Diseases of the Eye
Common Eye Diseases and Conditions
Our top priority is providing you the best eye care. We want to keep your eyes healthy through regular eye health evaluations, communication, and education. This page lists a few of the most common eye diseases.
Inflammation of eyelid margins.
Opacity or cloudiness of the crystalline lens that may prevent a clear image from forming on the retina.
Inflammation of the conjunctiva (mucous membrane that covers the white of the eye and inner surfaces of eyelids.
Retinal changes accompanying longstanding diabetes
Corneal and conjunctival dryness due to deficient tear production.
Particles that float in vitreous and cast shadows on the retina; seen by patient as spots, cobwebs, etc.
Group of diseases characterized by increased ocular pressure that results in damage to the optic nerve and retinal nerve fibers. Glaucoma is a common cause of preventable vision loss.
Retinal degeneration leading to permanent loss of central vision. (Peripheral vision remains intact)
Separation of sensory retina from underlying tissue, often requiring immediate surgical repair
Irritation Itching Red eyes Dandruff of eyelids
This condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes. Blepharitis can begin in early childhood, producing granulated eyelids, and continue throughout life as a chronic condition, or develop later in life.
Bacteria reside on the surface of everyone’s skin, but in certain individuals they thrive in the skin at the base of the eyelashes. The resulting irritation, sometimes associated with overactivity of the nearby oil glands, causes dandruff-like scales and particles to form along the lashes and eyelid margins.
Sometimes the scaling or bacteria produce only minor irritation and itching, but in some they may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria which surround them. This can lead to a more serious complication, inflammation of the eye tissues, particularly the cornea (the clear front window of the eye).
It is important that you see your optometrist or ophthalmologist if you demonstrate these symptoms. Treatment may include lid scrubs and an antibiotic ointment.
If lid scrubs and ointment are prescribed, the following is how to use the scrubs and antibiotic ointments: Mix a few drops of Johnson’s Baby Shampoo with a small amount of warm water. Gently scrub the eyelashes, right where the lashes grow from the lid, with this mixture using the tip of your finger, Q-tip, or the edge of a wash cloth twice daily or as frequently as instructed. As an alternative to Johnson’s Baby Shampoo, commercially formulated moist towlettes (one is called OcuSoft lid Scrubs) are also available. These moist towlettes are available without a prescription. If an ointment is prescribed, it will generally be erythromycin or bacitracin. You should apply a thin coat of the prescribed ointment to the eyelash line, right where the lashes grow from the lid, with the tip of your finger as frequently as instructed. It is not uncommon to clear blepharitis up and then have it come back. Sometimes patients may be instructed to use scrubs 2-3 times or so a week on a regular ongoing basis to control blepharitis. For additional information:
Who gets cataracts? Cataracts most often develop in people over the age of 55, but they are also found in younger people.
There are three basic types of cataracts: nuclear, cortical, and subcapsular.
- A nuclear cataract forms in the center of the lens (the center portion of the lens is called the nucleus) and is due to aging. This type of cataract normally produces a slow, gradual reduction in vision.
- A cortical cataract forms in the outer layers of the lens, which is called the lens cortex, and has cloudy spokes extending from the outer layers of the lens to the center. Many diabetics develop cortical cataracts.
- A subcapsular cataract generally begins towards the back of the lens. People with diabetes, high farsightedness, retinitis pigmentosa, or those who are taking high doses of steroids may develop a subcapsular cataract. A common complaint from someone with this type of cataract is poor vision in extremes of light-that is, in very bright or very dim light. A subcapsular cataract can also produce great impairment of near vision.
When a cataract forms, light cannot enter the eye as easily and your vision becomes blurry. The cataract may start out small, and at first have little or no effect on your vision.
The symptoms you may experience, as well as when they occur, are affected by the type of cataract you have.
You may notice trouble driving at night due to glare and halos from oncoming headlights.
- Colors appear faded and dull
- Haze over vision
- Cloudy vision
- Normal lighting appearing too bright or too dim
What causes cataracts? The development of a cataract is most often part of the natural aging process. Studies indicate that exposure to ultraviolet light is associated with some cataracts. It is often recommended that you wear sunglasses or a hat to lessen your exposure. Other studies suggest that people with diabetes are at a greater risk of developing cataracts. Other risk factors include the use of steroids and cigarette smoking.
How are cataracts treated? If a cataract develops to a point that your daily activities are affected, you may choose to have your cataract removed. Dr. Conner uses the most modern no shot, no stitch, no patch, no shield cataract surgery available. Dr. Conner will make a small incision in the eye and use ultrasound to break the cataract up into tiny pieces and suction it out. Once this is removed, he will replace it with a plastic intraocular lens (IOL). Calculations are done before surgery to calculate the power of this IOL. The calculation is generally done to create emmetropia, which is the condition where the eye is in focus (at distance) without any glasses. Though these calculations are accurate, there is some human variability in people’s eyes and so some correction, generally in the form of glasses, is needed for your very sharpest vision.
