Frequently Asked Questions

Click a question below to see the answer. Select a link below to find more about a specific topic.

Cataract

1. How are cataracts treated?

In routine cataract surgery, an ophthalmologist (Eye M.D.) removes the cataract, through a tiny incision (phacoemulsification). Usually, a synthetic intraocular lens (IOL) is inserted at the time of cataract extraction to replace the focusing power of the natural lens. IOLs can be monovision (fixed-focus for a preset distance) or multifocal, which allows focused vision at various distances. Cataract surgery should be performed when vision is reduced enough to interfere with ones normal lifestyle.

2. What is an IOL?

An intraocular lens (IOL) is a tiny, lightweight, clear plastic or silicone disc placed in the eye during cataract surgery. An IOL replaces the focusing power of the eye's natural lens and may be implanted either in front of or behind the iris. IOLs can be made of hard plastic, soft plastic, or soft silicone. Soft, foldable lenses are inserted through a small incision, which shortens recovery time following surgery.

The most common type of IOL is the monofocal or fixed-focus IOL. The monofocal lens helps you obtain clearer vision at one distance. Eyeglasses or contact lenses are still required in order for one to see clearly at all ranges of distance.

Another type of IOL is the multifocal IOL. The multifocal lens has several different powers built into the lens. The part of the lens one looks through will determine whether one can see at far, near, or intermediate distances.

A third type of IOL is the accommodative IOL. The accommodative lens has a hinge designed to work with your eye muscles, allowing the lens to move forward as the eye focuses on near objects and backward as the eye focuses on distant objects. This movement allows you to focus clearly at different distances.

3. What are the risks of IOLs?

Risks associated with implanting IOLs include overcorrection or under-correction, dislocation of the implant, halos, glare, clouding of a portion of the IOL, and loss of vision.

4. I had cataract surgery on one eye 10 years ago. My eye was extremely red and looked horrible for ays. Now, my other eye needs surgery. The doctor says this time it will be quick, painless and likely the eye will show no signs of surgery. What's changed?

The surgical technique for removing cataracts, as well as the technology, has improved immensely over the past 10 years. You probably had an extracapsular cataract extraction (ECCE). In extracapsular extraction, an incision is made in the side of the cornea at the point where the cornea and sclera, the white part of the eye, meet. This incision requires sutures because the lens is removed in one piece. Often the large incision and stitches can leave the eye looking angry and red.

Today most cataract surgeons use phacoemulsification (Phaco) to remove cataracts. In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye. The probe breaks up the center of the lens. The fragments are suctioned from the eye at the same time. A small incision that usually does not require sutures to is used, since the cataract is removed in tiny pieces. Most of the lens capsule is left behind and a foldable intraocular lens (IOL) is implanted permanently inside to help focus light onto the retina. Vision returns quickly and one can resume normal activities within a short period of time.

5. What happens before cataract surgery?

Prior to surgery, your doctor will order a test to measure the curve of the cornea and the size and shape of the eye. For patients who will receive an intraocular lens (IOL), this information helps your doctor choose the best type and refractive strength of IOL. Your doctor will likely ask that on the day of surgery you take all of your normal medications. You may have special instructions regarding a light breakfast or asked not to eat or drink anything after midnight the morning of your surgery.

6. What happens during cataract surgery?

When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. The area around your eye will be cleansed and sterile coverings will be placed around your head.

The operation usually lasts less than 30 minutes and is almost painless. Many people choose to stay awake during surgery, while others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye. You will not have to worry about holding your eye open because an instrument known as a lid speculum will hold your lids open. You will likely see light and movement during surgery, but the eye usually is not uncomfortable. You will be asked to hold your eye still during surgery if you have been given topical anesthetic (drops only).

After the operation, you will rest for a while and often have something to eat or drink. Most people who have cataract surgery go home the same day. Since you will not be able to drive, make sure you make arrangements for a ride.

7. What does cataract surgery consist of?

After numbing the area, the surgeon makes a small incision close to the edge of the cornea and then inserts a small, ultrasound instrument to break up the center of the cataract. Lens fragments are then vacuumed out through the incision. The surgeon folds and inserts the IOL through the same incision. The incision is usually self-sealing, requiring no stitches. Generally this outpatient procedure takes about 20 minutes.

8. What happens after cataract surgery?

After surgery, your doctor will schedule exams to check on your progress. Usually your doctor will want to examine you the day following surgery, and then at various intervals after that.

You will also be given a specific schedule of eye drops to help healing and control the pressure inside your eye. While being especially careful not to put pressure on the eye itself, the area around the operated eye should be gently cleansed in order to remove any excess eye drops or secretions. Ask your doctor how to use your medications, when to take them, and what effects they can have.

You will also need to wear an eye shield at night for the first few days in order to help protect the eye and prevent rubbing or pressing on the eye while sleeping. It is not necessary to wear the shield during the day and you may wear your normal eyeglasses during the day. If the operated eye sees much better without the glasses you may wish to remove the eyeglass lens of the operated eye, or if preferred, you may choose not to wear your glasses at all.

It's normal to feel mild foreign body sensation or discomfort for a while after cataract surgery. Some fluid discharge is also common, and your eye may be sensitive to light and touch. If you have discomfort, your eye doctor may suggest a pain reliever. After 1-2 days, mild discomfort should disappear. In most cases, complete healing will take about 6 weeks.

Some common problems can occur after surgery. These may include increased intraocular pressure, blurring from swelling, inflammation (pain, redness, swelling), and sometimes bleeding. More rare and serious problems include infection, loss of vision or light flashes. If you experience increasing pain or a worsening of vision after surgery, you should contact your eye doctor immediately. With prompt medical attention, almost all problems can be treated successfully.

When you are home, do not put your fingers in your eye and do not to lift heavy objects. Lifting heavy objects increases pressure in the eye. You can walk, climb stairs and do light household chores.

It is most important to take your drops exactly as directed and be sure to contact your doctor if you experience any problems.

. What is a posterior capsulotomy?

A posterior capsulotomy is a laser procedure that sometimes is necessary after cataract surgery.

During cataract surgery, part of the front (anterior) capsule of the eye?s natural lens is removed to gain access to and remove the lens. The clear, back (posterior) capsule remains intact and supports the intraocular lens (IOL), a plastic or silicone disc that is implanted in the eye to replace the natural lens. As long as that capsule stays clear, you will experience good vision. But in 10% to 30% of cases, the posterior capsule loses its clarity. When this happens, the ophthalmologist (Eye M.D.) can create an opening in the capsule using a laser in order to restore normal vision. This procedure is called a posterior capsulotomy.

Before the laser procedure, the ophthalmologist does a thorough ophthalmic examination to make sure there is no other reason for vision loss.

Cornea & External Disease

1. What is a cataract?

Your eye works a lot like a camera. Light rays focus through your lens onto the retina, a light-sensitive tissue at the back of the eye. Similar to photographic film, the retina allows the image to be "seen" by the brain.

Over time, the lens of the eye can become cloudy, preventing light rays from passing clearly through it. The loss of transparency may be so mild that vision is barely affected, or it can be so severe that no shapes or movements are seen--only light and dark. When the lens becomes cloudy enough to obstruct vision , it is called a cataract.

