Ophthalmology

• Cloudy or blurred vision
• Sensitivity to light and glare
• Frequent prescription changes for glasses or contact lenses
• Poor night vision
• Color vision changes and dimming
• Double vision in a single eye

Treatment for Cataracts
While there is no way to prevent cataracts, there are things you can do to slow their formation. Modifiable factors that increase the risk of cataract include smoking, high blood pressure, obesity, and excessive alcohol intake. You may also slow the formation of cataracts by protecting your eyes from direct sunlight.

In the beginning stages of cataracts, vision may be slightly improved using forms of visual correction. However, in the later stages, surgery may be required. Fortunately, surgery has proven to be extremely successful in the removal of cataracts. During cataract surgery, your physician will replace your natural lens with an IOL.

The optic nerve fibers from each eye combine at the optic chiasm located above the pituitary gland, located in the skull about 1 inch behind the bridge of the nose. Defects to the optic nerve in front of the chiasm will affect vision in only that eye, while defects at the chiasm and beyond (toward the back of the head) will affect vision in both eyes. Optic nerve atrophy can be diagnosed during an examination of the eyes. In optic atrophy patients will show a:

• Reduction in visual acuity
• Loss or reduction in color vision (especially to red)
• Pupil response abnormality (the pupil of the affected eye will not perform normally- called an afferent pupillary defect)

• The Optic Nerve will appear pale in color

Floaters

If you notice spots in your vision, then you have floaters. They can be age-related, but they can also occur in cases of severe nearsightedness. The jelly substance the eye is made of becomes more liquid and small clumps cast a shadow on the retina.

However, floaters can also be the result of a torn retina. If the tear isn’t repaired, then it can lead to retinal detachment. This is due to fluid accumulating behind the retina, causing it to separate from the eye.

Macular Degeneration

Macular degeneration is an age-related condition of the retina that causes central vision loss. It is very common in individuals over the age of 55, with approximately 10 million people in the United States suffering from the condition.

The symptoms tend to involve blurry central vision, warped straight lines, or difficulty focusing on fine details. Blind spots can develop as the condition worsens. Fortunately, there are treatments, such as an antioxidant supplement that can slow the progression, blocking unhealthy blood vessel development, and several others.

Diabetic Eye Disease

Those with diabetes are more susceptible to retinal damage. There are many people throughout Scranton and Wilkes-Barre, Pennsylvania, suffering from diabetes, and their eyes are paying a price. They notice blurry vision, double vision, floaters or dark spots, pressure or pain in at least one eye, trouble with peripheral vision, flashing lights, or rings.

The good news is that laser surgery is a treatment that can help a person suffering from diabetic eye disease. It is also important to note that diabetics are also at increased risk of glaucoma and cataracts.

Retinal Detachment

As mentioned earlier, retinal detachment can occur when too much fluid accumulates behind the retina, causing separation. However, there are other risk factors that increase the chances of retinal detachment. They are:

•      Extreme nearsightedness
•      Previous retinal detachment in the other eye
•      Genetic predisposition
•      Previous cataract surgery
•      The presence of other eye disorders
•      Eye injury

The presence of floaters indicates that retinal detachment may be occurring. There may also be flashes in the eye. If the condition isn’t quickly treated, it can cause permanent vision loss. If you suddenly notice floaters or you have had them and they have increased, see your doctor immediately. Other symptoms include a decrease in vision or seeing a gray curtain in your field of vision.

Retinitis Pigmentosa

Retinitis pigmentosa describes genetic conditions that can cause retinal degeneration. Vision loss gradually declines as the rods and cones die. Leber’s congenital amaurosis, Usher syndrome, Bardet-Biedel syndrome, rod-cone disease, and Refsum disease are some examples of conditions that are classified as retinitis pigmentosa.

Usually, rods are affected first, and then the degeneration moves to the cones. One of the earliest symptoms is night blindness, but some people experience central vision loss or color blindness. Adolescents and young adults are especially vulnerable since this is an inherited condition.

If you notice any changes in your vision, it is very important to have your eyes checked as soon as possible. While some changes may be benign, others can indicate more serious conditions.

