The Eyes Have It: Protecting Your Precious Gift of Sight
Rajiv Rathod, MD, MBA Retina Specialist Orange County Retina Medical Group Orange County Retina Types of Eye Doctors
Optometrist (OD) Attend 4 years of Optometry school after college Only focus on the eye General eye exams for glasses and basic eye disease Not licensed to perform procedures Types of Eye Doctors
Ophthalmologist (MD) Medical doctors that further specialize in diseases and surgery of the eye Attend medical school (4 years) then specialty training (4 years), and possibly subspecialty training (1-2 years) Licensed to take care of all aspects of eye disease, including diseases that affect the entire body Perform surgery of the eye and areas around the eye Vitreoretinal Surgeon
Any disease that affects the vitreous or retina Macular Degeneration Diabetes Vascular Eye Disease Retinal Detachment/Retinal Tear Macular Pucker/Macular Hole Cataract complications Infections inside the eye Tumors of the eye Main Points
Many eye diseases are age related “An ounce of prevention is worth a pound of cure.” Prevention: Healthy diet Exercise Quit smoking Protect eyes from sun (UV) Get an eye exam early detection and treatment can prevent many eye diseases from causing vision loss Healthy Diet Exercise Quit smoking Protect eyes from UV light
Should block 99% of UVA and UVB light Look for a label Get an eye exam
Not just getting checked for glasses Full exam includes checking eye pressure and a dilated eye exam Many eye diseases, if caught early enough, can be treated and possibly prevent vision loss Anatomy of the Eye The eye is similar to a camera Cornea
• Clear “frontcover” • Focuses light rays Sclera
• “Backbone” of the eye • Maintains its structure Iris
• Colored portion of the eye • Controls the size of the pupil (central opening) Anterior Chamber
• Space between the cornea and iris • Filled with aqueous fluid, which affects the pressure inside the eye Lens
• Further focuses light rays • Changes shape to focus for near vision Retina
• The inner lining of the eye • Made up of millions of photoreceptors Vitreous
• Clear gel that fills the inside of the eye • Where floaters form Optic Nerve
•“Big Cable” made up of millions of “tiny little cables” • Connects the receptors of the retina to the brain Common Problems
Refractive error Near-sighted (myopia) Far-sighted (hyperopia) Gradual loss of reading vision (presbyopia) Astigmatism
Blepharitis / Dry eye syndrome
“Computer fatigue syndrome” The eye is similar to a camera “Normal” Emmetropic Eye Myopia (Near-Sighted) Hyperopia (Far-Sighted) Presbyopia Astigmatism
*Not a serious condition, can be corrected with lenses Blepharitis / Dry eye syndrome
SYMPTOMS Red, irritated lids and/or eyes Lid crusting and/or tearing May lead to styes
CAUSES Reaction against excess bacteria normally found on the skin surface Inflammation causes the oil glands at the lid margin to become plugged
Blepharitis / Dry eye syndrome Treatment
Avoid dry, dusty, windy conditions Warm compresses Heat and moisture helps open the “pores” of the oil glands Eyelid margin massage Helps to express the thickened oil from the gland Eyelid scrubs Reduces bacteria responsible for the inflammation Artificial tears Helps lubricate the eye surface, until the oil glands start to function more normally Computer Fatigue Syndrome
SYMPTOMS Dry, irritated eyes Due to reduce blink rate Blurred vision / eye ache / headache Due to constant accommodation (flexing of lens) Computer screen may possibly trigger migraines (brightness, glare, flicker/refresh rate) Computer Fatigue Syndrome TREATMENT “20-20-20” for every 20 minutes on the computer, focus on something at least 20 feet away for about 20 seconds OR Close eyes for 20 seconds for every half-hour on the computer Artificial tears Computer/reading glasses Reduce screen brightness Ergonomic screen position
Diseases that are screened for during a complete eye exam
Diabetes
Glaucoma
Macular degeneration / Retinal diseases
The Eyes are the Window to the Soul
Many diseases that affect the body can be detected based on findings in the eye Only place in the body where blood vessels and nerves can be seen without cutting
Diabetes Hypertension Thyroid disease Carotid/vascular disease Sickle cell anemia Diabetes
Elevated blood sugars may cause the lens to swell, affecting the focus (typically causing near- sightedness) Usually reversible with improved blood sugar control
Diabetes
Persistently elevated blood sugars can damage the liningExamining of blood the bloodvessels vessels in the eye (retina) can give us an idea of how healthy the vessels are in
other organs Vessels can eventually leak, and the blood no longer gets to where it’s supposed to go
Can affect the major organs in your body (eyes, kidneys, nerves, heart, etc.) Cataract
A clouding of the lens inside the eye (part of the normal aging process)
Usually develops slowly throughout life and starts to affect most people in their 60’s and 70’s Symptoms
Blurred vision Difficulty reading Colors look faded Glare from sunlight or headlights Clear lens Poor night vision Double vision when looking out of one eye Painless
Cloudy lens (cataract) Risk Factors
Age (usually > 60 yrs old) Smoking Alcoholism Chronic use of steroid medications History of eye injury Diabetes Prolonged exposure to sunlight/ultraviolet light Obesity Treatment
Glasses (for early cataracts)
Surgery
Nothing Cataract Surgery
Outpatient surgery 10-20 minutes Cataract is removed and synthetic lens is placed Standard for all cataract surgery Different types of lenses available Different techniques available for surgery Laser assisted Glaucoma
Actually a group of diseases where the end result is damage to the optic nerve
Normal Glaucoma Does glaucoma mean high eye pressure?
