Hillcrest Vision: 2009

Wednesday, December 23, 2009

Google has chosen Hillcrest Vision as one of their Favorite Places!

Dr. Juawana Hall received a letter from Google announcing, “Congratulations! You’re a Favorite Place on Google.” To share this to with the public, Hillcrest Vision received a “We’re a Favorite Place on Google” poster. The poster was sent with a peel-and-stick picture and instructions to add the poster to your store window.

Printed on the poster was a two-dimensional QR barcode that when scanned takes the user to the Hillcrest Vision Local Business Listing on Google Maps. From here, users can read and write reviews, add the office as a 'favorite place' and find contact information. QR barcodes are the latest way to "stay connected' to your friends and will likely be used to update your location and list your favorite places on social sites like Facebook and LinkedIn.

Google gave the "Favorite Places" designation to the top 190,000 businesses in the entire country. To be given this designation within our first year of operation is an amazing accomplishment.

Hillcrest Vision recognizes that even the smallest advantage in online marketing can make a big difference to practice growth. Juawana Hall, owner of Hillcrest Vision, is grateful to receive this award and thanks its loyal patients for helping them enter the top tier of Google Maps.

Sunday, August 23, 2009

Uveitis

Uveitis is inflammation of the eye's uvea, an area that consists of the iris, the ciliary body and the choroid. The iris is the colored part of the eye that surrounds the pupil. The ciliary body is located behind the iris and produces the fluid that fills the anterior part of the eye. The choroid is the layer of tiny blood vessels in the back of the eye that nourishes the light-sensitive retina.

Uveitis is classified by which part of the uvea it affects: Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form. Intermediate uveitis refers to inflammation of the ciliary body. Posterior uveitis is inflammation of the choroid. Diffuse uveitis is inflammation in all areas of the uvea.
Many cases of uveitis are chronic, and they can produce numerous possible complications that can result in vision loss, including cataracts, glaucoma and retinal detachment.

Uveitis signs and symptoms

Uveitis most commonly affects people in their 20s to their 50s. Signs and symptoms of uveitis include red eyes, pain, sensitivity to light, blurred vision and dark spots moving across your field of vision (floaters). These signs and symptoms may occur suddenly and worsen quickly.
If you experience any of these potential warning signs of uveitis, see your eye doctor immediately.

What causes uveitis?

The cause of uveitis is often unknown. However, in some cases, it has been associated with:
Eye injuries.
Inflammatory disorders, such as multiple sclerosis, Crohn’s disease or ulcerative colitis.
Viral infections, such as herpes simplex or herpes zoster.
Autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis.
Other infections, including toxoplasmosis and histoplasmosis.

Uveitis treatment

To treat uveitis, your eye doctor may prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is in eye drop, pill or injection form depends on the type of uveitis you have. Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops. Intermediate uveitis can go either way, and posterior uveitis usually requires orally-administered medication or injections.
If an infection is suspected as the cause of your uveitis, your doctor may also prescribe additional medications to bring the infection under control. And if your uveitis has caused elevated intraocular pressure (IOP) in your eyes, drugs to reduce IOP to normal levels may also be used.
The duration of treatment for uveitis is often determined by the part of your eye that’s affected. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may require a much longer period of treatment before it is completely under control.
Episodes of uveitis can recur. See your eye doctor immediately if signs and symptoms of uveitis reappear after successful treatment.
For more information on uveitis and other eye conditions, visit All About Vision®.

Stye

A stye (or hordeolum) develops when an eyelid gland at the base of an eyelash becomes infected. Resembling a pimple on the eyelid, a stye can grow on the inside or outside of the lid. Styes are not harmful to vision, and they can occur at any age.

Signs and symptoms of styes

A stye initially brings pain, redness, tenderness and swelling in the area, and then a small pimple appears. Sometimes just the immediate area is swollen; other times, the entire eyelid swells. You may notice frequent watering in the affected eye, a feeling like something is in the eye or increased light sensitivity.

What causes styes?

Styes are caused by staphylococcal bacteria. This bacterium is often found in the nose, and it's easily transferred to the eye by rubbing first your nose, then your eye.

Treatment for styes

Most styes heal within a few days on their own. You can encourage this process by applying hot compresses for 10 to 15 minutes, three or four times a day over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.
Never "pop" a stye like a pimple; allow it to rupture on its own. If you have frequent styes, your eye doctor may prescribe an antibiotic ointment to prevent a recurrence.
Styes formed inside the eyelid either disappear completely or (rarely) rupture on their own. This type of stye can be more serious, and may need to be opened and drained by your eyecare practitioner.

