There has always been an endeavor on part of its founder Dr. S. Bharti to go ahead in the field of Ophthalmology and acquire the latest equipment for the center.
Bharti eye Foundation is the first eye centre in India to acquire:
The Automated lamellar keratomilleusis system
The IOL Master
The Sovereign Phaco emulsification machine
The Nidek Cx3 Quest Excimer Laser
The HRT3 Heidelberg Retinal Tomography System
The Moria Epi- LASIK system

Training
Bharti Eye Foundation is certified training center for training in phacoemulsfication and Lasik. Ophthalmologists from different part of India and Asia have been trained here.

Charity
Keshav Sagar Eye Research Foundation is the charity wing of Bharti Eye Foundation providing free eye care facility and cataract surgery to the poor and needy. Bharti eye foundation is actively involved in “Rotary Gift of Sight” campaign as well as Motiya Mukti abhiyan and organizes camps regularly.

VISION CORRECTION REFRACTIVE SURGERY

LASIK laser vision Correction

Dr.S.Bharti is now using the latest Nidek EC5000 Cx3 “Quest” Custom-LASIK machine for the most accurate results and safety. The Nidek Cx3 system incorporates the latest IRIS REGISTRATION software to detect smallest error in eye rotation (the torsion movement) during laser vision correction for more accurate correction of astigmatism. The Cx3 is a wavefront guided laser delivery system for CUSTOM LASIK. The LASIK (Laser-in-situ Keratimilleusis ) corrects all types of refractive errors (Spectacle powers) like Myopia (minus) Hyperopia (plus) and Astigmatism (cylinder ). It can correct mixed powers also (Cross compound )

LASIK is the most popular laser vision correction procedure in the world today. LASIK is a two stage procedure. The first step is creation of a flap of 90 – 130 micron thickness. The flap is then reflected and the exposed corneal stroma is called ”THE BED”. The second step is to modify the curvature of the cornea by laser shots – “ABLATION” on the bed according to the predetermined corneal profile made by computer suitable for the particular eye. The flap is the replaced on the bed to produce an un-interrupted surface . The flap sticks to the bed quickly in two minutes and there is no need of any stitch or bandage. The vision is good just after the procedure and gets better with time and in nearly all the cases becomes perfect in one day.

WAVEFRONT GUIDED C – LASIK
Wavefront is measurement of reflected light rays coming out of eye. This will measure the distortion of rays by aberrations in the eye. Wavefront guided C-Lasik corrects the corneal aberrations thereby offering a possibility of a super-vision which could be better than vision correction by glasses or contact lenses. Nidek NAVEX SYSTEM has 3 steps to a most accurate laser vision correction. The aberrometer “OPD Scan” measures 1440 points (Maximum in the industry – 80 to 200 in other machines) on the cornea and FINAL FIT software calculates the final profile and the laser shots to achieve that profile. This shot data is loaded into a USB pen drive and transferred to the EC5000Cx3 “Quest” Excimer laser machine which then corrects the error in the eye according to the pre-planned shape to achieve the best result.

Bharti Eye Foundation is a recognized LASIK training center imparting training to doctors from Asia and India . Dr.S.Bharti is the first and only International Clinical Investigator in the field of LASIK and is Instructor in LASIK.

Dr.S.Bharti has a passion for incorporating the latest technology as quickly as it comes and has the first EPI-LASIK system in the country.

Epi-LASIK is a new innovative technique where a thin epithelial flap of 50 micron is raised with Epi-Keratome instead of a 90 - 130 micron flap in LASIK thus making Epi-LASIK a safer procedure for correction of higher myopia of over 10 dioptres. Epi-LASIK saves atleast 60 microns of corneal tissue and thus allows a safer corneal profile after laser vision correction.

LASIK
This is a variant of Epi-LASIK where the epithelial flap is created with the help of alcohol. It avoids the keratome induced short time (1-2 minutes) increase in pressure of the eye. This procedure is helpful in conditions where eye pressure can not be raised e.g. after cataract , glaucoma and retina surgery.

LEPTO-LASIK
Lepto (Thin) lasik is best for eyes where a THIN FLAP LASIK is safer. In high powers the thin flap spares more corneal thickness allowing more residual thickness after laser ablation. The new generation microkeratomes have special heads for thin flap lepto-lasik making a thin flap of uniform thickness.

PRESBYOPIC LASIK is another new procedure where laser vision correction is done for correction of both far and near vision. Presbyopia ( Need of near glasses ) starts after the age of 40 years. A unique corneal remodeling is done with Presby-LASIK and 3 zones are created – The central zone is for far vision and the outer zone is for near vision thus providing independence from both distance and near glasses for person over 40 years of age.

