FREQUENTLY ASKED QUESTIONS

Advanced refractive surgery in Valencia

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REFRACTIVE
SURGERY

To treat the eye’s refractive errors (myopia, hyperopia, and astigmatism), it is necessary for the prescription to be stable, which usually occurs around the age of 20.

Yes, any of the current techniques, both laser and lens-based procedures, allow both defects to be corrected simultaneously.

It is important to keep the eye as still as possible. To achieve this, the patient lies back on a stretcher and focuses their gaze on a red light located in the excimer laser device.

A safety device called an “eye tracker” compensates for small involuntary eye movements by monitoring the eye’s position at intervals of a few milliseconds and adjusting the direction of the laser pulses accordingly. In the event of sudden eye movements, the safety system completely stops the treatmen

It is a quick procedure. On average, the patient spends 15–20 minutes in the operating room. Only a few of those seconds are for the application of the excimer laser; the rest of the time is for preparing the patient and the eye.

Refractive surgery procedures are performed under topical local anesthesia (drops), so you will not feel any pain during the procedure.

Laser procedures like LASIK and PRK have a very simple postoperative period—just a few eye drops and some artificial tears.

After the surgery, it is recommended to rest for at least 24 hours. Most work activities can be resumed after 48 hours, and for sports, you should wait at least a week.

Depending on the characteristics of each patient’s cornea, laser surgery may or may not be possible. Since this technique “reshapes” the cornea, it is necessary to estimate its postoperative thickness and shape. If certain safety criteria are not met, intraocular surgery should be chosen instead, which does not modify or alter the eye’s structures.

PRESBYOPIA

No. Presbyopia surgery with an intraocular lens replaces the natural lens that is beginning to become opaque. Therefore, it could be considered cataract surgery in its early stages, with the aim of eliminating the need for optical correction (whether glasses or contact lenses).

Yes. The implanted intraocular lens is permanent. If a small residual prescription remains, it can be corrected with laser. Only in exceptional situations is it necessary to remove the lens.

Of course. The cause of these refractive errors and the cause of presbyopia are completely different. Although all of these conditions result in the need to wear glasses or contact lenses, their origin is very different, so previous surgeries do not prevent presbyopia nor do they prevent its correction.

 

The surgery usually takes between 20–30 minutes per eye and is performed with topical anesthesia (eye drops) in most cases.

Yes. During presbyopia surgery, all of the patient’s refractive errors can be corrected. If any residual prescription remains, it can be corrected afterward with laser.

CATARACT
SURGERY

Cataract surgery is performed when the level of vision loss caused by the cataract begins to limit the patient’s everyday activities.

This limiting vision loss usually occurs from 0.5 on the ophthalmological scale (sometimes even earlier). At this point, driving and even reading already become difficult.

No. The development of cataracts is linked to aging and progresses irreversibly, so the only effective treatment is surgery.

Yes. When calculating the intraocular lens that replaces the natural lens during the surgery, it is adjusted to correct the patient’s myopia or hyperopia

Yes. There are several techniques to correct astigmatism during cataract surgery. One method involves making relaxing incisions that reduce astigmatism, while another uses special toxic lenses designed to correct it. In this case, the outcome is not as predictable as when correcting myopia or hyperopia, but astigmatism is generally significantly reduced.

It depends on the condition of the other structures in the eye. The visual prognosis will be determined based on an examination prior to the surgery.

A healthy eye that has 100% vision and loses sight due to a cataract will regain that 100% after surgery. However, if, for example, due to retinal deterioration the eye could only see 60% and then loses vision because of a cataract, after lens surgery it will reach a maximum of that 60% vision.

The type of intraocular lens implanted is determined based on the patient’s needs and daily activities.

  • Monofocal: Provides good distance vision and requires the use of small reading glasses.
  • Multifocal: Provides good distance and near vision with greater independence from glasses, only needing them for prolonged reading, precision work, low-light conditions, or computer use.
  • Toric: In its monofocal or multifocal versions, it also corrects the patient’s astigmatism.

Yes. Nowadays, lenses are made from very advanced materials that provide enough assurance to say they last a lifetime.

