Glaucoma

Glaucoma is a leading cause of blindness in the U.S. It occurs when the pressure inside the eye rises, damaging the optic nerve and causing vision loss. The condition often develops over many years without causing pain or other noticeable symptoms – so you may not experience vision loss until the disease has progressed.

Symptoms that you could be developing glaucoma include blurred vision, loss of peripheral vision, halo effects around lights, and painful or reddened eyes. People at high risk include those who are over the age of 40, diabetic, near-sighted, African-American, or who have a family history of glaucoma.

To detect glaucoma, your physician will test your visual acuity and visual field as well as the pressure in your eye. Regular eye exams help to monitor the changes in your eyesight and to determine whether you may develop glaucoma.

Once diagnosed, glaucoma can be controlled. Treatments to lower pressure in the eye include non-surgical methods such as prescription eye drops and medications, laser therapy, and surgery.

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Retinal Disorders

The retina is a thin sheet of nerve tissue in the back of the eye where light rays are focused and transmitted to the brain. The vitreous is a gel-like substance that fills the eye and is connected to the retina, optic nerve and many blood vessels. Problems with the retina and vitreous -- including retinal tear and detachment, macular degeneration, diabetic retinopathy, infection and trauma -- can lead to vision loss and blindness. Early detection and treatment are critical in correcting problems before vision is lost or preventing further deterioration from occurring.

Age Related Macular Degeneration (AMD)

Age related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. The visual symptoms of AMD involve loss of central vision. While peripheral vision is unaffected, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and generally looking at detail. Imagine being able to see a clock on the wall but unable to make out the time or unable to read because you could not see parts of words on the page.

Although the specific cause is unknown, AMD seems to be part of aging in those who are genetically predisposed. While heredity is the most significant risk factor for developing AMD, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. AMD accounts for most of the cases of new legal blindness in the US in those over the age of 60.

Nine out of 10 people who have AMD have the dry form, which results in thinning of the macula, the area of the retina responsible for central vision. Dry AMD takes many years to progress.  Progress of dry AMD or the conversion to the more severe “wet” (or leaking) form may be prevented with the use of anti-oxidant vitamin (A,C,E) supplements with zinc, and lutein and omega-3 fatty acids (found in fish oil). 

The wet form of AMD occurs much less frequently (one out of 10 people) but is more serious.  Recently, a number of important advances have occurred in the diagnosis and treatment of wet AMD. 

At South Jersey Eye Physicians, we use the latest in diagnostic techniques (including intravenous fluorescein angiography and optical coherence tomography) and treatment advances (including drug therapy with Avastin and Kenalog) to get the best possible results. It is now possible to improve the vision in many cases!

Low vision aids improve the quality of life in those with advanced dry AMD or wet AMD. The low vision program at South Jersey Eye Physicians offers compassionate, extensive training with advanced technology devices to maximize an individual’s functional capacity.

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Retinal Detachment

The vitreous is a clear liquid that fills our eyes and gives them shape. When we are young, the vitreous has a thick, gelatinous consistency and is firmly attached to the retina. As we age, the vitreous thins and separates from the retina. Although this usually results in nothing more than a few harmless floaters, tension from the detached vitreous can sometimes tear the retina.

If liquid seeps through the tear and collects behind the retina or between its nerve layers, the retinal tear can become a retinal detachment. Retinal detachment can cause significant, permanent vision loss and requires immediate medical treatment.

There are three kinds of retinal detachment. The most common form, described above, occurs when fluid leaks into the retina; people who are nearsighted or who have had an injury or eye surgery are most susceptible. Less frequently, friction between the retina and vitreous or scar tissue pulls the retina loose, something that occurs most often in patients with diabetes. Third, disease-related swelling or bleeding under the retina can push it away from the eye wall.

Signs of retinal tear or detachment include flashes of light, a group or web of floaters, wavy or watery vision, a sense that there is a veil or curtain obstructing vision, or a sudden drop in vision quality. If you experience any of these symptoms, call your doctor immediately. Early treatment is essential to preserve your vision.

