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Glaucoma is a painless, asymptomatic and insidious condition. It has been named "the silent thief of sight".
3 million Americans have glaucoma. Unfortunately, of these 3 million people who have glaucoma, half of them are unaware that they have the disease. A person does not realize their vision has been affected by glaucoma until serious, irreversible vision loss has occurred. Our goal here at the Family Eye Care Center is to prevent this from happening to any of our patients.
A glaucoma suspect is a person who during their comprehensive eye exam is found to have at least one of the following conditions :
1.) Borderline elevated or definitely elevated intra-ocular pressure (the pressure within the eye) in one or both eyes. Elevated pressures can directly damage the optic nerve tissue in the back of the eye. The higher the pressure and the longer the pressure is elevated, the higher the chance one has of developing glaucoma.
2.) Increased/large cupping of the optic nerve in the back of one or both eyes (increased "cup-to-disc ratio"). The "cup" of the optic nerve is the concavity or "scooped out" appearance seen in the center of the optic nerve. The larger the "cup", the higher the chance of glaucoma.
3.) A splinter-like hemorrhage seen either on or very close to the optic nerve upon examination.
4.) Strong family history of glaucoma.
5.) Pseudo-exfoliation syndrome.
6.) Pigment dispersion syndrome.
7.) Very shallow anterior chamber of one or both eyes (narrow occludable angles).
8.) Severe blunt trauma to one or both eyes.
Should one or a combination of the above conditions be present, your eye doctor must then determine whether you actually have glaucoma or not. A series of tests are performed and these consist of:
1.) Computerized visual field testing- This test checks the peripheral and central vision of each eye.
2.) Optical Coherence Tomography (OCT)- This test analyzes the tissue that comprises the optic nerve of each eye on a microscopic level. Essentially, this technology uses light to "biopsy" the extremely fine nerve fibers in the back of the eye that allows one to see.
3.) Digital stereoscopic photographs of each optic nerve- This provides a permanent record of the appearance of the optic nerve of each eye for current analysis and future reference.
4.) Gonioscopy- Your eye doctor directly looks at the internal drainage system of each eye using a special lens.
5.) Pachymetry- The thickness of the cornea of each eye is measured using ultrasound.
The results of these tests will be analyzed and interpreted. Should there be strong or definite evidence of glaucoma then a patient will be treated with eye drops in order to help lower the intra-ocular pressure. This person will then be followed regularly to make certain the treatment is effective.
A person who is deemed a glaucoma suspect needs to have these tests performed every year along with a comprehensive eye exam. Closely monitoring each patient will ensure that if glaucoma does emerge then it will be promptly diagnosed and subsequently treated so that vision loss does not occur. A glaucoma suspect has a much higher chance of developing glaucoma than someone who is not a glaucoma suspect.
For more about glaucoma, please see secton below on Glaucoma.
Most people have heard the term "glaucoma" however many do not know what glaucoma actually is. Simply put, glaucoma is increased pressure within the eye which over time causes damage to the optic nerve. This, in turn, leads to loss of peripheral vision then central vision.
The magnitude of this eye disease is enormous. Glaucoma is the second most common cause of blindness in the United States. At least 2 million people have glaucoma and roughly one half of them do not know it! Another 5 to 10 million people have elevated eye pressures which place them at risk for developing glaucoma.
To understand glaucoma, one should be familiar with what ``pressure of the eye" is. The human eye has an intrinsic pressure to it just as a basketball or a tire has. This pressure is NOT related to blood pressure. If the pressure of the eye becomes too high, the optic nerve can become affected. The optic nerve is the nerve in the back of the eye which is connected to the brain. The optic nerve is responsible for transmitting electric signals from the eye to the brain. The brain processes these signals into vision. As the optic nerve becomes damaged from prolonged high pressure, major loss of vision occurs.
The pressure of the eye is determined by the production and drainage of a clear fluid (called AQUEOUS HUMOR) within the eye. This fluid is responsible for nourishing the inside of the eye. The aqueous humor is constantly being produced and drained. If there is too much fluid production or inadequate drainage, the pressure inside the eye increases. This system is analogous to a sink with a faucet (fluid production) and a drainpipe (fluid drainage). If there is too much water flow or a clogged drain, the pressure builds up.
