Macular Degeneration

What is AMD?
AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.

In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects also may not appear to be as bright as they used to be.

AMD by itself does NOT lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.

The Macula
The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.

Who is at risk?
Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:
• Smoking. Research shows that smoking doubles the risk of AMD.
• Race. AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.
• Family history. People with a family history of AMD are at higher risk.

Does lifestyle make a difference?
Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:

• Avoid smoking
• Exercise regularly
• Maintain normal blood pressure and cholesterol levels
• Eat a healthy diet rich in green, leafy vegetables and fish

How is AMD detected?
The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam may include the following:

Visual acuity test. This eye chart measures how well you see at distances.
Dilated eye exam. Your eye care professional places drops in your eyes to widen or dilate the pupils. This provides a better view of the back of your eye. Using a special magnifying lens, he or she then looks at your retina and optic nerve for signs of AMD and other eye problems.
Amsler grid. Your eye care professional also may ask you to look at an Amsler grid. Changes in your central vision may cause the lines in the grid to disappear or appear wavy, a sign of AMD.
Optical coherence tomography (OCT). You have probably heard of ultrasound, which uses sound waves to capture images of living tissues. OCT is similar except that it uses light waves, and can achieve very high-resolution images of any tissues that can be penetrated by light—such as the eyes. After your eyes are dilated, you’ll be asked to place your head on a chin rest and hold still for several seconds while the images are obtained. The light beam is painless.
Fluorescein angiogram. In this test, a fluorescent dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. This makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of AMD. In rare cases, complications to the injection can arise, from nausea to more severe allergic reactions.

During the exam, your eye care professional will also look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD.

Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented. These changes will not affect your eye color.

What are the stages of AMD?
There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.

Early AMD. Early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss.
Intermediate AMD. People with intermediate AMD typically have large drusen, pigment changes in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience any symptoms.
Late AMD. In addition to drusen, people with late AMD have vision loss from damage to the macula. There are two types of late AMD:
o In geographic atrophy (also called dry AMD), there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and of the supporting tissue beneath the macula. These changes cause vision loss.
o In neovascular AMD (also called wet AMD), abnormal blood vessels grow underneath the retina. (“Neovascular” literally means “new vessels.”) These vessels can leak fluid and blood, which may lead to swelling and damage of the macula. The damage may be rapid and severe, unlike the more gradual course of geographic atrophy. It is possible to have both geographic atrophy and neovascular AMD in the same eye, and either condition can appear first.

AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.

Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years.

With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.

If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye.

If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, please contact the eye care professionals at Eye Group of Connecticut.

How is AMD treated?
Early AMD:
Currently, no treatment exists for early AMD, which in many people shows no symptoms or loss of vision. Your eye care professional may recommend that you get a comprehensive dilated eye exam at least once a year. The exam will help determine if your condition is advancing.

As for prevention, AMD occurs less often in people who exercise, avoid smoking, and eat nutritious foods including green leafy vegetables and fish. If you already have AMD, adopting some of these habits may help you keep your vision longer.

Intermediate and late AMD:
Researchers at the National Eye Institute tested whether taking nutritional supplements could protect against AMD in the Age-Related Eye Disease Studies (AREDS and AREDS2). They found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.

The first AREDS trial showed that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper can reduce the risk of late AMD by 25 percent. The AREDS2 trial tested whether this formulation could be improved by adding lutein, zeaxanthin or omega-3 fatty acids. Omega-3 fatty acids are nutrients enriched in fish oils. Lutein, zeaxanthin and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.


Eye Care for Your Life

Blepharitis

Blepharitis (blef-uh-RI-tis) affects the skin of the eyelids, and it usually involves the part of the eyelid where the eyelashes grow (lid margins). Commonly, blepharitis occurs when tiny oil glands located near the base of the eyelashes malfunction. When these oil glands malfunction, bacterial overgrowth can result, leading to inflamed, irritated and itchy eyelids. Blepharitis is often a chronic condition that is difficult to treat. Although it's uncomfortable and may be unattractive, blepharitis rarely causes permanent damage to eyesight.

Blepharitis can be difficult to treat. Good hygiene — regular cleaning of the area — can control signs and symptoms and prevent complications. But if your condition doesn't improve, we may prescribe an antibiotic cream or ointment. In some cases, eyedrops containing antibiotics and steroids may be prescribed. If your blepharitis is linked to an underlying cause such as dandruff or rosacea, treating those conditions may alleviate the blepharitis.

Blepharitis rarely disappears completely. Even with successful treatment, relapses are common. Paying extra attention to good hygiene at those times may help bring the condition back under control.

