Conditions

Are Those Stars in Your Eyes? Or is it VIIP?

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Image of stars.

NASA

Space travel, it’s the future. We’ve been hearing about it for decades. But with NASA’s commitment to a mission to Mars by 2030, Elon Musk’s Space X company single-handedly reigniting the excitement of building better rockets, and the International Space Station (ISS) orbiting Earth for nearly 18 years, life among the stars appears to be humanity’s destiny. But before we jump into our spaceships and don our space suits, there are some down-to-Earth, practical matters to attend to: vision issues.

It all started in 2005 when astronaut John Phillips noticed something when he looked down at planet Earth from the space station: it was blurry. Astronauts are expected to have 20/20 vision, so suddenly developing vision problems was, well, a problem. It’s not like you can schedule a visit to your eye doctor three months into your mission to Mars!

NASA Twins

Mike (left) and Scott Kelly. NASA Astronauts.

Years later, and now with 80 percent of long-duration mission astronauts reporting nearsightedness during and after their missions, NASA has been studying what’s happening up in space and has identified the condition as Vision Impairment and Intracranial Pressure (VIIP). In fact, the vision study is one of ten studies commissioned by NASA in their Twin Study this past year. In this study, identical twin brothers Scott and Mike Kelly are being observed for the biological effects of long-duration missions. Scott Kelly was in the ISS for 340 days while his brother Mike remained on Earth.

While the study on the effect on eyes hasn’t been completed yet, preliminary results are that being in a zero-gravity environment does affect the structure of the eyes. On Earth, we have gravity, which pulls our fluids down toward our feet. In space, there is no gravity, so those fluids can remain in the brain, putting pressure on the eyes and flattening the back of them out, causing nearsightedness. This study will help scientists plan for future space travel.


Seeing Double, Double Vision

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double visionAs the name suggests, double vision, called diplopia, is when you see two images of a single object. Double vision can happen in one eye (monocular) or both (binocular). The treatment for diplopia will largely depend on the type you have, and the underlying cause.

Diagnosis

To detect if diplopia is in one eye or both, your eye-care professional will cover one eye at a time during their exam and may use prisms to see what the level of double vision is. Not surprisingly, it is easier to detect in adults, as they can describe what they’re seeing. With children who are unable to talk about their vision, parents may need to watch for various behaviors: squinting, covering one eye to look at things, head tilting, or looking at things sideways.

Monocular Diplopia

According to Harvard Health, the causes of double vision in one eye can be cataracts, astigmatism, keratoconus (where the cornea becomes cone-shaped), pterygium (a growth of tissue on the eyeball), dislocated lens, swelling or mass in the eyelid, or dry eyes (Sjogren’s disease, etc.).

Binocular Diplopia

The causes of double vision in both eyes can be strabismus (crossed eyes), nerve damage, diabetes, myasthenia gravis (neuromuscular/autoimmune illness), Grave’s disease (hyperthyroidism), multiple sclerosis, migraines, stroke, or trauma (black eye).

Treatment

As mentioned above, treatment of diplopia largely depends on what is causing it. If other diseases such as diabetes, Sjogren’s, Grave’s, etc., are at the root of the problem, those conditions will need to be treated independently, and then the double vision problem can be revisited with your eye-care professional. For other issues — such as trauma, cataracts, or astigmatism — surgery or lens correction may resolve the double vision.


Eyelids: Focus on Blepharitis

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Eyelids are the thin skin folds covering our eyes. We use them to blink an astonishing 15-20 times per minute/1,200 times an hour to keep our eyes moist and dust-free. Eyelids block out the light when we sleep. And for some, eyelids are a canvas for applying colorful powders and mascara. From time-to-time, eyelids can develop infections that cause them to become swollen and sore. This condition is called Blepharitis.

Types of Blepharitis

There are two types of Blepharitis, anterior, meaning the outside/front of the lid, and posterior, which is the inner part of the lid, next to the eyeball itself.

Photo of a stye in the eye/Blepharitis

Photo Credit: Andre Riemann

Anterior Blepharitis is caused by bacterial infections or scalp dandruff. Posterior Blepharitis tends to be caused by clogged oil glands known as the meibomian glands. These glands can become infected due to acne rosacea or scalp dandruff.

In some cases, parasites (Demodex eyelash mites) can cause the infection. Blepharitis often occurs with pink eye (conjunctivitis), a stye (a tender, red lump near the eyelashes) and/ or a chalazion (a painless, firm lump).

