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Floaters and Spots
By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson You may sometimes see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. Floaters may look like specks, strands, webs or other shapes. Actually, what you are seeing are the shadows of floaters cast on the retina, the light-sensitive part of the eye. Eye Floaters and Spots Symptoms and Signs
If a spot or shadowy shape passes in front of your field of vision or to the side, you are seeing a floater. Because they are inside your eye, they move with your eyes when you try to see them. You may also see flashes of light. These flashes occur more often in older people as the vitreous humor thickens and tugs on the light-sensitive retina. They may be a warning sign of a detached retina. Flashes also occur after a blow to the head, often called "seeing stars." Some people experience flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine. If a headache follows the flashes, it is called a migraine headache. However, jagged lines or "heat waves" can occur without a headache. In this case, the light flashes are called an ophthalmic migraine, or a migraine without a headache. What Causes Eye Floaters and Spots?
For most people, floaters occur as they grow older. The vitreous humor thickens and clumps as we age, and floaters result from the clumped vitreous gel. Sometimes pregnant women see spots caused by little bits of protein trapped within the eye. Eye injury or breakdown of the vitreous humor may also cause spots and floaters. When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. It is a common cause of floaters, and it is more common for people who: • are nearsighted; • have undergone cataract operations; • have had YAG laser surgery of the eye; • have had inflammation inside the eye. Treatment for Spots and Floaters
Most spots and eye floaters are merely annoying but harmless when they temporarily enter the field of vision, and many fade over time. People sometimes are interested in surgery to remove floaters, but doctors are willing to perform such surgery only in rare instances. If you suddenly see new floaters, or eye floaters accompanied by flashes of light or peripheral vision loss, it could indicate serious conditions such as diabetic retinopathy; vascular abnormalities such as retinal hemorrhages or carotid artery disease, or the beginning of a retinal detachment. The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. You should see your eye doctor immediately. Glaucoma: The Second-Leading Cause
of Blindness in the
U.S.
Your eye has pressure just like your blood, and when this intraocular pressure (IOP) increases to dangerous levels, it damages the optic nerve. This can result in decreased peripheral vision and, eventually, blindness. Glaucoma is similar to ocular hypertension but with accompanying optic nerve damage and vision loss. Glaucoma affects an estimated 3 million Americans, with 120,000 blind due to the condition. Elsewhere in the world, glaucoma treatment is less available, and glaucoma ranks as a leading cause of blindness just about everywhere. Even if people with glaucoma do not become blind, vision can be severely impaired. Glaucoma Signs and Symptoms
Chronic glaucoma (primary open-angle glaucoma or POAG) is often called "the silent
thief of sight" because you have no warning sign, no hint that anything is wrong. About
half of Americans with chronic glaucoma don't know they have it. Glaucoma gradually
reduces your peripheral vision, but by the time you notice it, permanent damage has
already occurred. If your IOP remains high, the destruction can progress until tunnel
vision develops, and you will only be able to see objects that are straight ahead.
Macular Degeneration
Macular degeneration, often called AMD or ARMD (for age-related macular degeneration), is the leading cause of vision loss and blindness in Americans aged 65 and older. Because older people represent an increasingly larger percentage of the general population, vision loss associated with AMD is a growing problem. AMD is a degenerative condition of the macula, which is the part of the retina responsible for the sharp, central vision needed to read or drive. Because AMD affects the macula, central vision loss may occur. Macular degeneration is diagnosed as either dry (non-neovascular) or wet (neovascular). The dry form is more common than the wet, with about 85%-90% of AMD patients diagnosed with dry AMD. The wet form of the disease usually leads to more serious vision loss. Macular Degeneration Symptoms and Signs
Macular degeneration usually produces a slow, or rarely, sudden painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. Viewing a chart of black lines arranged in a graph pattern (Amsler grid) is one way to tell if you are having these vision problems. Click here to see how an Amsler grid works. An eyecare practitioner often detects early signs of macular degeneration before symptoms occur. This usually is accomplished through a retinal examination. When macular degeneration is suspected, a brief test using an Amsler Grid that measures your central vision may be performed. If the eyecare practitioner detects some defect in your central vision, such as distortion or blurriness, he or she may order a fluorescein angiography to specifically examine the retinal blood vessels surrounding the macula. What Causes Macular Degeneration?
