Eye Lecture Guide

THE EYE
The human eye is the organ which gives us the sense of sight, allowing us to
learn more about the surrounding world than we do with any of the other four
senses. We use our eyes in almost every activity we perform, whether
reading, working, watching television, writing a letter, driving a car, and in
countless other ways. Most people probably would agree that sight is the
sense they value more than all the rest.
The eye allows us to see and interpret the shapes, colors, and dimensions of
objects in the world by processing the light they reflect or emit. The eye is
able to see in bright light or in dim light, but it
cannot see objects when light is absent.
process of vision
Light waves from an object (such as a tree) enter the eye first through the
cornea, which is the clear dome at the front of the eye. The light then
progresses through the pupil, the circular opening in the center of the colored
iris. Next, the light passes through the crystalline lens, which is located
immediately behind the iris and the pupil.
Initially, the light waves are bent or converged first by the cornea, and then
further by the crystalline lens, to a nodal point (N) located immediately behind
the back surface of the lens. At that point, the image becomes reversed
(turned backwards) and inverted (turned upside-down).
The light continues through the vitreous humor, the clear gel that makes up
about 80% of the eye’s volume, and then, ideally, back to a clear focus on the
retina behind the vitreous. The small central area of the retina is the macula,
which provides the best vision of any location in the retina. If the eye is
considered to be a type of camera, the retina is equivalent to the film inside of
the camera, registering the tiny photons of light which interact with it.
Within the layers of the retina, light impulses are changed into electrical
signals and then sent through the optic nerve, along the visual pathway, to the
occipital cortex at the posterior or back of the brain. Here, the electrical
signals are interpreted or “seen” by the brain as a visual image. When the
light entering the eyes is bright enough, the pupils will constrict (get smaller),
due to the pupillary light response.
Actually, then, we do not “see” with our eyes but, rather, with our brains. Our
eyes merely are the beginnings of the visual process.
eye growth
The average newborn’s eyeball is about 18 millimeters in diameter, from front

to back (axial length); it grows slightly to a length of approximately 19½
millimeters as an infant; and it continues to grow gradually to a length of about
24-25 millimeters, or about 1 inch, in adulthood. (A ping-pong ball is about 1½
inch in diameter, which makes the average adult eyeball about 2/3 the size of
a ping-pong ball.) The eyeball is set in a protective cone-shaped cavity in the
skull called the “orbit” or “socket.”
extraocular muscles
The orbit is surrounded by layers of soft, fatty tissue which protect the eye and
enable it to turn easily. Three pairs of extraocular muscles regulate the
motion of each eye: the medial/lateral rectus muscles, the superior/inferior
rectus muscles, and the superior/inferior oblique muscles.
eye structures
Among the most important components of the human eye are the cornea,
conjunctiva, iris, crystalline lens, vitreous humor, retina, macula, optic nerve,
and extraocular muscles. Click on the names of each of these 9 ocular
structures on the left (either in the upper picture or in the lower frame of links)
to learn more about them. Then take the three short quizzes at the end, if you
wish.
Eye Anatomy
A guide to the many parts of the human eye and how they function.
The ability to see is dependent on the actions of several structures in and around
the eyeball. The graphic below lists many of the essential components of the
eye's optical system.
When you look at an object, light rays are reflected from the object to the
cornea, which is where the miracle begins. The light rays are bent, refracted and
focused by the cornea, lens, and vitreous. The lens' job is to make sure the rays
come to a sharp focus on the retina. The resulting image on the retina is upside-
down. Here at the retina, the light rays are converted to electrical impulses
which are then transmitted through the optic nerve, to the brain, where the
image is translated and perceived in an upright position!
Illustration by Mark Erickson
Think of the eye as a camera. A camera needs a lens and a film to produce an
image. In the same way, the eyeball needs a lens (cornea, crystalline lens,
vitreous) to refract, or focus the light and a film (retina) on which to focus the
rays. If any one or more of these components is not functioning correctly, the
result is a poor picture. The retina represents the film in our camera. It captures
the image and sends it to the brain to be developed. The macula is the highly
sensitive area of the retina. The macula is responsible for our critical focusing
vision. It is the part of the retina most used. We use our macula to read or to
stare intently at an object.
Buzzwords for eye anatomy

orbit: This cone shaped cavity in the skull is formed by the frontal, maxilla,
zygomatic, sphenoid, ethmoid, lacrimal and palatine bones. These bones are
thin and are often subject to fractures. The eye occupies the front portion on
the cavity with the rest being filled with fat, nerves, blood vessels, muscle and
the lacrimal (tear) gland.
anterior chamber: This front chamber of the three found in the eyeball itself
is found between the cornea and the iris.
posterior chamber: This chamber occupies space between the iris and the
lens.
aqueous humor: This fluid fills the anterior and posterior chambers. It is
made by cells of the ciliary body and circulates from the posterior chamber,
over the lens, to the anterior chamber and exits via the Canal of Schlemm. It
is similar to plasma but contains very little protein.
vitreous space: This chamber occupies the space behind the lens to the
retina. It is filled with a gelatinous substance called the vitreous body.
sclera: This a fibrous protective covering of the eyeball that is seen as the
white of the eye. It is made mostly of the structural protein collagen.
cornea: Transparent, colorless anterior one sixth of the covering of the

eyeball. The cornea consists of 5 layers with the outer one being a layer of
epithelium composed of 5-6 layers of cells that turnover every 7 days or so.
This layer and the internal endothelium are responsible for keeping the cornea
transparent. They do this by keeping the middle layers relatively dehydrated
which keeps the parallel collagen fibers present there from being opaque. The
cornea contains no blood vessels and gets its nutrients from those in the
anterior chamber fluid and surrounding vessels.
Schlemm's canal: This canal drains fluid from the anterior chamber.
Obstruction of this canal leads to an increased intraocular pressure which can
damage the retina. This condition is also called glaucoma.
choroid: This is the vascular layer of the eye.
retinal pigment epithelium: This layer lying betwen the retina and choroid,
contains melanocytes that make for its characteristic black color. This pigment
allows the inside of the eye to absorb stray rays of light like the black paint
inside a camera or within a dark room.
ciliary body: This is an expansion of the choroid at the front of the eye at the
level of the lens. The lens is attached to the ciliary body which has smooth
muscle within it. Contraction of this smooth muscle changes the shape of the
lens and allows the eye to focus on objects. Part of the ciliary body is
specialized to make aqueous humor.
iris: Another expansion of the choroid that partially covers the lens formed by
pigment cells, fibroblasts, blood vessels, contractile pigment cells. The
pigment found in the iris prevents light from entering the eye except through
the pupil. The melanocytes (pigmented cells) are responsible for the color of
the eyes. If there is little pigment in the cells the light reflected from the
choroid at the back of the eye will make the iris appear blue. As the amount of
pigment increases the iris appears greenish-blue, gray or brown.
pupil: Round opening in the iris that allows light to pass through. Pupil size
changes based on the amount of light present. More light causes the pupil to
contract while the pupil widens in the dark to collect as much light as possible.
lens: This biconvex structure is very elastic, at least in the young. With age
the lens looses its elasticity and therefore the ability to focus on near objects
decreases. The center of the lens is formed by elongated cells (fibers) that
have lost all organelles and are filled with special proteins called crystallins.
These fibers are replaced throughout life but the regeneration slows down
with age. Mature cataracts occur when these fibers accumulate pigment
granules so that they are less transparent.
retina: The photosensitive part of the eye lies between the vitreous body and
the choroid layer at the back of the eyeball and is a complex network of
photosensitive cells and various types of neurons. Light that reaches the
retina must travel through several layers of transparent neurons at the front of
the retina before reaching the photosensitive rods and cones. The
photosensitive part of rods and cones is housed in extensions of the cells that
look just like their names. The rods are responsible for black and white vision
while the cones detect color. The neurons within the retina act to integrate the
visual signals received by the rods and cones and transfer the information to
the optic nerve.
fovea: This specialized area of the retina is for the most acute vision. When a
person is actively focusing or attending to an object the eyes are moved so
that the image is focused on the fovea. It is thinner, containing only the cones
necessary for detection of sharp images. The cones in this area are long and
thin resembling rods so that they can be closely packed. Blood vessels are
absent as well. Each foveal cone is directly connected to a neuron in the optic
nerve.
blind spot: There are no photosensitive cells in this area of the retina. This is
where the optic nerve and blood vessels enter the eye through the optic disc.
Physiology of Vision
The eyes convert light energy in the wavelengths of 397 to 723 nanometers
into electrical signals in the optic nerve. Images of objects are focused on the
retina where the photosensitive cells convert the light energy to action
potentials. Rods contain the protein rhodopsin which contains a derivative of
Vitamin A. Light bleaches the visual pigments which causes photochemical
reactions to occur that amplify the signal. This information is transferred to the
associated neurons which integrate the signals and transfer the information to
the brain. A single rod is able to detect a single photon of light but the rods are
low resolution detectors so that images are formed but without much detail.
The human retina contains about 120 million rods. They very sensitive and
are the receptors used when low levels of light are encountered. Peak
sensitivity to light for rods is 505 nm which is roughly green light.
Color Vision
In the human, some 6 million cones are responsible for filling in the details
and colors in a visual image. The cone photopigment is called iodopsin. There
are three types of cones (red, green, and blue) based on their maximum
sensitivity to the visible light spectrum which is determined by the particular
variety of iodopsin produced by that cone. It is important to note that the
sensation of any color can be derived from the proper mix of these three
primary colors. Cones require a higher light intensity to illicit a response than
the rods because they have a higher threshold for stimulation.
Dark Adaptation
The human eye can see things in quite a remarkable range of light intensity,
bright sunshine to a moonless sky. This is due to dark adaptation, which is
due to a change in the visual threshold. For instance, when a person comes
inside to a movie theater from a bright sunny day their eyes gradually adapt to
the darker environment. It takes about 20 minutes for full adaptation. The
reverse process, adaptation from dark to light, takes about 5 minutes. Pilots,
radiologists and others who need maximal visual sensitivity in the dark can
avoid the 20 minute dark adaptation period if they wear red glasses or
goggles in the light. Red lighting is used in photographic print development as
well because the photographer can see acutely without ruining the print. This
is because the rods are only minimally simulated by red light and they are
chiefly involved in dark adaptation. The time required for dark adaptation is
due to the time required to build up rhodopsin stores within the rods.
Accommodation
The lens in the eye is an elastic structure that changes shape in order to focus
things near or far onto the retina. Optically, the greater the curvature of the
lens, the greater its refractive power. To bring close objects into focus on the
retina the lens must have a greater refractive power than in its resting state.
This is accomplished via contraction of the ciliary muscles that hold the lens in
place. When these muscle fibers contract, the lens, via its elasticity, springs
into a more convex shape allowing a focused image of near objects. This is
an energy requiring process since muscular effort is necessary, and therefore
can be tiring.
Near Point
The nearest point to the eye that an object can be brought into clear focus is
called the near point of vision. The near point gets farther away throughout life
due to a loss of lens elasticity. For example, the near point at age 10 might be
9 cm and 83 cm at age 60. The loss of accommodation is often sufficient by
age 40-45 to make close work and reading difficult. This can corrected by
wearing glasses with convex lenses.
The eye manifests its refracting power via several curved surfaces, each
separated by media with different indices of refraction. The most significant
refractive surfaces are the anterior and posterior cornea and the anterior and
posterior crystalline lens.
In the emmetropic eye (which has no refractive error), the range of corneal
refracting power is between 39 and 48 diopters, while the range of lenticular
refracting power is between 15 and 24 diopters. In the emmetropic eye, the
axial length (from the posterior corneal surface to the retina) varies from 22 to
26 millimeters, or approximately an inch.
The following are the clear ocular media and structures (through which light
passes before it reaches the retina) and their respective indices of refraction:
• pre-corneal tear film 1.3375
• cornea 1.3760
• aqueous humor 1.3360
• crystalline lens 1.4100
• vitreous humor 1.3360
The Physical Structures of the Eye

