Eye Conditions Home

The doctors at Lake Lazer Eye Center have helped thousands of people enjoy better vision. When you have a problem with your eyes, you know you can turn to us for help. Leading the way with new medications and surgical procedures, Lake Lazer Eye Center can diagnose and treat a wide range of diseases and conditions. Advances in technology have impacted all aspects of vision care. Surgical procedures that once required a hospital stay and lengthy recovery are now performed by our doctors on an outpatient basis, with most patients returning to their normal activities within hours.

We continually invest in the most state-of-the-art diagnostic and surgical equipment. And our doctors go through rigorous, ongoing training to ensure that we’re doing everything we can to improve our patients’ vision and quality of life. We’re committed to providing the most advanced care available.

For your convenience, we’ve developed an overview of common eye conditions. Click on any of the conditions on this page to learn more about symptoms, causes and treatments.

You know your eyes better than anyone. If they don’t see, feel or look as well as you’d like them to, schedule an appointment with one of our doctors by calling 586-792-3891.

Insurance

Treatment of many eye conditions is covered by insurance, including Medicare. If you have questions about what is covered by your private healthcare insurance, contact your plan provider, or provide us with a copy of your insurance card and we’ll check for you. We accept most major insurances.

If you have questions about your Medicare coverage, call 1-800-MEDICARE (1-800-633-4227) to speak to a Medicare Customer Representative. You can also go to www.medicare.gov to find out more about Medicare coverage. Our staff is also available to help you determine whether the eye care you need is covered by Medicare.

Your out-of-pocket expenses for Medicare or private insurance will depend of the type of insurance you have, whether you have supplemental insurance and whether you have a deductible on your policy. We’ll be glad to process all insurance claims for you. We also accept cash, personal checks, Visa, MasterCard, Discover and American Express.

Astigmatism

Astigmatism, unlike normal vision, occurs when the cornea is shaped like a football (more curved in one direction than the other) and often occurs in combination with myopia (nearsightedness) and hyperopia (farsightedness). This causes light to focus in more than one point on the retina, resulting in blurry and distorted vision.

Light focuses in more than one point on the retina causing blurry and distorted vision at all distances

Symptoms of astigmatism:

  • Blurry, distorted vision at all distances

Causes of astigmatism:

Heredity
Lid swellings such as chalazia
Corneal scars
Keratoconus

Diagnosing astigmatism:

Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.
Treatment of astigmatism:

Glasses and contact lenses are used by many for the temporary treatment of astigmatism. However, there are a number of vision correction procedures that can surgically reduce or eliminate astigmatism.

Other types of refractive errors include: nearsightedness, farsightedness and presbyopia.

Blepharitis

Blepharitis means inflammation of the eyelids.  Some doctors call it granulated eyelids. Almost everyone gets blepharitis at some time in his or her life. Some people get it repeatedly. Fortunately, blepharitis is relatively easy to treat.

Types of blepharitis:

Staphylococcus blepharitis is caused by a germ called Staphylococci, commonly known as “staph.” It often begins in childhood and continues throughout adulthood. This form of the condition results in collar scales on lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, sties, and chalazia (nodules on the eyelids) also occur.

Seborrhea blepharitis is the most common and least severe form of this condition. It is not an infection but is caused by improper function of the oil glands, which causes greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea.

Ulcerative blepharitis is a less common but more severe condition that may be characterized by matted, hard crusts around the eyelashes, which, when removed, leave small sores that may bleed or ooze. There may also be a loss of eyelashes, distortion of the front edges of the eyelids and chronic tearing.

In severe cases, the cornea, the transparent covering of the front of the eyeball, may also become inflamed.

Symptoms of blepharitis:

  • Itchy, burning, watery eyes
  • Sore eyes
  • Sticky discharge that causes the eyelashes to stick together
  • Redness of the eyelid edges
  • Frequent sty formation
  • Tiny pimples on the eyelid edges
  • Scaly skin flakes along the eyelid margins
  • Gritty sensation leading to irritated eyes and light sensitivity
  • Blurred vision

Causes of blepharitis:

  • Poor eyelid hygiene
  • Excess oil produced by the glands in the eyelid
  • Bacterial infection (often staphylococcal)
  • Allergic reaction

Treating blepharitis:

In addition to eliminating redness and soreness, treatment can prevent potential infection and scarring of the cornea. You doctor will perform a complete eye examination to determine the most effective treatment.

Cleaning
Usually, blepharitis can be controlled by careful, daily cleaning of the eyelashes. You can do this by moistening a clean washcloth with tap water as warm as you can stand without burning. Hold the washcloth against the eyelids until it cools, then rewarm and repeat for five to ten minutes.

After soaking, scrub each eyelid gently for one minute using a clean washcloth wrapped around your index finger and moistened with warm tap water. Cotton-tipped applicators, like Q-tips, are also useful to remove accumulated material from the eyelashes.

To remove excessive amounts of material from your eyelids, use a few drops of a non-irritating shampoo, such as baby shampoo, mixed in lukewarm water. Being careful to avoid getting shampoo in your eye, scrub back and forth along the eyelashes of all eyelids, and then rinse with plain tap water. Once the redness and soreness are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, return to daily cleansing immediately.

Medication
In some cases, your doctor may prescribe eye drops or ointment to be used along with the daily cleansing regimen. For ointments, use a clean fingertip to rub a small amount into the eyelashes. Be careful to follow recommended dosages; excess medication will cause temporary blurring of vision. And with any medication, there is a small possibility of allergy or other reaction. If you think this is happening, stop the medication and contact your doctor immediately.

For certain types of blepharitis, medications taken by mouth are helpful. Most of these medications are antibiotics that also improve or alter the oil composition of the eyelid oil glands. When taken properly, they are safe. However, side effects may occur in some individuals, including skin rash, slight nausea and increased sensitivity to sun.

Although medications may help control the symptoms of blepharitis, they alone are not sufficient; keeping the eyelids clean is essential.

If you think you may have blepharitis, your eye doctor can determine the cause and recommend the right combination of treatment specifically for you.

Cataracts

Over time cataracts typically result in blurred or fuzzy vision

Over fifty percent of people over the age of 60 (and quite a few younger than that) suffer from cataracts. Almost everyone develops cataracts as they grow older. Cataract formations occur at different rates and can affect one or both eyes.

A cataract is a progressive clouding of the eye’s natural lens. It interferes with light passing through the eye to the retina. Aging and other factors cause proteins in the eye’s lens to clump together forming these cloudy areas. Early changes may not disturb vision, but over time cataracts typically result in blurred or fuzzy vision and sensitivity to light. People with progressed cataracts often say they feel as if they’re looking through a waterfall or a piece of wax paper.

Symptoms of cataracts:

  • Decreasing vision with age
  • Blurred or double vision
  • Seeing halos around bright lights
  • Difficulty seeing at night
  • Vision that worsens in sunlight
  • Difficulty distinguishing colors
  • Poor depth perception
  • Frequent prescription changes for glasses
  • Difficulty reading

Causes of cataracts:

  • Age
  • Eye trauma
  • Heredity
  • Diabetes
  • Some medications including long-term use of oral steroids
  • Ultraviolet radiation
  • Smoking
  • Glaucoma
  • Certain metabolic conditions

Diagnosing cataracts:

Your eye doctor can perform a contrast sensitivity test to determine how much your vision has been affected by a cataract. But typically, when decreased vision affects your everyday activities or hobbies, a cataract should be treated.

Treating cataracts:

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery.

Corneal Abrasions

The cornea is the clear, outer window of the eye. A corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea very painful.


A corneal abrasion is simply a scratch in
the outer layer of the cornea

Symptoms of corneal abrasions

  • History of a recent eye trauma
  • Watery eyes
  • Acute pain
  • Sensitivity to light
  • Blurry vision
  • The feeling that there’s something in your eye
  • Twitching eyelid

Causes of corneal abrasions

  • Foreign body in the eye
  • Contact lenses
  • Chemicals
  • Blow to the eye
  • Scratched eye (fingernails, hairbrushes, tree branches, etc).

