Q&A for Common Eye Diseases

Questions:

1. What is Glaucoma? Is glaucoma preventable? How is Glaucoma treated?

2. What is dry eye? What are signs/symptoms of dry eyes and how to treat it?

3. What is Retinal Detachment?  Who have high risk of having retinal detachment? What are the warning symptoms, and how to treat it?

4. What is ARMD (Age Related Macular Degeneration) and how to treat it?

5. What is Cataract and how to treat it?

6. What are Floaters? Should they be treated?

7. What is Retinitis Pigmentosa (RP)? And how to treat it?

8. Having diabetes for several years increases risk of developing diabetic retinopathy?

9. What's allergic conjunctivitis and its treatment?

10. What is bacterial conjunctivitis and how to treat it?

11. What is Viral Conjunctivitis and how to treat it?

 

Answers:

1. What is Glaucoma? Is glaucoma preventable? How is Glaucoma treated?

Glaucoma is fairly common over the age of 35, affecting 2 of every 100 persons. There are several types of glaucoma, but all types are caused by increased pressure within the eye that can destroy the optic nerve if not treated promptly. A constant level of liquid called the aqueous humor is maintained in the inner chamber of the eye. Fluid flows into the eye from several structures, and fluid drains from the eye at a spongy outlet located at the angle where the corneal and sclera meet. If the outlet is clogged or if the drainage system is overwhelmed by too much liquid production, a buildup of fluid occurs and causes a pressure increase inside the eyeball. This places pressure on the optic nerve and its blood supply that can cause serious irreversible damage. If leave it untreated, glaucoma patients will lose their side vision first, slowly the loss will move to the center, blindness can occur at the late stage of glaucoma.

Glaucoma cannot be prevented, the next best measure to protect sight is early detection and treatment before optic nerve fibers have been destroyed. This can be accomplished only through regular comprehensive eye health examinations, because glaucoma is often symptomless. Everyone over the age of 35 should be tested for glaucoma every 1 year or whenever problems exist.

Damage to optic nerve fibers cannot be reversed. The goal of glaucoma treatment is to prevent further damage and preserve the highest possible level of vision. Glaucoma is treated by reducing the pressure within the eye. Medications, either pills or eye drops are used to lower pressure. If medication does not reduce pressure, surgery may be recommended to correct the drainage problems.

Facts about glaucoma

  • Glaucoma causes damage to sight at an earlier age than many eye conditions.

  • Blindness may develop rapidly.

  • Glaucoma is more common among persons who are nearsighted or diabetic.

  • Glaucoma is not contagious.

  • Glaucoma is often symptomless.

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2. What is dry eye? What are signs/symptoms of dry eyes and how to treat it?

Persistent dryness, scratching, burning, reddening and restraining in your eyes are signs of Dry Eye Syndrome. Some people also experience a "foreign body sensation," the feeling that something is in the eye. And it may seem odd, but sometimes watery eyes can result from dry eye syndrome, because the excessive dryness works to over-stimulate production of the watery component of your eye's tears.

To treat Dry Eyes, people usually use artificial tears, but it is a temporary solution.  If the syndrome persists, a small surgery can be done to insert tiny punctual plugs that will slow down or even stop the drainage of tears from the eye. These plugs are easily and comfortably placed in the lacrimal puncta in the eyelids. Initially you may have a temporary dissolving plug put in place to see if your signs and symptoms are actually responsive to this treatment. Such plugs will dissolve in about one week. If the results are good, the doctor will place a more permanent type of plug in the lacrimal puncta to affect a long-term solution in the next week. (If necessary, such permanent plugs can still be taken out).  This surgery takes two visits to the doctor’s office and each time it takes about 10 minutes.  The results are usually very satisfactory after which many patients are no more dependent on using artificial tears.

The procedure is simple and effective, and is usually covered by your health insurance, such as Bluecross, United Health Care, and Blue Shield etc.

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3. What is Retinal Detachment?  Who have high risk of having retinal detachment? What are the warning symptoms, and how to treat it?

