Patient Education


Dry Eye Syndrome

Tears run from our eyes when we cry or when our eyes are irritated – but tears have a much more important everyday function.  A film of tears, spread over the eye by a blink, makes the surface of the eye smooth and optically clear.  The eyes produce tears around the clock.  Without a tear film, good vision would not be possible. 

Some people do not produce enough tears to keep the eye wet and comfortable.  Stinging, burning, scratchiness, stringy mucus, and excess irritation from smoke are usual symptoms.  Problems with contact lenses can be caused by dry eyes, and can make it impossible to wear contact lenses.

 

Surprisingly, increased tearing may be a symptom of dry eyes.  If the basic tear secretion is below normal, excess tears are produced in response to the irritation.  Even though the eye is basically dry, overflow tearing can occur, masking the dryness which caused it in the first place.

 

What causes dry eye?

 

Normally, tear production decreases with age.  Dry eyes are more common in women, especially after the age of menopause, but dry eyes can occur at any age in both men and women.

 

Dry eyes can also be associated with arthritis.  The inside of the mouth may also become dry, due to inadequate production of saliva.  Drugs and medications can cause dry eyes by reducing tear secretion.  Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with “artificial tears.” 

 

Diagnosis

 

Dr. Share is often able to diagnose dry eyes by simply examining the eyes.  Sometimes tests which measure tear production may be necessary.

 

Treatment

 

Replacement with artificial tears is the basis of treatment.  These are available without a prescription, and are used as eye drops to lubricate the eyes and replace the missing moisture.  The artificial tears may be used as often as necessary.  Solid inserts that gradually release lubricants during the day are also beneficial to some patients.  A prescription medication, Restasis, is now available which helps patients to produce more of their own tears. 

 

Conserving tears which are naturally produced is another approach.  Tears leave the eye via the tear ducts in both eyelids and go down into the nose.  These channels may be closed by Dr. Share to create a blockage which will keep the eyes moist for longer periods.

 

Anything that adds to dryness, such as an overly warm room, hair dryers, windy days, or anything that adds an irritant to the air will make a person with dry eyes more uncomfortable.  Smoking is especially bothersome.

 

Scratchiness that is bothersome on first opening the eyes in the morning can be treated by using an ointment at bedtime.  Ointments containing Vitamin A are under investigation as treatment for dry eye and early results are promising.

 

If you suffer from dry eyes, you may only need over the counter artificial tears.  But since extreme dryness can cause serious eye damage, an examination and diagnosis by your ophthalmologist is suggested. 

 

The information in this article is from the American Academy of Ophthalmology, the world's largest professional association of eye physicians and surgeons.  Dr. Share is a member of the Academy.

 

Posterior Vitreous Detachment or Separation

The small specks or "bugs" that many people see moving in their field of vision are called "floaters". They are frequently visible when looking at a plain background, such as a blank wall or blue sky.

Floaters are small clumps of gel that form in the vitreous, the clear jelly-like fluid that fills the cavity of the eye. Although they appear to be in front of the eye, they are actually floating in the fluid inside the eye and are seen as shadows by the retina (the light sensing inner layer of the eye).

The appearace of floaters, whether in the form of little dots, circles, lines or cobwebs, may cause much concern, especially if they develop suddenly; however, they are usually of little importance, representing an aging process. The vitreous gel shrinks with time, pulls away from the retina and causes floaters. This is especially common in nearsighted people or after a cataract operation, and this is called a posterior vitreous detachment or separation.

Are Floaters Serious?

As the vitreous gel pulls away, the retina may be torn, sometimes causing a small amount of bleeding in the eye which may appear as a group of new floaters. If this tear becomes a retinal detachment it can be serious. Uncommonly, floaters result from inflammation within the eye or from crystal-like deposits which form in the vitreous gel.

What causes flashing lights?

The vitreous gel which fills the inside of the eye sometimes pulls or tugs on the retina. This pulling action causes the appearance of flashing lights or lightning streaks, though there is no flashing light actually present.

When a vitreous separation pulls the gel away from the retina, flashes of light may appear off and on for several weeks. This commonly happens as we grow older and is usually not cause for alarm. On rare occasions, light flashes are associated with a large number of new floaters and even a blacking out of part of the field of vision. When this occurs, an immediate examination is important to determine if a retinal tear or detachment has developed.

All of the above are checked for in a complete eye exam. If treatment is necessary, you will be advised.

