BELLS'S PALSY (Back To Top)
If you suffer from Bell's palsy, a paralysis of one side of the face caused by nerve inflammation, you may lose control over your eyelids. This eyelid paralysis can create problems for the sensitive cornea that protects the eye's lens and helps focus light waves into clear images. Fortunately, our experienced eye care professionals can recommend measures to soothe and protect the afflicted eye.
What causes this form of paralysis, which strikes so suddenly that many sufferers think they've had a stroke? While doctors are not entirely certain, it would appear that the herpes or shingles virus can produce a bout of Bell's palsy, along with viral meningitis or a facial injury.
Bell’s palsy occurs when the seventh cranial nerve, which relays motor commands and sensation to one side of the face, becomes impinged or inflamed. The pressure on the nerve stops the flow of information, causing severe weakness or total paralysis to the muscles on that side of the face -- including the muscles that control the upper and lower eyelids. As a result, you may experience an outward drooping of the lower lid, while the upper lid may refuse to close without assistance.
While the nerve paralysis that causes Bell's palsy may have no direct effect on your vision, it can cause serious eye issues indirectly. The inability to shut your eye, not even while sleeping, causes the cornea to dry out and develop dry eye syndrome. This is not unlike the dryness that occurs in computer users who forget to blink regularly. Lengthy periods of dehydration can lead to a painful condition called exposure keratitis.
Saving Your Eye from Pain and Irritation
Various medical treatments, including steroids and anti-viral drugs, can help you rebound from Bell's palsy to regain total or near-total muscle control. In the meantime, however, you must take steps to protect your affected eye from dehydration. Hourly use of artificial tears, which are easily obtained over the counter, can help soothe and protect the cornea during the daytime. We may recommend you apply tape or a patch to keep the eyelid shut at night. In some cases, a special external weight may be prescribed. Ask us to advise you on keeping your eye safe and healthy.
CYTOMEGALOVIRUS (CMV) (Back To Top)
Associated with acquired immunodeficiency syndrome (AIDS), this disease also affects people whose immune systems have been compromised for other reasons like chemotherapy or bone marrow transplant. The virus invades the retina and damages photoreceptor cells, causing floaters, blurry vision, flashes, and/or decreased peripheral vision. Left untreated, CMV retinitis leads to detached retina and blindness.
Cytomegalovirus (CMV) retinitis is a serious disease causing compromised vision and ultimately a total loss of vision. CMV retinitis is typically associated with AIDS. In the early days of the AIDS epidemic, nearly one-quarter of all individuals diagnosed with late-stage AIDS also developed CMV retinitis. Thanks to aggressive treatments and a new, potent combination of drugs used to treat HIV/AIDS, CMV retinitis has been reduced by more than 80 percent.
Causes and Symptoms of Cytomegalovirus
CMV retinitis is caused by the cytomegalovirus. Nearly 80 percent of all adults have antibodies for this very common virus, meaning they have been infected with the virus and their bodies have successfully fought it off. For individuals with compromised immune systems, especially due to HIV/AIDS, their bodies are unable to fight off the virus. All individuals with a weakened or suppressed immune system are at risk for CMV retinitis, including individuals who are undergoing chemotherapy or who have recently had a bone marrow transplant.
Common symptoms of CMV retinitis include seeing “eye floaters” or small specks in the eye. As the disease progresses, individuals experience blurry vision, decreased peripheral vision, and light flashes. If the virus is not treated, CMV retinitis can cause a detached retina, leading to blindness in under six months.
Diagnosis and Treatment of Cytomegalovirus
When stricken with CMV retinitis, the infection occurs in the most external part of your retina. The virus may be present for an extended period, but not active on this outer layer. Once the virus becomes activated, however, it will quickly trigger cell death and spread to deeper layers within the retina, ultimately leading to detachment and total vision loss.
If you have been diagnosed with HIV/AIDS or have a weakened immune system and are experiencing vision changes, make an appointment with our office immediately. Prompt care and treatment is absolutely essential to control the disease and prevent blindness. Anti-viral drugs are used to treat the progression of the disease, but these drugs cannot completely cure it. Anti-viral medication may be administered in pill form or as an implant in the eye.