If you want to know more about retinal disorders, or if you would like to set up an eye exam, contact us

It happens when the small central portion of your retina, called the macula, wears down. The retina is the light-sensing nerve tissue at the back of your eye.Because the disease happens as you get older, it’s often called age-related macular degeneration. It usually doesn’t cause blindness but might cause severe vision problems.Another form of macular degeneration, called Stargardt disease or juvenile macular degeneration, affects children and young adults.

Wet vs. Dry Macular Degeneration

There are two main types of age-related macular degeneration:

• Dry form. People with this may have yellow deposits, called drusen, in their macula. A few small drusen may not cause changes in your vision. But as they get bigger and more numerous, they might dim or distort your vision, especially when you read. As the condition gets worse, the light-sensitive cells in your macula get thinner and eventually die. In the atrophic form, you may have blind spots in the center of your vision. As that gets worse, you might lose central vision.
• Wet form. Blood vessels grow from underneath your macula. These blood vessels leak blood and fluid into your retina. Your vision is distorted so that straight lines look wavy. You may also have blind spots and loss of central vision. These blood vessels and their bleeding eventually form a scar, leading to permanent loss of central vision.

Most people with macular degeneration have the dry form, but the dry form can lead to the wet form. Only about 10% of people with macular degeneration get the wet form.If you have macular degeneration, you’ll need to monitor your eyesight carefully and see your eye doctor regularly.

Symptoms of Macular Degeneration

Early on, you might not have any noticeable signs of macular degeneration. It might not be diagnosed until it gets worse or affects both eyes.

Symptoms of macular degeneration may include:

• Worse or less clear vision. Your vision might be blurry, and it may be hard to read fine print or drive.
• Dark, blurry areas in the center of your vision
• Rarely, worse or different color perception

If you have any of these symptoms, go to an eye doctor as soon as possible.

What Treatments Are Available for Macular Degeneration?

There’s no cure for macular degeneration. Treatment may slow it down or keep you from losing too much of your vision. Your options might include:

• Anti-angiogenesis drugs. These medications — aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab (Lucentis) — block the creation of blood vessels and leaking from the vessels in your eye that cause wet macular degeneration. Many people who’ve taken these drugs got back vision that was lost. You might need to have this treatment multiple times.
• Laser therapy. High-energy laser light can destroy abnormal blood vessels growing in your eye.
• Photodynamic laser therapy. Your doctor injects a light-sensitive drug — verteporfin (Visudyne) — into your bloodstream, and it’s absorbed by the abnormal blood vessels. Your doctor then shines a laser into your eye to trigger the medication to damage those blood vessels.
• Low vision aids. These are devices that have special lenses or electronic systems to create larger images of nearby things. They help people who have vision loss from macular degeneration make the most of their remaining vision.

Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes.

The best ways to manage your diabetes and keep your eyes healthy are to

• manage your blood glucose, blood pressure, and cholesterol, sometimes called the diabetes ABCs
• If you smoke, get help to quit smoking External link
• have a dilated eye exam once a year

Often, there are no warning signs of diabetic eye disease or vision loss when damage first develops. A full, dilated eye exam helps your doctor find and treat eye problems early—often before much vision loss can occur.

How does diabetes affect my eyes?

Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high.

In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they’re changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.

If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes, when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.

Most serious diabetic eye diseases begin with blood vessel problems. The four eye diseases that can threaten your sight are

Diabetic retinopathy

The retina is the inner lining at the back of each eye. The retina senses light and turns it into signals that your brain decodes, so you can see the world around you. Damaged blood vessels can harm the retina, causing a disease called diabetic retinopathy.

In early diabetic retinopathy, blood vessels can weaken, bulge, or leak into the retina. This stage is called nonproliferative diabetic retinopathy.

If the disease gets worse, some blood vessels close off, which causes new blood vessels to grow, or proliferate, on the surface of the retina. This stage is called proliferative diabetic retinopathy. These abnormal new blood vessels can lead to serious vision problems.

Diabetic macular edema

The part of your retina that you need for reading, driving, and seeing faces is called the macula. Diabetes can lead to swelling in the macula, which is called diabetic macular edema. Over time, this disease can destroy the sharp vision in this part of the eye, leading to partial vision loss or blindness. Macular edema usually develops in people who already have other signs of diabetic retinopathy.

