Age-Related Macular Degeneration (ARMD)

This is a degenerative condition of the macular. It is the most common cause of vision loss in the United States in those 50 or older, and its prevalence increases with age. Macular Degeneration (MD), is caused by hardening of the arteries that nourish the retina. This deprives the sensitive retinal tissue of oxygen and nutrients that it needs to function and thrive. As a result, the central vision deteriorates.

MD varies widely in severity. In the worst cases, it causes a compete loss of central vision, making reading or driving impossible. For others, it may only cause slight distortion. Fortunately, MD does to cause total blindness since it does not affect the peripheral vision. (As illustrated below)

What is the difference between Wet and Dry MD?
MD is classified as either wet (neovascular) or dry ( non-neovascular). About 10% of patients who suffer from MD have wet MD. This type occures when new vessels form to improve the blood
supply to exygen deprived retinal tissue. However, the new vessels are very delicate and break easily, causing bleeding and damage to surrounding tissue.
Patients with wet macular degeneration, develop new blood vessels under the retina. This causes hemorrhages, swelling and scar tissue but it can be treated with laser in some cases. (Illustration on your right)  

Dry macular degeneration, although more common, typically results in a less severe, more gradual loss of vision.
The dry type is much more common and is characterized by drusen and loss of pigment in the retina. Drusen are small, yellow deposits that form within the layers of the retina. (Illustration below)            











         Drusen

SIGNS & SYMPTOMS
*Loss of central vision (Gradual with dry MD, sudden with wet MD)
*Difficulty reading or performing tasks that require detail
*Distorted vision (Straight lines such as doorways or edges of windows may appear wavy or bent.

DETECTION & DIAGNOSIS

Vision testing, Amsler Grid, Ophthalmoscopy, Fundus Photography and Fluorescein Angiography.
 Amsler Grid 
 (You can right click an send to your printer)
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*Use a bright reading light
*Wear your reading glasses (bifocals, progressive etc)
*Cover one eye
*Look at center dot
*Note irregularities (wavy, size, gray, fuzzy)
*Repeat test with other eye
*Contact your eye professional if you see any irregularities or notice any changes


TREATMENT
There is no proven medical therapy for dry macular degeneration. In selected cases of wet MD, laser photocoagulation is effective for sealing leaking or bleeding vessels.

Low Vision devices are available for ARMD, click on our "MDE Low Vision Store" to buy Low Vision Devices.



Amblyopia

This is a term used to describe an uncorrectable loss of vision in an eye that appears to be normal. It's commonly referred to as lazy eye and can occur for a variety of reasons.
A child's visual system is fully developed between the ages of 9-11. Until then, children readily adapt to visual problems by suppressing or blocking out image. If caught early, the problem can often be corrected and the vision preserved. However, after about age 11, it is difficult if not impossible to train the brain to use the eye normally.

Some causes of amblyopia include: strabismus (croosed or tuned eye) congenital cataracts, cloudy cornea, droopy eyelid, unequal vision and uncorrected nearsightedness, farsightedness or astigmatism. Amblyopia may occur in various degrees depending on the severity of the underlying problem. Some patients just experience a partial loss; others are only able to recognize motion. These patients lack binocular vision.

SIGNS AND SYMPTOMS
 

• Poor vision in one or both eyes
• Squinting or closing one eye while reading or watching tv.
• Crossed or turned eye
• Turning or tilting the head when looking at an object.

Children rarely complain of poor vision.

TREATMENT
Treatment for amblyopia depends on the underlying problem. In some cases, the strong eye is temporarily patched so the child is forced to use the weaker eye. For children with problems relating to a refractive error, glasses may be necessary to correct vision. Problems that impair vision such as cataracts or droopy eyelids often require surgery. Regardless of the treatment required, it is of utmost umportance that intervention is implemented as early as possible before the child's brain learn to permanently suppress or ignore the eye.

Astigmatism

Astigmatism is the most common vision problem, but most people, don't know what it is.
This may accompany nearsightedness or farsightedness. Usually it is caused by an irregularly shaped cornea (called corneal astigmatism). But sometimes it is the result of an irregularly shaped lens, which is located behind the cornea; this is called lenticular astigmatism. Either kind of astigmatism can usually be corrected with eyeglasses, contacts or refractive surgery.

