Vision Problems and Eye Health

How Do the Eyes Work?

To understand how the eyes work, it's helpful to compare the eyes to a camera. Cameras use a lens and film to produce an image, and in a way, so do the eyes.

Light comes in through the cornea, a clear tissue that covers the front of your eye. The pupil is the dark spot in the middle of your eye. It works like a camera shutter, controlling the amount of light that enters our eyes. When it's dark, the pupil dilates, or widens. When it's bright, the pupil gets smaller. Surrounding the pupil is the iris. This is the colored ring of muscle fibers that help the pupil change size.

When you look at an object, light rays enter your eyes. These light rays are bent and focused by the cornea, lens, and vitreous. The vitreous is a clear jelly-like fluid that fills the inside of your eye. The lens' job is to make sure the rays come to a sharp focus on the retina at the back of the eye. Think of the retina as the film in the camera. It's lined with light-sensitive cells, called photoreceptors, that capture, upside-down, the images in our visual field. The sensitive macula, critical for sharp focus, is the most active part of the retina. A healthy macula helps us read small print and see the images in our direct line of vision. When light rays reach the retina, they're converted into electrical pulses that travel through the optic nerve to your brain. It is there that the image gets flipped right-side up.

Vision Screening Guidelines

Guidelines for Adults

• At least one test between ages 20 and 29 and at least two between ages 30 and 39
• Vision tests every two to four years between ages 40 and 65 and every one to two years after age 65.

Guidelines for Children

• Children five years and younger should have their eyes checked each time they see their pediatrician. Teens should be examined once a year.

If you are experiencing any vision problems, it's a good idea to get checked more often.

Protecting the Eyes & Vision

While we can't control the risk factors that make us more vulnerable to vision problems, it's important to exercise caution:

• Know your family's medical history;
• Protect your eyes with sunglasses that absorb 100 percent of damaging ultra violet rays;
• Stay away from cigarettes which contain chemicals that can damage the eyes; and
• Eat a healthful diet.

Types of Vision Problems

It's normal for our vision to deteriorate as we age. Here are some very common vision problems that can usually be corrected with glasses or contacts:

• Farsightedness. This occurs when you can see well at a distance, but not close up.
• Nearsightedness. This is also called myopia. It occurs when you can see well close up, but not at a distance.

There are some vision problems that are much more serious and can even lead to blindness.

If you have a family history of eye disease, you'll have a higher risk of developing vision problems. You may also have other risk factors like previous eye injury, premature birth, diseases that affect the whole body, like diabetes, high blood pressure, heart disease, or AIDS. The only way for you to know for sure if you have serious eye problem is by having an eye exam given by an Optometrist (O.D.) or an Ophthalmologist (M.D.).

• Glaucoma. This occurs when the pressure of the fluid inside your eyes damages the fibers in your optic nerve, and causes vision loss. If left untreated, you can lose your eyesight altogether.
• Cataracts. A cataract means a 'clouding' of all or part of the normally clear lens within your eye, which results in blurred or distorted vision.
• Conjunctivis. This is commonly known as Pink Eye. It is caused by an inflammation of the conjunctiva. This is the thin, transparent layer that lines the inner eyelid and covers the white part of the eye. The inflammation is usually caused by a virus, and will resolve without any treatment. But, sometimes pink eye is caused by a bacterial infection and will require antibiotics.
• Eye Floaters. These may look like small dots or lines moving through your field of vision. They're actually tiny clumps of gel or cells inside the vitreous fluid in the eye. They may be a sign of retinal detachment and you should call your doctor right away.
• Macular Degeneration. This results from changes to the macula portion of the retina. The macula is responsible for clear, sharp vision. This condition can cause a blind spot in the middle of your sight line.
• Retinal Tears and Detachment. These affect the thin layer of blood vessels that supplies oxygen and nutrients to your retina. Initial symptoms are eye floaters. This condition must be treated immediately. If it isn't, it can lead to permanent vision loss.

Early detection is key to fixing problems with your sight. Don't take your eyes for granted. Get them checked regularly, and tell your doctor if you notice anything unusual.

Sources

Age Related Macular Degeneration. Bethesda, MD.: National Institute of Health, 2009. (Accessed October 18, 2009 at http://www.nei.nih.gov/health/maculardegen/index.asp.)

Vision Not Improved By Surgery for Complications of Age Related Macular Degeneration. Bethesda, MD.: National Institute of Health, 2008. (Accessed October 18, 2009 athttp://www.nei.nih.gov/news/statements/surgery_amd.asp.)