This can be combined with laser resurfacing to further rejuvenate the area.

Floaters and Flashes

Most of us experience small specks or black dots moving around in our vision at some point in our lives. It is not uncommon to initially believe you have an insect or eye lash only to quickly find you are unable to swat it away. These are referred to as floaters and are usually harmless. However, in some cases, they can lead to bigger problems.

What is a Floater?
Floaters are actually clumps of gel inside the eye. This gel in the posterior chamber is called vitreous. As a child, it is thick and solid in consistency. As we age, portions of vitreous may liquefy or shrink, resulting in clumps or strands of gel inside the eye. These clumps then cast shadows onto the retina, resulting in black spots in the visual field.

Floaters are most often benign. However, they can lead to serious problems. The vitreous gel adheres to the retina, the blood vessels and the optic nerve inside the eye. As it clumps and pulls away from those structures, there is a possibility for the retina to be torn or for bleeding to occur. This is more common in people who are nearsighted, have undergone cataract surgery or YAG laser surgery, or who have had inflammation inside the eye.

Flashes
Flashes of light may occur during this process as well. The mechanism of clumping and pulling away of the gel from the retina can result in flashes of light due to stimulation of the retina. These flashes may also indicate a possible retinal tear. A torn retina is always considered a serious problem because it can lead to a retinal detachment where the retina comes off the back of the eye.

What do I do if I am experiencing floaters and/or flashes of light?
Contact your Eye Group of Connecticut ophthalmologist as soon as possible if you experience new floaters, sudden flashes of light, or a shadow out in the periphery of your vision that appears to be enlarging. These may indicate the presence of a retinal tear or retinal detachment. Floaters that have not resulted in retinal tears or hemorrhage are harmless and usually become less noticeable over time and require no treatment. 

Glaucoma

More than 2.2 million Americans age forty and older have glaucoma, but as many as one half may be unaware they have this potentially blinding disease, because they have no symptoms.

Glaucoma is a condition in which the optic nerve is damaged. In most cases the condition is associated with elevated pressure inside the eye and can lead to vision loss.

There are two basic types of glaucoma. They include:

Open-angle glaucoma, the most common type that occurs in approximately 90 percent of those who suffer from the disease. This condition can develop gradually and undetected for years, slowly damaging vision. In early stages of open-angle glaucoma, medicated eye drops are usually prescribed to lower the eye's pressure. If the condition worsens, a laser procedure called a trabeculoplasty is performed to lower pressure further. Laser therapy usually takes approximately 10 minutes and has achieved excellent success rates in select patients.

Angle-closure glaucoma, which is much more rapid in the onset, affects less than ten percent of glaucoma patients. Symptoms occur suddenly and are much more severe, but vision can be preserved with prompt, effective treatment. The treatment for angle-closure glaucoma, or narrow-angle glaucoma, is generally initiated with laser iridotomy to open the drainage channels of the eye.

Appointments: 
(203) 374-8182

Excessive Tearing

Excessive tearing can result from an imbalance between tear production and tear drainage. Excess tear production often results from dry eye and/or unhealthy tear film. Insufficient drainage may be from abnormal tear duct position, narrowing or obstruction along the lacrimal pathway, starting from the eyelid and ending in the nose (the nasolacrimal duct). Non-invasive in-office evaluation can localize the problem. When a blockage is present, surgical treatments ranging from widening of the tear ducts to endoscopic nasal surgery can offer improvement. 

Cataracts

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. 

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.

Cataracts are an opacity or clouding of the normally crystalline lens of the eye, caused by the natural aging process, metabolic changes, injury, various forms of radiation, toxic chemicals and certain drugs. The leading cause of vision loss among adults age 60 or older, cataracts impair vision, making everyday activities increasingly difficult. In most cases, daily activities, such as driving and reading, can be resumed almost immediately, usually within a day or two. In simple terms, a cataract is usually part of the normal aging process that changes the natural, clear lens of the eye into a cloudy, opaque structure that inhibits or diminishes the passage of light to the retina. The condition can be compared to a window that is frosted or "fogged" with steam. Treatment of cataracts today is an outpatient, surgical procedure that takes only a short time.

Symptoms:
Patients with cataracts often experience the following symptoms:

    Blurring of vision
    Glare, or sensitivity to light.
    Double vision in one eye.
    Frequent changes in eyeglass prescription.
    Difficulty in reading in low light.
    Declining night vision.
    Fading or yellowing of colors.

