Cataracts are among the more common causes of visual loss in the United States today, affecting 80% of people over the age of 60. A cataract is a clouding of the normally clear lens of the eye.
Symptoms of cataract may include blurred vision, problems with glare, difficulty with reading, fading of colors and poor night vision.
During the early stages of cataract development, eyeglass prescription changes may improve vision. As the cataract progresses and associated symptoms interfere with the ability to perform daily visual tasks, surgical alternatives may be considered.
Cataract surgery is an advanced microsurgical technique with a low complication rate. Phacoemusification, in which the cataract is removed with ultrasound, is frequently performed through an incision that is less than 3 mm. The cataract is then replaced with an intraocular lens implant. Recently introduced premium intraocular lenses correct astigmatism and reading vision. This technique allows for rapid visual rehabilitation and a high rate of patient satisfaction.
Age-related Macular Degeneration
Age-related macular degeneration is the leading cause of visual impairment affecting patients over 50 years of age in the United States. Macular degeneration results in damage to the macula which is that portion of the retina responsible for central vision. This breakdown of the macula may develop as part of the aging process.
There are two major forms of macular degeneration. Dry macular degeneration is more common and associated with a gradual loss of central vision. Wet macular degeneration is associated with the growth of abnormal blood vessels which leak fluid and blood resulting in a sudden loss of vision.
Wet macular degeneration can be treated with a new generation of drugs known as angiogenesis inhibitors that block the growth of new blood vessels or laser surgery. There is some evidence that multivitamins with antioxidants and lutein may slow the progression of dry macular degeneration.
Regular eye examinations are important in the diagnosis and treatment of this condition
Glaucoma is defined as damage to the optic nerve from elevated eye pressure. Low tension glaucoma is a far less common form of optic nerve damage associated with normal pressure.
Open angle glaucoma is the more common type and can lead to loss of peripheral vision if not properly treated. Angle closure glaucoma is far less common and is associated with the sudden onset of blurred vision, seeing halos, headache, nausea and vomiting. This sudden elevation in eye pressure should be treated immediately to prevent permanent loss of vision.
Glaucoma is a leading cause of blindness among the elderly population. Proper treatment can prevent progression of optic nerve damage. Treatment modalities include eye drops, laser and surgery.
Since glaucoma is usually an asymptomatic disease, an annual eye exam is important for early diagnosis and treatment. Risk factors for glaucoma include age, family history of glaucoma, diabetes and past eye injuries.
Floaters, seen as black spots, lines or cobwebs, are caused by degeneration of the vitreous. The vitreous is a jelly-like substance that fills the central cavity of the eye. Liquification of the vitreous results in symptoms of flashing lights or floaters. This process, known as posterior vitreous detachment, occurs in 63% of persons over the age of 70.
As the vitreous liquifies, it separates from the retina. This process may result in a retinal tear in 10-15% of patients. Retinal tears can be treated with laser to prevent detachment.
The sudden onset of floaters should be thoroughly evaluated for potential retinal tears and detachments with a dilated eye examination.
Diabetes Mellitus can be associated with damage to the retinal blood vessels. This damage is referred to as diabetic retinopathy. Approximately 50% of patients with diabetes for 7 years have some form of retinopathy. Diabetic retinopathy is the leading cause of blindness in patients 20-64 years of age.
There are two forms of diabetic retinopathy. In background diabetic retinopathy, tiny retinal blood vessels leak fluid. If this leakage involves the macula, which is located within the center of the retina, blurred vision will result. These areas of leakage can be sealed with a laser to prevent further loss of vision.
Proliferative diabetic retinopathy is associated with the growth of abnormal blood vessels which may bleed, leading to loss of vision. Retinal lasers can be employed to shrink these abnormal vessels and prevent further bleeding within the eye cavity.
Patients with a diagnosis of diabetes mellitus should have an annual eye examination with a dilated retinal examination. Early diagnosis and treatment, along with strict blood sugar control, is critical in preventing loss of vision.
Conjunctivitis, also known as “pink eye”, is a common cause of the red eye. Symptoms of this infection may include lid crusting and sticking, discharge, redness of the eye, a gritty sensation and lid swelling.
There are two common forms of conjunctivitis. Bacterial conjunctivitis is associated with purulent discharge which is yellow or white. This infection responds to topical antibiotic eye drops.
Viral conjunctivitis is associated with watery discharge and is highly contagious. Infectious precautions such as frequent hand washing and separate use of towels and bed linens should be employed. Most patients are contagious for up to two weeks. Although there is no medical treatment for viral conjunctivitis, this condition commonly resolves within 2-3 weeks.
Patients with a red eye should seek prompt evaluation so a proper diagnosis can be made and appropriate treatment prescribed.
Myopia, also known as nearsightedness, typically presents during the school age years with blurred vision. Squinting to see the black board at school or a failed vision screening may lead to an eye examination.
Myopia can be evaluated with a thorough eye examination and corrected with a prescription for eyeglasses. Contact lenses represent an alternate method of correction that may be more cosmetically appealing in certain teenagers and young adults.
When myopia ceases to progress in the young adult years, refractive surgery represents an alternative method of correction that may permanently eliminate the need for eyeglasses and contact lenses. In photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK), micro-thin layers of tissue are removed from the cornea under computer guidance. This procedure results in vision of 20/40 or better in 95% of patients.
Dry Eye Syndrome
Dry eye syndrome is a common disorder. Symptoms of dry eyes may include burning, a dry sensation, light sensitivity and blurred vision.
Certain systemic conditions such as rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis and scleroderma may be associated with dry eyes. Medications that decrease tear production such as antihistamines, diuretics and beta blockers may contribute to a dry eye state.
With proper evaluation and diagnosis, multiple therapeutic interventions are currently available to alleviate the symptoms of this condition. A variety of artificial tear substitutes can provide marked improvement. Punctal occlusion, in which the drainage of tears is blocked, allows retention of the patients own tears. This procedure can aid the person with moderate to severe dry eyes.
Specific tests, such as the Schirmer tear test, can be employed to analyze the degree of tear deficiency. Based on these results and a thorough eye examination, appropriate treatment can then be prescribed.