2. What do the 5 layers of cornea do?

The layers of the cornea include: epithelium, Bowman's membrane, stroma, Descemet's membrane and the endothelium.

The epithelium is layer of cells that cover the surface of the cornea. It is only about 5-6 cell layers thick and quickly regenerates when the cornea is injured. If the injury penetrates more deeply into the cornea, it usually leaves a scar. Scars interfere with light entering the cornea, and may result in loss of visual activity.

Boman's membrane lies just beneath the epithelium. Because this layer is very tough and difficult to penetrate, it protects the cornea from injury.

The stroma is the thickest layer and lies just beneath Bowman's Membrane. It is composed of tiny collagen fibrils that run parallel to each other. This special formation of the collagen fibrils gives the cornea its clarity.

Descemet's membrane lies between the stroma and the endothelium. The endothelium is just underneath Descemet's and is only one cell layer thick. The cells in this layer pump water from the cornea, keeping it clear. If damaged or diseased, these cells will not regenerate.

Nourishment for the cornea is provided by tiny vessels at the outermost edge of the cornea, along with the aqueous and tear film.

3. What is corneal topography?

Corneal topography is a computer-assisted map used to measure the curvature of the cornea, the clear front window of the eye. The corneal topographer projects illuminated circles on the cornea that are reflected back to the computer and used to produce a map of the cornea. This map reveals irregularities in the cornea's curvature.

Corneal topography is commonly used to diagnose and follow the progression of keratoconus, and to assist in fitting patients with contact lenses. It is also used to plan refractive procedures such as LASIK. Following corneal transplant surgery, corneal topography helps the surgeon identify where to selectively remove sutures to smooth the shape of the new cornea.

Corneal topography is quick and painless. A technician seats the patient comfortably, resting his head against a bar on the topographer. While the patient looks into a lighted bowl, the technician takes a picture, which the computer uses to analyze the curvature of the cornea and to produce an image that the ophthalmologist (Eye M.D.) uses in determining the appropriate treatment.

4. What are the symptoms of corneal abrasions?

Symptoms associated with corneal abrasions include pain, foreign body sensation, tearing, redness, and blurred vision.

5. What is the treatment for corneal abrasions?

Treatment options for corneal abrasions include patching the injured eye, dilating pupils to relieve pain, wearing special contact lenses that promote healing, taking antibiotics to prevent infection, and using lubricating eyedrops.

Minor abrasions usually heal within a day or two, while larger abrasions may take as long as one week.

6. What are the symptoms of corneal erosion?

Symptoms of corneal erosion are similar to those of abrasions: pain, foreign body sensation, soreness, redness, and blurred vision.

7. What is the treatment for corneal erosion?

Treatment is the same as for corneal abrasion and may also include saline solution eyedrops or ointment. However, if the erosion recurs or fails to heal, further treatment may be necessary. These measures may include removal of the damaged epithelium, removal of corneal cells using a laser, or performing anterior stromal puncture, which involves making tiny holes on the surface of the cornea to promote stronger attachments between the top layer of corneal cells and the corneal stroma underneath.

8. What are the symptoms of corneal ulcers?

Symptoms of corneal ulcers may include pain, redness, blurred vision, tearing, discharge and light sensitivity.

9. What is the treatment of corneal ulcers?

Treatment for corneal ulcers depends on the cause. Treatment usually includes antibiotic or anti viral eyedrops. In some cases, hospitalization may be necessary in order to administer eyedrops every hour around the clock, intravenous antibiotics, and other treatments. In rare cases when the cornea is severely damaged, a corneal transplant may be necessary later in order to improve vision.

10. What is keratoconus?

Keratoconus is an uncommon condition where-in the dome-shaped cornea (the clear front window of the eye) becomes thin centrally and develops a cone-like bulge. As the condition progresses, the shape of the cornea is altered, distorting vision. Usually, keratoconus affects both eyes, although symptoms and progression in each eye may differ.

Early symptoms include blurring of vision, increased sensitivity to light and glare, and frequent eyeglass prescription changes. The rate of progression varies. Keratoconus usually begins in the teenage years. It may progress slowly for 10 to 20 years and then suddenly stop. As it progresses, the most common symptoms are increased blurring, increased nearsightedness and astigmatism and inability to wear contact lenses.

11. How is keratoconus treated?

Keratoconus is initially corrected with eyeglasses. However, as the condition progresses, rigid contact lenses may be needed to improve vision. If vision is greatly affected, a corneal transplant may be necessary. While this procedure relieves the symptoms of keratoconus, it does not cure it and the condition progresses after corneal transplantation.

12. What is a pinguecula and how is it treated?

A pinguecula is a yellowish patch or bump on the white of the eye, most often seen on the side closest to the nose. It is not a tumor but degeneration of normal tissue caused by chronic exposure to UV light (sunlight).

No treatment is necessary unless the pinguecula becomes inflamed. A pinguecula does not grow onto the cornea or threaten sight. On rare occasions, it may be surgically removed if it is particularly annoying.

13. What is a pterygium and how is it treated?

A pterygium is a sheet of vascularized tissue that grows over the cornea (the clear front window of the eye). It may remain small or may grow large enough to interfere with vision. A pterygium most commonly occurs on the inner corner of the eye, but can grow on the outer corner as well.

The exact cause of pterygia is not well understood. They occur more often in people who spend a lot of time outdoors, especially in sunny climates. Long-term exposure to sunlight, especially ultraviolet (UV) rays, and chronic eye irritation from dry, dusty conditions seem to play an important role. Dry eye also may contribute to pterygium.

When a pterygium becomes red and irritated, eyedrops or ointments can be used to help reduce the inflammation. If the pterygium grows rapidly or is large enough to threaten sight, it should be removed surgically.

Despite proper surgical removal, a pterygium may recur. Protecting the eyes from excessive ultraviolet light with proper sunglasses, avoiding dry, dusty conditions, and using artificial tears can reduce the incidence of recurrence.

14. My eyelids are itchy and irritated. Sometimes my eye is red too. Do I need to see an eye doctor?

So long as your vision is normal and you don't have any eye pain, you probably don't need to see a doctor. This sounds like eye margin disease. It is a common and frequently chronic inflammation of the eyelids. Symptoms include irritation, itching, and, occasionally, a red eye. This condition frequently occurs in people who tend to have oily skin, dandruff, or dry eyes.

Bacteria normally reside on the skin, but in some people, they thrive in the skin at the base of the eyelashes. Nearby oil glands may be plugged, and dandruff-like scales form along the lashes and eyelid margins.

Eye margin disease tends to be chronic, but symptoms can be controlled with a few simple, daily hygienic measures, such as the following:

    At least twice a day, a warm, wet washcloth is placed over the closed eyelids for a minute. The cloth can be rewet it as it cools, two or three times. This softens and loosens scales and debris. More importantly, it increases the blood supply to the eyelids and helps liquefy the oily secretions from the eyelids' oil glands, which helps prevent the development of a chalazion, an inflamed lump in an eyelid oil gland. The finger covered with a thin, wet washcloth, or a cotton swab, or commercial lint-free pad, can be used to gently scrub the base of the lashes for about 15 seconds per lid.

