Age-Related Eye Diseases and Conditions. Jonathan M. Frantz, MD, F.A.C.S. Cataract and Refractive Surgeon

Size: px

Start display at page:

Download "Age-Related Eye Diseases and Conditions. Jonathan M. Frantz, MD, F.A.C.S. Cataract and Refractive Surgeon"

Angelica Hodges
5 years ago
Views:

1 Age-Related Eye Diseases and Conditions Jonathan M. Frantz, MD, F.A.C.S. Cataract and Refractive Surgeon

2 Vision Changes Patients notice vision changes with aging. Many changes are common and can often be corrected. It is important for PCPs and other specialists to understand how aging and disease affects vision for appropriate referral and treatment to prevent or mitigate vision loss.

3 Eye Diseases and Conditions Diabetic eye disease Age-related macular degeneration (AMD) Cataracts

4 Diabetic Eye Disease Symptoms No early warning signs or symptoms Early detection and timely treatment can reduce the risk of vision loss Treatment options Laser treatment Surgery

5 What is a Retina and where is it? The retina is a thin layer of light sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see. A normal retina

6 What is Diabetic Retinopathy? This is what we call the most common diabetic eye disease Occurs when the blood vessels in the retina change Usually affects both eyes

7 Nonproliferative Diabetic Retinopathy (NPDR) This is the earliest stage of diabetic retinopathy. Damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Causes changes in the eye including: Microaneurysms: small bulges in blood vessels of the retina that can lead fluid. Retinal hemorrhages: tiny spots of blood that leak into the retina. Hard Exudates: deposits of cholesterol or other fats from the blood that lead into the retina. Most common cause of vision loss in diabetes. Macular edema: swelling or thickening of the macula caused by leaked fluid. Macular ischemia: small blood vessels (capillaries) close. This can cause blurred vision.

9 Proliferative Diabetic Retinopathy (PDR) PDR may cause more severe vision loss than NPDR Affects both central and peripheral vision PDR affects vision in the following ways: Vitreous hemorrhage: delicate new blood vessels bleed into the vitreous the gel in the center of the eye- preventing light rays from reaching the retina. Traction retinal detachment: scar tissue shrinks causing the retina to wrinkle and pull from its normal position. Neovascular glaucoma: if a number of retinal vessels are closed, new blood vessels may block the normal flow of fluid out of the eye, causing pressure in the eye to increase.

11 Diabetes, Cataracts & Glaucoma A cataract is a clouding of the eye's natural lens. People with diabetes are 2-5 times more likely than those without diabetes to develop cataract. Cataract also tends to develop at an earlier age in people with diabetes Glaucoma is a disease that initially has no symptoms. Elevated eye pressure leads to damage to the optic nerve, visual field loss, and can lead to permanent vision loss. In adults, diabetes nearly doubles the risk of glaucoma. Because most of these conditions are treatable if detected early, it is critical that diabetic patients have at least annual eye exams.

12 Diabetic Retinopathy symptoms normally affects both eyes but it doesn't have to affect both What are symptoms Diabetic Retinopathy? You can have Diabetic Retinopathy and not be aware. Symptoms may include: Spots, dots or cobweb-like dark strings floating in your vision Blurred vision Vision that changes periodically from blurry to clear Blank or dark areas in your field of vision Poor night vision Colors appear washed our or different Vision loss

13 Diabetic Retinopathy Risk Factors These factors influence the development and severity of diabetic retinopathy: Blood sugar levels, A1C etc. Blood pressure Duration of diabetes Blood lipid levels (cholesterol & triglycerides) Ethnicity Pregnancy

14 Diabetic Retinopathy Diagnosis The only way to detect diabetic retinopathy is through a comprehensive eye exam. It should be done once a year. Testing that is done in the office include: Optical coherence tomography (OCT) A non-invasive scanning laser that provides highresolution images of the retina. Fluorescein angiography A diagnostic procedure that uses a special camera to take a series of photos of the retina using a small amount of yellow dye (fluorescein)

15 Diabetic Retinopathy Treatment Treatment may include: - Medication injections- anti-vegf injections or steroids. Laser treatment for Macular Edema l l This procedure shrinks abnormal new vessels and reduces swelling. Performed in our office. - Vitrectomy Surgery An outpatient surgical procedure to remove blood and scar tissue that accompany normal blood vessels in the eye. This is for more advanced cases.

