Eye Conditions
Cataracts
Cataracts are the leading cause of visual loss in adults age 55 and older and the leading cause of blindness worldwide. By age 65, about half of the human population has a cataract, and by age 75, almost everyone has a cataract. However, cataracts are highly treatable, and through advances in both cataract surgery and intraocular lenses (IOLs), more people are experiencing full restoration of their vision than ever before.
Cornea/Conjuctiva
The cornea is the front clear part to the eye that covers the iris (the colored part of the eye). It is composed of five different layers, all of which work together to provide a clear window for images into the eye. The cornea provides focusing power for the eye and along with the lens helps to focus images on the retina in the back of the eye.
Fuchs Dystrophy (Insert Eyemaginations video Other diseases: Fuchs dystrophy) Fuchs dystrophy is an inherited condition in which the cells lining the inside of the cornea are diseased and fewer in number. These cells are called endothelial cells, and they are responsible for keeping the cornea thin and clear and preventing it from swelling. Fuchs dystrophy is inherited in an autosomal dominant fashion, which means that there is a 50% chance of each child of an affected individual having the condition. At birth, each individual is born with a set number of endothelial cells. With aging,there is a normal loss of cells; however, in Fuchs dystrophy, this loss of cells is accelerated so that by age 50 or 60 (earlier or later in some patients), affected patients may start to experience symptoms from corneal swelling. Symptoms include blurred vision and fluctuating vision, with vision usually worse in the morning and improving during the course of the day.
In mild cases, before there has been extensive cell loss, eyedrops can be used to help reduce swelling and clear the vision. In more advanced cases, however, there may be too much swelling and clouding of the cornea for medicines to overcome. For these patients, a corneal transplant may be recommended. Up until a few years ago, the only surgical option involved a full-thickness corneal transplant, in which all five layers of the cornea were removed and replaced. A new procedure, called DSEK (Descemet’s stripping endothelial keratoplasty), has been a surgical breakthrough (link to DSEK procedure). In this procedure, only the inner, diseased layers of the cornea, including the endothelial cells are replaced. This procedure, compared to a traditional corneal transplant, is much safer and allows for a much quicker recovery. Within a matter of a few weeks to months, the new transplanted endothelial cells pump out the swelling in the cornea, restoring a patient’s corneal clarity and significantly improving the vision.
Corneal ulcer A corneal ulcer is an infection on the cornea. If there is a breakdown of the surface of the cornea, the deeper layers can become susceptible to infection. Symptoms of a corneal ulcer include redness, irritation, burning, light sensitivity, tearing, blurry vision, and difficulty keeping the eye open. Depending on the size of the ulcer, you may be able to see a white spot on the cornea when looking in the mirror. Contact lens wearers are particularly susceptible to corneal ulcers. Patients with dry eye are also at risk. If you are a contact lens wearer and experience any of the above symptoms, see your ophthalmologist immediately. Your ophthalmologist will examine your eye and start you on antibiotic eye drops. Treatment needs to be started immediately, as corneal infections can lead to scarring and loss of vision.
Keratoconus Keratoconus which literally means “cone-shaped cornea,” is a progessive disorder resulting in thinning and bulging of the cornea. It is an unusual eye condition, affecting 1 in 2000 individuals, usually in their twenties. Early in the course of the disease, patients may notice mild blurring or distortion of their vision. Patients usually also have a high degree of astigmatism (see link to astigmatism) and frequent changes in their glasses prescription. Sometimes, patients with keratoconus can achieve good vision in glasses. However, most of the time patients will need to wear a rigid contact lens for best vision. A small percentage of patients cannot achieve good vision with either glasses or contact lenses. For these patients, surgery may be necessary. Having trained with the nation’s leading corneal surgeons, Dr. Kubal offers advanced surgical treatments for keratoconus not offered elsewhere, including Intacs (link to Intacs http://www.intacsforkeratoconus.com) and partial thickness corneal transplants (also known as DALK or “deep anterior lamellar keratoplasty”).
Viral conjunctivitis (“pink eye”)
Viral conjunctivitis (“pink eye”) is an infection of the white part of the eye. It is usually caused by adenovirus, one of the same viruses that causes the common cold. Therefore, it is not unusual for patients to have upper respiratory symptoms either preceding or during the eye infection. Patients will usually describe redness, tearing, and irritation of one or both eyes. There may also be associated eyelid swelling or discharge. The body clears the infection in a matter of one to two weeks. Antibiotic drops are usually not indicated. Cool compresses with a cool, moist washcloth and frequent use of artificial tears are helpful in relieving discomfort. This infection is extremely contagious and can easily spread from one eye to the other and from one patient to another. Therefore, it is important that infected individuals be very careful about washing their hands and disposing contaminated facial tissues. Taking time off from work or school may be necessary to avoid the spread of infection.