Diagnosing corneal abrasions

Your doctor will examine your eyes with a magnifying instrument

Your eye doctor can identify corneal abrasions by examining your eyes with magnifying instruments. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present. Depending on the initial exam, fluorescein dye may be used to help locate and identify the corneal abrasions. A test called the Seidel test (painting the wound with dye and observing for leakage) may be performed to uncover possible deeper injuries.

Treating corneal abrasions

Your doctor may apply a topical anesthesia to help relieve the pain. Usually, a tight patch will be placed over the eye and if the abrasion is small, the epithelium should heal overnight. If the abrasion is large, it may take a few days and your doctor may prescribe antibiotics to help prevent infections. It is important that you do not rub your eye, especially during the healing process.

Corneal Disease

The cornea is the clear front window of the eye. It transmits light to the interior of the eye allowing us to see clearly. Corneal disease is a serious condition that can cause clouding, distortion and eventually blindness. There are many types of corneal disease. The three major types are keratoconus, Fuchs’ endothelial dystrophy and bullous keratopathy.

Symptoms of corneal disease

  • With keratoconus, as the cornea protrudes or steepens, vision becomes increasingly blurred and contact lens wear, which is often an early treatment for the disease, becomes difficult. The contact lens may not stay on the eye due to the irregular shape of the cornea.
  • A person with Fuchs’ endothelial dystrophy or bullous keratopathy may first notice glare with lights at night or in bright sunlight. As these conditions progress, vision may be foggy or blurry in the morning and clear up as the day progresses. As the diseases further progress, vision will stay blurrier later into the day and eventually may not clear at all.
  • Some corneal diseases can be very painful.

Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.

Fuchs’ endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.

Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.

Causes of corneal disease

  • Infection: Bacterial, fungal and viral infections are common causes of corneal damage.
  • The cause of keratoconus in most patients is unknown.
  • Age: Aging processes can affect the clarity and health of the cornea
  • Cataract and intraocular lens implant surgery: Bullous keratopathy occurs in a very small percentage of patients following these procedures.
  • Heredity
  • Contact lenses
  • Eye trauma
  • Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.
  • Systemic diseases, such as Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome and osteogenesis imperfecta.

Diagnosing corneal disease

A slit lamp can detect corneal disease at an early stage

Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.

Treatment for corneal disease

As with any serious eye infection, corneal disease should be treated immediately. Although corneal transplant is almost always the necessary treatment to restore vision when the cornea becomes clouded, there are other measures that can be taken to prolong vision in the early stages of disease.

Corneal Ulcers

The front portion of the eye is covered with a thin, transparent membrane called the cornea, which protects the interior of the eye. If there is
a break or defect in the surface layer of the cornea, called the epithelium, and damage to the underlying stroma, a corneal ulcer results. The ulcer
is usually caused by microrganisms, which gain access to the stroma through the break in the epithelium.


If there is a break or defect in the surface
layer of the cornea, a corneal ulcer results

Corneal ulcers generally heal well if treated early and aggressively. However if neglected, corneal clouding and even perforation (a hole in
the cornea) may develop, resulting in serious loss of vision and possibly loss of the eye. Corneal ulcers are a serious vision-threatening condition
and require prompt medical attention.

Symptoms of corneal ulcers:

  • Watery eyes
  • Acute pain
  • Sensitivity to light
  • Blurry vision
  • The feeling that there’s something in your eye
  • Discharge from the eye

Causes of corneal ulcers:

  • Infection
  • Wearing contact lenses for excessive periods of time
  • Inadequate contact lens sterilization
  • Eye injury
  • Lack of tear production
  • Complications of herpes simplex keratitis, neurotrophic keratitis,
    chronic blepharitis, conjunctivitis, trachoma, bullous keratopathy and
    cicatricial pemphigoid
  • Vitamin A deficiency or protein malnutrition
  • Eyelid abnormalities

Diagnosing corneal ulcers:

Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. If left unattended, corneal ulcers may penetrate
the cornea allowing infection to enter the eyeball, which can cause permanent loss of vision and possible loss of the eye. Your eye doctor can identify corneal ulcers by examining your eyes with magnifying instruments and performing a culture study to identify infection. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present. Depending on the initial exam, fluorescein dye may
be used to identify the corneal defects. A test called the Seidel test (painting the wound with dye and observing for leakage) may be performed
to uncover possible deeper injuries.

Treatment for corneal ulcers:

If treated early, corneal ulcers are usually curable in two to three weeks. They are typically treated with antibiotic eye drops. Sometimes,
topical steroids will also be used to decrease the risk of scarring and inflammation.

Diabetic Retinopathy

Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. When the blood vessels in the eyes are affected, this is called diabetic retinopathy.

The retina is in the back of the eye. It detects visual images and transmits them to the brain. Major blood vessels lie on the front portion of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.

During the early stages of diabetic retinopathy, vision is typically not affected. However, when retinopathy becomes advanced, new blood vessels grow in the retina. These new vessels are the body’s attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal. They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision. The growth of abnormal blood vessels on the iris of the eye can lead to glaucoma. Diabetic retinopathy can also cause your body to form cataracts.

The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called retinal detachment and can lead to blindness if left untreated.

Symptoms of diabetic retinopathy:

  • There are usually no symptoms in the early stages of diabetic retinopathy
  • Floaters
  • Difficulty reading or doing close work
  • Double vision
  • If left untreated, severe vision loss can occur

Causes of diabetic retinopathy:

  • Diabetes: Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Changes in blood sugar levels increase the risk. Generally, diabetics don’t develop diabetic retinopathy until they’ve had diabetes for at least 10 years.

You can reduce your risk of developing diabetic retinopathy by:

  • keeping your blood sugar under control.
  • monitoring your blood pressure.
  • maintaining a healthy diet.
  • exercising regularly.
  • getting an eye exam at least once a year.

Diagnosing diabetic retinopathy:

There are usually no symptoms in the early stages of diabetic retinopathy. Vision may not change until the disease becomes severe. An exam is often the only way to diagnose changes in the vessels of your eyes. This is why regular examinations for people with diabetes are extremely important.

Your eye doctor may perform a test called fluorescein angiography. During the test, a harmless orange-red dye called Fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. Your doctor will use a special camera with a green filter to flash a blue light into your eye and take multiple photographs. The pictures will be analyzed to identify any damage to the lining of the retina or atypical new blood vessels.

Treatment for diabetic retinopathy:

Diabetic retinopathy does not usually impair sight until the development of long-term complications, including proliferative retinopathy (when abnormal new blood vessels bleed into the eye). When this advanced stage of retinopathy occurs, pan-retinal photocoagulation is performed. During this procedure, a laser is used to destroy all of the dead areas of retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.

If diabetic retinopathy has caused your body to form cataracts, they can be corrected with cataract surgery.

Droopy Eyes

Most likely, your eyes are the first thing people notice about your appearance. They are probably the most important aspect of facial attractiveness. Unfortunately, even with a good night’s sleep, loose skin over your eyes or bags under your eyes can make you look tired or sad, or older than you really are. As we go through life, even if we have taken care of ourselves, the skin around our eyes stretches and wrinkles. Fatty deposits cause the upper lids to sag, while under the eye the tissue bulges forward and becomes discolored. In severe cases, vision can become partially blocked.

Droopy eyes

Causes of droopy eyes:

  • Age
  • Sun exposure
  • Alcohol use
  • Smoking
  • Poor nutrition
  • Heredity
Baggy eyes

Treatment for baggy eyes:

The most common treatment for baggy eyes is called blepharoplasty or eyelid surgery.

Dry Eye

The name “dry eye” can be a little confusing since one of the most common symptoms is excessive watering! It makes more sense, though, when you learn that the eye makes two different types of tears.

The first type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.

The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you’re cutting onions, when you’re around smoke, or when you accidentally scratch your eye. The reflex tears gush out in such large quantities that the tear drainage system can’t handle them all and they spill out onto your cheek. Still another cause of reflex tearing is irritation of the eye from lack of lubricating tears. If your eye is not producing enough lubricating tears, you have dry eye.