Chalazion: Another type of eyelid bump

Often mistaken for a stye, a chalazion is an enlarged, blocked oil gland in the eyelid. A chalazion mimics a stye for the first few days, and then turns into a painless hard, round bump later on. Most chalazia develop further from the eyelid edge than styes.
Although the same treatment speeds the healing of a chalazion, the bump may linger for one to several months. If the chalazion remains after several months, your eye doctor may drain it or inject a steroid to facilitate healing.
To learn more about a stye, visit All About Vision®.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is a rare, inherited eye disease in which the light-sensitive retina slowly and progressively degenerates. This causes progressive peripheral vision loss, night blindness, central vision loss and, in some cases, blindness.

RP affects approximately 1 out of every 4,000 Americans.

Signs and symptoms of retinitis pigmentosa

The first symptoms of retinitis pigmentosa usually occur in early childhood, when both eyes typically are affected. However, some cases of RP may not become apparent until affected individuals are in their 30s or older.

“Night blindness” is the primary symptom of the disease in its early stages. During later stages of retinitis pigmentosa, tunnel vision can develop, with only a small area of central vision remaining.

In one study of RP patients who were at least 45 years old, 52% had 20/40 or better central vision in at least one eye, 25% had 20/200 or worse vision and 0.5% had no light perception (total blindness).

What causes RP?

Not much is known about what causes retinitis pigmentosa, except that the disease is inherited. It is now believed that RP can be caused by molecular defects in 100 different genes, causing significant variations in the disease from person to person.

Even if your mother and father don't have retinitis pigmentosa, you can still have the eye disease when at least one parent carries an altered gene associated with the trait. In fact, about 1% of the population can be considered carriers of recessive genetic tendencies for retinitis pigmentosa that, in certain circumstances, can be passed on to a child who then develops the disease.

In RP, the light-sensitive cells in the retina gradually die. Usually, cells called rods are primarily affected. These cells are needed for night vision and peripheral vision. However, other cells called cones can also be affected. Cone cells are responsible for our central vision and color vision.

Retinitis Pigmentosa tests and treatment

Visual field testing likely will be done to determine the extent of peripheral vision loss. Other eye exams may be conducted to determine whether you have lost night vision or color vision.

No treatments currently are available for retinitis pigmentosa, although some practitioners believe that vitamin A supplements may delay vision loss.

Illuminated magnifiers and other low vision devices can be helpful to help RP patients get the most out of their remaining vision. Occupational therapy and psychological counseling are also recommended to help the person with RP deal with their vision loss.

Researchers are looking into ways to treat RP in the future, such as retinal implants and drug treatments.

For more information on retinitis pigmentosa and low vision, visit All About Vision®.

Retinal Detachment

A retinal detachment is a serious and sight-threatening event, occurring when the retina – the light-sensitive inner lining of the back of the eye – becomes separated from its underlying supportive tissue. The retina cannot function when it detaches and, unless it is reattached soon, permanent vision loss may result.

Signs and symptoms of retinal detachment

If you suddenly notice spots, floaters and flashes of light, you may be experiencing a retinal detachment. Your vision might become blurry, or you might have poor vision. Another symptom is seeing a shadow or a curtain coming down from the top of the eye or across from the side. These symptoms can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

There is no pain associated with retinal detachment. If you experience any of the above symptoms, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision.

What causes retinal detachments?

An injury to the eye or face can cause a detached retina, as can very high levels of nearsightedness. Extremely nearsighted people have longer eyeballs with thinner retinas that may be more prone to detaching.

On rare occasions, retinal detachment may occur after LASIK surgery in highly nearsighted individuals. In a study of more than 1,500 LASIK patients, just four suffered retinal detachment; their pre-LASIK prescriptions ranged from -8.00 D to -27.50 D.

Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease may also cause retinal detachments. New blood vessels growing under the retina – which can happen in diseases such as diabetic retinopathy – may separate the retina from its underlying support tissue as well.

Treatment for retinal tears and detachments

Surgery is the only effective treatment for a torn or detached retina. The procedure or combination of procedures your doctor uses depends on the severity and location of the problem.

Laser surgery. Also called photocoagulation, laser surgery is generally used for retinal breaks and tears that have not yet become retinal detachments. The surgeon directs a laser beam into your eye through the pupil to “spot weld” the damaged retina to its underlying tissue. Photocoagulation requires no surgical incision and causes less irritation to the eye than other treatments.

