Glaucoma is
a disease in which the pressure in the eye is high enough to damage the
optic nerve, leading to a gradual loss in vision that can result in total
blindness. Since peripheral (side) vision is affected first, which tends
to be unnoticed, and most forms of glaucoma do not cause eye pain, virtually
all patients are checked for the presence of this “sneak thief
of sight.”
You are at greater risk for glaucoma if you have a family history of
glaucoma, are diabetic, African American, highly nearsighted or over
40 years of age.
In order to diagnose glaucoma, three areas of the visual system must
be checked: the eye pressure, the health of the optic nerve and peripheral
vision.We check eye pressure using a blue light called a Goldmann tonometer.
Studies have found this is the most accurate way to check eye pressure,
and most patients find it more comfortable than the “puff of air” technique.
Results can be artificially high if the front surface of the eye, the
cornea, is thicker than average. When this is suspected, corneal thickness
is checked using an instrument called a pachymeter. Average eye pressure
is 16 mmHg, but the “normal range” is considered under 21
mmHg. This is a bit misleading in that approximately one-third of patients
with glaucoma have eye pressure within this range. These patients have
a sensitive optic nerve that is damaged even in the presence of low pressure.
High eye pressure can be due either to an overproduction of fluid (aqueous)
within the eye or blockage of the fluid drainage system.
The optic nerve is evaluated using a variety of methods. The first
method is to use a light, called an ophthalmoscope, to look in the eye
and evaluate the size of the depression, or cup, in the head of the optic
nerve and the health of the surrounding rim. A more detailed
analysis is now possible using a retinal tomographer,
which provides a very precise three dimensional picture of the optic
nerve head. This allows us to detect damage three to six years sooner
than what can be detected using older techniques.
Peripheral vision is measured using a visual field analyzer.
The patient looks straight ahead into the instrument while small spots
of light flash off to the side. When a flash is seen, the patient depresses
a button. The flashes are made dimmer and dimmer until the patient can’t
see them anymore. This tells us what the “threshold of vision” is
throughout the patient’s field of vision.
In most cases glaucoma can be very effectively controlled using prescription
eye drops once or twice a day. In some cases, laser treatment or surgery
may be necessary to reduce pressure.
Macular
degeneration is the leading cause of blindness
in America. It results from changes to the macula,
a portion of the retina that is responsible for clear, sharp vision
and is located at the back of the eye. Most people with macular
degeneration have the dry form. Recent studies have show certain
nutritional supplements such as vitamins A and E, zinc and leutin
can help stabilize vision. Protection from ultraviolet light can
also be helpful. The less common wet form may respond to laser
procedures, if diagnosed and treated early.
Some common symptoms are a gradual loss of ability to see objects clearly,
distorted vision, a gradual loss of color vision and a dark or empty
area appearing in the center of vision.
Central vision that is lost to macular degeneration cannot be restored.
However, vision rehabilitation services utilizing
devices such as telescopic and microscopic lenses can be prescribed to
make the most out of remaining vision.
Conjunctivitis,
commonly known as “pink eye”, is an inflammation of the conjunctiva,
the thin, transparent layer that covers the white part of the eye and
wraps around to cover the inner eyelid.
The three main types of conjunctivitis are infectious, allergic and
chemical. The infectious type is caused by a contagious virus or bacteria.
Your body's allergies to pollen, cosmetics, animals or fabrics often
bring on allergic conjunctivitis. And, irritants like air pollution,
noxious fumes and chlorine in swimming pools may produce the chemical
form.
Common symptoms of conjunctivitis are red watery eyes, inflamed inner
eyelids, a scratchy feeling in the eyes and, sometimes, a thick or watery
discharge. Conjunctivitis can sometimes develop into something that can
harm vision so you should see us promptly for diagnosis and treatment.
Most forms of conjunctivitis respond very effectively to prescription
eyedrops.
To control the spread of infectious conjunctivitis, keep your hands
away from your eyes, thoroughly wash your hands before applying eye medications
and do not share towels, washcloths, cosmetics or eye drops with others.
Dispose of any contact lenses worn or cosmetics used when diagnosed with
conjunctivitis.
A cataract is
a clouding of all or part of the normally clear crystalline
lens within the eye, which results in blurred or distorted vision.
Cataracts are most often found in persons over age 55, but they can sometimes
be found in younger people.
Cataract formation is associated with excessive exposure to ultraviolet
radiation in sunlight, aging, injury, diseases such as diabetes, use
of certain medications, or an inherited predisposition.
Although cataracts develop without pain or discomfort, there are some
indications that a cataract may be forming. These include blurred or
hazy vision, increased sensitivity to glare or the feeling of having
a film over the eyes. A temporary improvement in near vision may also
indicate formation of a cataract. Currently, there is no proven method
to prevent cataracts from forming. However, cataract surgery is the most
common eye surgery today and results are nearly universally very good.
Anterior
uveitis or Iritis is
an inflammation of the middle layer of the eye, which includes
the iris (colored part of the eye)
and adjacent tissue, known as the ciliary
body. If untreated, it can cause permanent damage and loss
of vision from the development of glaucoma, cataract or retinal
edema (swelling). It usually responds well to treatment; however,
there may be a tendency for the condition to recur. Treatment usually
includes prescription eye drops, which dilate the pupils, in combination
with anti-inflammatory drugs. Treatment usually takes several days,
or up to several weeks, in some cases.
