Below is a list of some frequently asked questions, but please feel free to call our office if you need additional information. We are always pleased to assist you.
What are cataracts?
A cataract is a clouding of the normally clear lens of the eye. The lens, which lies just behind the pupil, helps the eye to focus. When the lens becomes clouded, the passage of light to the back of the eye is partially blocked, and a person's ability to see is reduced. This clouding of the lens of the eye is called a cataract. Thus, a cataract is not a growth or a tumor, but a change in the clarity of the lens.
Cataracts may form in the eyes of people of any age, but they are most common in older adults. In fact, after age 65, many people have a cataract. It is important to remember that if you have a cataract, you may not necessarily require an operation because many people have some minor clouding of the lens that does not affect vision. An operation to remove the cataract becomes necessary only if the patient's vision and ability to function become impaired. If you do need an operation to remove a cataract, you should know that advances that have been made in cataract operations in recent years have made cataracts one of the most treatable of eye disorders. Remember, as common as cataract surgery is — more than a million and a quarter such operations are performed in the United States each year — no two people undergoing the procedure are alike. The reasons for and the outcome of any operation depend on your overall health, age, the severity of lens opacity (cloudiness), and any other abnormalities of the eye or existing health conditions.
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What are ocular allergies?
Eye allergies are no different than allergies that affect your sinuses, nose or lungs. When an allergen comes in contact with your eyes, your body releases histamine - a chemical produced in reaction to a substance that the immune system can't tolerate. Special cells called mast cells make histamine. These cells are present throughout the body but are highly concentrated in the eyes.
Location of allergy symptoms depends somewhat on where the allergen has come into contact with your body. Ocular allergens tend to be airborne (as are most other allergens). The most frequent allergic triggers include:
- Pollen
- Pet hair or dander
- Dust
- Some medicines
There also are some triggers that irritate the eyes but are not true allergies, such as:
- Cigarette smoke
- Perfume
- Diesel Exhaust
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Important facts about glaucoma.
Glaucoma is a serious eye disease. If left untreated, it can lead to vision loss and blindness. Some more important facts are:
- Glaucoma is the second most common cause of legal blindness in the U.S. It is the leading cause of blindness for African-Americans.
- Glaucoma is a chronic (ongoing) condition that requires lifelong monitoring and treatment. It is important for people with glaucoma to work with their Eye M.D.s to find a treatment plan that is right for them.
- About 2 million Americans have glaucoma -- but only half of them are aware of it.
- In glaucoma, the fluid (different from tears) that normally flows through the front section of the eye cannot drain properly. This causes a buildup of pressure in the eye that can damage the optic nerve and lead to vision loss.
- Your Eye M.D. can use a series of painless tests and exams to check you for glaucoma. Other tests may be done if your Eye M.D. suspects you may have glaucoma.
- Vision loss is usually preventable if glaucoma is detected early. There is no "cure" for glaucoma, but early detection and ongoing treatment can control the disease and usually preserve vision.
- Treatment for glaucoma can include medication and/or surgery. The best treatment for each person is determined by a number of factors, including type and severity of glaucoma, and the person's medical history and lifestyle.
- Glaucoma usually has no symptoms until vision loss has occurred.
- Approximately 80,000 Americans are legally blind from glaucoma. Many more have visual impairment.
- Seniors, African-Americans and those with a family history of glaucoma are at higher risk for the disease and should have eye exams more often.
- Medications for glaucoma -- even eye drops -- can affect the whole body and may interact with other medications. It is very important for all your doctors to be aware of any medication you take.
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What is strabismus?
Strabismus is a visual defect in which the eyes are misaligned and point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward or downward. You may always notice the misalignment, or it may come and go. The turned eye may straighten at times and the straight eye may turn. Strabismus is a common condition among children. About 4% of all children in the United States have strabismus. It can also occur later in life. It occurs equally in males and females. Strabismus may run in families. However, many people with strabismus have no relatives with the problem.
What are floaters?
You may sometimes see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. While these objects look like they are in front of your eye, they are actually floating inside. What you see are the shadows they cast on the retina, the nerve layer at the back of the eye that senses light and allows you to see. Floaters can have different shapes: little dots, circles, lines, clouds or cobwebs.
Can anything be done for adults with misaligned eyes?
Yes. Recent treatment advances allow most adults with misaligned eyes to have surgical correction [See figure 1].
Is eye straightening as an adult strictly cosmetic?
No. Eye alignment surgery improves eye function in most adults and can lead to social and economic benefits.
Does my insurance cover the expense of this surgery?
Although eye muscle surgery is reconstructive (not cosmetic), one should check with the insurance carrier to determine their specific policy.
Is eye muscle surgery risky for adults?
No. However, every surgical procedure has some risks. For strabismus surgery, the most common risks are residual misalignment and double vision (usually temporary). Fortunately, the more serious risks of anesthetic complications, infection, bleeding, retinal detachment, and decreased vision are rare. Health risks vary with the general health of the individual. For those in poor health, surgery under local anesthesia (instead of general anesthesia) or botulinum toxin injection may be considered
How successful is eye muscle surgery?
