires to improve the quality of life of patients. We are a tertiary eye care center, with advanced technology providing treatment for all kinds of ophthalmic problems such as cataract, vitreo-retinal diseases, corneal transplantation, glaucoma, strabismus and low vision aid. Our department has all the latest diagnostics methods and treatment modules.
OPTICAL COHERENCE TOMOGRAPHY (OPTOVUE)
A state-of-the-art technology for performing high-resolution cross-sectional imaging of eye structures. OCT is analogous to ultrasound imaging, except that it uses light instead of sound. Hence, resolution in micron scale in situ and in real time. Optical coherence tomography is useful in diagnosing retinal conditions and disorders of the optic nerve, cornea and angle study.
HUMPHREY VISUAL FIELD Zeiss
Gold standard in perimetry for diagnosis , analysis and management of glaucoma . Many neurological diseases can affect peripheral vision. To diagnose and treat these conditions,specialized tests are available.
GALILEI FOR CORNEAL MAP ZIMMER
A non-invasive imaging technique for mapping the surface curvature of the cornea, the outer structure of the eye. Corneal topography has facilitated the diagnosis of keratoconus and pre-operative evaluation and post operative management for LASIK surgery.It is also useful for evaluation of lens and AC angle.
IOL MASTER 700 Zeiss
the IOLMaster 700 uses noncontact method and is highly accurate for preoperative IOL calculations.It is very useful in patients who have undergone lasik surgery earlier.
FUNDUS FLUORESCEIN ANGIOGRAPHY
It records the dynamic interaction of fluorescein with both normal and abnormal anatomic structures of the ocular fundus. A thorough understanding of the circulation phases is essential for interpretation of abnormalities. This can detect diabetic retinopathy, retinal vein occlusions, retinal artery occlusions, edema of the optic disc, and tumors.
This instrument can also be used for taking pictures of Ocular fundus.
A SCAN AND B SCAN Sonomed
A-scan or Amplitude Scan is an amplitude modulation scan. It is used to measure the IOL power.. B-scan or Brightness Scan is an important adjuvant for the clinical assessment of various ocular and orbital diseases. It also assesses the posterior segment in hazy ocular media.
COMPUTERIZED & PNEUMATIC TONOMETER, REFRACTOMETER
Non contact method to determine the intraocular pressure (IOP). It is an important test in the evaluation of patients at risk from glaucoma.
Autorefractokeratometer for evaluating refractive status and corneal keratometry readings
WAVEFRONT ANALYZER AND CORNEAL TOPOGRAPHY ( ZEISS)
Wavefront analyzer is used to customize your lasik correction.
Corneal topography is a computer assisted diagnostic tool, used during an eye exam that creates a three-dimensional map of the surface curvature of the cornea.
ELECTRORETINOGRAPHY (ERG) AND ELECTROOCULOGRAM (EOG)
The electroretinogram (ERG) is a diagnostic test that measures the electrical activity generated by neural and non-neuronal cells in the retina in response to a light stimulus. During a recording, the patient’s eyes are exposed to standardized stimuli and the resulting signal is displayed showing the time course of the signal’s amplitude (voltage). The ERG can provide important diagnostic information on a variety of retinal disorders including, but not limited to congenital stationary night blindness, Leber congenital amaurosis, and cancer-associated retinopathy. Moreover, an ERG can also be used to monitor disease progression or evaluating for retinal toxicity with various drugs or from a retained intraocular foreign body.
SPECULAR ENDOTHELIAL MICROSCOPY
The specular microscope is a special instrument that allows the doctor and photographer to see and record the corneal endothelial cells. These instruments take advantage of a bright specular or mirror like image that is created when the angle of the light for photography is at the correct angle. The images which result from the procedure allow a “cell count” of corneal endothelium. The range for normal is 2000-3200 per millimeter squared. Cell counts have been used to evaluate a wide variety of procedures, primarily those used in cataract surgery. Eye and tissue banks routinely use the specular microscope as one method of evaluating a donor cornea prior to corneal transplant.
