The ‘Eyes’ Have It

You may have heard the saying “the eyes are the window to the soul,” or perhaps read the Biblical verse Matthew 6:22-24: “The eye is the lamp of the body; so then if your eye is clear, your whole body will be full of light.”

This, and other literary phrases about eyes, point to the importance of the eyes and eye health.

Eye health concerns can include diabetic retinopathy, retinal tears, and dry eye syndrome. Diabetic retinopathy is the most common cause of vision loss among people with diabetes.

Diabetic Retinopathy
Dr. Melvin Wagner, an ophthalmologist with Stoken Wagner Ophthalmic Associates, Carlisle, said high blood sugar causes changes in the blood vessels in the eye — they can leak, swell, or close.

“The longer a patient has diabetes, the more likely they’ll have retinal damage. It tends to occur more frequently in people who don’t have their diabetes under control. Most patients show signs of diabetic retinopathy 10-15 years after they’ve been diagnosed with diabetes,” Wagner said, adding that having high blood pressure controlled is also important.

Diabetic retinopathy has several levels: mild, moderate, and severe. Wagner explained that in the early stages patients may not be aware they actually have diabetic retinopathy.

“It usually progresses until patients begin experiencing symptoms such as loss of vision or an increase in ‘floaters’ (bleeding from blood vessels can cause the appearance of floating spots). That’s why it’s so important for diabetics to have annual eye exams,” he said.

During an eye exam, the eye can be scanned using optical coherence tomography, a noninvasive imaging test that uses light waves to take cross-section pictures of the retina.

“It’s a wonderful tool. It allows us to see the blood vessels and the retina,” Wagner said.

If blood vessels are leaking or swollen, he said there are two main treatments: laser treatment to seal the blood vessel or injections targeted at the leaking blood vessel.

“We’re doing less and less laser treatment. Now it’s more common to use injections — the medicine is the same as what’s used to treat macular degeneration,” Wagner said.

In advanced cases of diabetic retinopathy, surgery to remove vitreous gel and blood from leaking vessels may be needed. It also treats any scar tissue that may be present.

Retinal Tears
The retina is a thin, pliable tissue at the back wall of the eye near the optic nerve. Wagner likens it to wallpaper. The eye is filled with vitreous, a gel-like substance. As we age, the vitreous shrinks and pulls away from the retina.

Wagner said 70 percent of people by age 70 have the vitreous pull away from the retina or detach, but this may not cause issues in every case. Additionally, people who are nearsighted have thin areas of the retina and are more prone to retinal tears.

Wagner said symptoms of a retinal tear commonly include floaters and, in some cases, what appear to be flashes of light, like a lightning strike, on the periphery.

“Most people have floaters, but any change in frequency or what you see is something to be concerned about, and an eye exam should be scheduled immediately. A retinal tear could lead to a retinal detachment, but most patients who develop a retinal tear don’t develop retinal detachment,” he stressed.

A retinal tear is often treated with laser and can be done in-office.

“When we see a tear in an exam, we often can do laser treatment in a few hours. When we seal the tear, it creates scar tissue and helps stabilize the retina. Tears are usually in the periphery, so the scar tissue doesn’t really affect vision — you can’t see the scar,” Wagner explained.

Retinal Detachment
People who are diabetic and nearsighted, who have had an eye injury, or who have had an eye surgery, such as cataract removal, have a higher risk of suffering a detached retina. While there is no pain to warn of a detached retina, there are some symptoms.

Wagner said they can include the sudden appearance of many floaters and flashes of light, blurred vision, reduced peripheral vision, black spots, or a curtain-like shadow in the field of vision. If these symptoms occur, seek treatment immediately. Treatment options include laser surgery.

Dry Eye Syndrome
Dr. Geoffrey Brent, Premier Eye Care Group, Camp Hill, said dry eye syndrome is a very common condition. It can cause a scratchy sensation, like something is in the eye.

“It’s more common as we get older, and it’s more common in women [due to hormonal changes during pregnancy or menopause]. Dry eye is also one of the reasons that people cite for discontinuing contact lens wear,” he said. “A lot of people have issues with dry eye at work, where the environment may be dry, or during winter when the heat is on.”

Dry eye can be the side effect of some over-the-counter and prescription medications. They include antihistamines and nasal decongestants.

Working at a computer for a long time without breaks can also be the cause of dry eye; we tend to blink less when we’re staring at the computer screen.

He said one of the main symptoms of dry eye is blurry vision, and another, surprisingly, is watery eyes. Dry eye occurs when the quantity or quality of tears fails to keep the surface of the eye lubricated.

Brent explained that tears consist of a water part, an oil part, and a mucin part (mucin is the general term for the proteins that give mucus its slimy consistency). The mucin part coats the eye and allows tears to spread over the surface of the eye.

“Dry eye syndrome runs the gamut. It can be a mild annoyance or a vision-threatening issue,” Brent said. “Vision loss could occur as a long-term issue. If left untreated, dry eye could lead to scarring of the cornea, or an infection of the cornea could develop. For the majority of people, dry eye is more of an annoyance than a serious condition. There are a lot of treatment options.”

Easy treatments include warm compresses, which help unblock the oil gland in the eye. Brent uses the analogy of oil in the blocked glands being similar to Crisco; when unblocked, the oil turns back into olive oil.

If a dry environment is the cause of dry eye, installing a humidifier should help alleviate the issue. Looking away from the computer screen or standing up to stretch can relieve dry eye caused by staring too long at the computer screen.

Artificial tears or lubricating eye drops are also a treatment option. There are a variety of over-the-counter brands to choose from, but Brent offers a word of caution.

“Visine and similar products are OK for periodic use, but ongoing use can actually cause redness of the eyes,” he said.

Artificial tears also are available in gels and ointments, which provide longer-lasting relief. Prescription medications, such as Restasis and Xiidra, encourage eyes to make more tears. As an extreme measure, Brent said some people have artificial tears created from their own blood plasma.

Another treatment option is placing plugs in the eye. They’re placed in tear-drainage ducts so tears don’t drain and remain in the eye longer.

“It’s an easy procedure to do. But we’ll try other options, such as artificial tears, first,” Brent said. BW