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Eye Disease
Diagnosing and treating eye disease is the main focus of our practice, so we are committed to keeping up with the latest advances in technology, diagnostics and techniques. We have listed below the most common types of eye disease and some corresponding information:
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Cataract
What is a Cataract?
A cataract is a clouding of the normally clear lens of the eye that typically occurs with age. It can be compared to a window that is frosted or "fogged" with steam. Also, there are various types of cataracts.
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| Eye without a cataract |
Eye with a cataract |
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| Normal vision |
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| Vision with a cataract |
Common symptoms of cataract includes:
- A painless, blurring of vision
- Glare or light sensitivity
- Frequent eyeglass prescription changes
- Double vision in one eye
- Needing brighter light to read
- Poor night vision
- Fading or yellowing of colors
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| Normal vision |
Vision through a cataract |
The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.
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Causes of Cataract
The most common type of cataract is related to aging of the eye, however other causes of cataracts include:
- Family History
- Medical problems, such as diabetes
- Injury to the eye
- Medications, such as steroids
- Previous eye surgery
How is a Cataract Detected?
A thorough eye examination by your ophthalmologist or optometrist can detect the presence and extent of a cataract. There may be other reasons for visual loss in addition to the cataract. If these problems are present, perfect vision may not return after cataract removal.
If such conditions are severe, removal of the cataract may not result in any improvement in vision.
Cataract Development
How quickly the cataract develops varies among individuals, and may vary even between the two eyes. Most cataracts associated with aging progress gradually over a period of years.
Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a few months. It is not possible to predict exactly how fast cataracts will develop in any given person.
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Treatment
Surgery is the only way your ophthalmologist can remove the cataract. However, if symptoms from a cataract are mild, a change of glasses may be all that is needed for you to function more comfortably.
There are no medications, dietary supplements, exercises or optical devices that have been proven to prevent or cure cataracts.
When Should Surgery Be Done?
Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities.
What Can I Expect From Cataract Surgery?
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| The cataract lens is broken up by phacoemulation and removed via aspiration |
It is an outpatient procedure done with topical (eye drops, no injection) anesthesia in which the cloudy lens is removed from the eye. In most cases, the clarity of the natural lens is restored by replacing it with a permanent intraocular lens implant. Your ophthalmologist performs this delicate surgery using a microscope, miniature instruments and other modern technology. Usually there are no injections, no stitches, or no patches.
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| The IOL in place following cataract surgery |
Although it is a common misconception, lasers are not typically used to remove cataracts. Ultrasound phacoemusilification is the state- of- the- art method used to remove a cataract.
Recovery is usually very rapid and most patients can return to nearly all activities shortly after surgery. Cataracts surgery is a highly successful procedure. However, it is important to understand that complications are very rare, but can occur during or after the surgery.
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| An intraocular lens (IOL) |
Cataracts are the most common cause of poor vision, particularly for the elderly, but they are treatable.
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Glaucoma
What is Glaucoma?
Glaucoma is a series of eye diseases in which the pressure inside the eye is too high for the optic nerve to handle. Glaucoma usually develops slowly over a period of years, but some rare forms can develop over hours. During this time, most people will NOT experience any symptoms. If left untreated, it can affect the vision and ultimately lead to permanent blindness.
Causes of glaucoma
Inside the eyes, a clear fluid, called the aqueous humor, is produced to nourish the structures within the eye. Normally, this fluid leaves the eye through a drainage system called the trabecular meshwork located in the angle of the eye. In glaucoma, this fluid fails to drain at a normal rate and the intraocular pressure (IOP) rises. This damages the optic nerve, which is responsible for sending visual images from the eye to the brain. When the nerve cells die, permanent damage occurs.
Types of glaucoma
• Primary Open Angle Glaucoma
This is the most common type of glaucoma. In these cases, the drainage area inside the eye (the angle) changes for unknown reasons. This causes the fluid to drain too slowly out of the eye. As the fluid builds up, the pressure inside the eye gradually rises.
