Georgia Eye Institute –

Dr. Shawna Strub Joins Georgia Eye Institute in Statesboro

Georgia Eye Institute (GEI) announces the addition of Dr. Shawna Strub to their Statesboro staff. Dr. Strub received her degree in optometry from Nova Southeastern University in Fort Lauderdale, Florida and joined the Georgia Eye Institute team in July 2014 working in their Glennville location. She is an active member of the Georgia Optometric Association and the American Optometric Association.

Georgia Eye Institute provides primary eye care, optical retail locations and sub-specialty eye care in 13 locations conveniently located throughout Southeast Georgia and the South Carolina Low country. The sub-specialty eye care includes cataract evaluation and management, retinal care, glaucoma management, functional cosmetic eye surgery and LASIK laser vision correction.   For more than 20 years your vision has been Georgia Eye Institute’s focus. For more information, visit gaeyeinstitute.com.

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Georgia Eye Institute –

Dr. Amy Murray Joins Georgia Eye Institute

Georgia Eye Institute (GEI) announces the addition of Dr. Amy W. Murray to their staff. Dr. Murray is a Doctor of Optometry and began seeing patients in GEI’s Glennville office on January 9^th. She received her Bachelor’s Degree from the University of Georgia in 1995, and a Doctor of Optometry Degree from Southern College of Optometry in Memphis in 1999, graduating Cum Laude. Dr. Murray is a member of the Georgia Optometric Association and the American Optometric Association.

Georgia Eye Institute provides primary eye care, optical retail locations and sub-specialty eye care in 13 locations conveniently located throughout Southeast Georgia and the South Carolina Low country. The sub-specialty eye care includes cataract evaluation and management, retinal care, glaucoma management, functional cosmetic eye surgery and LASIK laser vision correction.   For more than 20 years your vision has been Georgia Eye Institute’s focus.

For more information, visit gaeyeinstitute.com.

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What Your Eyes Can Tell You About Diabetes

Georgia Eye Institute –

What Your Eyes Can Tell You About Diabetes

November is National Diabetes Awareness Month, and the doctors at Georgia Eye Institute would like to encourage everyone to schedule an eye exam with diabetic eye screening every year just as you would your primary care physician or dentist.

Having your eyes checked annually is more common among people with glasses or contacts, but even if your eyes are not bothering you, an eye exam can determine signs of possible health problems such as diabetes. The following conditions that can be detected through diabetic eye screening.

Diabetic Retinopathy

If your eye was a camera, then the retina would be the film. The retina translates what the brain sees into images. Diabetic retinopathy occurs when the retina’s blood vessels are damaged. If left untreated, it could lead to poor vision and potentially blindness.

You could have had diabetes for years and not know it has already damaged your eyes. The best way to detect diabetic retinopathy is to have a dilated eye exam. Background retinopathy, which is the early stage of diabetic retinopathy, requires no treatment but early detection gives the best prognosis. If left untreated, diabetic retinopathy can progress to irreversible vision loss.

Maculopathy

The macula is the part of your eye that gives you detailed vision. When your retina’s blood vessels leak fluid or blood vessels grow, the macula can eventually become damaged. You should see your doctor before you have trouble reading, recognizing faces, or when figures look distorted. It is common to have diabetic maculopathy in only one eye and not know it because your healthy eye can make up for the difficulties in seeing. Laser surgery is a common treatment for diabetic maculopathy.

Other Conditions Detectable by Eye Exams

Glaucoma can affect people with or without diabetes, but those with diabetes are at higher risk. A high pressure in your eye, which in turn damages the optic nerve, causes glaucoma and vision loss. There are no symptoms.

Another diabetes-related eye complication is retinal detachment. This occurs when the retina pulls away from the blood vessels and deprives the retina of oxygen. This is a late stage of diabetic retinopathy and can lead to blindness even with expert care. Early diagnosis is best.

Protect Your Sight with an annual dilated exam.

See your eye doctor annually even if you are without symptoms. When you do experience symptoms, it may already be too late.

For more information or to schedule an eye exam in the Savannah area please contact us or visit our website.

