Article Problems and Diseases

Problems and Diseases

• Amblyopia (Lazy Eye)

Amblyopia (Lazy Eye)

Amblyopia, also known as "lazy eye," is a visual development disorder that cannot be corrected with eyeglasses or contact lenses. If left untreated, it can cause legal blindness in the affected eye. About 2% to 3% of the population is amblyopic.

Amblyopia Signs and Symptoms

Amblyopia generally starts at birth or during early childhood. Its symptoms often are noted by parents, caregivers or health-care professionals. If a child squints or completely closes one eye to see, he or she may have amblyopia. Other signs include overall poor visual acuity, eyestrain and headaches.

What Causes Amblyopia?

The most common cause of amblyopia is strabismus (intermittent or constant misalignment of the eyes). Another common cause is a significant difference in the refractive errors (nearsightedness, farsightedness and/or astigmatism) in the two eyes. It's important to correct amblyopia as early as possible, before the brain ignores vision in the affected eye.

Treatment of Amblyopia

Amblyopic children can be treated with vision therapy (which often includes patching one eye), atropine eye drops, the correct prescription for nearsightedness or farsightedness, or surgery.

Vision therapy exercises the eyes and helps both eyes work as a team. Vision therapy for someone with amblyopia forces the brain to use the amblyopic eye, thus restoring vision.

Sometimes the eye doctor or vision therapist will place a patch over the stronger eye to force the weaker eye to be used more. Patching may be required for several hours each day or even all day long, and may continue for weeks or months. If you have a lot of trouble with your child taking the patch off, you might consider a prosthetic contact lens that is specially designed to block vision in one eye but is colored to closely match the other eye.

In some children, atropine eye drops have been used to treat amblyopia instead of patching. One drop is placed in your child's good eye each day (your eye doctor will instruct you). Atropine blurs vision in the good eye, which forces your child to use the eye with amblyopia more, to strengthen it. One advantage of this method of treatment is that it doesn't require your constant vigilance to make sure your child wears an eye patch.

If your child has become amblyopic due to a strong uncorrected refractive error or a large difference between the refractive errors of their eyes, amblyopia can sometimes simply be treated by wearing eyeglasses or contact lenses full-time. In some cases, patching may be recommended along with the new glasses or contact lenses.

In cases when the amblyopia is caused by a large eye turn, strabismus surgery is usually required to straighten the eyes. The surgery corrects the muscle problem that causes strabismus so the eyes can focus together and see properly.

Amblyopia will not go away on its own, and untreated amblyopia can lead to permanent visual problems and poor depth perception. If your child has amblyopia and the stronger eye develops disease or is injured later in life, the result will be poor vision through the amblyopic eye. To prevent this and to give your child the best vision possible, amblyopia should be treated early on.

If amblyopia is detected and aggressively treated before the age of 8 or 9, in many cases the weak eye will be able to develop 20/20 vision.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Astigmatism

Astigmatism

Astigmatism is one of the most common vision problems, but most people don't know what it is.

Many people are relieved to learn that astigmatism is not an eye disease. Like nearsightedness and farsightedness, astigmatism is a type of refractive error - a condition related to the shape and size of the eye that causes blurred vision. 

In addition to blurred vision, uncorrected astigmatism can cause headaches and eyestrain and can make objects at all distances appear distorted.

Astigmatism Signs and Symptoms

If you have only a small amount of astigmatism, you may not notice it at all, or you may have only mildly blurred or distorted vision. But even small amounts of uncorrected astigmatism can cause headaches, fatigue and eyestrain over time.

Astigmatism usually develops in childhood. A study at The Ohio State University School of Optometry found that more than 28% of schoolchildren have astigmatism. 

Children may be even more unaware of the condition than adults, and they may also be less likely to complain of blurred or distorted vision. But astigmatism can cause problems that interfere with learning, so it's important to have your child's eyes examined at regular intervals during their school years. 

What Causes Astigmatism?

Usually, astigmatism is caused by an irregular-shaped cornea, the clear front surface of the eye. In astigmatism, the cornea isn't perfectly round, but instead is more football- or egg-shaped. 

In some cases, astigmatism may be caused by an irregular-shaped lens inside the eye. 

In most astigmatic eyes, the irregular shape of the cornea or lens causes light rays to form two distorted images in the back of the eye, rather than a single clear one. This is because, like a football, an astigmatic eye has a steeper curve and a flatter one.

How Is Astigmatism Treated?

In most cases, astigmatism can be fully corrected with eyeglasses or contact lenses. 

Rigid gas permeable (RGP or GP) contact lenses often provide the best correction for astigmatism. But special soft contact lenses for astigmatism, called toric soft lenses, are also available. 

Hybrid contact lenses are another option. These lenses have a GP center and a soft periphery to provide the clarity of gas permeable lenses and wearing comfort that is comparable to soft lenses.

Depending on the type and severity of your astigmatism, you may also have it corrected with LASIK or other types of refractive surgery.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Blepharitis

Blepharitis

Blepharitis is inflammation of the eyelids. It's a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis. 

Anterior blepharitis affects the front of the eyelids, usually near the eyelashes. The two most common causes of anterior blepharitis are bacteria and a skin disorder called seborrheic dermatitis, which causes itchy, flaky red skin.

Posterior blepharitis affects the inner surface of the eyelid that comes in contact with the eye. It is usually caused by problems with the oil (meibomian) glands in the lid margin. Posterior blepharitis is more common than the anterior variety, and often affects people who have rosacea.

Blepharitis Signs and Symptoms

Regardless of which type of blepharitis you have, you will probably experience eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness and red eyelid margins.

It's important to see an eye doctor and get treatment. If your blepharitis is bacterial, possible long-term effects are thickened lid margins, dilated and visible capillaries, misdirected eyelashes, loss of eyelashes and a loss of the normal position of the eyelid margin against the eye. Blepharitis can also lead to styes and infections or erosions of the cornea. 

Blepharitis Treatments

Blepharitis can be difficult to manage, because it tends to recur. Treatment depends on the type of blepharitis you have. It may include applying warm compresses to the eyelids, cleaning your eyelids frequently, using an antibiotic and/or massaging the lids to help express oil from the meibomian glands. 

If your blepharitis makes your eyes feel dry, artificial tears or lubricating ointments may also be recommended. In some cases, anti-bacterial or steroid eye drops or ointments may be prescribed.

Always wash your hands before and after touching your eyelids when treating blepharitis. Your eye doctor will provide instructions on the products and techniques you can use to relieve symptoms and get your blepharitis under control. Thereafter, a daily regimen of lid hygiene is helpful in preventing recurrences of blepharitis.

There is some evidence to suggest that taking a daily flaxseed oil supplement that contains omega-3 fatty acids may help prevent or reduce the severity of posterior blepharitis. Be sure to discuss any supplement use with your doctor.

Because blepharitis tends to be chronic, expect to keep up therapy for a prolonged period of time to keep it at bay. If you normally wear contact lenses, you may need to discontinue wearing them during the treatment period and even beyond. Sometimes, changing from soft contact lenses to rigid gas permeable (GP) contacts can be helpful, since GP lenses are less likely to accumulate lens deposits. In other cases, contact lens discomfort caused by blepharitis can be relieved by replacing soft contact lenses more frequently or changing to one-day disposable lenses.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• CMV Retinitis

CMV Retinitis

Cytomegalovirus (CMV) retinitis is a sight-threatening disease associated with late-stage AIDS (Acquired Immunodeficiency Syndrome). In the past, about 25% of active AIDS patients developed CMV retinitis. However, this figure appears to be dropping thanks to a potent combination of drugs that help restore the function of the immune system.

CMV Retinitis Signs and Symptoms

When the cytomegalovirus invades the retina, it begins to compromise the light-sensitive receptors that enable us to see. This does not cause any pain, but you may see floaters or small specks and experience decreased visual acuity, distorted vision or decreased peripheral vision. Light flashes and sudden loss of vision also can occur. The disease usually starts in one eye but often involves both eyes.

If left untreated, CMV retinitis can cause retinal detachment and blindness in less than six months.

AIDS patients sometimes also experience changes to the retina and optic nerve without clear signs of CMV retinitis.

What Causes CMV Retinitis?

CMV retinitis is caused by the cytomegalovirus, which is a very common virus. About 80% of adults harbor antibodies to CMV, which indicates their bodies have successfully fought it off. The difference for people who have AIDS is that their weakened or non-functioning immune system cannot stave off this virus. Other people with a weakened or suppressed immune system, such as those undergoing chemotherapy or a bone marrow transplant, are also at risk for CMV retinitis.

How Is CMV Retinitis Treated?

