Management of Ocular Diseases

Our eye doctors are up-to-date on the latest technology and techniques to make your visit as comfortable and effective as possible. Utilizing cutting edge technology we are diagnosing and managing, with greater precision, diseases like Glaucoma, Macular Degeneration, Cataracts and Diabetic Retinopathy. Earlier and more precise diagnosis means earlier treatment and better outcomes. We take an aggressive approach to diseases that previously had few treatment options. Great advances have been made in the treatment of these diseases.

• Cataract Surgery Co-Management
  Cataracts are a common cause of vision loss after age 55. Learn more about cataracts and their treatment.
• Glaucoma Testing & Treatment
  Glaucoma is a group of eye conditions that damage your eye’s optic nerve and can lead to vision loss and blindness. However, with early detection and treatment, you can often protect your eyes from serious loss of vision.
• Age-Related Macular Degeneration
  The macula is the portion of the retina which provides sharp, central vision, and is involved in processing the fine details of images. The gradual breakdown of this tissue over time in susceptible individuals is called age-related macular degeneration.
• Diabetic Retinopathy
  If you have diabetes, you need to be aware that this systemic disease puts you at greater risk for developing vision problems. Find out more about diabetic retinopathy including its prevention, symptoms, and treatment.

Cataracts are a clouding of the lens inside of the eye. Cataracts prevent clear images from appearing on the eye’s retina; causing mild, moderate, even severe blurred vision.

Cataracts are typically an eye disorder associated with aging (over half of the people in America over age 80 have either had a cataract or cataract surgery), generally occurring later in life as the lens structure within the eye changes over time.

During the evaluation of your eye health, we will carefully examine your lens for signs of cataract formation. If a cataract is noticed and the clouding is causing visual disruption, your optometrist will refer you to a trusted and respected surgeon for surgery, which is the only known cure for cataracts. Our doctors will be there for you providing pre and post cataract surgery care.

Glaucoma is a leading cause of preventable vision loss and blindness in adults in the United States and the second leading cause of blindness in the World.

What is Glaucoma?

Glaucoma is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye or intraocular pressure (IOP). When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it can’t be restored.

Treatments for glaucoma include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision loss. The type of treatment depends on the type and the cause of glaucoma.

Risk Factors

Prevention is possible only with early detection and treatment. Since symptoms are often absent, regular eye exams, which include a glaucoma screening, are essential, particularly for individuals at risk of the disease. While anyone can get glaucoma, the following traits put you at a higher risk:

• Age over 60
• Hispanic or Latino descent, Asian descent
• African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
• Family history of glaucoma
• Diabetics
• People with severe nearsightedness
  Certain medications (e.g. steroids)
• Significant eye injury (even if it occurred in childhood)

Types of Glaucoma

Primary open-angle glaucoma (POAG) gradually progresses without pain or noticeable vision loss initially affecting peripheral vision. By the time visual symptoms appear, irreparable damage has usually occurred, however, the sooner treatment starts the more further vision loss can be prevented. When untreated, vision loss will eventually result in total loss of side vision (or tunnel vision) and eventually total vision loss.

Normal-tension glaucoma or low-tension glaucoma is another form of open-angle glaucoma in which the intraocular pressure remains within the normal level. The cause of this form of glaucoma is not known, but it is believed to have something to do with insufficient blood flow to the optic nerve, causing damage. Individuals of Japanese descent, women and those with a history of vascular disease, or low blood pressure are at higher risk.

Angle-closure glaucoma can be a sudden increase in eye pressure causing severe pain, blurred vision, halos, nausea, and headaches. The pressure is caused by a blockage of fluid at the front of the eye which is a medical emergency and should be treated immediately. Without prompt treatment to clear the blockage vision can be permanently lost.

Congenital glaucoma is an inherited form of the disease that is present at birth. These babies are born with a defect that slows the normal drainage of fluid out of the eye and is usually diagnosed by the time they turn one. In these cases, there are typically some noticeable symptoms such as excessive tearing, cloudiness or haziness of the eyes, large or protruding eyes or light sensitivity. Surgery is usually performed with a very high success rate of restoring full vision.

Secondary glaucomas are complications that develop from eye surgeries, injuries or other medical conditions such as cataracts, tumors, or a condition called uveitis which causes inflammation. Uncontrolled high blood pressure or diabetes can result of another serious form called neovascular glaucoma.