16 Pearls 1.Diabetic eye disease include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma. 2. All forms of diabetic eye disease can cause severe vision loss and blindness. The earlier it is detected and treated, the better the prognosis. 3. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults. 4. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year. 5. Diabetic retinopathy can be treated with several therapies, used alone or in combination.

17 Macular Degeneration

18 Age Related Macular Degeneration (AMD) Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye s macula. The macula is the small area of the retina, responsible for your central vision, and allows you to see find details clearly. Like threading a needle, reading small print, and street signs Macular Degeneration develops as part of the body s natural aging process. Agerelated macular degeneration is the most common. There are two types: Dry and Wet. It is the leading cause of vision loss among people age 50 and older

19 Dry Macular Degeneration Caused by aging and thinning of the tissues of the macula. Vision loss is gradual. No medication or treatment for dry macular degeneration.

20 Signs & Symptoms of Dry Macular Degeneration Blurry distance and/or reading vision Need for increasingly bright light to see up close Colors appear less vivid or bright Hazy vision Difficulty seeing when going from bright light to low light (such as entering a dimly lit room from the bright outdoors) Trouble or inability to recognize people's faces Blank or blurry spot in your central vision You may not notice vision changes if only one eye is affected, as your unaffected eye can compensate for the affected eye.

Wet Macular Degeneration l l l l 10% of people with Macular Degeneration have the wet form. Wet Macular Degeneration occurs when abnormal blood vessels begin to grow underneath the retina.

21 Wet Macular Degeneration l l l l 10% of people with Macular Degeneration have the wet form. Wet Macular Degeneration occurs when abnormal blood vessels begin to grow underneath the retina. These new blood vessels may leak fluid or blood, which would blur or distort the central vision. Vision loss from this form of macular degeneration may be faster and more noticeable than that from dry macular degeneration. The earlier Wet Macular Degeneration is diagnosed and treated, the better chance of preserving your vision.

23 Signs & Symptoms of Wet Macular Degeneration Distorted vision straight lines will appear bent, crooked or irregular. (Metamorphopsia) Dark gray spots or blank spots in your vision. (Central or paracentral scotoma) Loss of central vision Size of objects may appear different for each eye. Colors lose their brightness; colors do not look the same for each eye

24 Amsler Grid Test Amsler grid every day/week to monitor vision at home. To use it: Cover one eye Focus your uncovered eye on the center dot. Are the lines straight, distorted, blurry or dark?

25 DRY WET

26 Who is at risk for Macular Degeneration? Patients are at risk for Macular Degeneration if: There is a history of Macular Degeneration in your family Researchers had identified nearly 20 genes that can affect the risk of developing AMD Ethnicity more common among Caucasians than among African-Americans or Hispanics/Latinos Natural Aging Smokers (Wet) -smoking doubles the risk High Blood Pressure (Wet)

27 Role of vitamins in AMD Treated? Antioxidant vitamins-- AREDS 2 formula 500 milligrams (mg) of vitamin C 400 international units of vitamin E 25 mg zinc as zinc oxide 2 mg copper as cupric oxide 10 mg lutein and 2 mg zeaxanthin If you have intermediate or late AMD, you might benefit from taking such supplements

28 How else is AMD Treated? AntiVegF injections in the eye Eylea Avastin Lucentis Laser treatment

29 Pearls 1. If you have intermediate or late AMD, you might benefit from taking such supplements. But first, be sure to review and compare the labels. Many of the supplements have different ingredients, or different doses, from those tested in the AREDS trials 2. You may see claims that your specific genetic makeup (genotype) can influence how you will respond to AREDS supplements. After analysis, we do not support the use of genetic testing to guide treatment for AMD 3. AREDS formulation is not a cure. It will not restore vision already lost from AMD, but it may delay the onset of late AMD. It also may help slow vision loss in people who already have late AMD. 4. Not everyone with early AMD will develop late AMD. 5. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. 6. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years. 7. With prompt detection of AMD, there are steps physicians can take to further reduce the risk of vision loss from late AMD.

30 WHAT IS A CATARACT? Clouding of the normally clear lens of the eye Most often the result of aging Things look blurry, hazy or less colorful Natural Clear Lens Natural Lens with Cataract

31 SYMPTOMS OF CATARACTS Colors lose their brilliance Vision can become hazy, cloudy or blurry Routine daily activities such as driving become increasingly difficult as vision continues to deteriorate WITH CATARACTS WITHOUT CATARACTS

32 When your cataracts make it difficult for you to carry out normal activities it might be time for Cataract Surgery.

33 CATARACT TREATMENT The only treatment for cataracts is surgery, during which the cloudy natural lens of the eye is removed and is replaced with an intraocular lens (IOL).