Glaucoma

Glaucoma is a group of eye diseases that can damage the optic nerve—the bundle of nerves that connects the eye to the brain. Diabetes doubles the chances of having glaucoma, which can lead to vision loss and blindness if not treated early.

Cataracts

The lenses within our eyes are clear structures that help provide sharp vision—but they tend to become cloudy as we age. People with diabetes are more likely to develop cloudy lenses, called cataracts. People with diabetes can develop cataracts at an earlier age than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes.

How common is diabetic eye disease?

Diabetic retinopathy

About one in three people with diabetes who are older than age 40 already have some signs of diabetic retinopathy.¹ Diabetic retinopathy is the most common cause of vision loss in people with diabetes. Each person’s outlook for the future, however, depends in large part on regular care. Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.

Glaucoma and cataracts

Your chances of developing glaucoma or cataracts are about twice that of someone without diabetes.

Who is more likely to develop diabetic eye disease?

Anyone with diabetes can develop diabetic eye disease. Your risk is greater with

• high blood glucose that is not treated
• high blood pressure that is not treated

High blood cholesterol and smoking may also raise your risk for diabetic eye disease.

Some groups are affected more than others. African Americans, American Indians and Alaska Natives, Hispanics/Latinos, Pacific Islanders, and older adults are at greater risk of losing vision or going blind from diabetes.

If you have diabetes and become pregnant, you can develop eye problems very quickly during your pregnancy. If you already have some diabetic retinopathy, it can get worse during pregnancy. Changes that help your body support a growing baby may put stress on the blood vessels in your eyes. Your health care team will suggest regular eye exams during pregnancy to catch and treat problems early and protect your vision.

Diabetes that occurs only during pregnancy, called gestational diabetes, does not usually cause eye problems. Researchers aren’t sure why this is the case.

Your chances of developing diabetic eye disease increase the longer you have diabetes.

What are the symptoms of diabetic eye disease?

Often there are no early symptoms of diabetic eye disease. You may have no pain and no change in your vision as damage begins to grow inside your eyes, particularly with diabetic retinopathy.

When symptoms do occur, they may include

• blurry or wavy vision
• frequently changing vision—sometimes from day to day
• dark areas or vision loss
• poor color vision
• spots or dark strings (also called floaters)
• flashes of light

Talk with your eye doctor if you have any of these symptoms.

When should I see a doctor right away?

Call a doctor right away if you notice sudden changes to your vision, including flashes of light or many more spots (floaters) than usual. You also should see a doctor right away if it looks like a curtain is pulled over your eyes. These changes in your sight can be symptoms of a detached retina , which is a medical emergency.

How do doctors diagnose eye problems from diabetes?

Having a full, dilated eye exam is the best way to check for eye problems from diabetes. Your doctor will place drops in your eyes to widen your pupils. This allows the doctor to examine a larger area at the back of each eye, using a special magnifying lens. Your vision will be blurry for a few hours after a dilated exam.

Your doctor will also

• test your vision
• measure the pressure in your eyes

Your doctor may suggest other tests, too, depending on your health history.

Most people with diabetes should see an eye care professional once a year for a complete eye exam. Your own health care team may suggest a different plan, based on your type of diabetes and the time since you were first diagnosed.

How do doctors treat diabetic eye disease?

Your doctor may recommend having eye exams more often than once a year, along with management of your diabetes. This means managing your diabetes ABCs, which include your A1c, blood pressure, and cholesterol; and quitting smoking. Ask your health care team what you can do to reach your goals.

Doctors may treat advanced eye problems with medicine, laser treatments, surgery, or a combination of these options.

Medicine

Your doctor may treat your eyes with anti-VEGF medicine, such as aflibercept, bevacizumab, or ranibizumab. These medicines block the growth of abnormal blood vessels in the eye. Anti-VEGF medicines can also stop fluid leaks, which can help treat diabetic macular edema.

The doctor will inject an anti-VEGF medicine into your eyes during office visits. You’ll have several treatments during the first few months, then fewer treatments after you finish the first round of therapy. Your doctor will use medicine to numb your eyes so you don’t feel pain. The needle is about the thickness of a human hair.

Anti-VEGF treatments can stop further vision loss and may improve vision in some people.