Cryopexy. In this treatment, the surgeon applies a freezing probe to the outer surface of the eye over the area of defective retina. The scarring that occurs from the freezing reattaches the retina to its support tissue.

Pneumatic retinopexy. This surgery is generally used to treat a retinal detachment in the upper half of the retina. The surgeon injects an expandable gas bubble inside the eye, positioning the bubble over the torn and detached retina. As the gas bubble expands, it pushes the detached retina against its support tissue. The surgeon then may use laser photocoagulation or cryopexy to firmly reattach the retina to the underlying tissue. Over time, your body absorbs the gas bubble. Until that occurs, certain precautions are necessary.

In a variation of pneumatic retinopexy, the surgeon may inject silicone oil rather than expandable gas into the eye to press the detached retina against its support tissue. In this procedure, the silicone oil must be removed from the eye after the retina is reattached.

Scleral buckling. This is the most common surgery used to treat a retinal detachment. In this procedure, the surgeon places a soft silicone band around the eye, which indents the outside of the eye toward the detached retina. The band is sutured against the tough outer white coating of the eye (the sclera). The surgeon then drains any fluid between the retina and its support tissue, and reattaches the retina with laser photocoagulation or cryopexy.

In about 90% of cases, detached retinas are successfully reattached with a single surgery. However, this does not mean your vision will return to normal. Patients who have the best visual outcomes from retinal detachment surgery are those who seek attention immediately upon noticing symptoms and have detachments that do not involve the central retina (the macula).

For more detached retina information, visit All About Vision®.

Ptosis

Ptosis (pronounced "toe-sis") refers to the drooping of an eyelid. It affects only the upper eyelid of one or both eyes. The droop may be barely noticeable, or the lid can descend over the entire pupil. Ptosis can occur in both children and adults, but happens most often due to aging.
Ptosis signs and symptoms
The most obvious sign of ptosis is a lower-than-normal positioning of one or both of the upper eyelids. Depending on how severely the lid droops, people with ptosis may have difficulty seeing. Sometimes people tilt their heads back to try to see under the lid, or raise their eyebrows repeatedly to try to lift the eyelids.
The degree of droopiness varies from one person to the next. If you think you may have ptosis, compare a recent photo of your face to one from 10 or 20 years ago to see if there is a noticeable change in the position of your upper eyelids.
Ptosis can look similar to dermatochalasis, a group of connective tissue diseases that cause skin to hang in folds. These diseases are associated with less-than-normal elastic tissue formation. Your eye doctor should be able to tell whether or not this is the cause of your drooping eyelids.
What causes ptosis?
Ptosis can be present at birth (congenital ptosis), or develop due to aging, injury or an aftereffect of cataract or other eye surgery. This condition can also be caused by a problem with the muscles that raise the eyelid, called levator muscles. Sometimes an individual's facial anatomy causes difficulties with the levator muscles. An eye tumor, neurological disorder or systemic disease like diabetes may also cause drooping eyelids.
How is ptosis treated?
Surgery is usually the best treatment for drooping eyelids. The surgeon tightens the levator muscles to restore the eyelids to their normal position. In very severe cases involving weakened levator muscles, the surgeon attaches the eyelid under the eyebrow to allow the forehead muscles to substitute for the levator muscles in lifting the eyelid. Eyelid surgery is also known as blepharoplasty.
After surgery, the eyelids may not appear symmetrical, even though the lids are higher than before surgery. Very rarely, eyelid movement may be lost.
It is important to choose your blepharoplasty surgeon carefully, since a poorly-done surgery could result in a less than desirable appearance or in dry eyes caused by your lids not being able to close properly after surgery. Before agreeing to ptosis surgery, ask how many procedures your surgeon has done. Also ask to see before-and-after photos of previous patients, and ask if you can talk to any of them about their experience.
Ptosis in children
Children born with moderate or severe ptosis require treatment in order for proper vision to develop. Failure to treat ptosis can result in amblyopia (diminished vision in one eye) and a lifetime of poor vision. All children with ptosis, even mild cases, should visit their eyecare practitioner every year so the doctor can monitor lid positioning and potential vision problems caused by congenital ptosis.
For more information on eye conditions, visit All About Vision®.
Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited

Presbyopia

Some time after age 40, people begin to experience blurred near vision when performing tasks such as reading, sewing or working at a computer. This change is called presbyopia. There's no getting around it — presbyopia happens to everyone at some point in life, even those who have never had a vision problem before.

