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All About Vision

Preparing for an Eye Exam

For both adults and children, an eye exam is a critical part in maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam.

Depending on your age, family history, general health and eye health, it is recommended to have an eye exam every one to two years. Of course if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.

The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)

Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ.

Optometrists

Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre- or post-op surgical care, however they do not perform surgery.

Ophthalmologists

Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK and deal with more urgent eye conditions such as retinal detachment.

Infant and Child Eye Exams

According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.

Adult Eye Exams

Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits.

Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended.

As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.

How to Prepare for Your Exam

Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses.

You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you.

In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.

Nearsighted (Myopia)

Nearsightedness, technically known as myopia, is a condition which causes difficulty focusing on objects at a distance, while near vision remains normal. Myopia is one of the most common vision problems worldwide and it is on the rise.

Myopia Signs and Symptoms

People with myopia are usually able to see well up close, but have difficulty seeing objects at a distance. Due to the fact that they may be straining or squinting to see into the distance, they may develop headaches, eye fatigue or eye strain.

Myopia Causes

Myopia is a refractive error caused by an irregular shaped cornea that affects the way light is focused on the retina. For clear vision, light should come to a focus point directly onto the retina. In myopia, the cornea is longer than usual, resulting in a focus point that falls in front of the retina, causing distant objects to appear blurry, while close objects can be seen normally.

Myopia typically has a genetic component as it often appears in multiple members of a family and it usually begins to show signs during childhood, often getting progressively worse until stabilizing around age 20. There may also be environmental factors that contribute to myopia such as work that requires focusing on close objects for an extended period of time and spending too much time indoors.

Diagnosis of Myopia

Myopia is diagnosed by an eye examination with an qualified optometrist. During the exam the optometrist will determine the visual acuity of the eye to prescribe eye glasses or contact lenses. A prescription for myopia will be a negative number such as -1.75.

Treatment for Myopia

Myopia is typically treated with corrective eyeglasses or contact lenses and in certain cases refractive surgery such as LASIK or PRK is an option. Surgery is the most risky treatment as it requires permanently changing the shape of the cornea. Other treatments involve implanting a lens that reshapes the cornea called a phakic intra-ocular lens or vision therapy. A treatment called Ortho-k, in which the patient wears corneal reshaping contact lenses at night to see without correction during the day can be another option.

While some people require vision correction throughout the day, others may only need it only during certain tasks such as driving, watching television or viewing a whiteboard in school. The type of treatment depends on the overall health of your eye and your eye and vision needs.

Keratoconus

Keratoconus is a rare, progressive disease that affects the cornea, which is the clear, transparent layer at the front of the eye. The cornea is responsible for focusing the light that comes into your eye onto the retina for clear, sharp vision. Keratoconus causes the corneal tissue to thin out and bulge into a cone-like shape which deflects the light entering the eye and distorts vision.

Causes of Keratoconus

The exact cause of keratoconus is not known. The disease usually starts to appear in the late teens or twenties and can affect one or both eyes, usually progressing at a slow pace and slowing or stabilizing after around 10-20 years. It is believed that there is a genetic component as often it runs in families.

New research suggests that there may be a link between keratoconus and oxidative damage which weakens the cornea. There is also an association with overexposure to ultraviolet (UV) radiation from the sun and chronic eye irritation.

Symptoms of Keratoconus

With the gradual change in the shape of the cornea, vision becomes progressively worse. The patient may experience nearsightedness, astigmatism, distorted vision (straight lines look wavy), blurry vision, light sensitivity and glare, and eye redness or swelling. Typically, patient’s eyeglass prescription will change often as the vision becomes worse and contact lenses will be difficult to wear due to discomfort and improper fit.

When keratoconus become more severe (which usually takes a long time however on occasion can happen rather quickly), the cornea can begin to swell and form scar tissue. This scar tissue can result in even further visual distortion and blurred vision.