Items refer to the human eye unless otherwise specified. This section leans heavily on
Wyszecki and Stiles (1982) an excellent book.
• Cornea
• Sclera
• Aqueous Humor
• Iris
• Pupil
• Lens
• Vitreous Humor
• Retina - gross anatomy
o The primary layers of the retina from outermost surface to innermost
surface:
CARE OF THE CLIENTS WITH EYE DISORDERS
 Diagnostic Assessment
1) Snellen’s Chart
- tests visual acquity
- normal result is 20/20
- result of 20/20 indicates legal blindness
2) Ishihara Plate
- test color vision
3) Retinoscopy
- determines refractive error of an eye
4) Cover – Uncover test
- differentiates various types of strabismus
5) Tonometry
- indirect measure of IOP
- normal is 11 – 21 mmHg
6) Gonioscopy
- a biomicroscopic examination that visualizes the anterior chamber
angle
- diagnoses congenital and secondary glaucoma
7) Perimetry
- measurement of the peripheral vision field
8) Bjerrum Tangent Screen
- measures central vision
9) Ophthalmoscopy
- examines the fundus of the eye
10) Slit Lamp Biomicroscopy
- assesses the eye’s anterior portion under high magnification and in
optical section.
- It can diagnose astigmatism
 Vision Protection and General Eye Care

- Regular ocular and physical examinations
- Avoid dangerous items (toys, gums, arrows, fireworks, rocks,etc)
- Early identification and treatment of strabismus in children
- Routine eye assessment programs in school
- Early treatment when eye symptoms occur
- Routine instillation of appropriate drops in the eyes of every
newborn
- Blood tests during pregnancy to identify syphilis
- Inoculation against rubella
- Regulation of oxygen concentrations administered to premature
infants
- Avoid habitual rubbing of the eyes
- Have adequate lighting when reading
- Periodically rest eyes during prolonged periods of close work,
reading or watching television
- Reduce glare and wear protected goggles
- Keep eye glasses clean, protected from scratching and breakage
and properly aligned
- Do not use eyewashes, eye drops, or any medications in the eyes
unless prescribed by a doctor
- Never use a soiled wash cloth around eyes
- Use care when using aerosol sprays
- Maintain a state of good health and eat well – balanced diet with
adequate vitamins A, B and C.
- Use care when using solvents, lye solutions, ammonia, caustic
solutions to avoid splashing or spilling into eyes
 Common Ocular Medications

- Local Anesthetics
- Parasympathomimetic drugs – used as miotics
▪ Pilocarpine HCl 0.5 – 10%
▪ Carbachol 1.5 – 3%
▪ Acetylcholine Cl 1%
- Parasympatholytic drugs – used mydriatics
▪ Neo – Synephrine 2.5 / 10%
▪ Atrophine SO4 0.%, 1, 4%
▪ Scopolamine Hydrobromide 0.25%
▪ Cyclopentolate HCl (Cyclogyl) 1%, 2%
▪ Tropicamide (Mydraicyl) 0.5, 1%
- Antimicrobials
▪ Gentamycin 0.3%
▪ Neosporin
▪ Chloroptic eye drop
- Steroids
- Carbonic anhydrase inhibitors – reduce aqueous humor production
▪ Diamox (Acetazolamide)
- Beta – Blockers – reduce aqueous humor production

▪ Timolol Maleate (Timoptic)
UVEITIS (Iritis)
Definition
Uveitis means "inflammation of the uvea", or the middle layer of the eye. The uvea
consists of three structures: the iris, the ciliary body, and the choroid. The iris is the
colored structure surrounding the pupil, visible in the front of the eye. The ciliary
body is a structure containing muscle and is located behind the iris which focuses the
lens. The choroid is a layer containing blood vessels that line the back of the eye and
is located between the inner visually sensitive layer, called the retina, and the outer
white eye wall, called the sclera. Inflammation occurring in any of these three
structures is termed "uveitis".
Inflammation in uveitis may involve any but not necessarily all of these three
structures. Depending upon which structures are inflamed, uveitis may be further
subcategorized into one of three main diagnoses, these include:
 iritis or anterior uveitis,

 iridocyclitis or intermediate uveitis, and
 choroiditis or posterior uveitis.
Uveitis may develop following eye trauma or surgery, in association with diseases
which affect other organs in the body, or may be a condition isolated to the eye itself.
Severe and permanent visual loss can result from uveitis. In addition, uveitis can lead
to other ocular complications, which may produce vision loss, including glaucoma,
cataracts, or retinal damage. Early detection and treatment is necessary to reduce the
risk of permanent vision loss.
Symptoms
Depending on which part of the eye is inflammed in uveitis different combinations of
these symptoms may be present.
 Redness
 Light sensitivity
 Floaters
 Blurry vision
 Pain
These symptoms may come on suddenly, and you may not experience any pain. The
symptoms described above may not necessarily mean that you have uveitis. However,
if you experience one or more of these symptoms, contact your eye doctor for a
complete exam.
Treatment
Treatment may include steroid eyedrops, injections, or pills, as well as eyedrops to
dilate the pupil and reduce pain. More severe cases of uveitis may even require
treatment with chemotherapeutic agents to suppress the immune system.
CONJUNCTIVITIS (Pink Eye)

Overview
Conjunctivitis, commonly known as pink eye, is an infection of the conjunctiva (the
outer-most layer of the eye that covers the sclera). The three most common types of
conjunctivitis are: viral, allergic, and bacterial. Each requires different treatments.
With the exception of the allergic type, conjunctivitis is typically contagious.
The viral type is often associated with an upper respiratory tract infection, cold, or
sore throat. The allergic type occurs more frequently among those with allergic
conditions. When related to allergies, the symptoms are often seasonal. Allergic
conjunctivitis may also be caused by intolerance to substances such as cosmetics,
perfume, or drugs. Bacterial conjunctivitis is often caused by bacteria such as
staphylococcus and streptococcus. The severity of the infection depends on the type
of bacteria involved.
Signs and Symptoms
Viral conjunctivitis
Watery discharge
Irritation
Red eye
Infection usually begins with one eye, but may spread easily to the fellow eye
Allergic conjunctivitis
Usually affects both eyes
Itching
Tearing
Swollen eyelids
Bacterial conjunctivitis
Stringy discharge that may cause the lids to stick together, especially after
sleeping
Swelling of the conjunctiva
Redness
Tearing
Irritation and/or a gritty feeling
Usually affects only one eye, but may spread easily to the fellow eye
Diagnosis
Conjunctivitis is diagnosed during a routine eye exam using a slit lamp microscope.
In some cases, cultures are taken to determine the type of bacteria causing the
infection.
Treatment
Conjunctivitis requires medical attention. The appropriate treatment depends on the

cause of the problem.
For the allergic type, cool compresses and artificial tears sometimes relieve
discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory
medications and antihistamines may be prescribed. Some patients with persistent
allergic conjunctivitis may also require topical steroid drops.
Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that
cover a broad range of bacteria.
Like the common cold, there is no cure for viral conjunctivitis; however, the
symptoms can be relieved with cool compresses and artificial tears (found in most
pharmacies). For the worst cases, topical steroid drops may be prescribed to reduce
the discomfort from inflammation. Viral conjunctivitis usually resolves within 3
weeks.
To avoid spreading infection, take these simple steps:

Disinfect surfaces such as doorknobs and counters with diluted bleach solution
Don’t swim (some bacteria can be spread in the water)
Avoid touching the face
Wash hands frequently
Don’t share towels or washcloths
Do not reuse handkerchiefs (using a tissue is best)
Avoid shaking hands
MACULAR DEGENERATION
Overview
Age-related macular degeneration (ARMD) is a degenerative condition of the

macula (the central retina). It is the most common cause of vision loss in the United
States in those 50 or older, and its prevalence increases with age. AMD is caused by
hardening of the arteries that nourish the retina. This deprives the sensitive retinal
tissue of oxygen and nutrients that it needs to function and thrive. As a result, the
central vision deteriorates.
Macular degeneration varies widely in severity. In the worst cases, it causes a

complete loss of central vision, making reading or driving impossible. For others, it
may only cause slight distortion. Fortunately, macular degeneration does not cause
total blindness since it does not affect the peripheral vision.
What is the difference between wet and dry macular degeneration?

AMD is classified as either wet (neovascular) or dry (non-neovascular). About 10%
of patients who suffer from macular degeneration have wet AMD. This type occurs
when new vessels form to improve the blood supply to oxygen-deprived retinal tissue.
However, the new vessels are very delicate and break easily, causing bleeding and
damage to surrounding tissue.
Patient with wet macular degeneration develop new blood vessels

under the retina. This causes hemorrhage, swelling, and scar tissue but
it can be treated with laser in some cases.