It is important to realize that the most common forms of glaucoma are painless! People who have undiagnosed glaucoma are unaware they have this condition because there are no early signs or symptoms. There is no pain, redness or obvious visual loss. The only way glaucoma can be detected early on is by having a complete eye exam. During this exam, the pressure of each eye is measured and the appearance of the optic nerve is assessed. If there is any suspicion of glaucoma, a visual field test is performed to determine one's peripheral and central
vision. In addition, a new testing modality called Optical Coherence
Tomography (OCT) is performed to assess the health of the optic nerve. This revolutionary test detects glaucoma damage at a much earlier stage thus preserving vision. We here at The Family Eye Care Center are pleased to offer this service. For more information on this test,
click on www.meditec.zeiss.com.
In summary, glaucoma is a disease which can silently cause blindness. Usually, there are no symptoms. The best way to detect glaucoma is by having a complete eye exam. In this manner, you can be certain whether you are at risk or not.
 For more information about Glaucoma, click on
www.glaucoma.org
What Is a Cataract?
In a normal eye, the lens is clear. In an eye that has a cataract, the lens has become cloudy or tinted. It is like a window that has become fogged with steam. The development of a cataract is usually age related. However, there are other reasons cataracts develop. For instance, long term medication use, medical problems such as diabetes, an injury to the eye, or long term unprotected exposure to the sun. These can all preclude cataract development.
How Do You Know If You Have a Cataract?
When a person has a cataract, they can experience some or all of the following symptoms:
- Painless blurring of vision
- Light sensitivity or glare
- Frequent eyeglass prescription changes
- Double vision in one eye
- A need for brighter light to read
- Poor night vision
- Fading or yellowing of colors
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Light Scatter
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It is not possible to give an answer to how fast a cataract develops. This depends on the individual and circumstances. When a cataract develops due to age, it may happen gradually over years. People with diabetes or taking medication might develop a cataract over a period of months. If the clouding of the lens is away from the center, a person might not even know they are developing a cataract.
Often a patient ends up at an ophthalmologist's office because they are experiencing some or all of the above symptoms. Upon receiving a thorough eye examination, the presence and extent of the cataract can be determined.
What Is The Treatment For Cataracts?
Having a cataract is a treatable condition. If a cataract is mild, a change in your eyeglass prescription might be all that is needed to improve your vision. However, surgery is THE ONLY WAY to remove a cataract. Medications, vitamins, exercises and or optical devices will not prevent or cure cataracts. Cataract surgery should be considered when the decreased vision interferes with your daily activities.
What Is Cataract Surgery?
Cataract surgery is performed by an ophthalmologist as an outpatient service either at a Hospital or an ambulatory surgery center. The operation is typically done under a local anesthetic. During cataract surgery the cloudy lens is removed from the eye and usually replaced by a permanent intraocular lens implant. Incredible advances have been made in the technology and procedures used by an ophthalmologist to perform this surgery.
Some surgeons, myself included, perform the ``NO STITCH" cataract surgery. As the name implies, the incision used to remove the cloudy lens and replace it with an implant is small enough that stitches are not necessary. This is a large benefit because it reduces the chance of complications and improves healing time. Each year more than 1.4 million people undergo cataract surgery. Over 90% have improved vision and more than 95% of the patients experience no complications. Cataract surgery is a highly successful medical procedure.
For more information about Cataracts, click on
www.medem.com
Diabetes can cause serious eye problems and in extreme cases, may even lead to blindness. Regularly scheduled eye exams lead to early detection of diabetic eye disease. Effective treatment can then be initiated resulting in better long-term results.
Diabetes Mellitus is a condition which causes a person's blood sugar levels to be elevated. Over time, these elevated blood sugar levels can affect a number of organs throughout the body. These include the heart, nerves, blood vessels, kidneys and the eyes.
The eyes can be affected in different ways. Diabetes can cause transient blurred vision when a person's blood sugar levels fluctuate wildly. Too high or too low blood sugar levels will change the amount of water in the eye's lens, in turn causing a change in one's vision. Stabilizing the blood sugar will prevent this.
Diabetes also can cause cataracts. A cataract is a cloudy or opacified lens inside the eye. This cloudiness or opacification leads to blurred vision. As a rule, people with diabetes develop cataracts earlier and faster than people who do not have diabetes.
People who have diabetes also have a higher chance of developing glaucoma. Glaucoma is a condition in which the pressure inside the eye is too high. The nerve in the back of the eye becomes affected over time, and loss of vision can result.
Diabetes can cause ``strokes" affecting the nerves which are responsible for movements of the eye. When this occurs, the patient will have double vision.
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Nonproliferative diabetic retinopathy. Due to diabetes, the retinal blood vessels have become "leaky" causing bleeding and swelling.