Vision Problems. Atlanta, GA.: A.D.A.M., 2008. (Accessed October 18, 2009 athttp://www.nlm.nih.gov/medlineplus/ency/article/003029.htm.)

HealthiNation offers health information for educational purposes only; this information is not meant as medical advice. Always consult your doctor about your specific health condition.

Reviewed by: Dr. Supriya Jain, Dr. Preeti Parikh and Dr. Holly Atkinson

Last Review Date: 08/29/2012

Host Reviewer: Dr. Roshini Raj

Author: Ms. Audra Epstein

Copyright © 2013-2014 HealthiNation, Inc. All rights reserved.

Glucosamine Supplements Tied to Risk of Eye Condition

By Denise Mann
HealthDay Reporter

THURSDAY, May 23 (HealthDay News) — Glucosamine supplements 

that millions of Americans take to help treat hip and knee osteoarthritis 

may have an unexpected side effect: They may increase risk for

 developing glaucoma, a small new study of older adults suggests.

Glaucoma occurs when there is an increase of intraocular pressure 

(IOP) or pressure inside the eye. Left untreated, glaucoma is one 

of the leading causes of blindness.

In the new study of 17 people, whose average age was 76 years, 

11 participants had their eye pressure measured before, during and 

after taking glucosamine supplements. The other six had their eye 

pressure measured while and after they took the supplements.

Overall, pressure inside the eye was higher when participants were 

taking glucosamine, but did return to normal after they stopped taking 

these supplements, the study showed.

“This study shows a reversible effect of these changes, which is 

reassuring,” wrote researchers led by Dr. Ryan Murphy at the 

University of New England College of Osteopathic Medicine in 

Biddeford, Maine. “However, the possibility that permanent damage 

can result from prolonged use of glucosamine supplementation 

is not eliminated. Monitoring IOP in patients choosing to supplement 

with glucosamine may be indicated.”

Exactly how glucosamine supplements could affect pressure inside the

 eye is not fully understood, but several theories exist. For example, 

glucosamine is a precursor for molecules called glycosaminoglycans,

 which may elevate eye pressure.

The findings are published online May 23 as a research letter in 

JAMA Ophthalmology.

The study had some shortcomings. Researchers did not have 

information on the dose or brand of glucosamine used, and they did 

not know how long some participants were taking the supplements.

Duffy MacKay, vice president for scientific and regulatory affairs at

 the Council for Responsible Nutrition, a Washington, D.C.-based

 trade group representing supplement manufacturers, said the findings 

don’t mean that people should stop taking the supplements.

“This research letter raises questions and introduces a hypothesis 

that should be explored further, but the small number of cases

 investigated and the [fact that] researchers did not count capsules or control 

for dose or intake or duration of use of glucosamine provide extremely limited 

evidence of harm,” MacKay said.

“This study should not change consumer habits; however, individuals

 with glaucoma or ocular hypertension who are taking glucosamine 

should let their doctor know so that the appropriate monitoring of 

intraocular pressure measurements can be done to identify any 

changes,” he said.

MacKay concluded: “The good news is that increased IOP was 

reversible. So if you take the product, and your IOP goes up, then you 

can stop taking the product to see if it returns to normal.”

However, previous studies have raised questions about whether 

glucosamine supplements provide any health benefit to consumers. 

A large recent study concluded it had no healing effect on arthritic pain.

The potential relationship between glucosamine and glaucoma is new

to Dr. Scott Fudemberg, a glaucoma surgeon at Wills Eye Institute, 

in Philadelphia. “The mechanism about how people can develop 

glaucoma isn’t completely understood, so how the supplements 

may play a role isn’t completely understood either,” he said.

While the study found an association between taking glucosamine 

and increased eye pressure, it didn’t establish a cause-and-effect 

relationship.

The best thing that anyone can do to preserve their vision is to get

regular eye exams, Fudemberg advised. “Glaucoma can be treated 

with medications, lasers and/or surgery,” he said. “These findings 

pose a question about whether oral glucosamine can raise intraocular 

eye pressure, but it doesn’t provide an answer. More research is 

now needed before any conclusions can be drawn.”

Eye Health and Vision Questions Answered by SkyVision Centers

Wow! Look at all of the posts here on our Skyvision blog! We started out hoping to be helpful to our Skyvision patients as well as our Cleveland neighbors, mostly by talking about the stuff our doctors and staff spend their days discussing in our Westlake office. How are we doing? Are we talking about stuff you are interested in?