When medications are necessary, they may include:

    artificial tears (over-the-counter eyedrops) to relieve symptoms of dry eye; antibiotics (oral or topical) to decrease bacteria on the eyelids; and steroids (short-term), to decrease inflammation.

15. What is Fuch's dystrophy and how is it treated?

Fuchs' dystrophy is a progressive disease that affects the cornea, the clear dome that covers the iris (the colored part of the eye) and helps focus light as it enters the eye.

Symptoms of Fuchs' dystrophy include hazy or cloudy vision and increased sensitivity to light. In early stages, as the cornea swells, vision in the morning may be hazy, but it clears up during the day. When the disease has progressed to a more advanced stage, vision no longer clears, and eventually the patient may experience pain and foreign body sensation.

In its early stage, Fuchs' dystrophy is treated with saline eyedrops which draw excess fluid from the cornea.

In the late stages of Fuch's Dystrophy, vision is permanently blurred, and a corneal transplant is necessary to restore vision. This procedure has asuccess rate as high as 90%.

16. What is a corneal transplant?

If a cornea is severely damaged or diseased, a corneal transplant may be needed in order to restore vision. One type of corneal transplant, called a penetrating keratoplasty (PKP), replaces the central corneal tissue with donor tissue.

Another corneal transplant procedure is called a lamellar keratoplasty. This is an advanced technique that replaces only the inner layers of the cornea using donor tissue, leaving the outer layers of tissue intact. Although this is a technically challenging procedure, the recovery is usually much faster than following penetrating keratoplasty.

17. What is fungal keratitis and how is it treated?

Fungal keratitis is a serious infection of the cornea-the clear, round dome covering the eye's iris and pupil. Symptoms of fungal keratitis include sudden blurry vision; unusual redness of the eye; pain in the eye; excessive tearing or discharge from your eye; and increased light sensitivity.

Fungal keratitis is treated with topical and oral antifungal medications. Patients who do not respond to medical treatment may require eye surgery, possibly a corneal transplant.

Safe handling, storage, and cleaning of contact lenses are key measures for reducing the risk of infection. Always use the following safe practices with contact lenses:

    Wash hands with soap and water and dry them before handling lenses. Wear and replace lenses according to the schedule prescribed by your ophthalmologist (Eye M.D.). Follow instructions from your ophthalmologist and lens solution manufacturer for cleaning and storing lenses. Make sure to always use fresh lens solution and replenish the solution daily.

18. What is herpes keratitis and how is it treated?

Herpes keratitis is a viral infection of the eye caused by the herpes simplex virus, best known for causing cold sores. Herpes keratitis usually affects only one eye and most often occurs on the cornea-the normally clear dome that covers the front part of the eye.

Symptoms of herpes keratitis include pain, redness, blurred vision, tearing, discharge and sensitivity to light.

Herpes keratitis is usually treated with antiviral medications, either in eyedrop or pill form. Depending on the progression of the infection, the ophthalmologist (Eye M.D.) use a steroid eyedrop to reduce inflammation. When the cornea is severely damaged, a corneal transplant may be necessary to restore vision.

19. How is glaucoma monitored?

Photographic images of the optic disc are essential for monitoring glaucoma.

Glaucoma damage is seen clinically as loss of the nerve fiber layer and an associated thinning of tissue at the optic nerve head. With this damage, ophthalmologists (Eye M.D.s) look for what they call ?cupping? of the optic nerve. Stereoscopic disc photos of the optic nerve are helpful in providing a baseline of information about the optic nerve?s condition for future comparison. These photographs are taken in the ophthalmologist?s office using a special camera that can create a stereo image.

Because one ophthalmologist may interpret the appearance of optic nerve cupping differently from another ophthalmologist, optic disc photography is invaluable because it helps create a baseline for future comparison. Your ophthalmologist later may take additional pictures for side-by-side comparison. These can help identify signs of glaucoma progression.

Ophthalmologists (Eye M.D.s) also check the condition of the optic nerve. One method for checking the optic nerve is with optic disc topography using a confocal scanning laser. This technique creates a three-dimensional image of the optic nerve head. Much like a CT scan, pictures that appear as slices of the nerve head are taken and then are reconstructed in a three-dimensional fashion.

Despite many new imaging techniques for glaucoma, disc photos and a careful clinical examination are still the standard of care for glaucoma.

Glaucoma

1. What is glaucoma?

A. Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind spots and vision loss.

Glaucoma has to do with the pressure inside the eye, known as intraocular pressure (IOP). When the aqueous humor (a clear liquid that normally flows in and out of the eye) cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve and lead to vision loss.

There are different types of glaucoma, including:

    primary open-angle glaucoma angle-closure glaucoma normal-tension glaucoma neovascular glaucoma glaucoma caused by trauma or medications (steroids)

2. How is glaucoma diagnosed?

Because it has no noticeable symptoms, glaucoma is a difficult disease to detect without regular, complete eye exams.

During a glaucoma evaluation, your ophthalmologist (Eye M.D.) will perform the following tests:

    Tonometry. Your ophthalmologist measures the pressure in your eyes (intraocular pressure, or IOP) using a technique called tonometry. Tonometry measures your IOP by determining how your cornea responds when an instrument (or sometimes a puff of air) presses on the surface of your eye. Eyedrops are usually used to numb the surface of your eye for this test. Gonioscopy. For this test, your ophthalmologist inspects your eye?s drainage angle?the area where fluid drains out of your eye. During gonioscopy, you sit in a chair facing the microscope used to look inside your eye. You will place your chin on a chin rest and your forehead against a support bar while looking straight ahead. The goniolens is placed lightly on the front of your eye, and a narrow beam of light is directed into your eye while your doctor looks through the slit lamp at the drainage angle. Drops will be used to numb the eye before the test. Ophthalmoscopy. With this test, your ophthalmologist can evaluate whether or not there is any optic nerve damage by looking at the back of the eye (called the fundus). There are two types of ophthalmoscopy: direct and indirect. With direct ophthalmoscopy, your ophthalmologist uses a small flashlight-like instrument with several lenses that magnifies up to about 15 times. This type of ophthalmoscopy is most commonly done during a routine physical examination. With indirect ophthalmoscopy, the ophthalmologist wears a headband with a light attached and uses a small handheld lens to look inside your eye. Indirect ophthalmoscopy allows a better view of the fundus, even if your natural lens is clouded by cataracts. Visual field test. The peripheral (side) vision of each eye is tested with visual field testing, or perimetry. For this test, you sit at a bowl-shaped instrument called a perimeter. While you stare at the center of the bowl, lights flash. Each time you see a flash, you press a button. A computer records your response to each flash. This test shows if you have any areas of vision loss. Loss of peripheral vision is often an early sign of glaucoma. Photography. Sometimes photographs or other computerized images are taken of the optic nerve to inspect the nerve more closely for damage from elevated pressure in the eye. Special imaging. Different scanners may be used to better determine the configuration of the optic nerve head or retinal nerve fiber layer.

