Eye Disease Evaluation

Aged-related macular degeneration (AMD) is the deterioration of the macula, the central portion of your retina that controls visual acuity (your ability to read, recognize faces and colors, drive, watch television, use a computer, and perform any other visual task that requires you to see fine detail).

AMD is the leading cause of vision loss in people age 50 and older. It is an incurable eye disease that gets worse over time:

• Early AMD: at this stage, no vision impairment is experienced however, our optometrist will diagnose the presence of medium-sized drusens (early aging of the macula that manifests itself as yellow deposits under the retina) during your retinal and OCT scans. Regular eye exams become important to monitor the progress of the disease.

• Intermediate AMD: some vision loss will occur but may not be noticeable. Symptoms include: blurry or fuzzy vision, straight lines looking wavy, objects seeming smaller than they actually are, dark/empty/gray areas appearing in your vision. Our eye doctor will look for larger drusens and pigment changes in your retina.

• Late AMD: vision loss is noticeable and permanent

Macular degeneration comes in 2 forms:

• Dry AMD is the more common form of AMD, experienced by 80% of AMD patients. The tissue of the macula gradually becomes thin and eventually stops working properly. You vision starts becoming dim and distorted until you lose central vision over time.

• Wet AMD is the less common but more serious form of AMD. It can progress rapidly. Dry AMD can turn into wet AMD. New, abnormal blood vessels grow under the retina and may leak fluids, therefore damaging light-sensitive retinal cells and scaring your macula. Your vision starts becoming distorted and blurry and as fluids continue to leak, scaring creates blind spots and permanent central vision loss.
  
  

Since AMD is an incurable disease, prevention and early detection is key to preserving your vision.

For anyone 50 years of age and older, we recommend optomap® retinal imaging as part of your eye health check-up during your annual eye exam, rather than dilation (unless necessary). Our eye doctor uses optomap® to detect drusens early and quickly assess the general health of your eye.

Based on clinical findings, our optometrist may require an OCT/OCTA scan to further assess the severity and progression of your drusens. Unlike other practices that may only have access to a regular OCT (ultrasound of the eye), our doctors use the latest angiography technology featured in our Optovue AngioVue OCTA® to view the vasculature of your eye without the need for uncomfortable dye injection into the eye, which helps guide best course of treatment for your care. The OCT/OCTA scan will reveal the extent and location of any blood vessel build-up or leakage.

Being wellness and preventive care focused, our eye doctors always prefer early detection over having you suffer partial/full vision loss and go through anti-VEGF eye injections to slow down the symptoms of intermediate or late stage AMD.

To help prevent AMD, here are some good habits you can adopt:

1. Eat plenty of dark leafy greens, nuts, fruits and vegetables rich in antioxidants and carotenoids (kale, spinach, collard greens, turnip greens, broccoli, brussel sprouts, lettuce, peas, okra, nuts, seeds… etc). Studies have shown that high level of Vitamin A, E, C and carotenoids made of lutein, zeaxanthin and meso-zeaxanthin help replenish the pigments in your macula to protect it from deterioration

2. Eat more fish or consider Omega-3 supplements

3. Exercise regularly: a combination of regular exercise and healthy diet helps control high blood pressure and cholesterol, which both affect blood flow to the eye

4. Avoid smoking: smoking speeds deterioration as it reduces number of protective nutrients, and oxygen delivered by the bloodstream to the eye

5. Protect your eyes from UV and blue light by wearing sunglasses outdoors. Though UV light has not been confirmed to cause AMD, studies suggest that overexposure to both UV and high energy visible (HEV) “blue” light may accelerate the deterioration of the macula in the eye

6. Consider MacuHealth vitamins if you are at risk of AMD: Many eye doctors may suggest AREDS 2 vitamin supplementation. However, our office currently prefers MacuHealth over AREDS 2 as the latest studies show debatable benefit and potential risk of higher Zinc dosage in the current AREDS/AREDS 2 formulation. Speak with our doctor to learn more.