Cataract Surgery

Cataract surgery, by itself, means removal of the natural lens of the eye by a surgical technique. Except for unusual problems, a cataract operation is indicated only when you cannot function adequately due to poor sight produced by the cataract. You and your doctor are the only ones who can determine if or when you should have a cataract operation --based on your own visual needs and medical considerations. Most people have improved vision following cataract surgery.  Be sure to view the videos on the links below at the end of this section titled How the eye sees, Cataract Formation, and Cataract Surgery.

Alternative Treatments
1. Intraocular lens implant - Today, this is the most common method of correcting vision after a cataract is removed. This is a small plastic artificial lens placed inside the eye at the time of surgery. Conventional eyeglasses (not cataract glasses) are usually required in addition to an intraocular lens. At the time of surgery, your doctor may decide not to implant an intraocular lens in your eye even though you may have given prior permission to do so.

2. Contact lens - This is prescribed for the unusual case where an intraocular lens cannot be utilized. Lenses are usually inserted and removed daily and not everyone can tolerate them. Handling of a contact lens is difficult for some individuals. For near tasks, conventional eyeglasses (not cataract glasses) are usually required in addition to contact lenses.

3. Spectacles ("cataract glasses") - Once the most common method of correction, these are used rarely following modern cataract surgery. Cataract glasses are usually thicker and heavier than conventional eyeglasses. Clear vision is obtained through the central part of cataract glasses, which means you must learn to turn your head to see clearly on either side. Cataract glasses usually cannot be used if a cataract is only in one eye (and the other is normal) because they may cause double vision.

Complications
Although many people undergo cataract surgery successfully, the results cannot be guaranteed. As a result of the surgery, it is possible that vision could be worse. Complications may occur weeks, months, or even years later. Complications may include hemorrhage (bleeding), loss of corneal clarity, infection, detachment of the retina, glaucoma, and/or double vision. These and other complications may occur whether or not a lens is implanted and may result in poor vision, total loss of vision, or loss of the eye.

YAG LASER POSTERIOR CAPSULOTOMY

Shortly after cataract surgery, vision improves significantly. Over time however some patients once again experience a decrease in vision due to clouding of the posterior capsule of the original lens which is purposely left in place at the time of the original surgery. This thin clear membrane is like the clear cellophane shrink wrap around many items that we buy daily and see through readily. The lens implant is placed in front of this membrane during surgery and it “shrink wraps” around it helping to secure it in place. This works well until the shrink wrap turns into “wax paper” making the vision blurry again. A simple yag laser procedure called yag laser posterior capsulotomy cuts a small hole in the center of the posterior capsule once again resulting in clear vision. Click on Cataract Yag Laser below to view the video.

How the Eye Sees
Cataract Formation
Cataract Surgery
Cataract YAG Laser



WHAT IS GLAUCOMA?


Glaucoma is a disease of the optic nerve. The optic nerve is the connection between the eye and the brain. This nerve is much like a big telephone cable with over a million individual wires in it. However in the optic nerve these are nerve fibers instead of wires. As glaucoma progresses more of the nerve fibers die and vision is lost a little at a time beginning with the peripheral vision. It is usually not noticed by an individual until it gets into the much later stages. Glaucoma is a problem that results from a number of different conditions that can affect the eye, many of which are associated with an increased intraocular pressure (eye pressure) medically referred to as ocular hypertension. It is important to realize that intraocular pressure is not glaucoma but rather the most important risk factor that we know of for the development and/or progression of this damage. Other possible causes of the glaucoma damage include poor circulation to the optic nerve and inherited problems.

Types of Glaucoma

There are several types of glaucoma. The two most common types are open angle glaucoma and angle closure glaucoma.

Open angle glaucoma is the most common type of glaucoma. There is no pain involved in this form and in many cases it is due to high intraocular pressure. The intraocular pressure is related to fluid which is produced in the eye and must exit through a drain within the eye. If the fluid can not exit through the drain quickly enough the fluid pressure within the eye increases to a level that the optic nerve can not tolerate and then the loss of optic nerve fibers occurs. The longer the intraocular pressure is at these intolerable levels the more optic nerve damage occurs and the more vision is lost. This is usually a gradual process and occurs over years of time.

Angle closure glaucoma however can be an acute process. This means it can occur suddenly. In acute angle closure glaucoma, the intraocular pressure rises quickly and in many cases will be associated with severe pain, blurred vision, redness of the eye, tearing, and eventually vision loss if not treated promptly. This is an ocular emergency. Acute angle closure glaucoma occurs when the passage way to the drain closes rapidly like a door slamming shut and the fluid can not exit the eye. Once again this form of glaucoma is less common than open angle glaucoma discussed above.

How is Glaucoma Detected?

