General Eye Care
At Pinehurst Surgical, we consider the whole body, not just the eyes, when caring for our patients. The eyes may be windows to the soul, but they can also be windows to the body, allowing the trained professional to detect and diagnose many vascular, inflammatory, and viral diseases during a comprehensive eye exam. For example, diabetes, hypertension, lupus, and herpes can potentially affect the eyes. At Pinehurst Surgical, our providers are trained to screen for these and other diseases, in addition to common eye disorders, during standard eye exams. If we find that a non-ocular disease is present, you will be referred to the appropriate medical professional for prompt attention.
During a comprehensive eye exam we screen for the following conditions:
- Dry Eye Syndrome
- Herpes Simplex
- Herpes Zoster (Shingles)
- Hypercholesterolemia (High Cholesterol)
- Macular Degeneration
- Multiple Sclerosis
- Sickle Cell Anemia
- Thyroid Disorders
Dry Eye Syndrome
The quality of your tears plays an enormous role in the health of your eyes. Tears keep the eyes comfortably lubricated, wash out particles and other irritants, and help to maintain good vision. When not enough tears are produced, or they lack the proper composition, dry eye syndrome can occur.
Affecting about 20 percent of the population, dry eye syndrome is a condition that causes burning, scratchiness, dryness, or a painful sensation in the eyes; in certain cases, it can also cause excessive tearing. It is especially prevalent in older people, and two to three times more likely to affect women than men. People with dry eye syndrome may notice that these symptoms worsen after long periods of working at the computer, reading, or watching TV. If left untreated, severe dry eye syndrome can cause corneal damage, leading to impaired vision. It is critical, therefore, that you see an ophthalmologist if you are experiencing any of these symptoms.
At Pinehurst Surgical, we treat dry eye syndrome with a number of different therapies, depending on the severity of the condition. For patients with mild symptoms, we may recommend the use of artificial tears to temporarily alleviate the effects. Preservative-free artificial tears are best, since they are more soothing and less likely to further irritate the eyes than those with preservatives. When symptoms are serious, any of the following treatments may be prescribed.
When inflammation of the cornea is involved, we may also prescribe an eye drop called Restasis to help enhance the patient’s natural tear production. Topical steroids in the form of an ointment or eyedrops may also be used to reduce inflammation.
For eyes that do not respond to treatment with eyedrops or ointment, we may recommend a simple procedure in which the flow of tears is blocked off by plugging the tear ducts. Punctal plugs, available in either dissolvable collagen or permanent silicone, help to keep the eyes moist since the tears no longer drain into the nose from the tear ducts. Punctal plugs are usually reserved for moderate to severe cases of dry eye syndrome.
Patients with dry eye syndrome can take specialized nutritional supplements, such as BioTears™ or HydroEye® plus Lutein, which stimulate the natural production of eye lubricants.
What You Can Do
If you have dry eye syndrome, there are a number of things you can do on your own to improve your condition. Drink plenty of water to keep your body hydrated and to flush out impurities (eight to ten glasses a day are recommended). Make a conscious effort to blink your eyes more frequently, especially during prolonged periods of reading or watching TV. Avoid cigarette smoke, overly heated rooms, and wind.
The retina plays a central role in visual perception, enabling you to see objects in your field of vision. Composed of millions of photoreceptor cells at the back of the eye, the retina captures light and converts it into electronic impulses that travel to the brain, where they are converted into images. The macula, at the center of the retina, is responsible for central vision and the ability to distinguish colors. When the macula becomes damaged, loss of vision occurs.
As people age, they may become vulnerable to macular degeneration, the leading cause of blindness in the United States. Age-related macular degeneration (AMD) accounts for 90 percent of severe vision loss. Typically affecting people over the age of 60, most frequently women, AMD causes a decrease in central vision, making it difficult to read and engage in other tasks that require fine discrimination. Distorted vision and the appearance of wavy lines over the visual field may also result from macular degeneration. These symptoms can manifest themselves suddenly or progress gradually over time, depending on whether the condition involves “wet” or “dry” macular degeneration.
Wet (neovascular) macular degeneration, the most advanced form of AMD, occurs when abnormal blood vessels forming behind the macula break, releasing blood and fluid. The pressure created by blood and fluids causes the macula to rise from its proper position in the retina, and sustain severe damage. Symptoms appear rapidly with this form of AMD.
With dry (non-neovascular) macular degeneration, the photoreceptor cells that make up the macula gradually break down, eroding the clarity of a person’s central vision. Blurry vision is the first sign of dry AMD, which may affect one or both of the eyes.
For treatment of wet macular degeneration, we offer a number of treatment options including injections of Avastin®, photodynamic therapy, and laser surgery.
Avastin® is used to inhibit the growth of abnormal blood vessels in the retina. By inhibiting growth in this way, we can halt vision loss and, in some patients, even improve vision.
Photodynamic therapy (PDT) also helps to slow down vision loss. By injecting a light-activated drug into the body, our ophthalmologist can target the area of the eye where fast-growing abnormal blood vessels form. Light is then directed into the eyes for a brief period, causing the drug to destroy the abnormal growths without damaging surrounding tissue.
Laser surgery can also destroy abnormal blood vessels to halt vision loss. However, this type of therapy is not appropriate for most AMD patients. Because laser therapy may also affect adjacent tissue, only patients whose abnormal blood vessels have developed away from the center of the macula should undergo this type of treatment. At Pinehurst Surgical we can determine which treatment option is most appropriate for your condition.
