Gayatri Opticals

Myopia is a condition in which light rays entering the eye come to a focus in front of the retina (see the blue dot in the diagram below). Objects can be seen distinctly only when very close to the eyes, while objects at a distance appear blurry. Myopia is treated with prescription eyeglasses, contact lenses, or refractive surgery.

Hyperopia is a condition in which light rays entering the eye come to a focus behind the retina (see the blue dot in the diagram below). Objects appear clearer at a distance than up close. People who have hyperopia often complain of headaches when reading, using the computer, or other near visual tasks. Hyperopia is treated with prescription eyeglasses, contact lenses, or refractive surgery.

Astigmatism

Astigmatism is a condition in which light rays entering the eye come to a focus in two different locations near the retina (see the blue dots in the diagram below). This is the result of two different corneal curvatures (causing the two focus points). Depending on the magnitude of the astigmatism, objects can be blurry at all distances. Astigmatism is treated with prescription eyeglasses, soft toric contact lenses, RGP ("hard") contact lenses, or refractive surgery.

Presbyopia

Presbyopia is a condition in which light rays from a near object from come to a focus behind the retina (see the blue dot in the diagram below). This is slightly similar to hyperopia. The difference is that this results from a decreased ability for the lens to focus (called "accommodation") as we age. Presbyopia typically becomes symptomatic around 40 years old. Presbyopia is treated with eyeglasses (either bifocals or, more commonly, dedicated reading-only glasses).

Ocular Diseases/Disorders

Computer Vision Syndrome

If you are like millions of others, you find yourself spending a great deal of time in front of a computer screen. Do your eyes ever feel tired, irritated, red, or do you get headaches after a long day? If you answered yes, then you likely suffer from what doctors commonly refer to as Computer Vision Syndrome (CVS). More than 100 million people visit their eye care professional annually for this common problem. Eye care professionals agree that one of the most effective ways to alleviate this condition is by having an anti-reflective coating on your eyeglasses. This coating significantly reduces eyestrain and improves visual comfort by blocking the glare from a computer screen.. This coating is also outstanding at reducing glare at night caused by car headlights and other bright lights. The anti-reflective coating puts a handsome finish on any lens and eliminates reflections. Now when someone looks at you they can see your eyes, not the light reflection!

Blepharitis

Blepharitis is a common condition that causes inflammation of the eyelids. The condition can be difficult to manage because it tends to recur.

Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff.

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).

Symptoms of either form of blepharitis include a foreign body or burning sensation, excessive tearing, itching, sensitivity to light (photophobia), red and swollen eyelids, redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes on awakening.

Stye: A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid.

Chalazion: This condition can follow the development of a stye. It is a usually painless firm lump caused by inflammation of the oil glands of the eyelid. Chalazion can be painful and red if there is also an infection.

Problems with the tear film: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Because tears are necessary to keep the cornea healthy, tear film problems can make people more at risk for corneal infections.

Treatment for both forms of blepharitis involves keeping the lids clean and free of crusts. Warm compresses should be applied to the lid to loosen the crusts, followed by a light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo. Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life. If the blepharitis is severe, an eye care professional may also prescribe antibiotics or steroid eyedrops.

When scalp dandruff is present, a dandruff shampoo for the hair is recommended as well. In addition to the warm compresses, patients with posterior blepharitis will need to massage their eyelids to clean the oil accumulated in the glands. Patients who also have acne rosacea should have that condition treated at the same time.

The National Eye Institute (NEI), part of the National Institutes of Health (NIH), is the Federal government's principal agency for conducting and supporting vision research. Inclusion of an item in this Information Resource Guide does not imply the endorsement by the NEI or the NIH.

Allergies

Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, particularly when the weather is warm and dry.

Antihistamine decongestant eyedrops can effectively reduce these symptoms, as does rain and cooler weather, which decreases the amount of pollen in the air.

An increasing number of eye allergy cases are related to medications and contact lens wear. Also, animal hair and certain cosmetics, such as mascara, face creams, and eyebrow pencil, can cause allergies that affect the eye. Touching or rubbing eyes after handling nail polish, soaps, or chemicals may cause an allergic reaction. Some people have sensitivity to lip gloss and eye makeup. Allergy symptoms are temporary and can be eliminated by not having contact with the offending cosmetic or detergent.

