CONDITIONS

Eye Diseases

What Is Eye Diseases

The National Eye Institute (NEI) reports that as of the most recent census, 3.3 million Americans aged 40 or older are blind or have moderate to severe vision impairment (low vision). If no changes to eye care are made,  the NEI predicts that the number of visually impaired people could be as high as 5.5 million by the year 2020 — a whopping 60% increase largely due to our aging population. Visual impairment and blindness are most often caused by one or a combination of several eye diseases and conditions. The NEI cites the following as the most prevalent eye diseases and conditions:


Age-Related Macular Degeneration (AMD). Age-Related Macular Degeneration (AMD) is the leading cause of permanent impairment of reading and fine or close-up vision among people aged 65 years and older, according to theCenters for Disease Control (CDC). The CDC estimates that 1.8 million Americans aged 40 years and older are affected by Age-Related Macular Degeneration (AMD). Another 7.3 million who have large deposits in the retina called drusen are at increased risk of developing AMD. By 2020, due to our aging populations, the number of Americans with AMD is predicted reach an estimated 2.95 million.

AMD occurs when the macula, an area of the retina that allows you to have detailed central vision, breaks down. It does not affect peripheral vision, which is the ability to see general shapes “out of the corner of your eye” even when you’re looking straight ahead. There are two main types of AMD:

  • Dry AMD (atrophic, non-neovascular) is the most common form. In Dry AMD, the tissues of the retina thin over time and small pieces of fatty protein develop under the retina, causing vision loss to occur gradually.
  • Wet AMD (exudative) only affects about 10% of patients with AMD. Typically,  the condition develops in people who already have dry AMD. Wet AMD creates more damage than dry AMD and progresses more quickly as blood vessels grow under the retina and leak fluid or blood.

Cataracts.  A cataract is a clouding of the lens of the eye that causes the lens to lose its ability to properly focus light, resulting in blurry vision. The CDC reports that an estimated 20.5 million (17.2%) Americans aged 40 years and older have a cataract in one or both eyes. Beyond that, 6.1 million (5.1%) have had their lenses removed surgically to eliminate cataracts. By 2020, the total number of Americans who have cataracts is estimated to jump to 30.1 million. 


Diabetic Retinopathy. In diabetic retinopathy, uneven blood sugar levels interfere with circulatory function in the retina, causing small blood vessels to swell and rupture. This results in clouded retinal swelling and clouded vision. Diabetic retinopathyis the leading cause of blindness among Americans between the ages of 20 and 74 years. The CDC reports that an estimated 4.1 million people are affected by retinopathy and that an additional 899,000 patients have vision-threatening retinopathy.


Dry Eye.  This condition happens if you don’t produce enough tears or a high enough quality of tears to keep your eyes hydrated. Dry eye is uncomfortable and can cause vision to be impaired and interfere with activities of daily living.


Glaucoma. This condition accounts for about one in every eight cases one of blindness in the United States, yet it is treatable if it is caught early. In glaucoma, an excess of ocular (eye) fluid that doesn’t drain properly causes damage to the optic nerve, resulting in blurred vision, a narrowed field of vision with some loss of peripheral vision, and eventually total blindness.

The three main types of glaucoma are:

  • Open-angle glaucomaThis is the most common form, also called primary open-angle glaucoma. In open-angle glaucoma, the trabecular meshwork, a spongy tissue near the cornea and  iris that drains ocular fluid, slowly becomes less effective at doing its job. When this occurs, intraocular pressure (IOP), rises to dangerous levels. This condition is almost always asymptomatic in the early stages.
  • Normal-tension glaucoma. In normal-tension glaucoma, damage occurs to the optic nerve despite an IOP within the normal range, between 10-20 millimeters of mercury (mm Hg).
  • Closed-angle glaucoma, also callednarrow-angle glaucoma or angle-closure glaucoma. This less common form of glaucoma happens suddenly, when the iris (colored part of the eye) shifts positions and blocks the flow of fluid through a drainage channel called the drainage angle. This can cause IOP to raise rapidly, necessitating emergency response.

Retinal Detachment. The middle of the eye contains a gel called the vitreous that is connected to the retina. As we age, the vitreous sometimes shrinks and pulls on the retina. This pulling can result in a tear or partial detachment of the retina from the back of the eye. This is painless and results in seeing flashes or floaters, dark spots or shapes that intermittently appear in the line of vision. Retinal tears allow for fluids to seep through torn areas and peel the retina away from the back of the eye, sometimes detaching it entirely, resulting in severe loss of vision or blindness.