SIGNS AND SYMPTOMS
If you have only a small amount of astigmatism, you may not notice it or have just slightly blurred vision. But sometimes uncorrected astigmatism can give you headaches or eyestrain, and distorted or blur your vision at all distances. Unfortunately, astigmatism can affect anyones ability to see well in school, during sports, driving, at work etc., so it's important to have your eyes examined at regular interval in order to detect any astigmatism early on.

WHAT CAUSES ASTIGMATISM
This occurs when the cornea is shaped more like a oblong football than a spherical basketball, which is the normal shape. In most astigmatic eyes, the oblong or oval shape causes light rays to focus on two points in the back of your eye, rather than on just one. This is because, like a football, as astigmatic cornea has a steeper curve and a flatter one.

TREATMENT
Unless it is extreme, astigmatism can be compensated for satisfactorily with eyeglasses or contact lenses. If your eyeglasses or contact lens prescription contains three parts rather than one, your eyecare practitioner has found some astigmatism in one or both of your eyes.

Many patients with astigmatism believe that they can not wear contact lenses, or that only rigid lenses (RGP) can correct astigmatism.This was true several years ago, but not there are soft contacts that correct astigmatism, called toric.

Depending on the amount of astigmatism, you may have to stay with prescription eyeglasses or depending on the type and severity of our astigmatism, you may also be able to have it corrected with refractive surgery. Discuss with your eye doctor which is best for you.


Cataracts

A cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, shape images. The lens is contained in a sealed bay or capsule. Over time, the cells accumulate causing the lens to cloud, making images look blurred or fuzzy. For most patients, cataracts are a natural result of aging.


Diabetic Retinopathy

This is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults.

HOW DOES DIABETES AFFECT THE RETINA
Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease's affect on the retina is the main threat to to vision. Most patients develop diabetic changes in the retina after approximately 20 years. The effect of diabetes on the eye is called diabetic retinopathy.

Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy. In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision.

The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unforunately, these delicate vessels hemorhage easily. Blood may leak into the retina and vitreous, causing spots or floaters along with decreased vision.

In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma.

SIGNS AND SYMPTOMS
Affect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Some common symptoms of diabetic retinopathy are listed below, however, diabetes may cause other eye symptoms.

*Blurred vision (this is often linked to blood sugar levels)

*Floaters and flashes

*Sudden loss of vision

     

DETECTION AND DIAGNOSIS
Diabetic patients require routine eye examinations so related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who in turn work closely with the eye doctor.

TREATMENT
Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. These include: fluorescein angiography, retinal photography and ultrasound imaging of the eye.

The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems treated by vitro-retinal surgeons. Laser surgery called pan retinal photocoagulation (PRP) is usually the treatment of choice for this problem.

Vitrectomy is another surgery commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal attachment or tears.

Low Vision Devices are available for Diabetic Retinopathy, click on our "MDE Low Vision Store" to buy Low Vision Devices.


Epitretinal Membrane (ERM)
(Macular Pucker)

ERM is a cellophane-like membrane that forms over the macular. It is typically a sow-progressing problem that affects the central vision by causing blur and distortion. As it progresses, the traction of the membrane on the macula may cause swelling.
ERM is seen most often i people over 75 of age. It usually occurs for unknown reasons, but may be associated with certain eye diseases such as: diabetic retinopathy, posterior vitreous detachment, retinal detachment, trauma and many others.

SIGNS AND SYMPTOMS
*Blurred vision
*Double vision that is noticeable even with one eye covered
*Distorted vision (straight lines may appear bent or wavy)

DETECTION AND DIAGNOSIS
Your eye doctor is able to detect ERM with an ophthalmoscopy during an examination of the retina. It has a glistening, cellophane-like appearance. The affect of ERM on the patient's central vision is assessed with a visual acuity test and the Amsler Grid (see above in ARMD for Amsler Grid, you can print to your computer). If the doctor suspects macular swelling, he may order fluorescein.

