Conditions and Treatments

Corneal Transplant

 

Corneal transplant surgery involves the removal of a patient’s diseased or damaged cornea and replacing it with a healthy donor cornea.  The cornea is the clear element at the front of the human eye, which begins to refract (focus) incoming light and pass it through to the inner eye.  When the cornea becomes misshapen, cloudy, scarred or otherwise damaged, there are a variety of treatments available.  An ophthalmologist resorts to a corneal transplant when other methods of treatment have been exhausted.  The corneal transplant is the most commonly performed, and most successful, of all transplant surgeries.

 

Reasons for considering a corneal transplant: 

  • Complications from other eye surgery resulting in failure of the cornea.

  • Dystrophy of the cornea.

  • Eye trauma resulting in corneal scarring.

  • Hereditary problems with the cornea.

  • Keratoconus, a disease in which the cornea degenerates into a steep cone shape.

  • Rejection of a previous corneal transplant.

  • Various corneal infections that lead to scarring, including herpes viruses.

 

Doctors usually prefer to exhaust other, non-invasive forms of treatment first.  However, when problems of vision and/or pain can no longer be treated with glasses, contacts, pharmaceuticals or other specialized treatments, corneal transplant surgery is a viable solution.

 

The Procedure

Once the decision is made to undergo corneal transplant surgery, a suitable donor cornea must be obtained.  This is done through an eye bank.  Each potential donor is carefully screened, both for diseases that could be transmitted and for clarity.  The surgery is usually an outpatient procedure.  In preparation the doctor may choose either a local or general anesthetic, whichever is most appropriate for the patient.  A speculum is used to hold the eye open.

 

The surgeon uses a trephine (circular) blade to extract the host cornea.  A similar portion of tissue is cut from the donor cornea, and placed in the host eye.  This is then sutured with extremely thin stitching.  The doctor administers antibiotic eye drops, then a patch over the eye.

 

The Recovery

The patient is advised to rest the day of the surgery.  There will be a post-operative appointment with the doctor the next day.  After this, the patient may resume gentle tasks and activities, but must wear glasses or a shield to protect the eye, and administer eye drops as instructed by the physician.  After a week, more strenuous activities (like exercise) may be carefully resumed.  The stitches may be left in the eye anywhere from a few months to a year or longer.  The patient must continue to remain vigilant for signs of complication, and contact the eye doctor immediately upon any abnormal occurrence.

 

If you have questions or would like to meet with the doctor, we encourage you to contact us today to schedule a consultation.

 
 

Diabetic Retinopathy

Diabetes (diabetes mellitus) is a common disease in which blood-sugar levels are chronically too high.  The disease has many related complications, and several eye diseases among them.  The most common eye complication of diabetes is diabetic retinopathy, a leading cause of adult blindness.

 

Diabetic retinopathy occurs when high blood-sugar levels affect the functionality of blood vessels in the retina (light-sensing cells in the eye).  In early phases of the disease, capillaries will leak blood or fluid.  This can cause swelling in the retina (which may result in blurring of central vision), and it can leak into the vitreous humor (the fluid surrounding the retina) causing floaters or obscuring vision.

 

During the beginning stage serious vision damage is less likely, however, it can lead to a more advanced stage of the disease, called proliferative diabetic retinopathy.  In this form, blood vessels in the retina actually close off.  New blood vessels grow to make up for the lack of blood flow to the retina.  The new blood vessels unfortunately are accompanied by scarring and more leakage.  This can lead to serious vision loss and blindness.

 

Early symptoms of diabetic retinopathy may include:

  • Decreased night vision.

  • Floaters or obscuring vision.

  • Blurry vision.

 

The condition can typically be diagnosed by an ophthalmologist during an eye exam, long before noticeable vision symptoms occur and when more treatment options are still available.  Thus it is very important for those suffering from diabetes to have regular eye exams, to monitor for diabetic retinopathy and other complications.

 

Treatment:

Treatments for diabetic retinopathy vary based upon the nature and progression of the condition.  The best way to preserve good vision is to vigilantly control blood-sugar levels, lessening the chance of retinopathy, and impeding its rate of advancement.

