Eye and Vision Conditions

Diabetic Retinopathy

Diabetes is a disease in which there is faulty regulation of blood glucose (sugar) levels. The body either fails to produce or does not properly respond to insulin, a hormone that causes the body’s cells to take glucose out of the blood stream and use it for energy or store it. The result is elevated blood sugar levels, which can damage the small blood vessels and make them become leaky.

Leaking vessels in the retina, the light-sensing structure in the back of the eye, is called diabetic retinopathy. Diabetic retinopathy is one of the leading causes of blindness in the U.S. The first visible signs of retinopathy include microaneurysms, outpouchings in the smallest vessels, and intraretinal hemorrhages, bleeding in the retina. Often these changes can take place without any visual symptoms.

When the leaking of fluid in the retina occurs near the center part of the vision, the macula, it can cause swelling called macular edema. Macular edema is the leading cause of moderate vision loss in diabetics. Laser treatment performed by a retinal specialist to seal off the areas of leakage reduces the risk of vision loss by 50%.

With significant diabetic damage, new blood vessels can grow in the retina and front portion of the eye, termed neovascularization or proliferative diabetic retinopathy. These new vessels can lead to severe vision loss from retinal detachment, glaucoma, or vitreous hemorrhage (bleeding in the back, fluid filled chamber of the eye). Laser treatment to larger areas of the peripheral retina can cause these new vessels to disappear, reducing the risk of complications.

Diabetics can reduce their risk of blindness from diabetic retinopathy by up to 90% by having dilated eye exams at least yearly and timely treatment when it is needed. Also, strict control of blood sugar, blood pressure, and cholesterol levels, along with not smoking reduces the risk of retinopathy. At Middletown and Settlers Walk Eye Care, our Doctors of Optometry are experienced in the diagnosis and management of diabetic retinopathy. They will also send a report to the Primary Care Physician, Internist, or Endocrinologist that is managing the diabetes to let them know the status of the ocular health.

Glaucoma

Glaucoma is an eye disease that is one of the leading causes of blindness in the U.S., with more than 2 million individuals affected. Since there are usually no symptoms until late in the disease process, nearly half of those affected are not aware they have the disease.

In glaucoma, the nerve fibers that fill the optic nerve (the nerve that transmits the visual information from the eye to the brain) become progressively damaged. The exact cause of this damage is not well understood. The damage initially causes subtle defects in the peripheral vision. Over time and without adequate treatment these peripheral vision defects gradually enlarge and can eventually expand into the central vision. The most common type of glaucoma, which this article describes, is open-angle glaucoma.

Elevated eye pressure is a significant risk factor for the development of glaucoma, but it alone cannot be used to diagnose glaucoma. Some individuals have what is referred to as ocular hypertension, where the eye pressure is elevated, but the optic nerve does not become damaged. Also, around 20% of the individuals with damage to the optic nerve from glaucoma have eye pressures that are considered normal. Other significant risk factors for glaucoma include age, with few individuals affected under the age of 40, family history of glaucoma since there is a genetic component to the disease, and race, with African Americans being affected at a 6 times greater rate than whites.

Although there is no cure for glaucoma, treatment can significantly slow the rate of progression so that an individual’s visual function is not affected during their lifetime. The goal of treatment is to lower the eye pressure. This is initially done with eye drops, but if that does not lower the pressure sufficiently, laser procedures or surgical techniques can be used.

Since diagnosing and treating glaucoma involves more than just an eye pressure reading, careful assessment of the optic nerve during routine eye exams is important. At Middletown and Settlers Walk Eye Care, our Doctors of Optometry have the experience and skill needed to make these assessments. We also have the latest technology available such as digital photography of the optic nerve and optical coherence tomography of the nerve fiber layer to aid in the diagnosis when glaucoma is suspected.

Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in the U.S. and can destroy the sharp, central vision. The retina is the thin, light-sensitive tissue in the back of the eye. The portion of the retina that has the highest concentration of light-sensing (photoreceptor) cells is called the macula.

There are two forms of AMD, wet and dry. Dry AMD accounts for nearly 90% of the cases. It occurs when the photoreceptor cells in the macula begin to slowly break down, gradually blurring the central vision. Drusen, small yellow deposits under the retina, are the most common finding in people with AMD. As dry AMD progresses, there is an increased risk of it becoming the wet form of the disease.

Wet AMD occurs when abnormal blood vessels begin to grow under the retina. These new blood vessels tend to leak blood and fluid, which can damage the overlying retinal tissue and leads to scarring in the retina. This process can lead to significant vision loss over a relatively short period of time.

Although there is no treatment or cure for dry AMD, the Age-Related Eye Disease Study (AREDS) found that high doses of certain vitamins and antioxidants can reduce the risk of progression to significant vision loss. Treatments for wet macular degeneration have improved significantly in the past several years. Injections into the eye can be done which prevent further vision loss in a majority of patients and actually restores a significant amount of vision in around 30% of patients. Laser treatments are also done, although the frequency of their use has gone down with the advent of the injections.

Since the treatments for wet AMD are much more effective when the disease is caught early, it is important to see a skilled and experienced eye doctor. At Middletown and Settlers Walk Eye Care, our doctors have both of those attributes. They also have the technology available to photograph and image the retina on a microscopic level to help detect the blood or fluid that begins to accumulate as the wet form of AMD develops.

The most significant risk factor for the development of AMD is age. Other significant risk factors include race (whites are much more likely to lose vision from AMD than African Americans), family history (specific genes have been identified that increase the risk, but no treatments are available yet to target these genes), smoking, and obesity.

If you have been diagnosed with AMD, there are steps you can take to reduce your risk of vision loss. They include not smoking, losing weight if you are obese, following the AREDS study recommendations on vitamins and antioxidants, home monitoring of your vision with an amsler grid (a checkerboard patterned grid that can help you notice changes in your vision), and having yearly or more frequent dilated eye exams.

American Optometric Association