TREATMENT
A procedure called a membrane peel is performed when vision has deteriorated to the point that it is impairing the patient's lifestyle. Most vitreo-retinal surgeons recommend waiting for treatment until vision has decreased to the point that the rish of the procedure justifies the improvement.

The Membrane Peel is performed under a local anesthesia in an operating room. After making tiny incisions the membrane peel is often done in conjunction with a procedure called vitrectomy.


Glaucoma

This is a disease caused by increased intraocular pressurer (IOP), resulting either from a malformation or malfunction of the eye's drainage structures. Left untreated, an elevated IOP causes irreversible damage the optic nerve and retinal fibers resulting in a progressive, permanent loss of vision. However, early detection and treatment can slow, or even halt the progression of the disease.

                                               cup to disc ratio
TYPES OF GLAUCOMA

Open Angle- is the most common type of glaucoma. Even though the anterior structures of the eye appear normal, aqueous fluid builds within the anterior chamber, causing the IOP to become elevated. Left untreated, this may result i permament damage of the optic nerve and retina.

Acute Angle Closure- Only about 10% of the population with glaucoma has this type. Abnormality of the structures in the front of the eye. In most cases, the space between the iris and cornea is more narrow than normal,leaving a smaller channel for the aqueous to pass through. If the flow of aqueous becomes completely blocked, the IOP rises sharply, causing a sudden angle closure attack.

Secondary Glaucoma- Occurs with other diseases or problems within the eye such as; inflammation, trauma, previous surgery, diabetes, tumor and certain meds. For this type, both the glaucoma and the underlying problem must be treated.

Congenital- Rare type of glaucoma that is generally seen in infants. In most cases, surgery is required.







Because glaucoma does not cause symptoms in most cases, those who are 40 or older should have an annual examination including a measurement of the intraocular pressure (IOP). Those who are glaucoma suspects may need additional testings.


SIGNS & SYMPTOMS-
Angle Closure (emergency)
*Sudden decrease of vision
*Extreme eye pain
*Headaches
*Nausea and vomiting
*Glare and light sensitivity
Congenital
*Tearing
*Light sensitivity
*Enlargement of the cornea

DETECTION AND DIAGNOSIS
Glaucoma does not cause symptoms in most cases, those who are 40 or older should have an annual examination including a measurement of the intraocular pressure. Those who are glaucoma suspects may need additional testing. Mearsuring the intraocular pressure, evaluate the health of the optic nerve, test the peripheral vision.

The progression of glaucoma is monitored with a visual field test. This test maps the peripheral vision, allowing the doctor to determine the extent of vision loss form glaucoma and a measure of the effectiveness of the treatment.

TREATMENT
Patients with glaucoma require only medication to control the eye pressure. Sometimes, several medications that complement each other are necessary to reduce the pressure adequately.
Surgery is indicated when medical treatment fails to lower the pressure satisfactorily.

Low Vision Devices are available for Glaucoma, click on our "MDE Low Vision Store" to buy Low Vision Devices.


Hyperopia
Farsightedness or hyperopia, occurs when light entering the eye focuses behind the retina, instead of directly on it. This is caused by a cornea that is flatter, or an eye that is shorter, than a normal eye. Farsightedness patients usually have trouble seeing up close, but may also have difficulty seeing far away as well.
Young patients with mild to moderate hyperopia are often able to see clearly because their natural lens can adjust, or accommodate to increase the eye's focusing ability. However, as the eye gradually loses the ability to accommodate (about 40 years of age), blurred vision from hyperopia often becomes more apparent.

SIGNS AND SYMPTOMS
*Difficulty seeing up close
*Blurred distance vision (occurs with highter amounts of hyperopia)
*Eye fatigue when reading
*Eye strain
*Crossed eyes in children

TREATMENT
Eyeglasses or contact lenses are required. However, it also depends on several factors such as the patient's age, activities and occupation and ability to compensate for their farsightedness with accommodation.