Currently an estimated 90 million people in the United States either have presbyopia or will develop it by 2014. This is generating a huge demand for eyewear, contact lenses and surgery that can help older Americans deal with their failing near vision.

Presbyopia signs and symptoms

With the onset of presbyopia, you’ll find you need to hold books, magazines, newspapers, menus and other reading materials farther away in order to see the print clearly. Headaches and eyestrain when reading or performing other near work after age 40 are other symptoms of presbyopia.

What causes presbyopia?

Presbyopia is an age-related loss of flexibility of the lens inside the eye. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and occur early in life. When the lens becomes hardened and less elastic, the eye has a harder time focusing up close.

Presbyopia treatment: Eyewear

Eyeglasses with bifocal or progressive addition lenses (PALs) are the most common correction for presbyopia.

“Bifocal” means two points of focus: the main part of the eyeglass lens contains a prescription for nearsightedness, farsightedness and/or astigmatism, while the lower portion of the lens holds the stronger near prescription for close work. Progressive addition lenses are multifocal lenses that offer a gradual transition between a number of lens powers for different viewing distances, with no visible lines in the lens.

Reading glasses are another choice. Unlike bifocals and PALs, which most people wear all day, reading glasses are typically worn just during close work. If you wear contact lenses, your eye doctor can prescribe reading glasses to wear over your contacts for near vision tasks. You may also purchase non-prescription “readers” over-the-counter at a retail store for the same purpose.

Multifocal contact lenses, available in gas permeable (GP) or soft lens materials, also are available for presbyopes.

Another type of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favor one eye or the other for different tasks.

Because changes in the lens of your eye continue as you grow older, your presbyopic prescription will increase over time. Your eyecare practitioner will prescribe a stronger correction for near work as you need it.

Presbyopia treatment: Surgery

Surgical options for the correction of presbyopia also exist. If you also have nearsightedness, farsightedness or astigmatism, monovision LASIK eye surgery can correct these problems and decrease your dependence on reading glasses as well. It’s also expected that a multifocal LASIK treatment option for presbyopia will soon be available in the United States.

If you only need glasses for reading and close work, conductive keratoplasty (CK) may be a good option. This surgical technique is less invasive than LASIK and can be performed on one eye for a monovision correction.

Another surgical treatment for presbyopia is refractive lens exchange (RLE), where your eye’s hardened lens is removed and replaced with a special type of intraocular lens (IOL) to restore your distance vision and near vision lost to presbyopia. This procedure is similar to cataract surgery, and is more invasive than CK or LASIK.

Because the field of vision correction surgery is changing rapidly, ask your eye doctor for the latest information about surgery for presbyopia if you are interested in this treatment option.

For more information on presbyopia and bifocals, visit All About Vision®.

Pink Eye (Conjunctivitis)

Technically, pink eye is the acute, contagious form of conjunctivitis – inflammation of the clear mucous membrane that lines the inner surface of the eyelids and overlies the white front surface of the eye, or sclera. Bacterial infection causes the contagious form of conjunctivitis.

However, the term “pink eye” is often used to refer to any or all types of conjunctivitis, not just its acute, contagious form.

Signs and symptoms of pink eye

The hallmark sign of pink eye is a pink or reddish appearance to the eye due to inflammation and dilation of conjunctival blood vessels. Depending on the type of conjunctivitis, other signs and symptoms may include a yellow or green mucous discharge, watery eyes, itchy eyes, sensitivity to light and pain.

How can you tell what type of pink eye you have? The way your eyes feel will provide some clues:

Viral conjunctivitis usually causes excessive eye watering and a light discharge.
Bacterial conjunctivitis often causes a thick, sticky discharge, sometimes greenish.
Allergic conjunctivitis affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing.
Giant papillary conjunctivitis (GPC) usually affects both eyes and causes contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids.

To pinpoint the cause and then choose an appropriate treatment, your eye doctor will ask some questions, examine your eyes and possibly collect a sample on a swab to send out for analysis.

What causes pink eye?

Though pink eye can affect people of any age, it is especially common among preschoolers and school children because of the amount of bacteria transferred among children.

Conjunctivitis may also be triggered by a virus, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral infections elsewhere in the body may also induce conjunctivitis.

Treatment of pink eye

Avoidance. Your first line of defense is to avoid the cause of conjunctivitis, such as contaminated hand towels. Both viral and bacterial conjunctivitis, which can be caused by airborne sources, spread easily to others.

To avoid allergic conjunctivitis, keep windows and doors closed on days when the airborne pollen count is high. Dust and vacuum frequently to eliminate potential allergens in the home.

