Arizona Eye Health Awareness

Questions and answers regarding GLAUCOMA

1. What is Glaucoma?

Glaucoma is a disease in which the Optic nerve is damaged causing progressive and irreversible loss of vision. The Optic nerve is what connects to the eye to the vision centers in the brain.

2. Are there different types of glaucoma?

There can be many causes of glaucoma, but the underlying common thread is irreversible damage to the optic nerve.  The two most common types of glaucoma are open angle glaucoma and angle closure glaucoma.

Open angle glaucoma accounts for over 90% of cases.  Individuals with open angle glaucoma usually have no symptoms until the end stages of the disease, thus, it has been referred to as the “sneak thief of sight”.

Angle closure glaucoma occurs in less than 10% of cases.   Angle closure glaucoma does have symptoms which include sudden onset of hazy vision, rainbows around lights, nausea, vomiting, headache, and pain around the eyes.  When an individual is in angle closure, it is considered a sight threatening emergency as without proper treatment, sight loss can occur rapidly.

3. How common is Glaucoma?

Glaucoma is the 2nd leading cause of blindness in the world

• 1 out of every 200 people below the age of 50 have it

• 2 out of every 100 people age 40 to 50 have it.

• 1 out of  every 10 people over the age of 80 have it

• 4 million Americans have glaucoma but only ½ know it

• It can occur at any age, even infants

4.  How does it affect your sight?

Glaucoma affects vision from the outside in, meaning peripheral vision is lost first.   In the latter stages, central vision is affected which can lead to blindness.

5.  What are the risk factors?

High intraocular pressure (IOP) in the biggest risk factor, although many cases of glaucoma may not have overly high readings when measured.  This may be due to diurnal fluctuation (most of us have our highest IOP when sleeping) or in many cases, normal pressure glaucoma may be the culprit.  Family history is another risk factor.

6.  How can you tell if you have Glaucoma?

Seeing your eye doctor for an eye examination on a yearly basis is the best way to maintain your vision.  Diseases such as glaucoma have no symptoms in early stages when most amenable to treatment.  In open angle glaucoma, 50 % or more of vision may be lost before becoming noticeable.  Vision loss from glaucoma is permanent.

7. What tests are performed to check for Glaucoma

While IOP testing is considered a standard part of any eye exam, examination of the optic nerves often provides more information when screening for glaucoma. If there is suspicion of glaucoma, more tests may be ordered.  These include:

• Visual field testing - We lose our peripheral vision first with glaucoma so a detailed analysis of our field of vision checks for functional optic nerve damage.  This is a very detailed test that can determine if small patches of our peripheral vision are fading long before an individual would notice any change.

• Digital imaging of the optic nerve and retinal nerve fiber layer- The optic nerve contains over 1.3 million individual nerve fibers.  A scanning test providing a three-dimensional digital image of the nerve and its associated nerve fiber layer of the retina can tell if damage has occurred.

• Photography of the optic nerve – this documents the current appearance for future comparison

• Corneal thickness measurement – Pachymetry measures the thickness of the central cornea. Individuals with a thinner than average central cornea are at a greater risk of vision loss from glaucoma.

• Drainage angle assessment – gonioscopy allows for viewing the structures responsible for fluid flow from the eye.  If the drainage angle narrows, IOP can increase.  If the angle narrows to the point of closure, it can cause an angle closure attack as described above.

8. Are there treatments for Glaucoma? Is it curable?

In the majority of cases glaucoma is treatable with medication in the form of  eye drops.  In  fact it is rare to see vision lost from glaucoma as medications have advanced greatly over  the past 10-15 years.  However, if glaucoma goes undiagnosed, particularly in those that  do not receive regular eye exams, vision loss can occur which is unfortunate as it is  preventable.  Advanced cases of glaucoma that do not respond to medical therapy my  require surgery to maintain sight.  Glaucoma is highly treatable, it is not curable.

See Dr. Gong and Dr. Vogl on ABC15! Click on the link below and find out more information about Optometric Vision Therapy!

http://www.abc15.com/dpp/lifestyle/sonoran_living/sl_sponsors/optometric-vision-therapy

What is Optometric Vision Therapy?