YOUR VISION, OUR FOCUS Georgia Eye Institute

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Diabetic Retinopathy FAQs

Georgia Eye Institute –

What is diabetic retinopathy?

Long-standing diabetic disease (in Type I or Type II diabetics) can lead to changes in the back of the eye that can cause a decrease in vision. Specifically, high blood sugar causes damage to the small blood vessels in the retina (layer at the back of the eye that sense light). This damage leads to multiple changes to the retina, especially to the macula, which is responsible for central vision (Figure 1).

What are the different types?

There are two main types of diabetic retinopathy – “Non proliferative Diabetic Retinopathy” and “Proliferative Diabetic Retinopathy.” Proliferative indicates that new, abnormal blood vessels are growing inside the eye, which can lead to bleeding, retinal detachment, and high pressure (all leading to vision loss). Proliferative disease is more sever, but legal blindness can be caused by changes from non-proliferative disease.

Figure 1 – Normal Macula (the central part of the retina responsible for central vision)

Why do people lose vision from diabetic retinopathy?

Diabetes can lead to vision loss for many reasons, including:

• Swelling in the center part of the vision (Macular edema)
• Loss of blood flow to the center part of the vision (Macular ischemia)
• Bleeding into the central part of the eye (Vitreous hemorrhage)
• Detachment of the back layer of the eye from scar tissue (Retinal detachment)

How is it diagnosed?

The retina can be visualized during a routine eye exam after dilation of the pupil (Figure 3). Optical coherence tomography is a type of non-invasive imaging that allows your physician to view the macula and macular edema (if present) in cross-section (Figures 3 and 4). This is useful for following the disease over time.

Figure 3. Cross sectional image (Optical Coherence Tomography, or OCT) of a normal macula. The “dip” in the center is the very center part of the vision, or the “fovea.” This is the “20/20” portion of the vision.

Figure 5. Photograph of the retina (angiogram) that shows loss of blood flow (dark areas).

Figure 4. Cross sectional image (OCT) of a macula with diabetic macular edema. Notice the loss of the “dip” and black spaces in the retina. The retina is also thicker because of the swelling. This thickening leads to decreased vision.

How is it treated?

Treatment of diabetic retinopathy depends on the type of disease present. Good blood glucose and blood pressure control are essential in stabilizing disease.

Macular Edema
Edema that affects the center part of the vision is initially treated with medication that is injected into the eye (Figure 6). There are several medications available (Avastin, Lucentis, Eylea, Osurdex implant, steroid). For certain types of edema laser may be used. Laser can be used to destroy leaking blood vessels. A newer technology (micropulse laser) uses non-destructive energy to cause the macula to release factors that cause vessels to stop leaking.

Figure 6. After the surface of the eye is anesthetized (numbed), a small amount of medication is injected into the middle of the eye (vitreous).

Proliferative Diabetic Retinopathy
Proliferative disease (especially if associated with bleeding [vitreous hemorrhage]) is generally treated with laser (panretinal photocoagulation). Laser is used to destroy sick tissue (areas in the back of the eye with loss of blood flow) – this causes abnormal blood vessels to shrink/resolve (Figure 7).

Figure 7. Photo of the retina shows vitreous hemorrhage covering the macula (center of vision) which blurs the vision. Laser scar can be seen peripheral to the blood. This patient required vitrectomy (surgery) to remove the blood.

Vitreous Hemorrhage and Traction Retinal Detachment
Proliferative disease that is untreated will lead to bleeding and retinal detachment. The blood itself will usually not harm the eye and will often resolve spontaneously. If the blood does not resolve or if there is retinal detachment that treats the macula (center part of the vision), surgery (vitrectomy) is necessary,. This surgery is performed in an operating room. Small instruments are introduced through micro-cannulas. One instrument provides light and the other instruments to remove blood and scar tissue and place additional laser (Figure 8).

When should a diabetic have a complete eye exam?

A type I diabetic should have their eyes examined within 3-5 years after diagnosis and yearly thereafter if no eye disease is found. A type II diabetic should have their eyes examined at the time of diagnosis and yearly thereafter if no eye disease is found. If diabetic retinopathy is present, follow-up and treatment depends on the severity of the disease or any other issues you may have.