Aside from possible links to a gene deficiency, the exact causes of age-related macular degeneration are still unknown. The dry form of AMD may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes. With wet AMD, new blood vessels grow (neovascularization) beneath the retina and leak blood and fluid. This leakage causes retinal cells to die and creates blind spots in central vision. Other risk factors for AMD include having a family member with AMD, smoking, high blood pressure, lighter eye color, farsightedness, and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of AMD, but this theory has not been proven conclusively. High levels of dietary fat also may be a risk factor for developing AMD. nutrients — zinc, lutein, zeaxanthin and vitamins A, C and E — help lower the risk for AMD or slow down the progression of dry AMD. Benefits of high levels of antioxidants and zinc for halting or slowing development of macular degeneration have been widely reported based on results released in 2001 from the Age-Related Eye Disease Study (AREDS) conducted by the National Eye Institute. The August 2001 issue of Archives of Ophthalmology reported findings that consumption of omega-3 fatty acids, which are particularly prevalent in cold-water fish, also had a protective effect against advanced macular degeneration. Meanwhile, consumption of omega-6 fatty acids, prevalent in vegetable oils, was associated with an increased risk of developing AMD. Some cases of macular degeneration can be induced as a result of the side effects of toxic drugs such as Aralen (chloroquine, an anti-malarial drug) or phenothiazine. Phenothiazine is a class of anti-psychotic drugs, including Thorazine (chlorpromazine, which is also used to treat nausea and vomiting, and intractable hiccups), Mellaril (thioridazine), Prolixin (fluphenazine), Trilafon (perphenazine) and Stelazine (trifluoperazine). For those who have suffered vision loss, many low vision devices are available to help improve vision by using magnifying lenses and bright lights. Some low vision aids shift images to the periphery for clearer vision. Surgical options for macular degeneration. Surgery likely would be considered a last
resort for patients who fail to respond to other, less invasive AMD therapies. Surgical
removal of damaged tissue (subretinal operation) might be one option. Injections of gas
and/or a drug that dissolves blood clots also have been investigated as a way to displace
unwanted blood (pneumatic displacement) accompanying abnormal blood vessel
growth and leakage. Translocation operations now being studied involve moving and
separating damaged tissue from healthy tissue as a way to preserve vision function.
Eyes Over 40: What to Do About
Presbyopia
Bifocal and Trifocal Options
If you need help seeing up close and in the intermediate distance, you'll find many new bifocal and multifocal lens options, no matter what your work and leisure activities are. Multifocal Contact Lenses
Offering the convenience of contact lenses as well as the ability to see close up and far away, multifocal and bifocal contacts help active Baby Boomers adjust to any situation without eyeglasses. Occupational Bifocals and Trifocals
People who perform certain tasks at home or at work may need special-purpose multifocal lenses. One example is a bifocal lens with a near-focus segment in the top half, for a mechanic who needs to look up a lot. By improving your eyes' focusing power, these special lenses can reduce eyestrain and fatigue. How Progressive Lenses Work
No lines! But progressive lenses have more going for them than just good looks. They let you see at all distances, from far away to up close, without the irritation of transitional lines. The right progressive lenses can help your eyes focus the way they would if you didn't need vision correction at all. Reading Glasses
If you're over 40 and beginning to experience blurry vision at near, reading glasses can be a quick fix. And they work great as an adjunct to distance vision-correcting contact lenses. Read about the pros and cons of drugstore readers, and find out what your best options are. Reading Glasses: New Styles
These are the latest designs in reading glasses, pendant magnifiers, and more. In vibrant colors and modern shapes, these aren't your Grandma's readers! Cataracts and Cataract Surgery
A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see. Cataracts are classified as one of three types: • A nuclear cataract is most commonly seen as it forms. This cataract forms in the
nucleus, the center of the lens, and is due to natural aging changes. • A cortical cataract, which forms in the lens cortex, gradually extends its spokes
from the outside of the lens to the center. Many diabetics develop cortical cataracts. • A subcapsular cataract begins at the back of the lens. People with diabetes, high
farsightedness, retinitis pigmentosa or those taking high doses of steroids may develop a subcapsular cataract. Cataract Symptoms and Signs
A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. A cataract may make light from the sun or a lamp seem too bright or glaring. Or you may notice when you drive at night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once did. The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur. When a nuclear cataract first develops it can bring about a temporary improvement in your near vision, called "second sight." Unfortunately, the improved vision is short-lived and will disappear as the cataract worsens. Meanwhile, a subcapsular cataract may not produce any symptoms until it's well-developed. If you think you have a cataract, see an eye doctor for an exam to find out for sure. What Causes a Cataract?
No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts — and information that may help to prevent them. Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eyecare practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure. Other types of radiation may also be causes. For example, a 2005 study conducted in Iceland suggests that airline pilots have a higher risk of developing nuclear cataract than non-pilots, and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at risk from cosmic radiation. Other studies suggest people with diabetes are at risk for developing a cataract. The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves. Some eyecare practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk. Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption. A small study published in 2002 found lead exposure to be a risk factor; another study in December 2004, of 795 men age 60 and older, came to a similar conclusion. But larger studies are needed to confirm whether lead can definitely put you at risk, and if so, whether the risk is from a one-time dose at a particular time in life or from chronic exposure over years.* Cataract Treatment
When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids. Think about surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision. Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with over 1.5 million cataract surgeries done each year. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40. the patient's clouded natural lens. Shown During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. One example is a new IOL that lets patients see at all distances, not just one. Another new IOL blocks both ultraviolet and blue light rays, which research indicates may What is Lens Implant?
