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Eye Conditions & Medical Procedures
Eye Conditions of the Elderly
Eye Conditions of the Young
Other Eye Care Issues
Eye Conditions of the Elderly
Cataract
A cataract is a cloudy or opaque area in the normally transparent lens of
the eye. As the opacity thickens, it prevents light rays from passing through
the
lens and focusing on the retina, the light sensitive tissue lining the back
of the eye. Early lens changes or opacities may not disturb vision. But as
the lens continues to change, several specific symptoms including blurred
vision; sensitivity to light and glare; increased nearsightedness; or distorted
images
in either eye, may develop.
Symptoms
Depending on the size and location of the cloudy areas in a lens,
a person may or may not be aware that a cataract is developing. If f the
cataract
is located on the outer edge of the lens, no change in vision may be
noticed. If the cloudiness is located near the center of the lens, it usually
interferes
with clear sight. Common symptoms experienced with developing cataracts
include:
- Blurred or double vision
- Sensitivity to light and glare which may make driving difficult
- Less vivid perception of color
- Frequent eyeglass prescription changes
Treatment
If you notice any cataract symptoms, consult an ophthalmologist as soon as
possible. Since cataracts most often form as a result of aging, individuals
over the age of 40 with a family history of cataracts should have their eyes
checked regularly.
The cataract may need no treatment at all if the vision is only a little blurry.
A change in your eyeglass prescription may improve vision for a while. There
are no medications, eye drops, exercises or glasses that will cause cataracts
to disappear once they have formed. When you are not able to see well enough
to do the things you like to do, cataract surgery should be considered. Surgery
is the only way to remove a cataract.
Cataracts cannot be removed with a laser, only through a surgical incision.
In cataract surgery, the cloudy lens is removed from the eye. In most cases,
the focusing power of the natural lens is restored by replacing it with a permanent
intraocular lens implant.
Glaucoma
Glaucoma is a leading cause of blindness in the United States, especially for
older people. But the loss of sight is preventable if you get treatment early
enough.
Glaucoma is a condition in which the optic nerve, which carries the images
we see to the brain, is damaged. Many people know that glaucoma has something
to do with pressure inside the eye. The higher the pressure inside the eye,
the greater the chance of damage to the optic nerve.
The optic nerve is like an electric cable containing about 1.2 million wires.
Glaucoma can damage nerve fibers, causing blind spots to develop.
Symptoms
Most people who have glaucoma don't notice any symptoms until they begin
to lose some vision.
As optic nerve fibers are damaged by glaucoma, small blind spots may begin
to develop, usually in the side -- or peripheral -- vision. The top photo at
left shows how a scene would be viewed by a person with normal vision. The
bottom image shows the same scene as viewed by a person with glaucoma. Many
people don't notice the blind spots until significant optic nerve damage has
already occurred. If the entire nerve is destroyed, blindness results.
One type of glaucoma, acute angle-closure glaucoma, does produce noticeable
symptoms. In angle-closure glaucoma, there is a rapid buildup of pressure in
the eye (intraocular pressure, known as IOP), which may cause any of the following:
- Blurred vision
- Severe eye pain
- Headache Haloes (which may appear as rainbows) around lights
- Nausea and vomiting
- Angle-closure glaucoma is a rare, but serious, form of the disease.
If
you have any of these symptoms, call your ophthalmologist immediately.
Unless
treated quickly, blindness can result.
Treatment
Depending on the type of glaucoma a patient may have, medications, laser surgery,
or other glaucoma surgeries may be used to lower and control the eye pressure.
See your Eye M.D. (Ophthalmologist) to find out which method is best for you.
Macular Degeneration
Located in the center of the retina, the sensitive macula provides us with
sight in the center of our field of vision. When we look directly at something,
the macula allows us to see the fine details. This sharp, straight-ahead vision
is necessary for driving, reading , recognizing faces, and doing close work,
such as sewing.
The two common types of macular degeneration are dry and wet. The dry form
accounts for 90% of cases and is caused by aging and thinning of the tissues
of the macula. It develops slowly and usually causes mild vision loss. People
often notice a dimming of vision when they read.
Wet macular degeneration is a much greater threat to vision loss even though
it accounts for only 10% of cases. With the wet form of the disease, new blood
vessels grow beneath the retina where they leak fluid and blood and can create
a large blind spot in the center of your visual field. If this happens, there
will be a marked disturbance of vision.