Optometric Vision Therapy is an individual program of treatment designed to improve visual function and performance. Its proven results are derived from vision based neurological and neuromuscular conditioning. It is a treatment modality for disorders including, but not limited to:

Strabismus (eye turns in or out)
Amblyopia (lazy eye)
Vergence Dysfunction (inability to align the eyes in or out together)
Ocular Motor Dysfunction (eye tracking and aiming skills)
Accommodative Disorders (focusing problems)
Visual Information Processing Disorders
Visual Sensory and Motor Integration
Visual Rehabilitation after traumatic brain injury

One can learn to use vision more effectively with lenses, prisms, filters, electronic targets with timing mechanism, optical instruments, and specialized medical equipment for feedback to effectively enable visual skills to become automatic in the patient.

The main benefits of optometric vision therapy include improved visual information processing and improved ability to sustain visual function over time. The American Optometric Association found that 35-40% of all children with learning disabilities have visual problems. At least 20% of  children with learning disabilities have significant visual processing problems and 15-20% of them lack visual efficiency skills.

Vision Therapy relieves eye strain, visually induced headaches, inability to concentrate with near visual tasks and reduces loss of place, reversals and complaints of moving print  when reading or writing. Optometric vision therapy also improves visual development and is part of a multi disciplinary effort following stroke or head injury.

Signs and symptoms to look for when suspecting a vision problem:

Physical signs or symptoms:
- Frequent eye strain or visually-related headaches
- Blurring at distance or near
- Avoidance of close visually demanding tasks
- Poor depth perception
- Misalignment of the eyes
- Tendency to cover or close one eye
- Double vision
- Poor eye-hand coordination
- Difficulty tracking
- Dizziness

Performance problems:
-   Frequent loss of place when reading
-   Poor reading comprehension
-   Difficulty changing focus from distance to near and vice versa.
-   Poor posture with near visual tasks
-   Poor handwriting
-   Letter or word reversals
-   Difficulty judging sizes and shapes
-   Can respond orally but cannot translate information to paper.

ADD/ADHD and Vision Problems:

Vision problems that are untreated can elicit the same symptoms that are commonly associated with ADHD. Recent research at the Children’s Eye Center at the University of San Diego showed that children with Convergence Insufficiency (inability to align the eyes inward for prolonged periods) are three times as likely to be diagnosed with ADHD than children without the disorder. Doctor Granet commented, “We don’t know if Convergence Insufficiency makes ADHD worse or if Convergence Insufficiency is misdiagnosed as ADHD. What we do know is more research must be done on the subject and that patients diagnosed with ADHD should also be evaluated for Convergence Insufficiency and treated accordingly.

25% of children may have a learning related vision problem. One study showed that 13% of children between 9 and 13 years of age suffer from moderate to marked Convergence Insufficiency.

What are learning-related visual problems that can have a significant impact on learning?

- Poor eye tracking skills
- Poor eye teaming skills
- Poor ability to simultaneously blend images from both eyes into one.
- Poor focusing skills
- Poor eye hand coordination
- Poor visual memory, visual form perception and visualization

Are 3-D movies or video games harmful?

BBC News (9/30/11) reported a study of the impact of 3D in the classroom has found that it improves test results by an average of 17%. The research conducted in 7 schools across Europe found that the 3D helped children concentrate more.

In order to see in 3D, one must align and focus both eyes on an object and then combine the visual images into one clear and single 3 dimensional image. The ability to see in 3D is more sensitive than the standard eye chart that we have used for the past 150 years because 3D viewing requires both eyes to work together as they converge, focus, and track the 3D image. For the 1 in 4 children that may have underlying issues, lack of 3D perception can help identify these undetected problems.

The American Optometric Association recommends knowing the 3 D’s of stereoscopic 3D viewing:

“Discomfort:
- Since 3D viewing is based on the eyes converging in front of or beyond the screen, viewing 3D images can potentially create eye strain and headaches. Consumers can reduce the conflict by sitting at a greater distance from the screen. 
Dizziness:
- 3D technology can exaggerate visual motion hypersensitivity (VMH) which can cause motion sickness and vergence accommodation conflict, causing consumers to feel dizzy or nauseous during or after viewing 3D content.
Lack of Depth:
- A viewer can lack binocular vision and won’t see 3D. While this doesn’t pose and problem viewing the screen it serves as a “vision screening” that something is abnormal with the viewer’s binocular vision.”
The American Optometric Association recommends seeing a doctor of Optometry for further evaluation if consumers answer yes to any of the following questions:

- Is the 3D viewing experience not as vivid as it is for others watching the same picture?
- Do you experience eyestrain or headaches during or after viewing?
- Do you feel nauseated or dizzy during or after viewing?