  • You can carry on with your normal life until the day of the surgery
  • In the days leading up to the surgery, you will need to apply some eye drops to prepare the eye.
  • Sign the informed consent form.
  • On the day of the surgery:
    1. Thoroughly clean your eyelids with the special wipes.
    2. Apply the dilation drops one hour before the procedure.
    3. You may take a pain reliever.
    4. Do not wear makeup or apply creams.
    5. Come accompanied and bring all your eye drops with you to the clinic.
POSTOPERATIVE
CATARACTS

  1. Follow the eye drop and medication schedule prescribed by the ophthalmologist.
  2. You should avoid physical exertion. You may watch TV and go for walks normally.
  3. If the eye waters, you should wipe the tear on the cheek, avoiding contact with the eye or tear duct, and then dispose of the tissue.
  4. When attending your follow-up appointment, you should wear the sunglasses we will provide to protect your eyes from sunlight, wind, dust, and other particles that could enter the eye.
  5. It is recommended to attend the follow-up appointment with the person who will help you apply the eye drops after the surgery, so they can receive brief instructions.

DURING THE FIRST WEEK

  • Wear sunglasses when going outside
  • Try to sleep on the side of the operated eye or on your back.

YOU SHOULD AVOID

  • Making physical efforts
  • Bending over, as standing back up requires effort.
  • Making sudden or abrupt movements with the head.
  • Wearing makeup.

Dolor con enrojecimiento o pérdida de visión.

In the document given to patients after surgery, other symptoms are detailed. Remember that later the same day or the following day we will examine your eye and determine whether all these signs are normal after the operation or not.

Also remember that it is common to experience a gritty sensation, see halos or glare (especially at night), or have hazy vision, although this tends to disappear within a few days.

The main purpose of cataract surgery is to restore the patient’s vision. To achieve this, the eye’s natural lens (called the crystalline lens) is replaced with a high-tech artificial lens. The power or prescription of this lens is customized for each patient based on various factors. This calculation is never exact in cataract surgery, and statistically, about 90% of patients end up with a residual refractive error of ±1.00 diopters.

Presbyopia, or “tired eyes,” is the loss of the eye’s ability to focus or accommodate. This function is used when shifting from distance vision to near vision and usually appears from the age of 40. People who have undergone cataract surgery do not have this accommodative capacity, so they will always need optical correction (glasses) to see up close. If a multifocal lens has been chosen, good vision can be achieved both at distance and near, and glasses will only be necessary on occasional occasions.

If you have chosen to have a monofocal intraocular lens implanted, your existing reading glasses may help you see better up close, even if they are not the exact prescription. One month after the procedure, we will provide you with the correct prescription so you can adjust your glasses accordingly.

Near, distance, bifocal, or progressive. The choice depends on each patient’s needs, but all are valid. The only thing to keep in mind is that adapting to progressive lenses can sometimes be a bit more challenging after cataract surgery.

This is a common concern among cataract patients, but today’s high-tech lenses include fixation systems that provide great stability, making it very unlikely for them to move.

No. Once cataracts are removed, they do not recur.

Approximately 1 in 4 patients who undergo cataract surgery experience, over time, an effect similar to that of a “dirty” lens.

Saying that the lens “gets dirty” is simply a way to help patients understand what is happening. In reality, a number of cells appear behind the lens and create a semi-transparent film on the capsule of the natural lens where the intraocular lens is placed. This effect may take several months to appear (if it does), is called posterior capsule opacification, and is progressive.

In cases where the lens becomes “cloudy” or “opaque,” a quick treatment is applied to eliminate this effect using a Neodymium:YAG laser. As it is not a surgical laser, it is performed in the office and does not cause pain.

KERATITIS

Indeed, if episodes of keratitis occur repeatedly, it usually indicates the presence of an underlying condition, such as dry eye, blepharitis, or difficulty closing the eyelids, especially during the night.

Although the basis of treatment is similar in all cases and involves maintaining proper eye hydration, there are many ways to achieve this, and it is advisable to use different therapeutic approaches tailored to each individual case. Additionally, it is vital to address the underlying cause to provide the most effective and lasting solution possible.

In addition to the discomfort and the impact on the patient’s quality of life, the severity of keratitis will depend on several factors:

  • The location of the lesion: if it is central, it can affect the visual axis.
  • The depth of the lesion: deeper lesions can cause permanent corneal scarring
  • Frequency: if these episodes occur frequently, the risk of associated complications increases.
  • Possible infection: if it becomes infected, it could cause a severe corneal infection, leading to potential vision loss.

Each case must be evaluated individually so that, depending on the location of the scar (central or peripheral), its depth, and the visual impairment it causes, a decision can be made between a more conservative observational approach, laser treatment (PTK), or a partial or full corneal transplant.

