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Eye Conditions
A cataract is a gradual clouding of the natural lens of the eye. As a cataract forms, more of the entering light is scattered rather than focused precisely on the retina. Cataracts are most commonly formed as part of the natural aging process. At the age of 60, over 50% of the population already have signs of cataracts. Cataracts can also form in younger patients. These cataracts may form due to injury to the eye, diabetes, or long-term use of certain medications.

Cataracts associated with aging often take years to develop. The rate of progression varies with each patient. There are no eye exercises, dietary supplements, or optical devices proven to prevent or cure cataracts. Protection from excessive sunlight may slow the progression of cataracts. Glasses with UV protection should be worn as much as possible.

What Causes Cataracts?

The most common causes of cataracts are aging, diabetes or other eye diseases, injury to the eye, some medications such as steroids, too much ultraviolet (UV) light, especially from sunlight, genetics and smoking.

What Are the Symptoms?

The most common symptoms of cataracts are blurry vision, details are hard to see, glare when driving or reading, more light is needed to read, some colors seem dull, glasses prescription keeps changing, and double vision in one eye. Macular Degeneration
  • Age-related macular degeneration, often called ARMD, is the leading cause of visual impairment in senior citizens in America. According to Prevent Blindness America, some 13 million Americans have some amount of ARMD. As the name “age-related” suggests, the chances of getting ARMD increase as one gets older, especially past age 65. It also tends to run in families, although having one or even two parents with the disease doesn’t automatically mean their children will develop ARMD.
  • As the name suggests, the disease causes a degeneration, or breakdown, of the macula. The macula is the center part of the retina responsible for the fine vision needed to read the newspaper or drive. Macular degeneration does not cause total blindness, but the vision may deteriorate to the point where driving and reading become difficult or impossible.
  • There are two types of macular degeneration: dry and wet. Dry macular degeneration accounts for about 90% of cases. Dry macular degeneration begins with the development of yellow-white deposits called drusen in the macula. These drusen are thought to interfere with the normal functioning of the cells of the macula, causing them to degenerate. In some cases, though, drusen deposits can be present for years without leading to ARMD.
  • Eventually, the changes in the macula from dry ARMD lead to a slow, gradual vision loss over many years. The loss of vision may be so slow that no change is noticed from one year to the next. Patients with dry ARMD generally do not lose central vision entirely, but vision loss may make it difficult to perform tasks that require fine vision. Although extensive research is underway, there is currently no way to reverse the vision loss from ARMD. Some patients may be able to slow or stop vision loss using vitamin therapy.
  • Wet macular degeneration accounts for about 10% of cases of ARMD. In wet ARMD, abnormal blood vessels grow underneath the macula and leak blood and fluid, causing a decrease in vision. Because the leakage can be sudden, wet macular degeneration can affect vision rapidly. Wet ARMD tends to cause more severe vision loss than dry ARMD, but there are new treatments that may slow down or stop the leakage. While some people can develop wet ARMD directly, many first develop dry ARMD that converts into wet ARMD later.

  • Glaucoma is one of the leading causes of blindness in the U.S. It most often occurs in people over age 40. People with a family history of glaucoma, African Americans, and those who are very nearsighted or diabetic are at a higher risk of developing the disease.
  • Glaucoma is a slowly progressing disease of the optic nerve. There is progressive damage to the nerve fibers responsible for vision. An increase in intraocular pressure (IOP) is thought to be the cause for progressive nerve damage in the majority of patients with glaucoma.
  • The eye constantly produces aqueous. This clear fluid fills the space between the cornea and the iris known as the anterior chamber. The aqueous filters out of the anterior chamber through a complex drainage system. The delicate balance between the production and drainage of aqueous determines the eye’s intraocular pressure (IOP).
  • An increase in intraocular pressure (IOP) can result from either a malformation or malfunction of the eye’s drainage structures. Left untreated, an elevated IOP causes irreversible damage to the optic nerve and retinal fibers resulting in a progressive, permanent loss of vision. However, early detection and treatment can slow, or even halt the progression of the disease.
  • Glaucoma cannot be prevented, but if diagnosed and treated early, it can be controlled. Unfortunately, vision lost to glaucoma cannot be restored. That is why annual eye examinations are recommended for people at risk for glaucoma.
Common Types of Glaucoma

  • Open Angle
    Open angle glaucoma is the most common type of glaucoma. Even though the anterior structures of the eye appear normal, aqueous fluid builds within the anterior chamber, causing the IOP to become elevated. Left untreated, this condition may result in permanent damage to the optic nerve and retina. Eye drops or laser treatments such as ALT or SLT are generally used to lower the eye pressure. In some cases, surgery is performed if the IOP cannot be adequately controlled with other forms of treatment.
  • Acute Angle Closure
    Acute angle closure is caused by an abnormality of the structures in the front of the eye. In most cases, the angle of the eye is narrower than normal, limiting the outflow of aqueous from the eye. When the outflow of aqueous is completely blocked, there is a sharp rise in IOP called an acute angle closure attack.