If you have active AIDS and are experiencing visual symptoms, you should see a retina specialist immediately. A person newly diagnosed with CMV retinitis can expect to visit the specialist every two to four weeks.

Once the disease is controlled, the retina specialist may recommend follow-up visits with your regular eye doctor every three to six months.

Drugs for CMV retinitis. Anti-viral drugs commonly used to treat CMV retinitis are ganciclovir (Cytovene), foscarnet (Foscavir) and cidofovir (Vistide). These medications can slow down the progression of CMV, but they can't cure it. These potent anti-viral drugs can also cause unpleasant or serious side effects.

Ganciclovir is available in a pill, used following two weeks of intravenous infusion, and also in an implant called Vitrasert. The implant releases medication directly into the eye, so it doesn't cause the side effects experienced with intravenous infusion or with the pill.

Drugs for HIV. The biggest breakthrough in AIDS treatment is highly active antiretroviral therapy (HAART), a combination of drugs that suppress the human immunodeficiency virus (HIV), also known as the AIDS virus. HAART allows your immune system to recover and fight off infections like CMV retinitis.

AIDS is a serious global health problem. If you have AIDS, are HIV positive or have a compromised immune system from other causes, see your eye doctor frequently to rule out CMV retinitis and to discuss the latest treatment options if a CMV-related eye problem is detected.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.


• Cataracts

Cataracts

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away.

The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Most cataracts occur gradually as we age and don't become bothersome until after age 55. However, cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataracts). Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications, such as steroids.

Cataract Signs and Symptoms

A cataract starts out small and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. However, as cataracts worsen, you are likely to notice some or all of these problems:

• Blurred vision that cannot be corrected with a change in your glasses prescription.
• Ghost images or double vision in one or both eyes.
• Glare from sunlight and artificial light, including oncoming headlights when driving at night.
• Colors appear faded and less vibrant.

What Causes Cataracts?

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts and gathering information that may help to prevent them.

Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure. Other types of radiation may also be causes. For example, a study conducted in Iceland suggests that airline pilots have a higher risk of developing a nuclear cataract than non-pilots, and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at greater risk of cataracts due to their higher exposure to cosmic radiation.

Other studies suggest people with diabetes are at risk for developing a cataract. The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves.

Some eyecare practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.

Other risk factors for cataracts include cigarette smoke, air pollution and heavy alcohol consumption. 

Cataract Treatment

When symptoms of cataracts begin to appear, you may be able to improve your vision for a while using new glasses, stronger bifocals and more light when reading. But when these remedies fail to provide enough benefit, it's time for cataract surgery.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with nearly 3 million cataract surgeries done each year. More than 90% of people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40, and sight-threatening complications are relatively rare.

During surgery, the surgeon will remove your clouded lens and replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and postoperative outcomes better for patients. Presbyopia-correcting IOLs not only improve your distance vision, but can decrease your reliance on reading glasses as well.

If you need cataracts removed from both eyes, surgery usually will be done on only one eye at a time. An uncomplicated surgical procedure lasts only about 10 minutes. However, you may be in the outpatient facility for 90 minutes or longer, because extra time will be needed for preparation and recovery.

Presbyopia-Correcting IOLs: Frequently Asked Questions

If you need cataract surgery, you may have the option of paying extra for new presbyopia-correcting IOLs that potentially can restore a full range of vision without eyeglasses.

Presbyopia-correcting IOLs are a relatively new option, so you may have questions such as:

1. What are presbyopia-correcting IOLs?

Presbyopia-correcting intraocular lenses (IOLs) are lens implants that can correct both distance and near vision, giving you greater freedom from glasses after cataract surgery than standard IOLs. They are available in two forms: multifocal lenses and accommodating lenses. Multifocal lenses are similar to multifocal contact lenses - they contain more than one lens power for different viewing distances. Accommodating IOLs have just one lens power, but the lens is mounted on flexible "legs" that allow the lens to move forward or backward within your eye in response to focusing effort to enable you to see clearly at a range of distances.

2. Aren't presbyopia-correcting IOLs a lot more expensive? How much extra do I have to pay?

Yes, presbyopia-correcting IOLs are more expensive than standard IOLs. Costs vary, depending on the lens used, but you can expect to pay up to $2,500 extra per eye. This added amount is usually not covered by Medicare or other health insurance policies, so it would be an "out-of-pocket" expense if you choose this advanced type of IOL for your cataract surgery.

3. Why won't Medicare or health insurance cover the full cost of presbyopia-correcting IOLs?

A multifocal or accommodating IOL is not considered medically necessary. In other words, Medicare or your insurance will pay only the cost of a basic IOL and accompanying cataract surgery. Use of a more expensive, presbyopia-correcting lens is considered an elective refractive procedure, a type of luxury, just as LASIK and PRK are refractive procedures that also typically are not covered by health insurance.

4. Can my local cataract surgeon perform presbyopia-correcting surgery?

Not all cataract surgeons use presbyopia-correcting IOLs for cataract surgery. Make sure your eye surgeon has experience with these lenses if you choose a multifocal or accommodating IOL. Studies have shown that surgeon experience is a key factor in successful outcomes, particularly in terms of whether you will need to wear eyeglasses following cataract surgery.

5. Are any problems associated with presbyopia-correcting IOLs?

At a 2007 American Society of Cataract and Refractive Surgery conference, some reports indicated that even experienced cataract surgeons needed to perform enhancements for 13% to 15% of cases involving use of presbyopia-correcting IOLs. Enhancements don't mean that the procedure itself was a failure, because you likely will see just fine with eyeglasses even if your outcome is less than optimal. But it's possible you may need an additional surgical procedure (such as LASIK) to perfect your uncorrected vision after cataract surgery with a presbyopia-correcting IOL. Depending on the arrangement you make with your eye surgeon, you also may need to pay extra for any needed enhancements.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Cornea Transplant

Cornea Transplant

A cornea transplant replaces damaged tissue on the eye's clear surface. Corneal transplants are often referred to as a keratoplasty, penetrating keratoplasty (PK) or corneal graft.

In cases where the cornea has been damaged due to disease or injury, a cornea transplant replaces your tissue with healthy corneal tissue donated from an eye bank. An unhealthy cornea affects your eyesight by scattering light and causing blurred or distorted vision. In some cases, a cornea can be so damaged or scarred that a transplant is necessary to restore your functional vision.

Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. The National Keratoconus Foundation estimates that more than 40,000 cornea transplants are performed in the United States each year. 

A newer version of corneal transplant, known as Descemet's Stripping Endothelial Keratoplasty (DSEK), removes only a very thin portion of the cornea for transplant. In 2009, the American Academy of Ophthalmology endorsed DSEK as superior to the conventional full-thickness corneal transplant procedure (penetrating keratoplasty) because it may offer better vision outcomes and stability, as well as fewer risk factors. However, if the majority of your cornea is diseased or scarred, more complete removal may be needed prior to transplant. 

Are You a Candidate for a Cornea Transplant?

Your eye doctor may recommend a corneal transplant for a variety of reasons, which can include the following:

• Scarring from infections, such as eye herpes or fungal keratitis.
• Eye diseases such as keratoconus.
• Hereditary factors or corneal failure from previous surgeries.
• Thinning of the cornea and irregular shape (such as with keratoconus).
• Complications from LASIK.
• Chemical burns on the cornea or damage from an eye injury.
• Excessive swelling (edema) on the cornea.

The Cornea Transplant Procedure

Once you and your doctor have decided that a corneal transplant is the best option to restore your functional vision, your name is placed on a list at an eye bank. The waiting period for a donor eye is generally one to two weeks due to a very sophisticated eye bank system in the U.S. Before donor corneas are released for transplant, tissue is checked for clarity. To further ensure the health and safety of the recipient, donor eye tissue is meticulously screened for diseases such as hepatitis and AIDS.

Typically, corneal transplants are performed on an outpatient basis, meaning that you will not need hospitalization. Local or general anesthesia is used, depending on your health, age, and whether you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement, and eye drops are used to numb the eye itself.

After the anesthesia has taken effect, the eyelids are held open while your eye surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A round, button-shaped section of tissue is then removed from your diseased or injured cornea. A nearly identical-shaped button from the donor tissue is then sutured into place. Finally, the surgeon will place a plastic shield over your eye to protect it from being inadvertently rubbed or bumped. The surgery takes one to two hours.

