Eye Disease Management​

Diabetes and vision go hand in hand. If you have diabetes, you need to know that having this systemic disease puts you at greater risk for developing vision problems.

Diabetes is associated with several eye health issues including cataracts and glaucoma, but the most well known diabetic eye disease is diabetic retinopathy.

Diabetic Retinopathy

Diabetic retinopathy is an eye disease that only affects diabetics. It occurs when the fragile vascular network that supplies the retina – the light sensitive tissue at the back of the eye that helps us see – begins to swell or leak. During the beginning stages of the disease, there may be no noticeable symptoms, so it’s important to have your eyes checked at least once a year, if you have diabetes.

Once symptoms of diabetic retinopathy do develop, they can include: dark or black spots in your visual field, or blurry vision, and it increases over time. This is a result of bleeding at the back of the eye, which prevents a clear image from being transmitted from the retina to the brain.

Whether you have type 1, type 2, or even just gestational diabetes, you are at risk for developing diabetic retinopathy. The longer you have had the disease, the greater the risk. It is essential to keep your blood sugar levels under control to prevent vision loss, and this may require a trip back to your primary care physician.

Treating diabetic retinopathy can include vitrectomy, replacing the inner gel-like substance that supports the eyeball structure, and laser surgery.

Special thanks to the EyeGlass Guide, for informational material that aided in the creation of this website.

Glaucoma is a condition that causes damage to your eye’s optic nerve and gets worse over time, so nipping it in the bud will always be better for the person being tested.

Glaucoma Eye Exams

Glaucoma is a leading cause of preventable vision loss and blindness in older individuals in the United States and Canada and the second leading cause of blindness in the World, even more than macular degeneration

What is Glaucoma?

Glaucoma is not a single disease. It is actually a group of eye diseases that cause damage to the optic nerve due to an increase in pressure inside the eye, which is called intraocular pressure (IOP). When detected in the early stages, glaucoma can often be controlled, preventing severe vision loss and blindness. However, symptoms of noticeable vision loss often only occur once the disease has progressed. This is why glaucoma is called “the sneak thief of sight”. Unfortunately, once vision is lost from the disease, it usually can’t be restored.

Treatments include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision loss. The type of treatment depends on the type and the cause of glaucoma.

Risk Factors

Prevention is possible only with early detection and treatment. Since symptoms are often absent, regular eye exams which include a glaucoma screening are essential, particularly for individuals at risk of the disease. While anyone can get glaucoma, the following traits put you at a higher risk:

Age over 60
Hispanic or Latino descent, Asian descent
African Americans over the age of 40 (glaucoma is the leading cause of blindness in African Americans, 6-8 times more common than in Caucasians.)
Family history of glaucoma
Diabetics
People with severe nearsightedness
Certain medications (e.g. steroids)
Significant eye injury (even if it occurred in childhood)

Understanding Glaucoma

Signs and Symptoms of Glaucoma: Due to a buildup of pressure in the eye, glaucoma causes damage to the optic nerve which is responsible for transmitting visual information from the eye to the brain. How does glaucoma affect your vision?

Types of Glaucoma: There are a number of types of glaucoma, some more acute than others. Learn about the common types of glaucoma and the differences between them.

Diagnosis and Treatment of Glaucoma: Early detection and treatment of glaucoma are essential to stopping or slowing the disease progression and saving vision. Treatment can include medicated eye drops, pills, laser procedures and minor surgical procedures depending on the type and stage of glaucoma.

Signs and Symptoms of Glaucoma

The intraocular pressure caused by glaucoma can slowly damage the optic nerve, causing a gradual loss of vision. Vision loss begins with peripheral (side) vision, resulting in limited tunnel vision. Over time if left untreated, central vision will also be affected which will increase until it eventually causes total blindness. Unfortunately, any vision that is lost from the optic nerve damage cannot be restored.

What are the Symptoms?

Typically, glaucoma sets in without any symptoms. At the early onset of the most common type of glaucoma “open angle” glaucoma, vision remains normal and there is no pain or discomfort. This is why the disease is nicknamed the “sneak thief of sight”.

