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Ophthalmology Department at Vithas Xanit, one of the most advanced laser platforms in the province of Malaga

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 24-01-2020

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We live in a world where technology progresses before our eyes, bringing us each time more advanced and effective solutions to our health problems. At Vithas Xanit, we are aware of the importance of offering the best solutions to our patients, hence the latest cutting-edge technology available in all our departments. When it comes to our Ophthalmology Department, almost all diagnostic and therapeutic procedures available today are included, from clinical consultations to treatments of any eyesight related problem. Besides, this Department has the most advanced types of lasers currently available, such as Femtosecond laser, Teneo laser or the newly incorporated laser for the treatment of glaucoma.

“At Vithas Xanit International Hospital, our Ophthalmology Department counts upon an extensive medical team of great experience, made up of 10 ophthalmologists, three optometrists and two auxiliary nurses, as well operating room instrumentalists specialised in ophthalmology, anesthesiologists, etc.,” explains Dr Cilveti, Head of this team.

“In specialties such as ophthalmology, despite having a seemingly small target organ such as the eye, the sub-specialization is very high. At Vithas Xanit we have specialists in ophthalmology dedicated to specific branches of ophthalmology, having defined units such as the Medical and Surgical Retinal Unit, the Refractive Surgery Unit, Oculoplasty Unit, Glaucoma Unit, Cataract Unit, etc.”, adds the specialist.

The department is led by Dr Ángel Cilveti, who has extensive professional experience of more than thirty years. Throughout his career, Dr Cilveti has worked in the Andalusian Healthcare Service and, in the last 15 years, also in different private centres. He specialises in different branches of ophthalmology such as diabetic retinopathy, corneal transplantation and, for almost two decades, also in vitreoretinal surgery. Dr Cilveti has a long teaching and research career at the University of Malaga as a professor of Human Anatomy and, since 1988, of Ophthalmology. He is a member of various medical societies and holds several specialist certificates.

 

Vithas Xanit International Laser Portfolio

 

Femtosecond Laser

It is a sophisticated instrument that allows different incisions to be performed in eye tissues without physical cuts, only volatilising molecules of the tissue in order to separate them. This is achieved with levels of accuracy unthinkable with other methods and, thanks to this type of laser, we can treat cases of myopia, presbyopia, astigmatism and hyperopia, as well as cataracts.

In cataract surgery, the use of this laser which avoids employing cutting instruments like in other laser systems, improves performance and accuracy, further reducing, to a minimum, the use of ultrasound during the surgery. Computer-assisted surgery also improves the accuracy of the intervention. This greater precision in the incisions allows faster recovery, a higher visual quality, with fewer corneal aberrations and less induced astigmatism in both refractive surgery, presbyopia and cataract surgery.

 

Teneo laser

The Teneo laser allows us to treat myopia, hyperopia, astigmatism and presbyopia and, together with femtosecond, is the most advanced refractive platform existing today. It is the most advanced version of the excimer laser and, among other qualities, highlights the speed of surgeries, which are now performed in a few seconds. The Teneo laser incorporates the possibility of extraordinarily improving the PRK by performing epithelial ablation (first step of PRK surgery).

Recently, Vithas Xanit International Hospital has incorporated a new module of Teneo laser that allows performing the PRK technique but this time without even touching the patient’s eye, i.e. it is performed exclusively with the laser. The advantages of this laser over other techniques are accuracy and safety above all since the alternative to laser de-epithelization is doing it manually, using diluted alcohol to remove the corneal epithelium, as performed until now.

 

 Laser for the treatment of glaucoma

Recently the Xanit hospital has also employed a novel laser for the treatment of glaucoma. It is a pathology that affects about 60 million people worldwide and it is considered as the second cause of blindness because if not treated, the diagnosis is the loss of vision. Cyclo G6 laser is a modification of the previous laser system used in the treatment of glaucoma using the destruction of the ciliary body. This laser system allows, with a few seconds effect on the surface of the eyeball, to significantly reduce intraocular pressure. Its ideal indications are open-angle glaucomas, not very advanced, with painless applications that do not require the opening of the eyeball.

