Patients should see their doctor for a comprehensive eye exam every one to three years, depending on their age, risk of disease, and overall physical condition. Children should have regular tests to ensure the proper development of their vision and prevent any interference with their academic achievements. Older adults are often at a higher risk for eye conditions such as glaucoma, macular degeneration and cataracts.
Even if your eyes are healthy, you should still have a regular eye exam to detect any problems as soon as possible and begin necessary treatment.
Dry eye occurs when the eyes aren't sufficiently moisturized, leading to itching, redness, pain, and blurry vision from dry spots on the surface of the eye. The eyes may become dry and irritated because of insufficient tear production, or because the tears themselves are not robust.
People usually begin experiencing dry eye symptoms as they age, but a lot of young people have dry eye too. Dry eye can also result from certain medications, conditions or injuries.
There are a lot of contributing factors for dry eye:
- Extended screen use
- Autoimmune conditions like Sjogren’s Syndrome
- Hormonal changes
- Contact lens use
- Environmental factors like dry heat
There are multiple tests for dry eye, but the real foundation for evaluation is examining your eye at the slit lamp in the office. In particular looking at the tear film, the surface of the cornea, and the position and health of your eyelids.
Dry eye is a chronic disease, and often the target of treatment is a regimen that keeps your dry eye controlled, rather than permanently eradicating it. There are many different treatment options, but starting with things that are easier for you and less expensive, then build from there. Ocular lubricants, like artificial tears, gels, ointment, are the foundation of treatment. Addressing the eyelids with warm compresses and lid scrubs can also be helpful. Anti-inflammatory drops are sometimes prescribed, like Restasis, Xiidra, or steroid drops. Environmental factors can also be modified, like using a humidifier, avoiding allergens, and taking breaks from screen time. We also can place punctal plugs in the office to reduce tear drainage.
Diabetic Eye Diseases
Patients with diabetes are at a higher risk for developing eye conditions because a high blood sugar level can damage blood vessels in the eye. Over 40 percent of patients diagnosed with diabetes develop some form of eye disease as a result. These conditions can cause blood or fluid to leak from the retina or new blood vessels to grow on the surface of the retina which can lead to significant damages to your vision and overall quality of life.
It is important for patients with diabetes to have dilated eye exams once a year to detect any signs of diabetic eye disease as soon as possible. You can also minimize your risk of developing diabetic eye disease by keeping your blood sugar, cholesterol, and blood pressure under control, eating a healthy diet and exercising regularly.
Diabetic retinopathy is the most common diabetic eye disease and is a leading cause of blindness in adults. Diabetic retinopathy develops as a result of elevated blood sugar levels or simply the presence of long-term diabetes. Some patients don't develop this condition until they have had diabetes for years. If high blood sugar levels cause blood vessels in the retina to leak blood or fluid, the retina may become swollen and form deposits.
Early stages of diabetic retinopathy do not usually require treatment, just that patients monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, treatment may be necessary to preserve your vision.
The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Age-related macular degeneration (AMD) occurs when the layer below the retina, called the retinal pigment epithelium (RPE) becomes diseased and stops functioning correctly. The RPE is important for keeping the overlying retina tissue healthy, and contains blood vessels that supply the retina.
Deprived of nutrients, the retinal tissues begin to weaken and die, causing vision loss. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of vision.
AMD is the number-one cause of vision loss in patients 65 and older in the U.S. Macular degeneration doesn't cause total blindness because it doesn't affect the peripheral vision. Possible risk factors include genetics, age, diet, smoking and sunlight exposure. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.
There are two kinds of AMD: wet (neovascular/exudative) and dry (non-neovascular). About 10-15% of people with AMD have the wet form. "Neovascular" means "new vessels." Accordingly, wet AMD occurs when new blood vessels grow behind retina as the eye attempts to compensate for poor blood supply. These new vessels are very fragile, and often leak blood and fluid between the layers of the retina and under the retina. Not only does this leakage distort vision, but when the blood dries, scar tissue forms on the retina as well. This creates a dark spot in the patient's vision. There are now medications that can be used to treat wet AMD, like Avastin, Eylea, and Lucentis. Intravitreal injections are performed in the office and deliver medication into the gel on the inside of the eye. They are used to treat a variety of ocular diseases, in particular those that cause macular edema (swelling that affects the central vision) or abnormal blood vessel growth in the eye. These diseases include macular degeneration, diabetic retinopathy, retinal vessel occlusions. We perform injections of Avastin (bevacizumab), Eylea (aflibercept), Lucentis (ranibizumab), and Ozurdex (dexamethasone implant).
Dry AMD is much more common than wet AMD. Patients with this type of macular degeneration do not experience new vessel growth. Instead, symptoms include thinning of the retina, loss of retinal pigment and the formation of small, round particles under the retina called drusen. Vision loss with dry AMD is sometimes slower and often less severe than with wet AMD. Patients with dry AMD may be advised to take over-the-counter AREDS2 formulation vitmatins to reduce their risk of developing wet AMD.
Glaucoma is a disease that damages the eye's optic nerve. Glaucoma happens when fluid builds up in the front part of the eye. This extra fluid creates an increase in the pressure in the eye, damaging the optic nerve. When glaucoma develops, patients often report no symptoms, so annual eye exams are vital to rule out the presence of glaucoma in the eye.
Glaucoma is one of the leading causes of blindness in the United States. It is estimated that over 3 million Americans have glaucoma, but only half of them know it. Possible risk factors include genetics and family history, high eye pressure, farsightedness or nearsightedness, history of eye injury, thin corneas, diabetes, or circulation issues. Glaucoma is a disease that usually progresses slowly, and vision loss or blindness can usually be prevented with early detection and treatment.
The most common form of glaucoma is known as primary open-angle glaucoma. This occurs when the part of the eye called the trabecular meshwork becomes less efficient at draining fluid. When this drain does not function properly, the eye pressure, called intraocular pressure (IOP), rises. Heightened eye pressure can damage the optic nerve. There is not a "right" eye pressure that is the same for all patients. Each patient's eye doctor will determine a target eye pressure that will protect the patient's optic nerve from further damage. Each patient has a different target eye pressure. Left untreated, open-angle glaucoma slowly damages the optic nerve and blank spots begin to appear in the field of vision. Patients may not notice these blind spots until the optic nerve is significantly damaged.
Another form of glaucoma is called angle-closure or narrow angle glaucoma. This happens when the drain in the front of the eye becomes blocked. A blockage in this drain causes eye pressure to rise quickly. Patients experiencing complete angle closure will experience acute pain, sudden blurriness, headache, and nausea, and should be treated by an ophthalmologist immediately. Patients who are at risk for closed-angle glaucoma should avoid medications where the packaging states not to use these products if you have glaucoma. These products may be safe to use if your eye doctor has treated you with a laser procedure called a peripheral iridotomy.
Glaucoma is treated by lowering the intraocular pressure. This is achieved through eyedrops, laser treatments, or eye surgery. We perform Selective Laser Trabeculoplasty (SLT), Laser peripheral iridotomy, and iStent surgery.
Sometimes our doctors label a patient a glaucoma suspect. They may do this because a patient has normal eye pressure but their optic nerve or visual field test looks suspicious for glaucoma. These patients must be watched carefully because they may be more likely to eventually develop glaucoma and need treatment. Other patients may have higher than normal eye pressure but no optic nerve damage. This is called ocular hypertension and must also be watched carefully because they are at higher risk for developing glaucoma.