Treatment for Keratoconus

In the early stages of the disease, standard eyeglasses and soft contact lenses will usually correct the nearsightedness and astigmatism experienced by the patient. As the disease progresses however, glasses and soft contact lenses may no longer correct vision and soft lenses may become uncomfortable. This is when other forms of vision correction will be recommended.

Gas Permeable and Scleral Contact Lenses
At the more advanced stage of keratoconus rigid gas permeable (RGP) contact lenses, scleral or semi-scleral lenses may be used for increased comfort and visual acuity. Since they are more rigid, RGP and scleral lenses are able to create a smooth, round shape around the cornea, creating a smoother surface for better vision. Scleral or semi-scleral lenses have a larger diameter which covers the entire cornea and reaches over into the white part of the eye, which is known as the sclera. Many patients find these more comfortable than regular RGPs and find that they move around less when the eyes move. The main disadvantage of these rigid lenses is that for some, they are somewhat less comfortable than soft lenses and they must be continually refit as the shape of the eye changes.

Whether it is glasses or contact lenses being used to correct vision, patients will likely have to undergo many tests and prescription changes as their vision needs change.

Intacs
Intacs are small, surgically implanted plastic inserts which are placed on the cornea to flatten it back to shape. Usually they are able to restore clear vision, with the continued use of glasses. Intacs are often recommended when contact lenses and eyeglasses are no longer able to correct vision adequately. Intacs take about 10 minutes to insert and can delay the need for corneal transplant.

Corneal Crosslinking (CXL)
In corneal crosslinking, a UV light and eye drops are used to strengthen and stiffen the cornea which helps to reduce bulging and restore the cornea to its natural shape.

Corneal Transplant
When corneal scarring occurs and eyeglasses and contact lenses no longer help, doctors may suggest a corneal transplant to replace the corneal with healthy donor tissue to restore vision. Most patients will still require eyeglasses or contact lenses for clear vision following the transplant.

Keratoconus is a condition that requires ongoing treatment by a qualified eye doctor. If you or a loved one suffers from this disease make sure that you find an eye doctor that you like and trust to accompany you on this journey.

Farsighted (Hyperopia)

Farsightedness or hyperopia is a refractive error in which distant objects are clear, while close objects appear blurry. A refractive error occurs when the eye is not able to refract (or bend) the light that comes in into a single point of focus, therefore not allowing images to be seen clearly. Nearsightedness, farsightedness and astigmatism are the most common types of refractive error.

What Causes Hyperopia?

Hyperopia is usually caused when the shape of the eye is shortened or the cornea (which is the clear front surface of the eye) is flatter than normal. This prevents light that enters the eye from focusing properly on the retina, and rather focuses behind it. This condition causes close objects to appear blurry, while typically objects at a distance remain clear.

Farsightedness, which is less common than nearsightedness, is often an inherited condition. It is common in children who experience some amount of hyperopia during development which they will eventually grow out of as the eye continues to grow and lengthen. Sometimes these children don’t even have symptoms as their eyes are able to accommodate to make up for the error.

Symptoms of Hyperopia

Symptoms of hyperopia vary. As mentioned, sometimes people with hyperopia don’t experience any symptoms while others will experience severe vision difficulties. In addition to blurred near vision, often squinting, eye strain and headaches will occur when focusing on near objects.

Treatment for Farsightedness

Farsightedness is easily treated with prescription eyeglasses or contact lenses. These lenses, will correct for the refractive error by changing the way the light bends upon entering the eyes. Refractive eye surgeries such as LASIK or PRK that reshape the cornea may also be options for vision correction. Treatment for farsightedness depends on a number of factors including your age, lifestyle, eye health and overall health.

Farsightedness vs. Presbyopia

Farsightedness is not the same as presbyopia, an age-related condition that also affects one’s ability to see near objects clearly. Presbyopia is caused when the natural lens of the eye begins to age and stiffens, causing difficulty focusing.

Farsightedness or hyperopia is a common refractive error that is easily treated. If you are experiencing difficulty seeing close objects it’s worth having an eye exam to determine the cause, ensure your eyes are healthy and to find a solution to improve your vision and quality of life.