It is recommended that (at least initially) you do not self-treat; different eye diseases and disorders frequently present with the same initial symptoms. Consult with an eye doctor (ophthalmologist or optometrist), as some cases may result in permanent damage if left untreated too long.

Conjunctivitis

Conjunctivitis describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye.

Conjunctivitis can spread from one person to another and affects millions of Americans at any given time.

At its onset, conjunctivitis is usually painless and does not adversely affect vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.

If you suspect you may have a form of conjunctivitis, consult with an eye doctor (ophthalmologist or optometrist) immediately, as some cases may result in permanent damage if left untreated too long.

Diabetic Retinopathy

Diabetic retinopathy is a potentially blinding complication of diabetes that damages the eye's retina. It affects half of all Americans diagnosed with diabetes.

At first, you may notice no changes in your vision. But don't let diabetic retinopathy fool you. It could get worse over the years and threaten your good vision. With timely treatment, 90 percent of those with advanced diabetic retinopathy can be saved from going blind.

The National Eye Institute (NEI) is the Federal government's lead agency for vision research. The NEI urges all people with diabetes to have an eye examination through dilated pupils at least once a year.

The retina is a light-sensitive tissue at the back of the eye. When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve to the brain. Without a retina, the eye cannot communicate with the brain, making vision impossible.

Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. At this point, most people do not notice any changes in their vision.

Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, blurring vision.

As the disease progresses, it enters its advanced, or proliferative, stage. Fragile, new blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina.

All people with diabetes are at risk--those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset).

During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

Visual acuity test: This eye chart test measures how well you see at various distances.

Your eye care professional will look at your retina for early signs of the disease, such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retina--signs of leaking blood vessels, (4) damaged nerve tissue, and (5) any changes in the blood vessels.

Should your doctor suspect that you need treatment for macular edema, he or she may ask you to have a test called fluorescein angiography.

In this test, a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to find the leaking blood vessels.

There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged.

These two treatments are laser surgery and vitrectomy. It is important to note that although these treatments are very successful, they do not cure diabetic retinopathy.

Laser surgery is performed in a doctor's office or eye clinic. Before the surgery, your ophthalmologist will: (1) dilate your pupil and (2) apply drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to prevent any discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes may eventually create a stinging sensation that makes you feel a little uncomfortable.

You may leave the office once the treatment is done, but you will need someone to drive you home. Because your pupils will remain dilated for a few hours, you also should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If your eye hurts a bit, your eye care professional can suggest a way to control this.

The retina prior to focal laser treatment The retina immediately after focal laser treatment

Macular Edema: Timely laser surgery can reduce vision loss from macular edema by half. But you may need to have laser surgery more than once to control the leaking fluid.

During the surgery, your doctor will aim a high-energy beam of light directly onto the damaged blood vessels. This is called focal laser treatment. This seals the vessels and stops them from leaking. Generally, laser surgery is used to stabilize vision, not necessarily to improve it.

Proliferative Retinopathy: In treating advanced diabetic retinopathy, doctors use the laser to destroy the abnormal blood vessels that form at the back of the eye.Scatter laser treatment

Rather than focus the light on a single spot, your eye care professional will make hundreds of small laser burns away from the center of the retina. This is called scatter laser treatment. The treatment shrinks the abnormal blood vessels. You will lose some of your side vision after this surgery to save the rest of your sight. Laser surgery may also slightly reduce your color and night vision.

Once you have proliferative retinopathy, you will always be at risk for new bleeding. This means you may need treatment more than once to protect your sight.

Instead of laser surgery, you may need an eye operation called a vitrectomy to restore your sight. A vitrectomy is performed if you have a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.

Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation.

Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

Vitrectomy is often done under local anesthesia. This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye.

You may be able to return home soon after the vitrectomy. Or, you may be asked to stay in the hospital overnight. Your eye will be red and sensitive. After the operation, you will need to wear an eyepatch for a few days or weeks to protect the eye. You will also need to use medicated eye drops to protect against infection.

The NEI is currently supporting a number of research studies in both the laboratory and with patients to learn more about the cause of diabetic retinopathy. This research should provide better ways to detect, treat, and prevent vision loss in people with diabetes.

