COMMON EYE CONDITIONS

ASTIGMATISM

What is astigmatism?

Astigmatism is a refractive error of the eye that causes blurred vision of both distant and near objects.

Why does astigmatism occur?

Astigmatism occurs when the cornea or lens has an irregular shape, similar to a football ball, rather than a smooth curved shape like a soccer ball. This causes light to focus on several points on the retina instead of just one, resulting in distorted vision.

What causes astigmatism?

• Genetic factors: Astigmatism is usually inherited.
• Environmental factors: Grinding your eyes can cause and worsen existing astigmatism.

What discomfort does astigmatism cause?

• Blurred vision of near and far objects.
• Eye fatigue.
• Squinting to see better.
• Difficulty seeing at night.
• Sensitivity to light

How is astigmatism treated?

• Glasses or contact lenses: Correct astigmatism by focusing light properly on the retina.
• Refractive surgery: Can permanently correct astigmatism by changing the shape of the cornea or lens.

1. LASIK/FEMTOLASIK: Laser on the cornea.
2. Phacorefractive: Replacement of the crystalline lens with a toric intraocular lens.

Can astigmatism be prevented?

• Frequent breaks from near activities are recommended.
• Children need to have regular eye exams to detect and treat astigmatism early.

PRESBYOPIA

What is presbyopia?

Presbyopia, also known as farsightedness, is an eye condition that affects most people over the age of 40. It is characterized by difficulty focusing on near objects, such as reading a book or using a cell phone.

Why does presbyopia occur?

Over time, the eye’s natural lens becomes less flexible and loses the ability to change shape to focus on near objects.

What causes presbyopia?

The main cause of presbyopia is the aging of the lens, the eye’s natural lens that helps focus light. Over time, the lens becomes less flexible and loses the ability to change shape to focus on near objects.

What discomfort does presbyopia cause?

• Difficulty focusing on near objects.
• Eye strain when reading or doing close work.
• Headaches.
• Squinting to see better.
• Moving text farther away to read.
• Need more light to read.

How is presbyopia treated?

• Glasses: Reading glasses are the most common way to correct presbyopia.
• Contact lenses: Multifocal or monovision contact lenses are an option for people who do not want to wear glasses.
• Refractive surgery: You can correct presbyopia by reshaping the cornea or lens.

1. LASIK/FEMTOLASIK Monovision: Laser on the cornea.
2. Phacorefractive: Replacement of the crystalline lens with a multifocal or extended focus intraocular lens.

Can presbyopia be prevented?

No.

Adults need to have regular eye examinations to detect and treat presbyopia early.

KERATOCONUS

What is keratoconus?

Keratoconus is a non-inflammatory, degenerative disease of the cornea, the transparent layer that covers the front of the eye. It is characterized by progressive thinning and protrusion of the cornea, which takes on a cone-like shape instead of its natural curved shape like a soccer ball.

Why does keratoconus occur?

Because of progressive thinning and protrusion of the cornea, which takes on a cone-like shape instead of its natural curved shape.

What causes keratoconus?

• Genetic factors: Keratoconus usually has a hereditary component.
• Environmental factors: Frequent eye rubbing, eye allergies, and certain diseases such as Down syndrome can increase the risk of developing keratoconus.

What discomfort does keratoconus cause?

• Blurred and distorted vision, especially at night.
• Progressive myopia and astigmatism.
• Sensitivity to bright light.
• Difficulty seeing at night.
• Double or multiple vision.
• Squinting to see better.
• Irregular astigmatism.

How is keratoconus diagnosed?

• Visual acuity.
• Refraction.
• Corneal topography: Measurement of the shape of the cornea.
• Optical coherence tomography (OCT): Measurement of corneal thickness.

How is keratoconus treated?

• Treatment of allergic conjunctivitis and avoidance of eye rubbing.
• Glasses or contact lenses: Correct blurred and distorted vision in mild cases. They do not slow the progression of the disease.
• Intracorneal rings: Acrylic rings inserted into the cornea to improve shape and vision.
• Corneal crosslinking: A procedure that strengthens the cornea using ultraviolet (UV) light and riboflavin. It slows the progression of the disease.
• Corneal transplantation: Replacement of the damaged cornea with a healthy one in severe cases.

Recommendations for keratoconus?

• People with keratoconus need to have regular eye examinations to monitor the progression of the disease.
• Eye rubbing should be avoided.
• If you have symptoms of keratoconus, please appoint me for appropriate treatment.

CATARACT

What is a cataract?

A cataract is a clouding of the crystalline lens, the eye’s natural lens that helps focus light. It is like the fogging of a window pane, causing vision to become blurred, cloudy, and less colorful.

