Tag Archives: Eyes

Eye Health: Why Corneal Transplants Are Rising

At one time, replacement parts for the eyes must have seemed unimaginable. Nowadays, if the inner lens of the eye becomes clouded by a cataract, a routine surgery to swap it out with a new artificial lens restores vision.

But what happens if the outer lens of the eye (the cornea) becomes damaged or diseased? You can have that replaced, too. “It’s not as common as cataract surgery, but many people get corneal diseases after age 50 and may need a corneal transplant,” says Dr. Nandini Venkateswaran, a corneal and cataract surgeon at Harvard-affiliated Massachusetts Eye and Ear.

More than 49,000 corneal transplants occurred in 2021 in the US, according to the Eye Bank Association of America.

What is the cornea?

The cornea is a dome of clear tissue at the front of each eye, covering the iris and pupil, that acts as a windshield that protects the delicate eye apparatus behind it, and focuses light onto the retina, which sends signals that the brain turns into images (your vision).

You need this combo of windshield and camera lens to focus and see clearly. But many things can go wrong within the five layers of tissue that make up the cornea. That can make it hard to see and rob you of the ability to read, drive, work, and get through other activities in your day.

How does damage to the cornea occur?

It may stem from a number of causes:

  • Injuries, such as a fall. “Falls are a big reason for people to come in with acute eye trauma. The cornea can be damaged easily if something pokes it,” Dr. Venkateswaran says.
  • Previous eye surgeries. “Especially for adults who’ve had several eye surgeries — such as cataract and glaucoma surgeries — the inner layers of the cornea can become damaged and weakened with age,” she adds.
  • Illness. Problems like severe corneal infections, or genetic conditions such as Fuchs’ endothelial dystrophy, can cause vision loss.

What are the options for treating corneal damage?

Cornea treatment depends on the type of problem you have and the extent of the damage. “It’s a stepwise approach. Sometimes wearing a specialty contact lens or using medications can decrease swelling or scarring in the cornea,” Dr. Venkateswaran says.

Technology: How AI Is Helping To Cure Blindness

Eye Health: Cataracts

Cataracts involve the lens of the eye which is located just back of the cornea.

The lens is composed of evenly aligned collagen fibers which are progressively damaged  by ultraviolet light as we age. Cataracts cause clouding of the lens and reduce visual acuity, as well as causing a stiffening and rigidity of the lens which keeps it from changing shape for close-up activities like reading.

If you live long enough, cataracts are almost inevitable and the main decision is when to get them corrected. With intraocular lenses, the operation has few downsides.

The halo around oncoming headlights disturbed my night driving, and was a major reason for me to get my cataracts removed.

I used to require glasses all the time, and took them off to read. Now I wear no glasses, and even reading is possible without glasses, since one of my eyes has a  -1.5 diopter cylindrical  astigmatism.  You can ask for one Intraocular lens to be slightly nearsighted, if you wish to avoid needing reading glasses.

I prefer to use my corrective glasses to read, however.

—Dr. C.

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Eye Infections: What Is Herpetic Keratitis?

Herpetic Keratitis is a viral infection of the transparent, frontmost part of the eye, the  cornea.

Herpes 1 or 2  when rubbed into the eye from a cold sore, or contacted from somebody else with herpes, will often affect the cornea. The use of corticosteroid eyedrops or ointment will allow the disease to spread faster.

The symptoms are pain and redness of the eye and are a medical emergency, needing prompt treatment by your doctor to prevent scarring and blindness.

Antiviral eyedrops, such as valacyclovir, are used to treat ophthalmic herpes.

A related condition is ophthalmic zoster, caused by the varicella zoster virus. The VZ virus will produce chickenpox in unimmunized people, go into dormancy in the nervous system, and then resurface, if immunity wanes, as shingles. If the shingles occurs in the ophthalmic division of the trigeminal nerve, affecting the skin near the eye, the cornea  will often be involved. Ophthalmic zoster is also treated by antiviral eyedrops.

The varicella zoster virus is closely related to the herpes simplex virus, and is a member of the same nasty family of viruses.

—Dr. C.

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Eye ‘Floaters’: Posterior Vitreous Detachment

This eye condition usually won’t threaten your vision or require treatment. But it can sometimes signal a more serious, sight-threatening problem. So it’s best to be checked by an ophthalmologist (a specialist who treats eyes) right away.

How can you tell that your vitreous may have detached? By a sudden increase in floaters — those small, typically harmless shapes that drift across your field of vision as you move your eyes.

