Patient Education
Please feel free to learn about various vision conditions. If you think that you may be affected by a vision problem do not hesitate to contact our office to arrange for an eye care appointment. 978.744.1177
Definition:
A cataract is a clouding of the lens of the eye. It can be compared to a window that is frosted or yellowed. The pattern of cloudiness within the lens can vary. It progresses over time but at varying rates. Sometimes an early cataract will take years before it becomes visually significant, but less frequently this can happen over months.
Cataracts are the leading cause of visual loss in adults 55 and over.
Treatment:
Surgery is the only way a cataract can be removed. However, if the cataract is not bothering the vision, surgery may not be needed. Sometimes a simple change in your eyeglass prescription may be helpful.
No medications, dietary supplements or exercises have been shown to prevent or cure cataracts.
Cataract Surgery:
Before having cataract surgery, there are a few steps to go through. You will have an ultrasound that measures the length of the eye so we can choose the proper implant. This painless and easy procedure is performed by one of our technicians.
You will also meet with one of our surgical coordinators who will arrange the dates for your surgery and follow up appointments and go over some basic information. Depending on when you last saw your Primary Care Physician (PCP), you may need to see them again to get medical clearance for your cataract surgery.
Our Surgical Coordinators will work with your PCP’s office to ensure that we receive the required information in a timely manner. You will be given a booklet that describes what to expect before & after your surgery. Prescriptions for eye drops will be sent electronically to your pharmacy or you may purchase combination drops at our office.
The Day of Surgery: Surgery is performed at North Shore Cataract and Laser Center in Stoneham, Massachusetts. You may be asked to skip breakfast, depending on the time of your Surgery.
When you arrive for surgery, you will be given eye drops and a mild sedative to help make you comfortable. A local anesthetic will numb your eye. In the operative suite, the skin around your eye will be thoroughly cleansed, and a sterile covering will be placed around your head. You may see light and movement, but you will not be able to see surgery while it is happening and the procedure is generally painless.
Under an operating microscope, two small incisions are made in the eye. In most cataract surgeries , tiny surgical instruments are used to aspirate the cloudy lens from the eye. The back membrane of the lens (Posterior capsule) is usually left in place. It is the original covering of the lens and is used to hold the implant. Then an acrylic or silicone intraocular lens is implanted in the eye to replace the natural lens that was removed.
After surgery is complete, your doctor may place a shield over your eye. After a short stay in the outpatient recovery area, you will be ready to go home.
Definition:
Macular Degeneration is a disease of the macula, a small area in the retina at the back of the eye. The macula allows you to see fine details clearly and do things such as read and drive. When the macula does not work properly, your central vision can be blurry and have areas that are dark or distorted. Macular Degeneration effects your ability to see near and far, and can make some activities, like threading a needle or reading, difficult or impossible.
Macular Degeneration is the most common cause of severe vision loss in people older than 50.
Although Macular Degeneration reduces vision in the central part of the retina, it usually does not effect the eye’s peripheral (side) vision. For example, you may be able to see the outline of a clock but not tell what time it is. Macular Degeneration alone usually does not cause total blindness. Even in more advanced cases, people usually continue to have some useful vision and are often able to take care of themselves. It may not effect your vision very much, in other cases, however, vision loss may be more rapid and severe.
Cause:
Many older people develop Macular
Degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is Age Related Macular Degeneration (AMD or ARMD).
Major risk factors for AMD are:
- Smoking
- Being more than 50 years old
- Having a family history of AMD
- Abnormal cholesterol levels
Many people with AMD have deposits under the retina called drusen. Drusen alone usually does not cause vision loss, but when they grow in size or number, there is an increased risk of developing advanced AMD. The two most common types of AMD are dry (non-neovascular) and wet (neovascular).
Symptoms: Macular Degeneration can cause different symptoms in different people. Some people hardly notice AMD in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. But when both eyes are effected, you notice the loss of central vision quickly. Usually, you notice vision loss when you find:
- Words on a page look blurred
- A dark or empty area appears in the center of your vision.
- Straight lines look distorted, as in the following diagram.
Treatment:
Anti-VEGF Treatments, Laser Surgery and PDT
These procedures may save more of your sight overall, though they are not cures that bring your vision back to normal. Even with advanced medical treatment, many people with Macular Degeneration still experience vision loss.
