Most people rank vision as their most precious sense. We are responsible for your vision, and helping you cope with aging and your eyes. As primary eye care providers we are responsible for helping you maintain the best possible vision, and managing your eyes as they relate to your overall health. There are many systemic diseases that manifest themselves with ocular signs and many ocular diseases that can uncover undiagnosed systemic disease.
We work with many other primary care physicians around and outside Oklahoma City to help patients manage ocular manifestations of Diabetes, Hypertension, Collagen vascular Disease, Neurologic disease, and Vascular disease and other Autoimmune Disease.
Some of the more common ocular problems we see daily are diabetic retinopathy, glaucoma, macular degeneration, dry eye and cataracts. All of fhese diseases are more common as we age, though there are other unique risk factors associated with each one.
According to the American Diabetes Association nearly 21 million Americans are affected by diabetes and another 54 million are pre-diabetic. Diabetes is the leading cause of death, disability, and blindness in the U.S. for adults 21-74. Diabetes prevents the body from making or using insulin to break down blood sugar in the bloodstream.
Diabetic retinopathy (DR) is a frequent complication of of diabetes and is a complication of long term elevation in blood sugar levels. Elevated blood sugar damages the delicate inner lining of the blood vessels of the retina, the back sensory layer of the eye. This damage causes the blood vessels to leak, bleed, and become blocked. DR can lead to vision loss and sometimes blindness.
As primary care providers we see diabetic patients on a yearly basis to complete dilated retinal exams to look for retinal changes. Patients with moderate or more severe retinal changes are seen much more regularly. The sooner significant DR changes are caught, the sooner treatment can be initiated, this can limit vision loss sometimes. Often early DR can have no symptoms at all and patients can maintain 20/20 vision.
Treatment of DR includes various types of laser treatment to the retina, as well as injectable medicines to help control swelling, or sometimes new blood vessel growth. Surgery is sometimes needed in advanced cases of DR. Once DR damage has been done is often permanent. This is why early detection is so important. Limiting the risk for DR, it is crucially important for the patient to maintain good blood sugar control and blood pressure control. Follow your doctors instructions carefully, and have yearly dilated retinal exam to monitor the progression of any retinal changes.
The macula is the very center area of the retina (the sensory tissue at the back of the eye) in which light is focused. Macular degeneration is a degenerative loss and damage to this central area, resulting in blurred, distorted or lost central vision. Macular degeneration (AMD) is the leading cause of severe vision loss in the U.S. for those over 50 years of age.
AMD can occur in two forms, “dry”, or atrophic and “wet”, or exudative. The dry form can cause gradual thinning of the central retina, causing slowly blurred and reduced vision. The wet form can cause thickening of the central retina caused by leakage from abnormal blood vessels which have grown through the damaged retina. The wet form can occur relatively rapidly over days to weeks, and cause sudden distorted, blurred vision.
Those at higher risk for AMD, include caucasions, women, smokers, those with higher body mass index, those who eat a high fat diet, and those with a family history of AMD.
Those with very early AMD may in fact be symptom free. Symptoms of later stage AMD include simply blurred vision in one or both eyes. Distorted or wavy looking lines or objects, loss of clear color vision, or dark or empty spots in your central vision. Diagnosis is made with a dilated retinal exam. OCT testing is often useful for determining dry AMD changes from early wet changes (see technology section for an explanation of how our OCT technology can help you).
There is no treatment currently for dry AMD, though there are many studies underway looking at possible treatments. Treatment of dry AMD is aimed at slowing and reducing progression mainly by lifestyle modification , dietary changes and nutritional supplementation.
Treatment for wet AMD includes injectable medications and some types of laser treatment. Both treatments try to reduce leakage by the abnormal blood vessels, and limit retinal damage. Rapid diagnosis and early treatment is crucial in the wet form of AMD to limit retinal damage and vision loss.
Glaucoma is third leading cause of blindness in the U.S. Glaucoma is a disease of the optic nerve. The optic nerve, in the back of the eye, contains approximately one million nerve fibers. These nerve fiber cells provide sensory information to the brain. Glaucoma involves gradual damage to the nerve fiber layer, leading to optic nerve damage and ultimately vision loss, usually in a “tunnel” like fashion. Glaucoma usually developes without pain, and generally can not be prevented, but it can be controlled, and vision loss can be prevented. At least half of people who have glaucoma don’t know they have it. Left untreated, glaucoma can lead to permanent vision loss.
Our comprehensive examinations include evaluation of intraocular pressure, and more importantly, dilated retinal evaluation and careful binocular ophthalmoscopic examination of the optic nerve. It is increasingly understood that the pressure inside the eye (intraocular pressure, IOP), is less of a factor in glaucoma, though it is certainly a factor. A large amount of people have glaucoma and do not have increased IOP above the mean average range. This is why careful optic nerve evaluation is so important. OCT technology is helpful at measuring nerve fiber layer thickness. Often early nerve damage is seen long before functional visual field (peripheral vision) damage is measured. Sometimes this helps guide treatment decisions if progressive nerve fiber loss is detected through serial nerve fiber layer analysis.
Treatment is still guided at reducing the IOP in the eye. There are many ways to lower the eye pressure, including eye drops, laser procedures and surgical drainage devices. Regardless of treatment, they all are aimed at reducing vision loss. Vision that has already been lost secondary to glaucoma cannot be regained. Early detection and treatment are key to limiting vision loss over the course of a patients lifetime.
Cornea, Dry Eye, and External Disease
The cornea is the thin, clear window of tissue in which light focuses through the eye. In a healthy eye the cornea will focus light clearly on the retina in the back of the eye. There are many diseases that affect the cornea, ocular comfort, and ultimately vision. It is vital to keep the ocular surface healthy to maintain optimal vision and there are many conditions that can affect the ocular surface.
Dry Eye Summary Update - Summary of dry eye disease and some current therapies
Ocular Surface Disease Index
Short questionairre to rate your dry eye symptoms, this is used clinically to gage dry eye treament
Dry Eye and Menopause
Letter from the National Womens’ Health Resource Center on scope and severity of Dry eye in post menopausal women
Disease Affecting the Cornea
One of the most common conditions affecting the cornea is dry eye. The symptoms of dry eye include: scratchy, sandy feeling in the eyes, burning and light sensitivity, redness, intermittently blurred vision, and sometimes ache and pain in the eyes. Dry eye symptoms are often confused with allergy symptoms, though sometimes both dry eye and allergy can occur together.
Dry eye is more common as we all age. It is more common in older women, those with systemic inflammatory disease, diabetes, thyroid disorders, and those doing extended near tasking or computer work through the day. Many medications can contribute to dry eye, including anti-histamines, anti-depressants, and some blood pressure medications. As we get older we naturally produce less tears. This combined with other factors can end up producing a state of dry eye.
Dry eye is an inflammatory condition which includes reduced tear quality and quantity. This underlying inflammation can cause small areas of damage to the cornea, or dry spots, which can cause blurred vision and sometimes loss of vision if permanent corneal scarring occurs in cases of severe dry eye.
There are many treatment options for dry, more then just artificial tear supplements. New medications, nutritional supplements, along with lifestyle changes often needed in combination to treat dry eye.
Dry Eye Information Handout