Glaucoma, What is it?

Article from The Second Wind

Dear Dr. Weaver,

A few of my friends have mentioned to me that they were recently diagnosed with chronic open angle glaucoma. I haven’t had an eye exam in years. So, I was wondering how I can tell that I’m developing glaucoma.

Sincerely,
Edith

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Dear Edith,

Chronic open angle glaucoma is an insidious disease that damages the optic nerve over a period of time. The optic nerve contains millions of nerve fibers leading from the retina to the brain. Damage to the optic nerve from glaucoma affects these nerve fibers, which thereby affects a person’s vision. The nerve fibers responsible for a person’s peripheral vision are lost first. Since people are not usually susceptible to vision changes in their peripheral visual field, the loss of these nerve fibers go unnoticed. Eventually, prolonged damage to the optic nerve causes more and more of the retinal nerve fibers to lose function. When the disease is quite advanced, glaucoma will start damaging the nerve fibers responsible for a person’s central vision. This is when aggressive treatment must be initiated as soon as possible, because any vision that is lost is not recoverable.

When you go in for an eye examination, the eye doctor is looking for a multitude of risk factors that would indicate that you have glaucoma or are a suspect of developing glaucoma. Some of these risk factors are a high intraocular pressure and cupping (loss of nerve fibers) of the optic nerve. Other risk factors are increased age and a family history of glaucoma.

To gain more information about a person’s risk of developing glaucoma, the eye doctor will usually order a battery of tests. These typically include a peripheral visual field test, a photo or computerized scan of the optic nerve, a scan of the nerve fibers in the retina, and an ultrasound of the cornea to determine its thickness. After interpreting all of this information, the doctor will then determine if treatment is necessary.

The only risk factor that the doctor can directly control is the intraocular pressure. The goal is to lower the pressure inside the eye to a level that the doctor believes will reduce or halt damage to the optic nerve, to preserve as much remaining vision as possible. What may be a high pressure for one person may be entirely normal for someone else. Everyone is different, so the treatment also differs.

The pressure inside the eye can be thought of as water in a kitchen sink. Controlling the amount of fluid (water level) in the eye is the inflow (faucet) and the outflow (drain). When the intraocular pressure increases, this occurs by too much water coming into the sink, something clogging the drain, or a combination of both. This eye pressure can be reduced with prescription eyedrops that act on both the inflow and outflow mechanisms to lower the eye pressure. However, patient compliance with using eyedrop medication daily can be an issue, especially since the patient usually has no symptoms in early glaucoma. Poor control results in a higher intraocular pressure, allowing glaucoma to progress. If the pressure is not controlled well, your eye doctor may also recommend a non-invasive procedure involving laser treatment to increase the outflow to lower the intraocular pressure. It is possible that a person may still require eyedrops after laser treatment, depending on how well the intraocular pressure was lowered.

Glaucoma is one disease out of a multitude of eye conditions that exhibit symptoms only when it is very advanced and severe. Individuals diagnosed with glaucoma and treated appropriately can live their entire life without any noticeable vision loss. It is extremely important to seek an eye exam yearly so that your eye doctor may ensure that your eyes are healthy, or to establish a treatment regimen to preserve the vision that you have.

Cataracts and Cataract Surgery

Article from The Second Wind

Dear Doctor Weaver,

Recently, I was told by my eye doctor that I have cataracts. It was recommended that I get cataract surgery, but I am very nervous about any form of eye surgery. What exactly is a cataract and can you share any information to help relieve my apprehensions about surgery?

Thanks,
Marion

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Dear Marion,

Everyone is born with a natural lens inside each eye. Like a camera lens, this natural lens focuses light and images that allows you to see. During childhood, this natural lens is very clear. As a person ages, the lens can change in shape, size, and color.

There are many different types of cataracts that affect different parts of the lens. Cataracts can be a darkening/clouding of the color of the lens or a physical change of its surface. Either of these changes affects the quality of vision by scattering light or letting less light into the eye.

Cataracts develop for many reasons. Some studies believe that long-term UV exposure contributes to the progression of cataract development. Systemic conditions, such as diabetes, also affect metabolic processes that cause cataracts to form more quickly. Injuries, such as blunt trauma to the eye, can also cause cataracts to develop. Typically, cataracts are an age-related condition, which means that the longer a person lives, the more likely he/she will develop cataracts.

When cataracts form, vision that was once clear now becomes hazy or blurry. Some people notice this especially when driving at night. During dark light conditions, the pupils dilate. This occurs to allow more light to enter the eye in order to see better at night. However, a cataract scatters light and reduces the amount of light entering the eye, which leads to the night-driving complaint or halos and glare. Cataracts also cause problems with vision during the day as well. Bright sunny days (especially with snow-covered ground) can cause a high amount of glare that makes it difficult to see comfortably.

Initially, when a cataract develops, this can cause a change in the shape of the lens. This, in turn, causes a change in a person’s eyeglass or contact lens prescription. So, if a patient comes in for an eye examination with a blurry vision complaint and early cataracts are present, the patient may only require a change in his/her eyeglasses to make things clearer. But when cataracts advance and cause an increase in the darkening/clouding of the natural lens, the vision is blurred because less light is entering the eye, not because the prescription has changed. At this point, cataract surgery is typically recommended.