Retinal is a nerve layer at the back of your eye that senses light and sends images to your brain. A retinal detachment occurs when the retinal is pulled away from its normal position. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated.

People who have the following conditions have higher chance to get retinal detachment:

  • Nearsightedness;
  • Previous cataract surgery
  • Glaucoma
  • Severe injury
  • Previous retinal detachment in your other eye
  • Family history of retinal detachment
  • Weak areas in your retina that can be seen by your optometrist (eye doctor)

These early symptoms may indicate the presence of a retinal detachment:

  • Flashing lights;
  • New floaters;
  • A gray curtain moving across your field of vision

These symptoms do not always mean a retinal detachment is present; however, you should see your optometrist (eye doctor) as soon as possible. Early detection is the only way to prevent blindness.

Most retinal tears need to be treated with laser surgery or cryotherapy (freezing), which seals the retina to the back wall of the eye. All the patients with retinal detachments require surgery to put the retina back in its proper position.

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4. What is ARMD (Age Related Macular Degeneration) and how to treat it?

Macular is located in the center of the retina, and it is responsible for central vision which is required for highly-focused, straight-on requirements, such as reading, driving a car, operating a computer or engaging in face-to-face conversation. Any damage to the macula will result in some loss or even total loss of the individual’s powers of central vision. There are two forms of ARMD:

  1. Dry form: This form affects approximately 90 percent of those who have macular degeneration. It is simply a case of deterioration of the macula. The process is gradual and for a period of time-months or years, it may affect only one eye. The patient may perceive that it is more difficult to see with one eye than the other. Some straight line types of objects, such as telephone pole, door frame or side of a building may appear to be distorted. It is also possible that small, dark spots may appear in the field of vision. As with all eye problems, regular examinations are the best method for early detection and prompt treatment in order to assure the best possible chances of preserving vision. The dry form of macular degeneration is more prevalent, but comparatively less serious. At this time there are few effective medical treatments. There are some low-vision aids and devices available. The best treatment is learning to use remaining peripheral vision.

  2. Wet form: Only about 10 percent of all victims of age-related macular degeneration are diagnosed as having the wet form of the disease, yet it accounts for 90 percent of the most serious loss of vision cases. The wet form occurs when tiny blood vessels in the retinal begin to degenerate with age causing leaks. This can cause the development of swellings, breaks or lesions in the retinal, thereby creating damage to the retina's light-sensitive nerve cells. If any of this damage occurs within the macula, serious and rapid deterioration of the person’s central vision capabilities can result. Several types of lasers have been used with varying degrees of success in treating the wet from of ARMD, but usually the best result is a slowing down of deterioration process.

It is important for ARMD patients to wear sunglasses and take vitamins which contain Lutein in it, which will slow down the progression of the Dry or Wet form of ARMD.

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5. What is Cataract and how to treat it?

A cataract is a clouding of the eye’s naturally clear lens. The lens focuses light rays on the retina at the back of the eye to produce a sharp image of what we see. When the lens becomes cloudy, the light rays cannot pass easily through it and the image becomes blurry. Cataract usually develop as part of the normal aging process, but they can also result from eye injuries, certain diseases of medications. Genetic factors may also play a role in cataract development.

A cataract may not need to be treated if your vision is only slightly blurry. Simply changing your eyeglass prescription may help to improve your vision. There are no medications, eye drops, exercises or glasses that will make cataracts to disappear once they have formed. Surgery is the only way to remove a cataract.  Surgery is considered when you are not able to see well enough to do the things you like to do. In cataract surgery, the cloudy lens is removed from the eye through a surgical incision (not with a laser). In most cases, the focusing power of the natural lens is restored replacing it with a permanent intraocular lens implant.

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6. What are Floaters? Should they be treated?