Although glaucoma is a pathology that can not be cured completely, by employing this laser it is possible to reduce the values of elevated intraocular pressure. By doing so, we avoid using eye drops (which, over time, lose effectiveness to lower eye pressure). We also avoid having to add other medication to achieve the necessary reduction of intraocular pressure, especially in those patients who tolerate eye drops badly due to redness and discomfort that those cause in general.

Also, this laser system helps us avoid surgical treatments for glaucoma, which are usually aggressive and sometimes lead to other eye problems, such as cataract formation or eye discomfort.

Although there are other laser procedures aimed at lowering the pressure that can be used alone or in combination with eye drops, the cyclo G6 laser is the newest of these procedures, which, by modifying the original procedure, manages to reduce the amount of aqueous humour produced during the surgery, satisfactorily reducing eye pressure associated with glaucoma.

Wearing contact lenses in summer

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 02-08-2019

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Summer is the perfect time to enjoy outdoor activities and get together with friends and family. Beach, swimming pool, riding a motorcycle, exercising outdoors or snorkelling are activities specially reserved for summer, but sometimes people who wear glasses find them as an uncomfortable inconvenience.

Summer happened to be the time of the year when people who are wearing glasses diced to try contact lenses instead.  There are also those who wear them all year round, but it is usually in summer when they wear contact lenses the most.

Whether you use them all year round or for the first time, you should keep in mind that proper hygiene of both hands and contact lenses is essential to avoid getting an infection. The most common is conjunctivitis, which occurs as a strong itching of the eyes accompanied by eye redness. In case of experiencing any of these symptoms, you should avoid aggressively rubbing the eye at all times.

It would be convenient to always have artificial tears at hand to relieve the discomfort. If the itching persists, the procedure would be to remove the contact lenses and see a doctor in order to avoid a major problem. Besides, frequent use of artificial tears will prevent the hot environment from drying out the eyes. The brand of the product should be consulted beforehand with a specialist since not all tears are compatible with contact lenses.

In any case, to avoid uncomfortable situations, it is recommended not to wear contact lenses for more than 8 hours continuously, nor to sunbathe with them on (unless we protect ourselves with sunglasses with a very high ultraviolet filter).

When storing contact lenses, it is always necessary to do so in their specific case and with the appropriate liquid. Under no circumstances should the lens be moistened with tap water, saliva or any product other than that indicated by a specialist.

In case of contact with chlorine in the pool or sand on the beach, contact lenses should be removed immediately to avoid infection and clean the eyes with saline solution.

Faced with the decision to buy daily or monthly contact lenses, it should be noted that daily contact lenses will be less likely to become contaminated as they are single-use. However, if proper hygiene and preservation of these are maintained, monthly ones may become equally advisable.

You should not abuse contact lenses or forget that, however comfortable they are when making plans for outdoors, the healthiest thing for the eyes is to let them breathe and protect them from the sun.

Get to know our femtosecond laser for refractive surgery

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 23-03-2019

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Vithas Xanit International Hospital counts upon the Department of Ophthalmology, which as a benchmark in the region offers ophthalmological solutions based on the knowledge and experience of a great team of professionals, led by Dr Cilveti, along with advanced technology.

Our portfolio of services includes almost all diagnostic procedures and treatments available today, from clinical consultations to the therapeutic treatments required in each individual case.

Today, in our blog, we will learn a little bit more about one of the leading technologies available in our department, the femtosecond laser. A novel refractive surgery technique that allows us to correct pathologies related to vision, such as myopia, hyperopia, astigmatism or presbyopia affecting more than 50% of the population who otherwise are forced to wear glasses.

What is a femtosecond laser?

