Cataracts
Cataracts occur as part of the normal aging process. Studies show that virtually everyone over age 65 has some cataract formation in their eyes. Cataracts can severely reduce your vision. At one time, cataracts were a leading cause of blindness in the world. Today, fortunately, they can be treated. Modern surgical techniques, intraocular lens implantation, and "same day surgery" make cataract surgery safe, fast and effective.

A cataract occurs when the normally clear lens of the eye becomes cloudy. As the cataract develops, the cloudiness no longer allows the lens to properly focus light on the back of the eye. This unfocused light causes vision to appear blurry or hazy. Development of cataracts has been associated with exposure to ultraviolet radiation. They are particularly prevalent in persons who spend a lot of time in the sun, such as fisherman and farmers. There is no known way to prevent the formation of cataracts.

Treatment
Treatment is indicated when decreased vision affects everyday activities, hobbies or quality of life. To determine how much vision has decreased, doctors use a test called Brightness Acuity Test (BAT). This test determines how much everyday vision has been affected by the cataract.

Cataract Surgery
Cataract surgery, in which the normal cloudy lens is removed, is now a very successful procedure. The most widely used technique is called phacoemulsification. A very small incision is made, and a tiny ultrasonic probe is used to break up the cataract and gently suction it away. A clear membrane is left in the eye where an intraocular lens is placed (IOL). This IOL is necessary to replace the focusing power of the natural lens that was removed. With insertion of an IOL, there is no need for the thick cataract glasses and contact lenses that were used years ago.

Small incision surgery has several benefits. The procedure is very quick, sometimes taking less than 20 minutes. Also, recovery time is short. Patients are able to eat a light snack and drink immediately after the surgery. The results of the surgery are almost immediate. Most people notice an improvement in their vision soon afterwards.

Cataract surgery and IOL implantation are relatively safe. IOLs must pass through a stringent approval process before they can be used. The benefits of the implant usually greatly outweigh the small added risk of implantation. As with any surgery, complications can occur. There is a possibility of hemorrhage or infection. Your Ophthalmologist can further discuss potential complications of cataract surgery and IOL implantation with you. You will still need glasses to read after the surgery, however many patients no longer need glasses for distance for most activities. The new prescription is given several weeks after the surgery.

Posterior Capsulotomy
The natural lens of the eye is held in place by a thin clear membrane called the lens capsule. The capsule completely surrounds the lens and separates it from the thick fluid in the back of the eye, called the vitreous, and the thinner fluid in the front of the eye, called the aqueous.

Cataract surgery is necessary when the natural lens becomes cloudy and must be removed. When cataract surgery was originally performed, surgical techniques were not as refined as today, and both the natural lens and the capsule were removed during surgery. Newer techniques allow the capsule to remain in the eye and hold the implanted lens (or intraocular lens, IOL) in place. Leaving the capsule in place during surgery is a great advancement because it allows the vision after surgery to be more stable and provides for less surgical complications.

Sometimes the posterior, or back, portion of the capsule becomes cloudy after cataract surgery. The reasons for this cloudiness are not completely known. If the posterior capsule becomes so cloudy that it detrimentally effects vision, then a capsulotomy is performed.

A capsulotomy is a procedure in which an opening is created in the center of the cloudy capsule. The opening allows clear passage of the light rays and eliminates the cloudiness that was interfering with vision. A laser beam is used to create this opening. This procedure is painless, very safe, and typically the results can be seen immediately. For capsulotomy, as with any surgery, rare complications can occur, such as swelling or retinal detachment. These complications can cause loss of vision.

A cloudy capsule will many times appear the same way as the original cataract. The vision is cloudy or hazy and the patient is heavily bothered by glare. In fact, vision is so similar that some patients think that the cataract has come back or regrown. This is impossible, however, because cataracts cannot return once the natural lens has been removed.

Glaucoma
Glaucoma is the leading cause of blindness in the United States. The most common form of glaucoma progresses slowly with no symptoms until vision is seriously impaired. It is a disease that most commonly affects older people, but it can occur at any age. Glaucoma is such a public health concern, that Medicare has recently approved a new code to provide glaucoma screening for anyone with a family history of glaucoma, personal history of diabetes, and for African-Americans over age 50. Once diagnosed, vision loss already caused by glaucoma cannot be restored but treatment can prevent progression of the disease.