You should check your vision daily by using an Amsler grid like the one provided below. You may find changes in your vision that you wouldn’t notice otherwise. Putting the grid on the front of your refrigerator is a good way to remember to look at it each day.
Glaucoma Definition
Glaucoma is a disease of the optic nerve which can over time lead to vision loss and blindness. The optic nerve is a bundle of over 1 million nerve fibers, analogous to a cable that transmits signals from the back of the eye to the brain. Glaucoma is associated with the death of these healthy nerve fibers over time. Initially, this leads to loss of peripheral vision which most often is undetectable to the patient. As the disease progresses it affects the central vision at which point substantial damage to the optic nerve has already been done.
Cause
Many forms of glaucoma exist. These include open-angle glaucoma, angle-closure glaucoma, congenital glaucoma and many secondary forms of glaucoma. In open-angle glaucoma, fluid is produced by the ciliary body, a structure in the back of the eye behind the iris, and flows towards the anterior chamber, the front portion of the eye. When fluid reaches the front part of the eye, it drains through the spongy tissue called the trabecular meshwork. In a sense, the eye can be thought of as having a faucet and a drain that controls the amount of fluid it holds. When too much fluid builds up, it can permanently damage the optic nerve which is a pressure sensitive tissue. Loss of optic nerve tissue leads to loss of vision since the eye does not have a healthy cable to relay these signals to the brain. This type of glaucoma can develop in eyes that have high or even seemingly normal eye pressure. This differs from angle closure glaucoma, where fluid produced by the eye cannot reach its drainage system because it is blocked by iris tissue, the colored part of the eye. In congenital glaucoma, children are born with trabecular meshwork that is defective and does not drain properly. Secondary glaucomas can develop as a result of pre-existing eye conditions such as a cataract, tumor, or inflammation to name a few. Open-angle glaucoma tends to be the most prevalent form of glaucoma. A few risk factors for the development of this type of glaucoma include African American race, increased age, and a family history of the disease.
Symptoms
Glaucoma often goes undiagnosed because in most cases it is not associated with any eye pain. It can also go undetected for a while because it initially causes loss of peripheral vision before affecting the central, most noticeable, part of our vision. Your ophthalmologist can perform a comprehensive eye exam and order specific glaucoma tests designed to diagnose and monitor your condition.
Treatment
There is no cure for glaucoma. All treatment is geared towards slowing down the disease process. There are three main treatment options. The first is medications in the form of eye drops or pills. The medications act to either decrease the rate of fluid production or increase the rate of drainage. Laser surgery can also be used to help stimulate the outflow of fluid. This is a procedure that can be performed at your doctor’s office and may require repeated attempts in order to be effective. The last option is conventional surgery. This is performed in a hospital setting. The purpose is to physically create another drainage site for the eye allowing for the pressure to be more effectively managed.
Definition:
A medical eye examination is the best way to detect vision changes inside your eye. If you have diabetes mellitus, high blood sugar levels can damage blood vessels in the retina (the layer at the back of the eye that senses light and helps to send images to the brain). The damage to retinal vessels is referred to as diabetic retinopathy.
Types of Diabetic Retinopathy:
There are two types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking deposits are called exudates.
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema, macular ischemia or both.
Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of vision loss in diabetic individuals.
Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly.
PDR is present when abnormal new vessels (neovascularization) grow on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to re-establish the blood supply that has been lost.
Unfortunately, the new abnormal blood vessels do not work properly. They can leak and are often accompanied by scar tissue that may cause wrinkling or detachment of the retina.
PDR has the potential to cause more severe vision loss in the following ways:
Vitreous hemorrhage– The fragile new vessels may bleed into the vitreous, a clear, gel-like substance that fills the center of the eye. If the vitreous hemorrhage is small, a person might only see a few new, dark floaters while a large hemorrhage might block the vision completely.
It may take a few weeks up to many months to re-absorb the blood, depending on the amount present. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy surgery may be recommended.
Vitreous Hemorrhage alone does not cause permanent vision loss. When the blood clears, vision may return to its former level unless the retina is otherwise damaged.
