DIABETIC EYE DISEASE
Patients with diabetes are advised to have annual eye exams due to the risk of diabetic eye disease which could lead to reduced vision. High blood sugar over time damages the small retinal blood vessels causing leakage of fluid and blood as well as deposits in the layers of the retina, growth of fragile new blood vessels and eventually scar tissue.
The best defense against vision loss from diabetes is good blood sugar control and routine eye exams.
As part of the annual diabetic eye exam, the doctors at Romeo Optometry recommend Optical Coherence Tomography (OCT). This is a non-invasive test which uses light waves and reflectance to take cross sectional images of the retina. This image aids diagnosis and guides treatment of Diabetic Eye Disease. If there is significant risk of vision loss, patients will be referred to a retinal specialist for possible treatment.
OHIP covers annual eye exams for patients with diabetes and rechecks during the year if necessary due to diabetic eye disease.
AGE-RELATED MACULAR DEGENERATION
Age-related macular degeneration (ARMD) is deterioration of the macula detail we direct our eyes so the image lands on the macula where the retinal cells are densely packed together to provide high resolution vision. As macular degeneration progresses the vision becomes blurred or distorted, making these tasks more difficult. ARMD does not affect peripheral vision.
There are 2 main types of ARMD, Dry and Wet.
Over 80% of cases are classified as Dry ARMD progressing to the more severe Wet ARMD.
Wet ARMD which is less common occurs when new fragile blood vessels. These vessels can leak blood and fluid which eventually causes scarring of the photoreceptor cells and significant vision loss.
Wet ARMD is a medical urgency. Treatments are available to slow the progression of Wet ARMD. Medications called anti-VEGF agents are injected at regular intervals into the eye to reduce new blood vessel growth and swelling in the retina preserving visual acuity.
Risk factors for ARMD are aging, heredity, smoking, obesity, inactivity and Early signs of ARMD can be detected during a retinal exam making it important when over 40 to have regular eye exams. As part of early detection and monitoring of ARMD the doctors at Romeo Optometry use Optical Coherence Tomography (OCT) to obtain high resolution images of the retina at the macula.
Cataract refers to cloudiness of the eye’s natural lens. Cataract can happen at any age, even newborn babies (Congenital Cataract), but it is most prevalent with aging as the proteins forming the natural lens change causing it to become denser, less flexible and less transparent.
An early stage cataract may have little effect on your vision other than a possible change of spectacle prescription. As it progresses, cataract could cause blurred or hazy vision, glare sensitivity or halos especially with lights at night and a dulling of bright colours.
Cataract surgery will be considered when the vision changes seriously impair your vision and affect your life. During surgery the clouded natural lens is removed and replaced with an intraocular lens (IOL), often referred to as an implant. By measuring your eye and properly choosing the power of the IOL the ophthalmologist (surgeon) can significantly reduce the patient’s refractive error
(nearsightedness, farsightedness, astigmatism and presbyopia). Cataract surgery is effective, painless and in most cases performed in an out-patient clinic under local anesthetic.
The doctors at Romeo Optometry have referral and co-management relationships with a number of surgeons and private clinics in the area. The decision of when and where to send a patient for cataract surgery, will always be made by the optometrist and patient together after a thorough discussion.
Diagnosis of glaucoma at an early stage is essential to maintain vision.
Glaucoma is a serious eye disease that can cause blindness by damaging the optic nerve which carries the visual image from your eyes to your brain. In most cases of glaucoma this damage is due to an increased fluid pressure or intraocular pressure (IOP) inside the eye. Clear fluid is constantly produced by a structure called the ciliary body and pumped into the eye. Fluid drains back into the blood stream through a structure called the trabecular meshwork located in the angular space where the front of the iris and the back surface of the cornea meet. If this drainage system narrows or is clogged, fluid backs up into the eye and pressure increases. There is a hereditary link for glaucoma with an increased risk especially if you have a parent or sibling affected.
Most types of glaucoma have no symptoms in the early stages and can only be detected during a comprehensive eye exam. If untreated, glaucoma initially causes peripheral vision loss and can eventually lead to blindness. Vision loss from glaucoma is permanent.
Primary open-angle glaucoma (POAG) is most common. In POAG the trabecular meshwork looks normal and the drainage angle is open however the amount of fluid leaving the eye is reduced and pressure increases.
Angle-closure glaucoma is less common but can be acute with a sudden increase in IOP and severe symptoms such as halos around lights, eye pain, blurred vision, nausea and vomiting. This is a medical emergency. If you experience these symptoms see an eye doctor or go to an Emergency Room immediately to have your IOP reduced to prevent permanent vision loss.
There is a rare condition called Normal Tension Glaucoma in which the IOP remains normal however the optic nerve damage and vision loss still occurs. Treatment is still effective in Normal Tension Glaucoma.
At Romeo Optometry the Intraocular Pressure (IOP) and the structure and function of the optic nerve are assessed during your routine comprehensive eye exam. If there is suspicion of glaucoma, extra testing will be necessary such as repeat IOP measurements, Automated Visual Field Testing and imaging of the optic nerve by Optical Coherence Tomography (OCT). It is quite common to monitor a patient at risk for glaucoma over months or years before a definitive diagnosis is made.
Your optometrist may start treatment for glaucoma at the time of diagnosis or preventatively for high risk patients. The most common initial treatment for glaucoma are topical medications (eye drops), used daily, to reduce IOP. In some cases laser surgery or other glaucoma surgeries may be indicated. The doctors at Romeo Optometry work in close collaboration with glaucoma specialists and will make referrals where indicated.
It is important to remember that glaucoma is a chronic condition and once diagnosed will need to be controlled for the rest of your life to prevent vision loss.
DRY EYE DISEASE
If you have dry eye you are not alone. This irritating condition is very common. In fact, a 2016 study estimated that over 20% of people in Ontario report symptoms of dry eye. Those symptoms include grittiness, redness, foreign body sensation, itchiness, watery eyes, blurred vision, burning, light sensitivity and eye fatigue.
There are 2 main types of Dry Eye Disease (DED). The most common, Evaporative Dry Eye, is caused by a lack of oil causing the tear film to evaporate too quickly. This is especially troublesome in dry or windy environments or when we blink less as we do when using a computer, a cell phone or a tablet. Less common is Aqueous Deficient Dry Eye due to the lacrimal gland failing to produce enough of the watery component of tears to coat the surface of the eye.
As part of your eye exam at Romeo Optometry, you will be asked to fill in a short 5 point questionnaire concerning the symptoms of dry eye. If your answers indicate the possibility of Dry Eye Disease the doctors will recommend extra diagnostic tests which provides analysis of your tear film aiding diagnosis and guiding treatment.
Treatment plans are individual and may include procedures such as BlephEx, iLux or IPL all provided in our Dry Eye Clinic.