Cornea Graft Rejection

Most corneal transplants are successful. The best way to prevent corneal transplant rejection is to recognize the warning signs:

• Redness
• Extreme sensitivity to light
• Decreased vision
• Pain

Rejection signs may occur as early as one month or as late as five years after surgery. If you have complications with your corneal transplant, your doctor will prescribe medication that can reverse the rejection process. Should your graft fail, the corneal transplant can be repeated, generally with good results. Still, overall rejection rates increase with the number of corneal transplants you have.

Recovering from a Cornea Transplant

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry, and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. As your vision is restored, you will gradually be able to return to your normal daily activities. 

For the first several weeks, heavy exercise and lifting are prohibited. However, you should be able to return to work three to seven days after surgery, depending on your job. Steroid eye drops will be prescribed for several months to help your body accept the new corneal graft. You should keep your eye protected at all times by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps or enters your eye.

Stitches may be removed from three months to more than a year after surgery, depending on the health of your eye and the rate of healing. Adjustments may be made to the sutures surrounding the new cornea to help reduce the amount of astigmatism resulting from an irregular eye surface.

Your Eyesight After a Cornea Transplant

Your vision will continue to improve up to one year following your surgery. But you will need glasses or contact lenses after surgery, because the curve of the corneal transplant cannot match exactly the curve of your natural cornea. After healing is complete and stitches are removed, it is possible to undergo laser vision correction (LASIK or PRK) to improve your vision and decrease your dependence on glasses or contact lenses.

Rigid gas permeable (RGP or GP) contact lenses often provide the best vision correction for corneal transplant patients due to the irregularity of the cornea after transplant. 

Regardless of whether you need corrective eyewear, it's wise to wear safety glasses after a cornea transplant to protect your eyes from injury.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Cornea Transplant (Conditions)

Cornea Transplant (Conditions)

A cornea transplant, which replaces damaged tissue on the eye’s clear surface, also is referred to as a corneal transplant, keratoplasty, penetrating keratoplasty (PK) or corneal graft.

A cornea transplant replaces central corneal tissue, damaged due to disease or injury, with healthy corneal tissue donated from an eye bank. An unhealthy cornea affects your vision by scattering light and causing blurred or distorted vision. In some cases, a cornea can be so damaged or scarred that a transplant is necessary to restore your functional vision.

Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. The National Keratoconus Foundation estimates that more than 40,000 cornea transplants are performed in the United States each year.

A new version of corneal transplant, known as Descemet's Stripping Endothelial Keratoplasty (DSEK), also has been introduced as a new surgical method that uses only a very thin portion of the cornea for transplant. In certain cases, this type of procedure may be preferred because it has advantages such as being less likely to create an irregular corneal surface (astigmatism) as a side effect.

Are you a candidate for a cornea transplant?

Your eye doctor may suggest a corneal transplant for reasons varying from diseases to eye injuries, which can include the following:

• Scarring from infections, such as eye herpes or fungal keratitis.
• Eye diseases such as keratoconus.
• Hereditary factors or corneal failure from previous surgeries.
• Thinning of the cornea and irregular shape (such as with keratoconus).
• Complications from LASIK.
• Chemical burns on the cornea or damage from an eye injury.
• Excessive swelling (edema) on the cornea.

The cornea transplant procedure

Once you and your doctor have decided that a corneal transplant is the best option to restore your functional vision, your name is placed on a list at a local eye bank. The waiting period for a donor eye is generally one to two weeks due to a very sophisticated eye bank system in the U.S. Before donor corneas are released for transplant, tissue is checked for clarity. Also, donor eyes supplying transplant tissue are meticulously screened for presence of diseases such as hepatitis and AIDS or other damage to ensure the health and safety of the recipient.

Typically, corneal transplants are performed on an outpatient basis, meaning that you will not need hospitalization. Local or general anesthesia is used, depending on your health, age, and whether or not you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement, and eye drops are used to numb the eye itself.

After the anesthesia has taken effect, the eyelids are held open while your eye surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A round, button-shaped section of tissue is then removed from your diseased or injured cornea. A nearly identical-shaped button from the donor tissue is then sutured into place. Finally, the surgeon will place a plastic shield over your eye to protect it from being inadvertently rubbed or bumped. The surgery takes one to two hours.

Cornea graft rejection

Most corneal transplants are successful. The best way to prevent corneal transplant rejection is to recognize the warning signs:

• Redness
• Extreme sensitivity to light
• Decreased vision
• Pain

Rejection signs may occur as early as one month or as late as five years after surgery. If you have complications with your corneal transplant, your doctor will prescribe medication that can reverse the rejection process. Should your graft fail, the corneal transplant can be repeated, generally with good results. Still, overall rejection rates increase with the number of corneal transplants you have.

Recovering from a cornea transplant

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. As your vision is restored, you will gradually be able to return to your normal daily activities.

For the first several weeks, heavy exercise and lifting are prohibited. However, you should be able to return to work three to seven days after surgery, depending on your job. Steroid eye drops will be prescribed for several months to help your body accept the new corneal graft. You should keep your eye protected at all times by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps or enters your eye.

Stitches may be removed from three months to more than a year after surgery, depending on the health of your eye and the rate of healing. Adjustments may be made to the sutures surrounding the new cornea to help reduce the amount of astigmatism resulting from an irregular eye surface.

Your eyesight after a cornea transplant

Your vision will continue to improve up to one year following your surgery. But you will need glasses or contact lenses after surgery, because the curve of the corneal transplant cannot match exactly the curve of your natural cornea. After healing is complete and stitches are removed, it is possible to undergo laser vision correction (LASIK or PRK) to improve your vision and decrease your dependence on glasses or contact lenses.

Rigid gas permeable (RGP or GP) contact lenses often provide the best vision correction for corneal transplant patients due to the irregularity of the cornea after transplant.

Regardless of whether you need corrective eyewear, it’s wise to wear safety glasses after a cornea transplant to protect your eyes from injury.

Article ©2012 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

• Diabetic Retinopathy

Diabetic Retinopathy

If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely they are to have retinopathy (damage to the retina) from the disease.

In its advanced stages, diabetes may lead to new blood vessel growth over the retina. The new blood vessels can break and cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris, which can lead to glaucoma. 

People with diabetes are 25 times more likely to lose vision than those who are not diabetic, according to the American Academy of Ophthalmology. In fact, between 12,000 and 24,000 new cases of blindness related to diabetic retinopathy occur in the United States each year, the CDC says.

Signs and Symptoms of Diabetic Retinopathy

Currently, more than 5 million Americans age 40 and older have diabetic retinopathy due to type 1 or type 2 diabetes. And that number will grow to about 16 million by 2050. Anyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics will be affected. In the early stages of diabetes, you may not notice any change in your vision. But by the time you notice vision changes from diabetes, your eyes may already be irreparably damaged by the disease. 

That's why routine eye exams are so important. Your eye doctor can detect signs of diabetes in your eyes even before you notice any visual symptoms, and early detection and treatment can prevent vision loss.

Floaters are one symptom of diabetic retinopathy. Sometimes, difficulty reading or doing close work can indicate that fluid is collecting in the macula, the most light-sensitive part of the retina. This fluid build-up is called macular edema. Another symptom is double vision, which occurs when the nerves controlling the eye muscles are affected. 

If you experience any of these symptoms, see your eye doctor immediately. If you are diabetic, you should see your eye doctor at least once a year for a dilated eye exam, even if you have no visual symptoms.

If your eye doctor suspects diabetic retinopathy, a special test called fluorescein angiography may be performed. In this test, dye is injected into the body and then gradually appears within the retina due to blood flow. Your eyecare practitioner will photograph the retina as the dye passes through the blood vessels in the retina. Evaluating these pictures tells your doctor or a retina specialist if signs of diabetic retinopathy exist, and how far the disease has progressed.

What Causes Diabetic Retinopathy?

Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes. Generally, diabetics don't develop diabetic retinopathy until they have had the disease for at least 10 years. As soon as you've been diagnosed with diabetes, you need to have a dilated eye exam at least once a year.

In the retina, high blood sugar can damage blood vessels that can leak fluid or bleed. This causes the retina to swell and form deposits. This is an early form of diabetic retinopathy called non-proliferative or background retinopathy.

In a later stage, called proliferative retinopathy, new blood vessels grow on the surface of the retina. These new blood vessels can lead to serious vision problems because they can break and bleed into the vitreous, the clear, jelly-like substance that fills the interior of the eye. Proliferative retinopathy is a much more serious form of the disease and can lead to blindness.

Fortunately, you can significantly reduce your risk of developing diabetic retinopathy by using common sense and taking good care of yourself:

• Keep your blood sugar under good control.
• Maintain a healthy diet.
• Exercise regularly.
• Follow your doctor's instructions to the letter.

How Is Diabetic Retinopathy Treated?

