Ocular Conditions

Macular Degeneration

Wet and Dry Macular Degeneration

Age-related macular degeneration (AMD) is a medical condition which usually affects older adults and results in loss of vision in the center of the visual field (the macula) because of damage to the retina. There are 2 types, dry macular degeneration and wet macular degeneration.

Dry macular degeneration results from accumulation of cellular debris called drusen. These look like yellow spots on the retina (see photo). These spots are related to elevated cholesterol deposits. There is no cure for macular degeneration, but taking vitamins high in antioxidants, lutein, xeaxanthin, and omega 3's are thought to slow progression of macular degeneration, and in some patients, improve vision. Examples of such vitamins include Ocuvite, Preservision, lcaps, etc.

Wet macular degeneration causes loss due to abnormal blood vessel growth in the macula, leading to blood leakage below the macula and rapid vision loss if left untreated. Avastin injections in to the eye by a retinal surgeon can often dry up the blood in the eye and improve vision if treated rapidly. See photo of wet macular degeneration.

Symptoms of Macular Degeneration include:

  1. Blurred vision
  2. Shadows or missing areas of vision
  3. Distorted vision - straight objects appear wavy
  4. Trouble discerning colors, especially dark ones from dark ones, and light ones from light ones
  5. Slow recovery of vision after exposure to light
  6. Loss in discerning contrast between things

Causes and risk factors of macular degeneration:

  1. Aging
  2. Family history - there is a 50% chance of developing macular degeneration if you have a family member with it
  3. Macular degeneration gene
  4. Hypertension
  5. Elevated cholesterol
  6. Obesity
  7. UV exposure
  8. Smoking - increases risk 2 to 3 times vs. non smokers
  9. Race - more common in Caucasians than people of African decent

The Amsler grid test is one of the simplest and most effective ways of monitoring the health of your macula. The Amsler grid is a pattern of intersecting lines with a black dot in the center. With normal vision, all the lines will look straight and even spaced when fixating on the central dot. In macular degeneration, the lines look bent, distorted or missing.


High Blood Pressure and Your Eyes
When blood pressure is very high for a long period of time, the small blood vessels in the eye undergo a number of changes. The vessels narrow and become constricted in places. Tiny amounts of fluid leak from the blood vessels in the retina (the inside layer at the back of the eye). This is called hypertensive retinopathy. Hypertensive retinopathy often has no visual symptoms until it is quite severe. During an eye examination, we dilate your eyes to look for several findings on your retina - flame hemorrhages, cotton wool spots (white fluffy areas caused by nerve fiber damage), hard exudates (lipid deposits from damaged blood vessels), swelling of the macula (central portion of retina responsible for the center of your vision), and swelling of your optic nerve.

The only treatment for hypertensive retinopathy is to control high blood pressure. The retina will generally recover unless the patient has had long standing, uncontrolled high blood pressure and severe retinal damage. If you have high blood pressure, it is very important to have regular eye examinations to detect retinal problems.

Diabetes and Your Eyes

If you are diabetic, it is important to have yearly dilated eye exams. Diabetes can cause damage to the blood vessels inside your eyes on the retinas. This is called retinopathy. Diabetic retinopathy is the leading cause of blindness in working age Americans. Risk factors for developing retinopathy include:

  1. severity of the diabetes
  2. length of time you have been diabetic
  3. how well you control your diabetes

80% of patients who have had diabetes 10 years or more will show some signs of diabetic retinopathy.

Most often, diabetic retinopathy will have no symptoms until the damage to your eye(s) is severe.

Symptoms Include:

  • blurred vision and slow vision loss over time
  • floaters
  • trouble seeing at night
  • shadows or missing areas of vision
  • occasional double vision

During a dilated eye exam, we examine the retina for early signs of the disease such as:

  1. leaking blood vessels
  2. retinal swelling (macular edema)
  3. pale, fatty deposits on the retina (called exudutes) which are signs of leaky blood vessels
  4. damaged nerve tissue (neuropathy)
  5. and any changes in the blood vessels

Diabetic Retinopathy

There are three main treatments for diabetic retinopathy to reduce vision loss:

  1. Laser surgery
  2. Injection of corticosteroids or Anti VEGF into the eye
  3. Vitrectomy - done when there is a lot of blood in the vitreous (fluid in the eye). This involves removing the cloudy vitreous in the eye and replacing it with saline.

