What is Glaucoma?

Glaucoma is a condition characterized by excessive pressure in the eye, or intraocular pressure. This irregularly high pressure is due to a buildup of fluid in the eye. As intraocular pressure increases, it can compress the eye’s optic nerve, eventually leading to vision loss.

Around 3 million people in the United States have glaucoma; although only half are aware of it. For people over 60 years old, glaucoma is a leading cause of blindness. The loss of vision is often so gradual that by the time you notice any difference in your vision, the glaucoma is already at an advanced stage.

Symptoms of Glaucoma

Different types of glaucoma have different symptoms. The most common form of glaucoma is open-angle glaucoma. It usually has no symptoms in the early stages. Later on, though, as the optic nerve is increasingly damaged, the following symptoms appear:

  • Blank spots in your field of vision, typically the peripheral vision
  • Tunnel vision during the later stages

Another type of glaucoma, called acute angle-closure glaucoma, happens very quickly. This is a medical emergency and can lead to blindness if untreated. If you experience any of the following symptoms, contact an ophthalmologist or visit the emergency room immediately:

  • Sudden blurry vision
  • Severe eye pain
  • Headache
  • Nausea or vomiting
  • Halos or rainbow-colored rings around lights
  • Reddening of the eye

Risk Factors for Glaucoma

Certain factors may increase your risk of developing glaucoma, including:

  • Already having increased intraocular eye pressure due to another reason
  • Being older than 60 increases the risk of glaucoma in general; people who are over 40 years old may have an increased risk of acute angle-closure glaucoma.
  • Being of certain ethnic descents, such as being of African-American, Japanese or other Asian descent
  • Family history of glaucoma
  • Medical conditions such as diabetes, heart disease, elevated blood pressure and underactive thyroid
  • Other eye conditions such as eye inflammation, injury, lens dislocation, retinal detachment or tumor
  • Use of corticosteroid medications over a long time

When to See an Eye Doctor

The most effective way to limit damage to your vision caused by glaucoma is with early diagnosis and treatment. This means having regular eye examinations that include measuring your intraocular pressure.

The American Academy of Ophthalmology recommends that people have a comprehensive eye exam at age 40. If you have no risk factors for glaucoma, you should have an exam every three to five years after that. If you are over age 60 or have other risk factors, you should have your eyes checked every one to two years. Ethnic groups with a greater risk of glaucoma may need to have an eye exam earlier.

If you experience gradual changes in vision, contact your eye doctor for an exam. If your vision changes suddenly, or if you have any other symptoms of acute angle-closure glaucoma, seek immediate care with an eye doctor or at the emergency room. Again, if left untreated, glaucoma can lead to blindness.

Fuchs’ Corneal Dystrophy

Fuchs’ dystrophy (pronounced fooks DIS-truh-fee) is an eye disease characterized by degenerative changes to the cornea’s innermost layer of cells. The cause for Fuchs’ dystrophy is not fully understood. If your mother or father has the disease, then there is roughly a 50 percent chance that you will develop it as well. While Fuchs’ dystrophy can sometimes be genetic, it can also occur in individuals who have no known family history of the disease.

Understanding Fuchs’ Dystrophy

Fuchs’ dystrophy typically causes vision problems in individuals who are 50 years or older, although symptoms are sometimes diagnosed in individuals who are younger. While Fuchs’ dystrophy can affect both genders, it most commonly affects women. This eye disease affects the innermost layer of cells in the cornea, the endothelium, causing degenerative changes. As the disease progresses, the cornea swells (known as a cornea edema) and clouds, which causes a decline in vision. Finally, the swelling also causes blisters to develop on the front of the cornea, a condition known as bullous keratopathy.

Symptoms and Diagnosis

Fuchs’ dystrophy symptoms include eye pain, foggy vision, blurred vision, sensitivity to light, the appearance of halos around a light source, and vision trouble at night. Individuals typically experience poor vision upon awakening that improves later in the day. Another common symptom is the sensation that a foreign object (e.g., an eyelash) is in the eye, even though nothing is there.

