Eye Disease Management and Treatment

Our clinic make it a policy to ensure that all staff members are up-to-date on the  latest technology and techniques to make your visit as comfortable and  effective as possible. As optometric technology changes, it is even more  important to select an eye doctor who has all the right optometry qualifications and follows the latest developments in eye care. 

Utilizing cutting edge technology, Dr. Leung is diagnosing and managing, with greater precision, diseases like Glaucoma, Macular  Degeneration, Cataracts, and Diabetic Retinopathy. Earlier and more precise diagnosis means earlier treatment and better outcomes. Dr. Leung is taking an aggressive approach to diseases that previously had few treatment options. Great advances have been made in the treatment of these diseases.

Unlike a routine eye exam that assesses your visual system and eye  health, anyone who was diagnosed with type 1 or type 2 diabetes requires  an additional test for their eye exam. Traditionally, everyone had  their pupils dilated in order to get a clear picture of the eye,  however, with modern advances in technology, many practices are adding a  digital retinal exam as well.

When your eye doctor starts the dilated eye exam, he or she will  instill dilating drops in each eye, which would enlarge your pupils to  give the doctor a better view of certain parts of the back of the eye.  The drops can take at most 20 to 30 minutes to take effect, but the  effects last well beyond the exam up to several hours.

Enlarging the pupils will allow for more light to enter the eye. When  more light can enter the eye, this allows for your eye doctor to have a  greater range of visibility within the eye. This provides your eye  doctor the ability to use a special magnifying lens to examine the  tissues at the back of the eye, including the retina, the macula, and  the optic nerve.

For anyone with diabetes, these exams are essential as diabetic retinopathy is a leading cause of blindness. By examining a greater  range of the eye’s interior, the diabetic eye exam can detect signs of  swelling or leaking of blood vessels in the retina.

While people might relax at the optometrist’s office until the  effects start to fade, it’s recommended that you invest in a pair of  polarized sunglasses. In some cases, your optometrist may supply you  with a free, generally temporary, pair of sunglasses to protect your  eyes. While tinted lenses can reduce the amount of light that enters the  eyes, during the time your eyesight is extra sensitive, the added  protection from polarization is essential.

The concept is very similar in children. Children naturally have  larger pupils, so their eyes are extra sensitive to light, and therefore  should wear sunglasses with UV protection.

The findings from your diabetic eye exam can give your doctor  important information about your overall health, particularly diabetes  and high blood pressure. Plus, your optometrist can help you manage your  diabetes and prevent the progression of the condition. For example,  most diabetics know that nutrition is the key factor in maintaining a  normal, healthy lifestyle. Your eye doctor is a great resource to review  your diet and can advise you on what foods are recommended and what to  avoid.

Cataracts are a common cause of vision loss after age 55. Learn more  about recognizing cataract symptoms, protecting your eyes and  understanding cataract surgery. 

Typically an eye disorder associated with aging (over half of the  people in America over age 80 have either had a cataract or cataract  surgery), cataracts generally occur later in life as the lens structure  within the human eye changes and gets older. In addition to age, other  risk factors that lead to cataracts include smoking, UV overexposure and diabetes

During the evaluation of your eye health we will carefully examine  your lens for signs of cataract formation. If a cataract is noticed and  the clouding is causing visual disruption, the optometrist will refer  you to a trusted and respected surgeon for surgery, which is the only  known cure for cataracts. Our Eye Care Practice will be there for you  providing pre and post cataract surgery care.

Cataract surgery is the removal of the natural lens of the eye (also  called “crystalline lens”) that has developed an opacification, which is  referred to as a cataract. Metabolic changes of the crystalline lens  fibers over the time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision. During  cataract surgery, a patient’s cloudy natural lens is removed and  replaced with a synthetic lens to restore the transparency of the lens.

Following surgical removal of the natural lens, an artificial  intraocular lens implant is inserted (eye surgeons say that the lens is  “implanted”). Cataract surgery is generally performed by an  ophthalmologist (eye surgeon) in an ambulatory (rather than inpatient)  setting, in a surgical center or hospital, using local anesthesia  (either topical, peribulbar, or retrobulbar), usually causing little or  no discomfort to the patient. Well over 90% of operations are successful  in restoring useful vision, with a low complication rate. Outpatient care, high volume, minimally invasive, small incision  phacoemulsification with quick post-op recovery has become the standard  of care in cataract surgery all over the world.

Diabetes is associated with several eye health issues including cataracts and glaucoma, but the most well known diabetic eye disease is diabetic retinopathy. 

Diabetic Retinopathy

Diabetic retinopathy is an eye disease that only affects diabetics.  It occurs when the fragile vascular network that supplies the retina –  the light sensitive tissue at the back of the eye that helps us see –  begins to swell or leak. During the beginning stages of the disease,  there may be no noticeable symptoms, so it’s important to have your eyes  checked at least once a year, if you have diabetes.