Resolving Eye Fatigue

I. What causes Eye Fatigue?

A. Uncorrected refractive error

B. Near Viewing tasks

1. Computer use greater than 2 hours
2. Paperwork
3. Crafts and hobbies

II. What are the Symptoms of Eyestrain?

A. Momentary blur
B. Trouble keeping place while reading
C. Becoming sleepy while doing reading or near work
D. Words moving on the page
E. Dry, gritty sandy feeling
F. Burning or stinging and redness while doing near work
G. Headaches that start in the frontal or temporal region and migrate to the occipital region

III. How do near visual tasks cause eyestrain?

A. Our eyes work together to form a 3D image.  When looking at a distance object our eyes are straight ahead, often the natural position of rest for the eyes.  When looking up close the eyes must converge to keep the object single and clear.  With time the eyes will naturally begin to drift outward, thus causing blur.  The muscles must constantly refocus the image.  This constant refocusing burdens the system and causes the eyes to fatigue
B. Eye alignment can make this burden even larger leading to increased symptoms  (2009 Study from Illinois College of Optometry)

IV. Self-test

Looking at a distance target, cover your right eye with your right hand.  Now switch your hand to your other eye, keeping one eye covered at all times.  If the stationary target you are looking at moves in the same direction as your hand, and you have headaches, eye alignment is a likely cause.

V. Relief of Symptoms

A. Special testing needs to be performed in the office to determine both refractive error and eye alignment.
B. Refractive error is corrected to improve near acuity and  prism may be used to correct eye alignment.
C. 20/20 rule of computer use.  Every 20 minutes of near work take a 20 second break by looking at a distant target.

VI. Conclusion

Many patients do not equate their symptoms of Headache to their eyes.  Proper eye examination and treatment can help relieve these symptoms.  Call 1-877-867-9268 to find the nearest location to schedule an appointment with an Eye Health Doctor.

A recent study conducted across five European countries showed that 50 percent of women in their 40s felt that contact lenses would have a positive effect on their quality of life.  41 percent said they would try contact lenses if their eye care practitioner recommended them and 22 percent said that contact lenses would be their first choice of vision correction.

They say 40 is the new 30, do you want to wear reading glasses?

It is inevitable; all of us start to lose our focusing ability around age 40. Whether you have never worn glasses or currently wear contact lenses, putting on reading glasses can be a blow to our perception of youth. However, with technological improvements in optical design, multifocal contact lenses can provide clear vision far, near, and everywhere in between. 

Simultaneous Vision

Multifocal contact lenses work on the principle of simultaneous vision. Images at all ranges are focused for our eyes. Our visual processing then takes over to determine which image is clearest for the object we are looking at.

Are multifocal contact lenses right for me?

If you require distance and near vision correction, or just need reading glasses, multifocal contact lenses may be of benefit.

What should I expect from multifocal contact lenses?

The goal is to enable one to have functional vision without the use of glasses.  For example, the ability to read your cell phone as well as street signs, or read a document while attending a presentation.

Will I still need reading glasses?

While many who wear multifocal contact lenses will not require any other correction, for some, mild powered reading glasses may be necessary in low illumination or for very fine print.

Can I wear contacts lenses if my eyes are dry?

Possibly.  New lens materials transmit high levels of oxygen to the eye's surface while maintaining wetability. Luckily, demonstration lenses are avaialble that allow one to "live with" lenses for a trial period to determine if acceptable comfort can be achieved.

What if I have an astigmatism?

Yes, there are specialized multifocal lenses that will correct for astigmatism.

Multifocal contacts lenses are one the newest advancements in primary eye care.  Weather your reading or driving, you can enjoy crisp clear vision with todays technology.  Please contact one of the convenient locations of our Independant Primary Eye Care Physicians to schedule your multifocal contact lens evaluation.