Dr. Shalu Pal

  • "If you want quality and wonderful service, please go to Dr. Shalu Pal! The patience, care, and true concern that Dr. Pal has for her clients is wonderful. "

    --Seleena J
  • " I was pleasantly surprised by finding a hidden gem within Dr. Pal's office"

    --Naveed
  • "Finally a doctor who is extremely knowledgeable, patient and explains things clearly. She is a wonderful human being who really takes the time to care for your needs. The office has a wonderful atmosphere and the staff are just as helpful as Dr. Pal. "

    --Mikail
  • "I couldn't ask for a better Optometrist. She is a delight to deal with, very patient, helpful and extremely knowledgeable. She was very good with my kids who can be very fussy at times.. And who could ask for a more beautiful location. Highly Recommend! "

    --Natalie M.
  • "My wife and I, highly recommend Dr. Pal. The staff, the service, the merchandise, are all top notch. They really make you feel welcomed. It has been several years since I have been able to see this well !!! You and your staff are the best !!!! "

    --Steve and Maria L.
  • "We barely go to optometrists so when we do, we should look for the best! I am super pleased I chose Dr. Pal\'s office. They were helpful from beginning to end, from booking on the phone to my actual visit. Dr. Pal was very detailed and went in-depth about my eye health. She is very patient and made me feel calm. The optician helped me pick a great pair of glasses, they were genuinely friendly which is a huge bonus."

    --Ahmad S
  • "I have been going to Dr. Pal for several years now. My most recent visit on June 6, 2016 was the best experience there that I have ever had. Firstly, the women on the desk were friendly and efficient - a very good prelude to my examination. Dr. Pal, herself, was, as usual, very thorough and encouraging in her examination. And she puts you at ease before we get into the eyes examination by discussing other things in life. That helps to ease any stress I may have. And they now have a man in the office who does that difficult examination (name of which I do not know!). He is so patient and encouraging and made the exam not so difficult for me this time. After all that, I saw Dr. Pal again before I left and she told me my eyes were good! Even had the news been not so good, I believe that I would be able to handle it because I truly believe that Dr. Pal and her staff would have taken good care of me. I will always go back to Dr. Pal and members of her team because I truly believe"

    --A. Howlett
  • " I have been to a few appointments at Dr. Pal\'s office over the last year for dry eye issues and every time it has been a very positive experience. The 3 receptionists at the front desk are warm and friendly. They are attentive and provide a very high level of customer service. I appreciate that they call me by name and remembered conversations we had at previous visits. I find Dr. Pal to be an excellent practitioner who is very thorough with her exams, has a lovely personality and takes the time to answer any and all questions that may arise. I am happy with the computer glasses I purchased and value the honest opinions I received from the staff when selecting frames. It was refreshing to have multiple opinions on styles and I felt they truly wanted me to walk out with a frame that was best suited to me. I highly recommend Dr. Pal \'s office! As a health care practitioner myself, I think all health care experiences should be this personilzed and friendly!"

    --A. Mclean
Narrow Angles


Contents

Narrow Angles

“Narrow angle” refers to the shallow space between the cornea at the front of the eye and the coloured iris that lies just behind the cornea. You might be thinking “What does that have to do with anything?” Well the width of the angle is imperative for numerous reasons the most important of which is proper eye functioning.

A nutrient-rich clear fluid is constantly being produced in the front part of our eyes. The fluid also known as aqueous humor circulates and nourishes the internal tissues before being drained from the eye. The actual drainage opening for the aqueous is formed by the juncture of the cornea and the iris. This drainage angle in the eye can be illustrated by visualizing an ocean clam – that’s right a mollusk. The degree to which a clam is open or closed depends on the angle formed between its upper and lower shells. When the clam is cracked open only a small amount for the sake of illustration think of this opening as a ‘narrow angle’. Likewise if the clam is wide open think of it as an ‘open angle’.

In the eye the cornea and iris represent the upper and lower clamshells respectively. At the point where these two tissue layers join together an angle is formed called the drainage angle. In most people this tissue angle is wide open (think of the open clam) and the aqueous fluid has the opportunity to flow out of the drain unimpeded. However in a smaller percentage of the population the drainage angle is very narrow or nearly closed so the drainage of the aqueous becomes problematic. In this case the eye pressure can rise – sometimes to a dangerously high level – often leading to vision loss and a painful attack. Known as angle closure glaucoma this can occur in two forms.

An acute attack is most likely to occur in dim light when the iris dilates and crowds into the angle. The pressure can build up rapidly within an hour causing increasingly harsh eye pain and headache along with nausea and at times even vomiting. Other symptoms include blurry vision visual rainbows or halos and red eye. Permanent visual loss may occur within hours if not treated promptly.

With chronic angle-closure a series of small attacks takes place over months to years. During each attack small sticky attachments tend to form which causes the iris to adhere to the cornea. They create partial blocks in the angle that can eventually become quite extensive. Some people experience periodic eye aching but usually symptoms are mild or non-existent. Unfortunately because of this you may not be aware of a problem until considerable peripheral vision is lost.

How to Detect if You Have a Narrow Angle

In order to determine the ‘angle of the eye’ a procedure known as gonioscopy is performed. The eyes are anesthetized with eyedrops and using a special biomicroscope for viewing a gonio lens is placed onto the cornea. This lens has mirrors that allow your eye care practitioner to inspect the drainage area and determine whether your angle is wide narrow or closed.

Treatment for Narrow Angles

For people with narrow angles who are at risk for chronic or acute angle closure attacks a procedure known as a laser iridotomy is performed. Laser iridotomy involves creating a tiny opening in the peripheral iris in order to facilitate the drainage of aqueous out of the eye. This procedure takes only a few minutes and requires no sedation.

 
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