Macular Hole

The condition known as a macular hole refers to a tiny break in the macula that results in blurry or distorted vision. To fully understand the condition, one must understand eye anatomy. The macula is a spot located in the center of the retina (the back portion of the eye). Located where light comes to a focused point in the eye, the macula is the portion of the eye most concentrated with color detecting cones and responsible for seeing clear color vision. The rest of the retina is covered with photosensitive rods, which detect darkness, light, or movement.

Symptoms

Macular hole development usually occurs gradually. As a result, the first symptoms include slight distortions of vision. For example, straight lines might appear wavy or you might have difficulty reading or recognizing faces. A sudden loss of vision in one eye usually follows these early symptoms.

Causes

A gel-like substance called vitreous fills most of the eye’s interior. Millions of fibers attach the vitreous to the retina, holding it in place and maintaining the eye’s round shape. Vitreous begins to shrink with age, and pull away from the retina, leaving pockets of space which become filled with fluid. Normally, this process occurs with no adverse effects. However, if the vitreous shrinks and the fibers are firmly attached, it can tear the retina. The fluid which then fills the void space can seep through the retina and pool on the macula, distorting and blurring vision.

Since most cases of macular holes develop as the result of age, individuals over the age of 60 are at the highest risk. Macular holes, however, can also develop due to injury, severe nearsightedness (myopia), retinal detachment, or macular pucker.

Diagnosis and Treatment

If left untreated, a macular hole can worsen over time, leading to permanent vision loss. If you notice any unusual eye symptoms, you should seek treatment with an eye care professional right away.

The most common treatment for a macular hole is a surgical procedure called a vitrectomy, and is performed by a retinal specialist. In this procedure vitreous gel and fibers are removed from the middle of the eye to prevent further tearing of the retina. A mixture of air and gas is then inserted into the space once filled with vitreous, putting pressure on the macular hole and allowing it to heal.

Nystagmus

Nystagmus is a vision condition characterized by repetitive, uncontrolled eye movements. These involuntary eye movements may be side-to-side, up and down, or in a circular pattern, which hinders the eyes’ ability to focus on a steady object. Individuals with nystagmus may hold their heads in unusual positions or nod their heads in an effort to compensate for these vision obstructions. Nystagmus that develops in childhood is typically inherited; if this condition develops later in life, it may be due to an accident injury. In some cases, however, the exact cause for nystagmus is not fully known.

Types of Nystagmus

Forms of nystagmus include congenital nystagmus and acquired nystagmus. Congenital typically develops between two and three months of age. Eyes appear to move in a horizontal swing fashion. Congenital nystagmus is associated with conditions like undeveloped optic nerves, albinism, congenital cataracts, and the congenital absences of the iris.

Acquired nystagmus generally occurs in adulthood. While the cause is typically not know, this condition may be triggered by central nervous system issues due to alcohol or drug toxicity, stroke, multiple sclerosis, or a blow to the head.

Diagnosis and Treatment

A comprehensive eye exam is necessary to diagnose nystagmus. An eye care professional will first study a patient’s history to determine whether environmental factors, general health problems, or medications could be causing any of the symptoms the patient is experiencing. Next, visual acuity measurements will be taken to assess the extent to which vision has been compromised. These tests will help determine the appropriate refractive lens necessary to compensate for nearsightedness, farsightedness, or astigmatism. Finally, tests will be done to determine how the eyes work together to move in unison and focus on a single object.

While there is no “cure” for nystagmus, treatment options are available to help correct other vision problems that may be associated with this condition. Depending on the type of nystagmus, it is also possible that the condition will spontaneously correct itself. In extremely rare cases, surgery may be performed to alter the position of the muscles that move the eye. However, lifestyle changes such as using large-print books, increased lighting, and magnifying devices are generally the preferred treatment methods.

Astigmatism

Many correctable vision problems are caused by abnormal eye anatomy. Very few people have perfectly shaped eyes that facilitate ideal vision. Rather, most people have some degree of abnormal curvature or other anatomical irregularities that cause slight visual changes. Astigmatism is one common form of visual impairment that results from irregular anatomy.

What Is Astigmatism?

The clear front area of the eye is called the cornea, which is important for refracting light rays to direct them onto the retinal surface. Light rays pass through the cornea onto the lens. The lens is flexible, changing shape to further focus the light rays and ensure that they hit the retina. Light must bend at a particular angle to result in clear, focused vision. Any abnormalities in eye structure may cause light to be improperly focused onto the retina, preventing visual sensory cells from processing the images.