In addition to the diseases and conditions cited by the NEI, there are several eye conditions that are less severe, but affect a large amount of people each day.

  • Presbyopia
  • Nearsightedness (Myopia)
  • Farsightedness
  • Astigmatism

Early detection of these most common eye diseases and conditions, especially those that are age-related, gives patients much higher chances of retaining their vision.

What Causes Eye Diseases

Age-Related Macular Degeneration (AMD] )

  •  Heredity Recent studies have shown that genetic changes are the cause of about 50% of the cases of AMD, both dry and wet.
  • Aging Atrophy means wasting away or deteriorating. This can happen with many tissue and organs in the body as we age. In the eye, atrophy or thinning of the macula gradually causes Dry AMD in some people. One study showed that the risk of getting macular degeneration rises from around 2 percent for people in their 50s to nearly 30 percent for people over age 75.
  • The reason that dry AMD progresses from dry to the more dangerous wet form for about 10% of those afflicted is unknown, but it does run in families.

Cataracts

  • Aging
  • Congenital or developmental cataracts (Hereditary or related to birth defects)
  • Diabetes
  • Steroid medications
  • Trauma from an eye injury

Diabetic Retinopathy

If blood sugar (glucose) levels are too high for stretches of time, the capillaries (small blood vessels) that supply blood to the retina can be damaged. After a while, the capillaries start leaking fluids and fats. This in turn causes edema or swelling in the eyes. A condition called ischemia, in which the capillaries close off completely, can also occur.    


Dry Eye (keratoconjunctivitis sicca)

The hormonal changes that come with menopause are the most common cause of this condition, which is why women are affected far more often than men.


Glaucoma

Open Angle and Normal Tension – These forms are often idiopathic, meaning that there is no known cause, but some causal factors may include

  • Heredity –Siblings of people with glaucoma are more likely to contract the condition.Sons and daughter of people with glaucoma are not a susceptible as siblings.
  • Injury to the eye
  • Inflammation of the eye
  • Diabetes
  • Steroid-containing medications, including pills, eyedrops, and spray

Angle-Closure

  • A congenitally narrow drainage area in the eye.
  • Being of Asian descent

Retinal Detachment

  • Aging
  • Eye injury
  • Diabetes, advanced
  • Eye inflammation

 

Risk Factors For Eye Diseases


Age-Related Macular Degeneration (AMD)

  • Oxidative stress – As our bodies interact with the oxygen in the environment, molecules called free radicals are formed. These can damage the cells and are thought to play a role in the development of AMD. About one-third of Caucasians are genetically more prone to oxidative stress and with it, AMD.
  • Inflammation This function of the immune system is meant to fight off infection but and overactive immune system has been linked to the development of AMD.
  • Smoking
  • High blood pressure
  • Abnormal cholesterol
  • Obesity
  • Heredity
  • Aging

Cataracts

  • Aging
  • Diabetes
  • Steroid medications
  • Trauma from an eye injury

Diabetic Retinopathy

  • Advanced diabetes in which blood sugar is not well controlled 

Dry Eye 

  • Menopause for women and age-related hormonal changes for both genders

Glaucoma

Open Angle and Normal Tension

  • Having a sibling with open angle glaucoma
  • Aging
  • Diabetes
  • Steroids 

Angle-Closure

  • Being of Asian descent

Retinal Detachment 

  • Being over 50
  • Suffering an eye injury
  • Poorly controlled diabetes
  • Eye inflammation such as conjunctivitis (Pink Eye)

Diagnosing Eye Diseases

If you or your doctor notice changes in your vision that suggest an eye disease or condition, you may be referred to an ophthalmologist (medical doctor specializing in the eye) for diagnosis. Below are the leading methods of diagnosis for eye diseases and conditions:


Age-Related Macular Degeneration (AMD)

