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Medical Eyecare

Dry Eye Disease Treatment

Dry eye can be a serious condition that can affect our quality of life. It can be caused by many things such as aging, a dry or windy environment, excessive computer use, contact lenses, and certain medications just to name a few. Signs and Symptoms that you may have if you have Dry Eye Disease (DED):  

  • Burning sensation in eyes
  • Gritty/sandy feeling in eyes
  • Light sensitivity and/or glare
  • Transient blurry vision (especially on the computer)
  • Tearing eyes (Think of how much your eyes tear after riding a bike into the wind, it is a reflex from your brain to tell you your eyes are extra dry)
  • Discomfort with your contact lenses by the end of the day  

Dr. Bansal takes dry eye seriously and wants her patients to know there is help. She uses a combination approach to diagnosing and treating your dry eye so you can see more clearly and comfortably. She will devise a customized treatment plan for each of her dry eye patients.   Some of the treatment she may use include:  

  • Eye drops (often, both over the counter and prescription drops are necessary)
  • Eye ointments 
  • External lid and lash hygiene 
  • Nutritional counseling 
  • Punctal occlusion
  • Lifestyle changes 
  • Moisture chambers
  • Referral for Serum Treatment, Eyelid Surgery, IPL and Lipiflow Treatments 

Diabetic Eye Exams

If you’ve been diagnosed with diabetes then having a diabetic eye exam is of utmost importance. You may feel that your vision is stable and doesn’t bother you, so why should you have your eyes examined thoroughly every year? Diabetic retinopathy is the most common cause of blindness in American adults and you may not have any noticeable changes in your vision until it is too late. Generally, the condition is treatable, but if not caught early enough it can lead to permanent vision loss and blindness. The disease is caused by changes in the blood vessels of the retina. The high amounts of insulin can cause the blood vessels to swell and leak fluid. In some people abnormal blood vessels grow on the surface of the retina and will need immediate treatment to preserve your vision. 

The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes will have some stage of diabetic retinopathy. Dr. Bansal will spend extra time carefully examining the retina for any signs of diabetic retinopathy. We also use special technology to take a photo of the inside of your eye to track your eye health. She will also communicate her findings to your primary care physician so that they can make sure you are not at risks for other conditions diabetes can cause.

During pregnancy, diabetic retinopathy may be a problem for women diagnosed with gestational diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam with retinal photography as soon as possible.

Common Retinal Conditions

that we treat

A view of the posterior pole of the retina from the doctor’s perspective

What is the Retina?

The retina is light-sensitive tissue that lines the back interior of the eye. This tissue is responsible for turning light into signal for the brain which, ultimately, results in the images we see.  Retinal imaging is the process of using high-resolution programs to take pictures of the inside of your eye.  Retinal imaging gives the Doctor an in-depth look at the internal structures in your eye. This helps them understand and assess the eye in ways that traditional eye exams and scopes cannot account for. 

A healthy retina is vital to vision. Retinal damage can occur more often than most people realize and symptoms of retinal damage can be tough to identify. Retinal imaging may be recommended based on findings during your annual, comprehensive eye care if a doctor suspects an underlying condition.

Macular degeneration is a progressive eye condition affecting as many as 10 million Americans and millions more around the world. This disease attacks the macula of the eye, where our sharpest central vision occurs. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision.

Symptoms include: Blurred central vision or blind spots.

Diabetic retinopathy occurs when the blood vessels in the back of the eye become weakened and damaged, causing swelling or leakage of blood in the eye. There are two types: nonproliferative and proliferative.

Non-proliferative Diabetic Retinopathy (NPDR)  is caused by fluid from the blood vessels in the Retina leaking into the macula, causing it to swell. This can lead to blurry or cloudy vision. In its more advanced stages.

Proliferative Diabetic Retinopathy (PDR) sets in and new blood vessels can form in the Retina. These irregular blood vessels can cause damage by leaking blood into the vitreous. If untreated, PDR can possibly lead to Retinal detachment and even glaucoma.

Floaters

Floaters are small abnormalities in a person’s vision. They can appear as tiny spots or small curvy lines that move along with the movement of the eye. There are many possible causes of floaters, but usually they are the result of foreign matter in the vitreous, physical injury to the eye, or another existing eye disease.While floaters do not have major adverse effects on overall vision, it is important that people experiencing these spots monitor them closely as they could be indicative of a more serious condition.

