General Eye Exam
Did you break your glasses? Have you noticed some gradual changes in your vision? Do you have a lot of glare when driving at night? Maybe you recently have been diagnosed with certain medical conditions. One of the best ways to know the health of our eyes is to have a regular exam by your eye doctor. At Collom & Carney Eye Institute we perform ocular exams for glasses, contacts or refractive surgery, as well as comprehensive exams for the treatment of cataracts, diabetes, glaucoma or other ocular diseases
Certain components of your eye exam will be performed by our trained ophthalmic staff before you see the doctor. Dilation – It may be necessary to dilate your eyes during your exam. Dilation will make you sensitive to light and you will not be able to see well up close. We provide disposable dark shades. Driving with dilated eyes may be compromised, so we recommend that you have someone to accompany you to drive.
- Medical History – Assessment of your general health and visual complaints
- Visual Acuity Testing - Measures a person’s ability to see fine detail with central vision.
- External Examination – Inspection of the eyelids, lacrimal system, and areas around the eyes
- Ocular Motility Exam – Detects eyes that are misaligned or not working properly together
- Confrontational Visual Field Examination – Testing of side vision
- Slit lamp examination – Examination of the cornea, lens and anterior chamber of the eye using a microscope.
- Tonometry – Determines pressure within the eye
- Ophthalmoscopy- Examination of the retina
- Refraction – Determines your best corrected visual acuity and is an essential part of the eye examination
Other tests can vary depending on the patient’s age, date of last exam and other factors. Not every part of the exam may be needed or performed during your visit. Dr. Northam and the Staff at Collom & Carney know that your sense of sight is precious. We are here to provide you the best options to achieve quality vision. Here is an overview of a few of the more common eye diseases and treatments.
The natural lenses of the eyes are naturally very clear but may become clouded due to time or other factors. This clouding is what doctors call a cataract and cannot be “cleaned” off in any way, so the entire lens must be replaced through surgery. Cataract surgery is quite common and has been perfected over many years since its inception.
The procedure itself consists of the removal of the clouded lens through a small slit in the cornea made by the surgeon. This can be accomplished through one of two ways. The first is through emulsifying the cataract through ultrasonic waves and suctioning the remaining material out. If the lens is so cloudy that it cannot be broken up, the surgeon will remove the stubborn lens nucleus in one piece through the slit before vacuuming the rest of the soft lens out.
In both cases, a new artificial intraocular lens (IOL) is placed in the vacated capsule. These new lenses are generally perfect replacements for the old, allowing the patient to achieve improved vision. In most cases, sutures are not needed, as the surgical wound will heal quickly on its own. The latest technology in cataract surgery is the invent of several refractive IOL’s (ReSTOR & Toric). These IOL’s give patients the option of not only having their cataracts removed, but also having the option of seeing without the aid of glasses or contact lenses after surgery.
Common issues incurred after surgery include mild discomfort, itchiness and crusting discharge. These annoyances should disappear within a few days. It is highly recommended that you refrain from rubbing your eyes for several weeks. The doctor will prescribe eye drops to facilitate healing which should be complete within two months. The doctor should be contacted immediately if you experience a sudden loss of vision, nausea, swollen eyes, light flashes, floaters or severe pain.
Diabetic retinopathy and diabetic eye disease are unfortunate effects of diabetes for many Texarkana patients. Over time, diabetes can damage blood vessels in the retina, which is the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.
Diabetic retinopathy (DR) is a process where the retina is damaged due to complications of diabetes, which can eventually lead to blindness. Approximately 80% of all patients that have diabetes for more than 10 years will get retinopathy. Blood glucose control plays a very important role in this process.
What are the symptoms?
Diabetic retinopathy has no early warnings signs. Sometimes, in macula edema, patients may get blurred vision. In most cases, blood glucose fluctuation will cause vision fluctuation.
What are the risk factors?
Of course, all patients with DM (Type I and II) are at risk for DR. The longer a person has DM, the higher the risk for DR.
Also pregnancy can pose an additional risk to women who already have DM.
Nonproliferative Diabetic Retinopathy
Nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema or macular ischemia, or both.
Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Laser treatment can be used to help control vision loss from macular edema. Newer treatments are being investigated such as injection of medication into the vitreous cavity.
Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy (PDR) is a more serious complication of diabetes caused by changes in the blood vessels of the eye. In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels. Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood.
Occasionally, these new blood vessels bleed and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.
The new blood vessels can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss.
What are the treatments?
There are 3 main treatments for Diabetic Retinopathy. They are very successful to prevent further vision loss. However, they don’t cure retinopathy.
- Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months, or even years.
- If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During a vitrectomy, the doctor removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth.
