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Most common causes for a visit to the eye doctor...

The most common eye problems are listed at continuation. If you feel you have any of the following conditions please don't hesitate to contact us. Our phone number is located at the top right of this window. To the left of this text you will find several links to eye care information resources.

Cataracts

A cataract is a clouding of the natural lens inside the eye that prevents light from focusing on the retina, causing blurry vision. Cataracts are generally thought to be a natural part of the aging process, but they can also be linked to certain medical conditions like diabetes, or trauma to the eye. Cataract symptoms become progressively worse over time - left untreated, cataracts can cause significant vision loss.

How are cataracts treated?

The best treatment for cataracts is lens replacement with intraocular lens implants. Over the last few years, cataract surgery has evolved, and treatment has become safer and more effective than ever before.

Glaucoma

Glaucoma is a disease of the optic nerve that is usually associated with increased eye pressure. As pressure increases, the optic nerve can become damaged, causing blind spots to develop. In the early stages of glaucoma, side vision (peripheral vision) may be affected, but if glaucoma is allowed to progress undetected, it is possible for the entire optic nerve to be destroyed, leading to significant vision loss or blindness.

Early detection is the key to effective treatment of glaucoma. At El Paso Eye Center we offer comprehensive glaucoma screenings for our patients. Some of the detection methods we use are visual field testing, measure intraocular pressure, and check for optic nerve damage. In most cases, treatment of glaucoma will consist of eye drops and/or laser therapy, in some cases, incisional surgery is necessary. To prevent vision loss, we recommend that our glaucoma patients visit us frequently for periodic checkups.

Age Related Macular Degeneration (AMD)

Age related macular degeneration (AMD) is one of the most common causes of poor vision in patients after the age of 60. Although the specific cause is unknown, AMD seems to be a part of aging. Heredity, blue eyes, high blood pressure, cardiovascular disease and smoking are risk factors. AMD accounts for 90 percent of new legal blindness in the US. Visual symptoms of AMD involve loss of central vision, but the peripheral vision is unaffected. Patients can lose the sharp, straight-ahead vision necessary for driving, reading and recognizing faces when parts of the image are missing.

Two categories of AMD are wet and dry. 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 develop. In some cases anti-oxidant treatment may be beneficial.

Wet macular degeneration occurs much less frequently (one out of 10 people) but is more serious. Currently there are many treatments available, including laser photocoagulation, photodynamic therapy (PDT) and anti-vascular endothelial growth factor ( anti-VEGF) medications. Anti-VEGF therapy, including Lucentis and Macugen, is the newest treatment for macular degeneration.

Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetes damages the body's normal circulation which is why people with diabetes may have problems with circulation to their legs, kidneys, heart, brain, and eyes. At least 50 percent of all diabetics will develop diabetic retinopathy (abnormal retinal blood circulation), and the incidence increases with the duration of the disease. After 20 years, more than 90 percent of diabetics have some degree of diabetic change.

Diabetic retinopathy is a leading cause of blindness in the United States in the middle-aged adults. Fortunately, new methods of treatment in recent years have decreased blindness among diabetics and have increased the possibility of retaining useful vision.

Types of Diabetic Retinopathy

There are two main types of diabetic retinopathy: non-proliferative and proliferative. In non-proliferative diabetic retinopathy, there is leakage caused by damage to small retinal blood vessels (capillaries). This leakage allows proteins and lipids from the blood to accumulate in the retina, causing swelling. If this swelling occurs in the area of central vision (macular edema), sight may be significantly diminished. As the disease progresses, retinal capillaries may also become closed off, resulting in poor retinal nutrition. Lack of circulation to the center of vision (macular ischemia) can result in severe and permanent loss of central vision.

When there is widespread impairment of retinal nutrition due to capillary leakage and closure, proliferative diabetic retinopathy develops. The poorly nourished retina sends out a chemical "distress signal" which causes new blood vessels to grow (proliferate) on the retinal surface. Unfortunately, these new blood vessels are very fragile and often rupture, allowing bleeding to occur within the eye (vitreous hemorrhage). Scar tissue can also grow around the abnormal blood vessels; which may lead to retinal detachment and possible permanent blindness. The proliferative form of diabetic retinopathy is present in approximately 20 percent of patients with diabetes of ten years duration.

Symptoms

In the early stages of diabetic retinopathy, there are usually no symptoms. Therefore, it is very important that all patients with diabetes have a comprehensive dilated eye examination at least once a year before any symptoms develop. During this exam, you eye specialist can check for any signs of damage to the retina and optic nerve, including leaking blood vessels, swelling of the macula, and growth of new vessels. To help prevent the development and progression of diabetic retinopathy, patients are urged to control their blood sugar, blood pressure, and cholesterol levels.

Treatment

Macular Edema

Macular edema is caused by damage to retinal paillaries which leads to leakage of blood products into the retina.

Large clinical trials have shown that the application of focal laser to areas of retinal swelling can stabilize the vision and reduce the risk of vision loss by 50 percent.

