Diabetic Retinopathy (Los Angeles)
People who have diabetes mellitus do not use and store blood sugar properly and the amount of sugar in the blood will be too high. High blood sugar levels can damage vessels in the retina. This damage is referred to as diabetic retinopathy. There are two types of diabetic retinopathy:
There are two types of diabetic retinopathy:
- Nonproliferative Diabetic Retinopathy (NPDR)
- Proliferative Diabetic Retinopathy (PDR)
NPDR - nonproliferative diabetic retinopathy - (Los Angeles)
NPDR (nonproliferative diabetic retinopathy), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels (microaneurysms) within the retina leak blood or fluid. The leaking fluid causes the retina to swell or form deposits called exudates; white deposits within the retinal nerve fiber layer that represents small patches of the retina that have lost their blood supply, also called cotton-wool spots.
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected in NPDR it is the result of macular edema and/or macular ischemia.
Macular edema is swelling or thickening of the macular region, which usually results in a temporary reduction in visual acuity, though in some cases may be permanent. The macula is a small area in the retina which is responsible seeing fine details clearly.
Macular ischemia occurs when small blood vessels close, causing vision to blur due to the macula no longer receiving a sufficient blood supply.
PDR - proliferative diabetic retinopathy - (Los Angeles)
PDR (proliferative diabetic retinopathy), is an attempt by the eye to grow or re-supply the retina with new blood vessels (neovascularization), due to widespread closure of the retinal blood supply. Unfortunately, the new, abnormal blood vessels do not re-supply the retina with normal blood flow, but bleed easily and are often accompanied by scar tissue that may wrinkle or detach the retina. PDR can cause visual acuity loss in three ways:
- Vitreous Hemorrhage: Patients may develop a vitreous hemorrhage, in which blood may leak into the vitreous causing new dark floaters and/or a very large hemorrhage might block out most or all vision. Due to the individual healing processes of people, re-absorption of blood may take days, months, or even years, depending on the amount of blood present. If the eye does not clear the vitreous blood adequately within a reasonable amount of time, your ophthalmologist may recommend surgery (vitrectomy) to remove the blood.
- Neovascular Glaucoma: In advanced and rare cases retinal blood vessel closure will cause new, abnormal blood vessels to grow on the iris and block normal flow of fluid out the eye, causing an increase in intraocular pressure.
- Traction Retinal Detachment: Scar tissue associated with neovascularization can shrink surrounding tissue causing a wrinkle or tear, more severe visual acuity loss can occur if the macular region is affected.
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Blepharitis (Los Angeles)
Blepharitis is a chronic inflammation – a long-term swelling – of the eyelids and eyelash follicles. It may be caused by seborrheic dermatitis, acne, bacterial infection, allergic reaction or poor eyelid hygiene. They eyes may become red, blurry or tear frequently. The eyelids crust, flake, scale or redden, and the smooth inside lining of the lids may become rough. In more serious cases, sores can form when the crusting skin is removed, the eyelashes may fall out, the eyelids can deform, the infection can spread to the cornea, and patients often suffer from excessive tearing. Blepharitis can also cause styes, chalazions and problems with the tear film.
Treatment and preventative care for blepharitis involves thorough but gentle cleaning of the eyelids, face and scalp. Warm compresses can be applied to loosen crust and dandruff shampoo can help keep the eyelids clear. This may be combined with antibiotics if a bacterial infection is causing or contributing to the problems.
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Presbyopia (Los Angeles)
Presbyopia is not truly a refractive error, but is the natural process of the lens losing its ability to accommodate, or change its shape inside the eye. Why does the eye lose its ability to focus at near? For certain, it is not a disease or degeneration of the eye. One popular theory holds that the tiny muscles inside the eye that control the lens grow tired and lose their tone with age. Exercises were tried in an attempt to strengthen these muscles. The best information we have today regarding the gradual loss of accommodation places blame on the lens itself, which lies within its own capsular casing. Unlike the rest of the body, which stops growing by the age of twenty, the lens of the eye continues to grow throughout life. As the lens ages and grows, it becomes harder in consistency and, because it is confined within that capsular casing, it is therefore resistant to changes in shape. The result is a gradual reduction in accommodation, and more dependence on reading glasses.
