Common Eye Diseases (Eye Conditions)

Age-Related Macular Degeneration

Age-related macular degeneration, or AMD, is a condition that affects the center of the retina, called the macula. The macula is the part of the eye responsible for our most acute vision, which we use when reading, driving, and performing other activities that require fine, sharp, or straight-ahead vision.

There are two different types of AMD:

Dry macular degeneration: Small yellow deposits, known as drusen, accumulate under the macula. Eventually, these deposits are disruptive to vision cells, causing them to slowly break down. With less of the macula working, this causes a gradual loss of central vision as time goes on.

This is the most common form of AMD, affecting approximately 90% of people who have the disease.

Wet macular degeneration: New blood vessels start to grow in areas of the macula where they shouldn’t be. This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time.

Although this type of AMD affects only about 10% of people with the disease, it is responsible for 90% of severe vision loss associated with AMD.

Risk factors for AMD

While the causes of AMD may be unknown; age, lifestyle and nutrition appear to play a role. Things like:

  • age
  • smoking
  • diet
  • obesity
  • exposure to sunlight
  • high blood pressure
  • family history of AMD

Risk factors for AMD

In the early stages, AMD goes largely unnoticed, and can only be detected through a dilated eye exam, which may reveal drusen accumulation. However, as AMD progresses, drusen impair the transportation of vital nutrients to the macula and damages the light-sensitive cells of the retina causing noticeable symptoms, including:

  • Blurred vision
  • A dark or empty area in the central area of vision
  • Distortion of straight lines

Management of AMD

Since peripheral vision is not affected, many people with dry AMD continue in their normal lifestyles with the aid of low-vision optical devices, such as magnifiers.

Wet AMD is treated with injected medications and/or laser surgery by sealing off the leaking blood vessels. These are usually brief and painless outpatient procedures that slow and sometimes even reverse the progression of the degeneration. A small, permanently dark spot is left where the laser makes contact, however.

There are currently no treatments for dry AMD. The use of eye vitamins as studied in the AREDS and AREDS2 studies have been shown to reduce the risk of progression in patients with moderate to advanced AMD.

Cataracts

If the lens becomes cloudy, the light reaching the retina is blurred and distorted, and your vision is affected. This clouded lens is called a cataract, and it must be removed before vision can be restored. A clouded lens can be compared to a window that is frosted or “fogged” with steam. Cataracts are not cancerous. They can be treated with a surgical procedure that has become a fairly common procedure in the United States.

The two most common types of cataracts are: the cortical cataract and a posterior subcapsular cataract. Depending on the type of cataract, a patient will experience different vision problems, but the most common cataract symptoms include:

  • blurring vision
  • sensitivity to light or glare
  • double vision in one eye
  • poor night vision
  • needing brighter light to read
  • experiencing fading or yellowing of colors.

If the cloudiness is not near the center of the lens, you may not be aware that you have a cataract.

Cataracts can be removed at any age. You no longer have to wait until the cataract “ripens” or until you lose your sight before surgery can be performed. In fact, the placement of an intraocular lens (IOL) implant to restore vision is best done in an eye when the cataract interferes with your daily activities or causes a decrease in vision.

In removing cataracts, the clouded lens (cataract) must be removed surgically. Cataracts cannot be removed via laser.

A common surgical procedure used today is extracapsular cataract extraction. The surgeon makes an incision in the eye and the front (anterior) capsule of the lens to remove the clouded lens. The lens tissue within the capsule is removed. The sac-like capsule that surrounds the lens remains in place. This capsule is left intact for two reasons: to avoid disturbing the gel, or vitreous, that fills most of the eye, and to support an intraocular lens.

After the cataract has been removed, the incision is closed. Often the sutures, which are finer than human hair, do not need to be removed. Some patients, in fact, don’t even need sutures, and the “no suture” surgery is popular today.

Another common type of extracapsular cataract extraction is phacoemulsification (often just called “phaco”), where the surgeon removes the cataract through an even smaller incision than the one used in conventional surgery. In this procedure, the surgeon uses a computerized instrument consisting of a needle about the size of a ballpoint pen tip which vibrates at about 40,000 times a second.

This ultrasonic vibration dissolves the cataract into fine particles, which are then vacuumed through an opening in the instrument.

The benefits of the phaco approach include an early restoration of vision and return to normal activities. Phaco is well suited for patients with a less-advanced cataract, when an earlier return to activity is required or when increased physical activity is part of the 

convalescent period.