What about bifocal or multifocal IOL, or accomodating implants? The usual implants Dr. Conner uses are what are called monofocal. That is they set the eye for distance vision. Even with a perfect result with a monofocal lens (where your distance vision, without glasses, is perfect) you will likely need the help of glasses to read up close. Multifocal implants (commonly referred to as bifocal implant, although the better name is multifocal implants) have been available for many years. Dr. Conner was the second ophthalmologist in Indiana to implant one of the most common type of multifocal implants. (At that time, the multifocal used was called the Array IOL). Certainly, many people with multifocal implants can see fairly well at both distance and near and can do see to do many things without glasses. However, multifocal implants are certainly far from a perfect solution. One has to understand how they work to understand some of their limitations. The multifocal implant actually breaks an image (of an object you are looking at) that is coming into your eye into multiple images. One of those images will be in fairly good focus on the back of your eye. Which image will be in focus depends on the how far away the object being looked at is located. Your eye, and thus your brain, is thus presented with one clear image and multiple blurry images. Your brain has to learn which one to pay attention to. This process is called neuro-adaption. In some people this occurs quickly, but most people take several weeks to neuro-adapt well, and some never do and thus never really benefit from multifocal implants. One of the biggest problems with multifocal implants is it is still very difficult to know who will neuro-adapt and who will not until surgery is done. If a person does not neuro-adapt and the multiple images (or other side effects which will discussed later) are bothersome enough, then the multifocal implants can be removed and replaced with monofocal implants. However, that surgery is actually a bit more difficult than the initial cataract surgery and likely has a higher complication rate.
In addtion, most people will have some glare and halos around lights at night. Most people say they become used to them with time and they are not too bothersome, but for some people, that are so bothersome that the multifocal implants must be removed and replaced with monofocal implants. (It is rare, though not impossible, for halos to occurs with monofocal implants.)
Because multifocal implant work by breaking an image into multiple images, the total “visual information” in any one image is degraded slightly. Thus, the image that your brain has to pay attention to has less “visual information” in it that an image that was not broken into multiple images. The scientific terms used to describe this phenomonon is a decrease in contrast sensitivity that occurs with multifocal implants. Contrast is the relative difference in between light and dark colors. Many visual activities involve high contrast situations. Reading black print on a white backgroud is one. This is a high contrast situation. Even if a patient’s contrast sensitivity is decreased from normal, most patients can still read black print on a white backgroud as there is still enough relative difference perceived between the black print and white page. However, much of life’s visual activities involve activities that do not involve high contrast. Seeing in environments with lower levels of light, especially evening or night activities, already present situations with decreased contrast sensitivity. That is why you do not see as well at night as during the day. One’s contrast sensitivity naturally decreased as one gets older. A multifocal implant decreased that even more. This may not be enough to cause visual difficulties when one is young, but many people complain of difficulty seeing at night as they get older and a multfocal implant is likely to make that worse as a patient ages.
Who does best with multifocal implants? Generally, multifocal implants work best in patients who do not have demanding visual requirements. Patients who want or demand precise vision generally will not be fully satisfied with them. Patients who are still working where their work requires use of a computer, or lots of reading, or use of small screens, may not have the vision from multifocals to perform all work requirements without additional visual help (in the form of glasses). Thus, multifocals may not live up to a promise of glasses free living.
Those who are near-sighted or have very much astigmatism are also not excellent candidates for multi-focal implants. The reason near-sighted people are not is because the quality of near vision with a multifocal IOL is generall not as good as a near-sighted person’s near vision is before cataract surgery. When the patient compares their near vision obtained from a multifocal lens to their vision after a multifocal implant, this poorer near vision can be a souce of dissatisfaction. Patients who are quite far-sighted may not have ever had excellent near vision without glasses and the level of near vision with a multfocal IOL may be quite acceptable to them and so far-sighted patients are better candidates. Those with much astigmatism are not excellent candidates as most all of the astigmatism has to be corrected at the time of cataract surgery in order for multifocal implants to work well. Astigmatism at the time of cataract surgery is certainly effective, but the surgery is not quite as accurate in creating the desired effect as is the actual calculation of the IOL power. If much astigmatism is left after multifocal implant surgery, then additional surgery may be needed to correct it in order to provide adequate vision.
For a patient to do well with a multifocal implant, it is best that they not have any other significant eye condition. Any diabetic retinopathy, any macular degeneration, any corneal problems or any other eye conditions that might limit one’s best vision is likely to markedly decrease a patent’s satisfaction with a multfocal implant. Even persistant dryness of one’s eye, which frequently occurs as one ages, can significantly limit the visual benefit of multifocal implants. Multifocals also work best when a multifocal is placed in each eye. Unilateral multifocals (a multfocal in one eye and a non-multifocal in the other eye) generally do not give good results.
This brings up another important point. I mentioned earlier that a person’s contrast sensitivity decreases with age and then additionally decreased with a multfocal implant. Most any eye condition that affects vision (macular degeneration, diabetic retinopathy, or corneal problems) will make contrast sensitivity worse also. This has to be considered in the long term, because many people will develop other eye conditions as they age, and if they do and if they have a multifocal implant, as the other conditions develop, they may lose considerable overall visiual function due to the multifocal implant. It is so common for patient’s in their late 60’s, in their 70’s, 80’s and older to lose considerble visual function from these age related changes that they cannot see as well as they would like even under ideal lighting and visual conditions. If adverse affects of a multifocal implant are added on top of these, then that patient may end up significantly visually impaired.