  • Dry AMD. 
    • Dilated Eye Exam. During dilated eye exams, special eye drops are given to patients to dilate, or widen, the pupil. The widening of the pupil allows for more light to enter the eye, giving doctors a better view of the workings of inner eye components. The drops take about twenty minutes to have their full effect. Once the pupil is fully dilated, the doctor can examine the eye with an ophthalmoscope, a specially designed optometric instrument to view the retina and other areas of the back of the eye. If he or she detects macular degeneration, an amsler grid (see below) can be conducted. The dilation caused by the drops can last for several hours following the exam, and typically results in temporarily blurred vision.  If you are planning to drive to the doctor’s office, you may want to ask a family member or friend to accompany you in the event that your blurred vision lasts longer than expected and you are unable to drive home.
    • Amsler grid. If the doctor detects macular degeneration based on described symptoms or an ophthalmoscope examination, you will be asked to look at a chart called the Amsler Grid to check for AMD symptoms such as dark, wavy, or blurry areas in your range of vision. With AMD, typically only your central vision will be changed.
  • Wet AMD
    • Fluorescein angiography. In this test, afluorescein dye made of food coloring and fluoresces (naturally ‘glowing’ particles) is injected into a vein in your arm. Because of its fluorescent properties, the dye is able to be photographed as it travels to the eyes and through the retinal blood vessels, revealing any abnormalities that could be signs of wet AMD. Dye components put people who have allergies to shellfish and/or iodine at a higher risk of complication from this test, so be sure to let your doctor know of any food or medication allergies. Properly prescribed antihistamines may be able to prevent allergic reactions.
    • Optical coherence tomography(OCT) is a non-invasive imaging test using light waves to take pictures of your retina that may revealabnormal blood vessels and macular damage contributing to wet AMD.

Cataracts

  • Slit-lamp exam.Slit-lamps are special microscopes that allow doctorst0 check for abnormalities in the areas at the front of your eye like the cornea, iris, lens, and the space between your iris and cornea. Light is focused on very specific areas, allowing doctors  to exam small portions of the eye at a time in greater detail.
  • Dilated eye exam. During dilated eye exams, special eye drops are given to patients to dilate, or widen, the pupil. The widening of the pupil allows for more light to enter the eye, giving doctors a better view of the workings of inner eye components. The drops take about twenty minutes to have their full effect. Once the pupil is fully dilated, the doctor can examine the eye with an ophthalmoscope, a specially designed optometric instrument to view the retina and other areas of the back of the eye. If he or she detects macular degeneration, an amsler grid (see below) can be conducted. The dilation caused by the drops can last for several hours following the exam, and typically results in temporarily blurred vision.
  • Refraction and visual acuity test. This is the standard test during which patients must read letters on an eye chart that progressively decrease in size to the best of their ability, and look at objects through a device called a phoroptor to assess sharpness and clarity of their vision. Each eye is tested separately.

Diabetic Retinopathy

  • Dilated Eye Exam (see above)
  • Refraction and visual acuity test (see above)
  • Ultrasound.Ultrasounds may not be necessary unless you already show signs of blood leakage in your eyes called vitreous hemorrhage, which may be signs of a detached retina

Dry Eye 

  • Schirmer test that measures tear production may be used to confirm the diagnosis.  The doctor will put filter paper strip under your lower eyelids and measure your rate of tear production.
  • Dye Eyedrops. After putting the drops in your eyes, the doctor will check for the time it takes for dry spots to show up on your cornea.
  • Standard Eye Exam. A standard eye exam involves a review of your eye medical history in addition to your current state of optic health.

Glaucoma

  • Tonometer Examination. In this test, a tonometer is used measure intraocular pressure (IOP). In healthy individuals, IOP generally falls between 10 and 21 mm of mercury (mm Hg). Optic nerve damage is typically a result of IOPs above 21 mm Hg, though there are cases when optic damage occurs at IOPs lower than 21, and cases where no damage occurs at pressures higher than 21 mm Hg.
  • Gonioscopy. In a gonioscopy, the eye is dilated and numbed with anesthetic drops in order for a specialized contact lens to be place on the lens of the eye. The mirrors within this specialized lens allow the doctor to view the drainage angle to check for potential blockage.  
  • Ophthalmoscope examination.In an ophthalmoscope examination, a doctor uses an ophthalmoscope to magnify the interior and rear portions of your eye. This can detect changes in the optic nerve and damage to the retina.
  • Visual Field Test. During a visual field test, patients are asked to look though an optical device called a perimeter at a yellow field on which blue spots will randomly appear. When a blue spot is seen, patients are asked to click a handset that they are holding, which feeds back to a central computer. Doctors are then able to see in what areas patients are able to see and in what areas they have blindspots, even those that may not be detectable in day to day life.
  • Pachymeter examination. During a pachymeter examination, doctors anesthetize the eyes and then place a probe on the cornea called a pachymeter, which measures the thickens of your central cornea. Your central corneal thickness, or CCT, can influence the interpretation of your IOP as measured by tonometers. A thin CCT means that the IOP is most likely higher than was measured with the tonometer, while a thick CCT is most likely indicative of a lower IOP.

