Common Eye Diseases and Imaging Equipment Used to Detect Them

There are some common eye diseases that can be detected during an annual eye exam. Some of these diseases may affect one’s vision and cause symptoms,  and some of them may not affect vision and therefore not cause any symptoms leaving the patient completely unaware that they have an eye disease that may be progressing.   Some of these diseases are easily detected by an eye doctor’s view of the retina or optic nerve,  and some of these diseases in its early or subtle form require the technology of advanced eye imagining equipment to detect them.   The value and advancement of these eye imaging equipment and its role it plays in eye disease detection has taken the eye exam to a very high level. Having the equipment at our disposal and using them to screen every patient during their annual eye exam,  has enabled us to confidently say their eyes are healthy and normal.

250px-Lefteyeoptomap-brightened

The Optomap and the OCT (Optical Coherence Tomography) are 2 of the eye imaging equipment we use to screen our patients during their comprehensive eye exam.   We use them together because they complement each other.   The Optomap produces a wide field image of the surface of the retina, optic nerve, blood vessels and choroid. We look for glaucoma, macular degeneration, retinal tears, retinal detachments, tumors, bleeding from the blood vessels from diseases such as diabetes etc.

The OCT is an ultrasound like device that uses light normal_eye_oct_smallinstead.   It splits up the retina and macular into a cross-section of its 10 layers so subtle problems presenting themselves in any of its layers below the surface that may easily be missed by the Optomap or by the doctor’s view, can easily be detected by the OCT image.   Think of the retina as a piece of cake.  The Optomap views the surface or the icing on the cake while the OCT views the layers of the cake below the icing.   In this way, some of these common diseases such as Macular Holes, Diabetic Macular Edema, Vitreo-Macular Traction Syndrome, Choroidal Neo-Vascular Membranes, Central Serous Choroidopathy,  Epi-Retinal Membranes etc. that may be more difficult to notice with the Optomap or Doctor’s view can easily be detected by the OCT.   In addition, the OCT also images the nerve fiber layer around the optic nerve and the ganglion cell complex in the macular for early glaucoma detection as well as glaucoma disease management and progression.

COMMON EYE DISEASES:

Cataracts:  Cataracts occur when the lens inside our eyes become cloudy as a result of the natural aging process of our eyes.  They do affect our vision causing blurry, cloudy vision as well as glare.  They are detected by a dilated exam.   OCT and Optomap are not needed to detect them.   Surgery is indicated when reduced vision starts to affect one’s daily activities.   The surgeon removes the cloudy lens and replaces it with an intra- ocular lens implant thereby restoring vision.

Glaucoma: Glaucoma also known as the silent thief of sight occurs when the nerve cells and ganglion cells that form the axons of our optic nerves start to die off due to a pressure in the eye that the eye cannot withstand.   Advanced stage glaucoma can easily be detected by the doctor’s view of the optic nerve.   Early stage glaucoma is best detected by OCT imaging of the nerve fiber layer and ganglion cell complex as well as other tests such as visual field testing.   Glaucoma initially does not affect central vision and therefore this type of glaucoma presents no symptoms to the patient.   It affects our side vision very slowly and progressively and eventually may advance towards our central vision as the disease progresses.   Glaucoma is usually detected at an eye exam and treated with drops to slow down further vision loss.   OCT imaging and visual field testing are important to manage and monitor for change and progression of this disease.

Macular Degeneration: This occurs when deposits called drusen start to build up in Intermediate_age_related_macular_degenerationthe deep layer of the retina as well as when the RPE layer in the deep retina starts to get affected.   Central vision is affected causing blurred and distorted vision.   There are 2 forms – the dry form and the wet form.  The dry form can be detected by the Optomap or the doctor’s view of the macular as well as OCT imaging.   The wet form is more easily detected by OCT imaging.   There is no treatment for the dry form except for certain vitamins to slow down the progression to the wet form.   The wet form causes a more devastating loss of vision if not treated early enough.   The wet form is treated by laser and needs to be done immediately to prevent further vision loss.   OCT imaging and Optomap can be used to manage change and progression of this disease.

Diabetic Retinopathy: This disease causes the blood vessels in the eye to bleed and downloadleak causing hemorrhages and other signs that can easily be detected by the Optomap or the doctor’s view of the retina.   Another form of this disease called Diabetic Macular Edema is more easily detected by OCT imaging.   OCT imaging is used to manage and monitor the changes of Macular Edema as it is being treated by laser surgery.