• Acute Angle Closure Glaucoma
A rare form of glaucoma where the drainage angle suddenly becomes blocked. As the pressure inside the eye rises, blurred vision, severe pain and occasionally nausea and vomiting can result. This is an ocular emergency. Prompt laser treatment may help resolve this problem.
• Other types of glaucoma
Congenital glaucoma, chronic angle closure and other types also exist.
Diagnosing glaucoma
Glaucoma is detected through a complete eye examination. The only way to prevent vision loss is by early detection and early treatment. Typically, the physician will check:
- Eye pressure
- Appearance of the optic nerve
- Visual field examination (periodically)
- Gonioscopy – looking at the drainage area of the eye (periodically)
- Examination of the nerve fiber layer of the optic nerve (periodically)
- Three-dimensional photographs of the optic nerve
- Pachymetry – measurement of the corneal thickness
Risk factors for glaucoma
- Race - African Americans and Hispanics
- Age - individuals over 40
- Diabetics
- Family history of glaucoma
- High blood pressure
- Nearsightedness
- Long-term steroid use
- Eye injuries
Symptoms
Early on, there are no symptoms. Vision stays normal and there is no pain. Over time and without treatment, people with glaucoma will experience a loss of peripheral vision, followed by a loss of central vision. Eventually without treatment, blindness can result.
Treatment
Glaucoma is not cured, but in most cases it can be controlled. The vast majority of people can be treated successfully with eye drops. Since glaucoma is a progressive disease, eye drops may need to be added or changed to maintain control of the pressure in the eyes. Occasionally, laser treatment or surgery needs to be performed. It is critical to use the drops daily as directed, and to have routine follow up eye examinations and testing with your eye doctor.
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Diabetes
What is Diabetic Retinopathy?
Diabetic retinopathy is caused by changes in the blood vessels of the retina. These damaged blood vessels may leak fluid, protein or blood, and/or develop fragile new blood vessels and scar tissue. The risk of developing diabetic retinopathy increases the longer a person has diabetes and the poorer the control of blood sugar levels.
Diabetic retinopathy is the leading cause of new blindness among adults in the United States. However, with improved methods of diagnosis and treatment, only a small percentage of those who develop retinopathy experience serious problems with vision.
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| Normal vision |
Vision with diabetic retinopathy |
Types of Diabetic Retinopathy
• Background retinopathy
This is the early stage of diabetic retinopathy. In this stage, fine blood vessels leak blood, protein and fluid. This may cause the retina to hemorrhage, swell, form cotton wool spots or deposits called exudates. Laser treatment may or may not be needed. Sight is usually not seriously affected. However, it can lead to more advanced stages.
• Proliferative retinopathy
This consists of the more serious changes that occur when new, abnormal blood vessels begin growing on the surface of the optic nerve or the retina. These new blood vessels are weaker and may rupture and cause bleeding inside the eye.
Also, these abnormal blood vessels frequently grow scar tissue with them which may cause a retinal detachment or glaucoma.
Causes and Symptoms
The cause of diabetic retinopathy is not completely understood. Early changes in the eye can go unnoticed unless discovered during a thorough eye examination.
Detection and Diagnosis
A comprehensive eye examination and appropriate treatment by an ophthalmologist is the best protection against eye damage due to diabetes. Serious retinopathy can be present without symptoms.
Treatment
When diabetic retinopathy is discovered, the ophthalmologist considers several factors before deciding if observation or treatment is most appropriate. When treatment is needed, a laser is usually used to seal or shrink the leaking blood vessels. Other treatments may include injections in or around the eye or vitrectomy surgery.
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Macular Degeneration
What is Macular Degeneration?
Macular degeneration is the breakdown and damage of the central retina, or macula. This small area in the back of the eye allows us to see fine details clearly. If there is damage to the macula, the central part of our vision becomes distorted, blurry or dark. It is one of the leading causes of vision loss in the United States. Macular degeneration affects both near and distant vision. Also, it can make some activities, like reading or threading a needle, difficult or impossible.