Uveitis

Uveitis is an inflammation of the middle layer of the eye that consists of the iris, ciliary body and choroid. Symptoms include: blurred/cloudy vision, floaters, eye pain or redness, increased sensitivity to light, and headaches.

Glaucoma Assessment 

Dr. Bansal has been trained to diagnose and treat glaucoma. In fact she has been involved with some of the major U.S. glaucoma research studies (Ocular Hypertension Treatment Study & Advanced Glaucoma Intervention Study) as a Research Coordinator. 

Glaucoma is a disease that affects over 2.5 million people. Glaucoma gradually deteriorates peripheral vision and eventually can lead to total blindness if not detected and treated. It is most often caused by high eye pressure that can damage the optic nerve that sends the vision signals to the brain. Once vision is lost it can never be recovered so it is very important to monitor for it yearly. You have a higher risk of glaucoma if someone in your family has had the disease, you are over 60, or you have African or Latin American heritage. 

If you are found to have glaucoma the eye pressure can be lowered with drops and monitored over time in order to prevent further vision loss. Dr. Bansal will check your eye pressure gently and accurately with an instrument called the Goldmann Tonometer (we do not use the air puff testing method) and evaluate your optic nerve for signs of glaucoma. She may recommend special testing such as a peripheral vision sensitivity test and also retinal imaging of your optic nerve to monitor patients for the development of the disease.

Glaucoma is the second leading cause of blindness worldwide but many people who have the disease don’t even know it.  For this reason, its often considered a silent disease like hypertension.  Glaucoma can gradually lead to vision loss, beginning in the periphery of one’s eyesight and later involving central vision. Prevention is key.

At B-Town Eyecare, we have the latest technology to help detect and monitor this challenging disease.  Advanced treatment options allow us to prevent unnecessary vision loss including blindness.

If it’s been a while since you have been screened for this serious eye disease, please call today for your appointment.

Ocular Emergencies

We know life can get busy and accidents happen too. To help you live your life, without missing a step, we offer same day appointments for urgent eye care issues. Call us at 206-242-8545 to speak to a team member today. Our staff will work with you to schedule your emergency eye exam appointment as soon as possible. State of the art equipment allow us to examine the front surface of the eye and facial areas around the eye for infection or injury. After assessing the extent of the injury or infection a treatment plan will be formulated and explained to you. Treatment may include medications and supportive care. Follow-up visits to monitor your recovery will be scheduled as needed.

Common Urgent Eye Care Issues We Treat: 

  • Chemical burn(s)
  • Corneal abrasion(s)
  • Foreign BodyConjunctivitis
  • Broken blood vessel(s)
  • Sudden onset of double vision
  • Sudden onset of visual disturbances such as flashes, floaters, wavy lines and static
  • Sudden loss of vision
  • Halos/Auras
  • The eye is red
  • Eye pain
  • Rash(es) around the eye

Call Us

if you are experiencing any of these issues please call us right away, at 206-242-8545, and one of our team members on the scheduling team will be more than happy to arrange an appointment for you.  

Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision.

Keratoconus can occur in one or both eyes.

Keratoconus is relatively rare. Most studies indicate it occurs in 0.15% to 0.6% of the general U.S. population. The onset of the disease usually occurs in people in their teens or early twenties.



What Causes Keratoconus?

Research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

How is Keratoconus Diagnosed?

Keratoconus can usually be diagnosed with a slit-lamp examination as well as corneal topography which precisely measures the curvature of the cornea. Your optometrist will look for signs such as corneal thinning, stress lines, and scarring at the apex of the corneal cone. Keratoconus, especially in the early stages, can be difficult to diagnose and its symptoms could be associated with other eye problems. Simply recognizing symptoms does not by itself diagnose the condition. Only a complete eye examination by a qualified expert can diagnose the condition in its earliest stages when it is easiest to treat and correct.

Symptoms of Keratoconus

In the early stages, keratoconus may cause slightly blurred or distorted vision. As it progresses, vision may become more and more distorted and your eye glass prescription may change often.  