- Injection of steroid into the vitreous cavity can prevent further macula swelling. The medication can last up to 3-4 months and reinjection sometimes is necessary.
How do you prevent DR?
A medical eye examination is the only way to discover any changes inside your eye. If your ophthalmologist finds diabetic retinopathy, he or she may order color photographs of the retina, a special test called fluorescein angiography, or optical coherence tomography (OCT) to find out if you need treatment.
If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose and visiting your ophthalmologist regularly. People with diabetes should schedule examinations at least once a year. Pregnant women with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy.
There is considerable evidence to suggest that rigorous control of blood sugar decreases the chance of developing serious proliferative diabetic retinopathy.
Glaucoma is a sight stealing eye disease affecting more and more of our population in Texarkana as we age. Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause subtle loss of peripheral vision and blind spots. If not treated, it can lead to progressive loss of central vision and blindness. It’s irreversible but preventable. Glaucoma is usually, but not always, associated with elevated intraocular eye pressure. The high pressure presses on the optic nerve and damages it.
What Causes Glaucoma?
Glaucoma has to do with the pressure inside the eye, known as intraocular pressure (IOP). When the aqueous humor (a clear liquid that normally flows in and out of the eye) cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the delicate optic nerve fibers and lead to vision loss.
What are the different types of glaucoma?
Primary open angle glaucoma:
The most common form of glaucoma is primary open-angle glaucoma, in which the aqueous fluid is blocked from flowing back out of the eye at a normal rate through a tiny drainage system. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
Ocular hypertension is often a forerunner to actual open-angle glaucoma. When ocular pressure is above normal, the risk of developing glaucoma increases. Several risk factors will affect whether you will develop glaucoma, including the level of IOP, family history, and corneal thickness. If your risk is high, your ophthalmologist may recommend treatment to lower your IOP to prevent future damage.
In angle-closure glaucoma, the iris (the colored part of the eye) may drop over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP or optic nerve damage. In acute angle-closure glaucoma there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing halos around lights, and eye pain.
Even some people with “normal” IOP can experience vision loss from glaucoma. This condition is called normal-tension glaucoma. In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.
This is a secondary glaucoma that’s more common in young patients. For reasons not yet understood, pigments detach from the iris, block the trabecular meshwork and prevent proper aqueous fluid outflow. This leads to elevated IOP and consequently damages the optic nerve fibers.
Exfoliation or pseudoexfoliation glaucoma
This can occur with open or closed angle glaucoma. There are flaky materials deposit in front of the lens and in the angles of the eye. The accumulation of these flakes blocks the drainage system of the trabecular meshwork and consequently leads to elevated IOP.
What are the risk factors?
- Age over 45
- Family history of glaucoma
- Black or Asian or American Indian or Hispanic ancestry
- Elevated IOP
- Nearsightedness or farsightedness
- History of injury to the eye, use of steroids (in the eyes or systemically)
Childhood glaucoma, which starts in infancy, childhood, or adolescence, is rare. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, childhood glaucoma may run in families.
Signs of this disease include:
- Clouding of the cornea (the clear front part of the eye);
- Tearing; and
- An enlarged eye.
How is glaucoma diagnosed?
Because it has no noticeable symptoms, glaucoma is a difficult disease to detect without regular, complete eye exams.
During a glaucoma evaluation, Dr. Northam may perform the following tests:
- Tonometry. Your ophthalmologist measures the pressure in your eyes (intraocular pressure, or IOP) using a technique called tonometry. Tonometry measures your IOP by determining how your cornea responds when an instrument presses on the surface of your eye. Eye drops are usually used to numb the surface of your eye for this test.
- Gonioscopy. For this test, Dr. Northam inspects your eye’s drainage angle—the area where fluid drains out of your eye. During gonioscopy, you sit in a chair facing the microscope used to look inside your eye. You will place your chin on a chin rest and your forehead against a support bar while looking straight ahead. The goniolens is placed lightly on the front of your eye, and a narrow beam of light is directed into your eye while your doctor looks through the slit lamp at the drainage angle. Drops will be used to numb the eye before the test.
- Ophthalmoscopy. With this test, Dr. Northam can evaluate whether or not there is any optic nerve damage by looking at the back of the eye (called the fundus). There are two types of ophthalmoscopy: direct and indirect. With direct ophthalmoscopy, your ophthalmologist uses a small flashlight-like instrument with several lenses that magnifies up to about 15 times. This type of ophthalmoscopy is most commonly done during a routine physical examination. With indirect ophthalmoscopy, the ophthalmologist wears a headband with a light attached and uses a small handheld lens to look inside your eye. Indirect ophthalmoscopy allows a better view of the fundus, even if your natural lens is clouded by cataracts.
