Common Eye Disorders & Treatments
Common Eye Disorders & Treatments
- Cataracts
There is a lens inside the eye that is similar to a camera lens and is typically clear at birth. As a part of the normal aging process, this lens becomes cloudy over time. This clouding is known as a cataract. By the age of 60, some fifty percent of people have a cataract, and this percentage increases with age. Current research suggests that diabetes, smoking and steroid use hasten the formation of a cataract. There is no effective treatment other than surgical removal.
- How will Cataracts Affect my Vision
There are a number of visual complaints expressed by people with cataracts. Glare becomes a problem, especially when related to night driving as cataracts progress. People see “halos” or “rays” around headlights or streetlights. Reading vision decreases as cataracts progress. Initially, people can no longer read as long as they used to because of eyestrain or their eyes getting tired. Distance vision diminishes with cataracts as well. People can no longer see street signs as clearly as they once could and the small print on the television screen becomes difficult to see. As cataracts progress, colors do not seem as bright and vivid as they once did. Once a cataract restricts normal activities, it is time to have it removed.
- Cataract Surgery
- Monofocal Implants
The standard lens placed in the eye during cataract surgery with the ability to give the patient clearer distance vision. Most people with this lens will still need distance glasses after the surgery and almost all will need reading glasses.
- Refractive Options with Cataract Surgery
- Astigmatic Correction by Wound Modification or Limbal Relaxing Incisions
Wound modification is changing of the normal incision during cataract surgery to reduce mild amounts of astigmatism. Limbal Relaxing Incisions are when a diamond knife is used to make corneal incisions to also reduce the amount of astigmatism.
- Toric or astigmatic implant
- ReStor or multifocal implant lens
This is an implant placed in the eye during cataract surgery that allows people to see both near and far without the use of glasses. In a clinical study, 80% of people with the Alcon ReStor lens did not use glasses at all! In Dr. Miller’s patients, the success rate has been greater than 90%. A comprehensive eye exam can determine if you are a suitable candidate for this revolutionary lens.
The following options are designed to eliminate or reduce the dependence on glasses for distance vision following cataract surgery, but reading glasses will still be needed with any of these options.
An astigmatism correcting implant is placed in the eye during cataract surgery to correct moderate to high amounts of astigmatism. With the Alcon Toric implant in both eyes, 97% of patients in a clinical trial did not wear distance glasses after surgery.
The option below reduces the dependency on glasses for both near and distance vision after cataract surgery.
- Secondary Cataracts
This is a clouding of the thin membrane or capsule behind the newly placed implant. This condition develops in at least fifty percent of patients that have cataract surgery and is easily removed with laser treatment. Common symptoms are identical to that created by a cataract.
- Comprehensive Eye Exam
An eye exam that assesses all parts of eye health. Glasses prescriptions are determined and the doctors also look for cataracts, glaucoma, macular degeneration, diabetes, high blood pressure and any number of other eye problems or diseases elsewhere in your body. Dilation of the pupils is required for this examination to be accomplished.
- Diabetes
Diabetes can cause complications with the eyes and is the leading cause of blindness in the United States. Blood vessels within the eyes can be damaged, which can eventually lead to loss of vision. Any bleeding or swelling in the retina can be detected with a dilated eye exam. There are two types of diabetic retinopathy, non-proliferative and proliferative.
- Non-proliferative Diabetic Retinopathy
Microaneurisms, which occur in the earliest stages, are balloon-like swellings in the retina blood vessels. If fluid leaks out of the blood vessels into the center part of the retina (the macula), it can cause blurred vision because of macular edema. If untreated, severe vision loss and even blindness can occur. This vision loss can occur whether you are a Type I or a Type II diabetic. As the diabetes disease progresses, blood vessels to the retina are blocked and the retinal tissue can die.
- Proliferative Diabetic Retinopathy
New blood vessels grow along the retina due to advancing diabetic retinopathy. These new blood vessels are abnormal and fragile, so they break open, filling the eye with blood. This leads to further scarring, retinal detachment, and severe loss of vision.
- Treatment Options for Diabetes
- Focal Laser Treatment
- Panretinal Laser Treatment
- Vitrectomy
Very small instruments are placed thru the white of the eye to remove scar tissue, repair retinal detachments and remove blood. The new “stitchless” vitrectomy surgery is available at Miller Eye Center to speed your recovery.
This is an office procedure in which small laser burns are placed in the areas of retinal swelling surrounding the macula. This laser slows the leakage of fluid and reduces the amount of fluid in the retina. It may be done more than once.
This is an office procedure in which up to thousands of laser burns are placed throughout the retina, but away from the macula. This causes the new and fragile blood vessels to shrink, thus preventing bleeding. This procedure usually takes more than one treatment. Both of these lasers have very high success rates, but they are not a cure for diabetic retinopathy.
- Hypertensive (high blood pressure) retinopathy
Uncontrolled high blood pressure can do damage to the retina and the vision. This leads to bleeding and fluid leaking into the retina. Strokes due to closure of the blood vessels can also occur. Treatment of this problem includes getting the blood pressure lower and consistently controlled. Laser treatment may also help if there is persistent retinal swelling.