DRY EYE

Although the final outcome is similar, not all types of dry eye are the same. The causes can be diverse, ranging from eyelid alterations to corneal conditions or disorders of the lacrimal gland. Identifying the origin will help us find the most effective treatment in each case.

Since each case of dry eye hides an underlying condition, not all treatments will be effective for every patient. The cornerstone of any therapeutic option is proper lubrication of the ocular surface, but there are various ways to achieve this, so treatment must be individualized in each case. Additionally, in certain eyelid disorders, surgical options can be very helpful in addressing dry eye.

Indeed, this is actually common among patients. It is important to differentiate between basal tears (which provide hydration and nutrition) and reflex tears (produced in response to an external stimulus, such as when something gets in the eye). The excess tearing seen in dry eye is not due to increased basal secretion but rather an increase in reflex secretion in response to the stress the eye is experiencing. Therefore, these tears do not have the necessary biochemical properties to maintain proper ocular health.

 

In most cases, dry eye primarily affects the patient’s quality of life by causing discomfort and mild photophobia (sensitivity to light). However, depending on the cause and severity of the dryness, it can lead to visual disturbances, the formation of corneal scars, and significant thinning of ocular tissues.

KERATOCONUS

Indeed, although genetics is not everything in this condition, there is a significant genetic component linked to its development. However, it is a multifactorial disease in which a combination of multiple causes contributes to its onset.

Yes. The initial symptoms of keratoconus are very subtle and often go unnoticed by the patient. That is why annual eye examinations allow for early diagnosis and, consequently, early treatment, thereby reducing the risk of associated complications

When a corneal deformity occurs, patients with keratoconus generally develop significant astigmatism, which is one of the warning signs that should raise suspicion of the disease.

Indeed, in predisposed patients, rubbing the eyes vigorously and frequently can lead to changes in the cornea’s ultrastructure, resulting in its deformation.

Transplantation is the last therapeutic option used in the most severe cases. In the past, it was the only treatment available, which is why corneal transplantation associated with keratoconus was relatively common. However, the diagnostic technology currently available allows us to detect cases at earlier stages and offer more conservative options such as corneal cross-linking and/or intrastromal rings.

Keratoconus is a progressive condition and varies among individuals. Depending on when it is detected, it may be possible to slow the disease to a greater or lesser extent, sometimes requiring a combination of treatments to achieve this goal.

Yes. Due to the high refractive errors it causes (high and irregular astigmatism), correction with regular glasses or contact lenses often fails to provide adequate visual quality. At our clinic, we offer a personalized contact lens service to give patients the best possible quality of life.

CORNEAL
TRANSPLANT

When performing a corneal transplant, we only use a “corneal button,” that is, the central part of the cornea.

Indeed. Current technological advances allow for transplanting only specific layers of the cornea rather than the entire cornea. Some of its layers, just a few microns thick, can be implanted separately. This reduces associated complications, although it requires greater technical skill.

We are all potential candidates for a corneal transplant; however, the risks and benefits must be assessed in each case. The cause of the corneal lesion does not determine candidacy; rather, it is the likelihood of a successful transplant that matters.

 

Unfortunately, yes. Many infectious conditions (such as herpetic or fungal infections) and corneal dystrophies can recur in the transplanted tissue, potentially requiring another transplant or worsening the final outcomes.

Yes. Although the cornea is a privileged tissue for transplantation because it lacks blood vessels (the absence of blood vessels allows it to remain transparent and let light enter the eye), rejection can still occur. For this reason, it is always essential, whenever possible, to inhibit any associated neovascularization (blood vessels that develop in response to certain conditions).

There is no limit to the number of transplants that can be performed. It is even possible to transplant specific layers of the cornea over an existing transplant.

RECURRENT
CORNEAL ULCERS

Experiencing recurrent corneal erosions or ulcers is usually associated either with a predisposition (for example, due to previous trauma that may have weakened cellular junctions) or with an underlying condition (such as a corneal dystrophy). Although the patient may have experienced this uncomfortable situation “for years,” it should not be considered normal, and it is advisable to seek evaluation by a specialist ophthalmologist. In certain conditions, there may be significant progression that can be slowed if diagnosed in time.

Although the basis of treatment is similar in all cases and involves maintaining proper eye hydration, there are many ways to achieve this, and it is advisable to use different therapeutic approaches tailored to each individual case. Additionally, it is vital to address the underlying cause to provide the most effective and lasting solution possible.