Each of these evaluation tools is an important way to monitor your vision to help ensure that glaucoma does not rob you of your sight. Some of these tests will not be necessary for everyone. Your ophthalmologist will discuss which tests are best for you. Some tests may need to be repeated on a regular basis to monitor any changes in your vision caused by glaucoma.

3. Are certain races more at risk for glaucoma?

If you are of African or Hispanic ancestry and especially if you have a known family member with glaucoma, you are at a higher risk for vision loss from this eye disease.

Primary open-angle glaucoma is the leading cause of blindness among people of African ancestry, occurring at a rate four times higher than among Caucasian patients. It also occurs about 10 years earlier among people of African ancestry than among Caucasians and develops more rapidly. Studies show that in the United States , African Americans between the ages of 45 and 64 are approximately 15 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group. Primary open-angle glaucoma is also the leading cause of blindness among people of Hispanic (and especially Mexican) ancestry, occurring at a rate approaching that of people of African ancestry.

It is not clear why people of African ancestry have higher rates of glaucoma and subsequent blindness than Caucasians. One factor may be that they are more susceptible to developing elevated IOP earlier in life, which is thought to contribute to optic nerve damage and eventual vision loss. Another reason may be that they are less likely than Caucasians to have early eye examinations that might detect and treat glaucoma. This also may be a factor in the increased rate of glaucoma among Hispanics.

Recommended intervals for a comprehensive eye evaluation in people of African ancestry are as follows:

    20 to 29 years of age: every 3 to 5 years; 30 to 64 years of age: every 2 to 4 years; 65 years and older: every 1 to 2 years.

It is also recommended that people of Hispanic ancestry have regular, comprehensive eye evaluations. This is especially important after age 60.

If you are diagnosed with glaucoma, please make sure to tell your family members and urge them to have an eye exam for glaucoma.

4. My ophthalmologist says I have high intraocular pressure. Does this mean I have glaucoma?

Elevated intraocular pressure (high pressure within the eye) is the number one risk factor for glaucoma. However, elevated intraocular pressure (IOP) does not always cause glaucoma.

The average eye pressure in adults ranges between 10 mm Hg and 21 mm Hg (?mm Hg? stands for ?millimeters of mercury?). There can be a significant difference in your IOP throughout the course of a day. This variation is known as diurnal fluctuation. We know that many patients with IOP in the 20s do not develop glaucoma. Up to 50% of patients diagnosed with glaucoma have an initial pressure reading lower than 22 mm Hg. Intraocular pressure is not a very sensitive tool for diagnosing glaucoma, but it becomes very useful in monitoring treatment for glaucoma.

A variety of methods can be used to check the intraocular pressure, but the most common is applanation tonometry. Your ophthalmologist (Eye M.D.) will often set a ?target? pressure for you and will work hard to keep the pressure at or below that target to help preserve your vision.

5. Can glaucoma be cured?

There is no cure for glaucoma. However, it can be controlled with proper management.

Elevated intraocular pressure (IOP) can damage the optic nerve, which may lead to vision loss. Treatment for glaucoma focuses on lowering the IOP to a level that is less likely to cause further optic nerve damage. This is known as the ?target pressure.? The target pressure differs from individual to individual. Your target pressure may change during your course of treatment if the progression of glaucoma is not arrested.

6. How is glaucoma treated?

Elevated intraocular pressure (IOP) can damage the optic nerve, which may lead to vision loss. Treatment for glaucoma focuses on lowering the IOP to a level that is less likely to cause further optic nerve damage. This is known as the ?target pressure.? The target pressure differs from individual to individual. Your target pressure may change during your course of treatment if the progression of glaucoma is not arrested with one or more of the following treatments:

    Topical eyedrops, e.g. betablockers, prostaglandin analogs, prostamides, carbonic anhydrase inhibitors, alpha agonists) Oral medications, e.g. carbonic anhydrase inhibitors) Laser treatment, e.g. argon laser trabeculoplasty, peripheral iridotomy, selective laser trabeculoplasty Surgery, e.g. trabeculectomy, seton surgery

7. I had a trabeculectomy. What can I do to make sure it lasts as long as possible?

The bleb (drainage ?bubble? under the upper eyelid) tissue is fragile, and it is important to take care of it to maintain proper functioning. Patients should avoid rubbing the bleb; direct contact with this area should be avoided. Patients should wear protective eyewear when engaging in sporting activities.

A bleb that functions well is often thin and is susceptible to infection. If there is any sign of redness or drainage, call your ophthalmologist (Eye M.D.) immediately. An infected bleb can lead to pain, decreased vision, and potentially even loss of vision. Patients who have had anti-scarring medication, such as 5-fluorouracil (5-FU) or mitomycin C, are even more prone to infection. Your ophthalmologist will tell you if this is the case for you.

Another complication that can occur either early or late is a bleb leak. If you detect any abnormal tearing or a change in visual acuity, you need to have your eye examined by your ophthalmologist as soon as possible.

A well-functioning trabeculectomy bleb can last a lifetime. Proper care and maintenance can help ensure that the bleb continues to control your eye pressure.

8. Where can I find additional information?

The Glaucoma Foundation
80 Maiden Lane, Suite 1206
New York , NY 10038
Phone: 800.GLAUCOMA (452.8266)
www.glaucoma-foundation.org

The National Eye Institute
2020 Vision Place
Bethesda , MD 20892-3655
Phone: 301.496.5248
www.nei.nih.gov

Prevent Blindness America
Phone: 800.331.2020
www.preventblindness.org

The American Academy of Ophthalmology
P.O. Box 7424
San Francisco , CA 94120-7424
www.aao.org

Laser Vision Correction

1. What is laser vision correction?

Laser vision correction utilizes a sophisticated laser to reshape the cornea and decrease the need for glasses or contact lenses used for nearsightedness, farsightedness and astigmatism. These procedures include, LASIK, LASEK, epi-LASIK, PRK and PTK.

2. Who are candidates?

Generally, any adult patient that requires contact lenses or glasses to correct their vision may be a candidate, but a complimentary screening exam with your surgeon is necessary to determine whether you qualify for surgery.

3. What is the recovery time?

The procedure is quick and painless. Most patients can return to work within 1-4 days depending on which procedure is performed.

4. Are the benefits of this surgery permanent?

The effect of this surgery is permanent, however in a small percentage of patients there may be a need for an enhancement after the initial surgery. Most, if not all patients will require reading glasses when they reach their forties.

5. What if I only use reading glasses now?

While the laser options for presbyopia are limited, alternative options can be discussed with your surgeon.

6. What does the surgery cost?

Laser vision correction performed by Dr. Scribbick is competitively priced. The cost is based on the procedure and technology employed. This cost includes the pre-op evaluation, procedure and all post-op visits during the first year. It also includes any secondary procedures or enhancements that are rarely required.

7. And does insurance pay for it?

Laser vision correction is considered an elective surgery by most insurance plans, however many insurance plans have an agreement with certain laser facilities that allow the patient to have the surgery for a reduced rate. If your insurance plan has this provision, we will honor that rate.

