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Common Eye Diseases

Diabetes and the Eye

People with diabetes may develop eye problems as a complication of the disease. This includes cataracts, glaucoma, and diabetic retinopathy. Early detection and timely treatment of diabetes and its complications can greatly reduce the risk of blindness.

What to Expect: You may experience fluctuating or changing vision as a result of altered blood sugar. This means you may see clearly through a pair of glasses one day, and not so well the next. This rarely represents a true change to the prescription and should return to normal once the blood sugar stabilizes. There may also be distortions in the vision due to bleeding or swelling of the retina. Unfortunately, you may not have any signs that your diabetes is affecting your eyes. You may not have any symptoms at all until the eye disease is advanced. Yearly comprehensive eye exams through dilated pupils are very important to check for early signs of disease.

Complications of Diabetes: Diabetic Retinopathy is the leading cause of blindness among working age adults in the US. It occurs when the small blood vessels that nourish the retina start to deteriorate and leak. A mild form of the disease causes bleeding and fluid build-up in the retina. The more severe form starts from a lack of oxygen in the retina and stimulates the growth of abnormal new vessels, which are leaky and lead to further bleeding. Laser surgery can be used to halt the progression of diabetic retinopathy. Laser surgery has also been proven to reduce the risk of vision loss from advanced diabetic retinopathy by 60 percent.

Age Related Macular Degeneration (AMD)

AMD is a progressive eye condition that affects central vision and is a leading cause of vision loss in people over 60 years old. Complete or total blindness does not occur because peripheral (side vision) is maintained. There are two types of AMD: dry and wet. The dry form is the most common type and accounts for 85% of all cases. Deposits called drusen are present. The wet form is least common and is the more severe form. Leaky blood vessels and bleeding can occur.

Risk Factors

  • Smoking
  • Ultraviolet Light (Sun)
  • Hypertension
  • Age
  • Females > Males
  • Caucasian
  • Poor Diet

Treatment

  • Currently there is no cure, but controlling your risk factors can help limit progression.
  • Protect eyes from sunlight. Look for sunglasses marked “blocks 99% UV” or “UV absorption up to 400um”
  • Stop smoking
  • Eat right and take your vitamins. Anti-oxidants (Vit A,C, E) , Zinc, and Lutein are important
  • Lose weight and exercise

Cataracts

Cataracts are formed by age related changes that occur to the natural lens in the eye. The lens sits behind the pupil and iris and works like a camera lens by focusing incoming light onto the retina. When we are young, the lens of the eye is completely translucent and light passes easily through it. With advancing age, proteins in the lens get clumped together and cause a clouding or opacification of the lens. This leads to blurry vision, since incoming light can no longer reach the retina as well. Eating a healthy diet, refraining from smoking, and wearing sunglasses can help prevent early onset cataracts. If a cataract starts to interfere with your daily activities, cataract removal surgery is an effective, safe procedure.

Symptoms and Signs

Cataracts grow gradually and at first have little to no effect on your vision. As the cataract grows symptoms include:

  • Blurred vision
  • Glare from sun or headlights
  • Colors appearing dull or dim
  • Requiring more light to read

Common Causes of Cataracts

  • Ultraviolet sun exposure
  • Diabetes
  • Medications including steroids and certain anti-psychotic drugs
  • Cigarette smoke
  • Air pollution and certain types of radiation

Multiple Sclerosis (MS)

Multiple Sclerosis is as an autoimmune disease where the immune system destroys myelin, which is the fatty substance protecting the nerves in the brain and spinal cord. Women are more susceptible to multiple sclerosis than men. It usually occurs between the ages of twenty and forty. There are multiple theories on the cause of MS, including demographics, genetics, and/or infection.

Ocular Symptoms of MS

  • Blurred or loss of vision in one eye
  • Pain in the eye, especially on eye movements
  • Double vision
  • Color vision changes
  • Dizziness

Research done at The Johns Hopkins Multiple Sclerosis Center recently used the OCT to scan the retinal nerve fiber layer of patients with MS. They found a strong association between RNFL loss and brain atrophy. This is important because the earlier MS can be detected, the sooner treatment can begin. With earlier treatment, there is less chance of irreversible nerve damage.

