Eye Diseases
/ PROFESSIONAL EYE CARE
Eye Diseases Symptoms & Treatments
Explore common eye diseases like cataracts, diabetic retinopathy, and macular degeneration. Learn symptoms, protection, and treatment options.
/ CATARACT SURGERY IN SAN FRANCISCO
Cataracts
Cataracts are one of the leading causes of vision loss in people over 45. A condition that commonly develops as the eye ages, by the time we reach 80, more than half of us will have developed a cataract.
What is a cataract?
A cataract is a clouding of the lens in your eye which is normally transparent. The lens, located inside the eye, behind the iris and the pupil, focuses light onto the retina at the back of your eye, where it is converted to nerve signals that are passed to the brain, allowing you to see. When your lens becomes cloudy, the images projected onto your retina become blurry and unfocused and therefore the signal to the brain is also unclear. You can compare this to looking through a dirty or cloudy window. If the window is not clear, you can’t see well.
Though cataracts are often associated with aging—particularly men and women over age 60, people in their 40’s and 50’s are also more prone to developing cataracts. Research suggests that lifestyle factors like cigarette and alcohol use, diabetes and prolonged exposure to the sun’s harmful UV rays could all contribute to lens yellowing with age, and cataracts.
Other types of cataracts include secondary cataracts from surgery for other eye disorders like glaucoma; cataracts that form as a response to eye trauma or injury; cataracts that develop after exposure to certain forms of radiation; and in some cases, cataracts are congenital—you’re born with them.
The point is—with cataract symptoms and treatment, as with all things eyecare-related—there’s no substitute for a comprehensive, regularly schedule eye exam to check for vision problems and maintain healthy sight.
Cataract signs & symptoms
Cataracts don’t suddenly develop overnight. They generally start off small and only begin to noticeably affect your vision as they grow. The first symptom is usually that your vision becomes blurred, hazy or cloudy. Additionally, you may become sensitive to light, making sunlight, oncoming headlights or indoor lighting appear exceptionally glaring or bright. Colors may seem dim and you may notice halos around lights or double vision.
The symptoms people experience from cataracts may vary. Some individuals even report a temporary improvement in near vision when a cataract first develops, a phenomenon known as “second sight”.
Here is a list of possible signs and symptoms of developing cataracts:
- Blurry or cloudy vision (that can’t be corrected with a change in eyeglass prescription)
- Glare from lamps, sunlight, oncoming traffic when driving at night or indoor lighting
- Colors appear dim and less vibrant
- Halos around lights
- Double vision
- Poor night vision
- Sudden improvement in near vision
If you experience any change in your vision, visit your eye doctor immediately.
Causes of cataracts
Cataracts are part of the natural aging process of the eye and therefore, if you live to an old age, you will likely eventually develop one. While most cases of cataracts develop as part of this process, there are instances of congenital cataracts which are present at birth. Further, secondary or traumatic cataracts can occur at any age as a result of an eye injury, surgery or disease.While the risk of developing a cataract does increase as you age, it is not the only risk factor.
Research shows that there are environmental, health and behavioral risk factors that can also play a role in cataract development. Many of these risk factors are avoidable and preventable. These risk factors include:
- Smoking and excessive alcohol consumption
- Prolonged exposure to ultraviolet (UV) radiation from the sun or other sources
- Obesity
- Diabetes
- Hypertension
- Certain medications such as steroids or statin medications
- History of eye injury or eye surgery
- Family history
Since they are largely a part of the the natural aging process of the eye, cataracts can’t necessarily be avoided, however knowing if you have additional risk factors can help you to take preventative steps to delay the onset of the condition.
Catarct surgery & treatment
Treatment for cataracts involves surgery, but being diagnosed with a cataract does not mean that you need to have surgery immediately, or maybe ever. You may be able to live with symptoms of early cataracts for a while by using vision aids such as glasses, anti-glare sunglasses, magnification lenses, strong bifocals or brighter lighting to suit your needs.