Multifocals do work! It may seem that this section has been all negative about multifocal implants. But they do work. Dr. Conner has many patients with multifocal implants that go about their day with little or no dependence on glasses. But multifocals are not perfect. There are trade-offs with any procedure. Only when a patient considers all the trade-offs and is willing to accept them is it reasonable to undergo cataract surgery with multifocal lenses.
The fine print about multifocals: Many patient’s looking into cataract surgery will find glowing articles about multifocal implants in ophthalmology practice’s websites. Those articles generally do not delve into the trade-offs noted above. They generally actively promote trying to get patients to choose multifocal implants. Much of this is financial. Most ophthalmology practices charge about $1,000 more (for surgery with a multifocal IOL) than cataract surgery with a monofocal IOL, and this $1,000 is never covered by insurance. In addition, about $1,000 more is charged for the supply of the multifocal IOL (generally this is charged by the hospital or surgery center and not the surgeon) over a monofocal IOL. This also is not covered by insurance. Thus, cataract surgery with a multifocal IOL generally costs about $2,000 more per eye, over and above the usual charge for cataract surgery. That is $4,000 more for both eyes. That is on top of what is paid by insurance, which is the amount paid for surgery with monofocal IOL’s. That $4,000 is not even considered by insurance and is all out of pocket. Certainly, steering patients to a multfocal IOL can be lucrative for an ophthalmologist, especially if he owns and runs the surgery center also. Currently, Dr. Conner does not charge extra for implanting a multifocal IOL, but the out-patient department of the hospital he operates at (Schneck Medical Center) does charge the extra amount for the supply of a multifocal IOL.
What happens after cataract surgery? You will need to have several follow-up visits to monitor the healing process. These follow-up visits are with Dr. Conner. He prefers to follow you himself during your post operative period. When completed, eyeglasses may be prescribed to provide you with your best vision.
If you feel you may have cataracts, please call our office at 812-524-3937 to schedule an appointment.
Allergic conjunctivitis is an allergic reaction of the eyes. This is an inflammation of the conjunctiva (the membrane covering the white of the eyes and inner lids) due to an allergy. Common allergens are pollen, dust, pet dander, smoke, mold, and air pollution. There are over 22 million people in the United States that suffer from allergy eyes. These allergies may be seasonal, in the spring and fall when pollen counts are at their highest, or may be year round.
- Itching and watering
- Redness and burning
- Scratchy sensation
- Sensitivity to light
A person should try to identify the allergy source and avoid exposing themselves to it. There are several antihistamines that can help to control allergy symptoms. There are also several excellent eye drops Dr. Conner, Dr. Smith, or Dr. Lambring can prescribe that can help alleviate your symptoms. It is very important for you to see your optometrist or ophthalmologist to determine whether it truly is allergic conjunctivitis and not a more serious problem.
Bacterial conjunctivitis is a condition also known as Pink Eye. This is an inflammation of the conjunctiva which is caused by a bacterial infection. The symptoms tend to be the same as allergic conjunctivitis. One main difference is that pink eye is often characterized by a discharge from the eye. The eyes will frequently be matted shut when first awaking in the morning.
This type of conjunctivitis is highly contagious. You must avoid sharing towels and pillowcases, wash hands often, avoid touching the infected area, and avoid using makeup that may have become contaminated. If you are a contact lens wearer, it is best to dispose of the contaminated contact lens and start with a fresh lens once the infection is gone. In order to clear the infection, you need to see your optometrist or ophthalmologist to be prescribed an antibiotic drop. It is important to use the drop exactly as directed by your doctor in order to fully get rid of the infection.
Viral conjunctivitis is caused by a virus-there is no specific treatment for it, only supportive measures like lubrication. (This is the same as a viral “cold.” No antibiotics are needed to “fight” the virus-your body must build up antibodies to the virus on its own to overcome the conjunctivitis.) However, sometimes Dr. Conner or Dr. Smith will prescribe an antibiotic to prevent a bacteria from taking hold in the eye tissues inflammed by the virus. This is called treating to prevent “superinfection” of bacteria on top of a viral infection. The symptoms of a viral conjunctivitis tend to be the same as allergic conjunctivitis. This type generally does not present any type of discharge, although it can.
Viral conjunctivitis, like bacterial, is also contagious, therefore you should use the same precautions as mentioned above. It is important to see your optometrist or ophthalmologist in order to get the correct diagnosis and to make sure this is not a more serious problem.
Retinal Tears and Detachment
What Is a Retinal Tear?
Retinal tears occur when there is tugging or pulling on the retina inside the eye. The retina is the thin layer of nerve cells that lines the inside of the eyeball. Filling the actual eyeball is a jelly-like substance called the vitreous gel. This vitreous gel is loosely attached to the retina in certain areas.
