Headaches

Glaucoma

Floaters

Diabetic Retinopathy

Age-Related Macular Degeneration

Cataracts

Headaches
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Headache is one of the most common ailments seen today. Most headaches are usually not serious, being caused most often by tension. A common misconception is that eyestrain and the need for glasses commonly cause headaches. However, this is actually rarely the case.

What causes headaches?
Almost all headaches can be divided into the following three groups:

1. Muscle contraction: This is the most frequent type of headache, resulting from the pulling of muscles in the neck and the base of the head secondary to tension. Pain can be referred to the eye or elsewhere in the head. Muscle contraction headaches can result from temporary increases in tension in everyday life, such as stress at work or at home. They may be a result of sleeping or working in a strange position, or of an unusually long period of close-up work. In these cases, however, the headache is usually temporary and is often relieved by a simple over-the-counter pain reliever.

2. Migraine: This is caused by stretching of the blood vessel walls in the head. Migraine headaches may run in families and may even affect children. They can produce different symptoms in different people. Visual symptoms often accompany or may be the only manifestation of migraine headaches. However, there are some common features of migraine headache. The pain tends not to be continuous, is often more severe on one side of the head, is often accompanied with nausea and vomiting, and is not often associated with serious complications. They may occur with a sudden increase or decrease in stress level.

3. Diseases of the head, eyes, ears, and teeth:
A) Headaches caused by eye disease are usually felt in the eye or in the brow on the side where the disease occurs. These are often associated with other symptoms, such as blurred vision, haloes around lights, or extreme sensitivity to light.
B) Headaches caused by diseases of the ear, teeth, jaw joint, or facial nerves are usually different than the usual headache pain and discomfort. This difference helps to determine the cause.
C) Headaches may also be caused by high blood pressure. A blood pressure measurement is, therefore, helpful in evaluation any lasting or recurring headache.
D) Headaches caused by brain tumor or disease are, fortunately, quite rare, and the pain may have several unique characteristics. For instance, it may appear quite suddenly, or become increasingly severe over several weeks to months. The intensity of pain may change with different body positions. It is often associated with other symptoms such as numbness, dizziness, weakness, or seizures. Most of all, such headaches tend to become dramatically worse with the passage of time.

What should I do about my headaches?

Because headaches are such a common problem, a thorough medical examination is advisable for any chronic or recurring headache. Your primary care physician can help determine the cause of headache. An ophthalmologist may also be very helpful in determining the cause of headaches and ruling out any eye problems. His/her medical training can help in the discovery of the proper diagnosis and treatment of the headache and in unusual cases when the need for glasses is the cause of the headaches.

Glaucoma
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What is glaucoma?
Glaucoma is a disease of the optic nerve which can cause vision loss if untreated. The optic nerve carries all the images we see from the eye to the brain where perception takes place.
It is often, but not always, associated with an elevated eye pressure. Usually there is no pain with glaucoma as the eye pressure must be very high to cause pain.

Some people may have elevated eye pressures without evidence of damage to the optic nerves called ocular hypertension. Other people may have consistently normal pressures but may suffer progressive optic nerve damage typical of glaucoma, called normal tension glaucoma.

Your ophthalmologist must put all the information together using family history, the appearance of both the front part of the eye and the optic nerves, eye pressures and often visual field examination to diagnose and monitor glaucoma.

How do I know if I have glaucoma?
You do not- unless you have careful eye examinations.

Usually glaucoma causes no pain or noticeable loss of vision until the late stages. Since vision loss from glaucoma is irreversible, it is important to diagnose and treat it before significant loss of vision occurs.

A more unusual type of glaucoma can cause pain and that is called acute angle closure glaucoma. This kind can cause rapid onset of headache and blurred vision, sometimes with nausea and vomiting. It is treated differently. Ophthalmologists can often detect those who might be at risk for this type of glaucoma at a routine eye exam. A painless evaluation with a special type of microscope called a slit lamp can demonstrate if your eye has the microscopic anatomy that is more risky for this type of glaucoma. It is more often found in people who are very farsighted.