Now that we know a little bit about glaucoma, let's talk about the detection process. Since most forms of glaucoma are painless the best way to detect it is through regular eye exams. Your eye care professional will examine your eyes and specifically look at the optic nerve, intraocular pressure, and visual field. A higher intraocular pressure in a patient increases the likelihood that glaucoma may be present. If the optic nerve has the appearance that glaucoma might be present, a formal visual field or peripheral vision test is done to confirm the diagnosis. The visual field test is repeated periodically to determine if the problem is stable or progressive. If the problem is progressing, additional treatment is indicated.

How is Glaucoma Treated?

At the present time the only treatment available for open angle glaucoma is to lower the intraocular pressure. This is usually done with medication in the form of eye drops or occasionally pills, laser procedures or surgery if necessary. Eye drops are usually used to lower the intraocular pressure much like a general physician uses pills to lower blood pressure. Single eye drops or a combination of eye drops may be necessary to lower the pressure adequately. If this does not work, laser treatment or surgery follows.

Angle closure glaucoma in the acute form is an emergency and requires medication to lower the intraocular pressure quickly. This is then followed by a laser treatment (see handout on laser peripheral iridectomy) to keep the problem from occurring again.

Research is being done on other ways to treat glaucoma. The current emphasis is to find a way to protect the optic nerve with medication so that there is something else to treat rather than intraocular pressure alone.

Who Is At Risk for Glaucoma?

Glaucoma occurs at all ages and in all races, however some people are at greater risk than others.
1. People over the age of 45. While glaucoma can develop in younger patients, it occurs more frequently with age.
2. People with a family history of glaucoma. Glaucoma can be inherited.
3. Nearsighted people are more prone to develop open angle glaucoma. Farsighted people are more prone to develop angle closure glaucoma.
4. There is no glaucoma exclusive to any race or ethnic group. However persons of African decent are more prone to develop open angle glaucoma by a ratio of 4:1 compared to Caucasians. Angle closure glaucoma is more common in Asians than open angle glaucoma.

Remember the best way to determine whether you have glaucoma or not is to have regular eye examinations. Once you are over age forty, you should have a complete eye exam every two years as a minimum. If you need to be seen more often than this, your eye care specialist will advise you.

Why Should you be Checked for Glaucoma?

Because if glaucoma is left untreated it can lead to blindness.

VISUAL FIELD TESTING FOR GLAUCOMA

Visual field testing is performed routinely on all glaucoma patients and those patients that are suspected of having glaucoma. The following information should be of help to you in understanding the reasoning behind visual field testing for these conditions.

Glaucoma is a disease of the optic nerve which in many cases is caused by increased pressure within the eye (intraocular pressure). This increase in pressure causes damage to the optic nerve. The damage to the optic nerve shows up as a loss in the visual field (peripheral vision as well as central vision). Visual field testing therefore allows us to determine:

1. If the intraocular pressure is causing damage to the optic nerve, and therefore if glaucoma is present in patients suspected of having the disease.

2. If a person that has glaucoma is adequately controlled on treatment.

If the visual field is worsening, additional treatment to lower the intraocular pressure is necessary to prevent further visual field loss and blindness. This treatment may include additional medications and/or surgery.

Visual field testing is routinely performed every six months to one year on the average glaucoma patient. It is one of the most important indicators as to whether the problem is being controlled. One visual field alone does not give us all the answers. The most important information is obtained after a series of fields are taken. A trend can then be established and treatment adjusted as necessary.

What to expect:

Usually, each eye is treated separately, taking approximately five minutes for each eye.

While focusing directly ahead at a yellow light (target), you will see lights out of the corner of your eye. You are expected to push a button whenever you see any lights, as soon as you see them. To insure the most accurate results, you must continue to look or stare at the target in the center at all times.

This procedure will be the same for both eyes.

NO dilation will be done for this procedure.

The visual field test is covered by Medicare.

Laser Peripheral Iridectomy

Glaucoma is a disease of the eye caused in some cases by the intraocular pressure in the eye becoming higher than the eye can tolerate. The eye produces fluid at a constant rate. There is a drainage area in the eye that is supposed to allow the fluid to escape at a constant rate. If this drain becomes blocked the pressure can rise to very high levels and cause optic nerve damage and vision loss.

