Conditions - Eye Testing Specialists

Eye Conditions

More than 4.2 million Americans aged 40 years and older are either legally blind having best-corrected visual acuity of 20/200 or worse or have low vision having best-corrected visual acuity less than 20/40.

The leading causes of blindness and low vision in the United States are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Continue reading to learn about the mosts common eye conditions in the United States.

Age Related Macular Degeneration

Macular degeneration, often called age-related macular degeneration (ARMD), is an eye disorder associated with aging and results in blurry central vision and vision loss. The macula is responsible for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula and central vision.

ARMD is the leading cause of permanent impairment of vision among people aged 65 years and older.

One of the earliest signs of ARMD is drusen. Drusen are tiny yellow or white deposits under the retina. They often are found in people aged 60 years and older. The presence of small drusen is normal and does not cause vision loss. However, the presence of large and more numerous drusen raises the risk of developing advanced ARMD.

In early stages, AMD may have no symptoms at all. When the disease progresses, the symptoms are:

As the macular degeneration progresses, AMD symptoms include:

There are two forms of ARMD-dry and wet

Dry AMD is when drusen gradually accumulate in the macula, disrupting the structure of the macula and causing moderate, blurry central vision. The dry form is more common and accounts for 70–90% of cases of AMD, it is less severe and progresses more slowly than the wet form.

Over time, as the macula becomes more damaged, central vision is gradually lost in the affected eye. Dry ARMD generally affects both eyes. It is estimated that 1.8 million Americans aged 40 years and older are affected by ARMD and an additional 7.3 million with large drusen are at substantial risk of developing ARMD. The number of people with AMD is estimated to reach 2.95 million in 2020.

Wet ARMD, the more severe form, is when drusen become larger and affect the macula structure and function to a greater degree. The causes abnormal blood vessels to start growing under the macula, ultimately leading to bleeding and fluid leakage. Bleeding, leaking, and scarring from these blood vessels cause damage and lead to rapid central vision loss.

Risk Factors

The primary risk factor for AMD is age—the older you are, the greater your risk. Also, people with a family history of ARMD, women, and people of European descent are at higher risk.

Some lifestyle factors are also known to increase your risk for AMD:

Cigarette smoking
Obesity
Hypertension (high blood pressure)
Excessive sun exposure
Diet deficient in fruits and vegetables
High cholesterol has also been linked to ARMD

Treatment and prognosis

No current treatment can prevent visual loss for patients with dry ARMD). However, the Age-Related Eye Disease Studies (AREDS), conducted by the National Eye Institute, have found that a nutritional supplement formula may delay and prevent intermediate dry AMD from moving to the advanced form.

The AREDS supplement formula, which is widely available over the counter, contains:

Vitamin C
Lutein
Vitamin E
Zeaxanthin
Zinc

Wet-AMD treatment has been revolutionized in recent years after the discovery of vascular endothelial growth factor (VEGF), a family of compounds in the body. VEGF regulates and promotes the growth of abnormal new blood vessels in the eye—known as neovascularization—that can lead to wet AMD.

Anti-VEGF drugs have been developed to help stop neovascularization and preserve vision for AMD patients. There are currently 4 anti-VEGF drugs:

Avastin® (bevacizumab)
Lucentis® (ranibizumab)
Eylea® (aflibercept)
Beovu® (brolucizumab)

Wet AMD cannot be cured, but its progression may be blocked with the use of intravitreal (in-the-eye) anti-VEGF injections. These injections may preserve, and even recover, vision. Local anesthetic eye drops are given before the injections to numb the eye and minimize discomfort.

There are 3 anti-VEGF treatment regimens:

Pro re nata (PRN) or “treat and observe”—patients are treated with three initial monthly injections, followed by treatment as needed.
“Treat and extend”—after 3 initial monthly injections, the time between treatments is gradually increased until wet AMD is stabilized.
Monthly injections.

How can I lower my risk for AMD?

Research shows that you may be able to lower your risk of AMD (or slow vision loss from AMD) by making these healthy choices:

Quit smoking — or don’t start
Get regular physical activity
Maintain healthy blood pressure and cholesterol levels
Eat healthy foods, including leafy green vegetables and fish

A positive note is although patients with either form of AMD can experience a severe decrease in visual acuity, they will almost never be completely blind.

