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Eye Care Associates of Nevada Blog

Disease Management Spotlight: Glaucoma Management

Disease Management Spotlight: Glaucoma Management

 

Glaucoma is a disease of the optic nerve that can potentially cause permanent loss of vision. Patients commonly hear that glaucoma is related to high eye pressure. Although it is true that we manage glaucoma often by controlling eye pressure, glaucoma itself has many different forms and causes. This blog will discuss how we manage open-angle glaucoma – the more common and chronic form of the disease. For a more detailed summary on the disease itself, click here.

 

What are risk factors for Open-Angle Glaucoma?

  • Age
  • Vascular conditions
  • Race: African Americans
  • Family history
  • High myopia
  • Optic nerve appearance
  • Elevated eye pressure
  • Corneal thickness

 

How is Open-Angle Glaucoma detected?

  • Unlike other eye diseases, visual symptoms are usually not evident until the disease is advanced-stage. It affects peripheral (side vision) before any loss to central vision – this is often why the disease goes undetected by patients! Because the vision loss is irreversible, it is important to detect and treat glaucoma before significant vision loss has occurred. Our testing can help identify early patterns of glaucoma to protect your vision.

 

What types of tests do we do for Glaucoma testing?

  • A glaucoma evaluation consists of a multitude of specialty testing to establish a baseline. Although there is no single definitive test for the disease, our subsequent visits throughout the year can monitor for any changes that are characteristic for glaucoma. Here are some of the glaucoma tests we do at Eye Care Associates:
    • Dilated eye exam
    • Eye pressure
    • Pupil testing
    • Visual Field Test (peripheral vision)
    • Corneal thickness measurements
    • Angle evaluation (gonioscopy)
    • Optic nerve head scans – optical coherence tomography (OCT)
    • Optic nerve photos

 

My eye doctor mentioned glaucoma at my last exam – how often should I go in for an eye exam?

  • Glaucoma suspects: patients may have eyes that are suspicious for glaucoma due to certain risk factors above – but not requiring treatment at this time. These patients are followed extensively in the beginning (every 3-6 months), and if stable (non-changing), they can be seen yearly at a minimum with selected updated glaucoma testing.
  • Unstable Glaucoma: every ~1-4 months. Stability requires multiple visits without worsening. Patients in this category often are recently diagnosed or have new changes to their medication/treatment plan that require a closer frequency of follow-ups to see if they are responding well to treatment. Patients with advanced-stage glaucoma are also seen in this time frame.
  • Stable Glaucoma: every ~4 months to a 1 year. With stable measurements at consecutive visits, some patients may be able to seen less frequently.

Source: http://www.icoph.org/downloads/ICOGlaucomaGuidelines.pdf
https://www.aao.org/summary-benchmark-detail/glaucoma-summary-benchmarks-2016

 

 

Every treatment plan is different for each individual depending on the form or severity of glaucoma. For concerns or questions, please ask your doctor at your next eye appointment.

 

 

 

 

 

Disease Management Spotlight: Macular Degeneration

Macular degeneration is a common degenerative condition of the retina that can progress and affect central vision.

There are two main forms of AMD: dry macular degeneration, the more common form (85-90%), and wet macular degeneration (10-15%). Wet macular degeneration is likely to cause severe vision loss. Although the more severe form of the disease is less common, 10% patients per year can progress from dry to wet form.

For a more detailed summary of the disease process, click here. Here are some common questions patients have with macular degeneration:

What are risk factors for AMD?

  • Age: also referred to as age-related macular degeneration as it is more common in individuals 50.
  • Smoking, high blood pressure, cardiovascular disease – research shows smoking doubles the risk.
  • Race: Caucasians are at higher risk than African Americans or Hispanic/Latinos
  • Family history

How is AMD detected?

  • Changes to your central vision.
  • Dilated eye exams. It is possible that early signs of AMD may be present without changing your vision. During your dilated exam at Eye Care Associates, we carefully examine the retina for any diseases. We also have specialty photography and imaging that help detect and further manage any signs of AMD.

How often should I go in for an eye exam? How do I treat AMD?

  • We recommend annual dilated eye exams to help screen for eye diseases. However, the follow-up for macular degeneration may require more frequent monitoring depending on the stage of the disease. Although there is no cure for the disease, we have ways of treating and minimizing the disease progression.