Corneal and Refractive Surgery
INTRA-LASIK AND EPI-LASIK
For correction of Near, Far Vision and Astigmatism, we use the most advanced LASIK correction of all refractive errors.
What is LASIK/Refractive Surgery?
LASIK surgery is performed as an outpatient procedure in the comfort and convenience of the laser surgical suite. The entire vision correction procedure takes less than 1 minute and both eyes are done in the same setting. The procedure is performed using topical anesthesia (eye drops). Patients see a dramatic improvement in their vision within the first day. Most patients return to their normal activities within a day or two.
The cornea is normally a clear layer of tissue covering the front of the eye, similar to a watch crystal. In cases where the cornea has become cloudy or opaque as a result of disease, swelling, scarring, infection, or chemical burns, a corneal transplant is sometimes necessary to restore functional vision.
IMPLANTABLE COLLAMER LENS (ICL)
Collamer is a technologically advanced lens material. Because of the collagen base in Collamer, it is 100% compatible with your body’s natural chemistry.
The Visian ICL procedure is a short 15 minute procedure. Patients then experience an immediate improvement in vision quality.
Descemet’s Stripping Endothelial Keratoplasty ( DSEK)
This is a type of corneal transplant where only the back layer of the cornea, the endothelium, is transplanted. This is different than a penetrating full thickness keratoplasty where the entire cornea is transplanted.
DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK)
It is a surgical procedure for removing the corneal stroma down to Descemet’s membrane. It is useful for the treatment of corneal disease in the setting of a normally functioning endothelium.
CORNEAL INLAY FOR PRESBYOPIA CORRECTION
Latest femtosecond assisted corneal inlay techniques for presbyopia patients.
Corneal inlays, also called keratophakia, are implants placed in the corneal stroma for correction of presbyopia, a condition in which the ability to accommodate or focus at near objects is decreased.
Generally, young people can focus easily both at distance and near. Near objects can be seen clearly due to contraction of the ciliary muscle and increase in the curvature of the anterior surface of the lens, a process called accommodation. This accommodative ability starts decreasing after the age of 40, making it difficult to see near objects. Wearing reading glasses is the common solution to presbyopia. Corneal inlays are one of the options for correction of decreased near vision in presbyopic people who desire spectacle-independent good vision at all distances. They do not restore the ability to accommodate, as they have no effect on the ciliary muscle or the lens. They work by increasing the depth of focus or the refractive power of the central or paracentral part of the cornea. Corneal inlays have also been used for correction of hyperopia, myopia, and astigmatism.
Cataract and Glaucoma Treatment
SUTURELESS CATARACT SURGERY (PHACO)
Phacoemulsification cataract surgery is a procedure in which an ultrasonic device is used to break up and then remove a cloudy lens, or cataract, from the eye to improve vision. The insertion of an intraocular lens (IOL) usually immediately follows phacoemulsification.
The latest technique in cataract surgery eliminates the need for uncomfortable injection of anesthesia behind the eye and bothersome, sometimes troublesome sutures. This offers the patient impressive benefits – safety, less time in surgery, relief from the usual discomfort and stress, less risk of complications and improved success rate
This type of laser is used to clean membranes in the eye that have become thickened after cataract surgery.
It is also used to treat certain types of glaucoma (Peripheral Ividotomy). The treatment is very effective for these conditions.
MICROINVASIVE GLAUCOMA SURGERY (MIGS)
MIGS stands for minimally invasive glaucoma surgery. The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve. Standard glaucoma surgeries — trabeculectomy and express shunts, are major surgeries. While they are very often effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications. The MIGS group of operations have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries.
