Focus Eyecare Wilmington NC | Eye Disease
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Focus

Eye Disease

“Routine” or comprehensive eye exams are essential in the early detection of eye disease. Unfortunately, most eye diseases have no symptoms whatsoever until the damage is done and irreversible. At Focus Eye Care, we have invested over $300K to enhance the office with state of the art equipment and better care for our patients! This equipment allows us to diagnose eye disease earlier, but also allows us to confirm the treatment is working as we monitor for progression.

Glaucoma

Glaucoma is a serious eye disease that can cause blindness when not detected early enough or treated aggressively. Often in glaucoma, the passages that allow fluid inside the eye to drain become blocked, or the eye produces too much fluid to drain adequately. This results in the amount of fluid in the eye building up and often causing increased pressure inside the eye. This increased pressure damages the optic nerve, which connects the eye to the brain. The optic nerve is the main carrier of vision information to the brain. Damage to it results in less information sent to the brain and a loss of vision.

Causes / Risks

The exact cause of glaucoma is not known and it cannot currently be prevented. It is one of the leading causes of blindness in the United States. But, if detected at an early stage and treated promptly, glaucoma can usually be controlled with little or no further vision loss. This is why regular eye examinations are very important. ANYONE can get glaucoma, however some people are at higher risk:

  • People over 40 years old
  • People with a family history of glaucoma
  • People who are very nearsighted
  • Diabetics
  • African Americans and Hispanics
  • People who use steroids for systemic conditions
  • People who have had an eye injury or surgery
  • People with thin corneas

Of the different types of glaucoma, primary open-angle glaucoma is the most common and often develops gradually and painlessly without warning signs or symptoms. This type of glaucoma is more common among African Americans and Hispanics and can cause damage and lead to blindness more quickly in these populations. This makes regular eye examinations, including tests for glaucoma, particularly important for African Americans and Hispanics over 35 years old.

The most common type of glaucoma has absolutely NO symptoms until it is too late. Vision stays normal and there is no pain.

Diagnosing Glaucoma

Most people think they can only have glaucoma if the pressure in their eye is increased. This is not always true. Whether or not you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. That means a person with a pressure of 12 could have glaucoma. Assessing glaucoma is like putting pieces of a puzzle together to be analyzed. That is why regular eye examinations are an important means of detecting glaucoma in its early stages. Tests used to detect glaucoma include the following:

  • Tonometry: a simple and painless measurement of the pressure in the eye. Pressure can vary hourly, daily, and weekly.
  • Ophthalmoscopy (dilation): examination of the optic nerve to look for changes in its color / shape
  • Visual field test: a check for the development of abnormal blind spots
  • Fundus Photography: digital photos taken of the optic nerve and compared for changes over time
  • Gonioscopy: a lens is placed on the eye in order to view the drainage system of the eye
  • Pachymetry: measures the thickness of the cornea
  • OCT: a scanning laser that produces a computer analysis of the nerve fiber layer and comparison to others of the same sex, age, and race

It is important to remember that these tests are used as a benchmarking technique to document even small changes in the nerve before your vision is affected. Even if immediate change is not detected from one visit to the next, this does not in any way ensure that it will not change in the future! For this reason the tests need to be repeated at regular intervals until there is no longer a suspicion of glaucoma.

Glaucoma Treatment

Treatment of glaucoma depends on the specific type, severity, and how the glaucoma is responding to treatment. It is important to know that you will NEVER be cured of glaucoma. The goal of treatment is to control any progression of the glaucoma. Glaucoma drops are used to decrease the pressure inside the eye and can be effective in delaying the onset of glaucoma or its progression. In some cases surgery may be necessary. Unfortunately, any loss of vision from glaucoma usually cannot be restored. But, early detection, prompt treatment, and regular monitoring can enable you to continue living in much the same way as you have always lived.

