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Category Archives: education

Macular Degeneration

In the U.S., macular degeneration is the leading cause of severe vision loss in people over age 60. It occurs when the small central portion of the retina, known as the macula, deteriorates. The retina is the light-sensing nerve tissue at the back of the eye. Because the disease develops as a person ages, it is often referred to as age-related macular degeneration (AMD). Although macular degeneration is almost never a totally blinding condition, it can be a source of significant visual disability.
There are two main types of age-related macular degeneration:
Dry form. The “dry” form of macular degeneration is characterized by the presence of yellow deposits, called drusen, in the macula. A few small drusen may not cause changes in vision; however, as they grow in size and increase in number, they may lead to a dimming or distortion of vision that people find most noticeable when they read. In more advanced stages of dry macular degeneration, there is also a thinning of the light-sensitive layer of cells in the macula leading to atrophy, or tissue death. In the atrophic form of dry macular degeneration, patients may have blind spots in the center of their vision. In the advanced stages, patients lose central vision.

Wet form. The “wet” form of macular degeneration is characterized by the growth of abnormal blood vessels from the choroid underneath the macula. This is called choroidal neovascularization. These blood vessels leak blood and fluid into the retina, causing distortion of vision that makes straight lines look wavy, as well as blind spots and loss of central vision. These abnormal blood vessels eventually scar, leading to permanent loss of central vision. Unforturnately, the vision loss can be quite rapid In wet AMD.

Most patients with macular degeneration have the dry form of the disease and will not lose central vision. However, the dry form of macular degeneration can lead to the wet form. Although only about 10% of people with macular degeneration develop the wet form, they make up the majority of those who experience serious vision loss from the disease.
It is very important for people with macular degeneration to monitor their eyesight carefully and see their eye doctor on a regular basis.

As the name suggests, age-related macular degeneration is more common in older adults. In fact, it is the leading cause of severe vision loss in adults over age 60.
Macular degeneration may be hereditary, meaning it can be passed on from parents to children. If someone in your family has or had the condition you may be at higher risk for developing macular degeneration. Talk to your eye doctor about your individual risk.
Smoking, high blood pressure, high cholesterol, obesity, and being white are also risk factors for macular degeneration.
In its early stages, age-related macular degeneration may not have symptoms and may be unrecognized until it progresses or affects both eyes. The first sign of macular degeneration is usually distortion of straight lines. This may progress to a gradual loss of central vision.
Symptoms of macular degeneration include:

Straight lines start to appear distorted, or the center of vision becomes distorted
Dark, blurry areas or white out appears in the center of vision
Diminished or changed color perception
Difficulty reading – skipping letters or words, losing one’s place

If you experience any of these symptoms, make an office appointment as soon as possible.

There is no cure, but age-related macular degeneration treatments may prevent severe vision loss or slow the progression of the disease considerably. Several treatment options are available, including:
Anti-angiogenic drugs. These medications — injected into the eye — block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. This treatment has been a major change in the treatment of this condition and many patients have actually regained vision that was lost. The treatment usually need to be repeated on follow-up visits.

Laser therapy. High-energy laser light can sometimes be used to destroy actively growing abnormal blood vessels that occur in age-related macular degeneration.

Photodynamic laser therapy. This therapy is a two-step treatment in which a light-sensitive drug is used to damage the abnormal blood vessels. A medication is injected into the bloodstream to be absorbed by the abnormal blood vessels in the eye. The doctor then shines a cold laser into the eye to activate the drug, damaging the abnormal blood vessels.
Vitamins. A large study performed by the National Eye Institute of the National Institutes of Health, called AREDS — Age-Related Eye Disease Study — showed that for certain individuals, vitamins C, E, beta-carotene, zinc, and copper can decrease the risk of vision loss in patients with intermediate to advanced dry age-related macular degeneration. Ask if these vitamin supplements will benefit you before taking them.