- Visual field test. The peripheral (side) vision of each eye is tested with visual field testing, or perimetry. For this test, you sit at a bowl-shaped instrument called a perimeter. While you stare at the center of the bowl, lights flash. Each time you see a flash, you press a button. A computer records your response to each flash. This test shows if you have any areas of vision loss. Loss of peripheral vision is often an early sign of glaucoma.
- Photography. Sometimes photographs or other computerized images are taken of the optic nerve to inspect the nerve more closely for damage from elevated pressure in the eye.
- Pachymetry. This determines the thickness of your cornea. Recent studies have shown that corneal thickness can influence the measurement of IOP. Thicker cornea may give falsely high reading and thinner cornea can give falsely low reading.
- Special imaging – Optical coherence tomography (OCT). This is a laser scanner that is used to better determine the configuration of the optic nerve head and retinal nerve fiber layer in micrometers. This new technology is able to obtain sub-surface images of translucent or opaque materials at a resolution equivalent to a low-power microscope. It is effectively ‘optical ultrasound’, imaging reflections from within tissue to provide cross-sectional images.
Each of these evaluation tools is an important way to monitor your vision to help ensure that glaucoma does not rob you of your sight. Some of these tests will not be necessary for everyone. Your ophthalmologist will discuss which tests are best for you. Some tests may need to be repeated on a regular basis to monitor any changes in your vision caused by glaucoma.
How is glaucoma treated?
The goal of glaucoma treatment is to lower your eye pressure to prevent or slow further vision loss. Your ophthalmologist will recommend treatment if the risk of vision loss is high. Treatment often consists of eye drops but can include laser treatment or surgery to create a new drain in the eye. Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring (every three to six months) is needed to watch for changes. Ask your ophthalmologist if you have any questions about glaucoma or your treatment.
These eye drops work by reducing the production of the aqueous humor into the eye or increasing the outflow of aqueous humor away from the eye.
- Beta blockers (Timolol, levobunolol, carteolol, metipranolol, betaxolol)
- Prostaglandin (latanoprost, travoprost, brimatoprost)
- Adrenergic agonists (bromonidine, apraclonidine)
- Carbonic anhydrase inhibitors (brinzolamide, dorzolamide)
- Parasympathomimetic agents (pilocarpine)
These are quick, painless, and relatively safe procedures.
- Laser iridotomy involves creating a hole in the iris to allow fluid to drain in narrow or closed angle glaucoma.
- Laser trabeculoplasty creates larger opening pores in the trabecular meshwork to allow the aqueous humor to percolate away from the eyes. It’s usually done in open angle or normal tension glaucoma.
- Laser cilioablation is another form of laser that’s reserved for severe form of glaucoma with poor visual potential. These laser burns destroy the cells that make the aqueous fluid, thereby, reducing the IOP. This is done only other more traditional therapies have failed.
If you have glaucoma and medications and laser surgeries do not lower your eye pressure adequately, your ophthalmologist may recommend a procedure called a trabeculectomy.
In this procedure, a tiny drainage hole is made in the sclera (the white part of the eye). The new drainage hole allows fluid to flow out of the eye into a filtering area called a bleb. The bleb is mostly hidden under the eyelid. When successful, the procedure will lower your intraocular pressure (IOP), minimizing the risk of vision loss from glaucoma. The surgery is performed in an operating room on an outpatient basis.
In cases of severe open-angle glaucoma or chronic (long-term) glaucoma, if your eye is at high risk for scarring and your IOP needs to be lowered to preserve your vision, your ophthalmologist may recommend placing a tiny drainage tube in your eye called a Seton.
The drainage tube creates a new channel for fluid to flow from the eye to a filtering area, called a bleb. A tiny plate placed on the eye helps the bleb form and remain open. The tube is covered with a patch and is typically not seen or felt. This procedure is performed in the operating room on an outpatient basis.
Macular Degeneration is one of the most common aging eye problems for seniors. In fact, Age-Related Macular Degeneration (ARMD) is one of the most common causes of poor vision after age 60. ARMD is a deterioration or breakdown of the macula. The macula is a small area at the center of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving.
What are the symptoms?
The visual symptoms of ARMD involve loss of central vision. While peripheral (side) vision is unaffected, with ARMD, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail.
What causes ARMD?
Although the specific cause is unknown, ARMD seems to be part of aging. While age is the most significant risk factor for developing ARMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. ARMD accounts for 90% of new cases of legal blindness in the United States.
Smoking tobacco increases the risk of macular degeneration by two to three times that of someone who has never smoked, and may be the most important modifiable factor in its prevention.
What are the 2 types of ARMD?
