B-Town Eyecare
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Eye Disease Management
Taking measures to prevent and manage chronic conditions is an important part of our overall health, especially when it comes to our eyes. Having regular comprehensive eye exams can detect problems long before symptoms show up and should be an important part of your regular preventative health routine.
CATARACT
As one ages, cellular changes occur in the lens that makes it less transparent. The loss of transparency may be so mild that vision is hardly affected or so severe that no shapes or movements can be seen, only light and dark. When the lens gets cloudy enough to obstruct vision, it is called a cataract.
Normal Eye Versus an Eye with Cataracts
What Causes a Cataract?
The most common cause of a cataract is aging, and it is estimated that 20.5 million Americans over the age of 40 are affected. Other causes include:
- Trauma
- Certain medications such as steroids
- Systemic diseases, including diabetes
- History of smoking
- Prolonged exposure to ultraviolet light
- Congenital cataract
Cataracts can occur in one or both eyes, and glasses or contact lenses may not sharpen vision if a cataract is present. Once formed, the only cure for a cataract is surgical removal. Patients may reduce the risk for developing a cataract by limiting the amount of ultraviolet light exposure and wearing a wide-brim hat and sunglasses.
What are the Signs and Symptoms of Cataracts?
Cataracts don’t suddenly develop overnight. They generally start off small and only begin to noticeably affect your vision as they grow. The first symptom is usually that your vision becomes blurred, hazy, or cloudy. Additionally, you may become sensitive to light, making sunlight, oncoming headlights or indoor lighting appear exceptionally glaring or bright. Colors may seem dim, and you may notice halos around lights or double vision.
Here is a list of possible signs and symptoms of developing cataracts:
- Blurry or cloudy vision (that can’t be corrected with a change in eyeglass prescription)
- Glare from lamps, sunlight, oncoming traffic when driving at night or indoor lighting
- Colors appear dim and less vibrant
- Halos around lights
- Double vision
- Poor night vision
- Sudden improvement in near vision
AGE-RELATED MACULAR DEGENERATION (AMD)
AMD is a common eye condition and a leading cause of vision loss among people aged 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead. This condition can cause the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.
Stages of Macular Degeneration
Who is at Risk for AMD?
Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:
- Smoking. Research shows that smoking doubles the risk of AMD
- Race. AMD is more common among Caucasians than among African Americans or Hispanics/Latinos
- Family history and genetics. People with a family history of AMD are at higher risk. At last count, researchers had identified nearly 20 genes that can affect the risk of developing AMD. Many more genetic risk factors are suspected
Does Lifestyle Impact AMD?
Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:
- Avoid smoking
- Exercise regularly
- Eat a healthy diet rich in green, leafy vegetables and fish (omega 3’s)
Protection and prevention are imperative, and here are some key areas to manage:
- Stop smoking
- Eat your green leafy vegetables
- Take eye nutrition supplements that include a balanced ratio of 10mg of Lutein and 2 mg Zeaxanthin
GLAUCOMA
Glaucoma is a group of diseases that damage the eye’s optic nerve, usually associated with an increase of pressure in the eye. This disease can result in vision loss and blindness, however, with early detection and treatment, you can often protect your eyes against serious vision loss.
Normal Eye Versus an Eye with Glaucoma
Can I Develop Glaucoma if I Have Increased Eye Pressure?
Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.
Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.
Can I Develop Glaucoma Without Increased Eye Pressure?
Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is a type of open-angle glaucoma.
Who is at Risk for Primary Open-angle Glaucoma?
There are several risk factors for developing glaucoma. These include:
- High intraocular pressure is the most common, and only modifiable, risk factor
- Age – Our risk for glaucoma increases as we age
- Thin corneal thickness can also impart a higher risk for developing glaucoma
- Race is another important risk factor – risk of developing glaucoma is highest in patients of African-Caribbean descent, followed by Hispanics and then Caucasians
- Family history in a first-degree relative (mother, father or sibling) is also a risk factor
- Patients who are nearsighted (myopic) may also be at higher risk for developing glaucoma, but this connection is not definitive.
A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.
Symptoms of Glaucoma
At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes.
Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.
DIABETIC & HYPERTENSIVE RETINOPATHY
Diabetes is a disease that affects many Americans and can cause serious damage to the eye. The most common complication from diabetes is diabetic retinopathy, and diabetics are also well known to be at a higher risk category for glaucoma, cataracts, and other eye diseases.
Every diabetic should have an eye doctor who knows their full history and screens for all these conditions during their comprehensive eye exams. If you are newly diagnosed with diabetes, please feel free to contact our office, and we would be happy to manage your diabetic eye care and communicate with your other physicians managing your diabetes.
