Blepharitis

Blepharitis, a common eye disease, is strictly defined as inflammation of the eyelid margins. Common symptoms include ocular redness, itching, irritation, and sometimes crusting of the lids. It is frequently mistaken for dry eyes due to the gritty or sandy sensation that may occur, though topical lubricants do little to improve symptoms. As several subtypes of blepharitis exist, treatment regimens should be customized to the individual. This may include the limited use of topical antibiotics, steroids, and oral medications such as Minocycline. However, the universal treatment principle in blepharitis is a daily routine of lid margin hygiene. This involves a warm compress and massage of the lids using a washcloth with facial soap or non-burning baby shampoo performed once or twice per day. Some commercially available lid scrubs have also shown promise in the daily hygiene routine. Eye make-up should be avoided until symptoms improve.

Glaucoma

One of the leading causes of blindness in our country, glaucoma is defined by progressive damage to the optic nerve with a specific pattern of visual field loss. Profound loss of peripheral vision can develop without symptoms, making early detection and treatment vital to preventing permanent damage. Glaucoma risk is higher in those with advancing age, a family history of glaucoma, elevated intraocular pressures, African or Mediterranean descent, systemic vascular and inflammatory diseases, steroid use, extreme farsightedness or nearsightedness, and prior ocular trauma.

Primary open-angle glaucoma is painless and is the most common subtype of glaucoma in this country. For reasons poorly understood, the ability of the eye to maintain healthy pressures is compromised, leading to optic nerve damage.

Narrow-angle glaucoma is also quite common, typically in patients who are farsighted or possess smaller, shorter eyes. Fluid pressure in the eye rises because normal outflow is compromised by a crowded or narrow drainage angle. This may lead to a painful, dangerous rise in pressure referred to as an angle closure attack, which often leads to the diagnosis. In the majority of patients, however, pressure increases are subtle, chronic, and painless, making them harder to identify and/or diagnose without frequent or timely eye examinations.

The diagnosis of glaucoma involves much more than a “screening test” of intraocular pressures.  A complete eye exam by an eye physician should include pressure testing, visual field testing, pupil dilation and direct visual assessment of the optic nerves, and evaluation of the fluid drainage pathways (angles) of the eye. Computer imaging of the optic nerve has also become standard and is extremely advantageous in both diagnosing and monitoring glaucoma.

Glaucoma patients with stable vision are monitored every three to four months, while those considered at risk (glaucoma suspects) are examined less frequently. For the majority of patients, treatment consists of the use of topical drop medications which act to lower the intraocular pressure. When drops alone are not sufficient, laser or incisional surgery may be implemented to halt or slow progression of the disease.

Diabetic Eye Care

Diabetic retinopathy is the most common cause of blindness among working-age Americans. Not only does this vision-threatening disease develop silently, but additionally, it is associated with ocular surface disease and accelerated cataract formation. Diabetic patients must have dilated eye exams at least annually to detect the emergence of diabetic retinopathy. If retinopathy is diagnosed in a timely fashion, laser or other treatments can be employed to minimize or reverse vision loss. If you are diabetic and have not had a recent eye checkup with an ophthalmologist, you should encourage your primary care provider to refer you for a complete dilated exam.

Macular Degeneration

Affecting mostly the elderly, macular degeneration is the leading cause of legal blindness in the United States. The macula, or central retina, is responsible for fine-point discrimination (detail) and color vision. Central vision loss usually occurs slowly, affecting both eyes at different rates and resulting in a loss of fine visual clarity (e.g., reading) and color perception. Peripheral vision typically remains clear. Advancing age, family history, Caucasian race, female gender, ultraviolet exposure, smoking, hypertension, elevated cholesterol, and diabetes are all risk factors associated with macular degeneration, though the root cause is still unknown.

There are two forms of age-related macular degeneration: wet and dry. The majority of cases of macular degeneration are of the dry form, in which there is thinning and degeneration of the tissues of the macula, resulting in the accumulation of abnormal yellow deposits called drusen. Progression of dry macular degeneration occurs very slowly, with unequal involvement in each eye. Wet macular degeneration occurs when abnormal or leaking blood vessels grow underneath the central retina. These changes can lead to distorted or blurred vision, and in some cases, hemorrhage can result in a rapid and severe loss of central vision.

Diagnosis of macular degeneration in its early stages may lead to a better overall prognosis, as treatments and technology continue to evolve, particularly for the wet form of the disease. While a comprehensive dilated examination with an eye physician is usually the first step in identifying the disease, other tests such as flourescein angiography, optical coherence tomography (OCT), and Amsler grid testing may also be helpful in the identification and classification of macular degeneration. A specialty consultation with a vitreoretinal surgeon is often initiated following diagnosis; however, during the early stages of macular degeneration, regular eye exams, cessation of smoking, in-home vision monitoring, and nutritional supplements (daily antioxidant multivitamins) may be all that is recommended.

The damaging effects of oxygen-charged molecules (free radicals) are directly linked to macular degeneration. Antioxidant vitamins such as carotenoids are thought to protect against the damage caused by free radicals. Two notable carotenoids that occur naturally in the macula are lutein and zeaxanthin. Reliable research has suggested that people with diets high in lutein and zeaxanthin may have a lower risk of developing macular degeneration and that those with this disease may experience a slower rate of progression. Multivitamin nutritional supplements are available, which contain these carotenoids and other antioxidants. There are natural sources of these nutrients as well. For example, fresh spinach, kale, and collard greens are vegetables which contain high levels of these antioxidants thought to counter the damaging effects of macular degeneration.

Treatments exist for some forms of wet macular degeneration. Laser may be recommended to destroy abnormal blood vessels beneath the macula. While this can arrest or slow the progression of disease, it generally cannot restore vision that has already been lost. Photodynamic therapy, another treatment option, may not only slow the progression of the disease, but may also lead to visual improvement. In addition, modern injectable drugs such as Avastin and Lucentis have been shown to improve visual function quite impressively in many patients with wet macular degeneration. For those cases of macular degeneration that are not treatable, low vision aids such as magnifiers and video devices are available that can dramatically enhance vision needed for routine daily activities.

General Eye Care Services / Complete Eye Exams

Periodic, routine eye exams help to maintain ocular health through the detection and prevention of disease. Early detection of silent diseases such as glaucoma, macular degeneration, and diabetic retinopathy will allow for a broader choice of treatment options and can reduce the risk of future vision loss.

At Hertzog Eye Center, our services go beyond specialty cataract and LASIK surgical consultations - we provide comprehensive ophthalmic care to patients of all ages and always welcome new patients. Patients who simply desire a basic eye exam and glasses prescription are encouraged to call and schedule an appointment. We do not operate an optical dispensary. All patients who are issued written glasses prescriptions are encouraged to fill these prescriptions at an optical dispensary of their choosing.

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