Once symptoms of diabetic retinopathy do develop, they can include:  dark or black spots in your visual field, or blurry vision, and it  increases over time. This is a result of bleeding at the back of the  eye, which prevents a clear image from being transmitted from the retina  to the brain.

Whether you have type 1, type 2, or even just gestational diabetes,  you are at risk for developing diabetic retinopathy. The longer you have  had the disease, the greater the risk. It is essential to keep your  blood sugar levels under control to prevent vision loss, and this may  require a trip back to your primary care physician.

Treating diabetic retinopathy can include vitrectomy, replacing the  inner gel-like substance that supports the eyeball structure, and laser surgery.

Glaucoma is a leading cause of preventable vision loss and  blindness in adults in the United States and Canada and the second  leading cause of blindness in the World, even more than macular degeneration.

Glaucoma is not a single disease. It is actually a group of eye  diseases that cause damage to the optic nerve due to an increase in  pressure inside the eye, which is called intraocular pressure (IOP).  When detected in the early stages, glaucoma can often be controlled,  preventing severe vision loss and blindness. However, symptoms of  noticeable vision loss often only occur once the disease has progressed.  This is why glaucoma is called “the sneak thief of sight”.  Unfortunately, once vision is lost from the disease, it usually can’t be  restored.

Treatments include medication or surgery that can regulate the IOP and slow down the progression of the disease to prevent further vision  loss. The type of treatment depends on the type and the cause of  glaucoma.

Prevention is possible only with early detection and treatment. Since  symptoms are often absent, regular eye exams which include a glaucoma  screening are essential, particularly for individuals at risk of the  disease. While anyone can get glaucoma, the following traits put you at a  higher risk:

• Age over 60
• Hispanic or Latino descent, Asian descent
• African Americans over the age of 40 (glaucoma is the leading cause  of blindness in African Americans, 6-8 times more common than in  Caucasians.)
• Family history of glaucoma
• Diabetics
• People with severe nearsightedness
• Certain medications (e.g. steroids)
• Significant eye injury (even if it occurred in childhood)
• 
  

Signs and Symptoms of glaucoma:  Due to a buildup of pressure in the eye, glaucoma causes damage to the  optic nerve which is responsible for transmitting visual information  from the eye to the brain. How does glaucoma affect your vision?

Types of glaucoma: There are a number of types of glaucoma, some more acute than others.  Learn about the common types of glaucoma and the differences between them.

Diagnosis and Treatment of Glaucoma: Early detection and treatment of glaucoma are essential to stopping or  slowing the disease progression and saving vision. Treatment can include  medicated eye drops, pills, laser procedures and minor surgical  procedures depending on the type and stage of glaucoma.

The intraocular pressure caused by glaucoma can slowly damage the  optic nerve, causing a gradual loss of vision. Vision loss begins with  peripheral (side) vision, resulting in limited tunnel vision. Over time  if left untreated, central vision will also be affected which will  increase until it eventually causes total blindness. Unfortunately, any  vision that is lost from the optic nerve damage cannot be restored.

Typically, glaucoma sets in without any symptoms. At the early onset  of the most common type of glaucoma “open angle” glaucoma, vision  remains normal and there is no pain or discomfort. This is why the  disease is nicknamed the “sneak thief of sight”.

An acute type of glaucoma, called angle-closure glaucoma, can present  sudden symptoms such as foggy, blurred vision, halos around lights, eye  pain, headache and even nausea. This is a medical emergency and should  be assessed immediately as the intraocular pressure can become extremely  high and cause permanent damage within hours.

The primary forms of glaucoma are open-angle and narrow-angle, with open-angle being the most common type.

POAG gradually progresses without pain or noticeable vision loss  initially affecting peripheral vision.  By the time visual symptoms  appear, irreparable damage has usually occurred, however, the sooner  treatment starts the more vision loss can be prevented.  When untreated,  vision loss will eventually result in total loss of side vision (or  tunnel vision) and eventually total vision loss.

This is another form of open-angle glaucoma in which the intraocular  pressure remains within the normal level. The cause of this form of  glaucoma is not known, but it is believed to have something to do with  insufficient blood flow to the optic nerve, causing damage. Individuals  of Japanese descent, women and those with a history of vascular disease  or low blood pressure are at higher risk.

Acute angle-closure glaucoma is marked by a sudden increase in eye  pressure, which can cause severe pain, blurred vision, halos, nausea,  and headaches. The pressure is caused by a blockage in the fluid at the  front of the eye which is a medical emergency and should be treated  immediately. Without prompt treatment to clear the blockage vision can  be permanently lost.

