Age-Related Macular Degeneration (ADM) is the leading cause of severe vision loss in adults over age 50. The Centers for Disease Control and Prevention estimate that 1.8 million people have AMD and another 7.3 million are at substantial risk for vision loss from AMD. Caucasians are at higher risk for developing AMD than other races. Women also develop AMD at an earlier age than men. This eye disease occurs when there are changes to the macula, a small portion of the retina that is located on the inside back layer of the eye. AMD is a loss of central vision that can occur in two forms: “dry” or atrophic and “wet” or exudative.

Most people with macular degeneration have the dry form, for which there is no known treatment. The less common wet form may respond to laser procedures, if diagnosed and treated early.

Some common symptoms are: a gradual loss of ability to see objects clearly, distorted vision, a gradual loss of color vision, and a dark or empty area appearing in the center of vision. If you experience any of these, contact your doctor of optometry immediately for a comprehensive examination. Central vision that is lost to macular degeneration cannot be restored. However, low vision devices, such as telescopic and microscopic lenses, can be prescribed to maximize existing vision.

Researchers have linked eye-friendly nutrients such as lutein/zeaxanthin, vitamin C, vitamin E, and zinc to reducing the risk of certain eye diseases, including macular degeneration. For more information on the importance of good nutrition and eye health, please see the diet and nutrition section.

  • Symptoms of AMD

    • Gradual loss of ability to see objects clearly
    • Objects appear distorted in shape. Straight lines look wavy or crooked.
    • Loss of clear color vision
    • A dark or empty area appears in the center of vision.
  • Diagnosis of AMD

    In its early stages, signs of macular degeneration can go noticed. Yet, if you experience any signs/symptoms, contact your doctor of optometry immediately. In a comprehensive eye exam, your optometrist will perform a variety of tests to determine if you have macular degeneration, or any other eye health problems.

  • Treatment of AMD

    With “dry” macular degeneration, the tissue of the macula gradually becomes thin and stops functioning properly. There is no cure for dry AMD, and any loss in central vision cannot be restored. However, doctors now believe there is a link between nutrition and the progression of dry AMD. Dietary changes favoring low-fat content and dark green leafy vegetables can slow vision loss. Nutritional supplements also may be beneficial.

    Less common, “wet” macular degeneration results when fluids leak from newly formed blood vessels under the macula and blur central vision. Vision loss can be rapid and severe. If detected early, “wet” AMD can be treated with laser treatment, which is often called photocoagulation. A highly focused beam of light seals the leaking blood vessels that damage the macula. Photodynamic Therapy (PDT) uses a medication injected into the bloodstream, which is then activated with a laser shone into the eye. A new therapy available, where a medication is injected into the back of the eye, is showing favorable results. These are not permanent cures but are used to slow the rate of central vision loss.

  • Nutrition and AMD

    There’s no substitute for the quality of life good vision offers. Adding certain nutrients to your diet every day – either through foods or supplements – can help save your vision. Researchers have linked eye-friendly nutrients such as lutein/zeaxanthin, vitamin C, vitamin E, and zinc to reducing the risk of certain eye diseases, including macular degeneration.

    Lutein and Zeaxanthin – 10 mg Lutein, 2 mg Zeaxanthin per day to slow AMD progression

    Lutein (LOO-teen) and zeaxanthin are important nutrients found in green leafy vegetables as well as other foods such as eggs. Many studies have shown that lutein and zeaxanthin reduce the risk of chronic eye diseases, including age-related macular degeneration (AMD).

    Much evidence supports the role of lutein and zeaxanthin in reducing the risk of AMD. In fact, The National Eye Institute presently is conducting a second large human clinical trial, Age-Related Eye Disease Study (AREDS2), to confirm whether supplements containing 10 mg a day of lutein and 2 mg of zeaxanthin per day affect the risk of developing AMD. Beyond reducing the risk of developing eye disease, separate studies have shown that lutein and zeaxanthin improve visual performance in AMD patients.

    Vitamin C – Need 500 mg per day to slow AMD progression

    Scientific evidence suggests vitamin C , when taken in combination with other essential nutrients, can slow the progression of age-related macular degeneration (AMD) and visual acuity loss. The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, was a landmark study that established AMD as a ‘nutrition-responsive disorder.’ The study showed that a 500 mg/day intake of vitamin C, taken with antioxidants beta-carotene, vitamin E and zinc supplementation, slows the progression of advanced age-related macular degeneration by about 25 percent. Emerging science, consisting of the AREDS results and seven smaller studies, have confirmed these results.