Vitreo-Macular Traction/Macular Holes/Epi-Retinal Membranes:  As we get download (1)older, the vitreous gel in our eyes become liquified.   This may cause the vitreous to detach from the retina where it is usually firmly attached.   The macular,  where we have our central vision is one of those sites where the vitreous is firmly attached to.   As the vitreous tugs onto the macular and pulls away from it,  it may pull away from it and detach without causing any problems.    Sometimes however, it may have such a firm attachment that it may pull part of the macular with it causing a macular hole.   It may also leave some cells onto the macular that may form an Epi-Retinal Membrane.   Macular Holes and Epi-Retinal Membranes may affect vision and cause distortion of one’s vision. Vitreo-Macular Traction and Macular Holes cannot be easily detected by the doctor’s view of the macular and may not be easily detected by the Optomap either.   They are best detected and managed by OCT imaging.

image-squareTumors:  Choroidal Nevi are flat benign pigmented lesions at the back of the eye.  They usually remain stable and mostly do not grow.  They do need to be monitored regularly with imaging to ensure they are not changing or growing as they may rarely turn into a Choroidal Melanoma which is a serious progressive cancer at the back of the eye.   Choroidal Nevi do not affect vision and they are easily detected with an Optomap image.  Malignant Choroidal Melanomas may not affect vision either unless it is growing near the macular area where our central vision is located.   If it grows in the peripheral area and away from the macular, it may go unnoticed by the patient.   Choroidal Melanomas can be detected by an Optomap image or through a dilated eye exam.

There are many more eye diseases that can be detected during the annual eye exam with the assistance and use of these equipment.  Advanced eye-imaging equipment has come a long way in helping us detect and manage eye disease and it has certainly taken the eye exam to a very high level.   All patients deserve the best care possible and imaging has enabled us to provide this higher standard of eye care.

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Orthokeratolgy

How would you like to go all day without glasses or contact lenses and still be able to see?  If you’ve been thinking about lasik or if you are too young to get lasik, there is a less expensive, non-surgical procedure that can correct your vision.  If your child’s eyesight is rapidly deteriorating and he or she keeps requiring stronger and stronger glasses, this procedure can help stop your child’s worsening vision.  This procedure has become more and more popular due to the positive research it has gathered regarding its ability to control myopia (nearsightedness) progression as well as offering its users complete freedom from their glasses and contact lenses all day.  This procedure is called orthokeratology or ortho k as it is now widely known.

If you have always wanted lasik but your prescription has not stabilized and it keeps getting higher each year, ortho k may be your answer to help stabilize your vision.  Studies have shown that Ortho k can control myopia progression.  Once your prescription has stabilized with ortho k, lasik can always be done.

Children and Teens. Ortho-k is arguably the treatment of choice for children and teens with low to moderate progressive nearsightedness.  Age is not a determinant of suitability. Young patients as old as only 7 years have done ortho-k.  Many received only a single prescription adjustment over the many years of treatment in order to maintain perfect eyesight.  Our young patients are fully independent when taught all lens care procedures including insertion and removal of lenses onto the eye.  We are continually impressed at how quickly they acquire excellent lens care technique.

Myopia (Nearsightedness) Control

Progressive myopia has always been a source of frustration for parents who are concerned for their child’s future.  If your child’s eyesight is deteriorating at every visit to your optometrist resulting in stronger glasses, the concern is understandable.  Many parents ask:  Can anything be done for my child’s eyes?

The answer now is a definite YES! We believe we can help your child!

Ortho k involves wearing specially designed contact lenses to sleep, and removing them in the morning when you awake.  These gas permeable lenses are made of a very high oxygen material so they are safe to sleep in.  They work by temporarily reshaping your cornea causing the light rays to focus back on your retina and allowing you to see again.  You can think of orthokeratology like wearing braces for your eyes.  The vision correction is temporary and you would need to wear your lenses every night to sleep to maintain your new corneal shape.  If you decide to stop ortho k treatment or decide to do lasik, you simply stop wearing the lenses and your cornea and vision will return to its original shape and state.

Imagine what it would be like to be free from your glasses and contact lenses. How would it be like being able to swim and see? Can you think of any other activities you would enjoy even more?

Not everyone is a candidate for ortho k.  During your eye exam, we will gather information from your vision and topography data to determine if you meet the criteria for success.
Topography is a map of your corneal shape and the contact lenses are designed and mirrored according to your unique corneal map. Once ortho k treatment begins, follow-up visits will be scheduled to ensure treatment is headed in the correct direction and the eyes are healthy.