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Diabetic Retinopathy

Patients with diabetes are at an increased risk of developing eye diseases that can cause vision loss and blindness, such as diabetic retinal disease (diabetic retinopathy), cataracts and glaucoma. These and other serious conditions often develop without vision loss or pain, so significant damage may be done to the eyes by the time the patient notices any symptoms.

People with diabetes sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. Because diabetic retinopathy often has no symptoms, if you have any form of diabetes you should have your eyes examined regularly by an ophthalmologist.  For this reason it is very important for diabetic patients to have their eyes examined once a year.

Diagnosing and treating eye disease early can prevent vision loss. It is also important to maintain a steady blood-sugar level, maintain normal blood pressure, have your cholesterol level evaluated (and treated if elevated), take prescribed medications, follow a healthy diet, exercise regularly and avoid smoking.

If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina.  Diabetic retinopathy is a complication of diabetes caused by changes in the blood vessels of the retina.

Non-Proliferative Diabetic Retinopathy (NPDR)

In NPDR, diabetic changes may cause the retinal vessels to leak, which may lead to swelling (edema) of the retina.  This swelling, along with poor circulation in the retina, can cause vision changes.

The retinal swelling in NPDR is treated with improved blood sugar, blood pressure, and cholesterol control.  At South Jersey Eye Physicians, we communicate with your primary care physician and other healthcare providers to aid in your treatment. 

We also use retinal laser treatment and drug therapy (such as Avastin and Kenalog) to treat the retinal swelling to prevent further vision loss.

In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels.  These new blood vessels leak and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.  Retinal laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding.  Drug treatment of the abnormal new vessels (with Avastin and Kenalog) may also prevent them from growing and bleeding.

The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months or even years. If the vitreous hemorrhage does not clear within a reasonable time, an operation called a vitrectomy can be performed. During a vitrectomy, the eye surgeon removes the hemorrhage and the abnormal blood vessels that caused the bleeding, improving the vision.

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Refractive Errors

To see clearly, light rays must be bent or refracted to focus on the retina, the light-sensitive nerve layer that lines the back of the eye. The cornea and lens of the eye work together to bend or refract light rays and bring them together on the retina. If a refractive error is present, the light is not focused directly on the retina, so images appear blurry.

• Myopia (nearsightedness): Distance vision is impaired when the eye is too long in relation to the curvature of the cornea. This causes light to focus before it reaches the retina. Close objects look clear but distant objects appear blurry.

• Hyperopia (farsightedness): Close vision is impaired, with some impairment of distance vision, as well. The eye is too short in relation to the curvature of the cornea. Light rays are not yet in focus when they reach the retina, so images appear blurry.

• Astigmatism (the cornea is oval shaped instead of round): The irregular curvature of the cornea causes light to focus on more than one point on the retina. Uncorrected astigmatism impairs both distance and near vision.

• Presbyopia (aging eyes): When young, the lens of the eye is soft and flexible, allowing people to see objects both close and far away. After the age of 40, the lens of the eye becomes more rigid, making it more difficult for the lens to change its shape, or accommodate, to do close work such as reading. This condition is known as presbyopia and is the reason reading glasses or bifocals are necessary at some point after age forty.

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Dry Eye

Dry eye can damage the eye's tissues and impair vision. People usually begin experiencing dry eye symptoms as they age, but the condition can also result from certain medications, conditions or injuries. The eyes may become dry and irritated because the tear ducts don't produce enough tears, or because the tears themselves have a chemical imbalance.

Non-surgical treatments for dry eye include blinking exercises, increasing humidity at home or work, and use of artificial tears or moisturizing ointment. If these methods fail, small punctal plugs may be inserted in the corners of the eyes to limit tear drainage, or the drainage tubes in the eyes may be surgically closed.

Learn more about SJEYE's Dry Eye Clinic »

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