According to the American Academy of Ophthalmology, 95% of those with diabetic retinopathy can avoid substantial vision loss if they are treated in time. 

Diabetic retinopathy can be treated with a laser to seal off leaking blood vessels and inhibit the growth of new vessels. Called laser photocoagulation, this treatment is painless and takes only a few minutes.

In some patients, blood leaks into the vitreous humor and clouds vision. Your eye doctor may choose to simply wait to see if the clouding will dissipate on its own, or a procedure called a vitrectomy may be performed to remove blood that has leaked into the vitreous humor.

Lasers also may be used to intentionally destroy tissue in the periphery of the retina that is not required for functional vision. This is done to improve blood supply to the more essential central portion of the retina to maintain sight.

In 2015, the FDA approved the use of a non-laser treatment called Lucentis for patients with diabetic retinopathy. Lucentis is an injectable medication that is administered by an ophthalmologist. Several other treatments that are currently being used for diabetic macular edema are also being reviewed by the FDA to treat patients with diabetic retinopathy.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Dry Eye Syndrome

Dry Eye Syndrome

Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.

Signs and Symptoms of Dry Eye 

Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.

Some people with dry eyes also experience a "foreign body sensation" - the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye's tears.

What Causes Dry Eyes?

In dry eye syndrome, the tear glands that moisturize the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs:

• As a part of the natural aging process, especially among women over age 40.
• As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills.
• Because you live in a dry, dusty or windy climate with low humidity.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).

Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. 

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty - a popular cosmetic surgery to eliminate droopy eyelids.

Treatment for Dry Eye

Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye - including dryness, scratchiness and burning - can usually be successfully managed. 

Your eyecare practitioner may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief. 

Another option for dry eye treatment involves a tiny insert filled with a lubricating ingredient. The insert is placed just inside the lower eyelid, where it continuously releases lubrication throughout the day.

If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.

Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.

To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection. 

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.

For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.

If your dry eye is caused by meibomian gland dysfunction (MGD), your doctor may recommend warm compresses and suggest an in-office procedure to clear the blocked glands and restore normal function.

Doctors sometimes also recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also offer some relief.

If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.

If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.


• Eye Allergies

Eye Allergies

Similar to processes that occur with other types of allergic responses, the eye may overreact to a substance perceived as harmful even though it may not be. For example, dust that is harmless to most people can cause excessive tear production and mucus in eyes of overly sensitive, allergic individuals. Also, eye allergies are often hereditary.

The American College of Allergy, Asthma and Immunology estimates that 50 million people in the United States have seasonal allergies, and their prevalence is increasing — affecting up to 30 percent of adults and up to 40 percent of children. Allergies can trigger other problems, such as conjunctivitis (pink eye) and asthma. In fact, most Americans who suffer from allergies also have allergic conjunctivitis, according to the American Academy of Ophthalmology.

Allergy Signs and Symptoms

Common signs of allergies include: red, swollen, tearing or itchy eyes; runny nose; sneezing; coughing; difficulty breathing; itchy nose, mouth or throat, and headache from sinus congestion.

What Causes Eye Allergies?

Many allergens (substances that can evoke an allergic response) are in the air, where they come in contact with your eyes and nose. Airborne allergens include pollen, mold, dust and pet dander. Other causes of allergies, such as certain foods or bee stings, do not typically affect the eyes the way airborne allergens do. Adverse reactions to certain cosmetics or eye drops, including artificial tears that contain preservatives, also may cause eye allergies.

Eye Allergy Treatment

Avoidance. The most common "treatment" is to avoid what's causing your eye allergy. If you have itchy eyes, try to keep your home free of pet dander and dust, and stay inside with the air conditioner on when a lot of pollen is in the air. If you have central air conditioning, use a high quality filter that can trap most airborne allergens, and replace it frequently.

Medications. If you're not sure what's causing your eye allergies, or you're not having any luck avoiding them, your next step will probably be medication to alleviate the symptoms.

Over-the-counter and prescription medications each have their advantages; for example, over-the-counter products are often less expensive, while prescription ones are often stronger.

Eye drops are available as simple eye washes, or they may have one or more active ingredients such as antihistamines, decongestants or mast cell stabilizers. 

Antihistamines relieve many symptoms caused by airborne allergens, such as itchy, watery eyes, runny nose and sneezing.

Decongestants clear up redness. They contain vasoconstrictors, which make the blood vessels in your eyes smaller, lessening the apparent redness. They treat the symptom, not the cause. In fact, with extended use, the blood vessels can become dependent on the vasoconstrictor to stay small. When you discontinue the eye drops, the vessels actually get bigger than they were in the first place. This process is called rebound hyperemia, and the result is that your red eyes worsen over time.

Some products have ingredients that act as mast cell stabilizers, which alleviate redness and swelling. Mast cell stabilizers are similar to antihistamines. But while antihistamines are known for their immediate relief, mast cell stabilizers are known for their long-lasting relief.

Other medications used for allergies include non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. In some cases, combinations of medications may be used.

Immunotherapy. You may also benefit from immunotherapy, in which an allergy specialist injects you with small amounts of allergens to help your body gradually build up immunity to them.

Eye Allergies and Contact Lenses

Even if you are generally a successful contact lens wearer, allergy season can make your contacts uncomfortable. Airborne allergens can get on your lenses, causing discomfort. Allergens can also stimulate the excessive production of natural substances in your tears that bind to your contacts, adding to your discomfort and allergy symptoms.

Ask your eye doctor about eye drops that can help relieve your symptoms and keep your contact lenses clean. Certain drops can discolor or damage contact lenses, so ask your doctor first before trying out a new brand. 

Another alternative is daily disposable contact lenses, which are discarded nightly. Because you replace them so frequently, these lenses are unlikely to develop irritating deposits that can build up over time and cause or heighten allergy-related discomfort.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Floaters and Spots

Floaters and Spots

Have you ever seen small specks or debris that look like pieces of lint floating in your field of view? These are called "floaters," and they are usually normal and harmless. They usually can be seen most easily when you look at a plain background, like a blank wall or blue sky.

Floaters are actually tiny clumps of gel or cells inside the vitreous - the clear, jelly-like fluid that fills the inside of your eye.

Floaters may look like specks, strands, webs or other shapes. Actually, what you are seeing are the shadows of floaters cast on the retina, the light-sensitive inner lining of the back of the eye.

Signs and Symptoms of Floaters and Spots

With special exam lights, your eye doctor can detect floaters in your eyes even if you don't notice them yourself. 

If a spot or shadowy shape passes in front of your field of vision or to the side, you are seeing a floater. Because they are inside your eye and suspended within the gel-like vitreous, they move with your eyes when you try to see them. 

What Causes Floaters and Spots?

Some floaters are present since birth as part of the eye's development, and others occur over time.

When people reach middle age, the gel-like vitreous begins to liquefy and contract. Some parts of the vitreous form clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment (PVD). PVD is a common cause of floaters.

Floaters are also more common among people who:

• Are nearsighted.
• Have undergone cataract surgery.
• Have had laser surgery of the eye.
• Have had inflammation inside the eye.

Treatment for Floaters and Spots

Most spots and floaters in the eye are harmless and merely annoying. Many will fade over time and become less bothersome. People sometimes are interested in surgery to remove floaters, but doctors are willing to perform such surgery only in rare instances.

Flashes of Light

You may also see flashes of light. These flashes occur more often in older people and usually are caused by mechanical stimulation of photoreceptors when the gel-like vitreous occasionally tugs on the light-sensitive retina. They may be a warning sign of a detached retina - a very serious problem that could lead to blindness if not treated quickly.

Some people experience flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine. If a headache follows the flashes, it is called a migraine headache. However, jagged lines or "heat waves" can occur without a headache. In this case, the light flashes are called an ophthalmic migraine, or a migraine without a headache.

Are Flashes, Floaters and Spots an Emergency?

The sudden appearance of a significant number of floaters, especially if they are accompanied by flashes of light or other vision disturbances, could indicate a retinal detachment or other serious problem in the eye. A study reported in the Journal of the American Medical Association in 2009 found that one in seven people with the sudden presence of eye floaters and flashes will have a retinal tear or detachment. If you suddenly see new floaters, visit your eye doctor immediately.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Glaucoma

Glaucoma

Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intraocular pressure or IOP), which can damage the eye's optic nerve - the structure that transmits visual information from the eye to the brain.

Glaucoma typically affects your peripheral vision first. This is why it is such a sneaky disease: You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness.

Glaucoma is currently the second leading cause of blindness in the United States, with an estimated 2.5 million Americans affected by the disease. Due to the aging of the U.S. population, it's expected that more than 3 million Americans will have glaucoma by 2020.

