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AMBLYOPIA
Amblyopia is often referred to using the non-medical term "lazy eye". Amblyopia results when an eye and the brain are not working properly together. The most common causes of amblyopia are large differences in prescription need between the two eyes, strabismus (the eyes not pointing in the same direction), or an inability to see out of one eye from birth. To overcome this situation the brain generally suppresses or ignores much of the information from one of the eyes. Once this occurs the effected eye cannot achieve a normal level of vision despite an accurate prescription.
The successful treatment of amblyopia is highly dependent on the age of the patient. A young child has a better prognosis for recovering normal vision. Treatment generally includes eyeglasses, patching or occluding the normal eye to force the "lazy" amblyopic eye to work, and sometimes vision therapy. As a general rule, amblyopia treatment has little benefit after the visual system matures. The point in time at which this occurs is highly variable from six months to twelve years of age.
BLEPHARITIS
Blepharitis is a common inflammation of the eyelids caused by toxins from skin bacteria. It is the most common cause of chronic infection of the external eye. The bacteria typically infect the oil producing glands inside the eyelids. Symptoms may include dryness, burning, gritty feeling, and itching of the eyelid margins. Common signs may include crusting deposits on the eyelid margin and eyelashes, redness of the eyelid margins and loss of eyelashes.
Blepharitis tends to be chronic in nature and typically requires ongoing treatment including eyelid hygiene, topical medications, and in advanced cases, sometimes oral tetracycline.
CATARACT
A cataract is a clouding of the eye's natural lens inside the eye. The word cataract is derived from a Greek word meaning "waterfall" (looking through falling water). Nearly half of the population over 65 will have some degree of cataract formation in their lifetime. Cataracts are most commonly caused by natural chemical changes within the lens of the eye, which is thought to be part of the natural aging process, but can also occur as a result of trauma, UV exposure, certain medications and systemic disease. A cataract is not considered a disease of the eye and presently there is no proven method of prevention. Cataract surgery is the treatment option when vision and lifestyle functionality are compromised.
OCULAR ALLERGIES
The most common complaints reported to eye doctors involving burning, itching, puffy eyelids and watery eyes can be attributed to ocular allergies. It has been estimated that 60% of the population has some degree of discomforting symptoms related to ocular allergies.
To provide some biological detail, the tear layer of the eye contains specialized cells called mast cells. Mast cells are large container cells that store large amounts of histamine cells. Under optimum conditions the cell walls of mast cells break releasing histamine in response to eye injuries and eye infections. In ocular allergies, especially if there is excessive eye rubbing, mast cells break open unnecessarily releasing large amounts of histamine. As a result, excess histamine causes the eyes to itch, thus the common historic treatment was to introduce anti-histamine drugs to reduce the itch symptoms.
Eye rubbing increases the itch response 15 fold, so all patients are urged to limit rubbing of the eyes as much as possible. Cool compresses may also helpful in reducing symptoms. The causative source of ocular allergies varies greatly including, seasonal pollens, animal dander, mold, etc. Reducing exposure to known allergy sources is prudent, but since we don't live in a bubble, it is difficult.
For patients troubled by ocular allergies, over-the-counter eye drops are often recommended to improve comfort. For patients with more troublesome symptoms, prescription medication is needed to help eliminate symptoms. Some of the prescribed drugs are called mast-cell inhibitors. These new classes of drugs are safe and generally used once or twice daily depending on a patient's symptoms during troublesome allergy times.
CORNEAL ULCER
The cornea is the central clear window of the eye. A corneal ulcer is an area of tissue disruption of this sensitive tissue often extending deep into the corneal structure. In most cases, corneal ulcers result from bacterial infection. Pain, light sensitivity, decreased vision and tearing are common symptoms of these lesions.
All types of corneal ulcers are serious, sight threatening lesions that require aggressive treatment and careful monitoring. Treatment usually includes special antibiotics, and often, anti-inflammatory medications. Scarring to the cornea may result despite treatment. Frequent examination is necessary until the ulcer is completely healed.
DRY EYE SYNDROME
Problematic dry eyes are one of the most common problems reported to eye doctors. Dry eyes result from either a decrease in the amount of tear production, or the quality or composition of the tears produced.
There are many common causes of dry eye syndrome including: advancing age, allergies, poor diet, heating/cooling environmental circumstances, normal hormonal changes, health status such as diabetes, arthritis, lupus, thyroid dysfunction, chemotherapy, radiation, acne rosacea, contact lens use, computer use and patients that have a history of LASIK surgery. In addition certain medications can contribute to dry eye symptoms such as antidepressants, antihistamines, decongestants, acne treatments, diuretics and some blood pressure medications.
Common symptoms of dry eyes may include blurred or variable vision, sensitivity to light, dryness, burning, stinging, gritty or foreign body sensations. Occasionally, the dry eye patient may experience a paradoxical excess or "reflex" tearing caused by the underlying eye surface irritation.