 

Once the disease is in advanced stages, the ophthalmologist may choose a type of laser surgery, called pan-retinal photocoagulation.  This technique burns many tiny dots across the retina, with the aim of sealing off leaky blood vessels and discouraging further blood vessel growth. This surgery does not cure diabetic retinopathy, but it can help to save remaining vision.

 

If the vitreous humor has become clouded by blood leakage, there is a chance it may be naturally purged by the eye.  If clouding persists, however, a vitrectomy, a surgical removal of the vitreous humor, may be necessary.  The ophthalmologist replaces it with a saline solution, and the eye naturally replenishes the vitreous fluid over time.  This procedure can restore vision that has been obscured in the vitreous, however, any vision loss due to retinal damage or detachment is not restored.

 

If you have diabetes or are experiencing any symptoms of diabetic retinopathy, we encourage you to contact us today to schedule a consultation.

 

Strabismus

 

Strabismus, also called a “crossed eye”, is a condition in which the eyes are misaligned.  Eye position is controlled by six muscles, called extraocular muscles, which surround the eye.  Strabismus is most often caused by one or more of these muscles pulling either too hard or not hard enough.  While one eye gazes straight ahead, the other may point inward, outward, up or down.  Strabismus is commonly congenital, or develops in young children, though it may develop in adulthood as well.  It is often hereditary.

 

Strabismus symptoms may include:

  • Eyes pointing in different directions.

  • Weakened depth perception.

  • Double vision, particularly in adults.

 

Strabismus is often visually evident (by the misalignment of the eyes), and sometimes is noticed by a parent before diagnosed by a physician.  Some types, however, are very difficult to identify.  There are also cases of pseudostrabismus, in which an infant or toddler appears to have inwardly-crossing eyes, but is actually exhibiting incomplete facial development; this requires no treatment, and remedies itself with further growth.  If strabismus goes untreated in children, it often develops into amblyopia (lazy eye), in which the brain ignores images coming from the weak eye, rendering a person effectively blind in one eye.  For this reason, all children should be checked by a physician for strabismus by age three or four.  Children with a family history of the condition should be examined even earlier.

 

Treatment:

Corrective lenses are a common initial treatment and sometimes glasses alone will be effective.  More often than not however, surgery is necessary to correct strabismus.  Surgery involves adjusting the extraocular muscles in one or both eyes so that the eyes point in the same direction.  Strabismus surgery is generally a safe and common procedure, and is often the only way to effectively treat the disorder.

 

If you are experiencing any symptoms of strabismus, we encourage you to contact us today to schedule a consultation.

 

Amblyopia (lazy eye)

 

Amblyopia, also called “lazy eye,” is an eye condition which develops in early childhood.  For a number of reasons, the images from one eye (or in rare cases, both eyes) will be “ignored” by the brain.  If this is left untreated, especially during the early vision development period in one’s life (until around age nine), these neurological pathways will become permanent, resulting in a lifetime of reduced vision.  Having one amblyopic eye also puts added strain on the dominant eye, in which case future eye disorders are more likely.

 

Amblyopia symptoms may include:

  • Squinting or closing one eye to see things.

  • Poor depth perception and contrast perception.

  • Poor visual acuity in general.

 

Amblyopia is often difficult to diagnose in children, since they often don’t know they have a vision problem.  A doctor usually tests for the condition by blocking each eye and observing the patient’s response to visual tests.  Amblyopic patients will often tend to do poorly on three-dimensional image tests.

 

Several conditions lead to Amblyopia:

  • Strabismus (crossed eye):  A condition where the eyes are misaligned, and do not gaze at exactly the same target.  A child’s brain will adapt, and learn to ignore the image from the crooked eye, to prevent double vision.  Surgery may be necessary to treat the strabismus, but the weak eye must also be treated for amblyopia.

  • Refractive discrepancy:  In this case the eyes have markedly different levels of nearsightedness, farsightedness or astigmatism.  The blurrier eye is ignored by the brain.  Once diagnosed, this vision condition may be treated with corrective lenses; however, often the amblyopia must be treated as well.

  • Eye clouding or obstruction:  Other eye problems such as trauma, congenital cataract, scarring, or anything preventing a clear image can result in disuse of that eye.  The ophthalmologist must address the obstruction, often by surgery, and then treat the amblyopia.