LASIK with TED (Iris Registration)
The Nidek Cx3 system incorporates the latest IRIS REGISTRATION software to detect smallest error in eye rotation (the torsion movement) during laser vision correction for more accurate correction of astigmatism

LASIK What to expect
Lasik is a painless procedure that takes about 5 minutes. The eye is made numb with eye drops. There may be slight watering or irritation after the effect of these eye drops go away but that does not last for over one day normally.

LASIK Technique
Lasik is a 2 stage procedure where a 90 – 130 micron flap is first made with a microkeratome and reflected. The exposed surface “BED” is the treated with laser shots “ABLATION” to modify the curvature to the desired shape to achieve refractive correction.

LASIK Pre-requisites
The minimum requirement is
1. Age above 18 years
2. Stable refraction (Spectacle power) for one year
Besides the 2 conditions mentioned above , a sufficient corneal thickness and a normal corneal profile is necessary.

LASIK Post-op Care
After LASIK a normal life routine is possible after 2 days. There are no restrictions on food, watching TV or reading and these activities can be performed to the level of comfort. Washing face and taking bath is allowed with eyes closed with care so that water does not enter the eye. There is no restriction on room lighting.

LASIK Results
After LASIK the person can perform all the tasks as before without dependence on glasses or contact lenses. The aim is to achieve a post lasik spectacle power of within +/- 0.50 D. Any residual power above this range may be corrected by enhancement after a minimum period of 3 months.

LASIK Complications
Lasik is basically a safe procedure and rate of complications is very low. Complications such as under or over correction can be managed by enhancement in majority of cases. The other complications are flap related and though are serious and vision threatening in nature , are becoming rarer with advances in microkeratomes and the present generation of microkeratomes are safer. Now the bladeless femtosecond laser keratome promises to be safer.

Phakic Intraocular lenses or Refractive IOLs are new age foldable IOLs which can be inserted through a small incision of 2.8 – 3.2 mm. These lenses are fixed between Iris and Natural lens of the eye without touching the natural lens and crowding the angle of the eye. This avoids complications like cataract and glaucoma. The other advantage of these lenses are that they can be removed any time.

REFRACTIVE LENS EXCHANGE
For person with a very high refractive error, the preferable choice is removal of clear natural lens and implanting:
1. IOL IMPLANTS
2. CAPSULAR TENSION RINGS (Endocapsular Rings)
IOL of appropriate power will reduce the spectacle power to a remarkable extent and in some cases where monovision is aimed ( One eye for distant vision, the other eye for near vision) this provides a spectacle free life is also possible.
The Endo capsular rings or Capsular tension rings keep the posterior capsule taut and thus reduce turbulence in the eye. This reduces the risk to the retina in such cases because retinal degenerations are more common in myopes and there is higher risk of retinal detachment in these eyes.

PRELEX
The new Multifocal intraocular lenses provide excellent distant and near vision and are now increasingly becoming the first choice for treatment of Presbyopia. Here a clear lens is removed and a multifocal IOL is implanted which thus provides good vision for near, far and middle distance.

REFRACTIVE KERATOTOMY
The old technique of “Diamond Cuts” on the cornea is still relevant in some cases. A high intolerable astigmatism after cataract surgery or a small residual power after lasik when the enhancement with lasik is not possible due to thin residual corneal thickness can very efficiently and accurately treated with keratotomy.

AUTOMATED LAMELLAR KERATOMILLEUSIS (ALK)
Lamellar keratomilleusis was procedure of choice little more than a decade ago when lasik was either not available or prohibitively expensive. A small disc of corneal tissue was removed by an automated keratome mechanically after making a flap just like in lasik. This procedure is now completely overtaken by lasik because of accuracy and versatility of lasik.

WHAT IS CATARACT
Cataract (Hindi: Safed Motia or Motiabind) is age related clouding and increasing opacification of the natural lens of the eye causing blurring of vision. It occurs with the age and starts after 5th decade of life.The symptoms of cataract can vary according to the area of the lens involved and the blurring is early and more pronounced when central part is opacified as compared to the peripheral part of the lens. The other other symptoms may be blurring of vision in sun and in bright light(Glare) , Coloured rings around the lights (Haloes), Multiple blurred images of an object (Polyopia), Blurring of vision in dim light, Difficulty in reading and driving, Repeated quick change in glasses power, eye strain and headache etc.
This clouding of lens can occur due to injury (Traumatic cataract) , Diabetes mellitus and various other diseases and thus can occur earlier also. In new born and infants it occurs due to genetic reasons or poor maternal health and diseases during pregnancy and then is called Congenital Cataract.