For example, it is likely that in the coming years researchers will develop drugs that turn off enzyme activity that has been shown to cause diabetic retinopathy. Some day, these drugs will help people to control the disease and reduce the need for laser surgery.

The NEI urges all people with diabetes to have an eye examination through dilated pupils at least once a year. If you have more serious retinopathy, you may need to have a dilated eye examination more often.

A recent study, the Diabetes Control and Complications Trial (DCCT), showed that better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible, had much less eye, kidney, and nerve disease. This level of blood sugar control may not be best for everyone, including some elderly patients, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

National Eye Institute
National Institutes of Health
NIH Publication No. 99-2171

Dry Eye

The continuous production and drainage of tears is important to the eye's health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable.

The tear film consists of three layers--an outer, oily (lipid) layer that keeps tears from evaporating too quickly and helps tears remain on the eye; a middle (aqueous) Layer that nourishes the cornea and conjunctiva; and a bottom (mucin) layer that helps to spread the aqueous layer across the eye to ensure that the eye remains wet. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.

The main symptom of dry eye is usually a scratchy or sandy feeling as if something is in the eye. Other symptoms may include stinging or burning of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and pain and redness of the eye. Sometimes people with dry eye experience heaviness of the eyelids or blurred, changing, or decreased vision, although loss of vision is uncommon.

Dry eye is more common in women, especially after menopause. Surprisingly, some people with dry eye may have tears that run down their cheeks. This is because the eye may be producing less of the lipid and mucin layers of the tear film, which help keep tears in the eye. When this happens, tears do not stay in the eye long enough to thoroughly moisten it.

Dry eye can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs. People with dry eye should let their health care providers know all the medications they are taking, since some of them may intensify dry eye symptoms.

People with connective tissue diseases, such as rheumatoid arthritis, can also develop dry eye. It is important to note that dry eye is sometimes a symptom of Sj�gren's syndrome, a disease that attacks the body's lubricating glands, such as the tear and salivary glands. A complete physical examination may diagnose any underlying diseases.

Artificial tears, which lubricate the eye, are the principal treatment for dry eye. They are available over-the-counter as eye drops. Sterile ointments are sometimes used at night to help prevent the eye from drying. Using humidifiers, wearing wrap-around glasses when outside, and avoiding outside windy and dry conditions may bring relief. For people with severe cases of dry eye, temporary or permanent closure of the tear drain (small openings at the inner corner of the eyelids where tears drain from the eye) may be helpful.

Glaucoma

This pamphlet is designed to help people with glaucoma and their families better understand the disease. It describes the causes, symptoms, diagnosis, and treatment of glaucoma. It is mainly about open-angle glaucoma, the most common kind in the United States.

Glaucoma is a group of diseases that can lead to damage to the eye's optic nerve and result in blindness.

Open-angle glaucoma, the most common form of glaucoma, affects about 3 million Americans--half of whom don't know they have it. It has no symptoms at first. But over the years it can steal your sight. With early treatment, you can often protect your eyes against serious vision loss and blindness.

The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina, the light-sensitive layer of tissue at the back of the eye, with the brain (see diagram). A healthy optic nerve is necessary for good vision.

In many people, increased pressure inside the eye causes glaucoma. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of this space and nourishes nearby tissues.

The fluid leaves the anterior chamber at the angle where the cornea and iris meet (see diagram). When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.

Open-angle glaucoma gets its name because the angle that allows fluid to drain out of the anterior chamber is open. However, for unknown reasons, the fluid passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises. Unless the pressure at the front of the eye is controlled, it can damage the optic nerve and cause vision loss.

Although anyone can get glaucoma, some people are at higher risk than others. They include:

At first, open-angle glaucoma has no symptoms. Vision stays normal, and there is no pain. As glaucoma remains untreated, people may notice that although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye.

Without treatment, people with glaucoma may find that they suddenly have no side vision. It may seem as though they are looking through a tunnel. Over time, the remaining forward vision may decrease until there is no vision left.

Most people think that they have glaucoma if the pressure in their eye is increased. This is not always true. High pressure puts you at risk for glaucoma. It may not mean that you have the disease.