DIABETIC RETINOPATHY (Back To Top)
What Is Diabetic Retinopathy?
Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes.
Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes.
Over time, diabetes damages the blood vessels in the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.
Symptoms of Diabetic Retinopathy
Symptoms of diabetic retinopathy include:
Often the early stages of diabetic retinopathy have no visual symptoms. That is why we recommend that everyone with diabetes have a comprehensive eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.
What Are The Other Risk Factors?
FUCH'S DYSTROPHY (Back To Top)
An inherited disease, Fuchs' corneal dystrophy causes endothelial cells which regulate fluid in the cornea to die. This leads to corneal edema (swelling). Symptoms include glare, blurred or distorted vision, painful blisters on the cornea, a cloudy or hazy cornea, corneal swelling, and corneal thickening.
Fuchs' dystrophy (pronounced fooks DIS-truh-fee) is an eye disease characterized by degenerative changes to the cornea’s innermost layer of cells. The cause for Fuchs' dystrophy is not fully understood. If your mother or father has the disease, then there is roughly a 50 percent chance that you will develop it as well. While Fuchs' dystrophy can sometimes be genetic, it can also occur in individuals who have no known family history of the disease.
Understanding Fuchs’ Dystrophy
Fuchs’ dystrophy typically causes vision problems in individuals who are 50 years or older, although symptoms are sometimes diagnosed in individuals who are younger. While Fuchs’ dystrophy can affect both genders, it most commonly affects women. This eye disease affects the innermost layer of cells in the cornea, the endothelium, causing degenerative changes. As the disease progresses, the cornea swells (known as a cornea edema) and clouds, which causes a decline in vision. Finally, the swelling also causes blisters to develop on the front of the cornea, a condition known as bullous keratopathy.
Symptoms and Diagnosis of Fuch's Dystrophy
Fuchs’ dystrophy symptoms include eye pain, foggy vision, blurred vision, sensitivity to light, the appearance of halos around a light source, and vision trouble at night. Individuals typically experience poor vision upon awakening that improves later in the day. Another common symptom is the sensation that a foreign object (e.g., an eyelash) is in the eye, even though nothing is there.
A comprehensive eye exam is necessary to diagnose Fuchs' dystrophy. During this exam, an eye care professional uses an instrument called a “slit lamp” to examine the cornea. The slit lamp magnifies the cornea, allowing us to detect the subtle changes to the cornea’s endothelium cells, which characterize the disease. The earliest clinical signs are a reduced number of endothelium cells and small, drop-like lesions along the endothelium.
Treatment For Fuch's Dystrophy
Treatment for Fuchs’ dystrophy depends on the stage of the disease at diagnosis. For an early-stage diagnosis, it is possible to improve vision with special 5% sodium chloride drops that remove excess water from the cornea. If the disease is caught in later stages, a cornea transplant may be necessary to replace a ruptured cornea. As an alternative to a full cornea transplant, a new treatment known as DLEK (deep lamellar endothelial keratoplasty) can replace the endothelium while leaving the upper layers of the cornea untouched. Finally, if you have been diagnosed with Fuchs’ dystrophy, keep in mind that certain eye surgeries, including LASIK, can actually worsen this condition.
GLAUCOMA (Back To Top)
Glaucoma is the second leading cause of blindness in the United States, making it an important public health priority. Although there are several factors that cause glaucoma, all types of glaucoma are characterized by damage to the optic nerve. This damage prevents the brain from receiving appropriate visual information, resulting in vision loss. If you experience any change in vision, contact our office immediately for a full examination.
Causes of Glaucoma
Although there are many types of glaucoma and the exact causes are unknown, the general characteristics are understood. Primary open-angle glaucoma is the most common form of the disease. This form results when the eye cannot drain fluids efficiently, leading to increased pressure in the eye and damage to the optic nerve. Changes to the blood supply fueling the optic nerve may also cause optic nerve damage, resulting in vision loss.
A less common form of glaucoma, called angle-closure glaucoma, occurs when the drainage angle between the iris and cornea is blocked. This causes a rapid buildup of fluid, which can permanently damage vision within one day of its onset. Other forms of glaucoma form because of medical conditions, physical injuries, abnormal eye conditions, or medication use.
