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Eye Disease Information

Eye Diagram | Cataracts | Posterior Capsulotomy | Laser Iridotomy | Flashes and Floaters | Diabetic Retinopathy | Glaucoma | Macular Degeneration

 

Eye Diagram

Cataracts

What is a cataract?

A cataract is a clouding of the eye’s naturally clear lens. When light enters the eye it is focused with the lens to a sharp point on the retina. This provides clear vision. With a cataract, light enters the eye and scatters producing a blurry image on the retina. This makes your vision fuzzy.

 

What causes cataracts?

Cataracts develop as a normal part of aging. If you live long enough everybody develops them. Cataracts can also form from injuries, certain diseases, medications, or long-term exposure to sunlight or ultraviolet light.

 

How can cataracts be treated?

If cataracts are only slightly blurry changing your eyeglass prescription may sharpen your vision for a while. There are no medications, eye drops, or exercises that improve or make cataracts disappear. Surgery is the only way to remove a cataract. When you are having problems doing you normal activities (driving at night, reading fine print, or needle work), cataract surgery should be considered.

 

Cataract surgery is the most commonly performed surgery in the United States. Surgeries are done as an outpatient surgery and usually only require topical anesthesia. Only one eye is done at a time, with the other eye done about 1 month later.

 

What happens during cataract surgery?

Under an operating microscope, the doctor makes 2 small incisions through the cornea for the instruments. The cloudy cataract is broken up into small pieces and is vacuumed out of the eye. A clear plastic lens is placed where the cataract was removed. A shield may be placed on your eye temporarily. After a small stay in the recovery room you are ready to go home.

 

What happens after cataract surgery?

Patients use eye drops for 3-4 weeks after surgery to prevent infections and for the eye to heal. You will be seen 1 day after surgery, about 5 days after surgery, and then every 1-2 weeks till your eye is healed. After about 6 weeks following the last eye a pair of glasses will be prescribed to fine tune your vision and to help with reading.

 

I thought cataract surgery is done with a laser?

Lasers are not used during cataract surgery, but may be used if scar tissue develops after surgery. The bag that holds the implant in the eye sometimes becomes cloudy months to years after cataract surgery. When the cloudy bag blurs your vision a procedure called a posterior capsulotomy can be performed to remove this scar tissue. This procedure uses a laser to remove the scar tissue and restores your vision back to normal.

 

What are possible complications of cataract surgery?

The success rate of cataract surgery is excellent. Improved vision is usually achieved as long as other vision problems are not present.

Although rare, possible complications are: infection, bleeding, swelling of the retina, retinal detachment, and blindness.

 

Posterior Capsulotomy

A posterior capsulotomy is a surgical procedure done with a laser this is sometimes necessary after cataract surgery. The bag that holds the lens implanted after cataract surgery sometimes develops scar tissue, which makes your vision blurry. This happens months to years following cataract surgery. A posterior capsulotomy uses a laser to create a clear opening in the bag to help restore your vision back to normal.

 

When should a posterior capsulotomy be performed?

You should contact your eye care professional if your vision decreases after cataract surgery. If scar tissue is discovered, a posterior capsulotomy may be recommended.

 

What happens during a posterior capsulotomy?

A cool laser is used to provide an opening at the back of the bag that holds the lens implant. This procedure is painless and is performed as an outpatient procedure. A topical anesthesia is used in eye drop before the procedure. Your vision should improve almost immediately after the laser procedure. There are generally no restrictions following this procedure.

 

What are the possible risks?

As with any eye surgery, there are associated risks, but they are extremely rare and include:

retinal detachment, increase eye pressure, dislocation of the implant, and prolonged inflammation of the eye.

Laser Iridotomy

A laser iridotomy is a surgical procedure used to treat patients who have a narrowing in the drain located at the front of the eye. If this drain becomes too narrow patients are at risk of developing closed-angle glaucoma.

 

What is Glaucoma?

There are 2 main categories of glaucoma: open-angle glaucoma or closed-angle glaucoma. Open-angle glaucoma is the most common type and is caused by an over production of clear fluid (aqueous humor) in the front of the eye or a slowing of the drain resulting in a chronic rise in eye pressure.

