Eye Disease Education
The following eye conditions can lead to vision loss and blindness. They may have few or no early symptoms. Regular eye exams are your best protection. If your eye care professional finds a problem early, there are often things you can do to keep your eyesight.
What is a cataract?
A cataract is a clouding of the lens of the eye. This results in blurred vision that cannot be improved with glasses. This may impair ones daily activities, such as reading and driving a car.
What causes cataracts?
There are many causes of cataract formation including trauma, inflammation, and some medications. The most common cause of cataracts however is the natural aging process. Although cataracts can occur at any age, including childhood, the incidence of cataracts increases with advancing age. All individuals over the age of 65 will start to develop some degree of cataract formation.
What can be done about cataracts?
As long as your vision allows you to perform your normal daily activities, nothing needs to be done about a cataract. You should see your doctor to obtain the best possible glasses correction of your vision. However, when your cataract progresses and the resulting blurred vision impairs your daily activities, the only definitive treatment is cataract surgery.
How are cataracts surgically removed?
A small incision (less than 3 millimeters) is made in the side of the eye which allows the use of an ultrasonic instrument to emulsify and aspirate the hard center of the cataract. Then an acrylic or silicone lens is folded and implanted into eye to restore natural vision. The incision then heals without sutures or in rare cases a single suture.
What restrictions are there after cataract surgery?
There are few restrictions after most cataract operations. It is usually recommended that you avoid dirty environments and strenuous physical activities for around a week. You may resume most activities including deskwork and driving within a day or two in most cases.
Are there any risks involved with cataract surgery?
Small incision cataract surgery is one of the most successful of all surgical procedures, with a success rate of over a 98% for improving vision. However any surgical procedure entails risk. Although the incidence of significant complications in cataract surgery is extremely small, there are remote risks of potentially serious complications. These should be thoroughly discussed with your doctor prior to surgery.
What is eye pressure? Everyone has a "normal" eye pressure that maintains the shape and function of an eyeball. However, sometimes the eye pressure becomes too high and can damage this delicate function.
Glaucoma refers to a group of diseases that starts with an eye pressure that is too high for the patient. This high eye pressure results in damage to the optic nerve and therefore possible permanent damage to vision.
Examining the eye for glaucoma involves measuring the eye pressure, but it is also important to do a complete examination of all parts of the eye. For example, the drainage meshwork at the base of the iris can be examined with a special mirrored lens. The optic nerve can show signs of damage upon direct observation. Additional evaluations such as Nerve Fiber Layer Analysis and Visual Field Testing are extremely helpful when indicated. Photography can document progression or stabilization of disease.
Glaucoma can be a gradual, progressive disease, or it can be a quick and sudden process. There are three main categories of glaucoma: Open Angle, Closed Angle, and Congenital. Many subtypes of each of these exist, and the specific type of glaucoma can greatly affect the best course of treatment.
Treatment involves lowering the pressure to a level thought to be safe for the eye. Eye drops are commonly used, but either laser surgery or conventional surgery is also utilized when indicated. Additionally, some glaucoma procedures can be combined with cataract surgery if both are requiring treatment. Significant advances have been made in all of these modalities over the years, and our success rate in controlling the disease has continued to increase.
With proper diagnosis, treatment, and monitoring, the majority of glaucoma patients can preserve useful vision throughout their lives.
Low Vision Rehabilitative Services
Low Vision rehab is the enhancement of poor vision by the use of magnifiers, telescopes, high power bifocals and other reading devices. If your vision is 20/50 or worse, you are considered to have low vision. Our goal is to use this special equipment to bring your vision to a level that allows you to do the tasks you have no longer been able to do. We hope to maintain your independence as much as possible. Low vision rehabilitation does not cure the disease process that has occurred, but simply allows you to compensate for the visual loss. Even with special reading devices, it takes more time and patience to do the things you once enjoyed with your healthy vision.
If you are severely visually impaired and low vision equipment is not helpful, we may refer you to blind services in your county for further assistance.
It is rare for insurance companies to pay for low vision equipment, including Medicare. There is a wide range of costs for this equipment, and you should be prepared to make a sizeable investment if you want to find equipment to help your low vision needs. Most insurance companies, however, do pay for the office consultation.
The surgery involves the use of lasers or incisional surgery to the outside or inside of the eye to treat a variety of problems. The most common problems are the occurrence of blood within the cavity of the eye (the vitreous), as may occur in from complications of diabetes or blocked-off veins within the retina. The repair of this condition entails the removal of the bloody vitreous from within the eye by the use of microsurgical tools (vitrectomy).
