Let's Talk Eye to Eye: Local Eye Surgeons Address Common Vision Concerns
January 2024 Issue — Pink Prescriptions
Let's Talk Eye to Eye
Local Eye Surgeons Address Common Vision Concerns
Eye exams at every age and life stage can help keep your vision strong. About 11 million Americans over age 12 need vision correction—but it’s just one of the reasons to get your eyes examined. Regular eye exams are also an important part of finding eye diseases early and preserving your vision. Early treatment is critically important to prevent some common eye diseases from causing permanent vision loss or blindness. Of the estimated 93 million US adults at high risk for vision loss, only half visited an eye doctor in the past 12 months. Regular eye care can have a life-changing impact on preserving the vision of millions of people.
By Dr. Erin Benjamin | Goulas Eye
I am diabetic, and I’ve heard this is dangerous to my vision. What are the effects of diabetes on the eyes?
Diabetes occurs when there is too much glucose in the bloodstream, leading to damage of blood vessels throughout the body, including the eyes. Early in the course of the disease and/or when blood glucose levels are controlled, a patient may not have any signs of diabetes in the eyes. However, if blood glucose levels are not controlled, a patient may develop diabetic retinopathy, which is the leading cause of blindness in American adults. Diabetic retinopathy occurs when the blood vessels in a patient’s retina are leaky, or when new, abnormal blood vessels grow on the retina, both of which can cause bleeding and swelling in the retina, leading to vision loss.
The macula is the center of the retina responsible for sharp, central vision and when blood vessels leak here, it can lead to what’s called macular edema, resulting in blurred and/or distorted vision. This would require treatment that may include lasers and/or injections into the eye.
Not only can new abnormal blood vessels grow in the retina, but in diabetics, these abnormal blood vessels can also grow on the iris, the colored part of the eye. This can lead to neovascular glaucoma, which is an increase in eye pressure that can lead to irreversible blindness if not treated.
Additionally, cataracts can form earlier and progress faster in diabetics versus non-diabetics due to increased sugar in the blood. This can lead to swelling and clouding of the natural lens and cause blurred vision. In these cases, cataract surgery may need to be performed earlier in age than non-diabetics.
What can I do to minimize vision loss if I’m a diabetic?
The best way to prevent eye disease related to diabetes is to manage your blood sugar levels through a low-sugar diet rich in vegetables and fruits, staying active and exercising, and following treatment regimen as prescribed by your primary care doctor or endocrinologist. Once diagnosed with diabetes, it is important to have a baseline, dilated eye exam, followed by annual exams to evaluate the health of the eyes and detect any changes. Other ways to minimize vision loss are to also lower blood pressure and/or cholesterol if these are concurrent diagnoses because these diseases can also worsen diabetic eye disease. Additionally, smoking can cause further damage to blood vessels, so it is very important to stop smoking.
What are the major causes/risks for vision loss over age 40?
After the age of 40, most people develop presbyopia—the inability to focus on near objects such as newspapers, books, or computer print. You may find yourself holding things further away to focus. This is a natural, aging process of the eye as the lenses in our eyes become more rigid and cannot change shape as easily to focus. Luckily, this is easily corrected through glasses or contact lenses.
Age-related cataracts can start to develop after the age of 40. To slow progression, patients should stop smoking, maintain a healthy diet, wear UV-blocking sunglasses when outdoors, and limit the use of steroid medications, if possible.
Glaucoma is a spectrum of diseases that can lead to irreversible vision loss due to damage of the optic nerve. It is essential to have regular eye exams to screen for glaucoma and treat it as early as possible, typically with eye drops, to prevent vision loss.
Macular Degeneration typically occurs after age 65, when lipids/proteins build up in the macula (dry macular degeneration), and/or new abnormal blood vessels grow in the macula (wet macular degeneration). The biggest risk factors for this include age and genetics, but lifestyle habits also play a role. Smoking, poor diets, obesity, and exposure to ultraviolet light from the sun increase the risk. While there is no cure, it is important to have regular, dilated eye exams to detect any changes and slow down progression.
My child seems to have one eye that appears smaller.
People say he has a “lazy” eye.
What is a lazy eye and can it be fixed?
A “lazy eye” is an eye that has what’s called “amblyopia,” which is a decrease in eye sight due to an abnormal development in vision. When this happens, the “lazy eye” is not receiving visual stimulation, and the brain starts to favor the opposite eye.
There are 3 reasons amblyopia happens:
Eye Misalignment, the most common cause of amblyopia, is when the eyes are not straight and one eye is pointing in a different direction—a “wandering eye”. This confuses the brain because it is receiving two different visual inputs and cannot create a single, clear image. In this case, the brain “shuts off” the vision in the wandering eye, leading to amblyopia if not diagnosed and treated early.
