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Cataract Surgery

What is a Cataract?

A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina (the layer of light-sensing cells lining the back of the eye) to produce a sharp image of what we see. When the lens becomes cloudy, light rays cannot pass through it easily and vision is blurred.

What causes a Cataract?

Cataract development is a normal process of aging, but cataracts also develop from eye injuries, radiation, certain diseases, medications or long-term exposure to sunlight. Your genes may also play a role in cataract development.

How can Cataract be treated?

A cataract may not need to be treated if your vision is only slightly blurry. Simply changing your eyeglass prescription may help to improve your vision for a while.

There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear or to prevent them from forming. Surgery is the only way to remove a cataract. When you are no longer able to see well enough to do the things you like to do, cataract surgery should be considered.

In cataract surgery, the cloudy lens is removed from the eye through a surgical incision. In most cases, the natural lens is replaced with a permanent intraocular lens (IOL) implant.

Light rays entering an eye with a normal lens

Light rays entering an eye with a cataract. When a cataract forms, the lens of your eye is cloudly. Light cannot pass through it easily and your vision is blurred.

What can I expect if I decide to have cataract surgery

Before Surgery

To determine if your cataract should be removed, your ophthalmologist (Eye M.D.) will perform a thorough eye examination. Before surgery, your eye will be measured to determine the proper power of the intraocular lens that will be placed in your eye. Ask your ophthalmologist if you should continue taking your usual medications before surgery. You should make

The Day of Surgery

Surgery is usually done on an outpatient basis, either in a hospital or an ambulatory surgery center. You may be asked to skip breakfast, depending on the time of your surgery.

When you arrive for surgery, you will be given eye drops and perhaps a mild sedative to help make you comfortable. A local anesthetic will numb your eye. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head.

Under an operating microscope, a small incision is made in the eye. During the surgery, you may see light and movement, but you will not be able to see the surgery while it is happening. In most cataract surgeries, tiny surgical instruments are used to break apart and remove the cloudy lens from the eye. The back membrane of the lens (called the posterior capsule) is usually left in place.

A plastic, acrylic or silicone intraocular lens (IOL) is implanted in the eye to replace the natural lens that was removed.

After surgery, your doctor may place a protective shield over your eye. After a short stay in the out-patient recovery area, you will be ready to go home.

During cataract surgery, tiny instruments are used to break apart and remove the cloudy lens from the eye.

In cataract surgery, the intraocular lens replaces the eye’s natural lens. 

The most common type of IOL is the monofocal lens, which provides vision at one distance. Other lenses, like multifocal and accommodative lOLs, provide both near and distance vision. Toric  lOLs correct irregularly shaped corneas (astigmatism). These lOLs are often called premium lOLs, and they typically are not covered by insurance.

In cataract surgery, the intraocular lens replaces the eye’s natural lens

Following Surgery

  • Use the eye drops as prescribed;
  •  Be careful not to rub or press on your eye;
  • Avoid strenuous activities until your ophthalmologist tell you to resume them;
  • Ask your doctor when you can begin driving;
  • Wear eyeglasses or an eye shield, as advised by your doctor.

You can continue most normal daily activities. Over-the-counter pain medication may be used, if necessary.

Is a laser used during cataract surgery?

Many surgeons make a tiny incision in the front of your eye and use a non-laser instrument to create sound waves (ultrasound) that break up the cataract. This instrument is then used to suction out the pieces.

However, another technique does use a laser, called a femtosecond laser, to perform one or more steps of the operation. Both methods are highly successful.

Sometimes the lens capsule (the part of the eye that holds the lens in place) becomes cloudy months or years after the operation. If the cloudy capsule blurs your vision, your Eye M.D. can perform a second procedure using a laser. This procedure, called a posterior capsulotomy, uses a laser to make an opening in the cloudy lens capsule, restoring normal vision.

Posterior capsulotomy: A laser is used to make an opening in the cloudy lens capsule. 

Will cataract surgery improve my vision?

