Conditions

Diabetes and the Eye

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Dry Eye Syndrome

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Flashes and Floaters

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Glaucoma

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Macular Degeneration

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Diabetes and the Eye

Diabetes can cause changes in the optics of the eye, resulting in blurred vision and trouble focusing. While also causing cataracts the disease can also cause double vision by affecting the nerves that control the alignment and movement of the eyes, and can cause the optic nerve to be more easily damaged by glaucoma.  

 The most important cause of visual impairment in diabetics is diabetic retinopathy, a condition in which changes occur in the tiny blood vessels that nourish the retina. In the early stages, small blood vessels weaken and leak fluid or tiny amounts of blood, which distort the retina slightly.  25 percent of diabetics have some degree of retinopathy.

Reduce the Risk

  • Keep blood sugar under good control
  • Monitor blood pressure
  • Maintain a healthy diet.
  • Exercise regularly.
  • See an eye doctor at least once a year.

Dry Eye Syndrome

What is Dry Eye?

Dry eye is a general term used to describe a heterogeneous group of diseases resulting from inadequate wetting of the cornea and conjunctiva by the precorneal tear film (PCTF). Millions of people worldwide suffer from dry eye.

What are the Signs and Symptoms?

The symptoms of dry eye vary considerably from one individual to another:

  • foreign body sensation
  • burning and general ocular discomfort.
  • red eyes  
  • scratchy
  • tearing
  • dry
  • sore 
  • gritty
  • smarting or burning feeling. 
  • photophobia
  • intermittent blurring or other problems with visual acuity.
  • eyes tire easily
  • frequency of blinking typically decreases during tasks that require concentration
  • Contact lens intolerance

What Causes Dry Eye?

Dry eye conditions are classified as various types of abnormalities that can lead to insufficient wetting of the corneal surface. These classifications are:

  • Abnormalities of the aqueous layer
  • Abnormalities of the mucin layer
  • Abnormalities of the lipid layer
  • Abnormalities of the corneal epithelium
  • Abnormalities of the lids

New Treatments Bring More Comfort to Dry Eyes

Written by Dr. Robert L. Epstein

           Dry eyes annoy many people especially during the winter.  People with dry eyes generally have eye irritation

Other people with tear insufficiency may even have tears running down the face 

yet the real problem is inadequate tear output without the extra stimulation that eye irritation makes. 

 Many people with sensitivity to fluorescent light actually have dry eyes as the cause.  

Dry eyes can cause chronic blurring of vision. Diseases and medications can dry the eyes. Such medicines include those for allergy relief, diuretics or water pills, and medications women may take for urinary frequency. Any disease that increases fluid loss such as diarrhea or fever can worsen dry eyes. Eye dryness can cause difficulty wearing contact lenses and make for more suffering from other problems like eye allergy, cigarette smoke eye irritation, and chronic eyelid infection. Sometimes very mild pain from dry may make the eyes itch, yet eye rubbing may worsen the condition by mildly injuring the front eye surface.For dry eyes there are various types of artificial tears to augment moisture. 

Artificial tears need to be used on a regular basis and often enough during the day to allow the tissue of the cornea to repair itself. This means at least three times daily and often as much as ten times daily, not just when eyes hurt, in order to reverse the subtle eye damage that causes irritation. One eye drop, SootheR, which contains mineral oil, slows tear evaporation and is useful twice daily in addition to other tear supplements. Drinking more water, reducing excessive alcohol consumption, placing skin lotion on the skin to lessens body fluid evaporation during the cold, dry months, sleeping in a room with a humidifier helps, and taking flax seed oil dietary supplement to reduce tear evaporation all may help reduce dry eye problems. If your urine is deep yellow, you should drink more water.There are new treatments and an eye-MD (ophthalmologist) should be consulted for help.  A more or less permanent improvement in eye moisture can be accomplished when the doctor painlessly, non-surgically inserts tiny gel plugs into the tear removal system while the patient sits in the examining chair.  The newer versions of plugs cannot be seen or felt, their effect remains for years, and health insurance pays for their insertion.  Slowing tear removal not only improves eye comfort but may improve vision. New medicines are helping dry eye sufferers.  Many people have dry eye due to an immune reaction in the body against the tear glands. A FDA-approved new medicine called RestasisR or Cyclosporine helps the eye make more of its own moisture by reversing that immune reaction.   It takes months for RestasisR to repair the tear making glands.  Treatment of dry eyes often involves all the methods taken together for best effect. 

Flashes and Floaters

Most flashes and floaters are caused by age-related changes in the gel-like material, vitreous, that fills the back of the eye. The vitreous is firmly attached to the retina when one is born. Within the thick vitreous, there may be clumps of gel or tiny strands of tissue, debris left over from the eye's early development.

Treatment Options

These clumps or strands are firmly embedded in the thick, young vitreous and cannot move around much. As you get older, the vitreous gradually becomes thinner or more watery. By the time you are in your twenties or thirties, the vitreous may be watery enough to allow some of the clumps and strands to move around inside the eye. This material floating inside the eye can cast shadows on the retina, which you see as small floating spots. 

Who Is At Risk?

Vitreous Detachment

Sometime after about age 55, you may experience the onset of larger, more bothersome floaters or flashes of light. By this age, the vitreous gel has usually become much more watery. It jiggles around quite a bit when you move your eye, making flashes and floaters much more common. Eventually, the aging vitreous can pull away from the retina and shrink into a dense mass of gel in the middle of the eyeball. Shadows cast onto the retina by the detached vitreous can cause you to see large floaters. 

Flashes and Floaters Continued

Who Is At Risk?