Anisometropia is when the refractive error is markedly different between each eye (for example, one is significantly more far-sighted than the other). The eyes are unable to focus together. In this case, the brain favors the eye with the better vision because it is receiving a clearer image.
Deprivation, the least common cause of amblyopia, is due to a blockage of vision which restricts a clear image from getting to the retina and brain. When clear images aren’t reaching the retina, this leads to amblyopia. Examples of deprivation include cataracts, cloudy corneas, or tumors in or around the eye.
Fortunately, there are treatments for each of these conditions, and if caught early enough, amblyopia may be prevented. Parents know their child best, so if anything seems off, it’s best to have an eye exam to diagnose and treat any issues as early as possible.
Erin P. Benjamin, DO is a board-certified ophthalmologist, specializing in comprehensive ophthalmology with an emphasis on micro-incision cataract surgery. She is also fellowship trained in pediatric ophthalmology and adult strabismus. She has performed thousands of cataract surgeries utilizing the latest advancements in the field, and also specializes in the diagnosis and treatment of glaucoma, diabetic eye disease, macular degeneration and dry eyes. She recently moved to the Lowcountry from Annapolis, Maryland, where she was named Southern Maryland’s Best Ophthalmologist in 2022. She is a member of the American Academy of Ophthalmology, the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery and the American Osteopathic Association.
By Dr. Mark Goulas | Goulas Eye
What is a cataract?
Inside our eyes, we have a natural lens. This lens bends light to help us focus and see clearly. When we are younger, the lens was clear. As we age, the lens becomes cloudy. Eventually the lens becomes so cloudy, the cataract will interfere with the clarity of our vision and make visual tasks more difficult. Symptoms of a cataract include:
• Blurry vision
• Seeing double or a ghosted image
• Increased sensitivity to light, especially at night with oncoming
headlights and increased glare and halos
• Needing more light when you read
• Colors become faded with a yellow tint to your vision
Aging is the most common cause of cataracts. People over the age of 60 usually start to have clouding of their lenses due to the proteins in the lens starting to break down. Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those in younger people or diabetics. Once a cataract becomes bothersome and affects a person’s activities of daily living (driving, reading, watching TV, playing sports, low light vision), the cataracts will need to be removed with surgery. During cataract surgery, your eye surgeon will remove the eye’s cloudy natural lens and replace it with an artificial lens (called an intraocular lens or IOL). There are different lens options that can help you decrease the need to wear glasses after surgery. Some IOL’s can help correct astigmatism (curvature of the eye) to make your distance vision clearer without glasses, too. There are IOL’s that can help you see distance and near (multifocal) so your dependence on glasses for distance and reading will be greatly reduced!
With dropless cataract surgery, the eye surgeon will insert the medications into the eye during surgery to alleviate using eye drops after surgery. It is just as safe as traditional cataract surgery with drops but without the expense and hassle of eye drops!
Cataracts are a very common reason people lose vision, but they can be treated. You and your ophthalmologist should discuss your cataract symptoms. Together you can decide whether you are ready for cataract surgery.
What do I need to know about Glaucoma?
Glaucoma is a disease that damages your eye’s optic nerve. It occurs due to an increase in the pressure of the eye which causes damage to the optic nerve and leads to permanent vision loss. As the optic nerve becomes damaged, you will develop blind spots in your vision. Advanced glaucoma can lead to blindness, but can often be prevented with early treatment. As we age, the eye becomes less efficient at draining fluid out of the eye, causing an increase in the eye pressure and damage to the optic nerve.
Glaucoma has no symptoms in the early stages, which is why half of all people with glaucoma do not know they have it! Having regular eye exams can help your ophthalmologist diagnose this disease before you lose vision. Glaucoma damage is permanent and cannot be reversed, but treatment can help prevent and stop further damage. Glaucoma is usually controlled with prescription eyedrops that help lower eye pressure by decreasing the formation of fluid and/or helping the fluid drain out of the eye better. Other treatments may include laser surgery, and in advanced cases, operating room glaucoma surgery. Because glaucoma has no symptoms, it is important to have regular eye exams to check for elevated eye pressure and vision changes.
Mark Goulas, MD is a board-certified ophthalmologist, specializing in cataract and refractive surgery. Born and raised in Detroit, he earned a Bachelor of Science degree from Michigan State University. He then pursued his dream of becoming a physician and graduated from Wayne State University School of Medicine in Detroit in 2000. He completed his ophthalmology training at Texas Tech University, where he developed strong clinical and surgical skills in ophthalmology that would set the foundation for surgical excellence. He has co-authored several research projects, ranging from lasers used in glaucoma to new surgical techniques used in pediatrics. He is the founder of Goulas Eye with locations in Bluffton and Hilton Head Island.