For additional information, please visit one of the following resources and references:

• American Macular Degeneration Foundation, “About Macular Degeneration – Symptoms, Risks, Stargardt, Anatomy“

• American Optometric Association, Macular Degeneration Fact Sheet

• American Academy of Ophthalmology, “Age-Related Macular Degeneration Preferred Practice Pattern 2019“

• National Eye Institute, “At a glance: Aged-Related Macular Degeneration“

• Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34, “Two Big Controversies in Ocular Nutrition” pg 41

A cataract is the clouding of your normally clear lens inside of your eye due to aging. It typically develops slowly over time and mostly affects people age 55 and over.

A clear lens allows light to focus onto the retina to produce a clear image. When clouding occurs due to a cataract, you will start experiencing the following symptoms:

• Blurry or hazy vision

• Trouble seeing at night

• Seeing colors as faded

• Increased sensitivity to glare from lights, particularly when driving at night

• Halos surrounding lights

• Needing more light to read in dark conditions

• Double vision in the affected eye

• Need for frequent changes in prescription glasses

During your eye exam, our optometrist will help you determine what kind of cataract you have and will explain how it’s affecting your vision:

1. Nuclear cataract affects and forms in the center of the lens. The nucleus tends to darken, changing from clear to yellow and eventually brown. This is the most common type of cataract associated with aging

2. Cortical cataract affects the edges surrounding the nucleus of your lens. The cataract looks like a wedge or a spoke.

3. Posterior capsular cataract affects the back outer layer of the lens. This type often develops more rapidly and interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night.

4. Congenital cataract is a cataract that people are born with or that was developed during childhood due to genetics, trauma or medical conditions such as intrauterine infection, myotonic dystrophy, galactosemia, neurofibromatosis type 2 or rubella… etc.
   
   

There is currently no cure for cataracts. If a cataract is negatively impacting your quality of life, our optometrist may suggest cataract surgery to remove the cataract by replacing the lens inside your eyes. Similar to any age-related diseases, the best way to avoid or delay cataracts is to maintain a healthy lifestyle.

1. Avoid and stop smoking

2. Wear sunglasses to protect your eyes from the sun’s harmful UV rays

3. Maintain healthy weight to avoid obesity

4. Eat fruits and vegetables that contain antioxidants, Vitamin A, C, and carotenoids such as lutein and zeaxanthin. Good sources include sunflower seeds, almonds, spinach, kale and other green, leafy vegetables (consider supplementation as needed)

5. Keep diabetes, cholesterol and other medical conditions in check

6. Reduce alcohol consumption

For additional information, please visit one of the following resources and references:

• American Academy of Opthalmology, “What Are Cataracts?“

• All About Vision, “Cataracts: 3 common types, causes, symptoms and treatments“

• National Eye Institute, “At a glance: Cataracts“

• MedicineNet, “Cataracts”

• Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34
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Diabetic retinopathy is an eye condition that may develop in patients with diabetes (type 1, type 2, and gestational) and can lead to vision loss and blindness. It is the leading cause of blindness among adults in the US and usually affects both eyes.

When left untreated or when not under control, high blood sugar levels damage the blood vessels in the retina (the light sensitive part of the eye). Blood and fluids then leak into the eye, which then hinder light from reaching and focusing onto your retina.

In early stages, you may not show any symptoms and not know that you have diabetic retinopathy. As the disease progresses, you will experience:

• Spots or floaters

• Blurred or cloudy vision

• Seeing a dark or blank spot in your center field of vision

• Poor night vision

• Faded or washed-out colors

If you or your family has a history of diabetes, it is important for you to have regular annual eye exams. Our optometrist will use optomap® retinal imaging to detect early signs of blood or fluid leakage, giving you an overview of the general health of your retina.

Based on clinical findings, he or she may also require an OCT/OCTA scan (ultrasound of your eye) to review how much blood or fluid has leaked into your eye. Our Optovue AngioVue® OCTA features the latest angiography technology to view blood vessel changes at the micron level without dye injection to your eye, which helps our doctor detect risks to your vision much earlier than before.

