Visual Conditions and Eye Diseases

There are many different types of cataracts, but the most common type is due to a normal course of aging. Inside each eye is a lens that helps focus light on the retina. When you reach your 50’s, the lens slowly turns from crystal clear to white and cloudy. These changes usually do not become noticeable to the patient until 10-15 years later. As a cataract becomes more “mature”, they cause blurry vision and difficulty with glare from lights. When this happens, the patient can elect to have the cataracts removed with a common surgical procedure in which the surgeon removes the cloudy lens and inserts a clear, new lens.

Many people are worried when they are told they have an astigmatism.  However, it is not a disease and it will not cause a permanent loss of vision.  Simply, it is a condition in which the cornea (the front of your eyeball) is “out of round” or not spherical.  An astigmatism can cause distance and/or near vision to be blurry, similar to nearsightedness and/or farsightedness.  It can be easily corrected with glasses, and most of the time, with contact lenses.

There are many different types of glaucoma but the most common type is Open Angle Glaucoma.  Many people are under the misconception that glaucoma is caused by high pressures inside the eye.  However, glaucoma is a disease of the optic nerve, and one can have glaucoma even if their pressures are “normal”.  In addition, open angle glaucoma does not have any symptoms such as pain or redness.  Glaucoma can cause a permanent, progressive, and irreversible loss of vision which is not noticeable until very late in the disease process.  First line treatment for glaucoma involves eye drops.  Laser and surgical treatments can also be used in more advanced situations.

Our entire retina (the inner lining of the eye) contains photoreceptors (the cells that make us see).  There is a tiny area within the retina which is “prime real estate”, meaning that the photoreceptors are packed together.  This allows us to see clearly and sharply.   Think of it this way: look directly at an object and notice how in-focus and detailed it is.  Now look about 6 inches or even a foot next to the object.  You can still see it but with less detail.   So when the macula becomes damaged, a person will lose their central, detailed vision.  There are two forms of macular degeneration- dry and wet.  Dry AMD is the most prevalent form, and in this stage, visual defects are mild to none.  Wet AMD is more serious.  In this stage, fragile, damaging blood vessels begin to grow causing vision loss and/or distortion.  Thankfully, there is a treatment which involves shots inside the eye to prevent the blood vessels from developing.

A lazy eye is one that cannot see 20/20, even with the correct prescription (glasses or contacts).   This is because the image coming inside the eye is not focusing properly on the back of the eye.  There are several causes for this.  Most people think of a lazy eye as one that is not pointing in the same direction as its fellow eye- this is called strabismus.  Another way an eye can be lazy is because of very different refractive errors in one eye versus the other.  In rare cases, someone who has a large refractive error (either very nearsighted or farsighted) in both eyes can have 2 lazy eyes.  The treatments for a lazy eye include surgery, glasses, and or vision therapy, depending on the cause.

Conjunctivitis means “inflammation of the conjunctiva”, which is a thin layer of tissue overlying the white part of the eye (the sclera).  Conjunctivitis is also known as pink eye and can be caused by bacteria, allergies, and viruses.  Like the common cold, most cases of conjunctivitis are viral in nature, meaning that an antibiotic eye drop, which is commonly prescribed, is unnecessary.  One should be careful at self-diagnosing, as there are many other reasons which cause eyes to become red, especially in a contact lens wearer.

As we age, parts of the clear gel inside our eye (the vitreous) begin to turn from a gel to a liquid.  As the gel changes consistency, it can cast a shadow on the retina which appear as tiny gnats, dots,  squiggly lines or other shapes.  Flashes of light occur in the peripheral vision as the vitreous pulls on the retina.  A new onset of flashes and/or floaters requires immediate care.  Many times the cause is a relatively benign condition called a vitreous detachment.  But sometimes they can be the result of a more serious cause such as a retinal tear or detachment.

Simply put, diabetics have too much sugar (glucose) in their bloodstream, which can lead to damage of the small blood vessels in the body. In the back of the eye (the retina), early damage can be seen as small hemorrhages (spots of blood) which can then lead to larger hemorrhages, leaking of blood vessels, swelling inside the eye, and loss of vision if better blood sugar control is not established. The blood vessels inside your eyes are the same ones that run through your heart, kidneys, lungs, and extremities. So if changes are seen on the retina, it is very likely that there is damage to other small blood vessels elsewhere in the body.

It is recommended that all diabetics have annual eye exams with pupil dilation.  Diabetes is the #1 cause of blindness in the U.S. and early detection and treatment is better than later.

To paraphrase the TFOS Dry Eye Workshop II report, dry eye is a multifactorial disease of the surface of the eye which results in tear film instability, inflammation and damage of the eye surface, and neurosensory abnormalities. Having said that, one can see that dry eye is much more than simply “the eyes don’t make enough tears”.

The most common demographic for dry eye previously was women ages 40-60. Now it is being seen in younger people (both males and females) and even in children as a result of increased digital screen use.

Rarely will a patient enter the exam room and say “my eyes feel dry”. More commonly, symptoms include watery/red/itchy/ eyes, eyes that burn or feel gritty, or having to blink a lot to make their vision clear.

There are many treatment options for dry eye, including over-the-counter artificial tears, prescription eye drops, nutritional supplements, and punctal plugs.