AOA Glaucoma Press Release

Glaucoma – the “Sneak Thief of Sight” – Can Lead to Vision Loss

Although not preventable, glaucoma can be treated if detected early

St. Louis, MO (January 7, 2009) – Glaucoma – often called “the sneak thief of sight” because it can strike without pain or other symptoms – is one of the leading causes of blindness in the United States. Unfortunately, the vast majority of Americans – 91 percent – incorrectly believe glaucoma is preventable, according to the newest survey by the American Optometric Association (AOA). Although glaucoma is not preventable, if diagnosed and treated early, doctors of optometry can help a patient control the disease. Medication or surgery can slow or prevent further vision loss.

Approximately 2.2 million Americans age 40 and older have glaucoma, according to National Glaucoma Research; of these, as many as 120,000 are blind because of the disease. The number of Americans with glaucoma is estimated to increase to 3.3 million by the year 2020, as baby boomers age.

According to the AOA, glaucoma is a group of eye disorders that occur when internal pressure in the eye increases enough to cause damage to the optic nerve, leading to loss of nerve tissue, resulting in vision loss. The AOA’s annual Eye-Q® survey, which identifies attitudes and behaviors of Americans regarding eye care and related issues, showed that a large number of consumers do not know what glaucoma is and how severe the effects of the disease can be. Ninety-five percent of respondents did not know that glaucoma damages the optic nerve, and only 21 percent of respondents were aware that glaucoma causes deterioration of peripheral or side vision.

According to the AOA, there are two types of glaucoma. The most common type, primary open-angle glaucoma, develops gradually and painlessly, usually without symptoms. A rarer type, acute angle-closure glaucoma, occurs rapidly, and its symptoms may include blurred vision, loss of peripheral vision, seeing colored rings around lights, and pain or redness in the eyes.

“As glaucoma progresses, a person may notice their side vision gradually failing,” said Kerry Beebe, O.D., Chair of AOA’s Clinical Care Group Executive Committee. “When glaucoma remains untreated, people may miss seeing objects to the side and out of the corner of their eye. Without treatment, people with glaucoma will continue to slowly lose their peripheral vision, and eventually their central vision as well. And vision lost to glaucoma cannot be recovered, so early detection and treatment is paramount.”

Anyone can develop glaucoma. However, some people are at higher risk than others. They include:

• African-Americans over age 40
• Anyone age 60 and older, especially Hispanics
• People with a family history of glaucoma

Since vision lost to glaucoma cannot be restored, the best way to detect glaucoma is in its early stages by having regular, comprehensive eye exams. A comprehensive exam should include dilating the eyes which allows a doctor to clearly see the retina, optic nerve and vessels in the back of the eye. The exam should also include a test to measure corneal thickness, eye pressure, and a visual field assessment to measure retinal function. African-Americans and Hispanics are genetically more susceptible to glaucoma. Yet, 37 percent of African-Americans and Hispanics did not have their eyes dilated during their last eye exam, according to the American Eye-Q® survey. The AOA recommends eye exams every two years for adults under age 60 and every year thereafter. A doctor may recommend more frequent exams depending upon a patient’s medical or family history.

Treatment for glaucoma includes prescription eye drops and medicines to lower pressure in the eyes. In some cases, laser treatment or surgery may be effective in reducing pressure.

Medicare patients at high risk for glaucoma can receive dilated eye examinations as a benefit of Medicare coverage. Currently eligible beneficiaries are individuals with diabetes mellitus, individuals with a family history of glaucoma, Hispanic-Americans age 65 and over, and African-Americans age 50 and over. The AOA provides a Glaucoma/Diabetes Hotline program which matches patients with participating optometrists in their area. To find an optometrist in your area, please call 800-262-3947.

For additional information on glaucoma and other issues concerning eye health, please visit www.aoa.org.

About the survey:
The third annual American Eye-Q® survey was created and commissioned in conjunction with Penn, Schoen & Berland Associates (PSB). From May 17-19, 2008, using an online methodology, PSB interviewed 1,001 Americans 18 years and older who embodied a nationally representative sample of U.S. general population. (Margin of error at 95 percent confidence level.)

Treating Eye Allergies

Allergy Signs and Symptoms

Symptoms of eye allergies include redness, itching, burning, and watery eyes. Other common signs of allergies may include sneezing, itching, runny nose, coughing, wheezing, difficulty breathing, and headache from sinus congestion. An allergic reaction occurs when the body treats something that is normally harmless, like pollen, as if it were a harmful to the body like a virus.