Risk Factors for Glaucoma
Certain groups of people are at greater risk for developing glaucoma.
Older Adults Individuals greater than 60 years old are at increased risk for developing the disease. The risk continues to rise slightly for each year beyond 60.
African Americans and Asians African Americans are significantly more likely to develop glaucoma than Caucasians, and that risk begins to rise at age 40. Similarly, Asian individuals are at greater risk of angle-closure glaucoma, while people of Japanese descent at a high risk of another form of the disease called low-tension glaucoma.
Diabetes and Cardiovascular Disease These medical conditions significantly increase glaucoma risk and high blood pressure is a risk factor for the disease.
Family History If you have one or more first-degree relatives with glaucoma, your risk for the disease increases. This suggests that there may be a genetic component to developing glaucoma.
Corticosteroid Use Corticosteroids are commonly prescribed to reduce inflammation related to arthritis, lupus, and other conditions. Chronic use of corticosteroids may increase your risk of developing glaucoma.
Diagnosis and Treatment for Glaucoma
A thorough optometry exam includes checking for symptoms of glaucoma. To make a diagnosis, the eye care provider may measure corneal thickness, check the pressure inside your eyes, test changes to your vision, evaluate your retinas, and assess abnormal eye anatomy. If glaucoma is caught early, further vision loss can be prevented. Treatments commonly include medications to reduce intraocular pressure or surgery. If you have noticed vision changes, schedule an appointment to determine if glaucoma may be the underlying cause.
KERATOCONUS (Back To Top)
An eye disease in which the cornea thins, weakens, and loses its normal round shape, keratoconus causes astigmatism and nearsightedness. Though the exact cause is not yet known, research has shown that an imbalance in enzymes within the cornea might cause keratoconus. No cure exists for keratoconus, but effective methods of treatment which slow its progression and reduce symptoms have been developed. If you find yourself experiencing blurred or distorted vision that seems to get worse year after year, you may suffer from an irregularity of the cornea known as keratoconus. This condition is infamous for causing astigmatism and nearsightedness that can progress rapidly, calling for constant updates to your corrective lens prescription. Fortunately, several treatment options are available to help you cope with keratoconus.
Causes and Symptoms of Keratoconus
While medical science has no clear explanation for the cause of keratoconus, the condition occurs more frequently in people who rub their eyes a lot, have worn contacts habitually for many years, or have certain genetic disorders such as Down syndrome. Pregnant women are also known to develop keratoconus, which might indicate that endocrine system imbalances are involved. The condition occurs when corneal tissue grows unusually weak or thin. This allows it to lose its perfectly spherical shape and take on more a cone-like outward bulge. A cornea deformed in this manner cannot refract incoming light in a way that creates an accurate image for the retina.
Keratoconus usually appears between late childhood and the mid-20s, at which point it may progress for many years. The progression is characteristically dramatic, with sufferers having to get new lens prescriptions practically every time they get an exam. Blurred vision is the obvious primary symptom, but in some cases eyesight can also become hazy or cloudy if a rupture at the rear of the cornea occurs. Patients also find that their eyes grow increasingly sensitive to bright light.
Diagnosis and Treatment for Keratoconus
The vision problems caused by mild to moderate keratoconus can usually be corrected through such conventional methods as eyeglasses and soft contacts. More stubborn cases may require gas-permeable rigid contacts, scleral lenses, or custom-made silicon hydrogel soft contacts. Some sufferers even "piggyback" a gas permeable lens on top of a hydrogel lens to achieve an optimal balance between vision accuracy and comfort.
Traditional laser surgeries such as LASIK are not usually recommended for keratoconus patients, but other types of structural correction may provide the desired vision correction. Intacs, tiny corneal inserts implanted just below the corneal surface to flatten out the cone-like curve, can be inserted in a minimally invasive surgery. Even the most extreme cases can be treated with a corneal transplant. However mild or severe your keratoconus, our office can help you understand your treatment options and devise an effective treatment plan.
