Amblyopia (Lazy Eye)
Amblyopia is a reduction of vision in an eye resulting from misalignment of the eyes (strabismus) or a significant difference in the refractive powers between the eyes.
Treatment is more effective if the cause of the amblyopia is detected and treated early. Treatment includes glasses, patching of an eye, and vision therapy.
Astigmatism is a condition in which an abnormal curvature of the cornea can cause two focal points to fall in two different locations - making objects up close and at a distance appear blurry. Astigmatisms may cause eye strain and may be combined with nearsightedness or farsightedness.
Treatment includes glasses, contact lenses, or refractive surgery.
Blepharitis is inflammation of the eyelids and eyelid margin. Blepharitis usually causes symptoms such as eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness, and red eyelid margins. It can be divided into two types:
- Anterior blepharitis affects the front of the eyelids near the eyelashes. The causes are seborrheic dermatitis (similar to dandruff) and occasional infection by Staphylococcus bacteria. Anterior blepharitis can cause crusting and matting of the lashes, loss of eyelashes, burning, and irritation of the eyes.
- Posterior blepharitis affects the back of the eyelids, the part that makes contact with the eyes. This is caused by the oil glands present in this region. The oil glands in the lid (meibomian glands) secrete a modified oil which leads to inflammation at the gland openings which are found at the edge of the lid. Many people with posterior blepharitis also have a rosacea skin type.
This ailment can sometimes lead to a chalazion (also called a stye), which is caused by the plugging up of the meibomian gland.
Treatment and management:
The single most important treatment principle is a daily routine of lid margin hygiene as described below. Such a routine needs to be continued lifelong to avoid relapses, as blepharitis is a lifelong condition.
- Warm compress to eyelids to soften lid margin debris and open clogged oils glands: Wash your hands, then dampen a clean wash cloth with warm water and place it over your closed eyelids for 5 minutes. Do this at least once a day. Eyelid massages are also sometimes recommended to mechanically empty glands located at the lid margin.
- Removal of lid margin debris: After using the warm compress (or after a shower), gently rub the eyelids with the warm washcloth to remove debris. Over-the-counter eyelid scrubs (Steri-lid, Ocusoft) or diluted tearless baby shampoo may also be used to clean the eyelid margin.
- Antibiotic treatment of the lid margin bacteria: After lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with fingertip along the lid margin (where that lashes come out). If the ointment gets in the eye it will cause blurry vision, but it will not harm the eye. Use prior to bedtime to avoid blurry vision.
Depending on the degree of inflammation of the lid margin, a combination of topical antibiotic and steroid drops or ointments can be prescribed to provide temporary relief. However, steroids can have side effects such as increased intraocular pressure and cataract formation. Because of this steroid medications usually cannot be used long term, and their use must be monitored by an ophthalmologist.
Some people believe that Omega 3 Fatty Acids (Flax seed oil or Fish oil) can be helpful. Use between 2000 and 4000mg per day (2-4 grams.) If acne rosacea coexists, treatment should be focused on this skin disorder as the underlying cause together with the above lid margin hygiene routine. Typically, 100 mg doxycycline by mouth once or twice per day is prescribed for four weeks which can then be tapered to 50 mg once daily. Contrary to common belief, use an oral antibiotic for blepharitis is not primarily to treat bacterial infection but rather help the oil glands make a more healthy oil.
Treatment is usually continued for several years. It will take a few months of treatment to determine if any improvement is being made.
Cataract and Cataract Surgery
A cataract is a clouding or opaque area over the lens of the eye - an area that is normally transparent. As this thickening occurs, it prevents light rays from passing through the lens and focusing on the retina - the light sensitive tissue lining located in the back of the eye. This clouding is caused when some of the protein which makes up the lens begins to clump together and interferes with vision.
In its early stages, a cataract may not cause a problem. The cloudiness may affect only a small part of the lens. However, the cataract may grow larger over time and affect more of the lens, making it harder to see. As less light reaches the retina, it becomes increasingly harder to see and vision may become dull and blurry. While cataracts cannot spread from one eye to another, many persons develop cataracts in both eyes.
What to Expect When Undergoing Cataract Surgery
Preparation before and follow-up after cataract surgery is usually quite simple. Although recommendations may vary slightly between surgeons, you may generally expect the following routine:
A thorough vision and eye exam with the surgeon is required prior to making a decision to proceed with cataract surgery. This pre-operative evaluation often includes dilation, and it is useful to consider bringing a family member or friend as a driver and a second set of ears.
After the decision is made with your surgeon to proceed with cataract surgery, surgery can be scheduled. This might be as soon as a couple of weeks or as long as a couple of months after your office visit depending upon your schedule. If both eyes need cataract surgery, then the surgeries might be scheduled 1-3 weeks apart.
Thorough instructions will be provided. You will usually be asked to schedule a pre-operative physical exam at your family physician’s office one or two weeks prior to surgery. Around the day of your surgery, you will start a simple eye drop regimen which will continue for a few weeks after surgery, and any necessary drops and/or prescriptions will be provided at the time of your pre-operative visit.