 

Treatment:

Whatever the origin, treating amblyopia requires a therapy aimed at making the child use the weak eye.  Most commonly used is an eye patch over the dominant eye worn full time or intermittently, over a period of a week or two, or longer, until the weaker eye matches the stronger one.  Alternately, the ophthalmologist may prescribe a blurred lens, or Atropine eye drops, which prevent the dominant eye from focusing.  These serve the similar purpose of imposing use of the weak eye.

 

Proper treatment during early childhood will often lessen or reverse amblyopia; however, it is common for the disorder to recur during this period requiring treatment to resume.  Once a child passes the age of nine, amblyopia will usually not relapse if it has been successfully treated up to that point.  Conversely, it is much more difficult to treat older patients with amblyopia.  Nonetheless, treatment can still be worthwhile for those beyond early childhood.

 

If your child is experiencing any symptoms of amblyopia, we encourage you to contact us today to schedule a consultation.

 

Cataract Care

A cataract is an opacity that clouds the natural lens inside the eye.  Normally the path of light to the retina (where the light sensors are) is as clear as possible.  When proteins that make up the lens clump together, the resulting cataract blocks some of the light, making vision blurry or hazy.

 

Cataracts typically occur more frequently in the aging population, however there are many other factors such as family history, diabetes, long term UV exposure, or certain medications like steroids that can cause cataracts.  Also, previous eye injuries can be an attributing factor.

 

Cataract symptoms may include:

  • Blurry vision.

  • Lights seem too bright or have a “halo” effect.

  • Double vision in one eye.

  • Decreased night vision – sensitivity to glare from headlights.

  • Dull or fading colors.

 

Some people actually experience an improvement in their near vision during the beginning stages of a cataract.  Unfortunately, this effect goes away as the disease progresses.  Early on, a cataract may be treated with increased glasses or contact prescription.  Once the cataract begins to interfere with daily tasks such as reading and driving, surgery is the only remaining option.

 

Cataract Surgery

Cataract surgery is a very common procedure, and complications (if any) are rare and treatable.  The surgery itself is highly successful in improving the vision of patients about 95% of the time.  Cataract surgery is an outpatient procedure usually taking less than 30 minutes to complete.

 

During the surgery, the doctor removes the cloudy natural lens from the eye while the patient is under a topical anesthesia.  Next, the doctor inserts an intraocular lens (IOL), which remains permanently in place of the removed natural lens.  The IOL compensates for the magnification the old lens provided.  Modern IOLs are designed for various functions and made out of different materials; your doctor will know which is most appropriate for your individual case.  After the operation the doctor will apply a shield for the eye and provide you with eye drops to use as directed.

 

Recovery from Cataract Surgery

The patient may return home the day of the procedure.  With proper rest and avoidance of any strenuous activities such as heavy lifting, recovery is usually a matter of days, with only minor discomfort.  Several follow up appointments will be required to ensure the eye is healing properly and initial results are sustained.

 

If you are experiencing any symptoms of cataract problems, we encourage you to contact us today to schedule a consultation.

 

Dry Eye

Dry eye syndrome is a common disease in which the eye under-produces tears or tears leave the eye too quickly.  A normal functioning eye constantly produces tears to form a tear film, which acts as moisturizer and lubricant.  For someone with dry eye, the resulting lack of moisture and lubrication can cause a variety of problems.

 

Dry eye symptoms may include:

  • A burning, stinging, or scratchy sensation in the eyes.

  • Eyes may redden and become easily irritated by wind or smoke.

  • The eyes may produce stringy mucus.

  • Contact lenses may be difficult or impossible to wear.

  • Sometimes the eye will actually produce excessive tears, and overflow.*

 

*Though it sounds contradictory, sometimes the eye will actually produce excessive tears, and overflow.  The eye becomes irritated by the lack of lubrication and attempts to cleanse itself with a flood of tears.  This is a similar phenomenon to the tearing that occurs when foreign matter is stuck in one’s eye.