Eye Floaters and Spots

Eye floaters are spots, squiggles or flecks that appear to drift into your visual field. Usually they are harmless, a benign, albeit annoying sign of aging. If however, your floaters are accompanied by a sudden loss of vision, pain or flashes, they could be a sign of an underlying serious eye condition and should be checked out by an eye doctor as soon as possible.

What are Eye Floaters and Spots?

Floaters, like their name, are specks or spots that float in and out of your visual field. Usually they move away when you try to focus on them. They can appear as dark dots, threads, squiggles, webs, or even rings.

But what causes them to appear? Floaters are shadows from clumps of fibers within the vitreous, the jelly-like substance in your eye, that are cast on the retina at the back of the eye. Usually, floaters don’t go away, but you tend to get used to them and eventually notice them less. Patients usually see them more when they are looking at a plain background, like the blue sky or a white wall.

In most cases, there is no treatment for floaters, people just get used to them, however if there are more serious symptoms that accompany them, there could be an underlying problem such as inflammation, diabetes or a retinal tear that needs to be addressed and treated. If the floaters are so serious that they are blocking your vision, a surgical procedure to remove the clumps may be performed.

What Causes Floaters?

Age: Although floaters may be present at any age, they are often more apparent as a result of aging. With time, the fibers in the vitreous begin to shrink and clump up as they pull away from the back of the eye. These clumps block some of the light passing through your eye, causing the shadows which appear as floaters. You are also more likely to develop floaters if you are nearsighted.

Eye Surgery or Injury: Individuals who have previously had an injury, trauma or eye surgery are more susceptible to floaters. This includes cataract surgery and laser surgery as well as other types of eye surgery.

Eye Disease: Certain eye diseases such as diabetic retinopathy, eye tumors or severe inflammation can lead to floaters.

Retinal Tears or Detachment: Retinal tears or detachments can be a cause of floaters. A torn retina can lead to a retinal detachment which is a very serious condition where the retina separates from the back of the eye and if untreated can lead to permanent vision loss.

When to See a Doctor

There are some cases where seeing spots is accompanied by other symptoms that could be a sign that there is a more serious underlying problem. The most common of these is seeing flashes of light. This often happens when the vitreous is pulling on the retina which would be a warning sign of a retinal detachment. Retinal detachment must be treated immediately or you can risk a permanent loss of vision. Flashes of light sometimes also appear as symptoms of migraine headaches.

If you experience a sudden onset or increase in floaters, flashes of light, pain, loss of side vision or other vision disturbances, see a doctor immediately. Further, if you have recently had eye surgery or a trauma and you are experiencing floaters during your recovery, it is advised to tell your doctor.

Generally, floaters are merely a harmless annoyance but keep an eye on your symptoms. As with any sudden or serious change in your health, it is worth having them checked out if they are really bothering you. In some cases, they may be an early warning sign of a serious problem that requires swift treatment to preserve your vision.

Eye Allergies

Along with congestion, runny nose, coughing, sneezing, headaches and difficulty breathing, individuals with allergies often suffer from eye allergies or allergic conjunctivitis resulting in red, watery, itchy and sometimes swollen eyes. Just as irritants cause an allergic response in your nasal and respiratory system, your eyes also react with an oversensitive immune response, triggered by an environmental substance that most people’s immune systems ignore. Most individuals with allergies also suffer from eye allergies which affect millions of North Americans, particularly with seasonal allergic conjunctivitis (SAC) which is common during the spring, summer and fall.

What Causes An Eye Allergy?

Eye allergies, or any allergies for that matter, occur when the immune system is hypersensitized to a stimulus in the environment that comes into contact with the eye. The allergen stimulates the antibodies in the cells of your eyes to respond by releasing histamine and other chemicals that cause the eyes and surrounding tissue to become inflamed, red, watery, burning and itchy.

Eye allergens can include:

  • Airborne substances found in nature such as pollen from flowers, grass or trees.
  • Indoor allergens such as pet dander, dust or mold.
  • Irritants such as cosmetics, chemicals, cigarette smoke, or perfume.