Cataract surgery involves the removal of the natural lens (containing the cataract) and replacing that with an artificial lens implant, called an intraocular lens. The power of this lens is carefully calculated based on non-invasive measurements that are performed at the surgeon’s office. There are two types of intraocular lenses: monofocal and multifocal. Monofocal lenses allow you to see at distance, requiring the use of bifocals or reading glasses to allow you to read up close. The advancement of new technology has allowed multifocal lens implants to provide both distance and near vision, possibly eliminating the need for eyeglasses completely.

During the surgery, a very small incision is made and typically no stitches are required. Cataract surgery used to require an overnight stay in a hospital, but now, it is an out-patient procedure performed at a surgical center. The actual surgery takes only about 10-15 minutes. The patient returns for regularly scheduled follow-up visits to ensure that the vision is acceptable and to monitor for any ocular complications. All patients are given drops to use routinely before and after the procedure to help minimize infection and inflammation. Typically, a new eyeglass prescription is determined one month after cataract surgery if needed.

To conclude, cataract surgery is an elective procedure. Your eye doctor may make a recommendation for surgery based on his/her findings, but the ultimate decision is up to you. Cataracts definitely affect the quality of vision as well as quality of life. So if you have cataracts and you are not seeing well with your current eyeglasses, I would recommend that you make an appointment with your eye doctor to review his findings with you and go from there.

Dry Eye, Artificial Tears, Other Treatment Options

Newspaper article from The Second Wind

Dear Doctor Weaver,

Recently, I have been experiencing a lot of dryness in both of my eyes. Is there anything that you would recommend? And why do my eyes seem to feel worse during the winter months?

Margaret

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Dear Margaret,

Dry eye can cause many symptoms, such as burning, tearing, redness, foreign body sensation, irritation, and temporary blurred vision. Many people experience dry eye symptoms all year-round, with certain periods of the year being more bothersome. Some people are affected by environmental conditions, such as the wind and decrease in humidity found during the winter. Others are affected by dry air heat that is commonly found in most homes and work environments. In either case, there are many solutions that can help you out.

The easiest solution is the use of artificial tears, or lubricating eye drops. These eye drops are formulated to coat the front surface of the eye like your natural tears. Such name brands include Systane, Refresh Tears, Bion Tears, and Tears Naturale, just to name a few. Most come packaged in a multi-dose bottle. However, some people are sensitive to the preservatives that are found in this kind of packaging. For those individuals, there are single-dose vials that do not contain any preservatives, which may feel more comforting to the eye.

These over-the-counter eye drops can be used on a regular bases (such as four times a day) or as needed. There are also gel formulations (ointments) that are more viscous. The thicker gel tends to blur vision more so than the lubricating drops, which is why it is typically reserved for use right before bed and first thing in the morning.

But if you’ve already tried these products, and are still having problems, there are other options available.

If you are a contact lens wearer, you should consider changing lens materials if you haven’t already done so. The newest technology for contact lenses now allow much more oxygen to travel through the contact lens to the eye, drastically reducing symptoms of dryness. Such examples of these contact lenses are Ciba’s Focus Night & Day, Bausch & Lomb’s Purevision, and Vistakon’s Acuvue Oasys.

However, even changing contact lenses may not be enough. The truth is, as the body ages, changes in the anatomy occur everywhere, including the eyelids. It is possible that the natural oil glands of the eyelids aren’t producing enough tears, or possibly that those tear ducts are clogged. Using a hot wash cloth on the eyelids while the eyes are closed sometimes stimulates tear production and unclogs static oil glands. Doing this on a routine basis, such four times a day for five minutes at a time, usually helps.

There are oral nutritional supplements that have been found to be beneficial for people suffering from chronic dryness. These over-the-counter supplements include Theratears Nutrition, Dry Vites, and Hydroeye to name a few. They basically contain omega-3 fatty acids, which are thought to keep the tear production system healthy. A diet can be changed to include more omega-3 fatty acids, or using the nutritive supplements containing flax seed oil or fish oils would also work.

It has recently been discovered that dry eye symptoms can be the result of inflammation. If you have tried over-the-counter drops and gels and are still having symptoms of dryness, you should seriously consider seeing your eye doctor for more specific treatment. Your eye doctor may prescribe a low-dose steroid eye drop in addition with your lubricating drops to help control this inflammation. He/she may also prescribe a topical cyclosporin medication called Restasis to help with moderate/severe dry eye.

Essentially, dry eye symptoms can occur in anyone, at any time of year. If left untreated, it can cause unnecessary discomfort and vision problems. It is recommended that you consult with your eyecare professional for guidance and assistance in this matter.

Contact Lenses, Monovision and Multifocals (Bifocals)

Article from The Second Wind

Dear Dr. Weaver,

I used to wear contact lenses many years ago, but once I started wearing bifocal glasses, I had to give up on wearing contact lenses. I was wondering if there are any options out there for me, because I would love to give up wearing eyeglasses altogether.