The success rate of cataract surgery is excellent. Improved vision is achieved in the majority of patients if other vision problems are not present.

Complications after cataract surgery

Though they rarely occur, possible serious complications of cataract surgery are:

  • Infection;
  • Bleeding;
  • Swelling of the retina; and
  • Detachment of the retina.

Call your ophthalmologist immediately if you have any of the following symptoms after surgery:

  • Pain not relieved by non-prescription pain medication;
  • Loss of vision;
  • Nausea, vomiting or excessive coughing;
  •  Injury to the eye.

Cataract

  • Blurring or dimming of vision

What is a Cataract?

A cataract is a clouding of the normally clear lens of the eye. It can be compared to a window that is frosted or yellowed.

The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.

There are many misconceptions about cataract:

Cataract is not:

  • A film over the eye;
  • Caused by overusing the eyes;
  • Spread from one eye to the other;
  • A cause of irreversible blindness.

Common symptoms of cataract include:

  • A painless blurring of vision;
  • Glare, or light sensitivity;
  • Poor night vision;
  • Double vision in one eye;
  • Needing brighter light to read;
  •  Blurring or dimming of vision
  • Fading or yellowing of colors.

Left, normal vision. At right, dulled or yellowed vision.

Blurring or dimming of vision

Blurring or dimming of vision

What causes a Cataract?

Cataract development is a normal process of aging, but cataracts also develop from eye injuries, radiation, certain diseases, medications or long-term exposure to sunlight. Your genes may also play a role in cataract development.

In a normal eye, light focuses precisely on the retina. 

Posterior capsulotomy: In an eye with cataract, light scatters throughout the eye instead of focusing precisely on the retina 

How Fast does a cataract develop?

How quickly the cataract develops varies among individuals and may even be different between the two eyes. Most age-related cataracts progress gradually over a period of years.

Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a short time. It is not possible to predict exactly how fast cataracts develop in any given person.

How can Cataract be treated?

A cataract may not need to be treated if your vision is only slightly blurry. Simply changing your eyeglass prescription may help to improve your vision for a while.

There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear or to prevent them from forming. Surgery is the only way to remove a cataract. When you are no longer able to see well enough to do the things you like to do, cataract surgery should be considered.

In cataract surgery, the cloudy lens is removed from the eye through a surgical incision. In most cases, the natural lens is replaced with a permanent intraocular lens (IOL) implant.

Read more about Cataract Surgery

Uveitis

What is uveitis?

The eye is shaped much like a tennis ball, with three different layers of tissue surrounding the central gel- filled cavity, which is called the vitreous.
The innermost layer is the retina, which senses light and helps to send images to your brain. The outermost layer is the sclera, the strong white wall of the eye. The middle layer between the sclera and retina is called the uvea. Uveitis (pronounced you- vee-EYE-tis) is inflammation of the uvea.

What is the importance of the uvea?

The uvea contains many blood vessels — the veins, arteries and capillaries — that carry blood to and from the eye. Because the uvea nourishes many important parts of the eye (such as the retina), inflammation of the uvea can damage your sight.

Uveitis may develop suddenly with redness and pain or with a painless blurring of your vision.

A case of simple “red eye” may in fact be a serious problem of uveitis. If your eye becomes red or painful, you should be examined and treated by an ophthalmologist (Eye M.D.).

What are the symptoms of uveitis?

Symptoms include:

  • Light sensitivity;
  • Blurred vision;
  • Pain
  • Floaters;
  • Redness of the eye.

What causes uveitis?

Uveitis has many different causes:

  • A virus, such as shingles, mumps or herpes simplex;
  • Systemic inflammatory diseases;
  • A result of injury to the eye; or
  • Rarely, a fungus, such as histoplasmosis or a parasite, such as toxoplasmosis.

How is uveitis diagnosed?

A careful eye examination by an ophthalmologist is extremely important when symptoms occur. Inflammation inside the eye can permanently affect sight or even lead to blindness if it is not treated.