The femtosecond laser allows, among other interventions, to correct presbyopia (tired eyesight), as well as to correct refractive defects such as myopia, astigmatism or hyperopia.

How is it used?

The femtosecond laser penetrates transparent tissues and acts at a certain depth. At this depth, which can vary, the laser breaks some molecules of the tissue, thereby making cuts and sectioning the tissues.

In ophthalmology, the main uses of laser are to make cuts in the cornea at a certain depth and shape, like in refractive surgery, or also to completely section the cornea or treat the lens directly, like in cataract surgery.

What benefits does it have?

Precision and efficiency are the main advantages of laser techniques used here at Vithas Xanit International Hospital. Laser techniques allow treatment with minimised risk of infection, with minimal pain and without hospitalisation.

The femtosecond laser eliminates the risks of cuts made in the cornea with mechanical procedures used in other anatomical sites using a knife.

 

AMD Age-Related Macular Degeneration

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 09-01-2018

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Sight is the sense that most deteriorates with age. Conditions of varying magnitudes and importance start to appear, including those which are quite common among the population such as age-related blurred near vision, presbyopia and cataracts, as well as other more serious ones such as Age-related Macular Degeneration (AMD).

Dr. Cilveti, Head of the Ophthalmology Department talks to us about this disease which affects around 700,000 people in Spain (1.5% of the population). It is expected to be one of the conditions associated with blindness that will increase most over the coming years.

AMD is a degenerative eye condition which affects the central area of the retina (called the macula) in people over the age of 50. The macula is responsible for central vision and fixation and therefore enables common activities such as reading, watching the television or driving. The main risk factor is age, the condition only affects people over the age of 50 with the risk significantly increasing after the age of 65.

It is one of the current challenges in ophthalmology as it can seriously affect central vision, that is to say, it can leave us unable to read or see details, it is becoming more and more common and does not have a definitive cure. However, we shouldn’t give up hope, we should learn to understand it, prevent it as much as possible, and above all, detect it in time to be able to treat it.

 

What symptoms does AMD cause?

The symptoms of macular affectation can include, from greater to lesser frequency:

  • Blurred central vision, preserving peripheral vision.
  • Alteration in the shape of images (metamorphopsia).
  • Alteration in the size of images: bigger (macropsia) or smaller (micropsia).

The causes are not understood in any depth, although we know many factors which encourage it. Firstly there is a genetic factor, we therefore see families where there are multiple cases, it appears more in patients with blue eyes and in those with greater exposure to the sun, it is also more common in those who are long sighted. It can be induced by mechanisms associated with poor nutrition, smoking, hypertension, hypercholesterolaemia and others.

It is clear that not all patients in whom these factors occur develop the disease, but they do have a greater disposition. 

What types of AMD are there?

Dry or atrophic AMD: is the most common form of the disease (90% of cases). Progression of the disease is slow (years) and severe loss of central vision can take decades. Initially it may not cause any symptoms and be diagnosed at ophthalmological check-ups. It causes a progressive loss of nerve cells in the macula.

Wet or exudative AMD: although this form is less frequent (10% of cases), it is more aggressive and leads to loss of central vision in a short time (weeks, months). New tissue appears under the deepest layers of the retina which grows, produces exudate and may bleed.

 

Diagnosis of Age Related Macular Degeneration

Many patients do not notice they have a problem until their vision has become blurred or visual disturbances such as metamorphopsia have appeared. With testing the ophthalmologist can detect the disease at its earliest stages, performing a series of tests, which depending on the degree of affectation, normally include: 

  • Amsler Grid Test: the patient looks at a gridded page to determine the degree of affectation or metamorphopsia. 
  • Fundoscopy: minute examination of the macular zone, to observe the degree of affectation, as well as to determine which one the two types is the problem.
  • Fluorescein Angiography (FA), generally used in wet AMD, it defines the location, extent and degree of activity of the neovascular membrane which fills with contrast.
  • Optical coherence tomography (OCT), displays virtual, microscopic slices of the macula and provides a lot of information to the ophthalmologist, in both the dry and wet forms of AMD. Indispensable for assessing the response to treatment in the wet form.