Signs and Symptoms of Glaucoma

Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But there are other forms of the disease (specifically, acute angle-closure glaucoma), where symptoms of blurry vision, halos around lights, intense eye pain, nausea, and vomiting occur suddenly. If you have these symptoms, make sure you see an eye care practitioner immediately or visit the emergency room so steps can be taken to prevent permanent vision loss.

What Causes Glaucoma?

The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of fluid produced inside the eye and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have.

Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels and vision is lost.

Types of Glaucoma

The two major categories of glaucoma are open-angle glaucoma and narrow-angle glaucoma. The "angle" refers to the structure inside the eye that is responsible for fluid drainage from the eye, located near the junction between the iris and the front surface of the eye near the periphery of the cornea. Some of the more common types of glaucoma include:

Primary open-angle glaucoma (POAG). About half of Americans with this form of chronic glaucoma don't know they have it. POAG gradually and painlessly reduces your peripheral vision. But by the time you notice it, permanent damage has already occurred. If your IOP remains high, the destruction can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead. 

Acute angle-closure glaucoma. Angle-closure or narrow angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your field of vision. 

Normal-tension glaucoma. Like POAG, normal-tension glaucoma (also termed normal-pressure glaucoma, low-tension glaucoma, or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range. Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.

The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

Congenital glaucoma. This inherited form of glaucoma is present at birth, with 80% of cases diagnosed by age 1. These children are born with narrow angles or some other defect in the drainage system of the eye. It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Pigmentary glaucoma. This rare form of glaucoma is caused by pigment deposited from the iris that clogs the draining angles, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.

Secondary glaucoma. Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of infection, inflammation, a tumor or an enlarged cataract.

How Is Glaucoma Detected?

During routine eye exams, a tonometer is used to measure your intraocular pressure (IOP). Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other types of tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye. Either the eye is producing too much fluid, or it's not draining properly.

Another method for detecting or monitoring glaucoma is the use of instruments to create images of the eye's optic nerve and then repeating this imaging over time to see if changes to the optic nerve are taking place, which might indicate progressive glaucoma damage. Imaging methods include scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy. 

Visual field testing is another way to monitor whether blind spots are developing in your field of vision from glaucoma damage to the optic nerve. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals so your eye doctor can determine if there is progressive vision loss.

Instruments such as an ophthalmoscope also may be used to help your eye doctor view internal eye structures, to make sure nothing unusual interferes with the outflow and drainage of eye fluids. Ultrasound biomicroscopy also may be used to evaluate how well fluids flow through the eye's internal structures. Gonioscopy is the use of special lenses that allow your eye doctor to visually inspect internal eye structures that control fluid drainage.

Glaucoma Treatments

Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, conventional (bladed) surgery, laser surgery or a combination of these treatments. Medicated eye drops aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage. In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness resulting from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid or increase the outflow (drainage) of this same fluid. Occasionally, a procedure will accomplish both.

Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures - especially the optic nerve - may be prevented.

Early Detection Is Key

No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP. 

People at high risk for glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the eye doctor.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Hyperopia

Hyperopia

Hyperopia, or farsightedness, is a common vision problem affecting about 25% of the U.S. population. People with hyperopia can usually see distant objects well, but have difficulty seeing objects that are up close.

Signs and Symptoms of Hyperopia

Farsighted people sometimes have headaches or eyestrain, and may squint or feel fatigued when performing work at close range. If you get these symptoms while wearing your glasses or contact lenses, you may need an eye exam and a new prescription.

What Causes Hyperopia?

Farsightedness occurs when light rays entering the eye focus behind the retina, rather than directly on it. The eyeball of a farsighted person is often shorter than normal.

Many children are born with hyperopia, and some of them "outgrow" it as the eyeball lengthens with normal growth.

People sometimes confuse hyperopia with presbyopia, which also involves difficulty with seeing up close. But presbyopia has a different cause and occurs after age 40.

Hyperopia Treatment

Eyeglasses or contact lenses can correct farsightedness to change the way light rays bend into the eyes. If your glasses or contact lens prescription begins with plus numbers, like +2.50, you are farsighted.

Depending on the amount of farsightedness you have, you may need to wear your glasses or contacts all the time, or only when reading, working on a computer or doing other close-up work.

Refractive surgery, such as LASIK or PRK, is another option for correcting hyperopia.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Keratoconus

Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.

Keratoconus is relatively rare. Most studies indicate it occurs in 0.15% to 0.6% of the general U.S. population. The onset of the disease usually occurs in people in their teens or early twenties.

Signs and Symptoms of Keratoconus

Keratoconus can be difficult to detect, because it usually develops slowly. However, in some cases, it may proceed rapidly. As the cornea becomes more irregular in shape, it causes a progressive increase in nearsightedness and irregular astigmatism, creating problems with distorted and blurred vision. Glare and light sensitivity also may be noticed. 

Keratoconic patients often have prescription changes every time they visit their eye care practitioner. 

What Causes Keratoconus?

Research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

Keratoconus Treatment

For the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts may no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses. If eyeglasses or soft contact lenses cannot control keratoconus, then gas permeable (GP) contact lenses are usually the preferred treatment. The rigid lens material enables GP lenses to vault over the cornea, replacing the cornea's irregular shape with a smooth, uniform refracting surface to improve vision.

But GP contact lenses can be less comfortable to wear than soft lenses. Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.

"Piggybacking" contact lenses. Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus, some eye care practitioners advocate "piggybacking" two different types of contact lenses on the same eye. For keratoconus, this method involves placing a soft contact lens on the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Hybrid contact lenses. Hybrid contact lenses have a relatively new design that combines a highly oxygen-permeable rigid center with a soft peripheral "skirt." Manufacturers of these lenses claim hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses. Hybrid lenses are also available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.

Scleral and semi-scleral lenses. These gas permeable contacts have a large diameter that allows the edge of the lens to rest on the white part of the eye, known as the sclera. These lenses vault over the irregularly shaped cornea, allowing for a more comfortable fit. They also move less as you blink. Scleral lenses cover a larger portion of the sclera, whereas semi-scleral lenses cover a smaller area.

Intacs. These tiny plastic inserts are surgically placed just under the eye's surface in the periphery of the cornea and help re-shape the cornea for clearer vision. Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes. Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress.

Corneal crosslinking. This procedure, often called CXL for short, strengthens corneal tissue to slow down or prevent bulging of the eye's surface, which in turn can reduce the need to undergo a corneal transplant.

There are two types of corneal crosslinking: epithelium-off and epithelium-on. With epithelium-off crosslinking, the outer portion of the cornea (epithelium) is removed to allow entry of riboflavin, a type of B vitamin, into the cornea. Once administered, the riboflavin is activated with UV light. With the epithelium-on method (also called transepithelial crosslinking), the corneal surface is left intact.

It's important to note that neither procedure is FDA-approved. However, several clinical trials are currently underway.

Corneal transplant. Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Macular Degeneration

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 unaffected by AMD, the most important aspect of vision is lost. 

AMD is the leading cause of vision loss and blindness in Americans 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.

The Two Forms of AMD

Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be. 

The dry form of AMD is more common - about 85% to 90% of all cases of macular degeneration are the dry variety.

Dry macular degeneration. Dry AMD is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes.

Dry macular degeneration is diagnosed when yellowish spots called drusen begin to accumulate in the macula. Drusen are believed to be deposits or debris from deteriorating macular tissue. Gradual central vision loss may occur with dry AMD. Vision loss from this form of the disease is usually not as severe as that caused by wet AMD. 

Two major studies conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The studies, called the Age-Related Eye Disease Study (AREDS) and AREDS2, showed that nutritional supplements containing antioxidant vitamins and multivitamins that also contain lutein and zeaxanthin can reduce the risk of dry AMD progressing to sight-threatening wet AMD. 

Wet macular degeneration. Wet AMD is the more advanced and damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration. 

With wet AMD, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive cells in the retina, causing blind spots or a total loss of central vision.

The abnormal blood vessel growth in wet AMD is the body's attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula. But the process instead creates scarring and central vision loss.

Macular Degeneration Signs and Symptoms

Macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In rare cases, AMD may cause a sudden loss of central vision.

An eye care practitioner usually can detect early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination.

What Causes Macular Degeneration?

Many forms of macular degeneration appear be linked to aging and related deterioration of eye tissue crucial for good vision. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration.

Who Gets Macular Degeneration?

Besides affecting older individuals, AMD appears to occur in whites and females in particular. The disease also can result as a side effect of some drugs, and it appears to run in families.