Astigmatism occurs when either the cornea or the lens is abnormally curved. It is important to note that nearly everyone has some degree of astigmatism, as ocular structures are rarely perfectly shaped. When the cornea or lens has particularly pronounced curvature, however, light rays fail to focus onto the retina. This leads to blurry vision. Unlike farsightedness or nearsightedness, astigmatism causes blurred vision at any distance. Many people have astigmatism as well as farsightedness or nearsightedness.

Diagnosis of Astigmatism

A comprehensive optometry exam checks your eye anatomy and vision for signs of astigmatism. Tests of visual acuity typically reveal some inability to clearly read letters on a distance chart. The eye care provider may also use a keratometer, a tool that measures the curvature of your cornea. By shining a bright light into your cornea and measuring its reflection, the eye doctor can assess the curvature of your cornea. Your eye care provider may also place different lenses in front of your eyes to determine if you have a refractive error and to what extent.

Treatments

Most commonly, treatment for astigmatism consists of prescription eyeglasses or contact lenses. An alternate treatment is orthokeratology, in which your eye doctor provides a series of rigid contact lenses for you to wear for relatively short periods of time. These lenses reshape your cornea, allowing you to have clear vision. Although orthokeratology does not permanently change the shape of your cornea, it may help you go without glasses or contact lenses for everyday activities. Surgery is another option for those who want a more permanent solution.

Astigmatism is very common and relatively easy to treat. If you experience any blurriness or change in vision, consult your eye doctor immediately to receive an optometric exam.

Eye Occlusions

An eye occlusion is a blockage in one of the arteries or veins supplying blood to the retina and/or optic nerve. These blockages can cause severe and sudden vision loss. Contact your eye care professional immediately if you experience sudden vision loss, and follow up right away with your family doctor. Eye occlusions often signal other serious health problems requiring immediate medical attention.

Diagnosis and Treatment of Eye Occlusions

There are 4 main types of eye occlusions, categorized based on the vessels involved, their location within the eye, and the type of vision loss they cause. An eye care professional will perform a complete eye exam to determine the root problem:

  • Branch Retinal Artery Occlusion or “BRAO”— Characterized by a sudden loss of peripheral vision, and occasionally central vision, from a broken clot or plaque traveling from the carotid (in the neck) artery into the branch retinal artery. Rapid treatment (within 12-24 hours of the onset of symptoms) with glaucoma medicine can help. 80% of patients with a BRAO can recover up to 20/40 in visual acuity.
  • Branch retinal vein occlusion or “BRVO”— Involves distorted and diminished vision, peripheral vision loss, and blind spots in one eye. This type of occlusion usually occurs in people with diabetes or high blood pressure. Your eye care professional will diagnose the condition based on retinal bleeding along one of the retinal veins, which is detected during a fluorescein angiogram test. Laser and pharmaceutical treatments can help some patients recover a degree of their lost vision.
  • Central retinal artery occlusion or “CRAO”— Manifests as painless, yet extensive and sudden vision loss in one eye and can point toward serious narrowing of the carotid artery or complications of diabetes. Immediate, full medical and eye exams are necessary to address the root cause. Vision loss is often permanent, with only a few therapies offering limited success at restoring some vision. Treatments must be implemented within a very short time frame after the onset of symptoms to have a chance of success.
  • Central retinal vein occlusion or “CRVO”— Diabetes and high blood pressure are risk factors for CRVO, which can cause mild to severe vision loss. Laser and pharmaceutical treatments can stop the damage and prevent worsening vision if caught early.

Any sudden vision loss, whether painful or painless, requires immediate attention because prompt treatment offers better vision outcomes in the case of eye occlusions. Also remember to check in with your physician for diagnosis and treatment of other potentially serious eye occlusion risk factors.

Optic Neuritis

Also known as demyelinating optic neuritis, optic neuritis refers to the inflammation of the optic nerve due to the loss of or damage to a protective covering called myelin, which surrounds the optic nerve. The myelin is essential to the function of the optic nerve. A more general term, optic neuropathy, refers to nerve damage or abnormalities due to blocked blood flow, disease, or toxic exposure. Optic neuritis is a type of optic neuropathy.

