Professor Kazem Fathie, M.D., F.A.C.S., F.I.C.S., Ph.D.

Chairman, American Academy of Neuological and Orthopaedic Surgeons

What can happen to your vision?

1. AMBLYOPIA

Amblyopia is when an eye does not develop normal sight during childhood and there is poor vision. This is often referred to as a "lazy eye". This is usually unilateral, which means only one eye is affected. During the growth of a newborn to childhood years, changes in the visual system continue to develop. An eye which did not develop normal sight during early childhood is called amblyopic. Therefore, it is recommended that eyes of children be checked by an ophthalmologist early in life. Sometimes this condition of amblyopia is inherited in a family

i) What causes amblyopia?
Misaligned eyes or strabismus or refractive errors such as unequal focus, or cloudiness in normally clear eye tissues. Amblyopia can be recognized by a misaligned eye or other differences in the vision between two eyes. An eye examination will clear the matter of the exact diagnosis and differential diagnosis of inflammation, tumors, cataracts, or other disorders.

ii) Treatment of amblyopia
Treatment of amblyopia is usually patching or covering one eye, specifically the strong eye for weeks or months and trying to recover the weak eye to the strength of the normal eye. This can also be treated with prescription glasses. Early treatment may correct this condition before any attempt at surgery. The key to treatment is to make sure the weak eye becomes stronger and the strong eye remains the same. Treatment for the amblyopia needs to be done to prevent further problems such as visual defects, abnormalities of depth perception, or future poor vision. Sometimes children are not in favor of having a patch over their eyes. Therefore, giving them glasses and covering the glass on the affected side is effective.

It should be mentioned that vision can be improved and amblyopia can be treated if the problem is properly recognized by a pediatrician during routine screening and an ophthalmologist is consulted for further advice and treatment.


2. MACULAR DEGENERATION

This problem occurs with the breakdown of the macula of the eye. It occurs most commonly in the elderly. In the back of the eye there is a small region called the macula, which allows us to clearly see details. If it is not functioning, blurring of the vision occurs. Macular degeneration decreases the vision of the central part of the retina. A patient may see the outline and does not see the center. The two most important causes of the disease are age related and caused by dryness of the eye or wetness of the eye, atrophic or exudative. Sometimes it is unilateral and sometimes it is bilateral. When both eyes are affected, the loss of central vision can be also quickly recognized and even a word on a page looks blurred. At the center of vision a dark area would be observed and a straight line looks distorted. This problem can be diagnosed by an ophthalmologist through an ophthalmoscope, by simple visual tests, as well as by angiography. The treatment of this problem focuses on helping the individual to find ways to cope with the visual impairment. It can sometimes be treated by laser surgery. If you are experiencing any of these problems, consultation with an ophthalmologist for further examination and advice would be wise. Checking the vision with an Amsier grid is advised.

 

3. CATARACT

This condition is characterized by a gradual cloudiness of the lens of the eye and the vision seems foggy, as if the patient has a hazy film before the eye. Common symptoms of this disease are blurring, glare, frequent changes in eyeglasses and sometimes double vision or poor night vision. Cataracts appear in the elderly most often but can also occur in children exposed to certain medications. Certain medical problems such as diabetes, injury to the eye, or medications, such as steroids, unprotected eyes to sunlight, or advancing age, commonly lead to cataracts. A cataract is easily detected by looking into the eye with an ophthalmoscope . It develops rather slowly and can be treated easily by an ophthalmologist by removal of the cataract and placement of an intraocular lens. For prevention of cataracts, among other things, the use of sunglasses that screen out ultraviolet light rays is advisable. Cataract surgery is carried out when the cataract has "matured". Surgery of this type is highly successful and has given patients newfound visual acuity. This problem is curable and patients should consult their doctor if they are experiencing these symptoms.


