Retinal Disorders

Retinal disorders are conditions that affect the layer of tissue at the back of the eye, known as the retina. This important part of the eye responds to light and passes on images to the brain. All retinal disorders affect your vision in some way, but some can also lead to blindness.

Macular degeneration. Also known as age-related macular degeneration (AMD), this condition affects the center part of the retina, the macula. This area is needed for the sharp, central vision that is used during everyday activities such as driving, reading or working with tools. This condition is a leading cause of vision loss in people over the age of 60 years old. Treatment can slow the loss of vision, but it will not restore vision that has already been lost.

Diabetic eye disease. The high blood sugar (glucose) levels that occur with diabetes can also affect vision. One type of diabetic eye disease is diabetic retinopathy, which affects the blood vessels in the retina. This can lead to blurry or double vision, blank spots in the vision and pain in one or both eyes. Diabetics may also be at higher risk of developing other eye conditions, such as cataracts and glaucoma.

Retinal detachment. This medical emergency happens when the retina pulls or lifts off of its normal position. It can cause symptoms such as floaters in the field of vision, light flashes and the feeling of a “curtain” in the way of your vision. If not treated right away, a retinal detachment can lead to permanent blindness in that eye.

Retinoblastoma. This cancer of the retina is generally uncommon; although, it is the most common type of eye cancer in children. The cancer starts in the cells of the retina, but can spread to other parts of the body (metastasize).

Macular pucker. Scar tissue on the macula can make the central vision become blurry and distorted. Although the symptoms are similar, macular pucker is not the same as age-related macular degeneration. The symptoms of a macular pucker are usually mild and do not require treatment. Sometimes, the scar tissue can fall off the retina on its own, and the vision will return to normal.

Macular hole. This condition is caused by a small break in the macula, which leads to blurriness and distortion in the central vision. Related to aging, this condition usually happens in people over the age of 60. Some macular holes close up on their own while others require surgery to help improve vision.

Floaters. These are specks, or “cobwebs,” that appear in the field of vision. Unlike scratches on the cornea, which follow your eye movements, floaters can drift even when the eyes are not moving. Most people have some floaters and have no problem with their vision. A sudden increase in the number of floaters, though, can indicate a more serious eye problem such as retinal detachment.

If you notice a change in your vision or simply have not undergone a routine eye ex

Age-Related Macular Degeneration

One of the leading causes of vision loss in people who are age 50 or older is age-related macular degeneration (AMD). This common eye condition leads to damage of a small spot near the center of the retina called the macula. The macula provides us with the ability to clearly see objects that are straight ahead.

AMD may progress very slowly, with vision loss taking a long time to occur. In some people, though, the disease may advance more quickly. It can affect one or both eyes. Some treatment options are available for later stages of AMD.

Symptoms of Age-Related Macular Degeneration

One of the first symptoms of AMD is a blurry area in the center of your field of vision. Over time, this blurred region may increase in size. You may also develop blank spots near the center of your vision. In addition, objects may not be as bright as they once were.

AMD does not lead to complete loss of vision. However, the central vision that is affected by AMD is needed for many everyday activities, such as being able to read, write, recognize faces of other people, drive a car, cook or fix things around the house.

Risk Factors for Age-Related Macular Degeneration

One of the main risk factors for AMD is being over 60 years old; although, this condition can happen in younger people. Other risk factors for AMD include:

  • Smoking. Smoking tobacco can double your risk of suffering from AMD.
  • Race. Caucasians are more at risk of AMD than Hispanics/Latinos or African-Americans.
  • Family history. If someone else in your family had AMD, you are at greater risk of developing it.
  • Genetics. Almost 20 genes have been linked to an increased risk of AMD.