Symptoms

Several vision symptoms accompany optic neuritis including blurred vision, blind spots, pain with eye movement, and reduced color vision. These symptoms typically precede a loss of vision. If left untreated, optic neuritis can lead to permanent optic nerve damage and permanent loss of visual acuity.

Causes

Although the exact cause of optic neuritis is not yet understood, optic neuritis occurs when the body’s immune system mistakenly attacks the myelin, which protects your optic nerve. The myelin is vital for the proper function of the optic nerve. When damaged, the nerve cannot efficiently transfer electric signals/information from the eyes to the brain, hindering vision.

Optic neuritis tends to occur in conjunction with several medical conditions, disorders, and diseases including multiple sclerosis (MS), neuromyelitis optica, systemic lupus erythematosus, sarcoidosis, Lyme disease, ocular herpes, syphilis, measles, mumps, and sinusitis. In addition, optic neuritis can also develop in reaction to certain medications.

Most common among women, young adults between the ages of 20 and 40 are at the greatest risk of developing optic neuritis.

Diagnosis and Treatment

Eye care professionals diagnose optic neuritis using a series of tests and evaluations including a routine eye exam, an ophthalmoscopy (to inspect the back of the eye, looking for a swollen optic nerve), pupillary light reaction test (to check for abnormal function of the pupil), and blood tests.

Patients diagnosed with optic neuritis are much more likely to develop MS. As a result, if a patient is diagnosed with optic neuritis, an MRI will often be recommended to look for further signs of nerve damage and the possible development of MS.

Optic neuritis may clear up on its own. If, however, it does not, an eye care professional will usually recommend a regimen of steroids administered both orally and intravenously to reduce inflammation and suppress the immune system.

If signs of MS are present in the patient, medications to slow the onset or development of MS will also be prescribed.

Sjogren’s Syndrome

Pronounced SHOW-grins, Sjogren’s syndrome is a disorder of the immune system, or an autoimmune disease, which causes the body’s immune system to attack and harm the body’s glands. Your glands are responsible for the production of saliva, tears, and other lubrication necessary for the proper function of the body.

Sjogren’s Syndrome Symptoms and Side Effects

The two most common symptoms of Sjogren’s syndrome are dry eyes and mouth. Eye dryness usually leads to an itchy, gritty feeling. Dry mouth causes a cottony feeling which can make regular speaking and swallowing difficult. In Sjogren’s syndrome, the body’s immune system first attacks the body’s glands, but eventually might target other parts of the body like the liver, kidneys, joints, nerves, thyroid, skin, and lungs. In addition to dry eyes and mouth, people with Sjogren’s syndrome might also experience one or more of the following:

  • Dry cough
  • Fatigue
  • Swollen salivary glands
  • Joint pain, swelling, and/or stiffness
  • Dry skin and skin rashes
  • Peripheral neuropathy

If left untreated, symptoms of Sjogren’s syndrome, particularly dry mouth and dry eyes, can lead to further complications such as cavities, oral yeast infections, and corneal ulcers.

Causes and Risk Factors

Like many autoimmune diseases, the exact cause of Sjogren’s syndrome is not understood. Research links the presence of a certain gene in the body to Sjogren’s syndrome, but it may also develop with an undetermined trigger such as a bacterial or viral infection. Post-menopausal women over 40 are most likely to develop Sjogren’s syndrome. Sometimes present alone, it often accompanies other autoimmune disorders such as lupus or rheumatoid arthritis.

Diagnosis

An eye care professional usually diagnoses Sjogren’s syndrome after a patient presents with dry eyes. After ruling out other possible causes such as medications, several tests will be performed to pinpoint Sjogren’s syndrome, including:

  • Blood tests for certain markers indicative of Sjogren’s syndrome
  • Schirmer’s test to measure tear production
  • Slit lamp eye exam
  • Sialogram, an X-ray of the salivary glands
  • Salivary scintigraphy, which tracks an isotope’s journey through the body’s glands
  • Biopsy looking for inflammatory cells

Treatment

No cure for Sjogren’s syndrome has been developed. Treatment focuses on relieving symptoms. Treatments include eye drops and lubricants, mouth lubricants, immune system suppressants, medications to increase saliva production, and surgery to prevent tears from draining. Patients have also found relief by increasing water intake and wearing protective eye glasses or goggles outdoors.

Uveitis

Uveitis refers to the inflammation of the eye’s middle layer, which consists of the iris, ciliary body, and choroid. Several fungal, viral, or bacterial infections lead to uveitis, as do certain autoimmune (systemic) and inflammatory conditions. In most cases of uveitis, however, the exact cause is unknown.