New evidence strongly suggests that smoking is high on the list of risk factors for macular degeneration. Other risk factors for AMD include having a family member with AMD, high blood pressure, lighter eye color and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of macular degeneration. A high-fat diet also may be a risk factor.

How Is Macular Degeneration Treated?

There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.

although a few now are in clinical trials. >span class="s2">While nutritional intervention may be valuable in preventing the progression of dry AMD to the more advanced, wet form, neither the AREDS1 nor the AREDS2 study demonstrated any preventive benefit of nutritional supplements against the development of dry AMD in healthy eyes.

For wet AMD, several FDA-approved drugs are designed to stop 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 AMD. 

Testing and Low Vision Devices

Although much progress has been made recently in macular degeneration treatment research, complete recovery of vision lost to AMD 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. AMD causes lines 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 AMD, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.

Article ©2015 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

• Myopia

Myopia

Myopia, or nearsightedness, is a very common vision problem. It's estimated that up to one-third of Americans are nearsighted. Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing.

Signs and Symptoms of Myopia

Nearsighted people often have headaches or eyestrain, and might squint or feel fatigued when driving or playing sports. If you experience these symptoms while wearing your glasses or contact lenses, you may need a stronger prescription.

What Causes Myopia?

Myopia occurs when the eyeball is slightly longer than usual from front to back. This causes light rays to focus at a point in front of the retina, rather than directly on its surface.

Nearsightedness runs in families and usually appears in childhood. This vision problem may stabilize at a certain point, although sometimes it worsens with age.

Myopia Treatment

Nearsightedness may be corrected with glasses, contact lenses or refractive surgery. Depending on the degree of your myopia, you may need to wear eyeglasses or contact lenses all the time, or only when you need sharper distance vision, like when driving, viewing a chalkboard or watching a movie. 

If your glasses or contact lens prescription begins with minus numbers, like -2.50, you are nearsighted.

Refractive surgery is another option for correcting myopia. This includes laser procedures such as LASIK and PRK, or non-laser options such as corneal inserts and implantable lenses. One advantage of the non-laser options is that, although they're intended to be permanent, they may be removed in case of a problem or change of prescription.

Then there's orthokeratology, a non-surgical procedure where you wear special rigid gas permeable (GP) contact lenses that slowly reshape the cornea while you sleep. When the lenses are removed, the cornea temporarily retains the new shape, so you can see clearly during the day without wearing glasses or contact lenses. 

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• Ocular Hypertension

Ocular Hypertension

Ocular hypertension means the pressure in your eye, or your intraocular pressure (IOP), is higher than normal. Elevated IOP is also associated with glaucoma, which is a more serious condition that causes vision loss and optic nerve damage. By itself, however, ocular hypertension doesn't damage your vision or eyes.

Studies suggest that 2% to 3% of the general population may have ocular hypertension.

Signs and Symptoms of Ocular Hypertension

You can't tell by yourself that you have ocular hypertension, because there are no outward signs or symptoms such as pain or redness. At each eye exam, your eyecare practitioner will measure your IOP using a tonometer.

When tonometry is used to measure IOP, your eye will likely be numbed with eye drops so that you don't feel the small probe that gently rests against your eye's surface. Other tonometers instead direct a puff of air onto your eye's surface and don't require any numbing drops.

What Causes Ocular Hypertension?

Anyone can develop ocular hypertension, but it's most common in African-Americans, people over 40, those with family history of ocular hypertension or glaucoma, and those with diabetes or high amounts of nearsightedness. 

IOP may become high due to excessive aqueous fluid production or inadequate drainage. Certain medications, such as steroids, and trauma can cause higher-than-normal IOP measurements as well.

Ocular Hypertension Treatment

People with ocular hypertension are at increased risk for developing glaucoma, so some eye doctors prescribe medicated eye drops to lower IOP in cases of ocular hypertension. Because these medications can be expensive and may have side effects, other eye doctors choose to monitor your IOP and take action only if you show signs of developing glaucoma.

Because of the increased risk for glaucoma, you should have your IOP measured at the intervals your doctor recommends if you have ocular hypertension.

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• Pingueculae

Pingueculae

Pingueculae and Pterygia

Pingueculae (singular form = pinguecula) are yellowish, slightly raised lesions that form on the surface tissue of the white part of your eye (sclera), close to the edge of the cornea. They are typically found in the open space between your eyelids, which also happens to be the area exposed to the sun. 

While pingueculae are more common in middle-aged or older people who spend significant amounts of time in the sun, they can also be found in younger people and even children - especially those who spend a lot of time in the sun without protection such as sunglasses or hats.

Signs and Symptoms of Pingueculae

In most people, pingueculae cause few symptoms. However, a pinguecula that is irritated might create a feeling that something is in the eye - called a foreign body sensation. In some cases, pingueculae can become swollen and inflamed, a condition called pingueculitis. Irritation and eye redness from pingueculitis usually result from exposure to sun, wind, dust, or extremely dry conditions.

Treatment of Pingueculae

The treatment for pingueculae depends on the severity of the growth and its symptoms. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for those with mild pingueculitis to relieve dry eye irritation and foreign body sensation. To relieve significant inflammation and swelling, steroid eye drops or non-steroidal anti-inflammatory drugs may be needed.

Surgical removal of the pinguecula may be considered in severe cases where there is interference with vision, contact lens wear or normal blinking.

Frequently, pingueculae can lead to the formation of pterygia.

Pterygia

Pterygia (singular form = pterygium) are wedge- or wing-shaped growths of benign fibrous tissue on the surface of the sclera. Because pterygia also contain blood vessels, they are considered a fibrovascular growth. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision. 

Because a pterygium is usually quite visible to others, a person who has one may become concerned about their personal appearance. As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.

Signs and Symptoms of Pterygia

Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye. Large and advanced pterygia can actually cause a distortion of the surface of the cornea and induce astigmatism and blurred vision.

How Pterygia Are Treated

Treatment depends on the pterygium's size and the symptoms it causes. If a pterygium is small but becomes inflamed, your eye doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.

The pterygium may be removed in a procedure room at the doctor's office or in an operating room setting. A number of surgical techniques are used to remove pterygia, and it is up to your eye doctor to determine the best procedure for you.

After the procedure, which usually lasts no longer than 30 minutes, you may need to wear an eye patch for protection for a day or two. For uncomplicated surgery, you should be able to return to work or normal activities the next day.

Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate can be as high as 40%. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is safe and reduces the chance of the pterygium growing back. After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.

It is important to note that pterygium removal can also induce astigmatism, especially in patients who already have astigmatism.

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• Pink Eye (Conjunctivitis)

Pink Eye (Conjunctivitis)

Technically, pink eye is the acute, contagious form of conjunctivitis - inflammation of the clear mucous membrane that lines the inner surface of the eyelids and overlies the white front surface of the eye, or sclera. 

Bacterial or viral infection causes the contagious form of conjunctivitis. However, the term "pink eye" is often used to refer to any or all types of conjunctivitis, not just its acute, contagious form.

Signs and Symptoms of Pink Eye

The hallmark sign of pink eye is a pink or reddish appearance to the eye due to inflammation and dilation of conjunctival blood vessels. Depending on the type of conjunctivitis, other signs and symptoms may include a yellow or green mucous discharge, watery eyes, itchy eyes, sensitivity to light and pain.  

How can you tell what type of pink eye you have? The way your eyes feel will provide some clues:

• Viral conjunctivitis usually causes excessive eye watering and a light discharge.
• Bacterial conjunctivitis often causes a thick, sticky discharge, sometimes greenish.
• Allergic conjunctivitis affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing.
• Giant papillary conjunctivitis (GPC) usually affects both eyes and causes contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids.

To pinpoint the cause and then choose an appropriate treatment, your eye doctor will ask some questions, examine your eyes and possibly collect a sample on a swab to send out for analysis. 

What Causes Pink Eye?

Though pink eye can affect people of any age, it is especially common among preschoolers and schoolchildren because of the amount of bacteria transferred among children. 

Conjunctivitis may also be triggered by a virus, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral infections elsewhere in the body may also induce conjunctivitis.

Treatment of Pink Eye

Avoidance. Your first line of defense is to avoid the cause of conjunctivitis, such as contaminated hand towels. Both viral and bacterial conjunctivitis, which can be caused by airborne sources, spread easily to others.

To avoid allergic conjunctivitis, keep windows and doors closed on days when the airborne pollen count is high. Dust and vacuum frequently to eliminate potential allergens in the home.

Stay in well-ventilated areas if you're exposed to smoke, chemicals or fumes. If you do experience exposure to these substances, cold compresses over your closed eyes can be very soothing.