8. What do I do now?

If you are interested, please call or email for your complimentary screening exam with Dr. Scribbick at (210) 223-5561 or toll free at 1-800-322-5056. Email: scribbicklasik@gmail.com

Oculoplastics: Cosmetic & Reconstructive Surgery

1. What are the risks and complications associated with eyelid surgery?

Eyelid surgery is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare but can include bleeding, infection, and eyelid asymmetry due to uneven wound healing. Differences in healing between the eyes may cause some unevenness after surgery.

After eyelid surgery, bruising or a black eye is common but resolves quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection. To most people, the improvement in vision, comfort, and appearance after eyelid surgery is very gratifying.

2. Does health insurance cover blepharoplasty?

The surgical procedure to remove excess eyelid tissues on the upper or lower eyelid (skin, muscle, or fat) is called blepharoplasty. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and cause the eyes to feel tired. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision rather than for cosmetic reasons only, the costs may be covered by your health insurance plan.

Blepharoplasty for the lower eyelid removes the large bags under the eyes. It is unusual for third-party payers to cover lower-lid blepharoplasty.

3. What can I expect after blepharoplasty surgery?

Swelling, bruising, and blurry vision are common after blepharoplasty. Stitches are removed three to five days after surgery, except in the case of transconjunctival blepharoplasty, where the self-dissolving sutures require no removal.

Possible complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision, and dry eye, to name a few. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.

4. What can I expect after a browlift?

Swelling and bruising, common after a brow- or forehead lift, begins to subside in seven to 14 days. Numbness and itching are common during the healing process. Sutures, staples or clips are removed within seven to 14 days after the surgery. Incisions in the hairline may damage hair follicles and result in some hair loss.

5. What is the treatment for drooping upper eyelids?

Drooping upper eyelids is called ptosis. Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases such as diabetes that involve the levator muscle or its nerve supply.

Treatment is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

6. I have eye problems associated with thyroid disease. How can an ophthalmologist help me?

Thyroid-related problems are treated by non-surgical and surgical methods. Non-surgical methods include taking steroid medications by mouth to control swelling and inflammation, wearing sunglasses to relieve light sensitivity, and applying lubricating ointment to relieve dry eye. Surgical methods include repositioning the eye muscles, removing scarred tissue, and relieving compression on the optic nerve to preserve sight.

7. Are BOTOX® injections safe?

BOTOX® is the trade name for botulinum toxin. In its pure form, botulinum toxin is a poisonous neurotoxic protein that is found in certain spoiled foods and causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications, including the treatment of ocular conditions such as blepharospasm, as well as for cosmetic purposes to soften wrinkles or deep furrows near the eyes.

Side effects of the injections are temporary. They can include a droopy upper eyelid, double vision, and being unable to close the eyelids.

When it comes to safety, the most important thing is to find doctor experienced with BOTOX® injections, such as Ophthalmology Associates? Dr. Green, who uses only freshly reconstituted BOTOX® at a dilution that is the most effective.

8. Are the results from cosmetic fillers permanent?

Corrections from cosmetic fillers, such as Restylane? or Botox? are usually are not permanent. Some fillers last longer than others, but patients should expect to need repeated treatments every four to 12 months or, with the longer-acting agents, every few years to maintain the desired results.

Complications from injectable fillers are infrequent and usually minor. Risks include allergic reactions (from collagen), bruising, swelling, puffiness, infection, and lumpiness.

Ask your ophthalmologist (Eye M.D.) about treatment options and decide together which cosmetic filler might be appropriate for you.

9. How are eyelid tumors treated?

Depending on the nature of your eyelid tumor, your ophthalmologist (Eye M.D.) may suggest one of many possible procedures to remove the tumor, including normal surgical excision, microsurgery, or cryosurgery. In some cases, radiation therapy may be an alternative or may be used in conjunction with surgery. You should discuss the various options and their advantages and disadvantages with your ophthalmologist.

Eyelid surgery to remove the tumor and repair the eyelid is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare, but asymmetry of the eyelids is one possible complication.

After eyelid surgery, bruising or a black eye is common, but it resolves quickly. It may be difficult for you to close your eyelid completely, making the eye feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring and infection.

10. What is ectropion?

Ectropion is an outward turning of the lower eyelid, most commonly caused by aging, although eyelid burns or skin disease may also be responsible.

Normally, the eyelids help lubricate and cleanse the eye during blinking. An eyelid that is drooping and has lost contact with the eye can cause dry eyes, excessive tearing, redness, and sensitivity to light and wind.

Outpatient surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid can then protect and lubricate the eye properly, so that irritation and other symptoms subside.

11. What is entropion?

Entropion is an inward turning of the eyelid and lashes toward the eye, usually caused by relaxation of the eye muscles and tissue due to aging.

Entropion usually affects the lower lid. The skin and eyelashes rub against the eye and cause discomfort and tearing. The irritated eye can produce mucus and become red and sensitive to light and wind. If entropion is not treated, rubbing of the skin and eyelashes can lead to infection or scarring of the eye, which can cause vision loss.

Outpatient surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid then protects the eye properly, and irritation and other symptoms subside.

Vitreo-Retinal

1. What is the retina?

The eye works much like a camera. In a camera, the aperture and lenses allow light to pass through and focus an image on the film that covers the back inside wall of the camera. In the eye, light passes through structures in the front of the eye including the cornea, the pupil and the lens. Additionally, light passes through the large space in the center of the eye that is filled with a clear jelly-like structure called vitreous. Finally, the light is focused on a thin film of tissue that covers and is attached to the back inside wall of the eye. This thin film is the retina. It is a highly specialized structure and it is the ?seeing? tissue of the eye. When light hits the retina, a picture is taken. Messages about this picture are then sent to the brain through the optic nerve. This is how we see.

The retina has two parts, the central part is called the macula and the surrounding, or side part is called the peripheral retina. The macula is responsible for our central vision and for our fine-detail vision. Conditions affecting the macula can have profound effects on our central vision and our ability to see details. For example, a patient with age-related macular degeneration may be able to see that a person is in front of them, but may have difficulty recognizing their face. Conditions of the peripheral retina can affect our side vision, or our ability to see things ?from the corner of our eye.?

It is important to understand that the vitreous, which fills the large central part of the eye, is firmly attached to the retina. Many problems of the retina are caused by the vitreous, and most retina surgeries require vitreous surgery (vitrectomy) as well.

2. How is the retina examined?

Your pupil will generally be dilated with eye drops in order for your ophthalmologist to examine the entire retina. Dilation can make your near vision poor and make you light-sensitive for several hours. Your ophthalmologist uses a special viewing light, called an indirect ophthalmoscope, and a hand-held lens to examine the retina. Sometimes, an anesthetic eye drop is placed on the eye and a small instrument is used to press on the eyelids or eye so that the far edges of the retina can be adequately examined.

Additional testing is often necessary to more thoroughly examine the retina. Optical coherence tomography (OCT) and fluorescein angiography are the most common diagnostic tests for the retina.