Although macular degeneration affects the central part of vision, it does not affect peripheral vision. As a result, macular degeneration alone does NOT lead to total blindness. People continue to have some useful vision and are able to take care of themselves.
Many older people develop macular degeneration as part of the body's natural aging process.
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| Examples of what a person with macular degeneration sees |
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| Retinal damage from macular degeneration |
Causes of Macular Degeneration
Many older people develop macular degeneration as part of the body's natural aging process.There are two main types:
•Dry (atrophic) macular degeneration
The most common type (90%). It is caused by aging, degeneration and thinning of the tissues of the macula. Vision loss is usually gradual and not as severe. There are no good treatments for this condition. This type only accounts for 10% of blindness related to macular degeneration.
•Wet (exudative) macular degeneration
This is present in about 10% of cases, but is responsible for 90% of the blindness associated with this condition. It results when abnormal blood vessels leak fluid or blood in the central retina. These changes can cause rapid and severe vision loss with possible permanent scarring. Some newer treatment may help with this condition.
Symptoms
Symptoms vary from person to person. Sometimes, one eye loses vision while the other eye continues to see well. Some common visual symptoms include:
- Dark or empty areas in the central part of vision
- Straight lines appear distorted
- Words appear blurred when reading
Diagnosing Macular Degeneration
This requires a thorough eye exam that may include special vision tests, high magnification views of the retina, and occasionally special diagnostic tests and photographs.
Risk Factors of Macular Degeneration
- Increasing age
- Light eye color
- Smoking
- Elevated cholesterol levels
- Cardiovascular disease
- Family history
Treatment
Despite extensive research, there is still no cure for "dry" macular degeneration. A recent study, the Age Related Study (AREDS) demonstrated a benefit in slowing the progression of dry macular degeneration by taking anti-oxidants, minerals and vitamins. Specifically, they used vitamins C and E, beta carotene, zinc and copper. Other studies suggest that lutein may also be beneficial. A variety of vitamin formulations are available over-the-counter or by mail order. "Wet" macular degeneration can be treated with lasers that may be combined with some intra-ocular treatments during its early stages. However, this treatment rarely makes the vision any better. Instead, it is primarily designed to prevent further loss of vision. Despite proper medical treatment, many people with macular degeneration still experience vision loss.
A wide range of support services and rehabilitation programs are available. Since peripheral vision is usually unaffected, this remaining vision is very useful. Often, people can continue with many of their favorite activities by using low vision optical devices.
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Presbyopia
What is Presbyopia?
Presbyopia is a normal, age related change in vision in which the lens of the eye gradually loses its flexibility and affects the focusing ability of the eye. This affects near vision. People may notice that their arms seem too short and that it takes longer to refocus their eye when looking from far to near.
Causes of Presbyopia
As we age, body tissues naturally lose their elasticity. In presbyopia, the lens of the eye loses its elasticity. This happens gradually over several years. However, it may appear to happen suddenly only because it has not previously impaired vision to such a significant degree.
The lens, cornea, and the shape of the eye help focus light precisely on the retina. In youth, the lens is very flexible and focuses on near and distant objects by bending or flattening out to help focus light rays. With age, the lens loses some of this flexibility and has more difficulty bending enough to focus on near objects. In addition to losing its ability to bend, the lens responds more slowly and takes longer to adjust to rapid changes in focus.
When does it occur?
The flexibility of the lens actually begins to diminish in youth. The onset of symptoms varies, but it usually begins to interfere with near vision in the late 30's and early 40's. It affects everyone eventually and there is no known prevention for the problem.