Types of Uveitis

Four classifications of uveitis exist. The exact parts of the eye affected by uveitis differ by classification.

  • Anterior uveitis (iritis) occurs closer to the front of the eye, and refers to inflammation of the iris or the iris and ciliary body.
  • Intermediate uveitis (cyclitis) refers to the inflammation of the ciliary body alone.
  • Posterior uveitis (choroiditis) refers to the inflammation of the choroid, located closer to the back of the eye.
  • Panuveitis (diffuse uveitis) refers to the inflammation of the entire middle layer of the eye.

Uveitis Symptoms

Uveitis symptoms vary depending on which type of uveitis the patient has. Anterior uveitis usually results in sensitivity to light, eye pain, redness, and a reduction in visual acuity. Interior and posterior uveitis cause floaters and blurred vision, but usually do not result in any pain. A combination of all these symptoms often accompanies panuveitis.

You should visit an eye care professional immediately if you experience any unusual symptoms around the eyes. If left untreated, uveitis can lead to cataracts, permanent vision loss, glaucoma, detached retina, and optical nerve damage.

Diagnosis and Treatment

In order to diagnose uveitis, an eye care professional will conduct a complete eye exam and a thorough consideration of your health history. Although the exact cause of uveitis is not always clear, a determinable cause is extremely helpful for treatment. If an eye care professional suspects an underlying cause for uveitis, he or she might refer you to a specialist for treatment.

In addition to receiving treatment for any condition causing uveitis, uveitis itself is usually treated with a steroid to reduce inflammation. Depending on the type of uveitis, a steroid is administered in eye drops, orally, or with injections. As anterior uveitis occurs closer to the surface of the eye, steroids in the form of eye drops are usually sufficient. Other forms of uveitis require oral steroids or injections. Sometimes, a small surgical drug implant is recommended for the administration of the anti-inflammatory steroid. An eye care professional might also prescribe eye drops to dilate the eye and reduce pressure.

Computer Vision Syndrome

Almost everyone uses computers in the modern world, whether for recreation, employment, education or any combination of the three. Unfortunately, our increased use of computers in almost every aspect of our lives — even using a smartphone to make a telephone call — requires our eyes to read a computer screen. According to a New York Times article, “Lenses to Ease the Strain from Staring at Screens,” by Mickey Meece, over 30 percent of adults over the age of 18 spend “at least five hours a day on a computer, tablet or smartphone.” This significant and increased amount of time has led the field of optometry to recognize and identify a visual and upper body muscular disorder now known as Computer Vision Syndrome.

Visual Challenges of Using Computers

The American Optometric Association took an early and necessary interest in what came to be known as Computer Vision Syndrome. Their research explains some of the reasons why reading words on a computer varies so much from reading words printed on ink on a paper page. Words are represented on a computer screen with pixels as opposed to ink or laser markings. Depending upon the screen’s pixel resolution, letters of the alphabet can be fuzzy and almost seem to move. Other, more expensive computer monitors with increased pixels can make letters stand out more sharply from the desktop background and thus, make reading easier. The lighting of computers is also different that the overhead or lamplight illumination used when we read words on paper. Paper such as that used for bound books does not reflect light back into our eyes, further limiting our ability to differentiate a letter sharply from another. A similar example can be observed when some individuals attempt to read off of glossy magazine pages and find it more difficult that reading a paperback book or an electric company bill.

The physical distance from a desktop computer and the viewing angle can also increase eyestrain. Using a laptop or tablet computer allows the user to modify the distance between their eyes and the screen, only to encourage poor cervical posture similar to a turtle’s head protruding from its shell. Finally, most individuals working at a desk are constantly readjusting their visual focus due to the various distances used for their work, such as reading correspondence, handwriting memos, reading an email online and switching to office telephone buttons or labels.

Symptoms for Your Eye Doctor to Evaluate

Visit your eye care provider if you experience one or more of the following symptoms:

• Eyestrain or “tired eyes”
• Headaches after working with a computer
• Blurry vision
• Dry eyes
• Neck and/or shoulder pain
• Worsening of existing eye disorders such as farsightedness, astigmatism or presbyopia

Treatments for Computer Vision Syndrome

The specific combination of treatment types used to help correct Computer Vision Syndrome is determined by their origin: visual, lighting, postural or mechanical. In many situations, experts advise computer users to increase word font sizes to minimize squinting and to adjust screen contrast systems so that words appear more distinctly. Some patients will require special computer glasses while others can find relief with use of an anti-glare computer screen. Dry eyes can be relieved by artificial tears and taking more frequent breaks from computer work. Ask your eye care provider today for treatments and techniques to minimize your chances of developing Computer Vision Syndrome.