Diagnosing Glaucoma
Significant advancements in the diagnosis and treatment of glaucoma have been made in the past few years. One of the newest technologies in glaucoma detection is a state-of-the-art diagnostic instrument called the Heidelberg Retinal Tomographer (HRT). The HRT is a confocal laser scanning ophthalmoscope that uses a laser to form a digital three-dimensional image of the optic nerve. That image is used to determine whether a patient is at risk for or already has glaucoma. The image is digitally stored and comparisons with later studies can document successful treatment or progression of the disease.

Primary Open-Angle Glaucoma
The most common form of glaucoma is called primary open-angle glaucoma, which is associated with aging. In this type of glaucoma, the aqueous, or fluid that flows through the front section of the eye, can not drain properly because the drainage canals become less efficient. This causes a buildup of the pressure in the eye, called intraocular pressure or IOP, which can cause damage to the optic nerve and lead to vision loss. It is now known, however, that pressure is not the only risk factor for glaucoma, and individuals with normal eye pressure can have glaucoma as well.

Who's at risk for Open-Angle Glaucoma?
People over the age of 60 are six times more likely to develop open-angle glaucoma. People of African descent are at higher risk. Other risk factors include a family history of glaucoma, diabetes, long-term steroid use whether topical, inhaled or systemic, hypertension and elevated IOP. People age 45 years and older who have risk factors for glaucoma should have eye exams every year.

Treatment for Open-Angle Glaucoma
In the vast majority of cases of open-angle glaucoma, successful treatment is achieved with prescription eye drops. In just the past two years pharmaceutical eye drop treatment for glaucoma has greatly improved. In the rare cases when eye drop medication doesn't work, laser surgery or incisional surgery is considered.

Angle-Closure Glaucoma
Another type of glaucoma called angle-closure glaucoma, which occurs rarely, is considered a medical emergency because optic nerve damage and vision loss can occur within hours.

Symptoms of Angle-Closure Glaucoma
Symptoms of this type of glaucoma include pain in and around the eye, nausea, vomiting, seeing halos around lights, morning headaches, redness in one eye or the other, blurry vision and swelling or cloudiness of the cornea. Angle- Closure Glaucoma requires immediate medical attention in an emergency room or an Ophthalmologist's office.

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Macular Degeneration
The macula is the most central part of the retina which is responsible for fine, detailed vision as well as color perception. Macular degeneration is an eye disease that damages this very important portion of the retina, causing impairment of central vision. It usually eventually affects both eyes, but often begins in one eye. Macular degeneration is typically an age-related condition, although certain hereditary forms sometimes affect children or teens.

Symptoms of Macular Degeneration
In many cases, patients are not aware of macular degeneration in one eye, because the brain preferentially uses the image from the better seeing eye. The most common symptoms include difficulty reading, driving and other activities requiring detailed vision. Often, straight lines are perceived as distorted.

Who is at risk for Macular Degeneration?
Macular degeneration occurs most often in people over fifty years of age. One in six Americans between the ages of 55 and 64 will be affected by macular degeneration to varying degrees. Macular degeneration does not cause total blindness and usually doesn't affect peripheral, or side vision.

Types of Macular Degeneration
There are two general types of macular degeneration. The most common is called the "Dry" form, which usually is caused by aging, progresses slowly and usually causes only mild vision loss. The other type of macular degeneration, the "Wet" form, is rare but may cause rapid, significant central vision loss. In the "Wet" form, abnormal blood vessels distort and destroy the normal architecture of the retina, thereby destroying central vision.

Treatment for Macular Degeneration
There is no cure for macular degeneration, but recent research suggests that certain vitamins and nutrients may slow the progress of the disease in certain patients. You can also learn some simple, at-home methods of helping to monitor your vision.
If the disease is advancing, laser surgery to destroy the abnormal blood vessels is an option in some cases of the "Wet" form of the disease to prevent further loss of vision. Another new, promising treatment for the "Wet" form is called Photodynamic Therapy, in which a laser is used to activate a drug which accumulates in blood vessels thereby destroying the abnormal blood vessels in the eye. If you have macular degeneration, regular examinations are important so that your Ophthalmologist can monitor for the development of the more worrisome "Wet" form of the disease.