The severity will depend on several factors:

  • The location of the lesion: if it is central, it can affect the visual axis.
  • The depth of the lesion: deeper lesions can cause permanent corneal scarring
  • Frequency: if these episodes occur frequently, the cell junctions weaken progressively, increasing the risk of associated complications.
  • Possible infection: if one of these erosions or ulcers becomes infected, it could cause a severe corneal infection, potentially leading to vision loss.

Each case must be evaluated individually so that, depending on the location of the scar (central or peripheral), its depth, and the visual impairment it causes, a decision can be made between a more conservative approach of observation, laser treatment (PTK), or a partial or full corneal transplant.

BLEPHARITIS

Of course. Blepharitis can cause redness of the eyelid margin along with “dandruff” on the eyelashes, with or without associated discomfort

Blepharitis is in fact one of the main causes of dry eye, as the glands responsible for secreting the lipid component of the tear film are altered in these patients.

Blepharitis is a condition that tends to be chronic. However, with proper treatment, its symptoms can be controlled and minimized.

Yes. Like many other conditions in our body, blepharitis can worsen during certain times of the year, in response to stress, or due to hormonal changes…

Blepharitis tends to worsen over the years, so it’s not surprising that something that never caused us problems before—and that we were therefore unaware of—starts to cause discomfort.

In most cases, blepharitis causes mild symptoms such as itching or dry eyes. However, in certain instances, it can lead to significant complications like scarring and corneal inflammation, putting the patient’s visual quality at risk.

BLEPHAROPLASTY

Cataract surgery to remove what are commonly called “bags” does not prevent you from carrying out basic daily activities. However, the appearance of bruising in the treated area (as with any surgery) makes it advisable to wear sunglasses, and many patients prefer to stay at home for a few days.

No. Despite the proximity of the eyeball, it is not manipulated during the surgery. A thorough knowledge of the periocular area is necessary to carry out the procedure as safely as possible.

As mentioned, the eyeball is not manipulated during the surgical procedure. However, some patients may experience improved vision, since if the upper eyelid was too “droopy,” it could have limited the visual field, and after the surgery, the patient may notice a “clearer” vision.

Of course. Blepharoplasty is aimed at removing the bothersome “bags,” but it does not eliminate other conditions that may be associated with them. Our ophthalmologists who specialize in oculoplastic surgery will study your case and offer you the most comprehensive solution possible, which in some cases may include combining several treatments to achieve the best possible results.

CONTACT
LENSES

Definitely not. There are many types of contact lenses depending on the material they are made from, their size, or their intended purpose. This is why many people seem to “not tolerate” contact lenses, when in reality they simply have not tried the right type of lens.

Studying the anatomy and physiology of each patient’s ocular surface is essential when recommending the most suitable contact lens for each case. For example, depending on the type of tear film, certain materials may be more or less appropriate. For this reason, a thorough ophthalmologic examination to assess the shape of the cornea, the quality of the tear film, and other factors is fundamental.

Of course. First of all, it is important that contact lenses are prescribed by an ophthalmologist in order to rule out any ocular condition that may go unnoticed in its early stages.

In addition, after years of use, contact lenses can cause changes on the ocular surface, making proper monitoring necessary to prevent long-term consequences such as dry eye, corneal infections, or papillary conjunctivitis.

No. Although their most common use is refractive (that is, as a substitute for glasses), contact lenses have many uses, for example a therapeutic use, acting as a bandage for the ocular surface.

RETINAL
DETACHMENT

Visual recovery after a retinal detachment is highly variable and will depend on several factors.

  • The cause of the detachment.
  • The time elapsed from when it occurred until it was treated
  • The area of the retina affected: those involving the macular area (the central part of the retina) usually have a worse prognosis.
  • The presence or absence of associated retinal pathology.

There are different types of retinal detachments, mainly classified according to their cause. The most common are those produced as a result of a tear in the retina (that is, a rupture), but there are also retinal detachments associated with systemic diseases or ocular inflammation in which no rupture of the tissue occurs.

Except for certain types of retinal detachment that can be treated with oral medication, in the vast majority of cases a surgical procedure is required to solve the problem and prevent its progression. Only in cases where it is detected at a very early stage, in the form of a retinal tear, can it be treated with laser in the clinic.

