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QUESTIONS AND ANSWERS ABOUT MODERN CATARACT SURGERY WILL IT HURT? No. The eye will be numbed with anesthetic eye drops and although you will be awake for the procedure, you should not feel any pain. IS IT SAFE? Yes. Although no surgical procedure is 100% risk free, millions of individuals have had their eyesight improved with cataract surgery. WHEN SHOULD I HAVE MY CATARACT SURGERY DONE? At one time ophthalmologists waited until a cataract was ripe, that is, the individual could no longer see, before proceeding with surgery. That was because the treatment required a hospital stay, general anesthesia and vision was only possible with very thick eyeglasses. Today’s improved procedures allow cataracts to be removed when they begin to interfere with your day-to-day activities. You need not wait until you are blind or the cataracts are ripe. HOW SOON CAN I SEE? With today’s advances in the surgical treatment of cataracts, your vision should improve within twenty-four hours. HOW WILL MY EYE FEEL?
ARE THERE ANY LIMITATIONS TO MY ACTIVITIES? Refrain from eye rubbing and swimming for the first several weeks following the surgery to avoid injury or introducing infection. You will normally be given eye drops to use four times a day for the first two weeks. No bandage is required and you are encouraged to use the eye right away. If your present prescription eyeglasses need to be changed, you may find a drug store type reading glass with +2.50 diopters correction will be satisfactory for reading. You may resume all other normal activities. GLAUCOMA ARE YOU AT RISK FOR GLAUCOMA? When we hear the word glaucoma, most of us think of blindness. Although glaucoma is one of the leading causes of preventable blindness, today, with advances in glaucoma treatment, most people can lead normal lives without fear of losing their vision. The term glaucoma describes a medical condition in which an increase in fluid pressure within the eye causes damage to the optic nerve, and ultimately, vision. Under normal circumstances, a certain amount of clear aqueous fluid is produced by a structure known as the cilliary body within the eye. This fluid bathes the inner structures of the eye assuring clear vision. However, in circumstances that are not clearly understood, this fluid fails to escape from the glaucomatous eye through normal channels, and that condition causes an abnormal build-up of pressure. If untreated, damage to the sensitive optic nerve can result, leading to loss of vision. It is very important to know that there are very few symptoms from glaucoma. In fact, most people with the disease have no symptoms at all. As the build-up of fluid pressure continues over time, a reduction of peripheral vision occurs gradually. Usually this can only be detected with a specialized test known as a visual field exam. CAN YOU TELL IF YOU ARE AT RISK FOR DEVELOPING GLAUCOMA?
The answer is not simple, and that’s why you need regular eye
exams. Glaucoma is an
insidious disease and can develop in any individual at any age.
It is, however, more common in individuals over forty years of age.
The single greatest risk factor in developing glaucoma is a family
history of glaucoma. Children
and siblings of people who have gl DIAGNOSIS The diagnosis of glaucoma can only be made by a thorough examination of the eye which includes a test for intraocular pressure (Tonometry), a measurement of the entire field of vision (Perimetry), and a direct examination of the optic nerve (Fundoscopy) to identify signs of damage (Optic Nerve Cupping). Because glaucoma can be a silent disease and the effects of visual loss irreversible if not diagnosed and treated early, everyone should have a complete examination for glaucoma as part of a regular eye examination. There are two major types of glaucoma, open-angle and –closed-angle. Closed-angle glaucoma is much less common and is usually seen in elderly individuals who are very farsighted or have a family history of angle closure glaucoma. It is distinguished by the painful sudden buildup of eye pressure by the mechanical apposition of the iris or colored part of the eye blocking the drainage of aqueous fluid through the normal drains. The open-angle variety is much more common and is distinguished by the painless buildup of eye pressure gradually over time as the normal drainage system of aqueous fluid within the eye becomes clogged. TREATMENT The treatment for these two types of glaucoma are different. Therapy takes several forms including eye drops to lower the production of fluid or increase its removal from the eye. When eye drops or oral medications are not effective in lowering eye pressure, then the argon laser may be used. Many individuals have reduced ocular pressure following a single laser treatment. This may decrease the need for additional eye medications. Many patients require oral medication with a pressure reducing drug known as a carbonic anhydrase inhibitor. Treatment may be discontinued due to undesirable side effects. Fortunately recent research has developed new more soluble forms of this compound that can be administered in eye drops without the potential problems that oral medication can cause. If eye pressure fails to respond to either medication or laser treatment, surgery may be performed. This surgery, for which there are presently several methods, creates a new channel for fluid drainage that bypasses the clogged drainage passages inside the eye.