  • Patients with acute angle closure may experience severe eye pain accompanied by nausea, blurred vision, rainbows around lights, and a red eye. This problem is an emergency and should be treated by an ophthalmologist immediately. If left untreated, severe and permanent loss of vision can occur in a matter of hours.

  • Secondary Glaucoma
    This type of glaucoma occurs as a result of another problem within the eye or systemic disease such as inflammation, trauma, previous surgery, diabetes, tumor, or medication. In this condition, both the glaucoma and the underlying problem must be treated.
Flashes and Floaters

  • The space between the crystalline lens and the retina is filled with a clear, gel-like substance called vitreous. As we get older, the vitreous thins and may separate from the back of the eye. This is called a posterior vitreous detachment (PVD). When the vitreous pulls free from the retina, light flashes or floaters often accompany it.
  • Are there other causes of floaters?
    PVD is the most common cause of floaters and light flashes. It is usually harmless and no treatment is necessary. However, floaters may also be caused by retinal tears, retinal detachment, infection, inflammation, or hemorrhage.
  • Is there any treatment for floaters?
    If the vision is significantly affected a vitrectomy (surgical removal of the vitreous) may be considered. This treatment is rarely needed since floaters typically become less bothersome over a period of weeks to months.
  • What causes light flashes?
    Typically light flashes are a result of the vitreous gel pulling on the retina. This may occur with PVD, an injury, or a blow to the eye. (Have you ever seen stars after bumping your head?) Occasionally, flashes of light are caused by neurologic problems such as a migraine headache. In this case, the flashes of light are seen in both eyes and usually last several minutes.
  • When should you see your doctor?
    If you notice a sudden shower of floaters, new light flashes, a veil or curtain obstructing your vision, or decrease in your vision, notify your physician immediately. Your doctor will dilate the pupil with drops and examine inside the eye.
  • You can monitor your symptoms by covering one eye at a time and testing your vision. While looking straight ahead, note any obstructions or change in the quality of your central and peripheral vision. Note the duration and intensity of your symptoms, comparing the vision of both eyes. Notify your doctor if you detect any significant changes.
Diabetes and the Eye

Diabetes can affect vision and eye health in many ways. High or unstable blood sugar levels can cause temporary changes in the optics of the eye, leading to blurred vision and trouble focusing. Diabetes can cause cataracts, a clouding of the lens inside the eye. The disease can lead to double vision by affecting the nerves and muscles that control the movement and alignment of the eyes. It can even make the eyes more susceptible to glaucoma. The most important cause of visual impairment from diabetes is diabetic retinopathy. This condition is a result of tiny blood vessels leaking into the retina. Diabetic retinopathy is so common among the diabetic population that up to 20% of patients already have some retinopathy by the time they are diagnosed with diabetes. Nearly all diabetic patients eventually develop this condition. Fortunately, with early detection, most of the visual problems from diabetic retinopathy can be prevented or delayed.

The early stages of retinopathy are called non-proliferative retinopathy. This condition is marked by leakage of fluid or bleeding by the tiny blood vessels in the back of the eye. Eventually the leakage and bleeding can cause the retina to swell and deposits to form. If swelling occurs in the macula, the center of the retina, vision can be affected even if the retinopathy is mild.

The later stages of retinopathy are known as proliferative retinopathy. At this advanced stage, the retina attempts to grow new blood vessels to take the place of the leaking, poorly functioning vessels. Unfortunately, these new blood vessels are fragile. Serious vision problems can develop if these fragile blood vessels bleed. Proliferative retinopathy is very serious and can lead to blindness. The abnormal blood vessels may also grow on the iris, leading to a condition known as neovascular glaucoma.

