Thursday, September 26, 2013

What is Macular Degeneration?

Macular degeneration is a progressive eye condition that affects as many as 15 million Americans. In macular degeneration, the light-sensing cells of the macula mysteriously malfunction and may over time cease to work.

Macular degeneration is caused by the deterioration of the central portion of the retina, known as the macula, the inside back layer of the eye that records the images we see and sends them, via the optic nerve, from the eye to the brain. It is responsible for focusing central vision in the eye.  

The disease robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision but, it rarely results in complete blindness.

It destroys the clear, "straight ahead" central vision necessary for reading, driving, identifying faces, watching TV, doing fine detailed work, safely navigating stairs and performing other daily tasks. It can also dim contrast sensitivity and color perception. Peripheral vision may not be affected making it possible to see "out of the corner of your eye".  

The disease occurs most often in people over the age of 55 years old. This form of the disease is traditionally referred to as Age Related Macular Degeneration (ARMD). 

Two Main Types of Age Related Macular Degeneration  

There are two types of age related macular degeneration: One form is known as "wet" and the other is "dry".
Approximately 90% of the cases of macular degeneration are the “dry” (atrophic) type. It is called “dry” macular degeneration because it does not involve any leakage of blood or serum. It is not uncommon for a patient with the "dry" form to develop the "wet" form later, so it is possible to experience both forms at the same time, in one or both eyes. The onset and progression of either type do not follow any particular pattern.
While there is no cure for AMD, new treatments are available. The most effective treatment is Low Vision Rehabilitation. Training and special devices can promote independence and a return to favorite activities.  

What are the Symptoms of Macular Degeneration?
  •  A dark empty area in the center of vision
  •  Blurring and diminished colors in central vision
  •  Distortion of lines and shapes
  •  Difficulty in seeing detail up close and at a distance
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Friday, September 20, 2013

How can high cholesterol affect vision?

September is National Cholesterol Education Month, it is fitting that we discuss the impact that cholesterol can have on your eyes. High cholesterol is so common, and many patients ask us about how this relates to eyes and vision.

High cholesterol levels in the blood cause a buildup of plaque in the arteries throughout the body over time. This can lead to narrowing of the arteries, thus reduces blood flow. Small blood clots then can lead to complete loss of blood flow to organs and tissues such as heart muscle (heart attack, myocardial infarction, angina), brain tissue (stroke) and lower extremities for example. Other risk factors such as Diabetes and Hypertension can increase the chances of blood vessel diseases. The small arteries and veins of the retina and optic nerve can become closed by blood clots also, which can lead to significant loss of vision. Symptoms of a retinal artery occlusion can be sudden, painless loss of central or peripheral vision in one eye.

Cholesterol in the bloodstream tends to accumulate in the cornea, the clear dome-shaped lens at the front of the eye. This appears as a white or gray ring around the peripheral cornea, making the iris color appear lighter, grayer or bluish. This can be quite prominent in some people. As we age, there is nearly always some of this appearance of Corneal Arcus, but when it is prominent or occurs at young ages (i.e.  50 years), it can indicate high cholesterol. This never affects the vision and we usually see some Corneal Arcus as a normal finding in patients over 50 years old.

Cholesterol material also appears around the eyes in some patients as fatty deposits of yellow material under the skin of the eyelids. This is called Xanthelasma. These are benign lesions and do not require removal. As with Arcus, these can occur with normal blood cholesterol levels also.

It is important to manage cholesterol levels with your primary care doctor to maintain good health of blood vessels throughout the body. A combination of diet management, exercise and medications is generally very effective for controlling cholesterol levels.
-R.Scott Hoffman, MD

Wednesday, September 11, 2013

How diabetes effects eyesight

The other day a patient asked me, Can diabetes have a negative effect on my eyesight?"

I explained that over a long period of time, the high blood glucose levels associated with Diabetes Mellitus can have an effect on many parts of the body. Especially sensitive to damage are small blood vessels, like ones in the retina of the eye and kidneys; and nerve cells. Many eye-related problems can occur with Diabetes, such as fluctuations in eyeglass measurements, lens opacities (cataracts) and retinal complications. Glaucoma problems, corneal problems, even orbital and neurological problems around the eye and orbit area can occur.
During your comprehensive eye exam, the ophthalmologist will look for all of these. Many of these problems appear with noticeable symptoms, such as changes in vision, distorted vision, night glare, sudden unusual floaters but the diabetic retina disease (retinopathy) is typically very slow and sneaks in without the patient’s awareness of it.

Cataracts develop often in younger aged individuals with diabetes. Large fluctuations in blood sugar cause swelling of the crystalline lens inside the eye, which can blur the vision temporarily, but eventually the lens becomes cloudier and affects the clarity of vision. Fortunately, we have effective treatments for cataracts when they become visually significant.

Diabetic Retinopathy is the condition of the retina when it is affected by long term elevations of blood sugar levels. The small arteries of the retina develop weak walls; these can dilate into microaneurysms with early retinopathy. These vessels eventually break, causing dots of bleeding and loss of blood supply to small areas of the retina. Sometimes these microaneurysms leak fluid into the retina, causing it to swell. This alone can cause reduced vision, distorted vision and blind spots.

There are helpful treatments today to reduce the impact on vision. With multiple hemorrhages and poor blood flow from advancing retinopathy, further problems occur as vessels grow inside the eye. Sudden bleeding from these larger weak vessels can cause severe loss of vision, huge floaters and opacities and retinal detachment. With early detection of these impending complications, before they are causing any noticeable symptoms, the treatments for the eye can be quite effective at stopping the progression to blindness.

We recommend eye exams, including dilated retina exam, every year for all diabetic patients, regardless of whether they need glasses or have any vision symptoms or problems. Primary care doctors are usually very good at assuring that their diabetic patients get checked yearly. Good control of blood glucose levels does decrease the chances of these problems dramatically, yearly eye exams allow for earlier detection of retinopathy and therefore earlier treatments if advancing to stages that require treatment.