Pisacano Eye

We often seek medical attention if our eyes hurt, or turn red, or if our vision becomes blurry. But we don’t often get our eyes examined regularly if we are not having any problems with them. Routine eye examinations are important even if our eyes and vision are fine—because many blinding eye diseases have few or no warning signs until they have taken away some or all of our vision. The most common cause of blindness in the United States is diabetic eye disease. In the early stages, when it is most easily treated, diabetic eye disease has no symptoms. The only way for a diabetic to know if he or she has diabetic eye disease is to get routine eye examinations at least once a year.

Glaucoma is an eye disease that can lead to blindness if not treated. While there is no cure for glaucoma, there are effective treatments that can save your sight. If you have glaucoma, it is necessary to have regular follow up visits to your eye doctor. The purpose of these visits is to make sure that your glaucoma is well controlled and not getting worse. Glaucoma gets worse very slowly, and because there are no symptoms that you can detect to tell if your glaucoma is getting worse. So regular visits—at least 2-3 every year—are very important to make you’re your glaucoma is not getting worse. During these visits, you will likely undergo a number of tests evaluating the status of your glaucoma. At every visit, your eye pressure will be measured. High eye pressure is thought to play a role in the damage that destroys vision. The goal of glaucoma treatment is to lower eye pressure. This is usually achieved with eye drop medications. Checking your eye pressure at each visit lets your doctor know if your drugs are still working effectively. There are several ways to measure eye pressure, including an air puff or a blue light. These various tests are all necessary to make sure that your eye pressure has been lowered enough to stop glaucoma from stealing your sight. Keeping your appointments faithfully, and using your eye drop medications regularly as prescribed, are important in keeping your glaucoma under control and saving your sight.

Modern cataract surgery makes use of an amazing array of high-tech equipment and techniques. Gone are the days when cataract surgery required a two-week stay in the hospital, with your head immobilized with sandbags until you healed. Today’s cataract surgery is an out-patient procedure that takes a half-hour or less and lets you get back to your normal activity level within a few days. One of the most dramatic advances in cataract surgery involves anesthesia for the procedure. Long ago, patients were put to sleep for cataract surgery. More recently, patients were given a shot behind the eye before surgery to numb it. But now, the vast majority of cataract surgeries are performed under topical anesthesia, with only a few numbing drops placed on your eye before the start of the procedure. This eliminates both the risks and discomforts of the shot. Also, the shot made the vision blurry for several hours after surgery—with just the numbing drops, some patients notice improved vision within minutes after the surgery is completed. The technique of cataract removal has also undergone major improvements. Once upon a time, the cataract was removed whole through an incision over a half-inch long. Modern cataract surgery is performed through an incision less than an eighth of an inch long. A small instrument is inserted through this tiny incision, and is used to break the cataract into many small pieces that are removed without the need for a large incision. There are many advantages to a smaller incision, including a faster recovery time, less need for glasses after surgery, and a smaller risk of infections after surgery. In addition, while the old incisions required many stitches to close up, modern cataract surgery can often be performed without any stitches, or with one stitch at most. Routine cataract surgery is so well tolerated that it has become the most common surgery performed on adults in the United States. As a result of these many high-tech developments in all aspects of cataract surgery, the operation is more successful—and has a faster recovery time—than ever before.

New advances in refractive surgery technology have greatly improved the success of these popular procedures designed to reduce or eliminate your need for glasses or contact lenses. Nearsightedness (myopia), farsightedness (hyperopia) and astigmatism can all be corrected by refractive surgery techniques. These vision problems arise when your eye’s focusing system is either too weak or too strong; refractive surgery corrects your eye’s focusing power system so you can see clearly without glasses or contacts. The most commonly performed refractive surgery is LASIK. In LASIK, a corneal flap is cut from the front surface of your eye and gently folded out of the way while the excimer laser sculpts your corneal shape to correct your nearsightedness, after which the flap is repositioned and the procedure is complete. Traditionally, the flap is cut with a special blade instrument called a microkeratome. A new laser system—called a femtolaser—has been developed to create the corneal flap without using a blade at all. The femtolaser approach allows your doctor to create a more precise flap, giving him or her more control over the size, shape and thickness of the flap, all of which ultimately improve the quality of your vision after surgery.