Sincerely,
Maggie

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Dear Maggie,

My first recommendation would be to get a contact lens exam from an eye care professional to review your options. There are many contact lens options for individuals in your situation. As long as your eyes are healthy and you have a desire to get back into wearing contact lenses, it doesn’t matter what age you are. Even for people who have never worn contact lenses, it’s never too late to try.

There have been advancements in contact lens design and convenience since you discontinued wearing contact lenses. Both the rigid gas permeable lens type and soft contact lens type are still available, but they are made with more “breathable” materials, allowing more oxygen to reach the front of the eye. This “breathable” material reduces symptoms of dryness, redness, burning, and irritation; some of the main reasons why people stop wearing contact lenses in the first place.

However, some people stop wearing contact lenses because they can no longer read or do any close work without using a pair of magnifying reading lenses. This creates the hassle of having to wear contacts in combination with glasses. This goes against the reason why people switch to contact lenses in the first place; so they don’t have to wear glasses. So what can be done about this?

As everyone ages, the eye’s ability to focus gets weakened. This is the reason why most people depend on some form of magnification for close work, such as reading glasses or bifocals. Recently, there have been new options with multi-focal (or bifocal) contact lenses. Most patients fitted with these types of lenses still maintain excellent vision, enough to be legally allowed to drive at night as well as read newspaper size print. However, your eye doctor may require you to return for follow-up visits to fine-tune your vision at distance and/or near. These lenses usually work 100% of the time for all vision tasks. But certain light situations (like a dimly lit restaurant) or the size of the print you are trying to read (stock listings in a newspaper’s business section) may require a mild boost in the magnification by adding the use of low power reading magnifying lenses.

Another option that is available is called “monovision.” This describes the use of contact lenses, where one eye is optimized for distance and the other is prescribed for near. As with multi-focal contact lenses, this option usually requires an adjustment period, just like any new pair of eyeglasses.

The adaptation to monovision and multi-focal contact lenses is variable. Basically, you won’t know if it works or not unless you try it out. So if you are willing to get back into wearing contact lenses, or if you are doing so for the first time, set up an appointment with an eye doctor that specializes in contact lenses so that he/she can review options that are best for you.

Age-Related Macular Degeneration (ARMD)

Newspaper article from The Second Wind

Dear Doctor Weaver,

I have a relative that was recently diagnosed with macular degeneration. What is the risk of getting this disease? Also, I’ve heard that there are two types, dry and wet. What’s the difference and is there any treatment for either?

Annie

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Dear Annie,

Macular degeneration describes a condition in which the area of the retina responsible for your central vision (the macula) undergoes changes. Essentially, the longer that you live, the more likely you are to develop macular degeneration. Also, long-term UV exposure has been thought to be a risk factor for macular degeneration. Individuals with high blood pressure, high cholesterol and heart disease also have a higher risk. Current smokers or any history of smoking has been shown to increase the risk of developing the disease.

There is a normal pigment contained beneath the retina called the retinal pigmented epithelium (RPE), and macular degeneration causes a change in this pigment as well as the formation of crystal-like deposits of varying shapes and sizes called drusen. This actually causes damage to the nearby retina, resulting in blurry or distorted central vision. This is called Dry Age-Related Macular Degeneration. Sometimes, this damage can also result in the formation of fluid (edema). When this occurs, the condition is named Wet Age-Related Macular Degeneration.

The dry form requires careful monitoring by an eyecare professional. If there are signs of early macular degeneration, the patient may be given a testing device containing crossed lines, like a checkerboard. This is called an Amsler Grid. Following the instructions of the doctor, the Amsler Grid is checked every day for any perceived changes in those crossed lines and is an important tool in detecting any subtle change in vision. There is no surgical treatment for dry macular degeneration. However, there was a study called the Age-Related Eye Disease Study (AREDS) that showed a certain combination of specific vitamins could slow down the progression of advanced disease. Two common over-the-counter multivitamins include Ocuvite Preservision by Bausch & Lomb and ICaps by Alcon. (You should first consult with your eye doctor if any of these multivitamins are right for you.)

The wet form requires the referral to a retina specialist for evaluation and treatment. The development of fluid greatly increases the risk of retina damage, which can lead to blindness. The fluid typically develops from the formation of leaky blood vessels that grow in the macula as a response to the degenerative changes. A retina specialist may use a laser to seal off the leaky blood vessels to reduce the fluid accumulation. An injection with a steroid or a compound that prohibits blood vessel formation may also be used.

To conclude, it is important for you to get a yearly eye examination in order to detect any signs of macular degeneration, or any other eye conditions that can cause blurry vision. Any history of smoking increases the risk of developing macular degeneration, so halting this habit is beneficial to the health of your body and eyes. Also, seeing your family doctor on a regular basis will allow him/her to diagnose, treat and monitor health conditions (such as high blood pressure, high cholesterol and heart disease) that are risk factors for macular degeneration.