Treatment

Avoidance
The easiest treatment for allergies is to try to avoid coming in contact with the substance you are allergic to. For example, if you know you are allergic to cedar pollen, it makes sense to keep the windows in your home closed and use central air conditioning or heat to filter the cedar pollen out of the air. You should also use air filters that are specifically designed for pollen and pet dander. Remember to change your filters out on a regular basis so they continue to work effectively. When riding in or driving your car, make sure to keep the windows rolled up and use the air conditioner.

Over the Counter Medications
There are many over the counter medications (OTC) that you can use to try and relieve your allergy symptoms. Some of these work quite well in the short term, but some may not be used for long periods of time.

Artificial Tears

Artificial tears have two uses in allergy relief. They may be used to flush pollens from the eye and they also are helpful in relieving the dry eye caused by oral antihistamines. Just a few examples include: GenTeal, Optive, Systane, Tears Naturale, Refresh Tears, Thera Tears, Bion Tears, and Refresh Endura.

Decongestants
Decongestants are vasoconstrictors. They are the drops that “Get the red out.” Decongestants work by making the blood vessels in your eye constrict or become smaller in diameter, thereby reducing your redness. They treat your symptoms only, not the underlying cause. In fact, your eyes may become redder, if they are used for more than a few days. This is called rebound redness. Examples include: Visine, Naphcon, Opcon.

Antihistamines
Over the counter antihistamine eye drops are generally only available in combination with a decongestant. If you want an antihistamine eye drop without worrying about the side effects of rebound redness caused by the decongestant, you will need to get a prescription for one of the newer antihistamines. In addition the OTC antihistamines generally need to be used four times a day. This can be inconvenient for contact lens wearers. You should never instill any medication in your eye while wearing contact lenses. You must wait at least 15 minutes after instilling a drop before you insert your contact lenses. The newer antihistamines have a much more convenient dosage schedule, generally just twice a day, once in the morning, before contact lens insertion, and once in the evening, after contact lens removal. The OTC medications do have the advantage of being less expensive for people who don’t have prescription drug coverage. Examples of Antihistamine/Decongestant Combination Drugs include: Naphcon A, Opcon A.

Prescription Medications

When you visit your optometrist he or she has several treatment options available for combating allergens. Sometimes one or more medications may be prescribed to provide you with your optimum treatment regimen.

Mast Cell Stabilizer
Mast cell stabilizers can virtually prevent the outbreak of an allergic reaction. However, it may take several weeks before this type of medication may become effective. A mast cell stabilizer must be prescribed either before a person will be exposed to an allergen or in conjunction with another more quickly acting medication until it can become effective.

Antihistamines
Antihistamines generally provide quick relief for most allergy sufferers. The advantage of prescription antihistamines is the convenient twice a day dosing. Examples of such antihistamines include Patanol, Pataday, Zaditor, and Optivar. These particular antihistamines also have the advantage of having mast cell stabilizing properties.

Corticosteroids
Sometimes it is necessary to prescribe stronger anti-inflammatory medications, such as corticosteroids, especially if there is a large amount of inflammation present. These medications are generally not used for long periods of time since they can, on rare occasions, cause cataracts. In addition, they can cause increased eye pressure in which can lead to glaucoma in susceptible individuals.

Nonsteroidal Anti-Inflammatory Drugs
As an alternative to corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to relieve the swelling and inflammation that may be associated with seasonal allergies. Many of the current NSAIDs on the market are very effective not only in relieving the inflammation associated with allergies, but also the itching.

Suffer No More
If you usually “suffer” from allergies at certain times of the year, there is no reason for you to continue to do so. There clearly are a number of treatment options available that can be tailored to your specific needs. Be sure to let your doctor know what you expect from your treatment also let your doctor know how intense your symptoms are. Is your allergy a first time event or does it occurs at the same time every year? Let your optometrist know if you are taking oral antihistamines. The better the information is that you provide your doctor, the better treatment plan he or she will be able to devise for you.

Preventing Diabetic Retinopathy

Today in the United States nearly 21 million children and adults have been diagnosed with diabetes, while another 54 million are at risk for the disease. Unfortunately there are more than 6 million undiagnosed diabetics in the United States. According to the American Diabetic Association, the number of people diagnosed with diabetes, both type 1 and type 2, increases by 6% each year. This means that that the population of diabetics doubles in the every 15 years.