As people age, this vitreous gel that fills the eye gradually becomes thinner and less gel-like and can pull away from its attachements to the retina. This is known as a posterior vitreous detachment (PVD) and when it occurs, it can sometimes pull hard enough on the areas where it is attached to the retina to actually tear the retina. PVDs are almost always harmless and cause floaters (see the explanation of floaters elsewhere on this website), but if they do cause a tear in the retina, fluid can move under the retina and actually detach it from the underlying tissue. This is a retinal detachment and where the retina is detached, it will no longer function to provide vision. A retinal detachment is potentially vision threatening and needs to be evaluated an treated emergenctly.
Who is at higher risk for this type of detachment where a tear in the retina allows fluid to separate the retina from the underlying tissue?
- People who are highly nearsighted
- People who have recently undergone eye surgery
- People who have experienced an injury to the eye
Another way a retinal detachment can occur is if scar tissue that is attached to the retina contracts and pulls on the retina hard enough to pull it loose from the underlying tissue. Who is at higher risk for this type of detachment, where scar tissue contracts and pulls the retina away from the underlying tissue? People with diabetes who have had significant problems with the diabetes affecting the eyes. These are generally diabetics who have had to have laser treatment or have had significant bleeding in the eyes from diabetes.
Another type of retinal detachment is when fluid collects between the layers of the retina, which causes the retina to separate from the underlying tissue.
Who is at higher risk for this type of detachment?
This usually occurs with the occurrence of another eye disease that causes swelling or bleeding, such as wet macular degeneration or other degenerations, or a condition known as central serous retinopathy. This type of detachment is different from the other two as it generally does not take surgery to repair, but treatment is directed at the underlying condition.
What are the Signs and Symptoms of a Retinal Detachment?
- Flashes of light
- “Wavy” vision
- A veil or curtain obstructing vision
- Shower of floaters
- Sudden decrease in vision
- Shadow in your peripheral vision
IT IS VERY CRITICAL THAT IF YOU HAVE ANY OF THE ABOVE SYMPTOMS TO CALL YOUR EYE DOCTOR IMMEDIATELY. TIME IS VERY CRUCIAL.
How are Retinal Detachments detected?
The only way a retinal detachment can be definitely identified is with a retinal exam. The person best able to do this is your optometrist of ophthalmologist.
What is the treatment for Retinal Detachments?
There are a few different ways to treat a retinal detachment. The type of treatment depends on the type of detachment, location, and severity. Methods to treat them as Laser Surgery Pneumatic Retinopexy (Gas Bubble) Scleral Buckle Vitrectomy surgery.
What you can do?
Early detection is the key to successfully treat retinal detachments and retinal tears. You should be aware of how your vision normally is in each eye, especially if you are in a high-risk group as discussed above. Try to monitor your vision a few times a week by covering one eye and then the other.
Report any changes in your vision immediately to your eye doctor.
There are 2 main types of diabetic retinopathy:
Nonproliferative Diabetic Retinopathy (NPDR): this type is commonly known as background retinopathy. This is an early stage of diabetic retinopathy. Tiny blood vessels within the retina leak blood or fluid. The leakage causes the retina to swell or to form deposits (called exudates). If the swelling occurs near the macula, which is the part of the retina in the back of a patient eye that provides a person with their fine center vision, it can adversely affect the vision and may need to be treated. Treatment of this is with a laser or, more commonly now, with injections of medication directly into the eye. Dr. Conner can evaluate and treat this right in the office-generally on the same day that it is diagnosed. Not all swelling or macular edema requires treatment-only if it is close enough to the center of vision and a large enough area to be likely to cause visual problems.
Proliferative Diabetic Retinopathy (PDR): this type is when abnormal new blood vessels begin to grow on the surface of the retina or optic nerve. Diabetes affects the blood vessels of the eye causing them to decrease the flow of blood to the eye. The retina responds to inadequate blood flow by growing new blood vessels as an attempt to supply more blood to the eye. Unfortunately, the new blood vessels do not resupply normal blood flow to the retina. The new blood vessels are abnormal and can break and bleed and thus, if the new blood vessels are present to any significant degree, they must be treated with laser treatment and/or injections directly into the eye. Proliferative diabetic retinopathy may cause more severe vision loss than nonproliferative retinopathy because it can affect both central and peripheral vision.
What are the visual symptoms of diabetes?
Diabetes can cause many different changes in vision, such as:
- Changes in nearsightedness and farsightedness
- Fluctuating or blurring of vision
- Occasional double vision
- Loss of visual field
- Flashes and floaters
Visual loss can be caused in the following ways:
Vitreous hemorrhage: the new blood vessels may bleed into the vitreous ( the clear, jelly-like substance that fills the eye). If the hemorrhage is small, you may only see a few floaters. If the hemorrhage is large, it may block out large portions of your vision. Usually the hemorrhage will clear on its own, although it could take days, months, or longer to clear. If the hemorrhage does not clear, then a surgical procedure, called a vitrectomy, might be recommended.
A vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, vision may return to its former level unless there has been damage done to the macula (small area in the center of the retina that allows us to see fine details clearly).
Traction retinal detachment: When proliferative diabetic retinopathy is present, scar tissue associated with new blood vessels can pull the retina from its normal position. More severe vision loss can occur if the macula or large areas of the retina are detached.