Strabismus

Commonly called crossed eyes, strabismus is a condition in which eyes do not work together, failing to maintain proper alignment. While one eye focuses on an object, the other does not. The failure of the eyes to work together causes double vision, and if untreated can lead to an extreme reduction of vision in one eye, amblyopia. Strabismus is classified by the direction of misalignment, frequency, and the eye or eyes in which strabismus occurs. These classifications include:

  • Esotropia – inward turning eye
  • Exotropia – outward turning eye
  • Hypertropia – upward turning eye
  • Hypotropia – downward turning eye

Strabismus is further classified by the frequency of the condition (constant or intermittent), whether one (unilateral) or both eyes (alternating) show signs of strabismus, and the degree of the turn (large or small angle).

Causes

Six external (extraocular) muscles control each eye’s movement and position. In order for binocular vision to work properly, the positioning, function, and neurological control of these muscles must work together perfectly to control the eyes. An anatomical problem, neurological condition, or trouble with the center of the brain which controls binocular vision can make it difficult to control the extraocular muscles, leading to strabismus.

Individuals with uncorrected farsightedness can also develop strabismus. If the eyes are overly strained while attempting to focus on a distant object, they can become crossed. This condition is known as accommodative esotropia, and can usually be treated with corrective lenses.

Genetics also play a prominent role in strabismus. Those with a parent who has strabismus have a much greater chance of developing the condition themselves. In addition, certain medical conditions such as Down syndrome, cerebral palsy, and stroke put individuals at a higher risk or developing strabismus.

Signs and Symptoms

The most prominent sign of strabismus is the misalignment of eyes, which can lead to amblyopia and vision problems. Small angle strabismus often leads to eye strain and headaches. In addition, strabismus often causes young sufferers significant emotional stress, as it affects the ability to make normal eye contact with others.

Diagnosis and Treatment

Eye care professionals diagnose strabismus using a series of tests: visual acuity, refraction, alignment and focusing, and an examination of eye health. Once strabismus is diagnosed, it can be treated according to its cause and severity. A case of accommodative esotropia can be corrected with glasses, but more serious cases of strabismus might require muscle surgery and vision therapy.

Presbyopia

As we age, our eyes—like the rest of our bodies—begin to lose flexibility and strength. When this happens to the lens of the eye and its surrounding muscles, your lens will become stiff. This makes it harder to see close objects clearly because the eyes can’t focus properly. It’s a natural part of aging that typically begins around age 40. Presbyopia can be corrected easily with eyeglasses or contact lenses from an optometry clinic.

Is Presbyopia the Same as Farsightedness?

No. Farsightedness is caused by distortions in the shape of the eyeball. Presbyopia occurs when your lens becomes stiff.

What Are the Symptoms of Presbyopia?

  • A need to hold things at arm’s length to read them
  • Blurry vision when reading things at a normal distance
  • Fatigue or headaches after doing work at a close distance

How Is Presbyopia Diagnosed?

Your eye care provider will conduct a thorough eye exam and check for presbyopia.

How Is Presbyopia Treated?

To help correct the symptoms, your eye care provider may advise you to use aids such as:

  • Prescription eyeglasses
  • Contact lenses
  • Reading glasses
  • Progressive lenses
  • Bifocals

Most commonly, bifocals or progressive lenses are recommended. The top portion of the eyeglass lenses correct vision at long distances, and the bottom portion helps you see clearly up close. Bifocals have a distinct edge between the two prescriptions, but progressive lenses have a graduated transition between the areas.

Over time, if your presbyopia continues to change your vision, then you may need to update your eyewear periodically to maintain clear vision.

If you prefer a more permanent treatment, ask your eye care provider if you’re a good candidate for conductive keratoplasty. In this procedure, precise radio waves reshape your cornea to improve your vision of nearby items.

As a sign of natural and healthy aging, presbyopia can be annoying, but it’s easy to address. Whether you prefer glasses, contact lenses or surgery, talk with your eye care provider to find out which options are best for you.