Eye Conditions

Age Related Macular Degeneration

"I used to read stories to my grandchildren, now I can't even see their faces when they read to me"

• Age related macular degeneration (AMD) is the leading cause of blindness in people over 60 years of age in the world
• Estimated 13 million Americans have evidence of AMD
• More than 1 million Americans have WET AMD
• 200,000 NEW cases of WET AMD will be diagnosed this year
• Between 20 - 25 million people affected worldwide - will TRIPLE with the increase in the aging population in the next 30 - 40 years
• By the year 2030 - 88 million Americans > age 65 - estimated 6.3 million people will have visual loss due to WET AMD
• According to WORLD HEALTH ORGANIZATION: estimated 8 million people with severe visual impairment due to AMD
• Disease breaks down the macula, the light sensitive part of retina responsible for sharp vision needed for reading or driving
• Central vision is lost making it impossible to appreciate fine detail

Anatomy

• MACULA is 5.5mm in diameter, 4mm from the optic disc
• FOVEA at its center
• Most highly developed area of the retina - Responsible for detailed central vision
• Free of blood vessels

Symptoms and Signs

AMD diagnosed as:

• DRY—90%
• WET—10%
• New ABNORMAL blood vessels grow beneath the retina, leak blood and fluid
• More sight threatening than DRY type—responsible for 90% of cases of severe visual loss in elderly

Symptoms

• Slow or Sudden painless loss of vision
• Straight lines may look wavy
• Vision may be fuzzy
• Blind areas appear in your central vision

Risk Factors

• Age: Those over age 75 have a 30% risk
• Family members with AMD
• Smoking
• High blood pressure
• Females
• Cardiovascular disease
• Farsightedness
• Light colored eyes

Diagnosis

• Comprehensive eye exam
• Amsler Grid
• Flourescein Angiogram

Treatment

• Anti-Oxidant / Vitamin Suplements for BOTH DRY & WET Age Related Macular Degeneration
• Anti-VEGF (Vascular Endothelial Growth Factor) injections for WET Age Related Macular Degeneration

Other Macular Disease Resources

Glaucoma

"At first you don't notice, but gradually the world becomes a smaller, darker place"

• Glaucoma is the leading cause of IRREVERSIBLE blindness in the world - accounting for about 12% of all cases of blindness
• Between 89,000 and 120,000 people are BLIND from glaucoma
• Nearly 3 million people age 40 and over have glaucoma
• Affects about 2 in 10 people over the age of 40
• At least one-half of those who have glaucoma are unaware of the disease - Can be completely ASYMPTOMATIC

Types of Glaucoma

• Glaucoma is a group of diseases characterized by:
• INCREASED Intraocular Pressure
• PROGRESSIVE Optic Nerve DAMAGE
• Gradual LOSS of Visual Field
• Basically, TWO types of Glaucoma:
• OPEN ANGLE Glaucoma
• NARROW ANGLE Glaucoma

OPEN ANGLE GLAUCOMA (PROGRESSIVE OPEN ANGLE GLAUCOMA—POAG)

• Most common form
• Drainage channels blocked within the wall of the eye
• Painless
• Insidious
• Progressive
• Undetected, can lead to complete, irreversible blindness

NARROW ANGLE GLAUCOMA

• The anatomical area known as the "Angle" is blocked by the iris (colored part of eye)
• Patients may present with headaches / halos around lights
• May progress to ACUTE ANGLE CLOSURE GLAUCOMA—An Ocular Emergency:
• Sudden very high intraocular pressure
• Eye Pain
• Headache
• Nausea
• Red eye
• Blurred Vision

CONGENITAL GLAUCOMA

ADOLESCENT GLAUCOMA

LOW TENSION GLAUCOMA

OCULAR HYPERTENSION (GLAUCOMA SUSPECT)

Risk Factors

• Over Age 40
• POSITIVE Family History (INHERITED - DOMINANT Gene)
• AFRICAN-AMERICANS
• HIGH MYOPIA
• DIABETES

Detection and Monitoring

Comprehensive Eye Exam by an OPHTHALMOLOGIST includes:

• Pressure check
• Visual Evaluation of Optic Nerve
• Visual Field exam
• Photographs of Optic Nerve
• HRT (High Resolution Laser Scan of the Optic Nerve)
• Pachymetry (measurement of Corneal thickness)

Treatment Options

Therapy is aimed at lowering intraocular pressure

• Open Angle Glaucoma:
• Drug Therapy:
• Topical (drops)
• Oral
• Laser: Argon Laser Trabeculoplasty (ALT) / Selective Laser Trabeculoplasty (SLT)
• Surgery (Filter - Valve)
• Narrow Angle Glaucoma:
• Laser Iridotomy

Other Glaucoma Resources

Cataract

Cataracts are a clouding of the natural crystalline lens in the eye that eventually leads to loss of vision

Cataracts are a leading cause of blindness among adults in the United States - Account for one out of every seven cases of blindness in people age 45 and older

20.5 million Americans age 40 and older have cataracts

Half of all Americans will develop cataracts by age 80

Cataract surgery is the MOST commonly performed surgical procedure in the United States

Close to 2 million cataract surgeries performed in the United States each year

There are different forms of cataracts:

Causes

• Age
• Medication
• Eye Trauma
• Previous Eye Surgery
• Systemic Diseases
• Congenital

