Gordon Newbern, MD

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• General Ophthalmology

  Comprehensive Eye Examination Regular eye examinations are important in maintaining eye health. During a comprehensive eye examination, eye diseases or other abnormalities that are not yet causing symptoms can be detected. Early intervention is crucial in preventing vision loss from a disease such as glaucoma, which may not cause symptoms until significant and irreversible damage has taken place. Early detection of eye problems gives a patient a choice of treatment options and reduces the risk of permanent damage. Benefits of a Comprehensive Eye Examination A comprehensive eye exam should be performed once every year. Children should have regular tests to ensure that their vision is normal so that their schoolwork does not suffer. Older adults are at higher risk for eye conditions such as glaucoma, macular degeneration and cataracts. During a comprehensive eye examination, simple refractive errors are detected, and serious eye problems or diseases, including the following, are diagnosed: Glaucoma Diabetes Macular Degeneration Thinning of the peripheral retina Even in younger, healthy adults who are asymptomatic, a regular eye examination is essential. Serious medical conditions, such as high cholesterol, diabetes, and high blood pressure, can be detected, allowing patients to seek treatment early. Many other health conditions may first present with eye findings which is why eye exams are an essential and important component of maintaining overall health. The Comprehensive Eye Examination Procedure In order to evaluate the eyes thoroughly and detect any problems, the following tests may be performed: Visual acuity Refraction Slit lamp examination Test of intraocular pressure Glaucoma screening Retina examination Possible Treatments Based on the diagnostic findings of the examination, eyeglasses or contact lenses, medication for infection or inflammation, and vitamins or other supplements may be recommended. In some cases, eye surgery may be necessary. Common Refractive Errors The most common eye conditions diagnosed during a comprehensive eye exam involve refractive errors that cause blurry vision. These conditions affect millions of people in the United States, and often get progressively worse as patients age. Refractive errors are easily treated. Myopia Also known as nearsightedness or shortsightedness, myopia is a condition of the eyes in which nearby objects are clear, and distant objects are blurry. Almost a third of people in the United States have some degree of nearsightedness. Hyperopia Also known as farsightedness, hyperopia is a condition of the eyes in which the focus on distant objects is better than the focus on objects closer to the eye, making nearby objects appear blurry. The eye is designed to focus images directly on the surface of the retina; with hyperopia, light rays focus behind the surface of the retina, producing a blurry image. Astigmatism Astigmatism occurs when curvature of the eye is irregular. There are two types of astigmatism: corneal, in which the shape of the cornea (the clear covering of the eye) is irregular, and lenticular, due to the shape of the lens. Corneal astigmatism is more common. Astigmatism can result in blurred vision at any distance. Presbyopia Presbyopia, meaning "old eye," is a condition in which the eyes lose their ability to focus on close objects. It is considered a normal part of the aging process. Symptoms typically begin when patients are between 40 and 45 years old. All of these vision conditions can be effectively treated with either eyeglasses or contact lenses. Corrective lenses may need to be used only during certain activities, such as reading, watching television or driving, or may always be needed. Comprehensive eye examinations are essential in checking for vision problems, eye diseases, refractive errors, and overall health. How frequently the eyes should be examined is based on the patient's age and specific circumstances.

