Management of Eye  Diseases Macular  Degeneration | Floaters &  Flashers | Retinal  Problems | Lacrimal  Disorders

Macular Degeneration What is it? Macular degeneration is damage or  breakdown of the macula of the eye. The macula is a small area at  the back of the eye that allows us to see fine details clearly. When  the macula doesn't function correctly, we experience blurriness or  darkness in the center of our vision. Macular degeneration affects  both distance and close vision, and can make some activities -- like  threading a needle or reading -- difficult or impossible. Although  macular degeneration reduces vision in the central part of the  retina, it does not affect the eye's side, or peripheral, vision.  For example, you could see the outline of a clock but not be able to  tell what time it is. Macular degeneration alone does not result in total blindness.  People continue to have some useful vision and are able to take care  of themselves. What causes it? Many older people develop macular  degeneration as part of the body's natural aging process. The two  most common types of age-related macular degeneration are "dry  (atrophic) and "wet" (exudative). Most people have "dry" macular  degeneration, caused by aging and thinning of the tissues of the  macula. Vision loss is gradual. "Wet" macular degeneration accounts  for about 10% of all cases. It results when abnormal blood vessels  form at the back of the eye. These new blood vessels leak fluid or  blood and blur central vision. Vision loss may be rapid and severe. What are the symptoms? Macular degeneration can cause  different symptoms in different people. Sometimes only one eye loses  vision while the other eye continues to see well for many years. But  when both eyes are affected, the loss of central vision may be  noticed more quickly. Here are some common ways vision loss is  detected: Words on a page look blurred; A dark or empty area appears in the center of vision; Straight lines look distorted or wavy. How is it  diagnosed? Many people do not realize that they have a  macular problem until blurred vision becomes obvious. A medical eye  doctor can detect early stages of macular degeneration during a  comprehensive eye exam that includes the following: Viewing the macula with an ophthalmoscope; A simple vision test in which you look at a grid resembling  graph paper; Sometimes special photographs, called angiograms, are taken to  find abnormal blood vessels under the retina. Fluorescent dye is  injected into your arm and your eye is photographed as the dye  passes through the blood vessels in the back of the eye. How is it treated? In its early stages, "wet"  macular degeneration can be treated with laser surgery, a brief and  usually painless outpatient procedure. Laser surgery uses a highly  focused beam of light to seal the leading blood vessels that damage  the macula. Although a small, permanently dark "blind spot" is left  at the point of laser contact, the procedure can preserve more sight  overall. There is currently no cure "dry" macular degeneration despite  ongoing research. Some doctors believe that nutritional supplements  may slow the condition, although this has not yet been proven.  Treatment focuses on helping a person find ways to cope with visual  impairment. Optical devices can be prescribed or you may be referred  to a low-vision specialist or center. A wide range of support  services and rehabilitation programs are also available to help  people with macular degeneration maintain a satisfying lifestyle. Side vision is usually not affected; therefore, a person's  remaining sight can be very useful. Often, people can continue with  many of their favorite activities by using low-vision optical  devices such as magnifying devices, closed-circuit television,  large-print reading materials, and talking or computerized devices. Floaters and  Flashers What are floaters? Floaters are the small specks or  clouds you may sometimes see moving in your field of vision. 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. What causes 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 immediately if you suddenly  develop new floaters, especially if you are over 45 years old. Are floaters ever serious? The retina can tear if the  shrinking vitreous gel pulls away from the wall of the eye. This  sometimes causes a small amount of bleeding in the eye that may  appear as new floaters. A torn retina is always a serious problem,  since it can lead to a retinal detachment. Seek medical attention as  soon as possible if: even one new floaters appears suddenly; you see sudden flashes of light. If you notice other  symptoms like the loss of side vision, return to your  ophthalmologist. What can be done about floaters? 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. What causes flashing lights? When the vitreous gel  rubs or pulls on the retina, you may see what look like flashing  lights or lightning streaks. You may have experienced this same  sensation if you have ever been hit in the eye and seen "stars." 