According to the American Optometric Association’s 2007 American Eye-Q® survey, more than 60 percent of adults know that diabetes is detectable through a comprehensive eye examination. However, only 32 percent of adults who do not wear vision correction have seen a doctor of optometry in the past two years.

With nearly two-thirds of adults not receiving regular, comprehensive eye examinations, millions of Americans are not only putting their vision, but also their health, at risk. In fact, diabetes is the leading cause of blindness in adults 20 to 74 years old. Diabetes is estimated to cause from 12,000 to 24,000 new cases of vision loss each year. Two complications of diabetes, cataracts and glaucoma, can also lead to a loss of vision. However, both are easily detectable with routine vision care.

Annual Eye Exams Mean Early Detection

An annual eye exam can serve as the first line of detection for diabetes because high blood sugar can cause blurry vision and a significant eye glass prescription change. The eye is the only place in the body that blood vessels can be seen directly in the human body. Complications from diabetes arise when weakening occurs in the walls of the tiny blood vessels found in the retina. This causes microaneurysms to form. These microaneursyms tend to leak fluid, sometimes causing diabetic macular edema. The macula is the portion of the retina that allows a person to see fine detail. If leakage or swelling occurs in the macula, the resulting vision loss can be devastating. If a diabetic has numerous microaneurysms, hemorrhages, and leakages, this can cause neovascularization. Neovascularization is the growth of new blood vessels in the retina. These new blood vessels hemorrhage very easily and can cause further devastating vision loss.

Treatment Options For Diabetic Retinopathy

Early detection is critical in maintaining healthy vision. . The earlier problems are detected and treated, the better outcome a person is likely to have. Several treatment options are available for diabetic retinopathy. Focal laser treatment is used to treat small areas of hemorrhage. Larger areas of hemorrhage may need to be treated using scatter laser therapy. In scatter treatment, a laser beam is used to produce many tiny burns scattered throughout the retina, sparing the macula. This slows the growth of new blood vessels and the development of hemorrhage and scar tissue.

The newest line of defense in the treatment of diabetic retinopathy lies in the use of VEGF inhibitors injected into the eye. New blood vessel growth in the retina and increased leakage of fluid from retinal blood vessels is due to the presence of Vascular Endothelial Growth Factor or VEGF. Three new drugs are available to help inhibit VEGF. These new drugs are Macugen, Lucentis, and Avastin. Studies of these new drugs are showing promising results. Researchers from the Johns Hopkins University-Wilmer Eye Institute reported results indicating that Lucentis injections are useful as a treatment for diabetic retinopathy based on the findings in a small clinical trial in which there was significant visual improvement in people with early stages of proliferative diabetic retinopathy that received Lucentis Injections. In particular, those patients with thickening in their macula noticed dramatic improvement within a week after treatment, which actually continued to improve with repeated therapeutic injections. Similar results have been reported with Avastin Injections.

Control Is The Key to Good Health

Several factors influence whether someone with diabetes develops diabetic retinopathy. These include blood sugar control, blood pressure levels, and length of time with diabetes. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery. Other studies have shown that controlling elevated blood pressure and cholesterol can also reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

Links:

http://www.diabetes.org/home.jsp

http://diabetes.niddk.nih.gov/

http://www.nei.nih.gov/health/diabetic/retinopathy.asp

http://www.austinretina.com/base.html

http://www.eyemdlink.com/Condition.asp?ConditionID=3

Help For Computer Vision Syndrome

Computer Vision Syndrome, or CVS, refers to the vision problems associated with the use of a computer monitor or video display terminal (VDT). The most common symptoms include dry, tired and burning eyes, difficulty focusing, eye strain, double vision, headaches, blurred vision, as well as, neck and shoulder pain.

The American Optometric Association recently conducted a telephone survey of 1,000 American consumers’ use of computers and hand held devices. The survey found:

• Forty-two percent of Americans spend three or more hours each day in front of a computer or handheld device.
• Forty-one percent have complained of eye strain and 45 percent suffer from neck or back pain from prolonged computer or hand held device use.
• Special computer glasses and other computer products are available to help reduce glare and discomfort, but only 11 percent of Americans currently use these devices.