Regardless of where your cataract surgery is performed, it will be an out-patient procedure. The actual surgery is typically no more than a 10 or 15 minute procedure, during which time light sedation is often provided mostly for anxiety. After surgery you will be asked to have a family member or friend drive you home. Because of preparation and a short recovery time, your family can expect to spend one to two hours in the waiting room.
At home the night after surgery, most patients are generally self sufficient. During the first week you will be asked to use your drops and be protective of your surgical eye. Because modern cataract surgery is so minimally invasive, there are usually few other restrictions and precautions during the recovery period. Commonly you will return to the office for a post-operative visit one day after surgery and less frequently thereafter. At each visit instructions and changes will be reviewed with you.
Cataract surgery is one of the safest medical procedures; however, as with any surgical procedure there is a small risk of complications. These risks will be discussed thoroughly during office visits. During the recovery period you will be reminded to call the office in order to report any unexpected problems. Although rarely needed, patients find it reassuring that our staff and surgeons are available for urgent problems 24 hours per day, 7 days per week.
Central Serous Chorioretinopathy
Central Serous Chorioretinopathy (CSCR) is a condition where fluid builds up underneath the retina due to a dysfunction in the layers underlying the retina itself. This build up of fluid may causes blurring and distortion of the vision. CSCR is often associated with “Type A” personalities or the use of steroid medications.
In the vast majority of patients this condition self-resolves and the vision recovers, although in rare circumstances blurred vision may persist. In these cases, various treatment options exist and an evaluation with a retinal specialist may help determine which treatment is the best option.
Chalazion (Stye or Hordeolum)
A chalazion is a persistent inflammation or swelling of the upper or lower eyelids. A chalazion is caused by a blockage of one of the oil glands in the eyelid. Swelling may also occur in other parts of the eye due to a secondary infection. Symptoms of a chalazion include:
- a small bump which can usually be felt in the eyelid
- a gradual swelling of the eyelid
- discomfort in the eye or difficulty with seeing if the chalazion is large (swelling of the eyelid is usually not painful)
If the initial chalazion becomes infected, the entire lid may become swollen and painful.
Treatment of a chalazion:
A small chalazion may go away on its own without treatment in a couple of months. However, treatment of a secondary infection or larger chalazion may include:
- applying warm, wet compresses around the eyes for approximately 15 minutes, several times throughout the day
- antibiotic drops for the eye
- if symptoms do not improve, surgery may be needed to drain the chalazion or injection of steroids for larger or recurrent lesions. ,
- If there are other associated conditions such as blephariits or acne rosacea, additional treatment may also be necessary.
Computer Vision Syndrome
Visual symptoms may result from computer use for prolonged periods of time. These symptoms include eyestrain, headaches, blurred vision, double vision, burning and tearing, neck/shoulder/back aches.
Treatment includes glasses, vision therapy, proper posture and computer alignment, glare filters, proper lighting
Conjunctivitis (Pink Eye)
Conjunctivitis, also known as "pink eye," is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eye and also a thin membrane that covers the actual eye.
There are many different causes of conjunctivitis. The following are the most common causes:
- Staphylococcus aureus
- Haemophilus influenza
- Streptococcus pneumoniae
- Neisseria gonorrhea
- Chlamydia trachomatis
- Adenoviruses and Herpes virus
- Chemicals (seen mostly in the newborn period after the use of medicine in the eye to prevent other problems)
Specific treatment depends on the underlying cause of the conjunctivitis.
- Bacterial causes: Your physician may order antibiotic drops to put in the eyes.
- Viral causes: Viral conjunctivitis usually does not require treatment. Your physician may order antibiotic drops for the eyes to help decrease the chance of a secondary infection.
- Allergic causes: Treatment for conjunctivitis caused by allergies usually will involve treating the allergies. Your physician may order oral medications or eye drops to help with the allergies.
- Herpes: If your child has an infection of the eye caused by a herpes infection, your physician may refer you to an eye care specialist. You may be given both oral medications and eye drops. This is a more serious type of infection and may result in scarring of the eye and loss of vision.
Infection can be spread from one eye to the other, or to other people, by touching the affected eye or drainage from the eye. Proper hand washing is very important. Drainage from the eye is contagious for 24 to 48 hours after beginning treatment.
Strabismus, a misalignment of the eyes, is one of the most common eye problems in children, but can occur at any age. The eyes (one or both) may turn inward, outward, turn up, or turn down. At times, more than one of these conditions is present. Strabismus is also called "wandering eye" or "crossed-eyes."
Strabismus results from failure of the eye muscles to work together. The brain controls the eye muscles, which are attached to the outside of each eye. Family history and uncorrected refractive error are risk factors. There appears to be a higher incidence of strabismus in children with disorders that affect the brain, such as cerebral palsy or hydrocephalus. Strabismus may also occur later in life as a result of an illness, cataract, or eye injury.