An acute type of glaucoma, called angle-closure glaucoma, can present sudden symptoms such as foggy, blurred vision, halos around lights, eye pain, headache and even nausea. This is a medical emergency and should be assessed immediately as the intraocular pressure can become extremely high and cause permanent damage within hours.

Types of Glaucoma

The primary forms of glaucoma are open-angle and narrow-angle, with open-angle being the most common type.

Primary open-angle glaucoma (POAG)

POAG gradually progresses without pain or noticeable vision loss initially affecting peripheral vision. By the time visual symptoms appear, irreparable damage has usually occurred, however, the sooner treatment starts the more vision loss can be prevented. When untreated, vision loss will eventually result in total loss of side vision (or tunnel vision) and eventually total vision loss.

Normal-tension glaucoma or low-tension glaucoma

This is another form of open-angle glaucoma in which the intraocular pressure remains within the normal level. The cause of this form of glaucoma is not known, but it is believed to have something to do with insufficient blood flow to the optic nerve, causing damage. Individuals of Japanese descent, women and those with a history of vascular disease or low blood pressure are at higher risk.

Angle-closure glaucoma

Acute angle-closure glaucoma is marked by a sudden increase in eye pressure, which can cause severe pain, blurred vision, halos, nausea, and headaches. The pressure is caused by a blockage in the fluid at the front of the eye which is a medical emergency and should be treated immediately. Without prompt treatment to clear the blockage vision can be permanently lost.

Congenital glaucoma

The inherited form of the disease that is present at birth. In these cases, babies are born with a defect that slows the normal drainage of fluid out of the eye; they are usually diagnosed by the time they turn one. There are typically some noticeable symptoms such as excessive tearing, cloudiness or haziness of the eyes, large or protruding eyes or light sensitivity. Surgery is usually performed, with a very high success rate, to restore full vision.

Secondary glaucomas

Glaucoma can develop as a complication of eye surgeries, injuries or other medical conditions such as cataracts, tumors, or a condition called uveitis which causes inflammation. Uncontrolled high blood pressure or diabetes can result in another serious form called neovascular glaucoma.

Pigmentary glaucoma

A rare form of glaucoma, this occurs when pigment from the iris sheds and clogs the drainage of fluid from the eye resulting in inflammation and damage to the eye and drainage system.

Treatment of glaucoma is dependant upon the severity and type of glaucoma present.

Glaucoma Diagnosis and Treatment

Detecting Glaucoma

During a routine comprehensive eye exam to check for glaucoma, your eye doctor will dilate your eye to examine the optic nerve for signs of glaucoma and will also measure the intraocular pressure (IOP) with an instrument called a tonometer.

IOP Measurement

Tonometry involves numbing the eye with drops and then gently pressing on the surface of the eye to measure the pressure. Since your IOP can fluctuate throughout the day and glaucoma can exist without elevated IOP this is not enough to rule out the disease. If there are signs of the disease, further testing will be performed.

Visual Field Test

A visual field test is designed to detect any blind spots in your peripheral or side field of vision. You will be asked to place your head in front of a machine while looking ahead and indicate when you see a signal in your peripheral field of view.

Retina Testing

Your doctor may also measure the thickness of the cornea with an ultrasonic wave instrument in a test called pachymetry or use imaging techniques such as digital retina scanning or optical coherence tomography (OCT) to create an image of your optic nerve to look for glaucoma damage.

Treating Glaucoma

Treatment for glaucoma depends on the type and severity of the disease and can include medication such as eye drops or pills or laser or traditional surgery.

Medication

Medication and drops to lower IOP are often the first resort for controlling pressure-related glaucoma. These drops may have some uncomfortable side effects, but compliance with the treatment plan is essential for preserving vision and halting the progression of the disease.

Surgery

Surgical procedures are designed to control the flow of fluids through the eye by either decreasing the amount of fluid produced or improving the drainage. Your doctor may decide that a combination of surgery and medication will be the most effective in many cases.

Prevention

It cannot be stressed enough that the most effective treatment for glaucoma happens when the disease is detected and treated early before significant vision loss occurs. Any vision that is lost cannot be restored. This is why the best prevention is awareness by knowing your risks and taking responsibility by having your eyes examined on a regular basis.