If you are a new glaucoma suspect or new glaucoma patient, you may require several visits at first to have your pressure checked until it is under control. The visits will then typically spread out into intervals of 3, 4, or 6 months as long as you remain stable. Compliance is extremely important in preventing vision loss. Glaucoma can be unpredictable. It is usually a slowly progressive disease, but the optic nerve can change unexpectedly and if you are not being checked as advised according to your risk level, irreversible damage to your eye health and vision can occur without symptoms.

Macular Degeneration

Age Related Macular Degeneration (ARMD) is the leading cause of blindness among Americans over the age of 65. The macula is an essential part of the retina, responsible for the central vision, therefore any loss of vision in this area can be devastating.

Dry ARMD is the most common type, in which the macular tissue typically thins and collects deposits, however there is no blood. These deposits can consist of pigment or debris from degenerating tissue. There is no current FDA approved treatment for Dry ARMD, however a healthy diet, exercise, nutritional supplements, UV protection, and abstinence from tobacco use can be protective for the macula.

Wet ARMD occurs when there is new and abnormal vessel growth beneath the retina. These fragile vessels leak blood and fluid, causing permanent damage to the tissue and blind spots in the vision. There are multiple FDA approved intraocular injections that can help limit the vessel formation, but they usually have to be repeated quite frequently. The retinal specialist may also choose to administer a laser treatment, or Photodynamic Therapy (PDT).

Presumed ARMD Risk Factors:

ARMD is not well understood, despite decades of research, however studies have linked the following with variable levels of association.

  • Age
  • Females
  • Obesity and inactivity
  • Heredity
  • High blood pressure
  • Smoking
  • Light eye color (Caucasians)
  • Drug side effects

Diagnosing ARMD:

  • Ophthalmoscopy (dilation): examination of the macula to look for changes
  • Fundus Photography: digital photos taken of the macula that allow a view through different color filters and compared for changes over time
  • OCT: a scanning laser that produces a computer analysis of the macula and retina, allowing visualization and measurement of any change in thickness or composition (deposition) within the layers
  • Amsler grid: you will be given a grid of black lines that help you monitor for subtle changes in the central vision between office visits

Floaters

Many people experience cobweb type particles floating in their vision. This is often completely normal, due to changes within the gel-like center of the eye that occur over time. However, it is important to know the difference between the floaters you are accustomed to seeing and those that might be dangerous. If you see a large number of new floaters, flashes of light, or a shade over any aspect of your vision, you should seek medical attention right away. This can be signs of a Posterior Vitreous Detachment (PVD), which is a normal and typically safe process associated with aging and liquefaction of the gel. However, it can also indicate a retinal tear, so it is important that you be dilated and examined.

Diabetic and Hypertensive Retinopathy

Diabetic retinopathy is the leading cause of blindness among working age Americans, affecting more than 5 million over 40 years old. Retinal damage occurs when abnormally high amounts of blood sugar clog or damage the vessels within the retina. This can occur when the diabetes is uncontrolled or even with good control, it can happen over time.

Diabetic and Hypertensive retinal damage can occur with or without symptoms. Some symptoms may include:

  • Fluctuating vision
  • Eye floaters and spots
  • Development of a scotoma or shadow in your field of view
  • Blurry and/or distorted vision
  • Corneal abnormalities such as slow healing of wounds due to corneal abrasions
  • Double vision
  • Eye pain
  • Near vision problems unrelated to presbyopia
  • Cataracts

Diabetic or Hypertensive Retinopathy can appear as simple changes in the blood vessel structure in its earliest stages. However, it can progress to include hemorrhages, retinal deposits, retinal edema (swelling), or macular edema. The process to diagnose these retinal changes is similar to that in ARMD.

There are many other diseases and conditions that can affect the eye, some which cause discomfort over time and others that threaten the vision. Regardless of the cause, early detection typically creates a better outcome less sacrifice for the patient. For this reason, yearly eye exams are critical in maintaining the health and comfort of your eyes. Your vision is a precious sense and preventative care is painless, affordable, and easily accessible!