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More Than You Expect!

Glaucoma is a family of eye diseases characterized by progressive damage and subsequent loss of optic nerve tissue. The optic nerve is responsible for transmitting visual signals from the eye to the brain. It is composed of approximately one million nerve fibers. Glaucoma leads to the death of these nerve fibers which in turn leads to permanent vision loss. Although there is no cure for glaucoma, it can be treated. Early detection and treatment of glaucoma is crucial in slowing down the progression of nerve fiber damage and subsequent vision loss. Glaucoma is asymptomatic in its early stages. Early vision loss usually occurs in the periphery and goes unnoticed by the patient until the advanced stages. Central vision is usually not affected until the advanced stages. Both peripheral and central vision loss with glaucoma is irreversible. Glaucoma is the second leading cause of blindness in the U.S. and it is estimated that over two million Americans have glaucoma. As many as half of these cases may be undiagnosed. Treatment generally involves prescription medical eye drops. Surgical options are also available and are sometimes necessary. Risk factors for glaucoma include family history, ethnicity, medical conditions, and corticosteroid use.

 

The most common form of Glaucoma is Primary Open Angle Glaucoma (POAG). The inside of the eye is constantly producing fluid. This is different than the tears produced on the outside of the eye. The fluid produced inside the eye leaves the eye through an area called the angle. The angle contains canals that allow for drainage of the fluid. It is believed that these drainage structures become inefficient in POAG, causing the subsequent build up of pressure within the eye. This fluid pressure pushes against the optic nerve and destroys it. Medical eye drops are prescribed to lower the pressure in the eye and slow down the progression of optic nerve damage. There are also laser surgeries available that help drain the fluid from the eye. Conventional surgeries are required when drops and laser surgeries are not effective in lowering eye pressure.

 

There are many other less common forms of glaucoma as well. Narrow Angle Glaucoma, for instance, can occur when the drainage angle is physically to narrow to effectively drain fluid. In some cases, the angle may completely close off and cause Acute Angle Closure Glaucoma. Acute Angle Closure Glaucoma is a true medical emergency. Pressure builds up rapidly and blindness can result in just two to three days. Symptoms usually include pain, headache, nausea, vomiting, ocular inflammation, and a drop in vision. Both medical and laser surgical intervention is required. Individuals with anatomically narrow angles may be treated with laser on a prophylactic basis if they are considered to be at risk for acute angle closure glaucoma. Normal Tension Glaucoma, yet another form of glaucoma, results in the loss of optic nerve tissue in the presence of what are considered to be normal pressures inside the eye. The causes for this are unknown, but may result from poor blood flow to the optic nerve or an abnormally sensitive optic nerve.

 

At Reflections Eyecare, Dr. Schultz and Dr. Cohen devote special attention to evaluating the health of your eye in order to detect and treat Glaucoma when it is present. Dr. Schultz and Dr. Cohen work in close association with the top glaucoma surgeons and specialists in the Atlanta area when surgical intervention is required.

 

Glaucoma

The following material is for educational purposes only. It is not intended as a source for diagnosis and treatment of medical eye conditions and symptoms. Please consult your eye care provider or emergency medical facility immediately if you are having a medical concern with your eyes.

 

Diabetes is a disease that causes problems with the body's ability to metabolize sugar. This leads to elevated sugar levels in the blood, which in turn, causes damage to the body's blood vessels. When blood vessels become damaged, the organs and tissues the blood vessels supply don't receive the proper oxygen and nutrients. Diabetic retinopathy is a condition in which the retina becomes damaged because of damage to the blood vessels that supply it. The retina is a sensory organ that lines the back of the eye. It detects images and transfers them to the brain via the optic nerve. The Macula is a small area in the center of the retina that is responsible for color vision and seeing fine detail. When retinal blood vessels become damaged from diabetes, they leak fluid. If this fluid leaks on the macula, it can cause permanent visual damage. When this occurs, laser treatment is usually required to try to seal the leaks. In addition to blood vessel leakage, the oxygen starved tissue in the retina may stimulate the growth of new blood vessels in the retina. Unfortunately, these are abnormal and may hemorrhage into the eye or cause complications such as glaucoma and retinal detachments. These situations usually require surgical intervention. New blood vessel growth usually requires laser treatment which consists of a series of laser burns which are applied to the retinal tissue causing the new blood vessels to shrink.

 

The early stages of diabetic retinopathy are not usually accompanied by symptoms. Because of this, the American Optometric Association recommends yearly dilated eye exams for all patients with diabetes. Not all patients with diabetes get diabetic retinopathy, but an exam is the only way to detect early diabetic changes if they are present. Early detection and treatment of these changes can reduce the potential for permanent vision loss from diabetic retinopathy. Generally, good control of blood sugar, healthy diet, exercise, and appropriate follow up with your medical doctor can reduce the risk of developing diabetic retinopathy. Typically, diabetic retinopathy will cause blurred or hazy vision. It may also cause floaters or a dark or empty spot in your vision. Any sudden changes in vision should be evaluated by an eye doctor immediately. At Reflections Eyecare, we can carefully monitor diabetic changes in your retina with the Optomap Digital Retinal Exam.