High eye pressure raises your risk of developing glaucoma, but doesn’t necessarily mean that you have or will develop glaucoma There are people who have high eye pressure and never develop glaucoma There are people who have normal eye pressure and still develop glaucoma Types of glaucoma
Imbalance between the production and drainage of aqueous fluid
Open Angle (More Common) Closed Angle (Less Common) Symptoms
Open angle Nothing, until the majority of the nerve is damaged Usually starts with loss of peripheral vision Left untreated, the vision loss creeps towards the center and eventually leads to blindness
Narrow angle Early on, there may be no symptoms Intermittent headaches or eye ache, usually associated with blurred vision Severe eye pain with vision loss and associated nausea and/or vomiting
Risk Factors
Someone who has an optic nerve that appears suspicious for glaucoma Someone who has higher than average eye pressure Glaucoma Normal Glaucoma Other risk factors: Suspect - Family history (especially siblings) - Age (> 60) - African-American or Hispanic - Very near-sighted (or far-sighted) - Steroid use - Diabetes/Hypertension
Treatment Lowering the eye pressure can slow down the progression of optic nerve damage:
• Medication (eye drops, pills) • Laser • Surgery However, at this point, there is still no treatment to reverse the damage that has already occurred
So the vision that has already been lost cannot be regained
SCREENING & EARLY DETECTION ARE KEY !!! Future Treatments
Time-released implants No more drops everyday! Newer surgical treatments iStent Currently approved Macular Degeneration
Disease that causes deterioration of the macula (part of the retina responsible for central vision) Types of Macular Degeneration
Dry: More common Accumulation of DRUSEN (yellow deposits)
Wet: Less common Bleeding under and within the retina Symptoms The dry form causes GRADUAL deterioration of your central vision (blurred/distorted) The wet form causes SUDDEN visual distortion/vision loss Risk Factors
Age Smoking Occurs in ~10% of those aged 66 to 74 Increases to 30% in those 75 to 85 Family 2 to 3history times the risk compared to non-smokers Each year you quit lowers your risk Sun If exposure you have a parent or sibling with macular degeneration, your risk is 2.5 times more than someone who has no family High historyOne blood study pressureshowed that / cholesterolthose who stayed / obesity outdoors in the summer sun for more than 5 hours a day in their teens and High30’ fats, had intake twice the chance of developing early macular Caucasiandegeneration Female Treatment
Dry form: an AREDS vitamin (high levels of antioxidants and zinc) may help prevent worsening
Wet form: includes laser, injection of medication and surgery These treatments can help reduce or eliminate new blood vessel growth, which can prevent worsening, but not necessarily improve vision
What are floaters?
When you see small spots moving in your vision Black or gray dots Squiggly lines Threadlike strands, which can be knobby and semi- transparent Cobwebs Ring shaped Am I the only one that sees floaters?
If you’ve ever tried to swat an insect and realized it’s something in your eye, you are not alone!
Floaters are VERY common Most people by age 70 report at least some type of floater during their life Not often part of regular conversation Why do floaters form?
With time, the gel starts to collapse and turn to liquid, forming clumps Starts at an early age Occurs earlier in very nearsighted eyes Eventually, the gel collapses to the point that it starts to separate from the retina Vitreous Detachment Sudden onset of new, large floater “Cobweb, spider web” “Film” “Looking through a cloud” Accompanied by flashes of light What can I do about them?
If you have new floaters See an ophthalmologist relatively quickly (1-2 days) Limit any vigorous activity Old/chronic floaters Most floaters do not actually go away With time, they can settle out of the way, or the eye/brain get used to them and ignore them In rare circumstance, remain extremely bothersome Interfere with ability to read, see clearly Can be removed surgically
Questions?