Neovascular glaucoma: Occasionally, new, abnormal blood vessels will start to grow on the iris (the colored part of the eye). This blocks the normal flow of fluid out of the eye. Pressure in the eye then builds up, resulting in neovascular glaucoma. This is a severe eye disease that damages the optic nerve.
How is diabetic retinopathy treated?
The best treatment is to prevent the development of diabetic retinopathy. It is important to control your blood sugar to lower your risk. One should also do all other things one knows to do for good general health as this will also likely decrease your risk of developing diabetic retinopathy. Thus, one should contol their blood pressure, their cholesteral and triglycerides, watch their weight and diet, and avoid tobacco. If you do develop diabetic retinopathy, it can be treated in the following ways:
Laser surgery and Injections into the eye – Laser treatment and/or injections of mediation directly into the eye are often recommended for PDR, macular edema, and neovascular glaucoma. The main goal of treatment is to prevent further loss of vision. Multiple laser treatments and/or injections are sometimes necessary. Laser treatment and/or injections do not cure diabetic retinopathy and do not always prevent further loss of vision. However, treatment frequently controls the diabetic retinopathy a helps improve vision of prevent further deterioration. Dr. Conner performs this laser surgery and injection in the office. After laser treatments or injections there are generally no restrictions. You may return to normal activity. Dr. Conner will follow your progress closely to determine if additional treatment may be indicated.
Vitrectomy – A vitrectomy may be recommended if you have advanced PDR. This is a surgical procedure performed in the operating room. The vitreous is removed and replaced with a clear solution. This often prevents further bleeding.
When should I schedule an exam?
If you have diabetes, it is recommended that you have a yearly eye health examination. If diabetic retinopathy is found, it may be necessary to be seen more frequently. Pregnant women with diabetes should have an examination in their first trimester. Diabetic retinopathy can progress quickly during pregnancy.
It is important to remember that if you need to be examined for glasses, your blood sugar should not be fluctuating. When your blood sugar is not stable, your vision will fluctuate also and any glasses you have made may not be the optimal prescription once your blood sugar has stablized.
If you have diabetes, call us today at 812-524-3937 or toll free at 1-888-690-6670 to schedule your eye health examination.
It is important to control your diabetes as much as possible to minimize your risk of developing diabetic retinopathy. Early detection of diabetic retinopathy is crucial. Remember that the best treatment is to prevent complications as much as possible by controlling your blood sugar.
For more information, visit the American Diabetes Association
Dry Eye Syndrome
What is dry eye and what are the causes?
Dry eye syndrome is corneal and conjunctival dryness due to deficient tear production. The tears your eyes normally produce are necessary for overall eye health and clear vision. Dry eye syndrome occurs when your eyes do not produce enough tears to satisfactorily lubricate the eye surface or the tears you produce don’t lubricate as well as they should. Dry eyes can result from the normal aging process, exposure to environmental conditions, less frequent blinking, hormonal changes, or from medications such as antihistamines, oral contraceptives, or antidepressants. Although dry eyes can occur in both men and women, it is more common in women, especially after menopause. What are the symptoms of dry eyes? The most common symptoms are stinging, itchy, scratchy and uncomfortable eyes. Sometimes it feels as if something is in your eye. When your eyes are dry, the irritation to that will sometimes temporarily produce more tears as a natural reflex to comfort the eye (reflex oversecretion). This will result in excessive watering – even though the eyes are really dry on a baseline level. (There are two mechanisms your body uses to produce tears. One mechanism produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other mechanism produces large amounts of tears as a response to eye irritation). In fact, irritation due to dry eyes is the most common reason seen for excess watering. What is the treatment for dry eyes? The most frequent treatment for dry eyes is the use of artificial tears. Artificial tears, such as Refresh Tears, can be purchased without a prescription. There are many name brands of tear drops we recommend. We tend to recommend specific name brand tears and not “store brand” or generic ones, as the preservatives in these name brand ones are much better (i.e. less likely to cause irritation) than the preservatives in the “store brand” or generic drops. (A list of recommended tears follows this article.) For more severe dry eyes, an ointment can be used. This is best when used at bedtime because it tends to blur vision. Tears drain away from the surface of the eye and drain into little openings in the upper and lower lids nasally (the puncti) and then drain into your throat. One treatment option for significant dryness is the placement of a small plug (punctum plug)in one or both of the puncti in each eye. These plugs are considered “permanent”, although they can come out on their own and need to be replaced or can be removed if they do not solve the irritation or in some way bother the patient. Another treatment option is to physically close off the puncti with what is called cautery. This is generally considered a truely permanent procedure, although rarely a puncum closed with cautery may reopen. Another treatment option is to use a prescription drop which was approved in the summer of 2003. This is called Restasis and currently reserved for somewhat more severe cases of dry eyes. It is helpful to prevent dry eyes by using a humidifier during the winter months when the heat is on. Anything that may cause dryness, such as an overly warm room, hair dryers or wind, should be avoided by a person with dry eye syndrome. Some people feel that smoking is also very bothersome when you have dry eyes.
Recommended Artificial Tears
Artificial Tears: These work well for most people.