Whether or not you get glaucoma depends on the level of pressure that your optic nerve can tolerate without being damaged. This level is different for each person.

View of boys by person with normal vision view of boys by person with glaucoma

Although normal pressure is usually between 12-21 mm Hg, a person might have glaucoma even if the pressure is in this range. That is why an eye examination is very important.To detect glaucoma, your eye care professional will do the following tests:

Yes. Although you will never be cured of glaucoma, treatment often can control it. This makes early diagnosis and treatment important to protect your sight. Most doctors use medications for newly diagnosed glaucoma; however, new research findings show that laser surgery is a safe and effective alternative.

Medicine: Medicines are the most common early treatment for glaucoma. They come in the form of eyedrops and pills. Some cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

Glaucoma drugs may be taken several times a day. Most people have no problems. However, some medicines can cause headaches or have side effects which affect other parts of the body. Drops may cause stinging, burning, and redness in the eye. Ask your eye care professional to show you how to put the drops into your eye. In addition, tell your eye care professional about other medications you may be taking before you begin glaucoma treatment.

Many drugs are available to treat glaucoma. If you have problems with one medication, tell your eye care professional. Treatment using a different dosage or a new drug may be possible.

You will need to use the drops and/or pills as long as they help to control your eye pressure. This is very important. Because glaucoma often has no symptoms, people may be tempted to stop or may forget to take their medicine.

Laser surgery (also called laser trabeculoplasty): Laser surgery helps fluid drain out of the eye. Although your eye care professional may suggest laser surgery at any time, it is often done after trying treatment with medicines. In many cases, you will need to keep taking glaucoma drugs even after laser surgery.

Laser surgery is performed in an eye care professional's office or eye clinic. Before the surgery, your eye care professional will apply drops to numb the eye.

As you sit facing the laser machine, your eye care professional will hold a special lens to your eye. A high-energy beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes 50-100 evenly spaced burns. These burns stretch the drainage holes in the meshwork. This helps to open the holes and lets fluid drain better through them.

Your eye care professional will check your eye pressure shortly afterward. He or she may also give you some drops to take home for any soreness or swelling inside the eye. You will need to make several follow-up visits to have your pressure monitored.

Once you have had laser surgery over the entire meshwork, further laser treatment may not help. Studies show that laser surgery is very good at getting the pressure down. But its effects sometimes wear off over time. Two years after laser surgery, the pressure increases again in more than half of all patients.

Conventional surgery: The purpose of surgery is to make a new opening for the fluid to leave the eye. Although your eye care professional may suggest it at any time, this surgery is often done after medicine and laser surgery have failed to control your pressure.

Surgery is performed in a clinic or hospital. Before the surgery, your eye care professional gives you medicine to help you relax and then small injections around the eye to make it numb

The eye care professional removes a small piece of tissue from the white (sclera) of the eye. This creates a new channel for fluid to drain from the eye. But surgery does not leave an open hole in the eye. The white of the eye is covered by a thin, clear tissue called the conjunctiva. The fluid flows through the new opening, under the conjunctiva, and drains from the eye.

You must put drops in the eye for several weeks after the operation to fight infection and swelling. (The drops will be different than the eyedrops you were using before surgery.) You will also need to make frequent visits to your eye care professional. This is very important, especially in the first few weeks after surgery.

In some patients, surgery is about 80 to 90 percent effective at lowering pressure. However, if the new drainage opening closes, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.

Keep in mind that while glaucoma surgery may save remaining vision, it does not improve sight. In fact, your vision may not be as good as it was before surgery.

Like any operation, glaucoma surgery can cause side effects. These include cataract, problems with the cornea, inflammation or infection inside the eye, and swelling of blood vessels behind the eye. However, if you do have any of these problems, effective treatments are available.

Although open-angle glaucoma is the most common form, some people have other forms of the disease.

In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur unexpectedly in people with normal eye pressure. People with this form of the disease have the same types of treatment as open-angle glaucoma.

In closed-angle glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye because the angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in pressure. Symptoms include severe pain and nausea as well as redness of the eye and blurred vision. This is a medical emergency. The patient needs immediate treatment to improve the flow of fluid. Without treatment, the eye can become blind in as little as one or two days. Usually, prompt laser surgery can clear the blockage and protect sight.