Our office uses the Wave Contact Lens System to design ortho k lenses among other specialty contact lenses like keratoconus. Here is a link of more information about the Wave system. Be sure to watch the video on ortho k: http://www.wavelenspatient.com/

Here is a link to the latest research and myopia control studies on ortho k: http://igolenses.co.uk/latest-research-orthokeratology.html

Here is the link to answers to questions that many others have asked. http://www.orthokdoctors.com/orthokeratology_faq.html

Here is our website to request your appointment with us to see if ortho k is right for you. http://www.visionsource-izaaceyes.com/

If you have recently (less than a year) had an eye exam with us, simply schedule a topography visit.

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Wave Custom Contact Lens System

Our office designs Wave Contact Lenses for patients requiring correction of distance, near, astigmatism, bifocal, orthokeratology, keratoconus, pellucid marginal degeneration,  and post corneal transplants or post refractive surgery.  They can be designed in both rigid gas permeable contact lenses (corneal size) as well as scleral contact lenses which are large diameter contact lenses.

Trained Wave providers can design custom contact lenses using your corneal “fingerprint” obtained through a camera and software that digitally maps one’s cornea to create your very own custom corneal fingerprint thereby creating a custom contact lens that follows every tiny shape on your cornea.  The outcome is a contact lens that mirrors the shape of your cornea giving you the most comfortable contact lens with optimum visual results.

The link below will explain all the details and be sure to watch the orthokeratology video.

http://www.wavelenspatient.com/

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How Would You Treat A Red-Eye?

You had a good night’s sleep and nothing out of the ordinary happened the night before, but somehow you woke up with a red-eye.  It may be watery, itchy or it may have some kind of discharge.  Your eye may have been shut and you had to pry it open, one eye or both eyes may be affected or it could be painful or sensitive to light or it may feel like something is in your eye.  Does this scenario sound familiar?

Possible Causes of Red Eyes:   You then start to ponder how something like this could suddenly have happened when your eyes felt absolutely fine the night before.  Did something get inside your eye?  Is it contact lens related?  Were you around anyone with “pink eye?”  Were you sick recently with a sore throat or an upper respiratory infection and it has now spread to your eyes?  Do you have some kind of auto-immune disorder which could be affecting your eyes?  Did you scratch your eye?  Do you get allergies and your eyes are now affected?  Do you have dry eyes?  It could possibly be any of the above!

The question is, what is your next step and what do you do about it?   You are most likely to wash your eyes, and perhaps apply some artificial tears and then wait to see what happens.  If your eye does not feel any better or if it starts to get worse you probably would quickly run over to CVS or Rite Aid and buy some kind of over the counter eye drops.  What eye drops do you buy?

Red Eyes Can Be Caused By:

  • Infection – bacteria and viruses.
  • Non infection – allergies, dry eyes, scratched cornea, foreign body etc.
  • Improper use of contact lenses and contact lens solutions
  • Inflammation

What Drops To Buy?   Do you buy allergy drops, artificial tears for dry eyes or drops to take the “red” out of your eye?  It really depends on what the cause of the red-eye is, doesn’t it?  If the cause is non-infection and your eyes are really itchy and both your eyes are affected, allergy drops and artificial tears may help.  If the cause is infection, contact lens associated, scratched cornea or inflammation, you would need to see your eye doctor to get the diagnosis and the correct type of drops and treatment.  Most patients see their eye doctors for a red-eye after they have tried some kind of over the counter eye drop unsuccessfully.

What about the drops that take the “red” out of your eye?  How do those drops work?    They work by constricting the blood vessels in the eye.  Once constricted, the eye now appears “less red.”  Is the drop solving the cause of the red-eye or is it simply making the eye look better by “hiding” the red eye?  Furthermore, with constricted blood vessels, the eye now receives less blood flow and nutrition.  The package insert will state not to overuse these drops because it can cause a condition called rebound hyperaemia – the eye becomes more red once the drops are stopped.  If the red-eye is not due to a serious problem, this drop may work fine as a quick fix but it should not be overused
more than 3 days.  If the red-eye persists, there is discharge, pain or your vision is affected, you would be wise to see your eye doctor (optometrist or ophthalmologist) right away.

As the case may be, it would be plausible and wise to see your eye doctor from the very onset of your red-eye.  Your eye doctor is second to none and is well-trained and experienced to diagnose and treat your red-eye and to provide the best treatment plan. Otherwise, any other way, makes you guess what drops to choose.  Our eyes are our most important of our senses.  They are the window to our world and they certainly deserve the best treatment.