Dry macular degeneration,
although more common, typically results in a less severe, more gradual loss of vision.
The dry type is much more common and is characterized by drusen and loss of
pigment in the retina. Drusen are small, yellowish deposits that form within the
layers of the retina.
What causes macular degeneration?

Macular degeneration may be caused by variety of factors. Genetics, age,
nutrition, smoking, and sunlight exposure may all play a role.
Signs and Symptoms
• Loss of central vision. This may be gradual for those with the dry type.
Patients with the wet type may experience a sudden decrease of the central
vision.
• Difficulty reading or performing tasks that require the ability to see detail
• Distorted vision (Straight lines such as a doorway or the edge of a window
may appear wavy or bent.)
Detection and Diagnosis

Eye physicians usually diagnose AMD. Vision testing, Amsler grid test,
ophthalmoscopy, fundus photography and fluorescein angiography are some common
tests performed during a retinal exam.
Treatment
There is no proven medical therapy for dry macular degeneration. In selected cases
of wet macular degeneration, laser photocoagulation is effective for sealing leaking or
bleeding vessels. Unfortunately, laser photocoagulation usually does not restore lost
vision, but it may prevent further loss.
Recently, photodynamic therapy has proven to be effective in stopping abnormal

blood vessel growth in some patients with wet AMD. This new type of laser treatment
is far less damaging than laser photocoagulation and is the treatment of choice in
many cases.
Early diagnosis is critical for successful treatment of wet macular degeneration.

Patients can help the doctor detect early changes by monitoring vision at home with
an Amsler grid.
Nutrition and macular degeneration

Several recent studies have indicated a strong link between nutrition and the
development of macular degeneration. It has been scientifically demonstrated that
people with diets high in fruits and vegetables (especially leafy green vegetables)
have a lower incidence of macular degeneration. More studies are needed to
determine if nutritional supplements can prevent progression in patients with existing
disease.
Tips for AMD patients
If you’ve been diagnosed with AMD, making a few simple lifestyle changes could
have a positive impact on the health of your retina.
• Monitor your vision daily with an Amsler grid. By checking your vision
regularly, changes that may require treatment can be detected early.
• Take a multi-vitamin with zinc. (check with your eye physician for a
recommendation). Antioxidants, along with zinc and lutein are essential
nutrients, all found in the retina. It is believed that people with AMD may be
deficient in these nutrients.
• Incorporate dark leafy green vegetables into your diet. These include
spinach, collard greens, kale and turnip greens. Always protect your eyes
with sunglasses that have UV protection. Ultraviolet rays are believed to
cause damage to the pigment cells in the retina.
• Quit smoking. Smoking impairs the body’s circulation, decreasing the
efficiency of the retinal blood vessels.
• Exercise regularly. Cardiovascular exercise improves the body’s overall
health and increases the efficiency of the circulatory system.
• These are a few tips to make reading easier:
• Use a halogen light. These have less glare and disperse the light better than
standard light bulbs.
• Shine the light directly on your reading material. This improves the
contrast and makes the print easier to see.
• Use a hand-held magnifier. A drugstore magnifier can increase the print size
dramatically.
• Try large-print or audio books. Most libraries and bookstores have special
sections reserved for these books.
• Consult a low vision specialist. These professionals are specially trained to
help visually impaired patients improve their quality of life. After a
personalized consultation, they can recommend appropriate magnifiers,
reading aids, practical tips, and many resources.
GLAUCOMA
Overview
Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either

from a malformation or malfunction of the eye’s drainage structures. Left untreated,
an elevated IOP causes irreversible damage the optic nerve and retinal fibers resulting
in a progressive, permanent loss of vision. However, early detection and treatment
can slow, or even halt the progression of the disease.
What causes glaucoma?
The eye constantly produces aqueous, the clear fluid that fills the anterior chamber
(the space between the cornea and iris). The aqueous filters out of the anterior
chamber through a complex drainage system. The delicate balance between the
production and drainage of aqueous determines the eye’s intraocular pressure (IOP).
Most people’s IOPs fall between 8 and 21. However, some eyes can tolerate higher
pressures than others. That’s why it may be normal for one person to have a higher
pressure than another.
Common types of glaucoma
Open Angle
Open angle (also called chronic open angle or primary open angle) is the most
common type of glaucoma. With this type, even though the anterior structures of the
eye appear normal, aqueous fluid builds within the anterior chamber, causing the IOP
to become elevated. Left untreated, this may result in permanent damage of the optic
nerve and retina. Eye drops are generally prescribed to lower the eye pressure. In
some cases, surgery is performed if the IOP cannot be adequately controlled with
medical therapy.
Acute Angle Closure
Only about 10% of the population with glaucoma has this type. Acute angle closure
occurs because of an abnormality of the structures in the front of the eye. In most of
these cases, the space between the iris and cornea is more narrow than normal, leaving
a smaller channel for the aqueous to pass through. If the flow of aqueous becomes
completely blocked, the IOP rises sharply, causing a sudden angle closure attack.
While patients with open angle glaucoma don’t typically have symptoms, those with
angle closure glaucoma may experience severe eye pain accompanied by nausea,
blurred vision, rainbows around lights, and a red eye. This problem is an emergency
and should be treated by an ophthalmologist immediately. If left untreated, severe and
permanent loss of vision will occur in a matter of days.
Secondary Glaucoma
This type occurs as a result of another disease or problem within the eye such as:
inflammation, trauma, previous surgery, diabetes, tumor, and certain medications. For
this type, both the glaucoma and the underlying problem must be treated.
Congenital
This is a rare type of glaucoma that is generally seen in infants. In most cases, surgery
is required.
Signs and Symptoms
Glaucoma is an insidious disease because it rarely causes symptoms. Detection and

prevention are only possible with routine eye examinations. However, certain types,
such as angle closure and congenital, do cause symptoms.
Angle Closure (emergency)
• Sudden decrease of vision

• Extreme eye pain
• Headache
• Nausea and vomiting
• Glare and light sensitivity
Congenital
• Tearing
• Light sensitivity
• Enlargement of the cornea
Because glaucoma does not cause symptoms in most cases, those who are 40 or older
should have an annual examination including a measurement of the intraocular
pressure. Those who are glaucoma suspects may need additional testing.
The glaucoma evaluation has several components. In addition to measuring the

intraocular pressure, the doctor will also evaluate the health of the optic nerve
(ophthalmoscopy), test the peripheral vision (visual field test), and examine the
structures in the front of the eye with a special lens (gonioscopy) before making a
diagnosis.
The above photos show progressive optic nerve damage (indicated by the cup to disc
ratio) caused by glaucoma. Notice the pale appearance of the nerve with the 0.9 cup
as compared to the nerve with the 0.3 cup.
The doctor evaluates the optic nerve and grades its health by noting the cup to disc
ratio. This is simply a comparison of the cup (the depressed area in the center of the
nerve) to the entire diameter of the optic nerve. As glaucoma progresses, the area of
cupping, or depression, increases. Therefore, a patient with a higher ratio has more
damage.
The progression of glaucoma is monitored with a visual field test. This test maps the
peripheral vision, allowing the doctor to determine the extent of vision loss from
glaucoma and a measure of the effectiveness of the treatment. The visual field test is
periodically repeated to verify that the intraocular pressure is being adequately
controlled.
The structures in the front of the eye are normally difficult to see without the help of a
special gonioscopy lens. This special mirrored contact lens allows the doctor to
examine the anterior chamber and the eye’s drainage system.
At St. Luke’s, another test called the Arden Screening Test is used to confirm the
diagnosis of glaucoma. This color test may show vision changes that occur before
problems appear on the visual field test.
Treatment
Most patients with glaucoma require only medication to control the eye pressure.
Sometimes, several medications that complement each other are necessary to reduce
the pressure adequately.
Surgery is indicated when medical treatment fails to lower the pressure satisfactorily.
There are several types of procedures, some involve laser and can be done in the
office, others must be performed in the operating room. The objective of any
glaucoma operation is to allow fluid to drain from the eye more efficiently.
CATARACT
What is a cataract?
When cataracts are mentioned, people often think of a film that grows on their eyes
causing them to see double or blurred images. However, a cataract does not form on
the eye, but rather within the eye.
Eye without a cataract Eye with a cataract
A cataract is a clouding of the natural lens, the part of the eye responsible for focusing
light and producing clear, sharp images. The lens is contained in a sealed bag or
capsule. As old cells die they become trapped within the capsule. Over time, the cells
accumulate causing the lens to cloud, making images look blurred or fuzzy. For most
people, cataracts are a natural result of aging.
In fact, they are the leading cause of visual loss among adults 55 and older. Eye
injuries, certain medications, and diseases such as diabetes and alcoholism have also
been known to cause cataracts.
Normal Vision
DRY EYE SYNDROME
Overview
Dry eye syndrome is one of the most common problems treated by eye physicians.
Over ten million Americans suffer from dry eyes. It is usually caused by a problem
with the quality of the tear film that lubricates the eyes.
Tears are comprised of three layers. The mucus layer coats the cornea, the eye’s clear
outer window, forming a foundation so the tear film can adhere to the eye. The
middle aqueous layer provides moisture and supplies oxygen and other important
nutrients to the cornea. This layer is made of 98 percent water along with small
amounts of salt, proteins and other compounds. The outer lipid layer is an oily film
that seals the tear film on the eye and helps to prevent evaporation.
Tears are formed in several glands around the eye. The water layer is produced in the
lacrimal gland, located under the upper eyelid. Several smaller glands in the lids
make the oil and mucus layers. With each blink, the eyelids spread the tears over the
eye. Excess tears flow into two tiny drainage ducts in the corner of the eye by the
nose. These ducts lead to tiny canals that connect to the nasal passage. The
connection between the tear ducts and the nasal passage is the reason that crying
causes a runny nose.
In addition to lubricating the eye, tears are also produced as a reflex response to
outside stimulus such as an injury or emotion. However, reflex tears do little to
soothe a dry eye, which is why someone with watery eyes may still complain of
irritation.
Dry eye syndrome has many causes. One of the most common reasons for dryness is
simply the normal aging process. As we grow older, our bodies produce less oil –
60% less at age 65 then at age 18. This is more pronounced in women, who tend to
have drier skin then men. The oil deficiency also affects the tear film. Without as
much oil to seal the watery layer, the tear film evaporates much faster, leaving dry
areas on the cornea.
Many other factors, such as hot, dry or windy climates, high altitudes, air-
conditioning and cigarette smoke also cause dry eyes. Many people also find their
eyes become irritated when reading or working on a computer. Stopping periodically
to rest and blink keeps the eyes more comfortable.
Contact lens wearers may also suffer from dryness because the contacts absorb the
tear film, causing proteins to form on the surface of the lens. Certain medications,
thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and
Sjogren’s can also cause dryness. Women frequently experience problems with dry
eyes as they enter menopause because of hormonal changes.
Symptoms
• Itching
• Burning
• Irritation
• Redness
• Blurred vision that improves with blinking
• Excessive tearing
• Increased discomfort after periods of reading, watching TV, or working on a
computer
There are several methods to test for dry eyes. The doctor will first determine the
underlying cause by measuring the production, evaporation rate and quality of the tear
film. Special drops that highlight problems that would be otherwise invisible are
particularly helpful to diagnose the presence and extent of the dryness.
Treatment
A treatment option - BioTears™
When it comes to treating dry eyes, everyone’s needs are a little different. Many find
relief simply from using artificial tears on a regular basis. Some of these products are
watery and alleviate the symptoms temporarily; others are thicker and adhere to the
eye longer. Preservative-free tears are recommended because they are the most
soothing and have fewer additives that could potentially irritate. Avoid products that
whiten the eyes – they don’t have adequate lubricating qualities and often make the
problem worse.
Closing the opening of the tear drain in the eyelid with special inserts called punctal
plugs is another option. This works like closing a sink drain with a stopper. These
special plugs trap the tears on the eye, keeping it moist. This may be done on a
temporary basis with a dissolvable collagen plug, or permanently with a silicone
plug.
There are also simple lifestyle changes that can significantly improve irritation from
dry eyes. For example, drinking eight to ten glasses of water each day keeps the body
hydrated and flushes impurities. Make a conscious effort to blink frequently –
especially when reading or watching television. Avoid rubbing the eyes. This only
worsens the irritation.
Treating dry eye problems is important not only for comfort, but also for the health of
the cornea.
A treatment option (BioTears)
Watch the Dry Eye Syndrome video
More about Dry Eye Syndrome
Nutrition and Dry Eye Syndrome
BLEPHARITIS (Granulated Eyelids)
Overview
Blepharitis is a common inflammatory condition that affects the eyelids. It usually