It is normal for a newborn's eyes to move independently and at times, even cross. However, by three to four months old, an infant should be able to focus on objects and the eyes should be straight, with no turning. If you notice that your child's eyes are moving inward or outward, if he/she is not focusing on objects, and/or the eyes seem to be crossed, you should seek medical attention. Children with strabismus are at risk for developing secondary vision loss (amblyopia, also known as lazy eye). The onset of strabismus is most common in children 3-6 years of age.
Treatment for strabismus may include one, or more, of the following:
- Eye drops
- Surgery to straighten the eyes
- Eye exercises
- Eye patch over the strong eye (if amblyopia is present) to improve the weak eye
Strabismus cannot be outgrown. However, early treatment can prevent visual impairment.
Diabetes is a disease characterized by a disturbance in blood sugar metabolism. Diabetes can affect multiple organ systems in the body including the eye. The primary determinants of eye disease are the length of time a patient is diabetic, blood sugar control, blood pressure control and blood lipid levels.
Eye screening for diabetic patients is as important as the tests doctors use to detect small blood vessel damage in kidneys and feet. Damage to small blood vessels in the eye, a condition known as diabetic retinopathy, often goes unnoticed and can result in irreversible vision loss or blindness. Fortunately, your primary care doctor can order a test to find problems inside the eye and help prevent vision loss, well before you even notice vision changes.
Diabetic Retinopathy can be divided into two stages, nonproliferative and proliferative disease.
Nonproliferative retinopathy (an early stage of diabetic retinopathy) is characterized by small blood vessel damage which may result in fluid leaking into the retina and/or bleeding. Chronic fluid within the retina may lead to progressive vision loss and requires prompt treatment to stabilize the fluid and reduce the risk of progressive vision loss.
Proliferative retinopathy (a more advanced stage of diabetic retinopathy) is caused by progressive blood vessel damage which results in reduced blood flow to the retina. Chemical signals are then released by the retina which results in abnormal blood vessel development. If left untreated, these abnormal vessels can rupture, bleed and scar which can lead to profound vision loss and even blindness. This condition requires urgent evaluation and treatment in order to preserve vision.
The screening involves a camera that takes photos of the eye (retina) and allows eye specialists to assess the damage, if any, to the small blood vessels essential to healthy eye function. There is usually no dilation of the eyes needed. Once the screening is complete, patients may be scheduled for a follow up visit with their physician based on the test results.
Springfield Clinic’s Eye Institute has expanded patient access to this sight-saving screening by offering walk-in hours. Doctors at the Eye Institute are working closely with primary care physicians to ensure their diabetic patients have a retinopathy screening once a year.
Once the primary care physician has ordered the screening, patients can take advantage of these convenient, walk-in hours:
- Tuesdays and Thursdays
- Location: Springfield Clinic Laboratory/Radiology, Main Campus - East Building, 1025 South 6th Street, Springfield
Diabetic retinopathy screenings are usually covered by commercial insurance plans and Medicare, but for self-paying patients, the cost is approximately $35.
Double Vision (Diplopia)
There are many causes that allow one to perceive two distinct images while looking at a single object. In binocular diplopia (double vision disappears when either eye is covered) this condition is usually due to third, fourth, or sixth cranial nerve palsies, strabismus, thyroid/Graves’ eye disease, myasthenia gravis, orbital tumors, and orbital fractures.
In contrast, monocular diplopia (double vision persists when the uninvolved eye is covered) is usually caused by refractive error, corneal opacity or irregularity, cataracts and dislocated lens.
Treatment may include prism glasses, strabismus surgery, and other medical and surgical treatments to fix the underlying problem
Dry eye syndrome is a common chronic condition caused by either an inadequate amount of tears or an insufficient quality of tears. Common causes: environmental factors, medication, age/gender, medical conditions, contact lens induced, surgery induced. Treatments: artificial tear eye drops, prescription medication, nutritional supplements, punctal plugs, punctual cautery and surgery such as tarsorrhaphy.
Ectropion (Out-turned Eyelid)
The eyelids are delicate structures integral to protecting and maintaining the health of the eye. As we age, the skin thins out, tissue stretches and sags. As a result, the eyelids can often turn away from the eye (ectropion), causing redness, irritation, and tearing. Treatment may involve ocular lubrication and surgical repair.
Entropion (in-turned eyelid)
The eyelids are delicate structures integral to protecting and maintaining the health of the eye. As we age, the skin thins out, tissue stretches and sags. As a result, the eyelids can often turn in towards the eye (entropion), causing redness, irritation, and tearing. Treatment may involve ocular lubrication and surgical repair.
An epiretinal membrane or macular pucker is a layer of superficial scar tissue that rests on the surface of the central retina. This scar tissue may contract with time resulting in distortion or blurring of the vision. This distortion may make it difficult to perform daily tasks such as reading or driving. Epiretinal membranes usually occur in older individuals when the vitreous gel within the eye liquefies and shrinks. It may also follow trauma or be associated with certain conditions such as inflammation, retinal tears or diabetes.