Your ophthalmologist will examine the inside of your eye. He or she may order blood tests, skin tests or X-rays to help make the diagnosis.

Since uveitis can be associated with disease in other parts of the body, your ophthalmologist will want to know about your overall health. He or she may want to consult with your primary care physician or other medical specialists. However, in approximately 40 to 60 percent of cases, no associated disease can be identified.

How is uveitis treated?

Uveitis is a serious eye condition that may scar the eye. It needs to be treated as soon as possible.

Eyedrops, especially corticosteroids and pupil dilators, can reduce inflammation and pain. For more severe inflammation, oral medication or injections may be necessary.

  • Uveitis can be associated with these complications:
  • Glaucoma (increased pressure in the eye);
  • Cataract (clouding of the eye’s natural lens);
  • Neovascularization (growth of new, abnormal blood vessels);
  • Damage to the retina, including retinal detachment.

These complications may also need treatment with eyedrops, conventional surgery or laser surgery.

If you have a “red eye” that does not clear up quickly, contact your ophthalmologist.

Are there different kinds of uveitis?

There are different types of uveitis, depending on which part of the eye is affected.

When the uvea is inflamed near the front of the eye in the iris, it is called iritis. Iritis has a sudden onset and may last six to eight weeks. Some types of anterior uveitis can be chronic or recurrent.

If the uvea is inflamed in the middle of the eye, it is called intermediate uveitis (or pars planitis). Episodes of intermediate uveitis can last between a few weeks to years. The disease goes through cycles of getting better, then worse.

An inflammation in the back of the eye is called posterior uveitis. Posterior uveitis can develop slowly and often lasts for many years.

Floaters and Flashes

Wnat are Floaters

You may sometimes see small specks or clouds moving in your field of vision. These are called floaters. 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 gel-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 it. What you see are the shadows they cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see.
Floaters can appear as different shapes, such as little dots, circles, lines, clouds, or cobwebs.

Floaters

Although the floaters appear to be in front of the eye, they are actually floating in the vitreous fluid inside the eye.

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. This is a common cause of floaters.

Posterior vitreous detachment is more common in 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 very suddenly. You should contact your ophthalmologist (Eye M.D.) right away if you develop new floaters, especially if you are over 45 years of age.

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. You should see your ophthalmologist as soon as possible if:

  • Even one new floater appears suddenly;
  • You see sudden flashes of light.

If you notice other symptoms, like the loss of side vision, you should see your ophthalmologist.

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 contact your ophthalmologist immediately in case the retina has been torn.

Can Floaters be removed

Floaters may be a symptom of a tear in the retina, which is a serious problem. If a retinal tear is not treated, the retina may detach from the back of the eye. The only treatment for a detached retina is surgery.

Other floaters are harmless and fade over time or become less bothersome, requiring no treatment. Surgery to remove floaters is almost never required. Vitamin therapy will not cause floaters to disappear.

Even if you have had floaters for years, you should schedule an eye examination with your ophthalmologist if you suddenly notice new ones.

Some people experience flashes of light that appear as jagged lines or “heat waves” in both eyes, often lasting 10 to 20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a 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. Contact your ophthalmologist if you experience these symptoms.

How are your eyes examined?

When an ophthalmologist examines your eyes, your pupils may be dilated (enlarged) with eye drops. During this painless examination, your ophthalmologist will carefully observe areas of your eye, including the retina and vitreous. If your eyes have been dilated, you will need to make arrangements for someone to drive you home afterward.

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 examination by an ophthalmologist to make sure there has been no damage to your retina.

LASIK

What is LASIK

Laser in situ keratomileusis, or LASIK, is an outpatient surgical procedure used to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. With LASIK, your ophthalmologist (Eye M.D.) uses a laser to reshape the cornea (the clear covering of the eye) to improve the way the eye focuses light rays onto the retina.