 

Closed- angle glaucoma is another form of glaucoma that causes a rise in pressure. In this form of glaucoma the pressure quickly rises because of a narrowing or blockage of the drain located at the front of the eye. This drain is responsible for draining the aqueous humor that fills the front part of the eye and is produced continually. When there is a problem with the drain the fluid backs up in the eye and causes the pressure inside the eye to spike quickly. If this happens this situation is called a closed-angle attack and is an emergency.

 

What are the symptoms of a closed-angle attack?

Symptoms of an acute closed-angle attack include:

-Severe eye pain and redness

-Decreased vision

-Halos around lights

-Headache on one side of your head

-Nausea or vomiting

 

If you experience these symptoms please call our office 217-233-3101 to be seen immediately. If this is not treated in a matter of hours you may lose your sight permanently.

 

Who is at risk of a closed-angle attack?

People who are far-sighted, have dense cataracts, or people who take cold or sleeping pills that may dilate the pupil.

 

What happens during a laser iridotomy?

An ophthalmologist uses a laser to create a small hole in the periphery of the iris to create a new pathway for the aqueous humor to drain. This pathway provides a way for the fluid to continually drain greatly reducing the chance of an angle closure attack. This procedure is done on an outpatient basis and is performed with a topical anesthetic. This procedure will only take a few minutes.

 

What are the potential complications?

Complications following the laser are uncommon, but some patients may experience some side effects, including: blurred vision, minor bleeding, light streaks, re-treatment, and inflammation. These are usually temporary and resolve with treatment.

 

 

 

Flashes and Floaters

 

 

What are Floaters and Flashes of light?

If you see black specks or squiggly lines that move around in your vision when moving your eye, these are called floaters. They are more noticeable when looking at a light background like the sky. Floaters are small clumps of gel that are suspended in the vitreous, the clear jelly-like substance that fills that back of the eye. Floaters can appear as different shapes such as little dots, circles, lines, clouds or cobwebs.

 

What causes floaters?

When people get older the vitreous shrinks, thickens, and forms strands inside the eye. As the vitreous shrinks it pulls away from the retina and causes a posterior vitreous detachment. This is the most common cause of floaters.

 

Posterior vitreous detachments are more common in people who: are near sighted, have undergone cataract surgery, have had a posterior capsulotomy, had trauma to the eye or head, or have had inflammation inside of the eye. If you see floaters or develop new floaters call us immediately at 217-233-3101. This is an emergency and could be a sign of a retinal tear or detachment.

 

Are floaters serious?

The retina can possibly tear when a posterior vitreous detachment occurs. A tear in the retina can lead to a retinal detachment. If a retinal detachment is not treated promptly, permanent vision loss can be a consequence. Contact us immediately at 217-233-3101 if you ever see a new floater or flashes of light.

 

What is the treatment for floaters?

If floaters are not caused by a retinal tear or detachment then they are harmless. Floaters usually fade or become less noticeable when gravity pulls them out of your line of sight. Observation is the treatment of floaters. There are no eye drops or vitamins that make floaters disappear.

 

What causes flashes of light?

Flashes of light are seen when the vitreous shrinks in the back of the eye and tugs on the retina. The vitreous is commonly attached at various places on the retina and around the optic nerve. Flashes of light may appear in either eye and can be an early warning sign of a tear or detachment of the retina. If you experience flashes of light in your vision call us immediately at 217-233-3101.


Diabetic Retinopathy

 

 

How does diabetes affect my eyes?

Diabetes is a disease that affects blood vessels and some of the smallest blood vessels are in the eye. When the blood vessels are damaged from diabetes they leak blood, protein, and other fluids in the retina. If this happens in the center of the retina, called the macula, this leads to a decrease in vision. Diabetes can also lead to retinal detachments and cataracts earlier in life if it is not well controlled.

 

(Normal picture of the retina. The arrow is pointing to the macula or central area of the retina).

 

Types of Diabetic Retinopathy

 

Non-proliferative diabetic retinopathy (NPDR)

(Yellow spots are exudates and red dots are leaking blood.)

 

Non-proliferative diabetic retinopathy or background diabetic retinopathy is an early stage of diabetic retinopathy. In this stage there may be blood or fluid that leaks within the retina. Sometimes the fluid causes the retina to swell forming exudates or deposits in the retina. Many diabetic s have mild NPDR, which usually doesn’t affect their vision. When vision is affected it is usually the result of macular edema and/or macular ischemia.