The inherited form of the disease that is present at birth. In these  cases, babies are born with a defect that slows the normal drainage of  fluid out of the eye; they are usually diagnosed by the time they turn  one. There are typically some noticeable symptoms such as excessive  tearing, cloudiness or haziness of the eyes, large or protruding eyes or  light sensitivity. Surgery is usually performed, with a very high  success rate, to restore full vision.

Glaucoma can develop as a complication of eye surgeries, injuries or  other medical conditions such as cataracts, tumors, or a condition  called uveitis which causes inflammation. Uncontrolled high blood  pressure or diabetes can result in another serious form called  neovascular glaucoma.

A rare form of glaucoma, this occurs when pigment from the iris sheds  and clogs the drainage of fluid from the eye resulting in inflammation  and damage to the eye and drainage system.

Treatment of glaucoma is dependant upon the severity and type of glaucoma present.

During a routine comprehensive eye exam to check for glaucoma, your  eye doctor will dilate your eye to examine the optic nerve for signs of  glaucoma and will also measure the intraocular pressure (IOP) with an  instrument called a tonometer.

Tonometry involves numbing the eye with drops and then gently  pressing on the surface of the eye to measure the pressure. Since your  IOP can fluctuate throughout the day and glaucoma can exist without  elevated IOP this is not enough to rule out the disease. If there are  signs of the disease, further testing will be performed.

A visual field test is designed to detect any blind spots in your  peripheral or side field of vision. You will be asked to place your head  in front of a machine while looking ahead and indicate when you see a  signal in your peripheral field of view.

Your doctor may also measure the thickness of the cornea with an  ultrasonic wave instrument in a test called pachymetry or use imaging  techniques such as digital retina scanning or optical coherence  tomography (OCT) to create an image of your optic nerve to look for  glaucoma damage.

Treatment for glaucoma depends on the type and severity of the  disease and can include medication such as eye drops or pills or laser  or traditional surgery.

Medication and drops to lower IOP are often the first resort for  controlling pressure-related glaucoma. These drops may have some  uncomfortable side effects, but compliance with the treatment plan is  essential for preserving vision and halting the progression of the  disease.

Surgical procedures are designed to control the flow of fluids  through the eye by either decreasing the amount of fluid produced or  improving the drainage. Your doctor may decide that a combination of  surgery and medication will be the most effective in many cases.

It cannot be stressed enough that the most effective treatment for  glaucoma happens when the disease is detected and treated early before  significant vision loss occurs. Any vision that is lost cannot be  restored. This is why the best prevention is awareness by knowing your  risks and taking responsibility by having your eyes examined on a  regular basis.

Untreated macular degeneration is one of the leading causes of blindness in those over 65 years old.

While researchers have not yet discovered a cure for age-related macular degeneration (AMD), there are treatment options which prevent the disease from  progressing to blindness, and in some cases, they can even improve  vision. It’s important to have an open discussion with your eye doctor  about the risks and limitations of AMD treatments.

There are 2 basic types of AMD, the wet form and the dry form.

• Dry macular degeneration is considered the less  aggressive form of AMD. It typically progresses much more slowly, and  the level of eyesight damage is less severe. Dry AMD is detected during  routine eye exams, which is why it’s important to have yearly testing.  Treating Dry AMD often involves high doses of zinc and antioxidants  which have been shown to slow diseases progression.
• Wet macular degeneration is the more severe form of  AMD. Call us to book an emergency eye doctor’s appointment if you  experience a sudden worsening of blurry central vision. Wet AMD occurs  when there is abnormal blood vessel growth (angiogenesis), and leakage,  which can cause scar tissue to develop. Treatments include laser  surgery, injecting light sensitive dyes, or AMD medication injected  directly into the eye to inhibit angiogenesis.

AMD is an age related eye disease that runs in families, and is a  leading cause of blindness in our aging population. There is no cure for  this ocular disease, and AMD related vision loss is cannot usually be  recovered. There are treatments, and preventative measures that can be  taken, if detected early, so routine eye exams are essential.

• Macular degeneration (also  called AMD, ARMD, or age-related macular degeneration) is an age-related  condition in which the most sensitive part of the retina, called the  macula, starts to break down and lose its ability to create clear visual  images. 
• Forms of Macular Degeneration: Dry macular degeneration  symptoms include: consistent, slightly blurred vision within your  central visual field. You may have difficulty in recognizing faces. And  have a sudden need for more light while reading or working. The dry form  of this disease gets progressively worse, over time. Wet macular  degeneration symptoms include: a distortion of straight lines and an  inability to focus properly on a single point within a grid. Wet macular  degeneration is an advanced stage of the disease, and often results in  blind spots and loss of centralized vision. 
• Symptoms & Risk Factors of  Macular Degeneration: Macular degeneration symptoms  vary based on the particular form of the disease (dry or wet), and the  stage the disease at the time it is discovered. 
• Treatment of Macular Degeneration: There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.