LASIK may decrease your dependence on glasses and contacts or, in some cases, allow you to do without them entirely. According to the American Academy of Ophthalmology, seven out of 10 LASIK patients achieve 20/20 vision, but 20/20 does not always mean perfect vision. If you have LASIK to correct your distance vision, you’ll probably still need reading glasses by around age 45. Therefore, it is important for you to consider the possibility that LASIK may not give you perfect vision.

Am I a good candidate for LASIK

The ideal LASIK patient is over 21 years old, since refractive error is more likely to still be changing in people younger than this. Some people older than 21 are still experiencing change in refractive error, making them unsuitable for LASIK. It’s also preferable to be free of any eye disease and not pregnant or nursing. You should not have had a change in your eye prescription in the last year and should have a refractive error within the range of correction for LASIK.

You must also be willing to accept the potential risks, complications and side effects associated with LASIK (see “risks” section of this handout). You should discuss these issues with your surgeon, carefully weighing the risks and rewards. If you’re happy wearing contacts or glasses, you may want to forego the surgery.

What happens before surgery

Your ophthalmologist will perform a thorough eye exam to measure your prescription and check for any abnormalities that might affect the procedure. Your doctor will check your eyes for unusual dryness, which could cause dry eyes symptoms postoperatively, or unusually large pupils, which could affect night or low-light vision.

How is LASIK done?

A suction ring placed on the eye lifts and flattens the cornea and helps keep your eye from moving. You may feel pressure from the eyelid holder and suction ring, similar to a finger pressed firmly on your eyelid. From the time the suction ring is put on the eye, until it is removed, vision appears dim or goes black.

Your ophthalmologist may use an automated microsurgical instrument called a microkeratome to make a flap in your cornea. This device is attached to the suction ring. As the microkeratome blade moves across the cornea, you will hear a buzzing sound. The microkeratome stops at a preset point, far enough from the edge of the cornea to create a hinged flap of paper-thin corneal tissue. The microkeratome and the suction ring are removed from your eye, and the flap is lifted and folded back.

Some ophthalmologists use a specific laser instrument instead of a bladed microkeratome to make the flap in your cornea. With this technique, tiny, quick pulses of laser light are applied to your cornea. Each light pulse passes through the top layers of your cornea and forms a microscopic bubble at a specific depth and position within your cornea. Your Eye M.D. then creates a flap in the cornea by gently separating the tissue where these bubbles have formed. The corneal flap is then folded back.

As the flap is moved aside, your vision gets blurrier. Then a special laser for sculpting the cornea — preprogrammed with measurements customized to your eye — is centered above the eye. In most cases, a pupil tracker will be used to keep the laser centered on your pupil during surgery.
You will stare at a special pinpoint light called a fixation light or target light while the laser sculpts the exposed corneal tissue. The laser makes a clicking sound you can hear during the procedure. After the laser has completed reshaping the cornea, the surgeon places the flap back into position and smoothes the edges. The flap adheres on its own in two to three minutes.

Eyelid speculum and suction ring

After a flap is created in the cornea, the laser sculpts the exposed corneal surface.

The tissue flap is replaced.

What happens after surgery?

To help protect your cornea as it heals, your ophthalmologist may place a see-through shield over your eye, if needed, or may ask you to wear a shield at night. It is normal for your eye to have a burning sensation or feel “scratchy” This usually disappears in a few hours. Plan on going home and taking a nap or just relaxing after the procedure. You will be given eye drops to help the eye to heal and to alleviate dryness. Healing after LASIK is usually more comfortable than with other methods of refractive surgery because the laser removes tissue from the inside of the cornea and not from the more sensitive corneal surface.

What are the risks, complications and side effects?

LASIK, like any surgery, has risks and complications that should be carefully considered. LASIK can sometimes result in under correction or overcorrection. Fortunately, these problems can often be improved with glasses, contact lenses, or an additional laser surgery.

Most complications can be treated without any loss of vision. Permanent vision loss is very rare. There is a chance, though extremely small, that your vision will not be as good after the surgery as before, even with glasses or contacts. This is called a loss of best-corrected vision.