Who is a glaucoma suspect?
A person who has some of the risk factors for glaucoma but has not shown definitive nerve damage due to glaucoma or has a history of glaucoma may need careful follow-up or special testing to assure that he or she receives any needed treatment.

Glaucoma in its early stages may be difficult to diagnose.

How is glaucoma treated?
Your ophthalmologist can use eye drops, laser or eye surgery to treat glaucoma. The treatment depends on the individual circumstances.

Your eyes are monitored over time because your condition may require changing therapy from time to time.

Certain medications can aggravate glaucoma so it is important you tell your doctor all medications that you are taking.

Glaucoma can be very complex. Be sure to ask your doctor any questions you may have.

Learn more about our glaucoma specialist, Thad A. Labbe, M.D.

Floaters
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What are floaters?
It is very common to see small specks or clouds moving in your field of vision. These are called floaters. They are sometimes more obvious when looking at a white or plain background or a blue sky. Floaters are actually tiny clumps of gel that originate from the vitreous, which is the clear jelly-like fluid that fills the inside of your eye. They can assume many shapes, including dots, circles, clouds, or cobwebs, and they appear to be located in front of they eye, even though they are actually floating inside the eye.

Posterior vitreous detachment
As people reach middle age, the vitreous may begin to shrink and liquefy, forming clumps or strands. It may later pull away from the back wall of the eye, causing a posterior vitreous detachment. The sudden onset of a large floater or a burst of floaters usually accompanies this condition. Any sudden floaters should prompt one to see an ophthalmologist right away, especially if you are over 45 years of age.

What happens if I have a vitreous detachment?
Most vitreous detachments do not affect the remainder of the eye. The floaters will typically fade over time and become less bothersome, although some may remain in your vision. On occasion, the detachment of the vitreous may actually cause a tear in the retina. The retina is akin to the film in a camera, and a torn retina is a very serious problem that can lead to a retinal detachment. This is why anyone with new floaters, especially if accompanied by flashes of light, should see their ophthalmologist as soon as possible. A retinal detachment is typically repaired with surgery, the sooner the intervention the better for final visual outcome.

What are flashes and are they serious?
Flashing lights without floaters may also signify a tear or detachment of the retina and should be investigated. Flashes may appear on and off for months, and may become more common as we age. Some people experience flashing lights that appear as jagged lines or “heat waves” in both eyes, lasting up to 10-20 minutes. These episodes may precede or follow a headache, and are felt to be a type of migraine. All patients with migraine need to be examined in order to ascertain whether any retina or vitreous problems are present.

Diabetic Retinopathy
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Diabetes mellitus is a condition that impairs the body’s ability to use and store sugar properly. It can cause elevated blood-sugar levels, excessive thirst and urination, and changes in the body’s blood vessels. Diabetes may affect vision by causing cataracts, glaucoma, and most importantly, damage to blood vessels inside the eye.

What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes that is caused by changes in the blood vessels of the retina, the light-sensing nerve layer in the back of the eye. These damaged blood vessels may leak fluid or blood, and develop fragile brush-like branches and scar tissue. This in turn can blur or distort the images that the retina sends to the brain.
The risk of developing diabetic retinopathy increases the longer one has diabetes. Approximately 80% of people with at least a 15-year history of diabetes have some blood vessel damage to their retina. Diabetic retinopathy is particularly likely to occur at a younger age in juvenile, or Type I, diabetics. It is the leading cause of blindness among adults in the United States, and people with untreated diabetes are said to 25 times more prone to blindness than the general population. However, with improved diagnostic techniques and treatment only a small percentage of those who develop retinopathy actually have serious vision loss.

