Basics of Glaucoma

More than 3 million people in the U.S. have glaucoma. Glaucoma is a complicated eye disease in which the optic nerve gets damaged due to high eye pressure. If it’s not treated properly or is ignored glaucoma can lead to progressive, irreversible loss of vision. Glaucoma is the second most common cause of blindness in the world today.

Glaucoma is incurable, but it can be managed through drug therapies. However, when medication fails to lower the eye pressure, or causes severe side effects, surgery is recommended. In some cases, doctors might recommend surgery as the first course of treatment.

Glaucoma surgery is typically categorized two ways: laser surgery; and incisional surgery. Your ophthalmologist will take into consideration the type of glaucoma you have, its severity, and your general eye health before deciding which type of surgery is most suitable for your condition.

Surgery can stabilize vision by lowering the eye pressure, but it cannot cure glaucoma or reverse any loss of vision which has already occurred.

The following is a brief overview of glaucoma laser surgery and incisional surgery, and what to expect during recovery.

Laser Surgery

Doctors ordinarily recommend laser surgery unless pressure in the eye is extremely high or the damage to the optic nerve is severe.

During this procedure, the eye surgeon improves the drainage system of the eye using a highly focused beam of light. The patient feels no pain during the surgery, as the eye is numbed. A special lens is held to the eye and the laser beam is directed into it.

Immediately after the surgery you may experience blurry vision and some irritation of the eye. Many patients are able to resume normal activities within a day or two after the surgery. However, most doctors recommend patients not lift anything heavy, refrain for any strenuous activity, or do any significant bending for at least two weeks.

Incisional Surgery

Your eye doctor may recommend incisional surgery for any of the following three conditions:

• Extremely high eye pressure
• A severely damaged optic nerve
• Failure to lower eye pressure with laser surgery

During incisional surgery, a small drainage hole is made in the sclera to allow intraocular fluid to bypass the clogged drainage canals and allow the fluid flow from the eye, helping reduce eye pressure.

Shortly after incisional surgery, patients may experience irritation, redness, and increased watering or tearing. Recovery time for incisional surgery is typically longer as compared to laser surgery. Most patients recover in two to four weeks. In some cases, however, recovery time might be longer – up to 2 months.

For more information please call 912.354.4800.

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Summer Eye Safety

Summertime means spending more time outdoors, at the beach or pool, and more time in the sun. Most people associate more time in the sun with applying sunscreen to protect the skin, but it’s equally as important to protect your eyes, as exposure to harmful sunlight can lead in an increased risk for eye diseases, including cataract, growths on the eye, and even cancer.

In addition to benefitting your vision health, taking precautionary measures to protect your eyes can also make summertime more fun. Follow these simple tips from Georgia Eye Institute and you and your family can enjoy the summer sun safely while protecting your vision.

Sunglasses are more than just a great accessory

Sunglasses not only look great, they can help protect your eyes from harmful UV rays and reduce the chances of burning your corneas. Sunglasses should fit snugly around your eyes and offer protection on the side of the eyes as well. Keep in mind that sunlight is strongest mid-day, at higher altitudes, and when reflected off water or sand.

Choose sunglasses labeled “100% UV protection,” and only use glasses that block both UVA and UVB rays. It’s important to note that even if you wear UV blocking contact lenses, you still need to wear proper sunglasses to fully protect your eyes.

For maximum protection, wear a hat along with your sunglasses. Broad-brimmed hats are best.

Wear eye protection

Warm, sunny weather means it’s the perfect time for yardwork or to make a dent in your long list of home improvement projects. While doing work on your yard or home, it is extremely important to protect your eyes from dust, dirt and flying debris. Safety goggles can be purchased at home improvement stores, and do a better job of protecting your eyes than sunglasses.

Swim with goggles

Nothing says summer like a day at the beach or the pool. The chlorine in most swimming pools can be particularly irritating to the eyes, causing minor infections and dryness. Salt water from the ocean, rivers other natural bodies of water also contain contaminants that may be harmful to eyes. Wear swim goggles when you’re in the water to protect your eyes from irritants and floating particles that could damage your eyes.

Don’t forget the little ones

While it’s best to keep children out of direct sunlight during the middle of the day, they should wear sunglasses and hats to protect their eyes whenever they’re in the sun, and goggles when they’re swimming.

Eat right for your sight

Nutrition plays an important role in preventing conditions such as cataracts and macular degeneration. A healthy diet of summer foods like strawberries, tomatoes, avocadoes and peppers can help protect your eyes from many common eye conditions. Vitamins C, E and zinc have been shown to slow the aging process in eyes.

Drinking plenty of water can also help keep your eyes healthy. During summer months, it’s easier to become dehydrated, which can cause vision problems. Drink plenty of water to help keep your eyes healthy.

Year-round care

Eyes can be damaged by the sun – even through clouds and haze- any time of year so be sure to give your eyes the same protection year ‘round.

In addition to protecting your eyes in summer, annual visits for your eyes are important and beneficial for your overall health. A thorough eye exam – which is not the same as having a “vision test” – performed by an optometrist or ophthalmologist can detect potentially harmful diseases like diabetes, cardiovascular disease, thyroid disorders and cancers, vision disorders, and issues with the muscles in your eyes.

Georgia Eye Institute provides leading edge primary eye care, corrective eye surgery, ophthalmic care, and surgical eye care at 13 area offices. For more than 20 years the pioneering surgeons and staff at GEI have set new standards for outpatient cataract surgery and lens implantation, offers advanced retinal care for diabetic eye disease, LASIK laser vision correction, glaucoma management, treatment for macular degeneration and corneal disease, oculoplastic surgery,and optometry. For more information, visit gaeyeinstitute.com.

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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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