Guest: Dr. Daya Sharma
Presenter: Wayne Bucklar
Guest Bio: Dr Daya Sharma is a Corneal, Cataract and Refractive surgeon. He was born and raised in country NSW, before moving to Sydney to study Medicine. He completed his Ophthalmology training at Sydney Eye Hospital and subsequently underwent fellowship training at Moorfields Eye Hospital in London, in his subspecialty interest areas of corneal, cataract and refractive surgery. His subspecialty training encompassed modern partial-thickness corneal grafting techniques (DSAEK, DALK and included laser-assisted corneal grafts), intracorneal ring segment implantation, corneal collagen cross-linking (CXL), corneal laser refractive surgery (LASIK and ASLA/PRK) and phakic intraocular lens implantation (eg ICL), and cataract surgery, particularly in corneal and anterior segment disease. He trained using multiple different laser refractive surgery platforms for correction of refractive errors.
Segment overview: In today’s Health Supplier Segment, know more about eye care and various vision-related procedures from our guest expert Dr. Daya Sharma from the Eye & Laser Surgeons of New South Wales in Australia. Dr Daya Sharma’s particular interests include management of astigmatism in cataract surgery using advanced corneal measurements, modern surgical management of keratoconus and other ectatic corneal diseases and management of corneal endothelial failure. He has expertise in multiple different types of refractive (vision correction) surgery, and is interested in management of complex cases, such as post-LASIK ectasia and high astigmatism after corneal transplant.
Health Professional Radio – Eye Laser Surgeons
Wayne Bucklar: You’re listening to Health Professional Radio. My name is Wayne Bucklar and today my guest is Dr. Daya Sharma. Daya is an Eye Surgeon, I guess is the easiest way to put it, but in more technical terms he’s a Corneal, Cataract and Refractive surgeon. And he’s from Eye and Laser Surgeons in Sydney Australia. Daya thanks for making this time available to us today and welcome to Health Professional Radio.
Dr. Daya Sharma: Thanks very much Wayne.
W: Now Daya I know Eye and Laser Surgeons is a state-of-the-art ophthalmology practice. But tell us what is it that you’ve been working on in particular?
S: So the focus of my work is Corneal, Cataract and Refractive Surgery. I have a particular interest in biometry in cataract surgery which means doing the measurements for cataract surgery and looking carefully the calculations to get the precise sort of refractive outcomes that we want – meaning looking at the patients’ requirements, what sort of visual outcomes they want and trying to get them as close as that as possible – so that’s with regards to cataract surgery. I also do LASIK, laser eye surgery for the younger population – for the young adults. And that’s a popular option for correcting patient’s vision to get out of glasses and contact lenses. I also do other forms of refractive surgery and I have a particular interest in treating patients with a corneal disease called “Keratoconus” which causes distorted vision and loss of best corrective vision with glasses.
W: Now I guess we can dig into any of those and expand them, but let’s start with the laser services just to begin with. That’s a very rapidly developing technology, isn’t it?
S: That’s right. So laser eye surgery, now as ophthalmologists we use different types of lasers. And when we talk about laser vision correction, we’re generally talking about performing laser on the cornea to reshape the cornea to improve the best vision without glasses. And the commonest type of laser eye surgery we do in that field is LASIK. And LASIK is when you make a flap in the cornea, lift up the flap and reshape the cornea with laser. The flap, generally most laser eye surgeons will create the flap with an intralase or femtosecond laser to create the flap and then the second laser to reshape the cornea. LASIK is popular because patients in this age group are generally working, they want to have minimal downtime. And so we get a pretty rapid visual recovery and the discomfort after the procedure is relatively minimal. So functionally, it requires minimal downtime to get the vision better.
W: Uh huh.
S: And that’s a very pleasing and satisfying technique to use for patients. That technology has been improving both in terms of getting precise refractive outcomes but also our diagnostic equipment is getting better for screening patients to make sure that we’re selecting our patients carefully and getting safer results. Although it’s a safe and effective technique, we’re getting safer and safer in terms of screening and getting good outcomes. So that’s a great area to be working in because patients are so happy with the results.
W: Yes. When you say minimum downtime, what’s the sort of average time of work for something like that?
