Kimberly Kaye Jaring

Glaucoma

Glaucoma refers to a category of eye disorders often associated with a dangerous build-up of internal eye pressure (intraocular pressure or IOP), which can damage the eye's optic nerve that transmits visual information to the brain. With untreated or uncontrolled glaucoma, you might eventually notice decreased ability to see at the edges of your vision (peripheral vision). Progressive eye damage could then lead to blindness. In fact, glaucoma creates at least some vision loss in more than half of the approximately 2.5 million Americans estimated to have the eye disease and is the second leading cause of blindness. Glaucoma Symptoms Glaucoma often is called the "silent thief of sight," because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.But with acute angle-closure glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.

Types of Glaucoma The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The "angle" in both cases refers to the drainage angle inside the eye that controls aqueous outflow. Other variations include normal-tension glaucoma, pigmentary glaucoma, secondary glaucoma and congenital glaucoma. Primary open-angle glaucoma (POAG). About half of Americans with chronic glaucoma don't know they have it. This common type of glaucoma gradually reduces your peripheral vision without other symptoms. By the time you notice it, permanent damage already has occurred.If your IOP remains high, the destruction caused by POAG can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead. Angle-closure glaucoma. Angle-closure or narrow-angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.These signs may last for a few hours, then return again for another round. Each attack takes with it part of your field of vision. Normal-tension glaucoma. Like POAG, normal-tension glaucoma (also termed normal-pressure glaucoma, low-tension glaucoma or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range.Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur. The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease. Pigmentary glaucoma. This rare form of glaucoma is caused by pigment deposited from the iris that clogs the drainage angle, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s. Secondary glaucoma. Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of eye infection, inflammation, a tumor or an enlarged cataract. Congenital glaucoma. This inherited form of glaucoma is present at birth, with 80 percent of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye. It's difficult to spot signs of

congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Cataract

A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract the power of the lens may be increased, causing near-sightedness (myopia), and the gradual yellowing and opacification of the lens may reduce the perception of blue colours. Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. The condition usually affects both eyes, but almost always one eye is affected earlier than the other.

Types
There are three cataract types, each defined by their location on the lens.

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Nuclear cataracts are found in the center, or nucleus of the lens. Cortical cataracts begin at the outer rim of the lens, which is known as the cortex, and work toward the center. Subcapsular cataracts affect the back of the lens in the capsule, or the membrane that envelops the lens.

Because each of these cataract types affects vision in a distinct manner, it is possible for a patient to have more than one type of cataract at the same time. While age is the most common risk factor for cataracts, some cataract types may also be attributed to: An experienced ophthalmologist can diagnose each of the different cataract types and discuss treatment options. In the majority of cases, patients choose to undergo cataract surgery in order to reduce symptoms such as cloudy vision.

Nuclear Cataracts Nuclear cataracts, which form in the lens' nucleus, are the most common type of cataracts. Because opacity develops in the center of the lens, known as the central nucleus, nuclear cataracts interfere with a person's ability to see objects in the distance. Usually the result of advancing age, nuclear cataracts can take years to develop and often give the nucleus a yellow tint.

Cortical Cataracts Cortical cataracts begin at the outer rim of the lens and gradually work toward the central core of the lens. This type of cataract resembles spokes of a wheel that extend from the outside of the lens to the center. Patients with cortical cataracts often notice problems with glare, or a "halo" effect around lights, and experience a disruption of both near and distance vision.

Subcapsular Cataracts Of all cataract types, subcapsular cataracts progress the most rapidly. While nuclear cataracts take years to develop, subcapsular cataracts reach an advanced stage of progression within a matter of months. Posterior subcapsular cataracts affect the back of the lens, causing glare and blurriness. This type of cataract is usually seen in patients who suffer from diabetes, extreme nearsightedness or retinitus pigmentosa, or who take steroid medication.

Congenital Cataracts Congenital cataracts refer to cataracts that are present from birth, or are developed in early childhood, and may include nuclear, cortical or subcapsular cataracts. Congenital cataracts may be linked to an infection contracted by the mother during pregnancy, or to a genetic condition. Because clear vision is essential to the development of the child's eyes and brain, it is important to diagnose congenital cataracts as early as possible.

Care of Corneal Disorders

Corneal Dystrophies Corneal dystrophies are inherited as autosomal dominant traits and manifest when the person is about twenty years of age. They are characterized by deposits in the corneal layers. Decreased vision is caused by the irregular corneal surface and corneal deposits. Corneal endothelial decompensation leads to corneal edema and blurring of vision. Persistent edema leads to bullous keratopathy (formation of blisters that cause pain and discomfort on rupturing). This condition is usually associated with primary open-angle glaucoma.

Care A bandage contact lense is used to flatten the bullae, protect the exposed corneal nerve endings and relieve discomfort. A bandage contact lens (therapeutic contact lenses) protects an injured or diseased cornea from the constant rubbing of blinking eyelids thereby allowing it to heal.

Symptomatic treatments, such as hypertonic drugs or ointment (5% sodium chloride), may reduce epithelial edema; lowering the IOP also reduces stromal edema. Treatment options include eye drops, eye ointments and surgery. Surgical options include removing the surface layer of the cornea with a diamond burr or excimer laser, corneal transplantation and phototherapeutic keratectomy (PTK).
Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now-smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 percent success rate in corneal repair using PTK for well-selected patients.

Keratoconus From the Greek, kerato meaning horn, cornea and konos meaning cone It is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal gradual curve. A condition characterized by a conical protuberance of the cornea with progressive thinning on protrusion and irregular astigmatism. This hereditary condition has a higher incidence among women. Onset occurs at puberty; the condition may progress for more than 20 years and is bilateral. Corneal scarring occurs in severe cases. Blurred vision is a prominent symptom. Despite considerable research, the etiology of keratoconus remains somewhat of a mystery. A number of sources suggest that keratoconus likely arises from a number of different factors: genetic, environmental or cellular, any of which may form the trigger for the onset of the disease Care Rigid, gas-permeable contact lenses correct irregular astigmatism and improve vision. Advances in contact lens design have reduced need for surgery. Gas permeable contact lenses = rigid lenses made of durable plastic that transmits oxygen.

Penetrating keratoplasty is indicated when contact lens correction is no longer effective. Penetrating keratoplasty = a full
thickness of the cornea is removed and replaced with donor tissue.