  Link: General Ophthalmology

• Diabetic Eye Disease

  Diabetes is due to the inability of the body to control blood sugar levels. The longer one has Diabetes, thus a longer period of uncontrolled blood sugar leading to increased risk of complications damaging the vessels supplying the vital organs such as kidneys and eyes, neuropathy, heart disease, and stroke. Patients with Diabetes are at a higher risk of developing eye conditions as a complication of their disease. These conditions can lead to vision loss and blindness and include diabetic retinopathy, cataracts, and glaucoma. Diabetic retinopathy is one of the most common serious complications and a leading cause of blindness worldwide. Diabetic eye conditions often develop without any noticeable loss of vision or pain, so significant damage may have occurred by the time the patients notice any symptoms, thus important for Diabetic patients to have regular eye exams. Early detection of eye disease can help prevent permanent damage. Diabetic eye problems develop from high blood sugar which causes damage to blood vessels in the eye. istock 912585344 Causes of Diabetic Eye Conditions Diabetic eye conditions affect different parts of the eye but is most common with most serious complications in the retina as a result of microvascular abnormalities. The tiny blood vessels within the retina develop microaneurysms that, over time, leak blood. As new blood vessels develop to replace the blood vessels that are no longer viable, they also leak blood causing hemorrhages, retinal detachment and permanent damage to the retina. Diabetic retinopathy has multiple stages. Diagnosis of Diabetic Eye Conditions Diabetic eye conditions often develop without any noticeable loss of vision or pain, so significant damage may have occurred by the time patients notice any symptoms. For this reason, it is important for diabetic patients to have their eyes examined at least once a year or more frequently depending on how well diabetes is controlled. Early detection of eye disease can help prevent permanent damage. Treatment of Diabetic Eye Conditions Treatment options depend on the severity of your diabetic eye disease. Regular follow-ups are imperative in reducing the chances of losing vision. While you may not need treatment right away, as diabetic eye disease progresses, proliferative retinopathy may require treatments preventing vision loss from macular edema. These treatment options may include medicine injection into the eye and/or using laser treatments. In cases of retinal detachment, surgery may be needed. Early detection is key in identifying potential complications and assessing the risk of progression.

  Link: Diabetic Eye Disease

• Cataracts

  Cataract is part of normal aging. Each year, cataract affects millions of people, including more than half of all older than 60. A cataract is a painless clouding of the eye's natural lens. If left untreated, cataracts worsen over time and can interfere with everyday activities such as reading or driving. Night vision is usually most affected. When cataracts are in their early stages, people are helped by brighter lighting. As cataracts get worse, however, many people may require surgery. istock 653477902 Risk Factors for Cataracts The most common cause of cataracts is aging. In addition to aging, the following other factors can increase the risk of developing cataracts: Diabetes Smoking Obesity Excessive exposure to sunlight Exposure to upper body radiation Family history of cataracts High blood pressure Previous eye injury or eye surgery Prolonged use of corticosteroid medications Diagnosis of Cataracts Several tests, including the following, are performed to diagnose cataracts: Visual acuity test Slit-lamp examination Retinal examination In combination, such tests help determine whether a patient has cataracts, or whether her or his vision problems have some other cause. They also assist in evaluating the degree of visual impairment, and whether surgery should be performed. Symptoms of Cataracts People with cataracts often do not realize they have them until vision is affected. Cataract symptoms include the following: Blurred, hazy or double vision when looking through one eye Decreased color perception Sensitivity to bright light and glare at night Poor night vision Perception of halos around lights Frequent changes in corrective-lens prescriptions Treatment of Cataracts Early cataracts can sometimes be treated with non-surgical methods, including the following: New corrective-lens prescriptions Anti-glare sunglasses Magnifying lenses Brighter lighting If cataracts begin to interfere with reading ability, work, night driving, or other daily activities, cataract surgery may be recommended Prevention of Cataracts Although there is no evidence that cataracts can be prevented, their development can sometimes be delayed by the following: Wearing sunglasses that block ultraviolet rays Not smoking; not drinking excessively Eating a healthy diet high in antioxidants