Symptoms of dry eye:

  • Watery eyes
  • The feeling that there’s sand in your eyes
  • Eyes that itch and burn
  • Vision that becomes blurred after periods of reading, watching TV, or using a computer
  • Red, irritated eyes that produce a mucus discharge

Causes of dry eye:

  • Age: As we get older, glands in the eyelid produce less oil. Oil keeps tears from evaporating off the eye. Decreased oil production allows tears to evaporate too quickly, leaving the eye too dry.
  • Diseases including diabetes, Sjogren’s and Parkinson’s
  • Hormonal changes, especially after menopause
  • Prescription medications: These include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids can also cause dry eye.
  • Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eye.
  • Reading, using a computer or watching TV
  • Contact lenses
  • Eye surgery: Some types of eye surgery, including LASIK can aggravate dry eye.
  • Inflammation: Recent research suggests that dry eye may be caused by inflammation due to an imbalance of “good” fats and “bad” fats.

Diagnosing dry eye:

Your eye doctor can check for dry eye by examining your eyes with magnifying instruments, measuring your rate of tear production and checking the amount of time it takes for tears to evaporate between blinks. The doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special, colored eyedrops call fluorescein or Rose Bengal.

TearLab is the single most accurate and objective test for diagnosing dry eye disease. TearLab generates an osmolarity number, which provides significant information to your doctor.

Treatments for dry eye:

The most common treatment is use of artificial teardrops that help make up for the lack of natural lubricating tears. Artificial tear products come in liquid form, longer lasting gelform and long-lasting ointment form, which is most often recommended for nighttime use. Many different brands of artificial tears are available over-the-counter. Some contain preservatives and some do not. Unpreserved tears may be recommended for people whose eyes are sensitive to preservatives. Artificial tears can generally be used as often as needed, from a few times per day to every few minutes. You should follow the regimen your doctor recommends.

When infection, inflammation of the eyelids or clogged oil glands contribute to dry eye, special lid cleaning techniques or antibiotics may be recommended. It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.

Restasis is an exciting new treatment for Dry Eye Disease. Restasis drops help the eyes produce more tears by reducing inflammation, which is often a cause of dry eye. Unlike artificial tears, Restasis is the first drug proven to effectively treat a cause of Dry Eye Disease rather than only temporarily alleviate symptoms.

Punctal occlusion is a medical treatment for dry eye that may enable your eyes to make better and longer use of the few lubricating tears they do produce.

AmbioDisk™ is a 4th generation amniotic membrane (AM) technology created by IOP Ophthalmics. It is a sutureless, overlay AM disk for the office-based or surgical treatment of the ocular surface.

Facial Wrinkles

We were all born with smooth, baby-soft skin. When we were children, the muscles under our skin contracted to display facial lines of emotion, signifying happiness or sadness. As soon as our emotions returned to normal, our expression lines disappear.

But as we go through a lifetime of emotions and our skin begins to lose its elasticity, those facial lines do not go away completely, making us look older than we feel. Our skin becomes a road map showing the effects of where we have been and what we have done.

Causes of facial wrinkles:

  • Age
  • Sun exposure
  • Alcohol use
  • Smoking
  • Poor nutrition
  • Heredity

Treatment for facial wrinkles:

There are several cosmetic procedures that can reduce facial wrinkles.

Farsightedness (Hyperopia)

Hyperopia, unlike normal vision, occurs when the cornea is too flat in relation to the length of the eye. This causes light to focus at a point beyond the retina, resulting in blurry close vision and occasionally blurry distance vision as well. Usually this condition is undetected until later in life because the young eye is able to compensate for the hyperopia by contracting the internal lens of the eye.


Light focuses beyond the retina causing
blurry close vision

Symptoms of hyperopia:

  • Objects in the distance appear clearly

    Blurry close vision

  • Occasionally, blurry distance vision

Causes of hyperopia:

  • Heredity

Diagnosing hyperopia:

Many people are not diagnosed with hyperopia without a complete eye exam. School screenings typically do not detect this condition because they test only for distance vision. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of hyperopia:

Glasses and contact lenses are used by many for the temporary treatment of hyperopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate hyperopia.

Other types of refractive errors include: nearsightedness, astigmatism and presbyopia.

Flashes and Floaters

Floaters

Flashes and floaters can be alarming. Usually, however, an eye examination will confirm that they are harmless and do not require any treatment.

Symptoms of flashes & vitreous floaters:

  • Seeing small, floating spots
  • Seeing bright flashes of light

Causes of flashes and floaters:

Flashes

Aging of the eye: Most flashes and floaters are caused by age-related changes in the gel-like material, called vitreous, that fills the back of the eye.

When you are born, the vitreous is firmly attached to the retina. In the very young, the vitreous is rather thick, like firm gelatin. Within the vitreous, there may be clumps of gel or tiny strands of tissue debris left over from the eye’s early development. These clumps or strands are firmly embedded in the thick, young vitreous and cannot move around much.

As you get older, the vitreous gradually becomes thinner or more watery. By the time you are in your twenties or thirties, the vitreous may be watery enough to allow some of the clumps and strands to move around inside the eye. This material floating inside the eye can cast shadows on the retina, which you see as small floating spots.


Vitreous Detachment

Sometime after about age 55, you may experience the onset of larger, more bothersome floaters or flashes of light. By this age, the vitreous gel has usually become much more watery. It jiggles around quite a bit when you move your eye, making flashes and floaters much more common.

Eventually, the aging vitreous can pull away from the retina and shrink into a dense mass of gel in the middle of the eyeball. Shadows cast onto the retina by the detached vitreous can cause you to see large floaters.

Who is at risk?

Flashes and floaters are very common. Almost everyone experiences them at one time or another. They become more frequent as we age. In rare cases, a doctor’s exam may reveal a more serious problem called a retinal tear or retinal hole, so it’s important to get regular eye exams and inform your doctor if you’re experiencing flashes or floaters.

Diagnosing flashes and floaters:

Using special instruments to look into your eyes, your doctor can distinguish between harmless floaters and flashes and more serious retinal problems such as holes, tears or detachment. The usual symptoms of these more serious problems include seeing hundreds of small floating spots, persistent flashing lights, or a veil-like blockage of a portion of the vision. If you experience any of these, you should contact your doctor immediately.

Treatment for flashes and floaters:

There is no way to eliminate the floater through surgery, laser treatment or medication. With time, the floater will become less noticeable as the brain adjusts to its presence and can “tune out” the floater. The floater will always be somewhat observable and present, particularly if one eye is covered and the patient looks at a light-colored background.

Anyone with flashes or the sudden onset of a new floater should be examined promptly by an ophthalmologist. The ophthalmologist will perform a dilated exam and look at the vitreous and retina with specialized equipment. Sudden flashes or floaters could be symptoms of a vitreous detachment, which is a benign condition that carries the risk of developing into a retinal tear and/or retinal detachment.

Fuchs’ Corneal Dystrophy

Overview

The cornea is the clear “window” in the front of the eye that allows light rays to enter.

The cornea has three layers – the outer epithelium (or skin), a middle area called stroma and a delicate, single celled inner lining called the endothelium. The endothelium acts as a barrier to prevent water inside the eyeball from moving into and swelling the other layers of the cornea. The cells of the endothelium actively pump water from the cornea back into the eye.

If the endothelium does not function normally, then water moves into the cornea causing swelling. Swelling causes clouding of the cornea and blurred vision. The more corneal swelling or “edema,” the more severely the vision is blurred. Eventually, the outer corneal layer (epithelium) also takes on water, resulting in pain and more severe vision impairment. Epithelial swelling reduces vision by changing the normal curvature of the cornea. It causes a sight-limiting haze to develop. Epithelial swelling may also form small “blisters” on the corneal surface. When these “blisters” burst, extreme pain can occur.

Endothelial cells can be counted with special photographic methods. Most people are born with approximately 4,000 cells per square millimeter of the endothelial surface. These cells do not divide and cannot reproduce or replace themselves. As we age, we gradually lose endothelial cells.

 

Age Endothelial Cell Density
Infant 3,000 – 4,000 / sq. mm
Teenager 3,000 / sq. mm
Adult 2,500 – 3,000 / sq. mm
Elderly 2,000 – 2,500 / sq. mm

 

Once lost, endothelial cells do not grow back. The remaining cells spread out to cover the empty spaces, trying to pump water from a larger area. The pump system becomes less efficient, causing corneal clouding, swelling and eventually, reduced vision. Fortunately, most people have enough endothelial cells throughout life to prevent corneal swelling or edema. If the cells are healthy and functioning properly, as few as 500 cells per square millimeter can maintain a clear cornea. If the cells are not healthy, fewer than 1000 cells per square millimeter may result in corneal swelling or edema.