Retinal Detachment

  • Ophthalmoscope examination. (see above)
  • Ultrasound Imaging. Ultrasounds produce an image of the eye that can reveal retinal damage and fluid leakage.

Symptoms of Eye Diseases

The National Eye Institute along with other respected sources warns that regular eye exams are crucial, especially for older adults, because vision-robbing eye conditions most often have no symptoms until damage has already been down.

The symptoms for different eye conditions and diseases vary and can be hard to detect, so be sure to get regular eye exams, especially if you are an older adult. Many eye conditions and diseases do not show symptoms until damage has been done, so it is important to be attentive to your symptoms and get treatment as they arise.

The following are symptoms that you may experience:

  • Dry AMD. In the early stages, the condition is almost always without any symptoms. As damage occurs over time, the fine detail of central vision you use for reading and threading a needle will become blurry, dark or even blank. . Side vision (peripheral) will is not affected. You might not notice vision changes if only one eye is affected. The other eye will compensate. Dry AMD symptoms progress fairly slowly.
  • Wet AMD. You may notice all of the above as well as crooked images and the fact that the size of images is different for each eye and color don’t look that same with each eye. Wet AMD symptoms progress very rapidly and require immediate medical attention.  
  • Cataracts. You probably won’t notice any signsearly on. Later, you may find that your vision is becoming cloudy and that you have trouble seeing in low light. You may also see halos around lights and colors may appear faded or yellowish. Double vision can also be a symptom.  
  • Diabetic Retinopathy. As with other eye conditions, this one is usually asymptomatic at the beginning. As time goes by, your vision may become blurry and you may notice symptoms similar to the ones describes above for cataracts.
  • Glaucoma.
    • For open-angle glaucoma, there are almost never any symptoms at the beginning. If the disease progresses, you’ll have blind spots in your peripheral (side) vision. For closed-angle glaucoma, an attack may bring on the following symptoms quite suddenly. If you experience any of the following, you should contact a doctor immediately.
    • Severe eye or brow pain
    • Redness of the eye
    • Decreased or blurred vision
    • Seeing colored rainbows or halos
    • Headache
    • Nausea
    • Vomiting
  • Dry Eye. Oddly, a main symptom is watery eyes. Your eyes may also burn itch, and get irritated by smoke or wind. If you’ve always worn contact lenses with no problem, you may now find them uncomfortable  
  • Retinal Detachment. 
    • The sudden appearance of floaters and flashes
    • A shadow in your peripheral (side) vision
    • A gray curtain making its way across your field of vision
    • A sudden decrease in your vision

 

Prognosis

  • Age-Related Macular Degeneration. Macular degeneration almost never causes total blindness. Even people with more advanced cases of AMD retain their peripheral (side) vision and can learn to compensate. In many cases, macular degeneration’s impact on your vision can be minimal.
  • Cataracts. Some cataracts are small enough that they affect vision only minimally and don’t require surgery. For cataracts large enough to cause visual impairment, surgery to implant an intraocular lens corrects the problem is the vast majority of cases. After the surgery, you’ll need to wear glasses or contact lenses but you won’t lose your sight.
  • Diabetic Retinopathy. Treatment early as possible in the progression of the disorder can often slow the course. Adherence to a healthy diet and regular administration of insulin can lower the risk of complications and blindness. Some patients, for unknown reasons, do lose their sight no matter what but many people have advanced diabetes for years and yet retain their vision.  
  • Dry Eye. This condition  is most often chronic. However, people with mild to moderate cases can typically find relief with treatments such as lubricants and don’t feel that their quality of life is negatively affected.  When dry eyes symptoms are severe, however, people have trouble keeping their eyes open and may be unable to drive. With the exception of the extreme cases of needing to keep the eyes closed, dry eye is not a threat to general vision.
  • Glaucoma. Unfortunately, glaucoma often goes untreated and results in severe vision loss or blindness. According the National Foundation of the Blind, about one in every one in every seven or eight cases of blindness in the US is caused by uncontrolled glaucoma. However, with early detection and continued treatment open-angle glaucoma can be controlled, and blindness can be prevented. As for actute-angle glaucoma, prompt treatment at the start of an attack can help control the attack and may allow vision to return to normal. Failure to treat an attack can result in blindness less than two days after the attack began. If you experience any of the symptoms of an acute-angle glaucoma attack, see a doctor immediately.
  • Retinal Detachment. According to Medline Plus, a service of the National Library of Medicine, the prognosis of a retinal detachment depends on the location and extent of the detachment. If the macula was undamaged, treatment can give excellent results and vision can be restored. However, successful repair of the retina does not always fully restore vision and some detachments can’t be repaired. Early treatment is essential.