Ultraviolet Radiation and the Eye

Did you know that ultraviolet radiation can damage the eyes? In fact, ocular changes from sun exposure can start as young as nine years old. In a study focusing on Australian students, 80% had damage by 15 years old. It is important for people of all ages to protect their eyes from the sun by wearing sunglasses and wide brimmed hats. Also try to avoid sun exposure at peak times (10am-4pm).

Ocular Damage from UV radiation:

  • Pterygia (growth of tissue on the conjunctiva of the eye)
  • Melanoma
  • Cataracts
  • Keratitis
  • Uveitis (inflammation, light sensitivity)
  • Early Presbyopia (need for reading glasses)
  • Age Related Macular Degeneration

Skin Damage from UV radiation:

  • Sunburn
  • Skin Cancer

The electromagnetic spectrum consists of ultraviolet light, visible light, and infrared light. UV light carries energy, which produces free radicals and causes a negative reaction in the skin or eye. There are 3 types of ultraviolet radiation, UVA, UVB, and UVC. UVA causes “Aging” and UVB for “Burn” is the most harmful to the eyes and accounts for 2% of total sunlight. Ozone is created naturally in the stratosphere by the combining of atomic oxygen (O) with molecular oxygen (O2). This process is activated by sunlight.

Scattered light that comes from the sky and ground is harmful to our eyes. Sand reflects 15% UVB light and snow reflects up to 85%. This is why you can become sunburned while sitting under an umbrella or may develop “snow blindness” while skiing.

Ultraviolet absorption depends on the amount of ozone in the stratosphere. Sun exposure increases by 10% for every 1000 feet elevation. For every 1% decrease in ozone layer, there is a 2% increase in UVB exposure, and a 4-6% increase risk of cancer. Ozone is destroyed naturally by the absorption of ultraviolet radiation and by the collision of ozone with other atmospheric molecules like CFCs. Since the late 1970s, scientists have discovered an “ozone hole” in Antarctica. A reduction of about 3% per year has been measured at Antarctica where most of the ozone loss is occurring globally. The World Meteorological Organization (WMO) said recently (9/2008) that “the hole in the Ozone Layer above Antarctica is already larger than in 2007”, although experts do not believe it will be as bad as in 2006.

Recommendations

  • Protect your eyes from the sun
    • Sunglasses with 100% UV protection
    • Some brands of contact lenses provide UV protection. These are to be worn in conjunction with a pair of sunglasses
  • Protect your child’s eyes from the sun
    • Ocular damage may start as young as 9 years old
  • Protect your eyes from the sun if you have had LASIK
    • The cornea is thinner after LASIK, and there may be more risk of cataract

Information from Cohen, Stephen. Educating Patients About Ultraviolet Radiation: Most patients are unaware of the damage that ultraviolet radiation can cause to their eyes. CL Spectrum 8/08.

Headaches

There are three types of primary headaches: Tension, Cluster, and Migraine. Tension headaches are the most common.

TENSION CLUSTER MIGRAINE
Sex (M & F) Equal M & F Males 5x more Females 3x more
Location Both sides of head One side of head One side of head
Pain Dull pressure Stabbing Pulsating/Throbbing
Aura No No Visual Symptoms*
Duration Hours-days 30-90 minutes Hours-days

Ocular Migraines (Visual Aura)

*Visual Auras occur in some people before the start of or during a migraine headache, and other people experience an aura without the headache. More than half of migraine sufferers get auras. An aura is a binocular visual disturbance that may consist of zigzag lines, white dots, or curved lines.  Often the images spread and move from one location in space to another. Usually the auras start out in your peripheral vision and move inwards. Vision may become blurred or you may get tunnel vision during an aura. Most auras last 5-20 minutes and should be completely gone within an hour. If you experience something like this for the first time, you should see you eye doctor immediately since certain retinal conditions can cause symptoms like this.

 

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