The good news is that up to 95% of patients with significant diabetic retinopathy can avoid vision loss if they are treated in time. Since early detection of retinopathy is important, it is recommended that all patients with diabetes have a dilated examination at least once a year.

If a patient is at risk of vision loss from retinopathy, they are often treated with a laser treatment to the retina. The goal of this treatment is to prevent abnormal blood vessel growth or reduce swelling in the macula, depending on the type and location of retinopathy.

It has been shown that people with diabetes can significantly reduce their risk of retinopathy in several ways:
  • Maintain good control of blood sugar and low hemoglobin A1c
  • Keep blood pressure within healthy limits
  • Make healthy food choices
  • Exercise regularly several days a week
  • See eye care provider for a dilated exam at least once a year.
Dry Eye Syndrome

Dry eye syndrome is one of the most common conditions treated by eye physicians. Over ten million Americans suffer from dry eyes. Dry eye syndrome is usually caused by a problem with the quality of the tear film that lubricates the ocular surface.
Tears are comprised of three layers. The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation for the tear film to adhere. The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is 98 percent water. The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.
Tears are formed in several glands around the eye. The water layer is produced in the lacrimal gland, located under the upper eyelid. Several smaller glands in the lids make the oil and mucus layers. With each blink, the eyelids spread the tears over the eye. Excess tears flow into two tiny drainage ducts in the corner of the eye by the nose. These ducts lead to tiny canals that connect to the nasal passage. The connection between the tear ducts and the nasal passage is the reason that crying causes a runny nose.
In addition to lubricating the eye, tears are also produced as a reflex response to outside stimuli such as injury or emotion. However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still experience irritation.
Dry eye syndrome has many causes. One of the most common reasons for dryness is simply the normal aging process. As we grow older, our bodies produce less oil—60% less at age 65 than at age 18. This is more pronounced in women, who tend to have drier skin than men. The oil deficiency also affects the tear film. Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.
Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. Stopping periodically to rest and blink keeps the eyes more comfortable.
Contact lens wearers may also suffer from dry eyes. Contact lenses tend to absorb the tear film, causing proteins to form on the surface of the lens. Certain medications, thyroid conditions, autoimmune diseases such as rheumatoid arthritis and lupus, vitamin A deficiency, Parkinson’s disease, and Sjogren’s can also cause dry eyes. Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes. Dry eye syndrome is an ongoing condition that may not be cured. The accompanying dryness, scratchiness, and burning can be managed. Your doctor may prescribe artificial tears—lubricating eye drops to alleviate the dry, scratchy feeling.
Your doctor may also prescribe Restasis (cyclosporine in a castor oil base). This eye drop medication can increase tear production in some patients. Restasis is normally used twice a day. It often takes several weeks before symptoms improve.
Doctors sometimes recommend special nutritional supplements for dry eyes. Studies have found that supplements containing certain essential fatty acids can decrease dry eye symptoms. You can also increase your intake of omega- 3 fatty acids which are commonly found in cold water fish such as sardines, cod, herring, and salmon.

Common Vision Problems
Refractive Error

Refractive errors occur when there is a variance between the focusing strength of the eye and the length of the eyeball. When a refractive error is present, light entering the eye is not focused, which results in a blurry image. Refractive errors are the most common vision disorder and can be corrected by eyeglasses, contact lenses or refractive surgery. The four most common refractive errors are myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia.


Astigmatism is a very common vision problem caused by an irregularly shaped cornea. Blurred vision at all distances is the most significant indicator of astigmatism and many people who have astigmatism also have myopia or hyperopia. It is often present at birth. Family history of the condition increases risk.


Presbyopia is a progressive condition that makes reading and doing close work, such as sewing, increasingly difficult as eyes age. For people in their 40's and early 50's, it's often the first sign of aging; by age 55, it affects everyone. Even those with perfect eyesight may find they can no longer read books and printed materials at normal distances.


Amblyopia (or lazy eye) occurs when vision in one of the eyes is reduced because the eye and the brain are not working together properly. Amblyopia is the most common cause of visual impairment in childhood. It affects about 2% of adolescents. Amblyopia usually develops before the age of 6 and can persist for life if untreated. It causes more vision loss than trauma and all other ocular diseases.


Strabismus is when eyes are turned in, turned out or not working as a team. It affects up to 5 percent of all children to some degree and can begin during infancy. Signs and symptoms include wandering eye, double vision, vision in only one eye and eyes that appear crossed.
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