TRATMENT OF CATARACT
Treatment of cataract is surgical removal of the cataractous lens. There is no drug or diet available for reducing cataract. The progress of cataract is different in different people and though in some it progresses rapidly and causes vision disturbances , in other people it may take many years to progress.

METHODS OF CATARACT SURGERY

Old Method:
The old system of cataract surgery involved injection around the eye, making the surrounding area and the eye numb, making a large incision (cut) of 12 to 13 mm and taking out the cataract through this incision in one piece ( Intracapsular) or just the central nucleus leaving behind the outer covering (the capsule) in which a intraocular lens could be fixed. The large incision was then closed with stitches. The eye was then bandaged for a period of one day or more. The visual recovery in these cases took upto 6 weeks and sometimes removal of stitches was required for complete recovery of vision.

Latest Method:
PHACO-EMULSIFICATION OR PHACO
Phacoemulsification ( Phaco = lens, emulsification) or phaco as it is popularly called is a technique where the lens is broken into small pieces , emulsified and then aspirated.

The ultrasound energy is used to emulsify the cataract. A handpiece with quartz crystals is used to produce the ultrasonic energy which moves the tip of 0.9 to 1.4 mm size back and forth to hit and emulsify the cataract.

The whole procedure is performed through an incision size of 3.2 mm in the form of a self sealing tunnel which does not require any stitches for its closure. The “phaco probe” has both irrigation and aspiration through the 3.2 mm and a continuous flow of a balanced fluid goes into the eye and is aspirated out along with emulsified pieces of cataract.

The lens has a nucleus in the center, surrounded by epinucleus and then cortex with “capsule” around it and a continuous round hole of approximately 5-6mm (the CCC or
Continuous curvilinear CAPSULORRHEXIS) is made so that the phaco tip can directly come into contact with the nucleus to emulsify it.

EYE-DROP ANAESTHESIA FOR PHACO
Anaesthetic eye drops are used prior to the procedure to numb the eye. Sometimes a diluted 1% lidocaine is irrigated into the anterior part of the eye to numb the sensitive iris in case the phaco tip touches it.
Since phaco is a short time painless procedure and there is very little handling of the eye, this no-injection eye drop anaesthesia is enough for a total comfort of the patient.
One should also remember that eye drop anaesthesia is safer than injection which can cause complications like drug reaction and peforation of the eye.

THE NO-STITCH PHACO
Phacoemulsification is done with a thin probe which can enter the eye through a 3.2 mm incision. This incision is made in such a manner that a small tunnel is formed with a length of approximately 2.5 mm. The configuration of the tunnel is such that it closes when the eye pressure is increased and so does not need any stitch to keep it closed.

BEST TIME FOR PHACO CATARACT SURGERY
Today the life style of every person is such that eyes are used extensively for reading/writing/driving during day and night/ watching television etc. and cataract surgery has become very patient friendly. The recovery is quick and discomfort is minimal. Also as the cataract “matures” , it becomes harder and difficult to emulsify with phacoemulsification.
It is therefore, advisable to get the phco-cataract surgery done as early as possible. Definitely when the person is able to read the top letter indicating cataract is sufficiently ready for operation.

PRECAUTIONS BEFORE & AFTER PHACO CATARACT SURGERY
It is advisable to maintain proper hygiene and cleanliness. No cosmetics should be used on the eye or face.
There are no dietary restrictions required before or after cataract operation. Dietary restrictions for other systemic diseases should be observed.
Splashing water in the eye to wash it is not to be done. Face can be washed and head bath can be taken with the eyes closed.

PHACO CATARACT SURGERY IN DIABETICS
Control of blood sugar is essential. A post prandial blood sugar level of up to 180 mg % should be maintained before and after cataract operation.

PHACO CATARACT SURGERY IN HIGH BLOOD PRESSURE
Blood pressure control should be maintained with appropriate medications before/ during and after surgery.

PHACO CATARACT SURGERY IN OTHER DISEASES
Other diseases like Bronchial Asthma, Rheumatoid Arthritis, Dependance on steroids should be discussed and appropriate measures should be taken.

THE COLD PHACO
New phacoemulsification probe produce less heat during ultrasonic vibration thus prteventing heat induced damage to the incision and cornea. This can even be used without infusion sleeve through a smaller incision of 1 – 1.4 mm.