  Link: Cataracts

• Glaucoma

  Glaucoma is a group of diseases that damage the optic nerve, often resulting in vision loss and possibly blindness. Glaucoma, a leading cause of blindness and visual impairment, can affect patients of all ages but is more common in older adults. Glaucoma is the number one preventable cause of blindness in the world. Many people affected with glaucoma do not experience any symptoms and may not be aware that they have the disease until they have lost a significant amount of vision. With early detection and treatment, however, eyes can be protected against the serious loss of vision or blindness. Catching glaucoma at an early, treatable stage is one important reason to have thorough eye examinations regularly. istock 1058808838 Risk Factors for Glaucoma There are several factors that increase the risk of developing glaucoma, including: Being over the age of 60 Having a family history of glaucoma Having elevated intraocular pressure Having a history of a major eye injury or trauma Having certain medical conditions, like diabetes Taking certain medications, such as corticosteroids for prolonged periods Patients with risk factors for the disorder should be especially vigilant about having regular eye examinations. Causes of Glaucoma Certain diseases or conditions can contribute to the development of glaucoma. These include: Increased pressure within the eye Severe eye infection Injury to the eye Blocked blood vessels Inflammatory conditions of the eye Glaucoma is considered primary if its origin is unknown and secondary if it results from another medical condition. Types of Glaucoma There are several types of glaucoma. The two most common types are Primary Open Angle Glaucoma and Angle Closure Glaucoma. The most common type of glaucoma is primary open-angle glaucoma. Narrow-angle glaucoma can lead to angle-closure which can acutely increase the pressure in the eye causing damage to the optic nerve. Childhood glaucoma may start in infancy, childhood, and adolescence. Other types of glaucoma, which occur much more rarely, include: Low Tension Glaucoma Congenital Glaucoma Secondary Glaucoma Pigmentary Glaucoma Pseudoexfoliation Glaucoma Symptoms of Glaucoma It is important to remember that patients with early-stage glaucoma are most often asymptomatic. When symptoms occur, they vary depending on the type of glaucoma and can occur in one eye or both eyes. There are usually no warning signs or symptoms of Open-Angle Glaucoma. Some symptoms of open-angle glaucoma may include: Gradual loss of peripheral vision Tunnel vision (at advanced stages) The symptoms of angle-closure glaucoma due to a sudden increase in intraocular pressure from the closure of drainage canals may include: Eye pain Nausea and vomiting Blurred vision Halos around lights Red eyes Headache Diagnosis of Glaucoma The diagnosis of glaucoma is made after a comprehensive medical examination of the eye and a review of the patient's medical history. Tests are conducted to confirm the diagnosis. Testing may include some of the following: Eye pressure measurement Picture of optic nerve and measurement Dilated eye examination Visual field test (perimetry) Retinal evaluation Measuring corneal thickness Inspecting the drainage angle Visual acuity test Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. Treatment of Glaucoma There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage. Some of the treatment methods for glaucoma are as follows: Eyedrops Oral Medications Surgery Depending on your situation, your treatment could involve a combination of methods. Your doctor will determine the right treatment for you during your evaluation.