Detection:
Adults over the age of 50 should schedule routine eye examinations on an annual basis to determine whether cataracts or other eye disorders are present. A thorough examination by an ophthalmologist usually includes:

    A visual acuity test to measure clarity at various distances.
    Pupil dilation to examine the lens and retina for other eye problems.
    Tonometry, a standard procedure to measure fluid pressure inside the eye.

To learn more about our Cataract Surgery services please click here.

Dry Eye Syndrome

More than 10 million Americans suffer from dry eye syndrome each year. It is caused by a deficiency in the quality and/or quantity of the tear film that lubricates the surface of the eye. Your tear film is made up of three layers:

• The mucous layer coats the cornea (the eyes clear window), forming a foundation so the tear film can adhere to the eye.
• The middle, aqueous layer which is 98 percent water provides moisture and supplies oxygen and other important nutrients to the cornea.
• The outer lipid layer is an oily film that sits on the watery layer to prevent evaporation of the tears.

Tears are formed by several glands around the eye. With each blink, the eyelids spread the tears over the surface of the eye. Tears exit the ocular surface via two tiny drainage ducts located in the inner corner of the eye near the nose.

Causes of Dry Eye Syndrome
Dry eye syndrome has many causes. One of the most common reasons for dryness is simply the normal aging process. As we grow older, our bodies produce less oil (60 percent less at age 65 then at age 18). This is more pronounced in women who tend to have dryer skin than men. The oil deficiency also affects the tear film. Without enough oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea which causes irritation.

Several other factors, such as hot, dry or windy climates, high-altitude, air-conditioning and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. During these tasks, we tend to blink less, and our eyes dry out. Stopping periodically to rest and blink helps to keep the eyes more comfortable.

Contact lens wearers may also suffer dryness because soft contact lenses stay soft by absorbing your tears. If your eyes are already a little short on tears, this may cause a dry eye problem. By covering the cornea, less oxygen is able to reach the corneal surface.

In addition, certain medications can cause dehydration and lead to ocular dryness. Thyroid conditions, vitamin A deficiency, or diseases such as Parkinson’s and Sjogren’s syndrome can also cause dryness. Women frequently experience problems with dry eyes as they enter menopause due to hormonal changes.

The Symptoms
Some of the symptoms of dry eyes include:

• itching
• burning
• a foreign body sensation
• redness
• blurry vision which improves with blinking
• excess tearing or discomfort after using the eyes while reading, watching television or working on a computer

There are several methods to test for dry eyes. Your doctor should first determine the underlying cause by measuring the tear production, the evaporation rate and quality of the tear film.

Treatment
When it comes to treating dry eyes, everyone’s needs are different. Many people find relief by using artificial tears on a regular basis. Some of these products are watery and help temporarily alleviate symptoms; others are thicker and adhere to the eye longer. Avoidance of products that “whiten the eye” is important. These contain chemicals which harm the blood vessels on the surface of the eye and may lead to chronic redness.

Occluding the tear drain in the eyelid with special inserts called punctal plugs is another option. This works like closing a sink drain with a stopper. The special microscopic sized plugs help keep the tears on the surface of the eye, keeping it moist. This may be done on a temporary basis with a dissolvable collagen plug or permanently with a silicone plug.

Prescription medicated eye drop are also available and have helped many dry eye sufferers. They function by decreasing the inflammation associated with dry eyes and actually help the eye produce more tears. Several eye drops are currently being tested before approval by the FDA and may be available soon. Let us work with you to find the most appropriate treatment for the cause of your individual dry eye issues.

There are also simple lifestyle changes that can significantly improve dry eyes. Drinking a lot of water keeps the body hydrated and flushes impurities. You should also make a conscious effort to blink frequently, especially when reading, watching television and working on a computer.

Treating dry eye problems is important not only for comfort but also for the health of your eyes. If you think you have dry eyes, contact Eye Group of Connecticut to schedule an examination.

Diabetic Eye Disease

Diabetes is a very serious disease that can cause problems such as blindness, heart disease, kidney failure, and amputations. But by taking good care of yourself through diet, exercise, and special medications, you can control diabetes. And there is more good news. Diabetic eye disease, a complication of diabetes, can be treated before vision loss occurs.
All people with diabetes need to get a comprehensive dilated eye exam at least once a year.

What is diabetic eye disease?
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness. Diabetic eye disease includes:

    Diabetic retinopathy: Damage to the blood vessels in the retina.
    Cataract: Clouding of the lens of the eye.
    Glaucoma: Increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

What is the most common diabetic eye disease?
Diabetic retinopathy. This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

What are the symptoms of diabetic eye disease?
There are often no symptoms in the early stages of diabetic retinopathy. There is no pain and vision may not change until the disease becomes severe. Blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. Even in more advanced cases, the disease may progress a long way without symptoms. This symptomless progression is why regular eye examinations for people with diabetes are so important.