Epiretinal membranes are diagnosed using a combination of physical examinations and imaging tests called optical coherence tomography and sometimes fluorescein angiography.
Mild epiretinal membranes that cause little or no distortion can often be monitored. More advanced cases may be treated with surgery to remove the scar tissue from the central retina. A qualified retina specialist can determine whether surgery would be a good option for cases where distortion interferes with daily activities.
Eye Lash Misdirection (Trichiasis)
Trichiasis is misdirected eyelashes which cause them to rub against the surface of the eye ball. Symptoms may include ocular irritation, foreign-body sensation, eye redness, and persistent tearing. Causes of this condition include chronic blepharitis, and eyelid scarring from trauma, prior surgery, or trachoma, and systemic disorders such as cicatricial pemphigoid.
In another related condition called distichiasis, an abnormal row of lashes arises from the Meibomian oil gland opening (from either congenital or inflammatory causes) and may result in similar symptoms.
Treatment options may include epilation of abnormal lashes or electrolysis, cryotherapy or surgery for more diffuse, severe or recurrent cases.
Management of any underlying blepharitis or inflammation of the eyelid is also important to prevent recurrence.
Eye and Lid Tumors
Cancer of the eyelid skin and eye ball is relatively common and there are several types that exist, such as basal cell carcinoma, squamous cell carcinoma, melanoma, and sebaceous gland carcinoma. If you notice the presence of a bump that grows, bleeds, ulcerates or is associated with blood vessel growth, color change, asymmetric boarders, and persistent irritation or itching, the lesion should be evaluated. A biopsy is usually required to confirm the diagnosis of cancer.
Typically, complete removal is needed to decrease the risk of recurrence. The area is then reconstructed in order to maintain proper eye and lid function and to optimize the cosmetic appearance.
Eye Removal (Enucleation & Evisceration)
The eye is sometimes removed due to severe trauma, infection and various conditions such as cancer and uncontrolled eye pressure causing pain and poor vision. The purpose of surgery is to remove the tumor or relieve the pain. Most patients elect to have a ocular prosthesis made with an ocularist and it typically leads to a good cosmetic outcome.
Facial Nerve Palsy
There are several conditions that may not allow full closure of the eyelid, leading to significant dryness of the eye surface. Treatment options may include use of ocular lubricants, moisture chambers or tape to avoid excessive dryness. There are also various surgeries that may be performed to allow better protection of the ocular surface, such as lower or upper eyelid malposition repair and upper lid weight placement.
There are many causes of periocular and facial spasms, including myokymia, benign essential blepharospasm, hemifacial spasm, and facial nerve misdirection syndrome.
In benign essential blepharospasm, there is uncontrolled forced contraction of the eyelids and brows, due to involuntary contraction of the muscles around the eyes. The condition affects both sides and may be accompanied by difficulty in opening eyes or abnormal movements of the mouth, and neck. The spasms are usually worse with bright lights, fatigue, and stress. The spasms usually disappear during sleep.
Hemifacial spasm typically involves twitching of both the upper and lower eyelids with progression to the entire face on one side. This condition may be associated with anatomical compression of the facial nerve. The spasms often do not dampen with rest or sleep.
Myokymia is twitching of one eyelid, usually associated with fatigue. These spasms are usually self-limited and resolves with rest.
Facial nerve misdirection syndrome occurs when the facial nerve makes the wrong muscle connections after prior injury or palsy. As result, stimulation of the facial nerve results in contraction of the wrong muscles, such that when the patient closes the eyes, it cause the mouth to move, or when the patient smiles or purses the lips, the patient closes the eyes.
The most common treatment of blepharospasm, hemifacial spasm, and facial nerve misdirection syndrome is Botulinum toxin is a substance that helps to relax muscles and help prevent uncontrollable muscle contractions. For facial nerve misdirection syndrome, selective injection of Botulinum toxin into muscle groups helps to block the aberrant contractions. For blepharospasm, tinted glasses and oral sedatives may also help and surgical excision of the contractile muscles can also be performed in severe cases. In hemifacial spasm, if an aberrant blood vessel was detected, decompression surgery may also be performed to help relieve pressure on the facial nerve.
Many individuals note small specks in their vision that move around as they move their eyes. These are called vitreous floaters and are generally the result of the vitreous gel within the eye liquefying as one ages. This is a very common disorder which is usually well tolerated. Rarely, vitreous floaters may be a sign of retinal damage and the sudden onset of floaters, especially when associated with flashing lights or peripheral vision loss, should prompt an examination by a qualified eye professional. Visually disabling floaters may also rarely occur, and if significant enough, they may be removed in an outpatient surgical procedure known as a vitrectomy. Any individual with visually disabling floaters should seek the advice of a qualified retinal specialist to assess whether surgery would be a good option.
Glaucoma is a condition in which the normal fluid pressure inside the eyes (intraocular pressure, or IOP) slowly rises as a result of the fluid aqueous humor - which normally flows in and out of the eye - not being able to drain properly. Instead, the fluid collects and causes pressure damage to the optic nerve (a bundle of more than 1 million nerve fibers that connects the retina with the brain) and loss of vision.
