Refractive Eye Conditions

Myopia (Nearsightedness)

Nearsighted individuals typically have problems seeing well at a distance and are forced to wear glasses or contact lenses. The nearsighted eye is usually longer than a normal eye, and its cornea may also be steeper. Therefore, when light passes through the cornea and lens, it is focused in front of the retina. This will make distant images appear blurred. There are several refractive surgery solutions available to correct nearly all levels of nearsightedness.

Hyperopia (Farsightedness)

Farsighted individuals typically develop problems reading up close before the age of 40. The farsighted eye is usually slightly shorter than a normal eye and may have a flatter cornea. Thus, the light of distant objects focuses behind the retina unless the natural lens can compensate fully. Near objects require even greater focusing power to be seen clearly and therefore, blur more easily. LASIK, Refractive Lens Exchange and Contact lenses are a few of the options available to correct farsightedness.

Astigmatism

Asymmetric steepening of the cornea or natural lens causes light to be focused unevenly, which is the main optical problem in astigmatism. To individuals with uncorrected astigmatism, images may look blurry or shadowed. Astigmatism can accompany any form of refractive error and is very common. Astigmatism can be corrected with glasses, contact lenses, corneal relaxing incisions, laser vision correction, and special implant lenses.  Mild to Moderate Astigmatism is correctable with Corneal incisions called LIMBAL RELAXING INCISIONS. They are performed at the time of cataract surgery and can correct up to 3 diopters of astigmatism. This can greatly enhance vision so that one sees better without glasses. This is often necessary to achieve excellent results with the deluxe lens technology.  Most of the time astigmatism is the result of corneal astigmatism. Astigmatism defines the condition of having two curves on the cornea.  This can be compared to a football versus and basketball. The basketball is “spherical” it has only one curve, while the football had two curves, one steeper the other flatter; this results in two points of focus causing a slight blur or shadow effect on images. It is correctable with glasses, contacts, Laser surgery and LRI surgery. Astigmatism can also be handled by a Toric (astigmatism correcting) Intraocular lens at the time of cataract surgery.

Presbyopia

Presbyopia is a condition that typically becomes noticeable for most people around age 45. In children and young adults, the lens inside the eye can easily focus on distant and near objects. With age, the lens loses its ability to focus adequately. Although presbyopia is not completely understood, it is thought that the lens and its supporting structures lose the ability to make the lens longer during close vision effort. To compensate, affected individuals usually find that holding reading material further away makes the image clearer. Ultimately, aids such as reading glasses are typically needed by the mid-forties. Besides glasses, presbyopia can be dealt with in a number of ways. Options include: monovision and multifocal contact lenses, monovision laser vision correction, and new presbyopia correcting implant lenses.

Floaters

Most people in their lifetime will experience floaters. Some start in their teen and most people in the 50’s.  65% of people 65 and older have floaters.  They are very bothersome and cause most people to seek an eye exam.  Most of the time (about 90%), they are harmless and are a result of the natural aging process in the eye.  Sometimes they are a warning sign of bleeding in the eye (most common among Diabetics) or of a retinal tear or detachment.  If you are experiencing new floater activity or a change in your floaters you should have a complete eye exam. 

Why do they occur?

The most common reason is due to changes in the VITREOUS which is the clear jelly-like hyaluronic acid which fills the back of the eye.  As we age it turns from a solid like jello to a runny jelly and at the same time the attachment to the retina loosens and the back surface of the vitreous pulls off of the retina into the eye.  When the vitreous separates from the retina it is called VITREOUS DETACHMENT or SEPARATION. Condensed vitreous, debris i.e. blood, Calcium soaps (called Asteroid Hyalosis), inflammatory cells, or rarer things can float around in the vitreous hence the name floaters.  They can result in many descriptions such as, dots, spots, a circle, half moon, insect-like shapes, lines, films or cobwebs.  Most of the time they are more bothersome in the first few months and then either disappear, sink down or up out of view or our brains tune them out.  Most people become accustomed to their floaters and are not bothered by them.  In extreme cases they may be always in the line of vision for driving or reading and may need to be surgically removed although this is only in very extreme cases.

What about the 10%?

In some cases when the vitreous pulls away from the retina, it can actually tear the retina.  This may result in symptoms of a large, bright flash of light or a stream of floaters that is usually described as red or black ribbons swirling around or unusual or many new floaters.  A torn retina is a medical emergency and needs to be treated as soon as possible before the retina detaches.  If a retinal detachment occurs one will usually see part of the vision obscured by a curtain-like shape coming from the periphery toward the center.  This is a medical emergency and one should seek an ophthalmologist emergently.

