Home >  About Us >

March 2005 Monthly Health Topic

Monthly Health Topic Archive

Common Eye Conditions

Marc Hirsch, M.D.
Ophthalmologist
Weiss Memorial Hospital
Phone: (773) 561-5655
Fax: (773) 561-0631

Cataract
A cataract is a clouding of the eye's natural lens. Depending on the degree of cloudiness, a cataract can cause a little blurring or severe loss of vision. The rate at which a cataract progresses is highly variable. It is not a tumor or a growth. It is not a film over the eye that can be peeled away. Vision can only be restored by surgical removal of the cataract.   One out of every fifty people will find it necessary to have this cloudy lens removed. Approximately 1,000,000 cataract operations are done each year in the United States.

The majority of cataracts form later in life as a normal part of the aging process. Some people develop cataracts earlier than others without any other eye problems. Cataracts can develop as a result of injury, eye disease, systemic problems (such as diabetes), side effects from certain medications, and in some rare cases babies are born with them. Cataracts are not caused or worsened by reading, watching too much television, sewing, or any other normal visual activity. Limiting your visual activity will not slow down the progression of a cataract.

Currently, the only effective treatment for cataracts is surgical removal. Medications cannot stop cataract formation.  The surgical procedure is usually performed without sutures, and through the use of topical anesthesia.

Once the cataract is removed, a synthetic lens is required to focus the eye.  The most common method of restoring excellent vision is by the use of an intraocular (IOL) lens. The IOL is placed in the eye during surgery and replaces the cloudy natural lens. In the past twenty years, millions of implants have been used in the United States. The presence of the IOL maintains the normal configuration of the eye and rarely needs to be replaced. It affords vision that is the most natural of the three methods.

In the "old days," cataract surgery involved prolonged hospitalization and immobilization. Many people remember their grandparents undergoing this type of operation and are unnecessarily alarmed about surgery. With today's advanced techniques, most patients will be able to do most of the recovery in the comfort of their own home.

Depending on the type of surgery and the specific situation, complete postoperative recovery ranges from approximately a few weeks to three months. At the end of this time, a final refraction for glasses will be done. The eye may continue to heal even past this time, making small refinements in glasses occasionally necessary.

Normal daily activities may be resumed within a day or so following surgery. Heavy or strenuous physical activity should be avoided for the first several weeks; this includes extreme bending or lifting of more than 20 pounds. Your surgeon will give you more specific information.

Macular Degeneration (ARMD)
Macular degeneration is the major cause of loss of vision in people over the age of 50 in our country. It rarely causes total blindness and is often called age-related macular degeneration (ARMD) because it is most often caused by aging. (There are some unusual types of macular degeneration that start very early in life).

Macular degeneration usually begins with the appearance of spots on the retina. These spots are called drusen (see the images below). Drusen are like age spots and do not directly cause changes in vision. Most patients with drusen never have a serious loss of vision and seldom develop severe macular degeneration with vision loss.

Loss of vision from macular degeneration usually begins in one eye and only later may affect the other eye. In some people, vision in the second eye is never affected. When a person loses their central vision from macular degeneration in one eye, the loss of vision may not even be noticed because the healthy eye maintains detail (or central) vision. The healthy macula compensates for the loss of vision in the affected eye. It is only when macular degeneration severely affects both eyes that it becomes difficult, or perhaps impossible, to do the kind of work that requires detail vision.

A person with severe macular degeneration, who has lost the ability to see detail with each eye, rarely loses peripheral vision and is able to get along fairly well. It is very rare for someone with macular degeneration to lose both macular (detail) and peripheral (side) vision. Macular degeneration rarely causes total blindness. Almost all people with severe macular degeneration in each eye can see well enough to take care of themselves and continue activities that do not require detail vision.

Flashers & Floaters
Floaters are opacities observed moving in one's field of vision. They may be small or large enough to block central vision. Floaters are actually aggregates of cells, blood, or debris in the jelly-like material in the back of the eye (the vitreous).

While floaters are not damaging, they may be a symptom of a tear in the retina. Retinal tears, if not treated, can lead to retinal detachments. Therefore, new floaters should always be considered potentially serious, and an eye examination should be obtained as soon as possible.

Flashing lights or streaks are additional symptoms that may herald the occurrence of a retinal tear. Flashes are the result of traction or rubbing against the retina. When they occur, especially in the presence of new floaters, an immediate eye examination should be obtained.

Glaucoma
Glaucoma is a group of diseases in which the pressure in the eye is higher than that particular eye can tolerate. The nerve fibers and blood vessels in the optic nerve become compressed and can be damaged or destroyed. This is called cupping. The optic nerve fibers are the "electrical cable" carrying sight from the eye to the brain, and damage to these fibers impairs vision.

The pressure in the eye is determined by the balance of the fluid (called aqueous humor) coming into the eye and the fluid leaving the eye by the normal drainage channels (called the trabecular meshwork).   For practical purposes, almost all glaucomas result from a decreased ability of fluid to leave the eye; the drainage mechanism is not working properly. A commonly used analogy is a faucet and a drain. In glaucoma the faucet is producing the correct amount of fluid, but the drain is not working properly so too much fluid accumulates within the eye and the pressure rises.

Glaucoma can occur in people of all ages from birth to very advanced years. It is more common in adults than children. Glaucoma most frequently occurs in people for no apparent reason. Certain groups of people, however, are known to be at a somewhat higher risk of developing glaucoma than others. These are people who have a family history of glaucoma, people who are nearsighted or diabetic, people suffering from other diseases of the eye and those who smoke.

Factors that have not been found to affect the development of glaucoma include: coffee, alcohol and fluid restriction diets. Patients with glaucoma may use other medications, even those with glaucoma warnings (i.e., antihistamines, cold remedies, etc.) as long as they inform their doctors. Steroids, however, should not be used unless the prescribing doctor is specifically aware of the glaucoma.

Open-angle glaucoma is treated initially by using medical therapy. When that is insufficient, laser therapy is often added. For those requiring further therapy, an additional step in the treatment of open-angle glaucoma is surgery.  

All decisions involving medical care involve weighing the good versus the bad. Doctors refer to this as the risk-benefit ratio. Given the possible risks of laser or glaucoma surgery, it is felt that in many forms of glaucoma, medical therapy should be used prior to proceeding with other forms of therapy. 

Damage in glaucoma usually manifests as a loss in peripheral vision. For that reason, careful visual field examinations are necessary.

Two basic types of visual field examinations are used. In the first type, the visual field is examined by manual techniques. This gives an excellent overall assessment of the visual field and valuable information about whether the visual field is changing or not.

The second manner in which visual fields are tested is by computerized examination techniques. These provide information similar to that of manual tests. Computerized fields are of value in determining if glaucoma is present at an early stage and are used to monitor the progress of the disease.

Some patients will be examined using one technique, and some using both. The doctor will determine the best technique based on the specific situation.

For more information, please contact your eye specialist at Weiss Memorial Hospital.