  Link: Glaucoma

• Dry Eye

  Millions of people are affected by Dry Eyes. Dry eye is a common condition in which the eyes are insufficiently lubricated, leading to redness and pain. The eyes can become dry and irritated because there is an insufficient amount of tears being produced, or because there is an imbalance in the makeup of the tears themselves. Tears are necessary to maintain a healthy ocular surface and provide sharp vision. The tears drain through ducts in the inner corners of eyelids and flow to the back of the nose. Tear film has three layers: Lipid layer (outermost layer), Aqueous Layer in the middle, and Mucin Layer (innermost layer). Alleviating the symptoms of dry eye is important. Left untreated, they have the potential to damage vision due to inflammation and scarring. Dry eye may be due to Meibomian gland dysfunction which leads to reduced oil in the oily layer of the natural tear film leading to evaporative loss as it is not able to protect the aqueous or water layer of the eye. (Meibomian glands are present in the eyelids). The Lacrimal Glands contribute to the aqueous layer of the tear film, required for maintaining a healthy ocular surface. image Causes of Dry Eye People of all ages may be affected by dry eyes. It can result from certain medications, medical conditions or injuries. Dry eye tends to affect women more than men because of the hormonal changes that take place during pregnancy and menopause. Oral contraceptives can also affect the consistency of tears. Other causes of dry eye include the following: Oral medications including: Antihistamines, decongestants, blood pressure medications, antidepressants. Rheumatoid arthritis, diabetes, Sjögren's syndrome, and thyroid disease Environmental conditions such as smoke, wind or excessive sun Long-term contact lens use Eye injury Eye or eyelid surgery Inflammation of the eye (conjunctivitis or keratitis), blepharitis Any of these factors, alone or in combination, can affect the frequency or consistency of tears, either of which can lead to dry eye. Symptoms of Dry Eye The symptoms of dry eye typically occur in both eyes, and include the following: Stinging, burning or scratchiness Eye fatigue Sensitivity to light Difficulty wearing contact lenses Excessive tearing Blurry vision Dry eye can damage eye tissues, leaving tiny abrasions on the surface that can impair vision. There are, however, many treatments for relieving dry-eye symptoms, restoring eye health, and protecting vision. Treatment of Dry Eye Treatment for dry eye depends on its cause and severity, as well as the patient's overall health and personal preference. Nonsurgical treatments, which include the following, are often effective: Deliberately blinking/ increasing rate of blinking Increasing humidity levels at home and at work Using artificial tears or a lubricating ointment Avoiding environmental irritants Eliminating medications that may be responsible Adding Omega-3 fatty acids to the diet or taking them as supplements Insertion of punctal plugs to limit tear drainage Punctal cautery to permanently close the drainage holes Treatment of an underlying disease If an eyelid condition is causing dry eye, eyelid surgery may be recommended. If dry eye is left untreated, it can lead to complications that include pain, corneal ulcers/scars or vision loss. Artificial tears and ointments over the counter to provide lubrication to the ocular surface are temporary measures to provide relief. Serum Tears from a patient's own blood containing proteins and growth factors to improve the health of the ocular surface. Prescription eye drops are also available to address the causes of dry eye such as inflammation and improve tear film quality. LipiFlow Treatments Lipiscan is a high definition imaging that helps to identify structural changes to the meibomian glands and allows capturing and storing the images of these glands which are vital to the health of the ocular surface. LipiFlow is a treatment available for evaporative dry eyes due to meibomian gland disease with deficient lipid production. The LipiFlow system applies local pulsed heat to the eyelids for patients with Meibomian Gland Dysfunction using a sterile single-use device called an Activator. It helps improve and relieve the blockage of the meibomian glands which contribute to the lipid layer of the tear film. image 2 Preventing Dry Eye There are steps that can be taken to prevent dry-eye symptoms. Simple lifestyle modifications such as wearing protective glasses on windy days and giving the eyes a break during reading or other tasks that require intense focus can effectively reduce the frequency and severity of symptoms. Humidifiers may be used to increase humidity to the living environment at home and at work.

  Link: Dry Eye

• Eye Allergies

  What are allergies? Millions of people are affected by seasonal allergies with swollen, itchy and red eyes due to tree pollen, ragweed, house dust and animal dander. Allergies are abnormal responses of the immune system to normally harmless substances. These substances are known as allergens. Some of the most common allergens affecting the ear, nose and throat are pollen, dust, mold and animal dander. When the body is exposed to an allergen, it releases a variety of chemicals, including histamine. Histamine is the precipitating cause of the allergic reaction. istock 684810440 What causes allergies? The precise cause of allergies remains unknown, but a hereditary factor may be involved. If one parent has allergies, his or her child is much more likely than the general population to have allergies. If both parents suffer from allergies, a child has a greatly increased risk of developing an allergy. The specific allergen affecting the child may be different from the one affecting the parent. Allergies may develop over time once a threshold of exposure has been reached. Common triggers for allergies may include: Specific foods Bee/wasp stings Medications Animal dander Pollen Dust How can allergies be treated? The most effective way to treat allergies is simply to avoid exposure to allergens but, of course, this is not always possible. For outdoor allergies, remaining indoors as much as possible during certain seasons may relieve symptoms. Because allergens often enter the body through the eyes, wraparound sunglasses may also prove helpful. Other treatments include antihistamines, decongestants, nasal sprays and eye drops. Allergy shots, a type of immunotherapy, may also be used as treatment. To increase a body's tolerance, an allergen is injected at increasingly larger amounts over time.