Symptoms
Although it's more common for people over 60, it is possible to develop symptoms
in your 40's or 50's. Macular degeneration often runs in families. Symptoms
can include:
- Blurry or fuzzy vision
- Straight lines, such as sentences on a page, telephone poles, and sides
of buildings, appear wavy
- A dark or empty area appears in the center of vision
If you
experience any of these symptoms in either one or both eyes, schedule an
appointment with your ophthalmologist for an examination immediately.
Treatment
Unfortunately, the cause of macular degeneration is unknown. Although your
ophthalmologist will be able to readily detect the disease during an eye
exam, he or she won't be able to cure it. The goal is to help the patient
see better and stabilize the condition.
Although there is no proven treatment for dry macular degeneration, some people
believe that antioxidants or zinc supplements may help.
Out-patient laser surgery may be an option for people with more severe wet
macular degeneration. The laser beam is used to destroy the abnormal blood
vessels and works best when these vessels have not grown under the macula.
Laser surgery is less helpful when the abnormal blood vessels have already
grown under the macula. In this case, the laser might cause as much damage
as the presence of abnormal blood vessels. This is why early diagnosis is so
important.
The "good" news about macular degeneration is that even though
people who have it experience mild to severe vision loss, macular degeneration
does
not affect peripheral, or side vision. One does not go blind. With the
help of low vision aids, people can continue to enjoy many of their favorite
activities
and can still lead normal, independent lives.
Eye Conditions of the Young
Amblyopia
Amblyopia is poor vision in an eye that did not develop normal sight during
early childhood. It is sometimes called "lazy eye." When one
eye develops good vision while the other does not, the eye with poorer
vision
is called amblyopic. Usually, only one eye is affected by amblyopia.
The condition is common, affecting approximately 2 or 3 out of every
100 people.
The best time to correct amblyopia is during infancy or early childhood.
Parents must be aware of this potential problem if they want to protect
their child's vision.
Symptoms
It is not easy to recognize amblyopia. A child may not be aware of having one
good eye and one weak eye. Unless the child has a misaligned eye or other
obvious abnormality, there is often no way for parents to tell that something
is wrong. Amblyopia is detected by finding a difference in vision between
the two eyes. Since it is difficult to measure vision in young children,
your ophthalmologist often estimates visual acuity by watching how well a
baby follows objects with one eye when the other eye is covered. If one eye
is amblyopic and the good eye is covered, the baby may attempt to look around
the patch, try to pull it off or cry.
Treatment
To correct amblyopia, a child must be made to use the weak eye. This is usually
done by patching or covering the good eye, often for weeks or months. Even
after vision has been restored in the weak eye, part-time patching may be
required over a period of years to maintain the improvement. Glasses may
be prescribed to correct errors in focusing. If glasses alone do not improve
vision, then patching is necessary. Occasionally, amblyopia is treated by
blurring the vision in the good eye with special eye drops or lenses to force
the child to use the amblyopic eye.
Amblyopia is usually treated before surgery to correct misaligned eyes, and
patching is often continued after surgery as well. If your ophthalmologist
finds a cataract or other abnormality, surgery is required to correct the problem.
After surgery, glasses or contact lenses can be used to restore focusing, while
patching improves vision. Amblyopia cannot be cured by treating the cause alone.
The weaker eye must be made stronger in order to see normally. Prescribing
glasses or performing surgery can correct the cause of amblyopia, but your
ophthalmologist must also treat the amblyopia. If amblyopia is not treated,
several problems may occur:
- The amblyopic eye may develop a serious and permanent visual defect
- Depth perception (seeing in three dimensions) may be lost
- If the good eye becomes diseased or injured, a lifetime of poor vision
may be the result.
Your ophthalmologist can give you instructions on how to
treat amblyopia, but it is up to you and your child to carry out this
treatment. Children
do not
like to have their eyes patched, especially if they have been depending
on that eye to see clearly. But as a parent, you must convince your
child to do
what is best for him or her. Successful treatment mostly depends
on your interest and involvement, as well as your ability to gain
your child's
cooperation.
In most cases, parents play an important role in determining whether
their child's amblyopia is to be corrected. For more information
on
Amblyopia, visit
the Ohio Amblyope
Registry.
Ptosis (droopy eyelids)
Ptosis refers to a situation in which the eyelids are not as open as they
should be. This situation is caused by a weakness of a muscle that opens the
upper eyelid. When ptosis is mild, it is just a cosmetic problem. However,
ptosis can interfere with vision if it is severe enough to block the vision
in the eye. In infancy, it is important that ptosis be eliminated so that vision
will develop normally. Correction of ptosis usually requires surgery on the
eyelid(s).