Living With Eye Diseases

In many cases, depending on the eye disease or condition you have and your response to treatment, your vision may not be not noticeably impaired and you won’t experience any pain or only mild discomfort.

However, you may need to compensate for partial loss of vision if you have a condition such as wet AMD that can’t be treated. Ask your eye care specialist about low-vision rehabilitation devices and services that will help you learn coping strategies so that you can to continue to live independently.

Many people with some vision loss have to stop driving. If that happens to you, visit SeniorDrivingAAA.comto get information about affordable and convenient ways to maintain your mobility.

Here are some top tips for living well with vision impairment:

  • To wake up, a person may use a talking watch or talking alarm clock.
  • To get dressed someone may have their own system of identifying clothes and colors. They might use safety pins to match the same color outfits together, or use Braille clothing tags.
  • Instruction is available for visually impaired people to learn independent meal preparation skills. Special dots or Braille can be put on conventional and microwave ovens to aid in instruction and use.
  • Someone with low vision might use a dark tablecloth with light colored dishes and a light tablecloth for dark dishes. Contrasting colors help individuals who have some remaining vision better see where things are.
  • Similarly, someone with low vision might use dark mugs or glasses to pour light colored liquid such as milk and light colored mugs or cups to pour coffee or other dark liquids such as tea or hot chocolate.
  • To locate keys, wallet or purse, they might make an effort to put them in the same place all the time so they can be found more easily.
  • For leisure activities a person can watch audio described movies, listen to recorded books called Talking Books, play cards or other adapted games with friends.

Screening

Serious eye diseases and conditions often have no symptoms until irreversible damage to vision has been done. If you wear prescription glasses and/or contacts, you probably go to an optometrist for an annual check-up to make sure your prescription hasn’t changed and to order a new batch of contacts if you’re running out of them. Optometrists conduct vision tests to check for basic vision impairment, and can prescribe glasses and contact lenses. They can also spot early warning signs and give you a referral to an ophthalmologist, an eye doctor with a medical doctor degree, for a more thorough examination. If you do not wear contact lenses or glasses, chances are you miss out this periodic optometric screening. Many times, family doctors with conduct a visual acuity test, which is a series of letters decreasing in size on a chart that patients are asked to read to the best of their ability. This gives doctors the opportunity to do as the optometrists would.

The standard recommendation for all adults over the age of 40 is to have an eye exam at least every two years, and for adults over 65, to have an eye exam every year.  According to the National Federation of the Blind, prompt detection and treatment can preserve your vision for a lifetime even if you do contract a serious eye condition or disorder. Schedule an eye exam with an optometrist. If he or she spots any problems that may be of concern, you will most likely be referred to an ophthalmologist, a medical doctor specializing in eyes, for further testing. Be sure to make an appointment with the ophthalmologist and follow recommendations regarding the frequency of follow-ups should any diseases or conditions be detected.

People with diabetes or at risk of developing gestational diabetes are recommended to get additional ophthalmic screening.

The American Academy of Ophthalmology recommends the eye screening schedule:

  • Type 1 Diabetes: Within five years of being diagnosed and yearly thereafter.
  • Type 2 Diabetes: At the time of diagnosis and yearly thereafter.
  • During pregnancy: During the first trimester and follow-ups if indicated.

Prevention

Medline Plus, a service of the National Library of Medicine, reminds us our best defense is to have regular checkups because eye diseases do not always have symptoms. Early detection and treatment are the keys to preventing vision loss.

Beyond that, a healthy diet that has sufficient vitamin and other nutrients will help keep your eyes lubricated and free of infections.

Also, avoid second hand smoke and if you smoke, kick the habit.