    Vitamin E – Need 400 mg per day to slow AMD progression

    The study showed that a 400 IU/day intake of vitamin E, taken with antioxidants beta-carotene, vitamin C and zinc supplementation, slows the progression of advanced age-related macular degeneration (AMD) by about 25 percent in individuals at high-risk for the disease.

    Zinc – Need 40 to 80 mg daily to slow AMD progression

    The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, was a landmark study that established AMD as a ‘nutrition-responsive disorder.’ The study showed that a 40-80 mg/day intake of zinc, taken with antioxidants beta-carotene, vitamin E and vitamin C, slows the progression of advanced age-related macular degeneration by about 25 percent and visual acuity loss by 19 percent in individuals at high-risk for the disease. Higher levels of zinc may interfere with copper absorption, which is why the AREDS study also included a copper supplement


Information courtesy of the American Optometric Association, 3/14/11

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Nearsightedness, or myopia, as it is medically termed, is a vision condition in which close objects are seen clearly, but objects farther away appear blurred. Nearsightedness occurs if the eyeball is too long or the cornea, the clear front cover of the eye, has too much curvature. As a result, the light entering the eye isn’t focused correctly and distant objects look blurred.

Nearsightedness is a very common vision condition affecting nearly 30 percent of the U.S. population. Some research supports the theory that nearsightedness is hereditary.  There is also growing evidence that it is influenced by the visual stress of too much close work.

Generally, nearsightedness first occurs in school-age children. Because the eye continues to grow during childhood, it typically progresses until about age 20. However, nearsightedness may also develop in adults due to visual stress or health conditions such as diabetes.

A common sign of nearsightedness is difficulty with the clarity of distant objects like a movie or TV screen or the chalkboard in school. A comprehensive optometric examination will include testing for nearsightedness. An optometrist can prescribe eyeglasses or contact lenses that correct nearsightedness by bending the visual images that enter the eyes, focusing the images correctly at the back of the eye. Depending on the amount of nearsightedness, you may only need to wear glasses or contact lenses for certain activities, like watching a movie or driving a car. Or, if you are very nearsighted, they may need to be worn all the time.

Another option for treating nearsightedness is orthokeratology (ortho-k), also known as corneal refractive therapy. It is a non-surgical procedure that involves wearing a series of specially designed rigid contact lenses to gradually reshape the curvature of your cornea. The lenses place pressure on the cornea to flatten it. This changes how light entering the eye is focused.

Laser procedures are also a possible treatment for nearsightedness in adults. They involve reshaping the cornea by removing a small amount of eye tissue.  This is accomplished by using a highly focused laser beam on the surface of the eye.

For people with higher levels of nearsightedness, other refractive surgery procedures are now available. These procedures involve implanting a small lens with the desired optical correction directly inside the eye, either just in front of the natural lens (phakic intraocular lens implant) or replacing the natural lens (clear lens extraction with intraocular lens implantation). These procedures are similar to one used for cataract surgery patients, who also have lenses implanted in their eyes (intraocular lens implants).

What causes nearsightedness?

The exact cause of nearsightedness is unknown, but two factors may be primarily responsible for its development:

  • heredity
  • visual stress

There is significant evidence that many people inherit nearsightedness, or at least the tendency to develop nearsightedness. If one or both parents are nearsighted, there is an increased chance their children will be nearsighted.

Even though the tendency to develop nearsightedness may be inherited, its actual development may be affected by how a person uses his or her eyes. Individuals who spend considerable time reading, working at a computer, or doing other intense close visual work may be more likely to develop nearsightedness.

Nearsightedness may also occur due to environmental factors or other health problems:

  • Some people may experience blurred distance vision only at night. This “night myopia” may be due to the low level of light making it difficult for the eyes to focus properly or the increased pupil size during dark conditions, allowing more peripheral, unfocused light rays to enter the eye.
  • People who do an excessive amount of near vision work may experience a false or “pseudo” myopia. Their blurred distance vision is caused by over use of the eyes’ focusing mechanism. After long periods of near work, their eyes are unable to refocus to see clearly in the distance. The symptoms are usually temporary and clear distance vision may return after resting the eyes. However, over time constant visual stress may lead to a permanent reduction in distance vision.
  • Symptoms of nearsightedness may also be a sign of variations in blood sugar levels in persons with diabetes or an early indication of a developing cataract.

An optometrist can evaluate vision and determine the cause of the vision problems.

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How is nearsightedness diagnosed?

Testing for nearsightedness may use several procedures in order to measure how the eyes focus light and to determine the power of any optical lenses needed to correct the reduced vision.

