Eye Disease Management

Approximately 75% of Serious Eye Disease is Preventable.

Eye Disease Management

Serious eye disease is common, and many diseases have no symptoms in the early stages. We believe early detection is crucial for the best prognosis. We diagnose and treat a wide array of eye pathology, and have strong relationships with our local ophthalmologists when surgical referrals are necessary.

Optometrists are the primary care doctors for your eyes; that means we should be your first stop when you have a foreign body in your eye, eye infection, spots in your vision or vision loss. Children should be screened by an optometrist at a young age for sight-threatening amblyopia, strabismus, cataract and glaucoma. Here are some of the most common eye diseases we work with:

Amblyopia

Amblyopia, sometimes called lazy eye, is when an eye does not see well, even with the best-possible spectacle prescription.  The eye may look normal, or it may be turned in or out relative to the other one.

When we are born, everything is blurry.  We do not see fine details.  As we experience the world, our eyes and brain are stimulated to develop rapidly, and nerve pathways grow between them that last the rest of our lives.  If something prevents one of our eyes from seeing clearly, our brains never learn how to see the tiny details of fine forms.

While there are several causes of amblyopia, the most common culprits are one (or both) of the following:

  • Strabismus is an eye muscle or nerve imbalance that causes both eyes to look in different directions (‘cross-eyed’, ‘wall-eyed’, etc.). To prevent double vision, the brain decides to simplify things by turning off the input from one eye, thus depriving it of the stimulation required for optimal development
  • Anisometropia means that the prescription is very different for each eye. When both eyes are far-sighted to very different degrees, amblyopia often results.  If one eye has a constantly blurry image due to uncorrected prescription, visual pathways to the brain do not develop to maximum potential.
Age-Related Macular Degeneration (AMD)

Age-related macular degeneration is a leading cause of severe vision loss in our adult population.  It involves change in the macula, a part of the eye’s retina that is responsible for central detail vision (as opposed to peripheral vision).  In the early stages, it may cause blurred vision that cannot be corrected with glasses.  As it progresses, it may lead to distortions, holes, or blind spots in the vision.  AMD is treatable but not curable.  Early detection is key.

Blepharitis

Blepharitis means ‘inflammation of the eyelids’. It is a chronic disorder, meaning it never goes away entirely, but it can be treated and symptoms can be controlled. Blepharitis can be caused by bacteria, parasites, allergies, or systemic diseases like rosacea. It may be asymptomatic, but it may also cause itching around the lashes or brows, loss of lashes, burning eyes, foreign body sensation under the lids, generally sore eyes, and red, irritated eyes.

Binocular Vision and ‘Tracking’ Disorders

To maintain clear and comfortable vision, many complex systems must work together. Sure, refractive error must be corrected to focus light properly. But consider also how the six muscles around each eye must work in perfect coordination; how the autofocus system must change quickly from far to near and back again without conscious thought; how we must incorporate our peripheral vision awareness to know where to move our eyes to read the next word in a sentence smoothly… An inefficiency in any one of these systems put stress on the others. Binocular vision and focussing disorders are common in both children and adults. Please let your optometrist know exactly what symptoms you are experiencing, as this will help guide the exam.

Your optometrist is professionally trained to diagnose binocular vision and tracking disorders and can direct you to appropriate and evidence-based treatments. Computer programs cannot substitute for optometrists in diagnosing binocular vision abnormalities. Other professions, though undeniably well-intentioned, do not have the background to diagnose and treat eye disorders and may inadvertently do more harm than good.

If you will not be attending the eye appointment with your child, please call the office ahead of time if there has been any concern relayed from teachers, or any struggle with academic performance in general. Children generally do not admit to problems.

Cataract

A cataract is a cloudiness or opacity in the eye’s natural lens, which sits directly behind the iris and the pupil. As the lens becomes more opaque, it prevents the passage of light through to the retina, resulting in blur, loss of contrast, and increased glare. While most cataracts are age-related and progress slowly, they may also occur secondary to trauma, some medications, systemic diseases, or be congenital.

Conjunctivitis

Conjunctivitis, or pink eye, is an inflammation of the thin layer of mucous membrane covering the white of the eye and the inside of the eyelids. Eyes may feel itchy, sore, or sticky, or crusty. There may be watery discharge, pus, or stringy mucus buildup. Conjunctivitis may be bacterial, viral, or allergic in origin. It sometimes also looks similar to red eyes caused by dry eye and systemic diseases. Your optometrist has the expertise and equipment to determine the cause of your red or pink eyes and will prescribe the appropriate treatment.