The Injection of steroids, such as triamcinolone, either around or into the eye has also recently been found to be of benefit. Side effects of steroid injections include increased eye pressure and cataract formation.

A new class of medications target the "distress signal" sent out by a poorly nourished retina. These agents bind and block the action of vascular endothelial growth factor (VEGF) and can be directly injected into the eye. Adverse effects of injections of these agents into the eye are rare but include bleeding, infection, cataract, and retinal tear or detachment.

Proliferative Diabetic Retinopathy

Widespread impairment of retinal blood circulation leads to the development of new, fragile blood vessels.

Large clinical trials have shown that a procedure called scatter laser photocoagulation can be effective in halting or reversing new vessel growth. Many eyes, even without visual problems, need to begin laser treatments if there are certain abnormal vessels present. Those eyes, having no visual problems, must be detected by examination. Overall, the incidence of blindness over two years can be reduced by 66 percent for eyes with new vessels on the optic nerve and by 37 percent for eyes with new vessels in other locations. The laser treatment consists of applying multiple laser burns to the peripheral retina, often divided into several sessions. Although mildly uncomfortable, the treatment usually can be done without the need for local anesthesia. The main complications from treatment are loss of some peripheral vision, a decrease in night vision, occasionally some loss of central vision, and possible mild enlargement of the pupil. If laser treatment is needed, the risk factors of not being treated are much higher than the risk of being treated.

Again, a new class of medications targeting VEGF produced by poorly nourished retina can be directly injected into the eye. The anti-VEGF drugs Avastin and Lucentis have been used with good results in managing proliferative diabetic retinopathy, often along with scatter laser photocoagulation treatment.

Vitreous Hemorrhage and Tractional Retinal Detachment

In cases where laser treatment is not successful in preventing hemorrhage into the eye or when a retinal detachment from scar tissue has occurred, a type of surgery called vitrectomy is often helpful. In the operating room, a microsurgical instrument is inserted into the eye, and the blood-stained vitreous is removed and replaced by a clear sterile solution. Fibrous bands which may cause retinal detachment are removed to allow the retina to flatten and return to a more normal configuration. Vitrectomy remains an operation performed only on eyes in which no other treatment is useful. Approximately 60 percent to 70 percent of selected eyes, otherwise hopelessly damaged, can be restored to at least ambulatory vision. Some eyes, however, actually can return to very good vision.

Protecting your Vision

It is critical for all diabetics to have a comprehensive eye exam at least once a year to evaluate for the presence of retinopathy. Patients should remember that both macular edema and proliferative retinopathy can develop without symptoms. Patients with visual symptoms and/or visual loss, at any stage of the disease, should be evaluated without delay to find out the cause of the visual change. Early detection and timely treatment can prevent vision loss

Floaters and Light Flashes

Floaters

Many people, at some time in their lives, notice floaters in one or both eyes. These are perceived as small spots or strands that seem to drift in the field of vision, trailing rapidly with eye movements and then floating slowly when eye movements cease. Floaters are most readily seen against a bright background such as well illuminated reading material, a computer screen, or bright sky.

Light Flashes

Light flashes may occur in conjunction with floaters or may occur separately. Unlike floaters, light flashes (photopsias) are typically perceived in subdued lighting or even total darkness. Photopsia can range from minimal light twinkles to flashes that are bright enough to suggest a neon sign or camera flash.

What Causes Floaters and Light Flashes?

Most occurrences of floaters or light flashes relate to changes in the jelly-like substance called vitreous which fills the entire back cavity of the eye. The vitreous is transparent and has a solid consistency similar to gelatin. As people grow older, the vitreous undergoes a normal aging process, becoming more liquid and less jelly-like. Often the partially liquefied vitreous will abruptly "collapse" inside the eye causing a shower of floaters to appear. The floaters are aggregates of protein which have formed in the vitreous during the liquefaction process.

When the vitreous collapses, it begins to separate from the retina. The mechanical pull of the vitreous on the retina during this separation causes light flashes. Sometimes during this separation process a retinal tear develops and can lead to a retinal detachment. Often when a retinal tear occurs, at least a small amount of bleeding is present in the vitreous and may be noted by the patient as a multitude of black dots or a hazy decrease in vision.

Know the Warning Signs

The sudden occurrence of floaters or flashes can be an important warning signal of impending retinal problems. A small percentage of people who develop the abrupt onset of prominent floaters or light flashes in an eye will be found to have a retinal tear on careful ophthalmoscopic examination. Retinal tears can often be treated with laser or freezing methods if a beginning retinal detachment is not present.

Fortunately, the majority of people who experience floaters or light flashes do not develop serious retinal problems. In most instances, the floaters and flashes gradually subside over a period of time with no permanent alteration in vision. Since flashes and floaters can, however, be an important warning of a retinal tear or impending retinal detachment, their sudden appearance is of sufficient concern to warrant careful evaluation by your ophthalmologist.

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