Low vision aids. Devices that have special lenses or electronic systems that produce enlarged images of nearby objects. They help people who have vision loss from macular degeneration make the most of their remaining vision. Dr McGrew provides this service; please make an appointment to discuss your options

Glaucoma

Glaucoma is the name for a group of eye diseases that damage the optic nerve . The optic nerve, which carries information from the eye to the brain, is in the back of the eye. When the nerve is damaged, you can lose your vision. Your risk for glaucoma rises after age 40. Race is also a factor. Blacks are more likely than whites to get the disease. You are also at if a close family member has had glaucoma
At first, people with glaucoma lose side (peripheral) vision. But if the disease is not treated, vision loss may get worse. This can lead to total blindness over time.
There are three types of glaucoma.
Open-angle glaucoma is the most common form in the United States. In this type of glaucoma, the optic nerve is damaged gradually and painlessly. This slowly leads to loss of eyesight. One eye may be affected more than the other. Sometimes a significant amount of eyesight may be lost before you notice it.
Closed-angle glaucoma is less common. About 10% of all glaucoma cases in the United States are closed-angle. In this type of glaucoma, the colored part of the eye (iris) and the lens block movement of fluid between the chambers of your eye. This causes pressure to build up and the iris to press on the drainage system of the eye. A related type is sudden (acute) closed-angle glaucoma. It is often an emergency. If you get this acute form, you will need medical care right away to prevent permanent damage to your eye.
Congenital glaucoma is a rare form of glaucoma that some infants have at birth. Some children and young adults can also get a type of the disease.

Damage to the optic nerve is often caused by increased pressure in the eye (intraocular pressure). This can happen when extra fluid builds up in the eye, such as when the eye makes too much fluid or does not drain well. But some glaucoma patients have normal eye pressure readings. these cases are tougher to diagnose and treat.
You can get glaucoma after an eye injury, after eye surgery, or because of an eye tumor. Some medicines (corticosteroids) that are used to treat other diseases may cause glaucoma.

Finding and treating glaucoma early is important to prevent blindness. If you are at high risk for the disease, be sure to have regular eye examinations. Glaucoma is usually treated with medicine such as eyedrops. Be sure to follow a daily schedule for your eyedrops so that they work the way they should. You will likely need to take medicine for the rest of your life. You may also need laser treatment or surgery.
Treatment can’t bring back vision that has been lost, but it can keep your vision from getting worse. Treatment aims to stop more damage to the optic nerve by lowering the pressure in the eyes.

Learning that you have glaucoma can be hard, since much of your vision may be gone by the time it is detected. With counseling and training, you can find ways to keep your quality of life. You can use vision aids, such as large-print items and special video systems, to help you cope with reduced eyesight. Dr. McGrew does provide these aids. Make an appointment to discuss your options.
Contact our office if you notice blind spots in your vision or if over time you are having more trouble seeing. It’s also a good idea to be checked for the disease if you have a family history of open-angle glaucoma, are age 40 or older, have diabetes, or have other risk factors for glaucoma.

Diabetic Retinopathy and Eye Health

Diabetic retinopathy is an eye condition that affects people with diabetes who have high blood glucose, or sugar, over a prolonged period of time, which untreated leads to blindness. Too much blood sugar can destroy the blood vessels in the back of the eye, preventing the retina from receiving the proper amount of nutrients it needs to maintain vision.
Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. In the early stages of diabetic retinopathy, these blood vessels leak fluid and distort sight. In the more advanced stage of diabetic retinopathy, fragile new blood vessels grow around the retina and in the vitreous humor (a clear substance that fills the eye). If left untreated, these blood vessels may bleed, clouding vision or detaching the retina.
Anyone with diabetes — either type 1 or type 2 diabetes — is at risk of developing diabetic retinopathy. However, the type of diabetes a person has, how often the person’s blood sugar fluctuates, how well controlled the sugars are, and how long a person has had diabetes all affect his or her risk. The better you control your blood sugar, the lower your risk.