Macular edema is swelling or thickening of the macula, the central area of the retina. The macula is used when reading, looking at faces, or any fine detailed work. This swelling is caused by leaking of flood from the blood vessels. Macular edema can cause mild to severe vision loss. Treatment may restore some or hopefully all of the lost vision.

 

Macular ischemia happens when small blood vessels (capillaries) close in the macula. Vision blurs permanently when the macula does not receive an adequate supply of blood.

 

Proliferative Diabetic Retinopathy (PDR)

PDR is present when abnormal blood vessels grow on the surface of the retina or optic nerve. The main reason for PDR is a widespread closure of blood vessels, preventing adequate blood flow. The retina responds by attempting to provide its own supply with these abnormal blood vessels. Unfortunately, the new blood vessels do not resupply the retina with normal blood flow. These vessels often cause a wrinkling or detachment of the retina. Proliferative diabetic retinopathy is usually more devastating to one’s vision because it can affect both central and peripheral vision.

 

(Example of proliferative diabetic retinopathy. The abnormal blood vessels are the thin stringy appearing red lines.)

 

PDR also has the ability to decrease vision from vitreous hemorrhages, retinal detachments, and neovascular glaucoma. Vitreous hemorrhages occur when the fragile abnormal blood vessels break and fill the back of the eye with blood. If the amount of blood is small a floater may be seen which causes only a minimal decrease in vision, but if the hemorrhage is large vision all of the vision may be blocked. It may take days to months for the blood to clear. If the blood does not appear to clear a surgery may be performed, called a vitrectomy, which will remove the blood from the back of the eye. When the vitreous hemorrhage is cleared vision should be restored to its previous state, unless there is damage to the macula.

 

Retinal detachments occur when scar tissue forms along with the abnormal blood vessels on the retina. This scar tissue can shrink, pull and tug on the retina from its normal position. If the scar tissue pulls hard enough it can pull the retina from the back of the eye forming a retinal detachment. If the retinal detachment is not surgically repaired soon, permanent vision loss may occur.

Neovascular glaucoma forms when extensive blood vessel closure on the retina causes abnormal blood vessel formation on the iris. The iris is the colored part of the eye that surrounds the pupil. These abnormal blood vessels grow in the drain in the front part of the eye. The drain becomes occluded with these blood vessels causing a sharp rise pressure inside the eye. If the pressure is not lowered soon it will cause permanent damage to the optic nerve resulting in possible blindness.

 

How is Diabetic Retinopathy Diagnosed?

A dilated retinal exam is recommended at least yearly for anybody with diabetes. During this exam your eye doctor will dilated your pupils to expand their view of your retina. With various lights and lenses your retina will be thoroughly examined from the central to the far periphery of the retina. If diabetic retinopathy is found near the central retina a special test may be ordered called a fluorescein angiography. This test uses a special dye that is injected into your arm while a technician takes pictures of your retina. These pictures will detect any leaking fluid in the central part of the retina. A newer non-invasive test may also be performed called an Optical Coherence Tomography (OCT). An OCT takes a retinal scan using light and detects the presence of fluid within the retina.

 

How is Diabetic Retinopathy Treated?

The best treatment is to prevent the development of retinopathy with strict control of blood sugar, blood pressure, and cholesterol. If diabetic retinopathy develops a referral to a retina specialist is usually warranted. Depending on the location of retinopathy this doctor may do an injection or laser treatment to help save or improve your vision.

 

When do I schedule my eye exam for diabetes?

Anybody diagnosed with diabetes should see an eye doctor within the first couple months of diagnosis for a baseline retinal exam. Diabetics who are not new should be seen at least yearly for a dilated eye exam. If your blood sugar has large fluctuations you may notice a decrease in vision. Especially if your blood sugar >200 this can cause a change in your vision for weeks after getting your blood sugar under control. Anytime a person with diabetes notices a change in their vision, they should contact their eye doctor immediately.

 

Glaucoma

 

What is Glaucoma?