Optical coherence tomography is a non-invasive test that provides a detailed photograph and measurement of the various layers of the retina. The test uses reflected light and sophisticated computer software to create these pictures. These pictures aid in the diagnosis of many retinal conditions. They are also used to monitor the course of various diseases and to monitor the effect of treatment, particularly for age-related macular degeneration. The test can be repeated many times with no harm to the eye or body.

Fluorescein angiography is a test to look at the circulation of blood in the back of the eye. It aids in the diagnosis of many retinal conditions including age-related macular degeneration and diabetic retinopathy. The test is also used to follow the course of many diseases. It can be repeated on multiple occasions with no harm to the eye or the body.

Fluorescein is an orange-colored dye that is injected into a vein in the arm. Fluorescein is not radioactive and does not contain iodine. The dye travels through the body to the blood vessels in the back of the eye, including the retina. A camera system with special filters is used to take many photographs of the back of the eye over several minutes. There are no x-rays involved.

If there are abnormal or leaking blood vessels in the back of the eye, the fluorescein dye will highlight these blood vessels. These abnormalities are then interpreted by your ophthalmologist.

Fluorescein angiography is very safe and side effects are rare. The test will make your skin and urine have a mild yellow-orange color until the dye is eliminated from the body, usually in 1-2 days. Mild allergic reactions are the most common side effect. Severe allergic reactions do occur, but are extremely rare.

3. What are flashes and floaters?

Small specks or clouds moving in your field of vision as you look at a blank wall or a clear blue sky are known as floaters. It is normal to have some floaters, but if they become numerous or suddenly become more prominent, this can be a sign of a problem.

Usually floaters are part of the natural aging process. They may look like cobwebs, squiggly lines or floating bugs in front of your vision. As we age, the vitreous (the clear, jelly-like substance that fills the center of our eye), shrinks a little and eventually separates from the back part of the eye. This forms clumps of vitreous that cast shadows on the retina and cause us to see floaters. Floaters often remain, but may fade and become less noticeable over time.

Pulling on the retina during the process of vitreous separation causes flashes of light. They often look like twinkles or lightning streaks. You may have experienced the same sensation if you were hit in the eye and ?saw stars.?

Rarely, flashes and floaters are associated with a tear in the retina. The vitreous can pull on the retina enough to cause a tear or even a detached retina. When this happens, it is a very serious problem that can lead to severe vision loss. For this reason, if you have new, or worsening flashes or floaters, you should see an ophthalmologist immediately.

4. What is macular degeneration and how is it treated?

Age-related macular degeneration (AMD) is one of the most common causes of vision loss in people over the age of 60. AMD accounts for 90% of new cases of blindness in the United States. AMD is a slow deterioration of the macula, the center part of the retina. The macula is responsible for our fine-detail vision and allows us to perform activities such as reading or driving.

The symptoms of AMD generally include a loss of central vision, while the peripheral (side) vision remains normal. The central vision may be blurry, distorted, or even missing. These symptoms can occur suddenly or slowly over time.

Although the exact cause(s) are unknown, AMD is related to aging. Many other risk factors contribute to AMD, including smoking, high blood pressure, blue eyes, heart disease and having family members with AMD.

There are two forms of AMD, a ?dry? form and a ?wet? form. Usually, the wet form is much more severe. Nine out of every 10 people with AMD have the atrophic or ?dry? form, which usually affects vision minimally. Dry AMD takes many years to develop. A specific vitamin regimen has been proven to slow the progression of this form of AMD, and to lower the risk of developing the wet form of AMD.

Exudative or ?wet? AMD occurs in one out of every 10 people with AMD. Abnormal blood vessels grow underneath the retina and leak fluid or blood. If this happens in the macula, the center of the retina, vision loss usually occurs. There are several excellent treatments for wet AMD, and vision can often be preserved or even improved with current treatments.

If the abnormal blood vessels from wet AMD are not too close to the macula, laser treatment can be offered. Laser is used to destroy the abnormal blood vessels and stabilize vision. If the blood vessels involve the macula, different options exists, including photodynamic therapy (an intravenous drug combined with a special laser that does less damage to the retina), and injections of medicine into the vitreous, the clear jelly-like structure in the middle of the eye. These injections are generally given on an as-needed basis, and most patients require several injections over a few years.

5. Is there anything I can do to prevent macular degeneration?

Age-related macular degeneration (AMD) is a disease caused by damage or breakdown of the macula, the small part of the eye?s retina that is responsible for our central vision. This condition affects both distance and close vision and can make some activities (like threading a needle or reading) very difficult or impossible. Macular degeneration is the leading cause of severe vision loss in people over 65.

Although the exact causes of AMD are not fully understood, a recent scientific study shows that antioxidant vitamins and zinc may reduce the effects of AMD in some people with the disease.

Among people at high risk for late-stage macular degeneration (those with intermediate AMD in both eyes or advanced AMD in one eye), a dietary supplement of vitamins C, E, and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25% to 30%. However, the supplements did not appear to benefit people with minimal AMD or those with no evidence of macular degeneration.

Light may affect the eye by stimulating oxygen, leading to the production of highly reactive and damaging compounds called free radicals. Antioxidant vitamins (vitamins C and E and beta-carotene) may work against this activated oxygen and help slow the progression of macular degeneration.

Zinc, one of the most common minerals in the body, is very concentrated in the eye, particularly in the retina and macula. Zinc is necessary for the action of over 100 enzymes, including chemical reactions in the retina. Studies show that some older people have low levels of zinc in their blood. Because zinc is important for the health of the macula, supplements of zinc in the diet may slow down the process of macular degeneration.

The levels of antioxidants and zinc shown to be effective in slowing the progression of AMD cannot be obtained through your diet alone. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet.

It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision you may have already lost from the disease. However, specific amounts of certain supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should speak with your ophthalmologist (Eye M.D.) to determine if you are at risk for developing advanced AMD and to learn if supplements are recommended for you.

6. What is central serous retinopathy and how is it treated?

Central serous retinopathy (CSR) is a small, round, shallow swelling that develops on the retina, the light-sensitive nerve layer that lines the back of the eye. Although the swelling reduces or distorts vision, the effects are usually temporary. Vision generally recovers on its own within a few months.

In the initial stages of CSR, vision may suddenly become blurred and dim. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.

CSR typically affects adults between the ages of 20 and 50. People with CSR often find that their retinal swelling resolves without treatment and their original vision returns within six months of the onset of symptoms. Some people with frequent episodes may have some permanent vision loss. Recurrences are common and can affect 20% to 50% of people with CSR. While the cause of CSR is unknown, it seems to occur at times of personal or work-related stress. Certain steroid medications are another risk for developing CSR.

As CSR usually resolves on its own, generally no treatment is necessary. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. If retinal swelling persists for more than three or four months, or if an examination reveals early retinal degeneration, laser surgery may be helpful.

7. What is a macular hole and how is it treated?

The macula is the center part of the retina and is responsible for central and fine-detail vision, the vision you use for reading, watching television, and recognizing faces. A macular hole is a small, round opening in the macula. The hole causes a blind spot or blurred area directly in the center of your vision.