Certain healthy lifestyle choices may slow the progression of AMD or reduce your risk of developing it, including:

  • Not smoking
  • Eating a well-rounded diet that includes a lot of fish and green, leafy vegetables
  • Keeping your blood pressure and cholesterol at normal levels
  • Doing regular physical activity

Treatments for Age-Related Macular Degeneration

There is no treatment for AMD during the early stages. Many people have no symptoms at this point. If you have early AMD, your eye doctor may suggest a yearly — or more frequent— eye exam to see if your disease is getting worse.

For intermediate- and late-stage AMD, some research has found that high doses of certain vitamins and minerals may slow the advance of this disease. This includes vitamins C and E, zinc, copper and beta-carotene (and perhaps lutein and zeaxanthin).

These will not help you if you have early-stage AMD. They may, though, slow vision loss in the later stages. To find out if nutritional supplements are right for you, check with your ophthalmologist.

Diabetic Eye Diseases

Diabetes is a condition that involves high blood sugar (glucose) levels. This can affect many parts of the body, including the eyes. One of the most common diabetic eye diseases is diabetic retinopathy, which is also a leading cause of blindness in American adults.

Diabetic Retinopathy

Diabetic retinopathy includes several conditions that affect the light-sensitive layer of tissue on the back of the eye, known as the retina. This tissue is responsible for capturing light and passing on images to the brain.

There are two main types of diabetic retinopathy:

  • Nonproliferative retinopathy. This is the most common type. In this condition, the tiny blood vessels (capillaries) at the back of the eye swell and form pouches. As this condition gets worse, it can starve the retina of its blood supply.
  • Proliferative retinopathy. When the retina doesn’t get enough blood, new blood vessels grow. These tend to be weak and can leak blood, which can cause vision loss or blindness.

Diabetic retinopathy can also cause vision loss when fluid leaks into the macula, the part of the retina that is responsible for the sharp, central vision. The leakage of fluid can lead to swelling of the macula (macula edema) and blurred central vision.

Glaucoma

Diabetics have a higher risk of developing glaucoma than people without diabetes. This risk increases with age and the length of time that you’ve had diabetes.

Glaucoma causes pressure to build up inside the eye, often because the fluid in the eye drains more slowly. The increased pressure can squeeze the tiny blood vessels that feed the optic nerve and retina. Over time, this can damage these structures and lead to loss of vision.

Cataracts

Cataracts are another condition that affects diabetics more often than non-diabetics. In this condition, the lens of the eye becomes cloudy, which prevents some of the light from reaching the retina.

In its early stages, treatment for cataracts may involve the use of prescription lenses. As cataracts advance, however, surgery may become necessary to remove the cataractous lens, replace it with an intraocular lens implant (IOL) and restore vision.

If you suffer from diabetes, it is particularly important to keep all your yearly eye exams, so your eye doctor can monitor the health of your eyes. If you notice changes in your vision, contact us immediately, so we can help diagnose and treat any eye conditions you may have.

Strabismus Causes and Treatment

In order for your eyes to focus normally, six muscles around each eye must work together. When your two eyes see different images, your brain tends to favor the stronger eye. This means the weak eye gets weaker, resulting in amblyopia, or “lazy eye.”

Risk factors for developing strabismus may include farsightedness and a family history of the disorder. Both adults and children suffer from strabismus, but the causes are different. For adults, causes include:

  • Diabetes
  • Stroke
  • Botulism
  • Graves’ disease
  • Shellfish poisoning
  • Guillain-Barré syndrome
  • Cranial nerve palsies
  • Tumors
  • Eye injuries
  • Traumatic brain injury
  • Vision loss

Treatment

Treatment for strabismus involves a few steps. First, your eye doctor will determine whether you need glasses. Then, he or she will treat your amblyopia. This typically involves wearing a patch over the stronger eye, forcing the weak eye to work harder. This can be frustrating and tiring, but is an important step.

Next, you might need surgery to help the eye muscles work together correctly. This surgery can be done at any age. Eye alignment surgery is generally performed as an outpatient procedure, often with local or regional anesthetic. However, in some cases, it might require hospitalization. Most people can return to their regular activities within a few days. Your doctor might restrict swimming and heavy lifting for several weeks.