- Refresh Tears
- Genteal (Mild Formula) or (Moderate Formula)
- Thera Tears
- Visine Pure Tears
- Tears Naturale II
Artificial Tears that have a “thicker” consistency: Some people like these “thicker” drops better, but many find them to be too “thick”.
- Refresh Liquigel
- Refresh Celluvisc
- Thera Tears Liquid Gel
- Systane Free Liquid Gel (Preservative Free)
- Genteal Gel
Preservative-Free Tears: These are always acceptable to use by anyone needing artificial tears. Sometimes, for certain cases, they are specifically recommended. They tend to be the most expensive artificial tears.
- Refresh Endura
- Refresh Plus
- Bion Tears
- Genteal PF
- Thera Tears Preservative Free
- Visine Pure Tears
Ointments: For use at bedtime.
- Refresh PM
- Genteal Gel
Floaters and Flashes
What are floaters?
Floaters appear as small black or transparent spots, lines, threads or “cobwebs” in your vision. As your eyes move, the floaters usually move too. Floaters are most noticeable when looking at something light colored (for example, a white wall, the sky, etc.)
What causes floaters?
The inner part of your eye is filled with a clear, jelly-like fluid called the vitreous. As you age, fibers in the vitreous tend to clump together. When they do, they cast a shadow, which is what is perceived as a floater. The floaters can look like dots, or lines, or webs, or bugs, or puddles, or gauze or almost anything. These floaters can sometimes be accompanied by flashes of light.
What are flashes?
Flashes are sensations of light, when no light is really there. They may appear as many tiny bright lights or like flashes of lightning. They may be more noticeable with eye movement or in a dark room.
What causes flashes?
Flashes may occur when the vitreous jelly pulls on the retina. They may only last for a second or two. These flashes may appear off and on for several weeks or months. As you grow older, it is more common to experience flashes. If you notice the sudden appearance of flashes of light, you should visit your eye doctor immediately to make sure the retina hasn’t been torn.
Are floaters and flashes serious?
Many people experience floaters. Floaters that you have had for years and have not changed, are usually not serious. It is usually the sudden onset of new floaters that may be serious and the onset of flashes of light with these floaters can also be serious. If you notice a shower of floaters, a sudden decrease in vision, or a curtain that is obstructing your vision you must call your eye doctor immediately.
IMPORTANT— ANYONE WITH FLASHES OR THE SUDDEN ONSET OF NEW FLOATERS SHOULD BE EXAMINED PROMPTLY BY THEIR EYE DOCTOR. THESE CAN BE SYMPTOMS OF A MORE SERIOUS PROBLEM LIKE A RETINAL DETACHMENT.
What is the treatment for flashes and floaters?
It is important that you have a dilated exam by your eye doctor at the onset of any flashes or floaters. Once determined that there is no serious problem, like a retinal detachment, there is no treatment needed. Your floaters and flashes will likely go away on their own within a few days, weeks, or months. Sometimes it may take longer for them to go away.
If your eye doctor finds a retinal detachment, surgery would be indicated to repair that.
See Section on Retinal Detachment for more info.
What is glaucoma?
Glaucoma is a disease generally, but not always, characterized by increased intraocular pressure that results in damage to the optic nerve (carries the images we see to the brain) and the retinal nerve fibers. The higher the pressure in your eye, the greater the chance of damage to the optic nerve. When nerve fibers are damaged, blind spots in your vision start to develop. These blind spots are sometimes not noticed until much damage has already been done to the optic nerve. If the entire nerve is destroyed, blindness results.
Early detection and treatment by Dr. Conner and Dr. Smith are the keys to preventing optic nerve damage and blindness from glaucoma.
What causes glaucoma?
Your eye is filled with a clear liquid, called the aqueous humor. This liquid circulates through the eye. A small amount of liquid is constantly being produced, while an equal amount of fluid is flowing out of the eye through a part of the eye called the drainage angle. (The aqueous humor is not part of your tears).
If the drainage angle does not drain enough fluid or gets blocked off, the fluid has no where to drain and the pressure within the eye may increase. Drainage may decrease due to injury, infection, disease, but most frequently decreases simply due to advance in age. The increase of pressure can cause damage to the optic nerve.
Regular eye health examinations are the best way to detect glaucoma. During your examination, Dr. Smith or Dr. Conner will measure your intraocular pressure in each eye, inspect the drainage angles of your eyes, evaluate any optic nerve damage, and test the visual fields of each eye. All of these tests may be repeated over time to evaluate any changes to the optic nerve and to determine if the damage is increasing over time.
What are the different types of glaucoma?
Chronic open-angle glaucoma: This is the most common type of glaucoma. Over 90% of adults with glaucoma have this form. As a person gets older, the drainage angle of the eye can become less efficient and the pressure within the eye can gradually increase. Usually vision damage is very gradual and painless and it is not noticed until the optic nerve has had severe damage.
Angle-closure glaucoma: This form of glaucoma results when the drainage angle becomes completely blocked off because of increased intraocular pressure. When the pressure builds up suddenly, it is called acute angle-closure glaucoma.
What are the symptoms of open-angle glaucoma?