 

If you are over the age of 55 and you are affected by some or all of the previously described risk factors you should undergo an ophthalmological review at least once a year, even if you don’t notice anything unusual with your sight.

If you are over the age of 55, whether you have any of the other risk factors or not, if you notice a loss of visual acuity, images becoming deformed or difficulty reading, you should request an appointment with your ophthalmologist as soon as possible.

The Ophthalmology Department at Vithas Xanit International Hospital can provide the different treatments and diagnostic procedures recommended for patients over the age of 55.

Computer screens and eyesight

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 23-10-2017

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“Don’t get so close to the screen, you’re going to damage your eyes.” This is one of the phrases most repeated by parents when they see the children spending hours and hours in front of a screen.  It used to be a television, now it’s a computer or mobile phone.

With Dr. Cilveti, Head of the Department of Ophthalmology at Vithas Xanit International Hospital we are going to answer some of the most commonly asked questions about the effect that continuous exposure to audio-visual devices can have on eyesight.

What damage can be caused by too much time in front of a computer?

Although it has been demonstrated that usage does not result in damage to the retina or the cornea, it does however cause tiredness and a certain amount of visual discomfort. When sight is continuously focused on a screen, blinking frequency is decreased, this in turn can cause dry eyes.

What are your recommendations for those who spend more than 8 hours in front of a computer?

There are people who have to spend long days in front of a screen for work or other reasons. In these cases, a rest for 2-3 minutes every 45 minutes would be an appropriate suggestion.

Regular use of artificial tears is also recommended to help keep eyes comfortable.

What happens to our eyes when focusing on a computer or mobile screen?

Using screens continuously, whether computer, tablet or mobile, causes eye strain, this manifests itself as eye discomfort which can sometimes be accompanied by red or dry eyes or even by generalised symptoms such as headache, nausea, dizziness, etc.

These symptoms can be worse if the user has uncorrected, or poorly corrected refraction defects, abnormal binocular vision or eye movement or if regularly taking psychotropic drugs.

Do symptoms worsen with age?

All symptoms caused by exposure to screens worsen with the passage of time, but not due to the cumulative effect of use of the computer or other device, but because the coping mechanisms of the eye – for example response to dryness or changes in focus – become weaker.

Can too many hours a day in front of the computer result in needing glasses for reading or carrying out other activities?

This is a controversial topic. In general, it appears that computer use, even when excessive, is not capable of generating new refractive problems. However, it appears that it can cause refractive abnormalities to surface, which until that moment the eye had been capable of compensating for. When the refractive defect manifests itself, the patient starts to need eye correction.

This leads on to the topic of so-called, “computer glasses.” These are a type of glasses used to resolve a problem mainly originating from eye strain in computer users during their usual work. It is the result of having to constantly move focus from mid distance at 60-70 cm to near vision of 30 cm.

This repeated change in focus requires the eyeball’s accommodation system to work continuously resulting in so-called eye strain. This process, associated with sustained changes in focus, is especially symptomatic in patients with uncorrected sight defects, latent hypermetropia or in normal sighted patients very close to the age at when presbyopia starts, that is to say in those over the age of 40. In these cases, after an individual assessment of each patient, computer glasses may be beneficial.

Your eyes and chlorine

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 11-09-2017

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Your eyes and chlorine

During summer there is no better place to be than in a swimming pool. High temperatures and holidays encourage us to spend more time soaking in the pool to cope with the heat and cool down our bodies. But this type of water has drawbacks, one of them being the treatment required to keep the condition of the pool perfect throughout the summer. We are, of course, talking about chlorine, a potent disinfectant which keeps our pools clean but which affects our eyes. How? Dr Cilveti, Head of the Ophthalmology Department at our hospital explains.

