Ocular Disease

Cataracts

  • What are Cataracts

    A cataract is a clouding of the eye's natural lens, called the crystalline lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away.

    As we age, the crystalline lens can become cloudy and gradually worsen vision over time. This is a cataract and it does advance with age.

    There are other types of cataracts that occur. Cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataracts). Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications, such as steroids.

  • Cataract Signs and Symptoms 

      

    1. • Blurred vision that cannot be corrected with a change in your glasses prescription.

    2. • Ghost images or double vision in one or both eyes.

    3. • Glare from sunlight and artificial light, including oncoming headlights when driving at night.

    4. • Colors appear faded and less vibrant.

    Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure.

  • Cataract Treatment 

    When symptoms of cataracts begin to appear, you may be able to improve your vision for a while using new glasses, stronger bifocals and more light when reading. But when these remedies fail to provide enough benefit, it's time for cataract surgery. The best option for you will be discussed and determined by you and your eye doctor. 

Diabetic Retinopathy 

  • Definition

      

    If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely they are to have retinopathy (damage to the retina) from the disease.

    In its advanced stages, diabetes may lead to new blood vessel growth over the retina. The new blood vessels can break and cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated.

    People with diabetes are 25 times more likely to lose vision than those who are not diabetic, according to the American Academy of Ophthalmology. 

  • Signs and Symptoms

    Anyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics will be affected. In the early stages of diabetes, you may not notice any change in your vision. But by the time you notice vision changes from diabetes, your eyes may already be irreparably damaged by the disease. 

    That's why routine eye exams are so important. Your eye doctor can detect signs of diabetes in your eyes even before you notice any visual symptoms, and early detection and treatment can prevent vision loss.

    If you are diabetic, you should see your eye doctor at least once a year for a dilated eye exam, even if you have no visual symptoms. 

  • What Causes Diabetic Retinopathy?  

    Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes. As soon as you've been diagnosed with diabetes, you need to have a dilated eye exam at least once a year.

    In the retina, high blood sugar can damage blood vessels that can leak fluid or bleed. This causes the retina to swell and form deposits. This is an early form of diabetic retinopathy called non-proliferative and if untreated can advance to late stage proliferative retinopathy where newer blood vessels have grown to replace the damaged ones. Breakage of the vessels and bleeding can lead to blindness.

    Fortunately, you can significantly reduce your risk of developing diabetic retinopathy by using common sense and taking good care of yourself:

    1. • Keep your blood sugar under good control.

    2. • Maintain a healthy diet.

    3. • Exercise regularly.

    4. • Follow your doctor's instructions to the letter.

    To monitor for the onset of diabetic retinopathy, an annual exam and dilation is recommended for all diabetics. However, more frequent visits maybe necessary if there are concerns or higher risk of development of diabetic retinopathy or if you have already developed early diabetic retinopathy. If it advances and is threatening your vision, you will likely then need to be evaluated, or treated, by an ophthalmologist.

Dry Eye Syndrome 

  • Definition

    Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections. 

  • Signs and Symptoms of Dry Eye

    Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Some people with dry eyes also experience a "foreign body sensation" - the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye's tears. 

  • What Causes Dry Eyes?

    In dry eye syndrome, the tear glands that moisturize the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

    Dry eye syndrome has several causes. It occurs:

    1. • As a part of the natural aging process, especially among women over age 40.

    2. • As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills.

    3. • Because you live in a dry, dusty or windy climate with low humidity.

    If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

    Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).

    Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. 

    Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Exposure to smoke and other environmental irritants can also cause dry eyes (dust, pollen, smoke, air conditioners, heaters) as well as wind and sun exposure.

    Certain medications such as anti depressants, high blood pressure medications, hormone medications can contribute to tear deficiency. Underlying lid disease will also contribute to the symptoms of dry eyes.

  • Treatment for Dry Eye

    Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye - including dryness, scratchiness and burning - can usually be successfully managed.

    Your eye care practitioner may recommend artificial tears. These are drops that lubricate the eye, usually providing relief from the dry, scratchy feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief. 

    There are various options for the management of dry eyes. Your doctor will discuss all of the options and recommend the best course of action for you.

Glaucoma 

  • Definition

    Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intraocular pressure or IOP), which can damage the eye's optic nerve - the structure that transmits visual information from the eye to the brain.

    Glaucoma typically affects your peripheral vision first. You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness. Glaucoma is currently the second leading cause of blindness in the United States. 

  • Signs and Symptoms of Glaucoma  

    Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss. 

  • What Causes Glaucoma?  

    The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of fluid produced inside the eye and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have.

    Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels and vision is lost. 

  • How Is Glaucoma Detected?

    During routine eye exams, a tonometer is used to measure your intraocular pressure (IOP). An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye. Either the eye is producing too much fluid, or it's not draining properly.