The reasons to have eye alignment surgery go way beyond cosmetic benefits. Eye misalignment can cause disabling and dangerous double vision. Since people with strabismus are often self-conscious about this condition, getting alignment surgery may improve your circumstances emotionally, socially and even economically.

What to Expect After Treatment

Any type of surgery bears risks, including infection, bleeding and anesthetic complications. The most common risks for strabismus surgery are double vision and residual misalignment. In rare cases, patients may suffer retinal detachment or decreased vision. However, most patients experience a significant improvement in eye alignment after surgery. They may feel pain and a pulling sensation around the eyes for a few days. Usually over-the-counter pain relievers can address this level of discomfort.

If you suffer from strabismus and would like to discuss your treatment options, call our clinic today.

Types of Refractive Surgery

There are several types of refractive surgery available to correct vision problems caused by refractive errors, including:

  • LASIK (laser-assisted in situ keratomileusis)
  • Custom or bladeless LASIK
  • Photorefractive keratectomy (PRK)
  • Laser epithelial keratomileusis (LASEK)
  • Epi-LASIK
  • Conductive Keratoplasty (CK)
  • Phakic Intraocular Lenses (IOLs)
  • Refractive Lens Exchange (Clear Lens Extraction)

Most of these procedures involve reshaping the curvature of the cornea with laser or heat. Sometimes, a very thin flap is made in the cornea, so the ophthalmologist can access and reshape the cornea underneath. Afterwards, the flap is replaced and the cornea is allowed heal on its own, without the need for sutures.

Before deciding on a type of refractive surgery, talk to your ophthalmologist about the potential risks and side effects. Keep in mind that there is not a single best procedure for everyone. Your ophthalmologist can help you choose a procedure that fits your visual requirements and lifestyle.

Medicated Eye Drops

Treatment for glaucoma often begins with medicated eye drops. The goal of these medications is to lower the pressure in the eye (intraocular pressure) and prevent damage to the optic nerve.

To gain the most benefits of these medications, use them exactly as prescribed by your eye doctor. Sometimes your doctor may prescribe more than one type of eye drop. In this case, check with your doctor about how long to wait between using each kind.

Side Effects of Medicated Eye Drops

Although eye drops for glaucoma can help save your vision, all of these medications have some side effects. In addition, some of the medication may be absorbed into the bloodstream, which can cause side effects that affect body parts other than your eyes.

The most common side effects of medicated eye drops include:

  • Redness of the eyes or skin around the eyes
  • An itching or stinging sensation
  • Blurred vision
  • Changes in the color of your eyes, the skin around your eyes or the appearance of your eyelid
  • Growth of your eyelashes
  • Changes in your heartbeat or pulse
  • Changes in your energy level
  • Breathing changes, especially if you have asthma or other lung conditions
  • Dry mouth

If you experience any of these side effects, tell your eye doctor. Do not stop taking your medicated eye drops unless you have spoken with your doctor. Using these eye drops as directed is the best way to help save your vision.

Types of Medicated Eye Drops

Your doctor may prescribe one or more type of eye drop. Some of the most common ones include:

  • Prostaglandins. These help reduce the pressure in your eye and increase the flow of fluid out of the eye.
  • Beta blockers. Beta blockers help decrease the pressure in the eye and how much fluid is made in the eye.
  • Alpha-adrenergic agonists. With this type of eye drop, you can increase the flow of fluid out of the eye and reduce how much fluid is made in the eye.
  • Carbonic anhydrase inhibitors. These are used to reduce how much fluid is made in the eye. These types of eye drops are not used very often.
  • Miotic or cholinergic agents. Using this type of eye drop helps increase the flow of fluid out of the eye.

If you have a family history of glaucoma or are noticing problems with your vision, contact your ophthalmologist immediately for an appointment. He or she can help diagnose your vision problem and suggest appropriate treatment options.

iStent

The iStent Trabecular Micro-Bypass is a surgical device that is available for use in treating patients with mild-to-moderate open-angle glaucoma.