Traction retinal detachment. When PDR is present, scar tissue associated with neovascularization can shrink which causes wrinkling and pulling on the retina. Macular wrinkling can cause visual distortion. The pulling force on the retina may tear it leading to a retinal detachment.
Neovascular glaucoma. Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris (the colored part of the eye) and in the drainage channels near the front of the eye. They can block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.
Rapid changes in blood sugar can cause fluctuating vision in both eyes, even if retinopathy is not present. As a diabetic, you should have your eyes checked by an ophthalmologist yearly or sooner, especially if you notice any sudden vision Changes.
Pregnant women with diabetes should schedule an appointment in the first trimester because retinopathy can progress quickly during pregnancy.
Treatment:
The best treatment is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar and blood pressure will significantly reduce the long-term risk of vision loss.
Medical Treatment Injections of anti-VEGF medication in the eye can stop the growth of new blood vessels and subsequent bleeding. VEGF is necessary for the eye to build new blood vessels and the use of anti-VEGF medication causes regression of these fragile and abnormal blood vessels. Sometimes a steroid medication may also be used. Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further vision loss.
Surgical treatment. Vitrectomy surgery is a procedure in which the vitreous gel that fills the center of the eye is removed. This can be helpful if a vitreous hemorrhage is not clearing or to fix a retinal detachment. Laser treatment is often done
Definition:
You may sometimes see small specks or clouds moving in your field of vision. These are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky.
Floaters are actually tiny clumps of cells inside the vitreous, the clear gel-like fluid that fills the inside of your eye.
While these objects look like they are in front of your eye, they are actually floating inside of the vitreous fluid in your eye. What you see are shadows that cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see.
Floaters can appear as different shapes such as little dots, circles, lines, clouds or cobwebs.
Cause:
What Causes Floaters?
When people reach middle age, the vitreous gel can pull away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters.
Posterior vitreous detachment is more common in people who:
- Are nearsighted
- Have undergone cataract operation Have had YAG laser surgery of the eye
- Have had inflammation inside the eye
What Causes Flashing Lights?
When the vitreous gel rubs or pulls on the retina, you may see what looks like flashing lights or lightning streaks. You may experience this same sensation if you have ever been hit in the eye and seen “stars”. The flashes of light can appear off and on for several weeks or months.
As we grow older, it is more common to experience flashes of lights and floaters While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina.
Treatment:
Floaters may be a symptom of a tear in the retina, which is a serious problem. If a retina tear is not treated, the retina may detach from the back of the eye. The only treatment for a detached retina is surgery.
Other floaters are harmless and fade over time or become less bothersome, requiring no treatment. Surgery to remove floaters is almost never required and vitamins will not make them disappear.
Even if you have had floaters for years, you should schedule an eye exam with your ophthalmologist if you suddenly notice new ones.
Treatment:
Oral Supplementation:
High Quality Omega-3 Supplements and diets rich in Omega-3 fatty acids, particularly EPA and DHA, play an important role in reducing inflammation, improving meibomian gland function, and enhancing tear film stability.
- PRN DE3 Omega supplements (2400mg) Nordic Naturals Ultimate Omega 2X (2150 mg)
- Nordic Naturals Ultimate Omega (1280 mg) Blink Nutritears
- Science Based Health HydroEye
Depending on the quality of your current diet, the amount of fish you consume, and other factors; you may benefit from more or less of this supplementation.
Please consult your Primary Care Provider before starting Fish Oil/Omega-3 supplementation.
Non-Prescription Drops Lubricating Tears:
Helps to replace moisture lost on the front surface of the eye.
Prescription Dry Eye Drops
These medications reduce inflammation caused by chronic dryness and help increase tear production.
Lid Hygiene
Commonly used to treat blepharitis, a chronic inflammation of the eyelids, often near the eyelashes. It can cause symptoms like redness, swelling, itching, burning, and gritty sensation. While blepharitis is chronic, it can be managed with good lid hygiene habits.
Non-prescription -Use once each morning
- Oasis Hypochlorous acid lid spray
- Oasis Tea Tree Oil lid wipes
- Ocusoft Lid Scrub Original
- Ocusoft Lid Scrub Plus
Heat Therapy
This is commonly used to help treat Meibomian Gland Dysfunction (MGD), a condition where the meibomian glands in the eyelids don’t produce enough quality oil, leading to dry eyes. Heat applied to the eyelids softens or liquefies the thickened oils in the meibomian glands and promotes better oil secretion.