MACULAR DEGENERATION (Back To Top)
One of the most important reasons for regular examinations by your eye care provider is evaluate for the development of macular degeneration. According to the Bright Focus™ Foundation, this condition is the primary cause of loss of vision and blindness in older individuals ages 60 and above and is known under these circumstances as age-related macular degeneration. Studies conducted by the American Academy of Ophthalmology (AAO) indicate that 10 to 15 million Americans have a diagnosis of age-related macular degeneration. Moreover, macular degeneration is a world-wide problem as the second most frequent cause of irreversible blindness globally. See the video below for more information!
When we think of our "eyes," we usually imagine the outer eye anatomy with the round pupil and white sclera. Eyesight -- or the lack of it -- is more often caused by damage to the unseen structures behind the pupil. One of these inner, unseen structures is the retina which contains "photoreceptor" cells. These cells pick up signals of light, movement and color that are translated by the brain into images. The back of the retina -- on the opposite side of the eyeball from the pupil -- is the retina's center, the macula. The macula processes signals that allow us to see straight ahead and with clarity, color, contrast and detail.
Types of Macular Degeneration
The science of optometry and ophthalmology, classify macular degeneration into one of two types: dry or wet. Diagnoses can change from one type to the other. The difference between the types can best be remembered by associating "wet" with blood vessels.
• Dry Macular Degeneration
This type of damage is the most common form, accounting for approximately 90 percent of macular degeneration diagnoses. Yellow-colored metabolic waste products known as drusen collect beneath the retina, causing a painless but progressive damage and cell death to retinal cells. This form of the disease usually progresses more slowly than does the wet form, however, its ultimate result can be devastating: sufferers may be left without any central version. Imagine a large dark "ball" blocking most of your site all of the time. Peripheral vision is all that may remain, markedly impairing or preventing normal activities of daily living such as driving, reading, watching television, cooking and any work that requires small, detail-oriented work.
• Wet Macular Degeneration
Wet macular degeneration makes up only 10 percent of this condition's diagnoses but is the culprit in legal blindness 90 percent of the time. In this form of the disease, the body attempts to make up for the death of photoreceptors cells by growing new, but fragile, blood vessels behind the macula. Leaking blood vessels can further impair sight and cause permanent scarring of the macula. Symptoms of the damage are similar to that of dry macular degeneration, however, its progress can take place rapidly.
MACULAR DYSTROPHY (Back To Top)
A genetic eye disorder, macular dystrophy damages the photoreceptor cells located on the macula (the center of the retina), leading to a loss of central vision. Central vision is used to look straight ahead and is necessary for activities such as reading, driving, and recognizing faces. There are two types of macular dystrophy: Best disease, which affects children, and adult onset macular dystrophy, which occurs in adulthood.
You may have heard of macular degeneration, an age-related condition in which people suffer permanent vision loss due to damage in a part of the retina called macula. But you may not be so familiar with a similar macular condition that also causes vision loss -- even in young people. This condition, known as macular dystrophy, takes its cue from the sufferer's genetic makeup and produces varying degrees of vision loss. If you have macular dystrophy, understanding the precise nature of your condition can help you make smart decisions for coping with it.
Understanding Macular Dystrophy
The macula is a collection of cells in the center of the retina, the spot at the back of the eyeball that relays images to the optic nerve. In turn, the optic nerve sends images to the brain's visual center for interpretation. Photoreceptors in the macula are responsible for sending information regarding the central field of vision and the perception of colors. Macula dystrophy occurs when a buildup of pigment in the macula causes the cells to lose their ability to function. This damage may cause you to lose some or all of your central field of vision, leaving your peripheral vision intact, or it may render you color blind.
Unlike macular degeneration, which also causes a loss of central vision but generally appears late in life, macular dystrophy is a genetic mutation that can express itself in young adulthood or even childhood. (The childhood variety is known as Best disease, named after the BEST1 gene that seems to cause it.)