Strabismus
Strabismus is a visual defect in which the eyes are misaligned and point in
different directions. One eye may look straight ahead, while the other eye
turns inward, outward, upward or downward. You may always notice the misalignment,
or it may come and go. The turned eye may straighten at times and the straight
eye may turn. Strabismus is a common condition among children. About 4% of
all children in the United States have strabismus. It can also occur later
in life. It occurs equally in males and females. Strabismus may run in families.
However, many people with strabismus have no relatives with the problem.
Diagnosis
Strabismus can be diagnosed during an eye exam. It is recommended that all
children have their vision checked by their pediatrician, family doctor or
ophthalmologist (medical eye doctor) at or before their fourth birthday. If
there is a family history of strabismus or amblyopia, an ophthalmologist can
check vision even earlier than age three. The eyes of infants often seem to
be crossed. Young children often have a wide, flat nose and a fold of skin
at the inner eyelid that can make the eyes appear crossed. This appearance
of strabismus may improve as the child grows. A child will not outgrow true
strabismus. An ophthalmologist can usually tell the difference between true
and false strabismus.
Treatment
Treatment for strabismus works to:
- Preserve vision
- Straighten the eyes
- Restore binocular (two-eyed) vision
After a complete eye examination, an ophthalmologist can recommend appropriate
treatment. In some cases, eyeglasses can be prescribed for your child.
Other treatments may involve surgery to correct the unbalanced eye
muscles or to
remove a cataract. Covering or patching the strong eye to improve
amblyopia is often necessary.
Other Eye Care Issues
Floaters
You may sometimes see small specks or clouds moving in your field
of vision. They are called floaters. You can often see them when
looking at a plain background,
like a blank wall or blue sky. Floaters are actually tiny clumps of gel
or cells inside the vitreous, the clear jelly-like fluid that
fills the inside
of your eye.
While these objects look like they are in front of your eye, they are actually
floating inside. What you see are the shadows they cast on the retina, the
nerve layer at the back of the eye that senses light and allows you to see.
Floaters can have different shapes: little dots, circles, lines, clouds or
cobwebs.
Causes of Floaters
When people reach middle age, the vitreous gel may start to thicken or shrink,
forming clumps or strands inside the eye. The vitreous gel pulls away from
the back wall of the eye, causing a posterior vitreous detachment. It is
a common cause of floaters. Posterior vitreous detachment is more common
for people who:
- Are nearsighted
- Have undergone cataract operations
- Have had YAG laser surgery of the eye
- Have had inflammation inside the eye.
The appearance of floaters may be alarming, especially if they develop
suddenly. You should see an ophthalmologist (a medical eye physician)
right away if
you suddenly develop new floaters, especially if you are over
45 years of age.
Treatment
Floaters can get in the way of clear vision, which may be quite annoying,
especially if you are trying to read. You can try moving your eyes, looking
up and then down to move the floaters out of the way. While some floaters may
remain in your vision, many of them will fade over time and become less bothersome.
Even if you have had some floaters for years, you should have an eye examination
immediately if you notice new ones.
Flashers
You may have experienced this same sensation if you have ever been hit in
the eye and seen "stars." When the vitreous shrinks, it tugs
on the retina, creating a sensation of flashing lights. The flashes of
light can appear
off and on for several weeks or months. As we grow older, it is more common
to experience flashes. If you notice the sudden appearance of light flashes,
you should visit your ophthalmologist immediately to see if the retina
has been torn.
Diabetic Retinopathy
If you have diabetes mellitus, you probably know that your body can’t
use or store sugar properly. When your blood sugar gets too high, it can
damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy.
(Your retina is the nerve layer that lines the inside of your eye and converts
light into nerve signals that your brain can interpret.)
Symptoms
Although diabetic retinopathy can severely damage your vision, it is not painful.
In fact, the early form of diabetic retinopathy called non-proliferative or
background retinopathy often produces no symptoms.
- If non-proliferative or background retinopathy leads to macular edema,
you may notice a gradual blurring of your vision, and have difficulty doing
close work such as reading.
- If the abnormal blood vessels associated with proliferative retinopathy
bleed, vision may become spotty, hazy, or disappear completely.
Treatment
The good news about diabetic retinopathy is that treatment may not
be necessary. Even when it is, vision loss can usually be prevented
or impaired vision
improved.
Good control of your diabetes with intensive management and control of your
blood sugar will delay, and possibly prevent, both the development and progression
of diabetic retinopathy.