  Some suggestions to alleviate the symptoms include:

Limit the amount of time you continuously use the computer. Practicing the 20/20 rule (look away from the computer every 20 minutes for 20 seconds) will minimize the development of eye-focusing problems and eye irritation caused by infrequent blinking.

Check the height and arrangement of the computer. More comfortable computer viewing can be achieved when the eyes are looking downward. Optimally, the computer screen should be 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and 20 to 28 inches from the eyes.

Check for glare on the computer screen. Windows or other light sources should not be directly visible when sitting in front of the monitor. When this occurs, turn the desk or computer to prevent glare on the screen.

Reduce the amount of lighting in the room to match the computer screen. A desk lamp can be substituted for a bright overhead light or a dimmer switch can be installed to give flexible control of room lighting. Turn three-way bulbs to the lowest setting.

Keep Blinking. To minimize the chances of developing dry eye when using a computer, make an effort to blink frequently. Blinking keeps the front surface of the eye moist. Artificial tears may also be used throughout the day to increase the moisture of the eyes.

Upgrade to a Large Flat Panel Display. The new LCD flat panel displays are much better than the old CRT displays and are easier on the eyes. They have an anti-reflective coating and do not have issues with flicker like their predecessors. If you must use a CRT, be sure to set the refresh rate to highest possible setting. When selecting an LCD monitor be sure to select one with the best possible resolution. Resolution is related to the “dot pitch” of the display. You will get a sharper image with a lower dot pitch display. Try to choose a display with a dot pitch of .28 mm or lower.

Consider Computer Eyewear. Computer users normally sit 20 to 26 inches from their computer. This is considered to be an intermediate zone of vision — closer than driving ("distance") vision, but farther away than reading ("near") vision. For this reason distance glasses and normal reading glasses may not work well at this intermediate distance. Computer users attempting to use their normal bifocal or progressive lenses may end up with neck and shoulder pain when they attempt to view their computer monitor through the lower portion of their lenses by lifting their chins up. Better options include single vision reading glasses set for the individual user’s computer distance, computer progressives, or a bifocal with the top portion of the lens set for the computer distance and the bottom for close work.

Computer Vision Syndrome affects not only millions of office workers, but also students and the retired who use computers on a daily basis. Only when the eyes are able to focus clearly at the appropriate distance, will computer users begin to feel relief from eyestrain. This can be achieved through the use of eyewear designed for use specifically at the computer. Further relief can be achieved by minimizing glare from overhead lights and windows. LCD monitors with their antireflective coatings and high resolution can provide even more relief. If you are suffer from symptoms of CVS, make an appointment with your eye doctor. He or she can help map out a plan to help you find relief.

Links:

http://www.allaboutvision.com/cvs/irritated.htm

http://www.allaboutvision.com/cvs/faqs.htm

http://www.allaboutvision.com/cvs/computer_glasses.htm

http://www.aoa.org/x5374.xml

Retinal Detachment: Symptoms and Treatment

Have you ever looked up at the clear blue sky on a sunny day and noticed strange objects that look like something you would see under a microscope? Or, have you ever thought you were seeing a bug out of the corner of your eye and tried swatting at something that wasn’t really there?

Flashes and Floaters

What you are seeing are floaters. Floaters are usually translucent and come in many shapes and sizes. The eye is filled with a clear, jelly-like substance called the vitreous. It is not unusual for small bits of protein to become trapped in the vitreous during the eyes formation, prior to birth, and remain trapped there indefinitely. Since floaters are in the eye, they move as the eye moves. Floaters will seem to dart away whenever you try to look at them directly. Floaters are normal and will gradually increase in number as you age. However, if you ever notice a sudden increase in the number of floaters you are seeing, and/or they are accompanied by flashes of light, you should schedule an eye examination as soon as possible. These changes can be an indication of a retinal break or detachment.

Symptoms of a Retinal Detachment

A retinal detachment is considered a sight threatening emergency and must be treated as such. The retina is the inner lining of the eye and is responsible for converting the image that falls on it into an electrical signal to be transmitted back to the brain. If the retina is not able to get the nutrients and oxygen it needs from the tissue it normally rests against, it can begin to atrophy and die within a few days. At this time the technology does not exist to restore the vision lost when retinal tissue dies. It is vital to reattach the retina as quickly as possible, in order to prevent permanent vision loss. Unfortunately, there is no pain associated with a retinal detachment. You must rely on recognizing the symptoms of this sight robbing emergency. These symptoms include not only flashes and floaters, but also include a sudden decrease in vision, a veil or curtain obstructing your vision, and wavy or watery vision.