Normal Eye Versus an Eye with Diabetic Retinopathy
Diabetes Can Affect Your Eyesight
If you have diabetes, your body does not store and use sugar properly. High blood sugar levels can damage blood vessels all over your body, specifically blood vessels in your retina. Damage to the blood vessels and subsequently, the nerve layer in the back of your eye, is referred to as diabetic retinopathy
What Causes Diabetic Retinopathy?
NPDR and PDR form due to high blood sugar levels and long-standing blood sugar fluctuations. PDR causes visual loss in the following ways:
- Eye hemorrhaging (bleeding)
- Retinal detachment (first distortion, then visual loss)
- Neovascular glaucoma (damage to the optic nerve)
Diagnosing Diabetic Retinopathy
During your comprehensive eye exam your retina is thoroughly examined looking for these types of changes to the blood vessels and retina.
Treating Diabetic Retinopathy
A retina specialist can treat bleeding vessels with a laser or eye injections.
What Can I Do to Protect My Eyes?
All patients with diabetes need to see an eye care professional at least once a year for a complete dilated eye exam.
In the 21st century, visual loss from diabetes is largely preventable. Excellent blood sugar control is the best defense against diabetic retinopathy. Early detection and treatment are essential.
What Causes Diabetic Retinopathy?
NPDR and PDR form due to high blood sugar levels and long-standing blood sugar fluctuations. PDR causes visual loss in the following ways:
- Eye hemorrhaging (bleeding)
- Retinal detachment (first distortion, then visual loss)
- Neovascular glaucoma (damage to the optic nerve)
Sources: American Academy of Ophthalmology, American Optometric Association.
retinal detachment
A retinal detachment is an eye problem that happens when your retina (a light-sensitive layer of tissue in the back of your eye) is pulled away from its normal position at the back of your eye.
What Does a Retinal Detachment Look Like?
What Causes a Retinal Detachment?
There are many causes of retinal detachment, but the most common causes are aging or an eye injury.
There are 3 types of retinal detachment: rhegmatogenous, tractional, and exudative. Each type happens because of a different problem that causes your retina to move away from the back of your eye.
Symptoms of a Retinal Detachment
If only a small part of your retina has detached, you may not have any symptoms.
But if more of your retina is detached, you may not be able to see as clearly as normal, and you may notice other sudden symptoms, including:
- A lot of new floaters (small dark spots or squiggly lines that float across your vision)
- Flashes of light in one eye or both eyes
- A dark shadow or “curtain” on the sides or in the middle of your field of vision
Retinal detachment is a medical emergency. If you have symptoms of a detached retina, it’s important to go to your eye doctor or the emergency room right away.
Treating Retinal Detachments
Depending on how much of your retina is detached and what type of retinal detachment you have, a retina specialist may recommend laser surgery, freezing treatment, or other types of surgery to fix any tears or breaks in your retina and reattach your retina to the back of your eye. Sometimes, they will use more than one of these treatments at the same time.
OCULAR (EYE) ALLERGIES
Eye allergies are a common eye condition. The medical term used to describe eye allergies is allergic conjunctivitis. When your eyes encounter an allergen, like pollen, your body’s defense system (immune system) works to attack the allergens by releasing histamines. When this happens, your eyes can become red and swollen (inflamed).
What Causes Eye Allergies?
Some of the most common causes of eye allergies include:
Seasonal Eye Allergies – certain seasons can be challenging for people who are allergic to tree, grass and weed pollens. Typically, these are more pronounced in the Spring, but can occur at other times of the year as well.
Year round or perennial conjunctivitis – people with allergies to dust mites, pet dander and indoor allergens may experience eye allergy irritation throughout the year.
Contact conjunctivitis – your eye has a natural balance and when something encounters your eye, it can upset that balance and result in contact conjunctivitis. This could include make-up, medications, perfume or even wind-blown objects. It may take two to four days after contact for symptoms to appear.
Giant Papillary Conjunctivitis (GPC) – this is an allergic reaction to contact lenses. Contact lenses can be contaminated by poor handling (not washing hands) or when the solutions or cases used with contact lenses become contaminated. Good contact lens hygiene can help prevent this.
Symptoms of Eye Allergies
- Itchiness
- Red, irritated eyes
- Tearing
- Swollen eyelids
- Light sensitivity
- Soreness, burning, or pain
Treatment of Eye Allergies
Ideally, we suggest you avoid coming into contact with the things that cause eye irritation. Since that isn’t always possible, there are several medications and non-prescription options available to help provide relief from eye allergies.