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 is torn. Flashers and migraine Some people experience flashes  of light that appear as jagged lines or "heat waves" in both eyes,  often lasting 10-20 minutes. These types of flashes are usually  caused by a spasm of blood vessels in the brain, which is called  migraine. If a headache follows the flashes, it is called a migraine  headache. however, jagged lines or "heat waves" can occur without a  headache. In this case, the light flashes are called ophthalmic  migraine, or migraine without headache. Floaters and flashes of light become more common as we grow  older. While not all floaters and flashes are serious, you should  always have a medical eye exam by an ophthalmologist to make sure  there has been no damage to your retina. Retinal  Problems Diabetic  Retinopathy Posterior  Vitreous Detachment Diabetic  Retinopathy Diabetes, a very common disease in the United States, is the  leading cause of blindness in adults under the age of 65. Diabetic  retinopathy is one of the main potential complications associated  with diabetes. People with untreated diabetes are said to be 25  times more at risk for blindness than the general population. The  longer a person has diabetes, the higher the risk of developing  diabetic retinopathy. About 80% of the people who have had diabetes  for at least 15 years have some blood vessel damage to their retina.  People with Type I, or juvenile diabetes, are more likely to develop  diabetic retinopathy at a younger age. What is it? Diabetic retinopathy is a disease of the  blood vessels in the delicate tissue called the retina (the retina  acts like film in a camera and does the actual sensing of light  within the eye). With diabetic retinopathy, retinal vessels become  incompetent and leak fluid and blood, thus failing to supply the  nutrients necessary for good health in the retina. The result is  blurred or distorted images that the retina sends to the brain. Types of diabetic retinopathy There are two forms of retinopathy: 1) Non-proliferative or  Background retinopathy (NPDR), and 2) Proliferative  retinopathy. NPDR consists of hemorrhages, leaky spots and small  dilations in the vessel walls. PDR is all of that plus new blood  vessels which are always abnormal and will leak and bleed if left  untreated. About 40% of all diabetics will develop PDR over a  15-year span. NPDR is the most common cause of decreased vision with diabetes  due to swelling in the retina from leaky blood vessels. This is very  difficult to treat, but with focal applications of laser light to  seal these leaks, vision may be preserved and occasionally improved.  PDR poses a very serious threat as well as large hemorrhages may  obscure vision for months at a time. When found, these new abnormal  vessels should be treated with laser therapy. Retinal detachments  can also occur because of traction created by these new vessels. What are the symptoms? Background retinopathy usually  has no symptoms, although gradual blurring of vision may occur if  macular edema is present. You may never notice changes in your  vision; a medical examination is the only way to find changes inside  your eye. When bleeding occurs, your sight may become hazy, spotty  or even disappear altogether. While there is no pain, proliferative  retinopathy is a severe form of the disease and requires immediate  medical attention. How is it diagnosed? Serious retinopathy can be  present without any symptoms. The best protection is regular medical  eye examinations by your ophthalmologist. If your ophthalmologist  suspects diabetic retinopathy, photographs of the retina or a  special test called fluorescein angiography may be used to find out  if you need treatment. The disease can improve with treatment. How is it treated? Your age, medical history,  lifestyle, and extent of damage to the retina will be considered  when determining if treatment is recommended and what type. Types of  treatment are described below. Laser surgery slows down vision loss if the condition is  detected early. Even in the more advanced stages of the disease, it  reduces the chance of severe visual impairment. Laser surgery uses a  powerful beam of light focused on the damaged retina. Small bursts  of the laser's beam seal leaking retinal vessels to reduce macular  edema. This is called photocoagulation. For abnormal blood vessel  growth, the laser beam bursts are scattered throughout the side  areas of the retina. The small laser scars reduce the abnormal blood  vessel growth and help bond the retina to the back of the eye,  preventing retinal detachment. Cryotherapy, or freezing, is used if the vitreous is  clouded by blood and laser surgery cannot be used. In some cases,  cryotherapy of the retina may help shrink the abnormal blood  vessels. Vetrectomy is used in advanced proliferative diabetic  retinopathy. This microsurgical procedure removes the blood-filled  vitreous and replaces it with a clear solution. About 70% of  vitrectomy patients notice an improvement in sight after surgery.  