If you've developed giant papillary conjunctivitis, odds are that you're a contact lens wearer. You'll need to stop wearing your contact lenses, at least for a little while. Your eye doctor may also recommend that you switch to a different type of contact lens, to reduce the chance of the conjunctivitis coming back.

Medication. Unless there's some special reason to do so, eye doctors don't normally prescribe medication for viral conjunctivitis, because it usually clears up on its own within a few days. Your eye doctor might prescribe an astringent to keep your eyes clean and prevent a bacterial infection from starting. Artificial tears also are commonly prescribed to relieve dryness and discomfort.

Antibiotic eye drops or ointments will alleviate most forms of bacterial conjunctivitis, while antibiotic tablets are used for certain infections that originate elsewhere in the body.

Antihistamine allergy pills or eye drops will help control allergic conjunctivitis symptoms. In addition, artificial tears provide comfort, but they also protect the eye's surface from allergens and dilute the allergens that are present in the tear film.

For giant papillary conjunctivitis, your doctor may prescribe eye drops to reduce inflammation and itching.

Usually conjunctivitis is a minor eye infection. But sometimes it can develop into a more serious condition. See your eye doctor for a diagnosis before using any eye drops in your medicine cabinet from previous infections or eye problems.

Prevention Tips 

Because young children often are in close contact in day care centers and school rooms, it can be difficult to avoid the spread of bacteria that causes pink eye. However, these tips can help concerned parents, day care workers and teachers reduce the possibility of a pink eye outbreak in institutional environments:

• Adults in school and day care centers should wash their hands frequently and encourage children to do the same. Soap should always be available for hand washing.
• Personal items, including hand towels, should never be shared at school or at home.
• Encourage children to use tissues and cover their mouths and noses when they sneeze or cough.
• Discourage eye rubbing and touching, to avoid spread of bacteria and viruses.
• Children (and adults) diagnosed with contagious pink eye that has not been treated with an antibiotic for 24 hours should avoid crowded conditions where the infection could easily spread.
• Use antiseptic and/or antibacterial solutions to clean and wipe surfaces that children or adults come in contact with, such as common toys, table tops, drinking fountains, sink/faucet handles, etc.

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• Presbyopia

Presbyopia

Sometime after age 40, people begin to experience blurred near vision when performing tasks such as reading, sewing or working at a computer. This change is called presbyopia. 

There's no getting around it — presbyopia happens to everyone at some point in life, even those who have never had a vision problem before. As of 2014, an estimated 114 million Americans were presbyopic, and this number continues to grow as the U.S. population ages. 

Presbyopia Signs and Symptoms

With the onset of presbyopia, you'll find you need to hold books, magazines, newspapers, menus and other reading materials farther away in order to see the print clearly. Headaches and eyestrain when reading or performing other near work are other symptoms of presbyopia.

What Causes Presbyopia?

Presbyopia is an age-related loss of flexibility of the lens inside the eye. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and occur early in life. When the lens becomes hardened and less elastic, the eye has a harder time focusing up close. 

Presbyopia Treatment: Eyewear

Eyeglasses with bifocal or progressive addition lenses (PALs) are the most common correction for presbyopia. 

"Bifocal" means two points of focus: the main part of the eyeglass lens contains a prescription for nearsightedness, farsightedness and/or astigmatism, while the lower portion of the lens holds the stronger near prescription for close work. Progressive addition lenses are multifocal lenses that offer a gradual transition between a number of lens powers for different viewing distances, with no visible lines on the lens.

Reading glasses are another choice. Unlike bifocals and PALs, which most people wear all day, reading glasses are typically worn only during close work. If you wear contact lenses, your eye doctor can prescribe reading glasses to wear over your contacts for near vision tasks. You may also purchase non-prescription "readers" over-the-counter at a retail store for the same purpose.

Presbyopia Treatment: Contact Lenses

Multifocal contact lenses, available in gas permeable (GP) or soft lens materials, also are available for presbyopes.

One method of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favor one eye or the other for different tasks. 

Because changes in the lens of your eye continue as you grow older, your presbyopic prescription will increase over time. Your eyecare practitioner will prescribe a stronger correction for near work as you need it.

Presbyopia Treatment: Surgery

Surgical options for the correction of presbyopia also exist. If you also have nearsightedness, farsightedness or astigmatism, monovision LASIK eye surgery can correct these problems and decrease your dependence on reading glasses as well. It's also expected that a multifocal LASIK treatment option for presbyopia will soon be available in the United States.

If you need glasses only for reading and close work, conductive keratoplasty (CK) may be a good option. This surgical technique is less invasive than LASIK and can be performed on one eye for a monovision correction.

Another surgical treatment for presbyopia is refractive lens exchange (RLE), where your eye's hardened lens is removed and replaced with a special type of intraocular lens (IOL) to restore your distance vision and near vision lost to presbyopia. This procedure is similar to cataract surgery, and is more invasive than CK or LASIK.

Because the field of vision correction surgery is changing rapidly, ask your eye doctor for the latest information about surgery for presbyopia if you are interested in this treatment option.

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• Ptosis

Ptosis

Ptosis (pronounced "toe-sis") refers to the drooping of an eyelid. It affects only the upper eyelid of one or both eyes. The droop may be barely noticeable, or the lid can descend over the entire pupil. Ptosis can occur in both children and adults, but happens most often due to aging.

Ptosis Signs and Symptoms

The most obvious sign of ptosis is a lower-than-normal positioning of one or both of the upper eyelids. Depending on how severely the lid droops, people with ptosis may have difficulty seeing. Sometimes people tilt their heads back to try to see under the lid, or raise their eyebrows repeatedly to try to lift the eyelids.

The degree of droopiness varies from one person to the next. If you think you may have ptosis, compare a recent photo of your face with one from 10 or 20 years ago to see if there is a noticeable change in the position of your upper eyelids.

Ptosis can look similar to dermatochalasis, a group of connective tissue diseases that cause skin to hang in folds. These diseases are associated with less-than-normal elastic tissue formation. Your eye doctor should be able to tell whether this is the cause of your drooping eyelids.

What Causes Ptosis?

Ptosis can be present at birth (congenital ptosis), or develop due to aging, injury or an after-effect of cataract or other eye surgery. This condition can also be caused by a problem with the muscles that raise the eyelid, called levator muscles. Sometimes an individual's facial anatomy causes difficulties with the levator muscles. An eye tumor, neurological disorder or systemic disease like diabetes may also cause drooping eyelids.

How Is Ptosis Treated?

Surgery is usually the best treatment for drooping eyelids. The surgeon tightens the levator muscles to restore the eyelids to their normal position. In very severe cases involving weakened levator muscles, the surgeon attaches the eyelid under the eyebrow to allow the forehead muscles to substitute for the levator muscles in lifting the eyelid. Eyelid surgery is also known as blepharoplasty.

After surgery, the eyelids may not appear symmetrical, even though the lids are higher than before surgery. Very rarely, eyelid movement may be lost.

It is important to choose your blepharoplasty surgeon carefully, to ensure the best possible post-operative appearance and to prevent the possibility of surgically induced dry eyes caused by lids that no longer close properly. Before agreeing to ptosis surgery, ask how many procedures your surgeon has done. Also ask to see before-and-after photos of previous patients, and ask if you can talk to any of them about their experience.

Ptosis in Children

Children born with moderate or severe ptosis require treatment in order for proper vision to develop. Failure to treat ptosis can result in amblyopia (diminished vision in one eye) and a lifetime of poor vision. All children with ptosis, even mild cases, should visit their eyecare practitioner every year so the doctor can monitor lid positioning and potential vision problems caused by congenital ptosis.

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• Retinal Detachment

Retinal Detachment

A retinal detachment is a serious and sight-threatening event, occurring when the retina - the light-sensitive inner lining of the back of the eye - becomes separated from its underlying supportive tissue. The retina cannot function when it detaches, and unless it is reattached soon, permanent vision loss may result.

Signs and Symptoms of Retinal Detachment

If you suddenly notice spots, floaters and flashes of light, you may be experiencing a retinal detachment. According to a study reported in the Journal of the American Medical Association, about one in seven people with sudden onset of flashes and floaters will have a retinal tear or detachment.  

Other symptoms include blurry vision, poor vision or a shadow or curtain coming down from the top of the eye or across from the side. Any of these symptoms can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

There is no pain associated with retinal detachment. If you experience any of the above symptoms, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision.

What Causes Retinal Detachments?

An injury to the eye or face can cause a detached retina, as can very high levels of nearsightedness. Extremely nearsighted people have longer eyeballs with thinner retinas that may be more prone to detaching.