KERATOCONUS
Keratoconus is when the normally spherical cornea thins and becomes “cone shaped”. As the cornea changes in shape, it changes the way light rays are focused on the retina. As a result, vision becomes blurry and distorted.
Keratoconus often begins in the late teen years and symptoms can progress slowly for 10 to 20 years.
Normal Eye Versus an Eye with Keratoconus
What Causes Keratoconus?
In patients with keratoconus, collagen fibers in the cornea become weakened and cannot hold the shape of the cornea.
The exact cause of this is unknown but it is thought that a decrease in protective antioxidants and an increase in free radicals is a cause. In some cases, keratoconus appears to be genetic. Around 10% of patients have an affected parent.
Keratoconus is also associated with overexposure to ultraviolet light, chronic eye irritation or excessive rubbing of the eyes. It is thought that excessive rubbing can damage corneal tissue, making symptoms worse.
Symptoms of Keratoconus
- Blurry or distorted vision
- Increased sensitivity to light and glare
- Redness or swelling of the eyes
- Rapidly changing eyeglasses prescription
- Difficulty wearing or fitting contact lenses
Treatment of Keratoconus
Treatment of keratoconus depends upon your symptoms. In early stages, eyeglasses or special contact lenses can be used to correct vision.
As symptoms progress, other treatments may be necessary. These include:
Intacs
Intacs are FDA approved small plastic arcs that are surgically placed in your cornea. Intacs bring the cornea closer to its original dome shape by flattening the curve.
Collagen Cross-Linking.
Corneal Collagen Crosslinking (CXL) is a treatment for patients with keratoconus and those who experience a keratoconus like condition after laser refractive surgery (so-called post-LASIK corneal ectasia). This procedure strengthens the bonds between collagen lamellae, which represent the main structural component of the cornea.
Corneal Transplant
In severe cases, all or part of the cornea can be replaced by donor tissue.
EYELID LUMPS & BUMPS
We receive many calls from patients telling us they have a ‘bump on their eyelid’ or something that looks like a pimple.
In most cases these ‘bumps’ turn out to be a hordeolum (stye) or a chalazion. In this section, we will explore what each of these are, including what causes them, how to treat them and when to see an Optometrist.
What is a Hordeolum (stye)?
A stye or hordeolum, is an infection involving the oil glands of the eyelids. They are typically caused by bacteria that colonize, or live on, the surface of the eyelid skin.
How does a Hordeolum Form?
A hordeolum can occur when bacteria become trapped in oil glands that are blocked or plugged. In some cases, medications or hormonal changes can alter the composition of the oil and make it more likely to plug the glands.
A hordeolum can affect either the external or internal surface of the eyelid, but they almost always involve the glands at the eyelid margin.
Symptoms of a Hordeolum
A hordeolum can cause swelling and inflammation of the eyelid, make it red, tender to the touch and sometimes painful.
They can also cause increased mucous production from the internal surface of the eyelids that can blur vision and cause crusting in the corners of the eyes or at the eyelid margins.
Infrequently, the infection can spread to surrounding tissues, which is referred to as cellulitis. In cases of cellulitis, patients may experience fever and swelling can be quite sever and the lids might block vision. This is considered a true emergency due to the impact the infection can have on the entire body.
Treatment for a Hordeolum
A mild hordeolum can usually be treated with warm compresses and eyelid hygiene two or three times a day. The warmth helps the oil flow from the glands more freely, and the lid hygiene removes bacteria and other debris that may be clogging the glands.
More moderate styes may be treated with topical antibiotic or combination antibiotic/steroid ointments in addition to warm compresses and lid hygiene.
A severe hordeolum and cases of cellulitis may require the addition of oral antibiotics. In cases of abscess formation, some styes will drain on their own, while others require surgical drainage.
What is a Chalazion?
A chalazion is an accumulation of firm nodular tissue called a “granuloma” that forms inside the eyelids where the oil glands have been inflamed.
This inflammation is a reaction to oil that has seeped out of the glands into the surrounding tissue of the eyelid where the glands become plugged.
This may occur on its own or following hordeolum formation and treatment. Patients are often left with a firm bump or nodule in the eyelid that is painless or only mildly irritating, however, some chalazia may be more symptomatic.
How is a Chalazion Treated?
Like a hordeolum, mild chalazia may be treated with warm compresses and eyelid hygiene.
Moderate to severe chalazia are treated with a combination of warm compresses, lid hygiene, and topical or injected steroids.
Chronic chalazia usually require surgical treatment with a small incision, usually through the inside surface of the eyelid to avoid external scarring.
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