Glaucoma is one of most misunderstood eye diseases that eye doctors treat. Most people have heard of glaucoma and know they don’t want to have it, but I’ve found that most of my patients aren’t really sure how it damages vision or how it gets treated. 2.7 million people in the United States have glaucoma and it is the second leading cause of blindness.
Certain types of glaucoma are painless, which gives the disease the dubious distinction of being called “the sneak thief of vision”. It is a disease that damages the optic nerve in the eye causing progressive loss of peripheral vision, and by the time someone notices that they have lost portions of their visual field it is too late, and that visual loss is irreversible. One of the variables that causes the optic nerve to sustain damage is elevated intraocular pressure. If the pressure in the eye is extremely high, the eye will be painful, but the majority of patients only have moderately elevated pressure and will not know it is high until it is detected on a routine eye exam. Factors that increase the risk of developing glaucoma include being African American, having a family history, hypothyroidism, being over 60, and previous eye trauma. Typically, the initial treatment modality is using eye drops that lower the intraocular pressure, but more advanced or complicated cases may need laser or surgery.
A disease such as glaucoma is a perfect example of why everyone needs routine eye care, even if they have 20/20 vision, since evaluation of the optic nerve, peripheral vision, and eye pressure measurements in the office are key to preventing devastating and permanent vision loss.
No, no and no. Not only can you not swim in them, but you can not expose your contact lenses to any type of water at all. This includes tap water, oceans, swimming pools, lakes, hot tubs, and even showers! Soft contact lenses absorb not only the water, but any viruses, bacteria, or other microbes that are living in the water. Although rare, an organism called Acanthamoeba which lives in impure water can attach itself to your contacts and cause your cornea to become extremely infected and inflamed and can cause permanent vision loss and/or a corneal transplant if not treated quickly and aggressively. A couple of weeks ago a young man from the UK shared his personal story of how he contracted Acanthamoeba – he initially thought he just scratched his eye putting in his contacts, but instead of getting better over time it got worse. Ultimately he was diagnosed with Acanthamoeba keratitis and even after months of different treatments and procedures he unfortunately lost the vision in his eye. The doctors concluded that he contracted the infection because he showered daily in his contact lenses. Although this is definitely a worse case scenario at the very least the water can cause your contacts to tighten up on your eye and create discomfort or can wash away your natural tears causing dry eyes. Waterproof well fitting swim goggles can be worn over contacts but an even safer option is to purchase a pair of prescription swim goggles to eliminate all risks of contamination.
As a dry eye patient myself I empathize with my fellow dry eye sufferers. For many of us, dry eye is a chronic condition that waxes and wanes for myriads of reasons. Dry eye sounds innocuous but anyone who has experienced it knows it can severely affect the ability to see both clearly and comfortably. Dry eye is a condition in which a person does not have enough “quality” tears to lubricate and nourish the eye. I give the example of driving with a dirty windshield – in order to see clearly to drive you need the wipers and the washer fluid in tandem to make the window clear and allow you to see well. So too if the tears and the eyelids are not working well together the vision will be impaired – like driving with a filthy windshield.
One reason for having dry eye is inadequate production of tears. This can be caused by age, gender (females), medications (such as antihistamines) and certain medical conditions. A dry and windy climate will also contribute to dry eye. Winter in New Jersey is tough on dry eye – the low humidity combined with artificial heating systems, especially the forced air types, wreak havoc on an already dry eye. Another reason for dry eye can be poor quality tears. I will address this more in length in another blog.
So how do we treat dry eye once it is diagnosed? Treatments are tailored specifically for each patient depending on the underlying cause for the dry eye. Ocular lubricants (fancy term for eye drops) are the mainstay of treatment and there are both over the counter and prescription options. If blepharitis (inflamed and irritated eyelids) is the culprit then lid hygiene is initiated as well.
In future blogs we will talk about more specific dry eye situations such as dry eye in contact lens wearers, dry eye in patients with underlying autoimmune diseases, and even dry eye in children.
For many allergy sufferers mere avoidance of the offending allergens is not enough to prevent symptoms. The first line of treatment is to use high quality over the counter artificial tears which help to lubricate irritated eyes as well as to wash out and dilute the pollen that reaches the eye. Cool compresses are another natural way to relieve symptoms. Although there are a myriad of over the counter topical allergy drops on the market, it is hard to figure out which ones might be right for you, don’t hesitate to make an appointment so we can figure it out. Prescription antihistamine and mast cell inhibitor drops are very effective, and if these are still not enough we can prescribe a pulsed dose of topical steroids to get things under control. In some instances a consult with an allergist may be necessary if there are other systemic symptoms such as asthma, coughing and rashes that are not being addressed. Oral medications or immunotherapy (allergy shots) may be helpful as a more long term solution.
Many other eye conditions can mimic allergy, so it is important not to self-diagnose. Dry eyes can also cause itching, and using an antihistamine, either orally or topically, can make dry eye worse by drying out the ocular surface. Very often contact lens wearers will have to temporarily discontinue contact lens use during allergy season or switch to daily disposables. Putting a fresh contact lens in the eye every day goes a long way in preventing further exposure to pollen and irritants.
Spring and summer should be a fun and enjoyable time of year – don’t let allergies get in the way. Make an appointment with any of our skilled doctors who will tailor an allergy attack plan specifically for your lifestyle.