Glaucoma
Glaucoma
Glaucoma is a disease that affects the optic nerve, the part of the eye which receives images collected by the retina and sends them to the brain. Every eye maintains a certain amount of internal pressure, called intraocular pressure. When this pressure rises to abnormal levels however, it can put extra stress on the optic nerve, causing significant damage. Optic nerve damage results in loss of vision, and ultimately blindness.
The front of the eye is constantly producing a fluid called aqueous humor. A healthy eye will continually produce small amounts of aqueous humor to ensure consistent pressure within the eye. When normal drainage becomes slowed or blocked, pressure increases, and may lead to glaucoma. There are several different types of glaucoma the two most common types being chronic open-angle glaucoma and closed-angle glaucoma.
Chronic open-angle glaucoma is the most common form of the disease and usually develops with age. With this type of glaucoma, pressure gradually increases around the eye causing it to work less effectively over a period of time. There are no symptoms in the early stages of open-angle glaucoma. Peripheral vision is usually the first to deteriorate. As the disease becomes more advanced, blank spots begin to appear in one’s vision. If left untreated, it eventually develops to blindness. The best way to avoid serious vision loss is early diagnosis and treatment.
Risk factors for chronic open-angle glaucoma include:
- Advanced age
- Family history of the disease
- Higher-than-normal intraocular pressure
- Certain ethnic races, particularly those of African descent
- Certain diseases or conditions, especially diabetes, farsightedness or nearsightedness, or previous eye trauma or surgery
Closed-angle glaucoma is less prevalent, but is considered a real eye emergency. This type of glaucoma occurs when a patient’s pupil moves or dilates and actually blocks off the drainage angles in the eye. This is considered a medical emergency in which an ophthalmologist should be contacted immediately to avoid any loss of vision.
Symptoms of closed-angle glaucoma include:
- Severe eye pain
- Headache
- Blurred vision
- Nausea or vomiting
- Rainbow halos around lights
High risk factors for closed-angle glaucoma include:
- Extreme farsightedness
- An iris that is abnormally large or far back in the eye
- Advanced age
- Heredity
- Certain ethnic races, especially Asians
Treatments for glaucoma:
There are a wide range of treatments for the disease, including medication, laser surgery and traditional surgery. The treatment (or combination of treatments) for an individual is chosen based upon the type of glaucoma and other details of the particular case. One option is medication such as prescription eye drops which help to reduce intraocular pressure, or pills called carbonic anhydrase inhibitors which slow down fluid production within the eye.
Laser surgery has also become a common treatment option for glaucoma. For open-angle glaucoma the doctor may choose a trabeculoplasty, a painless laser procedure which uses light to shrink and stretch eye tissue to allow more drainage of fluid. For closed-angle cases, in which the iris is blocking drainage of aqueous humor, a laser surgery called iridotomy may be preformed.
Other glaucoma treatment options involve various traditional surgeries. A common surgery for open-angle glaucoma is the trabeculectomy, where a doctor creates a small flap in the sclera (white part of the eye). Underneath the surface of the sclera, the doctor creates a small reservoir, called a filtration bleb, into which aqueous fluid may drain and then be disbursed, further reducing intraocular pressure.
There are a number of treatments available for Glaucoma patients. If diagnosed with glaucoma, your ophthalmologist will consult with you on your options in order to maintain the best possible health of your eyes.
Cataract Surgery
Cataract Surgery
A cataract is an opacity that clouds the natural lens inside the eye. Normally the path of light to the retina (where the light sensors are) is as clear as possible. When proteins that make up the lens clump together, the resulting cataract blocks some of the light, making vision blurry or hazy.
Cataracts typically occur more frequently in the aging population, however there are many other factors such as family history, diabetes, long term UV exposure, or certain medications like steroids that can cause cataracts. Also, previous eye injuries can be an attributing factor.
Cataract symptoms may include:
- Blurry Vision
- Lights seem too bright or have a “halo” effect
- Double vision in one eye
- Decreased night vision – sensitivity to glare from headlights
- Dull or fading colors
Some people actually experience an improvement in their near vision during the beginning stages of a cataract. Unfortunately, this effect goes away as the disease progresses. Early on, a cataract may be treated with increased glasses or contact prescription. Once the cataract begins to interfere with daily tasks such as reading and driving, surgery is the only remaining option.