Diabetic retinopathy will progress in stages:

1. Mild non-proliferative retinopathy: At this earliest stage, microaneurysms occur, which are small areas of balloon-like swelling in the retina’s tiny blood vessels.

2. Moderate non-proliferative retinopathy: As the disease progresses, some blood vessels that nourish the retina are blocked, swell and change shape. You may develop diabetic macular edema (DME) which is when your retina gets deformed because it is swollen with blood and fluids, therefore potentially affecting vision.

3. Severe non-proliferative retinopathy: Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

4. Proliferative retinopathy: At this advanced stage, abnormal new blood vessels grow inside your retina and into the vitreous humor, the clear gel that fills the inside of your eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, being thin with fragile walls, they leak blood and cause scar tissue to form, which then leads to vision loss from vitreous hemorrhage and also puts you at high risk of retinal detachment, causing blindness.

The goal of having regular eye exam is for our eye doctors to catch and monitor any microaneurysm formations early to avoid potential vision impairment. Our optometrist would prefer you keep your diabetes under control with preventive care over having you undergo invasive procedures like anti-VEGF eye injections or laser treatments to stop vision loss.

Even though laser treatments are effective at stopping internal eye bleeding, they are also known to scar the retina.

For additional information, please visit one of the following resources and references:

• American Diabetes Association, “Eye Complications“

• American Optometric Association, “Diabetic Retinopathy“

• American Academy of Ophthalmology, “What is Diabetic Retinopathy“

• National Eye Institute, “At a glance: Diabetic Retinopathy“

• Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34

Glaucoma is a group of serious eye conditions when the optic nerve is being damaged, leading to progressive and irreversible vision loss. It is one of the leading causes of blindness for people age 60 and older. Even though glaucoma is more common in older adults, it can occur at any age.
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Glaucoma is sometimes called the “silent thief of sight” because it slowly damages the eyes and can cause irreparable harm before there is any vision loss. But this disease is stealthy in more ways than one.
– Dr. Janey Wiggs, Massachusetts Eye and Ear Infirmary

The optic nerve damage is often, but not always, caused by abnormally high pressure in the eye. The optic nerve is a bundle of about 1 million individual nerve fibers that transmits the visual signals from the eye to the brain. Other theories suggest a lack of adequate blood flow to the optic nerve as possible cause for glaucoma.

By the time you notice vision loss symptoms, it may be too late. The vision loss cannot be restored and you can only save and maintain the current vision you have.

Different types of glaucoma will have different symptoms. The most common causes of glaucoma are listed below:

• Primary open-angle glaucoma, also called wide-angle glaucoma: this is the most common type of glaucoma, affecting at least 90% of all glaucoma cases, about 3 million Americans.It is caused by the slow clogging of the drainage canals, resulting in increased eye pressure (IOP). It is painless with no vision changes at first and will develop slowly as a lifelong condition. As the disease progress, you may experience:

  • Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes

  • Tunnel vision in the advanced stages

• Angle-closure glaucoma, also called closed-angle glaucoma, narrow-angle glaucoma: this is the less common form of glaucoma and is a medical emergency as it can cause blindness within a day of its onset. It is caused by blocked drainage canals when the angle between the iris and cornea is closing, resulting in sudden increase in internal ocular pressure (IOP). Angle-closure glaucoma can be chronic (progressing gradually) or acute (appearing suddenly). Please seek medical attention immediately if you experience:

  • Severe headache

  • Intense eye pain

  • Nausea and vomiting

  • Blurred vision

  • Halos around lights

  • Eye redness

• Secondary glaucoma: This is any type of glaucoma in which the increase in eye pressure was caused by another medical eye condition, physical injury, medication or in some rare occasion, eye surgery.