GLAUCOMA CAN DESTROY UP TO HALF OF THE SENSITIVE NERVE CELLS CONNECTING THE RETINA AND THE OPTIC NERVE BEFORE THE PATIENT NOTICES ANY VISUAL LOSS. Not only is this a silent disease without symptoms, it can be devastating as well. Ten million Americans have elevated intraocular eye pressure associated with glaucoma and one million of them have undiagnosed signs of the disease. Many individuals are at risk of losing their vision from a disorder that is treatable if identified early. MACULAR DEGENERATION AND VISION Age-related macular degeneration (AMD) is a disorder of the back of the eye (retina) that results in a deterioration of central vision. It is the number one cause of blindness in individuals 65 years of age and older. Dozens of studies have been undertaken over the past 15 years to better understand this frustrating disorder. Enthusiasm for new treatments for this disease has diminished as research studies show little progress in a medical or surgical “cure.” Many approaches to treatment such as interferon, radiation therapy, surgery to relocate the diseased area of the retina, blood plasma filtration treatments and photodynamic therapy have not yielded an improvement in vision. AMD is a genetic disorder. Some day we may understand why it occurs; why it is more common in family members with the disease; and what can be done to prevent its occurrence. In this article, I would like to outline what we do know about the benefits of early diagnosis and preventative care, to help slow the progression of AMD. You do not have to lose vision with AMD. MACULAR DEGENERATION AND THE ROLE OF NUTRITION
When your mother told you to eat your carrots because it was
good for your eyes, she was probably right. In fact, eating your spinach may actually be better.
The role of nutrition in the process of macular degeneration is
well known. Two substances
known as carotenoids found in green leafy vegetables may
significantly reduce an individual’s risk of developing AMD.
They may also help preserve vision and prevent further
deterioration of the retina. Substances,
also known as anti-oxidants, exist in high concentration within the
pigment of the central part of the retina in the back of the eye (ma Two specific carotenoids, lutein and zeaxanthin, have been associated with a decreased risk of AMD. As you might expect, these two substances also appear in high concentration within the macular pigment. The body cannot manufacture lutein on its own, and that is why an adequate dietary intake is important. A diet high in fruits and vegetables helps increase the concentration of this substance in the blood. A study published in 1988 showed that individuals with AMD who consume fruits and vegetables in their diet and increase their intake of beta carotene (vitamin A) had increased protection from AMD compared to those who did not. Vitamins A, C, and E, as well as the trace mineral zinc, also play an important role. CAROTENOID CONTENT OF VEGETABLES
FACTS ABOUT AMD
RISK FACTORS FOR AGE-RELATED MACULAR DEGENERATION
WHAT YOU CAN DO TO REDUCE YOUR RISK OF DEVELOPING AMD
WHAT YOU CAN DO TO MAXIMIZE YOUR VISION WITH AMD
WHO TO CALL FOR LOW VISION DEVICES
111 East 59th Street, New York, NY 10022 Phone (800) 334-5497 Fax (212) 821-9705 ATTN I&R Information on eye diseases, low vision resources
The Lighthouse Low Vision Catalog, Optical Products, Non-optical products and Educational Materials 111 East 59th Street, New York, NY
LS&S Group Catalog of products for the visually and hearing impaired Phone (800) 468-4789 Fax (847) 498-1482 E-mail Issgrp@aol.com
Tech-Optics International Catalog, vision care products 59 Hanse Avenue, Freeport, NY 11520 Phone (800) 678-4277 Fax (800) 678-0002
Eschenbach Optik of
America Catalog, Low Vision Rehabilitation Program 904 Ethan Allen Highway, Ridgefield, CT 06877 Phone (203) 438-7471 Fax (203) 438-1670 http://www.ESCHENBACH.com
Designs for Vision, Inc., Optical Aids for the Partially Sighted Custom designed telescopic and microscopic lens systems, special orders 760 Koehler Avenue, Ronkonkoma, NY 11779 Phone (800) 345-4009 Macular Degeneration Help Center Macular Degeneration Foundation AMD Alliance Macular Disease Society http://www.maculardisease.org