Floaters are usually small, semi-transparent cloudy specks or particles that can appear as threadlike strands or cobwebs in various shapes and sizes within the vitreous. The vitreous is a clear, jelly-like fluid in the eye. While these objects appear to be in front of the eye, they are actually located within the eye and are noticed only when they cast a shadow on the retinal. The retina is the nerve layer at the back of the eye that senses light and allows the ability to see. The floaters will move as your eyes move and seem to dart away when you try to look at them directly. They can be often be seen when looking at a plain background, like a blank wall or blue sky 

Floaters are often caused by small flecks or protein or other matter trapped during the formation of your eyes before birth. They can also result from deterioration of the vitreous fluid, due to aging; or from certain eye diseases or injuries. The vitreous can pull away from the back wall of the eye causing a posterior vitreous detachment leading to noticeable floater/s. Sometimes flashes or streaks of light may appear when the retinal is stimulated by this pulling action. These flashes are usually located in the peripheral vision and are very short in duration-last seconds.

Floaters are usually not harmful and rarely limit vision but can be an early indication of more serious eye problems. Occasionally, the retina can tear when the vitreous pulls away from the back wall of the eye. A torn retina is at risk for retinal detachment which can cause significant vision loss. An indication of torn retina or detachment is recurrent flashes. A dilated fundus examination is needed to evaluate if the floaters and/or flashes are harmful. 

Floaters can occasionally get in the way of vision and be annoying. Since most cases are benign, these are no good surgical or medicinal options to remove them. With time, most floaters will fade as you adapt to them becoming less bothersome. However, new and sometimes persistent floaters should be evaluated.

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7. What is Retinitis Pigmentosa (RP)? And how to treat it?

Symptoms of RP are: difficulty with night vision (often night blindness) and loss of peripheral vision are most common. Poor central vision or difficulty with color vision in late stage of the disease.

Critical signs include: clumps of pigment dispersed throughout the peripheral retina in a perivascular pattern, often assuming a “bone spicule” arrangement, areas of depigmentation or atrophy of retinal pigment epithelium (RPE), progressive visual field loss, usually a ring scotoma, which progresses to a small central field.

There is no definitive treatment for RP is currently known. However, vitamin A palmitate, 15,000 IU, was found in one study to slow down the progression of the disease.

All patients will benefit from genetic counseling (RP is inhereditary) and instruction on how to deal with their visual handicaps. In advanced case, low-vision aids and vocational rehabilitation are helpful.

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8. Having diabetes for several years increases risk of developing diabetic retinopathy?

People who have had diabetes for several years are at risk to develop a potentially blinding condition called diabetic retinopathy and need to take steps to protect their vision .

Over time, diabetics can weaken and cause changes in the small blood vessels that nourish the retina, the delicate lining at the back of the eye containing the light-sensitive nerve cells needed for seeing, says the American Optometric Association.

When these blood vessels begin to leak, develop brush-like branches or become enlarged, the condition is called diabetic retinopathy. Vision is affected in different ways depending on what changes are occurring and in what part of the retina they are happening.

Vision changes include blurred central or side vision, a blind spot in the center of vision, cloudy or hazy vision, blind spots or seeing floaters. Symptoms, however, often don’t appear in the early stages of diabetic retinaopathy.

That’s why people with diabetes need to have a thorough eye health and vision examination every year. Looking inside the eye with an instrument that allows direct viewing of the blood vessel there. The optometrist can diagnose diabetic retinopathy in its earliest stages, when treatment is most effective.

Treatment for diabetic retinopathy involves laser and surgical procedures. These are often successful in reducing the progression of this eye disease and in decreasing the risk of vision loss.

In addition to those who have had diabetes for a number of years, the following people also have increased risk for diabetic retinopathy :

  • People who have fluctuating blood sugar levels;
  • People who are pregnant;
  • People who have high blood pressure;
  • People who smoke;

Maintaining an adequate level of control of diabetes is an important factor in preventing the development of ocular and medical complications of diabetes, the American Optometric Association says.

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9. Allergic Conjunctivitis and Its Treatment

Conjunctiva is the clear and thin membrane that covers your eyeball and the inside of your eyelids. If something irritates this covering, your eyes may become red and swollen. Your eyes also may itch, hurt or water. This is called conjunctivitis. It is also known as "pink eye." When an allergen causes the irritation, the condition is called allergic conjunctivitis. This type of conjunctivitis is not contagious. It is irritating and uncomfortable, but it will not hurt your eyesight.