A comprehensive eye exam is necessary to diagnose Fuchs’ dystrophy. During this exam, an eye care professional uses an instrument called a “slit lamp” to examine the cornea. The slit lamp magnifies the cornea, allowing the eye care professional to detect the subtle changes to the cornea’s endothelium cells, which characterize the disease. The earliest clinical signs are a reduced number of endothelium cells and small, drop-like lesions along the endothelium.

Treatment

Treatment for Fuchs’ dystrophy depends on the stage of the disease at diagnosis. For an early-stage diagnosis, it is possible to improve vision with special 5% sodium chloride drops that remove excess water from the cornea. If the disease is caught in later stages, a cornea transplant may be necessary to replace a ruptured cornea. As an alternative to a full cornea transplant, a new treatment known as DLEK (deep lamellar endothelial keratoplasty) can replace the endothelium while leaving the upper layers of the cornea untouched. Finally, if you have been diagnosed with Fuchs’ dystrophy, keep in mind that certain eye surgeries, including LASIK, can actually worsen this condition.

Cytomegalovirus (CMV) Retinitis

Cytomegalovirus (CMV) retinitis is a serious disease causing compromised vision and ultimately a total loss of vision. CMV retinitis is typically associated with Acquired Immunodeficiency Syndrome (AIDS). In the early days of the AIDS epidemic, nearly one-quarter of all individuals diagnosed with late-stage AIDS also developed CMV retinitis. Thanks to aggressive treatments and a new, potent combination of drugs used to treat HIV/AIDS, CMV retinitis has been reduced by more than 80 percent.

Causes and Symptoms

CMV retinitis is caused by the cytomegalovirus. Nearly 80 percent of all adults have antibodies for this very common virus, meaning they have been infected with the virus and their bodies have successfully fought it off. For individuals with compromised immune systems, especially due to HIV/AIDS, their bodies are unable to fight off the virus. All individuals with a weakened or suppressed immune system are at risk for CMV retinitis, including individuals who are undergoing chemotherapy or who have recently had a bone marrow transplant.

Common symptoms of CMV retinitis include seeing “eye floaters” or small specks in the eye. As the disease progresses, individuals experience blurry vision, decreased peripheral vision, and light flashes. If the virus is not treated, CMV retinitis can cause a detached retina, leading to blindness in under six months.

Diagnosis and Treatment

When stricken with CMV retinitis, the infection occurs in the most external part of your retina. The virus may be present for an extended period, but not active on this outer layer. Once the virus becomes activated, however, it will quickly trigger cell death and spread to deeper layers within the retina, ultimately leading to detachment and total vision loss.

If you have been diagnosed with HIV/AIDS or have a weakened immune system and are experiencing vision changes, see an eye care professional immediately. Prompt care and treatment is absolutely essential to control the disease and prevent blindness. Anti-viral drugs are used to treat the progression of the disease, but these drugs cannot completely cure it. Anti-viral medication may be administered in pill form or as an implant in the eye.

Keratoconus

If you find yourself experiencing blurred or distorted vision that seems to get worse year after year, you may suffer from an irregularity of the cornea known as keratoconus. This condition is infamous for causing astigmatism and nearsightedness that can progress rapidly, calling for constant updates to your corrective lens prescription. Fortunately, several treatment options are available to help you cope with keratoconus.

Causes and Symptoms

While medical science has no clear explanation for the cause of keratoconus, the condition occurs more frequently in people who rub their eyes a lot, have worn contacts habitually for many years, or have certain genetic disorders such as Down syndrome. Pregnant women are also known to develop keratoconus, which might indicate that endocrine system imbalances are involved. The condition occurs when corneal tissue grows unusually weak or thin. This allows it to lose its perfectly spherical shape and take on more a cone-like outward bulge. A cornea deformed in this manner cannot refract incoming light in a way that creates an accurate image for the retina.

Keratoconus usually appears between late childhood and the mid-20s, at which point it may progress for many years. The progression is characteristically dramatic, with sufferers having to get new lens prescriptions practically every time they see their eye care provider. Blurred vision is the obvious primary symptom, but in some cases eyesight can also become hazy or cloudy if a rupture at the rear of the cornea occurs. Patients also find that their eyes grow increasingly sensitive to bright light.

