Cataracts

What is a Cataract?

A cataract is clouding of the normally clear lens of the eye. How much clouding can vary. If the clouding is minimal or not near the center of the lens it may not be noticeable or impact vision clarity.

What causes cataract?

The most common cause of cataract is the natural aging process of the eye. Other causes can include

How fast can a cataract develop?

Cataract usually progresses slowly over time and does not usually inhibit vision immediately after being discovered. In some people with diabetes, or younger than average development of cataracts, it can progress rapidly and develop more quickly. Cataract development does not follow a specific timetable so we are not able to predict the exact time it will take to develop in a specific person.

How does cataract affect vision?

Most patients complain of blurred vision with glare or sensitivity to bright lights. Another common complaint is a hazy or yellowed look to colors that were normally bright. Some patients complain of halos and/or starbursts around headlights and streetlights at night.

How is cataract treated?

Cataract can be detected by the doctor far before it can cause vision problems. When a cataract has developed to the point of surgery the doctor will discuss the options available. There are currently no medications, dietary supplements, or exercises that are shown to prevent or diminish existing cataract. Good nutrition, however, will help the overall health of your eyes.

Glaucoma

What is Glaucoma?

Glaucoma is a disease related to damage of the optic nerve. It is usually related to abnormally high pressure within the eye. The higher pressure causes tension against the nerve and causes damage. The feeling of pressure is not noticed and visual loss and damage approaches 95% before a person has any awareness of any visual loss. The visual loss is permanent and not reversible. In some cases the pressure within the eye is within normal ranges and the doctor begins treatment for glaucoma based on damage of the optic nerve. There are more rare forms of glaucoma that can be sudden onset but the average patient has damage that occurs slowly over time. Glaucoma is the leading preventable cause of blindness in the United States.

What causes Glaucoma?

Even with years of research, treatment, and experience, the root cause of glaucoma has not been found.

Who is at risk?

Glaucoma is most often but not always detected in patients older than the age of 40 or in patients with a strong family history of glaucoma. Glaucoma can only be diagnosed as a result of an exam with your eye doctor.

How is glaucoma treated?

The majority of patients diagnosed with glaucoma are treated with prescription eye drops that are administered on a schedule to provide a pressure lowering effect. Less frequently surgery or laser surgery are used to decrease the fluid pressure in the eye. Early detection is the best treatment for glaucoma to decrease the chance of damage to the optic nerve.

 

Macular Degeneration

What is macular degeneration?

Macular degeneration is the age related deterioration of the central vision portion of the retina. It affects the sharp seeing part of the eye and can affect a person's ability to read, drive, and distinguish people's faces. There are 2 types of macular degeneration: Wet Form and Dry Form. Dry form age related macular degeneration is the most common form that involves simple changes in the macula. It usually progresses very slowly and can affect only one eye. A patient may begin to notice more difficulty seeing with one eye compared to another, distortion in straight lines or power poles, and possibly areas of missing vision. The Wet form affects a very small portion of patients with age related macular degeneration but causes the majority of vision loss. Wet form causes rapid central vision loss as a result of small blood vessels beneath the retina leaking into the macula. The fluid can cause damage to the retina from breakage or lesions beneath it.

Macular degeneration rarely causes complete blindness. It does limit the patient to peripheral vision for vision tasks.

Who is at risk?

Macular degeneration is most common in patients over 50 years of age.

Are there treatments?

Dry form macular degeneration can be slowed by taking supplementation designed to increase certain minerals within the body. If you have a history of smoking, or currently smoke, there is another formulation designed for those patients. There is unfortunately no treatment that "cures" macular degeneration but it can slow the progression of the deterioration. Wet form is most commonly treated by intraocular injections to try and slow the progression of leakage behind the retina. There are other treatment options available for wet forms of macular degeneration that the doctor can discuss with the patient. We also refer some patients to retinal sub specialists that have further treatment options. For patients already suffering with loss of vision as a result of a previous episode of wet form macular degeneration, or who have had damage to the retina by the slow progression of dry form macular degeneration, there are fewer treatment options.

There are also adaptive technologies and low vision aides to help patients accommodate to the loss of central vision and use their peripheral vision more effectively.

Diabetes and the eye

Diabetes is one of the fastest growing conditions on the Unites States. Diabetes can affect the eye in several ways and in some patients can cause total blindness. There are two main forms of diabetes: 1. Insulin dependent Type I diabetes that can affect patients at an early age and 2. Non-insulin dependent Type-II diabetes that tends to affect patients more into middle age. The risk for complications in the eye is more serious in Type I diabetics, but can also affect Type II diabetics in similar ways. One major eye related complication is diabetic retinopathy. Diabetic retinopathy is also divided into 2 categories: background retinopathy and proliferative retinopathy. Background diabetic retinopathy is characterized by early stage weakening of the small blood vessels that feed the retina. When leakage occurs it can transmit fluid, deposits consisting of fat or protein, and blood that limits the amount of vital substances to the retina. Most patients are unaware that leakage is occurring in the early stages until the doctor discovers it during an exam. Proliferative retinopathy is marked by large leakage that can also be found in the vitreous inside the eye. It can cause blurry or cloudy vision as the blood seeps into the cavity of the eye. As leakage continues it can form scar tissue that could lead to a retinal detachment.

