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January is National Glaucoma Awareness Month.

What is Glaucoma?

Glaucoma, a silent eye disease, is the most common form of irreversible blindness in the world. It is actually a group of diseases that causes progressive damage to the optic nerve. 

  • Glaucoma is a progressive eye disease that can lead to permanent vision loss if not controlled. 
  • There is currently no cure for glaucoma, but there are many treatments available for stopping and slowing the progressive damage to the eye. Treatment, however, can’t reverse damage that is already done.
  • Glaucoma affects the optic nerve which sends visual information from your eye to your brain. 
  • Glaucoma is called the “Thief Sneak of Sight” because there are often no symptoms in the early stages such as pain or “pressure sensation” as one may expect, and by the time it is diagnosed there may already be permanent vision loss.
  • When vision loss occurs, peripheral vision is typically affected before central vision. As a result, glaucoma is a major public health issue because individuals usually do not notice any problem with vision until end stages of the disease when there is severe and irreversible vision loss.
  • Awareness and regular eye exams are key to early detection and preventing vision loss. 

What Causes Glaucoma?

Glaucoma is caused by a buildup of natural fluid that doesn’t drain properly from the eye. The buildup of fluid can result in high pressure in the eye which is the most common cause of the condition. There are many types of glaucoma, which include:

Chronic (open angle) glaucoma occurs when pressure builds up over time, usually as a result of aging. This is the most common type of glaucoma. 

Acute (angle closure) glaucoma is an acute condition where pressure builds up suddenly and demands immediate medical attention. Symptoms include blurred vision, eye pain, headaches, seeing halos around lights, nausea and vomiting. 

Secondary glaucoma results from another eye disease, condition or a trauma to the eye. 

Normal tension glaucoma is when there is no build up of pressure but the optic nerve is still damaged. We are still not yet sure what causes this type of glaucoma. 

Who is at Risk for Glaucoma?

Everyone is at risk of glaucoma however there are certain factors which increase the likelihood of developing the condition. Vision loss from glaucoma can be greatly reduced when detected and treated early which is why knowing your risk factors can play a tremendous role in prevention. 

Age

Age is one of the biggest risk factors, as your chances of developing glaucoma increase significantly after the age of 40. In fact people over 60 years old are six times more likely to get the condition. 

Ancestry and Family History

Individuals from African American, Hispanic, Asian and Native American or Aboriginal Canadian descent are at increased risk. Family history is a very strong factor as the condition occurs twice as much in people with close relatives who have had glaucoma. 

Previous Eye Injury, Traumas or Surgery

Eye injuries, traumas or surgeries have been known to sometimes cause secondary glaucoma which can happen immediately after the injury or procedure, or even years later. Even childhood injuries can result in secondary glaucoma later in life. 

Use of Steroids

Studies show that prolonged steroid use is linked to increased elevated intraocular pressure which increases the risk of open-angle glaucoma. 

 

Certain medical and eye conditions such as diabetes, hypertension and high myopia (nearsightedness) also increase a person’s risk of developing glaucoma. 

Glaucoma Treatment

While there is no cure for glaucoma, there are treatments to slow down the progression of the disease including eye drop medications, iridotomies, iridectomies, laser procedures and surgeries. 

Glaucoma Prevention

Other than taking care of any underlying conditions that may increase the risk of developing glaucoma, there is little one can do in the way of prevention. You can however reduce your chances of suffering vision loss. The first step is knowing the risk factors and signs of the condition (even though as mentioned most cases have no symptoms in the early stages, until vision is already lost). 

The best possible way to prevent vision loss is to have regular comprehensive eye exams to check the health of your eyes and if your eye doctors prescribes medication for glaucoma, make sure to diligently take them as directed. Your eye doctor will be able to conduct certain tests to detect eye diseases such as glaucoma before you even begin to notice symptoms. If you have any of the risk factors above, mention it to your eye doctor, and always be sure to schedule a yearly eye exam, or as often as your eye doctor recommends, to check the health of your eyes and rule out any underlying or developing eye conditions like glaucoma. 