Pigmentary glaucoma is a rare form in which pigment from the iris sheds and clogs the drainage of fluid from the eye resulting in inflammation and damage to the eye and drainage system.

Glaucoma Diagnosis and Treatment

Detecting Glaucoma
During a routine comprehensive eye exam to check for glaucoma, your eye doctor will examine the optic nerve for signs of glaucoma and will also measure the intraocular pressure (IOP) with an instrument called a tonometer. Since your IOP can fluctuate throughout the day and glaucoma can exist without elevated IOP this is not enough to rule out the disease. If there are signs of the disease, further testing will be performed.

A visual field test is designed to detect any blind spots in your peripheral or side field of vision. You will be asked to place your head in front of a machine while looking ahead and indicate when you see a signal in your peripheral field of view.

Your doctor may also measure the thickness of the cornea with an ultrasonic wave instrument in a test called pachymetry or use imaging techniques such as digital retina scanning or optical coherence tomography (OCT) to create an image of your optic nerve to look for glaucoma damage.

Treating Glaucoma
Treatment for glaucoma depends on the type and severity of the disease and can include medication such as eye drops or surgery.

Eye drops that lower IOP are often the first resort for controlling pressure-related glaucoma. These drops may have some uncomfortable side effects, such as dry eye, but compliance with the treatment plan is essential for preserving vision and halting the progression of the disease.

Surgical procedures are designed to control the flow of fluids through the eye by either decreasing the amount of fluid produced or improving the drainage. Your doctor may decide that a combination of surgery and medication will be the most effective in many cases.

It cannot be stressed enough that the most effective treatment for glaucoma happens when the disease is detected and treated early before significant vision loss occurs. Any vision that is lost cannot be restored. This is why the best prevention is awareness by knowing your risks and taking responsibility by having your eyes examined on a regular basis.

Age-related macular degeneration(AMD), as the name states, is an age-related eye disease that runs in families. Untreated macular degeneration is one of the leading causes of blindness in those over 65 years old. While researchers have not yet discovered a cure for age-related macular degeneration (AMD), there are treatment options which prevent the disease from progressing to blindness, and in some cases, they can even improve vision. This is why it is so important to have annual exams after the age of 50, early detection of AMD can prevent progression of vision loss. This is especially important if you have risk factors for AMD.

Risk Factors for Age-Related Macular Degeneration:

• Diet high in saturated fat (found in foods like meat, butter, and cheese)
• Overweight
• Smoker
• Over the age of 50
• Family history of AMD
• Are Caucasian (white)
• Have light colored eyes
• Have heart disease
• Have high cholesterol levels

Types of Age-Related Macular Degeneration:
There are two basic types of AMD, the wet form, and the dry form.

• Dry macular degeneration is considered the less aggressive form of AMD. It typically progresses much more slowly, and the level of eyesight damage is less severe. Dry AMD is detected during routine eye exams, which is why it’s important to have yearly testing. Treating Dry AMD often involves high doses of antioxidants which have been shown to slow diseases progression.
• Wet macular degeneration is the more severe form of AMD. It occurs when there is abnormal blood vessel growth (angiogenesis), and leakage, which can cause scar tissue to develop. Treatments include laser surgery, injecting light sensitive dyes, or AMD medication injected directly into the eye to inhibit angiogenesis.

Diabetic retinopathy occurs when the fragile vascular network that supplies the retina – the light sensitive tissue at the back of the eye that helps us see – begins to swell or leak. During the beginning stages of the disease, there may be no noticeable symptoms, so it’s important to have your eyes checked at least once a year if you have diabetes.

Once symptoms of diabetic retinopathy do develop, they can include: dark or black spots in your visual field, or blurry vision, and it increases over time. This is a result of bleeding at the back of the eye, which prevents a clear image from being transmitted from the retina to the brain.

Whether you have type 1, type 2, or even just gestational diabetes, you are at risk for developing diabetic retinopathy. The longer you have had the disease, the greater the risk. It is essential to keep your blood sugar levels under control to prevent vision loss.

There are a number of treatment options for diabetic retinopathy. Photocoagulation, or laser treatment, is usually very effective at preventing vision loss if it is done before the retina has become severely damaged. Surgical removal of the vitreous gel, or victrectomy, may also help improve vision if the retina is still relatively healthy. Sometimes injections of an anti-VEGF (vascular endothelial growth factor) medicine or an anti-inflammatory medicine help to shrink new blood vessel growth in proliferative diabetic retinopathy.