Most individuals have significant improvement in eye alignment with one surgery. Occasionally the surgery is only partially successful and additional surgery may be indicated.
How painful is this type of surgery?
Discomfort after eye muscle surgery is usually a foreign body sensation in the eye, lasting several days. Over-the-counter pain medication often reduces the discomfort, although stronger medication is sometimes prescribed. Most patients return to full activity in several days. Some surgeons limit swimming and heavy physical activity for several weeks after surgery.
What age is "too old" to have eye muscle surgery?
Eyes can be straightened at any age and should be considered as a treatment alternative if it enhances quality of life.
I am embarrassed by my misaligned eyes and avoid looking people in the eye. It seems to me that people are distracted by my wandering eye causing problems with social interaction and difficulty getting the job I want. Can this really be true?
Yes. Recent studies confirm these observations. Misaligned eyes can hinder social interaction, self-confidence and employment opportunities. All individuals deserve straight eyes if possible.
Is hospitalization required for eye alignment surgery? How will this affect normal activities?
Eye alignment surgery is usually performed as an outpatient procedure although the need for hospitalization varies depending upon general health and surgeon preference . Following surgery most individuals return to nearly all normal activities within a few days.
Who treats misaligned eyes in adults?
A specialist can be located in the directory of AAPOS, an organization of eye surgeons with special training in eye muscle problems. Your own eye doctor may also have a recommendation.
What is amblyopia?
A common vision problem in children is amblyopia, or \"lazy eye.\" It is so common that it is the reason for more vision loss in children than all other causes put together. Amblyopia is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then “learns” to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it can cause permanent loss of vision
What kinds of amblyopia are there?
There are several different types and causes of amblyopia: Strabismic amblyopia, deprivation amblyopia, and refractive amblyopia. The end result of all forms of amblyopia is reduced vision in the affected eye(s).
What is strabismic amblyopia?
Strabismic amblyopia develops when the eyes are not straight. One eye may turn in, out, up or down. When this happens, the brain “turns off” the eye that is not straight and the vision subsequently drops in that eye.
What is deprivation amblyopia?
Deprivation amblyopia develops when cataracts or similar conditions “deprive” young children’s eyes of visual experience. If not treated very early, these children can have very poor vision. Sometimes this kind of amblyopia can affect both eyes.
What is refractive amblyopia?
Refractive amblyopia happens when there is a large or unequal amount of refractive error (glasses strength) in a child\'s eyes. Usually the brain will \"turn off\" the eye that has more farsightedness or more astigmatism. Parents and pediatricians may not think there is a problem because the child’s eyes may stay straight. Also, the “good” eye has normal vision. For these reasons, this kind of amblyopia in children may not be found until the child has a vision test. This kind of amblyopia can affect one or both eyes and can be helped if the problem is found early.
Will glasses help a child with amblyopia to see better?
Maybe, but they may not correct it all the way to 20/20. With amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “relearn” how to see and the vision may increase. Remember, glasses alone do not increase the vision all the way to 20/20, as the brain is used to seeing blurry with that eye. For that reason, the normal eye is treated (with patching or eyedrops) to make the amblyopic (weak) eye stronger.
What can be done if my child has equal high amounts of farsightedness and/or astigmatism and is diagnosed with bilateral amblyopia?
Bilateral amblyopia is usually treated with consistent, early glasses, and or contact lenses with follow-up over a long period of time. If asymmetric amblyopia (one eye better than the other) occurs, then patching or eye drops may be added.
When should amblyopia be treated?
Early treatment is always best. If necessary, children with refractive errors (nearsightedness, farsightedness or astigmatism) can wear glasses or contact lenses when they are as young as one week old. Children with cataracts or other “amblyogenic” conditions are usually treated promptly in order to minimize the development of amblyopia.
How old is TOO old for amblyopia treatment?
A recent National Institutes of Health (NIH) study confirmed that SOME improvement in vision can be attained with amblyopia therapy initiated in younger teenagers (through age 14 years). Better treatment success is achieved when treatment starts early, however.
How can I get early treatment for amblyopia?
Some forms of amblyopia, such as that associated with large-deviation strabismus, may be easily detected by parents. Other types of amblyopia (from high refractive error) might cause a child to move very close to objects or squint his or her eyes. Still other forms of amblyopia may NOT be obvious to parents and therefore must be detected by Vision Screening.
What is Vision Screening?
Vision Screening is strongly recommended by the American Academy of Pediatrics (AAP) over the course of childhood to detect amblyopia early enough to allow successful treatment. Pediatricians check newborns for red reflex to find congenital cataracts. Infants are checked for the ability to fix and follow and whether they have strabismus. Toddlers can have their pupillary red reflexes tested with a direct ophthalmoscope (Brückner Test) or by photoscreening, or by remote autorefraction to identify refractive errors that can cause amblyopia. When children can consistently identify objects either by reading, or by matching, the acuity of each eye (with the non-tested eye patched or covered) is screened to identify amblyopia.