NEW BREAKTHROUGH RESEARCH: Ongoing Clinical Trials from the National Eye Institute http://www.nei.nih.gov/neitrials_script/toc-researcharea.asp Photodynamic Therapy http://www.AmericasDoctor.com/clin_trials_irb.html Visudyne http://www.visudyne.com/Vis_Graphics/site/HealthFrameset.html Complications of the Age-Related Macular Prevention Degeneration Laser Trial http:www.vitreoussociety.org/capt/frames/homefr.htm Age Related Macular Degeneration Radiotherapy Trial (AMDRT) http://www,mcg.edu/SOM/EYE/amdrt/index.html Submacular Surgery Trials http://www.meei.harvard.edu/research.abs/clinical.html#submacular Oral Anti-Protease Inhibitor Trial http://www.agouron.com/Pages/amd_frame.html Anti-VEGF Antibody Fragment Study http://www.gene.com/Pipeline/pipeline.html#rhufabv2 Thalidomide Clinical Trials Lipid Filtration from the Circulation Rheophoresis Study http://www.occulogix.com/AMD/
RETINITIS PIGMENTOSA Another, though more severe and inherited disease of the retina is Retinitis Pigmentosa or RP. Individuals who are diagnosed with one of the many forms of RP can experience severe and devastating loss of vision over time. Recent evidence has shown that Vitamin E is not helpful in this disease and because of adverse effects it is not advised. For patients with RP the use of Vitamin A has been advised. This should be taken as 15,000 International Units of Vitamin A palmitate. Beta Carotene was shown to have no prophylactic value. The recommended dosage of vitamin A palmitate was shown to be beneficial in reducing the rate of deterioration of the electroretinogram, a measurement of the sensitivity of the retina and therefore the visual field in patients with RP. Doses in excess of the recommended amount are potentially toxic and are to be avoided. Most likely a product will become commercially available in the near future. Those with RP and their families are encouraged to contact the RP Foundation at 1-800-683-5555 for more information.
Diabetes is a disorder in the body’s ability to absorb and
utilize sugar (glucose). Some
individuals inherit this condit As you recall, the retina is the thin film of tissue and blood vessels in the back of the eye that is responsible for recording the fine details of vision within it’s center, the macula, or it’s side vision, the periphery. The retinal is fed with millions of tiny vessels that provide oxygen carrying blood and nutrients and remove wastes. In diabetes these vessels can become fragile and break or leak. When this occurs, it is known as Background Diabetic Retinopathy. When circulation to the retina is impaired by progression of this process then these vessels can close and permanently impede the flow of nutrients and oxygen. The retina responds by creating new vessels in a process known as Proliferative Diabetic Retinopathy. Unfortunately, these new vessels are abnormal and re more likely to bleed and leak making the condition worse. A procedure known as Intravenous Fluorescein Angiography can be performed to photograph and study the leaking areas of the retina. There is a treatment for diabetic retinopathy using a high energy light beam known as a laser. Using this treatment, abnormal areas of the retina can be obliterated before the leaking and hemorrhage leads to permanent damage. The key to saving vision is early diagnosis and treatment. Diabetics are also at increased risk for the development of cataracts and glaucoma. In diabetic eye disease, warning signs and symptoms may not be apparent. That is why it is crucial that any individual with diabetes be examined by an ophthalmologist at least once a year or more frequently if any evidence of retinopathy is present on examination. The ophthalmologist will then decide if treatment is required and how often to be reexamined. The longer one has diabetes, the greater is the likelihood that complications from the disease will affect the eyes. Naturally, following the advice of your doctor and controlling blood sugar is the most important thing that can be done to prevent the complications of diabetes.
Previously called retrolental fibroplasia, this disorder of the
retina is commonly seen in infants born prematurely.
