Eye Health

Cataract

With the formation of a cataract, activities  like  reading,  bowling, or driving can be difficult. Fortunately, vision can be restored quickly, allowing the patient to return home within a few hours. With new advances in cataract surgery, vision improvement begins almost immediately, and an eye patch isn’t even needed.

So What is a Cataract? A Cataract is the clouding of the lens of the eye. (See above animation) Normally, light passes through the clear lens and is focused onto the Retina. However, the natural aging process can cause the lens to become cloudy. The Cataract or cloudy lens blocks the passage of light through the eye and causes distorted or blurred vision, glare, or difficulty seeing in poor lighting conditions.

Cataract surgery is the most common operation in the world. In the United States, more than 2.7 million procedures are performed annually. (National Institutes of Health)

There are 20.5 million cases of early cataracts among Americans aged 40 and older, and 50 percent of people older than 65 have developed significant cataracts. (National Institutes of Health)

Glaucoma

Glaucoma is actually a group of eye diseases that lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss and the possibility of blindness.

Optic nerve damage usually occurs in the presence of high intraocular pressure, but glaucoma can occur with normal or even below-normal eye pressure.

There are two main forms of glaucoma: open-angle (which is the most common form and affects approximately 95% of individuals) and closed-angle. There are also several other varieties of glaucoma, including secondary, normal-tension, congenital, pseudoexfoliation syndrome, juvenile, neovascular, pigmentary, and irido-corneal-endothelial syndrome (ICE syndrome).

Worldwide, it is estimated that about 66.8 million people have visual impairment from glaucoma, with 6.7 million suffering from blindness. In the United States, approximately 2.2 million people age 40 and older have glaucoma, and of these, as many as 120,000 are blind due the disease. The number of Americans with glaucoma is estimated to increase to 3.3 million by the year 2020. Vision experts estimate that half of those affected may not know they have it because symptoms may not occur during the early stages of the disease.

Glaucoma is a leading cause of blindness among African Americans and Hispanics in the United States. African Americans experience glaucoma at a rate of three times that of Caucasians and experience blindness four times more frequently. Between the ages of 45 and 64, glaucoma is fifteen times more likely to cause blindness in African Americans than in Caucasians.

High-risk factors for open-angle glaucoma, the most common form of the disease, include being an African American and over 40, having a family history of the disease, and being over 60 for the general population. Those who are very nearsighted, have a history of diabetes, have experienced eye injury or eye surgery, or take prescription steroids also have an increased risk of developing glaucoma. It has also been suggested that individuals with Japanese ancestry may be at a greater risk for normal-tension glaucoma, and that those of Asian and Eskimo descent may have a greater risk for closed-angle glaucoma.

Open-angle glaucoma, by far the most common form, has no symptoms at first. At some point, side vision (peripheral vision) is lost and without treatment, total blindness will occur.

Closed-angle glaucoma (acute glaucoma) results from a sudden, complete blocking of the fluid flowing out of the eye. Symptoms may include severe pain, nausea, vomiting, blurred vision, and seeing a rainbow halo around lights. Closed-angle glaucoma is a medical emergency and must be treated immediately or blindness could result rapidly.

Currently, there is no “cure” for glaucoma; however, early diagnosis and treatment can control glaucoma before vision loss or blindness occurs.

There are several tests that can help your eye care professional detect glaucoma; these include a visual acuity test, visual field test, dilated eye exam, tonometry (which measures the pressure inside of the eye), and pachymetry (which uses ultrasonic waves to help determine cornea thickness). Individuals at high risk for glaucoma should have a dilated pupil eye examination, and a visual field test annually.

Early treatment for open-angle glaucoma will usually begin with medications (pills, ointments, or eyedrops, for example) that either help the eye to drain fluid more effectively or cause it to produce less fluid. Several forms of laser surgery can also help fluid drain from the eye. Incisional surgery to create a new opening for fluid to drain is usually performed after the other treatment options have failed.

When a patient has glaucoma or is at high risk for developing the disease, physicians may document how the optic nerve changes over time by making drawings, taking photographs, or using a new technique called optic nerve imaging. Scanning laser polarimetry (GDx), confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph or HRT III), and optical coherence tomography (OCT) are all examples of optic nerve imaging techniques. The patient’s eye care professional will make the determination as to which method(s) to use.