Definition:
Nearsightedness (Myopia): Difficulty seeing objects far away.
Definition:
Farsightedness (Hyperopia): Difficulty seeing objects up close.
Definition
Uveitis is inflammation of the uvea. The uvea is the vascular layer of the eye in between the retina and the white part of the eye known as the sclera. The uvea extends toward the front of the eye and consists of the iris, choroid layer, and ciliary body. The most common type of uveitis is an inflammation of the iris called iritis. This eye condition can be very serious resulting in permanent vision loss.
Cause
Uveitis is caused by an immune reaction mounted by the body. Often times this immune reaction can be triggered by infections such as herpes, syphilis or toxoplasmosis among many others. It can also be found in association with autoimmune disorders such as lupus and rheumatoid arthritis or systemic diseases such as sarcoidosis.
Symptoms
The patient often presents with a painful, red eye accompanied by light sensitivity and tearing. Vision tends to be blurred and occasionally the patient may notice some floaters.
Treatment
The goals of treatment are to reduce pain and inflammation. Patients are placed on steroid drops to bring the inflammation under control. If the inflammation cannot be controlled with steroid drops, steroid injections or oral steroids can also be used. If steroids do not help, your ophthalmologist may recommend that you be treated with other systemic immunosuppressive medications. Sometimes the patient is also placed on a dilating drop to help reduce the pain associated with inflammation. If the uveitis recurs, your ophthalmologist may want to investigate for an underlying cause such as an infection or autoimmune disease.
Definition
Blepharitis is an inflammation of the eyelid margin, which often occurs together with meibomitis, a blockage of the oil glands of the eyelids, which are located at the lid margin. Interference of the normal function of these oil glands can reduce the quality and smoothness of the tear film.
Cause
Blepharitis and meibomitis may be caused by chronic infection, most often from Staphylococcus or Demodex. Blepharitis may also occur as a form of eczema, or as a manifestation of rosacea.
Symptoms
Patients with blepharitis may experience itchy, gritty or burning eyes. The eyes may appear red, and the irritation is often worse in the morning than it is late in the day. The eyelid margin may appear slightly thickened or red, and flakes or crusting along the eyelashes may occur.
Treatment
Warm compresses are applied to the eyelids to soften the blockage of the oil glands. Lid scrubs are used to clear bacteria and crust buildup from the eyelids. Artificial tears are used to supplement the tear film. In some cases, an antibiotic drop or ointment is indicated. In chronic blepharitis associated with ocular rosacea, an oral medication may be prescribed.
Definition
Keratoconus is a progressive thinning of the cornea, the clear”window” at the front of the eye. This thinning of the cornea makes it more susceptible to the normal pressure inside the eye, causing the cornea to bulge outward, in a cone-like shape. Irregular astigmatism is caused by the bulging cornea, resulting in blurry or distorted vision.
Cause
The underlying cause of keratoconus is not fully understood. Studies have suggested a genetic link, however, most patients with keratoconus do not have another family member with the condition. Genetic studies suggest a deficiency in the collagen structure of the cornea in patients with keratoconus, resulting in weaker support of the shape of the cornea. There is a higher incidence of keratoconus in patients with atopic disease, such as eczema, asthma or a chronic allergy. Because the cornea of patients with keratoconus is thinner and structurally weaker than a normal cornea, it is more susceptible to minor trauma. Patients with keratoconus should never rub their eyes, as there is a link between frequent eye rubbing and progression of the disorder.
Symptoms
Patients with keratoconus may experience blurry or distorted vision that is not improved with spectacles. An untrained observer will not usually notice anything abnormal about the appearance of an eye with keratoconus, however, your eye doctor can detect changes in the shape of the eye with a keratometer or corneal topographer, and can often observe changes in the appearance of the cornea with a slit lamp microscope.