Most macular holes occur in the elderly. When the vitreous (the gel-like substance inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing a tear that can eventually form a small hole. Sometimes injury or long-term swelling can cause a macular hole. No specific medical problem is known to cause macular holes.

Vitrectomy surgery, the only treatment for a macular hole, removes the vitreous gel and scar tissue pulling on the macula and keeping the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient must maintain a face-down position for one to two weeks to keep the gas bubble in contact with the macula. Success of the surgery often depends on how well the position is maintained.

With treatment, most macular holes shrink or close, and some or most of the lost central vision can slowly return. The amount of visual improvement typically depends on the length of time the hole was present.

8. What is an epiretinal membrane and how is it treated?

The retina is a layer of light-sensing cells lining the back of your eye. As light rays enter your eye, the retina converts the rays into signals that are sent through the optic nerve to your brain, where they are recognized as images.

The macula is the small area at the center of your retina that allows you to see fine details. The macula normally lies flat against the back of the eye, like film lining the back of a camera. As you age, the vitreous, a clear, gel-like substance that fills the middle of your eye, begins to shrink and pull away from the retina. In some cases, a thin ?scar tissue? or membrane can grow on the surface of the macula. When wrinkles, creases or bulges form on the macula due to this scar tissue, this is known as an epiretinal membrane or macular pucker. This may cause blurred or distorted central vision, making it difficult to perform tasks such as reading small print or threading a needle. Peripheral (side) vision is not affected.

Your ophthalmologist detects an epiretinal membrane by examination and special photographic techniques. If your symptoms are mild, no treatment may be necessary. Updating your eyeglass prescription or wearing bifocals may improve your vision sufficiently. If you have more severe symptoms that interfere with your daily routine, your ophthalmologist may recommend vitrectomy surgery to peel and remove the abnormal scar tissue. During this outpatient procedure, your ophthalmologist uses tiny instruments to remove the wrinkled tissue. Vision often improves.

Be sure to discuss your options with your ophthalmologist. If surgery is recommended, you should be aware that as with any surgical procedure, rare complications can occur, including infection, bleeding, retinal detachment, recurrence of the epiretinal membrane and earlier onset of cataract.

9. What is macular edema and how is it treated?

Macular edema is swelling of the macula, the small central area of the retina responsible for central, fine-detail vision. There are many eye conditions that can cause macular edema. The edema is caused by fluid leaking from retinal blood vessels. Central vision, used for reading and other close, detail work, is affected.

Because the macula is surrounded by many tiny blood vessels, anything that affects them, such as a medical condition affecting blood vessels elsewhere in the body or an abnormal condition originating in the eye, can cause macular edema.

Retinal blood vessel obstruction, eye inflammation, and age-related macular degeneration and diabetes mellitus have all been associated with macular edema. The macula may also be affected by swelling following cataract extraction, although typically this resolves itself naturally.

Treatment seeks to remedy the underlying cause of the edema. Eye drops, injections of steroids or other, newer medicines in or around the eye, or laser surgery can be used to treat macular edema. Recovery depends on the severity of the condition causing the edema and on how long the edema has been present.

10. Can diabetes affect the retina?

If you have diabetes mellitus, your body does not use and store glucose (sugar) properly. Over time, diabetes can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy. There are two types of diabetic retinopathy, nonproliferative diabetic retinopathy and the more severe type, proliferative diabetic retinopathy.

Diabetic retinopathy can cause vision loss in several ways. Damaged blood vessels can leak fluid into the retina causing swelling. If this happens in the center of the retina, it is referred to as macular edema and can cause vision loss. In many cases this can be treated with laser to preserve vision. Damaged blood vessels can result in poor blood flow to the center of the retina. This is referred to as macular ischemia and can also cause vision loss. Unfortunately, there is no effective treatment for macular ischemia. With more advanced diabetic retinopathy, new abnormal blood vessels begin to grow inside the eye. These vessels can cause bleeding inside the eye and even form scar tissue that can pull on the retina causing retinal detachment and severe vision loss. These problems often require surgery to preserve vision.

If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose and visiting your ophthalmologist regularly. People with diabetes should schedule examinations at least once a year. Pregnant women with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy.

11. What is nonproliferative diabetic retinopathy?

Nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.

Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema (swelling in the macula) or macular ischemia (poor blood flow to the macula), or both.

Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Laser treatment can be used to help control vision loss from macular edema. Newer treatments are being investigated.

Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.

A medical eye examination is the only way to discover any changes inside your eye. If your ophthalmologist finds diabetic retinopathy, he or she may order color photographs of the retina, a special test called fluorescein angiography, or optical coherence tomography (OCT) to find out if you need treatment.

12. What is proliferative diabetic retinopathy?

Proliferative diabetic retinopathy (PDR) is a complication of diabetes caused by changes in the blood vessels of the eye. If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries, and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina, the light-sensitive nerve layer that lines the back of the eye.

In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels. Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood.

Occasionally, these new blood vessels bleed and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.

The new blood vessels can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss.

Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months, or even years. If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During a vitrectomy, the eye surgeon removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth.

People with PDR sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. There is considerable evidence to suggest that rigorous control of blood sugar decreases the chance of developing serious proliferative diabetic retinopathy.

Because PDR often has no symptoms, if you have any form of diabetes you should have your eyes examined regularly by an ophthalmologist.

13. Can vascular disease affect the retina?

You probably know that high blood pressure and other vascular diseases pose risks to overall health, but you may not know that they can affect eyesight by damaging the veins and arteries in the eye. There are many diseases of the retina blood vessels, but two of the most common are central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO).

Central retinal vein occlusion (CRVO) blocks the main vein in the retina, the light-sensitive nerve layer at the back of the eye. The blockage causes the walls of the vein to leak blood and excess fluid into the retina. When this fluid collects in the macula (the area of the retina responsible for central vision), vision becomes blurry.

?Floaters? in your vision are another symptom of CRVO. When retinal blood vessels are not working properly, the retina grows new fragile vessels that can bleed into the vitreous, the fluid that fills the center of the eye. Blood in the vitreous clumps and is seen as tiny dark spots, or floaters, in the field of vision.

In severe cases of CRVO, the blocked vein causes painful pressure in the eye. Retinal vein occlusions commonly occur with glaucoma, diabetes, age-related vascular disease, high blood pressure, and blood disorders.

The first step of treatment is finding what is causing the vein blockage. There is no cure for CRVO. Your ophthalmologist may recommend a period of observation, since hemorrhages and excess fluid often subside on their own. Laser surgery may be effective in preventing further bleeding into the vitreous or for treating glaucoma, but it cannot remove blood or cure glaucoma once it is present. New experimental treatments are now under investigation.

Central retinal artery occlusion (CRAO) usually occurs in people between the ages of 50 and 70. The most common medical problem associated with CRAO is arteriosclerosis (hardening of the arteries). Carotid artery disease is found in almost half the people with CRAO.

The most common cause of CRAO is a thrombosis, an abnormal blood clot formation. CRAO can also be caused by an embolus, a clot that breaks off from another area of the body and is carried to the retina by the bloodstream.