The anatomy of some eyes are such that the area approaching the drain is very narrow or closed. There is the potential for the pressure to go up quickly under certain circumstances. The pressure indeed may have already started to increase slightly, or a full blown angle closure glaucoma attack may have already occured. At this point, it is recommended that a small opening be made in the iris or colored part of the eye with a laser called a peripheral iridectomy. This small opening will allow the fluid in the eye to reach the drainage area more easily and prevent angle closure glaucoma attacks in the future. If the procedure is not performed, there is an increased risk that the drainage area may become blocked and an attack of angle closure glaucoma may occur causing pain and permanent visual loss in many cases. Medications used prior to laser surgery may have to be continued afterward.

Argon Laser Trabeculoplasty

Glaucoma is a disease of the eye caused by an increase in the intraocular pressure. When the intraocular pressure reaches a level that the eye cannot tolerate, loss of vision occurs from optic nerve damage. Our first line of treatment is medication to lower the intraocular pressure. When maximum medical treatment is not sufficient to lower the intraocular pressure to a level that prevents further damage, the next line of treatment is the use of the laser.

The increase in intraocular pressure is due to the fact that the fluid produced in the eye is not exiting via the usual drainage mechanism quickly enough. The laser is aimed at the drain. Tiny burns are made along the drainage area which cause scarring. As the tiny scars contract, the drain is opened allowing the fluid to exit the eye more rapidly. This causes a decrease in the intraocular pressure.

Laser treatment is performed on each eye in either one or two sessions depending on the circumstances involved. The procedure is painless in most instances. Medications must continue to be used even though the laser treatment has been applied. In an occasional instance, one of the medications may be discontinued but in most cases they are all continued. If laser treatment does not lower the pressure sufficiently to prevent further damage to the eye, conventional glaucoma surgery performed in an operating room will be necessary. The effect of the laser treatment may be permanent, or may become less effective over a period of up to five years.

In summary, Argon laser trabeculoplasty is a procedure performed to try to allow fluid to pass through the drainage mechanism of the eye more easily in order to lower the intraocular pressure to a safe level. It is performed when medical therapy is no longer satisfactory to control glaucoma. In most instances it is painless and medications are still required after the treatment.

TEMPORAL ARTERITIS


Temporal arteritis is an arterial inflammatory disease of the elderly. It has an occurence rate of 133 per 100,000 people aged 50 or older. It is rarely seen in people under 50 years old and the cause is unknown. At least 40% to 50% of patients with temporal arteritis have ocular involvement. The common scenario involves a patient with sudden loss of vision in one eye and evidence for optic nerve damage in that eye. The visual acuity usually drops to the 20/400 level or less but occasionally may be better. It would be unusual for a patient to experience sudden bilateral loss of vision in temporal arteritis. The loss of vision is caused by poor circulation to the optic nerve from inflammation of the arteries that supply the optic nerve with blood.

Treatment of temporal arteritis involves large doses of systemic corticosteroids such as Prednisone tapered to keep the erythrocyte sedimentation rate in a normal range. Stabilization of vision and protection of the second eye are the major objectives but reversal of visual loss in the involved eye is occasionally felt to be possible. The vision in the second eye will be affected in 20% to 30% of patients left untreated usually within the first few weeks after the involvement of the first eye.

 


LOW VISION


When ordinary eyeglasses, contact lenses or intraocular lens implants cannot provide sharp sight, an individual is said to have low vision.  This condition should not be confused with blindness.  People with low vision still have useful vision which can often be imrproved with aids.

Though most often experienced by the elderly, people of all ages may be affected.  Low vision can occur from birth defects, inherited diseases, injuries, diabetes, glaucoma, cataracts and a deterioration of the retina, the light sensitive tissue in the back of the eye.  Vision loss from macular degeneration is limited to central vision and fortunately does not cause total blindness since side (peripheral) vision is not affected.

A low vision aid is a device which improves vision.  There is no single aid that magically restores normal vision in all circumstances.  In fact, you may need different aids for different purposes.  If possible, try to determine whether a particular aid is useful for you before you buy it.

Low vision aids fall into two general categories: optical and non-optical.

Optical low vision aids use lenses or combinations of lenses to provide magnification.  They should not be confused with standard eyeglasses.  There are five main kinds of optical aids; magnifying spectacles, hand magnifiers, stand magnifiers, telescopes, and closed-circuit TV (CCTV).

Non-optical aids include large print books, newspapers, and magazines, check writing guides, large playing cards, enlarged telephone dials and high contrast watch faces.

Governmental and private agencies provide social services for low vision patients.  These include talking books, independent home living instruction, and in some cases, orientation and mobility training.

If you would like more information please call our office at (386) 761-6665

CHECK OUT  www.GetEyeSmart.org  for a lot of useful information

Lasik Eye Surgery
www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/LASIK/ucm061358.htm






 


 



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