Stay in well-ventilated areas if you're exposed to smoke, chemicals or fumes. If you do experience exposure to these substances, cold compresses over your closed eyes can be very soothing.

If you've developed giant papillary conjunctivitis, odds are that you're a contact lens wearer. You'll need to stop wearing your contact lenses, at least for a little while. Your eye doctor may also recommend that you switch to a different type of contact lens, to reduce the chance of the conjunctivitis coming back.

Medication. Unless there's some special reason to do so, eye doctors don't normally prescribe medication for viral conjunctivitis, because it usually clears up on its own within a few days. Your eye doctor might prescribe an astringent to keep your eyes clean, to prevent a bacterial infection from starting. Another common prescription is for artificial tears, to relieve dryness and discomfort.

Antibiotic eyedrops or ointments will alleviate most forms of bacterial conjunctivitis, while antibiotic tablets are used for certain infections that originate elsewhere in the body.

Antihistamine allergy pills or eyedrops will help control allergic conjunctivitis symptoms. In addition, artificial tears provide comfort, but they also protect the eye's surface from allergens and dilute the allergens that are present in the tear film.

For giant papillary conjunctivitis, your doctor may prescribe eyedrops to reduce inflammation and itching.

Usually conjunctivitis is a minor eye infection. But sometimes it can develop into a more serious condition. See your eye doctor for a diagnosis before using any eye drops in your medicine cabinet from previous infections or eye problems.

Prevention tips

Because young children often are in close contact in day care centers and school rooms, it can be difficult to avoid the spread of bacteria causing pink eye. However, these tips can help concerned parents, day care workers and teachers reduce the possibility of a pink eye outbreak in institutional environments:

Adults in school and day care centers should wash their hands frequently and encourage children to do the same. Soap should always be available for hand washing.
Personal items, including hand towels, should never be shared at school or at home.
Encourage children to use tissues and cover their mouths and noses when they sneeze or cough.
Discourage eye rubbing and touching, to avoid spread of bacteria and viruses.
For about three to five days, children (and adults) diagnosed with pink eye should avoid crowded conditions where the infection could easily spread.
Use antiseptic and/or antibacterial solutions to clean and wipe surfaces that children or adults come in contact with, such as common toys, table tops, drinking fountains, sink/faucet handles, etc.

For more information on pink eye or types of conjunctivitis, visit All About Vision®.

Pingueculae

Pingueculae (singular form = pinguecula) are yellowish, slightly raised lesions that form on the surface tissue of the white part of your eye (sclera), close to the edge of the cornea. They are typically found in the open space between your eyelids, which also happens to be the area exposed to the sun.

While pingueculae are more common in middle-aged or older people who spend significant amounts of time in the sun, they can also be found in younger people and even children – especially those who spend a lot of time in the sun without protection such as sunglasses or hats.

Signs and symptoms of pingueculae

In most people, pingueculae cause few symptoms. However, a pinguecula that is irritated might create a feeling that something is in the eye – called a foreign body sensation. In some cases, pingueculae can become swollen and inflamed, a condition called pingueculitis. Irritation and eye redness from pingueculitis usually result from exposure to sun, wind, dust, or extremely dry conditions.

Treatment of pingueculae

The treatment for pingueculae depends on the severity of the growth and its symptoms. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for those with mild pingueculitis to relieve dry eye irritation and foreign body sensation. To relieve significant inflammation and swelling, steroid eye drops or non-steroidal anti-inflammatory drugs may be needed.

Surgical removal of the pinguecula may be considered in severe cases where there is interference with vision, contact lens wear or normal blinking.

Frequently, pingueculae can lead to the formation of pterygia.

Pterygia

Pterygia (singular form = pterygium) are wedge- or wing-shaped growths of benign fibrous tissue on the surface tissue of the sclera. Because pterygia also contain blood vessels, they are considered a fibrovascular growth. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision.

Because a pterygium is usually quite visible to others, a person who has one may become concerned about their personal appearance. As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.

Signs and symptoms of pterygia

Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye. Large and advanced pterygia can actually cause a distortion of the surface of the cornea and induce astigmatism and blurred vision.

How pterygia are treated

Treatment depends on the pterygium's size and the symptoms it causes. If a pterygium is small but becomes inflamed, your eye doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.

The pterygia may be removed in a procedure room at the doctor's office or in an operating room setting. A number of surgical techniques are currently used to remove pterygia, and it is up to your eye doctor to determine the best procedure for you.

