Since 1982, the Eye Unit of the Ruber International Hospital has been made up of a group of professionals specialising in different medical-surgical areas of Ophthalmology. This means that any type of condition can be treated, providing the most advanced technology, both for the diagnosis and for the different types of medical and surgical treatments in the eye speciality.
A cataract is the clouding over or loss of transparency of the lens that causes a gradual decline in vision. A patient with a cataract frequently sees glare when driving at night or when the sun is out during the day.
Deterioration of the lens occurs naturally with age, but there are other factors such as inheritance, diabetes or eye contusions that can cause cataracts.
Treatment of cataracts is always surgical and consists of the removal of the clouded lens, replacing it with an intraocular lens. All of this is carried out thanks to microincision surgery that we carry out as an outpatient procedure in approximately 10 minutes and with topical anaesthesia (drops) in most cases, which facilitates a speedy recovery.
In the past, the recommendation was to wait until the cataract was very advanced to carry out the operation, but now there is a tendency to perform it when the patient starts to notice the first symptoms, so that they do not have to suffer the deterioration that impedes a normal life.
Currently, in addition to correcting cataracts, it is possible to insert, in the same operation, progressive, monofocal lenses, with or without associated astigmatism, that allow certain patients to recover good vision from a distance, nearby and intermediate distance without needing to use glasses for the majority of tasks.
The name glaucoma indicates a set of processes in which the absolute or relatively high intraocular pressure causes characteristic lesions that affect the optic nerve, causing a deterioration in vision that can be total and irreversible if the process is not detected and treated properly at an early stage.
As it is an asymptomatic pathology until the very advanced stages, this condition is known as "silent blindness".
It can onset suddenly and in a painful way (acute glaucoma) or as a chronic and painless condition.
Ocular hypertension causes irreversible damage to the optic nerve, which can go unnoticed by the patient until the advanced phases of the condition. For this reason, eye examinations in patients over the age of 40 are recommended.
Our unit has an early detection programme, fundamental in patients with a family history of glaucoma, short-sighted individuals, diabetics, etc. We also have advanced technology to carry out the most accurate diagnoses, such as Optical Coherence Tomography (OCT), campimetry, pachymetry and tonometry.
Treatment can be medical (through the use of eye drops), laser (iridotomy or trabeculoplasty) or surgical, carrying out perforating or non-perforating trabeculoplasty, with or without mitomycin depending on the type and progression of the glaucoma. In some cases, the implant of a drainage device or valves (ExPress implant, Ahmed valve etc.) are necessary. Our patients are diagnosed and included in a follow-up protocol with appropriate treatment for each case.
Symptoms of glaucoma
Sudden loss of vision
Flashes of light
Eye pain and headache
- Vomiting and nausea
A series of procedures aimed at correcting so-called ametropia or ocular refractive errors are included in refractive surgery. These procedures range from laser techniques to the implantation of phakic or pseudophakic intraocular lenses.
Ametropia consists of refractive errors which are caused because the image is not formed at the level of the retina. Spherical ametropias are short-sightedness (myopia) and long-sightedness (hypermetropia).
In short-sightedness the image of a point located at infinity is formed in front of the retina. The short-sighted eye clearly sees nearby objects, but struggles to see distant objects. Regardless of whether patients can go to an optician to get their sight adjusted, they should be reviewed by their ophthalmologist once a year to rule out the existence of other related problems. Once stabilised, an adult's short-sightedness can be subject to operation through photorefractive surgery (Lasik / Lasek / PRK) depending on the corneal thickness, topography and number of dioptres. In some cases, it is necessary to insert an implantable contact lens (ICL) or to perform clear lens exchange surgery. In our department, we study each specific case, advising our patients of the best surgical solution for an optimal outcome.