Laser Treatment

Laser treatment, also called photocoagulation, creates tiny burns inside the eye with a beam of light. This method treats leaky blood vessels and extra fluid, called edema. Your doctor usually provides this treatment during several office visits, using medicine to numb your eyes. Laser treatment can keep eye disease from getting worse, which is important to prevent vision loss or blindness. But laser treatment is less likely to bring back vision you’ve already lost compared with anti-VEGF medicines.

There are two types of laser treatment :

• Focal/grid laser treatment works on a small area of the retina to treat diabetic macular edema.
• Scatter laser treatment, also called panretinal photocoagulation (PRP), covers a larger area of the retina. This method treats the growth of abnormal blood vessels, called proliferative diabetic retinopathy.

Vitrectomy

Vitrectomy is a surgery to remove the clear gel that fills the center of the eye, called the vitreous gel. The procedure treats problems with severe bleeding or scar tissue caused by proliferative diabetic retinopathy. Scar tissue can force the retina to peel away from the tissue beneath it, like wallpaper peeling away from a wall. A retina that comes completely loose, or detaches, can cause blindness.

During vitrectomy, a clear salt solution is gently pumped into the eye to maintain eye pressure during surgery and to replace the removed vitreous. Vitrectomy is done in a surgery center or hospital with pain medicine.

Cataract Lens Surgery

In a surgery center or hospital visit, your doctor can remove the cloudy lens in your eye, where the cataract has grown, and replace it with an artificial lens. People who have cataract surgery generally have better vision afterward. After your eye heals, you may need a new prescription for your glasses. Your vision following cataract surgery may also depend on treating any damage from diabetic retinopathy or macular edema.

What can I do to protect my eyes?

To prevent diabetic eye disease, or to keep it from getting worse, manage your diabetes ABCs: your A1c, blood pressure, and cholesterol; and quit smoking if you smoke. Read more information on how to manage diabetes.

Also, have a dilated eye exam at least once a year—or more often if recommended by your eye care professional. These actions are powerful ways to protect the health of your eyes—and can prevent blindness.

The sooner you work to manage your diabetes and other health conditions, the better. And, even if you’ve struggled in the past to manage your health, taking better care of yourself now can protect your eyes for the future. It’s never too late to begin.

What if I already have some vision loss from diabetes?

Ask your eye care professional to help you find a low vision rehabilitation clinic. Special eye care professionals can help you manage vision loss that cannot be corrected with glasses, contact lenses, medicine, or surgery. Special devices and training may help you make the most of your remaining vision so that you can continue to be active, enjoy hobbies, visit friends and family members, and live without help from others

Often called “pink eye,” conjunctivitis is a common eye disease, especially in children. It may affect one or both eyes. Some forms of conjunctivitis are highly contagious and can easily spread in schools and at home. While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more serious problem.

A viral or bacterial infection can cause conjunctivitis. It can also develop due to an allergic reaction to air irritants such as pollen and smoke, chlorine in swimming pools, ingredients in cosmetics, or other products that contact the eyes, such as contact lenses. Sexually transmitted diseases like chlamydia and gonorrhea are less common causes of conjunctivitis.

People with conjunctivitis may experience the following symptoms:

• A gritty feeling in one or both eyes
• Itching or burning sensation in one or both eyes
• Excessive tearing
• Discharge from one or both eyes
• Swollen eyelids
• Pink discoloration to the whites of one or both eyes
• Increased sensitivity to light

What causes conjunctivitis?

There are three main types of conjunctivitis: allergic, infectious and chemical. The cause of conjunctivitis varies depending on the type.

Allergic Conjunctivitis

• Allergic conjunctivitis occurs more commonly among people who already have seasonal allergies. They develop it when they come into contact with a substance that triggers an allergic reaction in their eyes.
• Giant papillary conjunctivitis is a type of allergic conjunctivitis caused by the chronic presence of a foreign body in the eye. People who wear hard or rigid contact lenses, wear soft contact lenses that are not replaced frequently, have an exposed suture on the surface of the eye or have a prosthetic eye are more likely to develop this form of conjunctivitis.