Glaucoma is characterized by an excessive accumulation of fluid inside the eye, which leads to an increase in the inner eye pressure (intraocular pressure). This can damage the optic nerve and lead to a gradual loss of vision.

How iStent Works

One cause of glaucoma is poor drainage of the fluid inside the eye, which, again, leads to increased intraocular pressure. The iStent device works by providing a permanent path for fluid to flow out of the eye. By restoring the flow of fluid, the pressure inside the eye is reduced.

While the device is used to treat glaucoma, it is implanted during cataract surgery. This is done as an outpatient surgery, which means you can go home after the procedure is finished.

The device is made of titanium and is very small (only 1 millimeter long). Once it is in place, you will not be able to see or feel it.

Safety and Benefits of iStent

After iStent surgery, most patients’ vision improves that day. Many are also able to stop using medicated eye drops to reduce the pressure inside their eye. Others may be able to reduce the number of eye drops they need to use to control their inner eye pressure.

The iStent device is implanted during a surgical procedure. The most common side effects after surgery are:

  • Swelling of the cornea (corneal edema)
  • Decrease in how well you can see with glasses or contacts (best corrected visual acuity)
  • Thickening of the back of the eye’s lens capsule, which causes cloudy vision
  • Blockage of the iStent device
  • Blurred vision
  • Increased pressure inside the eye

The iStent device is not recommended for people with certain conditions such as angle-closure glaucoma, certain eye tumors and thyroid eye disease.

Please contact our office to schedule an appointment and find out whether you are an appropriate candidate for iStent treatment.

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.

Keratoconus

While keratoconus can happen at any stage of life, young people between the ages of 10 and 25 are most likely to develop this disorder. For individuals with keratoconus, their cornea, the clear layer in the front of your eye, gradually thins and begins to bulge outward. Keratoconus typically causes nearsightedness and astigmatism in both eyes.

The first signs of keratoconus are rapid changes in vision that require frequent adjusting of prescription lenses. Other symptoms include increased sensitivity to light, eyes strain and irritation, halos around lights at night, headaches and an incessant urge to rub your eyes. Eventually, the corneas become noticeably cone shaped.

Keratoconus is the most common type of corneal dystrophy, or degenerative corneal disorder. It affects one in every 2,000 Americans, according to the National Eye Institute.

Diagnosis

Many symptoms of keratoconus are similar to those of other corneal disorders, especially during the onset of the condition. This makes keratoconus difficult to diagnose.

Nonetheless, to diagnose keratoconus, ophthalmologists use a slit lamp to inspect your cornea at the microscopic level. Telltale signs of keratoconus include corneal thinning, an iron-colored ring around the cone-shaped cornea, stress lines and scarring at the top of the cone. Your eye doctor will also use instruments and lights to measure the curvature of your cornea.

Causes and Risk Factors

Researchers are not exactly sure why some people develop keratoconus. Leading theories center on genetics, environment and hormones. Some scientists have noted a slightly higher chance of developing keratoconus if a family member has it, but this correlation has not been proven with absolute certainty. Possible environmental causes include allergies that lead to excessive eye rubbing or poorly fitted contact lenses. Some researchers hypothesize that keratoconus is related to the endocrine system (the collection of glands that secrete certain hormones), because the onset often happens at puberty and worsens during pregnancy.

Treatment

Usually, the cornea stabilizes, so vision can be corrected with glasses or contacts. But between 10 and 20 percent of people with keratoconus will have more severe problems that require an alternative form of treatment, such as the following

Corneal Crosslinking. Healthy corneas keep their shape because cross-linked collagen fibers serve as supports. Corneal collagen cross-linking (CXL) involves saturating the cornea with riboflavin drops and activating them with an ultraviolet light. This strengthens the cornea by increasing the amount of collagen cross-linking. While CXL doesn’t cure keratoconus, it can arrest the progress of the disorder.