Why does a cataract form?

The main cause is aging, but there are other causes such as trauma or eye injury, diabetes, glaucoma, prolonged exposure to sunlight, medications (steroids), and hereditary factors (genetic predisposition) that favor the development of cataracts.

What are the symptoms of cataracts?

Symptoms include blurred or cloudy vision, poor night vision, sensitivity to light, sunlight, or car lights, double vision, difficulty distinguishing contrasts and colors, and others.

How is a cataract removed?

Treatment consists of cataract surgery. This involves replacing the crystalline lens with an intraocular lens with a specific prescription for the affected eye. The intraocular lens may be monofocal (distance vision) or premium (distance and near vision).

How can I prevent cataracts?

Prevention consists of regular eye exams by an ophthalmologist starting at age 40 for early diagnosis. Proper control of metabolic diseases such as diabetes reduces the risk of developing cataracts. Wearing sunglasses with UV filters reduces the risk of developing cataracts. Avoid smoking, as smoking increases the risk of developing cataracts.

DIABETIC RETINOPATHY

What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina, the light-sensitive layer at the back of the eye. If left untreated, it can lead to blindness.

What causes diabetic retinopathy?

Diabetes can damage the small blood vessels in the retina, causing fluid and blood to leak. The number of years you have had diabetes and high blood glucose levels are the main risk factors for developing diabetic retinopathy.

Other factors, such as uncontrolled high blood pressure, high cholesterol and triglyceride levels, and smoking, can hasten the onset of diabetic retinopathy.

What symptoms does diabetic retinopathy cause?

• Blurred vision.
• Dark or floating spots in vision.
• Distorted vision.
• Severe visual loss or blindness.

How is diabetic retinopathy diagnosed?

A fundus exam, which requires dilating the pupils to see the entire retina in detail.

 Other ancillary tests include macular OCT, which provides details of the area of increased vision or macula, and fluorescein angiography, which provides details of the retinal circulation.

What are the types of diabetic retinopathy?

Nonproliferative diabetic retinopathy (NPDR): This is the earliest stage of the disease. There is no growth of new blood vessels. However, if left untreated, it can progress to severe disease.

 Proliferative diabetic retinopathy (PDR): This is the most advanced stage of the disease. It is characterized by the growth of new abnormal blood vessels in the retina. These blood vessels can become fragile and bleed, which can lead to vision loss.

How is diabetic retinopathy treated?

• Controlling diabetes: Keeping blood glucose levels under control is the best way to prevent diabetic retinopathy and slow its progression.
• Controlling blood pressure.
• Cholesterol control.
• Anti-angiogenic medications: Injections into the eye to treat the growth of new blood vessels.
• Laser photocoagulation: Laser treatment is used to reduce the oxygen demand of the retina and improve oxygenation of the retina.
• Vitrectomy: Surgery to remove the vitreous gel from the eye, remove traction membranes, and apply laser to the retina to control the disease.

What are the recommendations for a diabetic patient?

• It is important for people with diabetes to have regular eye exams to detect and treat diabetic retinopathy early.
• Diabetes, blood pressure, and cholesterol should be controlled.
• Smoking should be avoided.
• If you have symptoms of diabetic retinopathy, appoint me for appropriate treatment.

DIABETIC MACULAR EDEMA

What is diabetic macular edema?

Diabetic macular edema (DME) is a complication of diabetes that affects the macula, the central part of the retina responsible for central and detailed vision. It occurs when fluid leaks from damaged blood vessels in the retina and accumulates in the macula.

What causes diabetic macular edema?

High blood sugar: Diabetes can damage the small blood vessels in the retina, causing leakage and fluid accumulation.

High blood pressure and high cholesterol increase the risk of DME.

What symptoms does diabetic macular edema cause?

• Blurred vision.
• Distorted vision.
• Difficulty reading
• Difficulty seeing at night.
• Sensitivity to light.

How is diabetic macular edema diagnosed?

A fundus exam requires dilating the pupils to see the macula and the entire retina in detail.

Other ancillary tests, such as macular OCT, provide details of the macula that are key to diagnosis and patient follow-up.

How is diabetic macular edema treated?

• Diabetes control: Keeping blood glucose levels under control is the best way to prevent DME and slow its progression. Control blood pressure and cholesterol.
• Antiangiogenic drugs: Injections into the eye used to prevent fluid leakage from damaged blood vessels.
• Focal laser photocoagulation: Laser treatment is used to seal leaking blood vessels.
• Vitreoretinal surgery: Surgery to remove the vitreous gel from the eye and relieve any traction areas that cause macular edema with a tractional component.

What are the recommendations for a diabetic patient?