Symptoms of Blepharitis

  • inflamed, red eyelids
  • burning eyes
  • crusty debris at the base of the lid
  • watery eyes
  • dry eyes

 

Treatment

The most important aspect of treating Blepharitis, according to the National Eye Institute is keeping the eyelid clean. As it is difficult to get rid of, people who get this infection will need to practice good eyelid hygiene for the rest of their lives to keep recurring infections to a minimum. To keep the eyelid clean, a warm compress on the lid will help to soften the crusty bits on the eyelashes, then a diluted solution of water and baby shampoo is used with a clean, fresh cotton swab to gently and carefully scrub the debris away. A fresh cotton swab should be used for each eye to avoid cross-contamination.

If the above solution doesn’t work, your eye-care professional may prescribe antibiotics or, if needed, steroid eyedrops.

In the cases where scalp dandruff present, then dandruff shampoo for the scalp is recommended. Similarly, acne rosacea is causing the infection, then acne treatment under the care of a dermatologist is recommended. By treating these other contributing factors, it can help to reduce the cause of inflammation in the eyelid.


General Info on Age-Related Macular Degeneration

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Image Credit: National Eye Institute

Image Credit: National Eye Institute

For 10 million Americans ages 50 and over, macular degeneration looms on the horizon of age-related concerns. Macular degeneration is an incurable vision disease that attacks the center part of the retina (at the back of the eye) where “millions of light-sensing cells that provide the sharp, central vision” reside (National Eye Institute). The macula records the images we see and relays them to the optic nerve, which then passes the information to the brain.

These cells are responsible for our ability to read, to recognize faces, for driving, and for doing any close-up, detail work such as needlepoint. If these cells become damaged, the central field of view can become blurry, distorted, or form dark splotches.

Detection of Macular Degeneration

Comprehensive eye exams are the first line of detection for macular degeneration. During the visual acuity and eye dilation portion of the exam, eye-care professionals are able to look for yellowish deposits called drusen and for any pigment changes in the retina. The size of the drusen deposits will determine how advanced the macular degeneration (if any) has become.

Stages of Macular Degeneration

There are three distinct stages of this disease:

  • Early:  In this stage, the drusen deposits are medium-sized. There typically is no change in vision for the patient.
  • Intermediate:  At this point, the drusen will be large, and there may also be changes in the retina’s pigment.
  • Late:  Drusen deposits will be large, pigment changes will be present, and there will be vision loss at this stage. According to the American Macular Degeneration Foundation, the degeneration will be classified as either atrophic (dry) or exudative (wet).
    • Atrophic cases tend to be age-related, and 85-90 percent of macular degeneration falls into this classification. There is no leakage of blood or serum into the eye. Vision may still be good but may be fluctuating. Patients may have limited reading ability in dim lighting (such as in restaurants at night).
    • Exudative cases make up the remaining 10-15 percent. Exudative – or wet – macular degeneration occurs when abnormal blood vessels grow under the retina and bleed or leak fluid. This distorts vision.
Prevention and Treatment 

While there is no cure for macular degeneration, there is strong evidence that leading a lifestyle that promotes wellness will go a long way toward staving off the advancement of the disease. Not smoking, exercising regularly, eating a healthy diet with plenty of green leafy vegetables, and maintaining normal blood pressure levels, will all go a long way toward overall good health as well as preserving vision.

For intermediate- and late-stage atrophic (dry) macular degeneration, studies have shown that high doses of vitamins C and E, along with zinc and copper, can reduce the disease by up to 25 percent. For the exudative (wet) cases, anti-VEGF treatment (periodic injections in the eye of Avastin or Eylea) allows patients to remain stable instead of getting progressively worse.

The National Eye Institute has more comprehensive information available on the studies.


Condiciones y enfermedades de los ojos

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For our Spanish-speaking patients, we’re providing a link to articles in Spanish about common eye conditions at AllAboutVision.com. This site provides information about the following conditions:

If you have specific questions about your eyes, call us at (609) 653-9933 and ask to speak to Fransheska who speaks both English and Spanish and can help you.


Melanoma in Your Eyes

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Eye Graphic - Melanoma

Graphic courtesy of National Cancer Institute

When people generally think of melanoma, they usually think of skin cancer. And while it is rare, melanoma can develop in the eyes. It is called ocular melanoma and, according to the Ocular Melanoma Foundation, up to 2,500 Americans are diagnosed with this form of cancer each year.

“Melanomas are a type of cancer that develop in the cells that produce pigment. Pigment is the substance that gives your skin, hair and eyes color,” explains the American Academy of Ophalmology’s website. Melonaomas tend to develop in the uveal part of the eye, which is one of the three layers of the eye, the other two being the sclera (outer layer) and retina (innermost layer).