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Hybrid Contact Lenses

Contact lens technology has come a long way with new designs and materials.  Contact lenses were first “hard”, made of a non-permeable to oxygen material.  Rigid gas permeable (RGP) contact lenses then followed allowing more oxygen through the lens and to the eye.  Soft lenses soon emerged offering increased comfort and tolerability. And now, we have hybrid contact lenses.

What are the Benefits of Hybrid Contact lenses?

Hybrid contact lenses combine the benefits of both rigid gas permeable contact lenses and soft contact lenses all into one lens.  It has the all-day comfort of a soft contact lens and it has the crisp and stable vision a rigid gas permeable contact lens provides, all in one oxygen breathable contact lens material that rigid gas permeable contact lenses are known for.

The center of the lens is made of a rigid gas permeable (RGP) material and the lens has a soft skirt that extends from the central RGP.  The RGP corrects vision while the soft skirt gives the all-day comfort of a soft contact lens.  RGPs are able to provide crisp and stable vision because they can correct corneal astigmatism and their optics are unaffected by blink or gaze shifts.  Blink or gaze shifts may produce unstable or fluctuating vision in some soft toric contact lens wearers because blinking could make the lens rotate on the eye causing some patients to experience unstable vision correction.  Hybrid contact lens wearers are unaffected by these lens rotations or blink or gaze shifts providing consistently clear vision all the time.

Who can Benefit from Hybrid Contact Lenses?

  • Anyone with astigmatism or those currently using soft-toric lenses to correct astigmatism and are dissatisfied with their vision.
  • Current RGP wearers who are dissatisfied with their comfort and are seeking improved comfort.
  • Current Soft multifocal and monovision contact lens wearers who are dissatisfied with their close-up or far vision or who have astigmatism and are currently dissatisfied with their vision or who are seeking improved vision at all distances.
  • Current contact lens wearers who want their vision corrected for both far and near, or who have tried multifocal contact lenses and were either dissatisfied with the vision it provided or with its comfort.
  • Any new contact lens wearer desiring the benefits of both RGP and soft all in one lens.
  • Any one that has been diagnosed with keratoconus.
  • See this link for the latest hybrid lenses for keratoconus:  http://www.allaboutvision.com/ultrahealth/

Many things need to be considered when selecting the type of contact lens that may be right for an individual including one’s lifestyle, work, physical activities and vision correction needs.

There are new options to consider that may better fit your needs even if you currently wear contact lenses or if you’ve been told you cannot wear contact lenses.  With newer available designs and materials, it may now mean you could start to enjoy wearing contact lenses.

www.visionsource-izaaceyes.com

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Glaucoma

When it comes to our eyes, we have all heard of the term glaucoma in some way or other.  We may know of family and friends who have glaucoma and are being treated for it.  Some of us associate it with the air-puff test that measures our eye pressures inside our eyes during an eye exam.  There are several types of glaucoma.  In this article, I will only be discussing primary open angle glaucoma which forms about 90% of all glaucomas.

What is Glaucoma and what is the eye pressure inside the eyes?  Glaucoma is one of the leading causes of blindness in the United States.  Nearly 3 million people have it. Glaucoma is a group of eye diseases that damages the optic nerve inside the eye and thereby slowly and progressively causes vision loss.  It is caused by an eye pressure that is higher than the eye can endure.  This high eye pressure slowly damages the nerve cells in the optic nerve that is responsible for transmitting visual signals to the brain.  As more and more nerve cells are damaged, one progressively loses more side vision.  As the disease progresses, the loss in the side or peripheral vision gradually creeps into the central vision.  It is only when central vision is affected, does one notice the symptoms of vision loss.  Vision loss in glaucoma is irreversible.  Therefore, early detection and treatment is the only way to prevent further loss.  Glaucoma is also known as the “silent thief of sight”.  Additional risk factors of glaucoma are family history of glaucoma, age, race and ethnicity and having hypertension or diabetes.

Inside the eye, there is a constant eye pressure that maintains and keeps the eye structures healthy.  Fluid called aqueous humor is produced and it is drained through a structure called schlemm’s canal at the trabecular meshwork which is at the angle between the iris and cornea.  The production and drainage of aqueous humor maintains a normal eye pressure.  If more aqueous humor is being produced than can be drained or if there is an obstruction at the trabecular meshwork, the pressure inside the eye rises.  If the optic nerve cannot tolerate this higher pressure, damage to its structure and nerve cells will result in glaucoma.