Cataract Surgery
Cataract surgery is a very common procedure, and complications (if any) are rare and treatable. The surgery itself is highly successful in improving the vision of patients about 95% of the time. Cataract surgery is an outpatient procedure usually taking less than 30 minutes to complete.
During the surgery, the doctor removes the cloudy natural lens from the eye while the patient is under a topical anesthesia. Next, the doctor inserts an intraocular lens (IOL), which remains permanently in place of the removed natural lens. The IOL compensates for the magnification the old lens provided. Modern IOLs are designed for various functions and made out of different materials; your doctor will know which is most appropriate for your individual case. After the operation the doctor will apply a shield for the eye and provide you with eye drops to use as directed.
Recovery from Cataract Surgery
The patient may return home the day of the procedure. With proper rest and avoidance of any strenuous activities such as heavy lifting, recovery is usually a matter of days, with only minor discomfort. Several follow up appointments will be required to ensure the eye is healing properly and initial results are sustained.
Macular Degeneration
Macular Degeneration
Macular degeneration affects cells in the macula, which is the part of the retina responsible for central vision. Central vision is essential for most basic tasks like reading, driving, recognizing people, etc. Thus, although macular degeneration leaves peripheral vision un-impaired, it can be quite debilitating in its advanced state.
The disease exists in two forms, dry and wet.
Dry macular degeneration is by far the most common (roughly 90% of all cases). However, it is the milder of the two forms, develops gradually, and usually leads to only minor vision loss. Dry macular degeneration tends to occur when yellow fatty particles called drusen accumulate in the retina underneath the macula. This build-up results in thinning and drying-out of the macular cells.
Wet macular degeneration is less common, but the vast majority of severe vision loss cases result from this form. First, abnormal blood vessels form underneath the surface of the retina. Leakage of blood and other fluids from these blood vessels permanently damage the outside cells (which detect incoming light). As these cells are damaged, vision is lost.
The primary cause of macular degeneration remains unknown. Macular degeneration typically occurs more frequently in the aging population with patients over 60. Research has shown there are many other factors such as family history, smoking, hypertension, obesity, and/or a high cholesterol, high fat diet that may contribute towards the development of macular degeneration.
Macular degeneration symptoms may include:
- Shadows, blurriness, or holes in the center of vision
- Straight lines appear wavy
- Trouble seeing details both up close and at a distance
- Difficulty telling colors apart, especially ones close in hue
- Vision can be slow to come back after bright light exposure
Treatments for macular degeneration:
Unfortunately, there is no treatment for the dry form of macular degeneration. Those at high risk should schedule a checkup with their ophthalmologist at least once every one to two years, to catch the disease in its infancy. Also, it is thought that dietary supplementation of antioxidants and zinc may help to slow its development.
There is also no cure for wet macular degeneration. There are, however, several treatments designed to combat the disease. Early detection is very important because once vision is lost there is no treatment to regain it.
Closed-angle glaucoma is less prevalent, but is considered a real eye emergency. This type of glaucoma occurs when a patient’s pupil moves or dilates and actually blocks off the drainage angles in the eye. This is considered a medical emergency in which an ophthalmologist should be contacted immediately to avoid any loss of vision.
Treatments for wet macular degeneration:
- Laser photocoagulation: Seals abnormal blood vessels with a heated laser. This treatment will sometimes halt the disease, thus saving the remaining vision of a patient. However, the laser leaves a scar, creating a permanent blind spot in the patient’s vision. The treatment is only applicable to a small segment of cases, in which some vision is sacrificed to save remaining vision.
- Photodynamic therapy: Employs a light-activated drug and a “cold” laser. The drug is injected intravenously. Then the doctor shines the laser on the affected area, which activates the drug in the targeted tissue and blocks the leaking blood vessels. This procedure leaves no scar, and may be repeated several times as necessary.
- Anti-angiogenesis drugs: These inhibit proteins which contribute to abnormal blood vessel growth. They are known as anti-VEGF (anti-vascular endothelial growth factor) drugs. There are a variety of drugs that can be applicable for this purpose, some FDA approved, and some off-label (officially approved for a different application).
- Other pharmaceutical treatments: For example, angiostatic treatments, which combat blood vessel growth with steroid injections.
Diabetic Retinopathy
Diabetic Retinopathy
Diabetes (diabetes mellitus) is a common disease in which blood-sugar levels are chronically too high. The disease has many related complications, and several eye diseases among them. The most common eye complication of diabetes is diabetic retinopathy, a leading cause of adult blindness.