While physicians used to think that high intraocular pressure (also known as ocular hypertension) was the main cause of optic nerve damage in glaucoma, it is now known that even persons with normal IOP can experience vision loss from glaucoma. Thus, the causes are still unknown.
Commonly known as farsightedness, hyperopia is a refractive error in which an image of a distant object becomes focused behind the retina, either because the eyeball axis is too short, or because the refractive power of the eye is too weak. This condition makes close objects appear out of focus and may cause headaches and/or eye strain.
Treatment includes glasses, contact lenses, refractive surgery
Hyphema (Blood in the Eye)
Hyphema refers to blood in the anterior chamber of the eye. The anterior chamber is the front section of the eye's interior where fluid flows in and out, providing nourishment to the eye and surrounding tissues. A hyphema is usually caused by a trauma to the eye but can also occur spontaneously in children with other medical problems. Blood is seen in the eyeball. This is a medical emergency and immediate medical care is necessary.
Symptoms of hyphema include blood visible in the eye, usually following some type of trauma to the eye. The symptoms of hyphema may resemble other eye conditions or medical problems. Always consult your child's physician for a diagnosis.
Keratitis (Corneal Inflammation/Infection)
Keratitis is an inflammation or infection of the cornea of the eye. The cornea is the clear, dome-shaped surface that covers the front of the eye. Keratitis is a medical emergency because extensive involvement may lead to blindness.
There are many different causes of keratitis. The following are some of the more common causes:
- vitamin A deficiencies
- trauma (usually following insertion of an object into the eye)
The following are the most common symptoms of keratitis. However, each child may experience symptoms differently. Symptoms may include:
- pain and redness in the eye
- discomfort when the child looks at a light (photophobia)
- tearing, watery eyes, or discharge
- blurry vision
- feeling as if something is in the eye
The symptoms of keratitis may resemble other conditions or medical problems.
LASIK (laser assisted in-situ keratomileusis) is commonly used for the treatment of nearsightedness, farsightedness and astigmatism which allows a patient to reduce their dependency on contact lenses or glasses.
With the LASIK procedure, a thin corneal layer is lifted to create a flap. This stays connected on one side. The Excimer laser then sculpts the cornea with a cool ultraviolet light. Finally, the flap is returned to its original position for a quick natural recovery.
Our premier LASIK eye surgery procedure is conveniently performed in our state of the art Laser suite at our office in the Main Campus West building, conveniently located in Springfield, Illinois.
A free consultation is provided to determine if you are a candidate for LASIK surgery and to give you an opportunity to have all your questions answered. Call our office to schedule a free consultation to see if you are a candidate for refractive surgery.
In preparation for the consultation:
- Gas Perm contact lenses must be removed for at least 3 weeks prior to your appointment.
- Soft contact lenses must be removed for at least 1 week prior to your appointment.
- You will be dilated, so bring a driver with you!
- If you are pregnant you should wait 3 months after giving birth to schedule your consult.
- If you are nursing your baby, please wait 6 months after completion of nursingbefore you schedule your consult.
- You must be 21 years old.
At this appointment you will watch an educational video, have your eyes dilated and have many different eye measurements taken. You will meet with the doctor and it will be determined if you are a candidate for refractive surgery.
The fee for LASIK (Laser Assisted In-situ Keratomileusis) is $2,100 per eye. This fee includes:
- the initial consultation fee
- surgeon's fee
- surgical facility fee
- laser fee
- laser royalty fee
- one year of post-operative care
A $200 per eye discount is available for those patients that pay cash or a personal check two weeks in advance. If a LASIK enhancement is required within 24 months of the initial procedure there will be a $110 charge to cover the laser royalty fee.
Prepayment of surgical fees is required, even if you have insurance coverage. LASIK can be financed through many different healthcare finance companies, or surgical fees can also be paid by cash, check, money order, VISA, or MasterCard. All financing arrangements must be made at least two weeks prior to surgery.
Some insurance companies do not provide coverage for LASIK. We recommend that you contact your insurance company for verification of coverage. The CPT code for this procedure is 65760.
Dry eyes may occur before or after the LASIK procedure. It may be necessary to insert punctal plugs as treatment. If plugs are needed the procedure will be billed to your insurance. We will help you obtain a referral from your insurance company if desired.
LASIK Procedure Overview
An overview of what to expect on the day of surgery:
- You will arrive approximately one hour prior to your procedure.
- After registration a nursing history will be completed.
- Valium is offered to all patients.
- Antibiotic and topical numbing drops will be put into the eyes prior to your procedure.
- The approximate time spent in the laser suite is 20 minutes for both eyes!
- You will need a driver to drive you home.
Dr. Lohse and Dr. Nottage perform LASIK every month. Please call our office to scheduled a LASIK consultation.