“Vitreous detachments are pretty common,” says professor of ophthalmology at Cleveland Clinic Lerner College of Medicine Rishi P. Singh, MD. “When you see these new floaters, it’s best to have them evaluated and, specifically, to have a dilated eye examination performed by an ophthalmologist.”

DR. C’S JOURNAL: AMBLYOPIA

Amblyopia is an example of how the body suppresses or gets rid of activity that is not used. Amblyopia “ex anopsia” is the leading cause of poor vision in children, and the most common reason is a “lazy eye”. If the eyes do not work together for binocular vision, the weaker of the two eyes has suppressed development and eventually eyesight is lost.

I have a friend who was going in the pilot training, it was found to lack good depth perception, and could not proceed. He now complains occasionally of double vision, and may be an example of the suppressed eye with lack of binocular vision.

I have a muscle in balance which causes a rotation of my eye so that it’s hard to fuse on a horizontal linear object. I was probably able to fuse  when I was younger and avoid this loss of vision in the weaker eye.

So be on the alert for a squint, or wandering eye in children. Get them in early for treatment, the earlier the better, and it must take place before age 5 to 7.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #37: EYE IRRITATION

‘Something is in my eye” is a feeling that everyone has had, and it doesn’t take much to create that sensation. A speck of dust, a grain of sand, a gnat or an ill-behaved eyelash will do it. Most of the time your eye will tear up and the offender is washed away.

As I get older, this sensation is more frequent. I look at my eyes in the mirror, and there is no one-sided redness, displaced lash or anything else I can see. When I saw the doctor for my cataract surgery a couple of years ago, he took a sample of my tears, and found a deficit in the fatty component. He recommended twice daily, five minute warming of my eyes, but I stopped doing it after a while.

I have so many picky little things I do that this extra time didn’t see worth it. I know that my eyes are dry, which is common in older people, and often use “Refresh-plus” individual, preservative-free ampoules, which seems definitely worth the trouble. It makes my eyes feel better, alleviates the gritty sensation, and even clarifies my vision. I have also resumed warming my eyes with a clean washcloth, moistened with hot water, when I take my shower.

I fancy that I am stimulating my meibomian glands like the eye surgeon intended, to increase the lipid content of my tears. I’ll keep you posted. There are a number of other disorders which can cause the eye symptom, as the accompanying article indicates. Be sure that if the discomfort is more than trivial, or the affected eye is red, or if vision is affected, that you consult your eye doctor, or at least your primary care Physician.

Dr. C.

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MEDICAL VIEWS: ‘MACULAR DEGENERATION RESEARCH’

Macular degeneration is a leading cause of visual impairment in people over 65 and can lead to blindness. One in three people will eventually suffer some degree of macular degeneration, which is caused by abnormal blood vessels under the retina, the light-sensitive part of the eye. We treat both the more common “dry” as well as the more dangerous “wet” forms of macular degeneration. While there is currently no cure for this disease, we offer the latest treatments to reduce the risk of vision loss and blindness. These include anti-VEGF drugs—which attack proteins that create the abnormal blood vessels that cause macular degeneration—and photodynamic therapy, in which patients ingest medication that is then activated with a laser.

To learn more about macular disease at Yale, visit: https://www.yalemedicine.org/departme…​.

COMMENTARY:

This high quality video shows several aspects of macular degeneration. It discusses treatments with stem cells that are in the research phase; in the future there may be replacements for the abnormal support cells, the vascular cells and pigmented epithelium, that are diseased in macular degeneration.

Current treatment centers on control of abnormal blood vessels either by photo active laser, laser coagulation, or anti-VEGF.
Macular degeneration has two forms, wet and dry. The wet macular degeneration has accumulations, or Drusen, under the epithelium. There are also machines to check the thickness of the macula, which is an aid in diagnosis.

The main symptom of macular degeneration or loss of vision especially in The center of the visual field, which is essential for reading.
As I mentioned in my podcast, I made a posting on macular degeneration that includes an amsler grid. Some early symptoms of macular degeneration include waviness of the lines of this grid. Certainly if you have any visual distortion or loss you should see an ophthalmologist.

If your medical plan permits it, I feel but a regular check buy an ophthalmologist approximately every 6 to 12 months, is very useful. My own ophthalmologist checks my  retinal thickness, optic nerve, pressure and peripheral Field ( to pick up glaucoma) as well as my vision on each visit.

Dr. C.