As part of the testing, letters on a distance chart are identified. This test measures visual acuity, which is written as a fraction such as 20/40. The top number of the fraction is the standard distance at which testing is performed, twenty feet. The bottom number is the smallest letter size read. A person with 20/40 visual acuity would have to get within 20 feet to identify a letter that could be seen clearly at forty feet in a “normal” eye. Normal distance visual acuity is 20/20, although many people have 20/15 (better) vision.

Using an instrument called a phoropter, an optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand held lighted instrument called a retinoscope. The doctor may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient’s responses to determine the lenses that allow the clearest vision.

This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can’t respond verbally, or when some of the eye’s focusing power may be hidden, eye drops may be used. They temporarily keep the eyes from changing focus while testing is performed.

Using the information obtained from these tests, along with the results of other tests of eye focusing and eye teaming, your optometrist can determine if you have nearsightedness. He or she will also determine the power of any lens correction needed to provide clear vision. Once testing is complete, your optometrist can discuss options for treatment.

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How is nearsightedness treated?

Persons with nearsightedness have several options available to regain clear distance vision. They include:

  • eyeglasses
  • contact lenses
  • orthokeratology
  • laser and other refractive surgery procedures
  • vision therapy for persons with stress-related nearsightedness.

Eyeglasses are the primary choice of correction for persons with nearsightedness.  Generally, a single vision lens is prescribed to provide clear vision at all distances.  However, for patients over about age 40, or children and adults whose nearsightedness is due to the stress of near vision work, a bifocal or progressive addition lens may be needed.  These multifocal lenses provide different powers or strengths throughout the lens to allow for clear vision in the distance and also clear vision up close.

A large selection of lens types and frame designs are now available for patients of all ages. Eye glasses are no longer just a medical device that provides needed vision correction, but can also be a fashion statement. They are available in a wide variety of sizes, shapes, colors and materials that not only correct for vision problems but also may enhance appearance.

For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

Orthokeratology (Ortho-k), also known as corneal refractive therapy, involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer surface of the eye.  The contact lenses are worn daily for limited periods, such as overnight, and then removed. Persons with moderate amounts of nearsightedness may be able to temporarily obtain clear vision for most of their daily activities.

Nearsightedness can also be corrected by reshaping the cornea using a laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

In PRK, a laser is used to remove a thin layer of tissue from the surface of the cornea in order to change its shape and refocus light entering the eye. There is a limit to how much tissue can safely be removed and therefore the amount of nearsightedness that can be corrected.

LASIK does not remove tissue from the surface of the cornea, but from its inner layers. To do this, a section of the outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of corneal tissue needed to reshape the eye, and then the flap of outer tissue is placed back in position to heal. The amount of nearsightedness that LASIK can correct is limited by the amount of corneal tissue that can be removed in a safe manner.

People who are highly nearsighted or whose corneas are too thin to allow the use of laser procedures now have another option. They may be able to have their nearsightedness surgically corrected by implanting small lenses in their eyes. These intraocular lenses look like small contact lenses and they provide the needed optical correction directly inside the eye.

Vision therapy is an option for people whose blurred distance vision is caused by a spasm of the muscles which control eye focusing. Various eye exercises can be used to improve poor eye focusing ability and regain clear distance vision.

People with nearsightedness have a variety of options to correct their vision problem. In consultation with your optometrist, you can select the treatment that best meets you visual and lifestyle needs.

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On August 4th, 2010, posted in: Eye & Vision Problems by

Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Nystagmus may be accompanied by unusual head positions and head nodding in an attempt to compensate for the condition.

Nystagmus can be inherited and appear in early childhood or develop later in life due to an accident or illness. Generally, nystagmus is a symptom of some other underlying eye or medical problem. However, the exact cause is often unknown.

Persons with nystagmus may experience reduced visual acuity. They may also have problems with depth perception that can affect their balance and coordination. Nystagmus can be aggravated by fatigue and stress.

Most individuals with nystagmus can reduce the severity of their uncontrolled eye movements and improve vision by positioning their eyes to look to one side. This is called the “null point” where the least amount of nystagmus is evident. To accomplish this they may need to adopt a specific head posture to make the best use of their vision.

The forms of nystagmus include:

  • Congenital – most often develops by 2 to 3 months of age. The eyes tend to move in a horizontal swinging fashion. It is often associated with other conditions such as albinism, congenital absence of the iris (the colored part of the eye), underdeveloped optic nerves, and congenital cataract.
  • Spasmus nutans – usually occurs between 6 months and 3 years of age and resolves spontaneously between 2 and 8 years of age. Children with this form of nystagmus often display head nodding and a head tilt. Their eyes may move in any direction. This type of nystagmus usually does not require treatment.
  • Acquired – develops later in childhood or adulthood. The cause is often unknown, but it may be due to central nervous system and metabolic disorders or alcohol and drug toxicity.