Glaucoma is a condition that causes damage to your eye’s optic nerve and gets worse over time, so nipping it in the bud will always be better for the person being tested.

The macula is the portion of the retina that provides sharp, central vision, and is involved in processing the fine details of the image. The breakdown of the macula is a disease called macular degeneration.

What Is Age-Related Macular Degeneration or ARMD?

The macula on the retina provides a sharp, central vision. The breakdown of the macula is a disease called macular degeneration and can be serious. Untreated macular degeneration is one of the leading causes of blindness in those over 65 years old.

While researchers have not yet discovered a cure for age-related macular degeneration (ARMD), there are treatment options that prevent the disease from progressing to blindness, and in some cases, they can even improve vision. It’s important to have an open discussion with your eye doctor about the risks and limitations of ARMD treatments.

Types of Macular Degeneration:

There are 2 basic types of ARMD, the wet form, and the dry form.

Dry macular degeneration is considered the less aggressive form of ARMD. It typically progresses much more slowly, and the level of eyesight damage is less severe. Dry ARMD is detected during routine eye exams, which is why it’s important to have yearly testing. Treating Dry AMD often involves high doses of zinc and antioxidants which have been shown to slow disease progression.
Wet macular degeneration is the more severe form of ARMD. Call us to book an emergency eye doctor’s appointment if you experience a sudden worsening of blurry central vision. Wet ARMD occurs when there is abnormal blood vessel growth (angiogenesis), and leakage, which can cause scar tissue to develop. Treatments include laser surgery, injecting light sensitive dyes, or AMD medication injected directly into the eye to inhibit angiogenesis.

Learn More About ARMD

ARMD is an age-related eye disease that runs in families and is a leading cause of blindness in our aging population. There is no cure for this ocular disease, and ARMD related vision loss cannot usually be recovered. There are treatments, and preventative measures that can be taken, if detected early, so routine eye exams are essential.

LASIK – Laser-Assisted In Situ Keratomileusis – is the most common refractive eye surgery today. As of 2011, over 11 million LASIK procedures have been performed in the United States and as of 2009 over 28 million have been performed worldwide.

LASIK, often referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is performed by an ophthalmologist who uses a laser to reshape the eye’s cornea in order to improve visual acuity. For most patients, LASIK provides a permanent alternative to eyeglasses or contact lenses.

LASIK is most similar to another surgical corrective procedure, photorefractive keratectomy (PRK), and both represent advances over radial keratotomy in the surgical treatment of refractive errors of vision. For patients with moderate to high myopia or thin corneas which cannot be treated with LASIK and PRK, the phakic intraocular lens is an alternative.

LASIK is the premier surgery for vision correction. It is quick, almost painless and there is little or no discomfort after the procedure. Vision recovery is rapid – patients report seeing 20/20 within 24 hours.

LASIK corrects nearsightedness, farsightedness and even astigmatism. With a technique called mono-vision, it can reduce the need for reading glasses among patients over age 40 who wear bifocals.

Who Are The Optimal LASIK Candidates?

The best candidate for LASIK is age 21+, has healthy eyes with adequate corneal thickness. This is necessary because LASIK procedure removes tissue from the cornea to reshape the eye.

Chronic dry eye, corneal disease or other abnormalities may disqualify a candidate from LASIK surgery. A comprehensive eye exam is required to be sure. For your convenience, we are happy to provide LASIK pre-operative exams and consultations at our office.

Note that LASIK is an elective procedure and proper consideration must include the weight of personal needs, potential gain and willingness to accept the risks involved. There are no guarantees that LASIK will absolutely succeed to your expectations. The results are not always perfect vision. In some cases, your vision after LASIK may be permanently less clear than it was with glasses before LASIK. This outcome must be factored before deciding on LASIK surgery.

Certainly there is upside. In normal circumstances and conditions LASIK can reduce your dependence on glasses and almost always gives you the ability to function well without the need for glasses or contact lenses.

Specifics of The LASIK Procedure

LASIK is an ambulatory, two-step procedure. You walk into the surgery center, have the procedure and walk out about an hour later. The surgery event is about 15 minutes for both eyes, but allowances should accommodate for about at the surgery location, perhaps even a bit more.