A less frequent problem is tearing of the retina with ensuing separation of the retina from the wall of the eye (a retinal detachment). How this problem is addressed depends upon the cause of the detachmentand other circumstances peculiar to the patient and the patient's eye. Heating the edges of the detached retina (laser photocoagulation) may permit the retina to scar in place, curing the detachment or preventing it from enlarging. Only a few detachments can be treated this way. Injecting a gas bubble into the eye and positioning the head so the bubble rests against the retinal tear (pneumatic retinopexy) may cure some retinal detachments. Many retinal detachments are treated by indenting the outer layers of the eye by a brick or belt of silicone sewn to the white part of the eye (scleral buckling). Finally, some retinal detachments may be treated by removing the vitreous from within the eye (vitrectomy), and removing any scar tissue that may be preventing the retina from settling in place on the back of the eye.
Retinal surgery is also employed in the diagnosis and treatment of infections and chronic inflammation of the interior of the eye.
In recent years retinal surgery has been proposed as a treatment for retinal disorders that were previously considered medical disorders. For example, it is now possible to perform surgery to remove abnormalblood vessels that grow under the retina in some patients who have age-related macular degeneration or presumed ocular histoplasmosis. It now appears that some patients with the impending formation of holes in the central retina may benefit from removal of the vitreous.
Another aspect of retinal surgery is the diagnosis and treatment of tumors growing within or beneath the retina. Many options are possible in treating tumors, and which is selected depends on the particular tumor, the condition of the patient's eye and the medical circumstances peculiar to that patient.
The Aging Eye
One of the most common misconceptions that elderly patients have about their vision is that as they get older, their eyes will slowly deteriorate. Age, however, is not a reason for failing vision. In fact, most elderly people have excellent vision. Nonetheless, the most common eye diseases that cause loss of vision do become more prevalent in the aging population. Therefore, it is important to have your eyes checked regularly if you are over 50 to monitor for any potentially treatable eye diseases.
By far, the most common eye disease to affect aging patients is cataracts. In fact, cataracts will affect every person if they live long enough. They are, in essence, a natural aging process of the lens of the eye. As one gets older, the lens will start turning cloudy, and eventually, if untreated, will lead to blindness. Despite the availability of surgery, cataracts are still one of the top three causes of blindness in the United States and the number one cause of blindness worldwide.
The most common cause of blindness in developed countries is age-related macular degeneration (AMD). The macula is simply the center of the retina. It is the part of the retina we use to see fine details, such as reading or recognizing faces. In macular degeneration, this important part of the retina starts to degenerate, or "wear out." As its name implies, age is a major risk factor for developing AMD. In fact, 10% of people 66-74 years of age will have signs of AMD, whereas almost 30% of people from 75-85 years of age will show signs of the disease. In most cases, AMD cannot be treated, although several studies have shown that antioxidants and some nutrients play a role in preventing progression of the disease. In more severe forms of the disease, laser treatment to the macula can restore vision in some patients. There is some good news, however. A lot of research is being done on AMD, and we may soon have better treatments for macular degeneration.
Glaucoma is another leading cause of blindness in the world. Glaucoma is often referred to as the "Sneak Thief of Sight" because it doesn’t have any symptoms or warnings in its early stages. The only way it can be diagnosed early is with a complete eye exam. If found early, glaucoma can usually be treated successfully to prevent blindness. If left untreated, however, glaucoma slowly damages the optic nerve, causing irreversible damage along the way, and eventually leads to complete blindness.
Dry eyes are a major problem for some aging people, but this is usually not sight threatening. As we age, the tear glands simply don’t work as well. This can result in dry, burning, or itchy eyes. It can cause intermittent blurring of your vision, especially after reading for awhile or late in the day. Frequently, the eye will start to "water" to try to catch up on the dryness. Placing artificial teardrops in your eyes can treat mild or intermittent dry eyes. There are also several simple office procedures that can increase the effectiveness of your own natural tears.
Eyelid problems, such as drooping eyelids, also become more of a problem with age. If your eyelid position interferes with your vision or causes discomfort to your eye, surgery is indicated to re-position the eyelids.
Although there are several eye diseases that affect the aging eye, most people can maintain good vision if their eyes are checked regularly and diseases treated early and properly. All people over 50 years of age should have their eyes examined every two years, and those over 65 on a yearly basis. Furthermore, if you notice changes in your vision, you should see your eye doctor as soon as possible.