On rare occasions, retinal detachment may occur after LASIK surgery in highly nearsighted individuals. In a study of more than 1,500 LASIK patients, just four suffered retinal detachment; their pre-LASIK prescriptions ranged from -8.00 D to -27.50 D.

Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease may also cause retinal detachments. New blood vessels growing under the retina - which can happen in diseases such as diabetic retinopathy - may separate the retina from its underlying support tissue as well.

Treatment for Retinal Tears and Detachments

Surgery is the only effective treatment for a torn or detached retina. The procedure or combination of procedures your doctor uses depends on the severity and location of the problem.

Laser surgery. Also called photocoagulation, laser surgery is generally used for retinal breaks and tears that have not yet become retinal detachments. The surgeon directs a laser beam into your eye through the pupil to "spot weld" the damaged retina to its underlying tissue. Photocoagulation requires no surgical incision and causes less irritation to the eye than other treatments.

Cryopexy. In this treatment, the surgeon applies a freezing probe to the outer surface of the eye over the area of defective retina. The scarring that occurs from the freezing reattaches the retina to its support tissue.

Pneumatic retinopexy. This surgery is generally used to treat a retinal detachment in the upper half of the retina. The surgeon injects an expandable gas bubble inside the eye, positioning the bubble over the torn and detached retina. As the gas bubble expands, it pushes the detached retina against its support tissue. The surgeon then may use laser photocoagulation or cryopexy to firmly reattach the retina to the underlying tissue. Over time, your body absorbs the gas bubble. Until that occurs, certain precautions are necessary.

In a variation of pneumatic retinopexy, the surgeon may inject silicone oil rather than expandable gas into the eye to press the detached retina against its support tissue. In this procedure, the silicone oil must be removed from the eye after the retina is reattached.

Scleral buckling. This is the most common surgery used to treat a retinal detachment. In this procedure, the surgeon places a soft silicone band around the eye, which indents the outside of the eye toward the detached retina. The band is sutured against the tough outer white coating of the eye (the sclera). The surgeon then drains any fluid between the retina and its support tissue, and reattaches the retina with laser photocoagulation or cryopexy. 

In about 90% of cases, detached retinas are successfully reattached with a single surgery. However, this does not mean your vision will return to normal. Patients who have the best visual outcomes from retinal detachment surgery are those who seek attention immediately upon noticing symptoms and have detachments that do not involve the central retina (the macula).

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• Retinitis Pigmentosa

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is a rare, inherited eye disease in which the light-sensitive retina slowly and progressively degenerates. This causes progressive peripheral vision loss, night blindness, central vision loss and, in some cases, blindness. 

RP affects approximately one out of every 4,000 Americans.

Signs and Symptoms of Retinitis Pigmentosa

The first symptoms of retinitis pigmentosa usually occur in early childhood, when both eyes typically are affected. However, some cases of RP may not become apparent until affected individuals are in their 30s or older.

"Night blindness" is the primary symptom of the disease in its early stages. During later stages of retinitis pigmentosa, tunnel vision can develop, with only a small area of central vision remaining.

In one study of RP in patients who were at least 45 years old, 52% had 20/40 or better central vision in at least one eye, 25% had 20/200 or worse vision and 0.5% had no light perception (total blindness).

What Causes RP?

Not much is known about what causes retinitis pigmentosa, except that the disease is inherited. It is now believed that RP can be caused by molecular defects in our genes, causing significant variations in the disease from person to person. 

Even if your mother and father don't have retinitis pigmentosa, you can still have the eye disease when at least one parent carries an altered gene associated with the trait. In fact, about 1% of the population can be considered carriers of recessive genetic tendencies for retinitis pigmentosa that, in certain circumstances, can be passed on to a child who then develops the disease.

In RP, the light-sensitive cells in the retina gradually die. Usually, cells called rods are primarily affected. These cells are needed for night vision and peripheral vision. However, other cells called cones can also be affected. Cone cells are responsible for our central vision and color vision.

Retinitis Pigmentosa Tests and Treatment

Visual field testing likely will be done to determine the extent of peripheral vision loss. Other eye exams may be conducted to determine whether you have lost night vision or color vision.

Very few treatments currently are available for retinitis pigmentosa. Most of the therapies address associated conditions, rather than the RP itself. However, one recently approved prosthesis system can be used in advanced RP patients who are 25 years or older. The system utilizes glasses that capture images and wirelessly transmit the signals to an implant that is surgically placed on the surface of the retina.

Illuminated magnifiers and other low vision devices can help RP patients get the most out of their remaining vision. Occupational therapy and psychological counseling are also recommended to help the person with RP deal with their vision loss. In addition, many doctors believe that vitamin A supplements may delay vision loss.

Researchers are looking into ways to treat RP in the future, such as retinal implants and drug treatments.

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• Stye

Stye

A stye (or hordeolum) develops when an eyelid gland at the base of an eyelash becomes infected. Resembling a pimple on the eyelid, a stye can grow on the inside or outside of the lid. Styes are not harmful to vision, and they can occur at any age.

Signs and Symptoms of Styes

A stye initially brings pain, redness, tenderness and swelling in the area, and then a small pimple appears. Sometimes just the immediate area is swollen; other times, the entire eyelid swells. You may notice frequent watering in the affected eye, a feeling like something is in the eye or increased light sensitivity.

What Causes Styes?

Styes are caused by staphylococcal bacteria. This bacterium is often found in the nose, and it's easily transferred to the eye by rubbing first your nose, then your eye.

Treatment for Styes

Most styes heal within a few days on their own. You can encourage this process by applying hot compresses for 10 to 15 minutes, three or four times a day, over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.

Never pop a stye like a pimple; allow it to rupture on its own. If you have frequent styes, your eye doctor may prescribe an antibiotic ointment to prevent a recurrence.

Styes formed inside the eyelid either disappear completely or (rarely) rupture on their own. This type of stye can be more serious, and may need to be opened and drained by your eyecare practitioner.

Chalazion: Another Type of Eyelid Bump

Often mistaken for a stye, a chalazion is an enlarged, blocked oil gland in the eyelid. A chalazion mimics a stye for the first few days, and then turns into a painless hard, round bump later on. Most chalazia develop further from the eyelid edge than styes.

Although the same treatment speeds the healing of a chalazion, the bump may linger for one to several months. If the chalazion remains after several months, your eye doctor may drain it or inject a steroid to facilitate healing.

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• Uveitis

Uveitis

Uveitis is inflammation of the eye's uvea, an area that consists of the iris, the ciliary body and the choroid. The iris is the colored part of the eye that surrounds the pupil. The ciliary body is located behind the iris and produces the fluid that fills the anterior part of the eye. The choroid is the layer of tiny blood vessels in the back of the eye that nourishes the light-sensitive retina.

Uveitis is classified by which part of the uvea it affects: Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form. Intermediate uveitis refers to inflammation of the ciliary body. Posterior uveitis is inflammation of the choroid. Diffuse uveitis is inflammation in all areas of the uvea.

Many cases of uveitis are chronic, and they can produce numerous possible complications that can result in vision loss, including cataracts, glaucoma and retinal detachment.

Uveitis Signs and Symptoms

Uveitis most commonly affects people in their 20s to 50s. Signs and symptoms of uveitis include red eyes, pain, sensitivity to light, blurred vision and dark spots moving across your field of vision (floaters). These signs and symptoms may occur suddenly and worsen quickly.

If you experience any of these potential warning signs of uveitis, see your eye doctor immediately.

What Causes Uveitis?

The cause of uveitis is often unknown. However, in some cases, it has been associated with:

• Eye injuries.
• Inflammatory disorders, such as multiple sclerosis, Crohn's disease or ulcerative colitis.
• Viral infections, such as herpes simplex or herpes zoster.
• Autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis.
• Other infections, including toxoplasmosis and histoplasmosis.

Uveitis Treatment

To treat uveitis, your eye doctor may prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is in eye drop, pill or injection form depends on the type of uveitis you have. Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops. Posterior uveitis usually requires orally administered medication or injections. Depending on your symptoms, intermediate uveitis can go either way. Long-acting surgical implants are also used sometimes to treat posterior uveitis. 

If an infection is suspected as the cause of your uveitis, your doctor may also prescribe additional medications to bring the infection under control. And if your uveitis has caused elevated intraocular pressure (IOP) in your eyes, drugs to reduce IOP to normal levels may also be used.

The duration of treatment for uveitis is often determined by the part of your eye that's affected. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may require a much longer period of treatment before it is completely under control.

Episodes of uveitis can recur. See your eye doctor immediately if signs and symptoms of uveitis reappear after successful treatment.

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