Who is most likely to get diabetic retinopathy?
Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40-45 percent of those with diagnosed diabetes have some degree of diabetic retinopathy.

How is diabetic retinopathy detected?
If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam, which means eye drops are used to enlarge your pupils. This dilation allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.

Can diabetic retinopathy be treated?
Yes. The eye care professionals at Eye Group of Connecticut may suggest laser surgery in which a strong light beam is aimed onto the retina. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost, which is why finding diabetic retinopathy early is the best way to prevent vision loss.

Can diabetic retinopathy be prevented?
Not totally, but your risk can be greatly reduced. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy. The study found that the group that tried to keep their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. This level of blood sugar control may not be best for everyone, including some older adults, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

How common are the other diabetic eye diseases?
If you have diabetes, you are also at risk for other diabetic eye diseases, such as cataract and glaucoma. People with diabetes develop cataract at an earlier age than people without diabetes. Cataract can usually be treated by surgery.

A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser surgery, or conventional surgery.

What research is being done?
Much research is being done to learn more about diabetic eye disease. For instance, the National Eye Institute is supporting a number of research studies in the laboratory and with patients to learn what causes diabetic retinopathy and how it can be better treated. This research should provide better ways to detect and treat diabetic eye disease and prevent blindness in more people with diabetes.

What can you do to protect your vision?
Finding and treating the disease early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. So if you have diabetes, make sure you get a comprehensive dilated eye examination at least once a year.

Remember…
Diabetes is a disease that can cause very serious health problems. If you have diabetes:

1. Know your ABCs: A1C (blood glucose), blood pressure (BP), and cholesterol numbers.
2. Take your medicines as prescribed by your doctor.
3. Monitor your blood sugar daily.
4. Reach and stay at a healthy weight.
5. Get regular physical activity.
6. Quit smoking. 

The exact cause of primary open-angle glaucoma, is unknown. However, some of the other forms of glaucoma may occur along with other abnormalities of the eye.

There are usually no symptoms at first, but as the disease progresses, a person with glaucoma may notice his or her vision gradually failing with:
• Blurred vision
• Loss of peripheral vision
• Difficulty focusing on objects
• Presence of halos around lights

Although anyone can develop glaucoma, those who are at higher risk and should have an eye exam at least every one to two years include:
• African Americans over age 40
• Individuals over age 50
• People with a family history of glaucoma
• Individuals who have experienced a serious eye injury
• People with other health conditions, such as diabetes. (Individuals with diabetes should have an exam every year)

Importance of Early Detection
There are no symptoms. You don’t feel any different. Though some individuals are more at risk than others, it can afflict anyone. It can sneak up on you and steal your most valuable asset... your eyesight. Glaucoma, undetected, can eventually lead to blindness.

In the past, ophthalmologists would suspect a problem based on certain telltale signs such as elevated intraocular pressure or a decrease in one's peripheral vision, but by then, glaucoma could already have done significant damage to eyesight. With today’s advanced technology, we have the ability to foresee potential problems well before glaucoma sets in.

Does glaucoma testing take long?
Not at all. You can be screened for glaucoma in less than 30 minutes

Does glaucoma testing hurt?
No. The tests are painless and leave no after-effects.

What if the screening shows that there is a problem?
At that point, further examination is recommended to confirm glaucoma. If the diagnosis of glaucoma is confirmed, the sooner we begin treatment, the better.

At Eye Group of Connecticut, we utilize one of the most technologically advanced pieces of ophthalmic diagnostic equipment used today. The OCT or Ocular Coherance Tomography, is a sophisticated system that can visualize the individual layers of the retina. We can now directly measure structures in the retina that are susceptible to glaucoma damage at a very early stage, before symptoms arise.

That image and analysis then becomes a part of your permanent medical record. On future visits, we can compare images, note any changes, analyze, precisely diagnose, and recommend treatment.

What are the treatment options for glaucoma?
That's the good news. There are a number of highly effective treatment options for glaucoma patients. Most patients are started on eye drops as the initial treatment. Laser therapy may be appropriate for certain forms of glaucoma. Finally, if medical or laser therapy fails to control the disease, surgical therapy may be necessary. Fortunately, with early detection, most forms of glaucoma can be successfully treated and visual loss may be halted.

Early detection and treatment is the only way to combat vision loss caused by glaucoma.
If you’ve noticed change in your vision, or if you haven’t been to the office for a while, and would like to be tested for glaucoma, contact Eye Group of Connecticut to set up an appointment today.