Long-sightedness is characterised by the fact that the image is produced behind the retina. A long-sighted individual struggles to see nearby objects. In childhood, long-sightedness can result in deviations of the eyes (squint), that can cause decreased vision (amblyopia or lazy eye) if not corrected. In adults, long-sightedness can be corrected through Lasik or clear lens exchange surgery.
Astigmatism is an irregularity of the cornea that prevents the eyes from focusing clearly, in the case of nearby and distant objects. It can also be corrected through Lasik or toric phakic lenses.
Our Unit also has extensive experience in presbyopia surgery through the implantation of "premium" intraocular lenses for its correction. Presbyopia (tired eyes) is the physiological loss of the ability to focus on nearby objects due to age. It generally occurs from the age of 40, and means that glasses are necessary in order to be able to focus on nearby objects. To start with, glasses are needed intermittently for certain tasks which are more demanding in terms of visual effort and, subsequently, when the process advances, glasses are needed all the time.
The retina is the innermost layer of the eyeball and it can be affected by multiple conditions, which are always of significant repercussion on visual prognosis. That is why there is a need for an early diagnosis to prescribe the appropriate treatment in each case.
Age-related macular degeneration
This is the first cause of legal blindness in the Western world. It limits central vision, gradually disabling the patient for the performance of necessary tasks such as reading, writing, driving, etc.
There are two types: dry and wet (exudative). Treatment includes preventive measures, antioxidants and injections of antiangiogenic agents (Lucenthis®, Eylea® etc.)
There are also other eye conditions that can affect the macule such as short-sightedness or central serous choroidopathy, among others. For this reason, it is very important to go to a specialist, in the event of detection of any deformities in vision or curving of straight lines.
Hypertensive diabetic retinopathy
Diabetic and hypertensive patients have an added risk of developing a vascular problem at the back of the eye (retina). This situation can cause recurrent haemorrhages, macular oedema, venous thrombosis, arterial occlusions and can cause significant damage to vision.
Currently, we have diagnostic methods and advanced treatments to stop, as far as possible, the deterioration of vision caused by these conditions, through laser therapies and/or intraocular injections of antiangiogenic agents or corticosteroids.
The retina can suddenly become detached, most notably in short-sighted patients or after vitreous detachment (evolutionary process of ageing on the eye). This can cause partial or total loss of vision. Early detection of predisposing lesions is very important through an annual review of the back of the eye carried out routinely and on a preferential basis if there are symptoms (vision of floaters, flashes or decreased peripheral vision). Any sudden decrease in vision should be considered an emergency, with it being necessary to see a specialist for an early diagnosis and appropriate treatment.
We have a team with extensive experience in retinal laser treatments and in retinal surgery (banding, explants, cryotherapy, vitrectomy, ...).
Posterior vitreous detachment
Between the retina and the posterior side of the lens, enveloped by the "hyaloid" membrane is the "vitreous humour", which is a sort of gel. This gel, which is mostly formed by water, hyaluronic acid and collagen fibres, becomes more fluid like with age, which means that it moves, causing the membrane (hyaloid) to detach from the retina and the space that it leaves free to fill with fluid from the synchysis.
The patient will see some "floaters" matched to the movement of the eyes when they look to the light.
Retinal vein occlusions
When the retinal vein, or one of its branches, is obstructed this results in 'waterlogging' due to the lack of blood return. Loss of vision can occur if this occlusion affects the macule.
Vision development occurs during the first few years of life. For this reason, regular reviews in children are of great importance. They enable the correction of long-sightednesses, short-sightednesses and astigmatism, as well as amblyopia ("lazy eye"). The earlier the problem is treated, the better the visual prognosis will be since, after a certain age, the vision that the child does not have, cannot be acquired later on.
Sometimes, abnormalities are not entirely evident. Therefore, in the case of children, we should suspect that they have a condition if they rub their eyes a lot, go far away or come very close to read, if they twist their head trying to see in the most optimal way, if they have frequent headaches or if their eyes are red.