Tips for Coping With Eye Allergies

Allergies can go from mildly uncomfortable to debilitating. Knowing how to alleviate symptoms and reduce exposure can greatly improve your comfort and quality of life, particularly during allergy season which can last from April until October.

To reduce exposure to allergens:

  1. Stay indoors and keep windows closed when pollen counts are high, especially in the mid-morning and early evening.
  2. Wear sunglasses outside to protect your eyes, not only from UV rays, but also from airborne allergens.
  3. Avoid rubbing your eyes, this can intensify symptoms and increase irritation. When the eyes get itchy, it is difficult not to rub and scratch them. However, rubbing the eyes can aggravate the allergic cascade response, making them more swollen, red, and uncomfortable.
  4. Check and regularly clean your air conditioning filters.
  5. Keep pets outdoors if you have pet allergies and wash your hands after petting an animal.
  6. Use dust-mite-proof covers on bedding and pillows and wash linens frequently.
  7. Clean surfaces with a damp cloth rather than dusting or dry sweeping.
  8. Remove any mold in your home.
  9. Reducing contact lens wear during allergy season or switch to daily disposable contact lenses.

Treatment for the uncomfortable symptoms of allergic conjunctivitis include over-the-counter and prescription drops and medications. It is best to know the source of the allergy reaction to avoid symptoms. Often people wait until the allergy response is more severe to take allergy medication, but most allergy medications work best when taken just prior to being exposed to the allergen. Consult your eye doctor about your symptoms and which treatment is best for you.

Non-prescription medications include:

  • Artificial tears (to reduce dryness)
  • Decongestant eyedrops
  • Oral antihistamines

Prescription medications include eyedrops such as antihistamines, mast-cell stabilizers, or stronger decongestants as well as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.

Immunotherapy which are allergy injections given by an allergist are sometimes also helpful to assist your body in building up immunity to the allergens that elicit the allergic response.

If no allergy medicine is on hand, even cool compresses and artificial tears can help alleviate symptoms.

Finding the right treatment for your allergies can make all the difference in your quality of life, particularly during the time of year when most of us like to enjoy the outdoors.

Dry Eye Syndrome

Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.

Signs and Symptoms of Dry Eye

Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.

Some people with dry eyes also experience a “foreign body sensation” – the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye’s tears.

What Causes Dry Eyes?

In dry eye syndrome, the tear glands that moisturize the eye don’t produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs:

  • As a part of the natural aging process, especially among women over age 40.
  • As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson’s medications and birth control pills.
  • Because you live in a dry, dusty or windy climate with low humidity.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you’re staring at a computer screen all day.

Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren’s Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).

Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty – a popular cosmetic surgery to eliminate droopy eyelids.

Treatment for Dry Eye

Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye – including dryness, scratchiness and burning – can usually be successfully managed.

Your eyecare practitioner may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief.

Another option for dry eye treatment involves a tiny insert filled with a lubricating ingredient. The insert is placed just inside the lower eyelid, where it continuously releases lubrication throughout the day.

If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.

Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.

To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.

For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.

If your dry eye is caused by meibomian gland dysfunction (MGD), your doctor may recommend warm compresses and suggest an in-office procedure to clear the blocked glands and restore normal function.

Doctors sometimes also recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also offer some relief.

If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.

If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.

Corneal Transplant

A cornea transplant, also known as keratoplasty or a corneal graft, replaces damaged tissue on the clear front surface of the eye.

When disease or injury damages the cornea, eyesight is affected. Light that enters the eye becomes scattered, resulting in blurred or distorted vision. When the cornea is extremely scarred or damaged, a corneal transplant is needed to restore functional vision.

Keratoplasty is performed routinely and is regarded as the most successful of all tissue transplants. According to the National Keratoconus Foundation, over 40,000 cornea transplants are done annually in the United States.