Schedule and treatment for patients with:

  • Risk factors for AMD: Annual dilation to monitor for progression – UV eye protection while outside, smoking cessation
  • Early AMD: Annual dilation, above treatment
  • Intermediate AMD: 6-12 months depending on severity – above treatment plus self-monitoring with amsler grid, vitamin supplements to prevent progression
  • Advanced AMD / Wet AMD: Likely retinal consult with 1-3 month follow-ups

For concerns or questions with macular degeneration, please ask your doctor at your next eye appointment.

Dry Eye Treatment Spotlight: IPL Intensive Pulse Laser

There is an exciting new treatment for Dry Eye Disease (DED) at Eye Care Associates of Nevada, especially for patients with ocular rosacea. These dry eye patients have a specific underlying inflammation that is fueling the disease process. Here are some facts about this new treatment and how it can help with dry eye.

What is rosacea?
Rosacea is an inflammatory disease that causes redness of the skin; patients tend to be lighter in skin complexion, sunburn easily, and have facial flushing that worsens with alcohol consumption or spicy foods. The disease can involve skin and tissue around the eyes (ocular rosacea) – in which the inflammation may lead to meibomian gland dysfunction and a multitude of dry eye symptoms, including grittiness, scratchiness, burning, stinging, fluctuations in vision that clear with blinking, eye fatigue, or excessive tearing.

What is IPL?
Intensive Pulse Laser, or IPL, is an FDA-approved treatment for acne and rosacea that has been used in dermatology over the years. Recently, ophthalmology has discovered the therapeutic effects for helping patients with ocular rosacea to minimize the impact of dry eye disease.

How does it work?
This is an in-office medical device. A doctor or trained staff uses a flash lamp that emits specific wavelengths of light to help cauterize leaky blood vessels found in the skin’s surface. These leaky blood vessels are a primary source of inflammatory mediators to the eye, which cause redness, poor tear film stability, and discomfort. Most patients will receive four treatments 3-4 weeks apart, and occasional maintenance treatments depending on skin complexion and severity of dry eye. By cutting off the source of inflammation with IPL, the tear and oil glands can be restored to a healthy state, helping to bring stability to the patient’s tear film and overall enhanced comfort of their eyes.

What are the side effects?
The short-term side effects include slight redness and tenderness – similar to sunburn. This will require sunscreen protection for 1-2 weeks post-treatment. The long-term effects include a reduction of leaky blood vessels that ultimately leads to overall less surface redness. There are also cosmetic changes around the treated areas. The treatment tightens up the collagen in the skin around the eyes, which may reduce wrinkles. There are also some reports of darker sunspots being removed due to treatment. Dermatologists have been using this as a cosmetic procedure for many years due to these benefits!

I’m currently using other medications for dry eye – do I still continue other dry eye therapy with IPL treatment?
Your eye doctor will recommend which treatments to use before and after this procedure. Patients who continue with their dry eye therapy will often notice an enhanced therapeutic response after the IPL sessions due to a different mechanism of action. Despite the complexity and multiple factors involved with dry eye disease, there are compounding benefits to treatment if prescribed strategically. Ask your doctor at Eye Care Associates of Nevada for any additional questions on IPL and dry eye treatment.

Top 5 Q&A: Cataract Surgery

Top 5 Q&A: Cataract Surgery Part 2 – Life After Surgery

By: Brian Ki

 How long will I need to use drops after cataract surgery?

Typically, every patient will be on medicated eye drops for at least one month after surgery. This will be a combination of anti-inflammatory and antibiotic eye drops to ensure the best recovery after cataract surgery. This is often supplemented with lubricating drops depending on the nature of dryness that may be accompanied post-operatively.

Why do the medicated drops sting when I use them?

This is a fairly common observation that patients experience. The preservatives used in the drops may cause dryness or irritation to the eyes, but do not cause any long-term health consequences. You may also experience slightly blurry vision with these drops until your eyes have fully recovered from surgery. Rarely do patients have an allergic response to these medications. The medicated drops do an excellent job of calming down inflammation and preventing infection so it is best to continue the medication as directed by your surgeon until your follow-up appointments. Please talk to your eye doctor about any concerns with using your drops.

What happens to my old glasses after cataract surgery?