What about flashes of light?

Small arc-like momentary flashes of light in the peripheral vision are commonly experienced during vitreous separation. The vitreous pulls on the retina which makes one think they are seeing a light but it is caused by movement of the retina. Sometime the flashes persist for a few months until the vitreous is finished separating. Rarely flashes are associated with a tear in the retina. They should always be evaluated by an eye exam to be sure.

Another cause of flashes is ACEPHALGIC (without pain) MIGRAINE; other common names are OCULAR MIGRAINE, VISUAL MIGRAINE, or OPTICAL MIGRAINE. This is the visual aura of a classic migraine which begins first with visual phenomena followed by headache. ACHEPHALGIC MIGRAINE is more common as one ages, although it can occur in youth but usually the migraines transition from severe vascular headaches in later life to visual phenomena without the headaches. Some people have no history of painful headaches but develop the visual phenomena.

These can be varied to include any or all of the following symptoms:  holes or blurry places in the vision, heat waves or moving lines, jagged lightening bolt shaped lights that shimmer or move, kaleidoscope like white or colored lights that move. Sometime they are in the form of a crescent and move from the center to one side. The phenomena lasts for minutes to hours (15-20 min is most common). They are there with the eyes closed. The cause is vascular spasm in the occipital lobe or visual part of the brain. They are not associated with any permanent problem and one should rest and wait for it to pass. If severe headaches are involved one should seek the care of a neurologist.

Rarely visual phenomena can be symptoms related to the optic nerve or brain and may require ophthalmic or neurological diagnosis and treatment.

Dry Eye Syndrome or Ocular Surface Disease

Ocular surface disease is the preferred name because many people with dry eyes have symptoms of tearing.  Other symptoms include:  burning, stinging, redness, irritation, blurred vision, inability to wear contacts comfortably, foreign body sensation, and in severe cases, corneal breakdown, with scaring. 

This condition is more common with advancing age but can occur in youth and in both sexes. The tear film actually consists of:

• a mucous coat on the eye secreted by cells in the conjunctiva
• acrimal fluid excreted by the lacrimal gland
• an oil layer excreted by oil glands on the lid margins.

A defect in any or all of the above, results in ocular surface disease, and that is why some therapies may vary.

Causes can be aging, hormonal changes, auto-immune disease, lack of sensation, medications, chemical or thermal ocular injuries, poor blinking,  and other rare conditions or past infections. 

Therapy usually starts with artificial tears used 4-6 times daily or as needed. Some people can develop or have sensitivity to the preservatives used to prevent contamination and that is why preservative free artificial tears are also available. There are many over the counter artificial tears, gels, and ointments which can be tried. If replacement tears are not effective, closing the outflow of tears in the nasal corner of the lids either by plugs or surgical closure can be very effective. Some people who have an auto-immune cause are better after using Restasis, (which works by immuno-suppression) but it must be taken for two months before the result is appreciated. 

A condition known as BLEPHARITIS which is an inflammation or infection of the oil glands of the lid can exacerbate symptoms and may need to be treated also.  Usually that consists of lid hygiene, sometimes antibiotics, and hot and cold compresses.

If a local area of oil glands are occluded, and CHALAZION results which is a large swollen area on the eyelid margin that may form a white or yellow head on the outside or inside of the lid. This can swell up quite quickly and turn red. In its early development and chalazion responds well to hot and cold compresses, if it is chronic a steroid injection or surgical removal may by indicated. In the chronic phase it feels like a round ball in the lid when felt by fingertip. 

Recipe for hot and cold compresses

(This is also helpful in pink eye CONJUNCTIVITIS and any infection except herpetic infections when heat should not be applied)

Wet a clean terry cloth and wring it out slightly so that it is very wet but not dripping

1. Place it on a plate and heat in the microwave for about 25 seconds.
2. For 2 MINUTES place it on the affected area with the eyes closed, touching the lid off and on if it feels too hot at first.  As the skin temperature heats up you can leave it on. Do not burn yourself, if your fingers can handle it that should be OK.
3. For 30 SECONDS use and ice cube over the area gently moving it around, you will definitely not do this too long.
4. Repeat three times, always starting with the hot and ending with the cold.

The above thermal therapy is very successful if done about 3 times daily. It can be better than medical therapy in some bacterial and viral infections but should never by used in the case of herpetic infection.  It works by activating your own immune system, dilating and constricting blood vessels, and helping your body eliminate the inflammation.