First, the surgeon creates a thin, hinged flap of tissue on your cornea with an instrument called a laser. This flap is folded back so the laser reshaping of your eye can begin. After laser treatment, which lasts a minute or less, the flap is repositioned and the surgeon proceeds to your other eye.

What Is Wavefront LASIK?

Wavefront LASIK -wavefront-assisted, wavefront-guided or custom LASIK- uses laser treatment (ablation) mapped by computerized analysis. Wavefront-guided procedures are much more precise than ablations determined by using standard eyeglasses prescriptions. They can correct subtle optical imperfections of the eye called “higher-order aberrations” that regular ablations cannot treat. Studies prove wavefront-guided ablations provide sharper vision than conventional, non-wavefront LASIK and can improve night-vision, eliminating or reducing the risk of halos or glare.

After The Surgery

Following the LASIK procedure, you will use medicated eye drops and clear protective shields to cover your eyes. You can open your eyes and see well enough to walk without glasses, but you must not drive yourself home.

You will use medicated eye drops several times a day for a week or more to prevent infection and help the healing. You may also use artificial tears to keep your eyes moist and comfortable.

You should rest your eyes as much as possible the day of your surgery. You may find it more comfortable leaving the house lights on low dim.

The next day, you should see well enough to drive and resume your normal activities. Use care though not to rub your eyes until it is safe to do so. If you are currently using Latisse, discuss with your eye doctor how long after surgery to wait before re-starting the regimen.

You may be asked to return to visit your doctor the following day for an eye exam. They will want to check your vision and be sure your eyes appear to be healing as they should. You will be given any additional instructions necessary about eye drops and/or artificial tears, and you can ask the doctor any questions you may have.

Postoperative care may be performed by an eye doctor other than your LASIK surgeon. This is referred to as co-management. We are happy to provide post-operative care for you at our office through a co-management agreement with your surgeon. Ask us for further details.

If My Vision Is Blurry After LASIK…

Though most patients see clearly within a day or so after LASIK, it can take several months before your eyes completely stabilize. Until then, improvements in your vision can still occur in fits and jumps. If several months pass and your vision is still blurred, be sure to communicate and visit with your LASIK surgeon. It may be appropriate to have a second LASIK surgery -an enhancement- to sharpen your eyesight further.

If an enhancement is not required, eyeglasses or contact lenses may be used to help. We will be happy to examine your eyes and discuss the options available to you.

After LASIK Eyewear

Even if your vision seems perfect after LASIK, you may still require or be more comfortable with eyewear.

When outdoors, it’s optimal and sometimes urgent to protect your eyes from the sun’s strong and sometimes harmful rays. Use sunglasses that provide 100% UV protection. For sports-sunglasses, the lenses need to have poly-carbonate for extra strength and protection. Anytime you work with power tools or do any activity where eye injury is possible, be sure to use safety glasses with poly-carbonate lenses.

If you’re over 40 (or close), it’s likely you’ll need reading glasses after LASIK. Many LASIK patients benefit from prescription eyeglasses for night driving. Even a mild prescription will make your vision sharper for added safety and comfort at night.

After LASIK Eye Care

Remember to continue to schedule routine eye exams post-LASIK. Even with perfect vision you still need to have your eyes examined for glaucoma and other potential problems on a regular basis. Routine exams will help insure that your vision remains stable after LASIK.

Please call our Grand Island office at 716-775-2220 for further instructions. Use your best judgment. If you feel your vision issue is urgent, do not delay treatment – visit your nearest emergency treatment center.

It may sound confusing at first, but you can plan to use your vision insurance to your maximum benefit by fully understanding what is specifically covered or not covered under your vision insurance plan, and by also discussing options with your eye care professional to see how best to apply your particular vision coverage to your eye care expenses.

This planning includes fully understanding any traditional health insurance coverage you may have. Unexpected eye injury or the onset of certain eye diseases and their related treatments is often covered by your traditional health insurance rather than your specific vision insurance plan.

The point here is—it’s your vision insurance, your vision coverage—understanding your particular vision insurance plan is critical to maximizing those benefits.

We take the following insurance.

VSP
Eyemed Vision Care
Carecredit

Please visit our insurance page for more information.