Fuchs’ Dystrophy

Fuchs’ dystrophy(named after Dr. Fuchs)is an inherited condition that affects the delicate inner layer (endothelium) of the cornea. Patients with Fuchs’ dystrophy have endothelial cells that:

  1. Do not function as efficiently as normally
  2. Age and deteriorate more rapidly than normal cells

Fuchs’ dystrophy affects both eyes and is slightly more common in women then men. On average, half of the family members of an affected person may carry or suffer from the condition. The exact cause of Fuchs’ dystrophy is unknown. Hereditary, hormonal and inflammatory factors probably all play a role.

Signs and Symptoms

In early stages, people with Fuchs’ dystrophy may wake up with blurred vision, which gradually clears over the day. That’s because during the day, water continuously evaporates from the surface of the eye and is replaced with water drawn from the inner compartments of the eye. Overnight, when we sleep with closed eyes, water cannot evaporate from the surface of the eye and accumulates in the cornea, causing slight swelling which blurs vision. Once eyes are opened throughout the day, evaporation reduces the water content and the thickness of the cornea, allowing for clearing of vision. In later stages, as the dystrophy worsens, evaporation is not enough to remove accumulated water in the cornea, and swelling and blurred vision last all day.

Typical complaints among people with Fuchs’ dystrophy include:

  • Hazy vision that is often most pronounced in the morning
  • Fluctuating vision
  • Glare when looking at lights
  • Light sensitivity
  • Sandy, gritty sensation
  • Episodes of sharp, sometimes incapacitating pain

Detection and Diagnosis

Although doctors can often see early signs of Fuchs’ dystrophy in people in their 30s and 40s, the dystrophy rarely affects vision until people reach their 50s and 60s. Fuchs’ dystrophy is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry (which measures the thickness of the cornea) and specular microscopy (which photographs the cells for counting). As the dystrophy becomes more advanced, corneal clouding may make counting the cells impossible.

Treatment

Fuchs’ dystrophy cannot be cured. Doctors are unable to treat the endothelial cells to make them work better or to become more numerous. However, blurred vision resulting from the corneal swelling can be controlled with medication. Salt solutions containing sodium chloride (Muro 128 drops or ointment, 2% or 5%) are often prescribed to draw fluid from the cornea and reduce swelling. Steroid eye drops may be helpful in specific situations.

Another simple technique that reduces moisture in the cornea is to hold a hair dryer at arm’s length, blowing air towards the face with the eyes open. This warm air flow increases evaporation of water from the cornea, temporarily decreases swelling, and may improve vision. Often very helpful in early stages, this technique may not be effective when swelling is severe, as in advanced stages.

Corneal transplantation is considered when vision deteriorates to the point that it interferes with daily activities and impairs a person’s ability to function normally. This surgery replaces the full thickness of the cornea, including the endothelium, with healthy layers. The cloudy cornea is replaced with clear corneal tissue.

Fuchs’ Dystrophy in Patients with Cataracts

As people age, the lens within the eye often becomes cloudy, developing into a cataract. Cataract surgery is very common and has a very high success rate. Any eye surgery causes some damage to the delicate endothelial cell layer of the cornea, causing a reduction in the number of cells remaining to pump water from the cornea. If the number of endothelial cells is insufficient following cataract surgery, corneal swelling will develop, reducing vision. Corneal transplantation may be necessary to recover vision. When patients with Fuchs’ dystrophy develop cataract, it is important to carefully evaluate the status of the endothelium to decide whether the cornea is likely to continue to function well following cataract surgery. A recommendation may be made to combine cataract surgery with corneal transplantation. One combined surgery can achieve what would otherwise require two separate surgeries with a longer post-operative recovery.

More details about this combined surgery are available from your surgeon.

Glaucoma

What is Glaucoma?

Glaucoma is a disease that affects the optic nerve, the part of the eye which receives images collected by the retina and sends them to the brain. Every eye maintains a certain amount of internal pressure, called intraocular pressure. When this pressure rises to abnormal levels, it can put extra stress on the optic nerve, causing significant damage. Optic nerve damage results in loss of vision and, ultimately, blindness.

The front of the eye is constantly producing a fluid called aqueous humor. A healthy eye will continually produce small amounts of aqueous humor to ensure consistent pressure within the eye. When normal drainage becomes slowed or blocked, pressure increases and may lead to glaucoma. There are several different types of glaucoma. The two most common types are chronic open-angle glaucoma and closed-angle glaucoma.

Chronic open-angle glaucoma

Chronic open-angle glaucoma is the most common form of the disease and usually develops with age. With this type of glaucoma, pressure gradually increases around the eye, causing it to work less effectively over a period of time. There are no symptoms in the early stages of open-angle glaucoma. Peripheral vision is usually the first to deteriorate. As the disease becomes more advanced, blank spots begin to appear in one’s vision. If left untreated, it eventually develops to blindness.

Risk factors for chronic open-angle glaucoma include:

  • Advanced age.
  • Family history of the disease.
  • Higher-than-normal intraocular pressure.
  • Certain ethnic races, particularly those of African descent.
  • Certain diseases or conditions, especially diabetes, farsightedness or nearsightedness, or previous eye trauma or surgery.

Closed-angle glaucoma

Closed-angle glaucoma is less prevalent but is considered a real eye emergency. This type of glaucoma occurs when a patient’s pupil moves or dilates and actually blocks off the drainage angles in the eye. This is considered a medical emergency in which an ophthalmologist should be contacted immediately to avoid any loss of vision.

Symptoms of closed-angle glaucoma include:

  • Severe eye pain.
  • Headache.
  • Blurred vision.
  • Nausea or vomiting.
  • Rainbow halos around lights.

Risk factors for closed-angle glaucoma include:

  • Extreme farsightedness.
  • An iris that is abnormally large or far back in the eye.
  • Advanced age.
  • Heredity.
  • Certain ethnic races, especially Asians.

Early detection

Vision loss from glaucoma is permanent but can usually be prevented with early detection and treatment. Glaucoma management is usually a lifelong process that requires frequent monitoring and constant treatment. Since there is no way to determine if glaucoma is under control based on how a person feels, doctor visits should be on a regular basis.

Treatments for glaucoma

There are a wide range of treatments for the disease, including medication, LASER surgery and traditional surgery. The treatment (or combination of treatments) for an individual is chosen based upon the type of glaucoma and other details of the particular case. One option is medication such as prescription eye drops which help to reduce intraocular pressure, or pills called carbonic anhydrase inhibitors which slow down fluid production within the eye.

LASER surgery has also become a common treatment option for glaucoma. For open-angle glaucoma the doctor may choose a trabeculoplasty, a painless laser procedure, which uses light to shrink and stretch eye tissue to allow more drainage of fluid. For closed-angle cases, in which the iris is blocking drainage of aqueous humor, a LASER surgery called iridotomy may be preformed.

Selective Laser Trabeculopasty (SLT)

SLT (Selective Laser Trabeculoplasty) is a safe and simple in-office laser treatment that effectively reduces eye pressure for most patients with glaucoma. The SLT mechanism of effect does not rely on medicines, instead, it uses an advanced laser system to target only specific cells of the eye—those containing melanin, a natural pigment. This allows for only these cells to be affected, leaving surrounding tissue intact. As a result, your body’s own healing response helps lower the pressure in your eye.

Selective Laser Therapy (SLT) is an advancement over other lasers that have been used in the treatment of open-angle glaucoma for more than two decades.Benefits of SLT

  • Safe: SLT is not associated with systemic side effects or the compliance and cost issues of
    medications.
  • Selective: SLT utilizes selective photothermolysis to target only specific cells, leaving the
    surrounding tissue intact.
  • Smart: SLT stimulates the body’s natural mechanisms to enhance outflow of the fluid in
    your eye.
  • Sensible: SLT therapy is reimbursed by Medicare and many other insurance providers,
    which minimizes your out-of-pocket expenses.

