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Forms of Macular Degeneration

There are two forms of macular degeneration, dry (non-neovascular) or wet (neovascular). The term neovascular refers to the growth of new blood vessels.

Dry AMD (non-neovascular)

Dry AMD is the most common form of the disease, making up about 85%-90% of all cases of AMD. It is characterized by blurred central vision or blind spots, as the macula begins to deteriorate. Dry AMD is an early stage of the disease and is less severe than the wet form,.

Dry AMD occurs when the aging tissues of the macula begin to thin out and break down. Tiny pieces of white or yellowish protein called drusen begin to appear, which are thought to be deposits from the macular tissue as it deteriorates. The appearance of these drusen are often what leads to a diagnosis of AMD during an eye exam.

With dry AMD vision loss happens gradually, however, the dry form can progress to wet AMD rapidly. There is currently no cure for dry AMD, however there is research that shows that some people can benefit from supplemental vitamin therapy including antioxidants, lutein and zeaxanthin.

Wet AMD (neovascular)

Wet AMD is less common occurring in only about 10 percent of those with AMD. AMD is classified as Wet AMD when abnormal blood vessels begin to grow under the retina and leak fluid and blood into the macula, resulting in blind spots and a loss of central vision. Wet AMD can cause more damage to vision and permanent scarring if not treated quickly, so any sudden blur in vision should be assessed immediately, especially if one is aware that they have AMD. Usually vision loss happens faster and is more noticeable than in dry AMD so the quicker it is treated, the more vision you can preserve.

Eye Allergies

Along with congestion, runny nose, coughing, sneezing, headaches and difficulty breathing, individuals with allergies often suffer from eye allergies or allergic conjunctivitis resulting in red, watery, itchy and sometimes swollen eyes. Just as irritants cause an allergic response in your nasal and respiratory system, your eyes also react with an oversensitive immune response, triggered by an environmental substance that most people’s immune systems ignore. Most individuals with allergies also suffer from eye allergies which affect millions of North Americans, particularly with seasonal allergic conjunctivitis (SAC) which is common during the spring, summer and fall.

What Causes An Eye Allergy?

Eye allergies, or any allergies for that matter, occur when the immune system is hypersensitized to a stimulus in the environment that comes into contact with the eye. The allergen stimulates the antibodies in the cells of your eyes to respond by releasing histamine and other chemicals that cause the eyes and surrounding tissue to become inflamed, red, watery, burning and itchy.

Eye allergens can include:

  • Airborne substances found in nature such as pollen from flowers, grass or trees.
  • Indoor allergens such as pet dander, dust or mold.
  • Irritants such as cosmetics, chemicals, cigarette smoke, or perfume.

Tips for Coping With Eye Allergies

Allergies can go from mildly uncomfortable to debilitating. Knowing how to alleviate symptoms and reduce exposure can greatly improve your comfort and quality of life, particularly during allergy season which can last from April until October.

To reduce exposure to allergens:

  1. Stay indoors and keep windows closed when pollen counts are high, especially in the mid-morning and early evening.
  2. Wear sunglasses outside to protect your eyes, not only from UV rays, but also from airborne allergens.
  3. Avoid rubbing your eyes, this can intensify symptoms and increase irritation. When the eyes get itchy, it is difficult not to rub and scratch them. However, rubbing the eyes can aggravate the allergic cascade response, making them more swollen, red, and uncomfortable.
  4. Check and regularly clean your air conditioning filters.
  5. Keep pets outdoors if you have pet allergies and wash your hands after petting an animal.
  6. Use dust-mite-proof covers on bedding and pillows and wash linens frequently.
  7. Clean surfaces with a damp cloth rather than dusting or dry sweeping.
  8. Remove any mold in your home.
  9. Reducing contact lens wear during allergy season or switch to daily disposable contact lenses.

Treatment for the uncomfortable symptoms of allergic conjunctivitis include over-the-counter and prescription drops and medications. It is best to know the source of the allergy reaction to avoid symptoms. Often people wait until the allergy response is more severe to take allergy medication, but most allergy medications work best when taken just prior to being exposed to the allergen. Consult your eye doctor about your symptoms and which treatment is best for you.

Non-prescription medications include:

  • Artificial tears (to reduce dryness)
  • Decongestant eyedrops
  • Oral antihistamines

Prescription medications include eyedrops such as antihistamines, mast-cell stabilizers, or stronger decongestants as well as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.