Surgery should be considered when the condition begins to seriously impair your vision to the extent that it affects your daily life such as reading or driving, playing golf, playing cards, watching TV, etc. Sometimes surgery is also necessary if the cataracts are preventing treatment of another eye problem. The good news is that cataract surgery is typically very successful in restoring your vision. Together with your eye doctor, you will decide if and when the time for surgery has arrived.
Cataract Surgery
Cataract surgery is one of most common surgeries performed in North America and has a 90% success rate (meaning the patient has improved vision, between 20/20 and 20/40 vision, following the procedure).
The surgery involves removing the clouded natural lens and usually replacing it with a clear, plastic intraocular lens (IOL) that becomes a permanent part of the eye. It is a relatively quick and painless procedure and you will not feel or see the IOL after the implant.
Preventing cataracts
While development of cataracts is largely associated with age, there are other factors that can increase the risk of developing the condition. By knowing these risk factors, there are steps you can take to delay or prevent the development of cataracts:
- Sun Protection: Ultraviolet radiation can be a factor in the development of cataracts. It is recommended to protect your eyes from ultraviolet sunlight by wearing 100% UV protective sunglasses and a hat with a brim when you are exposed to the sun.
- Stop Smoking and Limit Alcohol Intake: These habits have been shown to increase the chances of developing cataracts, so if you smoke or regularly consume large amounts of alcohol – stop these habits.
- Proper Nutrition: Research shows that maintaining good health and nutrition can also reduce the risk of age-related cataracts, particularly by eating foods rich with vitamins A (beta-carotene), C and E and other antioxidants found in green leafy vegetables, fruit and a diet rich in Omega-3s.
- Regular Eye Exams: Once you reach the age of 50, or if you have diabetes or other eye conditions, it is important to have a comprehensive eye exam every year to check for signs of cataracts and other age-related eye conditions such as age-related macular degeneration or glaucoma. Early detection and treatment for many of these eye and vision disorders is often essential to save your vision.
Common questions about presbyopia-correcting IOLs
During cataract surgery, the Intraocular lens (IOL) replaces the clouded natural lens in your eye to provide the function of focusing light onto the retina. IOLs are usually made of plastic and most of them are monofocal lenses to correct for distance vision.With advances in technology, specialized IOLs have and continue to be developed to improve the ease and success of cataract surgery and to improve the patient’s vision. Now, from multifocal IOLs to IOLs that block UV and blue light radiation, patients have greater options available to them.
Presbyopia Correcting IOLs – Multifocal or Accommodating IOLs
Presbyopia is another common condition associated with aging, in which the eyes begin to have difficulty focusing on near objects. This condition makes it hard for people to read small print, which is why many people over 40 keep reading glasses close by.
Similar to bifocal or multifocal reading glasses, accommodating and multifocal IOLs provide vision correction for far and near (reading) vision to provide the patient with clear sight at a range of distances without the need for reading glasses. Although you may be able to do most activities without glasses, there may be situations that require an eyeglass prescription to sharpen your vision.
Multifocal lenses contain multiple lens powers for various viewing distances, while accommodating lenses have one lens power but accommodate or move with your eye as it focuses on objects at a range of distances.
Other Types of IOLs
IOLs that block out ultraviolet (UV) and blue light radiation, which have both proven to be dangerous to your eyes, are also available.
Other premium IOLs exist such as aspheric IOLs which, similar to your real lens, are aspheric in shape and can improve vision quality, especially in low light conditions or toric IOLS which are suitable for correcting astigmatism, nearsightedness or farsightedness. Premium lenses such as these are more costly than standard monofocal IOLs and may not be right for everyone.
Selecting the right IOL for your eyes, lifestyle and vision is a decision that should be made together with a trusted eye doctor. For some people, it may even be an option to place different IOLs in each eye.