- tunnel vision
- visual field gradually decreases
- can cause blindness if left untreated
What are the symptoms of angle-closure glaucoma? blurred vision severe eye pain headache rainbow haloes around lights nausea and vomiting If you have any of these symptoms, call our office immediately. Angle-closure glaucoma needs to be treated immediately to prevent blindness.
Who is at risk for glaucoma?
High pressure alone does not necessarily mean that you have glaucoma. Dr. Smith and Dr. Conner gather a lot of different information from your examination to determine your risk for developing it.
- African ancestry
- family history of glaucoma
- past injuries to the eyes
How is glaucoma treated?
The best treatment for glaucoma is prevention. It is very important to have regular eye health examinations to detect the disease early.
Glaucoma is usually controlled well with eye drops. These drops are designed to lower the intraocular pressure in the eye. In order for these medications to work properly, it is important to use them continuously and exactly as prescribed by your doctor.
In open-angle glaucoma, the drainage angle is treated. The laser is used to modify the drain to help control eye pressure. This type of laser treatment is referred to as trabeculoplasty.
In angle-closure glaucoma, the laser actually creates a hole in the iris in order to improve the flow of aqueous fluid to the drainage angle. This type of laser treatment is referred to as iridotomy.
This type of surgery is called trabeculectomy. Dr. Conner uses an instrument to create a new drainage channel for the aqueous fluid to drain from the eye. This new channel that is created helps to lower the pressure.
Treatment of glaucoma requires teamwork between the doctor and you, the patient. If you are prescribed eye drops to control your pressure, you must make sure that you take your drops as instructed. Never stop taking your medication. Frequent eye health examinations are critical to monitor your eyes and vision for any changes.
What is macular degeneration?
Macular degeneration is an age related deterioration of the central portion of the retina known as the macula. This area of the eye records the fine details of the images that we see and sends them through the optic nerve to the brain. The macula is responsible for central vision and controls our ability to see fine detail, recognize faces, read, and see well enough to drive a car.
What causes macular degeneration?
There are two types of macular degeneration:
Dry macular degeneration
The “dry” type of macular degeneration leads to thinning of the macular tissues and pigment clump formation in the macula. Dry macular degeneration is much more common than wet macular degeneration. It tends to progress more slowly than “wet” type. The amount of central vision that is lost is related to how severely the macula is affected. Interestingly, one cannot always judge how much vision is affected by the aparent amount of dry macular changes, although generally, the more changes that are seen the more the vision will be affected. Vision loss tends to be gradual with dry macular degeneration, whereas, it is generally abrupt with wet macular degeneration. There is currently no treatment for dry macular degeneration, other than specific vitamins and mineral supplements that have been proven to slow, but not prevent, progression of the macular degeneration. The specific vitamins and mineral supplements are mentioned later in this discussion.
Wet macular degeneration
With “wet” macular degeneration, abnormal blood vessels grow under the retina and macula. These new blood vessels may then bleed and leak fluid, causing the macula to swell and lift. When this happens central vision becomes distorted. Vision loss may be quite rapid and severe.
What are the signs and symptoms of macular degeneration?
a gradual loss of the ability to see objects clearly
objects appearing to be distorted in shape and straight lines appearing wavy or crooked
a loss of clear color vision
a dark area appearing in or near the center of vision
There is a simple test called the Amsler grid test that allows you to monitor your vision on your own. This tool can indicate a change in your macular degeneration that will tell you that you should see your eye doctor promptly for evaluation. It is recommended that the test be done at least twice a week.
How is Dry Macular Degeneration treated?
The only treatment for “dry” macular degeneration is to take certain dosages of specific vitamins and minerals. This was shown, in a landmark study called the AREDS-Age Related Eye Disease Study, to slow the progression of dry macular degeneration. The recommended dosages and some information on that study follows.
Why Vitamin & Mineral Supplements?
The Age Related Macular Degeneration Study (AREDS)
An excellent study that demonstrated the benefits of vitamin and mineral supplementation was published in the October 2001 issue of the Archives of Ophthalmology. In this study, people with a high risk of developing advanced stages of macular degeneration lowered their risk by 25% when treated with specific vitamin and mineral supplements. The supplements benefited patients with both the wet and dry forms of macular degeneration. The supplements did not benefit patients with early macular degeneration or with no macular degeneration. (Early macular degeneration is defined by some very specific findings that can be noted only by your eye doctor. Some of the earliest signs of macular degeneration can be small yellowish spots, called drusen, noted by your doctor when he looks into the back of your eye. If there are only several small drusen or a few medium-sized drusen in one or both eyes, then that is considered early macular degeneration and patients will not benefit from supplements.) Patients with macular degeneration must realize that taking supplements does not mean that their macular degeneration will not get worse, but that it only lessens their chance that their macular degeneration will get worse.