Infectious Conjunctivitis

• Bacterial conjunctivitis is an infection most often caused by staphylococcal or streptococcal bacteria from your own skin or respiratory system. Insects, physical contact with other people, poor hygiene (touching the eye with unclean hands), or using contaminated eye makeup and facial lotions can also cause the infection. Sharing makeup and wearing contact lenses that are not your own or are improperly cleaned can also cause bacterial conjunctivitis.
• Viral conjunctivitis is most commonly caused by contagious viruses associated with the common cold. It can develop through exposure to the coughing or sneezing of someone with an upper respiratory tract infection. Viral conjunctivitis can also occur as the virus spreads along the body’s own mucous membranes, which connect the lungs, throat, nose, tear ducts and conjunctiva. Since the tears drain into the nasal passageway, forceful nose blowing can cause a virus to move from your respiratory system to your eyes.
• Ophthalmia neonatorum is a severe form of bacterial conjunctivitis that occurs in newborn babies. This is a serious condition that could lead to permanent eye damage if it is not treated immediately. Ophthalmia neonatorum occurs when an infant is exposed to chlamydia or gonorrhea while passing through the birth canal. For several years, U.S. delivery rooms have applied antibiotic ointment to babies’ eyes as a standard prophylactic treatment.

Chemical Conjunctivitis

• Chemical Conjunctivitis can be caused by irritants like air pollution, chlorine in swimming pools, and exposure to noxious chemicals.

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How is conjunctivitis diagnosed?

Conjunctivitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the conjunctiva and surrounding tissues, may include:

• Patient history to determine the symptoms, when the symptoms began, and whether any general health or environmental conditions are contributing to the problem.
• Visual acuity measurements to determine whether vision has been affected.
• Evaluation of the conjunctiva and external eye tissue using bright light and magnification.
• Evaluation of the inner structures of the eye to ensure that no other tissues are affected by the condition.
• Supplemental testing, which may include taking cultures or smears of conjunctival tissue. This is particularly important in cases of chronic conjunctivitis or when the condition is not responding to treatment.

Using the information obtained from these tests, your optometrist can determine if you have conjunctivitis and advise you on treatment options.

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How is conjunctivitis treated?

Treating conjunctivitis has three main goals:

1. Increase patient comfort.
2. Reduce or lessen the course of the infection or inflammation.
3. Prevent the spread of the infection in contagious forms of conjunctivitis.

The appropriate treatment for conjunctivitis depends on its cause:

• Allergic conjunctivitis. The first step is to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. People with persistent allergic conjunctivitis may also require topical steroid eye drops.
• Bacterial conjunctivitis. This type of conjunctivitis is usually treated with antibiotic eye drops or ointments. Bacterial conjunctivitis may improve after three or four days of treatment, but patients need to take the entire course of antibiotics to prevent recurrence.
• Viral conjunctivitis. No drops or ointments can treat viral conjunctivitis. Antibiotics will not cure a viral infection. Like a common cold, the virus has to run its course, which may take up to two or three weeks. Symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation. However, these drops will not shorten the infection.
• Chemical conjunctivitis. Careful flushing of the eyes with saline is a standard treatment for chemical conjunctivitis. People with chemical conjunctivitis also may need to use topical steroids. Severe chemical injuries, particularly alkali burns, are medical emergencies and can lead to scarring, damage to the eye or the sight, or even loss of the eye. If a chemical spills in your eye, flush the eye for several minutes with a lot of water before seeing your medical provider.

Contact Lens Wearers

 Contact lens wearers may need to temporarily stop wearing their lenses while the condition is active. Your doctor can tell you if this is necessary.

If you developed conjunctivitis due to wearing contact lenses, your eye doctor may recommend that you switch to a different type of contact lens or disinfection solution. Your optometrist might need to change your contact lens prescription to a lens that you replace more frequently. This can help prevent the conjunctivitis from recurring.

Self-care

Practicing good hygiene is the best way to control the spread of conjunctivitis. Once an infection has been diagnosed, follow these steps:

• Don’t touch your eyes with your hands.
• Wash your hands thoroughly and frequently.
• Change your towel and washcloth daily, and don’t share them with others.
• Discard eye cosmetics, particularly mascara.
• Don’t use anyone else’s eye cosmetics or personal eye-care items.
• Follow your eye doctor’s instructions on proper contact lens care.

You can soothe the discomfort of viral or bacterial conjunctivitis by applying warm compresses to your affected eye or eyes. To make a compress, soak a clean cloth in warm water and wring it out before applying it gently to your closed eyelids.