Ocular Disease Management

Cataracts

A cataract is a painless, cloudy area in the lens of the eye that blocks the passage of light to the retina. The retina is the nerve layer at the back of the eye. The nerve cells in the retina detect light entering the eye and send nerve signals to the brain about what the eye sees. Because cataracts block this light, they can cause vision problems.

What causes cataracts?

Aging and exposure to sunlight can cause cataracts. Changes in your eyes are often a normal part of aging. But the changes do not always lead to cataracts.

Cataracts can also happen after an eye injury, as a result of eye disease, after you use certain medicines, or as a result of health problems such as diabetes.

Sometimes children are born with cataracts.

What are the symptoms?

Cataracts can affect your vision.

• You may have cloudy, fuzzy, or foggy vision.
• You may see glare from lamps or the sun. You may have trouble driving at night because of glare from car headlights.
• You may need frequent changes to your eyeglasses prescription.
• You may get double vision in one eye.
• Your near vision may improve for a short time if you get a cataract. This temporary improvement is called second sight.

The vision loss from a cataract often happens slowly and may never become severe. Sometimes cataracts do not cause any vision problems.

How are cataracts diagnosed?

Your doctor can find out if you have cataracts by doing a physical exam and by asking questions about your symptoms and past health. You may need tests to make sure you have a cataract or to rule out other conditions that may be causing vision problems.

How are they treated?

Surgery can remove cataracts. For most adults, surgery is only needed when vision loss caused by a cataract affects their quality of life.

There are a number of things you can do that may help you manage your vision problems. Many people get along very well with the help of eyeglasses, contacts, or other vision aids. Keep your eyeglasses or contact lens prescription up to date. Also make sure you have plenty of lighting in your home. You may be able to avoid or delay surgery.

Whether you need cataract surgery depends on how much of a problem the cataract causes for daily activities like driving and reading. Surgery is almost always by your choice (elective) and can be scheduled when it is convenient. For people who decide to have surgery, the surgery usually works very well.

Some people have to have surgery. Children are sometimes born with cataracts that need to be removed. Other people may get cataracts after an eye injury or as a result of eye disease or other health problems. Cataracts from these causes may also need to be removed.

How can I prevent cataracts?

There is no proven way to prevent cataracts. But there are some things you can do that may help slow cataract growth. Do not smoke. Wear a hat or sunglasses when you are in the sun. And avoid sunlamps and tanning booths. Eat healthy foods. And keep diabetes under control.

Pterygium

Pterygium (pronounced tur-IJ-ee-um) is a common eye condition that affects people who spend a lot of time outdoors. People with pterygium have a growth of pink, fleshy tissue on the white of the eye. It usually forms on the side closest to the nose.

Pterygium is also known as surfer’s eye because it often affects surfers.

It is a noncancerous lesion that usually grows slowly throughout life. Or it may stop growing after a certain point. In rare cases a pterygium can continue growing until it covers the pupil of the eye and interferes with vision.

A pterygium may affect one or both eyes. When it affects both eyes, it is called a bilateral pterygium.

Pterygium is usually not a serious condition. But it can cause annoying symptoms such as a feeling of a foreign body in the eye.

Symptoms of Pterygium

Sometimes, a pterygium causes no symptoms other than its appearance. An enlarging pterygium, however, may cause redness and inflammation.

In some cases, a pterygium can grow onto the cornea (the clear, outer layer of the eye). This can distort the shape of the cornea, causing a condition called astigmatism. The result can be blurred vision.

Symptoms of pterygium may include:

• Burning
• Gritty feeling
• Itching
• Sensation of a foreign body in the eye
• Blurred vision

Causes of Pterygium

It’s not clear what causes a pterygium to develop. But most experts believe that significant risk factors include:

• Prolonged exposure to ultraviolet light
• Dry eye
• Irritants such as dust and wind

Pterygium occurrence is much greater among people who live near the equator. But it also can develop in anyone who lives in a sunny climate. It’s most often seen in young adults ages 20 to 40. It appears to be more common in men than in women.

Pterygium is often preceded by a related noncancerous condition called pinguecula (pin-WEK-yoo-la). This is a yellowish patch or bump on the conjunctiva near the cornea. The conjunctiva is the thin, moist membrane on the surface of the eye.

Treatment of Pterygium

See an ophthalmologist if you have symptoms of pterygium. He or she can diagnose the condition by examining the front part of your eye with a microscope called a slit lamp.

Pterygium usually doesn’t require treatment if symptoms are mild. If a temporary worsening of the inflamed condition causes redness or irritation, it can be treated with:

• Lubricating eye drops or ointments, such as Blink or Refresh drops
• Occasional use of vasoconstrictor eye drops, such as Naphcon A
• Short course of steroid eye drops, such as FML or Lotemax

If the lesion causes persistent discomfort or interferes with vision, it can be surgically removed during an outpatient procedure. You and your doctor may also take into account appearance and the size of the pterygium when making a decision about surgery.