- Dry Eye
- Artificial tears are over-the-counter eye drops used multiple times during the day to lubricate the front surface of the eye.
- An over-the-counter ointment used primarily at bedtime can be used in moderate to severe cases of dry eye. The ointment helps to keep the front surface of the eyes moist while sleeping and is usually used in conjunction with artificial tears during daytime hours.
- Hydroeye contains omega 3 and omega 6 fatty acids that increase tear production and decrease surface inflammation. This nutritional supplement has been more effective than artificial tears for many patients.
- Punctal plugs are small plugs temporarily placed in the drainage system in the eyelid to prevent tears from draining off of the front surface of the eye, therefore, keeping the limited tears longer on the eye. This procedure can be done in the office.
- Restasis is a drug that is available by prescription only. Restasis is designed to reverse the dry eye process by locally suppressing the immune system and actually helping the patient produce more tears. It usually takes four to six months before peak effect is achieved with Restasis.
- Tarsorrhaphy is an office procedure that repositions the eyelid to help relieve the chronic symptoms of severe dry eye.
A chronic shortage of tears on the front surface of the eye found in up to 20% of the population. This can cause a number of symptoms including burning, watering, redness and blurred vision along with a scratchy feeling, a foreign body sensation and sharp shooting eye pains. There are a number of successful treatments.
- Excess Tearing
There is an elaborate drainage system that exists to remove tears from the surface of the eye. Two small holes in the lids near the nose serve to conduct tears into a sac that then drains into one’s throat. This is why you can “taste” eye drops. If the drainage system becomes plugged or is smaller than normal, tears do not drain properly. They can pool in the eye and run down the face. This is called punctal stenosis and can be fixed with dilation or punctalplasty, both minor procedures that are performed in the office. Excess tearing can also be related to improper position of the lower eyelid. If the eyelid is turned out (ectropion) or turned in (entropion), excess watering can occur. The eyelids can be repositioned by means of surgical procedures performed in the office.
- Glaucoma
- Primary open angle glaucoma makes up sixty to seventy percent of all glaucomas. Patients usually have an elevated eye pressure above normal before treatment.
- Normal tension glaucoma makes up twenty-five to thirty percent of all glaucomas. Patients usually have an eye pressure of 21 or lower before treatment.
- Narrow angle glaucoma (acute glaucoma) makes up two to three percent of all glaucomas. Patients have a very high eye pressure, two to four times normal. Pain is usually associated with this glaucoma along with headache, blurred vision, and even vomiting.
- Secondary glaucoma, pseudoexfoliation glaucoma, pigmentary dispersion glaucoma and steroid response glaucoma are all rarer types of glaucoma caused by different factors.
Glaucoma is damage to the optic nerve in the eye that can lead to vision loss. It is the second leading cause of blindness in the U.S. There are many different varieties of glaucoma.
- How is Glaucoma Diagnosed?
- OCT (optical coherence tomography) is a measurement of the thickness of the retinal nerve fiber layer in the eye to determine if the nerve fiber layer is thinner than normal. This is the test that usually diagnoses glaucoma first and not all offices have this technology available to them. If nerve damage is present, the OCT can also monitor for progression of the disease.
- ONP (optic nerve photography) is a three-dimensional picture of the optic nerve used to assess nerve damage. Repeating the photos over time monitors for changes in the appearance of the optic nerve that occurs with progressive glaucoma.
- Visual Field is the only test available to determine vision damage from glaucoma. Vision damage usually starts in the side (peripheral) vision. If there is any vision damage present, it will show up on this test long before a patient will notice any abnormality. We can also use the visual field test to monitor for progression of the glaucoma damage.
- Gonioscopy is a technique used to determine if the drainage system on the inside of the eye is too narrow. If the drain is too narrow, it can cause a sudden attack of narrow angle glaucoma that can lead to blindness in hours.
- Pachymetry is a test used to measure corneal thickness. Based on clinical studies, corneal thickness can be a risk factor for developing glaucoma and can also be a factor used to help determine how likely it is to see progression of glaucoma.
Through a comprehensive eye exam and specialized testing, your doctor can determine if you are at risk for glaucoma. Your doctor looks at your eye pressure, your optic nerve inside the eye and also for other risk factors such as a positive family history for glaucoma or diabetes. Race can also be a factor as African-Americans or Asians are more likely to get glaucoma as Caucasians. By assessing your risk for glaucoma, your doctor can then determine if any extra testing needs to be done to rule out glaucoma. At Miller Eye Center, five glaucoma tests are done to determine if treatment is necessary.
Once all of the testing is complete, your doctor will meet with you to review the results of the tests. If it is determined that you do have glaucoma, treatment will be initiated.
- What Treatments are Available for Glaucoma?
- Prescription drops are used to decrease eye pressure and also prevent large fluctuations in eye pressure.