Immunotherapy which are allergy injections given by an allergist are sometimes also helpful to assist your body in building up immunity to the allergens that elicit the allergic response.

If no allergy medicine is on hand, even cool compresses and artificial tears can help alleviate symptoms.

Finding the right treatment for your allergies can make all the difference in your quality of life, particularly during the time of year when most of us like to enjoy the outdoors.

Symptoms & Risk Factors of Macular Degeneration

Macular Degeneration can cause low vision and debilitating vision loss, even blindness if not diagnosed and treated in the early stages. Because the disease often has no obvious symptoms early on, it is critical to have regular comprehensive eye exams, particularly if you are at risk.

Symptoms of AMD

Macular degeneration is a disease in which the macula slowly breaks down, resulting in a gradual progressive vision loss, at least in its’ early stages. Frequently there are no symptoms and the disease is only diagnosed when a doctor detects signs such as a thinning macula or the presence of drusen in a comprehensive eye examination. Early vision loss can include blurry, cloudy or distorted central vision or dark spots in your central field of view. With advanced stages, vision loss can be severe and sudden with larger blind spots and total loss of central vision.

Risk Factors for Macular Degeneration

Age is the most prominent risk factor for AMD, as the disease is most common in individuals over the age of 60 (although it can happen in younger individuals as well). Other risk factors can increase your chances of developing the disease such as:

  • Genetics and Family History: Research shows that there are actually almost 20 genes that have been linked to AMD, and they suspect that there are many more genetic factors to be discovered. Family history greatly increases your chances of developing AMD.
  • Race: Caucasians are more likely to get AMD than Hispanics or African-Americans.
  • Smoking: Cigarette smoking can double your likelihood of developing AMD.
  • Lifestyle: Research shows that UV exposure, poor nutrition, high blood pressure, obesity and a sedentary lifestyle can also be contributing factors.
  • Gender: Females have a higher incidence of AMD than males.
  • Medications: Certain medications may increase the chances of developing AMD.

To reduce your risks of developing AMD it is recommended to make healthy choices such as:

    • Regular eye exams; once a year especially if you are 50 or over.
    • Stop smoking.
    • Know your family history and inform your eye doctor.

 

  • Proper nutrition and regular exercise: Research indicates that a healthy diet rich in “Eyefoods” with key nutrients for the eyes such as orange peppers, kale and spinach as well as regular exercise may reduce your risks or slow the progression of AMD.
  • Maintain healthy cholesterol levels and blood pressure.
  • Dietary supplements: Studies by the National Eye Institute called AREDs and ARED2 indicated that a high dosage of supplements of zinc, vitamin C, vitamin E and lutein may slow the progression of advanced dry AMD (it is not recommended for those without AMD or early AMD). Speak to a doctor before taking these supplements because there may be associated risks involved.
  • Wear 99% -100% UV-blocking sunglasses.

 

The first step to eye health is awareness. By knowing your risk, taking preventative measures and visiting your eye doctor on a regular basis, you can greatly reduce your chances of facing this debilitating disease.

Treatment of Macular Degeneration

While there is no cure for macular degeneration, treatments do exist that can delay the progression of the disease, preserve existing vision and sometimes even improve vision loss.

Currently, there are no approved treatments to prevent or cure dry AMD, although there is evidence that indicates that certain nutritional supplements, including omega 3 fatty acids, lutein and zeaxanthin, can prevent the progression of the disease to the more advanced wet form, which can cause more severe vision loss.

There are a couple of options for treating wet AMD to slow the progression of vision loss which include medicated injections and laser therapy. These therapies are designed to stop the development of new blood vessels, to destroy existing ones and to prevent leakage into the macula – the main dangers with wet AMD.

Unfortunately, while much research continues to be conducted, currently there is no treatment and no way to fully regain vision lost by AMD. Those who have suffered significant vision loss can benefit from the many low vision devices on the market which utilize your existing vision to assist in maintaining your independence. Such devices include standing and hand-held magnifiers and telescopes and other aides that can help to improve your vision.

If you have been diagnosed with AMD, regular vision tests are essential. Close monitoring and adherence to treatment can not only prevent further vision deterioration but can sometimes even improve vision.