Other glaucoma treatment options involve various traditional surgeries. A common surgery for open-angle glaucoma is the trabeculectomy, where a doctor creates a small flap in the sclera (white part of the eye). Underneath the surface of the sclera, the doctor creates a small reservoir, called a filtration bleb, into which aqueous fluid may drain and then be disbursed, further reducing intraocular pressure.

There are a number of treatments available for glaucoma patients. If diagnosed with glaucoma, your ophthalmologist will consult with you on your options in order to maintain the best possible health of your eyes.

Keratoconus

Keratoconus, often referred to as “KC” is an eye disease that causes the cornea to become progressively thinner. A normal cornea is round or spherical in shape, but with keratoconus the cornea bulges forward, assuming more of a cone shape. As light enters the cone shaped cornea it is bent and distorted and unable to come to a point of clear focus on the light-sensitive retina.

Keratoconus usually affects both eyes but the two eyes often progress at different rates. This disease typically begins during teenage years. In most patients, it progresses for several years before stabilizing in the third to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to thin and bulge outward, further blurring vision. Scarring of the cornea can also develop.

Symptoms of keratoconus:

  • bulging, cone-shaped cornea
  • nearsightedness
  • astigmatism
  • glare and light sensitivity
  • the need for frequent prescription changes

Who is at risk:

Researchers believe that approximately three million people worldwide have keratoconus. It affects males and females of all races throughout the world. The causes are still being researched, but the likelihood of developing keratoconus is greater if you:

  • have a relative with keratoconus
  • have had excessive laser eye surgery
  • have hay fever, eczema, asthma or food allergies

Treatment

In mild cases, glasses and soft contacts can be effective, but in more advanced cases, these no longer work well.

Gas permeable (GP) contact lenses

Gas permeable contact lenses
are the primary treatment
for keratoconus.

These are the primary treatment for kratoconus. To counteract the distortion of the cornea, most keratoconus patients require special GP lenses to provide a smooth surface that can focus light in place of their own cornea’s distorted surface. Because the pattern of distortion in keratoconus is as unique as a fingerprint, the GP lenses are custom prescribed and manufactured.

A proper contact lens fitting is crucial to ensure optimal vision, comfort, and eye health. Poor fitting lenses can lead to corneal abrasions, scarring, and infection.

Corneal Collagen Crosslinking

Corneal Collagen Crosslinking is a procedure that has proven effective in strengthening the cornea and preventing it from becoming progressively thinner. The cornea consists of layers that are crosslinked together by collagen fibers that give it its strength. With keratoconus, these cross links degenerate over time, allowing the cornea to weaken, bulge forward. The medical term for this is called ectasia which is defined as the thinning and distortion of a membrane.

The procedure has been available internationally since 1998 and has been proven to stop the progression of keratoconus. It involves saturating the cornea with Riboflavin eye drops (also known as Vitamin B2) and then exposing the cornea to ultra-violet light. This causes a chemical reaction and increases the collagen crosslinks that bond the corneal layers together, making the cornea stronger and stiffer.

It is available in the US in various crosslinking studies for qualified patients.

Surgery

Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. If your doctor determines you have significant scarring of the cornea, he or she may recommend corneal transplant surgery. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. About 10 to 20% of keratoconus patients will eventually require a corneal transplant. However, corneal transplantation is not a cure. Following a successful corneal transplant, most patients still need glasses, soft contacts, or GP lenses for adequate vision.

Intacs prescription inserts

Your doctor may recommend a relatively new surgery for keratoconus using Intacs prescription inserts. This surgery is sometimes called intra-stromal corneal ring segment implantation. It is a procedure for patients who can’t wear GP lenses but whose disease has not progressed to the point of needing to have a corneal transplant. During this surgery, tiny plastic segments are placed inside the cornea beneath the surface to reduce nearsightedness and astigmatism. Normally, eyeglasses are still required after the procedure to give you the best possible vision.

Precautions

Patients with keratoconus must not have LASIK or PRK laser eye surgery due to an unacceptable risk of a poor outcome. The cornea in keratoconus is unusually thin and weak. For patients with keratoconus, LASIK surgery thins and weakens their corneas further. This can irreversibly destabilize the cornea and accelerate its distortion. Rubbing the eyes may also increase the progression of keratoconus. Eye rubbing can often be very vigorous with patients using excessive force with their knuckles. Corneas already weakened by inflammation may develop thinning and protrusion as a result of rubbing.

Low Vision

What is low vision?

Low vision means that even with regular glasses, contact lenses, medicine or surgery, people find everyday tasks difficult to do. Reading the mail, shopping, cooking, seeing the TV and writing can seem challenging.

Millions of Americans lose some of their vision every year. Irreversible vision loss is most common among people over age 65.

Is losing vision just part of getting older?

No. Some normal changes in our eyes and vision occur as we get older. However, these changes usually don’t lead to low vision.

How do I know if I have low vision?

There are many signs that can signal vision loss. For example, even with your regular glasses, do you have difficulty:

  • Recognizing faces of friends and relatives?
  • Doing things that require you to see well up close, like reading, cooking, sewing, or fixing things around the house?
  • Picking out and matching the color of your clothes?
  • Doing things at work or home because lights seem dimmer than they used to?
  • Reading street and bus signs or the names of stores?

Vision changes like these could be early warning signs of eye disease. Usually, the earlier your problem is diagnosed, the better the chance of successful treatment and keeping your remaining vision.

How do I know when to get an eye exam?

Regular dilated eye exams should be part of your routine health care. However, if you believe your vision has recently changed, you should see your eye care professional as soon as possible.

What can I do if I have low vision?

Many people with low vision are taking charge. They want more information about devices and services that can help them keep their independence.

Talk with your eye care professional

It’s important to talk with your eye care professional about your vision problems. Even though it may be difficult, ask for help. Find out where you can get more information about services and devices that can help you.

Many people require more than one visual device. They may need magnifying lenses for close-up viewing, and telescopic lenses for seeing in the distance. Some people may need to learn how to get around their neighborhoods.

Ask your eye doctor about vision rehabilitation. These programs offer a wide range of services, such as low vision evaluations and special training to use visual and adaptive devices. They also offer guidance for modifying your home as well as group support from others with low vision.

Investigate and learn

Be persistent. Remember that you are your best health advocate. Investigate and learn as much as you can, especially if you have been told that you may lose more vision. It is important that you ask questions about vision rehabilitation and get answers. Many resources are available to help you.

Write down questions to ask your doctor, or take a tape recorder with you.

Rehabilitation programs, devices, and technology can help you adapt to vision loss. They may help you keep doing many of the things you did before.

What can I do about my low vision?

Although many people maintain good vision throughout their lifetimes, people over age 65 are at increased risk of developing low vision. You and your eye care professional or specialist in low vision need to work in partnership to achieve what is best for you. An important part of this relationship is good communication.

Here are some questions to ask your eye care professional or specialist in low vision to get the discussion started:

Questions to ask your eye care professional

  • What changes can I expect in my vision?
  • Will my vision loss get worse? How much of my vision will I lose?
  • Will regular eyeglasses improve my vision?
  • What medical/surgical treatments are available for my condition?
  • What can I do to protect or prolong my vision?
  • Will diet, exercise, or other lifestyle changes help?
  • If my vision can’t be corrected, can you refer me to a specialist in low vision?
  • Where can I get a low vision examination and evaluation?
  • Where can I get vision rehabilitation?

Questions to ask your specialist in low vision

  • How can I continue my normal, routine activities?
  • Are there resources to help me in my job?
  • Will any special devices help me with daily activities like reading, sewing, cooking, or fixing things around the house?
  • What training and services are available to help me live better and more safely with low vision?
  • Where can I find individual or group support to cope with my vision loss?

Macular Degeneration

Macular degeneration is a disease of the macula, an area of the retina at the back of the eye that is responsible for fine detail vision. Vision loss usually occurs gradually and typically affects both eyes at different rates. Even with a loss of central vision, however, color vision and peripheral vision may remain clear.

Symptoms of macular degeneration:

  • Early macular degeneration may cause little, if any noticeable change in vision
  • Difficulty reading without extra light and magnification
  • Distorted or blurred objects
    Blind spots
  • Seeing objects as distorted or blurred, or abnormal in shape, size or color
  • The perception that objects “jump” when you try to look right at them
  • Difficulty seeing to read or drive
  • Inability to see details
  • Blind spot in center of vision

There are two forms of age-related macular degeneration, wet and dry.