Figure 8. Removal of the vitreous and blood from inside the eye using the “vitrector” (left side of picture). A small instrument (right side of the picture) provides the light to see inside the eye. This is done under a microscope.

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Cataract Awareness Month

Georgia Eye Institute –

June is Cataract Awareness Month

Cataracts are the leading cause of blindness in the United States, according to Prevent Blindness America, which declared June as Cataract Awareness Month. Cataracts affect more than 24 million Americans 40 and older. More than half of all Americans have cataracts by the time they are 80 years old, but cataracts can also appear in young adults or even newborns. Prevent Blindness America (PBA) estimates that by 2020, 30 million Americans will have cataracts. Unlike many other causes of vision loss, vision loss resulting from cataracts can be managed or significantly restored. There is no better time than Cataract Awareness Month to learn the symptoms and risk factors of cataracts, and to schedule an appointment with your eye care professional.

What Causes Cataracts?

There are several risk factors that may lead to cataracts, including:

• Heredity–family history of cataracts
• Inflammation of the eye
• Certain diseases such as diabetes or metabolic disorders, which can increase your risk of developing cataracts
• Intense heat or long-term exposure to UV rays from the sun
• German measles while pregnant can cause the newborn to be born with cataracts
• Long-term steroid use
• Eye injury, also known as traumatic cataracts
• Hypertension
• Smoking or alcohol use
• High myopia, or nearsightedness
• Medications such as statin medicines used to reduce cholesterol, or hormone replacement therapy

Cataracts may develop in one eye, particularly traumatic cataracts. More often, they develop in both lenses. Like myopia or astigmatism, they don’t always advance in the same way or at the same rate. One eye can have greater vision loss than the other as cataracts develop.

How does Cataracts Affect Vision?

The lens of the eye contains mostly water and protein. The protein in the eye is normally arranged in a way that keeps the lens clear, allowing light to pass through it. Cataracts occur when proteins in the lens of the eye begin to clump up.

The lens of the eye acts as a camera lens. It focuses light on the retina for clear vision. It also adjusts the eye’s focus, helping us to see things both close and far away.

There are several types of cataracts, and they are categorized by where they form and what causes them.

• A subcapsular cataract forms at the back of the lens. This type is more common in people with diabetes or those taking high doses of steroids. This form of cataract will interfere with reading and reduce your vision in bright light and can cause glare or halos around lights at night.
• A nuclear cataract forms in the nucleus (central zone) of the lens. These cataracts most often occur because of aging. This cataract will turn your lenses brown and interfere with your ability to detect color.
• A cortical cataract forms white, wedge-like opacities that start at the edge of the lens and work their way to the center. They look like wagon spokes and form in the lens cortex. This is the part of the lens that surrounds the central nucleus. These types of cataracts affect your peripheral vision and causes problems with glare.

Since cataracts tend to form over a long period of time, you may not know you have a cataract for years. If left undiagnosed, your vision may eventually acquire a brownish shade. Here, the cataract doesn’t affect your vision. As cataracts progresses, you may lose the ability to identify blues and purples. Your vision will start to dull or blur, and you will develop poor night vision, and halos may appear around lights, headlights, or lamplights. Having to change prescriptions in your eyeglasses or contacts regularly can also be a sign of a developing cataract.

How are Cataracts Detected?

A comprehensive eye exam includes testing for cataracts and other disorders of the eye such as macular degeneration and glaucoma.

You can expect:

• A review of your personal and family health history including any history of eye problems.
• A visual acuity test to determine how well you see at various distances.
• A dilated eye exam, where drops are placed in your eyes to dilate your pupils. Your retinas and optic nerves will be examined for signs of damage and other issues.
• Tonometry will measure the pressure inside the eyes. Numbing drops might be applied for this test.

If your doctor detects signs of a cataract, they might do additional testing to see whether your eyes are sensitive to light or if your peripheral vision (side vision) is affected.

If you are Diagnosed with Cataracts

There are several treatment options available for cataracts, depending on the severity. Your eye care professional will probably recommend new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures prove unsuccessful, the only option left is surgery. Some people can go years before needing surgery.