Some people experience temporary side effects after LASIK that usually disappear over time. In the rare situations, they may be permanent. These side effects may include:

  • Discomfort or pain;
  • Hazy or Blurry vision;
  • Scratchiness;
  • Dryness;
  • Glare;
  • Halos or starbursts around lights;
  • light sensitivity;
  • Small pink or red patches on the white of the eye.

Almost everyone experiences some dryness in the eyes and fluctuating vision during the day. These symptoms usually fade within one month, although some people may continue to have symptoms for a longer period of time.

Infections is a small possibility with any surgical procedure, including LASIK. Antibiotics can usually clear up such infections. Rarely, complication during surgery may cause irregularities in the corneal flap, requiring further treatment.

What will my vision be like after LASIK?

LASIK, like any surgery, has risks and complications that should be carefully considered. LASIK can sometimes result in under correction or overcorrection. Fortunately, these problems can often be improved with glasses, contact lenses, or an additional laser surgery.
It is important that anyone considering LASIK have realistic expectations. LASIK allows people to perform most of their everyday tasks without corrective lenses. However, people looking for perfect vision without glasses or contacts run the risk of being disappointed.

Over 90 percent of people who have LASIK achieve somewhere between 20/20 and 20/40 vision without glasses or contact lenses. If the procedure results in an under o overcorrection, your doctor may decide to perform a second surgery, called an enhancement, to further refine the result.

LASIK cannot correct presbyopia, the age-related loss of close-up focusing power. With or without refractive surgery, almost everyone who has excellent distance vision will need reading glasses by the time they reach 40 or 50. Some people choose a vision correction method called monovision, which leaves one eye slightly nearsighted. The nearsighted eye is used for close worl, while the other is is adjusted for distance vision.

Although monovision is acceptable for most people, some may not be comfortable with this correction. To determine your individual needs and your ability to adapt to this correction, you may wish to try monovision with contact lenses before surgery.

If 20/20 vision is essential for your job or leisure activities, consider whther 20/40 vision would be good enough for you. You should be comftable with the possibility that you may need a second surgery or that you might need to wear glasses for certain activities, such as reading or driving at night.

Summary

Today’s LASIK procedure is the most popular form of refractive surgery for decreasing dependence on eyeglasses or contact lenses. If LASIK surgery is appropriate for your eyes, you should join thousands of people who have benefited from this widely performed procedure to make the decision that’s right for you, discuss with your ophthalmologist whether or not you are a good candidate for LASIK.

Glaucoma

What is Glaucoma

Glaucoma is a disease of the optic nerve — the part of the eye that carries the images we see to the brain. The optic nerve is made up of many nerve fibers, like an electric cable containing numerous wires. When damage to the optic nerve fibers occurs, blind spots develop. These blind spots usually go undetected until the optic nerve is significantly damaged. If the entire nerve is destroyed, blindness results.

Early detection and treatment by your ophthalmologist (Eye M.D.) are the keys to preventing optic nerve damage and blindness from glaucoma.

Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma can often be prevented with early treatment.

If the drainage angle is blocked, excess fluid cannot flow out of the eye, causing the fluid pressure to increase.

What causes glaucoma

Clear liquid called aqueous humor circulates inside the front portion of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system. (This liquid is not part of the tears on the outer surface of the eye.)
Because the eye is a closed structure, if the drainage area for the aqueous humor — called the drainage angle — is blocked, the excess fluid cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve and causing damage.

What are the different types of glaucoma

Primary open-angle glaucoma. This is the most common form of glaucoma in the United States.The risk of developing primary open-angle glaucoma increases with age. The drainage angle of the eye becomes less efficient over time, and pressure within the eye gradually increases, which can damage the optic nerve. In some patients, the optic nerve becomes sensitive even to normal eye pressure and is at risk for damage. Treatment is necessary to prevent further vision loss.

These blank spots in your day-to-day activities until the optic nerve is significantly damaged and these spots become large. If all the optic nerve fibers die, blindness results.