Retinal detachment is considered a semi-urgent condition, meaning it is advisable to undergo surgery as soon as possible, although not necessarily at the exact moment of diagnosis. It is essential to have an experienced team specializing in retinal pathology to address it.

Depending on the type of retinal detachment and the surgery performed—which will not be the same in every case—the vitreous (the gel that gives shape to the eye) may be replaced with gas or silicone, or it may not be replaced at all. Based on this, considering the densities of these substances and the location of the tear, your ophthalmologist will indicate the most suitable position in each case, which is vital for an optimal post-surgical outcome.

AGE-RELATED MACULAR
DEGENERATION (AMD)

Age-related macular degeneration, as its name indicates, is a process linked to the aging of the retina. However, there are many other causes that can produce macular disease in young people with similar consequences

It is true that AMD has a significant genetic component, so good prevention is key. There is no foolproof method or treatment to prevent it, but we can control the associated risk factors—for example, by quitting smoking and maintaining a healthy diet.

No. Intravitreal injections used for macular degeneration are intended to inhibit neovascularization—that is, the blood vessels that form as a result of the disease and cause excess fluid in the retina. Therefore, in cases where there is no neovascularization and no fluid, the injections do not have a role.

Treatment with intravitreal injections should be kept to the minimum necessary to control the disease. The injection schedule varies between patients; it usually starts with a monthly regimen and, depending on the response, the intervals are gradually extended until the optimal dose for each case is reached. The decision on when to stop treatment is debated and must be individualized, but it is clear that as long as there is treatable neovascularization and the treatment improves the patient’s vision, it must be continued.

We can influence certain aspects of the disease by controlling its risk factors and managing its complications. However, currently there is no effective and definitive cure for AMD.

INTRAVITREAL
INJECTIONS

No. The term intravitreal injection refers to the introduction of a substance into the interior of the eyeball through an injection; however, the substance injected may be antibiotics, antivirals, antifungals, chemotherapy, anti-inflammatory drugs, or more commonly antiangiogenic agents (substances that inhibit the formation of new blood vessels responsible for the presence of intraretinal fluid). Depending on the condition being treated, the content of the injection will be different.

Under sterile conditions, the injection is administered inside the eyeball through a specific area called the pars plana, since injecting at this point minimizes associated complications.

The procedure is performed under topical anesthesia (with drops), which blocks pain sensation. However, the patient is still aware of the touch and pressure, and may feel slight discomfort.

No. Intravitreal injections have very specific indications and are not effective for many retinal conditions, such as those involving tissue atrophy (cell death) or those requiring surgical intervention; in these cases, they are not a solution on their own.

Uno de los usos más frecuentes de las inyecciones intravítreas es la degeneración macular asociada a la edad o DMAE. En este caso, su propósito es el de inhibir la neovascularización, es decir, los vasos sanguíneos que se forman como consecuencia de dicha patología siendo los causantes del exceso de fluido a nivel de la retina.


FLOATERS

All of us, at one stage of life or another, will see a small shadow that is more or less translucent, especially against clear and bright surfaces. This is a process linked to the natural aging of the vitreous, the gel inside the eye. What we see are simply the shadows of the fibers that compose it.

In most cases, we only notice floaters at certain moments because the vitreous is a mobile gel. Therefore, the commonly called “floaters” change position, and depending on the lighting conditions they may be more or less visible. In addition, a process of neuroadaptation occurs, through which we gradually get used to them to a greater or lesser extent.

Although their presence is generally a physiological phenomenon linked to the degeneration of the vitreous gel inside the eye, in some cases they can indicate a pathological condition. Therefore, if floaters appear suddenly—especially if accompanied by other symptoms such as flashes of light (photopsia) or eye redness—it is essential to have an ophthalmological evaluation.

No. Solo en algunos casos pueden ser señal de alguna patología como un desgarro en la retina o un proceso inflamatorio intraocular. Sin embargo, cabe recalcar que en la mayoría de ocasiones son fruto del envejecimiento normal del gel vítreo.

HIGH MYOPIA

High myopia is considered a pathology in itself, far beyond simply needing to wear glasses. Eyes with a significant myopic prescription have an increased axial length, meaning they are larger than normal. For this reason, certain ocular structures such as the retina and the vitreous undergo changes, making them more susceptible to the development of conditions such as retinal detachment or the formation of neovascular membranes.

Once myopia has developed, it is recommended to attend regular ophthalmological check-ups to monitor its progression and to act early against any complications before they lead to serious consequences.