Allergic conjunctivitis Patients with red, itchy, watery eyes may suffer from allergic conjunctivitis. Some patients may have a history of seasonal allergies accompanied by a runny or stuffy nose. Others may have a history of asthma. Certain environmental triggers, such as dust, pollen, or mold may trigger symptoms, which are usually seasonal, occurring at a certain time of year. Avoiding the allergen, if known, is the first step in eliminating symptoms. Cool washcloths or artificial tears can also help. However, if these are inadequate, your ophthalmologist can provide you with prescription medications that are very effecting in providing relief.
Subconjunctival hemorrhage A subconjunctival hemorrhage develops when a blood vessel in the conjunctiva breaks, leaving a bright red spot on the white part of the eye. The redness is blood trapped under the conjunctiva, a clear membrane that covers the white of the eye (called the sclera). While alarming in appearance, it generally is painless and resolves in about one week.
Pterygium (insert Eyemaginations video Other diseases: Pterygium) A pterygium is an abnormal growth from the conjunctiva (the white of the eye) over the cornea. Pterygium usually grow from the inside corner of the eye near the nose toward the center of the cornea. Small pterygia usually do not cause any symptoms. Larger pterygium can sometimes become red, inflammed, or irritated. Sometimes pterygium can grow large enough that they blur the vision, either by distorting the shape of the cornea or by physically blocking the vision. If they are causing symptoms, they can be surgically removed (see link). All of our surgeons use new, innovative techniques to remove pterygium and prevent their recurrence. Please use UV block sun glasses to prevent this problem.
Pingueculum A pingueculum, like a pterygium, is a growth on the white part of the eye that results from sun damage. Unlike a pterygium, however, it does not grow over the cornea. Patients may sometimes notice these as a gelatinous appearing white lumps. These usually do not cause any problems and do not need to be removed. However, sometimes they may become red and inflammed. If this occurs, treatment with anti-inflammatory eye drops may be of benefit. Wearing sunglasses and keeping the eye lubricated with artificial tears can prevent the pingueculum from getting larger. Please use UVA and B block sun glasses to prevent this problem.
Dry Eye
Dry Eye is an extremely common eye condition with higher prevalance in the elderly and among women. Approximately 10-15% of adults over the age of 65 suffer from dry eyes. Some patients will have an underlying endocrine or immunologic condition, such as thyroid disease, Sjogren’s syndrome, or rheumatoid arthritis that results in decreased tear production. Symptoms of dry eye include irritation, redness, stinging or burning, and contact lens intolerance. Blurry vision or eye strain is also common, particularly at the end of the day or with prolonged reading or computer work. Patients also often describe a gritty sensation in the eyes, and tearing, although seemingly counter intuitive, is a frequent complaint as the irritation from the dryness stimulates additional tear production. Dry eye can be a cause of significant discomfort and can greatly affect quality of life. Fortunately, a number of treatments are available that can help provide relief. Environmental changes such as avoiding smoke-filled places or using a humidifier to increase the moisture in the air are important first steps. Dietary modifications, including increasing hydration and consuming foods rich in omega-3 fatty acids (salmon, flaxseeds, walnuts, almond), are also beneficial. Omega-3 supplements, such as Tozal eye health formula offered for sale at our office , are a good alternative for those who do not get enough omega-3 fatty acids in their diet. Artificial tear drops and lubricating ointments are available over the counter and are also useful first-line treatments. If these alone cannot bring your dry eye symptoms under control, your ophthalmologist may recommend a prescription eye drop to help stimulate your own natural tear production. Tear duct plugs are another excellent option. Each eye has two tear drains located near the nose, one on the upper eyelid and one on the lower eyelid. A small plastic plug can be placed into one or both drains to prevent drainage of tears off the surface of the eye and keep the ocular surface moist. These plugs are placed in the office, and the insertion process is quick and painless. If you suffer from dry eye, ask your ophthalmologist about your treatment options.