/ DIABETIC RETINOPATHY
Diabetes and Eyesight
Diabetes is a disease that affects the way we process food for energy and growth. With all forms of diabetes—type 1, type 2 and gestational diabetes—the body has trouble converting sugar in the blood into energy, resulting in a host of potential health problems.
There’s no separating diabetes and vision. If you have diabetes, then you should understand vision problems that increase in likelihood as a result of the disease.
What is the relation between diabetes and vision?
Diabetes increases the likelihood that common diabetes-related vision problems or diseases might occur:
- Diabetics are prone to developing cataracts (a clouding of the eye’s lens) at an earlier age.
- People with diabetes are almost 50% more likely to develop glaucoma, an eye disorder that damages the optic nerve often marked by an increase of internal eye pressure.
- Macular edema (and macular degeneration) are more common in diabetics due to malfunctioning blood vessels in the middle region of the retina responsible for central, sharp vision.
- Most notably, diabetes can result in diabetic retinopathy; an eye disease that affects the blood vessels in the all-important retina. Nearly 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.
What is diabetic retinopathy?
Diabetic retinopathy involves swelling, leaking or abnormal growth of blood vessels in or near the retina. There are multiple stages to this disease, the earliest of which may not present any symptoms you can see.
Symptoms you can see include dark or black spots in your vision that increase over time, or severely blurred vision due to bleeding within the eye.
That’s why comprehensive eye exams are so important when thinking about diabetes and eye sight—both type 1 and type 2 diabetics are at risk for developing diabetic retinopathy, and the longer you have diabetes, the more likely you are to develop some form of the disease.
Treatments for diabetic retinopathy include replacement of the inner gel inside the eye (called a vitrectomy) and different kinds of laser surgery. A recent clinical trial also suggested that better control of blood sugar levels slows the onset and progression of the disease in many patients.
Signs and symptoms of diabetic retinopathy
Diabetes prohibits the body from properly using and storing sugar, leaving excessive amounts of sugar in the bloodstream which can cause damage to blood vessels and various parts of the body- including the eyes and visual system. Diabetic retinopathy is when this condition results in progressive damage to the retina at the back of the eye. The retina is a light-sensitive tissue that is essential for vision, so if left untreated, diabetic retinopathy will eventually cause blindness.
Sadly, despite the fact that proper monitoring and treatment can successfully halt the progression of the diabetic eye disease, it is still the leading cause of new cases of blindness in adults in North America.
Symptoms of Diabetic Retinopathy
Diabetic retinopathy progressively damages the blood vessels of the retina to the point that they begin to leak blood and fluids. This leakage causes swelling in the retinal tissue which can impact your ability to focus causing vision loss and if left untreated, eventually will cause blindness. Retinopathy typically affects both eyes and often will have no symptoms in the early stages – making regular eye exams essential for anyone with diabetes. The longer an individual has had diabetes, the more likely it is that they will have some degree of retinopathy.
Symptoms include:
- Blurred or cloudy vision
- Seeing floaters or spots
- Difficulty reading or seeing close objects
- Double vision
- Poor night vision
Untreated diabetic retinopathy can also lead to a detached retina. This can happen if the disease has progressed to proliferative retinopathy in which new, fragile blood vessels grow in the retina and the vitreous at the back of the eye. The blood vessels can break, leaking fluid and causing the growth of scar tissue which can cause the retina to detach. If left untreated this can cause blindness as well.
Many of the symptoms of diabetic retinopathy, particular in the early stages of vision loss, can be reversed with proper treatment and control of blood sugar levels. Diabetics with or without retinopathy must see an eye doctor at least once a year for a comprehensive eye exam to monitor any changes and ensure that proper treatment is prescribed.
Causes of diabetic retinopathy
What are the causes of diabetic retinopathy and long-term diabetes? Changes in blood-sugar levels is the main culprit. People suffering from diabetes generally develop diabetic retinopathy after at least ten years of having the disease. Once you are diagnosed with diabetes, it is essential to have an eye exam once a year or more.