In congenital glaucoma, children are born with defects in the angle of the eye that slow the normal drainage of fluid. Children with this problem usually have obvious symptoms such as cloudy eyes, sensitivity to light, and excessive tearing. Surgery is usually the suggested treatment, because medicines may have unknown effects in infants and be difficult to give to them. The surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas can develop as a complication of other medical conditions. They are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). One type, known as pigmentary glaucoma, occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Also, corticosteroid drugs-used to treat eye inflammations and other diseases--can trigger glaucoma in a few people. Treatment is with medicines, laser surgery, or conventional surgery.

The National Eye Institute (NEI) is the Federal government's lead agency for vision research. The NEI is supporting many research studies both in the laboratory and with patients. This research should provide better ways in the future to detect, treat, and prevent vision loss in people with glaucoma.

For instance, researchers recently found a gene that causes a form of glaucoma that starts at a young age. This is the first glaucoma gene ever located. This finding could help us learn more about how glaucoma damages the eye.

The NEI is also supporting clinical studies that will tell us more about who is likely to get glaucoma, when to treat people with increased pressure, and which treatment to use first.

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day and see your eye care professional regularly.

You can also help protect the vision of family members and friends who may be at high risk for glaucoma--Blacks over age 40 and everyone over age 60. Encourage them to have an eye examination through dilated pupils every two years.

Low Vision

Low vision is a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with a person's ability to perform everyday activities.

Low vision can result from a variety of diseases, disorders, and injuries that affect the eye. Many people with low vision have age-related macular degeneration, cataract, glaucoma, or diabetic retinopathy. Age-related macular degeneration accounts for almost 45 percent of all cases of low vision.

People age 65 and older, as well as African Americans and Hispanics over age 45, are at higher risk. African Americans and Hispanics are at higher risk for low vision because they are at higher risk for developing diabetes and diabetic retinopathy, and African Americans are at a higher risk for developing glaucoma.

Approximately 14 million Americans--about one out of every 20 people--have low vision. About 135 million people around the world have low vision.

[The Lighthouse. (1994). The Lighthouse National Survey on Vision Loss: The Experience, Attitudes, and Knowledge of Middle-Aged and Older Americans. New York: The Lighthouse, Inc., Louis Harris and Associates, Inc.]

Yes. About one in eight Americans is now 65 or older. That number is expected to double.

More than $22 billion is spent annually on care and services for people who are blind or have visual impairments. These costs include treatment, education, loss of personal income, and associated costs, such as Social Security disability benefits.

[National Alliance for Eye and Vision Research. (1995). A Vision of Hope for Older Americans: Progress and Opportunities in Eye and Vision Research. An official report to the White House Conference on Aging.]

People with low vision experience physical, economic, and psychological changes that diminish their quality of life. Low vision affects daily routines (walking, going outside, cooking), leisure activities (reading, sewing, traveling, sports), and the ability to perform job-related functions that can lead to a loss of income. These consequences often lead people with low vision to become confused, grief-stricken, fearful, anxious, and depressed. In addition, people with low vision who lose their depth perception are at greater risk of falling and injuring themselves.

One-third of all people with visual impairments who responded to a 1994 survey by The Lighthouse, a vision advocacy and social service organization, said that their vision problems created some difficulty in performing their jobs. Half of all respondents said that loss of income as a result of low vision was a somewhat serious or very serious problem.

Evidence suggests that the loss of stereoscopic vision and depth perception increases a person's chances of tripping, falling, or running into objects such as an open cabinet door, for example.

[Bachelder, J., and Harkins, D., Jr. (1995). Do occupational therapists have a primary role in low vision rehabilitation? American Journal of Occupational Therapy 49:927-930. Swagerty, D., Jr. (1995). The impact of age-related visual impairment on functional independence in the elderly. Kansas Medicine 96:24-26.]

What agencies and organizations provide people who have low vision with help and information?

Is a low vision examination covered by health insurance, Medicaid, or Medicare?