The problem with ocular melanoma is that it typically doesn’t have symptoms and is usually only detected during a routine, comprehensive eye dilation exam.

Who is at Risk?

Research suggests that there is a strong genetic component for people who develop eye cancer and that it tends to affect those with lighter skin tones who have blue or green eyes and of that group, it tends to affect people ages 50 and above. Another major factor, not surprisingly, is overexposure sunlight or ultraviolet light from tanning beds. The simple act of wearing sunglasses can go a long way toward reducing the risk of developing ocular melanoma.

How is it Detected?

As mentioned above, a routine eye exam where eyes are dilated is the best detection method, given that the cancer is relatively symptom-free. That said, if you notice dark spots on your iris (colored part of your eye), a change in the shape of your pupil, blurred vision, or a loss of vision, you should see your eye care professional. These issues can also be present for other eye problems, so further assessment will be needed.

If eye cancer is suspected during the routine eye exam, the next step may be to see a specialist for an ultrasound of the eye, a fluorescine angiography (where dye is injected into your body and a special camera takes pictures of the contrast image), or a biopsy (where eye tissue is removed and examined).

How is it Treated?

Depending on the severity of the ocular melanoma, radiation and/or surgery are the traditional treatments. In the last few years, medical oncologists at Memorial Sloan Kettering Cancer Center have been testing experimental drug therapies and are having promising results.


It’s a bird! It’s a plane! Never mind, it’s just a floater.

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Floaters are tiny spots that randomly appear in your vision. According to the Mayo Clinic, “they may look like black or gray specks, strings, or cobwebs that drift about when you move your eyes and appear to dart away when you try to look at them directly.” They tend to be more visible when you look at bright surfaces such as computer screens, white paper, or a blue sky.

But where do they come from in the first place? Are they harmful? And can they be treated?

Drawing of the various components of the human eye.

Image Provided by National Eye Institute

Floaters, while an apt description, are actually formed from vitreous, the gel-like substance that makes up around 80 percent of the eyeball (see diagram) and helps to maintain the round shape of the eye. As we begin to age, it begins to shrink. During this process, microscopic vitreous fibers begin to clump together and they then form the floaters.

People who are nearsighted, those who have diabetes, or folks who have had cataract operations tend to have more floaters than others (National Eye Institute). While not harmful in and of themselves, as with most things, a sudden increase in their volume – to where they begin to affect your vision – can be problematic. If you lose your peripheral vision or see flashes of light with the increased floaters, you may have a retinal detachment, which is a serious condition requiring immediate medical attention.

In cases where the floaters are affecting vision and can no longer be simply ignored, a surgical procedure called a vitrectomy can be performed. In this surgery, the vitreous gel is removed from the eye and replaced with a salt solution. As with most surgeries, the risk of complications must be fully considered as your sight could be adversely affected.


Learn About Your Eyes and Diabetes

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November is National Diabetes Month

Did you know that this disease can be detected through a routine, comprehensive eye exam? The American Optometric Association says that diabetes is the leading cause of vision loss for Americans under the age of 74. If left untreated, it may lead to blindness, so it is important to keep diabetes under control through dietary choices, exercise, not smoking, and if needed, medicine.

DEDInfographic

What is diabetes?

The Diabetes Research Institute describes this condition as, “A group of diseases where there is too much sugar (glucose) in the blood. Sugar comes from the foods we eat, like bread, cereals, pasta, rice, fruit, starchy vegetables and dairy items. Sugar is used by the body for energy. Insulin is a hormone that is made in the pancreas and works like a key to a door – insulin opens the door of the cells of our body allowing the sugar to go from the bloodstream into the cells where it is then used for energy. If there is not enough insulin or if the insulin can’t open the door to the cell, the sugar levels rise in the blood and diabetes occurs.”

The most common type of the disease is type 2 diabetes (a chronic condition that affects the way the body processes glucose), type 1 diabetes (also a chronic condition where the pancreas produces little or no insulin), prediabetes (where blood sugar is high, but not high enough to trigger type 2 diabetes), and gestational diabetes (which affects pregnant women).

The primary effects of diabetes are high blood pressure, high cholesterol, and a lack of blood glucose control.

What are the symptoms of diabetes?

Typically, people with diabetes will feel thirsty, hungry, tired, have to urinate frequently, and have blurry vision.

How does diabetes affect the eyes?

Because diabetes increases blood sugars in blood vessels, causing them to swell and leak, it can affect the blood vessels in the eyes as well. This can lead to several eye conditions, most noticeably in the retina, the light-sensitive tissue at the back of the eye.

A major complication of the disease is diabetic retinopathy, which is a condition causing progressive damage to the tiny blood vessels in the retina.