Diagnosis and Treatment for Macular Dystrophy
If you suffer from early signs of central vision loss or difficulty registering colors, you may have macular degeneration or cataracts. If you test negative for those conditions, however, you may want to get checked for macular dystrophy. Our doctor may inject yellow-green dye into the veins of the eye to look for signs of the condition, or check for remnants of cells sloughed away by retinal disease. Electrodes can measure your eye's ability to react to light as well. These tests, along with genetic testing, can help you discover what type of macular dystrophy you may have, if any.
While no treatment currently exists for macular dystrophy, the fact that it tends to progress slowly puts time on your side. Some cases even stop progressing on their own.
MACULAR HOLE (Back To Top)
The condition known as a macular hole refers to a tiny break in the macula that results in blurry or distorted vision. To fully understand the condition, one must understand eye anatomy. The macula is a spot located in the center of the retina (the back portion of the eye). Located where light comes to a focused point in the eye, the macula is the portion of the eye most concentrated with color detecting cones and responsible for seeing clear color vision. The rest of the retina is covered with photosensitive rods, which detect darkness, light, or movement.
Symptoms of a Macular Hole
Macular hole development usually occurs gradually. As a result, the first symptoms include slight distortions of vision. For example, straight lines might appear wavy or you might have difficulty reading or recognizing faces. A sudden loss of vision in one eye usually follows these early symptoms.
Causes of a Macular Hole
A gel-like substance called vitreous fills most of the eye's interior. Millions of fibers attach the vitreous to the retina, holding it in place and maintaining the eye's round shape. Vitreous begins to shrink with age, and pull away from the retina, leaving pockets of space which become filled with fluid. Normally, this process occurs with no adverse effects. However, if the vitreous shrinks and the fibers are firmly attached, it can tear the retina. The fluid which then fills the void space can seep through the retina and pool on the macula, distorting and blurring vision.
Since most cases of macular holes develop as the result of age, individuals over the age of 60 are at the highest risk. Macular holes, however, can also develop due to injury, severe nearsightedness (myopia), retinal detachment, or macular pucker.
Diagnosis and Treatment of a Macular Hole
If left untreated, a macular hole can worsen over time, leading to permanent vision loss. If you notice any unusual eye symptoms, you should schedule an appointment with us right away.
The most common treatment for a macular hole is a surgical procedure called a vitrectomy, and is performed by a retinal specialist. In this procedure vitreous gel and fibers are removed from the middle of the eye to prevent further tearing of the retina. A mixture of air and gas is then inserted into the space once filled with vitreous, putting pressure on the macular hole and allowing it to heal.
NYSTAGMUS (Back To Top)
Nystagmus is a vision condition characterized by repetitive, uncontrolled eye movements. These involuntary eye movements may be side-to-side, up and down, or in a circular pattern, which hinders the eyes’ ability to focus on a steady object. Individuals with nystagmus may hold their heads in unusual positions or nod their heads in an effort to compensate for these vision obstructions. Nystagmus that develops in childhood is typically inherited; if this condition develops later in life, it may be due to an accident injury. In some cases, however, the exact cause for nystagmus is not fully known.
Types of Nystagmus
Forms of nystagmus include congenital nystagmus and acquired nystagmus. Congenital typically develops between two and three months of age. Eyes appear to move in a horizontal swing fashion. Congenital nystagmus is associated with conditions like undeveloped optic nerves, albinism, congenital cataracts, and the congenital absences of the iris.
Acquired nystagmus generally occurs in adulthood. While the cause is typically not known, this condition may be triggered by central nervous system issues due to alcohol or drug toxicity, stroke, multiple sclerosis, or a blow to the head.
Diagnosis and Treatment of Nystagmus
A comprehensive eye exam is necessary to diagnose nystagmus. Our doctor will first study a patient’s history to determine whether environmental factors, general health problems, or medications could be causing any of the symptoms the patient is experiencing. Next, visual acuity measurements will be taken to assess the extent to which vision has been compromised. These tests will help determine the appropriate refractive lens necessary to compensate for nearsightedness, farsightedness, or astigmatism. Finally, tests will be done to determine how the eyes work together to move in unison and focus on a single object.