Protect your eyes from injury by wearing plastic eye guards if you’re involved in any activity that poses a risk of flying objects or particles.

Finally, remember that overexposure to the sun is just as bad for your eyes as it is for your skin. Wear sunglasses and stay away from tanning beds, as UV rays can be harmful and may exacerbate your vision issues.

Medication And Treatment

Age-Related Macular Degeneration

  • Dry AMD. According to Eyesmart.org, a service of the American Academy of Ophthalmology; there is no single treatment for the dry form of macular degeneration that works in all cases. However, the Age-Related Eye Disease Study 2 (AREDS2) showed that taking a dietary supplement of vitamin C, vitamin E, lutein and zeaxanthin, along with zinc, lowered the risk of dry AMD progressing to Wet AMD for some people.  The supplements did not appear to benefit f people with minimal macular degeneration.

 


Here is what was in the dietary supplement that was tested in the study:

•   Vitamin C – 500 mg
•   Vitamin E – 400 IU
•   Lutein – 10 mg
•   Zeaxanthin – 2 mg
•   Zinc oxide – 80 mg
•   Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc. Another large study showed that taking folic acid and vitamins B6 and B12 benefited women with AMD.

Another large study showed that taking folic acid and vitamins B6 and B12 benefited women with AMD. But remember, however, that vitamin supplements don’t cure AMD or give you back any vision that has been lost.

  • Wet AMD. The American Academy of Ophthalmologylists the following treatments that may reduce but not eliminate vision loss:
    • Anti-VEGF medication injection treatments. The injections contain drugs such as Avastin, Lucentis, and Eyelea that target a chemical called vascular endothelial growth factor (VEGF) in your body. VEGF causes abnormal blood vessels to grow under the retina. In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies:
    • Laser treatment. This is an outpatient procedure in the doctor’s office or at the hospital. A high-energy beam of light creates a small burn on the retina, destroying the abnormal blood vessels and preventing further leakage and growth.
    • Photodynamic therapy (PDT). This therapy uses a light-activated drug called a photosensitizer and a low-power, or cool, laser. The doctor injects the drug into a vein in your arm. It travels to the abnormal vessels behind the central macula and the low-power laser activates the drug, which causes damage to the unwanted blood vessels. Multiple treatments may be necessary.

Cataracts. If your vision is only slightly blurry, you may only need a change in the prescription for your glasses and/or contacts. However, if that doesn’t cause enough improvement, you may want to consider surgery. Waiting for the cataracts to “ripen” is no longer necessary and recovery is faster than it used to be.

The National Federation of the Blind reports that a great deal of progress has been made recently in the development of improved forms of cataract surgery, including use of freezing probes and ultrasonic  devices that make removal of the lens possible through a small opening. An estimated 95% of patients regain useful sight.


Diabetic Retinopathy

  • Laser treatments are sometimes used to seal or “weld” a detached portion of the retina back into place.
  • Photocoagulation treatment involves of scattering hundreds of quick flashes of laser light across the retina in order to seal abnormal blood vessels as long as no bleeding or detachment of the retina has already occurred.

Dry Eye

  • Artificial tears. These eyedrops lubricate your and are available without a prescription
  • Preventing your own tears from draining. Your ophthalmologist may close these channels that drain your tears, either temporarily with plugs or permanently using heat.

Glaucoma

  • Medicated eyedrops. You put one drop in each eye every night at bedtimes. The drops lower your eye pressure.
  • Glaucoma surgery. For some patients, glaucoma surgery is recommended to improve the flow of fluid out of the eye in order to lower pressure.
  • Laser trabeculoplasty.  is often used to treat open-angle glaucoma. There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).
  • Laser iridotomy.  is recommended for people with closed-angle glaucoma and others with narrow drainage angles.
  • Peripheral iridectomy. This is used is to stop an acute closed-angle glaucoma attack. A small piece of the iris is removed. If more conservative treatments are successful, this surgery is not necessary.
  •  Trabeculectomy. A small flap is made in the outer coating of the eye and a filtration reservoir is made under the membrane that covers the white of the eye.
  • Aqueous shunt surgery. A shunt is a small plastic tube or valve that acts as an artificial an artificial drainage system. That is implanted in the eye through a small incision.