Closed-angle glaucoma. Some eyes are formed with the iris (the colored part of the eye) too close to the drainage angle. In these eyes, which are often small and farsighted, the iris can be pushed forward, blocking the drainage channel completely. Since the fluid cannot exit the eye, pressure inside the eye builds rapidly and causes an acute closed-angle attack.

Symptoms may include:

  • Blurred vision;
  • Severe eye pain;
  • Headache;
  • Rainbow-colored halos around lights;
  • Nausea and vomiting.

This is a true eye emergency. If you have any of these symptoms, call your ophthalmologist immediately. Unless this type of glaucoma is treated quickly, blindness can result.

Two-thirds of those with closed-angle glaucoma develop it slowly without any symptoms prior to an attack.

Who is at risk for glaucoma

Your ophthalmologist considers many kinds of information to determine your risk for developing the disease.

The most important risk factors include:

  • Age;
  • Elevated eye pressure;
  • Family history of glaucoma;
  • African or Hispanic ancestry;
  • Farsightedness or nearsightedness;
  • Past eye injuries;
  • Thinner central corneal thickness;
  • Systemic health problems, including diabetes, migraine headaches and poor circulation;
  • Pre-existing thinning of the optic nerve.

Your ophthalmologist will weigh all of these factors before deciding whether you need treatment for glaucoma, or whether you should be monitored closely as a potential glaucoma patient. This means your risk of developing glaucoma is higher than normal, and you need to have regular examinations to detect the early signs of damage to the optic nerve.

How is Glaucoma detected

Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. A glaucoma screening that checks only the pressure of the eye is not sufficient to determine if you have glaucoma. The only sure way to detect glaucoma is to have a, complete eye examination.

During your glaucoma evaluation, your ophthal-mologist will:

  • Measure your intraocular pressure (tonometry);
  • Inspect the drainage angle of your eye (gonioscopy);
  • Evaluate whether or not there is any optic nerve damage (ophthalmoscopy);
  • Test the peripheral vision of each eye (visual field testing, or perimetry).

Photography of the optic nerve or other computerized imaging may be recommended. Some of these tests may not be necessary for everyone. These tests may need to be repeated on a regular basis to monitor any changes in your condition.

How is Glaucoma treated

As a rule, damage caused by glaucoma cannot be reversed. Lowering eye pressure is the only proven way to treat glaucoma. Eyedrops, laser surgery and surgery in the operating room are used to lower eye pressure and help prevent further damage. In some cases, oral medications may also be prescribed.
With any type of glaucoma, periodic examinations are very important to prevent vision loss. Because glaucoma can progress without your knowledge, adjustments to your treatment may be necessary from time to time.

Medications

Glaucoma is usually controlled with eyedrops taken daily. These medications lower eye pressure, either by decreasing the amount of aqueous fluid produced within the eye or by improving the flow through the drainage angle.
Never change or stop taking your medications without consulting your ophthalmologist. If you are about to run out of your medication, ask your ophthalmologist if you should have your prescription refilled.
Visual field testing is used to monitor peripheral, or side, vision.

Some eye drops may cause:

  • A stinging or itching sensation;
  • Red eyes or redness of the skin surrounding the eyes;
  • Changes in pulse and heartbeat;
  • Changes in energy level;
  • Changes in breathing (especially with asthma or emphysema);
  • Dry mouth;
  • Eyelash growth;
  • Blurred vision;
  • Change in eye color.

All medications can have side effects or can interact with other medications. Therefore, it is important that you make a list of the medications you take regularly and share this list with each doctor you see.

Glaucoma medications can preserve your vision, but they may also produce side effects. You should notify your ophthalmologist if you think you may be experiencing side effects.

Loss of vision can be prevented

Laser surgery treatments may be recommended for different types of glaucoma.
In open-angle glaucoma, the drain itself is treated. The laser is used to modify the drain (trabeculoplasty) to help control eye pressure.
In closed-angle glaucoma, the laser creates a hole in the iris (iridotomy) to improve the flow of aqueous fluid to the drain.