After the first eye has undergone cataract surgery, there may be a brief period where you may find it more comfortable with or without your habitual glasses. This is because your prescription is still helpful for the eye with the cataract, but overcorrects for the eye with the new prescription lens implant. Ultimately, once both eyes have undergone cataract surgery, your habitual glasses prescription will need to be updated to complement your lens implants. At your cataract evaluation, your surgeon will discuss whether you will need glasses after cataract surgery.

How soon after the first eye can I have the other eye done?

The earliest we can schedule the cataract surgeries is one week apart. This ensures precise lens measurements for the second eye depending on how the first eye recovers from cataract surgery. We try to minimize the time between cataracts surgeries due to the transition period mentioned in the last question – however, there are no long-term health consequences for choosing to delay the surgery for longer than one week. Please consult with your eye doctor for any additional questions.

Will my prescription ever change again after cataract surgery?

The majority of patients have successful long-term vision after cataract surgery. The implantable lenses do not “age” like the human lens – meaning the material does not fog up, breakdown, or change prescription on their own. Changes to your vision could be a sign of other biological processes such as a film growing over the lenses, ocular surface disease, or other eye disease. If you are experiencing changes to or fluctuations of your vision, please contact us and schedule an appointment.

By: Trish Duffield

Am I a candidate for cataract surgery?

At Eye Care Associates of Nevada, we provide a comprehensive cataract surgery evaluation prior to scheduling the cataract surgery procedure.  This is a time to meet with our cataract surgeons and to answer any questions you may have.

Will I need to wear glasses after cataract surgery?

While every patient case is different, there are many lens implants available that can be utilized to potentially eliminate the need for full-time glasses wear after cataract surgery.  During your cataract surgery evaluation at Eye Care Associates of Nevada these lens options will be discussed in detail.

What is the cataract surgery recovery like?

If it is determined that both of your eyes need cataract surgery, you will be scheduled for one eye at a time with 1-2 weeks in between.  Most patients experience blur and halos the first day after surgery, which gradually improves over the next week of healing.

What is the protocol for follow-up care?

At Eye Care Associates of Nevada we check your visual and healing progress at 1 day, 1 week, and 1 month after surgery for either eye.  Proper instillation and usage of eye drop medication is the most important factor in reducing healing time.  We keep our patients on a regimen of eye drops for 1 month total.

What are the possible complications of cataract surgery?

The lens implants placed inside your eyes will last forever and the surgery has an excellent success rate.  The most common issues after cataract surgery are problems with glare and mild irritation as the ocular surface heals.  If present, these minor issues improve with time.  As with any surgical procedure, there are more serious complications that can occur but those are extremely rare.

 

 

Top 5 Q&A: Pterygium

By Rachel Murphy

What is a pterygium?

A pterygium is a wedge-shaped bump on the white part of the eye (the sclera) that can invade the cornea. It is sometimes called “surfer’s eye.” Pterygia are benign growths meaning they are not cancerous. They are more common on the inside corner of the eye closest to the nose, but can occur on the outside corner as well. It can occur in one or both eyes. A pterygium typically grows very slowly and does not affect vision, but in severe cases it can grow across the cornea and block vision. The most common symptoms are burning, grittiness, itching, a foreign body sensation, and blurred vision. It can lead to increased dryness and irritation. Occasionally it can become red and inflamed which can cause mild pain.

What causes a pterygium?

A pterygium is basically a callus that develops from exposure to sunlight, wind, and dust. Pterygia are more common in individuals with dry eye and can also increase the severity of the dryness. The exact cause of the growth is unknown. They are more common in farmers, fishermen, and people living near the equator. They are also more common in younger individuals age 20 to 40 and seems to be more prevalent in men than women.

How is a pterygium treated?

In many cases of mild pterygium there may be no symptoms and no need for treatment. The most common complication associated with a pterygium is increased dryness, which may be relieved using artificial tears. If a pterygium becomes irritated or inflamed, it can be treated with topical medication such as a steroid drop for short periods of time. Artificial tears and topical medications will help with irritation, but they do not shrink the size of the pterygium. The only way to remove a pterygium is through surgery. This can be done for cosmetic reasons or to improve vision if the pterygium begins to block vision.

What can I expect during a pterygium removal surgery?