causes burning, itching and irritation of the lids. In severe cases, it may also cause
styes, irritation and inflammation of the cornea (keratitis) and conjunctiva
(conjunctivitis). Some patients have no symptoms at all.
Blepharitis is usually a chronic problem that can be controlled with extra attention to
lid hygiene. However, it is sometimes caused by an infection and may require
medication.
Signs and Symptoms
• Sandy, itchy eyes

• Red and/or swollen eyelids
• Crusty, flaky skin on the eyelids
• Dandruff
Blepharitis is detected during a routine examination of the eyelids and lashes using a
slit lamp microscope.
Treatment
The key to controlling blepharitis is to keep the eyelids and eyelashes clean. Begin by
soaking a clean washcloth in hot tap water. (You may also warm the washcloth by
dampening it first and placing it in the microwave for 15-20 seconds. Use caution, all
microwaves heat at different intensities. Hold the washcloth to your cheek to test for
temperature before placing it on the eyes.) Place the compress on closed eyelids for
five minutes, and then repeat. Next, gently scrub the eyelids with a washcloth or
cotton swab soaked in a mixture of equal parts of baby shampoo and water.
Afterward, rinse the lids thoroughly with warm water.
This treatment should be repeated two to three times daily for two weeks, and then
reduced to once daily. Like dandruff, there is no cure for blepharitis; but it can be
controlled. In some cases, anti-inflammatory and antibiotic drops or ointments are
necessary for flare-ups or more severe cases.
HERPES SIMPLEX EYE DISEASE
Overview
Herpes simplex is a very common virus affecting the skin, mucous membranes,
nervous system, and the eye. There are two types of herpes simplex. Type I causes
cold sores or fever blisters and may involve the eye. Type II is sexually transmitted
and rarely causes ocular problems.
Nearly everyone is exposed to the virus during childhood. Herpes simplex is

transmitted through bodily fluids, and children are often infected by the saliva of an
adult. The initial infection is usually mild, causing only a sore throat or mouth. After
exposure, herpes simplex usually lies dormant in the nerve that supplies the eye and
skin.
Later on, the virus may be reactivated by stress, heat, running a fever, sunlight,
hormonal changes, trauma, or certain medications. It is more likely to recur in people
who have diseases that suppress their immune system. In some cases, the recurrence
is triggered repeatedly and becomes a chronic problem.
When the eye is involved, herpes simplex typically affects the eyelids, conjunctiva,
and cornea. Keratitis (swelling caused by the infection), a problem affecting the
cornea, is often the first ocular sign of the disease. In some cases, the infection
extends to the middle layers of the cornea, increasing the possibility of permanent
scarring. Some patients develop uveitis, an inflammatory condition that affects other
eye tissues.
Signs and Symptoms
• Pain
• Red eye
• Tearing
• Irritation, scratchiness
• Decreased vision (dependent on the location and extent of the infection)
Herpes simplex is diagnosed with a slit lamp examination. Tinted eye drops that
highlight the affected areas of the cornea may be instilled to help the doctor evaluate
the extent of the infection.
Treatment
Treatment of herpes simplex keratitis depends on the severity. An initial outbreak is

typically treated with topical and sometimes oral anti-viral medication. The doctor
may gently scrape the affected area of the cornea to remove the diseased cells.
Patients who experience permanent corneal scarring as a result of severe and recurrent
infections may require a corneal transplant to restore their vision.
DIABETIC RETINOPLASTY
Overview
Diabetes is a disease that occurs when the

pancreas does not secrete enough insulin or the
body is unable to process it properly. Insulin is
the hormone that regulates the level of sugar
(glucose) in the blood. Diabetes can affect
children and adults.
How does diabetes affect the retina?
Patients with diabetes are more likely to develop

eye problems such as cataracts and glaucoma, but the disease’s affect on the retina is
the main threat to vision. Most patients develop diabetic changes in the retina after
approximately 20 years. The effect of diabetes on the eye is called diabetic
retinopathy.
Over time, diabetes affects the circulatory system of the retina. The earliest phase of
the disease is known as background diabetic retinopathy. In this phase, the arteries in
the retina become weakened and leak, forming small, dot-like hemorrhages. These
leaking vessels often lead to swelling or edema in the retina and decreased vision.
The next stage is known as proliferative diabetic retinopathy. In this stage, circulation
problems cause areas of the retina to become oxygen-deprived or ischemic. New,
fragile, vessels develop as the circulatory system attempts to maintain adequate
oxygen levels within the retina. This is called neovascularization. Unfortunately,
these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous,
causing spots or floaters, along with decreased vision.
In the later phases of the disease, continued abnormal vessel growth and scar tissue
may cause serious problems such as retinal detachment and glaucoma.
Signs and Symptoms
The affect of diabetic retinopathy on vision varies widely, depending on the stage of
the disease. Some common symptoms of diabetic retinopathy are listed below,
however, diabetes may cause other eye symptoms.
• Blurred vision (this is often linked to blood sugar levels

• Floaters and flashes
• Sudden loss of vision
Diabetic patients require routine eye examinations so related eye problems can be
detected and treated as early as possible. Most diabetic patients are frequently
examined by an internist or endocrinologist who in turn work closely with the
ophthalmologist.
The diagnosis of diabetic retinopathy is made following a detailed examination of the

retina with an ophthalmoscope. Most patients with diabetic retinopathy are referred
to vitreo-retinal surgeons who specialize in treating this disease.
Treatment
Diabetic retinopathy is treated in many ways depending on the stage of the disease
and the specific problem that requires attention. The retinal surgeon relies on several
tests to monitor the progression of the disease and to make decisions for the
appropriate treatment. These include: fluorescein angiography, retinal photography,
and ultrasound imaging of the eye.
The abnormal growth of tiny blood vessels and the associated complication of
bleeding is one of the most common problems treated by vitreo-retinal surgeons.
Laser surgery called pan retinal photocoagulation (PRP) is usually the treatment of
choice for this problem.
With PRP, the surgeon uses laser to destroy oxygen-deprived retinal tissue outside of
the patient’s central vision. While this creates blind spots in the peripheral vision,
PRP prevents the continued growth of the fragile vessels and seals the leaking ones.
The goal of the treatment is to arrest the progression of the disease.
Vitrectomy is another surgery commonly needed for diabetic patients who suffer a
vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the
eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous
from the eye, and replaces it with clear salt solution (saline). At the same time, the
surgeon may also gently cut strands of vitreous attached to the retina that create
traction and could lead to retinal detachment or tears.
Patients with diabetes are at greater risk of developing retinal tears and detachment.
Tears are often sealed with laser surgery. Retinal detachment requires surgical
treatment to reattach the retina to the back of the eye. The prognosis for visual
recovery is dependent on the severity of the detachment.
Prevention
Researchers have found that diabetic patients who are able to maintain appropriate
blood sugar levels have fewer eye problems than those with poor control. Diet and
exercise play important roles in the overall health of those with diabetes.
Diabetics can also greatly reduce the possibilities of eye complications by scheduling
routine examinations with an ophthalmologist. Many problems can be treated with
much greater success when caught early.
RUBEOSIS
Overview
Rubeosis is a term that describes abnormal blood vessel growth on the iris and the
structures in the front of the eye. Normally there are no visible blood vessels in these
areas.
When the retina has been deprived of oxygen, or ischemic, as with diabetic
retinopathy or vein occlusion, abnormal vessels form to supply oxygen to the eye.
Unfortunately, the formation of these vessels obstructs the drainage of aqueous fluid
from the front of the eye, causing the eye pressure to become elevated. This usually
leads to neovascular glaucoma.
Signs and Symptoms
Patients' primary symptom associated with rubeosis is a gradual loss of peripheral

vision related to the secondary problem of glaucoma. Rubeosis is usually
undetectable with the naked eye.
The doctor can diagnose rubeosis with a slit lamp microscope. Often, a special
mirrored gonioscopy lens is used to examine the blood vessel growth in the front of
the eye.
Treatment
The primary concern with rubeosis is the treatment of the secondary problem of
glaucoma. It is often difficult however, to control the intraocular pressure with this
type of glaucoma. Both medical and surgical treatment are often required.
KERATOCONUS
Overview
Keratoconus is a degenerative disease of the cornea that causes it to gradually thin

and bulge into a cone-like shape. This shape prevents light from focusing precisely
on the macula. As the disease progresses, the cone becomes more pronounced,
causing vision to become blurred and distorted. Because of the cornea's irregular
shape, patients with keratoconus are usually very nearsighted and have a high degree
of astigmatism that is not correctable with glasses.
Keratoconus is sometimes an inherited problem that usually occurs in both eyes.
Signs and Symptoms