In the early stage of diabetic retinopathy, called background or non-proliferative retinopathy, high blood sugar in the retina damages blood vessels, which bleed or leak fluid. This leaking or bleeding causes swelling in the retina, which forms deposits.
In the later stage of diabetic retinopathy, called proliferative retinopathy, new blood vessels begin to grow on the retinal. These new blood vessels may break, causing bleeding into the vitreous, which is the clear gelatinous matter that fills the inside of the eye. This breakage can cause serious vision difficulties. This form of diabetic retinopathy can cause blindness, and is therefore the more serious form of the disease.
It is not hard to greatly reduce your risk of diabetic retinopathy by following some simple steps and being aware of your overall health. The most important factor you can control is maintaining your blood sugar at a healthy level. Eating a healthy diet will help greatly in controlling blood sugar levels. A regular exercise regimen is also a great help. Finally, make sure to listen to your doctor’s instructions.
Treatment for diabetic retinopathy
95% of people diagnosed with diabetic retinopathy, if treated promptly, can avoid significant vision loss.
Laser photocoagulation treatment seals off blood vessels that are leaking into the eye, and stops new blood vessels from growing. This laser treatment only takes a few moments, and is painless.
Sometimes in diabetic retinopathy blood leaks into the vitreous humor in the eye, clouding vision. Some eye doctors wait before choosing treatment, as the blood may dissipate by itself. Another treatment option is a vitrectomy, which removes blood that has already leaked into the vitreous humor.
To improve the supply of blood to the core inner portion of the retina, a laser may be used to destroy tissue on the outside of the retina which is not essential for basic vision. This procedure is used to save vision.
Lucentis is a medication that is administered by an eye doctor using injections. This medication was approved by the FDA is 2015, and is the first non-laser treatment approved by the FDA. The FDA is currently reviewing several other non-laser treatments for diabetic retinopathy.
/ EYE DOCTOR FOR KIDS
Macular Degeneration
As a disease usually associated with aging, macular degeneration is also called age-related macular degeneration (ARMD), though there are other, less common types of macular degeneration.
Age-related macular degeneration is the leading cause of vision loss in Americans over age 60, and presents itself in two forms: dry macular degeneration and wet macular degeneration. Of the two, the “dry” form is far more common. Both affect the center region of the retina, the light-sensitive area in the back of the eye responsible for processing images we see.
What is macular degeneration?
Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision – the part of our sight we use to read, drive and recognize faces. So although a person's peripheral vision is left unaffected by AMD, the most important aspect of vision is lost.
AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older. And because older people represent an increasingly larger percentage of the general population, vision loss associated with macular degeneration is a growing problem.
It's estimated that more than 1.75 million U.S. residents currently have significant vision loss from AMD, and that number is expected to grow to almost 3 million by 2020.
Forms of macular degeneration
There are two forms of macular degeneration, dry (non-neovascular) or wet (neovascular). The term neovascular refers to the growth of new blood vessels.
Dry AMD (non-neovascular)
Dry AMD is the most common form of the disease, making up about 85%-90% of all cases of AMD. It is characterized by blurred central vision or blind spots, as the macula begins to deteriorate. Dry AMD is an early stage of the disease and is less severe than the wet form.
Dry AMD occurs when the aging tissues of the macula begin to thin out and break down. Tiny pieces of white or yellowish protein called drusen begin to appear, which are thought to be deposits from the macular tissue as it deteriorates. The appearance of these drusen are often what leads to a diagnosis of AMD during an eye exam.
With dry AMD vision loss happens gradually, however, the dry form can progress to wet AMD rapidly. There is currently no cure for dry AMD, however there is research that shows that some people can benefit from supplemental vitamin therapy including antioxidants, lutein and zeaxanthin.
Wet AMD (neovascular)
Wet AMD is less common occurring in only about 10 percent of those with AMD. AMD is classified as Wet AMD when abnormal blood vessels begin to grow under the retina and leak fluid and blood into the macula, resulting in blind spots and a loss of central vision.