Treatment of this condition may include artificial tears, gels and/or lubricating ointments at bedtime, daily eyelid hygiene scrubs, a prescribed medication regime, Omega-3 essential fatty acid nutritional supplements (fish and flaxseed oil), and punctal (tear drainage) occlusion of the eyelid to retain moisture.
As you can see, the causes and possible treatment options are complex. An individual treatment plan will be formulated for you based on severity and known causes. Please follow my recommendations and outlined treatment plan carefully.
KERATOCONUS
Keratoconus is a condition of the normally clear outer window of the eye, the cornea. The word keratoconus is formed from two Greek words, kerato, meaning cornea, and konus, meaning cone. The cornea is generally shaped like a dome or sphere. It is primarily responsible for surface protection of the eye and performs a greater degree of light focusing than any other part of the eye.
Keratoconus gradually causes the central area of the cornea to weaken, thin, or bulge. It eventually distorts from its more spherical shape to a cone shape. This distortion may cause significant changes in vision which may begin in the late teen years and may not stop until age 40. While keratoconus can be an inherited bilateral (two eye) condition, many patients have no clear inheritance pattern. It has been estimated to occur in 1 out of every 2,000 persons.
The earliest changes of keratoconus may require frequent changes of glasses. As the corneal distortion worsens, contact lenses may be required to obtain adequate vision. In this case, contact lenses mask the warp or cone-like changes of the underlying cornea. Generally, most keratoconus patients can be safely managed with contact lenses yielding good vision and comfort. In more advanced cases of keratoconus, vision in an eye can be suddenly, yet usually temporarily, lost through an event called "hydrops." During this process, the stretching cone-area of the cornea cracks, swells and in some cases may causes scars.
When contact lenses can no longer correct vision adequately, or when highly specialized contact lenses can no longer be made to remain comfortably on the eye surface, surgical replacement of the distorted corneal area may be considered. Surgical treatment is found to be necessary in only about 10% of the cases. This surgery is performed using donor cornea tissue to return the eye surface to a more normal shape. Cornea transplants are highly successful (over 95%). Although a transplant may not eliminate the need for glasses or contacts it will likely restore the visual function that keratoconus slowly distorts.
DIABETES & THE EYE
Diabetes is the second leading cause of blindness and may soon top the list of sight-loss conditions. Diabetes and its complications can affect many parts of the eye. Diabetic eyes are 25 times more likely to develop blindness than non-diabetic eyes. Diabetes can also cause earlier development of cataracts, a higher tendency toward glaucoma, dry eye symptoms, and, most importantly, damage to blood vessels nourishing the sensitive retina.
A comprehensive eye health examination may reveal early warning signs or simply the suggested presence of diabetes. Patient history, reported symptoms, observed changes in the retina, unexpected prescription changes, and early cataracts may all be an indication of diabetic complications. More frequent dilated eye examinations is highly recommended for patients with the disease, patients that are suspects, and patients with a strong family history of diabetes.
PRIMARY OPEN-ANGLE GLAUCOMA
Glaucoma is a condition where various factors cause damage to the optic nerve and resultant loss of vision. Many factors including family history, race, eye pressure, thin corneas, and/or, the appearance of the optic nerve can increase the risk of developing glaucoma. The ultimate diagnosis of glaucoma is based on these factors, as well as, analysis of the retinal nerve fiber layer and visual field studies.
Primary open angle glaucoma is the most common form of glaucoma. The exact cause of the disease is not completely understood but typically has some relation to the pressure inside the eye. Open-angle refers to the fact that the area where fluid drains from the eye is open or unrestricted. Primary open angle glaucoma is a slowly progressive disease that must be diagnosed and treated early to avoid irreversible loss of vision.
Primary treatment involves the use of drops, but laser treatment, and even surgery, may be required in more advanced cases. Unfortunately, glaucoma has no symptoms until the disease is well advanced and significant loss of vision has occurred.
For this reason, the health of the optic nerve must be closely followed to assure treatment is effective and vision loss is not progressing.
AGE-RELATED MACULAR DEGENERATION
Age related macular degeneration (AMD) is a deterioration of the central vision area of the retina called the macula. The macula is responsible for our fine central detailed vision. Although the exact cause of AMD is not known, it is thought to be an accelerated by the aging process. The risk of developing macular degeneration increases with age, family history, vascular status, active smokers, and lifetime sun exposure.
There are two forms of age related macular degeneration, a "wet" type, and a "dry" type. The "dry" type has a better prognosis. On average, this condition is slowly progressive and functional vision is maintained. Although there is no cure for dry macular degeneration, treatment is available. Nutritional supplements, protection from ultraviolet radiation, special medications, and laser treatment are all considerations depending on the degree of advancement of the condition. Careful monitoring is imperative to track possible advancement.