After the procedure, which usually lasts no longer than 30 minutes, you may need to wear an eye patch for protection for a day or two. For uncomplicated surgery, you should be able to return to work or normal activities the next day.

Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate can be as high as 40%. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is safe and lowers the chance of the pterygium growing back. After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.

It is important to note that pterygium removal can also induce astigmatism, especially in patients who already have astigmatism.

For more information on eye conditions, visit All About Vision®.

Ocular Hypertension

Ocular hypertension means the pressure in your eye, or your intraocular pressure (IOP), is higher than normal levels. Elevated IOP is also associated with glaucoma, which is a more serious condition that causes vision loss and optic nerve damage. By itself, however, ocular hypertension doesn't damage your vision or eyes.

Studies suggest that 2% to 3% of the general population may have ocular hypertension.

Signs and symptoms of ocular hypertension

You can't tell by yourself that you have ocular hypertension, because there are no outward signs or symptoms such as pain or redness. At each eye exam, your eyecare practitioner will measure your IOP and compare it to normal levels.

During routine eye exams, a tonometer is used to measure your IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

What causes ocular hypertension?

Anyone can develop ocular hypertension, but it's most common in African-Americans, people over 40, those with family history of ocular hypertension or glaucoma, and those with diabetes or high amounts of nearsightedness.

IOP may become elevated due to excessive aqueous fluid production or inadequate drainage. Certain medications, such as steroids, and trauma can cause higher-than-normal IOP measurements as well.

Ocular hypertension treatment

People with ocular hypertension are at increased risk for developing glaucoma, so some eye doctors prescribe medicated eye drops to lower IOP in cases of ocular hypertension. Because these medications can be expensive and may have side effects, other eye doctors choose to monitor your IOP and only take action if you show signs of developing glaucoma. Because of the increased risk for glaucoma, you should have your IOP measured at the intervals your doctor recommends if you have ocular hypertension.

For more information on ocular hypertension or glaucoma, visit All About Vision®.

Myopia

Myopia, or nearsightedness, is a very common vision problem. It’s estimated that up to one-third of Americans are nearsighted.

Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing.

Signs and symptoms of myopia

Nearsighted people often have headaches or eyestrain, and might squint or feel fatigued when driving or playing sports. If you experience these symptoms while wearing your glasses or contact lenses, you may need a stronger prescription.

What causes myopia?

Myopia occurs when the eyeball is slightly longer than usual from front to back. This causes light rays to focus at a point in front of the retina, rather than directly on its surface.

Nearsightedness runs in families and usually appears in childhood. This vision problem may stabilize at a certain point, although sometimes it worsens with age.

Myopia treatment

Nearsightedness may be corrected with glasses, contact lenses or refractive surgery. Depending on the degree of your myopia, you may need to wear eyeglasses or contact lenses all the time, or only when you need sharper distance vision, like when driving, viewing a chalkboard or watching a movie.

If your glasses or contact lens prescription begins with minus numbers, like -2.50, you are nearsighted.

Refractive surgery is another option for correcting myopia. This includes laser procedures such as LASIK and PRK, or non-laser options such as corneal inserts and implantable lenses. One advantage of the non-laser options is that, although they’re intended to be permanent, they may be removed in case of a problem or change of prescription.

Then there's orthokeratology, a non-surgical procedure where you wear special rigid gas permeable (GP) contact lenses that slowly reshape the cornea over time to correct your myopia. When the lenses are removed, the cornea temporarily retains the new shape, so you can see clearly without the lenses. These cornea-shaping lenses are worn during sleep, so you have daytime vision without contacts or glasses.

For more information on myopia or orthokeratology, visit All About Vision®.

Macular Degeneration

Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision – the part of our sight we use to read, drive and recognize faces. So although a person’s peripheral vision is left unaffected by AMD, the most important aspect of vision is lost.

AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older. And because older people represent an increasingly larger percentage of the general population, vision loss associated with macular degeneration is a growing problem.

It’s estimated that more than 1.75 million U.S. residents currently have significant vision loss from AMD, and that number is expected to grow to almost 3 million by 2020.

The two forms of AMD

Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be.

The dry form of AMD is more common – about 85% to 90% of all cases of macular degeneration are the dry variety.

Dry macular degeneration - Dry AMD is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes.

Dry macular degeneration is diagnosed when yellowish spots called drusen begin to accumulate in the macula. Drusen are believed to be deposits or debris from deteriorating macular tissue. Gradual central vision loss may occur with dry AMD. Vision loss from this form of the disease is usually not as severe as that caused by wet AMD.