Who is More Likely to Develop a Retinal Detachment?

It has been estimated that one in approximately 10,000 to 15,000 people will experience a retinal detachment, or roughly 6% of the population. You are more prone to developing a detached retina if you are highly nearsighted or myopic. Other risk factors for retinal detachment include: a family history of retinal detachment, previous retinal detachment in a fellow eye, a history of trauma to the eye, cataract surgery, lattice degeneration, a posterior vitreal detachment, or a history of uveitis. Systemic diseases can also predispose you to developing certain types of detachments. Some of these conditions include diabetes, sickle cell disease, leukemia, eclampsia, and tumors from breast cancer or malignant melanoma.

How are Detachments Diagnosed?

Retinal detachments are generally diagnosed by your eye doctor after careful examination of your retina. This can be done with a binocular indirect ophthalmoscope. This instrument gives your doctor a stereoscopic (3-D) view of your retina. Magnifying lenses may also be used with a Slit Lamp, or Biomicroscope, to get an alternate view of your retina. A retinal camera, such as the Optomap, may be used as well. If it is not possible to get a clear view of the retina by normal means, due to the presence of cataracts or hemorrhaging, ultrasound may be used to determine whether the retina is in its proper place or not.

Tests of your peripheral vision can also be very diagnostic. Wherever the retina is detached, there will be a corresponding loss of peripheral vision. Loss of peripheral vision is not diagnostic for detachments found in the outer edges of the retina, since most peripheral vision tests only check the central thirty degrees or so of vision and not the entire field of vision.

Treatment

If you do find yourself with a retinal detachment, the good news is that there are several techniques available to repair the damaged tissue. The type of treatment chosen depends upon the location, severity, and type of the detachment found.

Pneumatic retinopexy may be used to reattach the retina in cases where there is only a small break in the retinal tissue or just a few small breaks located close together. With this technique a gas bubble injected into the eye is used to push the retina back into place. The surgeon will often ask the patient involved to keep his or her head in a specific position in order to manipulate the bubble into the desired position. Because gas rises, this treatment works best for detachments in the upper portion of the retina. The gas bubble will be slowly reabsorbed over a one to two week period of time.

After the once errant tissue is in position, an additional procedure will be preformed during which the retina will be “tacked down.” This is done either with a laser procedure or by cryotherapy. During cryotherapy a cold probe is touched to the outside of the eye. The extreme cold is then transmitted through the thin wall of the eye, opposite the area needing to be treated. This in turn creates scar tissue at the site causing the retina to be “tacked down.” Laser treatment works much the same way. A laser is sited through the patient’s pupil and is then used to zap around the edges of the torn retina, “spot welding” the retina in place.

Some detachments are best treated with a surgical procedure called a scleral buckle. During this procedure a retinal surgeon will attach a tiny sponge or silicone band to the outside of the eye so that it is pressed inward. Pressing the eye inward helps hold the retina in place so that the surgeon will be able to “tack” the retina in place with either cryotherapy or laser surgery after he has removed the vitreous gel from the eye. The buckle is not visible and remains permanently attached to the eye. Sometimes this technique can elongate the eye, causing nearsightedness or increasing it greatly.

When other techniques have been unsuccessful, in some cases it may be necessary to use silicone oil to reattach the retina. First the vitreous gel is removed and then it is replaced with silicone oil. The oil is then used to press the retina into place. Vision is very poor as long as the oil remains in the eye. Once the retina has resealed itself against the back of the eye, a second procedure may be preformed to remove it.

What Can You Do To Keep Your Retina Healthy?

Annual eye examinations allow your eye doctor to monitor the health of your retinas on a regular basis. If you are in one of the high risk groups for retinal problems, make sure you monitor your vision on a daily basis. It is a good idea to compare the vision between your eyes. One way to do this is to pick out an object and look at it with one eye and then with the other and make sure that it looks equally clear and that you notice no distortion. The object should look pretty much the same to both eyes. Also make sure to be aware of the symptoms of a retinal detachment. If you ever notice a sudden increase in floaters, flashes of light, a curtain or veil over your vision, blurred or distorted vision, or wavy or watery vision make sure you contact your eye doctor immediately!