Glaucoma is a disease usually caused by increased eye pressure (intraocular pressure or IOP) that leads to damage of the optic nerve. This nerve acts like a cable sending all of the visual information from the retina to the brain to be processed. If glaucoma damages this nerve a gradual loss of peripheral vision develops. Over time if glaucoma is not treated irreversible blindness may occur. Blindness can often be prevented with early detection and treatment.

Picture on the left is normal vision and picture on the right demonstrates vision with advanced glaucoma.

 

What causes Glaucoma?

A clear liquid called the aqueous humor constantly circulates around the front part of the eye. This fluid is continually be produced and drained to provide a healthy pressure to the eye. If the aqueous humor is over-produced or if there is a problem with the drain the pressure in the eye raises to an unhealthy level.

 

What are the different types of Glaucoma?

There are 2 main categories of glaucoma: open-angle glaucoma or closed-angle glaucoma. Open-angle glaucoma is the most common type and is caused by an over production of clear fluid (aqueous humor) in the front of the eye or a slowing of the drain resulting in a chronic rise in eye pressure. Typically with this type of glaucoma there are no signs or symptoms. In its early stages vision remains normal. As the optic nerve becomes more damaged, field loss happens so gradual it is not noticed. Side vision loss is not typically noticed until significant damage has occurred to the nerve resulting in large chunks of vision missing. If all of the nerve fibers die, this results in blindness.

 

Closed- angle glaucoma is another form of glaucoma that causes a rise in pressure. In this form of glaucoma the pressure quickly rises because of a narrowing or blockage of the drain located at the front of the eye. This drain is responsible for draining the aqueous humor that fills the front part of the eye and is produced continually. When there is a problem with the drain the fluid backs up in the eye and causes the pressure inside the eye to spike quickly. If this happens this situation is called a closed-angle attack and is an emergency. Symptoms of a closed-angle attack include: blurred vision, severe eye pain, headache on one side of your head, halos around lights, nausea and vomiting. This is a true emergency. If you have any of your symptoms call us immediately at 217-233-3101. Unless this is treated quickly (hours) blindness may result.

 

What are the risk factors for Glaucoma?

Age, elevated eye pressure, family history of glaucoma, African or Hispanic ancestry, past eye injuries, thinner central corneal thickness, systemic problems: diabetes, high blood pressure, migraines, or poor circulation, and pre-existing damage to the optic nerve.

 

If you have one or multiple risk factors along with any possible signs of glaucoma your eye doctor will decide if you have glaucoma or should be followed as a glaucoma suspect. This requires regular office visits and possible treatment if there are any signs of progression.

 

How is Glaucoma diagnosed?

Annual eye examinations are the best way to detect glaucoma. This includes a pressure check and a dilated exam to view the nerve. During the exam, if the doctor feels there are any signs of glaucoma ancillary tests may be ordered to aid in the possible diagnosis of glaucoma. These tests include: side vision test, nerve scan, measure of central corneal thickness, ocular blood flow, optic nerve photos, and multiple pressure checks over a several hour time period called serial tonometry. These tests are usually repeated yearly to monitor for any changes.

 

How is Glaucoma treated?

Treatments for glaucoma include: eye drops, laser surgery, and a filtering surgery. The goal for all of these treatments is to lower the pressure in the eye to prevent further optic nerve damage or side vision loss. Eye drops are the most common type of treatment and are usually started when the diagnosis of glaucoma is made. Eye drops work by improving the outflow of the drain or decreasing the amount of fluid produced in the eye. Never run out or stop using your drops without consulting your eye doctor. It is common for drops to cause stinging or itching, red eyes or redness of the skin around the eyes, changes in energy level, changes in pulse or heart rate, dry mouth, eyelash growth, blurred vision upon instillation, or a change in eye color. If you think you are experiencing any side effects contact your eye doctor to see if the medication should be discontinued. All medications have side effects or can interact with other medications. It is important that you make a list of all you current medications and share it regularly with your eye care provider.

 

A laser surgery may be a good option as a first line treatment or for people that have a hard time remembering or instilling eye drops. The newest laser procedure is called a selective laser trabeculoplasty or SLT. This procedure is done in our office with a cool laser and has been shown to be quite effective. After your laser sessions we can usually stop one of your eye drops if you have had a good effect from the laser. The laser is aimed into the drain and cleans the debris with each shot. This laser is painless and is usually covered on most medical insurances.