• Nearsightedness
• Astigmatism
• Blurred vision - even when wearing glasses and contact lenses
• Glare at night
• Frequent prescription changes in glasses and contact lenses
• Eye rubbing
Keratoconus is usually diagnosed when patients reach their 20's. For some, it may
advance over several decades, for others, the progression may reach a certain point
and stop.
Keratoconus is not usually visible to the naked eye until the later stages of the
disease. In severe cases, the cone shape is visible to an observer when the patient
looks down while the upper lid is lifted. When looking down, the lower lid is no
longer shaped like an arc, but bows outward around the pointed cornea. This is called
Munson's sign.
Special corneal testing called topography provides the doctor with detail about the
cornea's shape and is used to detect and monitor the progression of the disease. A
pachymeter may also be used to measure the thickness of the cornea.
Treatment
The first line of treatment for patients with keratoconus is to fit rigid gas permeable
(RGP) contact lenses. Because this type of contact is not flexible, it creates a smooth,
evenly shaped surface to see through. However, because of the cornea's irregular
shape, these lenses can be very challenging to fit. This process often requires a great
deal of time and patience.
When vision deteriorates to the point that contact lenses no longer provide satisfactory
vision, corneal transplant may be necessary to replace the diseased cornea with a
healthy one.
RETINAL TEAR & DETACHMENT
Overview
Retinal Tear
Retinal tears commonly occur when there is traction on the retina by the vitreous gel
inside the eye. In a child’s eye, the vitreous has an egg-white consistency and is
firmly attached to certain areas of the retina. Over time, the vitreous gradually
becomes thinner, more liquid and separates from the retina. This is known as a
posterior vitreous detachment (PVD).
PVDs are typically harmless and cause floaters in the eye; but in some cases, the
traction on the retina may create a tear. Retinal tears frequently lead to detachments
as fluids seep underneath the retina, causing it to separate and detach.
Retinal Detachment
A retinal detachment occurs when the retina’s sensory and pigment layers separate.
Because it can cause devastating damage to the vision if left untreated, retinal
detachment is considered an ocular emergency that requires immediate medical
attention and surgery. It is a problem that occurs most frequently in the middle-aged
and elderly.
There are three types of retinal detachments. The most common type occurs when
there is a break in the sensory layer of the retina, and fluid seeps underneath, causing
the layers of the retina to separate. Those who are very nearsighted, have undergone
eye surgery, or have experienced a serious eye injury are at greater risk for this type of
detachment. Nearsighted people are more susceptible because their eyes are longer
than average from front to back, causing the retina to be thinner and more fragile.
The second most common type occurs when strands of vitreous or scar tissue create
traction on the retina, pulling it loose. Patients with diabetes are more likely to
experience this type.
The third type happens when fluid collects underneath the layers of the retina, causing
it to separate from the back wall of the eye. This type usually occurs in conjunction
with another disease affecting the eye that causes swelling or bleeding.
Signs and Symptoms
Light flashes
“Wavy,” or “watery” vision
Veil or curtain obstructing vision
Shower of floaters that resemble spots, bugs, or spider webs
Sudden decrease of vision
Retinal detachments are usually found because the patient calls the doctor’s office
with a symptom listed above. It is critical that these problems are reported early,
because early treatment can greatly improve the chance of restoring vision.
The doctor makes the diagnosis of a retinal detachment after thoroughly examining
the retina with ophthalmoscopy. The retinal surgeon’s first concern is to determine
whether the macula (the center of the retina) is attached. This is critical because the
macula is responsible for the central vision. Whether or not the macula is attached
determines the type of corrective surgery required and the patient’s chances of having
functional vision after the operation.
Ultrasound imaging of the eye is also very useful for the doctor to see additional
detail of the condition of the retina from several angles.
Treatment
There are a number of ways to treat retinal detachment. The appropriate treatment
depends on the type, severity and location of the detachment.
Pneumatic retinopexy is one type of procedure to reattach the retina. After numbing
the eye with a local anesthesia, the surgeon injects a small gas bubble into the vitreous
cavity. The bubble presses against the retina, flattening it against the back wall of the
eye. Since the gas rises, this treatment is most effective for detachments located in
the upper portion of the eye. In order to manipulate the bubble into the ideal location,
the surgeon may ask the patient to keep his or her head in a specific position.
The gas bubble slowly absorbs over the next 1-2 weeks. At that time, an additional
procedure is usually performed to “tack down” the retina. This can be done either
with cryotherapy, a procedure that uses nitrous oxide to freeze the retina, sealing it in
place, or with laser. Local anesthesia is used for both procedures.
Some types of retinal detachments, because of their location or size, are best treated
with a procedure called a scleral buckle. With this technique, a tiny sponge or band
made of silicone is attached to the outside of the eye, pressing inward and holding the
retina in position. After removing the vitreous gel from the eye with a procedure
called a vitrectomy, the surgeon usually seals a few areas of the retina into position
with laser or cryotherapy. The scleral buckle is not visible and remains permanently
attached to the eye. This technique of reattaching the retina may elongate the eye,
causing nearsightedness.
In rare cases where other types of retinal detachment surgeries are either inappropriate
or unsuccessful, silicone oil may be used to reattach the retina. The vitreous gel is
removed and replaced with silicone oil, which presses the retina into place. While the
oil is inside the eye, the vision is extremely poor. After the retina has resealed itself
against the back of the eye, a second procedure may be performed to remove the oil.
What you can do…
Early detection is key in successfully treating retinal detachments and tears.

Awareness of the quality of your vision in each eye is extremely important, especially
if you are in a higher-risk group such as those who are nearsighted or diabetic.
Compare the vision of your eyes daily by looking straight ahead and covering one eye
and then the other.
Notify your doctor immediately if you notice any of the following:
• An obstruction of your peripheral vision (veil, shadow, or curtain)

• Sudden shower of floaters
• Light flashes
• Spider webs
Related surgical procedures:
Vitrectomy
CYTOMEGALOVIRUS
Overview
The cytomegalovirus (CMV) is related to the herpes virus and is present in almost
everyone. Normally, most people’s immune systems are able to fight the virus,
preventing it from causing problems in their bodies. However, when the immune
system is suppressed because of disease (HIV), organ or bone marrow transplant, or
chemotherapy, the CMV virus can cause damage and disease to the eye and the rest of
the body.
Photographs of retinas affected with CMV retinitis
CMV is the most common type of virus that infects those who are HIV positive. It
affects the eye in about 30% of the cases by causing damage to the retina. This is
called CMV retinitis. The likelihood of developing CMV retinitis increases as the
CD4 cell count decreases.
Normal (unaffected) retina
CMV retinitis may affect one eye at first, but usually progresses to both eyes and
becomes worse as the patient's ability to fight infection decreases. The virus is sight
threatening and usually requires the care and treatment of a vitreo-retinal surgeon.
Patients with CMV retinitis are at risk of retinal detachment, hemorrhages, and
inflammation of the retina that can lead to permanent loss of vision and even
blindness.
Signs and Symptoms

CMV retinitis usually causes symptoms, but not always. Patients with a condition
that suppresses the immune system should watch for the following eye symptoms
while under the care of a physician.
Floaters (spots, bugs, spider webs)
Light flashes
Blind spots
Blurred vision
Obstructed areas of vision
Sudden decrease of vision
Most patients with CMV retinitis are referred for eye treatment by another physician.
The vitreo-retinal surgeon diagnoses CMV retinitis by thoroughly examining the back
of the eye using ophthalmoscopy. Fluorescein angiography may be needed to
evaluate the circulatory system of the retina.
Treatment
When managing CMV retinitis, the doctor’s goal is to slow the progression of the
disease and to treat related eye problems. Anti-viral medications such as ganciclovir
or foscarnet are often prescribed. These drugs can be administered orally,
intravenously, injected directly into the eye or through an intravitreal implant.
COLORBLINDNESS
Overview
Color blindness may be a hereditary condition or caused by disease of the optic nerve
or retina. Acquired color vision problems only affect the eye with the disease and
may become progressively worse over time. Patients with a color vision defect
caused by disease usually have trouble discriminating blues and yellows.
Inherited color blindness is most common, affects both eyes, and does not worsen
over time. This type is found in about 8% of males and 0.4% of females. These color
problems are linked to the X chromosome and are almost always passed from a
mother to her son.
Color blindness may be partial (affecting only some colors), or complete (affecting all
colors). Complete color blindness is very rare. Those who are completely color blind
often have other serious eye problems as well.
Photoreceptors called cones allow us to appreciate color. These are concentrated in
the very center of the retina and contain three photosensitive pigments: red, green and
blue. Those with defective color vision have a deficiency or absence in one or more
of these pigments. Those with normal color vision are referred to as trichromats.
People with a deficiency in one of the pigments are called anomalous trichromats (the
most common type of color vision problem.) A dichromat has a complete absence in
one cone pigment.
Signs and Symptoms
The symptoms of color blindness are dependent on several factors, such as whether
the problem is congenital, acquired, partial, or complete.
• Difficulty distinguishing reds and greens (most common)