Lens Implants are used to correct vision either with or without removal
of the eye's natural lens. Most of the time, the natural lens is removed
due to a cataract, but some people with high corrections choose lens
removal for vision correction as well. There are several types of lenses
for correcting vision after the natural lens is removed.
Crystalens IOL
ReZoom IOL
The ReZoom lens is a multifocal lens implant. It bends the light differently over different parts of the lens optics and allows for a better range of distance, intermediate, and near vision. This means greater independence from glasses than monofocal IOLs. Anyone who has a normal eye exam and is dependent on reading glasses or bifocals may be a candidate. Although ReZoom lenses are initially approved for cataract patients with or without Presbyopia, it is not necessary to need cataract surgery to qualify for the ReZoom lens. Diabetic Retinopathy
By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely he is to have retinopathy. In later stages, the disease may lead to new blood vessel growth over the retina. The new blood vessels can cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris, which can lead to glaucoma. People with diabetes are 25 times more likely to lose vision than those who are not diabetic, according to the American Academy of Ophthalmology. Diabetic Retinopathy Symptoms and Signs
Everyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics do develop it. In its early stages, you may not notice any change in your vision, but it can lead to the later, sight-threatening form of the disease. Floaters can be a sign of diabetic retinopathy. Sometimes difficulty reading or doing close work can indicate that fluid is collecting in the macula, the most light-sensitive part of the retina. This fluid build-up is called macular edema. Another sign is double vision, which occurs when the nerves controlling the eye muscles are affected. If you experience any of these signs, see your eye doctor immediately. Otherwise, diabetics should see their eye doctor at least once a year for a dilated eye exam. Your eye doctor may diagnose retinopathy using a special test called fluorescein angiography. In this test, dye is injected into the body and then gradually appears within the retina due to blood flow. Your eyecare practitioner will photograph the retina with the illuminated dye. Evaluating these pictures tells your doctor how far the disease has progressed. What Causes Diabetic Retinopathy?
Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes. Generally, diabetics don't develop diabetic retinopathy until they have had diabetes for at least 10 years, but it is not wise to wait that long to have an eye exam. As soon as you've been diagnosed with diabetes, you need to have a dilated eye exam at least once a year. High blood sugar can damage blood vessels in the retina, and when they are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits. This is an early form of diabetic retinopathy called nonproliferative or background retinopathy. In a later stage, called proliferative retinopathy, new blood vessels grow on the surface of the retina. These new blood vessels can lead to serious vision problems because they can break and bleed into the vitreous, the clear, jelly-like substance that fills the center of the eye. Proliferative retinopathy is a much more serious form of the disease and can lead to blindness. Fortunately, you can significantly reduce your risk of developing diabetic retinopathy by using common sense and taking good care of yourself. • Keep your blood sugar under good control. • Monitor your blood pressure and keep it under good control, or seek appropriate • Maintain a healthy diet. • Exercise regularly. • Follow your doctor's instructions to the letter. Diabetic Retinopathy Treatment
According to the American Academy of Ophthalmology, 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time. The possibility of early detection is why it is so important for diabetics to have a dilated eye exam at least once a year. Diabetic retinopathy can be treated with laser photocoagulation to seal off leaking blood vessels and destroy new growth. Laser photocoagulation doesn't cause pain, because the retina does not contain nerve endings. In some patients, blood leaks into the vitreous humor and clouds vision. The eye doctor may y wait to see if the clouding will dissipate on its own, a period called "watchful waiting." A d a vitrectomy removes blood that has leaked into the vitreous humor. The body gradually replaces mor, and vision usually improves. If diabetic retinopathy has caused your body to form a cataract, ed surgically. Patients who have developed glaucoma should see a glaucoma specialist. Office Hours Accepted Insurance Policy
1. PPO and POS insurance policies of all companies are accepted. 2. Patients must have paid their deductibles or plan to pay at the time of 3. All appropriate co-pays must be paid at the time of the visit 4. Selected HMO's are accepted with the appropriate referral. 5. Medicare deductibles must be paid at the time of the visit. Billing and Payment Policy
1. We file an insurance claim within 7 days of your date of service. 2. If we do not receive a response from your insurance carrier within 61- 90 days, you will receive a statement and will need to contact your insurance carrier regarding payment. The balance due for medical services will be your responsibility. 3. A billing statement covering medical services rendered will be mailed 4. After 6 months from the original date a claim has been filed, we place accounts with a collection agency. Patients are then responsible for any collection costs. If you have a financial problem, please ask to discuss a payment plan with our staff. We accept cash, checks, VISA, or MasterCard as payment. In the event a personal check is returned unpaid from your bank, your account will be charged a $20 returned check fee. Please note all copays are due at the time of service. If we must bill you for a copay, Minor Patients
The parent/guardian/adult accompanying a minor child is responsible for payment. Any child 18 or over is legally an adult and responsible for his/her bill, regardless of attending college, living at home, or being covered by parents insurance. If both parents have insurance, the parent with the first birthday in the year is most often the primary insurer. Please check your insurance policy to determine which company is primary before your appointment. In divorce cases, the parent who brings the child in for services is ultimately the responsible party. If you had a previous collection balance or are presently in collection, the physician may use his or her discretion as to seeing you again. It may be required that you pay your previous balance in full prior to being seen. You will be responsible for payment of the office visits, copay, deductible, etc., on the day of the visit. Dry Eye Syndrome
By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson Dry eye syndrome is a chronic lack of sufficient lubrication and moisture in the eye. Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye. Dry Eye Syndrome Symptoms
and Signs
Persistent dryness, scratching and burning in your eyes are signs of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this. Some people also experience a "foreign body sensation," the feeling that something is in the eye. And it may seem odd, but sometimes watery eyes can result from dry eye syndrome, because the excessive dryness works to overstimulate production of the watery component of your eye's tears. What Causes Dry Eyes?
Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health. In dry eye syndrome, the eye doesn't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly. Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications, and birth control pills; or because you live in a dry, dusty or windy climate. If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers. Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and the rubbing of the lenses against the conjunctiva seems to be a cause of dry eyes. Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. Tears are composed of three layers: the outer, oily, lipid layer; the middle, watery, lacrimal layer; and the inner, mucous or mucin layer. Each layer is produced by a different part of the eye (the lacrimal gland produces the lacrimal layer, for example), so a problem with any of those sources can result in dry eyes. Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Treatment for Dry Eyes
Dry eye syndrome is an ongoing condition that may not be cured (depends on the cause), but the accompanying
dryness, scratchiness and burning can be managed. Your eyecare practitioner may prescribe artificial tears,
which are lubricating eyedrops that may alleviate the dry, scratching feeling.
Restasis eyedrops (cyclosporine in a castor oil base) go one step further: they help your eyes to increase tear production. Restasis treatment is the first of its kind. Sometimes people use the eye drops that "get the red out" to treat their dry eyes. This won't work unless the eye drops also contain artificial tears, and the original "get-the-red-out" formulation doesn't. These drops can reduce or eliminate the redness temporarily, but they don't treat the cause of the redness, whether it's dryness, environmental irritation, or some other problem. Not only that, but the vasoconstrictors in those formulas that reduce redness by contracting the eye's blood vessels are addictive, in the sense that over time, more and more is needed to achieve the same effect. And with frequent use, the effect diminishes after a while, anyway — the blood vessels simply won't constrict as much as they did when you first used the drops. If you wear contact lenses, be aware that many eye drops, especially artificial tears, cannot be used while your contacts are in your eyes. You'll need to remove them before using drops, and wait 15 minutes or even longer (check the label) before reinserting the lenses. If your eye dryness is mild, then contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Check the label, but better yet, check with your optometrist or ophthalmologist before buying any over-the-counter eye drops. It will probably save you a lot of money, because he or she will know which formulas are effective and long-lasting and which ones are not, as well as which eye drops will work with your contact lenses. If the problem is environmental, you should always wear sunglasses when outdoors, to reduce
exposure to sun, wind, and dust. You may want to try the kind that has a foam or other seal at the
sides, to keep wind and dust from getting to your eyes at the top, bottom, and sides (see photo on
this page). Indoors, an air cleaner can filter out dust and other particles from the air, while a
humidifier adds moisture to air that's too dry because of air conditioning or heating.
Temporary or permanent silicone plugs in the lacrimal (tear) ducts keep tears in your eye from draining away as quickly. Called lacrimal plugs or punctal plugs, they can be inserted painlessly
while you're in the eye doctor's office and are normally not felt once inserted.
A new type of punctal plug made of acrylic is a small rod that becomes a soft gel when exposed to your body heat after insertion. It is designed to accommodate to the size of any punctum canal. Advantages of this type of plug are that one size fits all so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation Another new kind is made of a hydrogel that expands into a soft, pliable gel in the punctum canal. It has no cap, and should it need to be removed, the eyecare practitioner can simply flush it out with saline sotion. With some people, however, punctal plugs aren't effective enough, so their tear ducts need to be
closed surgically.Doctors sometimes recommend special nutritional supplements for dry eyes.
Studies have found that supplements containing certain essential fatty acids (linoleic and gamma-
linolenic) can decrease dry eye symptoms. You could also eat more cold-water fish, such as
sardines, cod, herring, and salmon, which contain omega-3 fatty acids.

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