The eyes are not fully developed until almost a year after an
infant is born. If the child
is born too soon, the eyes and particularly the retina is not fully
formed. Because of its
immaturity, the retina is particularly susceptible to the influence of
excess oxygen. Premature
infants have breathing problems due to the immaturity of their lungs and
often they require added oxygen for prolonged periods of time.
This can lead to the development of abnormal vessels in the retina
(ROP). Left undiagnosed and untreated this condition can lead to blindness. That is why all premature infants or children who required oxygen shortly after birth, should have their retinas examined by an ophthalmologist. At one time or another, everyone has experienced the symptoms of red eye. Red eye refers to the inflammation of the outer coating of the eyeball, the conjunctiva, which is why it is also called conjunctivitis. The four most common causes of red eye are dry eye, allergy, bacterial and viral infection (so-called pinkeye). When the eye gets irritated from dryness or exposure to irritants such as cigarette smoke, hairspray, exhaust fumes and the like, its outer covering will swell and the microscopic blood vessels on its surface will dilate causing the eye to look red. In dry eye, the eyes may feel gritty or sandy and may tear profusely. Treatment usually takes the form of eye drops made of artificial tears, and the use of a humidifier. Untreated dry eye can lead to secondary infections with bacteria or viruses. In allergic conjunctivitis, a pollen, mold or allergen causes the eye to release histamine, the surface of the eye to swell and a whitish mucus to be produced as the body’s way of trying to rid itself of the antigen. Avoidance of known allergens that usually also make your nose run or cause you to sneeze or itch can help. The use of over-the-counter decongestant eye drops (with an ingredient such as naphazoline) can provide some symptomatic relief. Also cool compresses, a washcloth placed on the closed eyelids, may be comforting. Sometimes oral antihistamines are required. If the red eye produces a colored discharge that is yellow or green it is probably a bacterial infection of the eye. These infections are quite common and are easily passed between children at school, or between children and adults. They are best diagnosed and treated by an ophthalmologist with the appropriate antibiotic eye drops that are available by prescription only. Watery discharge from a red eye, sometimes associated with the common cold, sore throat, earache, or swollen lymph nodes is most commonly viral in origin. Viral infection can sometimes lead to secondary bacterial infections and that is why careful examination by an ophthalmologist is advised. Viral conjunctivitis is very contagious (the so-called infectious pinkeye) and is easily passes from person to person by casual contact, water droplets such as a sneeze and hand to eye contact such as sharing towels. For these reasons it is important to isolate anyone who has a viral conjunctivitis from contact with others until the infection has cleared.
A subconjunctival hemorrhage commonly occurs during sleep when a small blood vessel breaks and bleeds. It appears as a red velvety collection of blood under the conjunctiva of the white part of the eye. It is harmless. Foreign bodies are common after grinding or hammering metal with some entering the eye. They should always be removed. Abrasions occur when the skin covering the cornea is scraped off. This can happen following direct trauma with a fingernail or something striking the eye and is common with contact lens wearers. It should be treated by cleansing, applying an antibiotic ointment and bandaging until healed. When an infection of the cornea occurs with the herpes virus, a characteristic foreign body sensation, light sensitivity and discomfort occurs. Much like a cold sore on the lips, herpes infection of the eye is recurrent and because of its location on the eye, can permanently affect vision. When the possibility of a herpes infection is present, prompt evaluation and treatment by an ophthalmologist is indicated. Fortunately, there are antiviral medications to shorten the duration of the attacks. Iritis is an inflammation of the inside of the eye which causes pain, light sensitivity and decreased vision. It needs prompt treatment with anti-inflammatory medications and like the herpes infection, it is often recurrent. Any red eye that fails to improve within three days of treatment should alert the individual to the possibility of a more serious cause that requires medical evaluation and treatment. Red eyes although uncomfortable, generally do not affect vision and are NOT painful; therefore if a red eye is associated with a change in vision or eye pain prompt evaluation and treatment is advised. Everyone experiences symptoms of dry eyes at one time or another. Conditions that speed up the evaporation of tears from the surface of the eye such as dry, arid climates, wind, a fan blowing, running and air conditioner or heater in your car, or sitting in front of a fireplace, can all bring on the symptoms of dry eye. In addition, certain diseases such as thyroid problems, diabetes, or rheumatoid arthritis can increase the likelihood that dry eyes will develop. Women are more symptomatic than men, and those who are menopausal are most likely to be affected. Also, environment plays an important role whether or not a dry eye problem will affect you. Those who live in cold or hot arid climates are more susceptible to symptoms, for example, than those who live in moist, tropical environments with high levels of humidity.