There is no treatment currently available to prevent vision loss for patients with advanced dry macular degeneration. However, there are a number of things you can do to delay and even prevent dry AMD from progressing to the advanced stage.
What You Can Do
Recent studies have shown that the risk of developing both the dry and wet forms of age-related macular degeneration can be significantly reduced by taking high-doses of zinc and certain antioxidants at the recommendation of your eye care specialist. Current research also indicates that a diet rich in green, leafy vegetables helps to prevent AMD.
Diabetic Eye Disease
One of the more common eye disorders related to diabetes is diabetic retinopathy. The term actually covers a range of retinal disorders that can be caused by diabetes. Diabetic retinopathy is generally classified into two types: non-proliferative and proliferative.
Non-proliferative retinopathy is the most common form of diabetic retinopathy. Non-proliferative retinopathy refers to a condition in which capillaries in the back of the eye swell to form pockets or pouches. As a result, the capillary walls are less able to control the flow of blood and other fluids to the retina. Fluid can actually leak into the macula (the part of the retina that is responsible for our central vision) and cause macular edema, a condition in which the macula swells. Macular edema has the potential to cause significant vision loss. Fortunately, macular edema can be treated so that vision loss is halted and, in some cases, restored.
When diabetic retinopathy is left untreated and is allowed to progress to more serious stages, proliferative retinopathy may result. In this type of diabetic retinopathy, blood vessels in the eye become so damaged that they completely cut off the flow of blood. This stimulates new blood vessels and scar tissue to develop. There is often leaking of blood, also called vitreous hemorrhaging. Enlarging and shrinking scar tissue can also cause the retina to become dislocated or detached. Both conditions can cause severely impaired vision, including blindness.
For many diabetics, there are no symptoms of diabetic retinopathy in its earliest stages. However, our eye specialists can detect early retinopathy during a comprehensive exam, even if no symptoms are present. We recommend that you get screened regularly as a preventive measure.
As retinopathy progresses, vision may become blurred as the macula swells due to fluid leakage or the growth of new blood vessels on the retina. If bleeding occurs, the field of vision becomes hazy or distorted, a possible sign of an advanced form of retinopathy. The sooner diabetic retinopathy is diagnosed, the better the chances are for saving the patient’s vision with effective treatments.
Non-proliferative retinopathy does not require treatment. By controlling the levels of blood pressure, blood sugar, and cholesterol, the progression of non-proliferative retinopathy can be halted. However, if macular edema has begun, or if diabetic retinopathy has advanced to the proliferative stage, surgical treatment (laser, injection, or operation) is usually required. Most surgical procedures for diabetic retinopathy are highly effective at restoring vision, but none of them provide a cure. Patients require close follow-up treatment to protect their vision.
Focal Laser Surgery
If macula edema has occurred, focal laser surgery is typically the recommended course of treatment. During focal laser surgery, an ophthalmologist treats the retinal areas where there is leakage, thereby reducing the amount of fluid in the retina. Focal laser surgery reduces vision loss by up to 50 percent, stabilizes vision, and can usually be successfully completed in one session if only one eye is being treated. For treatment of both eyes, focal laser surgery is done over two sessions, several weeks apart.
Scatter Laser Surgery (Panretinal Photocoagulation ( PRP)
If diabetic retinopathy has progressed to the proliferative stage, then scatter laser surgery is usually the recommended course of treatment, unless there has been bleeding. By treating the retina, away from the macula, an ophthalmologist can shrink abnormal blood vessels to preserve central vision. There are some potential drawbacks to this procedure, however, including slightly decreased side vision, night vision, and color vision. Most scatter laser surgery can be completed in one or two sessions.
When the growth of abnormal blood vessels in the retina has caused bleeding (vitreous hemorrhaging), a vitrectomy is usually required. This procedure removes blood clouding the vitreous gel at the center of the eye. During a vitrectomy, performed while the patient is under either general or local anesthesia, the ophthalmologist makes a very small incision in the eye, uses a tiny instrument to remove the vitreous gel, and replaces the gel with saline solution to restore clear vision. Typically done as an outpatient procedure, a vitrectomy requires the use of an eye patch and medicated eyedrops for several days following surgery.
Who Is at Risk?
People with type I and II diabetes are at risk for developing some form of diabetic retinopathy and should have their eyes examined regularly. Those with high blood sugar, high cholesterol, and high blood pressure levels may also be at risk. Pregnancy may also be a risk factor.
What You Can Do
Studies suggest that people who maintain consistently normal blood sugar levels are less likely to develop diabetic retinopathy. You should therefore closely monitor your blood glucose level by checking it daily and recording results in addition to following the diet your doctor has developed for you.
Try to be physically active at least 30 minutes per day to help keep your blood pressure normal. If you are a smoker, work with your doctor to develop a plan to help you quit. Most importantly, see an ophthalmologist at least once a year for a comprehensive eye exam. Make sure your ophthalmologist knows you need to be screened for cataracts, glaucoma, and diabetic retinopathy.
If you have diabetes, you are at risk for a number of diabetic eye diseases, including cataracts, glaucoma, and diabetic retinopathy. Regular eye exams are essential to maintaining the health of your vision and your body. At Pinehurst Surgical, your total well-being is our primary concern. To schedule an eye exam today call (919) 774-8631.