A major study conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The study, called the Age-Related Eye Disease Study (AREDS), showed that high levels of antioxidants and zinc significantly reduce the risk of advanced dry AMD and its associated vision loss.

The AREDS study also indicated that taking high dose formulas containing beta carotene, vitamins C and E and zinc can reduce the risk of early stage AMD progression by 25%.

Wet macular degeneration - Wet AMD is the more advanced and damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration.

With wet AMD, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive cells in the retina, causing blind spots or a total loss of central vision.

The abnormal blood vessel growth in wet AMD is the body's misguided attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula. But the process instead creates scarring and central vision loss.

Macular degeneration signs and symptoms

Macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In rare cases, AMD may cause a sudden loss of central vision.

An eyecare practitioner usually can detect early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination.

What causes macular degeneration?

Many forms of macular degeneration appear be linked to aging and related deterioration of eye tissue crucial for good vision. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration.

Who gets macular degeneration?

Besides affecting older individuals, AMD appears to occur in whites and females in particular. The disease also can result as a side effect of some drugs, and it appears to run in families.

New evidence strongly suggests that smoking is high on the list of risk factors for macular degeneration. Other risk factors for AMD include having a family member with AMD, high blood pressure, lighter eye color and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of macular degeneration, and a high-fat diet also may be a risk factor.

How is macular degeneration treated?

There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.

There are no FDA-approved treatments for dry AMD, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.

For wet AMD, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet AMD.

Testing and low vision devices

Although much progress has been made recently in macular degeneration treatment research, complete recovery of vision lost to AMD probably is unlikely. Your eye doctor may ask you to check your vision regularly with an Amsler grid – a small chart of thin black lines arranged in a grid pattern. AMD causes the line on the grid to appear wavy, distorted or broken. Viewing the Amsler grid separately with each eye helps you monitor your vision loss.

If you have already suffered vision loss from AMD, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.

For more information on macular degeneration or to use an Amsler Grid, visit All About Vision®.

Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.

Keratoconus is relatively rare. Most studies indicate it occurs in 0.15% to 0.6% of the general U.S. population. Onset of the disease usually occurs in people in their teens or early twenties.

Signs and symptoms of keratoconus

Keratoconus can be difficult to detect, because it usually develops slowly. However, in some cases, it may proceed rapidly. As the cornea becomes more irregular in shape, it causes a progressive increase in nearsightedness and irregular astigmatism, creating problems with distorted and blurred vision. Glare and light sensitivity also may be noticed.

Keratoconic patients often have prescription changes every time they visit their eye care practitioner. It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is unfamiliar with the early-stage symptoms of the disease.

What causes keratoconus?

Research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

Keratoconus treatment

For the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses: If eyeglasses or soft contact lenses cannot control keratoconus, then gas permeable (GP) contact lenses are usually the preferred treatment. The rigid lens material enables GP lenses to vault over the cornea, replacing the cornea's irregular shape with a smooth, uniform refracting surface to improve vision.

But GP contact lenses can be less comfortable to wear than soft lenses. Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.

"Piggybacking" contact lenses: Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus, some eye care practitioners advocate "piggybacking" two different types of contact lenses on the same eye. For keratoconus, this method involves placing a soft contact lens on the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Hybrid contact lenses: Hybrid contact lenses have a relatively new design that combines a highly oxygen-permeable rigid center with a soft peripheral "skirt." Manufacturers of these lenses claim hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses. Hybrid lenses are also available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.

Intacs: These tiny plastic inserts are surgically placed just under the eye's surface in the periphery of the cornea, and help re-shape the cornea for clearer vision. Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes. Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress.

C3-R (corneal collagen cross-linking with riboflavin): This investigational, non-invasive procedure involves placing eye drops containing riboflavin (vitamin B2) on the cornea, which are then activated by ultraviolet (UV) light to strengthen links between the connective tissue (collagen) fibers within the cornea.

Studies of the C3-R procedure have shown promising results. In one small German study, progression of keratoconus was stopped in all of the 23 eyes studied. Most patients also had some reversal of keratoconus and minor vision improvement. Researchers concluded that this simple method of treatment might significantly reduce the need for corneal transplants among keratoconus patients.

Corneal transplant: Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.

For more information on keratoconus, visit All About Vision®.

Hyperopia

Hyperopia, or farsightedness, is a common vision problem affecting about 25% of the U.S. population. People with hyperopia can usually see distant objects well, but have difficulty seeing objects that are up close.

Signs and symptoms of hyperopia

Farsighted people sometimes have headaches or eyestrain, and may squint or feel fatigued when performing work at close range. If you get these symptoms while wearing your glasses or contact lenses, you may need an eye exam and a new prescription.

What causes hyperopia?

Farsightedness occurs when light rays entering the eye focus behind the retina, rather than directly on it. The eyeball of a farsighted person is often shorter than normal.

Many children are born with hyperopia, and some of them "outgrow" it as the eyeball lengthens with normal growth.

People sometimes confuse hyperopia with presbyopia, which also involves difficulty with seeing up close. But presbyopia has a different cause and occurs after age 40.

Hyperopia treatment

Eyeglasses or contact lenses can correct farsightedness to change the way light rays bend into the eyes. If your glasses or contact lens prescription begins with plus numbers, like +2.50, you are farsighted.

Depending on the amount of farsightedness you have, you may need to wear your glasses or contacts all the time, or only when reading, working on a computer or doing other close-up work.

Refractive surgery, such as LASIK or PRK, is another option for correcting hyperopia.

For more information on hyperopia, visit All About Vision®.

Glaucoma

Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intraocular pressure or IOP), which can damage the eye's optic nerve – the structure that transmits visual information from the eye to the brain.

Glaucoma typically affects your peripheral vision first. This is why it is such a sneaky disease: You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness.

Glaucoma is currently the second leading cause of blindness in the United States, with an estimated 2.5 million Americans being affected by the disease. Due to the aging of the U.S. population, it’s expected that more than 3 million Americans will have glaucoma by the year 2020.

Signs and symptoms of glaucoma

Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But there are other forms of the disease (specifically, acute angle-closure glaucoma), where symptoms of blurry vision, halos around lights, intense eye pain, nausea, and vomiting occur suddenly. If you have these symptoms, make sure you immediately see an eye care practitioner or visit the emergency room so steps can be taken to prevent permanent vision loss.

What causes glaucoma?

The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of fluid produced inside the eye and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have.

Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels and vision is lost.

Types of glaucoma

The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The “angle” refers to the structure inside the eye that is responsible for fluid drainage from the eye, located near the junction between the iris and the front surface of the eye near the periphery of the cornea. Some of the more common types of glaucoma include:

Primary open-angle glaucoma (POAG): About half of Americans with this form of chronic glaucoma don't know they have it. POAG gradually and painlessly reduces your peripheral vision. But by the time you notice it, permanent damage has already occurred. If your IOP remains high, the destruction can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead.

Acute angle-closure glaucoma: Angle-closure or narrow angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your field of vision.

Normal-tension glaucoma: Like POAG, normal-tension glaucoma (also termed normal-pressure glaucoma, low-tension glaucoma, or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range. Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.

The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

Congenital glaucoma: This inherited form of glaucoma is present at birth, with 80% of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye. It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Pigmentary glaucoma: This rare form of glaucoma is caused by pigment deposited from the iris that clogs the draining angles, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.

Secondary glaucoma:Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of infection, inflammation, a tumor or an enlarged cataract.

How is glaucoma detected?

During routine eye exams, a tonometer is used to measure your intraocular pressure (IOP). Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye. Either the eye is producing too much fluid, or it's not draining properly.

Another method for detecting or monitoring glaucoma is the use of instruments to create images of the eye's optic nerve and then repeating this imaging over time to see if changes to the optic nerve are taking place, which might indicate progressive glaucoma damage. Instruments used for this purpose include scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy.

Visual field testing is another way to monitor whether blind spots are developing in your field of vision from glaucoma damage to the optic nerve. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals so your eye doctor can determine if there is progressive vision loss.

Instruments such as an ophthalmoscope also may be used to help your eye doctor view internal eye structures, to make sure nothing unusual interferes with the outflow and drainage of eye fluids. Ultrasound biomicroscopy also may be used to evaluate how well fluids flow through the eye's internal structures. Gonioscopy is the use of special lenses that allow your eye doctor to visually inspect internal eye structures that control fluid drainage.

Glaucoma treatments

Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, conventional (bladed) surgery, laser surgery or a combination of these treatments. Medicated eye drops aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage. In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness resulting from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid or increase the outflow (drainage) of this same fluid. Occasionally, a procedure will accomplish both.

Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures – especially the optic nerve – may be prevented.

Early detection is key

No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP.

People at high risk for glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the eye doctor.

For more information on glaucoma and glaucoma treatment, visit All About Vision®.

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