KUWAIT CITY, Jan 28: Dr Mohammed Muhtaseb is Director of Mowasat Opthalmology Center, specializing in cornea, cataract and refractive surgery. With expertise from the UK, in training and experience, Dr Muhtaseb discusses the most common eye problems in Kuwait and the advanced treatments available.

Cataract and refractive lens
Vision changes with age and difficulty in seeing clearly for reading and close work is among the most common problems adults develop between the ages of 40 to 60. Reduced reading ability and the inability to focus from far to near is called Presbyopia.

The other common change in vision is the clouding, usually occurring in late 50s to early 60s where the lens of the eye instead of being clear starts to become yellow and opaque forming a cataract.

The treatment is a very common and straightforward operation to remove the cataract. Dr Muhtaseb highlights the advanced cataract surgery and refractive lens replacement now available at the New Mowasat hospital, “In cataract surgery, the lens of the eye is removed and a lens implant is put in its place. Mostly, those lens implants are simple monofocal lenses where patients are able to see things in the distance but need glasses for reading and working on the computer.”

“The hospital now provides multifocal lens implants to people for whom computer usage and reading is an integral part of their lifestyle, for work and leisure, after cataract surgery or refractive lens exchange. It is a very important lifestyle benefit that patients should be aware of in choosing the kind of lens they want”, he said. Regular lens implants do not correct astigmatism. He pointed out, “If someone has astigmatism, the best lens implant for them would be a Toric lens. Just as people use Toric contact lenses, Toric lens implants are the best option for those with astigmatism.”  Dr Muhtaseb also stated that people do not need to wait until they develop cataracts to have these surgeries, “For anyone who is over the age of 45 or 50 and wanting to correct their vision, LASIK might not be the best option for them. They might need a refractive lens exchange with these lens implants.”

He also challenges the idea that cataracts can be prevented with eye drops, “A lot of people think that you can prevent cataract with drops or that drops can treat it. Well, no kind of drops can prevent cataract and no kind of drop can treat cataract.”

He adds, “Cataract is like having a clear window that has become dirty, unless you clean the dirt you are not going to see anything clearly.”

Corneal transplant
Dr Muhtaseb ran a corneal transplant service for a government hospital in the UK and introduced a lot of services there that were very modern. Corneal transplants usually involve removing the whole thickness of the cornea and transplanting new donor cornea with stitches and recovery period of about 1.5 to 2 years.

The hospital now offers partial thickness corneal transplants in which only the part of the cornea that is diseased is removed - the outer part or the inner part. He said, “This has been the most important advance in corneal transplant surgery in the last few years with the selective replacement of the endothelium, the inner layer of the cornea. That is done through quite a technically challenging operation but it is a very beneficial procedure.”

The procedure is preferred for the faster recovery period and greatly decreased risks of complications, he informed, “So instead of taking a year or two years, recovery is seen in 3 months. People get very rapid improvement in the vision and are able to regain their lifestyle and their activities.”

Diabetic retinopathy
With 26 percent of Kuwait’s population suffering from diabetes, the threat of visual impairment from diabetic retinopathy is severe. Retinopathy can affect the very central part of the retina called the macular or the peripheral retina which can lead to lack of blood supply to the retina and growth of new blood crystals. The consequences of that are different from the consequences of macular retinopathy. They have different approaches to diagnosis and treatment.

Diabetic retinopathy has few visual or ophthalmic symptoms until visual loss develops. As such, early detection and screening is paramount. “Diabetic retinopathy is something that we look for here in diabetic patients. We have diagnostic equipment which is second to none that helps us detect early changes and monitor the effect of our treatments,” said Dr Muhtaseb. Intensive control of glucose, blood pressure, cholesterol and fat levels contribute to reducing the risk. Smoking exacerbates all diabetic problems and should be avoided. Annual check ups with a diabetic physician or an ophthalmologist is highly recommended; in cases where changes are observed, the check ups should be more frequent depending on the problem and severity.

Common problems
The most common of eye problems in Kuwait are dry eyes and ocular irritation. This is easily remedied with cleaning of the eye and lubricating eye drops. The condition may be related to general medical inflammatory syndromes like rheumatoid arthritis. But it is more commonly caused by the environment – the heat, working and living in air-conditioned spaces, or the prevalent activity of people – long hours of staring into the computer or reading.

Most visits to an eye doctor are done in search of an answer to the cause of headaches. Dr Muhtaseb said, “I see a lot of people with headaches who have a feeling that it is related to their eyes. The eye can contribute a small number of diagnoses to the field of headaches. So when people come, I check them to make sure that the eye is not the cause of headaches. In most cases, it really isn’t.” A headache or an ache around the eye may be caused by eye problems in cases where people have a need for glasses and they don’t wear them, an inflammatory problem or pressure in the eye.

Keratoconus or weak corneas are common in Kuwait, “The corneas instead of being curved are more bulging, and this is more common in hotter environments.” Dr Muhtaseb has also noticed that the conditions might be more advanced in Kuwaiti patients as compared to those in the UK. He said, “People that I have treated in the past with cataract surgery and lens implants tend to come in at an earlier stage and are keen on having their cataracts treated. In my experience, with patients here who have cataracts, they usually come in at a later stage with much more advanced cataracts.”   Dr Muhtaseb attributes this to the perception of surgery as an amplified concept that causes anxiety. “Anxiety is a big factor. I think the understanding of the risks and the experience is not the really comparable to the realities of cases. People may have relatives or friends who did not have a good experience and that will also induce anxiety. In the case of expatriates, many prefer to have surgery in their home countries.”

 Alternative treatments
“I’ve seen patients who come to the ophthalmology clinic for treatment of pathology having been to alternative therapists. It is of course, a biased population because I only see people for whom alternative therapy has not worked.” Dr Muhtaseb does not support alternative therapy for pathological eye problems because as it can result in severe and irreversible vision loss, “For someone with glaucoma or corneal infection, they could be losing valuable time.”

Children
Any kind of concern should cause parents to seek advice with regard to the visual health of their children. “Children cannot complain about poor vision. They don’t have the concept. So they should be screened for refractive error and vision around the age of 4 or 5.”
The development of vision occurs between birth and the ages of 8 – 9. It is in this window that vision can either deteriorate or improve with treatment. “The closer you get to age 8, the less likely it is that efforts will be successful. Vision problems must be picked up early, around the early ages of 3-5.”

Diet and Care
When it comes to the eye, care is mostly cure based. A prevention-based approach is not customary as most eye problems are not really avoidable. Early detection can facilitate effective treatment. However, only a small minority go for regular eye checks.

Vitamin A is very important for the health of the retina and is a good anti-oxidant. But Vitamin A in high doses can prove detrimental, especially in pregnancy. “Any kind of mineral, vitamin taken in too high a dose can reach toxic levels and have a counterproductive effect. A well-balanced diet is the right approach.”