Eye problems can range from mild to severe; some are chronic, while others may resolve on their own, never to appear again. The articles below will give you a basic understanding of some of these problems and their implications. The cardinal rule is if your eyes don’t look good, feel good or see well, you should visit your doctor.
Eye Condition Treatment
Below is a brief overview of some of the common eye conditions we diagnose and treat, including astigmatism, dry eye, and presbyopia. For information about cataracts, glaucoma, macular degeneration, and diabetic retinopathy, please visit our Eye Disease Management section.
Astigmatism
Astigmatism: Causes and Symptoms
Astigmatism is a very common eye condition that’s easily corrected with eyeglasses or contact lenses and on some occasions, surgery.
Astigmatism is caused when your eye is not completely round. Because our bodies are not perfect, astigmatism occurs in nearly everybody to some degree but for some, not to the degree that it causes blurring. Your eye is naturally shaped like a sphere. Under normal circumstances, when light enters the eye, it bends evenly, creating a clear picture on the back of your eye. In a person with astigmatism, their eye is shaped more like a football and light entering the eye is bent more in one direction than the other. This causes only part of the picture to be in focus at any given time. Objects at any distance can appear blurry and wavy. For vision problems due to astigmatism, glasses or contact lenses, and sometimes even vision correction surgery are all possible treatments.
People with undetected astigmatism often have blurred vision which can be associated with fatigue and eyestrain. While these symptoms may not necessarily be the result of astigmatism, you should schedule an eye exam if you are experiencing one or more symptoms.
Our Optometric Staff Know Astigmatism!
Your eye doctor can diagnose astigmatism with a thorough eye exam. Astigmatism may occur in combination with other vision problems such as nearsightedness and farsightedness, or even dry eyes. Because astigmatism gets worse over time, visit our practice whenever you notice changes in your vision.
Presbyopia
As we reach middle age, particularly after age 40, it is common to start to experience difficulty with reading and performing other tasks that require near vision. This is because with age, the lens of our eye becomes increasingly inflexible, making it harder to focus on close objects. Unlike a true eye disease, this condition is so common, it eventually happens to almost everyone who reaches old age to some extent. It’s called presbyopia.
To avoid eyestrain, people with untreated presbyopia tend to hold books, magazines, newspapers, and menus at arm’s length in order to focus properly. Trying to performing tasks at close range can sometimes cause headaches, eye strain or fatigue in individuals who have developed this condition.
Causes of Presbyopia
During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty. As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.
Presbyopia is a natural result of the aging process and not much can be done to prevent it. Its onset has nothing to do with whether you already have another vision impairment such as nearsightedness, farsightedness or astigmatism. Everyone will notice some degree of loss of near vision focusing power as they age, although for some it will be more significant than others.
Symptoms and Signs of Presbyopia
Presbyopia is characterized by:
- Difficulty focusing on small print
- Blurred near vision
- Experiencing eyestrain, fatigue or headaches when doing close work or reading
- Needing to hold reading material or small objects at a distance to focus properly
- Requiring brighter lighting when focusing on near objects
Presbyopia can be diagnosed in a comprehensive eye exam.
Treatment for Presbyopia
There are a number of options available for treating presbyopia including corrective eyewear, contact lenses or surgery.
Eyeglasses
Reading glasses or “readers” are basically magnifying glasses that are worn when reading or doing close work that allow you focus on close objects.
Eyeglasses with bifocal or multifocal lenses such as progressive addition lenses or PALs are a common solution for those with presbyopia that also have refractive error (nearsightedness, farsightedness or astigmatism). Bifocals have lenses with two lens prescriptions; one area (usually the upper portion) for distance vision and the second area for near vision. Progressive addition lenses or PALs similarly provide lens power for both near and distance vision but rather than being divided into two hemispheres, they are made with a gradual transition of lens powers for viewing at different distances. Many individuals prefer PALs because unlike bifocals, they do not have a visible division line on the lens.
Bifocal and Multifocal Contact Lenses
For individuals that prefer contact lenses to glasses, bifocal and multifocal lenses are also available in contact lenses in both soft and Rigid Gas Permeable (RGP) varieties.
Multifocal contact lenses give you added freedom over glasses and they allow you to be able to view any direction – up, down and to the sides – with similar vision. People wearing progressive lenses in glasses on the other hand have to look over their glasses if they want to view upwards or into the distance.
Another option for those who prefer contact lenses is monovision. Monovision splits your distance and near vision between your eyes, using your dominant eye for distance vision and your non-dominant eye for near vision. Typically you will use single vision lenses in each eye however sometimes the dominant eye will use a single vision lens while a multifocal lens will be used in the other eye for intermediate and near vision. This is called modified monovision. Your eye doctor will perform a test to determine which type of lens is best suited for each eye and optimal vision.
Surgery
There are surgical procedures also available for treatment of presbyopia including monovision LASIK eye surgery, conductive keratoplasty (CK), corneal inlays or onlays or a refractive lens exchange (RLE) which replaces the hardened lens in the eye with an intraocular lens (IOL) similar to cataract surgery.
Since it affects so much of the older population, much research and development is going into creating more and better options for presbyopes. Speak to your eye doctor about the options that will work best for you.
Dry Eye
Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Irritation
- Watery eyes
- Blurred vision
- Pain
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
Preventing Dry Eyes
If the cause of your dry eyes is something external or environmental, eliminating that cause may solve the problem and resolve the symptoms. Avoid dry environments, hair dryers, heaters and fans, (particularly directed toward the eyes) and smoky environments and wear eye protection such as wrap around glasses or goggles when in dusty or windy areas. Use a humidifier to add moisture to dry indoor air. If working on computer or watching television, make sure to blink purposefully as our natural tendency is to reduce our blink rate when staring at a screen. Also avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least 8 to 10 glasses of water per day can also help.
Dry eye disease won’t have a permanent effect on your vision, but there is no reason to endure dry, itchy and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It’s also important to realize that this is a chronic disease that needs consistent treatment. Your doctor will work with you to create a long term strategy to keep your eyes as comfortable as possible.
Treatment for Dry Eyes
There are many treatment options for dry eyes which are highly dependant upon the cause and severity of the condition. Many mild forms of DED can be alleviated using artificial tears or lubricant eye drops to make up for the lack of natural tears usually produced by your eyes. If over-the-counter drops don’t alleviate your symptoms, your doctor might prescribe prescription drops that actually stimulate tear production or steroids for short-term relief.
More severe cases of dry eyes might be treated with a punctal insert which is a tiny insert containing a slow-release lubricating substance that is placed inside the lower eyelid. Since DED is often related to eyelid inflammation known as blepharitis your doctor may prescribe a heated hot compress mask, specialty eyelid scrubs and sometimes an antibiotic ointment. Finally, punctal plugs might be recommended for severe cases which would be inserted into the tear ducts to reduce the tear drainage in your eyes to keep them from drying out.
In cases where discontinuation or switching to different medications is possible this can eradicate symptoms. Your doctor may also recommend that you limit or refrain from contact lens use for a certain amount of time or switch to a different brand or type of contact lens which will reduce dehydration.