CRAO blocks the central artery in your retina. The first sign of CRAO is a sudden and painless loss of vision that leaves you barely able to count fingers or determine light from dark.

Loss of vision can be permanent without immediate treatment. Irreversible retinal damage occurs after 90 minutes, but even 24 hours after symptoms begin, vision can still be saved. The goal of emergency treatment is to restore retinal blood flow. After emergency treatment, you should have a thorough medical evaluation.

14. Is it true that retinitis pigmentosa can be passed on to my children?

There are many inherited retinal diseases. Retinitis pigmentosa is one of the more common and serious conditions that can be passed on to children.

Retinitis pigmentosa (RP) describes a group of related diseases that tend to run in families and cause a slow but progressive loss of vision. RP affects the rods and cones of the retina, the light-sensitive nerve layer at the back of the eye, and results in a decline in vision in both eyes. RP usually affects both eyes equally, with severity ranging from no visual problems in some families to blindness at an early age in others.

The earliest symptom of retinitis pigmentosa, usually noticed in childhood, is night blindness or difficulty with night vision. People with normal vision adjust to the dark quickly, but people with night blindness adjust very slowly or not at all. A loss of side vision, known as ?tunnel vision,? is also common as RP progresses. Unfortunately, the combination of night blindness and the loss of peripheral vision can be severe and can lead to legal blindness in many people.

While there is a familial pattern of inheritance for RP, 40% of RP patients have no known previous family history. Learning more about RP in your family can help you and your ophthalmologist predict how RP will affect you and your children.

Usher?s syndrome, a condition that causes both deafness and blindness, is a form of RP. The incidence of Usher?s syndrome is difficult to determine, but surveys of patients suggest up to 10% of RP patients are deaf. The incidence of Usher?s syndrome is three cases per 100,000. It is the most frequent cause of combined deafness and blindness in adults.

Considerable research is being done to find the hereditary cause of RP. As hereditary defects are discovered, it may be possible to develop treatments to prevent progression of the disease. While developments are on the horizon, particularly in the area of genetic research, there is currently no cure for retinitis pigmentosa.

Nutritional supplements may be of benefit in RP, although this is controversial. It has been reported that vitamin A can slow the progression of RP. Large doses of vitamin A are harmful to the body, and supplements of vitamin E alone may make RP worse. Vitamin E is not harmful if taken along with vitamin A or in the presence of a normal diet. Your ophthalmologist can advise you about the risks and benefits of vitamin A and about how much you can safely take.

Despite visual impairment, people with RP can maintain active and rewarding lives through the wide variety of rehabilitative services that are available today. Until there is a cure, periodic examinations by your ophthalmologist will keep you informed of legitimate scientific discoveries as they develop.

15. What is a retinal tear or detachment, and how is it treated?

A retinal detachment is a very serious problem that usually causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur, see an ophthalmologist right away.

As one gets older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and take on a more watery consistency. Sometimes as the vitreous shrinks, it exerts enough force on the retina to make it tear.

Retinal tears can lead to a retinal detachment. Fluid vitreous, passing through the tear, lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) is often used to seal retinal tears and prevent detachment.

If the retina is detached, it must be reattached before sealing the retinal tear. There are three ways to repair retinal detachments. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear. The scleral buckle procedure requires the fluid to be drained from under the retina before a flexible piece of silicone is sewn on the outer eye wall to give support to the tear while it heals. Vitrectomy surgery removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body?s fluids.

16. What is uveitis and how is it treated?

The uvea is the middle layer in the eye sandwiched between the retina (innermost layer) and the sclera (outermost layer). The uvea contains many blood vessels that carry blood to and from the eye. Uveitis is inflammation of the uvea. Since the uvea nourishes many important parts of the eye, uveitis can damage your sight.

Symptoms can include pain, ?floaters,? blurriness, light sensitivity and redness. Uveitis may develop suddenly with redness and pain or with just a blurring of vision.

There are many causes of uveitis. In fact, uveitis is frequently the first sign of an underlying systemic disease. Some common causes of uveitis include viruses like mumps, shingles or herpes simplex; eye injuries; fungi or parasites; autoimmune diseases such as lupus and many others. In most cases, however, the cause is unknown.

Uveitis is diagnosed by an examination of the eye. In addition, your ophthalmologist may order blood tests, skin tests or x-rays and also will want information about your overall health. Often, examinations and testing will be required by other specialists in order to identify associated systemic illness.

Because uveitis is a serious condition that can cause permanent damage to the eye, it needs to be treated as soon as possible. Eye drops and pupil dilators reduce inflammation and pain. For more severe inflammation, oral medications or injections may be necessary. If uveitis is associated with other conditions like glaucoma or retinal damage, surgery may be required.

If you have a ?red eye? that does not clear up quickly, ocular pain or other significant symptoms, see your ophthalmologist as soon as possible.

17. What is vitrectomy surgery?

Vitrectomy is a type of eye surgery used to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye). It may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, epiretinal membrane (wrinkling of the retina), and macular holes.

During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through these tiny incisions. Repairs include removing scar tissue or a foreign object if present, and re-attaching the retina.

During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. An air or gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position, or a special fluid that is later removed may be injected into the vitreous cavity.

Recovering from vitrectomy surgery may be uncomfortable, but the procedure often improves or stabilizes vision. Once the blood- or debris-clouded vitreous is removed and replaced with a clear medium (often a saltwater solution), light rays can once again focus on the retina. Vision after surgery depends on how damaged the retina was before surgery.

18. What can I expect after vitrectomy/retina surgery?

After vitrectomy surgery it is common for vision to be poor for an extended period of time. In fact vision may not improve much for many weeks. The final vision obtained after vitrectomy surgery depends on how damaged the retina was before surgery. Many times the purpose of vitrectomy surgery is to prevent further vision loss, not necessarily to improve vision. There are many reasons for poor vision immediately after vitrectomy surgery. Often the eye is filled with a gas bubble that will dissolve over weeks to months, or with oil that will need to be removed at a later date. In either case, these substances in the eye affect your vision.

The success of vitrectomy surgery often depends on your ability to maintain a certain head position. If a gas bubble was placed in your eye, you must keep your head facing downward or turned to a particular side for up to several weeks after surgery so that the bubble will remain in the right position. In some cases the positioning requirements are full-time, and in others it may be part-time. If you lie in the wrong position, such as face-up, pressure may be applied to other parts of the eye, causing further problems like cataract or glaucoma. To assist you in keeping your face pointed downward, special equipment is available, including adjustable face-down chairs, tabletop face cradles, face-down pillows and mirrors.

Your eye may be red and may be sore to the touch or feel scratchy and irritated for several days after vitrectomy surgery. Often pain medication is needed for a few days and can be prescribed by your ophthalmologist. Severe or worsening pain is not normal, and you should see your ophthalmologist immediately if you are experiencing such pain.

Eye drops are used for up to several weeks after surgery to aid in healing, to minimize inflammation and to prevent infection. It is important to use them as directed by your physician to ensure the best possible outcome and provide for the most comfortable post-operative course.


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