The symptoms are made worse when an individual is using oxygen or taking medications such as, diuretics, antihistamines and bronchodilators, which dry out the mucous membranes. HOW CAN I TELL IF I HAVE DRY EYE? The symptoms of dry eye include a feeling of something in the eye often described as “like someone threw sand in my eyes,” a burning sensation, and blurry vision. These symptoms can lead to excessive tearing and redness. Symptoms may be greatest upon awakening if the eyes have dried out during sleep or may worsen as the eye continue to dry out during the day. TREATMENT The treatment of dry eye eliminates the factors which promote drying and supplements the normal tear production. Eliminating drafts on the face, such as rolling up the windows when driving often may be all that is needed. Using sunglasses or eye protection out of doors, especially on windy days, and using a room humidifier during sleep may provide marked improvement in symptoms. There are a wide range of artificial tear supplements available without prescription from a pharmacist. Choose preservative-free eye-drops as they are less likely to cause allergic reactions. Avoid decongestants, (the so-called “whitening” additives, such as tetrahydralazine) they may get the red out but they do so by drying the eye out and can make the problem worse. Tear supplements are most effective it used frequently throughout the day before symptoms develop. They are less effective when used intermittently or after symptoms occur. If dry eye bothers you upon awakening, the use of a bland ophthalmic ointment at bedtime applied to the crease between the eyelid and the eye may prevent drying out of the eyes during sleep. CATCH IT SOON
Severe and frequent dry eye symptoms can lead to the breakdown of
the outer surface of the eye and to the development of serious eye
infections that may require m In addition, those who have other symptoms of dryness such as dry mouth may have a specific entity known as keratoconjunctivitis sicca. The treatment of this problem may include bandaging of the eye, closure of the tear ducts to prevent evaporation of moisture, and the use of goggles to reduce tear evaporation. The sun can be an enemy to your eyes as well as your skin. Eyelid skin is the most delicate and thinnest of all skin, and yet people rarely think to protect it from the sun’s damaging rays. Fortunately many commercial products are available, some of which are specially prepared for the eyelid area. The structures within the eye can be harmed by excess sun exposure just like the outer structures of the eye. The use of a brimmed hat and ultraviolet protecting sunglasses is a must during sunlight hours. Avoid the common mistake of reading out of doors in the direct sunlight without eye protection. The reflective rays of sunlight can be damaging to the outer surface of the eye leading to burns to the clear portion, the cornea, and redness and swelling of the white portion of the eye, the conjunctiva and sclera. This may be felt several hours later as a sensation of gravel in the eye or foreign body sensation under the eyelid and can lead to actual pain, depending upon the extent of the injury. All structures of the eye are susceptible to sun damage, both from ultraviolet radiation, as well as the intensity of the full visual spectrum of light. The best protection can be provided through the use of oversized sunglasses incorporating a dark tint and ultraviolet (UV400) filter. If the eyeglasses does not specifically state that is an ultraviolet protecting lens, then assume it is not. Ask your local optician about the availability of ultraviolet protection incorporated into your daily eye wear. SYSTEMIC DISEASE AND YOUR EYES
It is unfair, but chances are if you suffer from a respiratory
disease, thyroid disease, or rheumatoid arthritis, you may be at added
risk for ocular disease as well. Many medications which are quite effective for improving
breathing, also have a drying effect on the eyes (such as decongestants
and antihistamines). Other
medications such as prednisone, can lead to the development of cataracts
