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
Corneal Dystrophy


Contents

Corneal Dystrophy

Introduction

A corneal dystrophy (dis-truh-fee) is the gradual deteriorations of one or more layers of the cornea, the dome-shaped, clear surface of the eye, located in front of the iris. The cornea is the first surface light strikes on its way through the ocular structures to the retina, in the back of the eye. It is the primary refractive surface, which means it is responsible for most of the focusing of light entering the eye.

There are over many different types of corneal dystrophies, but they share some common diagnostic clues. First, they affect both eyes and are not caused by infections, trauma or dietary issues. They do not affect other areas of the body, nor do other diseases or conditions cause them; they can occur in people who are quite healthy otherwise. They progress, but do so gradually.

Symptoms include pain or irritation, worse in either the morning or evening that can be dependent on episodes of disease activity, and varying levels of vision disruption.

Dystrophies are most often inherited and can occur at an early age, even in infancy. There are a variety of dystrophies, which affect different layers of the cornea. The two most common are epithelial basement membrane dystrophy and endothelial cell dystrophy.

Epithelial Basement Membrane Dystrophy

The epithelium is the top layer of the cornea, which is made up of several layers of flat, specialized skin cells that are normally of uniform size and arranged regularly across the surface. The basement membrane forms a barrier between the epithelium and the corneal stroma (see illustration). It is normally smooth and flat, with an even thickness throughout.

Sometimes referred to as map-dot or fingerprint dystrophy, it generally occurs in adults after the age of 40, although it can appear as late as age 70. The name of this dystrophy comes from the appearance of the cornea under high magnification in the biomicroscope, a precision optical instrument. In this form of dystrophy, the basement membrane becomes thicker and irregular in shape, so that the cells begin to break apart and disintegrate. As the membrane begins to fall apart, light can no longer be transported through the cornea to a sharp focus.

This dystrophy causes redness of the eye and discomfort that can range from mild irritation to severe pain, with these symptoms being worse at the beginning of the day, because sleep does not allow blinking, which keeps the surface of the cornea lubricated with tears.

Treatment starts with efforts to supplement the natural lubricants with artificial tears, used periodically during the day and just before sleep. At night, an ointment or gel-type lubricant may be recommended for better morning comfort; these are not typically used during the day because they blur the vision. Patients should follow their eyecare practitioner’s advice for the exact type of eye drops to use, because different formulations are appropriate for treatment, while others may do more harm than good. A vaporizer to increase the humidity in the home or workplace gives some relief, as does an eye patch; special contacts called bandage lenses may be recommended to help heal the membrane and restore its natural smooth character. In more advanced or severe cases, surgical debridement (removal of cells) of the corneal epithelium and basement membrane can be helpful to re-establish healthy tissue.

The refractive surgery called PRK (photorefractive keratectomy, called phototherapeutic keratectomy in this setting) can also be used to remove the affected cells. (The two different labels are used to differentiate between PRK performed for the reduction of nearsightedness, which is a cosmetic procedure, and PRK performed for treatment of a medical condition. The latter are usually covered by medical insurance, while cosmetic procedures are not.)

Endothelial Cell Dystrophy

This dystrophy affects the inner layer of the cornea and is sometimes called Fuch’s Dystrophy (Few-k’s). It is most common in adults of middle-age and affects women more often than men. It is also thought to be hereditary, but can occur without a previous family history, leaving the cause unknown.

The endothelium is responsible for removing water from the corneal tissues, which is the main factor in maintaining its transparency; when fluid accumulates, the cornea becomes cloudy, affecting vision. The blurred vision is usually worse in the morning, because fluid cannot evaporate away from the ocular surface as it does during the day.

As the dystrophy progresses, corneal swelling due to excess moisture can cause blister-like lesions on the front of the cornea, which are known as bullae (bull-eye); when this occurs it is referred to as bullous keratopathy.

Treatment of this particular dystrophy is aimed at removing moisture from the eyes and is done with the use of specific ointments and hypertonic eye drops. Patients should not use eye drops other than those specifically recommended by their eyecare practitioner, as most eye drops and lubricants add moisture to the eyes, not remove it.

In some patients, Fuch’s Dystrophy may occur along with glaucoma, an eye disease that is characterized by increased pressure within the eye. Increased pressure makes the endothelium less efficient, so medications aimed at reducing intraocular pressure (IOP) may be prescribed.

If cornea bullae are present and begin to rupture, this will cause increased pain and significant vision loss. In this case, a corneal transplant may be needed, although bandage lenses to help relieve the irritation and pain are sometimes helpful in the short term.

As in map-dot dystrophy (above), an alternate treatment with a laser may be recommended, this time called deep lamellar endothelial keratoplasty (DLEK), which affects the inner layers of the cornea, leaving the other areas untouched. Recently, an advanced form of DLEK using a femtosecond laser has shown encouraging results. (The femtosecond laser is being introduced into other types of ocular surgery as well, such as cataract extraction.)

Summing Up

Unfortunately, most corneal dystrophies are progressive and affect both eyes, but new strategies and treatments using laser-assisted surgery have shown promise for treatment.


 
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