S: So normally I have my patients take a day off from the day of procedure and they come see me the next day. Some of the patients will be back to normal activities on that first day after LASIK and almost all of them, the following day they will be right to go back to work and their normal activities as long as they’re able to put eye drops in. So it’s a pretty rapid visual recovery, a lot of patients are already seeing 20-20 … on the first day without correction in both eyes and with relatively minimal sort of discomfort. Maybe a bit of … foreign body sensation but so it’s very quick in terms of that recovery.
W: Yes, particularly yes. I’m digging back into my clinical history of about 40 years ago when eye surgery was 10 days laying on your back for recovery and in darkness or partial darkness, dramatically different result in just a generation.
S: That’s right, it changed dramatically. You’re right.
W: Now Daya you mentioned that one of your area of interest is “keratoconus.” Explain what you’ve been doing there.
S: So keratoconus is a condition that affects the cornea. The cornea is the front window of the eye and although there is a lens inside the eye which helps bend the light rays, the use the term “lens” often leads people to think that the lens is the most important optical component but in fact it’s actually the cornea that provides most of the power for bending the light rays and creating the focus. So if the cornea is an abnormal or irregular shape, it causes a significant degradation of the vision. And keratoconus is a disease basically of young people primarily, that comes on after puberty usually and it progresses. And it’s often related to allergic eye disease and eye rubbing, so there is a progressive steepening and thinning of the cornea that distorts the vision and that in some cases can lead to a corneal transplant – which is a fairly dramatic procedure to do on the eye. Now we’re getting better and better at treating keratoconus. Earlier some patients will be picked up during screening for refractive surgery, some patients will be picked up by their optometrist when the optometrist can’t get a quite good enough vision that they would like. And the exciting thing about treating keratoconus is that over the last more than 10 years or so, a new procedure has been introduced into our armamentarium called “Corneal Collagen Cross Linking” and that’s a procedure where we can apply it to the cornea and stiffen the cornea so that the cornea doesn’t progressively get worse. And that works in more than 95% of cases. The exciting thing about that is patients who may have ended up needing a corneal transplant and all the associated visits and risks of that, maybe able to avoid a corneal transplant altogether and potentially even maintain good vision just with glasses. And that’s a really exciting change in the management of these patients. And in some institutions where Corneal Collagen Cross Linking has been used for a number of years, we’re seeing a decrease in the numbers of transplants they need to do for these patients. And I think that’s pretty exciting.
W: Yes. It’s an exciting development, isn’t it?
S: Yeah, absolutely. And there are other treatments that we can use to improve the vision in patients with keratoconus who can’t use the hard contact lens. So they’re special contact lenses that a lot of keratoconus patients will be able to use to see well if they don’t see well with glasses. But not everybody is going to be able to use the sort of hard lenses. So I’m particularly interested in ways that we can rehabilitate the vision in those patients so that they don’t need a corneal transplant. And I should stress that if the disease is advanced to where there’s central scarring or it’s very thin then corneal transplant is really good operation, and it’s an important operation to have in our armamentarium for the more advanced cases. But I’m particularly interested in things that we can do to rehabilitate vision and help the patients keep their own cornea and avoid transplant.
W: You’re listening to Health Professional Radio and my guest today is Dr. Daya Sharma from Eye and Laser Surgeons in Sydney. Daya many of our listeners are clinicians of one kind or another, we get a fair number in acute care and hospitals. But also we get a lot of aged care clinicians having a listen to us. Do you have a message for clinicians in neither of those groups of practice today?
S: Absolutely. The first thing I want to stress is that when patients are being considered for admission to a nursing home or aged care facility, it’s really important that people consider whether or not the patient has had a cataract surgery or not and has had their eyes tested recently. We know that patients above the age of 80 who haven’t had cataract surgery are at increased risk of falls and hip fractures. We also know obviously that cataracts will affect driving performance, but also their ability to mobilize with confidence, it affects the ability to read. And we know that patients who’ve got dementia will often get worse as their cataract gets worse. And that’s really important to consider, sometimes the effect of cataract on vision makes dementia appear worse whereas it’s something that’s correctable with surgery. But it’s important to realize also that cataract surgery is safer in patients who haven’t got significant dementia because obviously we do almost all our cataract surgery with the patients awake. And if the patient – the more cooperative the patient is, the patient is the safer the surgery. And then if patients have significant dementia sometimes they need general anesthetic, which we really try to avoid.