Wet AMD can cause more damage to vision and permanent scarring if not treated quickly, so any sudden blur in vision should be assessed immediately, especially if one is aware that they have AMD. Usually vision loss happens faster and is more noticeable than in dry AMD so the quicker it is treated, the more vision you can preserve.
Symptoms & risk factors of macular degeneration
Macular Degeneration can cause low vision and debilitating vision loss, even blindness if not diagnosed and treated in the early stages. Because the disease often has no obvious symptoms early on, it is critical to have regular comprehensive eye exams, particularly if you are at risk.
Symptoms of AMD
Macular degeneration is a disease in which the macula slowly breaks down, resulting in a gradual progressive vision loss, at least in its’ early stages. Frequently there are no symptoms and the disease is only diagnosed when a doctor detects signs such as a thinning macula or the presence of drusen in a comprehensive eye examination. Early vision loss can include blurry, cloudy or distorted central vision or dark spots in your central field of view. With advanced stages, vision loss can be severe and sudden with larger blind spots and total loss of central vision.
Risk factors for macular degeneration
Age is the most prominent risk factor for AMD, as the disease is most common in individuals over the age of 60 (although it can happen in younger individuals as well). Other risk factors can increase your chances of developing the disease such as:
- Genetics and Family History: Research shows that there are actually almost 20 genes that have been linked to AMD, and they suspect that there are many more genetic factors to be discovered. Family history greatly increases your chances of developing AMD.
- Race: Caucasians are more likely to get AMD than Hispanics or African-Americans.
- Smoking: Cigarette smoking can double your likelihood of developing AMD.
- Lifestyle: Research shows that UV exposure, poor nutrition, high blood pressure, obesity and a sedentary lifestyle can also be contributing factors.
- Gender: Females have a higher incidence of AMD than males.
- Medications: Certain medications may increase the chances of developing AMD.
To reduce your risks of developing AMD it is recommended to make healthy choices such as:
- Regular eye exams; once a year especially if you are 50 or over.
- Stop smoking.
- Know your family history and inform your eye doctor.
- Proper nutrition and regular exercise: Research indicates that a healthy diet rich in “Eyefoods” with key nutrients for the eyes such as orange peppers, kale and spinach as well as regular exercise may reduce your risks or slow the progression of AMD.
- Maintain healthy cholesterol levels and blood pressure.
- Dietary supplements: Studies by the National Eye Institute called AREDs and ARED2 indicated that a high dosage of supplements of zinc, vitamin C, vitamin E and lutein may slow the progression of advanced dry AMD (it is not recommended for those without AMD or early AMD). Speak to a doctor before taking these supplements because there may be associated risks involved.
- Wear 99% -100% UV-blocking sunglasses.
The first step to eye health is awareness. By knowing your risk, taking preventative measures and visiting your eye doctor on a regular basis, you can greatly reduce your chances of facing this debilitating disease.
How is macular degeneration treated?
There are no FDA-approved treatments for dry macular degeneration, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.
For wet macular degeneration, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet macular degeneration.
Testing and low vision devices
Although much progress has been made recently in macular degeneration treatment research, complete recovery of vision related vision loss is probably is unlikely. Your eye doctor may ask you to check your vision regularly with an Amsler grid – a small chart of thin black lines arranged in a grid pattern. Macular degeneration causes the line on the grid to appear wavy, distorted or broken. Viewing the Amsler grid separately with each eye helps you monitor your vision loss.
If you have already suffered vision loss from macular degeneration, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.
Macular degeneration statistics
Currently, macular degeneration is the leading cause of vision loss in persons over age 60. Caucasians are far more likely to lose vision from ARMD than African Americans, and studies show that obesity, smoking, and exposure to UV rays may also be risk factors for developing the disease.
Macular degeneration tends to affect women more than men, and has also been linked to heredity. Nearly 90% of all diagnosed ARMD is the dry form.