Not only are diabetics at risk to develop retinopathy, but they are also at higher risk to develop cataracts and glaucoma. A diabetic develops cataracts earlier than non-diabetics, and they are also nearly twice as likely to get glaucoma as other adults.


Dry Eye Syndrome
Dry eyes occur when your tears cannot provide enough moisture for your eyes. This can occur if you do not produce enough tears or if you produce poor quality tears.

Symptoms of dry eyes include:

  • Red, irritated, scratchy eyes
  • Burning in the eye
  • Gritty feeling, like sand in the eye
  • Fluctuation in vision, with vision clearing after a blink and then blurring as the tears evaporate
  • Watery eyes. There are three layers in the tears. If the outer layer is deficient or missing, the middle water layer will come out of the eye causing tearing
  • Light sensitivity

There are several common causes of dry eyes. These include:

  • Dry environments such as hospitals, factories, air planes
  • Ceiling fans, air conditioning and heating vents
  • Medications such as water pills, antidepressants, antihistamines, and birth control pills
  • Poor nutrition, especially drinking a lot of coffee, tea, and soft drinks
  • Wearing dirty, clogged contact lenses
  • Natural aging, especially menopause

There are several treatments for dry eyes:

  • Decrease intake of coffee, tea, and soft drinks
  • Increase water intake - drink 6-8 Eight ounce glasses of water per day
  • Use artificial tears 4-6 times per day
  • Take 2500mg omega 3's daily

If these things do not help, we can prescribe Restasis, a prescription drug which is used to treat dry eyes. Punctal plugs can also be inserted in the eyelid to reduce the outflow of tears. Sometimes steroid drops are needed to get dryness under control.

Dry eyes are common in several diseases such as Sjogren's syndrome, rheumatoid arthritis, rosacea, and collagen vascular diseases.

Do you have Dry Eye? Just answer the 12 simple multiple choice questions in the Refresh Dry Eye Quiz to find out. When you’re finished, print out your results and bring it to our office and Dr. Neuhoff can help determine the appropriate treatment for you.

Do you have Dry Eye? Just answer the 12 simple multiple
choice questions Dry Eye Quiz to find out!   

Flashes & Floaters
You may often see spots, strings, circles, clouds or cobwebs moving in your vision. These are called floaters and are actually tiny clumps of cells in the vitreous, the clear gel-like liquid that fills the inside of the eye. While these objects look like they are in the front of you, they are actually floating inside the eye. What you see are the shadows they cast on the retina.

When the vitreous gel pulls on the retina, you may see what looks like flashing of lights or lightening streaks. These are called flashes. As we grow older, it is more common to experience floaters and flashes as the vitreous gel changes with age, gradually pulling away from the inside surface of the eye. This pulling of the vitreous away from the back of the eye is called a posterior vitreous detachment. This condition is common in people who are:

  • Nearsighted
  • have undergone cataract surgery
  • have had YAG laser on the eye
  • have had inflammation (swelling) inside the eye
  • has had an injury to the eye

To find out if a retinal tear or detachment is occurring, you should call your eye doctor immediately if you notice the following symptoms:

  • Sudden increase in size and number of floaters
  • a sudden appearance of flashes
  • having a shadow or curtain appears in the periphery of your vision
  • see a gray curtain moving across your vision
  • have a sudden decrease in your vision

Blue Light Exposure & Your Vision
Recent Studies have shown that blue-violet light can cause retinal cell death and contribute to cataract formation. Cumulative blue light exposure is a risk factor for developing macular degeneration. Besides affecting our vision and eye health, blue light exposure at night before going to bed can alter sleep patterns by suppressing melatonin production. Lower melatonin levels not only produce a poor night’s sleep, they also can depress a person's immune system.

Advances in modern technology have increased our daily exposure to blue light in the form of smart phones, LED TVs, Ipads, tablets and even compact fluorescent light bulbs (the curly light bulbs used in lamps and light fixtures). There is such concern about harmful blue light exposure, that nine different optical companies have developed lenses that filter blue light. There are several things that you can do to protect your eyes from blue light exposure. First, limit your usage of these devices. Wear blue light filtering lenses such as Crizal Prevencia or Unity BluTech lenses. Avoid using the devices at least one hour before going to bed to avoid disrupting melatonin levels. Finally, do no use compact fluorescent bulbs in bedrooms or bathrooms which may be used at night. Normal fluorescent bulbs which give off less harmful yellow light are a better choice.

References: "The New Blue", Vision Monday, January 2015
"Protecting Eyes From Bad Blue Light", Vision Monday, September 9, 2013


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