Diabetics can also see early development of cataract. If the patient has blood sugar instability, or many years of being diabetic, glucose can leach into the lens of the eye. As sugar seeps into the lens, water from the bloodstream follows to cause the lens to swell. This process helps the natural lens to become cloudy sooner than average. For information about cataract surgery click here.

Are there treatments for diabetic retinopathy?

Early stage diabetic retinopathy usually does not need treatment but should be monitored by the doctor closely. Further development of leakage can be treated by laser surgery to slow leaking vessels. The Eye Clinic of Sandpoint provides on-site laser treatment. The best treatment is regular eye exams to detect problems early before they become serious. The doctor recommends an eye exam yearly with a visit sooner if you are having vision troubles.

Dry Eye and Allergies

What is dry eye?

We call the lack or diminished production of tears to keep the eye comfortable dry eye. A common question patients ask is "My eyes always water, how can I have dry eye?". Normal tears have 3 parts: An oily part responsible for smoothing the tear surface and reducing evaporation, a mucus part helping to spread the liquid part evenly, and the liquid, watery part that is responsible for cleansing on the eye. Overproduction of the liquid part of tears does not help to keep the eye as lubricated as all 3 parts together. Tears themselves are meant to be produced at a slow, steady rate and then in larger quantities in response to irritation or emotion. With the liquid part of the tear overproducing it can cause more dryness without enough oil and mucus helping the tears. It can then irritate the eye and cause further overproduction and setting in a cycle that is not healthy for the eye. We tend to decrease the amount of tear production as we get older which can increase the risk for dry eye.

Are there treatments?

Yes, there are treatments to help dry eye. Over the counter artificial tears can help, but non-preserved tears can help with preservative sensitivity. Ointment in the eye at night can help decrease symptoms as well. The doctor can also insert punctal plugs to help retain more natural tears on the eye. There is prescription medication that can help with dry eye. Ask the doctor if this treatment is right for you.

How do allergies affect eyes?

Allergies can cause increased dryness, redness, and irritation. The most common seasons for problems are spring and fall. Allergic response by the body is driven by the immune system's response to normally harmless airborne pollen or mold. It can also be triggered by other airborne particles or environmental factors. The bodies' response can sometimes cause inflammation of the eye described as "seasonal allergic conjunctivitis".

Any treatment options for allergies?

Many patients find relief by using over the counter antihistamine eye drops. Our doctors recommend Naphcon A or Opcon A. If possible limiting exposure to the allergen, if known, can significantly reduce irritation symptoms. Another simple help can be washing your hands and then rinsing your eyelids with cool water. There are also prescription medications that the doctor can recommend if your allergies become severe.

Flashes and Floaters

What are flashes and floaters?

Floaters are thickened areas or protein deposits in the vitreous that can usually be seen under certain lighting conditions and most are formed in the eye before birth. They are harmless, distracting, and usually annoying spots that rarely cause loss of vision. They can be indicative of a problem if they are caused by injury to the head or eye, or if they appear suddenly and in great quantities. Some patients describe this as "hundreds of frog eggs on a lake" or "a cloud of birds in the sky". These situations could be a symptom of a serious problem. Flashes are described as bursts of light usually in the peripheral vision and most noticed in the evening. They can be seen with the eye closed. Both flashes and floaters can be symptoms of a problem called a vitreous detachment. As we age, the vitreous fluid begins to be less like jelly and more liquid in the center. The edges near the retina are still firmer and when the vitreous collapses it can cause the vitreous to separate away from the retina. It can bump or scrape against the retina causing the flashes. Occasionally when the vitreous detaches it can pull the retina with it and cause a retinal tear or a retinal detachment. Symptoms are the same whether it is a benign vitreous detachment or a more serious tear or detachment.

When should I seek treatment?

Most of us face floaters and flashes as part of the natural aging process. The warning signs that there is something more serious going on are very similar to when the vitreous harmlessly separates. It is best to have the doctor check of you have had any new floaters than previously noted, a rapid explosion in the amount of floaters, flashes of light off to the peripheral vision that can be seen with the eye closed, or flashes and new floaters noticed simultaneously.

What can be done to treat a problem?

The doctor can examine the retina and if a tear is found, a laser can be used to seal the tear back into the retinal surface. This treatment can be done here in our office. The sooner after the onset of symptoms occurs, the easier it is to treat a retinal tear. If left untreated it can lead to loss of vision, or in some cases, a severe loss of vision.

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