Glaucoma

Glaucoma is a group of eye conditions that damage the optic nerve, which is vital to good vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the leading causes of blindness in the United States. It can occur at any age but is more common in older adults.

Anyone can develop glaucoma but at high risk are African Americans over age 40, everyone over age 60, people with a family history of glaucoma

A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eye drops reduce the risk of developing glaucoma by about half.

Glaucoma can be treated with eye drops, pills, laser surgery, traditional surgery or a combination of these methods. The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible.

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Macular Degeneration

Age related macular degeneration is the leading cause of vision loss in those over 65. By definition, macular degeneration affects only the macular portion of the retina. The retina, like film in a camera, is the photosensitive layer of the eye. It is “wall-papered” to the back of the eye and is extremely thin. The macular portion of the retina, a very small area, is the part we use for sharp, clear central detail vision. The rest of the retina, the peripheral or side vision retina, is used for mobility and detecting motion.

Early signs of vision loss from Age related macular degeneration include shadowy areas in your central vision or unusually fuzzy or distorted vision. An Amsler grid is composed of straight lines, with a reference dot in the center and is one of the tools used to detect macular degeneration. Someone with macular degeneration may see some of the lines as wavy or blurred, with some dark areas at the center. Dry macular degeneration symptoms usually develop gradually and without pain. They may include: Visual distortions, such as straight lines seeming bent. Reduced central vision in one or both eyes.

The wet/neovascular type of macular degeneration affects approximately 10-15% of individuals with age-related macular degeneration, but accounts for approximately 90% of all cases of severe vision loss from the disease. In wet age-related macular degeneration, abnormal blood vessels under the retina begin to grow toward the macula.

When the macula degenerates, whether it’s wet or dry, only the central vision is reduced. The side vision always remains.

Atrophic (dry) macular degeneration is when the cells in the macular die. Causes can be aging, nutrition, sunlight, smoking, genetics and other causes we may not know about yet. There is simply no medical treatment. Dead retinal cells cannot be brought back to life. Retinal cells cannot be regrown, replaced, moved or transplanted.

Exudative (wet) macular degeneration is caused by leakage of fluid from the blood vessels behind the macula. Because the macula has its own blood supply, only the macular area is affected. The peripheral retina has another blood supply.

Treatment with injections is aimed at stopping the leak. These injections are called angiogenesis inhibitors. The two most commonly used are Lucentis and Avastin.

What can you do to prevent Macular Degeneration?

Healthy habits are key. Maintain a healthy weight, exercise regularly. Eat a nutritious diet that includes green leafy vegetables, yellow and orange fruit, fish and whole grains. Don’t smoke and have a comprehensive annual eye exam.

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Low Vision

Low vision is vision loss that’s so severe, it can’t be corrected with regular eyeglasses, contact lenses or surgery. Low vision and vision loss could be defined as best corrected vision which is insufficient to do what you want to do.

There are two parts to the definition:

• The Vision: best corrected with conventional spectacles or contact lenses.
• The Task: activities that you want to do but are now difficult or impossible. For example, activities include reading, writing, driving, television, playing cards, or seeing medication bottles.

For a person to benefit from Low Vision Care there must be a degree of usable vision and a goal to do a visual task. Dr. Bissell is trained by the International Academy of Low Vision Specialists (IALVS) and will discuss these issues in a free telephone interview before an appointment is offered.

Most conditions that cause irreversible vision loss do not cause complete and total blindness. Usually a person is left with “residual” vision that can be useful, especially with the help of low vision doctors. Low vision doctors of IALVS are uniquely trained and experienced in providing low vision glasses and devices plus rehabilitation training to make the most of the vision that remains.

Vision loss can occur from medical conditions, degenerative changes, congenital or genetic defects, and traumatic injuries. While most vision loss occurs in people over 65, low vision can occur at any age. Some of the major causes of vision loss are age related macular degeneration, diabetic retinopathy, inoperable cataracts, and open angle glaucoma.

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Cataracts

Cataracts occur when the lens in your eye becomes cloudy from natural proteins that build up over time. As the condition progresses, the clouded lens allows less light to pass through your eye and your vision becomes blurred.

Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world.

There are three types of cataracts:

• Subscapular cataract – diabetics and individuals taking high doses of steroids are prone to this type of cataract.
• Nuclear cataract – generally associated with aging
• Cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion.

Vision may be improved by changing your prescription, but eventually, your cataracts may need to be surgically removed.

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Diabetic Eye Disease

Diabetics need to be particularly vigilant in taking care of their eyes. Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.

Diabetic retinopathy, the most common of the group is caused by damage to the blood vessels in the tissue at the back of the eye (retina). Poorly controlled blood sugar is a risk factor.

Early symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors.

There is no cure for diabetic retinopathy. But laser treatment (photocoagulation) is usually very effective at preventing vision loss if it is done before the retina has been severely damaged. Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged.

The best course of treatment is to have an annual comprehensive eye exam unless you are being treated for one of these diabetic diseases.

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Dry Eye Treatment

Dry eye syndrome is a chronic and typically progressive condition affects about 10 to 20 percent of the population, and most of those who have the disease are over age 50. Activities that decrease blink rate can increase the prevalence of dry eye syndrome. For example, long hours spent at a computer is a well-established risk factor for dry eye.

Symptoms of Dry Eye include:

• gritty/sandy/foreign body sensation
• tearing
• burning/stinging
• blurry vision
• light sensitivity
• contact lens intolerance

For mild cases of dry eyes caused by computer use, reading, schoolwork and other situational causes, the best dry eye treatment may simply be frequent use of artificial tears or other lubricating eye drops.

In addition to eye drops, there are lubricants, a surgical procedure and intense pulsed light treatments that may help to alleviate dry eyes. Talk with the doctors at Bissell Eye Care for the best course of treatment to dry eyes.

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Concussions

Eye and vision problems are fairly common after a brain injury or concussion. Concussions range from mild to severe and your brain needs time to heal to avoid ongoing chronic symptoms. You may, for instance, have trouble focusing your eyes when switching your gaze between near and far objects.

There are several symptoms of a concussion. Some are physical symptoms (such as a headache or vision problems), while others are cognitive (feeling in a fog or visual perceptual challenges), others are emotional, and others can affect sleep. The multitude and variability of concussion symptoms make medical evaluation very important following a concussion.

Post-Concussion Syndrome (PCS) are symptoms that exist for an extended period of time following a concussion and can include:

• Headache, Dizziness, Nausea, Vomiting
• Fatigue, Insomnia
• Difficulty concentrating and performing mental tasks
• Reduced tolerance to stress, emotional excitement, irritability, personality change
• Staring behavior, low blink rate, eye turn
• Blurred vision, double vision
• Loss of peripheral or focal vision
• Sensitivity to light/noise
• Impaired memory
• Words jumping on the page when reading
• Clumsy, poor depth perception
• Disoriented, poor balance