How is amblyopia treated?
One of the most important treatments of amblyopia is correcting the refractive error with consistent use of glasses and/or contact lenses. Other mainstays of amblyopia treatment are to enable as clear an image as possible (for example, by removing a cataract), and forcing the child to use the nondominant eye (via patching or eyedrops to blur the better-seeing eye).
When should patching be used for amblyopia treatment?
Patching should only be done if an ophthalmologist recommends it. An ophthalmologist should regularly check how the patch is affecting the child’s vision. Although it can be hard to do, patching usually works very well if started early enough and if the parents and child follow the patching instructions carefully. It is important to patch the dominant eye to allow the weak eye to get stronger. [See figure 2]
Are there different types of patches?
The classic patch is an adhesive \"Band-Aid\" which is applied directly to the skin around the eye [See figure 3]. These may be available in different sizes for younger and older children. For children wearing glasses, both cloth and semi-transparent stickers (Bangerter foils) may be placed over or onto the spectacles. \"Pirate\" patches on elastic bands are especially prone to \"peeking\" and are therefore only occasionally appropriate.
Is there an alternative to patching to treat amblyopia?
Sometimes the stronger (good) eye can be “penalized” or blurred to help the weaker eye get stronger. Blurring the vision in the good eye with drops or with extra power in the glasses will penalize the good eye [See figure 4]. This forces the child to use the weaker eye. Ophthalmologists use this treatment instead of patching when the amblyopia is not very bad or when a child is unable to wear the patch as recommended. For mild and moderate degrees of amblyopia, studies have shown that patching or eyedrops may be similarly effective. Your pediatric ophthalmologist will help you select treatment regimen is best for your child.
Do drops work for all amblyopic children?
Not all children benefit from eye drop treatment for amblyopia. Penalizing eye drops (such as atropine) work less well when the stronger eye is nearsighted.
How many hours per day patching is enough when treating amblyopia?
The mainstay of treating amblyopia is patching of the dominant (good) eye, either full or part-time during waking hours. Although classic teaching suggests that the more hours per day patching is performed, the greater the result, recent studies suggest that shorter periods may achieve similar results as longer amounts of patching in patients with moderate amounts of amblyopia.
How long does amblyopia patching therapy take to work?
Although vision improvement frequently occurs within weeks of beginning patching treatment, optimal results often take many months. Once vision has been improved, part-time (maintenance) patching or periodic use of atropine eyedrops may be required to keep the vision from slipping or deteriorating. This maintenance treatment may be advisable for several months to years.
During which activities should patching be performed?
The particular activity is not terribly important, compared to the need to keep the patch on during the allotted time. As long as the child is conscious and has his or her eyes open, visual input will be processed by the amblyopic eye. On the other hand, the child may be more cooperative or more open to bargaining if patching is performed during certain, desirable activities (such as watching a preferred television program or video). Some eye doctors believe that the performance of near activities (reading, coloring, hand-held computer games) during treatment may be more stimulating to the brain and produce better or more rapid recovery of vision.
Should patching be performed during school hours?
In many instances, school is an excellent time to patch, taking advantage of a nonparental authority figure. Patching in school hours gives the class an opportunity to learn valuable lessons about accepting differences between children. While in most instances, children may not need to modify their school activities while patching, sometimes adjustments such as sitting in the front row of the classroom will be necessary. If the patient, teacher, and classmates are educated appropriately, school patching need not be a socially stigmatizing experience. On the other hand, frequently a parental or other family figure may be more vigilant in monitoring patching than is possible in the school setting. Parents should be flexible in choosing when to schedule patching.
What if my child refuses to wear the patch?
Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, etc. Children will often throw a temper-tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period.
Can surgery be performed to treat amblyopia?
Surgery on the eye muscles is a treatment for strabismus - it can straighten misaligned eyes. By itself, however, surgery does not usually or completely help the amblyopia. Surgery to make the eyes straight can only help enable the eyes to work together as a team. Children with strabismic amblyopia still need close monitoring and treatment for the amblyopia, and this treatment is usually performed before strabismus surgery is considered.
Children who are born with cataracts may need surgery to take out the cataracts. After surgery, the child will usually need vision correction with glasses or contact lenses and patching.
What are appropriate goals of amblyopia treatment?
|In all cases, the goal is the best possible vision in each eye. While not every child can be improved to 20/20, most can obtain a substantial improvement in vision. Although there are exceptions, patching does not usually work as well in children who are older than 9 years of age.
What happens if amblyopia treatment does not work?
In some cases, treatment for amblyopia may not succeed in substantially improving vision. It is hard to decide to stop treatment, but sometimes it is best for both the child and the family. Children who have amblyopia in one eye and good vision only in their other eye can wear safety glasses and sports goggles to protect the normal eye from injury. As long as the good eye stays healthy, these children function normally in most aspects of society
Where can I learn more about amblyopia research?
More information about past and ongoing clinical studies regarding amblyopia can be found at the National Eye Institute web site.
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