Glaucoma
Glaucoma (Insert eyemaginations video Glaucoma: glaucoma description)
Glaucoma is an eye disease in which patients lose peripheral vision. It is associated with elevated eye pressures which cause damage to the optic nerve, a structure that connects the eye to the brain. Glaucoma is a slowly progressive disease usually affecting patients later in life. The loss of vision early in the disease is often imperceptible to most patients. However, as the disease progresses patients may describe “tunnel vision,” with severe limitations of their peripheral vision. If left untreated, glaucoma can even involve the central vision and lead to blindness. People at high risk include those who are over the age of 40, diabetic, near-sighted, African-American, or who have a family history of glaucoma. For those diagnosed with glaucoma, there are a number of excellent treatments designed to prevent further loss of vision. Unfortunately, there are no treatments currently available to restore vision that has been lost by glaucoma. Eye drops are used as initial treatment, but for those with more advanced glaucoma, laser and surgical options are also available (link to section on surgical treatments for glaucoma). With a thorough eye exam and the help of additional tests, your ophthalmologist at Santa Monica Eye Medical group can detect early glaucoma and successfully prevent further loss of vision.
Eye Lids
Dermatochalasis (upper eyelid bags) Dermatochalasis refers to excess upper eyelid skin and it is usually a result of aging (insert image of dermatochalasis from smeyemedinstitute.com website). Patients with dermatochalasis have very loose, redundant eyelid skin that often hangs over the upper eyelid lashes. In addition to being a cosmetic issue for patients, dermatochalasis can be a functional problem as well, with the excess skin weighing down the eyelids and blocking the vision. This extra skin can be removed with a simple procedure called blepharoplasty (link to blepharoplasty).
Blepharitis (Insert eyemaginations video Other diseases: blepharitis)
Blepharitis is an inflammatory condition of the eyelids. Both the upper and lower eyelids can become coated with oily, scaly particles and bacteria near the base of the eyelashes. This condition is also associated with meibomianitis which is a disruption of the oil glands of the eyelids, called meibomian glands. This common condition may cause irritation, itchiness, redness, and stinging or burning of the eye.
Chalazion (Insert eyemaginations video Other diseases: chalazion)
A chalazion is a collection of oil within an eyelid oil gland that has become inflamed. Most patient see and feel a red bump within the eyelid that can be tender. A chalazion is caused when the opening of an oil-producing gland in the eyelid called the meibomian gland gets clogged with oil and becomes enlarged. Treatment with hot compresses to the lid for 3-5 minutes several times a day along with eye lash wash with baby shampoo can help to unclog the oil plug and allow drainage of the inflamed material. Sometimes despite of all these treatments, surgical excision and drainage of the gland or steroid injection to the gland may be needed. Consult your ophthalmologist to discuss your treatment options.
Entropion Entropion refers to a condition in which the eyelids, usually the lower eyelid, turn in towards the eyeball, resulting in eye irritation, light sensitivity and foreign body sensation due to lashes rubbing the cornea. Entropion is usually the result of aging or scarring. This condition usually requires surgical correction.
Ectropion Ectropion, which is also usually due to aging, involves the outward displacement of loose lower eyelids from the eyeball. This can cause excessive dryness or tearing and eye irritation. Like entropion, this condition can be corrected surgically.
Ptosis Ptosis is a drooping of the upper lid of one or both eyes which can be present at birth, or can be acquired later in life. Ptosis can be corrected surgically for functional or cosmetic reasons.
Retina
The retina is the light-sensitive tissue that lines the back of the eye. Light rays are captured by the retina and transmitted to the brain where they are interpreted as images. There are a variety of eye conditions which involve the retina:
Age-related macular degeneration (AMD) is a deterioration of the eye’s macula. The macula is a small area in the central part of the retina that is responsible for your central vision, allowing you to see fine details clearly. Many older people develop macular degeneration as part of the body’s natural aging process.
A break in the center of the retina, or fovea, is called a macular hole. Symptoms can include distortion or blurring of the vision. Some patients may benefit from surgical correction of the break.
An epiretinal membrane is an accumulation of tissue on the central retina which wrinkles or puckers the retinal surface. Patients who are symptomatic may experience distorted or blurred vision. Based on a patient’s visual symptoms, a surgical procedure to remove the membrane may be performed.
Macular edema is a painless condition in which swelling or thickening occurs of the central retina (macula) and is usually associated with blurred or distorted vision. One common cause of macular edema is diabetes (diabetic macular edema). Macular edema can also occur in patients who have had cataract surgery (pseudophakic macular edema), or in patients with uveitis or vein blockages, or occlusions. Depending on the cause of the edema, treatment may include eye medications including corticosteroids and non-steroidal anti-inflammatories, or laser treatments.