Dry ARMD takes many years to develop. A specific vitamin regimen has been shown to slow progression of dry ARMD. Your doctor will discuss the vitamin regimen upon diagnosis of Dry ARMD.
Nine out of 10 people who have ARMD have atrophic or “ dry” ARMD, which results in thinning of the macula and leads to loss of central vision. No medical or surgical treatment is available for this condition, however vitamin supplements with high doses of antioxidants, lutein and zeaxanthin have been suggested by the National Eye Institute and others to slow the progression of dry macular degeneration and, in some patients, improve visual acuity.
Exudative or “ wet” ARMD
Until recently, no effective treatments were known for wet macular degeneration. However, new drugs, called anti-angiogenics or anti-VEGF (anti-Vascular Endothelial Growth Factor) agents, can cause regression of the abnormal blood vessels and improvement of vision when injected directly into the vitreous humor of the eye. The injections have to be repeated on a monthly or bi-monthly basis. Examples of these agents include ranibizumab (trade name Lucentis), bevacizumab (trade name Avastin, a close chemical relative of ranibizumab) and pegaptanib (trade name Macugen). Worldwide, bevacizumab has been used extensively despite its “off label” status. The cost of ranibizumab (Lucentis) is approximately US$2000 per treatment while the cost of bevacizumab (Avastin) is approximately US$150 per treatment. Both drugs are made by Genentech.
Promising ARMD research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers, and other low vision aids help people with ARMD make the most of their remaining vision.
ARMD and Nutritions
Although the exact causes of ARMD are not fully understood, a recent scientific study shows that antioxidant vitamins and zinc may reduce the effects of ARMD in some people with the disease.
Among people at high risk for late-stage macular degeneration, a dietary supplement of vitamins C, E, and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25% to 30%. However, the supplements did not appear to benefit people with minimal ARMD or those with no evidence of macular degeneration.
Light may affect the eye by stimulating oxygen, leading to the production of highly reactive and damaging compounds called free radicals. Antioxidant vitamins (vitamins C and E and beta-carotene) may work against this activated oxygen and help slow the progression of macular degeneration.
Zinc, one of the most common minerals in the body, is very concentrated in the eye, particularly in the retina and macula. Zinc is necessary for the action of over 100 enzymes, including chemical reactions in the retina. Studies show that some older people have low levels of zinc in their blood. Because zinc is important for the health of the macula, supplements of zinc in the diet may slow down the process of macular degeneration.
The levels of antioxidants and zinc shown to be effective in slowing the progression of ARMD cannot be obtained through your diet alone. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet.
It is very important to remember that vitamin supplements are not a cure for ARMD, nor will they restore vision you may have already lost from the disease. However, specific amounts of certain supplements do play a key role in helping some people at high risk for advanced ARMD to maintain their vision.
Macular degeneration can advance to legal blindness and inability to drive. It can also result in difficulty or inability to read or see faces.
Adaptive devices can help people read. These include magnifying glasses, special eyeglass lenses, and computer screen readers
Amsler Grid Test
The Amsler Grid Test is one of the simplest and most effective methods for patients to monitor the health of the macula. The Amsler Grid is, in essence, a pattern of intersecting lines (identical to graph paper) with a black dot in the middle. The central black dot is used for fixation (a place for the eye to stare at). With normal vision, all lines surrounding the black dot will look straight and evenly spaced with no missing or odd looking areas when fixating on the grid’s central black dot. When there is disease affecting the macula, as in macular degeneration, the lines can look bent, distorted and/or missing.
Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they’re more visible. This is what causes the whites of your eyes to appear reddish or pink.
Pink eye is commonly caused by a bacterial or viral infection, an allergic reaction, or — in babies — an incompletely opened tear duct.
Though pink eye can be irritating, it rarely affects your vision. Treatments can help ease the discomfort of pink eye. Because pink eye can be contagious, early diagnosis and treatment can help limit its spread.
The most common pink eye symptoms include:
- Redness in one or both eyes
- Itchiness in one or both eyes
- A gritty feeling in one or both eyes
- A discharge in one or both eyes that forms a crust during the night that may prevent your eye or eyes from opening in the morning
When to see a doctor
Make an appointment with your doctor if you notice any signs or symptoms you think might be pink eye. Pink eye can be highly contagious for as long as two weeks after signs and symptoms begin. Early diagnosis and treatment can protect people around you from getting pink eye too.
People who wear contact lenses need to stop wearing their contacts as soon as pink eye symptoms begin. If your symptoms don’t start to get better within 12 to 24 hours, make an appointment with your eye doctor to make sure you don’t have a more serious eye infection related to contact lens use.
In addition, there are other serious eye conditions that can cause eye redness. Typically, these conditions will also cause pain and blurred vision. If you experience these symptoms, seek urgent care.