In untreated diabetic retinopathy, scar tissue that forms on the back of the retina as a result of a contraction of the new blood vessels can cause the retina to pull away from the back of the eye. This is called a retinal detachment, or a detached retina. Retinal detachment can cause permanent blindness if left untreated.
Diabetic retinopathy can also cause macular edema. The macula is the most central part of the retina that allows for detail to be seen. When fluid from blood vessels leaks into the macula, it can swell and make vision blurry.

There are often no early symptoms of diabetic retinopathy and sight may not be affected until the condition is severe. Sometimes, loss of central vision when reading or driving, loss of the ability to see color, and blurriness of vision are the only signs of diabetic retinopathy. Small spots or floaters may also indicate blood vessel leaks and may clear up in days, weeks, or even months. But, because bleeding often occurs more than once, it is important to have an eye exam each year, and immediately if you experience any of these symptoms.

High Blood Pressure and Eye Disease

Along with causing heart and kidney problems, untreated high blood pressure can also affect your eyesight and lead to eye disease. Hypertension can cause damage to the blood vessels in the retina, the area at the back of the eye where images focus. This eye disease is known as hypertensive retinopathy. The damage can be serious if hypertension is not treated.
A person typically won’t experience symptoms of hypertensive retinopathy; it is usually discovered during a routine eye exam. However, symptoms might include headaches and vision problems.
An optometrist can diagnose hypertensive retinopathy. Using an ophthalmoscope, an instrument that projects light to examine the back of the eyeball, the doctor will look for signs of retinopathy that include:
Narrowing of blood vessels
Fluid oozing from the blood vessels
Spots on the retina known as cotton wool spots and exudates
Swelling of the macula (the central area of the retina) and optic nerve
Bleeding in the back of the eye
To prevent hypertensive retinopathy, keep your blood pressure under control by changing your diet, exercising more, and taking your high blood pressure medications as prescribed. In addition, see your doctor and our optometrists on a regular basis for follow-up care.

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Floaters and Flashes

What are floaters?
Floaters, also referred to as spots, are small, cloudy particles within the vitreous, the gel-like fluid that fills the inside of your eyes. They appear as small specs, clouds or thread-like strands in your field of vision and are frequently visible when you look at a bright, even background like white paper or blue sky. They usually move as your eyes move and dart away when you try to look directly at them.

What causes them?

Sometimes small flecks of protein or other matter become trapped in the vitreous as the eye is developing. They remain in the vitreous after birth, resulting in floaters in your line of sight.

Floaters can also be related to aging. As you get older, the vitreous may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous then pulls away from the back wall of the eye in a condition called posterior vitreous detachment – a common cause of floaters.

The most worrisome cause for floaters is the result of certain eye disease or injuries. These must be evaluated by an eye doctor. A sudden onset of significant floaters, especially if accompanied by flashes of light, should be evaluated promptly.

Who is most likely to have floaters?

Almost everyone sees floaters at some time, but they can occur more frequently and become more noticeable as you get older. Floaters caused by posterior vitreous detachment are more common in people who:
*Are nearsighted
*Have undergone cataract surgery
*Have had certain types of laser surgery
*Have had inflammation of the eye

Are floaters dangerous?

Floaters are usually harmless and rarely limit vision. But in some cases, floaters are an indication of a more serious problem. If the vitreous pulls away from the wall of the eye, the retina can tear, leading to retinal detachment. Retinal detachment is a serious, sight-threatening condition that requires surgery to repair.

How are floaters diagnosed and treated?

During a comprehensive eye exam, your eye care doctor will dilate your pupils with special drops, allowing a better view of the inside of your eyes. Special instruments will be used to observe the floaters and check for damage to the retina.
Floaters usually aren’t treatable, but many of them will fade over time and become less noticeable. If floaters are interfering with your vision, try moving your eyes quickly, looking up and down or side to side to shift them out of your line of sight.

What are flashes?

Flashes often accompany posterior vitreous detachment. When the vitreous shrinks, it can pull on the retina, which responds by sending an impulse to the brain that is seen as a flash of light. It’s the same sensation you experience when you are poked or hit in the eye and see “stars.”