 

Dry eye syndrome is typically more common in older people and women; however, there are many other factors that can cause this to happen.  A common cause of dry eye can be over the counter and prescription medications such as antihistamines, beta-blockers, sleeping pills, pain relievers and many others.  Overuse of diuretics can also play a role in developing dry eye.  For this reason, it is very important to inform your ophthalmologist about any medications you are currently taking, which can help the doctor in the proper diagnosis of the disease.

 

Sometimes the cause is unknown in a case of dry eye.  Known causes of dry eye may be natural, related to a larger condition, or the side effect of certain medications.  Also, tear production often slows down as people get older.  This is particularly common for women after menopause.

 

Treatments for dry eye:

  • Artificial tears:  Mild to moderate cases of dry eye syndrome may be treated by applying artificial tear eye drops as little or as often as necessary.  There are a wide range of products available without a prescription that the doctor can recommend.

  • Prescription medications:  Can sometimes increase tear production for those with chronic dry eye.  It does this by targeting inflammation in the eye.

  • Conserving tears:  An effective way to make better use of the tears in the eye is surgery to close the tear ducts, thus preventing existing tears from leaving the eye as quickly.  This may be done temporarily, with punctal plugs made of collagen, or permanently with silicone plugs or by cauterizing the tear ducts closed.

  • Controlling one’s environment:  Patients should avoid situations in which tears evaporate quickly; for example, by using a humidifier in a dry house, wearing wrap-around glasses in the wind, and not smoking.

 

If you are experiencing any symptoms of dry eye, we encourage you to contact us today to schedule a consultation.

 

Glaucoma

 

Glaucoma is a disease that affects the optic nerve, the part of the eye which receives images collected by the retina and sends them to the brain.  Every eye maintains a certain amount of internal pressure, called intraocular pressure.  When this pressure rises to abnormal levels however, it can put extra stress on the optic nerve, causing significant damage.  Optic nerve damage results in loss of vision, and ultimately blindness.

 

The front of the eye is constantly producing a fluid called aqueous humor.  A healthy eye will continually produce small amounts of aqueous humor to ensure consistent pressure within the eye.  When normal drainage becomes slowed or blocked, pressure increases, and may lead to glaucoma.  There are several different types of glaucoma the two most common types being chronic open-angle glaucoma and closed-angle glaucoma.

 

Chronic open-angle glaucoma is the most common form of the disease and usually develops with age.  With this type of glaucoma, pressure gradually increases around the eye causing it to work less effectively over a period of time.  There are no symptoms in the early stages of open-angle glaucoma.  Peripheral vision is usually the first to deteriorate.  As the disease becomes more advanced, blank spots begin to appear in one’s vision.  If left untreated, it eventually develops to blindness.  The best way to avoid serious vision loss is early diagnosis and treatment.

 

Risk factors for chronic open-angle glaucoma include:

  • Advanced age.

  • Family history of the disease.

  • Higher-than-normal intraocular pressure.

  • Certain ethnic races, particularly those of African descent.

  • Certain diseases or conditions, especially diabetes, farsightedness or nearsightedness, or previous eye trauma or surgery.

 

Closed-angle glaucoma is less prevalent, but is considered a real eye emergency.  This type of glaucoma occurs when a patient’s pupil moves or dilates and actually blocks off the drainage angles in the eye.  This is considered a medical emergency in which an ophthalmologist should be contacted immediately to avoid any loss of vision.

 

Symptoms of closed-angle glaucoma include:

  • Severe eye pain.

  • Headache.

  • Blurred vision.

  • Nausea or vomiting.

  • Rainbow halos around lights.

 

High risk factors for closed-angle glaucoma include:

  • Extreme farsightedness.

  • An iris that is abnormally large or far back in the eye.

  • Advanced age.

  • Heredity.

  • Certain ethnic races, especially Asians.

 

Treatments for glaucoma:

There are a wide range of treatments for the disease, including medication, laser surgery and traditional surgery.  The treatment (or combination of treatments) for an individual is chosen based upon the type of glaucoma and other details of the particular case.  One option is medication such as prescription eye drops which help to reduce intraocular pressure, or pills called carbonic anhydrase inhibitors which slow down fluid production within the eye.