No. Refractive surgery (aimed at eliminating dependence on glasses or contact lenses through laser or intraocular lens) reduces the need for optical correction and improves quality of life, but it does not change the length of the eye—that is, it does not affect the vitreous or the retina, which are the structures most impacted by pathological or high myopia.

Indeed, high myopia has a significant hereditary component, and it is common for several members of the same family to be affected.

Since high myopia—defined as myopia above six diopters—can lead to significant conditions during adulthood (especially vitreoretinal disorders), it is essential to prevent or slow its progression in the early stages of life. To achieve this, there are several treatments aimed at slowing down or at least minimizing the progression of myopia in children whose annual increase is very significant and who have a family history of high myopia. Through the use of certain eye drops or contact lenses, we can achieve this goal with very satisfactory results. The myopia control department is one of the priorities at Clínica Rahhal.

DIABETIC
RETINOPATHY

No. The type of diabetes and therefore the age at which it appears will play an important role in determining the likelihood of developing diabetic retinopathy. Each patient’s glycemic control is also of vital importance, as well as the management of other associated risk factors such as blood pressure.

Not necessarily. Diabetic retinopathy has different stages, and not all patients will develop all the associated complications. In addition, the degree of visual impairment will depend largely on whether or not the diabetic retinopathy is accompanied by macular edema.

Indeed, visual acuity can be reduced as a result of diabetic retinopathy and its associated complications. That is why proper monitoring is essential from the outset.

In general, an annual eye exam is always recommended. However, if any abnormalities are detected, depending on the severity of the lesions, your ophthalmologist may recommend more frequent check-ups, individualized for each case.

Of course. The best prevention against developing diabetic retinopathy is good blood sugar control. However, it is important to keep in mind that other factors are also involved.

Although the best-known eye condition secondary to diabetes is diabetic retinopathy, it is also associated with involvement of other ocular structures, leading to dry eye or the early development of cataracts.

OCULAR
HYPERTENSION

No. They refer to different concepts. Blood pressure depends on our cardiovascular system, while eye pressure depends on the eye’s ability to “filter” the fluid inside it.

The pain caused by high eye pressure depends on whether the pressure is chronically elevated, in which case the eye “gets used” to it and usually does not cause pain, or if it rises suddenly (acute). In the latter case, if the increase is significant, it can cause pain. However, in most cases, eye pressure is chronically elevated and the increase is mild, so the patient remains asymptomatic and ocular hypertension is often detected incidentally during an eye exam.

Although both methods are accepted for measuring eye pressure, air-puff tonometry is much less accurate and therefore provides only an approximate value.

Normal eye pressure is generally considered to be below about 21 mmHg. However, many patients with slightly higher pressures never develop eye disease, while some patients with even lower pressures do. In summary, although the maximum pressure is around 21 mmHg, each individual has their own optimal pressure range, so the same value may not be normal or pathological for different patients.

Not in all cases. These situations should be closely monitored to determine whether the elevated pressure is causing any eye pathology.

Not necessarily. Slightly elevated eye pressure does not cause disease in all patients. Conversely, pressures considered “normal” for most people may be enough in some individuals to promote the development or progression of glaucoma. Eye pressure is a risk factor for glaucoma, and a thorough evaluation by an ophthalmologist is needed to determine the appropriate therapeutic approach in each case.

Of course. Genetics play a very important role, which is why patients with family members affected by glaucoma should undergo close ophthalmological monitoring.

GLAUCOMA

No. They refer to different concepts. Blood pressure depends on our cardiovascular system, while eye pressure depends on the eye’s ability to “filter” the fluid inside it.

The pain caused by high eye pressure depends on whether the pressure is chronically elevated, in which case the eye “gets used” to it and usually does not cause pain, or if it rises suddenly (acute). In the latter case, if the increase is significant, it can cause pain. However, in most cases, eye pressure is chronically elevated and the increase is mild, so the patient remains asymptomatic and ocular hypertension is often detected incidentally during an eye exam.

Although both methods are accepted for measuring eye pressure, air-puff tonometry is much less accurate and therefore provides only an approximate value.

It depends on the case. Based on each patient’s optimal eye pressure and the reduction achieved with surgery, it may be possible to reduce or stop the use of eye drops. In many cases, a combination of both drops and surgery is needed to reach the desired eye pressure.