Flashes and floaters are very common

Almost everyone experiences them at any given time. 

They become more frequent as we age. It's important to get regular

 eye exams to check for flashes and floaters and to prevent and

 other serious problems occurring.

Treatment Options

There is no way to eliminate the floaters through surgery,

 laser treatment or medication. 

With time, the floater will 

become less noticeable as the brain adjusts to its presence and can 

"tune out" the floater. The floater

 will always be somewhat observable and present.

Glaucoma

 Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma is preventable if you get treatment early enough.

Glaucoma is a disease of the optic nerve. The optic nerve carries the images we see to the brain. Many people know that glaucoma has something to do with pressure inside the eye. The higher the pressure inside the eye, the greater the chance of damage to the optic nerve.

The optic nerve is like an electric cable containing a huge number of wires. Glaucoma can damage nerve fibers, causing blind spots to develop.

Often people don’t notice these blind areas until much optic nerve damage has already occurred. If the entire nerve is destroyed, blindness results.


Early detection and treatment by your ophthalmologist are the keys to preventing optic nerve damage and blindness from glaucoma.
 

How is Glaucoma Detected?

Causes

 Clear liquid, called the aqueous humor, flows in and out of the eye. The liquid is not part of the tears on the outer surface of the eye. You can think of the flow of aqueous fluid as a sink with the faucet turned on all the time.

If the “drainpipe” gets clogged, water collects in the sink and pressure builds up. If the drainage area of the eye-called the drainage angle—is blocked, the fluid pressure within the inner eye may increase, which can damage the optic nerve. 

Types of Glaucoma

 Chronic open-angle glaucoma: the most common glaucoma. It occurs as a result of aging. Can also result in optic nerve damage. The “drainpipe” or drainage angle of the eye, becomes less efficient with time, and pressure within the eye gradually increases. Over 90% of adult glaucoma patients have this type of glaucoma. It can damage vision so gradually and painlessly that you are not aware of trouble until the optic nerve is already badly damaged.


Angle-closure glaucoma: Sometimes the drainage angle of the eye may become completely blocked. It is as though a sheet of paper floating near a drain suddenly slips over the opening and blocks the flow out of the sink. In the eye, the iris may act like the sheet of paper closing off the drainage angle. When eye pressure builds up rapidly, it is called acute angle-closure glaucoma. 

Glaucoma Continued

How is it Detected?

During complete and painless regular eye examinations, your eye doctor will: 

  • Measure your intraocular pressure (tonometry)
  • Inspect the drainage angle of your eye (gonioscopy)
  • Evaluate any optic nerve damage (ophthalmoscopy)
  • Test the vision of each eye

Symptoms

  • Blurred vision
  • Severe eye pain
  • Headache
  • Rainbow haloes around lights
  • Nausea and vomiting

If you have any of these symptoms, call your ophthalmologist immediately. 

Who is at Risk?

  •  Age
  • Near-sightedness
  • African ancestry
  • A family history of glaucoma
  • Past injuries to the eyes
  • A history of severe anemia or shock

Your eye doctor will weigh all of these factors before deciding whether you need treatment for glaucoma.

Macular Degeneration

Macular Degeneration is the leading cause of blindness in the world. Macular degeneration is more common in people over age 65. The disease breaks down the macula, the light-sensitive part of the retina responsible for the sharp, direct vision needed to read or drive.

 Most cases of macular degeneration are related to aging, but it also can occur as a side effect of some drugs, and it appears to run in families. Macular degeneration can produce a slow or sudden painless loss of vision. If straight lines look wavy, vision begins to seem fuzzy, or there are shadowy areas in central vision, it may indicate early signs of age-related macular degeneration.

For more information 

Read Dr. Epstein's Article

MACULAR DEGENERATION By Dr. Robert Epstein

Test Your Vision with the Amsler Grid

Amsler Grid

MACULAR DEGENERATION By Dr. Robert Epstein

 Age related macular degeneration or AMD is a very common and increasingly important cause of legal blindness in the United States.  It strikes most often after age 65; at a time when reading may be one of life’s few pleasures. The most elderly are more affected with 15% of people over 85 having AMD. More likely to have the disease are causasians, women, and present or past smokers. Smoking is the most important, preventable cause of macular degeneration. A recent published medical study showed that smokers are three times more likely to get AMD than non smokers.  Past smokers were found to be only 30% more likely than non smokers to get macular degeneration. Multivitamin antioxidant supplementation with zinc and lutein may be helpful in preventing or slowing the progression of macular degeneration.  A diet rich in green leafy vegetables is helpful as well An Amsler grid is a useful tool for monitoring your central visual field. It is an important way to detect and monitoring early and sometimes subtle visual changes in age-related macular degeneration. With the Amsler grid, each eye is tested separately by you.  One kind of Amsler grid, called a Yannuzzi card, is shown here: 

Amsler Grid

Amsler Grid Directions

  To test yourself with the Amsler grid, use adequate lighting and wear your reading glasses or look through the reading portion of your bifocals (if you normally read with spectacles). Hold the Amsler grid at normal reading distance (about 14 inches).  Cover one eye at a time with the palm of your hand. Stare at the center of the chart at all times. Do not let your gaze drift from the center dot.

 Then as you check each eye separately, ask yourself 

(a) Are any of the lines crooked or bent?  

(b) Are any of the boxes different in size or shape from the others?  

(c) Are any of the lines wavy, missing, blurry, or discolored?  


You should check each eye with the card held both vertically and horizontally. If you think you or a friend or relative may have macular degeneration, you should seek an examination by an ophthalmologist or eye-MD.