Diabetic Retinopathy
Diabetes is a disease that affects the small blood vessels throughout the body, particularly vessels in the kidney and eye. Diabetic retinopathy occurs when the blood vessels in the eye are affected.
The retina lies in the back of the eye and is a multi-layered tissue that detects visual images and transmits these to the brain. There are minute blood vessels which lie on the surface, or the front portion, of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.

Diabetic Retinopathy is a frequent cause of blindness in the United States and is the leading cause in patients 20 to 64 years of age. The longer a person has diabetes, the higher the incidence of developing diabetic retinopathy. Approximately 80% of people who have diabetes for 15 years have some damage to their retinal vessels. With treatment only a small percentage of people have serious vision problems today.

There are two types of Diabetic Retinopathy
Background Retinopathy (or Non-Proliferative Retinopathy) is considered the early stage. Reading vision is typically not affected during this stage, but the disease can advance and cause severe vision problems. There are usually no symptoms with Background Diabetic Retinopathy. An exam is the only way to diagnose changes in the vessels of the eyes.

When the retinopathy becomes advanced, new vessels grow and proliferate in the retina. These new vessels are the body's attempt to overcome and replace the vessels that have been damaged by diabetes. But these new vessels are not normal. They may bleed, which causes vision to become hazy and sometimes causing a total loss of vision. These new vessels can also damage the retina by forming scar tissue and by pulling the retina away from its proper location.

This stage, called Proliferative Retinopathy, requires immediate medical attention. Treatment is necessary to prevent severe loss of vision. Regular eye exams are crucial for all persons with diabetes. The progressing damage to the blood vessels in the eye can be slowed with treatment.

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Dry Eyes
The eye produces a complex tear film coating its outer layer. This tear film is composed of three layers and is very important for the lubrication and comfort of the eye, as well as for clarity of vision. With age, this protective tear film diminishes, leaving the eye more exposed to the drying effects of air, wind and dust. In many people the dryness is worse in the afternoon and evening.
Dry eye is caused by a lack of moment to moment tear production. Generally reflex and emotional tearing such as crying, or tearing in response to pain is intact. In fact, the eye can still make sufficient tears such that many patients who suffer from dry eye complain of wet eyes and tearing. Dryness causes the eye to produce tears by reflex in an effort to replace the tear film. Dry eye is probably the most common problem seen in the eye doctor's office.

Symptoms of Dry Eye
Dry eye symptoms include burning, stinging or a gritty sensation, which may come and go depending on many factors. Itching, tearing and light sensitivity may also occur.

Blinking is very important for the maintenance of the tear film. When performing such activities as reading or working on a computer, we blink less frequently. This aggravates the symptoms of dry eyes. Sometimes environmental factors can also aggravate dry eye symptoms. Dry weather, either in hot or cold temperatures, robs the eye of needed lubricants. Cigarette smoke, fumes, dust and airborne particles are common irritants. Contact lens use often exacerbates dry eye and can lead to an improper contact lens fit. In most patients, this condition is not associated with systemic disease. However, there are systemic diseases such as Sjogren Syndrome, associated with dry eye.

Treatment of Dry Eye
Treatment helps in most patients. We cannot cure this condition, so treatment is an ongoing project. Usually artificial tears, available over-the-counter, soothe the eyes and give temporary relief. These artificial tears, however, work for only an hour or two, at best, and must be repeated at frequent intervals. Ointments last longer, but they blur vision and are most effective at night.
Newer techniques to treat dry eye, which give lasting relief include plugs which block the tear drainage system. These plugs allow for the natural tears to remain on the surface of the eye longer, before draining away. Plugs can be placed in the two drainage tubes, top and bottom, in both eyes or in only the lower ducts. Test plugs are also available, which dissolve a few days after insertion. These temporary plugs are generally placed as a test of the system prior to placing the more permanent plugs. If the dry eye symptoms disappear when the temporary plugs are inserted, then permanent plugs should be considered as a treatment option.