PRK

Photorefractive Keratectomy or PRK is a type of refractive laser eye surgery used to correct a patient’s vision to eliminate or reduce their dependence on glasses or contact lenses. PRK is the style of laser eye surgery that preceded LASIK, having been the former most common type of refractive surgery until LASIK came along.

PRK is effective in correcting nearsightedness (myopia), farsightedness (hyperopia) and astigmatism and has very similar rates of success and outcomes as LASIK. PRK remains a common option for laser eye surgery.

How Does PRK Differ From LASIK

PRK and LASIK both permanently reshape the cornea to improve vision by using a laser (an excimer laser to be exact) to remove part of the tissue underneath the corneal epithelium. The epithelium first needs to be removed in order to get access to the tissue and how this is done is what differentiates the two procedures. While LASIK creates and lifts a flap on the outer corneal layer, reshapes the corneal tissue underneath and then replaces the flap, PRK removes the outer layer of the cornea completely. The outer layer will regenerate usually within a few days.

Advantages of PRK

Since PRK completely removes the outer corneal layer, there is a greater area of the cornea to work with. This is ideal for patients with a thin cornea who would otherwise be at risk with LASIK. It is also usually recommended for patients with chronic dry eyes. With PRK, there is also less risk of infection or issues having to do with the flap and the related healing process. This is an advantage for individuals who lead a lifestyle in which they are at risk for eye injuries (athletes, military, law enforcement etc.) which may subject the flap to injury or complications.

So, Why Is LASIK More Popular?

The main advantages that LASIK has over PRK are two-fold and mainly have to do with comfort and recovery time. First of all, PRK patients usually experience slightly more discomfort during the first couple of days of recovery, mainly because it takes time for the outer corneal layer to heal. They will be prescribed eye drops to be taken for several months to prevent infection, increase comfort and assist the healing process. LASIK patients on the other hand, typically experience less discomfort and if they do, it subsides very quickly.

Additionally, vision recovery takes longer with PRK. While LASIK patients can typically see normally within a few hours after the surgery, with vision gradually continuing to improve within the next few months, PRK patients may experience blurred vision for up to three days and it can take up to six months until they achieve full visual clarity. While patients who undergo LASIK can usually drive and resume normal functioning within a day or two, PRK patients shouldn’t plan on returning to normal for at least several days until the outer layer of the cornea has grown back.

Whether PRK or LASIK is a better option for you depends on a number of factors, including the health and structure of your eye. This is a decision that your eye doctor or surgeon will help you make. Rest assured however, that both procedures have been shown to be incredibly successful in correcting vision, with minimal complications.

What You Need to Know About PRK

Prior to any laser correction surgery, you will meet with a surgeon for a thorough exam to assess your eye health and determine whether you are a candidate and if so, which type of surgery would be best suited to your needs. During this exam it is essential to tell the doctor any relevant medical history (injuries, hospitalizations, diseases etc.) and existing conditions you have. The surgeon will determine if you are currently eligible for surgery and if not, if you will be at a future point, and whether you require any specialized care pre or post surgery.

The surgery itself is an ambulatory procedure. It takes about 15 minutes or less for both eyes and you go home the same day. You will need someone to drive you home from the procedure.

The first step in the procedure is that your eye will be anesthetized using numbing eye drops and then a device will be inserted to prop your eyelids open so you won’t blink. Once the eye is numb, the surgeon will remove the outer epithelial layer of the cornea to expose the underlying tissue. Then the surgeon will use the laser to reshape the corneal tissue. You may feel a small amount of pressure during this step. Lastly, the surgeon will apply medicated eye drops and place a temporary contact lens that is used as a bandage to protect the eye.

Following the surgery you will be instructed to apply medicated eye drops multiple times each day to reduce the risk of infection and you may also be given prescription pain relievers to alleviate any pain or discomfort.

As with any type of surgery, it is critical to carefully follow your surgeon’s instructions after PRK. Make sure that you take your medication as prescribed, get enough rest, and call your eye doctor immediately if you experience any problems.

It is normal for it to take several days or even weeks for your vision to improve and up to 3-6 months for full recovery to clear and stable visual acuity. Usually, your doctor will require you to refrain from driving for a week and up to three weeks depending on how fast your vision recovers.