W: Uh huh.
S: That’s one of the main messages that I want to get out there. The vision needs to be assessed and we need to think about cataract surgery in both patients whenever they’re being admitted or if they have deterioration on their function. And at any ages cataract surgery can be very, very beneficial to patients, even if it just means they can see people’s faces more clearly or they can see their food more clearly to eat, it can lead to a significant benefit in their function.
W: And I don’t generally associate surgery as a preferred option with people in their 80’s. But for cataract surgery, it’s quite common?
S: Yeah, absolutely. Cataract surgery is obviously more common in people above 60 and then as patients get older, more and more common in those age groups. If somebody hasn’t had surgery by the age of 80, we know that the lens is going to have a significant yellowing that affects the contrast sensitivity.
W: Uh huh.
S: And something that people often don’t realize is that some patients won’t be able to meet the driving standard on the high contrast test that we use – the Snellen test. But in real world conditions, they actually don’t see as well as they should to drive with confidence. And so often patients will say how much more quickly they notice something happening in front of them and how much easier it is to mobilize and see clearly once they’ve had their cataract surgery, even if they previously met the driving standards. And that’s due to the yellowing of the lens, blocking of the lights and reducing the contrast sensitivity.
W: Very interesting. Now Daya my favorite question in every interview is about misconceptions. Is there a misconception in your industry be it amongst your colleagues, clients, patients that drive you nuts and keep you awake at night that we can help straighten out a little bit?
D: One of the big misconceptions is that refractive surgery can’t treat astigmatism. So with laser vision correction, patients often have the idea that astigmatism can’t be treated. And that’s probably a throwback to the very early days of laser vision correction where only the spherical area, the astigmatism part of the prescription error could have been treated. But we can treat stigmatism quite well and even irregular astigmatism with keratoconus we have options to treat that. And particularly with cataract surgery we can also treat astigmatism, and I’m always trying to minimize the astigmatism in patients that I’m operating on because it increases the visual function without glasses. So that’s a really important thing to keep in mind and to remember. And if I can go onto one other misconception that is really important – one of the public health things that I’m interested in is the use of UV protection. So we know that in Australia especially we get a lot of UV, we have outdoor lifestyle, a lot of people are like going to beach. There are diseases of the eye that are particularly related to UV light exposure, for example “pterygium or surfer’s eye” which is a wing shaped growth on the cornea; “pinguecula” which is a related disease on the surface of the eye; and also eyelid cancers. It’s really important to get the message out there. Sunglasses are not just for fashion, sunglasses are really important for protecting the eye against ultraviolet light and the damages it causes. So some of these things we can fix with surgery, but it’s much better to avoid getting the disease in the first place. And so protection of the eyes should start in the childhood years as well. So kids get a lot of UV exposure in their early years, and the eyes actually are more susceptible to UV in childhood as well so you can get more transmission of ultraviolet into the eye during childhood. And it’s important to also consider the design of the sunglasses so they should have obviously the UV blocking that they be should wrapped around and have side protection because we know that it’s light from the side that actually causes a lot of this damage. And in glasses that are just made for fashion, a lot of light can get in through the side and when you have a sun glass lens in front of the eye, it makes the person more comfortable. They can spend more time in the sun, but if it’s not good side protection, they can actually end up getting significant damage from that light that passes in through the side. So that’s really important to think about as well.
W: So a timely warning for anyone listening with children, sunglasses are not just a fashion item for your children but wrap-around sun glasses with UV blocking can save a lot of drama in eyes later on. Daya Sharma thank you very much for sharing your time with us today, I realize you’re a busy man. For people who want to get in touch with you I guess the website is the best bet at www.eyeandlaser.com.au
S: That’s right. Thank you so much Wayne, it’s been a pleasure.
W: It’s a pleasure having you on. If you’ve just missed my conversation with Daya Sharma then you have my sympathy because it was really interesting. But the good news is, there is a transcript that you can read on our website. And we also have an audio archive, so you can in fact listen to the whole thing again on both SoundCloud and YouTube. And you can find links to all of those on our website at www.hpr.fm. My name is Wayne Bucklar, you’re listening to Health Professional Radio.