Wet macular degeneration

Wet macular degeneration occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula. These changes can lead to distorted or blurred vision and, in some cases, a rapid and severe loss of straight ahead vision.

Dry macular degeneration

The vast majority of cases of macular degeneration are the dry type, in which there is thinning or deterioration of the tissues of the macula or the formation of abnormal yellow deposits called drusen. Progression of dry macular degeneration occurs very slowly and does not always affect both eyes equally.

Causes of or contributing factors to macular degeneration:

The root causes of macular degeneration are still unknown. Women are at a slightly higher risk than men. Caucasians are more likely to develop macular degeneration than African Americans.

  • Age: Macular degeneration is the leading cause of decreased vision in people over 65 years of age.
  • Heredity: Macular degeneration appears to be hereditary in some families but not in others
  • Long-term sun exposure
  • Smoking
  • High blood pressure
  • High cholesterol
  • Hypertension
  • Nutritional deficiencies
  • Diabetes
  • Head injury
  • Infection

Diagnosing macular degeneration:

An Amsler Grid

Your eye doctor can identify changes of the macula by looking into your eyes with various instruments. A chart known as an Amsler Grid can be used to pick up subtle changes in vision.

Angiography is the most widely used macular degeneration diagnostic test. During the test, a harmless orange-red dye called Fluorescein will be injected into a vein in the arm. The dye travels through the body to the blood vessels in the retina. A special camera takes multiple photographs. The pictures are then analyzed to identify damage to the lining of the retina or atypical new blood vessels. The formation of new blood vessels from blood vessels in and under the macula is often the first physical sign that macular degeneration may develop.

Optical Coherence Tomography (OCT) uses light waves to create a contour map of the retina and can show areas of thickening or fluid accumulation.

Treatment for macular degeneration:

In the early stages of macular degeneration, regular eye check-ups, attention to diet, in-home monitoring of vision and possibly nutritional supplements may be all that is recommended.

Diet and nutritional supplements

There has been active research on the use of vitamins and nutritional supplements called antioxidants to try to prevent or slow macular degeneration. Antioxidants are thought to protect against the damaging effects of oxygen-charged molecules called free radicals. A potentially important group of antioxidants are called carotenoids. These are the pigments that give fruits and vegetables their color. Two carotenoids that occur naturally in the macula are lutein and zeaxanthin. Some research studies suggest that people who have diets high in lutein and zeaxanthin may have a lower risk of developing macular degeneration. Kale, raw spinach, and collard greens are vegetables with the highest amount of lutein and zeaxanthin. You can also buy nutritional supplements that are high in these and other antioxidants.

Low Vision Aids

Unfortunately, the vast majority of cases of wet macular degeneration and virtually all cases of dry macular degeneration are not treatable. In these cases, low vision aids may help make it easier to live with the decreased vision of macular degeneration. Low vision aids range from hand-held magnifying glasses to sophisticated systems that use video cameras to enlarge a printed page. Lifestyle aids such as large print books, tape-recorded books or magazines, large print playing cards, talking clocks and scales and many other devices are available.

Injection

LUCENTIS  and Macugen are new treatments for the wet form of age-related macular degeneration. These injections block abnormal blood vessel growth and leakage.

Laser Treatments

In rare cases of wet macular degeneration, laser treatment may be recommended. This involves the use of painless laser light to destroy abnormal, leaking blood vessels under the retina. This form of treatment is only possible when the abnormal blood vessels are far enough away from the macula that it will not damage it. Only rare cases of wet macular degeneration meet these criteria. When laser treatment is possible, it may slow or stop the progression of the disease but is generally not expected to bring back any vision that has already been lost.

Some cases of wet macular degeneration can be treated with photodynamic therapy or PDT. In those cases where PDT is appropriate, slowing of the loss of vision and sometimes, even improvement in vision are possible.

Monovision

During childhood, people with normal vision have the ability to focus on objects as close as their nose and also on objects very far away. They can rapidly, without conscious thought, switch focus from near to far vision. This is called accommodation. As each year passes, that ability to focus and to switch focus decreases. By the time most people reach their forties, they need an aid, such as reading glasses or bifocals, to focus on objects close up. This condition is called presbyopia.

Monovision is a technique where one eye (usually the dominant eye) is corrected for clear distance vision, and the other eye is corrected for comfortable near vision. Monovision allows a person to see close objects clearly with one eye and distance objects clearly with the other eye. The vision part of the brain tends to filter out the image from the eye that is not in clear focus, so those who have monovision eventually do not pay attention to the eye that is not as clearly focused. Those who have monovision are often able to see well enough both at distance and near to do things at any age without corrective lenses.

Monovision can be achieved with contact lenses or with vision correction procedures by correcting the non-dominant eye for near vision and the dominant eye for distance vision. If you are considering a vision correction procedure, your doctor can put you into monovision contact lenses so you can try it before you permanently correct your eyes with monovision.

Most people’s brains automatically get used to monovision within a couple of weeks or months. In our experience, most people over the age of 40 to 45 who try monovision and take the time to fully become accustomed to it, like it and find it very useful.

Narrow-Angle Glaucoma

Narrow-angle glaucoma (also called closed-angle glaucoma) is much more rare and is very different from open-angle glaucoma in that eye pressure usually goes up very fast. This happens when the drainage canals get blocked or covered over. The iris gets pushed against the lens of the eye, shutting off the drainage angle. Sometimes the lens and the iris stick to each other. This results in pressure increasing suddenly, usually in one eye. There may be a feeling of fullness in the eye along with reddening, swelling and blurred vision.


The drainage canals get blocked or covered over

Symptoms of narrow-angle glaucoma:

The onset of acute narrow-angle glaucoma is typically rapid, constituting an emergency. If not treated promptly, this glaucoma produces blindness in the affected eye in three to five days. Symptoms may include:

  • Inflammation and pain
  • Pressure over the eye
  • Moderate pupil dilation that’s non-reactive to light
  • Cloudy cornea
  • Blurring and decreased visual acuity
  • Extreme sensitivity to light
  • Seeing halos around lights
  • Nausea and/or vomiting

Causes of narrow-angle glaucoma:

  • Defect in the eye structure
  • Anything that causes the pupil to dilate — dim lighting, dilation drops
  • Certain oral or injected medications
  • Blow to the eye
  • Diabetes-related growth of abnormal blood vessels over the angle

Diagnosing narrow-angle glaucoma:

Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be at higher risk for narrow-angle glaucoma, including those who are Asian, farsighted or over the age of 60, should have their pressure checked every year or two.

Because of the rapid, potentially devastating results of narrow-angle glaucoma, you should seek medical treatment immediately if you experience any of the above symptoms.

During eye exams, your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.
Tonometry is used to check your eye pressure
An ophthaolmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be cupped or is not a healthy pink color, additional tests will be run.
An ophthalmoscope is used to examine your optic nerve
Gonioscopy is used to determine whether the angle where the iris meets the cornea is open or closed, a key difference between open-angle glaucoma and narrow-angle glaucoma.
Goniscopy is used to help your glaucoma type
CIRRUS HD-OCT 500 offers comprehensive care practices essential OCT capabilities with a broad range of clinical applications in an easy-to-learn, easy-to-use instrument. It aids in the management of glaucoma and retinal disease, retina assessment for cataract surgery and anterior segment imaging for corneal disease. CIRRUS HD-OCT 500
The Diopsys® NOVA-VEP Vision Testing System is a part of the Diopsys® NOVA suite of tests which use a technology called Visual Evoked Potential (VEP) to objectively measure the functional responses of the entire visual pathway from the anterior segment of the eye to the visual cortex. Using VEP test results can help improve sensitivity and specificity in diagnosing visual pathway disorders when used in conjunction with other diagnostic tests.
The Diopsys® NOVA-ERG Vision Testing System is an office-based pattern electroretinography (ERG) module – a part of the Diopsys® NOVA suite of tests. Pattern electroretinography can help doctors gain objective, functional information about the performance of the inner retinal cells of the eye, especially in the macula.