Diabetic retinopathy occurs when high blood-sugar levels affect the functionality of blood vessels in the retina (light-sensing cells in the eye). In early phases of the disease, capillaries will leak blood or fluid. This can cause swelling in the retina (which may result in blurring of central vision), and it can leak into the vitreous humor (the fluid surrounding the retina) causing floaters or obscuring vision.
During the beginning stage serious vision damage is less likely, however, it can lead to a more advanced stage of the disease, called proliferative diabetic retinopathy. In this form, blood vessels in the retina actually close off. New blood vessels grow to make up for the lack of blood flow to the retina. The new blood vessels unfortunately are accompanied by scarring and more leakage. This can lead to serious vision loss and blindness.
Early symptoms of diabetic retinopathy may include:
- Decreased night vision
- Floaters or obscuring vision
- Blurry vision
The condition can typically be diagnosed by an ophthalmologist during an eye exam, long before noticeable vision symptoms occur and when more treatment options are still available. Thus it is very important for those suffering from diabetes to have regular eye exams, to monitor for diabetic retinopathy and other complications.
Treatment:
Treatments for diabetic retinopathy vary based upon the nature and progression of the condition. The best way to preserve good vision is to vigilantly control blood-sugar levels, lessening the chance of retinopathy, and impeding its rate of advancement.
Once the disease is in advanced stages, the ophthalmologist may choose a type of laser surgery, called pan-retinal photocoagulation. This technique burns many tiny dots across the retina, with the aim of sealing off leaky blood vessels and discouraging further blood vessel growth. This surgery does not cure diabetic retinopathy, but it can help to save remaining vision.
If the vitreous humor has become clouded by blood leakage, there is a chance it may be naturally purged by the eye. If clouding persists, however, a vitrectomy, a surgical removal of the vitreous humor, may be necessary. The ophthalmologist replaces it with a saline solution, and the eye naturally replenishes the vitreous fluid over time. This procedure can restore vision that has been obscured in the vitreous, however, any vision loss due to retinal damage or detachment is not restored.
Dry Eye
Dry Eye
Dry eye syndrome is a common disease in which the eye under-produces tears or tears leave the eye too quickly. A normal functioning eye constantly produces tears to form a tear film, which acts as moisturizer and lubricant. For someone with dry eye, the resulting lack of moisture and lubrication can cause a variety of problems.
Dry Eye symptoms may include:
- A burning, stinging, or scratchy sensation in the eyes
- Eyes may redden and become easily irritated by wind or smoke
- The eyes may produce stringy mucus
- Contact lenses may be difficult or impossible to wear
- Sometimes the eye will actually produce excessive tears, and overflow*
*Though it sounds contradictory, sometimes the eye will actually produce excessive tears, and overflow. The eye becomes irritated by the lack of lubrication and attempts to cleanse itself with a flood of tears. This is a similar phenomenon to the tearing that occurs when foreign matter is stuck in one’s eye.
Dry eye syndrome is typically more common in older people and women; however, there are many other factors that can cause this to happen. A common cause of dry eye can be over the counter and prescription medications such as antihistamines, beta-blockers, sleeping pills, pain relievers and many others. Overuse of diuretics can also play a role in developing dry eye. For this reason, it is very important to inform your ophthalmologist about any medications you are currently taking, which can help the doctor in the proper diagnosis of the disease.
Sometimes the cause is unknown in a case of dry eye. Known causes of dry eye may be natural, related to a larger condition, or the side effect of certain medications. Also, tear production often slows down as people get older. This is particularly common for women after menopause.
Treatments for dry eye:
- Artificial tears: Mild to moderate cases of dry eye syndrome may be treated by applying artificial tear eye drops as little or as often as necessary. There are a wide range of products available without a prescription that the doctor can recommend.
- Prescription medications: Can sometimes increase tear production for those with chronic dry eye. It does this by targeting inflammation in the eye.
- Conserving tears: An effective way to make better use of the tears in the eye is surgery to close the tear ducts, thus preventing existing tears from leaving the eye as quickly. This may be done temporarily, with punctal plugs made of collagen, or permanently with silicone plugs or by cauterizing the tear ducts closed.
- Controlling one’s environment: Patients should avoid situations in which tears evaporate quickly; for example, by using a humidifier in a dry house, wearing wrap-around glasses in the wind, and not smoking.