Check out this video on more on glaucoma:

http://www.youtube.com/watch?v=BXC64Whs9KE&feature=youtube_gdata_player

How is glaucoma detected?  Since there are no symptoms of glaucoma in its early stages, glaucoma is usually detected during an eye exam.  The optometrist or ophthalmologist will look at the optic nerve with a special magnified lens with the use of a biomicroscope to detect any structural damage to the optic nerve.  The eye doctor will also measure the eye pressures inside the eye.  If there is any suspicion of glaucoma, a glaucoma workup visit will be scheduled so that additional testing and investigating can be done.

The glaucoma workup consists of several additional tests:

  • Visual Field Testing:  The patient has his or her head placed in an instrument and he or she pushes a button every time a presented light can be detected using one’s side vision. The purpose of the test is to map out any peripheral or visual field loss. This test forms a baseline and is compared to further tests that are done in the future.  In glaucoma, one can have 50% nerve cell damage before it may start to affect the visual field.
  • Dilated Exam:  When the eye is dilated, the optic nerve and its structures can be better viewed with increased detail and magnification.
  • Gonioscopy:  A lens is placed on the patient’s eye so that the eye structures responsible for the drainage of fluid can be viewed for any obstruction that may be causing the increase in eye pressures.
  • Central Corneal Thickness:  The central cornea thickness is measured with an instrument called a pachymeter.  Having a thin cornea is an increased risk factor for developing glaucoma.
  • HRT, GDX and OCT:  These are a group of instruments that scans and measures the nerve fiber layer, ganglion cell complex and optic nerve for any structural damage. Thickness values are quantified and they are used as a baseline to establish stability or progressive changes of the disease during future visits.
  • Optic Nerve Photos:  Photos are taken of the optic nerves to establish a baseline and they are used to compare them with photos taken in the future.  Progressive optic nerve damage can be determined by this comparison.

How is Glaucoma treated and monitored?  If glaucoma is diagnosed, treatment is usually started with eye drops that will decrease the eye pressures to a level that hopefully does not cause further vision loss and optic nerve damage.

How do we know that further vision loss and optic nerve damage is not occurring?  Follow ups every 3 to 4 months are necessary to check on the eye pressures to ensure the pressures are at the level they are targeted to be at,  and to make certain the patient is compliant with using the eye drops.  Visual field testing and an OCT, HRT or GDX are done every 6 months to monitor for any progressive vision loss or optic nerve changes.  If further loss is occurring, a second eye drop can be added to decrease the pressures further or a laser surgery procedure can be done.  It is important to realize that glaucoma is a disease that needs to be managed, monitored and followed-up upon.

Since glaucoma is usually detected at a routine eye exam without the patient expressing any symptoms,  it is crucial that we get our eyes examined once a year.  In view of the fact that glaucoma is a progressive disease, it is imperative we remain compliant with using our drops and critical we do not miss our follow-up appointments.

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Punctal Plugs for Dry Eyes!

Dry eyes is a chronic progressive eye surface disease that affects a large number of us.  There are a lot of risk factors and causes.  Inflammation on the eye surface and eyelids are some of the main causes of dry eyes.  This inflammation affects the ability of the eye to make good quality tears.   If the eye surface does not have good quality tears, the tears evaporate quickly off the eye producing dry spots and thereby resulting in dry eyes.

Another cause of dry eyes is the inability of the eye to produce a sufficient quantity of tears.  Tears drain through a small tear duct or opening in the eyelid called a puncta.  When more tears are drained through the puncta than can be produced by the eye, it results in dry eyes.

If we could somehow block the puncta with a medical device, we could prevent the tears from draining.  We would keep more of the tears on the eye surface and prevent the eye from drying out.  This medical device is called a punctal plug.   An optometrist or ophthalmologist can insert punctal plugs at their office and the procedure is painless and only takes several minutes.

A temporary punctal plug is tried and inserted first.  They are made of collagen and are dissolvable.  This is to determine if the permanent ones will relieve the patient’s dry eye symptoms and that they do not cause excessive tearing.  The patient tries them for several days to ensure that their dry eye symptoms are indeed diminished.  When the punctal plugs dissolve, he or she should also feel their dry eye symptoms getting worse once again.  This confirms the effectiveness of the punctal plugs and the patient returns in 10 days to have the permanent ones inserted.

A primary reason for contact lens dissatisfaction and contact lens discontinuation is dryness and discomfort.  Dry eyes often gets worse if one is on the computer several hours a day.  The goal of managing contact lens related dry eyes and discomfort is to keep the patient in contact lenses and this involves medically managing the dry eyes.  Management may require quite a few follow-up visits and a number of treatment strategies and punctal plugs has certainly remained a successful and viable option to treat dry eyes.

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