In the Ophthalmology Unit at Ruber International we have an early diagnosis and treatment programme for vision disorders in newborns: retinopathy of prematurity, congenital cataracts, intraocular tumours.
Most common paediatric eye problems
A squint is the loss of eye parallelism, in such a way that one eye becomes dominant (fixating eye) and the other deviates in any direction, vertical, horizontal or oblique. It can appear at any age, and it can be triggered by different causes.
It is normal for newborns not to fix their gaze, but if the deviation persists after the first three months of life, it should be assessed by the ophthalmologist, to establish a diagnosis and early treatment.
Treatment of ocular motility disorders (squint, double vision or diplopia, nystagmus) includes: glasses, prisms, occlusions, penalties, botulinum toxin and muscular surgery.
Lazy eye (amblyopia)
In this condition, the brain rejects the information that reaches it from one of the eyes, due to the fact that the connection between the eye and the brain has not developed properly. This can cause significant vision loss in some cases, and, in others, the deviation of the lazy eye.
Treatment of amblyopia should be done as soon as possible (in childhood), and thus the chances of success increase considerably.
Treatments for the correction of amblyopia involve:
- Correction of refractive vision problems (short-sightedness, astigmatism, long-sightedness) with the use of glasses.
- Vision re-education. The most common procedure is to cover the eye with the correct vision to force the brain to accept images from the lazy eye. The use of eye drops that obscure the vision of the correct eye is also possible.
Eye exercises: such as the distancing and approach of a pen.
Blocked tear duct (Congenital Dacryocystitis)
It is very common for children not to have a completely formed tear duct when they are born, which will mean that they have watery, irritated eyes with sleep in them.
This problem usually corrects itself naturally after a few months, which is why the treatment will be reduced to some small massages in the area of the tear duct and some antibiotic eye drops, if necessary.
Astigmatism, short-sightedness and long-sightedness are refractive problems that can appear in childhood. Their early detection is fundamental so that children can lead a normal life through the simple use of a pair of glasses.
The orbit is the bony space that houses both the eyeball and the structures that surround it (muscles, fat, vessels and nerves). Benign or malignant tumours, as well as inflammatory problems, that require a medical-surgical treatment can appear in this complicated space.
The Ruber International Hospital offers the possibility of treating these conditions jointly with other departments (radiotherapy, neurosurgery, Gamma surgery), to achieve the optimal outcome.
The Ophthalmology Unit carries out decompressions in thyroid-associated orbitopathy, surgical treatment of orbital floor fractures and removal of orbital tumours.
This is currently one of the most common conditions with which people consult. It can be considered a multifactorial disease that affects the tear film both in quantity and quality, causing damage to the ocular surface and non-specific, but chronic, discomfort that alters the patient's everyday life. In serious cases, it can end up damaging the cornea with significant visual impairment.
Symptoms such as stinging, itch, sensation of grit, are some of the details that are used to diagnose this condition. Furthermore, an eye examination is required to determine if blepharitis, allergy or palpebral abnormalities are present that promote dry eye.
Systemic diseases (Sjogren's syndrome, thyroid abnormalities, rheumatological conditions, hormonal disorders, etc.) can have dry eye as a first manifestation.
The diagnosis is based on the symptoms, the examination and on the complementary studies such as the osmolarity test, Schirmer's test or Rose bengal staining.
In the mildest cases, when there are no associated eye or general conditions, the treatment is replacement therapy, using artificial tears suitable for each case. In more severe cases, the placement of punctal plugs that help to retain more tears in the eye, anti-inflammatory drugs, autologous serum, etc. may be associated.
Finally, if there are associated eye conditions such as Blepharitis or Eyelid Malposition (Entropion, Ectropion, Lagophthalmos), these must be treated to improve outcomes. In the light of severe systemic diseases that may affect the cornea with decreased visual acuity, the use of corticosteroids, ciclosporin or permanent lacrimal punctal plugs may be necessary.