The surgery is typically about 30 minutes and usually requires wearing a patch for one to two days after surgery. During the surgery, the callused patch is skin is removed and a graft placed over the area. The graft can come from another part of the conjunctiva (the clear tissue overlying the sclera) or from a graft made from amniotic tissue. Full recovery may take several weeks, but the patient should be able to return to work and normal activity after a few days. Swimming and rubbing the eye should be avoided during the recovery period. The most common side effects of surgery are redness, swelling, and soreness. Your doctor will typically prescribe a steroid drop to use for up to a few weeks after the surgery.

Will my pterygium return after having it removed?

It is possible for a pterygium to return after surgery particularly if no graft is used the surgery. If a graft is used, recurrence rate is about 5-10%. Recurrence is most common in the first year after surgery. It is very important to protect your eyes from sunlight using UV blocking sunglasses and a hat with a brim. This also helps reduce exposure from wind and dust. In some cases, pterygium removal may also change the shape of the cornea resulting in astigmatism.

Top 5 Q&A: Dry Eye Disease

By: Kellen Robertson

How do I know if I have Dry Eye Disease?

Dry Eye Disease (DED), also known as Ocular Surface Disease (OSD), has many signs and symptoms. Dry Eye Disease is a chronic and progressive disease. Symptoms you may experience include: dryness, grittiness, scratchiness, foreign body sensation, burning, stinging, redness, fluctuations in vision that clear with blinking, eye fatigue, and excessive tearing. There are many tests Eye Care Associates of Nevada will perform to determine if your symptoms can be contributed to DED.

My eyes water, how can I have dry eyes?

Excessive tearing is a common sign of dry eye disease. Your tear film is made of three layers: a mucin (mucous) layer, an aqueous (water) layer, and a lipid (oil) layer. If your oil layer is deficient, your tears evaporate faster and you experience dryness, which results in excessive tearing. Unfortunately, these reflex tears are not healthy tears and do not have the nutritional components to keep your eye feeling moist and healthy. Other causes of reflex tears are inflammation on the surface of your eyes as well as high tear osmolarity (salt content). At Eye Care Associates of Nevada we perform tests that will assess eye surface inflammation and tear osmolarity.

What causes dry eye disease?

There are many potential causes of dry eye disease. It has been reported that the prevalence of dry eyes is 5-35%. That means as high as 1 in 3 people will have some level of Dry Eye Disease. Women and those over the age of 50 are at higher risk for DED. Other causes of DED are meibomian gland dysfunction and blepharitis, two common eye diseases that can cause evaporative DED. Certain medications can cause dryness, these include: birth control, anti-depressants, and medications for allergy, acne, and high blood pressure. Systemic diseases can increase risk for DED, these include: diabetes, rheumatoid arthritis, lupus, thyroid disease, and Sjogren’s syndrome. Make sure to tell your doctor if you have dry eyes accompanied by dry mouth. Environmental factors such as smoking, extreme heat or cold, air conditioning/heating, and air pollutants can also cause dry eye symptoms. Prolonged reading or computer/phone use decreases your blink rate which can lead to dry eyes. Other things that can cause dryness are wearing contact lenses and refractive surgery, such as LASIK.

What are my treatment options?

There are many treatment options for Dry Eye Disease depending on the classification and category of DED. The standard initial treatment is artificial tear eye drops and warm compresses. Here at Eye Care Associates of Nevada we also have advanced technology treatment for meibomian gland dysfunction and blepharitis, the two most common causes of DED. These advanced technology treatment options include LipiFlow and BlephEx. We may also consider adding a supplement called HydroEye which has been proven to improve tear film quality and resolve signs and symptoms. Your doctor may also consider starting you on prescription eye drops called Restasis. Restasis is the most commonly prescribed drop for DED and has been shown to increase tear production and reduce inflammation. Your doctor will determine the best customized treatment based on your signs and symptoms.

Is there a cure for my dry eyes?

There is no cure for Dry Eye Disease. Treatment is aimed at improving the health of the surface of your eyes as well as treating symptoms. The treatment is often a stepwise approach and should be viewed as a marathon, not a sprint. Often times the signs and symptoms of DED have been causing damage to the surface of the eyes for months to years and it may require months to years of treatment before signs and symptoms are managed.