Conjunctivitis (Bacterial)
The conjunctiva is the clear membrane that forms the smooth, clear outer coat of the eye. The white of the eye actually lies behind the conjunctiva. The conjunctiva has many small blood vessels, and it serves to lubricate and protect the eye while it moves in its socket. When the conjunctiva becomes inflamed, this is called Conjunctivitis.

Causes of Conjunctivitis
Conjunctivitis ("pink eye") can have many causes, such as bacteria, viruses, chemicals, allergies, and more. In many cases it is difficult to determine the primary cause for the inflammation. One of the most common versions is bacterial conjunctivitis.
Bacterial conjunctivitis is associated with swelling of the lid and a yellowish discharge. Sometimes it causes itchiness of the eye and a mattering of the eyelids, particularly upon waking. The conjunctiva appears red and sometimes thickened. Often both eyes are effected.
The bacteria most commonly at fault are the Staphylococcus, the Streptococcus, and H. Influenza. Bacterial conjunctivitis is very contagious, and it can be easily transmitted through household items, such as towels or handkerchiefs, that have been touched by an infected person. It is common that entire families become infected.

Treatment for Conjunctivitis
Conjunctivitis can be directly cured with treatment. Usually antibiotic drops and compresses ease the discomfort and clear up the infection in just a few days. In a few cases, the inflammation does not respond well to the initial treatment with eye drops. In those rare cases, a second visit to the office must be made and other measures undertaken. With severe infection, oral antibiotics are necessary. Covering the eye is counterproductive because a cover provides protection for the germs causing the infection. If left untreated, conjunctivitis can create serious complications, such as infections in the cornea, lids, and tear ducts. Certain precautions can be taken to avoid the disease and stop its spread. Careful washing of the hands, the use of clean handkerchiefs, and avoiding contagious individuals are all helpful. Young children frequently get conjunctivitis due to poor hygiene.

Corneal Abrasion
The cornea is the clear outer coating of the front of the eye. A corneal abrasion occurs when the outer layer of the cornea, called the epithelium, is torn away, usually by some sort of trauma.

Causes of Corneal Abrasion
Corneal Abrasion can have numerous causes, such as a finger, tree branch, or shattered glass from a car accident injuring the eye. Corneal abrasions are one of the most common injuries to the eye. The cornea has the highest concentration of nerve endings than virtually any other part of the body, and so any damage to the cornea is very painful. Abrasions usually heal in a short time period, sometimes within hours. While they are healing they can cause excessive tearing, redness, blurred vision and light sensitivity. While the epithelium is growing to cover the cornea, the cornea is at risk for infection.

Treatment for Corneal Abrasion
Treatment consists of an antibiotic because the open area of the epithelium invites infection. Small abrasions heal rapidly. However, if one covers more than one-third of the cornea, it may take several days for the epithelium to completely recover the front of the cornea.

Typically, an anesthetic is used in the eye doctor's office to ease the pain and to aid in the examination. After the examination, the pain typically returns, but repeated use of anesthetic can harm the eye and is therefore not used in the treatment of abrasions. It may take several weeks for all of the blurriness to resolve. Permanent loss of vision is very rare with superficial abrasions.
DO NOT rub the eyes during the healing phase that follows an abrasion. New cells require time to reconnect to the non-damaged layers of the cornea. These new cells can be easily rubbed off. If the new cells get removed, the pain returns and the whole healing process begins again.

Occasionally, long after an abrasion has healed, it recurs spontaneously, often upon waking in the morning. This is called a recurrent erosion and represents an area of the epithelium that is not reconnected well to the deeper parts of the cornea. Treatment is similar to that for the original corneal abrasion. Sometimes, the surface of the cornea is treated with a special instrument in order to help form better connections between the corneal layers. Extended use of bedtime ointments or lubricants may also help prevent recurrent erosions.

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Blepharitis
Blepharitis is an inflamation of the oil glands associated with the eyelashes and the surrounding eyelids. It is very common, and it is a permanent condition. Once it is present, it will always be present, but the severity may change over time. In some cases, the symptoms can disappear for long time periods, months or years, before returning.