Diabetic Retinopathy

Cataracts are usually a result of normal age related changes to the lens inside the eye. Cataracts can also result from trauma and corticosteroid use. Occasionally, a patient can be born with a congenital cataract. The lens is situated behind the iris (the colored part of the eye), and functions to focus light on the retina. As we get older, the lens becomes cloudy and more difficult to see through. Early cataracts may not have a significant impact on vision, but they may cause changes to your spectacle prescription.

 

When the cataract becomes more advanced, patients will typically complain of blurred or hazy vision. The only treatment for a cataract is to surgically remove it. Fortunately, this is a very common outpatient procedure. When the cataract advances to the point that vision with an updated spectacle prescription is no longer adequate, we will typically recommend a surgical consult. Dr. Schultz and Dr. Cohen work in close association with the top cataract surgeons and specialists in the Atlanta Area. In the meantime, we can carefully monitor the changes of the lens inside the eye with digital photography.

 

The macula is a small area in the center of the of the retina responsible for color vision and seeing fine detail. Macular degeneration is a progressive disease that causes this area to degenerate. It is the leading cause of severe vision loss in people over the age of 50. Risk factors for macular degeneration include age, family history, smoking and long term sun exposure. Caucasians are at greater risk for developing macular degeneration than other races. There are two forms of macular degeneration: Dry and Wet.

 

Dry Macular Degeneration causes a gradual thinning and permanent loss of the macular tissue. It is a slowly progressing condition. Typical symptoms include a gradual blurring or distortion of central vision. Patients may have a blank area in the center of their vision in more advanced cases. There is no cure for macular degeneration, but there is an association with macular degeneration and nutrition. The nutrients Zeaxanthin and Lutein are believed to reduce the risk of developing macular degeneration as well as slowing down its progression. Certain combinations of antioxidant vitamins are also believed to slow down the progression of advanced macular degeneration.

 

Wet Macular Degeneration occurs when abnormal new blood vessels grow under the macula. Fluids from these blood vessels leak and can cause rapid and severe vision loss. Symptoms of wet macular degeneration, as with dry macular degeneration, also include blurring, distortion and/or loss of central vision. These symptoms may occur more rapidly and severely than with the dry form of the disease. Treatment of wet macular degeneration may involve medications injected directly into the eye which cause shrinking of the leaking blood vessels. Laser treatment may also be applied to the blood vessels in an effort to seal them.

 

Early stages of macular degeneration may not be accompanied by symptoms. It is therefore important for patients at risk for the disease to have routine yearly eye exams. Any patients that experience symptoms of macular degeneration should contact their eye doctor immediately. At Reflections Eyecare, Dr. Shultz and Dr. Cohen can carefully monitor dry changes of the macula with digital retinal photography.

Macular Degeneration

Dry eyes may result from a variety of dysfunctions in the eyes ability to produce good quality tears. Tears function to lubricate the eye and keep vision clear . They contain nutrients and antibodies that protect and nourish the eye. Tears are produced by tiny glands in and near the eyelids. These glands produce oil, water and mucus which are all crucial components of good quality tears. In addition to these glands, the lacrimal gland also produces water. The lacrimal gland is located just above the outer corner of the eye. It is believed that the lacrimal gland contributes very little to the eyes normal level of tears. It serves a flushing function when something gets in the eye or irritates it. When the eye becomes dry, it becomes irritated and the lacrimal gland will often respond by flushing the eye. Although counterintuitive, this explains why people who suffer from dry eyes often complain of excess tearing. Unfortunately, these tears do not contain the proper amounts of mucus and oil and do not adequately lubricate the eye. Because of their watery composition, they do not stick to the eye and spill over the eyelid. In addition to excess tearing, patients with dry eye may also experience an irritated gritty or burning feeling in their eye. Dryness may also cause blurred vision and in severe cases, scarring of the ocular surface. Factors that contribute to dryness include age, medications, underlying inflammatory medical conditions and environmental conditions. Chronic inflammation of the eyelids can also cause dry eyes (see Blepharitis).

 

There are several treatment approaches used to manage dry eye. The most common approach is to use artificial tears. These are used to supplement the eyes natural tear production. There are a variety of artificial tears available over the counter. Consult with your eye care provider for recommendations regarding which product is most suitable for you. In some cases, artificial tears may not be sufficient to adequately manage the symptoms caused by dry eye. Another method of managing dry eye is to conserve the natural tears produced by the eye. This is accomplished by blocking the tear drains with tiny plugs. These can be temporary dissolving plugs or removable silicone plugs. This procedure is referred to as punctal occlusion (punctum = tear drain). Other treatment options involve increasing tear production. Nutritional supplements containing omega 3 fatty acids and prescription anti inflammatory eye drops have been shown to be effective. Finally, treatment of any underlying inflammatory condition of the eyelids may be necessary. This is usually accomplished with prescription eye drops, medicated eyelid cleaners, and warm compresses.