Depending on your refraction, we can determine the likelihood of reaching 20/30 or better. Although many patients see 20/20 or better, we cannot guarantee this. 20/40 vision is required to drive without correction, day or night in the state of Illinois.
Low vision is a condition that involves a minimal ability to see (particularly central vision) that is unresolved or uncorrected with traditional eyeglasses, contact lens, intraocular lens implants, or corrective surgery. However, in some cases, persons with low vision may be aided with special visual devices.
There are a variety of different causes of low vision, including, but not limited to, the following:
- macular degeneration (the most common cause of low vision; involves damage to a person's central vision making it difficult to read, drive, or perform other daily activities that require fine, central vision)
- aging (Aging is a risk factor for low vision, however, persons of any age may be affected.)
- congenital defects (present at birth)
- disease (including diabetes)
- other eye diseases (i.e., glaucoma, cataracts)
Although, in most cases, persons with low vision have disabled central vision (also called reading vision), there are other types of low vision which may include the following:
- disabled or partial peripheral vision
- disabled or partial color vision
- disabled or partial ability to adjust to different light settings
- disabled or partial ability to adjust to different contrasts
- glared vision
Because low vision cannot be improved by more traditional methods (i.e., the use of eyeglasses, contact lenses, etc.) persons with low vision often rely on the use of a number of different instruments, called low vision devices, and tailored equipment for improved vision. Low vision devices, categorized as either optical or non-optical, help to improve visual ability for millions of people everyday.
Simply stated, optical low vision devices involve the use of one of many types of lenses to improve vision. For example:
- magnifying devices (i.e., magnifying eyeglasses, hand magnifiers, magnifying lamps, telescopic viewing devices, etc.)
- closed circuit television or CCTV involves enlarged images, exaggerated contrasts, and adjustable magnification
- Non-optical low vision devices help bring images closer to the eyes. This may include the use of any, or all, of the following:
- larger print items (i.e., magazines, newspapers, books, calendars, address books, cookbooks, dictionaries, games, playing cards, sheet music, street signs, etc.)
- larger, illuminated watches and clocks
- writing guides
- instruments that provide voice instruction (i.e., computers)
- instruments that provide voice information (i.e., clocks, timers, calculators, scales, key chains, etc.)
Age-related macular degeneration (AMD) is a common condition which results in damage to the central retina which may cause distortion and loss of central vision. Fortunately, macular degeneration does not result in total blindness as the peripheral undamaged portions of the retina provide some degree of vision. Macular degeneration is diagnosed by physical examination as well as diagnostic imaging tests performed by an ophthalmologist or optometrist.
AMD may be divided into two categories, nonexudative or “dry” disease and exudative or “wet” disease. Dry macular degeneration generally causes a slow but progressive damage to the central retina and accounts for 80% of all cases of macular degeneration. The current goal of treatment involves nutritional and lifestyle modifications in an effort to slow the progression of the damage. Wet macular degeneration accounts for 20% of all cases. It can result in rapid deterioration of central vision and results from abnormal blood vessel growth underneath the retina. This condition is generally treatable if detected early. Various treatment options exist, and a qualified retinal physician can help determine which treatment is best for each individual case.
A macular hole is a full thickness loss of central retina tissue which results in a spontaneous decrease in central vision. Macular holes may result from traumatic injuries but are more commonly linked to the aging process. As a person ages, the clear vitreous gel within the eye liquefies and shrinks which may cause traction on the central retina. If this traction is strong enough, a hole may be pulled open resulting in decreased vision. Fortunately, macular holes are generally treatable with surgical intervention if performed within a timely manner. Any loss of central vision should therefore be promptly reported to one’s eye physician.
Myasthenia Gravis is an autoimmune disorder which results in muscle weakness. This condition may involve muscles of the eyelid or eye ball, leading to droopy eyelids (ptosis) and double vision (diplopia). The severity of these symptoms may vary throughout the day but is typically worse at the end of the day when tired. Individuals may also have difficulty swallowing or breathing, and it may also cause weakness of other facial muscles or limb muscles.
Blood testing, electromyogram, and other tests may be required to confirm the diagnosis. Myasthenia gravis may be associated with other autoimmune disorders, such as Grave’s eye disease/thyroid orbitopathy.
Various medical treatments and surgical therapies, such as ptosis repair, are often effective in improving the quality of life.
Myopia, or nearsightedness, is a refractive error in which an image of a distant object becomes focused in front the retina, either because the eyeball axis is too long, or because the refractive power of the eye is too strong. This condition makes distant objects appear out of focus and may cause headaches and/or eye strain.
Treatment includes glasses, contact lenses, and refractive surgery.
Migraine (Ophthalmic Migraine)
Ophthalmic migraine attacks may present with visual changes, such as flashing zigzagging lights that expands over 10 to 30 minutes. Other symptoms may include blurry vision, visual field loss, unilateral throbbing headache associated with nausea, vomiting, light sensitivity, fatigue. It is possible to present only with visual symptoms without a headache.