If the ophthalmologist finds that you have diabetic retinopathy, you may need
to have special photos of your retina taken. This series of photos is called
fluorescein angiography.
When you have fluorescein angiography, a yellow dye is injected into your
arm which then passes through the blood vessels in your retina. This makes
it easier to see the blood vessels in the photos. Your ophthalmologist can
then use the photos if you need laser surgery for diabetic retinopathy.
Tips on Lasik Eye Surgery
If you're tired of wearing glasses or contact lenses, you may be considering
Lasik eye surgery - one of the newest procedures to correct vision
problems. Before you sign up for the surgery, get a clear picture of what
you can expect.
- Lasik is surgery to a very delicate part of the eye.
- Hundreds of thousands of people have had Lasik, most very successfully.
- As with any surgery, there are risks and possible complications.
- Lasik may not give you perfect vision. The American Academy of Ophthalmology
(AAO) reports that seven out of 10 patients achieve 20/20 vision,
but 20/20 does not always mean perfect vision.
- If you have Lasik to correct your distance vision, you'll still need
reading glasses around age 45.
Lasik surgery is too new to know if there are any long-term
ill effects beyond five years after surgery.
- Lasik surgery cannot be reversed.
- Most insurance does not cover the surgery.
- You may need additional surgery - called "enhancements" -
to get the best possible vision after Lasik.
Understanding Your Eyes
To see clearly, the cornea and the lens must bend - or refract - light rays
so they focus on the retina - a layer of light-sensing cells that line the
back of the eye. The retina converts the light rays into impulses that are
sent to the brain, where they are recognized as images. If the light rays don't
focus on the retina, the image you see is blurry. This is called a refractive
error. Glasses, contacts and refractive surgery attempt to reduce these errors
by making light rays focus on the retina. Refractive errors are caused by an
imperfectly shaped eyeball, cornea or lens, and are of three basic types:
- myopia - nearsightedness; only nearby objects are clear.
- hyperopia - farsightedness; only objects far away are clear.
- astigmatism - images are blurred at a distance and near.
There's also presbyopia - "aging eye." The condition usually
occurs between ages 40 and 50, and can be corrected with bifocals
or reading glasses.
Are You A Good Candidate for Lasik?
Lasik is not for everyone.
- You should be at least 18 years old (21 for
some lasers), since the vision of people younger than 18 usually
continues to change.
- You should not be pregnant or nursing as these conditions might change
the measured refraction of the eye.
- You should not be taking certain prescription drugs, such as Accutane
or oral prednisone.
- Your eyes must be healthy and your prescription stable. If you're
myopic, you should postpone Lasik until your refraction has
stabilized, as
myopia may continue
to increase in some patients until their mid- to late 20s.
- You should be in good general health. Lasik may not be recommended
for patients with diabetes, rheumatoid arthritis, lupus,
glaucoma, herpes infections of
the eye, or cataracts. You should discuss this with your
surgeon.
- Weigh the risks and rewards. If you're happy wearing contacts
or glasses, you may want to forego the surgery.
- Understand your expectations from the surgery. Are they realistic?
- Ask your doctor if you're a candidate for monovision - correcting
one eye for distance vision and the other eye for
near vision. Lasik cannot
correct
presbyopia
so that one eye can see at both distance and near.
However, Lasik can be used to correct one eye for distance and the
other for
near. If
you can adjust
to
this correction, it may eliminate or reduce your
need for reading glasses. In some instances, surgery on only one eye is
required.
If your doctor
thinks you're a candidate, ask about the pros and
cons.
Finding a Surgeon
Only ophthalmologists (Eye MDs) are permitted to perform
Lasik. Ask your Eye MD or optometrist for a referral
to an Eye MD
who performs
Lasik. The
Ohio
Ophthalmological Society can provide you with a list
of their members who perform Lasik.
Ask your surgeon the following questions:
- How long have you been doing Lasik surgery?
- How much experience do you have with the Lasik procedure?
- How do you define success? What's your success rate?
What is the chance for me (with my correction)
to achieve 20/20? How many of your patients have achieved
20/20 or 20/40 vision?
- How many patients return for enhancements? In general
5-15% return.
- What laser will you be using for my surgery? Make sure
your surgeon is using a laser approved by the
U.S. Food and Drug Administration
(FDA). As of this
publication's printing, the FDA has approved five lasers
for Lasik; they are manufactured by VISX, Summit, Bausch
and Lomb, Nidek and
ATC. Contact the FDA
for updates.
- What's involved in after-surgery care?