Symptoms
- Difficulty Reading
- Holding reading materials further away to see them
- Eye fatigue with reading
- Headaches with reading
- Delay in focus from near to far
Treatment
The usual treatment is prescription reading glasses. These help focus light rays more effectively to compensate for the loss of flexibility of the lens. Some people with no other eye conditions, such as astigmatism or nearsightedness, may only need to wear glasses for reading and other near tasks. Contact lenses are also an option for many people. In addition, new multifocal intraocular lens implants can help people see more clearly at distance and near. Another option may be an accommodating IOL. This involves lens removal surgery (cataract surgery) and implantation of an implant that changes shape and/or focus. The effectiveness of this procedure is still under debate. Although it may be aggravating to acknowledge that we are growing older, these changes are normal, gradual, and should not cause significant disruptions to a person's lifestyle.
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Dry Eye
What is Dry Eye?
Dry eye occurs when a person does not produce enough tears or the quality of the tears is not appropriate to keep the surface of the eyes healthy and comfortable. Normally, the eye produces tears at a constant slow and steady rate. This helps keep the eye moist and comfortable. If this system breaks down, dry eyes become the result.
Symptoms
The usual dry eye symptoms are
- Stinging or burning eyes
- Scratchiness or a foreign body sensation
- Excessive tearing
- Excessive eye irritation
- Discomfort when wearing contact lenses
Excess tearing caused by dry eyes may sound illogical. However, if the tears responsible for maintaining lubrication are inadequate to keep the surface of the eye moist and comfortable, the eye becomes irritated. The excessive eye irritation causes the tear gland to over compensate and results in a large volume of tears flooding the surface of the eye and overwhelming the tear drainage system.
Causes
Tear production normally decreases with age and appears to be affected by changes in hormonal levels. As a result, post-menopausal women are at the highest risk for dry eyes.
Several medications, both prescription and over-the-counter can cause dry eye problems. The most common medications include diuretics, beta blockers, anti-histamines, pain medications, or certain sleeping medications.
In addition, certain medical conditions may predispose patients to having dry eye problems. Individuals with Sjogren’s syndrome (dry eyes, dry mouth, and arthritis), lupus, rheumatoid arthritis, or certain other auto-immune or connective tissue diseases have a higher risk of this condition.
Frequently, dry eyes related to these conditions are more difficult to treat.
Certain activities are frequently associated with dry eye symptoms. Any activity that requires a person to concentrate may cause dry eye problems. We typically relubricate our eyes by blinking. However, when we concentrate on a particular task (reading, computer work, sewing, crossword puzzles) our blink rate decreases. This in turn leads to less lubrication of the surface of the eye and to dry eye symptoms.
Testing
Dry eyes can usually be diagnosed by a careful examination of the eyes and tear film. Certain tests can be used to measure the quantity of tears produced (Schirmers testing) or the quality of the tear film (tear break up time). In addition, several dyes can be used to diagnose particular patterns of dryness of the surface of the eye.
Treatment
The primary method to relieve dry eyes is to increase the amount of tears on the surface of the eyes. This is done by using artificial tears (lubricating eye drops). Several brands are available and they are all over-the-counter medications. Artificial tears are available in two types, with or without preservatives. Individuals that need to use artificial tears more than 5 or 6 times a day or who have had recent ocular surgery should consider using preservative free tears. Some artificial tears come in thicker solutions “liquid gels” (syrup-like consistency), gels, or ointments. The thicker the lubricant the longer the effect, but this also results in temporary blurry vision following treatment.
In addition, patients can attempt to conserve more of their own natural tears. Typically, tears drain away from the eye through openings on the upper and lower eyelids. These openings may sealed either temporarily (punctal plugs) or permanently. This allows a patient to conserve their own tears and helps artificial tears last longer.
For some individuals, the primary cause of dry eyes is microscopic inflammation on the surface of the eyes. This is more frequently seen in patients with autoimmune and connective tissue diseases. Prescription eye drops are now available that reduce this inflammation and improve the health of the surface of the eye. This leads to less irritation of the eye and fewer symptoms and tearing problems.
Some individuals may also benefit by taking oral fish oil supplements that may improve the quality of the tear film.
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