Patients sometimes come in with disfiguring vessel growth in the corners of their eye. This is very common in patients who spend a lot of time outdoors. The condition is known as a pterygium and it's a winged like fiber vascular growth that you can think of as almost scar tissue or a callus growing over the surface of the eye.
For Pterygiums that are either growing, impacting one's vision or level of comfort because a chronic irritation patients may consider to have the Pterygium removed. Like most of the procedures we perform pterygium surgery can be done as an outpatient, is easy for a patient to go through, and offers a fairly quick recovery. Essentially what happens is the Pterygium is peeled off the and a special graft of healthy tissue is glued into place in the area where the Pterygium was removed. The patients are patched overnight and upon removing the patch the next day are asked to use some eyedrops or ointment over the course of the ensuing few weeks.
One of the leading causes of vision impairment in patients over the age of 60 is glaucoma. What Glaucoma is, is it's damage to the optic nerve. The optic nerve is in the back of the eye, and that's what brings the vision back to the brain. Glaucoma is typically associated with an eye pressure that's too high for an individual's optic nerve and the optic nerve starts to sustain damage. It's thought of is the silent thief of sight. In other words, patients can have problems from Glaucoma and not even know it. That's why it's important for patients to schedule an annual eye exam to make sure that they're not having problems from this horrible disease.
Treatments for Glaucoma involve trying to lower the eye pressure to a more safe level for that individual. Typical ways of lowering the eye pressure are eye drops that either speed the flow out of the eye of fluid or decrease the production of fluid so that the eye pressure takes on a lower point. There are also laser treatments that can be performed in order to improve the outflow of fluid from the eye. This procedure is called an SLT laser treatment, and it's done as an outpatient and it doesn't hurt. There's no real recovery process and it has about an 80% chance of lowering the pressure in an individual case. In order for a patient to really know whether or not they have glaucoma and if they have glaucoma, how well it's being controlled is to make sure to have scheduled visits with your ophthalmologist.
There are two types of macular degeneration. Dry and wet. The dry type can lead to bad vision loss, but the wet type is the one that can quickly do so. It is the wet kind where most of the treatment modalities are focused. With the wet macular degeneration, abnormal blood vessels find their way underneath the retina and begin to leak. There's a chemical known as vascular endothelial growth factor that is released around these blood vessels. Special medications can be given to the eye that inhibit that growth factor and allow those blood vessels to regress, to go away, so that the bleeding and the leakiness will resolve. The retina then can assume a more normal configuration. When I was in training, these medicines didn't exist. It's been one of the most dramatic improvements in healthcare in general since I started medicine.
In terms of ways to try to prevent the chance of having vision loss from macular degeneration, adjustable lifestyle changes would be things like refraining from smoking, exercise, and eating a lot of leafy green vegetables. For patients with early signs of macular degeneration, there are some vitamin preparations that have been shown to decrease the chance of vision loss. These special vitamins under the name of AREDs 2 include vitamin C, vitamin E, zinc, Lutein, and zeaxanthin. Patients who have been found to be at risk of macular degeneration may be given a special grid to look at at least weekly to identify any changes in their vision. Patients may notice a waviness to lines or maybe even missing spots when viewing that grid. The grids called an Amsler grid and you're ophthalmologist will go over that with you.
One of the most common things that we'll see are patients with dry eyes. The dry eye patient will come in maybe complaining of a grittiness, kind of like there's a grain of sand in the eye. They may complain that their eyes are red or that their vision gets rather blurry after just a short period of time reading or in front of the computer. Particularly people who are in dry climates - so maybe the midwest in the wintertime or southern California at any point in time. It's really kind of a ubiquitous problem. Fortunately, there's a lot of things that we can do to help these patients.
Fortunately, there are so many different things that we can do to help our dry eye patients. It may range from just taking breaks in front of the computer to tear supplements (medications that stimulate tear production) or minor in-office procedures - all designed to really help make patients' eyes feel more comfortable and see better.
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