What is your part in treatment

Treatment for glaucoma requires teamwork between you and your doctor. Your ophthalmologist can prescribe treatment for glaucoma, but only you can make sure that you follow your doctor’s instructions and use your eye drops.

Once you are taking medications for glaucoma, your ophthalmologist will want to see you more frequently. Typically, you can expect to visit your ophthalmologist every three to six months. This will vary depending on your treatment needs.

Sugery in the operating room

When surgery in the operating room is needed to treat glaucoma, your ophthalmologist uses fine microsurgical instruments to create a new drainage channel for the aqueous fluid to leave the eye. Surgery is recommended if your ophthalmologist feels it is necessary to prevent further damage to the optic nerve. As with laser surgery, surgery in the operating room is typically an outpatient procedure.

Regular medical eye exams can help prevent unnecessary vision loss.

People at any age with symptoms of or risk factors for glaucoma, such as those with diabetes, a family history of glaucoma, or those of African descent, should see an ophthalmologist for an exam. Your ophthalmologist will let you know how often to return for follow-up exams.

Adults with no symptoms of or risk factors for eye disease should have a complete screening at age 40 — the time when early signs of disease and changes in vision may start to happen. Based on the results of the initial screening, your ophthalmologist will let you know how often to return for follow-up exams.

Adults 65 years or older should have an eye exam every one to two years, or as recommended by your ophthalmologist.

Macular Degeneration

  • Macular degeneration

What is macular degeneration

Macular degeneration is a disease of the macula — a small area in the retina at the back of the eye. The macula allows you to see fine details clearly and do things such as read and drive. When the macula does not work properly, your central vision can be blurry and you may have areas that are dark or distorted. Macular degeneration affects your ability to see near and far, and can make some activities — like threading a needle or reading — difficult or impossible.

Macular degeneration is the most common cause of severe vision loss in people older than 50.

Although macular degeneration reduces vision in the central part of the retina, it usually does not affect the eye’s side (peripheral) vision. For example, you may be able to see the outline of a clock but not be able to tell what time it is. Macular degeneration alone usually does not cause total blindness. Even in more advanced cases, people usually continue to have some useful vision and are often able to take care of them. In some cases, macular degeneration may not affect your vision very much. In other cases, however, vision loss may be more rapid and severe.

Macular degeneration

What causes macular degeneration?

Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD or ARMD).

Our bodies constantly react with the oxygen in our environment. Over time, as a result of this activity, our bodies produce molecules called free radicals. These free radicals affect our cells, sometimes damaging them. This is called oxidative stress, and is thought to play a major role in how AMD develops. Many people (approximately 1 in 3 Caucasians) have genetic changes that make them more prone to this damage.

Major risk factors for AMD are:

  • Cigarette smoking;
  • Genetic predisposition or having a family history of AMD;
  • Being more than 50 years old.

Another risk factor for developing AMD may include having abnormal cholesterol levels.

Many people with AMD have deposits under the retina called drusen. Drusen alone usually do not cause vision loss, but when they grow in size or number, there is an increased risk of developing advanced AMD.

The two most common types of AMD are dry and wet.

Amsler grid with wavy lines

Dry Macular degeneration

Ninety percent of people with AMD have the “dry” form. This condition is caused by damage (oxidative stress) and results in thinning of macular tissue. Vision loss is usually gradual. Many people with this form also have difficulty adjusting to changes in light. For example, they may find it takes them some time to adjust to seeing indoors when they come in from outside.

Wet Macular degeneration

Ten percent of people who have AMD have the “wet” form. Many of these people develop significant vision loss. Wet AMD results when abnormal blood vessels form underneath the retina. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.

What are the symptoms of macular degeneration?

Macular degeneration can cause different symptoms in different people. Some people hardly notice AMD in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. But when both eyes are affected, you notice the loss of central vision quickly.