Eyelid Surgery
Eyelid Surgery
Blepharoplasty is an eyelid surgery that can be performed to improve visual function and cosmetic appearance. Excessive upper eyelid tissue can block the upper field of vision. Correction of the overhanging skin folds will improve the function of the upper eyelid and peripheral vision. Even if vision is not affected, Blepharoplasty may be performed to give a rejuvenated appearance to the surrounding area of your eyes making you look more rested and alert.
What causes the excess eyelid tissue?
Sun, diet, gravity, heredity and poor skin care can cause the skin around the eyes to loosen and relax. Over time, sagging occurs from the force of gravity pulling down the eyelid tissue.
What are the symptoms that indicate a Blepharoplasty is needed?
Excessive eyelid tissue can cause physical discomfort, limited field of vision, brow aches and fatigue. In some cases the eyelashes actually turn inward and irritate the eye.
How is Blepharoplasty performed?
Excess skin and fatty tissue are removed around the eyes. Fine incisions are made hidden in the natural skin folds of the eyelids. Incision lines may initially appear as small as red marks which fade over time. The fine hairline scars become virtually unnoticeable.
What is the Recovery like after eyelid surgery?
After eyelid surgery, there will be stitches in both upper lids that will remain for about 10 days. It is common for swelling and some bruising to occur, but within 1 to 2 weeks the eyelids will look normal depending on the patients rate of healing. Quiet rest with the head elevated is recommended after surgery to relieve any discomfort. Cold compresses are applied to reduce swelling and bruising. An antibiotic ointment is applied to the suture line a couple of times a day for the first week after surgery.
What type Anesthesia is normally used?
Local anesthesia is injected into the skin around the lids and a calming medication is given. The final outcome depends on the patient’s skin structure and healing process.
Is Blepharoplasty safe?
Healthy individuals who do not have a life threatening illness or medical condition that impairs healing are normally good candidates for eyelid surgery.
Tell your doctor if you have any of these medical conditions:
- Eye diseases such as dry eye
- Thyroid disorders such as Graves Disease or under or overactive thyroid
- Diabetes, High blood pressure, or other circulatory disorders
General Eye Examination
General Eye Examination
A thorough eye examination consists of a variety of standard tests designed to measure visual acuity and other vision faculties, as well as observe the health of the eye and check for common eye diseases. There is no pain or discomfort associated with an exam, and they typically take less than an hour.
General eye exams can diagnose a variety of eye conditions early on and are the best way to preserve good vision. For children, strabismus (crossed eye) and amblyopia (lazy eye) can often be diagnosed and treated in early childhood, avoiding life-long vision impairment. Also, rare eye conditions from birth (like congenital cataracts) can be diagnosed and treated. For all ages, refraction tests can determine whether prescription eyewear would be beneficial, and what power is necessary. Furthermore, many debilitating eye diseases can be diagnosed before noticeable symptoms occur, potentially making the difference between minor damage and major vision loss.
Eye exams are recommended regularly throughout all phases of one’s life. In the first three years, infants should have their vision checked as part of regular pediatric checkups. Between age three and six, an eye exam every year or two is recommended. Throughout childhood and the teenage years, exams should be scheduled as necessary. Adults should have at least one exam in their twenties, at least two in their thirties, and an exam every two to four years after that. Exams are recommended for seniors every one to two years. People with diabetes should have at least one exam per year. Exams are also more frequent for patients monitoring a diagnosed eye condition, or with a hereditary predisposition to an eye disease.
Common tests and evaluations during an eye exam include:
- Introductory interview: The doctor will ask basic questions about a patient’s medical history and eye health history.
- External examination: The doctor inspects all outward visible parts of the eye and surrounding tissue.
- Pupil inspection: The patient’s pupils will be inspected for equal size and regular shape. Then the doctor tests how they react to light and objects at various distances.
- Eye muscle health and mobility: Eye movement is checked in six directions (corresponding to the six extraocular muscles), as well as tracking a moving object (such as a pen).
- Visual field: The patient covers one eye at a time, and with the other eye gazing straight ahead, identifies objects in peripheral vision (often simply the number of fingers the doctor is showing.)
- Visual acuity: A common means of measuring visual acuity is the Snellen chart. This is a large card or projection with progressively smaller horizontal lines of random block letters. The test determines how well a patient can discern detail at a given distance. Patients taking this test will cover one eye and then read aloud the letters of each row, starting from the top. The smallest row that can be accurately read indicates the patient’s visual acuity in that eye.