Surgery has a risk of complications, such as the recurrence of a more aggressive lesion. So surgery is usually considered only if:

• Conservative treatments have failed
• The patient’s eyesight is at risk

The type of surgery most commonly used today uses the patient’s own conjunctiva (surface eye tissue) or preserved amniotic membrane (placenta) to fill the empty space created by the removal of the pterygium. In this procedure, the pterygium is removed and the conjunctiva or amniotic membrane is glued or stitched onto the affected area.

Pterygium surgery typically takes 30 to 45 minutes. After surgery, patients usually need to wear an eye patch for a day or two. But they can return to work or normal activities (avoiding swimming and eye rubbing) after a few days.

Often, patients are told to use steroid eye drops for several weeks. This will reduce inflammation and prevent pterygium recurrence.

The main complication of pterygium surgery is recurrence after removal. Without a conjunctival or amniotic graft, the recurrence rate is nearly 50%. Pterygium removal with a conjunctival or amniotic graft is associated with a much decreased recurrence risk of 5%-10%.

Surgical complications may also include corneal scarring and perforation. In some cases, surgical removal of pterygium can cause astigmatism.

Patients need to be carefully followed for a year because 97% of recurrences occur during the first 12 months after surgery.

Prevention of Pterygium

You may prevent pterygium by wearing sunglasses every day, even on cloudy days. Choose sunglasses that block 99%-100% of both ultraviolet A (UVA) and ultraviolet B (UVB) radiation.

Wraparound sunglasses provide the best protection against ultraviolet light, dust, and wind.

Experts also recommend wearing a hat with a brim to protect the eyes from ultraviolet light.

To keep your eyes moist in dry conditions, apply artificial tears.

Diabetic Retinopathy

Retinopathy is a disease of the retina. The retina is the nerve layer that lines the back of your eye. It is the part of your eye that “takes pictures” and sends the images to your brain. Many people with diabetes get retinopathy. This kind of retinopathy is called diabetic retinopathy (retinal disease caused by diabetes).

Diabetic retinopathy can lead to poor vision and even blindness. Most of the time, it gets worse over many years. At first, the blood vessels in the eye get weak. This can lead to blood and other liquid leaking into the retina from the blood vessels. This is called nonproliferative retinopathy. And this is the most common retinopathy. If the fluid leaks into the center of your eye, you may have blurry vision. Most people with nonproliferative retinopathy have no symptoms.

If blood sugar levels stay high, diabetic retinopathy will keep getting worse. New blood vessels grow on the retina. This may sound good, but these new blood vessels are weak. They can break open very easily, even while you are sleeping. If they break open, blood can leak into the middle part of your eye in front of the retina and change your vision. This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to move away from the wall of the eye (retinal detachment). This is called proliferative retinopathy. Sometimes people don’t have symptoms until it is too late to treat them. This is why having eye exams regularly is so important.

Retinopathy can also cause swelling of the macula of the eye. This is called macular edema. The macula is the middle of the retina, which lets you see details. When it swells, it can make your vision much worse. It can even cause legal blindness.

What causes diabetic retinopathy?

If you are not able to keep your blood sugar levels in a target range, it can cause damage to your blood vessels. Diabetic retinopathy happens when high blood sugar damages the tiny blood vessels of the retina.

When you have diabetic retinopathy, high blood pressure can make it worse. High blood pressure can cause more damage to the weakened vessels in your eye, clouding more of your vision.

What are the symptoms?

Most of the time, there are no symptoms of diabetic retinopathy until it starts to change your vision. When this happens, diabetic retinopathy is already severe. Having your eyes checked regularly can find diabetic retinopathy early enough to treat it and help prevent vision loss.

If you notice problems with your vision, call an eye doctor (ophthalmologist) right away. Changes in vision can be a sign of severe damage to your eye. These changes can include floaters, pain in the eye, blurry vision, or new vision loss.

How is diabetic retinopathy diagnosed?

An eye exam by an eye specialist (ophthalmologist or optometrist) is the only way to detect diabetic retinopathy. Having a dilated eye exam regularly can help find retinopathy before it changes your vision. On your own, you may not notice symptoms until the disease becomes severe.

Can diabetic retinopathy be prevented?

You can lower your chance of damaging small blood vessels in the eye by keeping your blood sugar levels and blood pressure levels within a target range. If you smoke, quit. All of this reduces the risk of damage to the retina. It can also help slow down how quickly your retinopathy gets worse and can prevent future vision loss.