Treatment for narrow-angle glaucoma:

Laser iridotomy is a common treatment for narrow-angle glaucoma. During this procedure, a laser is used to create a small hole in the iris, restoring the flow of fluid to the front of the eye. In most patients, the iridotomy is placed in the upper portion of the iris, under the upper eyelid, where it cannot be seen.


Laser iridotomy

Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.


Filtration surgery

Nearsightedness (Myopia)

Myopia, unlike normal vision, occurs when the cornea is too curved or the eye is too long. This causes light to focus in front of the retina, resulting in blurry distance vision.


Light focuses in front of the retina
causing blurry distance vision

Myopia is a very common condition that affects nearly 30 percent of the U.S. population. It normally starts to appear between the ages of eight and 12 years old, and almost always before the age of 20. As the body grows, the condition often worsens. It typically stabilizes in adulthood.

Objects nearby appear clearly

Symptoms of myopia:

  • Blurry distance vision

Causes of myopia:

  • Heredity

Diagnosing myopia:

Many times, myopia is diagnosed during school screenings. Sometimes parents notice that their children are having difficulty seeing street signs or the television. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of myopia:

Glasses and contact lenses are used by many for the temporary treatment of myopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate myopia.

Other types of refractive errors include: farsightedness, astigmatism and presbyopia.

Normal Vision

The human eye gives us the sense of sight, allowing us to learn more about the surrounding world than any of the other five senses. The eye allows us to see and interpret the shapes, colors and dimensions of objects by processing the light they reflect or give off.


Light is focused directly onto the retina

The cornea (the clear window on the front of the eye) and the lens of the eye (the transparent structure inside the eye) are both critical to normal vision. The goal of these two lenses is to focus light onto a layer on the back of the eye known as the retina. As light enters into the eye it is focused by the cornea and the lens so that images appear clearly on the retina. The retina then transmits these images to the brain where they are processed. If the images focus perfectly on the retina, this results in 20/20 vision; focusing in front or behind the retina results in nearsightedness or farsightedness. If the cornea is shaped like a football instead of a sphere, this is called astigmatism. When any of these conditions occurs, images are perceived by the brain as being blurry. This is due to “refractive error” which means the eyeball is not the right size or the cornea does not have the right curve. Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects.

Open-Angle Glaucoma

It is estimated that over two million Americans have some type of glaucoma and half of them do not know it. Ninety percent of glaucoma patients have open-angle glaucoma. Although it cannot be cured, it can usually be controlled. Vision loss may be minimized with early treatment. The eye receives its nourishment from a clear fluid that circulates inside the eye.


Fluid circulating inside eye

This fluid must be constantly returned to the blood stream through the eye’s drainage canal, called the trabecular meshwork. In the case of open-angle glaucoma, something has gone wrong with the drainage canal. When the fluid cannot drain fast enough, pressure inside the eye begins to build.


Excess fluid builds pressure

This excess fluid pressure pushes against the delicate optic nerve that connects the eye to the brain. If the pressure remains too high for too long, irreversible vision loss can occur.


Excess fluid pressure pushes
against the optic nerve

Symptoms of open-angle glaucoma:

  • In the early stages, there are no symptoms. There is no pain or outward sign of trouble.
  • Mild aching in the eyes
  • Gradual loss of peripheral vision (the top, sides and bottom areas of vision)
  • Seeing halos around lights
  • Reduced visual acuity (especially at night, that is not correctable with glasses)

Who is at risk

Glaucoma can occur in people of all races at any age. However, the likelihood of developing glaucoma increases if you:

  • are African American
  • have a relative with glaucoma
  • are diabetic
  • are very nearsighted
  • are over 35 years of age

Diagnosing open-angle glaucoma:

Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be at higher risk, including those over the age of 60 should have their pressure checked every year or two.

Your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.
Tonometry is used to check your eye pressure
An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be cupped or is not a healthy pink color, additional tests will be run.
An ophthalmoscope is used to examine your optic nerve
Perimetry is a test that maps the field of vision. Looking straight ahead into a white, bowl-shaped area, you’ll indicate when you’re able to detect lights as they are brought into your field of vision. This map allows your doctor to see any pattern of visual changes caused by the early stages of glaucoma.
Perimetry maps your field of vision
Gonioscopy is used to check whether the angle where the iris meets the cornea is open or closed. This helps your doctor determine if they are dealing with open-angle glaucoma or narrow-angle glaucoma.
Goniscopy is used to help your glaucoma type
CIRRUS HD-OCT 500 offers comprehensive care practices essential OCT capabilities with a broad range of clinical applications in an easy-to-learn, easy-to-use instrument. It aids in the management of glaucoma and retinal disease, retina assessment for cataract surgery and anterior segment imaging for corneal disease. CIRRUS HD-OCT 500
The Diopsys® NOVA-VEP Vision Testing System is a part of the Diopsys® NOVA suite of tests which use a technology called Visual Evoked Potential (VEP) to objectively measure the functional responses of the entire visual pathway from the anterior segment of the eye to the visual cortex. Using VEP test results can help improve sensitivity and specificity in diagnosing visual pathway disorders when used in conjunction with other diagnostic tests.
The Diopsys® NOVA-ERG Vision Testing System is an office-based pattern electroretinography (ERG) module – a part of the Diopsys® NOVA suite of tests. Pattern electroretinography can help doctors gain objective, functional information about the performance of the inner retinal cells of the eye, especially in the macula.

Treatments for open-angle glaucoma:

To control glaucoma, your doctor will use one of three basic types of treatment: medicines, laser surgery, or filtration surgery. The goal of treatment is to lower the pressure in the eye.

Glaucoma medication
comes in many forms

Medicines come in pill and eye drop form. They work by either slowing the production of fluid within the eye or by improving the flow through the drainage meshwork. To be effective, most glaucoma medications must be taken between one to four times every day, without fail. Some of these medications have some undesirable side effects, so your doctor will work with you to find a medication that controls your pressure with the least amount of side effects. Medicines should never be stopped without consulting your doctor, and you should notify all of your other doctors about the medications you are taking.

Argon Laser Trabeculoplasty and Selective Laser Trabeculoplasty surgery treat the drainage canal. Requiring only numbing eye drops, the laser beam is applied to the trabecular meshwork resulting in an improved rate of drainage. When laser surgery is successful, it may reduce the need for daily medications.


Laser surgery can reduce
the need for daily medication

Endoscopic CycloPhotocoagulation (ECP) is another type of laser procedure. Instead of treating the drainage canal, it treats the ciliary body. Treating the ciliary body reduces the amount of fluid production thereby reducing the intra ocular pressure. ECP is most often performed along with cataract surgery but can be done on an outpatient basis when in the best interest of the patient. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications.

Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.


Filtration surgery

Pink Eye (Conjunctivitis)

Conjunctivitis is an inflammation of the conjunctiva, the thin, transparent membrane covering the surface of the inner eyelid and the front of the eye. The conjunctiva has many small blood vessels. It lubricates and protects the eye while the eye moves in its socket. When the conjunctiva becomes inflamed, this is called conjunctivitis.

Bacterial conjunctivitis, often called pink eye, typically causes swelling of the eyelid and a yellowish discharge. Sometimes it causes itching and/or matting of the eyelids. Bacterial conjunctivitis is very contagious and can be easily transmitted by rubbing the eye and then infecting household items such as towels or handkerchiefs. It is common for entire families to become infected.

Symptoms of conjunctivitis:

  • Red, watery eyes
  • Inflamed eye lids
  • Blurred vision and a sandy or scratchy feeling in the eyes
  • Pus-like or watery discharge around the eyelids
  • Matting of the eyelids

How can conjunctivitis be prevented?

Certain precautions can to taken to avoid the disease and stop its spread. Careful washing of the hands, the use of clean handkerchiefs, and avoiding contagious individuals are all helpful. Children frequently get conjunctivitis because of their poor hygiene.

If you or someone in your household has contracted conjunctivitis, follow these steps to prevent the spread of the infection:

  • Every time you touch your eyes or face, including when using medicine in your eye(s), wash your hands thoroughly.
  • Wash any clothing touched by infected eyes including clothes, towels and pillowcases.
  • Do not share make-up. If the infection is caused by bacteria or a virus, you must throw away your used make-up and buy new make-up.
  • Do not touch the infected eye because the infection will spread to the other eye.