- Who will handle after-surgery care? Who will be responsible?
What about risks and possible complications?
- What about risks and possible complications?
Risks and Possible Complications
Before the surgery, your surgeon should explain to you the
risks and possible complications, and potential side
effects, including the pros and cons of
having one or both eyes done on the same day. This is the "informed
consent" process. Some risks and possible complications include:
- Over- or under-correction. These problems can often be improved with
glasses, contact lenses and enhancements.
- Corneal scarring, irregular astigmatism (permanent warping
of the cornea), and an inability to wear contact lenses.
- Corneal infection.
- "Loss of best corrected visual acuity" - that is, you would
not be able to see as well after surgery, even with glasses or contacts,
as you
did with
glasses or contacts before surgery.
- A decrease in contrast sensitivity, "crispness," or sharpness.
That means that even though you may have 20/20 vision, objects
may appear fuzzy
or grayish.
- Problems with night driving that may require glasses.
Flap problems, including: irregular flaps, incomplete
flaps, flaps cut off entirely, and ingrowth of
cells under the flap.
The following side effects are possible, but usually
disappear over time. In rare situations, they may be
permanent.
- Discomfort or pain
- Hazy or blurry vision
- Scratchiness
- Dryness
- Glare
- Haloes or starbursts around lights
- Light sensitivity
- Small pink or red patches on the white of the eye
Surgery: What to Expect Before, During and After
Before:
You'll need a complete eye examination by your refractive surgeon. A preliminary
eye exam may be performed by a referring doctor (Eye MD or optometrist). Take
your eye prescription records with you to the exams. Your doctor should:
- Dilate your pupils to fine-tune your prescription.
- Examine your eyes to make sure they're healthy. This
includes a glaucoma test and a retina exam.
- Take the following measurements:
- The curvature of your cornea and your pupils. You may
be rejected if your pupils are too
large.
- The topography of your eyes to make sure you don't
have an irregular astigmatism
or a cone-shaped cornea - a condition called Keratoconus.
- The pachymetry - or thickness - of your cornea.
You need to have enough tissue
left after your corneas have been cut and reshaped.
- Ask you to sign an informed consent form after
a thorough discussion of the risks,
benefits, alternative options and possible complications.
Review the
form carefully. Don't sign until you understand
everything in
the form.
- If your doctor doesn't think Lasik is right for you,
you might consider getting a second opinion;
however, if the
opinion
is the same, believe
it.
If you qualify for surgery, your doctor may tell you
to stop wearing your contact lenses for a while before
the
surgery
is scheduled because
contacts can temporarily
change the shape of the cornea. Your cornea should be
in its natural shape the day of surgery. Your doctor
also
may tell
you to stop wearing
makeup, lotions
or perfume for a few days before surgery. These products
can interfere with the laser treatment or increase the
risk of
infection after
surgery.
During:
Lasik is an outpatient surgical procedure. The only anesthetic is an eye drop
that numbs the surface of the eye. The surgery takes 10 to15 minutes for each
eye. Sometimes, both eyes are done during the same procedure; but sometimes,
surgeons wait to see the result of the first eye before doing the second eye.
The Surgical Procedure: A special device cuts a hinged flap of thin corneal
tissue off the outer layer of the eyeball (cornea) and the flap is lifted out
of the way. The laser reshapes the underlying corneal tissue, and the surgeon
replaces the flap, which quickly adheres to the eyeball. There are no stitches.
A shield - either clear plastic or perforated metal - is placed over the eye
to protect the flap.
After:
Healing is relatively fast, but you may want to take a few days off after
the surgery. Be aware that:
- You may experience a mild burning or sensation for a few hours after
surgery. Do not rub your eye(s). Your doctor can prescribe a painkiller,
if necessary,
to ease the discomfort.
- Your vision probably will be blurry the day of surgery, but it will
improve considerably by the next day when you return for a follow-up
exam.
- If you experience aggravating or unusual side effects, report them
to your doctor immediately.
- Do not drive until your vision has improved enough to safely do so.
- Avoid swimming, hot tubs and whirlpools for two weeks after surgery.
Alternatives to Lasik
You may want to discuss some surgical alternatives to Lasik with your eye doctor:
- Photorefractive keratectomy (PRK) is a laser procedure used to reduce
myopia, hyperopia and astigmatism without creating a corneal flap.
- Astigmatic keratotomy (AK) is an incisional procedure to reduce astigmatism.
- Intrastromal corneal rings are clear, thin, polymer inlays placed on
the eye to correct low myopia only.
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