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Most importantly, diabetes can affect the retinal blood vessels. The retina is the tissue in the back of the eye which is responsible for processing light into vision. The blood vessels become abnormal, leading to leakage, swelling and bleeding in the retina. Also, new abnormal blood vessels can grow, leading to bleeding in the posterior chamber of the eye, as well as retinal detachments. All of these retinal problems can cause significant loss of vision.
Many of the diabetic eye problems described above can be treated effectively if diagnosed early enough. Although a person with diabetes may be unaware of having any problems with his or her eyes, one may be developing. It is imperative for a diabetic patient to get a yearly eye examination. Problems will be diagnosed before vision is affected, increasing the chances of a successful treatment.
There are several effective treatments for problems such as cataracts, glaucoma and diabetes retinopathy. Cataracts can be removed surgically. Glaucoma can be treated with drops, pills or laser surgery. Diabetic retinopathy can be treated with laser surgery.
This is an example of proliferative diabetic retinopathy. New abnormal blood vessels have grown.These in turn bleed and may cause a retinal retachment.
With the doctor and patient working together, the majority of potential visual loss can be avoided.
For more information about Diabetes, visit
www.diabetes.org
I would bet you have heard the term Macular Degeneration at one time or another. But what actually is this condition? Is it treatable? And how do you get it?
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Age-Related Macular Degeneration (ARMD) is a breakdown of the macula, the central most area of the retina. The retina is the tissue lining the back of the eye. It is responsible for processing light. Therefore, the condition called Age-Related Macular Degeneration (ARMD) manifests itself as visual disturbances. ARMD is a condition that can cause permanent loss of eyesight. It rarely causes total blindness but Age-Related Macular Degeneration (ARMD) is the major cause of vision loss in people over the age of 50. ARMD may also lead to ``legal blindness." ``Legal Blindness" is defined as 20/200 vision or worse in a person's better eye.
The vision loss is a result of ``damage" to the macula. The damage is often in the form of the macular tissue thinning, or breaking down. Exactly why this breakdown occurs is unknown. But, since the macula is responsible for ``straight ahead" vision, the eye can usually still see objects to the side or peripherally. However, this type of limited vision makes it hard to do close work such as reading.
Is ARMD treatable or preventable ? At this time, NO treatment has been uniformly effective. However, there is thought that proper nutrition plays a role in ARMD. Zinc is one of the most common trace minerals in our body and it is highly concentrated in the eye. It has been shown that many older people have low concentrations of zinc in there blood. This is important because zinc is necessary for certain chemical reactions in the retina. Hence, this school of thought is that supplements of zinc might slow down the process of ARMD. Another theory based on the importance of good nutrition is the thought that ``free Radicals" in the retina can contribute to cell degeneration. Eating plenty of fruits and vegetables containing the antioxidant vitamins A, C, and E may neutralize these ``free radicals." Again, at this time there is no consensus that these antioxidants actually help ARMD. Since recommended daily allowances of these vitamins are readily available through a diet rich in fruits and vegetables or in supplement form, many ophthalmologists recommend to their patients paying attention to their diets and taking vitamin supplements. So there really was a reason why you were told eating carrots is good for your eyes.
- ARMD is most often related to aging ( there are other types.)
- ARMD is most likely to affect fair-skinned and \ or light-haired people.
- ARMD may be hereditary, and might run in families.
- ARMD may only affect one eye, or it may effect both eyes.
- A frequent and important symptom of ARMD is distortion of objects.
- Often when symptoms are noticeable, the person is no longer in the early stages of ARMD.
- Early detection by an Ophthalmologist is important because further damage may be prevented.
- Age-Related Macular Degeneration (the most common type) has no known cure at this time.
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The drusen may coalesce and produce large areas of atrophy. A person with this would typically have very poor central vision.
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There are ophthalmic laser treatments or low vision aids that may be used to treat patients.
Most importantly, have a complete eye exam by an Ophthalmologist (eyeMD- medical Eye Doctor) on a regular basis. They could detect early Age-Related Macular Degeneration even before a patient experiences symptoms.
- Wear your reading glasses, if you have some.
- Cover one eye.
- While looking directly at the center be sure that all the lines are straight and all the small squares are the same size.
- If there is a distortion, blurred, discolored or otherwise abnormal spot on the grid you should call your ophthalmologist.
- Perform test on each eye separately.
If you notice any distortion of the grid, please contact your eye doctor.
For more information regarding Macular Degeneration, visit
www.macular.org
The human eye is a hollow, closed structure. The portion of the eye in front of the iris (the colored part of a person's eye) is known as the anterior chamber (see diagram above). A clear liquid (known as aqueous humor) is formed behind the iris and travels forward into the anterior chamber. This fluid nourishes the front portion of the eye and drains out through the drainage angle. The drainage angle encircles the periphery of the anterior chamber.