MICRO-INCISION CATARACT SURGERY (MICS)
Phacoemulsification through a smaller incision of around 1 mm with a sleeveless phaco tip and irrigation through a separate side port provides an advantage of speedy recovery, faster healing and lesser surgery induced astigmatism. The surgery involves insertion of a rollable lens of 5.5mm dia which can be inserted through 1.2 mm incision (The microincision).

SPECIAL LENSES
1. MULTI-FOCAL IOL
2. ACCOMODATIVE IOL
3. ROLLABLE IOL
4. BLUE BLOCKING IOL
5. LIGHT ADJUSTABLE IOL

GLAUCOMA
Glaucoma is complex disease of the eye involving irreversible damage to the optic nerve because of increased intraocular pressure. It is common after 5th decade of life, is genetically determined and is more prevalent in Diabetics. Glaucoma can occur in new born , young children and young adults also.
Glaucoma can be broadly divided into 2 types: 1. Acute Glaucoma characterized by sudden increase in eye pressure, painful and red eye, decrease in vision, appearance of coloured haloes around lights and rapid deterioration in vision if not treated in time.
2. Chronic Glaucoma characterized by slow increase in eye pressure causing irreversible damage to the optic nerve associated with slow deterioration in vision and defects in the visual field.
Diagnosis of Glaucoma depends on
1.Complete eye examination including eye pressure,
2.Fundus examination for optic nerve head,
3. Gonioscopy (Study of angle of eye),
4.Pachymetry (Corneal Thickness),
5.SWAP Perimetry (Field test) and
6.Retinal Nerve fibre analysis.
Heidelberg Retinal Tomograph ( HRT 3 ) Retinal Nerve Fibre Analysis determines the thickness of the retinal nerve fibres, which reduces in Glaucoma. Thinning of retinal nerve fibres occurs much before the damage to the fibres and optic nerve causing field defects.
HRT analysis can detect the possibility of glaucoma 3 to 7 years before the appearance of field defects and detection of Glaucoma with other diagnostic procedures.
Treatment of Glaucoma is possible both with medicines and operation. HRT 3 and Perimetry determine the efficacy of medical treatment in preventing the progress of disease and HRT 3 acts as a guide to maintaining good vision. These tests should be repeated at appropriate interval to judge the efficacy.
Bharti Eye Foundation has the first HRT3 in India.

Diabetes starts affecting the retina when the person has had diabetes for over 12 years. Though a good glycaemic ( Blood sugar ) control is necessary for a general well being and may delay the appearance of Diabetic Retinopathy, it may not halt it altogether. It is necessary for a diabetic to get his eyes checked up atleast once a year to know if it has affected the retina. A Fluorescien Angiography ( FFA ) may be required to assess the affect and if there is any, a Laser photocoagulation is done to treat it. It has been seen that an early treatment with laser will benefit most and may be able to preserve excellent vision for a life time.
In most of advanced Diabetic Retinopathy cases it might become necessary to correct the damage , remove the blood ( Heamorrhage ) and do endo-laser with vitrectomy ( V-R Surgery).
Vitrectomy for Diabetic Retinopathy is an advanced Microsurgery of the eye and is available in the Retina Services of Bharti Eye Foundation.
Age Related Macular Degeneration (ARMD) occurs in the 7th decade of life and onwards and leads to loss of central vision. It is of two types- The Dry ARMD and The Wet type. Wet ARMD can be treated with good success by PDT(Photo Dynamic Therapy) and TTT (Trans-pupillary Thermo therapy) . Both of these are Laser procedures. Newer drugs are coming in the market for treatment of this debilitating age related disorder.
Retina Services at Bharti Eye Foundation is fully equipped for treatment of various diseases of Retina including damage due to High Blood pressure, CSR, Inflammatory disorders and other diseases.

MACULAR DEGENERATION

AGE-RELATED MACULAR DEGENERATION
Age Related Macular Degeneration (ARMD) occurs in the 7th decade of life and onwards and leads to loss of central vision. It is of two types- The Dry ARMD and The Wet type. Wet ARMD can be treated with good success by PDT(Photo Dynamic Therapy) and TTT (Trans-pupillary Thermo therapy) . Both of these are Laser procedures. Newer drugs are like MACUGEN and AVASTIN are now available in the market for treatment of this debilitating age related disorder.

OCULOPLASTY
Most advanced Oculoplasty procedures like Surgery for Ptosis, Dacryo - cysto-rhinistomy, Blow – out fractures, Congfenital and Acquired lid defects and anomalies, Z – plasty , Correction of Epicanthus , Entropion and Ectropion, Senile droopin g and lid lag are available at Bharti Eye Foundation .