4. FLOATERS AND FLASHERS

This condition is characterized by a patient seeing small specks of dust or clouds flying in front of their eyes. This is due to clumps of gel or cells inside the vitreous, floating in the fluid and giving that visual perception by shadows they cast on the retina. Floaters can have different shapes such as little dots, circles, clouds cobwebs or lines. When a person reaches middle age, this problem is rather common. Floaters are not serious if the retina is not torn. What causes flashing lights is that the vitreous gel pulls on the retina and the patient may see flashing lights or lightening streaks. It is the same experience as when someone is hit in the eye and sees "stars". When this is seen, a patient should contact an ophthalmologist immediately to see if the retina has been torn. Some people experience headaches and flashes of light with jagged lines or heat waves. It could be headaches due to migraine. A proper diagnosis by an ophthalmologist in this matter should be made so that this matter can be recognized and treated.


5. DRY EYE

This condition occurs due to the lack of secretion of tears produced in the lacrimal gland, which keeps the eyes dry. It causes symptoms such as stinging and scratchiness of the eyes, or irritation of the eyes or even excess tearing with possible difficulty of using contact lenses. A film of tears spread over the eye by a blink makes the surface of the eye smooth and clear. When the eye becomes dry, artificial tears are advisable. When a person is receiving diuretics, antihistaminic medication, betablockers, or other medications for nerves or sedative, this condition can develop. Tears can evaporate by heat or medication which causes dryness of the eyes. Sometimes lack of Vitamin A is the cause of dry eyes and can be remedied by Vitamin A ointment.


6. GLAUCOMA

This is a very important condition which can cause blindness and therefore must be given high priority for early detection and treatment. This is a disease of the optic nerve and is caused by pressure inside the eye. The higher the pressure inside the eye, the greater the chance of damage to the optic nerve. The optic nerve consists of many fibers of nerves which carries messages, much like electric wires, to the brain. Unfortunately, people usually do not notice the signs right away and should be examined for this condition. The major cause of glaucoma is the flow of the aqueous fluid in the eye has improper drainage of the fluid behind the eyes. If the drainage angle is blocked, the fluid pressure within the inner eye may increase, which can damage the optic nerve. Glaucoma is divided into different types such as chronic, acute, or subacute. When the drainage angle of the eye becomes completely blocked this is called angle-closure glaucoma. Symptoms of glaucoma may include visual blurring, pain in the eyes, headaches, rainbow haloes around lights, or nausea and vomiting. Glaucoma can be detected by a physician through tonometry (measuring eye pressure) and gonioscopy, as well as evaluation of the optic nerve by ophthalmoscopy and test of visual field by perimetry examination. People at risk for this disease are people of African ancestry, a person who has a family history of glaucoma, the elderly, and people with injuries to their eyes in the past. A person with this disease should be carefully treated by an ophthalmologist with administration of eye drops and medication. Glaucoma medications can have complications such as eye drops causing redness of the eyes, slowing the pulse and heartbeat, headaches or blurring, and this should be kept in mind. Certain tablets also can create complications such as loss of appetite, drowsiness, bowel irritation, kidney stones or anemia. Laser surgery may be advisable in either open-angle glaucoma or closed-angle glaucoma. Operative surgery can also be performed so that loss of vision can be prevented. Advice is that the patient should see their ophthalmologist and make sure this condition does not progress, leading to complications and specifically, to blindness.

7. DIABETIC RETINOPATHY

It has been known for many years that that diabetes can create neuropathy such as retinopathy, which needs the utmost care before it creates macular edema or macular ischemia. Leaking in the back of the eye can form deposits called exudates, or even vitreous hemorrhages. Areas of ischemia lead to the proliferation of many abnormal blood vessels. Traction retinal detachment, as well as neovascular glaucoma could also be observed by examination. Diagnosis is mostly done by fluorescein angiography. Treatment with laser surgery is sometimes advisable. Ophthalmologists sometimes recommend Vitrectomy. To prevent complications, this condition should be recognized at an early stage to prevent loss of vision. Sometimes the problem can affect only one eye, or can sometimes affect both eyes. It is often seen in people who have developed Type I or Type II diabetes and is associated with other diabetic problems such as polyneuropathy, kidney failure, heart trouble, coronary artery disease, and other complications of diabetes. The best prevention of these complications is tight control of the blood sugar in order to keep it within a normal range. Chronically high sugars lead to more complications.

IN CONCLUSION

Look for these presentations and recognize the above syndromes and treat them.
Make sure children have glasses, if needed, and practice eye safety for children and adults. Consult your physician and opthalmologist, or contact the American Academy of Opthalmology for further details and advice.