Risks and Complications of PRK

While serious complications are rare, like any surgery, there are some risks to PRK, and these happen to be very similar to any laser corrective surgery like LASIK. They include:

  • Dry eyes- this condition usually goes away within a couple of months, but there is a chance that it could become chronic.
  • Infection or Inflammation- the risk of infection is greatly reduced if you take proper care to follow your doctor’s instructions following the procedure.
  • Vision Problems- which can include glare, seeing halos around lights poor night vision and sometimes a general haziness.
  • Incomplete Vision Correction – sometimes an additional procedure might be needed to achieve optimal visual acuity.

In general, PRK is considered to be a relatively safe and effective treatment for vision correction. If you wish to live a life without depending on your glasses or contact lenses, speak to your eye doctor about whether PRK is an option for you.

Surgery for Presbyopia

Presbyopia is a common age-related condition in which near vision worsens due to the hardening of the lens of our eye. It causes people to have difficulty reading and performing other tasks that require sharp and focused close vision.

Symptoms begin around the age of 40 when you begin to see people with untreated presbyopia holding books, magazines, newspapers, and menus at arm’s length in order to focus properly and avoid eye strain. Other symptoms include headaches or fatigue when trying to focus on something at close range.

Causes of Presbyopia

During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty. As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.

Surgical Treatment for Presbyopia

The most common form of treatment for presbyopia is wearing reading glasses, bifocals or progressive lenses. Bifocal and multifocals are also available in contact lenses for those who prefer to be glasses-free. A third option, however, is a number of surgical procedures that allow you the freedom of correcting your near vision without the use of glasses or contact lenses.

LASIK

Monovision LASIK

Monovision is a technique that began with presbyopia-correcting contact lenses designed for individuals with presbyopia and nearsightedness or astigmatism. Each eye gets a different lens power – one lens is used in the dominant eye to correct for distance vision and the other for near vision. The eyes adapt to the two lens powers by learning to use the appropriate eye for the necessary distance power. Monovision LASIK surgery is based on the same principle of correcting each eye for a different refractive power and has shown just as high if not higher success rates than the contact lens technique. Usually, patients will try out monovision with contacts first to ensure that it works and that the eyes adapt properly.

PresbyLASIK

PresbyLASIK is a procedure that is currently available in Canada and Europe and undergoing clinical trials in the United States. As opposed to monovision LASIK, this procedure is a multifocal alternative in which different rings of refractive power are created on the cornea, similar to multifocal lenses. This provides vision correction at all distances simultaneously.

Conductive Keratoplasty (CK)

Conductive Keratoplasty uses radio waves via a hand-held instrument to mold the corneal surface to improve near vision. The procedure can be done on one eye using the monovision principle and is a good solution for those that do not need vision correction for nearsightedness or astigmatism. The effects of CK, however are not permanent and the improvement in near vision will diminish over time.

Corneal Inlays or Onlays

Corneal inlays and onlays involve surgically implanting a small lens into the eye to increase focus and near vision. The distinction between inlays and onlays is in where the lens is placed on the eye.

Refractive Lens Exchange

In refractive lens exchange the eye’s hardened lens is replaced with an artificial lens called an intraocular lens (IOL) to provide multifocal vision. This surgery is similar to and often done in conjunction with cataract surgery.

Corneal Inlays and Onlays

Corneal inlays and onlays are corneal implants that are used to correct presbyopia, a common condition for individuals over age 40 in which the eyes have difficulty focusing on near objects. Presbyopia occurs as the lens of the eye begins to age and weaken, reducing the ability to focus on close objects without the assistance of reading glasses or another visual aid.

Corneal implants, such as inlays and onlays, offer a treatment solution to correct presbyopia as an alternative to using reading glasses or multifocals to obtain clear vision at a close range. Corneal inlays and onlays are like tiny contact lenses that are inserted into the cornea which reshape it to improve the refractive power and thereby improve near vision. Unlike corrective laser surgery such as PRK or LASIK the actual corneal tissue isn’t touched, but rather the shape of the cornea is changed by the transplanted lens.

Corneal inlays are placed in the stroma, the middle layer of the cornea (thus the name “in-lays”), while onlays are implanted closer to the surface of the cornea, under the epithelium, which is the thin outer layer of the cornea. The procedures for both inlays and outlays are relatively simple and quick, with minimal recovery.

Corneal Inlay and Onlay procedures are still in the early stages of development and with a number of clinical trials in progress, the technology should only improve in coming years.

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