Hypertensive Retinopathy 

 The findings in hypertensive retinopathy all stem form hypertension, induced changes to the retinal microvasculature. Hypertension leads to a laying down of cholesterol into the tunica intima of medium and large arteries. This leads to an overall reduction inthe lumen size of these vessels. In arteriolosclerosis, hypertension leads leads to focal closure of the retinal microvasculature. This gives rise to microinfarcts (cotton wool spots) and superficial hemorrhages. In extreme cases, disc edems develops. The mechanism behind this phenomenon is poorly understood, but it may be related to a hypertension- related increase in intracranial pressure and hence is considered true papilledema. 
Arteriolosclerotic changes in the retinal microvasculature persist even with the reduction of systemic blood pressure. However, hypertensive retinopathy changes resolve over time with the reduction of systemic blood pressure (BP) Cotton Wool Spots develop 24 to 48 hours with the elevation of BP, and resolve in tow to 10 weeks with the lowering of BP. Amacular star develops within several weeks of the development of elevated BP and resolves within months to years after the BP in reduced. Papilledema develops within days to weeks of increased BP and resolves within weels to months following BP lowering.

Findings in hypertensive retinopathy include cotton wool spots and flame shaped hemorrhages. Only rarely will there be retinal or macular edema. in advanced cases, there will be a macular star (ring of exudates from the disc to the macular) and disc edema. Arteriolosclerosis (arteriolar narrowing, arterio-venous crossing changes with venous constriction and banking, arteriolar color changes, vessel sclerosis) is often found concurrently.

SIGNS AND SYMPTOMS
Patients with hypertensive retinopathy, as expected, suffer form hypertension. However, the hypertension may be unknown to the patient and the eye exam may yield the first clue to this relative asymptomatic systemic disease. Most commonly, the patient is middle age or older and more common in African-Americans than Caucasians.

Low Vision Devices are available for Hypertensive Retinopathy, click on our "MDE Low Vision Store" to buy Low Vision Devices.


Myopia

Nearsightedness or myopia, occurs when light entering the eye focuses in front of the retina instead of directly on it.  This is caused by a cornea that is steeper, or an eye that is longer, than a normal eye.  Nearsighed patients typically see well up close, but have difficulty seeing far away.

This is often discovered in school-age chidren who report having trouble seeing the chalkboard. Near-sightedness usually becomes progressively worse through adolescence and srabilizes in early adulthood. It is an inherited problem.

SIGNS AND SYMPTOMS
*Blurry distance vision
*Vision seems clearer when squinting

DETECTION
Myopia is detected with a acuity test and refraction.

TREATMENT
Depends on several factors such as the patient's age, activities and occupation. Vision can be corrected with glasses, contacts or surgery. Refractive procedures such as Lasik can be considered for adults when the prescription has remained stable for at least one year.


Ocular Histoplasmosis Syndrome

This is caused by a fungus commonly found in the dust and soil of the Mississippi-Ohio River Valley region. Approximately 62% of the adult population living in this region are carriers. 
Histoplasmosis is contracted by inhaling dust that carries the fungal spores. Its effect on the body can vary widely in severity from one person to another. Many carriers have no symptoms at all, but those with mild exposure may experience flu-like symptoms and mild respiratory infections. Histolplasmosis is more likely to become a serious problem in people who already have  weakened immune system.

The fungus may affect the eye by causing small areas of inflammation and scarring of the retina. These are called "histo spots" and may be found in both eyes. Their affect on vision depends on the location of the scars. Scarring in the peripheral area of the retina may have little or o impact o vision, while a central scar affecting the macula may cause a prominent blind spot.

SIGNS AND SYMPTOMS
*Many patients with histo spots in their eyes have no symptoms.
*Others may experience the following: 
*Distorted vision
*Blind spots
*Scars in the retina, ranging in severity

TREATMENT
Usually requires no treatment except when abnormal blood vessels develop in the central retina. For these patients, laser treatment may be necessary. In some cases, surgical removal of the tiny abnormal vessels has been successful.
Click on "MDE Low Vision Store" to buy Low Vision products.


Posterior Capsule Opacification

Posterior Capsule Opacificaton (PC Haze), is the remaining portion of the capsule becomes clouded in about 25% of cataract surgery patients. When this occurs, patients pexperience symptoms similar to thoe from the original cataract. That's why posterior capsule opacification (PC Haze) is also known as a secondary cataract.