GLAUCOMA TREATMENT (SURGERY OR LASER)
Glaucoma is a degeneration of the optic nerve of the eye resulting in progressive loss of peripheral vision.Measurement of IOP, angle study, corneal pachymetry,OCT optic nerve analysis and Visual field analysis(perimetry) are essential tools for management of glaucoma.The eye pressure is modulated with eye drops, laser or incisional surgery. There are 2 types of laser treatment depending on the type of glaucoma you have:
SLT (selective laser trabeculoplasty) and LPI (laser peripheral iridotomy). SLT is a relatively new laser that uses low energy light to enhance the natural mechanism of fluid drainage from the eye to help treat open-angle glaucoma. SLT and LPI treatments are painless.
LASER TRABECULOPLASTY FOR GLAUCOMA
Laser trabeculoplasty uses a very focused beam of light to treat the drainage angle of the eye. This surgery makes it easier for fluid to flow out of the front part of the eye, decreasing pressure in the eye.
AHMED GLAUCOMA VALVES
Glaucoma drainage devices are designed to divert aqueous humor from the anterior chamber to an external reservoir, where a fibrous capsule forms about 4-6 weeks after surgery and regulates flow.
These devices have shown success in controlling intraocular pressure (IOP) in eyes with previously failed trabeculectomy and in eyes with insufficient conjunctiva because of scarring from prior surgical procedures or injuries.
They also have demonstrated success in complicated glaucomas, such as uveitic glaucoma, neovascular glaucoma, and pediatric and developmental glaucomas.
Treatment for Keratoconus
SPECIAL LENS FOR KERATOCONUS PATIENTS
Keratoconus is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment. Depending on the severity of your disease the treatment may vary. Eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism caused in the early stages of keratoconus. As the disorder progresses and the cornea continue to thin and change shape, rigid gas permeable contact lenses are generally prescribed to correct vision more adequately. Soft contact lenses designed for keratoconus are generally thicker centrally than standard soft lenses, ranging from 0.3mm to 0.6mm. This increased center thickness helps prevent the lens from conforming to the irregular shape of the cornea. Soft lens allows it to mask some mild to moderate irregular astigmatism.
During the corneal crosslinking treatment, custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. This process has been shown in clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea.The aim of this treatment is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation.It is an outpatient procedure and non-invasive.
INTRACORNEAL RING WITH INTRALASE
Intacs are placed in the cornea with IntraLase. This is less traumatic and more accurate than using a mechanical keratome..Corneal shape is modulated with rings. Corneal thinning disorders often lead to protrusion, irregular astigmatism, and even perforation. Keratoconus, PMD (Pellucid Marginal Degeneration), and Keratoglobus do not have a known cause. However, corneal ectasia can also be acquired after the LASIK procedure. Corneal ectatic disease may impair vision which can be restored by optical means such as glasses, soft, or rigid gas permeable contact lenses. However, severe cases may require correction or restoration of tectonic integrity of the cornea by surgical means. Intrastromal corneal ring segments (ICRSs) are made of PMMA (polymethylmethacrylate). They are implanted in the deep corneal stroma to modify the corneal curvature. The intrastromal corneal ring (ICR) is a device designed to correct mild-to-moderate myopia by flattening the anterior corneal curvature without encroaching on the visual axis.
Eye Deviation Surgery (Squint)
EYE DEVIATION SURGERY (SQUINT)
Strabismus is the medical term for what people commonly call “crossed eyes. Strabismus is a vision condition in which a person can not align both eyes simultaneously under normal conditions. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time).Strabismus in children does not go away on its own and strabismus in adults is treatable.
strabismus patients are treated by eye glasses orthoptic exercises Amblyopia treatment and surgery in selected cases.
PLASTIC LID SURGERY (BLEPHAROPLASTY)
Upper and Lower Eyelid Fat Removal without cutting the skin. Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face.
Ptosis is a drooping of the upper or lower eyelid. Ptosis surgery is usually done under local anesthesia as a day case.
EYELID COSMETIC SURGERY
Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert.