Diagnosing conjunctivitis:

Doctor’s Allergy Formula provides an FDA- approved, non-invasive proprietary, diagnostic test designed to objectively diagnose your specific allergies. This simple, painless (shot free) 3-minute test is covered by major medical insurance. The results of the test are read after only 10- 15 minutes. Once we identify what you are allergic to, we can create custom treatment protocols specific to your needs.

Treatment for conjunctivitis:

Antibiotic drops and compresses can ease discomfort and clear up the infection, normally within just a few days. Sometimes, the inflammation does not respond well to the initial treatment with eye drops. In those rare cases, a second visit to the office should be made. When there is severe infection, oral antibiotics are necessary. If left untreated, conjunctivitis can create serious complications such as infections in the cornea, eyelids and tear ducts.

Presbyopia

Presbyopia makes it difficult
to focus on close objects

Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects. During the early and middle years of life, the crystalline lens of the eye has the ability to focus both near and distant images by getting thicker for near objects and thinner for distant objects. When this ability is lost, presbyopia results.

Symptoms of presbyopia:

  • Blurry close vision that starts after age 40
  • Difficulty adjusting focus when switching from near to distance vision
  • Eye fatigue along with headaches when doing close work

Causes of presbyopia:

As we age, the lenses in the eyes lose some of their elasticity

Age: As we age, the lenses in the eyes lose some of their elasticity, and without elasticity they lose some of their ability to change focus for different distances. Presbyopia may seem to occur suddenly, but the actual loss of flexibility takes place over a number of years. Long before an individual is aware that seeing close up is becoming more difficult, the lenses in the eyes have begun losing their ability to flatten and thicken. Only when the loss of elasticity impairs vision to a noticeable degree is the change recognized. Presbyopia usually becomes noticeable in the early to mid-forties.

Diagnosing presbyopia:

A comprehensive examination will include testing for presbyopia. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and near. A visual acuity test will determine your ability to see sharply and clearly at all distances. Your eye doctor will also check your eye coordination and muscle control, as well as your eyes’ ability to change focus. All of these are important factors in how your eyes see.

Treatment of presbyopia:

Reading glasses and contact lenses are used by many for the temporary treatment of presbyopia. However, there are a number of vision correction procedures that can surgically reduce or eliminate the effects of presbyopia. Some presbyopic patients like monovision, which allows them to see distance clearly in one eye and close-up clearly with the other eye.

Presbyopia can be present in combination with other types of refractive errors such as nearsightedness, farsightedness and astigmatism.

Pterygium

A pterygium is a fleshy triangular tissue that grows over the cornea, usually on the inner corner of the eye. Sometimes, it grows big enough that it interferes with vision. As the pterygium develops, it may alter the shape of the cornea, causing astigmatism.

Symptoms of a pterygium:

  • Tissue growing over the eye
  • Irritation
  • Redness
  • Tearing

Causes of a pterygium:

The exact cause of pterygia isn’t known, but it’s thought to be linked to:

  • Long-term exposure to sunlight
  • Dry, dusty conditions
  • Age: Ptergia is typically found in adults over the age of 30.

Diagnosing a pterygium:

Chances are, you’ll notice a pterygium. Your eye doctor can also diagnose it during a routine eye exam.

Treatment of a pterygium:

Eye drops or ointment can be used to reduce the irritation caused by a pterygium. If the pterygium grows toward the central cornea,it may need to be removed surgically. Prevention is important. It’s a good idea to protect your eyes with sunglasses if you’ll be in the sun or a dusty, dry environment.

Photo courtesy of N. Friedman, M.D.

Retinal Detachment

In patients who are very nearsighted or who have suffered an injury, the retina can tear loose and become “detached” from the layers below it.

Retinal detachment occurs when the retina is lifted or pulled from the wall of the eye. If not treated immediately, a retinal detachment can cause permanent vision loss. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should call the office immediately.

Symptoms of retinal detachment

  • The appearance of a curtain over the field of vision.
  • Seeing light flashes
  • Wavy or watery vision
  • A sudden decrease in vision
  • A sudden increase in the number of floaters in the field of vision

Who is most at risk for retinal detachment?

  • Those who are very nearsighted
  • The elderly
  • People with a family history of retinal detachment
  • Those who have had cataract surgery
  • Patients with diabetes or other eye disorders

Treatment for retinal detachment

Retinal detachments are treated with surgery that may require a hospital stay. In some cases, a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. Vitrectomy is a procedure in which the vitreous humor is removed and replaced with a gas that pushes the retina back onto the wall of the eye. Over time the eye produces fluid that replaces the gas. In both of these procedures either a laser or a cryopexy (a freezing device) is used to “weld” the retina back in place.

Retinal Vein Occlusion

A blocked vein can cause leakage of blood into the retina and vision loss. This is known as a branch vein occlusion and can be treated with medication or a laser.

There are veins in the retina that drain blood out of the retina, back to the heart. If those veins become blocked, this can cause fluid leakage, which can lead to vision loss. If you experience sudden loss of your central vision or a blurry or missing area of vision, call our office at once.

Symptoms of retinal vein occlusion

  • Sudden, painless loss of vision
  • Sudden increase in floating spots or flashing lights
  • Blurred or missing area of vision

Causes of retinal vein occlusion

  • High blood pressure
  • High cholesterol
  • Obesity
  • Smoking
  • Glaucoma, diabetes and other conditions

Treatment for retinal vein occlusion

The type of treatment depends on the cause of the blockage and the extent of damage. A laser can be used to reduce leakage and the growth of abnormal new blood vessels.

Strabismus

An eye patch is sometimes used to stimulate a “lazy” eye.

Strabismus is a condition in which the eyes point in different directions. Types of strabismus include crossed eyes (esotropia), out-turned eyes (exotropia), or vertical misalignment (hyper or hypotropia). Turning of the eye may be constant or may show up only some of the time. Strabismus should be evaluated and treated.

Symptoms of strabismus

  • Double vision
  • Eyes that look in different directions
  • Head tilt or turn

Causes of strabismus

Strabismus is caused by a lack of coordination between the eyes. In children, the cause of strabismus is not known, although the condition runs in families and occurs more commonly in children with neurological problems.

In adults, causes of strabismus include injury to an eye muscle or the nerves controlling those muscles; head trauma; conditions such as diabetes or high blood pressure; loss of vision; an eye or brain tumor; Graves’ disease, stroke or other muscle and nerve disorders.

Treating strabismus

Children with strabismus must be identified and treated at a young age in order to prevent permanent vision problems. In children, when the two eyes fail to focus on the same image, the brain may learn to ignore the input from one eye. If this is allowed to continue, the eye that the brain ignores will never see well. Children do not grow out of strabismus.

Treatment options depend upon the type of strabismus and may include glasses, patching one eye, prism lenses and/or surgery.

Photo courtesy of National Eye Institute, National Institutes of Health

Uveitis

Uveitis is an inflammation that affects a part of the eye called the uvea. The uvea provides most of the blood supply to the retina. Uveitis causes spotty areas of scarring that can lead to vision loss. The degree of vision loss depends on the amount and location of the scarring. Uveitis is responsible for approximately 10% of the blindness in the United States.

SymptomsEye with Uveitis

  • Red eyes
  • Blurred vision
  • Sensitivity to light
  • Dark, floating spots in the vision
  • Eye pain
  • Intraocular pressure that is higher than normal

Causes

Many conditions, diseases and infections can lead to the development of uveitis. In some cases the cause is unknown. Uveitis usually affects people between 20-50 years of age.

Diagnosing Uveitis

Uveitis is diagnosed with a thorough internal examination of the eye. Near and distance vision, plus intraocular pressure are also evaluated.  In some cases, blood tests are performed to check for underlying disease or infection.

Treating uveitis

The appropriate treatment for uveitis is determined by the severity of the disease and which eye structures are involved.  Uveitis is typically treated with topical eye drops and/or oral medications to reduce inflammation.  Sometimes, medication is required to lower the intraocular pressure, too. If complications are advanced, surgery may be necessary.

After the inflammation has gone down, such as scar tissue,  cataracts and  glaucoma that have resulted from uveitis may need to be treated.