• Difficulty distinguishing blues and greens (less common)
The symptoms of more serious inherited color vision problems and some types
acquired problems may include:
• Objects appear as various shades of gray (this occurs with complete color
blindness and is very rare)
• Reduced vision
• Nystagmus
Color vision deficiency is most commonly detected with special colored charts called
the Ishihara Test Plates. On each plate is a number composed of colored dots. While
holding the chart under good lighting, the patient is asked to identify the number.
Once the color defect is identified, more detailed color vision tests may be
performed.
Treatment
There is no treatment or cure for color blindness. Those with mild color deficiencies
learn to associate colors with certain objects and are usually able to identify color as
everyone else. However, they are unable to appreciate color in the same way as those
with normal color vision.
RETINITIS PIGMENTOSA
Overview
Retinitis pigmentosa (RP) is a rare, hereditary disease that causes the rod
photoreceptors in the retina to gradually degenerate. The rods are located in the
periphery of the retina and are responsible for peripheral and night vision. Cones,
another type of photoreceptor, are densely concentrated in the macula. The cones are
responsible for central visual acuity and color vision.
The disease may be X-linked (passed from a mother to her son), autosomal recessive
(genes required from both parents) or autosomal dominant (gene required from one
parent) trait. Since it is often a sex-linked disease, retinitis pigmentosa affects males
more than females.
People with RP usually first notice difficulty seeing in dim lighting and gradually lose
peripheral vision. The course of RP varies. For some, the affect on vision may be
mild. Others experience a progression of the disease that leads to blindness.
In many cases, RP is diagnosed during childhood when the symptoms begin to

become apparent. However, depending on the progression of the disease, it may not
be detected until later in life.
Signs and Symptoms
• Difficulty seeing dim lighting

• Tendency to trip easily or bump into objects when in poor lighting
• Gradual loss of peripheral vision
• Glare
• Loss of contrast sensitivity
• Eye fatigue (from straining to see)
Retinitis pigmentosa is usually diagnosed before adulthood. It is often discovered

when the patient complains of difficultly with night vision. The doctor diagnoses RP
by examining the retina with an ophthalmoscope. The classic sign of RP is clumps of
pigment in the peripheral retinal called "bone-spicules." A test called
electroretinography (ERG) may also be ordered to study the eye's response to light
stimuli. The test gives the doctor information about the function of the rods and cones
in the retina.
Treatment
There is currently no standard treatment or therapy for retinitis pigmentosa;

however, scientists have isolated several genes responsible for the disease. Once RP
is discovered, patients and their families are encouraged to seek genetic counseling.
Current Research
Scientists at Johns Hopkins University are developing a micro-computer chip

prosthesis called the Multiple-unit Artificial Retina Chipset (MARC). Once
implanted in the retina, the chip transmits images to the brain that are captured from a
small camera mounted on the patient's glasses. The chip is still in development and is
not yet available for widespread use.
Doctors continue to search for treatments for RP but have yet to find a cure.
CORNEAL ULCER
Overview
A corneal ulcer forms when the surface of the cornea is damaged or compromised.
Ulcers may be sterile (no infecting organisms) or infectious. The term infiltrate is
also commonly used along with ulcer. Infiltrate refers to an immune response
causing an accumulation of cells or fluid in an area of the body where they don't
normally belong.
Whether or not an ulcer is infectious is an important distinction for the physician to

make and determines the course of treatment. Bacterial ulcers tend to be extremely
painful and are typically associated with a break in the epithelium, the superficial
layer of the cornea. In some cases, the inflammatory response involves the anterior
chamber along with the cornea. Certain types of bacteria, such as Pseudomonas, are
extremely aggressive and can cause severe damage and even blindness within 24-48
hours if left untreated.
Sterile infiltrates on the other hand, cause little if any pain. They are often found near
the peripheral edge of the cornea and are not necessarily accompanied by a break in
the epithelial layer of the cornea.
There are many causes of corneal ulcers. Contact lens wearers (especially soft) have
an increased risk of ulcers if they do not adhere to strict regimens for the cleaning,
handling, and disinfection of their lenses and cases. Soft contact lenses are designed
to have very high water content and can easily absorb bacteria and infecting
organisms if not cared for properly. Pseudomonas is a common cause of corneal ulcer
seen in those who wear contacts.
Bacterial ulcers may be associated with diseases that compromise the corneal surface,
creating a window of opportunity for organisms to infect the cornea. Patients with
severely dry eyes, difficulty blinking, or are unable to care for themselves, are also at
risk. Other causes of ulcers include: herpes simplex viral infections, inflammatory
diseases, corneal abrasions or injuries, and other systemic diseases.
Signs and Symptoms

The symptoms associated with corneal ulcers depend on whether they are infectious
or sterile, as well as the aggressiveness of the infecting organism.
• Red eye
• Severe pain (not in all cases)
• Tearing
• Discharge
• White spot on the cornea, that depending on the severity of the ulcer, may not
be visible with the naked eye
Corneal ulcers are diagnosed with a careful examination using a slit lamp
microscope. Special types of eye drops containing dye such as fluorescein may be
instilled to highlight the ulcer, making it easier to detect.
If an infectious organism is suspected, the doctor may order a culture. After numbing
the eye with topical eye drops, cells are gently scraped from the corneal surface and
tested to determine the infecting organism.
Treatment
The course of treatment depends on whether the ulcer is sterile or infectious.

Bacterial ulcers require aggressive treatment. In some cases, antibacterial eye drops
are used every 15 minutes. Steroid medications are avoided in cases of infectious
ulcers. Some patients with severe ulcers may require hospitalization for IV antibiotics
and around-the-clock therapy. Sterile ulcers are typically treated by reducing the eye's
inflammatory response with steroid drops, anti-inflammatory drops, and antibiotics.
STRABISMUS
(CROSSED OR TURNED EYE)
Overview
Strabismus is a problem caused by one or more improperly functioning eye muscles,

resulting in a misalignment of the eyes. Normally, each eye focuses on the same spot
but sends a slightly different message to the brain. The brain superimposes the two
images, giving vision depth and dimension. Here's an easy way to see how the eyes
work together: hold your finger at arm's length. While looking at your finger, close
one eye, then the other. Notice how your finger changes position. Even though the
images are slightly different, the brain interprets them as one.
Each eye has six muscles that work in unison to control movements. The brain
controls the eye muscles, which keep the eyes properly aligned. It is critical that the
muscles function together for the brain to interpret the image from each eye as a
single one.
Strabismus must be detected early in children because they are so adaptable. If a

child sees double, his or her brain quickly learns to suppress or block out one of the
images to maintain single vision. In a very short time, the brain permanently
suppresses vision from the turned eye, causing a weak or amblyopic eye. Children
may also develop a head tilt or turn to compensate for the problem and eliminate the
double image. Unlike children, adults with a newly acquired strabismus problem
typically see double.
There are many causes of strabismus. It can be inherited, or it may be caused by

trauma, certain diseases, and sometimes eye surgery.
Signs and Symptoms
Adults are much more likely to be bothered by symptoms from strabismus than young
children. It is unusual for a child to complain of double vision. Children should
undergo vision screening exams to detect problems early. The younger the child is
when strabismus is detected and treated, the better the chance of normal vision. The
following are common signs and symptoms:
• Turned or crossed eye

• Head tilt or turn
• Squinting
• Double vision (in some cases)
Strabismus is detected with a comprehensive eye exam and special tests used to
evaluate the alignment of the eyes such as: the Krimsky test and prism testing.
Treatment
The appropriate treatment for strabismus is dependent on several factors including the
patient's age, the cause of the problem, and the type and degree of the eye turn.
Treatment may include patching, corrective glasses, prisms, or surgery.
With patching, the better eye is covered, forcing the child to use the weaker eye. Over
time, the brain adjusts to using the weaker eye and vision gradually improves. For
this treatment to be effective, it must be done at a young age before the child can
develop amblyopia.
Surgery is sometimes performed for both adults and children to straighten a crossed
eye. The procedure may be done with local or general anesthesia. There are several
different surgical techniques used to correct strabismus. The appropriate one is
dependent on the muscle involved and the
degree of the eye turn.
CHALAZION
Overview
A chalazion (stye) is a small lump in the eyelid caused by obstruction of

an oil producing or meibomian gland. Chalazia may occur in the upper
or lower lids, causing redness, swelling and soreness in some cases.
Signs and Symptoms
• Raised, swollen bump on the upper or lower eye lid

• Often red
• May be tender and sore
Diagnosis
Patients often request an examination after an episode of pain and swelling of the lid.
The doctor can make the diagnosis during a simple examination of the eyelids.
Treatment
In the early stages, chalazia may be treated at home with the repeated use of warm
compresses for 15 - 20 minutes followed by several minutes of light lid massage.
This helps to reduce the swelling and makes the lid more comfortable. However, if the
chalazion does not diminish or recurs, medical attention may be necessary. This may
include draining the chalazion along with the use of antibiotic and anti-inflammatory
medications.
AMBYLOPIA
Overview
Amblyopia is a term used to describe an uncorrectable loss of vision in an eye that

appears to be normal. It’s commonly referred to as “lazy eye” and can occur for a
variety of reasons.
A child’s visual system is fully developed between approximately the ages of 9-11.
Until then, children readily adapt to visual problems by suppressing or blocking out
the image. If caught early, the problem can often be corrected and the vision
preserved. However, after about age 11, it is difficult if not impossible to train the
brain to use the eye normally.
Some causes of amblyopia include: strabismus (crossed or turned eye), congenital
cataracts, cloudy cornea, droopy eyelid, unequal vision and uncorrected
nearsightedness, farsightedness or astigmatism. Amblyopia may occur in various
degrees depending on the severity of the underlying problem. Some patients just
experience a partial loss; others are only able to recognize motion.
Patients with amblyopia lack binocular vision, or stereopsis – the ability to blend the
images of both eyes together. Stereopsis is what allows us to appreciate depth.
Without it, the ability to judge distance is impaired.
Signs and Symptoms