If you also have a cataract (cloudy lens) developing you may be a candidate for a premium IOL (intraocular lens) that can decrease your dependence on glasses. (Premium IOL)
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Dry Eye (Los Angeles)
Dry eye occurs when the eyes aren't sufficiently moisturized, leading to itching, redness and pain from dry spots on the surface of the eye. The eyes may become dry and irritated because the tear ducts don't produce enough tears, or because the tears themselves have a chemical imbalance.
People usually begin experiencing dry eye symptoms as they age, but the condition can also result from certain medications, conditions or injuries.
Dry eye is not only painful, it can also damage the eye's tissues and impair vision. Fortunately, many treatment options are available.
Non-surgical treatments for dry eye include blinking exercises, increasing humidity at home or work, and use of artificial tears or moisturizing ointment. If these methods fail, small punctal plugs may be inserted in the corners of the eyes to limit tear drainage, or the drainage tubes in the eyes may be surgically closed. Eyelid surgery is also a solution if an eyelid condition is causing your dry eyes.
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Floaters (Los Angeles)
Floaters are small specks or clouds moving in your field of vision. You often see them when looking at a plain background. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. Even though they are actually floating inside, what you see are the shadows they cast on the retina.
A common cause of floaters is posterior vitreous detachment. The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. A torn retina is serious since it can lead to a retinal detachment which can lead to blindness if untreated.
When the vitreous pulls hard enough to tear the retina, fluid may pass through the retinal tear, lifting the retina off the back of the eye.
Most retinal tears need to treated with laser surgery or cryotherapy which seals the retina to the back wall of the eye. Almost all retinal detachments require surgery to put the retina back in its proper place.
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Age Related Macular Degeneration - AMD - (Los Angeles)
Age related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. The visual symptoms of AMD involve loss of central vision. While peripheral vision is unaffected, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and generally looking at detail. Imagine being able to see a clock on the wall but unable to make out the time or unable to read because you could not see parts of words on the page.
Although the specific cause is unknown, AMD seems to be part of aging in those who are genetically predisposed. While heredity is the most significant risk factor for developing AMD, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for most of the cases of new legal blindness in the US in those over the age of 60.
Nine out of 10 people who have AMD have the dry form, which results in thinning of the macula, the area of the retina responsible for central vision. Dry AMD takes many years to progress. Progress of dry AMD or the conversion to the more severe "wet" (or leaking) form may be prevented with the use of anti-oxidant vitamin (A,C,E) supplements with zinc, and lutein and omega-3 fatty acids (found in fish oil).
The wet form of AMD occurs much less frequently (one out of 10 people) but is more serious. Recently, a number of important advances have occurred in the diagnosis and treatment of wet AMD.
At Advanced Vision Care, we use the latest in diagnostic techniques (including intravenous fluorescein angiography and optical coherence tomography) and treatment advances (including drug therapy with Avastin and Kenalog) to get the best possible results. It is now possible to improve the vision in many cases!
Low vision aids improve the quality of life in those with advanced dry AMD or wet AMD. The low vision program at Advanced Vision Care offers compassionate, extensive training with advanced technology devices to maximize an individual's functional capacity.
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Pterygium Removal surgery: Sutureless (Los Angeles)
A pterygium is an eye condition that results in the growth of abnormal tissue on the surface of the cornea (the transparent window on the front surface of the eye). This is not a malignant condition. Pterygia typically occur on the inner part of the eye and commonly affect patients that live in sunny climates or work outdoors. It is believed that long-term exposure to UV rays contribute to the growth of pterygia. Therefore, we advise patients to use UV protected sunglasses outdoors.
Patients may experience chronic eye irritation, redness, or decreased vision as a result of this condition. If the pterygium enlarges and interferes with central vision or causes chronic irritation, a surgery can be performed to remove this abnormal tissue. The traditional method of surgery is to remove this tissue and suture a membrane (conjunctival autograft or amniotic membrane graft) to the bed of the defect on the white part of the eye. However, newer techniques using a fibrin adhesive rather than sutures can accomplish the same result with greater comfort for the patient. Pterygium surgery is performed in an out-patient setting.
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