Frequently Asked Questions About Eye Care
How often should I visit an Ophthalmologist?
Before Age 5
All children should have an eye exam before they start school. A child should be seen immediately if he or she develops crossed eyes, a lazy eye, or a droopy eyelid.
Ages 5 to 20
If the child or teenager has no symptoms, then every 2-3 years is adequate. If they wear glasses or CTL, then every year.
Ages 20-40
Again, if the individual has no symptoms, then every 2-3 years is adequate. If they wear CTL, then every year.
Ages 40-65
These individuals should have an eye exam every 1-2 years to check for the development of cataracts, glaucoma, AMD, diabetic eye disease, or other disease that may affect the eye. If they wear CTL, then every year.
Ages 65 and Above
These individuals should have an eye exam every year to check for the development of cataracts, glaucoma, AMD, diabetic eye disease, or other disease that may affect the eye.
What are cataracts?
A Cataract is what we call the natural lens within the eye when it becomes cloudy. This clouding causes symptoms of blurry vision, glare and sensitivity to light, problems seeing at night, fading and yellowing of colors, double vision in one eye, and/or rapid changes in glasses prescriptions. Cataracts most often form naturally as a normal process of aging but can occur due to eye trauma, genetic inheritance, diseases such as Diabetes, and certain medications.
Treatment of Cataracts is surgical removal. There are no medications or exercises that will slow or reverse the development of cataracts. Vitamins and nutrition, also, have not been shown to affect the development of cataracts. Cataracts may occur in children or may be complicated by Glaucoma. In these very rare cases, urgent removal of the cataract is indicated. Otherwise, cataract surgery is an elective procedure and only needs to be performed if the cataracts interfere with a person's daily activity. The presence of cataracts in an adult does not harm the eye and if they don't interfere with a person's life, they can be left alone.
Cataract surgery is the most frequently performed surgery in the United States, with more than one million being done every year. Cataract surgery is a low risk surgical procedure that is performed with the use of high frequency ultrasound. A needle is inserted into the eye through a small incision. The needle vibrates creating an ultrasonic wave that breaks up the cataract allowing it to be removed through the needle. A clear artificial lens implant is then often placed inside the eye to replace the natural lens/cataract.
Occasionally, the membrane that is left to hold the implant in place inside the eye turns cloudy. When this happens, a laser can be used to clear this clouding almost immediately. This is the "Laser for Cataracts" that you often hear about.
What is glaucoma?
Glaucoma is a disease in which the optic nerve is damaged by a process associated with elevated pressure inside the eye. The optic nerve is the nerve that carries the signals from the retina, the part of the eye that senses the light, to the brain. The exact cause of the disease is unknown. Risk factors for glaucoma are increased pressure inside the eye, diabetes, black race, age over 50, family members with glaucoma, and trauma to eye.
Glaucoma often has no symptoms early on. Symptoms develop once significant damage has occurred. Therefore, early detection and treatment are very important to prevent vision loss. People with the risk factors listed above should be tested every year. The more risk factors a person has, the greater the chance of developing glaucoma. Glaucoma can progress to complete loss of vision in one or both eyes if untreated.
Treatment of glaucoma involves lowering the pressure inside the eye with eye drops, medications, laser, and/or surgery. Treatment cannot reverse damage that has already occurred, it can only help to prevent further damage and vision loss.
What is macular degeneration?
Age-Related Macular Degeneration (AMD) is a disease occurring in patients over 50 years of age in which there is loss of central vision. The exact cause of the disease is unknown and there is no known treatment that will stop or reverse the vision loss. The disease affects the pigment layer that lies underneath the retina (the part of your eye that senses light). The pigment layer is like the pigment in your skin which makes a person tan in the sun. The pigment layer protects and nourishes the retina. For reasons we do not understand, the pigment in the central or macular area of the retina which gives you sharp 20/20 vision breaks down (degenerates). When the pigment layer degenerates, the retina that it supports also degenerates.
Symptoms of AMD include distortion (straight lines appear wavy), decreased vision, decreased ability to distinguish colors, dark or grayed out areas in the central vision. AMD is most commonly seen in fair skinned, blond hair, blue eyed people. It can be inherited and is associated with hypertension (high blood pressure) and smoking. Poor nutrition can make the disease worse but is not thought to be a cause of the disease.
There are two forms of AMD, the dry and the wet form. In the dry form, we just see degeneration of the pigment and the overlying retina. In the wet form, we see the development of fragile leaky blood vessels underneath the retina in areas where there is significant breakdown of the pigment layer. These blood vessels may bleed or leak fluid underneath the nerve causing distortion and a rapid drop in vision. The blood vessels later cause significant scarring which destroys the overlying retina causing loss of all central vision.
Things that have been shown to slow the progression of the disease include good nutrition, green leafy vegetables, a glass of red wine or red grape juice a day, zinc, and antioxidants. Too much zinc has been shown to worsen the disease and so exceeding the daily recommended allowance of zinc is not recommended. If the wet form of the disease develops, laser treatment to destroy to growing blood vessels can be used to prevent the scarring and minimize the loss of vision.
What is diabetic eye disease?
Every year, between 12,000 and 24,000 people lose their sight because of diabetes. About 15 million people have diabetes in the US. Diabetes is associated with cataracts and glaucoma and can cause a retinopathy (damage to the retina, the part of the eye that senses light). Diabetes is a disease of the blood vessels. What damages the blood vessels is the blood sugar being too high. When the blood vessels are damaged, they leak, bleed, or clot off (stop circulating blood) and when this happens in the retina, we call it retinopathy. Diabetes affects all parts of the body, but the retina needs more blood than any other part of the body and so it is often damaged first. The kidneys come a close second after the eye. The heart and brain require a lot of blood but they have a lot of backup blood vessels which the eye and kidneys don't have and so the heart and brain are spared until later in the disease.
There are two types of diabetic retinopathy, Non-Proliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic Retinopathy (PDR). In NPDR, we see swelling of the retina from leaky blood vessels, bleeding below, into, and above the retina, and infarction of the retina (destruction of a part of the retina caused by loss of circulation). These signs cause symptoms of decreased vision and/or distorted vision. In PDR, we see all the signs of NPDR plus the growth of new blood vessels into and above the retina. The blood vessels grow in response to the loss of circulation. These new blood vessels sound like they should be a good thing, unfortunately, they are growing from damaged blood vessels and carry the same damage. Because they are new blood vessels, they are more fragile and therefore leak, bleed, and clot off even worse than the original. This leads to more rapid progression of the damage to the retina and greater loss of vision.
The most important treatment for diabetic retinopathy is prevention with good blood sugar and blood pressure control. Once retinopathy has developed, a laser can be used to reduce the swelling caused by the leaky blood vessels as well as stop or even reverse the growth of new blood vessels.
Retinopathy is usually seen 10-15 years after diabetes develops. Unfortunately, many diabetics can go years before they are diagnosed with the disease and so don't know exactly how long they have been diabetic. It is therefore recommended that all diabetics receive a complete eye exam with an Ophthalmologist (Eye M.D.) at the time they are diagnosed and yearly after that.
Where can I find more information?
Your best source of information is your ophthalmologist (Eye M.D.). You may also find more information at the public website of the American Academy of Ophthalmology.