Treatment
Patients with mild cases of keratoconus may be able to achieve the adequate vision through spectacles or specialty soft contact lenses. Many patients with keratoconus are fit with rigid gas permeable contact lenses. The rigidity of the lens allows the tears to pool under the contact lens, creating a more optically smooth surface by masking irregular astigmatism. Some patients will need to wear glasses over the contact lenses in order to achieve optimal vision correction. In advanced cases of keratoconus, patients may be unable to be successfully fit with rigid contact lenses. These patients may be fitted with a scleral lens, a large diameter specialty lens, or a corneal transplant may be indicated. Currently, procedures designed to slow the progression of the disorder through collagen crosslinking are being evaluated in clinical trials.
Definition
A pterygium is a triangular shaped fibrous growth of tissue that begins on the conjunctiva and overlaps a portion of the cornea. A pterygium most often begins as a pinguecula, an elevated, yellowish-white deposit of collagen tissue underlying the surface of the conjunctiva. Fine blood vessels are visible within the pterygium, resulting in a pink appearance to the growth.
Cause
The most common cause of pterygium is chronic sun and wind exposure and is most prevalent in those who have lived close to the equator or who work outdoors.
Symptoms
While often asymptomatic, some patients with pterygium may notice redness of the eyes, or be concerned by the physical appearance of the pterygium. Patients with an elevated pterygium may notice a gritty sensation if the surface does not remain coated by the tear film. In severe cases, the pterygium may grow into the center of the cornea and interfere with vision. A pterygium may inhibit contact lens wear.
Treatment
In most cases, the only treatment necessary is lubrication with artificial tears to prevent drying out of the elevated surface of the pterygium. Occasionally, the pterygium may become inflamed, and a topical vasoconstrictor or steroid may be indicated. In severe cases, where vision is affected, the pterygium may be surgically removed; however recurrence of pterygium may occur.
When someone has a corneal dystrophy one or multiple parts of the cornea will lose regular clearness or clarity due to a build-up of cloud-like materials. Corneal dystrophies are numerous and may affect all aspects of the cornea. Some of the symptoms include:
- Both eyes are affected
- Can occur in healthy people
- In most cases, they are inherited
- They are not typically caused by outside or environmental factors
Corneal dystrophies can cause widespread visual impairment. If you are concerned about this eye problem or would like to seek a second opinion our eye doctors are here to help.
Definition
A corneal ulcer represents a breakdown in the surface cells of the cornea accompanied by an infiltrate. An infiltrate appears to be a whitish opacity in the eye, but in reality, it represents a collection of white blood cells. Ulcers can be infectious or sterile (non-infectious) in nature. Your ophthalmologist can distinguish between the two forms and treat you accordingly.
Cause
Most infectious ulcers are caused by bacterial organisms and therefore most ulcers are treated as such until proven otherwise. If an ulcer is small, it is typically treated without obtaining any cultures. If an ulcer is large, your ophthalmologist may choose to obtain cultures for further evaluation. Culturing the cornea is a way of identifying which organisms are responsible for the infection. While bacteria are the most common culprits, an infection can be caused by a virus such as herpes or a fungus or even a protozoan. As a rule of thumb, infectious ulcers tend to be extremely painful and rapidly progressive. Risk factors for infectious ulcers include sleeping in or wearing contact lenses for extended periods of time, improper cleaning or handling of contact lenses, having a history of dry eyes, or incurring any trauma to the cornea among many others.
Noninfectious ulcers tend to have a milder presentation. In many cases, they represent a vigorous immune reaction to an inciting factor. In many patients, the coexistence of lid margin disease, also known as blepharitis, is the inciting factor. Contact lens wearers can also develop a noninfectious ulcer, but this tends to be a diagnosis of exclusion.
Symptoms
Patients tend to complain of the following symptoms:
- pain
- redness
- blurry vision
- light sensitivity
- discharge
- contact lens intolerance
They may also notice a white opacity on their cornea.
Treatment
The treatment of corneal ulcers is tailored to the cause. For infectious ulcers, patients are started on medicated eye drops aimed at targeting the specific organism. If the patient wears contact lenses, they are asked to dispose of the current contacts and refrain from further use until the treatment course is completed. If the infection is extensive, the patient may need to be hospitalized for aggressive treatment which can involve taking eye drops every 30 minutes. For sterile or noninfectious ulcers, patients may be placed on a steroid drop along with an antibiotic drop.