While there is no “cure” for nystagmus, treatment options are available to help correct other vision problems that may be associated with this condition. Depending on the type of nystagmus, it is also possible that the condition will spontaneously correct itself. In extremely rare cases, surgery may be performed to alter the position of the muscles that move the eye. However, lifestyle changes such as using large-print books, increased lighting, and magnifying devices are generally the preferred treatment methods.
RETINITIS PIGMENTOSA (Back To Top)
A rare, inherited disease, RP causes the photoreceptor cells in the retina to progressively degenerate. This degeneration first narrows the field of vision and leads to decreased night vision. Eventually, photoreceptors deteriorate so extensively that the disease causes near blindness with only slight peripheral and a small area of central vision remaining.
The term retinitis pigmentosa (RP) refers to a set of degenerative genetic diseases that gradually kill off the light-sensing cells (rods and cones) of the retina, eventually causing blindness. It is a relatively rare genetic disorder, affecting only 1 in 4,000 people. Retinitis pigmentosa can be difficult to adapt to without proper support. Although there is currently no cure for RP, regular visits with your eye care professional are important to monitor the progression of the disease, adapt to the condition, and become aware as new RP treatments are available.
Symptoms of Retinitis Pigmentosa
Although there are variations dictating how a person inherits and develops retinitis pigmentosa, this condition is usually characterized by the following symptoms:
1) Poor and narrowing peripheral (side) vision.
2) Difficulty seeing or driving in dimly-lit conditions. This is often called “night blindness.”
3) As the disease progresses, vision may narrow to just a small, central vision field or “tunnel vision.”
4) Difficulty discerning colors.
5) Problems reading or doing intricate work due to deficiencies in the central field of vision, which often disappears first.
The progression of the disease can vary significantly depending on whether the condition is inherited as a dominant or recessive trait. Regular testing is very important if you have RP for two reasons:
Eye exams and vision tests can give you an idea of how your condition is progressing so that you can be aware of and prepare for any adaptations you need to make as your vision declines.
With modern technology, there are currently efforts under way to provide treatments to slow the progression of RP, or to create solutions that simulate the behavior of healthy retina cells. We can inform you of any developments that might be able to make a positive impact in the quality of your life as you live with this condition.
If you or a loved one suffers from any of these symptoms, please contact our office today for an appointment.
STARGARDT DISEASE (Back To Top)
Loss of eyesight and macular degeneration are typically associated with aging. Stargardt disease, however, an inherited form of macular degeneration, commonly affects children and young adults. Also referred to as Stargardt macular dystrophy (SMD) or flavimaculatus, the term Stargardt disease refers in particular to the form of inherited macular degeneration which affects individuals at a young age.
Causes of Stargardt Disease
The death of photoreceptor cells located in the center of the retina (back of the eye) causes Stargardt disease. The photoreceptor cells of the macula, the center of the retina where light comes to a sharp point, are responsible for central vision. Central vision is used for activities like facial recognition, reading, watching television, and driving. Stargardt disease does not typically affect peripheral vision or motion-detecting vision.
Symptoms of Stargardt Disease
A progressive loss of central vision is the primary symptom of Stargardt disease, in addition to difficulty seeing in low light and the eventual loss of color vision at late stages of the disease. The visual acuity of sufferers can deteriorate to vision as bad as 20/40 to 20/400.
Risk Factors of Stargardt Disease
An inherited condition, Stargardt disease is passed on to a child via two parents carrying the recessive gene, where each parent has a recessive Stargardt gene paired with a normal gene. Children of two carriers have a 25 percent chance of inheriting two Stargardt genes linked together, and therefore inheriting the disease.
Research has identified the recessive gene associated with Stargardt disease, ABCA4, and individuals can be tested to find out if they are carriers. Couples who are both carriers of the Stargardt disease recessive gene can seek genetic counseling prior to having children to learn about the risks associated with the disease.
Diagnosis and Treatment of Stargardt Disease
Dr. Verna will use a slit lamp to diagnose Stargardt disease by observing the presence of yellow deposits of lipofuscin (a type of fat), which accumulate abnormally, and the presence of vitamin A dimers (clumps) in the retina.
Exposure to UV light has been shown to accelerate the disease's progress. Anyone diagnosed with Stargardt disease should always wear sunglasses with 100% UV protection.