Resources and strategies depend on the severity of a person's vision impairment. At home, people need devices that can help them read, write, and manage the tasks of daily living. These adaptive devices include adjustable lighting, prescription reading glasses, large-print publications, magnifying devices, closed-circuit televisions, cassette recordings, electronic reading machines, and computers with large print and speech output systems. Simple strategies include writing with bold black felt tip markers and writing on tablets with bold lines to make it easier to write in a straight line. Also, contrasting colors are helpful: people can place colored tape on the edges of steps to help them see the steps and prevent a fall. Dark-colored light switches and electrical outlets can provide contrast on light-colored walls. Motion lights that automatically turn on when someone enters a room are helpful. Telephones, clocks, and watches with large numbers can help people use those instruments more easily, and large-print labels placed on the stove and microwave oven can help, too.

Among the visual devices that can help people with low vision are reading glasses with high-powered lenses and reading prisms; telescopes and telescopic spectacles for tasks requiring vision at near, middle, and far distances; and reversed telescopes for visual field defects. These devices must be prescribed by eye care professionals, and patients must be trained to use them properly.

What agencies and organizations provide people who have low vision with help and information?

Many agencies and organizations in the community provide assistance and information to people who have low vision, and to their families and caregivers. State agencies for the blind and visually impaired can make referrals to a variety of organizations that provide assistance. Such services include vision rehabilitation, recreation, counseling, and job training or placement.

Many people don't know that help exists. They think of low vision as a natural part of aging, not as a problem that can be treated. Others feel that these services and devices are for people who are blind, not for people with low vision. Also, the cost of many devices keeps people from obtaining them. Finally, people may know that help exists, but they don't know what their options are and aren't sure how to ask for help or whom to consult.

First, note the kinds of vision problems that are occurring. Some warning signs include the following:

A person who is having these vision difficulties should immediately make an appointment with an eye care professional for an eye examination. If the person's vision cannot be treated by conventional methods, such as glasses, contact lenses, medication, or surgery, then he or she should ask the eye care professional for information about vision rehabilitation. These services may include eye examinations, a low vision evaluation, training on how to use visual and adaptive devices, support groups, and training on how to perform everyday activities in new ways.

Urge that person to make an appointment with an eye care professional for an eye examination. Then help the person find out about low vision and vision rehabilitation services and encourage him or her to take advantage of all available resources.

While costs vary by region, typically a low vision evaluation costs between $100 and $200.

Is a low vision examination covered by health insurance, Medicaid, or Medicare?

Policies vary by state, but generally Medicare will cover low vision examinations performed by eye care professionals. Private health insurance usually does not cover low vision examinations, but one should check with their carrier to be sure.

The National Eye Institute (NEI) is part of the Federal government's National Institutes of Health. Congress authorized the establishment of the NEI in 1968. NEI's mission is to find new ways to prevent, diagnose, and treat diseases of the eye and visual system, thus preventing, reducing, and possibly even eliminating blindness.

The Low Vision Education Program is part of the the National Eye Health Education Program (NEHEP), which was created by the NEI to implement large-scale information, education, and applied research programs. The NEHEP's goal is to prevent vision loss and blindness by educating the public and health professionals about sight-threatening eye diseases and ensuring that the results of eye and vision research benefit everyone. The NEHEP emphasizes public, patient, and professional education on the importance of early detection and treatment of eye diseases and disorders. The NEHEP is coordinated by the NEI in partnership with more than 60 public and private organizations.

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a disease that affects your central vision. It is a common cause of vision loss among people over age of 60. Because only the center of your vision is usually affected, people rarely go blind from the disease. However, AMD can sometimes make it difficult to read, drive, or perform other daily activities that require fine, central vision.

The macula is in the center of the retina, the light-sensitive layer of tissue at the back of the eye. As you read, light is focused onto your macula. There, millions of cells change the light into nerve signals that tell the brain what you are seeing. This is called your central vision. With it, you are able to read, drive, and perform other activities that require fine, sharp, straight-ahead vision.

Macular Hole

The macula is a tiny oval area made up of millions of nerve cells located at the center of the retina. The retina is the light-sensitive tissue at the back of the eye. The macula is responsible for sharp, central vision. A macular hole is just that: a hole in the macula.

This information was developed by the National Eye Institute (NEI) to help patients and their families search for general information about macular hole. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.