Central Serous Retinopathy or CSR
is an eye condition that usually occurs in one eye in patients between the ages of 30-50, more often men, where there is a blurring or distortion of the central vision due to leakage of fluid under the retinal tissue in the back of the eye. It is thought that stress can be a cause of CSR. Normally there is a barrier or seal between the supportive tissue of the retina, or choroid, which does not allow fluid to enter the sub-retinal space. In CSR, the seal breaks down and fluid accumulates in the subretinal space. Treatment is generally observation, with resolution of signs and symptoms over a few weeks to a few months. In patients where the fluid does not resolve on its own, a laser treatment may help to encourage the fluid to be reabsorbed.
Choroidal Melanoma
Choroidal Melanoma, which is similar to melanoma of the skin, can grow inside the eye. Unlike skin cancers, choroidal melanomas are not visible to the patient and require a full dilated ophthalmologic examination for proper identification and treatment. On examination, a choroidal melanoma appears as an elevated retinal mass which is usually pigmented but on occasion can be amelanotic (non-pigmented). It is very important to have routine dilated examinations by an ophthalmologist to rule out this unfortunate cancer. If it is diagnosed early it can have a better prognosis and can be life-saving to the patient.
Hypertensive retinopathy
High blood pressure can cause problems in the retinal blood vessels, including bleeding, lack of oxygen, and even a stroke of the eye. If this occcurs, severe vision loss may result. Good preventative care with excellent blood pressure control and routine eye exams can prevent these unfortunate outcomes.
When the retina pulls away from the back of the eye, it is called a retinal detachment. A retinal detachment can cause a curtain or shadow in the vision especially at the peripheral vision, or a sudden decrease in vision along with many new floaters and flashing lights. Patients should seek immediate medical attention for retinal detachment symptoms.
When people reach middle age, the vitreous gel may start to shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters. Some patients may also experience flashes of light which occur when the vitreous gel pulls or tugs on the retina. Flashes and floaters may be a symptom of a tear in the retina, so patients should call their ophthalmologist right way to schedule an eye examination.
Diabetic retinopathy, the most common diabetic eye disease, is caused by changes in the blood vessels of the retina. Leakage of fluid or blood into the retina (non-proliferative diabetic retinopathy), or the growth of new abnormal blood vessels (proliferative diabetic retinopathy), can cause a decrease in vision. Early detection and treatment, in conjunction with good blood glucose control, are important in the prevention of vision problems from diabetes. To detect changes and prevent any vision loss, it is crucial to have an annual dilated eye exam by your ophthalmologist. It is also very important to have good control of your blood sugar to prevent eye or systemic problems–including kidney and heart disease–from diabetes.
Refractive Errors
Refractive error is an error in the focusing power of the eye and is the most common cause of decreased vision. In a patient who is emmetropic, or who has no refractive error, images are focused on the retina in the back of the eye. In patients with refractive error, images are not focused on the retina, resulting in blurry vision. Fortunately, diminished visual acuity from refractive errors can be corrected with glasses, contact lenses, or laser vision correction. The most common refractive errors are listed below.
Myopia (link to eyemaginations video refractive errors: myopia cause).
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Myopia (nearsightedness) results when the eye has too much power. This may be due to a cornea that is too steep or an eye that is too long. As a result, light is focused in front of the retina. Myopic patients usually have excellent near vision but blurry distance vision.
Hyperopia (farsightedness) results when the eye has too little power, either from a flat cornea or a short eye. As a result, light is focused behind the retina. Hyperopic patients usually have blurry near vision. Distance vision may or may not be blurry depending on the degree of hyperopia.
Astigmatism (link to eyemaginations video refractive errors: astigmatism description).In order to view the content, you must install the Adobe Flash Player. Please click here to get started.
Patients with astigmatism have eyes that are more oval rather than round. Because of the oval shape, light shined in the eye focuses in multiple points in the eye, rather than in a single point on the retina. This results in a blurry or distorted image for both distance and near objects. Astigmatism, like myopia and hyperopia, can be corrected with corrective lenses or laser vision correction.
Presbyopia
Presbyopia is a natural process of aging during which the lens in the eye loses the ability to focus up close. This process usually occurs between the ages of 45-55 but may occur sooner or later in some individuals. Presbyopic patients who never wore glasses before their forties will find that they need to wear reading glasses to help them focus up close. Patients with myopia, hyperopia, or astigmatism, who then reach the age of presbyopia, often need to change their glasses to bifocals in order to provide clear vision for both distance and near tasks