In recent years, an innovative type of corneal transplant has gained popularity. Known as Descemet’s Stripping Endothelial Keratoplasty (DSEK), this new procedure removes a smaller and thinner portion of the cornea. In 2009, DSEK was declared by the American Academy of Ophthalmology as superior to the conventional surgery because it may provide better vision outcomes and more eye stability. It is also associated with less risk factors. However, when the majority of the cornea is damaged, a more comprehensive removal may still be necessary to facilitate a successful transplant.

Criteria for a Corneal Transplant

A multitude of reasons indicate candidacy for a corneal transplant. Possible reasons include:

  • Eye diseases, such as keratoconus
  • Complications from laser surgery, such as LASIK
  • Extreme inflammation on the cornea
  • Scarring as a result of infections, such as eye herpes or fungal keratitis
  • Thinning of the cornea and an irregular shaped cornea
  • Hereditary factors
  • Corneal failure due to previous surgical procedures
  • Chemical burns or injuries that damaged to the cornea

Cornea Transplant Procedure

Once a patient has been recommended and approved for a corneal transplant to restore vision, the patient’s name is added to a list at an eye bank. The United States has a very advanced eye bank system, and the general wait time for a donor eye is one to two weeks. The tissue of donor corneas is checked for clarity and screened meticulously for disease before it is released for transplant.

The actual surgery is generally performed as an outpatient procedure that does not require hospitalization. General or local anesthesia may be used, depending upon the patient’s preference, age and health condition. Local anesthesia is injected into the skin surrounding the eye, which relaxes the muscles that control movement and blinking. Eye drops numb the eye itself.

Once the anesthesia has taken effect, the surgeon inspects and measures the damaged corneal area in order to decide upon the size of the transplantation. Eyelids are held open during this time. The surgeon then removes a round, button-shaped piece of the corneal tissue and replaces it with a nearly identical sized button of donor tissue. The new, healthy tissue is sutured into place. The entire procedure takes approximately one to two hours.

Following the surgery, a plastic shield must be worn over the eye in order to protect it against any inadvertent bumps or rubbing.

Rejection of the Corneal Graft

Although the vast majority of cornea transplants are successful, sometimes the new tissue is rejected. Warning signs of rejection include:

  • Extreme sensitivity to light
  • Redness
  • Pain
  • Decreased vision

These symptoms may be experienced as soon as one month after the surgery, or as delayed as five years later. Medications can be prescribed to reverse the rejection process. If the corneal graft fails completely, the transplant can be repeated and the outcome is generally positive. Yet the total rejection rates do increase with the total number of corneal transplants.

Recovery and Healing

It can take up to a year or longer to heal completely from a corneal transplant. At the beginning, vision is blurry and the transplant site is often swollen and thicker than the rest of the cornea. As vision returns, patients are able to return to normal daily tasks and most people can return to work within three to seven days after surgery. However, heavy lifting and exercise must be avoided for the first few weeks.

To help the body accept the corneal graft, steroid eye drops must be applied for several months. A pair of eyeglasses or a protective shield must also be worn for eye safety. Depending upon the health of the eye and the healing rate, stitches may be removed at any time from three months to more than a year later. Astigmatism often occurs as a result of an irregular corneal surface, and adjustments may be made to the sutures around the new cornea in an effort to reduce this problem.

Vision after a Cornea Transplant

Vision improvement after a cornea transplant is a process that can last up to one year later. Eyeglasses or contact lenses must be worn immediately after the surgery, since the curvature of the corneal transplant will not precisely match the natural corneal curve.

When healing is complete and stitches are removed, laser surgery may be indicated to correct vision. LASIK or PRK are both procedures that can help decrease dependence on eyeglasses or contacts. An irregular corneal surface may point to the need to wear rigid gas permeable (GP) contact lenses for vision correction.

CMV Retinitis

CMV or cytomegalovirus retinitis is a vision threatening virus that causes inflammation of the retina, primarily in individuals with a compromised immune system, such as those with AIDS (Acquired Immunodeficiency Syndrome).