Treatment for Blepharitis
Blepharitis can be controlled by careful cleansing of the eyelashes, and warm, moist compresses as part of the daily hygiene regimen. This can be accomplished with warm water and mild shampoo (such as baby shampoo). Once the redness and soreness are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, daily cleansing must be resumed immediately. Medication is of secondary importance in the treatment. In some cases, eye drops or ointment will be prescribed to be used along with the daily cleansing. Only in certain cases is systemic antibiotics used.
In any case, medication alone is not sufficient; keeping the eyelids clean is essential.

Causes of Blepharitis
There are two main causes of Blepharitis: staphylococcus bacteria and seborrhea. Staphylococcus bacteria commonly begins in childhood and continues throughout adulthood. It is a normal collinization of the skin. However, there can be an overgrowth of the bacteria in the oil glands of the eyelid and this leads to increased inflammation.

Symptoms of Blepharitis
Common symptoms include scales on the lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, sties, and chalazia also occur. Treatment is very important. In addition to eliminating the redness and soreness, treatment can prevent potential infection and scarring of the cornea and conjunctiva.

Seborrhea is secondary to poorly functioning, overactive eyelid glands in causing greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas as well. Hormones, nutrition, general physical condition, and stress are factors in seborrhea.

Flashers and Floaters
The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits these to the brain. In front of the retina lies the vitreous humor. The vitreous is the jelly-like material that fills the large central cavity of the eye. It is composed primarily of water, but it is also made up of proteins and other substances which are more fibrous. The water and fibrous elements together give the vitreous the consistency of gelatin.

The vitreous is normally loosely connected to the retina. With age, the watery portion of the vitreous separates from the fibrous portions. As this occurs, the fibrous elements contract and can pull the vitreous away from the retina. This is called a Posterior Vitreous Detachment. This contraction on the retina is responsible for the characteristic "flashes" that often accompany the Posterior Vitreous Detachment.

The "floaters" are frequently caused by the fibrous elements changing position during the Posterior Vitreous Detachment. They can also be caused by pieces of the retina being dislodged as the vitreous contracts. Besides aging, flashes and floaters are also associated with nearsightedness and injuries to the eye.

All patients who have experienced a recent onset of flashes and floaters should be examined immediately by an Ophthalmologist. Most of the time nothing unusual is found, and simple reassurance is the only thing necessary. The flashes eventually go away, and the floaters diminish and become less bothersome with time.

However, in about 10% of the patients with a Posterior Vitreous Detachment, a tear of the retina is found. If left untreated, these tears may lead to a full retinal detachment. A full retinal detachment is a very serious sight-threatening condition, requiring a major surgical procedure to repair. When symptoms appear, it is important to examine the eye within a day of their onset. Changes can occur rapidly, and time is critical if a retinal detachment is present. Retinal tears are treated by sealing the tear with a laser or freezing technique(cryotherapy).

Detached Retina
The retina lies in the back of the eye. It is a multi-layered tissue, which is responsible for detecting visual images and transmitting them to the brain. The retina is similar to the film inside a camera in that it records an image that is later developed and sent to the brain. A retinal detachment occurs when the retina pulls away from the back of the eye.

Causes of Retinal Detachment
Retinal detachments can have many causes:
Vitreous, the natural gel in the eye, shrinks naturally with age and pulls away from the retina. This can cause a detachment. Other causes include external injury to the eye, diabetic retinopathy, tumors, and small tears or holes in the retina that allow liquid to seep through and lift the retina off its underlying tissue. Sometimes a detachment occurs spontaneously, without known cause or explanation.

Symptoms of Retinal Detachment
Typically following a retinal detachment, different types of images appear. These include flashing lights, an apparent covering or curtain over part of the visual field, or many more floaters than usual. These symptoms, however, can also be present without a retinal detachment, so an immediate exam is necessary to determine the cause of these symptoms.

Sometimes the retina does not fully detach but only tears. In this type of case, treatment is done usually with a laser or freezing technique (cryotherapy) that seals the tear. If the retina is fully detached, surgery is performed to place the retina back into position.