The chlorine added to pool water eliminates the germs which cause contamination. Its ability to act as a disinfectant agent is achieved by mixing with the water and forming hydrochloric acid and hypochlorous acid, the latter being the disinfectant, oxidising the walls of bacteria and destroying them.

The mixture of hypochlorous acid and products which contain nitrogen, such as perspiration and urine (both frequently found in swimming pools), as well as other chemical products such as deodorant, creams, etc. form chloramines. Chloramines have no disinfectant capability and are highly irritating to the eyes and even the skin.

Chloramines are therefore the main irritant to the eyes in swimming pools, they become more abundant with less careful use of the pool. The amount of chlorine used is also significant, if the amount of chlorine is excessive, the concentration of hypochlorous acid and hydrochloric acid will be high and, therefore, the pH excessively acidic, this can also be a source of irritation and redness.

On the other hand, if chlorine concentration is low, the bacterial contamination of the water will be increased, this can also sometimes cause eye problems, including for example, conjunctivitis of infectious origin with the resulting conjunctival redness and irritation.

So how can I protect my eyes in the pool?

The best protection is maintaining optimal chlorination of the pool and making sure there are no products there capable of giving rise to chloramines. For this reason a proper shower is essential before getting into and after getting out of the pool. If you are going to dive or swim under the water it is advisable to wear goggles.

Contact lenses should not be used in the swimming pool due to the increased risk of serious corneal infections. The use of artificial tears is also recommended after getting out of the pool, they have a cleansing effect on the surface of the eye.

Swimming pool conjunctivitis can affect children and adults, however, it is more common in children as they are usually less careful. Children are also more predisposed to certain eye infections that can be contracted in the pool.

To relieve irritation it is important not to fall into the trap of self-medicating and confusing irritant conjunctivitis with infectious conjunctivitis, the infectious type needs to be assessed by a doctor and specific treatment prescribed. To differentiate one from the other, note whether or not there are any secretions and if so what they are like. If the irritation and redness is accompanied by secretions (a crust) which are yellowish or greenish, advice should be sought from a doctor.

If eyes are stinging but are simply red and watery they can be treated with cold artificial tears and increased hygiene measures.

Problems caused by chlorine, symptoms and tips for avoiding them

  • Very often non-specific irritant conjunctivitis is caused by chlorine, especially its derivatives as previously mentioned.
  • Bacterial conjunctivitis predominantly produces thick and dirty looking secretions.
  • Viral conjunctivitis usually presents with very severe reddening and secretions which can be variable in appearance.
  • Allergic conjunctivitis is less frequent in this case.
  • Much less frequently keratitis can develop, on rare occasions caused by protozoa such as amoeba, which can be extraordinarily dangerous to sight. Fortunately this is very uncommon in our environment, but consideration should be given to this when those who wear contact lenses have been swimming in very hot or tropical countries, especially in places with natural, and therefore non-chlorinated, fresh water.

The main symptoms are usually reddening, stinging, itching, a feeling of something in the eye and photophobia. Different types of secretions may be present with the eyelids stuck together first thing in the morning. The majority of cases only produce mild redness. If symptoms involve more than just reddening, you should always consult a doctor. Symptoms including pain and/or any alteration in sight should be symptoms for alarm!

The best way to avoid damaging our eyes is to use common sense. We should not expose our eyes to overly chlorinated, cloudy or dirty swimming pool water. When swimming in the sea we must avoid areas where there is floating debris and be careful with stagnant freshwater when there is little or no flow. If in doubt it is better to avoid swimming or to wear goggles. A good shower is recommended after swimming to remove traces of pool water from the eyelashes and eyelids.