• Normal-tension glaucoma (NTG) or low-tension glaucoma: In this form of glaucoma, your optic nerve is damaged even though your eye pressure remains within the normal range. It is unclear why this would happen but some theorize that you may have abnormally sensitive optic nerve, or that you have lower blood flow going to the optic nerve due to a medical condition that impairs blood circulation, such as atherosclerosis, which is a hardening of the arteries from a buildup of fatty deposits (plaque) in the arteries.

  • You may experience blind spots in your vision.

• Pigmentary glaucoma: Tiny bits of pigment granules from your iris (the colored part of your eye) break into the clear fluid and slowly clog or block your drainage canals. Rigorous physical activities like jogging may stir up the pigment granules and cause intermittent increase in eye pressure.

• Congenital Glaucoma: Infants and children may also have glaucoma due to a hereditary defect, an abnormal development during pregnancy when there’s incorrect or incomplete development of the eye’s drainage canals, or other medical conditions. For uncomplicated defect correction, microsurgery may be an option. For others, both surgery and medication would be required. Children with glaucoma may show the following symptoms:

  • Unusually large eyes

  • Excessive tearing

  • Cloudy eyes

  • Light sensitivity

When you arrive for your appointment, our optometrist will check for signs of glaucoma during the eye health check portion of your eye exam if you completed the optomap® retinal imaging or dilation. Visual field testing is also used to check if you have any blind spots in your vision, which is a common symptom of glaucoma.

Because most glaucomas progress so slowly with no vision loss symptoms in its earliest stage, our eye doctors use the most advanced technology in both retinal imaging and optical coherence tomography angiography (OCTA) to detect glaucoma early.

1. We prefer the optomap® retinal imaging over dilation as it allows our optometrists to better gauge and monitor year-to-year changes to your retina and optic nerve, which therefore increases your chance to detect glaucoma early before you suffer irreversible vision impairment.

2. Based on clinical findings, our eye doctor may also require an OCT/OCTA scan (ultrasound of your eye) to further measure Focal Loss Volume (FLV%), which is the current single best predictor of conversion to glaucoma according to the latest studies.

If you fall under one of the following categories, it is extremely important that you do a comprehensive eye exam (with eye health screening) instead of a basic routine eye exam during your annual check-up as you are more at risk of developing glaucoma:

• Age over 60: Each year of age slightly increases your risk of developing glaucoma. African Americans, Hispanics/Latinos are at increased risk after age 40.

• Race: African Americans are significantly more likely to get glaucoma than Caucasians, and they are much more likely to suffer permanent vision loss. People of Asian descent and Native Alaskans are at higher risk of angle-closure glaucoma. People of Japanese descent are more likely to develop low-tension glaucoma. Others of Irish, Russian, Hispanic, Inuit and Scandinavian descents are also at greater risk.

• Family history of glaucoma

• Medical conditions: Some studies indicate that diabetes, high blood pressure, heart disease, and sickle cell anemia may increase the risk of developing glaucoma.

• Physical injuries to the eye: Severe trauma, such as being hit in the eye, can result in immediate increased eye pressure. Internal damage from such a trauma can also cause future increases in pressure. Injury can also dislocate the lens, closing the drainage angle and increasing pressure.

• Other eye-related risk factors: thinner corneas and optic nerve sensitivity, conditions such as retinal detachment, eye tumors, eye inflammations… and high amounts of nearsightedness or farsightedness all increase your risk for developing glaucoma

• Corticosteroid use: Long-term use of corticosteroids (including cortisone, hydrocortisone and prednisone) appears to put some people at risk of getting secondary glaucoma.

For additional information, please visit one of the following resources and references:

• Glaucoma Research Foundation

• The Glaucoma Foundation

• International Glaucoma Association, “About glaucoma”

• National Eye Institute, “At a glance: glaucoma”

• Review of Optometry, Oct 2019, Wellness Essentials for Clinical Practice, see “The Nuts and Bolts of Nutrients” pg 8, “The Virtues of Vitamin C” pg 14, “Carotenoids: Front to Back Ocular Protection” pg 21, “Put Wellness on the Menu” pg 34