In May of 2013, a study came out and showed that a new formulation of vitamin, mineral and nutrient supplements (which would likely be better tolerated by most people) was just as effective as the initial formulation. This new formulation is called AREDS 2. The new formulation removed the vitamin A (also known as beta-carotene) and added lutein and zeaxanthin. As the new formulation is likely better tolerated, and is just as effective, it is now the recommended supplement for those with dry macular degeneration that is considered moderate or worse (once again, if a person’s macular degeneration is felt to be milder than what is considered moderate, then no supplementation is needed). In addition, this formula can be used by both smokers and non-smokers (different formulas of the original vitamin and mineral supplement were recommended for smokers and non-smokers) . When you buy supplements, you should now look to see that it is the AREDS 2 formula. As long as it is, then it is the correct one. Follow the instructions on the bottle as to how many to take a day (it may vary from 1 to 4), although usually 2 a day is the recommended dose. Note that some supplements that say they have the AREDS 2 formulation may additionally have omega-3 or fish oil added to them. The study showed that these did not add to the protective effects, but it is fine to take supplements that contain these additional nutrients. So, when shopping for vitamins for macular degeneration, look for: AREDS 2 Formula
Conner-Smith Eye Center, 707 West Tipton Street, Seymour, IN 47274 812-5 Some people may wish to consider whether or not they wish to take these supplements for medical reasons. Taking supplements with zinc may cause a copper deficiency, which can lead to anemia. (That is why copper is included in the recommended dosages.) Also, very high zinc levels can be associated with kidney problems. Patients may want to discuss the best combination of supplements to take with their primary care physician. In addition, the impact of taking these supplements for decades is not known.
The dosages of the vitamins, minerals and nutrients studied are listed below. These are the recommended daily amounts.
1. Vitamin C, 500 mg.
2. Vitamin E, 400 IU
3. Zinc, 80mg., as zinc oxide
4. Copper, 2mg., as cupric oxide (this is added to help prevent the copper deficiency that can be associated with use of zinc)
5. Lutein, 10 mg.
6. Zeaxanthin, 2mg.
Always look to be sure what you buy says it is the AREDS 2 formula.
The study assessed only these dosages of these supplements, and so it simply is not known if other dosages of these vitamins and minerals and nutrients or if other vitamins or minerals or nutrients are of benefit. Numerous commercially available supplements for macular degeneration that contain close to these specific amounts are available. Many of the supplements advertised as made specifically for macular degeneration also promote that they contain other ingredients, but just be aware that no other ingredients have been shown to be helpful in providing protection from macular degeneration. All AREDS 2 supplements can be purchased without a prescription at your local drug store.
For more information:
www.alconlabs.com Alcon Drug Company (I-Caps) AREDS Formula
www.allergan.com Allergan Drug Company (Ocuvite Preservision)
www.preventblindness.org Prevent Blindness America
www.macular.org American Macular Degeneration Foundation
How is Wet Macular Degeneration treated?
The treatment of wet macular degeneration has undergone substantial improvements since 2003.Treatments prior to that were always laser treatments, but the laser was only able to treat a small number of wet macular degeneration cases.
A newer type of laser treatment called PDT (Photo Dynamic Therapy) is available. However, the current most common treatment of wet macular degeneration has now shifted to the use of intraocular injections of anti-VEGF (Vascular Endothelial Growth Factor) medications. Photo Dynamic Therapy is rarely used at this time, though at times it can be combined with anti-VEGF injections. The anti-VEGF drugs of Avastin and Lucentis are the current drugs Dr. Conner prefers for intraocular injections to treat wet macular degeneration. Lucentis was approved by the FDA in June of 2006.
Avastin and Lucentis treatment of wet macular degeneration has had great results. Dr. Conner has been performing many of these treatments routinely, in the office, for his wet macular degeneration patients with gratifying results. In the past, before anti-VEGF treatment, Dr. Conner would tend to see most patients with wet macular degeneration undergo a progressive decline in vision, often to legal blindness. Treatments had been generally unsatisfactory.
With Avastin and Lucentis, that has changed significantly. Treatment consists of injections of Avastin or Lucentis directly into the eye. Most people find this idea to be disturbing, but in reality, nearly everyone tolerates the treatment with minimal or no discomfort–it actually seems less bothersome to most patients than a shot given in the arm or leg.
The treatment is not a perfect treatment, but 30% of those receiving it have improvement in their vision. Of the remaining 70%, many will maintain their current vision. Unfortunately, some will go on and lose some vision even with treatment. However, this possibility of improvement and stabilization of vision represents a monumental step forward in treating macular degeneration.
Macugen is another anti-VEGF medication that was regularly used before Avastin and Lucentis, but it does not have as great an effect as Avastin and Lucentis, and it is rarely used now.
What you should know about injections with Anti Vascular Endothelial Growth Factor medications such as Avastin and Lucentis:
These medications are administered by injection directly into the eye. Although this sounds as if it would be a terrible experience, these injections are performed on multiple patients most every day that Dr. Conner is seeing patients and patients tolerate them quite well. The eye is numbed with drops, the eyelids are held open with a special instrument, the eye is cleansed with an anti-bacterial agent, and then the injection is administered through a very tiny needle directly through the white of the eye, generally with the eye looking up and toward the nose. Yes, it does sting for about 2 seconds, but most people tolerate it quite well. The eye will tend to feel scratchy for a day or so afterwards and the vision may be slightly more blurry for the rest of the day. If you have an injection and notice a severe decrease in vision, or severe pain, then you should be seen immediately.