How about this? Tell us what kinds of things YOU are interested in. Maybe it's a question about yourself, or maybe someone in your family has an eye disease and you'd like more information. Thinking about LASIK? Perhaps there's an area of research that peaked your interest. Fashion questions for our optical staff?

Really, pretty much anything that's eye or vision related is fair game. You can leave a comment for us here on the blog, or leave a comment on our Skyvision Centers Facebook page (just search for 'Skyvision Centers'). We are on Twitter @drdarrellwhite and @skyvisioncenter, too, if you are a Twitterbug!

Let us know what YOU are interested in, Cleveland!

Eyemaginations Video Education

Have you been to our Westlake  Skyvision Center's office? The first thing you see when you walk into the lobby is a great big 52 inch television screen. And on that screen is running one of the coolest things in all of eye care: Eyemaginations!  A continuous loop of animated videos to teach you all about the eye and how we take care of your eyes.         

Eyemaginations is a big part of how we interact with you at Skyvision. We always ask for your e-mail address when you call to make an appointment. One of the reasons we do so is because we want to send you an e-mail with some Eyemaginations videos about your eyes. Do you have a cataract? How about dry eyes? We can send a video right to your own home computer to start teaching you about whatever problem you might have.

Each of our examination rooms is equipped with a terminal for our electronic medical record. We have 19 inch monitors right next to your exam chair. We can show you an Eyemaginations  video right in the exam room. These animated videos have been scripted with the help of experienced eye doctors, including Dr. White who has consulted for Eyemaginations more than six years.

How about the end of your visit? After the doctors and technicians have explained your problem and given you detailed instructions, often in writing, we might ask you again if you have given us your e-mail address. If so we have the opportunity to send another batch of Eyemaginations videos to your home. 

Easy to use and easy to see, Eyemaginations Is just one more thing the doctors and staff at Skyvision Centers is bringing to you in order to provide the very best experience possible in eye care!

The Continuing Education Tailgate!

SkyVision Centers had a Tailgate last night at The Surgery Center! 45 local eye doctors came out, some of them dressed in their finest Browns and Buckeye gear for our fourth Continuing Education seminar presentation. Connie and the Surgery Center staff had classic football tailgate fare on hand to feed our guests.

Our invited speaker was Jeff Peres, President and CEO of the patient education company Eyemaginations. Jeff laid out the rationale for going the extra mile to make sure that your patients are as well-informed as possible. Not only does this make their care better and keep their eyes healthier, but Eyemaginations has some research that shows a higher degree of loyalty of doctors of all kinds who make special efforts to educate their patients. SkyVision Centers has used the entire collection of Eyemagination videos in our office and as part of our "at home" educational program since our founding. We are excited to offer the latest iPad programs in the first quarter of 2013!

Dr. White presented part 2 of his series on developing a protocol for seeing patients who have Glaucoma.  The SkyVision protocol puts the interests of the patient first in an attempt to simultaneously provide the best possible outcomes in the most efficient and cost-conscious way. After showing the attendees how Drs. White, Schlegel, and Kaye take care of Glaucoma Dr. White asked for a voluteer from the audience to develpop a protocol for their office. Dr. Jim Kershaw raised his hand and Dr. White offered a couple of pearls for Dr. Kershaw to consider!

We are already planning our Winter Symposium, dreaming about what kind of surprise we will serve up for the local community of eye docs!

Newest Glaucoma Surgery

As the U.S. population ages we are seeing more and more cases of Glaucoma, damage to the optic nerve usually associated with high pressure inside the eye. In America the treatment strategy usually involves eyedrops and lasers with surgeries reserved for the most advanced cases. This is not the case in the United Kingdom where surgery is most frequently used if a single eyedrop is not effective enough to control the eye pressure. The surgery most often used in both the U.S. and the U.K. is a trabeculectomy, but newer surgeries now available will probably be used instead of the trabeculectomy. Glaucoma is very likely to become a surgical rather than a medical disease.

The company Glaukos very recently had approval granted for a unique and exciting glaucoma implant called the micro-bypass iStent. This tiny instrument is inserted into the eye's natural drainage system called the trabecular meshwork. It functions as an enhanced drain to decrease eye pressure. Usually inserted along with cataract surgery, it can also be used in stand-alone glaucoma surgery.

The studies that were used to prove that the iStent is effective have shown that a single shunt will decrease pressure to the point where pressure is very often controlled with one or no eyedrops! In addition, two or more iSent devices can be implanted at the same time to give a greater decrease in eye pressure. You don't have to use them during cataract surgery; the iStent can be implanted in a stand-alone procedure for Glaucoma only.

Research into new medicines and surgeries for Glaucoma continues. At SkyVision Centers we pledge to remain on the front line in fighting this disease.