Dry eye syndrome is a common condition that affects as many as 10 million people in the United States. Symptoms of dry eye syndrome include burning and an itchy or scratchy sensation, like having sand or grit in your eyes. Many people with dry eye syndrome have intermittent blurry vision that temporarily improves with rapid blinking. There are many causes of dry eye syndrome, but in general, the condition occurs because your tears are either abnormal or they are evaporating from your eye’s surface too quickly. Dry eye syndrome is often a nuisance, and in some cases, can lead to scaring of the eye’s surface with loss of vision. There are several treatments available. These range from simple lifestyle modifications to prescription medications, depending on the severity of the condition.

The eye is filled with a clear jelly called the vitreous gel. The vitreous gel inflates the back part of the eye in the way that water inflates a water balloon. As we age, the vitreous gel begins to dissolve into a more watery form. Once enough of the vitreous gel has dissolved – usually when we are in our late 50’s or early 60’s – the gel pulls free of its attachments to the back of the eye. This sudden and often dramatic event – called a posterior vitreous detachment – often causes a number of symptoms that can be alarming. One common symptom of a posterior vitreous detachment is the appearance of floaters. Floaters are exactly what they sound like – tiny bits of debris that appear when the vitreous gel separated from the back of the eye. These bits of cloudy debris float in the liquefied vitreous like snow in a snow globe. If you have a single small floater, you may have the sensation that a bug is flying in your face. Often in eyes with posterior vitreous detachments, the floaters are bigger and somewhat stringy, and you may describe it as a spider web or cobweb in your vision. Typically, these floaters will move around in your vision, especially when you move your eyes around. Floaters usually do not stay in exactly the same spot in your vision.

The visual field test measures your peripheral vision, also called your side vision. Many diseases can reduce your peripheral vision. To diagnose and treat these conditions, we must carefully measure the peripheral vision. Your peripheral vision is measured with a special test called a visual field test. Taking a visual field test can be challenging, and the results are only useful if you can perform the test well. Each eye will be tested separately, and the eye not being tested will be covered with an eye patch. To get started, your head will be comfortably positioned in the visual field machine. The test takes 5-10 minutes per eye, and if you are uncomfortable, you will not be able to do a good job taking the test. If you are not comfortable, tell your technician so you can be adjusted until you’re comfortable. Once you are comfortably positioned, you will be looking into a dimly-lit bowl. Your technician will ask you to stare at a small target light in the middle of the bowl. Your job is to keep staring at that spot throughout the whole test. You may blink your eyes whenever you need to—this will not affect the test. Before the test begins, you will be handed a small device with a button on it. Try pushing the button a few times before starting the test. If you have arthritis or any other health problem that makes it hard for you to push the button in your hand, now is the time to tell your technician.

As we age, our bodies undergo many significant changes. One such change that often causes concern for people is the gradual loss of near vision that occurs when we reach our 40’s. This normal and unavoidable effect of aging is called presbyopia, or “old eyes.” The symptoms for presbyopia are familiar to anyone over age 45. At first, you will notice that after you’ve been reading for a short time, the words seem to run together. After a brief rest, you can again read for a short time before it happens again. Over time, reading small print – such as numbers in the phone book, the box scores in the newspaper, or items on a menu – becomes harder and then impossible. You may notice that if you hold reading material farther away than normal, the words come into sharper focus. As presbyopia continues to develop, you may find yourself hold your newspaper farther and farther away until at last your arms aren’t long enough to compensate.

Diabetes is a common disease in the United States, and diabetic eye disease is the most common cause of blindness in the US. Regular eye examinations are important in diabetes because diabetic eye disease and the vision loss caused by it are completely preventable. In diabetes, high sugar levels in the blood damage blood vessels throughout the entire body. Damage to blood vessels in the kidneys can cause kidney failure requiring dialysis. Damage to blood vessels in nerves can cause neuropathy. Your eye also has many blood vessels in it, and diabetes can also damage those blood vessels. In particular, high blood glucose levels cause damage to the blood vessels in the retina of the eye. The retina lines the back of your eye like wallpaper, and is like the film in a camera—it detects the light entering your eye and turns it into pictures for your brain to see. When the retina’s blood vessels are damaged, the retina stops working properly, and sight can be lost.