 

Depending on the individual situation of the patient, effective treatment may involve punctal occlusion or simply the right combination of over the counter supplements. Whatever the case may be, Dr. Schultz and Dr. Cohen have a variety of treatment options available to manage the dry eye patient at Reflections Eyecare.

Dry Eyes

Blepharitis is an inflammatory condition of the eyelids. It causes the eyelid margins to become red and inflamed. The formation of dandruff like particles in the eyelashes may also occur. It is usually caused by bacteria or skin conditions such as rosacea. Patients with blepharitis often experience burning, swollen eyelids, tearing, redness of the eyelid margins, frequent styes, and dry eyes. In severe cases, scarring of the ocular surface and cornea may result. Blepharitis is a chronic condition and depending on the severity, may need to be managed on an ongoing basis.

 

Anterior blepharitis involves the front of the eyelid and the eyelashes. It is most commonly caused by an abnormally high amount of bacteria that normally live on our eyelids and skin. Anterior blepharitis may also result from rosacea and skin disorders that cause dandruff of the eyebrows and scalp.

 

Posterior blepharitis results from the improper function of the oil glands that line the inner edge of the eyelids. The oils secreted by these glands are an important component of normal healthy tears. It can be caused by underlying skin conditions such as rosacea and scalp dandruff. As a result, the normally clear oil secretions of the gland become cloudy and stagnant. This creates an ideal environment for bacterial growth which may result in stye formation.

 

Treatment involves cleaning the eyelids with medicated lid scrubs available over the counter. Warm compresses over the eye lids as well as lid massage help restore the proper function of the oil glands. In more severe cases, prescription anti-inflammatory antibiotic combination eye drops are beneficial.

The conjunctiva is a thin clear membrane that coats the inner surface of the eyelids and the white part of the eye. Conjunctivitis and pink eye are generic terms that refer to an infection or inflammation of the conjunctiva. Conjunctivitis is most often caused by infections and allergies. Infections may be bacterial, viral, or fungal. Conjunctivitis may also result from anything that irritates of the conjunctiva. Examples include a dirty contact lens or chlorine from a swimming pool. Some forms of conjunctivitis are contagious and care must be taken not to transmit the infection by touching the eye and then touching other objects that people may come into contact with. Some forms of conjunctivitis may resolve on their own and some may require medical treatment. Conjunctivitis may involve the cornea, the clear tissue that forms the window in the front of the eye. When this occurs, there is the potential for scar formation on the cornea which may result in permanent visual compromise. In this situation, prompt medical intervention is necessary. It is therefore important to see an eye care professional as soon as possible whenever a red eye develops, especially in the presence of blur or pain.

 

A corneal ulcer is often mistaken for pink eye. It usually results from a bacterial infection of the cornea but can be caused by other organisms and sources of inflammation. Corneal ulcers are most commonly seen in patients who sleep in their contacts. The patient typically experiences a red eye accompanied by pain, tearing, and light sensitivity. Without prompt medical care, permanent visual loss can result from corneal scaring. When left untreated, the infection can penetrate the cornea resulting in the loss of the eye. Once again, it is important to see an eye care professional as soon as possible if a red eye develops, especially in the presence of blur or pain. Dr. Schultz and Dr. Cohen are both certified in the therapeutic treatment and management of ocular disease and are able to treat a wide variety of ocular conditions.

Conjunctivitis and The Red Eye

The cornea is the clear tissue that forms the window in the front of the eye. Keratoconus is a condition that causes the cornea to become thin and distorted. The irregular corneal surface prevents light from coming to a sharp point of focus on the retina, causing the image to be distorted and blurry. This disease typically appears during the late teenage years and may continue to progress for one to two decades before stabilizing. The amount of progression is different for each patient and severe cases may require a corneal transplant. The majority of keratoconus patients however, will not require surgery.

 

Treatment of keratoconus is directed towards correcting the visual distortions and blur created by the condition. In its early stages, glasses and soft contact lenses can be effective. As the condition progresses, custom contact lenses may be required. In the past, we were limited to rigid gas permeable contact lenses (RGPs). Today RGPs still remain an excellent option for the management of keratoconus. Recently however, there has been much emphasis among specialty contact lens companies to develop soft lens and rigid soft lens hybrid technology to treat keratoconus. As a result, there are new and exciting treatment options available. At Reflections Eyecare, we specialize in the custom contact lens fitting of keratoconus patients. Dr. Schultz and Dr. Cohen thoroughly evaluate each case to derive the most effective treatment option for the keratoconus patient.

 

Keratoconus