Nystagmus can be further classified by the type of motion the eyes make:

  • Pendular nystagmus – the speed of movement of the eyes is in same in both directions.
  • Jerk nystagmus – the eyes move slowly in one direction and then quickly “jerk” back in the other direction.

What causes nystagmus?

Nystagmus results from the instability or impairment of the system responsible for controlling eye movements. When nystagmus develops in early childhood, it can be caused by a problem with the visual pathway from the eye to the brain. Often the child has no other eye or medical problem. Acquired nystagmus, which occurs later in life, can be the symptom of another condition such as stroke, multiple sclerosis or a blow to the head.

Other causes of nystagmus include:

  • Lack of development of normal eye movement control early in life
  • Albinism
  • Very high refractive error, e.g. nearsightedness (myopia) or astigmatism
  • Congenital cataracts
  • Inflammation of the inner ear
  • Medications such as anti-epilepsy drugs
  • Central nervous system diseases

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How is nystagmus diagnosed?

Nystagmus can be diagnosed through a comprehensive eye exam. Testing for nystagmus, with special emphasis on how the eyes move, may include:

  • Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems, medications taken, or environmental factors that may be contributing to the symptoms.
  • Visual acuity measurements to assess the extent to which vision may be affected.
  • A refraction to determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism).
  • Testing how the eyes focus, move and work together. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move and work in unison. This testing will look for problems that affect the control of eye movements or make it difficult to use both eyes together.

Since nystagmus is often the result of other underlying health problems, your optometrist may refer you to your primary care physician or other medical specialist for further testing.

Using the information obtained from testing, your optometrist can determine if you have nystagmus and advise you on treatment options.

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How is nystagmus treated?

Nystagmus can not be cured. While eyeglasses and contact lenses do not correct nystagmus, they can help to correct other vision problems such as nearsightedness, farsightedness or astigmatism.

Some types of nystagmus improve throughout childhood. In addition, vision may be enhanced with prisms and special glasses. The use of large-print books, magnifying devices and increased lighting can also be helpful.

Rarely, surgery is performed to alter the position of the muscles, which move the eyes. While it does not cure nystagmus, it may reduce the amount of head turn needed for best vision.

Treatment for other underlying eye or medical problems may help to improve or reduce nystagmus.

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American Optometric Association, 8/4/10

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Ocular Hypertension

On August 4th, 2010, posted in: Eye & Vision Problems by

Ocular hypertension is an increase in the pressure in your eyes that is above the range considered normal with no detectable changes in vision or damage to the structure of your eyes. The term is used to distinguish people with elevated pressure from those with glaucoma, a serious eye disease that causes damage to the optic nerve and vision loss.

Ocular hypertension can occur in people of all ages, but it occurs more frequently in African Americans, those over age 40 and those with family histories of ocular hypertension and/or glaucoma. It is also more common in those who are very nearsighted or who have diabetes.

Ocular hypertension has no noticeable signs or symptoms. Your doctor of optometry can check the pressure in your eyes with an instrument called a tonometer and can examine the inner structures of your eyes to assess your overall eye health.

Not all people with ocular hypertension will develop glaucoma. However, there is an increased risk of glaucoma among those with ocular hypertension, so regular comprehensive optometric examinations are essential to your overall eye health.

There is no cure for ocular hypertension, however, careful monitoring and treatment, when indicated, can decrease the risk of damage to your eyes.

American Optometric Association, 8/4/10

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On August 4th, 2010, posted in: Eye & Vision Problems by

Presbyopia is a vision condition in which the crystalline lens of your eye loses its flexibility, which makes it difficult for you to focus on close objects.

Presbyopia may seem to occur suddenly, but the actual loss of flexibility takes place over a number of years. Presbyopia usually becomes noticeable in the early to mid-40s. Presbyopia is a natural part of the aging process of the eye. It is not a disease, and it cannot be prevented.

Some signs of presbyopia include the tendency to hold reading materials at arm's length, blurred vision at normal reading distance and eye fatigue along with headaches when doing close work. A comprehensive optometric examination will include testing for presbyopia.

To help you compensate for presbyopia, your optometrist can prescribe reading glasses, bifocals, trifocals or contact lenses. Because presbyopia can complicate other common vision conditions like nearsightedness, farsightedness and astigmatism, your optometrist will determine the specific lenses to allow you to see clearly and comfortably. You may only need to wear your glasses for close work like reading, but you may find that wearing them all the time is more convenient and beneficial for your vision needs.

Because the effects of presbyopia continue to change the ability of the crystalline lens to focus properly, periodic changes in your eyewear may be necessary to maintain clear and comfortable vision.

American Optometric Association, 8/4/10

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