Symptoms of CMV Retinitis

Symptoms of CMV retinitis often appear relatively suddenly. They include general blurriness, seeing flashes or floaters, sudden loss of peripheral (side) vision, or blind spots in central vision. These symptoms all appear as the virus attacks the retina, the light-sensitive layer of nerves at the back of the eye. If left untreated, the virus can cause retinal detachment and will eventually destroy the retina and damage the optic nerve, causing permanent vision loss. Usually there is no pain felt as the retinal damage is taking place. Symptoms usually start in one eye and but can spread to the other eye as well.

Causes of CMV Retinitis

Cytomegalovirus is a herpes type virus that is actually present in most adults. However, most healthy adults never experience any symptoms or problems from the virus. Individuals with a weakened immune system however, such as those with AIDS, chemotherapy or leukemia patients, newborns or the elderly are at greater risk of the virus being activated and spreading throughout the body, including the retina.

Treatment for CMV Retinitis

Treatment includes antiviral medications such as ganciclovir, foscarnet or cidofovir, which can be administered orally, via injection through a vein or directly into the eye or through a time-release implant the releases the medication at intervals. Laser surgery to improve the damaged area of the retina, such as in a retinal detachment, may also be prescribed.

Immune strengthening is also a critical part of preventing and treating CMV retinitis. Individuals with HIV or AIDS may be put on a regimen of highly active antiretroviral therapy (HAART) to boost the immune system and fight the virus. This has been shown to be highly effective in reducing the incidence of CMV retinitis in AIDS patients and reducing the damage for those that are affected.

While these treatments can stop further damage to the retina, any vision that is lost cannot be restored. Further, even if the virus is temporarily stopped, further progression may occur in the future. This is why it is critical to see a retinal specialist on a regular basis if you have had the condition or you are at risk.

Blepharitis

Blepharitis is an eye condition characterized by an inflammation of the eyelids which causes redness, itching and irritation. The common eye condition is caused by either a skin disorder or a bacterial infection. Blepharitis is generally not contagious and can affect patients of any age. While it can be very uncomfortable, it usually does not pose any danger to your vision.

There are two types of blepharitis: anterior and posterior.

Anterior blepharitis occurs on the front of your eyelids in the area where the eyelashes attach to the lid. This form is less common and is usually caused by a bacterial infection or seborrheic dermatitis, which is a skin disorder (dandruff) that causes flaking and itching of the skin on the scalp and eyebrows. While it is more rare, allergies or mites on the eyelashes can also lead to this condition.

Posterior blepharitis occurs on the inner eyelid that is closer to the actual eyeball. This more common form is often caused by rosacea, dandruff or meibomian gland problems which affect the production of oil in your eyelids.

Symptoms of Blepharitis

Blepharitis can vary greatly in severity and cause a variety of symptoms which include:

  • Red, swollen eyelids
  • Itching
  • Burning or gritty sensation
  • Excessive tearing
  • Dry eyes
  • Crusting on eyelids

If left untreated, symptoms can become more severe such as:

  • Blurred vision
  • Infections and styes
  • Loss of eyelashes or crooked eyelashes
  • Eye inflammation or erosion, particularly the cornea
  • Dilated capillaries
  • Irregular eyelid margin

Treatment for Blepharitis

Treatment for blepharitis depends on the cause of the condition but a very important aspect is keeping the eyelids clean. Warm compresses are usually recommended to soak the lids and loosen any crust to be washed away. It is recommended to use a gentle cleaner (baby soap or an over the counter lid-cleansing agent) to clean the area.

For bacterial infections, antibiotic drops or ointments may be prescribed, and in serious cases steroidal treatment (usually drops) may be used.

Blepharitis is typically a recurring condition so here are some tips for dealing with flare-ups:

  • Use an anti-dandruff shampoo when washing your hair
  • Massage the eyelids to release the oil from the meibomian glands
  • Use artificial tears to moisten eyes when they feel dry
  • Consider breaking from use of contact lenses during the time of the flare-up and or switching to daily disposable lenses.

The most important way to increase your comfort with blepharitis is by keeping good eyelid hygiene. Speak to your doctor about products that he or she recommends.

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