Diabetes is becoming much more prevalent around the globe. According to the International Diabetes Federation, approximately 425 million adults were living with diabetes in the year 2017 and 352 million more people were at risk of developing type 2 diabetes. By 2045 the number of people diagnosed is expected to rise to 629 million. 

Diabetes is a leading cause of blindness as well as heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. In fact, in 2017, diabetes was implicated in 4 million deaths worldwide. Nevertheless preventing these complications from diabetes is possible with proper treatment, medication and regular medical screenings as well as improving your diet, physical activity and adopting a healthy lifestyle.

What is Diabetes?

Diabetes is a chronic disease in which the hormone insulin is either underproduced or ineffective in its ability to regulate blood sugar. Uncontrolled diabetes leads to hyperglycemia, or high blood sugar, which damages many systems in the body such as the blood vessels and the nervous system.  

How Does Diabetes Affect The Eyes?

Diabetic eye disease is a group of conditions which are caused, or worsened, by diabetes; including: diabetic retinopathy, diabetic macular edema, glaucoma and cataracts. Diabetes increases the risk of cataracts by four times, and can increase dryness and reduce cornea sensation.

In diabetic retinopathy, over time, the tiny blood vessels within the eyes become damaged, causing leakage, poor oxygen circulation, then scarring of the sensitive tissue within the retina, which can result in further cell damage and scarring. 

The longer you have diabetes, and the longer your blood sugar levels remain uncontrolled, the higher the chances of developing diabetic eye disease. Unlike many other vision-threatening conditions which are more prevalent in older individuals, diabetic eye disease is one of the main causes of vision loss in the younger, working-age population. Unfortunately, these eye conditions can lead to blindness if not caught early and treated. In fact, 2.6% of blindness worldwide is due to diabetes. 

Diabetic Retinopathy

As mentioned above, diabetes can result in cumulative damage to the blood vessels in the retina, the light-sensitive tissue located at the back of the eye. This is called diabetic retinopathy. 

The retina is responsible for converting the light it receives into visual signals to the optic nerve in the brain. High blood sugar levels can cause the blood vessels in the retina to leak or hemorrhage, causing bleeding and distorting vision. In advanced stages, new blood vessels may begin to grow on the retinal surface causing scarring and further damaging cells in the retina. Diabetic retinopathy can eventually lead to blindness. 

Signs and Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy often have no symptoms, which is why it’s vitally important to have frequent diabetic eye exams. As it progresses you may start to notice the following symptoms:

  • Blurred or fluctuating vision or vision loss
  • Floaters (dark spots or strings that appear to float in your visual field)
  • Blind spots
  • Color vision loss

There is no pain associated with diabetic retinopathy to signal any issues. If not controlled, as retinopathy continues it can cause retinal detachment and macular edema, two other serious conditions that threaten vision. Again, there are often NO signs or symptoms until more advanced stages. 

A person with diabetes can do their part to control their blood sugar level. Following the physician’s medication plan, as well as diet and exercise recommendations can help slow the progression of diabetic retinopathy. 

Retinal Detachment

Scar tissues caused by the breaking and forming of blood vessels in advanced retinopathy can lead to a retinal detachment in which the retina pulls away from the underlying tissue. This condition is a medical emergency and must be treated immediately as it can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision. 

Diabetic Macular Edema (DME)

Diabetic macular edema occurs when the macula, a part of the retina responsible for clear central vision, becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and causes vision loss. 

Treatment for Diabetic Retinopathy and Diabetic Macular Edema

While vision loss from diabetic retinopathy and DME often can’t be restored, with early detection there are some preventative treatments available. Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection therapy, laser surgery or corticosteroids. 

Prevent Vision Loss from Diabetes

The best way to prevent vision loss from diabetic eye disease is early detection and treatment. Since there may be no symptoms in the early stages, regular diabetic eye exams are critical for early diagnosis. In fact diabetics are now sometimes monitored by their health insurance to see if they are getting regular eye exams and premium rates can be affected by how regularly the patients get their eyes checked. Keeping diabetes under control through exercise, diet, medication and regular screenings will help to reduce the chances of vision loss and blindness from diabetes. 

 

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