• People with diabetes need to have regular eye exams to detect and treat DME early.
• Diabetes, blood pressure, and cholesterol should be monitored.
• If you have symptoms of DME, consult me for appropriate treatment.

AGE-RELATED MACULAR DEGENERATION

What is Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is an eye disease that affects the macula, the central part of the retina responsible for central and detailed vision. It is the leading cause of legal blindness in people over the age of 60.

What are the types of AMD?

• Dry AMD: This is the most common form of the disease. It is characterized by thinning and loss of cells in the macula.
• Wet AMD: This is a less common but more severe form of the disease. It is characterized by the growth of abnormal blood vessels under the macula that can leak blood and fluid.

What causes AMD?

• Age: The most important risk factor for AMD is age.
• Genetics: AMD can be inherited.
• Smoking: Smoking cigarettes increases the risk of developing AMD.
• Obesity: Abdominal obesity may increase the risk of developing AMD.

What symptoms does AMD cause?

• Blurred vision in the center of the field of vision.
• Difficulty reading or doing near activities.
• Distorted vision.
• Decreased color perception.
• Sensitivity to light.

How is AMD diagnosed?

• Visual acuity.
• Fundus examination.
• Optical coherence tomography (OCT): Measurement of retinal thickness; key to diagnosis and patient follow-up.
• Fluorescein angiography: Test that uses a dye to evaluate the retina.

How is AMD treated?

• Control risk factors: Stop smoking and control body weight.
• Antioxidants and vitamins: It has been shown that some supplements, such as lutein and zeaxanthin, can reduce the risk of progression of AMD.
• Intravitreal injections: Injections into the eye of anti-angiogenic drugs that are used to stop leakage and prevent new blood vessel growth in wet AMD.

What are the recommendations for preventing AMD?

• People over the age of 50 need to have regular eye exams to detect and treat AMD early.
• Body weight should be controlled and smoking should be stopped.
• If you have family members with AMD or symptoms of AMD, consult with me to assess your case.

MACULAR HOLE

What is a macular hole?

A macular hole is a small circular opening that forms in the macula, the central part of the retina that is responsible for central and detailed vision. It occurs when a small area of the macula thins and ruptures.

What causes a macular hole?

• Aging: The most common cause of a macular hole is aging. As we age, the vitreous (the clear jelly-like fluid that fills the eye) shrinks and separates from the retina. In some cases, the vitreous can pull on the retina and cause a macular hole.
• Eye trauma: A blow or injury to the eye can cause a macular hole.
• Myopia: People with myopia have an increased risk of developing a macular hole.

What discomfort does a macular hole cause?

• Blurred vision in the center of the visual field.
• Distorted vision.
• Perception of a dark spot in the center of vision.
• Difficulty reading or performing near activities.

How is a macular hole diagnosed?

• Visual acuity.
• Examination of the fundus.
• Optical coherence tomography (OCT): Key to diagnosis, and measurement of the macular hole.

How is a macular hole treated?

• Observation: Small macular holes may not require treatment.
• Vitrectomy: Surgery to remove the vitreous and relax the edges of the macular hole.

EPIRETINAL MEMBRANE

What is an epiretinal membrane?

An epiretinal membrane (ERM) is a thin layer of scar tissue that forms on the surface of the retina, the light-sensitive layer at the back of the eye. It affects the macula, the central area of the retina responsible for central and detailed vision.

What causes epiretinal membranes?

In most cases it is idiopathic or unknown. In some other cases, it can be identified as secondary to previous inflammation, diabetes mellitus, retinal holes, etc.

What symptoms does an epiretinal membrane cause?

• Blurred vision.
• Distorted vision.
• Difficulty reading or doing near activities.
• Perception of a spot or wrinkle in the field of vision.

How is an epiretinal membrane diagnosed?

• Visual acuity.
• Fundus examination.
• Optical coherence tomography (OCT): To assess the anatomy and thickness of the macula. Key for the diagnosis and follow-up.

How is an epiretinal membrane treated?

• Observation: Asymptomatic or mildly symptomatic ERMs may not require treatment.
• Vitrectomy with membrane peeling: Surgery to remove the vitreous and remove the epiretinal membrane from the surface of the retina.

What are some recommendations for patients with ERM?

People with symptoms of ERM need to consult an ophthalmologist for appropriate treatment.

RETINAL DETACHMENT

What is a retinal detachment?

A retinal detachment is a serious eye condition in which the retina, the light-sensitive layer at the back of the eye, separates from the underlying layer called the retinal pigment epithelium. When this happens, the retina cannot function properly and vision loss occurs.

What causes a retinal detachment?