or glaucoma. Individuals with thyroid disease are also at risk for severe dry eye. And those with rheumatoid arthritis are at risk for dry eye as well as the complications of Prednisone usage. Patients who take Plaquenil should be examined by an ophthalmologist while on therapy, which should include serial visual field testing to screen for retinal damage from accumulation of the drug. Those who take Amiodarone for their heart can develop deposits on the cornea from the drug. Patients who take Mevacor for cholesterol can develop cataracts while on therapy. Viagra is associated with alterations in vision and should be avoided in some individuals. It is always important to tell your doctor what medications you may be taking as the potential for side effects from the drugs on the eye and systemic drugs can occur. I am often asked, “Will you be using a laser for my eye surgery?” Ophthalmologists have employed the use of lasers for several decades successfully in the treatment of eye diseases. In fact, ophthalmology was one of the first fields of medicine to recognize the importance and benefits of laser surgery. However, laser surgery is not applicable to every individual or every eye disease. Laser is actually an abbreviation for Light Amplification of Stimulated Emission of Radiation. It refers to a series of specialized optical devices that take a specific wavelength of light and amplify it in such a way that the beam that is produced is extremely concentrated. Lasers emit a narrow, finely focused beam of light energy. That is why even though a very lower energy laser beam, such one one-thousandth of a watt, can be far more powerful than an ordinary sixty watt light bulb. Lasers can be used to treat a variety of medical conditions within the eye. Because the eye is optically clear, laser beams can pass into the eye without being absorbed and can therefore be directed specifically at a target tissue to be treated. Depending upon the source or wavelength of light, the color and intensity of each individual laser is correspondingly created. Each individual laser wavelength has a particular use in ophthalmic surgery. Some lasers focus their energy to burn or coagulate and seal vessels in tissue, some cut and some vaporize or ablate tissue. Lasers
have been used in Ophthalmology to treat the eye since the early 1970s.
The lasers are safe and clinically effective. HOW LONG DOES THE TREATMENT TAKE? Most laser treatment sessions are completed in a matter of minutes. Eyedrops are often used to dilate the pupil. HOW DOES MY DOCTOR AIM THE LASER? The laser is connected to a slit lamp. This is a microscope that is similar to the one your doctor uses to examine your eyes. The microscope is focused on the precise part of your eye that needs to be treated. The laser beam is so finely concentrated that no damage occurs to other parts of your eye. WILL THE LASER TREATMENT BE PAINFUL? No. There is little, if any, discomfort associated with the laser treatment. WHAT WILL I EXPERIENCE DURING THE LASER TREATMENT? You will see the light of the slit lamp microscope. You may notice two small red laser beams that are used to focus the laser, and hear the clicking of the shutter of the laser. WHAT IF I MOVE MY EYE OR CLOSE MY EYELIDS? The doctor is in control of the laser during the treatment. You will need to stay focused with your head still while the treatment is in progress. WILL MY VISION BE BLURRED FOLLOWING THE TREATMENT? The bright light may blur your vision as if you stared into a camera's flash. You may see some floating specks for a period following the treatment-this is normal. SHOULD I TAKE MY REGULAR EYE MEDICATIONS ON THE DAY OF THE LASER TREATMENT? Yes. Unless specifically told otherwise, you should take all your medications as you normally would. WHERE
WILL THE LASER PROCEDURE TAKE PLACE? The laser is located within Dr. Kershner's offices. WILL I BE ABLE TO DRIVE MYSELF HOME? Although your vision will be close to normal by the time you leave, most people undergoing laser surgery are a little nervous. It might be best for you to leave the driving to someone else. Argon lasers consist of a laser beam delivered through an optical microscope system and focused by the surgeon into the eye. Argon lasers are in the blue/green spectrum and, therefore, are best absorbed by the pigment within the eye. Their use includes treatment of the drainage system of aqueous fluid for glaucoma, known as Argon laser trabeculoplasty. By placing a series of microscopic dots into the trabecular meshwork drainage system in front of the iris, the surgeon can open up the drains and increase the flow of fluid from the eye. This can reduce eye pressure and its potential damage to the eye in glaucoma. Argon lasers are also used in diabetic retinopathy to coagulate tissue and vessels to prevent leakage of blood and fluid. KRYPTON LASER The krypton laser is another particular wavelength of laser absorbed within the macula or central region of the retina where central vision occurs. This particular laser is utilized by retinal surgeons to treat areas within the macula that may be leaking fluid and to promote sealing of vessels. YAG LASER This most unusual laser was first developed by the Swiss watch industry to drill microscopic gems. | ||||||||||||||||||||||||||||||||||