• Poor vision in one or both eyes
• Squinting or closing one eye while reading or watching television
• Crossed or turned eye
• Turning or tilting the head when looking at an object
Note: Children rarely complain of poor vision. They are able to adapt very easily to
most visual impairments. Parents must be very observant of young children and
should have a routine eye exam performed by the age of 2-3 to detect potential
problems.
When amblyopia is suspected, the doctor will evaluate the following: vision, eye
alignment, eye movements, and fusion (the brain’s ability to blend two images into a
single image).
Treatment
The treatment for amblyopia depends on the underlying problem. In some cases, the
strong eye is temporarily patched so the child is forced to use the weaker eye. For
children with problems relating to a refractive error, glasses may be necessary to
correct vision. Problems that impair vision such as cataracts or droopy eyelids often
require surgery. Regardless of the treatment required, it is of utmost importance that
intervention is implemented as early as possible before the child’s brain learns to
permanently suppress or ignore the eye.
ASTIGMATISM
Overview
Astigmatism means that the cornea is oval like a football instead of spherical like a
basketball. Most astigmatic corneas have two curves – a steeper curve and a flatter
curve. This causes light to focus on more than one point in the eye, resulting in
blurred vision at distance or near. Astigmatism often occurs along with
nearsightedness or farsightedness.
Signs and Symptoms
Blurred vision (near and distance)
Astigmatism can be detected and measured with corneal topography, keratometry,

vision testing and refraction.
Treatment
Astigmatism can be corrected with glasses, contacts, or surgically. The most common
surgeries used to correct astigmatism are astigmatic keratotomy (procedures that
involve placing a microscopic incision on the eye) and LASIK. The objective of
these procedures is to reshape the cornea so it becomes more spherical or uniformly
curved.
COMPUTER VISION SYNDROME
Overview
Computer vision syndrome (CVS) is a term that describes eye-related problems and
the other symptoms caused by prolonged computer use. As our dependence on
computers continues to grow, an increasing number of people are seeking medical
attention for eye strain and irritation, along with back, neck,
shoulder, and wrist soreness.
These problems are more noticeable with computer tasks than

other near work because letters on the screen are formed by
tiny dots called pixels, rather than a solid image. This causes
the eye to work a bit harder to keep the images in focus.
Magnified view of a
printed letter
There is no scientific evidence that computer screens are
harmful to the eyes. A common myth is that too eye strain
caused by reading and close work is damaging to the eyes.
This is not true; however, those who work at computers often
experience many frustrating symptoms.
Magnified view of a
letter on a computer
screen
DACROCYSTITIS
Overview
Dacryocystitis is an infection of the tear sac that lies between the inner corner of the
eyelids and the nose. It usually results from blockage of the duct that carries tears
from the tear sac to the nose. The blocked duct harbors bacteria and becomes infected.
Dacryocystitis may be acute (sudden onset) or chronic (frequently recurs). It may be
related to a malformation of the tear duct, injury, eye infection, or trauma.
This problem is most common in infants because their tear ducts are often
underdeveloped and clog easily. Babies often have recurrent episodes of infection;
however, in most cases, the problem resolves as the child grows. In adults, the
infection may originate from an injury or inflammation of the nasal passages. In many
cases, however, the cause is unknown.
Signs and Symptoms
• Generally affects one eye

• Excessive tearing
• Tenderness, redness, and swelling
• Discharge
• Red, inflamed bump on the inner corner of the lower lid
During the exam, the doctor will determine the extent of the blockage. Cultures may
be taken of the discharge to identify the type of infection. The doctor will also
determine whether the infection has affected the eye.
Treatment
The treatment for dacryocystitis is dependent on the person's age, whether the
problem is chronic or acute, and the cause of the infection.
Infants are usually treated first by gently massaging the area between the eye and nose
to help open the obstruction along with antibiotic drops or ointments for the infection.
Surgery may be necessary to clear the obstruction if medical treatment is not effective
and the problem persists over several months.
Before surgery, the doctor may treat the child with antibiotics to make sure the
infection is cleared. The operation is performed under general anesthesia. The tear
duct is gently probed to open the passage.
For adults, the doctor may clear the obstruction by irrigating the tear duct with saline.
Surgery is sometimes necessary for adults if irrigation, or antibiotics fail to resolve the
infection or if the infection becomes chronic. In these cases, dacryocystorhinostomy
(DCR) is performed under general anesthesia to create a new passage for the tear
flow.
FARSIGHTEDNESS (Hyperopia)
Overview
Farsightedness or hyperopia, occurs when light entering the eye focuses behind the
retina, instead of directly on it. This is caused by a cornea that is flatter, or an eye that
is shorter, than a normal eye. Farsighted people usually have trouble seeing up close,
but may also have difficulty seeing far away as well.
Young people with mild to moderate hyperopia are often able to see clearly because
their natural lens can adjust, or accommodate to increase the eye’s focusing ability.
However, as the eye gradually loses the ability to accommodate (beginning at about
40 years of age), blurred vision from hyperopia often becomes more apparent.
Signs and Symptoms
• Difficulty seeing up close

• Blurred distance vision (occurs with higher amounts of hyperopia)
• Eye fatigue when reading
• Eye strain (headaches, pulling sensation, burning)
• Crossed eyes in children

Hyperopia is detected with a vision test called a refraction. Young patients’ eyes are
dilated for this test so they are unable to mask their farsightedness with
accommodation. This is called a wet refraction.
Treatment
The treatment for hyperopia depends on several factors such as the patient’s age,
activities, and occupation. Young patients may or may not require glasses or contact
lenses, depending on their ability to compensate for their farsightedness with
accommodation. Glasses or contact lenses are required for older patients.
Refractive surgery is an option for adults who wish to see clearly without glasses.
LASIK, Clear Lens Extraction And Replacement, LTK and intraocular contact lenses
are all procedures that can be performed to correct hyperopia.
PTOSIS
Overview
Ptosis (pronounced toe' sis), or drooping of the upper eyelid, may occur for several
reasons such as: disease, injury, birth defect, previous eye surgery and age. In most
cases, it is caused by either a weakness of the levator muscle (muscle that raises the
lid), or a problem with the nerve that sends messages to the muscle.
Children born with ptosis may require surgical correction of the lid if it covers the
pupil. In some cases, it may be associated with a crossed or misaligned eye
(strabismus). Left untreated, ptosis may prevent vision from developing properly,
resulting in amblyopia, or lazy eye.
Patients with ptosis often have difficult blinking, which may lead to irritation,
infection and eyestrain. If a sudden and obvious lid droop is developed, an
ophthalmologist should be consulted immediately.
Signs and Symptoms
The causes of ptosis are quite diverse. The symptoms are dependent on the
underlying problem and may include:
• Drooping lid (may affect one or both eyes)

• Irritation
• Difficulty closing the eye completely
• Eye fatigue from straining to keep eye(s) open
• Children may tilt head backward in order to lift the lid
• Crossed or misaligned eye
• Double vision
When examining a patient with a droopy lid, one of the first concerns is to determine
the underlying cause. The doctor will measure the height of the eyelid, strength of the
eyelid muscles, and evaluate eye movements and alignment. Children may require
additional vision testing for amblyopia.
Treatment
Ptosis does not usually improve with time, and nearly always requires corrective
surgery by an ophthalmologist specializing in plastic and reconstructive surgery. In
most cases, surgery is performed to strengthen or tighten the levator muscle and lift
the eyelid. If the levator muscle is especially weak, the lid and eyebrow may be
lifted. Ptosis can usually be performed with local anesthesia except with young
children.
RETINAL VEIN OCCLUSION
Overview
Retinal vein occlusion occurs when the circulation of a retinal vein becomes
obstructed by an adjacent blood vessel, causing hemorrhages in the retina. Swelling
and ischemia (lack of oxygen) of the retina as well as glaucoma are fairly common
complications.
The visual symptoms can vary in severity from one person to the next, and are
dependent on whether the central retinal vein or a branch retinal vein is involved.
Patients who experience a branch vein occlusion often notice a gradual improvement
in their vision as the hemorrhage resolves. Recovery from a central vein occlusion is
much less likely since it affects the macula.
This problem appears equally in males and females and is more common after the age
of 60.
Symptoms
• Sudden onset
• Blurred or missing area of vision (if a branch vein is involved)
• Severe loss of central vision (if a central vein is involved)
Vein occlusion is diagnosed by examining the retina with an ophthalmoscope.

Fluorescein angiography may be performed in some cases to study the circulation of
the retina and to determine the extent of macular edema or swelling.
Treatment
Following a vein occlusion, the primary concern is to treat the secondary

complications. If areas of the retina are oxygen-deprived, LASER may be used to
prevent growth of delicate vessels that could break, bleed or cause glaucoma.
The following are common risk factors for vein occlusion:
Diabetes
Hypertension
Cardiovascular disease
RESEARCHES / RELATED ISSUES

Januray 2005
Do Mobile Phones Cause Eye Cancer?
Eye Surgeons Question the Connection
Scientists have long questioned the possible link between certain types of brain
cancer and cell phone use. The concern surrounding mobile phones lies in the
fact that they emit low levels of radiofrequency energy - the same type that
radiates from microwaves. However, despite extensive ongoing research, the
Food and Drug Administration has yet to find scientific evidence supporting a link
between the two.
Cell Phones and Eye Cancer...
A recent study published in the journal Epidemiology, suggested a connection

between a type of eye cancer called uveal melanoma and cellular phone use.
Uveal melanoma affects the eye's uveal tract: the iris, ciliary body and choroid.
The study, conducted in Germany, compared the cell phone usage patterns of 118
people known to have the eye cancer and 475 people with healthy eyes. The
investigators did not know if they were examining a healthy person, or one with
eye cancer.
After questioning each group regarding their mobile phone use and habits, they
concluded that those with eye cancer had used the phones at higher rates than
those without cancer. Even though the study was published, the head researcher
admitted that further investigation is needed before concluding that the phones
caused the cancer.
St. Luke's vitreo-retinal surgeon Dan Montzka, MD, agrees that more evidence is
needed. "I think it's quite a leap to make a correlation between uveal melanoma
and cell phone use based on this study alone. I think the FDA's case control
studies will give us much more definitive information."
The FDA agrees that there has been precious little evidence that clearly supports
the hypothesis. Research done on rats and mice is very difficult to correlate to
humans, and studies comparing the healthy to those with cancer have yet to turn
up any conclusive evidence.
Until the ongoing research is complete, the FDA offers a few suggestions for
concerned individuals:
• Mobile phone with an antenna located outside the car

• Hand-held phone with a built-in antenna connected to an external antenna
mounted outside the car
• Headset with a remote antenna (the phone is carried at the waist)
Sources: The Sunday Times, Jan. 14, 2001; www.fda.gov
High Levels Of Amino Acid May Be Biomarker For