Diabetic Retinopathy

A leading cause of vision loss among working-age people, diabetic retinopathy occurs when fluctuations in blood sugar levels damage the delicate blood vessels in the light-sensitive tissue at the back of the eye. Weak blood vessels tend to leak, leading to hemorrhages, swelling, and poor oxygen supply to the retina. In its earliest stages, there are no symptoms of diabetic retinopathy. Left undetected and untreated, however, it can cause blurred and distorted vision, blind spots, and even progress to retinal detachment and blindness. People with diabetes need at least annual eye exams to monitor for the earliest stages of this complication. If detected early, treatments are often possible.

Dry Eye Disease

Dry eye is a complex disease with multifactorial aetiology, and once the cycle takes hold it can be very difficult to reign in.

The normal functioning tear layer is a thin film across the surface of the eye (cornea and conjunctiva, specifically). It is a soupy mixture of water, oil, mucus, proteins, enzymes, and salts. To maintain comfort and health of the ocular surface, each of these elements must be present in just the right proportions. When they are not, the symptoms and signs of dry eye begin.

The purpose of mucus in our tears is to help the water spread across the surface of the cornea; without mucus, water would just bead up and run off. Too much mucus is produced in response to chronic irritation; it is clumpy, sticky and can blur vision when it moves into your line of sight.

The water in our tears holds the bacteria-fighting enzymes, proteins, and salts, which maintain the pH of the tear film. Too little water produced means there is now too much salt, proportionally! Eyes tend to sting, burn, or even itch; the feeling of actual dryness is often interpreted as tired feeling eyes. Also, when there is too little water, the mucus and oil layers mix together and create tiny balls of ‘gunk’: this creates a gritty, sandy feeling.

The oil layer floats on the surface of the tear layer. It creates a better surface tension to keep the water from flowing out over the the cheeks: that’s why a lack of oil will often result in watery eyes. The oil layer also prevents the water from evaporating into the air. When a dry spot suddenly appears, there is often a sharp pain for a second or two. Poor oil often results in poor water and the symptoms listed above. These symptoms create chronic irritation, which causes the eye to produce more mucus. Mucus interferes with the oil’s ability to coat the eye evenly: The cycle grabs hold and continues on and on…

Your optometrist can determine the specific weakness in your natural tears and together, help you formulate a plan to tackle the disease.

Floaters

Floaters are a very common concern presenting in an optometric office. Some look like little fruit flies, hairs, or webs. Others may look like greyish blobs or indiscreet shadows that drift by your line of sight. A floater can be caused by any opacity in the optical system of the eye. While some floaters are completely benign and even normal, others can alert to potentially sight-threatening conditions.

Most floaters live in the vitreous humor, a jelly that fills up the hollow eyeball. Commonly, loose cells or clumpy spots in the jelly (think of the consistency of a raw egg white) are recognized as floaters. These are the normal kind, which float freely around the inside of the eye. You might see them only in bright lighting, or when looking at a white wall or piece of paper. Unfortunately, there are other very serious conditions that can cause floaters too, such as inflammation, bleeding into the eye, or retinal detachment. It is important that you notify your optometrist about any changes to your floaters. Only through a dilated eye health exam can she determine which kind you have, and whether or not they pose any risk.

Glaucoma

Glaucoma is a group of diseases that cause gradual deterioration of the optic nerve, which sends sensory information from the retina to the brain. There are many types of glaucoma. While most are associated with high fluid pressure building up in the front of the eye, eye pressure may also be low in other types of glaucoma. Often there is poor blood flow to the optic nerve, which makes it more susceptible to damage.

There are no symptoms of glaucoma in early and even moderate stage disease, but it can progress to blindness in late stages. The vision loss it causes is irreversible but progression can be slowed with treatment. Testing for glaucoma involves identifying a person’s risk factors and watching for changes over time. There is not one test for glaucoma that comes back positive or negative. The best chance of early diagnosis and treatment comes from routinely-scheduled regular appointments with your own optometrist, who is familiar with your past measurements.

Posterior Vitreous Detachment

The clear jelly inside the hollow eyeball, the vitreous humor, is loosely attached to the inner walls of the eyeball, except near the front and at the very back of the eyeball, where attachments are stronger. The consistency of the vitreous becomes more watery with age, and we expect the jelly to shrink and peel away from the walls of the eye.

This is called a Posterior Vitreous Detachment. Usually the strong attachment at the back of the eye will pop off as well, leaving a very prominent floater called a Weiss Ring. As the vitreous peels away from the walls of the eye, flashes of light may be perceived due to traction on the retina. Any eye with flashes of light should be checked every six to eight weeks while flashes persist, because if the retina is torn as a result of the pulling, it does not experience any pain.

Please call us to make your appointment.