34 CATARACTS AND SYMPTOMS Colors lose their brilliance Vision can become hazy, cloudy or blurry Routine daily activities such as driving become difficult as vision continues to deteriorate Cataract Symptoms which indicate cataract surgery should be helpful

35 TRADITIONAL CATARACT SURGERY The Procedure Your eye will be treated with anesthetic prior to the procedure so you ll feel little, if any, discomfort. Tiny incision is made to allow a small instrument (about the size of a pen tip) to break up the cloudy cataract. Phacoemulsification

36 NEARSIGHTED VS FARSIGHTED Nearsightedness occurs when light entering the eye is bent too strongly and focuses in front of the retina Farsightedness occurs when light entering the eye is not bent strongly enough and focuses behind the retina

37 ASTIGMATISM When the front of the eye is not perfectly round but instead is shaped more like a football than a basketball. Results in 2 focal points causing blurred vision both distance and near. Over 60% of the population has visually significant astigmatism. If Left untreated, expect to need glasses for distance as well as intermediate and near vision.

38 You Have Choices Refractive Cataract Surgery Dropless laser cataract surgery Minimize need for glasses by correcting astigmatism and/or using premium IOL Considered cosmetic - not covered by insurance Basic Cataract Surgery Manual dropless cataract surgery Basic monofocal intraocular lens (IOL) Expect to need glasses after surgery Basic benefit covered by insurance

39 BASIC MONOFOCAL IOL Until recently monofocal IOLs were widely used These provide only one point of focus usually distance Spectacle correction required for near, intermediate and possibly distance visual activities Monofocal IOL

40 LIFESTYLE LENS Provides a full range of vision Decreases dependency on glasses

41 NEWEST TECHNOLOGIES Laser Cataract Surgery: The SAFEST and MOST PRECISE way to remove a cataract. Verion image guided system. Only one is SW Florida Laser Astigmatism Correction much better using laser than manual blade ORA intraoperative power measure to insert the best power lens Reduce dependence on readers with Lifestyle Lenses Using No Drops after surgery (Dropless)

H-D OCT TECHNOLOGY Excellent Scan Depth and Analysis Ability to image anterior cornea to posterior capsule in one single image Actual real-time

42 H-D OCT TECHNOLOGY Excellent Scan Depth and Analysis Ability to image anterior cornea to posterior capsule in one single image Actual real-time image-guided planning and monitoring Not a computer generated animation High-contrast resolution Clearly visualize all anterior segment structures

43 ACTUAL LENSX LASER PROCEDURE

44 ORA SYSTEM WITH VERIFEYE OPTIWAVE REFRACTIVE ANALYSIS Optiwave technology provides real-time intraoperative measurements of your eye that allows us to adjust your procedure on the operating table to further customize your surgery and enhance the quality of your vision.

45 DROPLESS THERAPY PATIENT BENEFITS Support physically and/or mentally challenged patients Eliminate compliance challenges of proper dosing Lift burden from family members/caregivers assisting with instillation Put patients with Eye Drop Phobia at ease Avoid pharmacy issues: premature refills, generic switches, QID/BID dose alterations Help extended care patients in nursing facilities Aid patients without insurance, money or access to sample drops Ø Osteoarthritis Ø Rheumatoid Arthritis Ø Scoliosis Ø Parkinson s Ø Kyphosis Ø Alzheimer s Ø Dementia Cost savings to you Safety

46 CATARACT SURGERY LOWERS RISK OF OSTEOPORISIS & FRACTURES IN SENIORS Journal of the American Geriatrics Society study evaluated 57,972 individuals who had cataracts & 57,972 patients who did not have cataracts over 6.4 years. The diagnosis of cataracts was associated with a 29% increased risk of developing osteoporosis and fracture. Patients who underwent cataract surgery had a 42% lower risk of developing osteoporosis or fracture (nearly half).

47 THANK YOU Questions? BetterVision.net

The Human Eye. Cornea Iris. Pupil. Lens. Retina

The Human Eye. Cornea Iris. Pupil. Lens. Retina The Retina Thin layer of light-sensitive tissue at the back of the eye (the film of the camera). Light rays are focused on the retina then transmitted to the brain. The macula is the very small area in