In the "wet" type of macular degeneration, abnormal blood vessels grow in the macular region causing leakage, bleeding, and scarring. Although there is no cure for wet macular degeneration, new treatments have proven to be effective for some in slowing, or stopping, the progression of the disease. Therapeutic injections, nutritional supplements, protection from ultraviolet radiation, special medications, and laser treatments are all considerations depending on the degree of advancement of the condition. This condition must be closely monitored for possible advancement.
ASTIGMATISM
85-90% of all eyeglass prescriptions contain some correction for astigmatism. The eye, like a camera, has an outer curved lens, the cornea, to focus light. Most commonly, astigmatism occurs when this front surface has more than one curvature, rather than a perfectly round shape. With astigmatism, the shape of the cornea is asymmetrical, or somewhat "egg" shaped, rather than uniformly round like a ball. As a result, an astigmatic eye requires a special two-power lens to precisely focus light.
Since astigmatism causes two different focuses per eye, and especially if astigmatism exists in both eyes, the brain has much to contend with. As a result, uncorrected or incorrect prescriptions for astigmatism cause blurred and distorted vision, as well as, annoying symptoms of eyestrain such as headaches, eye fatigue, sensitivity to light, loss of visual achievement and poor visual concentration.
It is expected that first correction or large changes in correction of astigmatism may cause objects or straight lines to appear tilted or distorted. This perception of distortion will decrease steadily with time. As with most prescriptions, it is common for the degree of astigmatism to change naturally over time. Eyeglasses, and/or, special astigmatic (toric) contact lenses are available to correct astigmatism.
HYPEROPIA or FARSIGHTEDNESS
The medical term for farsightedness is hyperopia. As with most refractive errors, farsightedness is commonly caused by the shape of the eye. Farsighted eyes are generally shorter from front to back or because the front curvature of the eye is flatter than normal. An uncorrected farsighted eye must use the near focusing system of the eye, normally only used for close-range tasks, to assist distance vision. As a result, this places an even greater focusing effort on close-range vision. Uncomfortable symptoms and fatigue are common for the uncorrected or under-corrected farsighted eye since the visual system is in a constant state of over effort.
Clarity and comfort of vision for the farsighted person depends on their degree of farsightedness and the efficiency of their focusing system. In general, farsighted eyes always see better at far distance than at closer distances. Farsighted adults gradually see less clearly at all distances due to a natural and expected decline in the eyes close-range focusing ability over time.
Farsightedness is most commonly corrected with eyeglasses or contact lenses. If adults require different prescriptions for distance and near, special dual-focus contact lenses are now available. Less commonly, refractive surgery techniques such as LASIK, or lens replacements are also treatment options for adults.
MYOPIA or Nearsightedness
The medical term for nearsightedness is myopia. When you are nearsighted, your distance vision is blurred. Close range vision is generally clear at some near distance without correction, thus the term "nearsighted." As with most refractive errors, nearsightedness is simply caused by the shape of the eye. In this case, the eye is longer front to back, or has a steeper curve to the front lens of the eye, the cornea. Genetic, environmental or functional factors can also play a role in the development of nearsightedness.
Nearsightedness is generally corrected with eyeglasses or contact lenses. For adults, refractive surgery such as LASIK, or lens replacements are additional options.
PRESBYOPIA (prez-bee-O-pee-ah)
Presbyopia is a normal decline in close-range focusing ability of our eyes with time. Presbyopia seems to present close-range issues suddenly but actually it does not. Our eyes have maximum focusing ability in our teens, about 50% at age 40, and we gradually decline to a fixed non-variable focus around the age of 70. The average person requires a different prescription for distance vs. reading tasks around the age of 42.
Most people falsely think that muscles inside the eye weaken over time causing this gradual loss of close-range focus. To the contrary, presbyopia is a loss of elasticity of the focusing lens inside the eye. In addition, many falsely believe that if eyeglasses are worn often it will weaken the eyes' further. It is important to understand that wearing appropriate eyeglasses or multi-focus contact lenses full-time or part-time will not weaken or change your future visual status in any way. All humans experience this unavoidable and fully correctable visual condition.
RETINAL DETACHMENT
Retinal detachment is a serious problem, and with no treatment, vision is almost always lost. Although anyone can have a retinal detachment, they tend to occur more frequently in patients who have a high degree of nearsightedness, who have had trauma to the eye, and/or, have a family history of retinal detachment. Also, patients who have had cataract surgery, or retinal laser treatments, are more prone to develop a retinal detachment.
Most retinal detachments require immediate laser, or surgical repair. In most cases, there is high likelihood of successfully reattaching the retina. The return of good vision depends on how quickly the repair is performed, its location, specifically whether or not the macula, or area of central vision was detached prior to surgery. If the macula was detached, the prognosis for return of central vision is poor.