Symptoms

• Blurred Vision
• Dim Vision
• Halos around lights at night
• Increased Glare
• Difficulty discerning colors
• Need for frequent changes of eyeglass prescriptions, which eventually may NOT improve vision

Treatment

Surgery

Most advanced current technique: ULTRASOUND (PHACOEMULSIFICATION)

Cataracts are removed by ultrasound and replaced with an INTRAOCULAR LENS (IOL) in a painless 15minute procedure, using only drops to anesthetize the eye accompanied by comfortable Intravenous sedation:

INTRAOCULAR LENSES are made of:

• SILICONE
• ACRYLIC
• POLYMETHYLMETHACRYLATE (PMMA)

INTRAOCULAR LENSES TECHNOLOGY:

Refractive Errors

• FARSIGHTED (HYPEROPIA): Cornea is too flat and/or the eye is too short - The image is focused behind the retina
• NEARSIGHTED (MYOPIA): Cornea is too steep and/or the eye is too long - The image is focused in front of the retina
• ASTIGMATISM: The cornea and/or the lens create multiple focal points on the retina- Refractive power is not uniform in all meridians - Images are distorted & blurred at all distance
• PRESBYOPIA: "old age vision" a diminished power of accommodation arising from loss of elasticity of the crystalline lens, as occurs with aging.

Treatment

Farsighted (hyperopia) & nearsighted (myopia) are corrected by intraocular lenses.

Presbyopia is corrected by the crystalens®

Corneal astigmatism is corrected by limbal relaxing incisions

Limbal relaxing incision: Small incisions in the peripheral cornea to make the cornea more spherical and eliminate visual distortion

Dry Eye

• Affects approximately 60 million Americans
• Affects 75% of people over age 65
• Tear volume decreases by as much as 60% by age 65

The human eye is lubricated by two mechanisms of tear production:

• BASELINE tears - lubricate and nourish the cornea
• REFLEX tears - response to irritation

Symptoms

• Irritation
• Burning
• Redness
• Blurred Vision that improves with blinking
• Increased Discomfort after periods of reading, watching TV, or working on computer
• Excessive Tearing or Watering

Causes and Contributing Factors

• Age
• Blepharitis
• Smoking
• Contact lenses
• Environment:
• Hot, dry, windy climates
• Air conditioning
• Ceiling fans
• Diseases:
• Rheumatoid arthritis
• Lupus
• Thyroid disease (Graves disease)
• Parkinson's
• Sjorgren's syndrome
• Women's hormonal changes
• Medications:
• Diuretics
• Antidepressants
• Antihistamines
• Birth control pills
• Appetite suppressants
• Blood pressure medications
• Over-the-counter vasoconstrictors (e.g., Visine)

Treatment

• Tear Supplements
• Drops / Gels / Ointments
• Preservative-free
• Oral supplements of:
• Omega-3 Essential Fatty Acids (EFAs) (Cold water fish: salmon, sardines, herring - flaxseed, walnuts, canola oil) Omega-6 Essential Fatty Acids (EFAs) (Raw nuts: almonds, walnuts - Seeds: sesame, sunflower - Whole grains - Soybean - Legumes)
• Cyclosporin (Restasis) and/or Mild topical steroids
• Punctal Plugs / Cautery

Blepharitis

• Can be difficult to manage—Recurs
• Caused by Staphylococcus bacteria
• Commonly associated with skin disorders:
• Acne Rosacea
• Seborrhea
• Dandruff
• Dry Eye

Symptoms

• Foreign body or burning sensation
• Excessive tearing
• Itching
• Photophobia (sensitivity to light)
• Red and swollen lids
• Red eyes
• Crusting of lashes on awakening
• Stye
• Chalazion

Treatment

• Lid hygiene
• Antibiotic / steroid drops or ointments
• Oral antibiotics

General

Regular eye exams are important—early detection and treatment are the keys to preventing loss of sight.

Ways of Seeing

"Help for the visually impaired can mean the difference between managing at home or being totally dependent upon others"

• Emphasize good direct lighting
• Large-print reading materials
• Magnifying aids
• Closed-circuit television
• Audio tapes
• Electronic reading machines
• Computers that use large print and speech

Signs of Possible Eye Trouble

Any changes in the appearance of your eyes or vision should be investigated further:

• Unusual trouble adjusting to dark rooms
• Difficulty focusing on near or distant objects
• Unusual sensitivity to light or glare
• Red-rimmed, encrusted or swollen lids
• Recurrent pain in or around eyes
• Double vision
• Dark spot in the center of vision
• Lines and edges appear distorted or wavy
• Seeing spots, ghost-like images
• Dry eyes with itching or burning

The following may be indications of potentially serious problems:

• Sudden loss of vision
• Sudden hazy or blurred vision
• Flashes of light or black spots
• Halos or rainbows around light
• Curtain-like obstruction of vision
• Loss of peripheral vision

Five Steps to Safeguard Your Eyesight

1. Regular physical exams
2. Comprehensive eye exam at least every 1–2 years
3. Be aware of risk factors (e.g., family history of glaucoma, diabetes, HBP)
4. Do not delay an exam for any of the above problems
5. Sunglasses (blocks all UV rays) and a wide-brim hat

Low Vision Resources List