Not necessarily. Slightly elevated eye pressure does not cause disease in all patients. Conversely, pressures considered “normal” for most people may be enough in some individuals to promote the development or progression of glaucoma. Eye pressure is a risk factor for glaucoma, and a thorough evaluation by an ophthalmologist is needed to determine the appropriate therapeutic approach in each case.

Of course. Genetics play a very important role in this disease, which is why patients with family members affected by glaucoma should undergo close ophthalmological monitoring.

Aunque hay ciertos tipos de glaucoma que pueden aparecer en edades tempranas de la vida, incluso estar presente en el nacimiento, la incidencia de glaucoma es mayor a partir de los 40 años. Es por ello que una revisión oftalmológica anual sería ideal de cara a descartar posible patología.

No. Surgical treatment is only necessary in cases where eye pressure cannot be controlled with medication or if the patient is intolerant to it.

STRABISMUS

ADULTS

Unfortunately, no. Lazy eye or amblyopia can only be treated in the early stages of life, as it is caused by a lack of development of the visual system due to insufficient stimulation. Corrective strabismus surgery in adult patients who have had strabismus since childhood is mainly performed for aesthetic purposes.

The extraocular muscle system is relatively complex, and in many cases it is difficult to determine exactly which muscles are affected when strabismus has been present for a long time. Even if the problem started in one muscle, eventually all may be secondarily affected. Therefore, although the issue is often resolved with the first surgery, in more complex cases a second surgery may be needed to achieve the desired result.

The need for a second surgery is greatly reduced when the procedure is performed under topical anesthesia (with drops only), as this allows intraoperative adjustment of the muscles and real-time observation of the results. This technique requires great expertise and offers the most satisfactory outcomes from the start, since the surgeon can see the adjustments as they are made, achieving more precise results.

Of course. In fact, refractive errors are often closely related to strabismus, and correcting them can complement the overall treatment.

No. In these cases, the patient develops double vision (diplopia) because the visual system has already fully developed in early life, and the brain cannot “suppress” the image from one eye as it does in childhood. Since it cannot ignore one of the two images or fuse them, double vision occurs.

Acquired cases must be evaluated with special care, as not all of them will require surgery. Some will resolve spontaneously, others with a session of botulinum toxin, and in other cases through the use of prism glasses. The severity of the strabismus and its cause will be decisive when choosing the best therapeutic option for these patients.

PEDIATRIC

In children, it is extremely important to closely monitor strabismus from the moment it appears, as it may indicate an underlying condition. Many eye diseases (for example retinal disorders) can present through the deviation of one eye, so when this sign is detected it is essential to contact an ophthalmologist
In addition, certain types of strabismus that persist over time can lead to amblyopia or lazy eye, meaning that the child’s vision will not develop properly, resulting in reduced vision in adulthood.

No. There are different types of strabismus, and depending on the case, some can be corrected with optical correction (glasses), botulinum toxin, or may require surgery.

This will depend greatly on each patient. Surgery can be delayed as long as the strabismus—and therefore the risk of amblyopia or lazy eye—is being controlled by other means (such as optical correction with glasses or botulinum toxin). Surgery is usually postponed until the child can cooperate reasonably well so that the necessary measurements for surgical correction can be taken. However, as mentioned, each case must be highly individualized.

En la mayoría de ocasiones sí. Sin embargo hay que tener en cuenta que la falta de colaboración en algunos casos para realizar las mediciones necesarias y el hecho de tener que realizar la cirugía bajo anestesia general no nos permite ajustar intraoperatoriamente los músculos (en adultos al realizar la cirugía solo con anestesia tópica – gotas – podemos ajustar en el mismo acto quirúrgico los resultados), por lo que en un porcentaje minoritario, será necesario una segunda cirugía futura para obtener el resultado deseado.

El objetivo del uso de parches es frenar el desarrollo de ambliopía u ojo vago al obligar al cerebro a trabajar con ambos ojos, evitando que se produzca una falta de desarrollo en alguno de ellos. Sin embargo, no va a solucionar de forma permanente la desviación ocular.

Although the best-known eye condition secondary to diabetes is diabetic retinopathy, it is also associated with involvement of other ocular structures, leading to dry eye or the early development of cataracts.

First consultation

Leave us your information, and we will contact you to schedule an appointment with one of our ophthalmologists. We will send you a confirmation email acknowledging receipt, along with the details of your requested appointment. Within the next few business hours, we will personally contact you by phone to confirm your appointment

    Clínica Rahhal
    963 52 77 27
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