According to the American Diabetes Association, having diabetes may increase your chances of having additional eye-related complications as well: a 60 percent increased risk for cataracts, a 40 percent increased risk for glaucoma.

How can comprehensive eye exams help?

During the comprehensive eye exam, eyes are dilated with eye drops, allowing a clear view of the blood vessels at the back of the eye. By having yearly exams, an eye-care professional can detect retinopathy, cataracts, and glaucoma early and start treatment programs.

 

 

 


Glaucoma – A two-part series

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This will be a two-part series on glaucoma that will include the main types of the disease, the symptoms and risk factors, and treatments available to combat the disease.  

What is Glaucoma? 7544734516_bc4180a6f4_z

Glaucoma is a group of eye diseases which produces increased pressure within the eye, due to a fluid build-up. Over time, according to the Glaucoma Foundation, this pressure can cause damage to the optic nerve and cause vision loss. The optic nerve is part of the central nervous system and carries the visual information from the eye to the brain. Once pressure builds on this nerve, it can start to die, and may lead to blindness.

There are several types of glaucoma, but the two most common are open-angle and closed-angle, with open-angle being far more common of the two. In fact, it is estimated that at least 90 percent of all glaucoma cases are this type, affecting about three million Americans.

Open-Angle Glaucoma

Open-angle glaucoma tends to develop slowly over time and does not present with noticeable symptoms until well into the disease. The Glaucoma Research Foundation says, “Glaucoma is an eye disease that gradually steals vision.” By the time the patient is aware of vision loss, it is often too late to prevent it. Vision loss due to glaucoma is permanent. Open-angle glaucoma is caused by the slow clogging of drainage canals within the eye structure, which results in increased eye pressure. The aspect of “open angle” refers to the angle where the iris meets the cornea is as wide and open as it can be.

Risk Factors 

So the question begs, if you don’t know it’s happening, how can you prevent it or stop it? One way is to understand common risk factors. Knowing your family medical history is an excellent place to start since glaucoma tends to be hereditary. Those of African-American or Latino descent are also at risk. And those who are diabetic, obese, or have cardiovascular disease may also be at higher risk of developing glaucoma. Of course, age plays a factor as well.

Prevention

Knowing if you are at risk is just one part of the equation, however. The best line of defense is getting annual check-ups with your eye-care professional. They will perform a comprehensive dilated eye exam, which will help to diagnose early signs of glaucoma.

Treatment

If it is determined that you have open-angle glaucoma, medications are available to help reduce eye pressure, and several different types of surgery are available as well, including selective laser trabeculoplasty and argon laser trabeculoplasty.

Part two of this series will focus on closed-angle glaucoma and will be posted on Monday, October 10. 

 


Aging Eyes

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 Reading Newspaper It starts out simply enough. One day, you hold the newspaper, magazine, book, or menu you’re reading a little farther away than you did before. Time marches on and a while later – after you’ve been slowly adjusting – you realize that you’ve run out of arm to hold your newspaper and that’s when it dawns on you: either your arms have gotten shorter or your eyes are starting to go.

Welcome to middle age.

According to the AARP (American Association of Retired Persons), right around the age of 40, many adults begin to develop age-related eye conditions. The most noticeable one is called presbyopia (prez-bee-OH-pee-uh), a loss of near vision. This happens when the lens of the eye starts to stiffen, making it harder to see close objects. In addition to your vision changing, the National Institute on Aging says presbyopia can cause headaches or strained, tired eyes. A visit to an optometrist will help you to identify if just a pair of reading glasses or a bifocal or multi-focal prescription is necessary. All About Eyes has a wide variety of eyeglasses available to choose from.

Aging Eyes

In addition to presbyopia, some adults will begin to see a need for better lighting when they read. When the lens of the eye becomes less transparent, it makes it harder for light to pass through to the retina. The Merck Manual, a reference for doctors, says that adults ages 60 and above need three times more light to read than a 20-year-old.

Other issues that can affect aging eyes are changes in how color is perceived, due to the lens yellowing over time, making it harder to spot the difference between shades of the same color or similar colors. Dry eyes can also start to happen, where the fluid lubricating the eyeball begins to diminish. And then, there are the floaters. As we age, more floaters will begin to appear in our field of vision. The spots can look like clear or dark strings. You may notice them more when looking at the sky during daytime or other bright, plain surface. They are made up of bits of normal fluid that have solidified. And finally, cataracts may also develop as we age. Cataracts are a clouding of the lens in the eye which causes the vision to progressively get blurrier. They can be removed by surgery.

Regular check-ups with your optometrist can help to identify – and in many cases – correct all of these aging eye issues.