Corneal Conditions

Diseases affecting the cornea are:

  • Allergies
  • Conjunctivitis (pink eye)
  • Corneal Infections
  • Dry Eye
  • Fuchs’ Dystrophy
  • Herpes Zoster (shingles)
  • Iridocorneal Endothelial Syndrome
  • Keratoconus
  • Lattice Dystrophy
  • Map-Dot-Fingerprint Dystrophy
  • Ocular Herpes
  • Pterygium
  • Stevens-Johnson Syndrome

Cosmetic Surgery

The way you feel about yourself has a great impact on how you think, act, and interact with others. It can also affect the way you are perceived by others. When you feel good about yourself, your self confidence shows. The eyes are termed "the window to the soul,” as they reveal much about a person’s personality, feelings, and mood. Restoring the youthfulness around your eyes can have a great impact on your overall appearance.

At Sadguru Netra Chikitsalaya, we offer an array of aesthetic procedures that can help rejuvenate your appearance. Our specialized equipment and efficient in-room layout create an ideal environment to ensure the best possible results for patients. Further, we provide a discreet location, offering our patients privacy and confidentiality. Aesthetic procedures are typically performed on an outpatient basis, under local or sometimes general anesthesia. Most patients can resume normal activities over the next couple of days. Mild swelling and bruising gradually disappear in one or two weeks with most patients describing their total experience as completely painless.

Diabetic Retinopathy

Diabetic retinopathy is the leading cause of blindness the United States.  The elevated blood sugar seen with diabetes can cause vision loss by damaging small blood vessels in the retina (back part of the eye).  Diabetes can also affect vision by development of cataracts, glaucoma, macular edema and retinal detachment.

Symptoms:

  • Blurred vision and slow vision loss over time
  • Floaters
  • Shadows or missing areas of vision
  • Trouble seeing at night

Many patients with early diabetic retinopathy may have no symptoms and hence regular eye exams should be performed.

Signs and tests

A complete ophthalmic examination to examine the retina is necessary as well as photographs, fluorescein angiography and OCT may be needed for diagnosis.   Please make an appointment with one of our specialists for further evaluation.

Eye Movement Disorders

When you look at an object, you're using several muscles to move both eyes to focus on it. If you have a problem with the muscles, the eyes don't work properly.

Strabismus

Most of us are fortunate because our eyes started to work as a team very early in infancy and have continued to work together ever since. We are able to focus each eye on whatever we look at, regardless of the direction, and our brain combines the picture or image from each eye into the mental picture we actually see in three dimensions.

About two percent of every 100 children are not as fortunate. For a variety of reasons, their eyes do not work as a team. Both eyes are not directed or focused at the same object. This condition is called "strabismus."

The child with strabismus rarely complains. In most cases, it is the appearance of the eye that first catches the parent's attention. A child should be examined by an ophthalmologist whenever the eyes appear not to be working together.

There are three basic kinds of strabismus: esotropia, exotropia and hypertropia, depending on which direction the eyes are deviated.

Esotropia

The most common type of strabismus is esotropia, which occurs when either one or both eyes turn in toward the nose. Some children are born with this condition. More frequently, it starts at about age 2 1/2. When esotropia occurs in these older children, eyeglasses can often help to treat the condition by correcting the child's vision for farsightedness or hyperopia. This can reduce or eliminate the crossing by changing the child's need for excessive focusing.

In some children a broad nasal bridge or an extra skin fold give the false appearance of esotropia. This condition is known as pseudoesotropia.

Exotropia

Exotropia is the second most common kind of strabismus. In this condition, one or both eyes turn out. It usually starts at age two or three. In the beginning, the eye may drift out only for a few seconds when the child is tired or ill. It typically occurs when the child looks far away. Closing one eye in bright sunlight when playing outside is also a common early sign.

Hypertropia

Hypertropia is the least common type of strabismus. In this condition, one eye is higher than the other. As a result, the child often tilts or cocks his or her head to one side to get rid of the double vision that this problem frequently causes.

Strabismus in Adults

Although strabismus is much more common in children, many adults have strabismus, either since childhood or developed in adult life. A special section of the Wills Eye Pediatric and Ocular Genetics Service, called Adult Motility, is set aside for the management of this group of patients. No person is ever too old to have treatment for stabismus.

Treatment

Treatment of strabismus may involve patching, eyeglasses, surgery or some combination of these therapies. Strabismus surgery is a delicate procedure performed on the muscles that attach to the outside of the eyeball. There are six muscles attached to each eyeball that move it around.