- Refraction: This test is used to find the best corrected vision, if necessary for prescription eyewear or contacts. The doctor will try various lenses in front of each eye, as the patient focuses on a chart at a distance or up-close, to help determine the best power of correction.
- Color vision: The doctor shows the patient a series of images with symbols embedded in color dots or patterns. Based upon the patient’s ability to identify the symbols, certain types of colorblindness can be diagnosed or ruled out.
- Ophthalmoscopy: This test is often done with an ophthalmoscope, a handheld instrument with light and magnifying lenses. Alternatively, the doctor may use other means, such as a slit lamp, which affords a more three-dimensional view. Ophthalmoscopy aims to inspect the retina and surrounding internal eye. This test can help diagnose problems with the retina or detachment of the retina, and monitor diseases like glaucoma and diabetes. An opacity in the eye can indicate a cataract. Sometimes the doctor will dilate the pupils with eye drops, to gain a wider view of the internal eye.
- Tonometry: This test measures intraocular pressure, which can be a sign of glaucoma if pressure is abnormally high. Internal eye pressure is measured either with a puff of air at the cornea or brief direct contact with the cornea, to measure how easily it is pushed inward.
Laser Vision Correction Exam
Laser Vision Correction Exam
Is Laser Vision Correction right for you? If you’re tired of wearing eyeglasses or contact lenses, you may wonder whether LASIK or PRK surgery is best for you. Photorefractive keratectomy (PRK) is a type of laser eye surgery used to treat nearsightedness, farsightedness, and astigmatism by reshaping the cornea.
- Do you suffer from nearsightedness, farsightedness, or astigmatism?
- Do you find glasses or contacts cumbersome or uncomfortable, and wish you could reduce their prescription or discard them?
If you answered “YES” to either of these questions, you may be a good candidate for PRK or other vision corrective surgery. Before the decision can be made however, you must have an eligibility exam and consultation. The doctor will ask questions about your medical history and give a thorough eye exam designed to determine if the procedure is appropriate for your individual case. The doctor will also talk about the benefits, risks, available options, and preparation and recovery associated with the surgery to ensure that your goals and expectations are realistic.
Advantages of PRK
- An estimated 90 to 95 percent of people who undergo PRK achieve 20/40 vision or better without wearing glasses or contacts. You may still need glasses for reading and nighttime activities, and vision typically declines with age.
- PRK can achieve the same long term benefits as LASIK.
- PRK may be an alternative option for people who are not good candidates for LASIK, including patients with thin corneas.
- Athletes may be better candidates for PRK rather than LASIK. During LASIK, a flap is made in the cornea and can become dislocated by contact or injury.
Photorefractive Keratectomy (PRK)
Laser refractive surgery has seen a significant increase in popularity over the past decade. This popular procedure is done as a corrective measure for those suffering from nearsightedness, farsightedness and astigmatism. Millions of these procedures have been performed throughout the country with an overwhelming rate of satisfaction.
If you wish to be free from glasses or contacts, or just want to greatly improve your vision, corrective laser eye surgery could be the solution. There are many different types of laser surgeries offered today. Consult with your doctor on which option is best for you.
Reasons to consider PRK:
- Nearsightedness (myopiaa)
- Farsightedness (hyperopiaa)
- Astigmatism (irregularly shaped cornea)
- Cornea too thin for LASIK
- Pupil too large for LASIK
The Procedure
In preparation for surgery, anesthetic eye drops are administered. Next, a speculum is placed in the eye to keep the eyelids open, which is normally not uncomfortable. While the patient fixes his or her gaze on a target, the laser reshapes the cornea by removing tissue (a process called ablation), which is controlled and closely monitored by the doctor. The laser is actually guided by a detailed map of the patient’s eye which has been programmed into a computer beforehand. The ablation usually takes around a minute for each eye, depending on how high the patient’s vision prescription is. Most patients feel no pain during the procedure. After the procedure is complete, a bandage contact lens is placed on the eye. The patient may go home shortly after the procedure; however, someone else must drive or alternate transportation must be arranged.
The Recovery
The doctor may prescribe pain medication for recovery; however, most patients don’t require it since only minor discomfort is experienced. The doctor will also schedule several check-up appointments to monitor the healing process, followed by periodic visits over the next several months. During the recovery process, the patient should rest, and refrain from any strenuous activities for at least a week. Most patients can return to work in a day or two, though it is best to take a few days off to ensure a smooth recovery.