Diagnosis and Treatment

The vision problems caused by mild to moderate keratoconus can usually be corrected through such conventional methods as eyeglasses and soft contacts. More stubborn cases may require gas-permeable rigid contacts, scleral lenses, or custom-made silicon hydrogel soft contacts. Some sufferers even “piggyback” a gas permeable lens on top of a hydrogel lens to achieve an optimal balance between vision accuracy and comfort.

Traditional laser surgeries such as LASIK are not usually recommended for keratoconus patients, but other types of structural correction may provide the desired vision correction. Intacs, tiny corneal inserts implanted just below the corneal surface to flatten out the cone-like curve, can be inserted in a minimally invasive surgery. Even the most extreme cases can be treated with a corneal transplant. However mild or severe your keratoconus, your eye care professional can help you understand your treatment options and devise an effective treatment plan.

Macular Dystrophy

You may have heard of macular degeneration, an age-related condition in which people suffer permanent vision loss due to damage in a part of the retina called macula. But you may not be so familiar with a similar macular condition that also causes vision loss — even in young people. This condition, known as macular dystrophy, takes its cue from the sufferer’s genetic makeup and produces varying degrees of vision loss. If you have macular dystrophy, understanding the precise nature of your condition can help you make smart decisions for coping with it.

Understanding Macular Dystrophy

The macula is a collection of cells in the center of the retina, the spot at the back of the eyeball that relays images to the optic nerve. In turn, the optic nerve sends images to the brain’s visual center for interpretation. Photoreceptors in the macula are responsible for sending information regarding the central field of vision and the perception of colors. Macula dystrophy occurs when a buildup of pigment in the macula causes the cells to lose their ability to function. This damage may cause you to lose some or all of your central field of vision, leaving your peripheral vision intact, or it may render you color blind.

Unlike macular degeneration, which also causes a loss of central vision but generally appears late in life, macular dystrophy is a genetic mutation that can express itself in young adulthood or even childhood. (The childhood variety is known as Best disease, named after the BEST1 gene that seems to cause it.)

Diagnosis and Treatment

If you suffer from early signs of central vision loss or difficulty registering colors, you may have macular degeneration or cataracts. If you test negative for those conditions, however, you may want to get checked for macular dystrophy. Your eye care professional may inject yellow-green dye into the veins of the eye to look for signs of the condition, or check for remnants of cells sloughed away by retinal disease. Electrodes can measure your eye’s ability to react to light as well. These tests, along with genetic testing, can help you discover what type of macular dystrophy you may have, if any.

While no treatment currently exists for macular dystrophy, the fact that it tends to progress slowly puts time on your side. Some cases even stop progressing on their own.

Retinitis Pigmentosa

The term retinitis pigmentosa (RP) refers to a set of degenerative genetic diseases that gradually kill off the light-sensing cells (rods and cones) of the retina, eventually causing blindness. It is a relatively rare genetic disorder, affecting only 1 in 4,000 people. Retinitis pigmentosa can be difficult to adapt to without proper support. Although there is currently no cure for RP, regular visits with your eye care professional are important to monitor the progression of the disease, adapt to the condition, and become aware as new RP treatments are available.

Symptoms of Retinitis Pigmentosa

Although there are variations dictating how a person inherits and develops retinitis pigmentosa, this condition is usually characterized by the following symptoms:

  • Poor and narrowing peripheral (side) vision.
  • Difficulty seeing or driving in dimly-lit conditions. This is often called “night blindness.”
  • As the disease progresses, vision may narrow to just a small, central vision field or “tunnel vision.”
  • Difficulty discerning colors.
  • Problems reading or doing intricate work due to deficiencies in the central field of vision, which often disappears first.

The progression of the disease can vary significantly depending on whether the condition is inherited as a dominant or recessive trait. Regular testing by your eye care professional is very important if you have RP for two reasons:

  1. Eye exams and vision tests can give you an idea of how your condition is progressing so that you can be aware of and prepare for any adaptations you need to make as your vision declines.
  2. With modern technology, there are currently efforts under way to provide treatments to slow the progression of RP, or to create solutions that simulate the behavior of healthy retina cells. Your eye care professional can inform you of any developments that might be able to make a positive impact in the quality of your life as you live with this condition.

If you or a loved one suffers from any of these symptoms, please contact your eye care professional today for an appointment.