New research is focusing not only on lowering pressure inside the eye, but is also exploring medications that will protect and preserve the optic nerve from the damage that causes vision loss as well as the role of genetic factors. There has been progress in understanding the genetics of glaucoma in the last few years. Genes have been found that are associated with congenital glaucoma, juvenile glaucoma, normal-tension glaucoma, adult-onset open-angle glaucoma, pigmentary glaucoma, and other conditions that are associated with secondary glaucoma.

Keratoconus

Keratoconus is an eye disease that concerns the cornea. The cornea is a thin, clear tissue covering the surface of the front of the eye.

It is a very important contributor to our vision, accounting for 2/3 of the eye’s optical power. A normal, healthy cornea holds its round shape and helps us see.

But sometimes the cornea becomes structurally weakened and loses its shape. Instead of a dome, it becomes cone-shaped, prohibiting clear vision. This is known as keratoconus.

Causes of keratoconus

The cause of keratoconus is unknown. Some research shows that keratoconus may run in families and may affect those with allergies more often. Other research suggests too much eye rubbing can cause keratoconus. Although it is not proven that eye rubbing can exacerbate keratoconus, it is probably a good idea to keep from rubbing the front of your eye too much anyway, as it is a delicate part of the body.

Most of the time, there is no eye injury or disease that provokes keratoconus. If you develop keratoconus, you were probably bound to develop it from birth. Keratoconus is most prevalent in those who are near-sighted.

There are no preventative measures for keratoconus, but if you develop it, there are many treatment options available.

Onset and Treatment

Keratoconus usually develops early, in the teenage years and twenties, but it can begin even earlier, during childhood.

It will most likely present in a patient before age 30. Keratoconus can progress for 10-20 years and then slow down considerably as the patient ages.

The first symptoms of keratoconus are blurred vision and increased sensitivity to light. At first, you may be able to wear soft contact lenses or eyeglasses to correct the mild near-sightedness and/or astigmatism caused by keratoconus.

Eventually keratoconus may progress so far that glasses cannot correct your vision.

Advanced Treatment

Usually keratoconus can be corrected over a lifetime using rigid gas-permeable contact lens and regular check-ups. In advanced cases, the cornea wears down at the very point of the cone shape. If this happens, you may need to undergo a corneal transplant. Recovery from this surgery can take a long time, but the risk of the body rejecting a transplanted cornea is very low. Most often, patients will still need to wear contact lenses after the surgery.

There are a few different options to prevent the need for a corneal transplant:

• Intrastromal corneal ring segments: a surgical procedure where small implants are inserted into the eye to correct vision.

• Mini asymmetric radial keratotomy: a controlled scarring of the cornea by administering a careful pattern of incisions. Scar tissue develops around the incision points and reshapes the cornea.

• Corneal cross-linking: a method where custom riboflavin eye drops are activated by ultra-violet light over a 30-minute session, meant to increase collagen cross-linking in the cornea and thereby strengthen it.

Diagnosis

To test for keratoconus, your eye doctor will check for distorted vision, blurred vision of objects (both near and far), sudden changes in one eye’s vision or double vision when using only one eye and halos around bright lights.

Keratoconus can be diagnosed by examination. A slit-lamp examination may be performed. A slit-lamp is a kind of low-power microscope that shines a bright beam of light into the eye. This examination can be used to detect many eye diseases and problems, including corneal injuries, cataracts and macular degeneration (a disease of the macula, the part of the eye that allows you to see fine details).

Another type of examination called corneal topography can be performed using computerized instruments to create a map of the cornea. This is an advanced technology and offers the most complete view of your cornea.

If you are considering corrective laser eye surgery, it is imperative you do not even have borderline keratoconus. Corneal topography will be performed on any patient seeking LASIK treatment to make sure they do not have keratoconus before scheduling surgery.

Prevention

Although there are no specific ways to prevent keratoconus, some basic lifestyle choices can help keep your eyes healthy.