• Retinal tear: A tear or hole in the retina can allow fluid to seep under the retina and separate it from the pigment epithelium.
• Eye trauma: A blow or injury to the eye can cause retinal detachment.
• Eye disease: Diabetic retinopathy may increase the risk of retinal detachment.
• Eye surgery: Rarely, a retinal detachment may occur after eye surgery.

What are the symptoms of retinal detachment?

• Flashes of light: Flashes of light in the visual field, especially in peripheral vision, maybe a sign of a retinal tear, which may precede a retinal detachment.
• Floaters: Floaters are small spots or specks that float in the visual field. If they appear suddenly or increase in number, they may be a sign of a retinal tear.
• Blurred vision: Blurred vision, especially in peripheral vision, may be a sign of early retinal detachment.
• Curtain or veil in the visual field: The perception of a curtain or veil falling may be a sign of retinal detachment.

How is retinal detachment diagnosed?

• Visual acuity.
• Fundus examination.

How is a retinal detachment treated?

• Laser photocoagulation: Used to seal retinal tears and prevent retinal detachment.
• Cryotherapy: Used to freeze and seal retinal tears.
• Surgery: There are different types of surgery to repair retinal detachment, such as placement of a cerclage, pneumoretinopexy, or vitrectomy.

What are some recommendations for patients with retinal detachment?

People with symptoms of retinal detachment must visit an ophthalmologist immediately.

GLAUCOMA

What is glaucoma?

Glaucoma is a group of eye diseases that damage the optic nerve, which is responsible for sending the images we see to the brain. This damage can cause vision loss and, if left untreated, can lead to blindness.

What are the risk factors for glaucoma?

• High intraocular pressure: This is the main risk factor for glaucoma.
• Age: The risk of glaucoma increases with age.
• Race: African Americans and Hispanics have a higher risk of developing glaucoma.
• Family history: Having a family member with glaucoma increases the risk for the disease.
• Diseases: Some diseases, such as diabetes, high blood pressure, and sleep apnea, can increase the risk of glaucoma.

What symptoms does glaucoma cause?

• Loss of peripheral vision (side vision).
• Blurred vision.
• Eye pain.
• Nausea and vomiting.
• Redness of the eyes.
• Sensitivity to light.

How is glaucoma diagnosed?

• Visual acuity.
• Intraocular pressure measurement.
• Pupil dilation.
• Examination of the fundus.
• Optical coherence tomography (OCT): Measurement of the retinal nerve fiber layer.
• Campimetry: Determination of the visual field.

How is glaucoma treated?

Glaucoma treatment aims to reduce intraocular pressure and prevent damage to the optic nerve. It may include:

• Medications: drops or pills to reduce intraocular pressure.
• Laser: Selective laser trabeculoplasty (SLT) or laser peripheral iridotomy (YAG) to improve drainage of the aqueous humor.
• Surgery: Trabeculectomy or valve implantation to create a new aqueous drainage pathway.

What are some recommendations for patients with glaucoma?

People with risk factors need to have regular eye exams to detect the disease early.

If you have symptoms of glaucoma or a family history, appoint me for appropriate treatment.

UVEITIS

What is uveitis?

Uveitis is an inflammation of the uvea, the middle layer of the eye. The uvea contains many blood vessels that nourish the iris, ciliary body, and choroid.

Types of uveitis:

1. Anterior: Affects the iris and ciliary body.
2. Intermediate: Affects the pars plana, which is the posterior part of the ciliary body.
3. Posterior: Affects the choroid.
4. Panuveitis: Affects the uvea in all 3 areas equally.

Causes:

• Autoimmune diseases: Uveitis can be caused by autoimmune diseases such as ankylosing spondylitis, psoriatic arthritis, Crohn’s disease, and sarcoidosis.
• Infections: Some infections, such as toxoplasmosis, tuberculosis, and syphilis, can cause uveitis.
• Trauma: A blow or injury to the eye can cause uveitis.
• Other: Some types of cancer, exposure to toxins, and medications can cause uveitis.

Symptoms:

• Eye pain.
• Redness of the eyes.
• Sensitivity to light.
• Blurred vision.
• Loss of vision.

Diagnosis:

Is made by a complete eye examination including:

• Visual acuity.
• Fundus examination
• In some types of uveitis, tests may be needed to determine the cause of the uveitis or to rule out systemic disease.

Treatment:

Depends on the cause and severity of the inflammation. It may include:

• Anti-inflammatory medications: Corticosteroid drops, tablets, or injections.
• Immunosuppressive medications: Used to control inflammation in chronic and severe cases.
• Antibiotics or antivirals: Used to treat infections that cause uveitis.
• Surgery: Surgery may be performed to treat complications of uveitis.

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