Sometimes the ophthalmologist may wait from several months up to a  year to see if the blood clears on its own before proceeding with a  vitrectomy. Retinal repair reattaches the retina if scar tissue  detaches the retina from the back of the eye. Severe sight loss or  blindness can result unless surgery is performed to reattach the  retina. What is my part in treatment? Your attitude and  attention to medications and diet are essential for the successful  care of diabetic retinopathy. Pregnancy, smoking, high blood  pressure, high cholesterol and triglycerides may aggravate diabetic  retinopathy. Physical activity is usually no problem for people with  background retinopathy. Occasionally, those with active  proliferative retinopathy are advised to restrict physical activity. Posterior Vitreous  Detachment A Posterior Vitreous Detachment (PVD) is a rather dramatic event  in the normal aging process of the human eye. The vitreous is the jelly-like material that fills the large  central cavity of the eye. It is 98% water and 2% proteins, which  give the vitreous a stiff consistency similar to double-strength  gelatin. The vitreous has normal connections to the retina, the  light sensitive layer in the back of the eye. As we age, the watery elements in the vitreous separate from the  fibrous components. With this comes a contraction of the fibrous  elements away from the retina -- a Posterior Vitreous Detachment.  This contraction on the retina is responsible for the characteristic  "flashes" that often accompany PVDs. The "floaters" frequently  reported are from the reorganization of the fibrous elements as well  as from some fragments of retina that may have been dragged into the  vitreous cavity by this separation. Besides age, other contributing  factors include nearsightedness and injuries to the eye. Both may  speed up the normal aging process. All patients who experience a recent onset of flashes and  floaters should be examined carefully by an ophthalmologist. Most of  the time nothing unusual is found, and simple reassurance is all  that is needed. The flashes eventually go away, and the floaters  diminish and become less bothersome with time. However, a tear in the retina is found in about 10% of eyes with  a PVD. If left untreated, these tears may lead to a retinal  detachment, a very serious sight-threatening condition requiring a  major surgical procedure to repair. Even in the best of hands, the  results of this procedure can be very unpredictable. When symptoms appear, it is important to examine the eye within a  day of their onset. Changes can occur rapidly, and time can be of  the essence if a retinal detachment is present. Even if all is  normal in the first eye, patients cannot assume that all will be  well with the second one. It also should be carefully examined and  treated if necessary. If retinal tears are found, treatment is simple and very  effective. They should be sealed to prevent a retinal detachment.  This is done either by spot welding several circles of burns around  the tear with a laser or by sealing it with a freezing unit. Both  accomplish the same purpose with good results and low complication  rates. The procedure is done in an outpatient setting under a local  anesthetic. Lacrimal  Disorders Dry Eye Wet  Eye Bacterial  Conjunctivitis Chalazion Dry Eye What is it? Dry eye is probably one of the most common problems seen in the ophthalmologist's office. As we age, the  protective tear film on the surface of the eye diminishes. This leaves the delicate tissues of the eye exposed to the drying effects  of air, wind, dust and the sun. The eye can still make tears; in  fact, many patients complain of wet eyes and tearing with this condition. This is due to the dryness producing a reflex tearing in an effort to keep the eye well lubricated. What causes it? In many people, the dryness is worse  in the afternoon and evenings. Since we blink less frequently when  we read, reading can also aggravate the symptoms of dry eyes.  Sometimes environmental factors play a role as well. Dry weather,  either in hot or cold temperatures, robs the eye of needed  lubricants. Cigarette smoke, fumes, dust and airborne particles are common irritants. In most patients, this condition is not associated  with any systemic disease. What are the symptoms? Symptoms include burning,  stinging, or a gritty sensation which may come and go depending on  many factors. Itching, tearing, and light sensitivity may bother  other patients. Occasionally long strings of mucus can be stretched  from a dry eye. Actually, excessive watering of the eyes may  indicate dry eyes, similar to the tearing which occurs with foreign  material or lashes in the eye. How it is treated? Treatments helps in most patients. Because  there is no cure, treatment must be ongoing. usually artificial  tears, available over the counter, soothe the eyes and temporary relief. The disadvantage is that artificial tears only work for an  hour or two, at best, and must be repeated at frequent intervals.  