Red Eye

The redness associated with “red eye” is usually caused by dilated or swollen blood vessels. As a result, the surface of the eye looks bloodshot. In contrast to vision problems or pain in the eye, red eye is often less of a concern. However, there are times when red eye may be a sign of a more serious condition.

Causes of Red Eye

When the blood vessels running over the surface of the white part of the eye (sclera) become swollen, the eyes look red or bloodshot. This can be caused by:

  • Acute glaucoma, a medical emergency in which a sudden increase in eye pressure causes severe pain and vision problems
  • Colds or allergies
  • Dryness of the eyes
  • Dust or other small particles in the eye
  • Exposure to chemicals, such as in a chlorine swimming pool
  • Infection
  • Injury, such as scratches of the outer layer of the eye (cornea)
  • Subconjunctival hemorrhage, which is caused by a broken blood vessel on the surface of the eye, often after coughing or straining
  • Sun overexposure

Red eye caused by inflammation of infection may occur along with discharge, itching, pain or vision problems. Several conditions can cause this, such as:

  • Blepharitis, which is characterized by inflammation or swelling of the edge of the eyelids
  • Conjunctivitis, also known as pink eye, which is characterized by infection or swelling of the layer of clear tissue that covers both the surface of the eye and the inner surface of the eyelids (conjunctiva)
  • Corneal ulcers, which are open sores on the cornea that are often caused by a serious viral or bacterial infection
  • Uveitis, which is inflammation of the uvea, the part of the eye that includes the iris

When to See an Eye Doctor

Short periods of red eye that happen occasionally are not usually a problem. They may clear up on their own after resting your eyes or avoiding anything that was irritating them.

However, red eye that continues for longer periods or occurs alongside vision problems or pain in the eye may be a sign of a more serious problem. Contact your eye doctor if you experience any of the following:

  • Discharge from one or both eyes
  • Minor vision changes
  • Pain in the eye
  • Redness that lasts longer than one or two days

Seek immediate medical help for any of the following:

  • Being unable to open your eye or keep it open
  • Feeling like a foreign object is in your eye
  • Loss of vision
  • Puncture wound to the eye
  • Seeing halos around lights
  • Severe eye pain, headache, nausea or sensitivity to bright lights

If you are experiencing long-lasting red eye or red eye combined with any of the symptoms listed above, call us today to schedule an appointment, so we can assess your eye health and provide any necessary treatment options.

Stargardt Disease

Loss of eyesight and macular degeneration are typically associated with aging. Stargardt disease, however, an inherited form of macular degeneration, commonly affects children and young adults. Also referred to as Stargardt macular dystrophy (SMD) or flavimaculatus, the term Stargardt disease refers in particular to the form of inherited macular degeneration which affects individuals at a young age.

Cause

The death of photoreceptor cells located in the center of the retina (back of the eye) causes Stargardt disease. The photoreceptor cells of the macula, the center of the retina where light comes to a sharp point, are responsible for central vision. Central vision is used for activities like facial recognition, reading, watching television, and driving. Stargardt disease does not typically affect peripheral vision or motion-detecting vision.

Symptoms

A progressive loss of central vision is the primary symptom of Stargardt disease, in addition to difficulty seeing in low light and the eventual loss of color vision at late stages of the disease. The visual acuity of sufferers can deteriorate to vision as bad as 20/40 to 20/400.

Risk Factors

An inherited condition, Stargardt disease is passed on to a child via two parents carrying the recessive gene, where each parent has a recessive Stargardt gene paired with a normal gene. Children of two carriers have a 25 percent chance of inheriting two Stargardt genes linked together, and therefore inheriting the disease.

Research has identified the recessive gene associated with Stargardt disease, ABCA4, and individuals can be tested to find out if they are carriers. Couples who are both carriers of the Stargardt disease recessive gene can seek genetic counseling prior to having children to learn about the risks associated with the disease.

Diagnosis and Treatment

An eye care professional uses a slit lamp to diagnose Stargardt disease by observing the presence of yellow deposits of lipofuscin (a type of fat), which accumulate abnormally, and the presence of vitamin A dimers (clumps) in the retina.

Exposure to UV light has been shown to accelerate the disease’s progress. Anyone diagnosed with Stargardt disease should always wear sunglasses with 100% UV protection.