Ptosis
Ptosis occurs when the upper eyelid droops to an abnormal level and covers part of the eye. It can have many causes including age, injury or nerve malfunction. It can also occur at birth.

Causes of Ptosis
Age is the most common cause of Ptosis. The muscles that elevate the eyelid stretch and become thinned, resulting in a loss of muscle tone and the inability to hold the upper lid in the proper position above the eye.

Injury is another common cause of Ptosis. Trauma, like that which can occur during an automobile accident, can damage the delicate structures around and in the eye.

Sometimes Ptosis can be noticed at birth. In these cases, it is due to an abnormality in the development of the muscles that elevate the upper lid. Three-quarters of the time, it affects only one eye.
Ptosis can also be caused by a malfunction of the nerves that control and activate the eyelid muscles. These cases are rare and proper diagnosis is important in order to avoid unnecessary surgery.

Symptoms of Ptosis
When a neurological disorder is present, symptoms typically include visual complaints independent of the droopy eyelid. Difficulty reading and driving are common complaints. Raising the entire brow and eye lid with the muscles of the forehead and scalp may cause headaches and eyestrain as well. In newborns, this problem must be addressed and treated properly to insure normal maturation of the visual system and the avoidance of Amblyopia (lazy eye).

Treatment for Ptosis
The most common treatment for Ptosis is surgical, and there are a number of possible approaches. The goal is to tighten the muscles so that the affected lid is elevated to match the lid on the other side, with a minimum of scars and side effects. One possible complication is that the muscles can be overly tightened. This results in an inability to close the eye completely after surgery. Such a situation creates a dry eye condition that may be difficult to manage.

In the age-related form, both eyelids may be drooping, but often only one is low enough to require surgery. Almost invariably in these cases, the unoperated eyelid will appear lower after a successful repair of the first eye. The second eye also may eventually require surgery.

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Ocular Migraines
The common migraine is a severe headache, which is accompanied by nausea, vomiting and mood changes. Other symptoms include light, sound and vibration sensitivity. Classic migraines typically are preceded by a prodrome of visual disturbances called "sintilating scatoma" in which visual images look gray or have a wavy appearance. They almost always occur in only one eye. The visual distortion, when it occurs, normally starts in central vision and then moves off to one side. Other common symptoms are loss of vision, particularly in one eye, and increased sensitivity to bright lights. The severe headache follows usually within 30 minutes to an hour.

The ocular migraine can occur either in conjunction with the classic migraine or without the corresponding headache. Generally, when it accompanies the classic migraine, the visual disturbances happen before the onset of headache symptoms. In younger people with common migraine, it is typical for the ocular migraines to also occur. As people age, it becomes more common to experience ocular migraines without headache symptoms.
In general, there are no serious complications caused by ocular migraine. Treatment, in most instances, is not necessary unless the ocular migraine is linked to the common migraine.

Optic Neuritis
The retina lies in the back of the eye and is a multi-layered tissue that detects visual images. These images are transmitted to the brain through approximately one million tiny nerve fibers. Before going to the brain, these nerve fibers converge in the back of the eye into a bundle called the optic nerve. If some or all of the nerve fibers are damaged, visual capability deteriorates.

Optic neuritis occurs when the optic nerve becomes inflamed. The nerve tissue becomes swollen and red, and the nerve fibers do not work properly. If many of the nerve fibers are involved, vision may be dramatically affected; if the optic neuritis is mild, vision is nearly normal.

Causes of Optic Neuritis
Optic Neuritis can be caused by many diseases and conditions and may affect the optic nerve of one or both eyes. Some people, especially children, develop optic neuritis following viral illnesses such as mumps, measles, or a cold. In others, optic neuritis may occur as a sign of a neurologic disease affecting nerves in various parts of the body, such as multiple sclerosis. In a rare condition called Leber's Optic Neuropathy, which often runs in families, a special kind of optic neuritis may appear in both eyes within a short span of time. Most of the time, however, the cause for optic neuritis is unknown. In these cases, the eye disorder is called Neuritis Idiopathic, meaning that no particular cause can be found.