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Clear Liquid Called Aqueous Humor is constantly being produced within the eye (left).
If the drainage angle of the eye is blocked, fluid cannot flow out of the eye (right).
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During an eye exam, the depth of the anterior chamber is evaluated. When the anterior chamber is found to be shallow, the drainage angle may be narrow with the potential of being blocked. This is called a NARROW, OCCLUDABLE ANGLE. The internal pressure of the eye (intraocular pressure) is usually normal or slightly high at this point.
When a narrow drainage angle becomes blocked, the intraocular pressure becomes quickly elevated. This condition is known as ACUTE ANGLE CLOSURE GLAUCOMA. This is a true ocular emergency. When an angle closure glaucoma attack occurs, a person most likely will experience sudden vision loss and severe eye pain. If untreated, angle closure glaucoma can lead to severe, permanent loss of vision or even blindness in less than 24 hours.
When a shallow anterior chamber/narrow drainage angle is detected, a discussion with the patient takes place regarding the possibility of developing angle closure glaucoma. Depending how narrow the drainage angle is, prophylactic treatment may be indicated. A laser procedure (known as Laser Peripheral Iridotomy -LPI) may be needed to make a tiny opening in the upper part of the iris. A laser peripheral iridotomy is a painless, outpatient procedure. Performing a laser peripheral iridotomy eliminates the possibility of ever developing angle closure glaucoma. Risks, benefits and alternatives to a laser peripheral iridotomy need to be considered. The risks of the procedure are exceedingly low. The risks consist of intraocular bleeding and inflammation. Also, extraneous light entering through the new opening in the iris is possible but rare. Post-operatively, the patient should expect mild blurred vision and aching for a few hours following the procedure. The benefits consist of eliminating the possibility of developing a potentially devastating angle closure glaucoma attack.
Should you have any questions, please do not hesitate to ask Dr. Baharozian or his staff.
One of the most common problems seen in the eye doctor’s office is dry eye syndrome. Symptoms include burning, stinging or a gritty sensation. The eyes may become red and irritated. A patient may not be able to tolerate wearing contact lenses. Often patients complain of excess tearing when they actually have dry eyes. How can this be? This is because a person has two types of tearing. The main form of tearing is “baseline” tearing. This occurs naturally and continuously. A second form of tearing is called “reflex” tearing. Reflex tearing occurs during such events as cutting an onion, watching a sad movie or getting punched in the nose. A person who has truly dry eyes may produce tears reflexively thus causing excessive tearing!
There are many causes of dry eye syndrome. Medication such as antidepressants, antihistamines (for seasonal allergies) and cold preparations can induce dry eye syndrome. Contact lens wear can exacerbate dry eyes. For many people, the dryness is worse in the afternoon and the evenings. Also, dry eye syndrome is worse in the winter when many buildings are heated by forced hot air heat. Long periods of reading or staring at a computer screen can aggravate the symptoms of dry eyes. Environmental factors play a role as well. Cigarette smoke, fumes, dust and airborne particles are common irritants. Dry eye syndrome is also associated with systemic conditions such as arthritis and collagen-vascular diseases.
Treatment is helpful in most patients. Dry eye syndrome cannot be cured but can be helped. Artificial tears which are available over-the-counter soothe the eyes and give temporary relief. The best tear drops seem to be Systane, Refresh liquigel, TheraTears and Celluvisc. These drops last roughly one hour per application and must be repeated at frequent intervals. Ointments last longer but they may blur vision. Ointments are most effective at night. The best ointments are Genteal Gel and Refresh PM. Tear preparation without preservatives are preferable to those with preservatives. The next stage of treatment would be blocking the opening of the tear duct drainage system with silicone “punctual plugs” (PUNCTAL OCCLUSION). This drainage system normally carries tears away from the eye into the nose. By blocking this drainage of tears, punctual occlusion increases the tears available to the eye thus relieving most dry eye symptoms. This quick and painless procedure is performed in the eye doctor’s office. Flaxseed oil (which is rich in omega-3 oils) taken orally is thought to improve symptoms of dry eye syndrome. Lastly, a prescription eye drop named Restasis, has recently been approved by the FDA. Restasis may help induce the natural production of a person’s tears.
In conclusion, if a person experiences dry eye symptoms, an evaluation should be scheduled. With proper diagnosis and treatment, the majority of patients can be helped.
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