Anterior uveitis can occur as a result of trauma to the eye, such as
a blow or foreign body penetrating the eye. It can also be a complication
of other eye disease, or it may be associated with general health problems
such as rheumatoid arthritis, rubella and mumps. In most cases, there
is no obvious underlying cause.
Symptoms may include a red, sore and inflamed eye, blurring of vision,
sensitivity to light and a small pupil. Since the symptoms of anterior
uveitis are similar to those of other eye diseases, we will carefully
examine the inside of your eye to determine the presence and severity
of the condition. We may also perform or arrange for other diagnostic
tests to help pinpoint the cause.
Retinitis
pigmentosa (RP) is a group of inherited diseases
that damage the light-sensitive rods and cones located in the retina,
the back part of our eyes. Rods, which provide side (peripheral)
and night vision are affected more than the cones, which provide
color and clear central vision.
Signs of RP usually appear during childhood or adolescence. The first
sign is often night blindness followed by a slow loss of side vision.
Over the years, the disease will cause further loss of side vision. As
the disease develops, people with RP may often bump into chairs and other
objects as side vision worsens and they only see in one direction – straight
ahead. They see as if they are in a tunnel (thus the term tunnel vision).
Fortunately, most cases of retinitis pigmentosa take a long time to
develop and vision loss is gradual. It may take many years for loss of
vision to be severe.
Currently, there is no cure for RP, but there is research that indicates
that nutritional supplements vitamin A and lutein may slow the rate at
which the disease progresses.
Also, there are many vision rehabilitation
services, using tools such as telescopic and magnifying lenses,
night vision scopes as well as other adaptive devices, that are available
to help people maximize their vision.
Since it is an inherited disease, research into genetics may one day
provide a prevention or cure for those who have RP.
Dry eye happens
when your eyes do not produce enough tears or that you produce tears
which do not have the proper chemical composition. The tears your eyes
produce are necessary for overall eye health and clear vision. Often,
dry eye is part of the natural aging process. It can also be caused by
blinking or eyelid problems, medications such as antihistamines, oral
contraceptives and antidepressants, a dry climate, wind and dust, general
health problems like arthritis or Sjogren's syndrome, and chemical or
thermal burns to your eyes.
Symptoms may include irritated, scratchy, dry, uncomfortable or red
eyes, a burning sensation or feeling of something foreign in your eyes,
and blurred vision. Excessive dry eyes may damage eye tissue, scar your cornea (the
front covering of your eyes) and impair vision and make contact lens
wear difficult.
Dry eye can be treated with use of lubricating drops or prescription
eye drops that reduce the inflammation associated with dry eye. Devices,
called punctual plugs, can also be used to prevent the tears from draining
as quickly from the eye, allowing them to stay on the surface of the
eye longer to nourish the tissue.
Diabetes is
a disease that interferes with the body's ability to use and store sugar
and can cause many health problems. One, called diabetic retinopathy,
can weaken and cause changes in the small blood vessels that nourish
your eye's retina. These blood vessels may begin to leak, swell or develop
brush-like branches.
The early stages of diabetic retinopathy may cause blurred vision, or
they may produce no visual symptoms at all. As the disease progresses,
you may notice a cloudiness of vision, blind spots or floaters.
If left untreated, diabetic retinopathy can cause blindness, which is
one reason why it is important to have your eyes examined regularly in
our office. This is especially true if you are a diabetic or if you have
a family history of diabetes.To detect diabetic retinopathy, we look
inside your eyes with an instrument called an ophthalmoscope that lights
and magnifies the blood vessels in your eyes. If you have diabetic retinopathy,
laser and other surgical treatments can be used to reduce its progression
and decrease the risk of vision loss. Early treatment is important because
once damage has occurred, the effects are usually permanent.
If you are a diabetic, you can help prevent diabetic retinopathy by
taking your prescribed medication as instructed, sticking to your diet,
exercising regularly, controlling high blood pressure, avoiding alcohol,
don’t smoke and have your eyes examined at least yearly.
Keratoconus is
a vision disorder that occurs when the normally smooth surface of the
eye, the cornea becomes thin and irregularly
(cone) shaped. This abnormal shape prevents the light entering the eye
from being focused correctly on the retina and causes distortion of vision.
In its earliest stages, keratoconus causes slight blurring and distortion
of vision and increased sensitivity to glare and light. These symptoms
usually appear in the late teens or late twenties. Keratoconus may progress
for 10-20 years and then slow in its progression. Each eye may be affected
differently. As keratoconus progresses, the cornea bulges more and vision
may become more distorted. In a small number of cases, the cornea will
swell and cause a sudden and significant decrease in vision (corneal
hydrops). The swelling occurs when the strain of the cornea's protruding
cone-like shape causes a tiny crack to develop. The swelling may last
for weeks or months as the crack heals and is gradually replaced by scar
tissue. If this sudden swelling does occur, your doctor can prescribe
eyedrops for temporary relief.
Eyeglasses or soft contact lenses may be used to correct the mild nearsightedness
and astigmatism that is caused by the early stages for keratoconus. As
the disorder progresses and the cornea continues to thin and change shape,
GP contact lenses can be prescribed to correct vision adequately. In
some cases, special contact lens designs such as the Macrolens,
may be necessary to achieve proper vision and comfort. The contact lenses
must be carefully fitted, and frequent checkups and lens changes may
be needed to achieve and maintain good vision.
In a few cases, a corneal transplant is necessary. However, even after
a corneal transplant, eyeglasses or contact lenses are often still needed
to correct vision.