• Regular eye examinations are a must. It is during these exams that your health care provider has a chance to detect any conditions like keratoconus before they become a bigger problem. Once a year check-ups are instrumental in maintaining health vision over your lifetime.

• Wearing sunglasses to protect your eyes is an easy way to guard your vision against UV damage.

•  A healthy lifestyle keeps your blood pressure, cholesterol and blood sugar in balance. Suggestions include no smoking, limited alcohol consumption and lots of leafy, green vegetables high in antioxidants.

When to see a eye care professional:

If your child or teenager has vision problems that cannot be corrected to 20/20 with glasses, they should be evaluated by a eye care professional with experience in diagnosing and treating keratoconus.

Always see your eye care professional immediately if you have any sudden changes in vision. This includes darkening around the edges of your vision, dark spots in front of your eyes, halos around bright lights, a loss of vision in one part of your field of sight or any other noticeable change.

Macular Degeneration

Age-related Macular Degeneration (AMD) is an eye disease causing clear vision to fail in millions of older People.

When electrical signals from the retina (the inner layer of the eye that captures light and turns it into electrical signal) are received by the brain through the optic nerve, they are translated into images

Age related Macular Degeneration is traditionally described as a form of the disease which affects individuals over the age of 55 years. However, we have recently discovered that a significant number of these individuals may have a major genetic component that contributes to the disease.

There are 2 types of AMD, dry and wet. Dry AMD is more common, causing about 90% of AMD. It can develop so gradually that in the beginning stages you might not notice changes in vision. Wet AMD is less common (about 10% of cases) but is more severe and may progress more rapidly.

Dry Macular Degeneration, in which the cells of the macula slowly begin to break down, is diagnosed in 90 percent of the cases. Yellow deposits called “drusen” form under the retina between the retinal pigmented epithelium (RPE) and Bruch’s membrane, which supports the retina. Drusen deposits are “debris” associated with compromised cell metabolism in the RPE and are often the first sign of Macular Degeneration. Eventually, there is a deterioration of the macular regions associated with the drusen deposits resulting in a spotty loss of “straight ahead” vision.

Wet Macular Degeneration occurs when abnormal blood vessels grow behind the macula, then bleed. There is a breakdown in Bruch’s membrane, which usually occurs near drusen deposits. This is where the new blood vessel growth occurs (neovascularization). These vessels are very fragile and leak fluid and blood (hence ‘wet’), resulting in scarring of the macula and the potential for rapid, severe damage. “Straight ahead” vision can become distorted or lost entirely in a short period of time, sometimes within days. Wet macular degeneration accounts for approximately 10% of the cases, however it results in 90% of the legal blindness.

What does Macular Degeneration do to your vision?

Macular degeneration is the imprecise historical name given to that group of diseases that causes sight-sensing cells in the macular zone of the retina to malfunction or lose function and results in debilitating loss of vital central or detail vision.

What are the Symptoms of Macular Degeneration?

Macular Degeneration can cause different symptoms in different people. Sometimes only one eye loses vision while the other eye continues to see well for many years. The condition may be hardly noticeable in its early stages. But when both eyes are affected, reading and close up work can become difficult.

What can you or your loved one do if diagnosed with Macular Degeneration?

First it is important to modify those environmental risk factors that we know about. You should:

Eat a low-fat, low cholesterol diet.

Wear sunglasses with UV protection.

Try to consume at least two servings of leafy dark green vegetables per day.

Do not smoke and avoid exposure to secondhand smoke.

If you are post-menopausal, you should consult with your physician concerning estrogen replacement therapy. This may have a favorable impact upon cholesterol lipid levels that play a role in worsening the disease.

Develop healthy habits! If you smoke, QUIT SMOKING! Exercising, maintaining normal blood pressure, cholesterol levels and eating a healthy diet is a step in the right direction. Eat food and-or supplements rich in vitamin E,C and Lutein. Lutein is a plant antioxidant found in high quantities in spinach, kale and other dark green, leafy vegetables.

People who eat fish and green leafy vegetables may be at lower risk of AMD. There is no treatment for early dry AMD, although a special combination of supplements (zinc and antioxidant vitamins) may slow progression in some people with more advanced disease. Early intervention for wet AMD can delay progression.