There are various types of treatment for migraines, including acute management of an ongoing attack, and prophylactic medications to prevent its recurrence. Avoidance of agents that may trigger migraines is also recommended, such as alcohol, red wine, caffeine, chocolate, MSG (monosodium glutamate), and aged cheeses, and nitrates, which are often found in processed foods.
Ocular trauma and orbital fractures
Trauma to the eye and orbit may result in a multitude of significant injuries, leading to severe vision loss. Bleeding may occur inside the eye (hyphema) or within the eye socket (orbital hemorrhage) and cause irreversible blindness. Eyelid or globe lacerations as well as retained foreign body materials may also incite severe vision-threatening infections. In addition, persistent ocular inflammation (iritis), swelling of the retina (commotion retinae), detachment of the retina, optic neuropathy, and even glaucoma may occur as a result of the injuries.
Fractures of the bones of the eye socket may also cause persistent double vision, pain with eye movement, and sinking-in of the eye (enophthalmos), and typically needs to be repaired in a timely manner. Eyelid or nasolacrimal injuries may also need to be reconstructed to avoid excessive tearing or eyelid closure problems. For the severely damaged non-repairable eye or the functionally blind and painful disfigured eye, then removal of the eye may be necessary as well.
Optic neuritis is one of the most common causes of sudden visual loss in patients less than 45 years old. The loss of vision may be mild or severe, and it often occurs over days, and is associated with pain in or around the eyes, especially with eye movement. There is typically loss of color vision and reduced perception of light intensity. There may also be associated neurological symptoms, such as weakness, numbness, and tingling in the extremities.
Brain imaging tests and other studies may be performed to confirm the suspicion of optic neuritis and to rule out associated disorders such as multiple sclerosis. Intravenous steroids and other immune suppressants may be recommended to accelerate visual recovery and reduce the chance of recurrence.
Orbital Diseases (Tumors and Infections)
There are many disorders that affect the orbit (the soft tissues that surround the eye ball). Infections of the orbit (orbital cellulitis), which may cause serious irreversible blindness, typically result from adjacent sinus infections (sinusitis). Orbital cellulitis can also occur from infections the lacrimal gland (dacryocystitis), dental abscess, or found in patients who are immunocompromised or have suffered a traumatic injury. Symptoms may include eyelid swelling, pain, redness, blurred vision, headaches, double vision, and prominence of eye (proptosis). Antibiotic treatment is typically required to treat these infections, although surgical drainage of the infection is sometimes needed as well.
Orbital tumors may cause symptoms of double vision (diplopia), pain, pressure sensation, decreased vision, and prominence of eye (proptosis). These tumors may be benign and primarily localized in the eye socket. However, it may also be malignant and arise from other parts of the body in cases of tumor metastasis.
Imaging and lab testing are often needed to characterize the lesion and biopsy and/or surgical removal may be needed as well.
The pituitary gland, which is located in close proximity to the visual pathway, is the master gland that sends signals to regular other endocrine glands throughout the body. An abnormal growth of the cells within the pituitary gland not only causes dysregulation of hormones, but it may also cause vision loss due to its compressive mass effect on the optic nerves and chiasm-parts of the visual pathway.
Pituitary tumors may produce headaches and blurred vision, or visual fields loss, which is typically located on the outside peripheral portion of the visual field in both eyes. Imaging tests are needed to characterize the size and location of a suspected pituitary tumor. Some of these tumors may be responsive to medical therapy, while in other cases, surgery or radiation therapy may be offered.
Presbyopia is an age related form of farsightedness resulting in a gradual loss of the ability to focus on near objects, usually starting abound age 40. Treatments: glasses, contact lenses, refractive surgery
Pseudotumor Cerebri (Intracranial Hypertension)
Pseudotumor cerebri, or idiopathic intracranial hypertension, is a condition whereby the cerebral spinal fluid outflow is reduced in the brain, leading to high pressure build-up. As a result, the pressure is transmitted to the back of the eyeball, causing swelling of the optic disc, which may lead to vision loss. Common symptoms include headaches, double vision, and transient episodes of vision loss lasting seconds, as well as nausea, vomiting, and rushing noise in their ears.
The cause of this condition is not clear, but it occurs more often in young women who are overweight. Other associated factors include pregnancy, high doses of vitamin A, oral contraceptives, steroid use, and certain antibiotics.
Diagnostic testing may include brain imaging tests and spinal tap to measure the pressure and to rule out tumors, infections, and other inflammatory conditions.
Treatments include weight loss and reduction of cerebral spinal fluid production with medications, such as Diamox. In more severe cases, surgical shunting procedures such as lumbo-perioneal shunt, or optic nerve sheath fenestration may be needed to increase the outflow of the cerebral spinal fluid.
Both pterygium and pingueculum represent benign degeneration of the deeper conjunctival layers, typical resulting from chronic sun exposure or irritation. Pingueculum appears as white-yellow plaques or nodules in the sun exposed zone of the white part of the eyes, whereas pterygium typically appears as a wedge-shaped fibrovascular tissue growth, which may extend onto the central corneal surface.