To prevent allergic conjunctivitis, try to identify and avoid the allergens that cause your symptoms. For example, if you are allergic to pollen or mold, stay indoors when pollen and mold levels are high. You can usually find out when allergen levels are high from the weather report. Keep your doors and windows closed, and use an air conditioner during the summer months. 

Several types of eye drops are available to treat allergic conjunctivitis. They can help relieve itchy, watery eyes and may keep symptoms from returning. Eye drops may contain an antihistamine, a decongestant, a nonsteroidal anti-inflammatory drug (NSAID), or a mast-cell stabilizer. Some drops contain a combination of these. Some eye drops require a prescription.

Antihistamine pills (which many people take for their allergies) may also help. Your doctor will talk with you about which treatment is right for you. 

It may help to put a cold washcloth over your eyes for relief. Lubricating eye drops (sometimes called artificial tears) may also make your eyes feel better. You can buy these drops without a prescription. 

It’s not a good idea to wear contacts while you have allergic conjunctivitis because you might get an eye infection. Instead, wear your glasses until your eyes feel better.

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10. What is bacterial conjunctivitis and how to treat it?

Patients with bacterial conjunctival infections present with injection of the bulbar conjunctiva, episcleral vessels and perhaps papillae of the palpebral conjunctiva. The infection often starts in one eye, then soon spreads to the other. There will be thick mucopurulent discharge, and patients usually say that their eyelids and eyelashes are matted shut upon awakening. There may be mild photophobia and discomfort, but usually no pain. Visual function is normal in most cases.

The eye has a battery of defenses to prevent bacterial invasion. These include bacteriostatic lysozymes and immunoglobulins in the tear film, the shearing force of the blink, the immune system in general, and non-pathogenic bacteria that colonize the eye and compete against external organisms that try to enter. When any of these defense mechanisms break down, pathogenic bacterial infection is possible.

Invading bacteria, and the exotoxins they produce, are considered foreign antigens. This induces an antigen-antibody immune reaction and subsequently causes inflammation. In a normal, healthy person the eye will fight to return to homeostasis, and the bacteria will eventually be eradicated. However, an extra heavy load of external organisms can be too difficult to fight off, causing a conjunctival infection and setting the eye up for potential corneal infection.

If your see such symptoms in your eyes, see your eye doctor as soon as possible.  Your eye doctor will treat your bacterial conjunctivitis with many kinds of antibacterial medicines, depending on the specific kind of bacteria that cause the problem.

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11. What is Viral Conjunctivitis and how to treat it?

Most viral infections produce a mild, self-limiting conjunctivitis, but some have the potential to produce severe, disabling visual difficulties. The two most common self-limiting forms of viral conjunctivitis are epidemic keratoconjunctivitis and pharyngoconjunctival fever.

Pharyngoconjunctival fever (PCF) is characterized by fever, sore throat and follicular conjunctivitis. It may be unilateral or bilateral. It is caused regularly by adenovirus 3 and occasionally 4 or 7. Corneal infiltrates are rare. The disorder varies in severity but usually persists for four days to two weeks. Epidemic Keratoconjunctivitis (EKC) often presents as a bilateral, inferior, palpebral, follicular conjunctivitis, with epithelial and stromal keratitis. Subepithelial corneal infiltrates are much more common in EKC than in PCF and are typically concentrated in the central cornea. EKC is regularly caused by adenovirus types 8 and 19.

Viral conjunctival infections are thought to be caused by airborne respiratory droplets or direct transfer from one’s fingers to the conjunctival surface of the eyelids. After an incubation period of five to 12 days, the disease enters the acute phase, causing watery discharge, conjunctival hyperemia and follicle formation. Lymphoid follicles are elevated, with avascular lesions ranging from 0.2 to 2mm in size. They have lymphoid germinal centers that have responded to an infectious agent.

Because EKC and PCF are contagious and self-limiting, it is very important that the patients call their eye doctor for treatment as soon as possible, and also stay home from work or school until there is absolutely no discharge. They should not share utensils, glasses, linens or wash cloths with others.

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