  • Usually, you will notice vision loss when you find:
  • Words on a page look blurred;
  • A dark or empty area appears in the center of vision;
  • Straight lines look distorted, as in the diagram above.

How is macular degeneration diagnosed?

Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist (Eye M.D.) can detect early stages of AMD during a medical eye examination.

This exam includes:

  • A simple vision test in which you look at a chart that looks like graph paper (called an Amsler grid);
  • A dilated eye exam, which allows for a better view of the macula;
  • An exam of your macula with special lenses;
  • Having special photographs taken of your eye with fluorescein angiography and optical coherence tomography (OCT). Fluorescein angiography uses photographs and a fluorescein dye to illuminate any abnormal blood vessels that may be under your retina. OCT scanning is a sophisticated and exact tool that detects abnormal blood vessels by creating a special picture of your macula. An OCT scan also helps detect fluid that can accumulate under the retina.

     

How is Macular degeneration treated?

Nutritional Suplements

Antioxidant vitamins and zinc may reduce the impact of AMD in some people. The latest large scientific study on AMD and nutritional supplements found that people at risk for developing advanced stages of AMD lowered their risk by at least 25 percent when treated with a high-dose combination of:

  • Vitamin C (500 mg);
  • Vitamin E (400 iu);
  • Lutein (10 mg);
  • Zeaxanthin (2 mg);
  • Zinc (80 mg), and
  • Copper (2 mg).

Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12.

Among those who either have no AMD or very early AMD, the supplements do not appear to be beneficial. Family members of patients with AMD should check with their doctor before taking these vitamins themselves.

It is very important to remember that vitamin supplements are not a cure for neither AMD, nor will they give you back vision that you may have already lost from the disease. In certain cases, there may be some risks with taking supplements. However, specific amounts of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. Talk with your ophthalmologist to find out if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.

Anti-VEGF treatments, laser surgery and pdt

The most common treatment for wet AMD involves injecting a drug into the eye that stops blood vessel growth and bleeding. These drugs, known as VEGF blockers or anti-VEGF treatments, target a specific chemical in your body that causes abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). These anti-VEGF treatments improve vision in some people with wet AMD, and over the long term, anti-VEGF treatments stop the progression of further vision loss.

 

Certain types of wet macular degeneration can be treated with laser surgery, which is a brief, outpatient procedure that uses a focused beam of light to slow  or stop leaking blood vessels that damage the macula.

 

A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels.

These procedures may save more of your sight overall, though they are not cures that bring your vision back to normal. Even with advanced medical treatment, many people with macular degeneration still experience vision loss.

Making the most of the vision you have

To help you use the vision you do have, your Eye M.D. can prescribe low-vision equipment to help with everyday tasks or refer you to a low- vision specialist or center. There are many support services and rehabilitation programs to help people with AMD stay active and independent. Because your side vision is usually not affected, your remaining sight is very useful. Often, you can continue with many of your favorite activities by using low-vision equipment, such as a variety of magnifiers, portable electronic aids, special television equipment, large-print reading materials and talking or computerized items.

In addition to low-vision aids, it’s important that you learn how to make the best use of your remaining peripheral or side vision by working with a low vision specialist.

Testing your vision with the amsler grid

You should check your vision daily by using an Amsler grid like this on this page. You may find changes in your vision that you wouldn’t notice otherwise. Putting the grid on the front of your refrigerator is a good way to remember to look at it each day.

To use the grid:

  1. Wear your reading glasses and hold this grid 12 to 15 inches away from your face in good light.
  2. Cover one eye.
  3. Look directly at the center dot with the uncovered eye.
  4. While looking directly at the center dot, note whether all lines of the grid are straight or if any areas are distorted, blurred or dark.
  5. Repeat this procedure with the other eye.
  6. If any new area of the grid looks wavy, blurred or dark, call your ophthalmologist promptly. If you are unsure, re-check your Amsler grid the next day. If the grid still looks distorted, call your doctor.

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