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
Understanding and Avoiding Contact Lens Complications: Polymegathism, Neovascularization and the Endothelial Pump


Contents

Understanding and Avoiding Contact Lens Complications: Polymegathism, Neovascularization and the Endothelial Pump

Introduction

Avoiding complications related to contact lens wear is easy: keep the lenses as sanitary as possible, clean and care for them as your eyecare practictioner recommends, and wear them as directed.

Three big long words describe a set of interrelated complications of contact lens wear that are the result of a decrease in oxygen levels at the surface of the eye. The cornea, the clear, dome-shaped structure that allows light to enter the eye, is sensitive to the flow of oxygen, which normally comes from the air around it and dissolved in the tears, which bathe and lubricate it. When the amount of oxygen getting through falls, in this case from interference by contact lenses, the cornea reacts by adapting itself in several possible ways.

"Endothelial pump" is the term used to describe the function of the cells lining the back wall of the cornea in removing excess water from the tissues, which then goes into the aqueous humour and circulates out of the eye normally. Without this pump, the cornea takes on excess fluid and becomes swollen. A swollen cornea is cloudy so vision is affected as well.

"Neovascularization" describes the growth of new blood vessels into the corneal tissue from the white sclera surrounding it. Normally, the cornea is an avascular tissue and completely free of arteries and veins, unless there is a problem with decreased oxygen. Once blood vessels grow into the cornea, they never disappear; they may become empty (“ghost” vessels) but never go completely away.

"Polymegathism" describes a characteristic look to endothelial tissues that is seen with the slit lamp, a piece of ophthalmic equipment that is a large microscope with a controllable light beam that eyecare practitioners use to evaluate ocular tissues. The normal appearance of endothelial tissue is one that might be described as looking like a honeycomb or chicken wire; that is, all the cells are about the same size and form a regular pattern with their neighbors so the cell walls match up on six sides, forming the honeycomb pattern. In polymegathism, the cells lose their regular honeycomb appearance and look more random, with larger and smaller cells randomly scattered across the tissue. This appearance indicates that the cornea is no longer able to maintain its normal function of removing excess fluids.

These particular complications are seen less often today because materials contact lenses are made from are much more breathable than in the past. However, eyecare practitioners do still see them, usually in patients who have been in contact lenses for a long time.

There are no symptoms that patients can monitor for themselves; there is no pain or irritation, and the onset of blurred vision from a swollen cornea is so gradual that most patients don’t notice it until it is well advanced.

The only way to diagnose and treat these particular complications is to have frequent and regularly-scheduled visits to the eyecare practitioner, who will use specialized equipment to measure and evaluate their presence.

Treatment

Oxygen must be allowed to get to the cornea. Usually, this can be accomplished by refitting the patient with one of the newer contact lens materials that are much less of a barrier to oxygen flow. It can also be improved by changing the fitting characteristics themselves, by using a lens that moves on the eye more, which increases the amount of tears being exchanged under the lens with normal blinking.

In addition, if the patient is wearing his or her lenses in an extended-wear modality, overnight wear should be discontinued immediately. If the cornea has reacted to decreased oxygen during the day that decrease is only worsened by closing the lids over the lens in sleep.

Frequent lens replacement will also help restore the cornea to pre-lens condition, because a fresh lens has no protein buildup that can get in the way. Daily disposable contacts are often the healthiest and most comfortable way to wear lenses.

 
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