- ALT (argon laser trabeculoplasty) is a five minute laser procedure that is performed in the office. Two treatments may be done with this laser to achieve an eighty-six percent success rate of lowering eye pressure. On average, the laser treatment lasts for five to ten years in controlling the pressure. Most insurance plans cover this procedure.
- ECP (endocyclophotocoagulation) is a surgical procedure done at the hospital that lowers eye pressure by decreasing the production of fluid. A laser is used during this procedure as well, but it is done internally inside the eye.
- Trabeculectomy is a glaucoma surgery that is usually done on advanced glaucoma patients when none of the other therapies have been successful at lowering eye pressure.
- Follow-up Visits for Glaucoma
If your doctor determines that you have glaucoma and need to be treated, they will typically follow up every three months to monitor the eye pressure. Glaucoma testing including repeating OCT, visual fields and optic nerve photography periodically to look for progression of the disease that can change at any time.
Glaucoma is the second leading cause of blindness in the United States. It is usually a painless, symptom-free disease that can eventually lead to blindness if not treated. Anyone with a family history of glaucoma should be seen regularly by their eye doctor.
- Refractive Error (or why I can’t see without glasses or contacts)
- Hyperopia
- Myopia
- Astigmatism
- Presbyopia
Commonly known as “farsightedness”. The focusing power of the eye is too weak to bring light rays from a distant object into sharp focus on the retina. When left uncorrected, this condition commonly causes headaches and eyestrain along with blurred vision. In children, high amounts of farsightedness are common when amblyopia or a “lazy eye” is present.
Commonly known as “nearsightedness”. The focusing power of the eye is too strong, therefore bringing light rays from a distance object in focus before the retina. The most common complaint with nearsightedness is blurred distance vision.
The eye surface is shaped like a football rather than a baseball. Uncorrected astigmatism makes the vision blurry. This can lead to headaches and eyestrain. Astigmatism can be corrected with glasses, contact lenses, surgery to the cornea, and if you will be having cataract surgery, a Toric Implant can be used to achieve good distance vision without glasses.
A condition in which the natural lens in the eye becomes less flexible and the muscles of the focusing system weaken, therefore resulting in the eye’s inability to focus at near. Typically this occurs in the mid forties of age. The most common complaint with presbyopia is blurred reading vision. This condition is corrected with reading or multifocal glasses, which includes bifocals, trifocals and progressive addition lenses. If you will be having cataract surgery, the ReStor lens implant can be used to correct your vision at near and far without the need for glasses.
- Refractive Surgery
- Radial Keratotomy (RK)
- Lasik (keratomileusis)
- Relaxing Incision
- Clear lens extraction and implant
- Toric or Astigmatic Implants
- ReStor Lens Implant
Surgical procedures designed to eliminate or reduce the need for corrective glasses or contact lenses. This is accomplished by reshaping the high-powered corneal surface or implanting an artificial lens into the eye.
This is the oldest refractive surgical procedure in which four or more radial incisions are made in the cornea that aims to flatten or weaken the corneal power. Patients commonly complain of halos around lights, especially with night driving. Unpredictable and unstable outcomes have caused this procedure to rarely be performed these days.
A surgical procedure in which a laser is used to reshape the central cornea. The laser is applied after a thin surface corneal flap is removed by a very precise razor blade.
A surgical procedure in which a small incision is made in the cornea. The goal of this procedure is to reduce the amount of corneal astigmatism.
One’s clear lens is removed surgically and a monofocal implant implanted to correct far or nearsightedness.
A surgical procedure in which an astigmatism correcting implant is used in the eye to correct moderate to high amounts of astigmatism.
A surgical procedure in which an implant is put in the eye that produces clear vision at distance and near. This greatly reduces one’s dependency on glasses when the implant is placed in both eyes. At least eighty percent of patients stated they did not have to wear glasses after having the ReStor implant in both eyes.
- Retina Laser (Surgery)
The retina is the light sensitive tissue that lines the inside of the eye. This layer of nerves senses light and sends images to the brain. Certain conditions such as diabetes, high blood pressure, high cholesterol or macular degeneration can cause bleeding complications in the retina. Retina laser is then needed to close the leaky blood vessels caused by these conditions. Retina laser is also used to treat small holes or tears in the retina. This treatment usually prevents a retinal detachment.
- Retinal Detachments
- Scleral Buckle
- Pneumatic Retinopexy
- Vitrectomy
These occur when the retina is pulled away from its normal position. Common symptoms included flashing lights, floaters or a gray curtain or shadow moving towards the center of your vision. Retina detachments almost always require surgery. Options available to repair a retinal detachment include:
A flexible band is placed around the eye to counteract the force pulling the retina out of place.
A small gas bubble is injected into the open space inside the eye. The gas bubble pushes the torn retina back into place.
The vitreous gel, or jelly-like fluid inside the eye, is removed and replaced with a large gas bubble. The gas bubble temporarily presses the retina to allow scarring to hold the retina in the correct position.
Click here to view a simulation of various common eye problems.