The last treatment option for glaucoma is a filtering surgery. This is usually reserved for advanced glaucoma where the pressure is not adequately controlled with multiple drops and laser treatments. Filtering surgery is performed by a glaucoma specialist in an operating room. This surgery is an outpatient surgery that creates a drainage channel for the fluid in the eye to drain.

 

Macular Degeneration

 

What is Macular Degeneration?

Macular degeneration is a deterioration or breakdown of the macula. The macula is the central part of the retina that is responsible for central vision. If the macula has any diseases or irregularities, then the central part of a person’s vision will be distorted or blurry. Macular degeneration affects a person’s near and far vision, and can make some activities like reading or needle work difficult.

 

This is a diagram of a normal appearing retina. The fovea is the very center of the macula.

 

 

 

(This is a picture of dry macular degeneration. The white dots in the macula are called drusen and are a hallmark of macular degeneration.)

 

What causes macular degeneration?

Macular degeneration is more common as a person ages. People who have a family history of macular degeneration are also more like to develop it. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65 years old. Why macular degeneration develops is unknown, but a lot of research is aimed at finding the cause and possible prevention.

There are two main types of ARMD or age-related macular degeneration: dry (atrophic) or wet (executive) macular degeneration. The most common is the dry form of ARMD. This is usually caused by the retina wearing out from aging and usually causes a gradual decrease in vision. The wet form of macular degeneration accounts for about 10% of people with ARMD. This type is caused by abnormal blood vessels that form underneath the macula and bleed. Vision is severely affected and can occur quickly.

 

What are symptoms of macular degeneration?

In the early stages vision remains unaffected, but as this disease progresses central vision loss becomes prominent. A person may not notice changes in one eye, but if both eyes are affected changes in vision are easily detected. Common changes that people notice that could be a sign of macular degeneration are: missing or blurry words while reading, unable to distinguish facial characteristics, and a waviness or distortion of straight lines. A common test that doctors give their patient to monitor changes in macular degeneration is called the Amsler Grid. <-Make amsler grid a link to another page for someone to print out.

 

 

Most common variation of an Amsler Grid. Directions are below.

Directions:

1. Put on any glasses you use to read with.

2. Hold the grid at about 16 inches from your eyes.

3. Cover one eye with your hand

4. While looking at the central dot, make sure you can see all four corners and note any wavy lines or missing areas of the grid.

5. Contact your doctor if any areas of the grid change over time.

6. Repeat with other eye.

 

How is macular degeneration diagnosed?

Annual dilated eye exams with your eye doctor are the best way to monitor for macular degeneration. During this exam your eyes will be dilated to get a direct view of the macula to detect any sign of macular degeneration. If there are any signs of macular degeneration, photos or retinal scans will be taken to document any sign of macular degeneration and to use as a comparison for future visits.

 

How is macular degeneration treated?

Treatments for this disease depend on what form of macular degeneration you have. The dry form of macular degeneration is treated with vitamins. These vitamins are a formula of antioxidants, zinc, copper, lutein, and vitamin A. This formulation of vitamins was taken from the AREDS studies. These studies have shown that taking these vitamins at the recommended dosages can help slow or stop the transformation of dry macular degeneration into wet macular degeneration.

 

Wet macular degeneration can be treated with a cool laser treatment called photodynamic therapy (PDT) or with injections into the eye of anti- vascular endothelial growth factor (anti-VEGF). The PDT laser is a cool laser that is aimed at the abnormal blood vessels in the retina to stop them from leaking. This treatment is seldom used compared to the anti-VEGF injections. The chemical in the retina that is responsible for the formation of abnormal blood vessels in wet macular degeneration is VEGF. The injections of anti-VEGF bind to the retina blocking the VEGF from binding. This causes the abnormal blood vessels to stop growing and slows their leaking. These treatments are more effective the earlier wet macular degeneration is caught.

To help patients adapt with decreased vision from macular degeneration, your eye doctor may send you out for low vision consultation. A low vision specialist can provide a wide range of services to help people maintain an active lifestyle. You may be prescribed magnifying glasses, telescopes, or other visual aids to help perform a specific task.