Increased Risk Of Age-Related Macular Degeneration
People who have elevated homocysteine in their blood, an amino acid which is a known
biomarker for cardiovascular disease, may also be at an increased risk of developing age-
related macular degeneration (AMD), according to a study in the January issue of the
American Journal of Ophthalmology.
Researchers measured the fasting plasma homocysteine levels of 934 individuals who were
participating in an ancillary study of the Age-Related Eye Disease Study. Five hundred and
forty seven people with AMD and 387 control subjects were tested at the Massachusetts Eye
and Ear Infirmary (Boston, Massachusetts.) and Devers Eye Institute (Portland, Oregon).
“We found that elevated homocysteine in the blood may be another biomarker for increased
risk of AMD,” said lead author Johanna M. Seddon, M.D., director of Epidemiology at the
Massachusetts Eye and Ear Infirmary who is also an associate professor of ophthalmology at
Harvard Medical School and at the Harvard School of Public Health. “Homocysteine can be
reduced by dietary intake of vitamins B6, B12 and folate, so the relationship between this
amino acid and AMD deserves further study.”
Dr. Seddon's finding adds to the growing body of evidence that there may be overlapping
disease mechanisms between AMD and cardiovascular diseases.
Dr. Seddon and her colleagues first proposed this potential relationship between
homocysteine and AMD in the mid-1990s and published this hypothesis in a review article in
1999. She and her team previously established that smoking and nutrition are modifiable
factors associated with the development and progression of AMD. They are now also
searching for the genes involved in the etiology of this increasing cause of blindness.
Adapted from the following source: Massachusetts Eye and Ear Infirmary
Dr. Seddon is an Ad Hoc member of the Scientific Review Committee for Macular
Degeneration Research, a program of the American Health Assistance Foundation. We are
proud to have previously funded Dr. Seddon’s research concerning biological markers of
inflammation and their correlation with the progression of age-related macular degeneration.
Sutureless Technique Simplifies Retinal Surgery
Retina surgery patients enjoy the benefits of no-stitch incisions
Since the early 1990's, cataract surgeons have operated through incisions that
didn't need to be sutured after the procedure. Soon after it was introduced, the
technique caught on, and practically revolutionized cataract surgery. "No-stitch
incisions opened the door for surgical innovations, new instrumentation and
breakthroughs in anesthesia," explains Dr. Rowsey. "Plus, the patients benefited
by getting a safer procedure and faster recovery."
Prompted by an interest in reducing patients' recovery time, doctors at St. Luke's

integrated self-sealing incisions with vitrectomy - a procedure that is often
performed along with other vitreo-retinal surgeries. The tiny 2 millimeter
incisions used for the procedure, known as sclerotomies, are made on the scleral
tissue. Most vitreo-retinal surgeries require 3 sclerotomies: one for the line that
keeps the eye inflated with fluid, a second for the light source, and a third for the
surgical instrument. Because of the way the incision is constructed, it seals
naturally from the eye's internal pressure.
After introducing the self-sealing sclerotomies in 1996 at the Vitreous Society

Meeting in New Orleans, other vitreo-retinal surgeons adopted the technique.
Today, doctors at St. Luke's have performed self-sealing sclerotomies for more
than 2,000 vitrectomy surgeries with no serious complications. "Our goal is take
a minimalist approach to surgery. That translates to less time in the operating
room, and it reduces the recovery, swelling and discomfort,".
The St. Luke's retinal team has also discovered that when applied to scleral
buckling surgery, a procedure used to repair retinal detachment, patients enjoy
similar benefits. "We used to suture a band on the eye to push the retina into
place. Now, we thread the band like a belt through tiny stitchless scleral tunnels
that resemble belt loops," explains Dr. Montzka.
Aside from the benefits to the patient, this technique often makes surgery easier
to perform. "There are times that I need to work in very awkward positions,"
says Dr. Montzka. "Sutureless incisions give me more flexibility because I can
easily swap the position of the instruments from one sclerotomy to the other with
no problem."
"It's always exciting to refine techniques that lead to better care for the patient
and to share these with other surgeons looking for better ways to do things,".
The St. Luke's doctors plan to teach the technique to other surgeons at
ophthalmic symposiums later this year.
Cataract Formation Linked to Smoking
Study concludes that giving up cigarettes can reduce the risk of cataracts
In a study of nearly 21,000 U.S. male physicians, spanning an average of 13.6

years, researchers found a direct link between smoking and the development of
cataracts. The study, known as Physicians Health Study I, evaluated physicians
between the ages of 40 and 84 who had no prior history of cataracts before
1982.
Participants were asked to complete questionnaires that included information

such as: number of cigarettes smoked daily, age when they started smoking, and
their age if they stopped smoking. Each participant received annual eye exams
and were required to report the results to the study investigators. The
participants' ophthalmologists and optometrists confirmed the results.
Adjustments were made to account for other cataract risk factors.
Decreased incidence of cataract among past smokers
Past smokers were grouped by the number of years they had stopped
smoking. The participants who were past smokers were found to have a 23%
less risk of cataracts when compared with current smokers; however, they
still had a greater risk of developing cataracts than those who had never
smoked. Also of interest is that the past smokers were found to be in better
health than smokers and lead more healthy lifestyles.
Smoking has also been linked to eye diseases such as age-related macular
degeneration. St. Luke's surgeon J. James Rowsey, MD hopes that research such
as the Physicians Health Study will make smokers think twice before lighting up.
"We learn more every day about the harmful affects smoking has on the
body, but not many people realize the connection between smoking and
their vision. Young people who quit while they're ahead are very lucky because
much of the damage is reversible. Long-time smokers on the other hand, aren't
always as fortunate."
What's in a Name?
Find out what the initials after your eye care professional's name mean
Ever wonder about the qualifications of the people who examine your eyes?
Confused by all those O's -- optician, optometrist, ophthalmologist, ocularist,
orthoptist? Find out what these titles mean and more.
Ophthalmologist (MD or DO): An ophthalmologist is a medical doctor whose

training includes: bachelor degree, 4 years of medical school, a 1-year
internship, and a 3-4 year residency program. Many doctors continue their
education with a 1-2 year fellowship that concentrates on a particular
subspecialty such as glaucoma or retinal disease. Ophthalmologists are trained to
diagnose and treat eye diseases and conditions with medications and surgery.
Optometrist (OD): An optometrist has acquired a bachelor's degree, and

completed 4 years of additional education at an accredited school of optometry.
Optometrists specialize in prescribing and fitting glasses and contact lenses as
well as the detection and diagnosis of eye diseases. Optometrists often work with
ophthalmologists to manage diseases and to care for patients following eye
surgery.
Ocularist: An ocularist is specially trained to fit prosthetic (artificial) eyes after

surgery or to cover disfigurements. Ocularists must complete a 5 year apprentice
program and pass a board examination for certification.
Orthoptist (CO): Orthoptists specialize in evaluating the visual system and

muscle function, especially with infants, children, and young people. They work
along with optometrists and ophthalmologists to provide non-surgical treatments
to correct muscle imbalances and associated eye problems. An orthoptist must
complete 2 years of specialized training as well as a board examination.
Optician (ABOC - American Board of Opticianry Certified and NCLC -

Certified National Contact Lens Examiner): An optician is specially trained to
make and fit eyeglasses. Opticians require 2 years of training prior to sitting for a
board examination. Some opticians also become certified in contact lens fitting.
Allied health personnel (COA, COT, COMT): Ophthalmic medical personnel

assist the physician in the diagnosis of conditions, treatment of disease and
injury, and care of patients. The Joint Commission on Allied Health Personnel
grants certification at three difference levels after passing a board examination
and skill test: certified ophthalmic assistant (COA), certified ophthalmic
technician (COT), and certified ophthalmic medical technologist (COMT). Each
level of certification requires additional education, skill and experience over the
previous level.
Certified Ophthalmic Retinal Photographer (CRA): Certified ophthalmic

photographers specialize in photography of the eye used for diagnosis and
documentation. Individuals may become certified by sitting for a board
examination and passing a skill evaluation.
Ophthalmic Registered Nurse (ORN): An ophthalmic registered nurse has

received special training and certification ophthalmology in addition to his or her
nursing education of 2-4 years.

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THE EYE

The average newborn’s eyeball is about 18 millimeters in diameter, from front

Buzzwords for eye anatomy

cornea: Transparent, colorless anterior one sixth of the covering of the

choroid: This is the vascular layer of the eye.

The Physical Structures of the Eye

CARE OF THE CLIENTS WITH EYE DISORDERS

 Vision Protection and General Eye Care

 Common Ocular Medications

- Beta – Blockers – reduce aqueous humor production

 iritis or anterior uveitis,

CONJUNCTIVITIS (Pink Eye)

Signs and Symptoms

Conjunctivitis requires medical attention. The appropriate treatment depends on the

To avoid spreading infection, take these simple steps:

Age-related macular degeneration (ARMD) is a degenerative condition of the

Macular degeneration varies widely in severity. In the worst cases, it causes a

What is the difference between wet and dry macular degeneration?

Patient with wet macular degeneration develop new blood vessels

Illustration by Mark Erickson

What causes macular degeneration?

Signs and Symptoms

Detection and Diagnosis

Recently, photodynamic therapy has proven to be effective in stopping abnormal

Early diagnosis is critical for successful treatment of wet macular degeneration.

Nutrition and macular degeneration

Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either

What causes glaucoma?

Acute Angle Closure

Signs and Symptoms

Glaucoma is an insidious disease because it rarely causes symptoms. Detection and

Angle Closure (emergency)

• Sudden decrease of vision

Detection and Diagnosis

The glaucoma evaluation has several components. In addition to measuring the

Eye without a cataract Eye with a cataract

Detection and Diagnosis

A treatment option (BioTears)

Watch the Dry Eye Syndrome video

More about Dry Eye Syndrome

Nutrition and Dry Eye Syndrome

BLEPHARITIS (Granulated Eyelids)

Blepharitis is a common inflammatory condition that affects the eyelids. It usually

Signs and Symptoms

• Sandy, itchy eyes

Detection and Diagnosis

HERPES SIMPLEX EYE DISEASE

Nearly everyone is exposed to the virus during childhood. Herpes simplex is

Signs and Symptoms

Detection and Diagnosis

Treatment of herpes simplex keratitis depends on the severity. An initial outbreak is

Diabetes is a disease that occurs when the

How does diabetes affect the retina?

Patients with diabetes are more likely to develop

Signs and Symptoms

• Blurred vision (this is often linked to blood sugar levels

Detection and Diagnosis

The diagnosis of diabetic retinopathy is made following a detailed examination of the