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.
When I was eight, my eye doctor prescribed glasses for me to see the blackboard. The truth was, my vision was so bad I should have worn glasses all the time, but my mother told me that wearing glasses would make my vision worse so I walked around in a blurry haze for ten years until I got my first pair of contact lenses. When my own daughter needed glasses at the age of six (bad genetics from her dad) I made sure she wore them all the time so she would not miss out on seeing the beautiful details in the world around her the way I did (love you mom). One thing that concerned me however was how quickly her prescription changed, sometimes every six months. Back then the idea of slowing the progression of nearsightedness was not even in its infancy and according to the conventional wisdom of the time I had her wear bifocals. Fast forward almost twenty years and controlling the progression of nearsightedness is now a reality.
There are a couple of options out there such as Ortho K (wearing hard lenses overnight to reshape the cornea), atropine eye drops, and soft multifocal lenses with specific parameters to help blur certain parts of the vision and attenuate others. Although these modalities are FDA approved, they are not necessary FDA approved for myopia (nearsightedness) control. A few days ago CooperVision announced that they came out with a daily disposable soft multifocal lens called MiSight which is specifically approved by the FDA for myopia control. This is a very exciting addition to our arsenal of myopia control tactics and one that I believe will be embraced by both parents and eye care professionals alike due to its ease of use and availability. As soon as I get more information on the accessibility of the lens I will post a little more on how the technology works and who would be a good candidate for this treatment.
Last month a story came out of England about a teenager who went blind from eating only junk food. I found this very interesting and bookmarked the article so I could blog about it when I had the time. Well oopsie, September passed by in a blur and the email I had saved with the link to the article got buried in my inbox until yesterday when in a frantic attempt to organize my life by starting with my work emails I encountered the article I had saved. After doing a little research on the story I was glad I waited to share the information because the initial story that most of the media outlets shared left out certain details that misrepresented the real lesson to be learned from this young man’s tragic vision loss.
The basic story is that a teenager in the UK whose diet consisted of Pringles, white bread, french fries and occasionally some ham lost his eyesight to a condition called nutritional optic neuropathy which like it sounds, develops due to the lack of the proper nutrients that the eyes need in order to function. Many of the articles used this story as a cautionary tale, admonishing junk food eaters and parents of picky eaters that this is what could happen if you don’t eat a healthy diet. Turns out the young man who went blind was not a “picky eater” but rather , he had an eating disorder called ARFID (Avoidant Restrictive Food Intake Disorder) which led to various nutritional illnesses. The media however jumped on the bandwagon of the evils of junk food and fad diets instead of using the story as an opportunity to bring awareness to the importance of detecting mental health disorders in children and teenagers. Does poor nutrition due to a diet limited to french fries lead to blindness? Absolutely that can happen, but this story was way more complex than simply blaming Pringles and fries.
Contrary to popular belief, a cataract is not an eye disease, rather it is a natural age related change to the lens of the eye which causes it to become opaque and difficult to see through. Generally cataracts are very slow growing and most commonly develop in people over the age of 55. Signs and symptoms can be subtle at first, ranging from blurry vision, glare from headlights, difficulty driving at night and frequent eyeglass prescription changes. Most people come into the office complaining that their glasses are not working when in reality they are experiencing blurred vision from cataracts.
So what exactly is a cataract? There is a part of the eye called the lens which is located behind the iris, the colored part of the eye and it functions to focus light on the retina. When we are young the lens is clear and flexible but as we age the lens becomes opaque or cloudy and consequently images on the retina become blurred. Cataracts can also form in patients with diabetes, smokers, and those on certain medications like steroids. There is no proven way to prevent cataracts but UV protection, smoking cessation and a healthy diet that includes antioxidants can help prevent their premature development.
How do we treat cataracts? When cataracts start to interfere with quality of life and ability to function, surgical removal of the cataract is indicated. The lens of the eye is removed and replaced with an artificial lens which greatly improves vision. The most common comment I get on the first day after the operation is how bright and beautiful colors look. As with any surgery there are risks, but we co-manage surgery with the best cataract surgeons in order to ensure the best possible outcomes.