  Link: Eye Allergies

• Age-Related Macular Degeneration

  Age-related macular degeneration (AMD) is the most common cause of vision loss in individuals over the age of 50. The name of the condition derives from its cause: damage to the macula, the most sensitive spot on the retina, required for clarity in the center of the vision. Damage to the macula results in retinal tissue degeneration that gradually worsens, diminishing or destroying central vision. The speed at which AMD advances is variable. In some patients, the condition progresses slowly and the changes in vision are imperceptible for some time. In others, the disease moves at an accelerated pace, leading relatively quickly to loss of central vision in one or both eyes. While AMD does not result in complete blindness because some peripheral vision always remains, it does make ordinary activities, particularly those that require close visual acuity, increasingly difficult. istock 963177108 Types of Macular Degeneration Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Dry macular degeneration is the more common diagnosis and is considered to be an early stage of the disease. This form of the disorder usually develops as the macular tissues thin during aging. Deposits of pigment within the macula may also occur. In only a small percent of patients does the condition progress to the more advanced form of the disease. If this occurs and the patient develops wet macular degeneration, new abnormal blood vessels develop beneath the macula, causing a leakage of blood and fluid. This leakage can lead to the creation of blind spots and permanent damage to central vision. The exact cause of macular degeneration is not exactly known. Early detection is key in preserving vision and preventing vision loss for a longer period. Risk Factors for Macular Degeneration As people age, everyone is at risk for macular degeneration, but some people are at elevated risk due to genetic and/or environmental factors. Macular degeneration is most common in females and people with light eye color, and the risk for all patients increases as they age. Individuals over the age of 50 with a family history of the disease are at increased risk of developing AMD. Environmental factors may also increase risk. Other factors that may increase the risk of developing macular degeneration include: Hereditary Obesity Blue Eye color Smoking High fat diet Elevated cholesterol levels Prolonged sun exposure High blood pressure Certain medications Patients can minimize their risk of macular degeneration by exercising, eating a diet rich in Omega-3 fatty acids, and getting regular eye examinations. Symptoms of Macular Degeneration Just as there are a number of signs that indicate the presence of AMD to the Ophthalmologist, there are a number of symptoms experienced by the patient. Visual symptoms of macular degeneration may include: Shadowy areas in the central vision Fuzzy and distorted vision Difficulty perceiving color Difficulty seeing fine details Blind spots in central vision Wavy lines Gradual lessening of color perception Distorted or blurry vision Dimmed vision, especially when reading Dark spots in the center of the visual field If the disease progresses to the wet form, patients may also perceive straight lines as wavy or crooked, and have larger and larger blind spots, increasingly losing central vision. With wet macular degeneration, central vision loss can occur rapidly, sometimes in as little as a few days or weeks. Macular degeneration may necessitate many lifestyle changes as it progresses. Patients may lose the ability to drive, have difficulty reading, and have difficulty recognizing faces. Because they retain peripheral vision, however, they usually remain capable of managing independently. Diagnosis of Macular Degeneration The Ophthalmologist may be able to detect early signs of macular degeneration through a regular eye examination while the patient is still asymptomatic. Any signs of this condition can be further confirmed by testing a patient's central vision with an Amsler grid test. Treatment of AMD While there is not yet a cure for macular degeneration, many patients have been helped greatly by recent innovations in treatment. Regular eye exams to facilitate early detection of AMD are essential since most therapies work best when started at an early stage of either type of the disorder. It is essential for patients with macular degeneration, wet or dry, to seek continuous medical treatment to manage the condition and prevent permanent vision loss. Even though treatments cannot reverse the disease process, they are often able to stop the progression of symptoms so the patient can maintain as much vision as possible.

  Link: Age-Related Macular Degeneration