Common Eye Disorder in the Elderly

CATARACTS

Cataracts are the leading cause of blindness in the world.

A cataract is any opacity or discoloration of the lens of the eye. The gradual yellowing of the lens may reduce the perception of blue colors in its early stages. Denser and more central opacities will cause deterioration in vision as well as difficulties with glare. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated.

The most effective treatment is to surgically remove the cloudy lens. During surgery, the original lens is removed and replaced with an artificial intraocular lens implant which stays in the eye permanently. Cataract operations are usually performed using a local anesthetic and the patient is allowed to go home the same day.

GLAUCOMA

What is Glaucoma?

Glaucoma is a group of eye diseases causing optic nerve damage. The optic nerve carries images from the retina (a specialized light sensing tissue) to the brain so we can see. In glaucoma, eye pressure plays a role in damaging the delicate nerve fibers of the optic nerve. When a significant number of nerve fibers are damaged, blind spots develop in the field of vision. Once nerve damage and visual loss occur, it is permanent. Most people don't notice these blind areas until much of the optic nerve has been damaged. If the entire nerve is destroyed, blindness results.

Early detection and treatment are the keys to preventing optic nerve damage and vision loss from glaucoma.

What Are The Different Types Of Glaucoma?

Open-angle glaucoma is the most common form of glaucoma. The "open" drainage angle of the eye can become clogged or slowly malfunction leading to gradual increased eye pressure. If this increased pressure results in optic nerve damage, it is known as open-angle glaucoma. The optic nerve damage and vision loss usually occurs so gradually and painlessly that you are not aware of trouble until the optic nerve is already badly damaged.

Angle-closure glaucoma results when the drainage angle of the eye narrows and becomes completely blocked.

In the acute type of angle-closure glaucoma, the drainage angle can close off suddenly, causing pressure to build up rapidly. The symptoms include severe eye pain, blurred vision, headache, rainbow haloes around lights, nausea and vomiting. Unless an ophthalmologist treats acute angle-closure glaucoma quickly, blindness can result.

In the chronic type of angle closure glaucoma, the drainage angle slowly becomes blocked and pressure builds up gradually. Because of the gradual rise in pressure, symptoms might be absent or so mild, the patient might ignore them.

How Is Glaucoma Detected?

Regular eye examinations by your ophthalmologist are the best way to detect glaucoma. Your ophthalmologist will:

- Measure eye pressure (tonometry)
- inspect the drainage angle of your eye (gonioscopy)
- evaluate your optic nerve (ophthalmolscopy and OPTICAL COHERENCE TOMOGRAPHY [OCT])
- and test the visual field of each eye (perimetry)

Optic nerve evaluation and visual field testing are performed at regular intervals to monitor the effects of glaucoma. The information from these tests provides an indication of the effectiveness of the treatment being used and whether further treatments may be necessary. Not all of these tests are necessary for every person, nor at every visit. The objective is to determine if glaucoma damage has progressed over time.

FLOATERS

What are Floaters?

Small specks or clouds moving in your field of vision are called floaters. You may see them more clearly when looking at a plain background, such as a blank wall. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. Floaters can have different shapes, such as little dots, circles, lines, clouds or cobwebs.

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.

When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. Floaters often occur when the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. In some cases the retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. A torn retina is always a serious problem, since it can lead to a retinal detachment.

The appearance of floaters may be alarming, especially if they develop suddenly. You should see an ophthalmologist right away if you suddenly develop new floaters, especially if you are over 45 years of age.

Refractive Errors

Refractive errors are disorders, not diseases. A refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image.

The common refractive disorders are described below.

Myopia (distant objects are blurry)
Also known as nearsightedness, myopia is usually inherited and is often discovered in childhood. Myopia often progesses throughout the teenage years, when the body is growing rapidly. People with high degrees of myopia have a higher risk of detached retina which can be repaired with surgery.

Hyperopia (close objects are blurry)
Also known as farsightedness, hyperopia is usually inherited. Children are often hyperopic and this lessens as they reach puberty. Hyperopia may develop in adulthood.

Presbyopia (aging of the lens in the eye)
After age 40, the lens of the eye becomes more rigid and does not flex as easily. The result is that it is more difficult to read at close range. This normal aging process of the lens can also be combined with myopia, hyperopia or astigmatism.

Astigmatism (blurred vision at all distances)
Astigmatism usually occurs when the front surface of the eye, the cornea, has an irregular curvature. Normally the cornea is smooth and equally curved in all directions and light entering the cornea is focused equally on all planes, or in all directions. In astigmatism, the front surface of the cornea is curved more in one direction than in the other. This abnormality may result in vision that is much like looking into a distorted, wavy mirror. Usually, astigmatism causes blurred vision at all distances.

Treatment

Refractive disorders are commonly treated using corrective lenses, such as eyeglasses or contact lenses. Refractive surgery can also be used to correct some refractive disorders.

MACULAR DEGENERATION

Macular degeneration refers to damage to or breakdown of the macula of the eye. The macula is a small area in the retina (at the back of the eye) that allows us to see fine details clearly. Macular degeneration makes close work like threading a needle or reading a book, difficult or impossible. When the macula doesn't function correctly, we experience blurriness or darkness in the center of our vision.

Although macular degeneration reduces vision in the central part of the retina, it does not affect peripheral vision. There are two forms of macular degeneration:

- The Dry Type. This is the most common form. In this type of macular degeneration, the delicate tissues of the macula become thinned and cease to function properly.

- The Wet Type. This is less common, but is typically more damaging. The wet type of macular degeneration is caused by the growth of abnormal blood vessels behind the macula. The abnormal blood vessels tend to bleed or leak. If left untreated, scar tissue may form.

Macular degeneration causes a progressive loss of central vision but spares the peripheral vision. For example, you could see a clock but not be able to tell what time it is.

Macular degeneration alone does not result in total blindness. The remaining peripheral vision allows a certain amount of mobility in normal surroundings. Most people continue to have some useful vision and are able to take care of themselves.

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

EYE CENTER

Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6252

CENTER FOR PATIENT PARTNERSHIP

Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444