An eye care professional can determine the presence of keratoconus using a slit lamp evaluation or by examining the surface of the cornea through corneal topography. Symptoms of keratoconus include: 

  • Distorted vision at all distances
  • Glare
  • “Ghost” images – the appearance of several images when looking at one object
  • Multiple changes to eyeglass prescription

Treatment for Keratoconus

In the early stages, contact lenses or eyeglasses are an effective treatment for most cases of keratoconus.  However, as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts may no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

  • Custom soft contact lenses: specially designed soft contact lenses to help correct keratoconus
  • Gas permeable contact lenses. If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP) contact lenses are usually the preferred treatment. The rigid lens material enables RGP lenses to vault over the cornea, replacing the cornea’s irregular shape with a smooth, uniform refracting surface to improve vision. RGP contact lenses can be less comfortable to wear than soft lenses. Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.
  • “Piggybacking” contact lenses: Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus, some eye care practitioners advocate “piggybacking” two different types of contact lenses on the same eye. For keratoconus, this method involves placing a soft contact lens on the eye and then fitting a RGP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid RGP lens.
  • Hybrid contact lenses: Hybrid contact lenses have a relatively new design that combines a highly oxygen-permeable rigid center with a soft peripheral “skirt.” Manufacturers of these lenses claim hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses. Hybrid lenses are also available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.
  • Scleral and semi-scleral lenses: These gas permeable contacts have a large diameter that allows the edge of the lens to rest on the white part of the eye, known as the sclera. These lenses vault over the irregularly shaped cornea, allowing for a more comfortable fit. They also move less as you blink. Scleral lenses cover a larger portion of the sclera, whereas semi-scleral lenses cover a smaller area.
  • Intacs: These tiny plastic inserts are surgically placed just under the eye’s surface in the periphery of the cornea and help re-shape the cornea for clearer vision. Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses. Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes. Intacs might delay but can’t prevent a corneal transplant if keratoconus continues to progress.
  • Corneal cross-linking (CXL): Until recently, people with keratoconus had few treatment options. The best their eye doctors could offer were increasingly stronger eyeglasses, special contact lenses, and eventually, in many cases, a corneal transplant. In spring 2016, the FDA approved a new treatment for this condition, which causes your corneas (the clear outer covering of the eye) to bulge gradually into a cone shape, distorting your vision. That treatment, called collagen cross-linking, or CXL, is now available. This procedure strengthens corneal tissue to slow down or prevent bulging of the eye’s surface, which in turn can reduce the need to undergo a corneal transplant. There are two types of corneal crosslinking: epithelium-off and epithelium-on. With epithelium-off crosslinking, the outer portion of the cornea (epithelium) is removed to allow entry of riboflavin, a type of B vitamin, into the cornea. Once administered, the riboflavin is activated with UV light. With the epithelium-on method (also called transepithelial crosslinking), the corneal surface is left intact.
  • Corneal transplant: Some people with keratoconus can’t tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.

Nutrition

There are a number of sources for proper eye nutrition. A healthy lifestyle makes a difference – smoking and excessive alcohol consumption increase progression of cataracts and age-related macular degeneration. Smoking has also been shown to exacerbate dry eye disease. Supplementing your diet with added vitamins and minerals could be the key to the wellness of your vision and longstanding eye health. 

Vitamins and Minerals: A number of vitamins have been shown to have positive effects on the eyes. Vitamin A effectively supports retinal function, and can be found in most orange, yellow, and green fruits and vegetables.

Vitamin C is useful in lens longevity and Vitamin E is an antioxidant and could be the key to delaying cataracts. Beyond vitamins, there are a variety of minerals that can boost your eye health. Omega-3 fatty acids in fish oils have anti-inflammatory properties that can reduce the risk of age-related macular degeneration. Zinc and selenium helps your body absorb the vitamins you eat, particularly Vitamin E. Lutein and zeaxanthin may protect your macula by filtering out blue light. 

Food to Enjoy: The foods you eat should be high in vitamins and nutrients. Your first clue is the color of the food. Orange, yellow, or green foods are often quite high in Vitamin A. Mangoes, sweet potatoes, carrots, and cantaloupe are great sources. Leafy greens and nuts contain lots of vitamin E, while citrus fruits and peppers are loaded with vitamin C.

Foods to Avoid: Excessive sugar and salt are the number one detriment to your eye health, and are difficult to reduce. Decreasing your use slowly will allow your tastebuds to adjust while avoiding abating cravings. Processed foods like refined grains should be avoided, as well as trans or saturated fats. Make a habit of reading the label before putting foods in your shopping cart – eye health starts in the grocery store. 

Supplements: If you’re not sure you’re getting the right amount of nutrition for your eyes, a supplement could be beneficial. There are a number of vision supplements created to support the systemic health of your eyes. These should not replace proper nutrition, but can boost the amount of vitamins and minerals you’re already getting from a wholesome diet. Talk to Dr. Bansal about which supplements are right for you.