Types of diabetic retinopathy
Diabetic retinopathy can be divided into two types:
1. Background diabetic retinopathy (BDR): This is an early stage of retinopathy in which tiny blood vessels in the retina become damaged and leak blood or fluid. Sometimes, the leaking fluid collects in the macula, the part of the retina that lets us see fine details. This problem is known as macular edema. Vision may be affected if this occurs.
2. Proliferative diabetic retinopathy (PDR): This is a later stage of retinopathy in which new, abnormal blood vessels begin growing on the surface of the retina. These new blood vessels are fragile and can easily break and bleed, causing hemorrhages in the center and back of the eye. Vision may be severely decreased if this occurs. Additionally, the new blood vessels may grow scar tissue that pulls the retina away from the back of the eye. This retinal detachment usually needs to be repaired with a surgery. Abnormal blood vessels may also grow in the front of the eye, potentially leading to glaucoma.

Diagnosis and treatment
Diabetic retinopathy may not cause any symptoms in the early stages. Later in the course of retinopathy, one may notice floaters and/or decreased vision. The best protection against diabetic retinopathy is to have regular medical examinations by an ophthalmologist. If BDR is found, careful observation may be all that is warranted. However, the presence of macular edema may require treatment with a laser to close off leaking blood vessels. The goal of this treatment is to prevent future vision loss. For PDR, a different laser technique is used to cause regression of the new blood vessels. Laser surgery does not require an incision and may be performed in the ophthalmologist’s office. It is generally very well tolerated and is very effective in reducing the chance of severe visual impairment in most cases.

Age-Related Macular Degeneration
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What is macular degeneration?
Age-related macular degeneration, or AMD, is defined as damage or breakdown of the macula, which is a small area of the retina in the back of the eye that is responsible for central vision. It is one of the leading causes of decreased vision in the United States in patients over the age of 50. Symptoms of macular degeneration include blurred vision and distortion of central vision, both up close and in the distance. Side vision is rarely affected in this condition.

What is dry versus wet AMD?
AMD is commonly broken down into two types:
(1) “Dry” AMD (atrophic): This type accounts for up to 90% of all cases, and is caused by aging and thinning of the tissues of the macula. Vision loss is mild to moderate in many cases and is usually gradual.

(2) “Wet AMD (exudative): This type accounts for about 10% of all cases, but a majority of cases with severe visual loss. It results from abnormal blood vessels that develop beneath the retina, in an area called the choroid. These vessels may leak fluid or bleed, causing an elevation of the macula and subsequent central vision distortion. The vision loss may be rapid.

How do you know if you have AMD?
AMD can be diagnosed by your ophthalmologist during a general eye examination. If you notice a decline in central vision and/or distortion of central vision, you should have an ophthalmologist perform an eye examination in order to determine if AMD or another eye problem may be present. AMD can be detected based on a dilated examination and supporting tests, including fluorescein angiography. This is a test in which dye is injected into a vein in the arm and special photographs are taken in order to determine if there are any abnormal choroidal blood vessels.

How is AMD treated?
Dry AMD is treated by careful observation and sometimes by nutritional supplements. Some forms of wet AMD may be treated with laser surgery to help prevent further visual deterioration. The fluorescein angiogram will be helpful in determining which cases are amenable to treatment with laser. Only your ophthalmologist will be able to determine the best possible treatment for your condition. Currently, there is ongoing active research to look for alternative treatment options.

Cataracts
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Cataracts are one of the most common causes of poor vision, particularly for the elderly. A cataract is a clouding of the normally clear lens of the eye. It can cause a variety of symptoms including blurred vision, glare, halos, fading of colors and frequent eyeglass prescription changes. Fortunately, this condition is successfully treated with over 1.4 million people undergoing cataract surgery each year in the United States. Over 95% of these surgeries occur without serious complications.

There have been dramatic improvements in the technology of cataract removal in recent years. The surgery is now done under local anesthesia and often uses a topical anesthesia which requires no injection. The cataract is removed is an approximately 20 minute operation through a small incision which seals without sutures, and a foldable implant is inserted. The return of vision is often quite rapid as is the return to normal daily activities. You will use eyedrops postoperatively as directed by your doctor. Although the surgery is extremely safe and successful, it is important to understand that complications can occur and a perfect result can not be guaranteed.

A visit with our doctors can tell you whether a cataract or some other problem is the cause of your visual difficulties. We can help you decide if cataract surgery is appropriate for you.

Crystalens

ReSTOR