Retinal Breaks and Detachment

  • Cryotherapy. As a treatment for retinal breaks, a freezing probe is applied to the surface of the eye. This prompts the growth of beneficial scar tissue that promotes reattachment of the edges of the breaks.
  • Lasers. The lasers are used to burn tissue and “weld” the retina–a light-sensitive layer of tissue, lining the inner surface of the eye–to the back of the eye.
  • Scleral buckle. A flexible band around the eye counteracts the force pulling the retina out of place.
  • Pneumatic retinopexy. A temporary gas bubble is injected into the vitreous the eye, in combination with laser surgery or cryotherapy. The bubble pushes the retinal tear back into place and eventually disappears.
  • Vitrectomy. The vitreous gel–a clear gel that fills most of the interior of the eyeball—is removed and replaced with a gas bubble or an oil bubble. One of the main functions of this gel is simply to enable the eyeball to hold its spherical shape, as without the gel the eyeball would collapse.

Complementary and Alternative Treatment

Age-Related Macular Degeneration  (AMD). The National Center for Complementary and Alternative Medicine (NCCAM) notes that a follow-up to the NIH Age-Related Eye Disease Study found the following results regarding proposed changes to a supplement containing high doses of vitamins C and E, beta carotene, and zincthat may delay the progression from dry AMD to wet AMD:

  • Adding omega-3 fatty acids (fish oil) did not improve the effectiveness of the supplement combination.
  • Reducing the amount of zinc or omitting beta-carotene from the supplements did not decrease their effectiveness.
  • Adding lutein and zeaxanthin (two carotenoids found in the eye) to the supplements improved their effectiveness in people who were not taking beta-carotene and those who consumed only small amounts of lutein and zeaxanthin in foods.
  • The results also suggested that the supplements might be improved by substituting lutein and zeaxanthin for beta-carotene.

Cataracts. NCCAM reports that supplements of antioxidants (vitamins C and E and beta-carotene) do not prevent cataracts or slow their progression.


Diabetic Retinopathy. No dietary supplements have been shown to be helpful for diabetic retinopathy.


Glaucoma.

  • No supplements have been show to be helpful in the treatment of this condition. Research that has been done on the use of Ginkgo biloba, coenzyme Q10, melatonin, resveratrol, and antioxidants with limited or no evidence of effectiveness.
  • The American Academy of Ophthalmologyrefutes the widely held belief that marijuana helps treat glaucoma. The official statement from on the Academy’s EyeSmart site is: “Marijuana has been proven to lower IOP but only for a short period of time and at considerable risk to your overall health. . . The Academy does not recommend marijuana as a treatment for glaucoma.”

Retinal Detachment. No alternative treatments have been proven to be effective.

When To Contact A Doctor

In addition to your regularly scheduled visits to your eye care professionals, get immediate medical attention if you notice any sudden change in your vision or experience unusual symptoms such as extreme eye pain, burning, itching, redness, or fluid coming out of your eye. Also, get help if you have an eye injury.

Questions For A Doctor

Before you visit your doctor, write down a list of questions and concerns. Consider bringing a friend or family member along who can help you make sure you get all the information you need. In addition, writing down the doctor’s answers and recommendation for later reference is a good idea. Also come prepared with your medical history, information about any allergies you have, your family medical history, and a complete list of all medications you take including over-the-counter herbs and supplements.

Here are some questions you might pose when you visit your optometrist:

  • I started having trouble reading up close not long after I turned 40 so I bought a pair of readers at the drugstore. Is that OK? And did I pick the right strength?
  • I’ve always been nearsighted. Do I now need bifocals or progressive lenses?
  • I’ve heard about progressive contact lenses and monovision lenses. Would one of those options be right for me?
  • My eyes feel dry even when I blink. Is that a sign of a condition I’ve heard about called dry eye?
  • My eyes tear in cold weather, especially when it’s windy out. Is that a bad sign?
  • I work at a computer all day. Is that a risk for eyestrain?
  • Has my prescription changed in the last year? If so, is that a bad sign?

Here are some questions you might pose if you are referred to an ophthalmologist:

  • Which eye diseases or conditions are you screening me for?
  • If you diagnose an eye disease or condition, how much will medication and/or surgery cost?
  • Will the treatments control my problems so that I retain my vision?
  • How often will I need to come back to you for check-ups?
  • Should my adult children be checked if my condition is hereditary?
  • Are there any lifestyle changes I can make that will help prevent other eye diseases or the progression of the ones I already have?
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