 

Laser surgery has also become a common treatment option for glaucoma.  For open-angle glaucoma the doctor may choose a trabeculoplasty, a painless laser procedure which uses light to shrink and stretch eye tissue to allow more drainage of fluid.  For closed-angle cases, in which the iris is blocking drainage of aqueous humor, a laser surgery called iridotomy may be performed.

 

Other glaucoma treatment options involve various traditional surgeries.  A common surgery for open-angle glaucoma is the trabeculectomy, where a doctor creates a small flap in the sclera (white part of the eye).  Underneath the surface of the sclera, the doctor creates a small reservoir, called a filtration bleb, into which aqueous fluid may drain and then be disbursed, further reducing intraocular pressure.

There are a number of treatments available for Glaucoma patients.  If diagnosed with glaucoma, your ophthalmologist will consult with you on your options in order to maintain the best possible health of your eyes.

 

If you are experiencing any symptoms of glaucoma, we encourage you to contact us today to schedule a consultation.

 

Macular Degeneration

Macular degeneration affects cells in the macula, which is the part of the retina responsible for central vision.  Central vision is essential for most basic tasks like reading, driving, recognizing people, etc.  Thus, although macular degeneration leaves peripheral vision un-impaired, it can be quite debilitating in its advanced state.

The disease exists in two forms, dry and wet.  Dry macular degeneration is by far the most common (roughly 90% of all cases).  However, it is the milder of the two forms, develops gradually, and usually leads to only minor vision loss.  Dry macular degeneration tends to occur when yellow fatty particles called drusen accumulate in the retina underneath the macula.  This build-up results in thinning and drying-out of the macular cells.

Wet macular degeneration is less common, but the vast majority of severe vision loss cases result from this form.  First, abnormal blood vessels form underneath the surface of the retina.  Leakage of blood and other fluids from these blood vessels permanently damage the outside cells (which detect incoming light).  As these cells are damaged, vision is lost.

The primary cause of macular degeneration remains unknown.  Macular degeneration typically occurs more frequently in the aging population with patients over 60.  Research has shown there are many other factors such as family history, smoking, hypertension, obesity, and/or a high cholesterol, high fat diet that may contribute towards the development of macular degeneration.

Macular degeneration symptoms may include:

  • Shadows, blurriness, or holes in the center of vision.

  • Straight lines appear wavy.

  • Trouble seeing details both up close and at a distance.

  • Difficulty telling colors apart, especially ones close in hue.

  • Vision can be slow to come back after bright light exposure.

 

Treatment for dry macular degeneration:

Unfortunately, there is no treatment for the dry form of macular degeneration.  Those at high risk should schedule a checkup with their ophthalmologist at least once every one to two years, to catch the disease in its infancy.  Also, it is thought that dietary supplementation of antioxidants and zinc may help to slow its development.

 

There is also no cure for wet macular degeneration.  There are, however, several treatments designed to combat the disease.  Early detection is very important because once vision is lost there is no treatment to regain it.

 

Treatments for wet macular degeneration:

  • Laser photocoagulation:  Seals abnormal blood vessels with a heated laser.  This treatment will sometimes halt the disease, thus saving the remaining vision of a patient.  However, the laser leaves a scar, creating a permanent blind spot in the patient’s vision.  The treatment is only applicable to a small segment of cases, in which some vision is sacrificed to save remaining vision.

  • Photodynamic therapy:  Employs a light-activated drug and a “cold” laser.  The drug is injected intravenously.  Then the doctor shines the laser on the affected area, which activates the drug in the targeted tissue and blocks the leaking blood vessels.  This procedure leaves no scar, and may be repeated several times as necessary.

  • Anti-angiogenesis drugs:  These inhibit proteins which contribute to abnormal blood vessel growth.  They are known as anti-VEGF (anti-vascular endothelial growth factor) drugs.  There are a variety of drugs that can be applicable for this purpose, some FDA approved, and some off-label (officially approved for a different application).

  • Other pharmaceutical treatments:  For example, angiostatic treatments, which combat blood vessel growth with steroid injections.

 

If you are experiencing any symptoms of macular degeneration, we encourage you to contact us today to schedule a consultation.

Peninsula Eye Physicians

101 So San Mateo Dr. Ste. 310

San Mateo, Ca 94401

For Life-Threatening Emergencies Call 911
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