Glaucoma 201: Side Vision Loss

Why is Glaucoma such a devastating disease? Well, two reasons. The first, of course, is that it robs you of your vision. The second is that this "thief" steals your vision slowly and painlessly, and you may not even know you have glaucoma until it's too late!

Your peripheral, or side vision is the first part of your vision to be lost in glaucoma. This is one of the reasons it's so hard to know that you have the disease, because your central vision, the vision you read and drive with, is preserved until very late in the disease.

We measure your side vision with a test called a "Visual Field" or Perimetry test. Modern testing is computerized. You place your chin on a chin rest and look into a dim, white bowl. When you see a light come into view you press a button. The readout looks like this: 

   

In the early stages you might only lose a very small portion of your vision.

In very late stages much of your side vision is gone; it can be like looking through a tunnel.

Don't let glaucoma steal your vision!                  

Glaucoma 101

Glaucoma is one of the "silent blindness" disease of older folks all over the world. Most glaucoma has no symptoms at all, no warning that there is a problem. The only way to know that you have glaucoma is to have a complete eye examination performed by an eye doctor. Even then addtional testing might be necessary.

Glaucoma is damage to the optic nerve, the nerve that carries "light" from the eye to the brain. It usually comes with high eye pressure, but not always. There are lots of people who have glaucoma who have eye pressure that seems normal, and there are even more people who have high pressure who will never get glaucoma. The "normal" pressure in the eye is 11-21. Most people who get glaucoma are older, usually older than 60.

There are several ways to measure pressure in the eye. The two most common methods are Non-Contact Tonometry--the air puff-- and Contact Tonometry--the blue light. The "blue light" technique is much more accurate and is necessary to treat glaucoma. The "air puff" is a great screening test for glaucoma because it's easy to do, and easy to have done.

There's lots to talk about with Glaucoma so we'll try to teach you as much as we can here on the Skyvision Blog. All of our Doctors, Dr. White, Dr. Kaye, and Dr. Schlegel have lots of experience in treating people with glaucoma here in Cleveland. Stay tuned!

Eye Doc Education 3.0!

This evening the doctors of SkyVision Centers will be hosting their 3rd educational seminar for local eye doctors. The first two seminars were rousing successes and we expect nothing less tonight. Each session has included two talks by either our very own SkyVision docs or invited guests. The topics covered have included the new Tear Osmolarity technology and Cataract Implants for Astigmatism among others. In addition, the two meetings have included very interesting dinner fare!

Attendees at 1.0 were treated to an Italian feast with accompanying Italian wines, while 2.0 featured artisinal pizza and Brew Kettle beer brewed especially for the meeting!

Tonight the speakers will be Dr. Darrell White and Dr. Scott Schlegel. Dr. White will introduce the concept of "service lines" in the development of protocols to diagnose, treat, and follow specific diseases in "Glaucoma Protocol Development I". Dr. Schlegel will be tackling the subject of introducing a patient with cataracts to the choices they will face when then are trying to decide what type of Intra-Ocular lens to use for their surgery.

What about dinner? Well, tonight we will be serving Mexican! Their will be a fajita bar with all of the fixin's, traditional Mexican cookies, and of course something interesting to wash it all down! We are all looking forward to seeing our friends in the eye care community as we gather to improve our collective understanding of how best to treat our patients.

Family History and Glaucoma Screening

You've seen them at the mall or at a health fair, the Glaucoma screening booths. The dreaded "air puff" to check your eye pressure to see if you might have Glaucoma. There are actually lots of different ways to screen for Glaucoma risk, and this is a very active area of research for eye doctors. What's the best way to screen for Glaucoma?

First, a couple of thoughts on what a screening test should do and not do. When you have a disease that is sneaky, like Glaucoma, and it doesn't have any outward symptoms to let you know it is there, sometimes it makes sense to have some kind of test that will let you know that you DO either have the disease or at a high risk to get it. Glaucoma is like this; there are no symptoms in early Glaucoma, and by the time your vision is affected to a point where you know something is wrong it's too late.

A screening test should be easy to do. It should be relatively inexpensive. It shouldn't hurt! The test should be able to identify pretty much anyone who MIGHT have the disease, and it definitely shouldn't miss anyone who actually HAS the disease (a false negative result). In a perfect world the screening test would not falsely find that healthy people have a the test (a false positive result), but we usually accept less accuracy here because we don't want to miss anyone who is at risk.

