Eye Diseases

Introduction
Loss of Vision
Cataract
Glaucoma
Retinal Disorders
Retinal Detachment
Macular Pucker
Macular Hole

Eye problems are minor and fleeting. But some lead to a permanent loss of vision. Common eye problems include

• Cataracts - clouded lenses
• Glaucoma - damage to the optic nerve from too much pressure in the eye
• Retinal disorders - problems with the nerve layer at the back of the eye
• Conjunctivitis - an infection also known as pink eye

Your best defense is to have regular checkups, because eye diseases do not always have symptoms. Early detection and treatment could prevent vision loss. See an eye care professional right away if you have a sudden change in vision or everything looks dim or if you see flashes of light. Other symptoms that need quick attention are pain, double vision, fluid coming from the eye and inflammation.

Vision impairment, or low vision, means that even with eyeglasses, contact lenses, medicine or surgery, you don't see well. Vision impairment can range from mild to severe. The leading causes of vision impairment and blindness in the United States are age-related eye diseases: macular degeneration, cataract and glaucoma. Other eye disorders, eye injuries and birth defects can also cause vision loss.

A loss of vision means that you may have to reorganize your life and learn new ways of doing things. If you have some vision, visual aids such as special glasses and large print books can make life easier. There are also devices to help those with no vision, like text-reading software and braille books.

Sometimes, vision loss is preventable. Regular comprehensive eye exams and prompt treatment are critical.

A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all people in the United States either have a cataract or have had cataract surgery.

• Blurry vision
• Colors that seem faded
• Glare
• Not being able to see well at night
• Double vision
• Frequent prescription changes in your eye wear

Cataracts usually develop slowly. New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses can help at first. Surgery is also an option. It involves removing the cloudy lens and replacing it with an artificial lens. Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts.

• Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
• Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
• Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
• Radiation cataract. Cataracts can develop after exposure to some types of radiation.

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.

As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.

Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.

Glaucoma damages the eye's optic nerve. It is a leading cause of blindness in the United States. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first, but a comprehensive eye exam can detect it.

People at risk should get eye exams at least every two years. They include

• African Americans over age 40
• People over age 60, especially Mexican Americans
• People with a family history of glaucoma

Early treatment can help protect your eyes against vision loss. Treatments usually include prescription eyedrops and/or surgery. Although open-angle glaucoma cannot be cured, it can usually be controlled. While treatments may save remaining vision, they do not improve sight already lost from glaucoma.

The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. In the center of this nerve tissue is the macula. It provides the sharp, central vision needed for reading, driving and seeing fine detail.

Retinal disorders affect this vital tissue. They can affect your vision, and some can be serious enough to cause blindness. Examples are

• Retinal detachment - a medical emergency, when the retina is pulled away from the back of the eye
• Macular pucker - scar tissue on the macula
• Macular hole - a small break in the macula that usually happens to people over 60
• Floaters - cobwebs or specks in your field of vision

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

Symptoms include a sudden or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

There are three different types of retinal detachment:

Rhegmatogenous -- A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional -- In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

Exudative -- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

A macular pucker is scar tissue that has formed on the eye's macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular pucker can cause blurred and distorted central vision.

Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects, except for a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.

A macular pucker usually requires no treatment. In many cases, the symptoms of vision distortion and blurriness are mild, and no treatment is necessary. People usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker. Sometimes the scar tissue--which causes a macular pucker--separates from the retina, and the macular pucker clears up.

Rarely, vision deteriorates to the point where it affects daily routine activities. However, when this happens, surgery may be recommended. This procedure is called a vitrectomy, in which the vitreous gel is removed to prevent it from pulling on the retina and replaced with a salt solution (Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous). Also, the scar tissue which causes the wrinkling is removed. A vitrectomy is usually performed under local anesthesia.

Surgery to repair a macular pucker is very delicate, and while vision improves in most cases, it does not usually return to normal. On average, about half of the vision lost from a macular pucker is restored; some people have significantly more vision restored, some less. In most cases, vision distortion is significantly reduced. Recovery of vision can take up to three months. Patients should talk with their eye care professional about whether treatment is appropriate.

The most common complication of a vitrectomy is an increase in the rate of cataract development. Cataract surgery may be needed within a few years after the vitrectomy. Other, less common complications are retinal detachment either during or after surgery, and infection after surgery. Also, the macular pucker may grow back, but this is rare.

A macular hole is a small break in the macula, located in the center of the eye's light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.

Most of the eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most cases, there are no adverse effects. Some patients may experience a small increase in floaters, which are little "cobwebs" or specks that seem to float about in your field of vision.

However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Also, once the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula, blurring and distorting central vision.

Macular holes can also occur from eye disorders, such as high myopia (nearsightedness), macular pucker, and retinal detachment; eye disease, such diabetic retinopathy and Best's disease; and injury to the eye.

The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. For a few months after surgery, patients are not permitted to travel by air. Changes in air pressure may cause the bubble in the eye to expand, increasing pressure inside the eye.

Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery. If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a vitrectomy. However, there are a number of devices that can make the "face-down" recovery period easier on you. There are also some approaches that can decrease the amount of "face-down" time. Discuss these with your doctor.