The eye contains a jelly-like substance called the vitreous. Shrinking of the vitreous usually causes the hole. As a person ages, the vitreous becomes thicker and stringier and begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result.

The size of the hole and its location on the retina determine how much it will affect vision. Generally, people notice a slight distortion or reduction in their eyesight. However, if the hole goes all the way through the macula, you can lose a lot of your central and detailed vision.

No, they are two different diseases even though they have similar symptoms. An eye care professional will know the difference.

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids.

Following surgery, patients must usually keep their faces down for two or three weeks. This position allows the bubble to press against the macula and seal the hole.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment either during surgery or afterward.

The surgery is about 90 percent effective in closing the hole. However, improvement in people's vision is more variable. More than half of those who have the surgery can expect an improvement of two lines or more on the vision chart.

Very few people get a macular hole in the second eye. Your eye care professional will be able to talk to you about your risk.

The National Eye Institute (NEI), part of the National Institutes of Health (NIH), is the Federal government's principal agency for conducting and supporting vision research. Inclusion of an item in this Information does not imply the endorsement of the NEI or the NIH.

Retina Detachment

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

This information was developed by the National Eye Institute (NEI) to help patients and their families in searching for general information about retinal detachment. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

Symptoms include a sudden or gradual increase in the number of floaters and/or light flashes in the eye or the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

Although anyone can experience a retinal detachment, people with certain eye conditions are at increased risk. Some examples of these conditions include posterior vitreous detachment, lattice degeneration, x-linked retinoschisis, degenerative myopia, and uveitis. Injuries to the eye or head can also cause retinal detachment.

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back to into place. Cryopexy is a similar procedure that freezes the area around the hole.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed to treat more severe cases. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous. Salt solution is then injected to into the eye to replace the vitreous.

Early treatment can usually improve the vision of most patients with retinal detachment. Some patients, however, will need more than one procedure to repair the damage.

The National Eye Institute, part of the National Institutes of Health, is the Federal government's principal agency for conducting and supporting vision research. Inclusion of an item in this Information Resource Guide does not imply the endorsement by the National Eye Institute or the National Institutes of Health.

Ocular Diseases/Disorders

Computer Vision Syndrome
Blepharitis
Allergies
Conjunctivitis
Diabetic Retinopathy
Dry Eye
Glaucoma
Low Vision
Macular Degeneration
Macular Hole
Retina Detachment

Frequently Asked Questions - EYE CARE

Refractive Conditions

Myopia (Nearsightedness)
Hyperopia (Farsightedness)
Astigmatism
Presbyopia (40 and over)

Myopia ("Nearsightedness")

Astigmatism

Presbyopia

Ocular Diseases/Disorders

Computer Vision Syndrome

Blepharitis

Allergies

Conjunctivitis

Diabetic Retinopathy

Diabetic retinopathy is a potentially blinding complication of diabetes that damages the eye's retina. It affects half of all Americans diagnosed with diabetes.

Dry Eye

Glaucoma

Low Vision

Low vision is a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with a person's ability to perform everyday activities.

Age-Related Macular Degeneration

Macular Hole

Retina Detachment

Ocular Diseases/Disorders

Glaucoma

Low Vision

Age-Related Macular Degeneration

Macular Hole

Retina Detachment



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Frequently Asked Questions - EYE CARE

Refractive Conditions

Myopia (Nearsightedness) Hyperopia (Farsightedness) Astigmatism Presbyopia (40 and over)

Myopia ("Nearsightedness")

Astigmatism

Presbyopia

Ocular Diseases/Disorders

Computer Vision Syndrome

Blepharitis

Allergies

Conjunctivitis

Diabetic Retinopathy

Diabetic retinopathy is a potentially blinding complication of diabetes that damages the eye's retina. It affects half of all Americans diagnosed with diabetes.

Dry Eye

Glaucoma

Low Vision

Low vision is a visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with a person's ability to perform everyday activities.

Age-Related Macular Degeneration

Macular Hole

Retina Detachment

Ocular Diseases/Disorders

Glaucoma

Low Vision

Age-Related Macular Degeneration

Macular Hole

Retina Detachment

Myopia (Nearsightedness)
Hyperopia (Farsightedness)
Astigmatism
Presbyopia (40 and over)