Movable Artificial Eye (Hydroxyapatite)
Artificial eye is a type of craniofacial prosthesis that replaces an absent natural eye. Hydorxyapatite promotes fibrovascular ingrowth and seemingly true integration of the motility implant to the residual ocular structures.
Retinal Disease Treatment
LASER TREATMENT FOR RETINAL DISEASES
The retina is the inner layer of the eye that senses light and helps you to see. Laser has been one of the great advances in treating retinal diseases like retinal holes, tears, diabetic retinopathy and macular degeneration.
Argon laser treatment can be used to treat a number of eye conditions including glaucoma, diabetic eye disease and some retinal holes and tears. It can also be used to prevent an eye condition from getting worse, or sometimes to cure it. The laser machine is attached to a slit-lamp microscope, similar to that used when your eyes are being examined in the clinic.
INTRAVITREAL LUCENTIS INJETION
Advanced treatment option for diabetic macular edema,neovascularizion due to wet ARMD and retinal vein occlusion.
Instead of retinal laser and complicated surgery very small amount of medicine is injected in the eye.
Lucentis, also known as ranibizumab injection, is a medication that was initially used to treat the wet form of age-related macular degeneration, also known as AMD or ARMD in 2006. Age-related macular degeneration affects the macula, the part of the eye that provides sharp, central vision. Now Lucentis is also used for swelling in the macula, or macular edema, due to a vein occlusion or diabetes. Lucentis slows the development of vascular endothelial growth factor, or VEGF, a protein that causes abnormal blood vessels to grow and leak, damaging the macula. By slowing the development of VEGF, Lucentis aids in the
prevention and reversal of vision loss experienced by patients with macular edema. Lucentis was designed specifically for use in the eye.
Vitreoretinal surgery is the treatment of disorders related to the retina, vitreous and macula. Ophthalmic surgeons use specialized techniques, instruments and solutions to treat conditions that include retinal detachment, macular degeneration, diabetic retinopathy, and uveitis. Retinal and vitreous problems can cause severe loss of vision or even blindness.
Vitrectomy is surgery to remove some or all of the vitreous humor (a clear gel that fills the space between the lens and the retina of the eyeball) from the eye.
Retinal Detachment Surgery
Methods of repairing a retinal detachment include:
Pneumatic retinopexy. In this procedure, your eye doctor injects a gas bubble into the middle of the eyeball. The gas bubble floats to the detached area and presses lightly against the detached retina, flattening it so that the fluid below it can be reabsorbed. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
Scleral buckling surgery. Your eye doctor places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves pulling (traction) on the retina, preventing tears from getting worse, and it supports the layers of the retina.
Transnasal D.C.R (Dacryocystorhinostomy)
A surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.it is done through nose hence no scars.
Pediatric ophthalmology is a sub-specialty of ophthalmology concerned with eye diseases, visual development, and vision care in children. Children experience a variety of eye problems, many quite distinct from adult eye diseases. Our ophthalmologists are specially trained to manage the following disorders: Infection (Conjunctivitis), strabismus, blocked tear ducts, refractive errors (such as myopia and astigmatism), ptosis and amblyopia (lazy eye).
LOW VISION AIDS FOR THE VISUALLY IMPAIRED
Low Vision Aids are tools that help those with vision loss to maximize their remaining vision It is clinically proven to improve reading speed:
Video magnifier are sometimes called “closed-circuit television (CCTV) systems” and generally use stand-mounted or hand-held video cameras to project a magnified image onto a video monitor, a television (TV) screen, or a computer monitor. Desktop video magnifiers generally have a table surface on which the object is placed. Directly above the object, is a camera and monitor upon which the magnified image is projected. Some desktop systems allow the user to project the image onto a standard TV instead of an integrated monitor.
Neuro-ophthalmologists take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Although some problems seen by neuro-ophthalmologist are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition. Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.