If you have a dilated eye exam regularly, you and your doctor can find diabetic retinopathy before it has a chance to get worse. For most people, this will mean an eye exam every year. Finding retinopathy early gives you a better chance of avoiding vision loss and blindness.

How is it treated?

Surgery, laser treatment, or medicine may help slow the vision loss caused by diabetic retinopathy. You may need to be treated more than once as the disease gets worse.

Glaucoma

Glaucoma is the name for a group of eye diseases that damage the optic nerve. The optic nerve, which carries information from the eye to the brain, is in the back of the eye. When the nerve is damaged, you can lose your vision.

At first, people with glaucoma lose side (peripheral) vision. But if the disease is not treated, vision loss may get worse. This can lead to total blindness over time.

There are three types of glaucoma.

• Open-angle glaucoma is the most common form in the United States. In this type of glaucoma, the optic nerve is damaged bit by bit. This slowly leads to loss of eyesight. One eye may be affected more than the other. Sometimes much of your eyesight may be lost before you notice it.
• Closed-angle glaucoma is less common. About 10% of all glaucoma cases in the United States are closed-angle. In this type of glaucoma, the colored part of the eye (iris) and the lens block movement of fluid between the chambers of your eye. This causes pressure to build up and the iris to press on the drainage system of the eye. A related type is sudden (acute) closed-angle glaucoma. It is often an emergency. If you get this acute form, you will need medical care right away to prevent permanent damage to your eye.
• Congenital glaucoma is a rare form of glaucoma that some infants have at birth. Some children and young adults can also get a type of the disease.

Finding and treating glaucoma early is important to prevent blindness. If you are at high risk for the disease, be sure to get checked by an eye specialist (ophthalmologist) even if you have no symptoms.

Your risk for glaucoma rises after age 40. Race is also a factor. Blacks are more likely than whites to get the disease. You are also at risk if you have diabetes or if a close family member has had glaucoma.

What causes glaucoma?

Damage to the optic nerve is often caused by increased pressure in the eye (intraocular pressure). This can happen when extra fluid builds up in the eye, such as when the eye makes too much fluid or does not drain well. But some cases of glaucoma aren’t caused by increased pressure. In these cases, the cause may not be found.

You can get glaucoma after an eye injury, after eye surgery, or because of an eye tumor. Some medicines (corticosteroids) that are used to treat other diseases may cause glaucoma.

What are the symptoms?

If you have open-angle glaucoma, the only symptom you are likely to notice is loss of vision. You may not notice this until it is serious. That’s because, at first, the eye that is not affected makes up for the loss. Side vision is often lost before central vision.

Symptoms of closed-angle glaucoma can be mild, with symptoms like blurred vision that last only for a short time. Severe signs of closed-angle glaucoma include longer-lasting episodes of blurred vision or pain in or around the eye. You may also see colored halos around lights, have red eyes, or feel sick to your stomach and vomit.

In congenital glaucoma, signs can include watery eyes and sensitivity to light. Your baby may rub his or her eyes, squint, or keep the eyes closed much of the time.

How is glaucoma diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. If your doctor thinks you have glaucoma, you will be sent to an ophthalmologist for more tests. This may take more than one visit.

An ophthalmologist or an optometrist can diagnose and treat glaucoma. An optician cannot diagnose or treat this disease.

See your doctor if you notice blind spots in your vision or if over time you are having more trouble seeing. It’s also a good idea to be checked for the disease if you have a family history of open-angle glaucoma, are age 40 or older, have diabetes, or have other risk factors for glaucoma.

How is it treated?

Glaucoma is usually treated with medicine such as eye drops. Be sure to follow a daily schedule for your eye drops so that they work the way they should. You will likely need to take medicine for the rest of your life. You may also need laser treatment or surgery.

In adults, treatment can’t bring back vision that has been lost, but it can keep your vision from getting worse. Treatment aims to stop more damage to the optic nerve by lowering the pressure in the eyes.

How do you cope with glaucoma?

Learning that you have glaucoma can be hard, since much of your vision may be gone by the time it is detected. With counseling and training, you can find ways to keep your quality of life. You can use vision aids, such as large-print items and special video systems, to help you cope with reduced eyesight. You can also create a support group of people who can help with tough tasks.

Blepharoplasty

Eyelid surgery, also known as blepharoplasty,  improves the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

Treatable conditions:

• Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids.
• Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision, can be treated by eyelid lift surgery.
• Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.
• Bags under the eyes can be corrected by blepharoplasty.
• Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).

Is it right for me?

A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

You should undergo blepharoplasty surgery for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

You must tell your doctor if you have any of these medical conditions:

• Eye disease such as glaucoma, dry eye or a detached retina
• Thyroid disorders such as Graves’ disease and under or overactive thyroid
• Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes