A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.
A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

How can cataracts affect my vision?

Age-related cataracts can affect your vision in two ways:

1. Clumps of protein reduce the sharpness of the image reaching the retina.
The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.
When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.

2. The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.
As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.

If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

When are you most likely to have a cataract?

The term "age-related" is a little misleading. You don't have to be a senior citizen to get this type of cataract. In fact, people can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and do not affect vision. It is after age 60 that most cataracts steal vision.

What can I do, as a patient to minimize the risk of getting eye changes from diabetes?

* Keep weight in the normal range.
* Perform aerobic exercise for 20 minutes on a regular basis three times a week.
* Maintain dietary restrictions as appropriate: consult a dietician
* Have your blood pressure checked and maintained less than 140/90.
* Maintain good control of your blood sugar by regular checks with an internist, and self monitoring with a home glucometer
* Have at least a yearly dilated eye exam by an ophthalmologist. The earlier the treatment, the better the prognosis

What does diabetes do to the eye?

Diabetes may cause changes in the back of the eye, the retina (analogous to the film in a camera)

There are "two flavors" of diabetes in the retina:

* a mild form of leakage of fluid from tiny blood vessels causing "water in the retina" and mild to moderate blurring of vision
* Bleeding from blood vessels, which produces floaters, cobwebs, streaks, or a "lava lamp" effect.

What can you do to treat these conditions?

The painless office Argon Laser is the mainstay of our therapy to treat leaking/bleeding vessels. Before your laser treatment you may also have a diagnostic Flourscien angiography performed in the office. This involves a small injection of a dye in a vein. Special photographs are then taken to help identify "problem areas in the retina" for treatment.

Diabetic Retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes (uncontrolled blood sugar) damages the tiny blood vessels inside the retina, which is the light-sensitive tissue at the back of the eye and will generally affect both eyes.

If you have diabetic retinopathy, you may not initially notice changes of your vision. The earliest phase of the disease is known as background diabetic retinopathy or non-proliferate diabetic retinopathy (NPDR). In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision.

People with non-proliferative diabetic retinopathy may experience no difficulties with vision. However, those who do experience problems are those who develop macular edema or macular ischemia.

Macular edema occurs when the macula, the small area in the center of the retina that provides central detail vision, can swell from the leakage of blood and fluid from blood vessels in the retina. Central vision loss may be mild to severe, and side (peripheral) vision loss can also occur. Reduced sensitivity to color is also a result. Macular ischemia (oxygen-deprived) will occur when small blood vessels feeding the macula block. Because the macula doesn't receive sufficient blood, the cells in the macula no longer work correctly, which causes vision to blur.

The next stage is known as proliferate diabetic retinopathy (PDR). In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, weaker, vessels develop as the circulatory system attempts to maintain enough oxygen levels within the retina. This is called neovascularization. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.

In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and/or glaucoma.

Diabetics should see their eye doctor at least once a year for a dilated eye exam. Your eye doctor may diagnose retinopathy using a special test called fluorescein angiography. In this test, dye is injected into the body and then gradually appears within the retina due to blood flow. Your retina will then be photographed with the illuminated dye. Evaluating these pictures tells your doctor how far the disease has progressed.

According to the American Academy of Ophthalmology, 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time. The possibility of early detection is why it is so important for diabetics to have a dilated eye exam at least once a year.

Diabetic retinopathy can be treated with laser photocoagulation to seal off leaking blood vessels and destroy new growth. Laser photocoagulation doesn't hurt because the retina does not have nerve endings.

In some patients, blood leaks into the vitreous humor and clouds the vision. Your eye doctor may choose to simply wait to see if the clouding will break up on its own. A procedure called a vitrectomy removes blood that has leaked into the vitreous humor. The eye gradually replaces lost vitreous humor, and the vision usually improves.

If diabetic retinopathy has caused your eye to form a cataract, it can be corrected surgically. Patients who have developed glaucoma can usually be treated with topical medicated eye drops.

Secondary glaucoma

Secondary glaucoma is also known as neovascular glaucoma. With this complication, delicate new blood vessels in the eye may form a new group directly on the iris, blocking the outflow of fluid from the eye. This condition results in increased pressure of the fluid in the eye, and can cause optic nerve atrophy and loss of the full visual field. Treatment involves the application of a laser to the leaking areas. Standard glaucoma treatment with drops or diuretics may also be recommended to lower intraocular pressure.

Retinal detachment

The abnormal blood vessels that grow in proliferative diabetic retinopathy are often accompanied by hemorrhage and scar tissue formation. This scarring can cause wrinkling of the retina and even separation from the wall of the globe. This is known as a retinal detachment. Wrinkling of the retina can result in visual distortion whereas retinal detachment can cause severe vision loss depending on where the separation has occurred.

Floaters are little "cobwebs" or spots that float into your field of vision. They are usually small, dark shapes that can look like spots or thread-like strands. They move as your eyes move and seem to move away when you try to look at them directly. They do not follow your eye movements and usually float away when your eyes stop moving.

In most cases, floaters are part of the natural aging process and simply an annoyance. They can be distracting, but eventually tend to "settle" at the bottom of the eye, becoming less bothersome. Most people have floaters and learn to ignore them. Floaters can become apparent when looking at something bright, such as white surfaces or a blue sky.
Floaters occur when the vitreous, a jelly-like substance that fills about 80 percent of the eye and helps it maintain its round shape, slowly begins to shrink. As the vitreous shrinks, it becomes a bit stringy, and the strands may cast tiny shadows on the retina. These are floaters.

Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation. There are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhaging, retinal tears, and injury to the eye.