Common symptoms include eye redness, irritation, foreign body sensation, and decreased vision.
Treatment includes protection of the eyes from sun, dust, and wind. Topical lubrication with artificial tears as well as anti-inflammatory drops may be used to reduce ocular irritation. Surgical removal may be considered if contact lens wear becomes difficult or the growth of the pterygium approaches the visual axis and causes blurry vision.
The retina is a layer of nerve tissue that lines the back wall of the eye. The retina functions like the film in a camera and sends light to the brain in order to be processed into an image. In order for the retina to function properly, it must remain attached to the back wall of the eye and receive nourishment from the choroid layer underneath it. The retina is a very delicate structure and damage generally results in some loss of vision
A retinal detachment generally occurs due to a tear in the retina with subsequent fluid accumulation which may be rapid. As a person ages, the vitreous gel within the eye begins to liquefy and shrink. At some point this shrinkage becomes significant enough that the vitreous gel pulls away from the retina. Rarely, this results in a tear in the retina which can then lead to retinal detachment. Peripheral retinal degenerations may also occasionally lead to holes or tears in the retina which may lead to retinal detachment.
Retinal detachments are a very serious condition which generally requires prompt evaluation and management by a retina specialist. This condition is generally treated with surgery but in rare cases it can be repaired in the office. Only a qualified retinal specialist would be able to determine which treatment option is best.
Retinal Vein Occlusions
The retina contains arteries and veins like all other tissues in the body. These blood vessels may develop disruptions in their blood flow and this condition is known as a vascular occlusion. Retinal vein occlusions are the second most common retinal vascular disease following diabetes. They are generally related to the aging process but can be associated with a number of different vascular, coagulation and inflammatory disorders.
Retinal vein occlusions can range from mild to severe and may result in significant damage to the underlying blood vessel. This damage may cause fluid to leak into the retina resulting in a condition known as macular edema.
Temporal Arteritis (Giant Cell Arteritis)
Temporal arteritis or Giant cell arteritis is the most common form of systemic vasculitis that causes irreversible vision loss in the elderly. The disease primarily affects patients over age of 50, with an increasing prevalence among women and those of Scandinavian and Northern European descents. Polymyalgia rheumatica is also frequently associated with temporal arteritis. Associated symptoms may include headache, jaw claudication (pain with chewing), scalp tenderness, muscle and joint aches, weight loss, poor appetite, and fevers.
Temporal arteritis may lead to sudden, painless, vision loss. If left untreated, up to 50% of the patients may also develop significant vision loss in the opposite eye within days or week onset.
Once temporal arteritis is suspected, laboratory testing may be done to assess the degree of inflammation. Steroids or other anti-inflammatory medication may be used to reduce the chance of further vision loss. A temporal artery biopsy is often performed to confirm or rule-out the diagnosis. This outpatient procedure is performed through an incision hidden in the temple scalp region.
Patients with temporal arteritis will often require long-term immunosuppressive therapy and often need close monitoring to assess for recurrences of the disease.
Thyroid (Graves’) Eye Disease (Protruded Irritated Eyes)
Graves’ disease, or thyroid orbitopathy is an autoimmune inflammatory disorder, in which there is overproduction of abnormal antibodies that attack the thyroid gland. These abnormal antibodies also affect the tissues of the eyelids, extraocular muscles, and soft tissues around the eyeball. Consequently, the eyes may bulge and appear protruded and the eyelids may become retracted, resulting double vision (diplopia), in inability to close the eyes (lagophthalmos), dry eyes, ocular surface scarring, as well as vision loss.
In most cases, the orbital inflammation is self-limited, but in some cases, steroids and even radiation treatment may need to be used to reduce the swelling. In severe cases with vision loss, surgery may need to be done to decompress the eye socket in order to relieve the pressure and prevent damage to the vision.
After resolution of the inflammation, which may take up to 6 months to a few years, orbital decompression can be done to allow the eyes to return back to a more normal position in the eye socket. Double vision can also be treated with eye muscle surgery or prism glasses. Surgery to correct retracted eyelids may also be performed in order to restore normal eyelid closure to improve appearance.
Of note, cigarette smoking typically prolongs the course of disease and worsens the inflammatory process so avoidance of smoking is strongly recommended.
There are many causes of tearing, including overproduction of tears from allergies or dryness, and poor drainage from lower lid malposition or blocked tear drain system. A tear duct blockage may lead to infection and chronic pink eye. Various procedures, such as tear duct probing, balloon dilation, stent placement, or tear drain bypass surgery may be performed to help alleviate the blockage and reduce the risk of recurrent infections.
- Adult Tearing- Causes and Treatment- American Society of Ophthalmic Plastic and Reconstructive Surgery
- Blocked Tear Ducts-Kids - American Society of Ophthalmic Plastic and Reconstructive Surgery
- Blocked Tear Duct Surgery - Dacryocystorhinostomy (DCR)- American Society of Ophthalmic Plastic and Reconstructive Surgery