When the Treatment is Surgery

Traditional cataract surgery typically involves using a blade to remove the clouded lens and replacing it with an artificial one. It is usually only recommended when vision loss interferes with your daily activities, but it can also be recommended if it interferes with the eye care professional’s ability to examine or treat the rest of your eye. Laser cataract surgery provides a level of safety and comfort similar to bladeless LASIK where a femtosecond laser is used to make to make the incision.

Cataract surgery can slightly increase your risk of retinal detachment especially if you have other eye conditions which can also increase your risk. Talk with your eye care professional about the pros and cons of any options you are considering.

That said, cataract surgery is one of the most commonly performed surgeries, and is usually an outpatient procedure. More than 3 million Americans undergo cataract surgery every year, according to PBA. Nearly nine out of ten people who have cataract surgery regain very good vision, between 20/20 and 20/40.

It is important to speak with your doctor about vision issues you might be having, and to make informed decisions about the care and protection of your eyes. Your eye care professional should be able to sit down with you and discuss all your risk factors and help you weigh those against the benefits of the treatment options offered. If you are 65 or older, it’s important to get a complete eye exam every one or two years, even if you have no problems seeing. Schedule your appointment during Cataract Awareness Month and be proactive about your eye health.

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Georgia Eye Institute –

6 Tips to Maintain Healthy Vision

#1 – Wear Sunglasses

You probably know the sun can damage your skin… but did you realize the risk the sun poses on the health of your eyes? While sunglasses are a great aesthetic accessory, protection from UV Rays is ultimately what they’re used for.

Be careful to avoid these harmful side effects from the sun:

• Cataracts, which is when the lens of the eyes becomes cloudy, resulting in blurred vision. Approximately 20% of all cases are a result of UV exposure.
• Macular Degeneration happens when the retina is damaged and destroys central vision. This is the leading cause of blindness.
• Pterygium is a growth of tissue on the white part of the surface of your eye that affects the curve of your eyeball. The result is astigmatism.

When purchasing sunglasses look for something that blocks almost 100% of UVB and UVA radiation.

#2 – Quit Smoking

Did you know smoking can be harmful to your eyes? Sight -related problems are rarely discussed, so here are a few reasons that might help you kick the habit:

• Studies show that smokers are at three times the risk for developing AMD, and female smokers aged 80 plus are over 5.5 times likely to acquire AMD than those that don’t smoke and are the same age.
• Smoking doubles the risk of diabetes. Smoking is also a risk factor for progression of diabetic retinopathy, and hypertension.
• Smokers show higher rates of blindness and other issues in old age.

#3 – Annual Eye Exams Are Necessary

Recent studies have found that 25% of adults have not had their eyes checked in the last two years. Studies also show that 25% of all people are unaware that a simple eye exam can prevent blindness. If you’ve had laser vision surgery or are naturally blessed with good vision, it is still recommended that you have regular eye exams, preferably annually (after age 40).

“Vision tests” are not the same as having a complete eye exam. A thorough eye exam performed by an optometrist or ophthalmologist can detect potentially harmful diseases, vision disorders, and issues with the muscles in your eyes. If things begin to look blurry or you have trouble seeing objects far or near, this is an indication that you should have your eyes checked.

#4 – Healthy Eating for Healthy Vision

There is a strong connection between food and one’s overall health. It has become apparent that having a healthy diet rich in vitamins and minerals provides long-term protection for your vision. Physicians tell us, “One of the best things you can do for your eyes is to eat a balanced diet high in fruits and vegetables, but also low in saturated fats and sugar.

#6 – Ensure the health of your Eyes by Washing Your Hands

The number of times you wash your hands daily can prevent the spread of infectious diseases, according to the Centers for Disease Control. By washing your hands frequently, you prevent the collection of dirt and germs that may be easily transferred to the eyes. This is caused by we touch this area subconsciously throughout the day. Not only will it reduce the chances of getting sick, it also helps control the spread of bacteria and viruses that are responsible for causing as-conjunctivitis (pinkeye) as well as corneal ulcers.

A great habit to practice is washing your hands before you eat or prepare food, before you treat injuries, before using any type of dispensing machine, and before you take out or put in contact lenses. An important instance where washing your hands should be your number one priority is before you get something in your eye or eyelash.