Sometimes a section of the vitreous pulls the fine fibers away from the retina all at once causing new floaters to appear suddenly. This is called a vitreous detachment, which in most cases is not sight threatening and requires no treatment. However, a sudden increase in floaters, sometimes accompanied by flashes of light or peripheral (side) vision loss, could indicate a retinal detachment. A retinal detachment occurs when any part of the retina is pulled from its normal position at the back wall of the eye. A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent visual loss within two or three days or even blindness in the eye. Those who experience a sudden increase in floaters, flashes of light or a loss of peripheral vision should have an eye doctor examine their eyes as soon as possible.

For people who have floaters that are just bothersome, no treatment is recommended. On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a vitrectomy, a surgical procedure that removes floaters from the vitreous, may be needed. A vitrectomy removes the vitreous gel, along with its floating debris, from the eye. The vitreous is replaced with a salt solution. This operation carries significant risks to vision because of possible complications, which include retinal detachment, retinal tears, and cataracts. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.

Macular degeneration is a common eye condition that can cause visual loss in affected patients. The disease is divided into a dry form and a wet form. The dry form generally causes gradual vision loss from deterioration of the retina. The wet form involves the growth of abnormal blood vessels under the retina called choroidal neovascularization; these blood vessels can leak fluid and blood and cause more rapid deterioration in vision. The diagram illustrates the growth of these abnormal blood vessels under the retina in wet ARMD

There is a new "family" of laser treatments for "wet" macular degeneration or leaky blood vessels in the back of the eye.

Visudyne

Is an office procedure involving a dye injection through an arm vein with simultaneous laser treatment. The laser is painless, and the treatment takes just over one minute. The dye is light sensitive, and is activated by the laser to seal off the leaking blood vessels in the macula, the center of the retina in the back of the eye. Frequently, the treatment has to be repeated every three months until the blood vessels completely stop leaking. Avoidance of sun exposure for 3 days following the treatment is necessary. The treatment decreases the risk of further visual loss, but does not restore reading vision. Visudyne is not for everyone with macular degeneration, but only a special form of leakage which doctors call "classic.". A fluorescein angiogram test or leakage test, which is a photographic test done in the office, is done first to evaluate whether the treatment is appropriate. This treament can halt the progression of macular degeneration, but does not restore the reading vision.

TTT or Transpupillary Thermo therapy

Is another painless office laser treatment for "wet" macular degeneration . A "red wavelength" laser treatment is applied in the office for one minute. This treatment is used for what doctors call "occult" choroidal neovascularization or leaky blood vessels. The doctor can determine if the patient qualifies for this treatment by performing a Fluorescein angiogram. This is an office picture test of the back of the eye. This treament can halt the progression of macular degeneration, but does not restore the reading vision.

A refractive error, is when the focusing of light by the eye in not accurate and leads to blurried vision or reduced visual acuity.

Types

An eye that has no refractive error when viewing a distant object is said to have emmetropia or be emmetropic. An eye that has a refractive error when viewing a distant object is said to have ametropia or be ametropic.

Refractive errors can be divided into spherical errors and cylindrical errors. Spherical errors occur when the optical power of the eye is either too large or too small to focus light on the retina. This can be influenced most by two areas of the eye: the corea or the length of the eye. If your eye is too long or the cornea is too steep your have myopia. If they eye is too short or the cornea is too flat you have hyperopia.

Cylindrical errors occur when the optical power of the eye is too powerful or too weak across one axis of the optics. This too will cause a blur. This is called astigmatism.

Causes

Refractive errors are thought to occur due to a combination of genetic and environmental factors. Trauma or ocular disorders such as keratoconus may induce refractive errors.

Diagnosis

To diagnosis a refractive error, the method is basically provocative. If the symptom of blurried vision is corrected with corrective lenses, and other disease processes are eliminated, the diagnoisis can be made. A phoropter with multiple lenses can be used to measure the power of the refractive error. Once the doctor arrives at an estimate, he or she typically shows the patient lenses of progressively higher or weaker powers in a process known as refraction or refractometry. Cycloplegic agents are frequently used to more accurately determine the amount of refractive error, particularly in children.

An automated refractor is an instrument that call objectively estimate a person's refractive error.

Treatment and management

How refractive errors are treated or managed depends upon the amount and severity of the condition. Those who possess mild amounts of refractive error may elect to leave the condition uncorrected, particular if the patient is asymptomatic. For those who are symptomatic, glasses, contact lenses, refractive surgery, or a combination of the preceding three may be used.

My eyes water , How can I have dry eyes?

Dry eyes are the decline in the quantity or quality of the tears bathing your eye. In other words you can have dry eye if you don’t make enough tears, and you can have dry eye if the tears you make don’t “do the job”. If you have poor quality tears your eye will make extra tears to compensate making the eye water.

If addition to watery eyes, you may feel a sandy gritty sensation. Other symptoms include blurred vision which is cleared by blinking, itching, and red eyes. This can develop as the lacrimal gland, the tear producing gland, slows down over time. Environmental factors such as wind and exposure to chemicals are a few causes of dry eye.

There are two basic concepts to treating dry eye: produce more tears or retain the tears that are made. Artificial tears have been a mainstay in the treatment of dry eye. Most artificial tears attempt to supplement your own tear film. You, the patient best determine what brand is preferred. Preservatives in artificial tears have been implicated in making dry eye worse, so preservative free or preservative disappearing drops are recommended. An additional treatment is punctal plugs which close off “the drain” for the tears and, therefore, help you retain more tears.

Most recently Restatis or cyclosporine has been introduced which helps decrease inflammation in the tear gland. Decreasing the inflammation helps the gland produce more tears.

Dry eye is a chronic syndrome, which means that it usually must be treated for a long time or life. Fortunately, with new medications and treatments, this common eye disease can now be treated easier than ever before.