Intacs Surgery. Your eye doctor may suggest inserting Intacs, extremely thin plastic semi-circles. These flatten the cornea, improving vision. You may or may not still need to wear prescription lenses after Intacs surgery.

Corneal transplant. If keratoconus progresses until the cornea is too thin or scarred to tolerate contacts, your ophthalmologist may recommend a corneal transplant. According to the National Eye Institute, this operation is successful in more than 90 percent of those suffering from advanced keratoconus.

If you are experiencing signs of keratoconus, call us so we can diagnose your vision condition and suggest an appropriate plan of action for your visual needs.

Corneal Disorders

The cornea is the clear, dome-shaped outer layer of your eye. It is comprised of five layers. Each is responsible for a separate function. This collection of cells, fluids and proteins must remain clear and undisturbed in order for you to see well, and to shield your eyes from dust and germs. The cornea protects your lens and iris, and is responsible for about 70 percent of the eye’s focusing power.

Unfortunately, the cornea is susceptible to a range of disorders, which are collectively referred to as corneal disorders. The following are some common corneal disorders that can affect this sensitive and important part of the eye.

Corneal disorders can be frightening, but researchers have developed many treatments. If you have any symptoms of corneal disorders, call us today so we can discuss your treatment options.

Iridocorneal Endothelial Syndrome

This syndrome most commonly affects women between 30 and 50 years old. Symptoms include changes to the iris, corneal swelling and the onset of glaucoma.

Stevens-Johnson Syndrome

This skin disorder, also called erythema multiforme major, sometimes causes painful lesions on the eyelids. Stevens-Johnson syndrome can cause painful corneal blisters and even holes, leading to vision loss.

Pterygium

Pterygium is characterized by a pink tissue growth on the sclera (the white part of the eye), which seems to be the result of chronic exposure to ultraviolet light. In fact, because many surfers suffer from pterygium, the condition is often called surfer’s eye. Pterygium is not cancerous and may continue to grow gradually or stop growing after a certain point. If symptoms are mild, the condition does not require treatment. However, if the condition starts to interfere with vision, treatment may become necessary.

Pterygium Cause and Symptoms

A pterygium is spurred on by exposure to the sun and wind. For this reason, the condition is often referred to as surfer’s eye. Pterygia often cause a foreign body sensation and can become red and swollen. When a pterygium grows large enough, it can distort the shape of the eye, causing astigmatism and visual acuity problems.

Pterygium Diagnosis and Treatment

An eye care professional will make a diagnosis based on a close observation with a slit lamp. Pterygium treatment depends on the severity of symptoms, whether the pterygium is growing, and its causes. Mild cases can be treated with steroid eye drops. Severe cases require surgical removal, usually performed in the doctor’s office with local anesthetics. To prevent regrowth, an eye care provider might perform an autologous conjunctival autografting.

Keratoconus

While keratoconus can happen at any stage of life, young people between the ages of 10 and 25 are most likely to develop this disorder. For individuals with keratoconus, their cornea, the clear layer in the front of your eye, gradually thins and begins to bulge outward. Keratoconus typically causes nearsightedness and astigmatism in both eyes.

Corneal Dystrophies

This group of corneal disorders includes more than 20 variations. Each affects different parts of the cornea, causing it to get cloudy and compromising vision. Most of these dystrophies are inherited, affect both eyes equally and spread between layers of the cornea as they gradually progress.

Viruses

Herpes Zoster (Shingles)

If you ever had chickenpox, you’re at higher risk of developing shingles later in life. Shingles can affect many parts of the body. If it travels to your eyes, your cornea can become inflamed and even scarred. Corneal damage might not be apparent until months after the shingles have otherwise disappeared.

Ocular Herpes

The herpes simplex virus can cause recurring flare-ups of herpes in the eye. People who suffer from ocular herpes may notice painful sores on the eyelid or the eye’s surface, or an inflamed cornea. Untreated, it can lead to blindness.