Glaucoma

Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve.

The symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive eye exam and special tests specifically designed for the detection of glaucoma.

There’s no cure for glaucoma, but early treatment can often stop the damage and protect your vision.

What are the symptoms of glaucoma?

At first, glaucoma doesn’t usually have any symptoms. That’s why half of people with glaucoma don’t even know they have it. Over time, you may slowly lose peripheral vision, it happens so slowly, many people can’t tell that they are losing vision.

As the disease progresses, you may start to notice that you can’t see things off to the side anymore. Without treatment, glaucoma can eventually cause blindness.

Risk Factors for Glaucoma

Anyone can get glaucoma, but some people are at higher risk. You’re at higher risk if you:

Have high eye pressure (intraocular pressure)
Being over age 60
Being black, Asian or Hispanic
Having a family history of glaucoma
Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
Having thin corneas
Being extremely nearsighted or farsighted
Having had an eye injury or certain types of eye surgery
Taking corticosteroid medications, especially eyedrops, for a long time

Prevention

These self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.

Get regular dilated eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends having a comprehensive eye exam every five to 10 years if you’re under 40 years old; every two to four years if you’re 40 to 54 years old; every one to three years if you’re 55 to 64 years old; and every one to two years if you’re older than 65. If you’re at risk of glaucoma, you’ll need more frequent screening. Ask your doctor to recommend the right screening schedule for you.

Know your family’s eye health history. Glaucoma tends to run in families. If you’re at increased risk, you may need more frequent screening.

Exercise safely. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise program.

Take prescribed eyedrops regularly.Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by your doctor need to be used regularly even if you have no symptoms.

Glaucoma Treatment

Doctors use a few different types of treatment for glaucoma, including medicines (usually eye drops), laser treatment, and surgery.

If you have glaucoma, it’s important to start treatment right away. While it won’t reverse any damage already caused, treatment can stop it from getting worse.

Prescription eye drops are the most common treatment. They lower the pressure in your eye and prevent damage to your optic nerve.

Laser treatment. To lower pressure in your eye, doctors can use lasers to help the fluid drain out of your eye. It’s a simple procedure that your doctor can do in the office.

Surgery

If medicines and laser treatment don’t work, your doctor might suggest surgery. There are several different types of surgery that can help the fluid drain out.

While glaucoma is a serious disease, treatment works well. Remember these tips:

If your doctor prescribes medicine, be sure to take it every day
Tell your doctor if your treatment causes side effects
See your doctor for regular check-ups
Encourage family members to get checked for glaucoma, since it can run in families

Diabetic Retinopathy

If you have diabetes, it’s important to get a comprehensive dilated eye exam at least once a year. Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision.

Managing your diabetes — by staying physically active, eating healthy, and taking your medicine — can also help you prevent or delay vision loss.

Diabetic retinopathy (DR) is a common complication of diabetes

It is the leading cause of blindness in American adults. It is characterized by progressive damage to the blood vessels of the retina. DR progresses through four stages:

mild nonproliferative retinopathy
moderate nonproliferative retinopathy
severe nonproliferative retinopathy
proliferative retinopathy (most advanced stage).

The risks of DR are reduced through disease management that includes good control of blood sugar, blood pressure, and lipid abnormalities. Early diagnosis of DR and timely treatment reduce the risk of vision loss; however, as many as 50% of patients are not getting their eyes examined or are diagnosed too late for treatment to be effective.

It is the leading cause of blindness among U.S. working-aged adults aged 20–74 years. An estimated 4.1 million Americans are affected by diabetic retinopathy.

Symptoms of diabetic retinopathy

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go depending on fluctuation blood sugar levels.

In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel-like fluid that fills your eye). If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.

Preventing diabetic retinopathy

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels in a healthy range. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for your diabetes medicine or insulin.

To make sure your diabetes treatment plan is working, you’ll need a special lab test called an A1C test. This test shows your average blood sugar level over the past 3 months. You can work with your doctor to set a personal A1C goal. Meeting your A1C goal can help prevent or manage diabetic retinopathy.

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So controlling your blood pressure and cholesterol can also help lower your risk for vision loss.

What’s the treatment for diabetic retinopathy and DME?

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.

In later stages, it’s important to start treatment right away — especially if you have changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.

Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.

Laser treatment. To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.

If you have diabetes be sure to have a yearly eye exam to monitor your eye health closely.

What’s the treatment for diabetic retinopathy and DME?

Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.

Laser treatment. To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.

If you have diabetes be sure to have a yearly eye exam to monitor your eye health closely.

Plaquenil and Retinal Toxicity

Plaquenil (hydroxychloroquine) and the less used chloroquine are antimalarial drugs with anti-inflammatory properties that are used for the treatment of inflammatory conditions such as Rheumatoid Arthritis and Lupus.

While Plaquenil is less toxic than chloroquine, long-term use of either drug can result in retinal toxicity. Retinal toxicity usually begins without symptoms or blurred vision in early stages, but over time, if left undiagnosed, can lead to retinal damage and severe vision loss.

Plaquenil toxicity is of serious concern because it is not treatable reversible. However, it has been shown that remaining vision can be preserved, if the medication is discontinued.

The goal of screening for retinopathy is to recognize classic signs of toxicity at an early enough stage to prevent a loss of vision. The latest screening guidelines published by the American Optometric Association indicates the most important risk factors are dosage and duration of use.

With annual eye exams, retinal toxicity and permanent vision loss can be prevented.

Plaquenil Toxicity Testing:

Diagnosing Plaquenil Retinal Toxicity requires testing. Each test is included in the baseline and annual appointments. The new American Optometric Association Plaquenil eye exam testing guidelines include:

Visual field testing is used to detect vision loss caused by Plaquenil.
Ocular coherence tomography of the retina allows early detection of damage to the tissue under the retina before signs of retinal damage are visible to the doctor.
Retinal Function testing with Multifocal ERG. ERG has the ability to detect early macular dysfunction BEFORE it causes vision loss to the patient.
Retinal Photos with Fundus Autofluorescence (FAF) can show areas where the retina is damaged. FAF reveals early photoreceptor and/or late RPE loss.
Color vision and Amsler Grid testing can provide diagnostic information as well.

Testing is performed yearly. We will communicate our findings with your primary physician and rheumatologist. Communication with the prescribing physician is key to proper treatment and management.

Risk Factors of Plaquenil Toxicity

Are you currently taking Plaquenil? If the answer is Yes, continue reading to understand the risk factors of retinal toxicity:

When did you start?
Anytime you are taking Plaquenil, you are at risk for retinal toxicity and vision loss. Risk of toxicity increases greatly after 5 years of use.

What is your current dosage?
Dosage is based on weight. Doses less than 5.0mg/kg body weight are safer, doses greater than 5.0 mg/kg dramatically increases risk. Extreme doses can be exceedingly dangerous.

Are you currently under the care of an optometrists?
All patients beginning plaquenil should have a baseline eye exam and testing. Annual eye exams are critical to monitoring toxicity and detecting changes early. If toxicity is detected, your dosage may be lowered or eliminated all together.

How often do you see your rheumatologist?
Seeing your doctor as scheduled is important in avoiding problems related to plaquenil.

Are you being treated for kidney disease or taking tamoxifen?
Kidney disease and tomoxifen are both high risk factors for developing retinal toxicity with the use of Plaquenil.

Avoiding Plaquenil Toxicity

Managing your arthritis early can help prevent the need for plaquenil, or at least lower the dosage needed.

Guard your joints against damage. Keep them in good shape with some tweaks to your lifestyle. Diet, exercise, and using the right tools can make a huge difference.

Lose Weight. If you carry extra pounds, be kind to your joints and shed a few. Added body weight puts more stress on your hips, knees, and feet. Those extra pounds can make it harder to keep your joint pain and symptoms under control.

Stay Active. Regular exercise helps your joints work like they should, eases stiffness, and relieves fatigue. It strengthens the muscles that support your joints.

Stop Smoking. Help for your inflammation is just one more reason to quit tobacco. Research shows smoking can make it harder to treat the disease.

Avoid Strain on a Single Joint. Use your large, strong joints to spare smaller, fragile ones.

Eat Foods with Omega-3 fatty acids. Studies show that foods rich in omega-3 fatty acids can help lower inflammation. Some good sources are fatty fish like salmon, herring, tuna, and sardines. Supplements, while not as effective, but more convenient are also an option.