The lens capsule is the thin, elastic-like bag that holds the intracocular lens (IOL) in position after cataract surgery. During the operation, the front (anterior) portion of the lens capsule is carefully opened and the cataract is removed. The IOL is inserted into the remaining (posterior) portion of the capsule.

SIGNS AND SYMPTOMS
*Gradual decrease of vision
*Blurred vision
*Glare from lights and sun

TREATMENT
Simple procedure called the YAG posterior capsulotomy is performed to restore vision lost form the clouded capsule. The YAG is a type of "cold" laser used to create a small opening in to center of the capsule, allowing a clear area for light to enter the eye. The procedure is painless, requires no anesthesia and has very little risk since no incision is required. After the dilating drops wear off from the procedure, most patients notice an immediate improvement in vision. The improvement each person experiences is dependent on the extent of the capsular clouding and the overall health of their eyes.


Posterior Vitreous Detachment

The space between the crystalline lens and the retina is filled with a clear, gel-like substance callled vitreous. In a newborn, the vitreous has an egg-white consistency and is firmly attached to the retina. With age, the vitreous thins and may separate from the back of the eye. This is called posterior vitreous detachment (PVD).

As the vitreous pulls free from teh retina, it is often accompanied by light flashes or4 floaters. Floaters are caused by tiny bits of vitreous gel or cells that cast shadows on the retina. Flashes occur when the vitreous tugs on the sensitive retina tissue.

There are other more serious causes of flashes and floaters, with include, retinal tears, retinal detachment, infection, inflammation, hemorrhage, or an injury such as a blow to the head may also cause floaters and flashes. (Have you ever seen stars after bumping your head) Occasionally, flashes of light are caused by neurological problems such as a migraine headache. When related to a headache, the flashes of light are seen in both eyes and usually lasts 20-30 minutes before the headaches starts.

SIGNS AND SYMPTOMS
*Black spots or spider webs that seem to float in the vision in a cluster or alone.
*Spots that move or remain suspended in one place.
*Flickering or flashing lights that are most prominent when looking at a bright background like a clear sky.

SYMPTOMS THAT MAY INDICATE A MORE SERIOUS PROBLEM
*Sudden decrease of vision along with flashes and floaters
*Veil or curtain that obstructs part or all of the vision
*Sudden increase in the number of floaters

Notify your physician immediately if you notice a sudden shower of floaters, new light flashes, a veil or curtain obstructing your vision or any other change.

TREATMENT
Because of the rish, surgery is rarely indicated for PVD except when the floaters obscure the vision. In these cases, surgical removal of the vitreous may be considered only if the vision is significantly affected. This treatment is rarely needed since floaters typically become less bothersome over a period of weeks to months as they settle below the line of sight. However, vitrectomy may be indicated in a select group of patients with visually disabling vitreous floaters, as long as an objective assessment of the patient's visual disfunction from the floaters is made.


Presbyopia 

This is which the natural lens can no longer accommodate. Accommodation is the eye's way of changing its focusing distance:  the lens thickens, increasing its ability to focus close-up. At about age 40, the lens becomes less flexible and accommodation is gradually lost. It is a normal process that everyone eventually experiences. However, nearsighted people can simply take their glasses off because they see best close-up.

SIGNS AND SYMPTOMS
*Difficulty seeing clearly for close work
*Print seems to have less contrast
*Brighter or more direct light required for reading
*Reading material must be held further away to see
*Fatique and eyestain when reading

TREATMENT
Treatment for presbyopia is very simple, and depends on patients age, lifestyle, occupation, and hobbies. Progressive bifocals are a great source, vision at all distances, and you can not see the line in your eyeglasses. Trifocals, works like a progressive lens but you can see the line in your eyeglasses, bifocal with the line, blended bifocal (on-line, but not progressive), 2 pairs of eyeglasses, one for distance and one for reading, or bifocal contact lenses (depending on patients prescription), monovision with contacts, adjusting one eye for distance vision, and the fellow eye for reading vision.