So how about Glaucoma screening? Well, high pressure is a risk factor for Glaucoma, so identifying people with high pressure will get them referred to an eye doctor which is what we want. There is something called a "nerve fiber analyzer" which will also do the same thing but with a little higher accuracy. Both of these screenings suffer from the expense of the equipment and the need to have trained people doing the test.

It turns out that for Glaucoma there is a really effective screening test that identifies one of the top two risk factors for developing the disease and losing vision: ask someone if they have a family member who has or had Glaucoma! Research has shown that a family history of Glaucoma, especially vision loss from Glaucoma, is the most important risk factor, and that if you DO have a family history you should have a complete Glaucoma examination at the eye doctor's office. Like Skyvision in Cleveland!

Do you have Glaucoma? Tell all of your relatives to have a complete eye exam.

Top Doc AGAIN!

Congratulations to our Dr. Darrell White for being named one of Cleveland Magazine's Top Docs once again!

"I'm incredibly flattered to receive this honor again!" said Dr. White. "It's really a team honor for all of us at Skyvision Centers. Every patient experience depends on each one of us working together as a team and pulling for our patients."

Dr. White has been on the list of Top Docs since 2003.

Glaucoma Awareness Month

January is Glaucoma Awareness month in the United States. Glaucoma is damage to the optic nerve, the part of the eye that brings vision information from the eye to the brain. It is usually, but not always associated with high eye pressure. The normal eye pressure is 11-21. Some people who have very high pressure will never develop Glaucoma, but unfortunately some people with "normal" pressure will develop all of the vision problems associated with the disease.

The most common type of Glaucoma, Primary Open Angle Glaucoma, causes a slow, painless loss of side vision before any central vision problems come up. Vision loss is permanent, so the name of the game is prevention!

The most common risk factor for the development of Glaucoma is a family history, especially if your family member had severe vision loss from Glaucoma or developed it a very early age. Not everyone in a family will get Glaucoma, but the risk could be as high as 30%! Make sure you know your family eye history.

Every person should have a complete eye exam that includes a dilated pupil examination of the optic nerve. If there is high pressure or any question of abnormalities you may be asked to under further testing. Be aware of Glaucoma, this month and every month!

How Often Should My Eyes Be Examined?

OK...you've graduated from school and now you are an adult. Congratulations! When, and how often, should you have your eyes examined? Well, if you are healthy and you don't need any glasses at all, you can probably be seen every 3 or 4 years until you reach 40 or so. After that once every 2 years is reasonable. At the age of 60 the Skyvision doctors think everyone should have a complete eye exam every year.

If you wear glasses to see near, far, or both it's best to be seen every two years until the age of 60, and then every year after that. For people who wear contact lenses, EVERYONE needs to be seen at least once per year. Contact lenses sometimes have "silent" problems, and the only way to know if you are safe to continue wearing them is by seeing your Skyvision Centers doctor every year.

There are some special rules for  people with specific eye or medical problems. For example, if you have diabetes you need to have a complete, dilated eye exam at least once per year. We will send a note to your treating doctor with the results. Other medical problems or treaments like the use of Plaquenil or treating Hepatitis C have special requirements. Of course, if you have an eye disease like Glaucoma or Macular Degeneration you should follow your doctor's recommedations regarding follow-up exams.

Remember to keep your eyes safe! Don'f forget your eye exams!!

Nearsightedness: A New Risk For Glaucoma

Glaucoma is damage to the optic nerve, usually but not always associated with high pressure in the eye. Eye doctors first see Glaucoma in changes to the optic nerve, the fine nerve fibers that enter the nerve, or in tests of the side vision. Unfortunately, the damage to the eye from Glaucoma is permanent once it occurs. This is why prevention and early detection are so important.

There are a number of risk factors or associations for Glaucoma risk that have been known for a long time. The most important risk is having a family history of Glaucoma, especially if a family member has had a severe loss of vision from Glaucoma. Other known risks include diabetes and certain family heritages (African-Americans have a much higher risk to develop Glaucoma). Of course, the greatest risk factor is age, as the risk to develop Glaucoma goes up dramatically as we age.

A recent study has confirmed that MYOPIA, being nearsighted, is a risk for Glaucoma. People who have a nearsighted prescription of greater than -3.00 have TWICE the risk of developing Glaucoma as people with little or no myopia, or people with farsightedness or hyperopia. Simply being nearsighted does not mean you will get Glaucoma, but if you have any other risk factors and you are also nearsighted you should consider having your eye doctor do a complete evaluation to rule out this severe, potentially blinding disease.

Feel free to call us at Skyvision centers if you live in Cleveland and have any questions about Glaucoma.