Symptoms of Optic Neuritis
Optic Neuritis usually comes on suddenly, and the patient notices that vision is blurred in one or both eyes. The patient's vision is dim, like somebody turned down the lights, and colors may appear to be washed out. There may be pain in the area of the eye socket, especially when moving the eyes. Vision may continue to get worse over a week or two, and it may seem worse after exercising or a hot bath. A careful description of these symptoms is important for the diagnosis of Optic Neuritis.

Diagnosing Optic Neuritis
The Optic Nerve enters the back of the eye where it appears as a small disc. An eye doctor can examine the optic nerve inside the eye by using a special instrument called an Ophthalmoscope. Swelling of the optic nerve may or may not be visible. If the optic nerve inflammation occurs inside the eye, it can be readily detected. If swelling of the nerve occurs behind the eye, the doctor may not be able to see the swollen nerve tissue.

Since optic neuritis can be confused with many other causes of poor vision, an accurate medical diagnosis is important. Ultrasound, CT scans, or visual brain wave recordings may be ordered. Other tests that may be performed include color vision, side vision, and the pupils reaction to light.

Treatment for Optic Neuritis
Unfortunately, there is no good long term treatment for Optic Neuritis. Cortisone-like medications (steroids) can be prescribed, but in most cases they are only effective at shortening the duration of the attack and do not generally affect the long term outcome. In most cases, patients with Optic Neuritis improve without treatment. Vision may return to normal, or in some cases, good but incomplete improvement occurs. A few patients fail to recover normal vision, especially those with special conditions.

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Retinitis Pigmentosa
Retinitis pigmentosa (RP) refers to a group of related genetic diseases, which tend to run in families and cause slow but progressive loss of vision. In retinitis pigmentosa, there is gradual destruction of some of the light sensors in the retina.

Symptoms of Retinitis Pigmentosa
The first symptoms usually occur in youth or young adulthood, although they may be first seen at any age. Retinitis Pigmentosa initially causes night blindness and eventually loss of side vision. In normal persons, the visual system adjusts to darkness after a short period of time. People with night blindness adjust to darkness very slowly or not at all. Due to the loss of side vision (peripheral vision) in patients with Retinitis Pigmentosa, mobility becomes increasingly difficult.

Causes of Retinitis Pigmentosa
Most forms of Retinitis Pigmentosa are inherited. Different patterns of heredity are associated with different degrees of progression. An attempt to know more about how severely the disease has affected other family members may help predict how a specific person will ultimately be affected, though variability exists within each family. Such knowledge is also helpful in making decisions about marriage, family and occupation.

Treatment for Retinitis Pigmentosa
In general, there is no specific treatment for RP. Recent research suggests that some patients may benefit from certain kinds of vitamin therapy. But these studies are not conclusive. Much research is directed toward solving this problem. Periodic examinations by an Ophthalmologist are advised.
It is important to keep in mind that patients with Retinitis Pigmentosa may develop other treatable diseases, such as glaucoma or cataracts. Low vision aids may be prescribed. In some cases, Retinitis Pigmentosa may be associated with other disease processes, which might need evaluation by other medical specialists. Despite visual impairment, the many rehabilitative services that are available today allow patients with Retinitis Pigmentosa to live meaningful and rewarding lives.

Color Vision
The human eye has receptors that are sensitive to three primary colors: red, green and blue. The brain is able to blend these three primary colors so that the eye is able to discriminate very slight differences between them. A person with normal color vision can see approximately 8,000 colors in nearly 8 million different shades and tints.

The retina is made up of 10 layers of different kinds of cells. These cells are connected to the brain by approximately 1 million tiny nerve fibers. When stimulated by light, these nerve fibers transmit electrical impulses from the eye to the brain, where the signals are interpreted to give vision. The retina is where the "color receptors" are located.

The very back layer of cells in the retina is made up of photoreceptors. There are two types of these cells: rods and cones. Rods function well in dimly lit situations and can perceive only black, white and shades of gray. Rods are located primarily in the peripheral portion of the retina, away from central vision. Cones are the second type of receptor, and they are located primarily in the central part of the retina. This type of receptor functions to provide daytime vision and important central detail vision, such as is used for reading small print. There are three types of cones: red, green and blue. These three types of cones combine to provide for the wide range in color vision. There are only about 1/3 as many cones as rods.