Although not directly related to this matter, wearing sunglasses as much as possible is essential during summer to protect ourselves from harmful UV radiation. We need to remember that children should also wear appropriate sunglasses. It is important to bear in mind that in childhood the retina suffers from sun damage just as much as the skin does, and we continue adding to this throughout our lives every time we are exposed to the sun. As regards eyesight, the sun is an important factor in the development of AMD (Age-related Macular Degeneration), a disease which is becoming more and more common.

It is possible to enjoy the pool in complete safety, with no ill effects on our body. We simply need to follow these recommendations and remember to go to see a specialist in the event that we develop any problems with our eyes after spending a day at the pool.

CATARACTS – WHEN SHOULD I HAVE SURGERY?

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on 06-10-2016

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imagen-laser

Cataracts are one of the most commonly occurring eye problems, currently affecting more than 50% of the population, particularly those over the age of 65 as prevalence increases with age.

If a person has cataracts their vision becomes blurred and their night time vision deteriorates. Other symptoms that sufferers have to live with include sensitivity to light and the need to change lens prescription frequently, seeing colours less vividly whilst requiring good light for reading. These symptoms often lead people to consider undergoing cataract surgery.

If you are considering cataract surgery, you should first find out if it is appropriate in your case and whether or not it might improve your eyesight.

Today Dr. Cilveti, Head of the Ophthalmology Department at Vithas Xanit International Hospital, is going to provide some answers to the most common questions relating to cataract surgery.

What are the symptoms that show someone might need cataract surgery?

Blurred vision or refractive changes, lights appearing too bright or glaring, an unexpected improvement in near vision, difficulty with reading or driving, colours appearing less vivid etc.

And when is the right time to have surgery for this condition?

Years ago surgery was only performed for cataracts when the patient was no longer able to see. Currently due to technological improvements, as well as improvements in safety and outcomes, surgery tends to be performed earlier than this. Today we operate when the patient starts to have cataract related sight difficulties and we take activity, age and visual markers into account.

Is there a minimum age for surgery?

No, currently cataract surgery is even performed in children, there are several types of cataracts, each one affecting a particular age group.

What surgical techniques are available nowadays?

The majority of cataract surgeries performed today are performed with phacoemulsification. This technique involves breaking up the lens within the eye with a small incision and very little manipulation. In the last 2-3 years we have been using a new technique at Vithas Xanit International Hospital: the Femtosecond Laser.

This laser makes the incisions without manual intervention from the surgeon, it performs the most delicate part of the surgery with a precision which is difficult to achieve manually. This technique is called Femtosecond laser-assisted cataract surgery.

 

Why is this type of laser better and what benefits does it have?

As mentioned, this computer assisted technique further increases surgical precision, it also allows a quicker recovery time whilst providing a better quality of sight.

The Femtosecond laser also guarantees maximum safety, possible errors are eliminated due to individual programming.

Other advantages of Femtosecond laser cataract surgery in comparison to the manual technique are as follows:

  • Precision incisions, generating less astigmatism.
  • Precision capsulorhexis, perfectly centred with the size required by the surgeon.
  • Fragmentation of the lens into the number of desired parts.
  • General reduction of post-operative inflammation with faster sight recovery. It is ideal for cataracts when refractive surgery is required.

How long does the operation take?

The average time for a case is usually about 20 minutes, sometimes up to 30, as long as there are no complications (which are uncommon). There are some cataracts which may require more time due to being particularly hard. However in each case the patient is advised before surgery commences.

What is the recovery time after surgery and what treatment will I need?

After surgery we review the patient on the same or following day depending on the individual case. If everything is fine then there is usually another follow-up appointment at 15 or 30 days.

Regarding treatment, the only thing that the patient needs to do is follow the eye drop regime as prescribed. Normally patients can already notice an improvement in sight after 24-48 hours and sight is usually very good for everyone after 7 days. If the patient requires glasses they will not be prescribed until 30 days after surgery.

For more information on our new refractive surgery system you can contact the Ophthalmology Department at the hospital by phone on 647 789653 or by email at: info@vision1-2-3.com