Ointments last longer, but they blur vision and are most effective  at night. Newer methods of treatment for seriously dry eyes are soft  contact lenses in combination with artificial tears. Sometimes a  slow-release medicine under the lower lid is helpful as well. Should symptoms persist, the drainage ducts can be temporarily or permanently closed, slowing the drainage of tears so they can soothe the dry eye. Much research is being done on this subject because it is such a common problem. Time-release artificial tears seem to hold the most  promise, but details of its use are still being worked out. Wet Eyes Blockage within the lacrimal drainage system can keep tears from  draining into the nose, causing the tears to build up on the lower eyelid and spill over onto the face. The nasolacrimal duct, a bony canal carrying tears into the nose, is the most common site of obstruction. The main symptom is constant tearing from one or both eyes with tears running down the face. Because access into the nose is blocked, mucous builds up in the lacrimal sac making the patient prone to infection. Infection in the lacrimal sac can be serious as  it can spread to the face, orbit and brain. This condition is treated initially with antibiotics followed by surgical correction of the obstructed duct. Bacterial  Conjunctivitis The conjunctiva is the clear membrane that encircles and protects the eyeball. When you look at the white of the eye, you are really  looking through the conjunctiva at the sclera, the tough, leathery outer coat of the eye. The conjunctiva has many small blood vessels running through it. The purpose of the conjunctiva is to lubricate and protect the eye and to allow it to move in its socket. Conjunctivitis is an inflammation of the lining of the eye. It can be caused by bacteria (as in "pink eye"), viruses, chemicals,  allergies, and more. It is sometimes difficult to tell exactly which  is the real cause. Bacterial conjunctivitis is characterized by swelling of the lid,  a yellowish discharge, sometimes a scratchy feeling in the eye, and itching and mattering of the lids, especially in the mornings upon  awakening. The conjunctiva is red and sometimes thickened. Often both eyes are involved. The bacteria most commonly at fault are the staphylococcus, the streptococcus, and H. influenza. This disease is very contagious, and sometimes entire families are infected.  Laboratory cultures are not typically used to make the diagnosis  since this is expensive and time consuming. Most infections are over by the time the results of the lab tests come back. Treatment is curative. Usually antibiotic drops and compresses ease the discomfort and clear up the infection in just a few days.  Occasionally, the infection does not respond well to the drops. In  those rare cases, a second visit to the office should be made and other measures undertaken. In severe infections, oral antibiotics  are necessary. Covering the eye is not a good idea because that  incubates the germs. If left untreated, conjunctivitis can create serious complications, such as infections in the cornea, lids, and  tear ducts. Prevention is important for avoiding the disease and stopping its  spread. Careful washing of the hands, the use of clean handkerchiefs, and avoidance of contagious individuals are all helpful. Little children frequently get conjunctivitis because of  their lack of understanding about hygiene and a resulting contact with germs. Chalazion Along the upper and lower lids are located a number of glands  that manufacture part of the tear film that protects and lubricates the eyeball. If one of these glands becomes blocked, a small lump  forms. This is called a chalazion (chalazia, plural). Chalazia may vary in size from small, almost invisible lumps to rather large masses as big as a little fingernail. Sometimes tender in their early stages, they are later painless and frequently will  form a firm swelling in the lid. This lump can distort the eyeball,  causing blurred vision if left untreated. Chalazia are not caused by infection; however, they may become a  site for infection once they have become established. Their exact cause remains unknown. Several conditions are associated with  chalazia: seborrhea, chronic lid inflammation, dry eyes, and acne. Most chalazia will disappear in a few weeks without any special  therapy. To help them go away, frequent hot packs throughout the day  and drops are helpful, especially in the early stages. In some cases, oral medicines can help prevent recurrences. If a chalzaion persists, a simple in-office surgical procedure can be performed to remove it. The chalazion is drained from the inside of the lid after a small injection of a local anesthetic. There is no visible scar  and healing is rapid and painless. Often the eye is patched overnight to ensure proper healing.