Color vision testing can be used to identify color vision defects. There are many types of color vision tests, from the general screening methods that test gross perception of color to other more sensitive tests, which are much more time consuming. The most common type of color vision loss is inherited and occurs from birth, but several diseases, are also known to cause color vision losses later in life as well.

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Refractive Eye Problems

Myopia (Nearsightedness)
The cornea and lens of the eye work together to properly focus visual images on the retina. If an image is out of focus, it is because the overall shape of the eye is incorrect or because the cornea does not have the proper curvature. When the eye is too long or the cornea too steep, visual images are focused in front of the retina instead of on it. This condition is called myopia, or nearsightedness.

Myopia normally starts to appear between the ages of eight and twelve and almost always before the age of twenty. Once myopia starts, it often increases as the body grows. The condition typically stabilizes in adulthood. Changes in glasses or contact lens prescriptions are necessary during growth periods.

Someone with myopia has difficulty seeing objects at a distance, such as street signs, chalk boards and television sets. Many times, myopia is diagnosed during school screenings.
Treatment for nearsightedness includes prescription lenses, which allow visual images to be focused on the retina rather than in front of it. The prescription can be in the form of contact lenses or glasses. Once the eyes have stabilized, and myopia is no longer progressing, laser vision correction is a viable option for many people.

Hyperopia (Farsightedness)
In order to focus images from the visual world onto the retina (the back of the eye), the cornea and lens must work together. If an image is out of focus, it is usually because the overall shape of the eye is incorrect or because the cornea does not have the proper curvature. Farsightedness, or hyperopia, occurs when the eye is too small or the cornea too flat. When either of these is the case, visual images are focused behind the retina instead of directly on it.

A person with hyperopia is able to see objects at a distance but has trouble with objects up close, like books or newspapers. Many people are not diagnosed with hyperopia without a complete eye exam. School screenings typically do not discover this condition because they test only for distance vision. Symptoms of hyperopia may include headaches and eye strain, especially when performing near tasks. In children, one eye may turn in, although this can also be a symptom of other, more serious problems.

Treatment includes contact lenses or glasses that correct for near vision. Corrective lenses should be worn for near tasks, such as reading but do not need to be used for distance vision tasks, such as driving, in most cases. Other treatment options include refractive surgery and implantable contact lenses (ICLs). Some candidates are more well-suited to these procedures than others.

Astigmatism
In order for the eye to work properly, light coming into it must be properly focused on the retina (the back of the eye). When there is an irregularity in the eye, the images created on the retina are not in focus. Such an irregularity can be in the overall shape of the eye, in the curvature of the cornea (the clear outer covering of the eye), or both. The cornea should be curved equally in all directions. Astigmatism occurs when the cornea is curved more in one direction than another.

Astigmatism is quite common. In the vast majority of cases, it is caused by genetic variation. Just as people have differently shaped feet or hands, people also have differently shaped corneas. Rarely, astigmatism is caused by lid swellings such as chalazia, by corneal scars, or by keratoconus (a rare condition in which the cornea becomes misshapen and pointed rather than smooth and rounded).

Astigmatism may cause blurred vision, eye strain, and headaches. It can also cause images to appear doubled, particularly at night. Small amounts of astigmatism can be ignored, but if any of its symptoms are present, astigmatism can be corrected by wearing glasses or contact lenses. In most patients hard contact lenses do a better job of correcting for astigmatism than soft contact lenses. For many people, refractive surgery is a permanent option as well.

Presbyopia
During the early and middle years of life, the lens of the eye usually provides for the capability to focus both near and distant images clearly. To accomplish this, the lens must change shape, becoming thicker for near objects and thinner for distant ones.

Presbyopia occurs when the lens of the eye loses its flexibility. This typically takes place around age forty but can occur significantly earlier or later in some cases. Presbyopia causes near objects to appear blurry and creates difficulty in switching focus between near and distant objects.

Glasses prescriptions for presbyopia patients are based on distance vision. For people who are nearsighted, removal of their distance glasses may make reading easier. Others need glasses or bifocals to see near objects clearly. A complete eye examination can determine the strength of lenses needed to see well at all distances.

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