Migraine headaches are sometimes preceded by flashes of light that appear as jagged lines or “heat waves.” These types of flashes are usually caused by a spasm of blood vessels in the brain, and may last for 10 to 20 minutes. When these flashes occur without the headache, it’s called ocular migraine.

When should you have your eyes examined?

Because floaters or flashes can be an indication of a serious problem, you should see your eye doctor when:

• You see Floaters for the first time
• You notice an increase in the number of floaters or their size
• You experience the sudden onset of flashes

In most cases, no serious problems are found, but a complete eye examination is important. If there is damage to the retina, it needs to diagnosed and treated immediately to prevent vision loss.

photo credit: Les fenêtres de l’âme via photopin (license)

Conjunctivitis

Conjunctivitis is one of the most common and treatable eye conditions in children and adults. Often called “pink eye,” it is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid and the white of the eyeball, and helps keep the eyelid and eyeball moist. Symptoms of pink eye include:
Redness in the white of the eye or inner eyelid
Increased amount of tears and/or mucous
Itchy eyes
Discomfort
Blurred vision
Swelling of the eyelid

In allergic conjunctivitis these symptoms are usually present in both eyes (not always equally). Viruses, bacteria, irritating substances (shampoo, dirt, smoke, pool chlorine), sexually transmitted diseases (STDs), or allergens (substances that cause allergies) can all cause conjunctivitis. Pink eye caused by bacteria, viruses, or STDs can spread easily from person to person but is not a serious health risk if diagnosed promptly; allergic conjunctivitis is not contagious.
Tips:
Don’t touch or rub the affected eye(s).
Wash your hands often with soap and warm water.
Wash your bed linens, pillowcases, and towels in hot water and detergent to reduce allergens.
Avoid wearing eye makeup.
Don’t share eye makeup with anyone else.
Never wear another person’s contact lens.
Do not share face towels with others.
Wear glasses instead of contact lenses to reduce irritation.
Wash your hands before applying the eye drops or ointment to your eye or your child’s eye.
Do not use eye drops that were used in an infected eye in a non-infected eye.

An appointment needs to made for our doctors to properly diagnose and treat conjunctivitis.
It is important to find out whether your pink eye is caused by allergies or infection because each condition has different treatments. Allergy-associated pink eye may disappear completely, either when the allergy is treated with antihistamines, or when the allergen is removed. Our doctors may recommend you use one or more of the following:
Ocular (topical) decongestants: These medicines reduce redness by constricting small blood vessels in the eye. They are not recommended for long-term use. Using these drops for more than a few days can actually worsen symptoms.
Ocular (topical) antihistamines: These medicines reduce redness, swelling, and itching by blocking the actions of histamine, the chemical that causes these symptoms of allergy. They are available both over-the-counter and by prescription.
Ocular (topical) steroids: When other medicines fail, your doctor may prescribe steroid eye drops to relieve the symptoms of conjunctivitis. These must be used with the supervision of your doctor since they can cause elevated pressure inside of the eye, which can lead to vision damage. Your doctor also must check for viral eye infections, such as herpes, before ocular steroids are used
Ocular (topical) mast cell stabilizers (such as Cromolyn): This medicine works by preventing specialized cells from releasing histamine. It works best when started before symptoms occur.
Systemic (oral) versions of the above medications: These are used for severe cases.

To relieve symptoms of “allergy eyes”:
Remove contact lenses, if you wear them.
Place cold compresses on your eyes.
Try nonprescription “artificial tears,” a type of eye drop that may help relieve itching and burning (note: Other types of eye drops may irritate the eyes and should not be used). Do not use the same bottle of drops in the other eye if it is not affected.
The best defense against allergic pink eye is a good offense: Try to avoid substances that trigger your allergies.
Avoid rubbing the eyes. Eye rubbing and scratching stimulates blood flow to the area which accelerates the allergic reaction.

An appointment needs to made for our doctors to properly diagnose and treat conjunctivitis.

photo credit: Thine Iris via photopin (license)