    An elevated IOP is a risk factor for the presence, or development, of glaucoma. Other tests are done to evaluate the health of the optic nerve, including visualization of the nerve during the dilation portion of the exam. Computer imaging, visual field testing and other tests are often necessary for the diagnosis of glaucoma. These tests will likely need to be repeated at intervals to monitor for new onset, or progression, of the disease. 

  • Glaucoma Treatments 

    Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, conventional (bladed) surgery, laser surgery or a combination of these treatments. Medicated eye drops aimed at lowering IOP usually are tried first to control glaucoma. If IOP is not optimally controlled with the prescribed topical drops, other treatment such as laser or surgery may be indicated.

    Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage. In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness resulting from glaucoma.

    Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures - especially the optic nerve - may be prevented. 

  • Early Detection Is Key 

    No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP. 

    People at high risk for glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the eye doctor.

Macular Degeneration 

  • Definition

    Macular degeneration (also called ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision - the part of our sight we use to read, drive and recognize faces. So although a person's peripheral vision is unaffected by AMD, the most important aspect of vision is lost. 

    AMD is the leading cause of vision loss and blindness in Americans ages 65 and older. 

  •  The Two Forms of AMD 

      

    Dry macular degeneration. Dry AMD is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes. Gradual central vision loss may occur with dry AMD. Vision loss from this form of the disease is usually not as severe as that caused by wet AMD. 

    Wet macular degeneration. Wet AMD is the more advanced and damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration. With wet AMD, new blood vessels grow beneath the retina and leak blood and fluid.

    The abnormal blood vessel growth in wet AMD is the body's attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula. But the process instead creates scarring and central vision loss. 

  • Macular Degeneration Signs and Symptoms 

    Macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In rare cases, AMD may cause a sudden loss of central vision.

    An eye care practitioner usually can detect early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination. 

  • What Causes Macular Degeneration? 

    Many forms of macular degeneration appear be linked to aging and related deterioration of eye tissue crucial for good vision. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration. 

  • Who Gets Macular Degeneration? 

    Besides affecting older individuals, AMD appears to occur in whites and females in particular. The disease also can result as a side effect of some drugs, and it appears to run in families.

    New evidence strongly suggests that smoking is high on the list of risk factors for macular degeneration. Other risk factors for AMD include having a family member with AMD, high blood pressure, lighter eye color and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of macular degeneration. A high-fat diet also may be a risk factor. 

  • How Is Macular Degeneration Treated?  

    There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.

    While nutritional intervention may be valuable in preventing the progression of dry AMD to the more advanced, wet form, neither the AREDS1 nor the AREDS2 study demonstrated any preventive benefit of nutritional supplements against the development of dry AMD in healthy eyes. Two major studies conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The studies, called the Age-Related Eye Disease Study (AREDS) and AREDS2, showed that nutritional supplements containing antioxidant vitamins and multivitamins that also contain lutein and zeaxanthin can reduce the risk of dry AMD progressing to sight-threatening wet AMD. 

    For wet AMD, several FDA-approved drugs are designed to stop abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet AMD. 

Retinal Detachment

  • Definition

    A retinal detachment is a serious and sight-threatening event, occurring when the retina - the light-sensitive inner lining of the back of the eye - becomes separated from its underlying supportive tissue. The retina cannot function when it detaches, and unless it is reattached soon, permanent vision loss may result. 

  • Signs and Symptoms of Retinal Detachment

    If you suddenly notice spots, floaters and flashes of light, you may be experiencing a retinal detachment. These symptoms are often experienced prior to, or during the development of a retinal detachment. Experiencing the symptoms, however, does not mean you are having a retinal detachment. Of most importance is that if you have these symptoms you are evaluated as soon as possible by an eye care practitioner to determine if there exists the development of a retinal tear, hole, or detachment.

    Other symptoms include blurry vision, poor vision or a shadow or curtain coming down from the top of the eye or across from the side. Any of these symptoms can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

    There is no pain associated with retinal detachment. If you experience any of the above symptoms, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision. 

  • What Causes Retinal Detachments?

    An injury to the eye or face can cause a detached retina, as can very high levels of nearsightedness. Extremely nearsighted people have longer eyeballs with thinner retinas that may be more prone to detaching. Also, certain necessary ocualr surgeries can increase the risk of retinal detachment. 

  • Treatment for Retinal Tears and Detachments 

    Surgery is the only effective treatment for a torn or detached retina. The procedure or combination of procedures your doctor uses depends on the severity and location of the problem. If there is a problem found in your retina, the Optometrist will refer you to a Retinoloigist/Ophthalmologist to determine the appropriate management for any retinal findings.

    In about 90% of cases, detached retinas are successfully reattached with a single surgery. However, this does not mean your vision will return to normal. Patients who have the best visual outcomes from retinal detachment surgery are those who seek attention immediately upon noticing symptoms and have detachments that do not involve the central retina (the macula). 

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