Eye muscle surgery consists of weakening or strengthening one or more of these muscles in one or both eyes, depending on the type of strabismus. This procedure is done with the child asleep under general anesthesia. Usually, the child comes to the hospital the morning of the surgery and is discharged the same day, several hours after surgery. The eyes are moderately red for a week following the procedure. Once the child leaves the hospital, there is minimal discomfort. In most cases he or she may return to his or her usual activities at home. However, it should be noted that sometimes more than one surgery is required.

Amblyopia

Amblyopia (lazy eye) is another frequent condition, occurring in about three or four of every 100 children. When a child is born with normal eyes, he or she has the potential for good vision in both eyes, but must learn to see with each of them. If for some reason, the child prefers to use one eye more than the other, the preferred eye learns to see well but the other suffers from lack of use. It does not learn to see as well, even with glasses. The non-preferred eye is said to be lazy or have amblyopia.

One of the common causes for lazy eye is strabismus. When the child's eyes are pointed in different directions, the child has to use one eye at a time to avoid seeing double. If he or she uses one eye more than the other, the other eye becomes lazy.

Children without strabismus can also develop a lazy eye. Even though their eyes are straight, one eye is preferred more than the other. This non-preferred eye becomes lazy and does not learn to see.

Amblyopia does not bother the child because there are no symptoms. It is found only by checking the vision in each eye. This can be done fairly accurately in any child three years or older. For this reason, all children should have their vision tested by age four.

The treatment for amblyopia involves forcing the lazy eye to be used more often. Usually this is accomplished by patching the preferred, or good eye. This may have to be continued for several months until each eye sees equally well. Fortunately, it is usually successful in restoring good sight. Sometimes the patching must be continued intermittently until age nine. If the lazy eye is out of focus, eyeglasses may be required, in addition to patching the good eye, to obtain the best sight.

Eye Movement in Children

Many children enter the world with less than 100 percent of their expected visual capacity, a deficiency that is not always obvious to
parents or medical professionals. One sign of possible eye problems, however, is eye movement. Eye movements tell a lot about vision, even if a child is pre-verbal. How well a child follows faces or large objects is a clue to his or her visual abilities. Another indication of a possible disorder is unusual jiggling of a child's eye(s), called nystagmus. These eye movements can be constant or intermittent. They can be horizontal, vertical, oblique, torsional (circular) or combinations of the above. Thus, the study of eye movement can provide important information regarding sight.

Eye Movement Testing

The testing is conducted with sophisticated computer technology and video recording equipment. The specially designed tests can record eye movements in thousandths of a second and fractions of a degree that show the slightest irregularity and patterns of the jiggling.

Eye Movement Analysis

By using electro-oculograms, where small electrodes are placed on the skin around an infant’s eyes, eye movements of children under one year of age can be recorded. (This test is not painful or harmful to the child.) Patients are routinely videotaped for further analysis. The general behavior of the child at the time of the test is also assessed. This system has enabled our researchers to describe and document the different types of eye movements in infants — something that no other center had previously been able to do.

For more accurate recordings of adults and older children, special contact lenses containing fine hairline wires are placed on the eyes and then connected to recording devices. A computer-controlled target is directed onto a screen so that precise areas of the retina can be stimulated, even in randomly moving eyes. The special contact lenses provide horizontal, vertical or torsional recordings with a precision and range not usually available, affording measurements on eyes that cannot accurately track a target.

Vision Testing

The vision of infants, preverbal children and certain adults is measured by a spatial frequency sweep VEP (visually evoked potential). During this test a patient watches a television screen filled with lines, the sizes of which are changed by computer. As the lines are reversed, the brain waves that are generated by vision are recorded until the widths of the lines are too small to be seen. After analyzing these waves, the computer provides highly accurate estimates of the patient's visual acuity.

Another type of VEP uses flashes instead of lines. This test is particularly helpful in determining which nystagmus patients have albinotic traits - those that occur in albino children — and whether the child has any potential for binocular vision.

Because children are always growing and developing, the Foerderer Center provides ongoing testing as the child's condition evolves. Children with eye movement disorders are monitored closely with repeat testing while they are young.

Nystagmus

Nystagmus is a condition where the eyes make repetitive movements. The eyes can jerk exclusively in one direction, or make back and forth movements. With nystagmus, the eye can look jittery and can affect both eyes or just one eye.