Some quick facts to digest when it comes to the protection of your eyes via washing your hands:

• Half of all people fail to wash their hands after sneezing or coughing.
• Over half of all men and almost one fourth of women doesn’t wash their hands after using restroom facilities.
• Over one third of all people don’t think it is necessary to wash their hands before a meal.
• Left-handed people tend to wash their right hand more thoroughly than they’re left and conversely for right handed people.

We hope these tips help you in your quest for top-notch vision! For more information please visit our Homepage.

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Cataract Newsletter

Georgia Eye Institute –

Cataract Surgery Risks and Benefits

Cataract surgery has changed over the past 20 years from large incisions with long recovery times to our current surgery with a 2.4mm incision, self sealing wound, and possible expectations of refractive benefits where glasses are not required for distance nor near. Some of the greatest difficulties with cataract surgery involve managing reasonable expectations.

This letter will review cataract surgery and its risks and benefits. It will focus on the new refractive options that are available because of new lens designs. Lastly, it will review unexpected benefits about glaucoma.

Cataract surgery involves the removal of a cloudy lens from the center of the eye and its replacement with a thin plastic lens that is designed to focus the light on the retina. The normal lens is optically clear but as we age, and occasionally in association trauma or illness, the lens becomes cloudy and discolored. It is no longer able to focus the light but rather causes the light to amplify or scatter in a random manner, what you might describe as glare or blurred vision. If these changes interfere with your daily activities and quality of life, it is reasonable to consider surgery. Your doctor will also consider other factors, beyond the scope of this letter, when considering your cataract.

While cataract surgery is one of the most successful and predictable surgeries, risks are still present. To each patient it remains a major surgery as there is the potential for vision loss and rarely actual loss of the eye from infection, bleeding or retinal detachment.

The excitement of cataract surgery comes from the refinements in instruments that allow a very small self sealing wound and the precise calculation of a monofocal lens implant that minimizes the need for glasses after surgery. Often, the residual refractive error, or need for glasses, is not significant and the patient is content with only reading glasses.

The special lens is also available to treat most astigmatism. These toric lenses are aligned with your eye to treat the moderate corneal irregular curvature that is not treated by a standard lens. The higher level of premium lens implant is a multifocal lens that is designed to minimize the need for distance and near vision glasses. There are multiple brands that utilize different technologies, but the goal is to have some light focused for near and some for far. This may limit contrast sensitivity and can be associated with a glare but for many patients, the benefits far exceed these issues. Not every patient is a candidate for the toric or the multifocal implant and for that reason, Medicare allows an out of pocket charge for the extra evaluation and services. Patients with dry eyes or other surface abnormalities do not tolerate these lenses well, and some consider macular degeneration to be a relative contraindication. Your doctor will take these factors into consideration if you are considering a premium lens implant.

Recent studies have highlighted other benefits of cataract surgery.

The Ocular Hypertension Treatment Study reported on the benefits of cataract surgery in patients with ocular hypertension in September 2012. The report had a better design and confirmed what other studies had reported, a reduction in postoperative intraocular pressure. There was an average 16.5% reduction in IOP and there was a greater reduction in eyes with the highest preoperative pressure. A lower intraocular pressure limits the potential for glaucoma damage and in some patients may make glaucoma drop therapy no longer necessary. This can be a considerable financial saving given the price of glaucoma medications.

In July 2012, a new study published in The Journal of the American Medical Association examined the incidence of hip fractures in the year after cataract surgery. The study showed 16% fewer hip fractures in the year after surgery. Interestingly, the patients between the ages of 65 and 69 had a slightly higher rate of hip fracture but the patients ages 80 to 84 experienced a 28% reduction in hip fractures compared to those Medicare beneficiaries who did not have cataract surgery.

Other studies have shown benefits in mental health and overall quality of life after cataract surgery. It is a very exciting time in ophthalmology and cataract care. It is amazing to think of the distance we have covered in the last 20 years. While all surgeries carry some risk, there is a lot more to be excited about than feared when you are told, “ You have cataracts and we need to consider surgery to make you see better.”

For more information please visit our Home Page.

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