Ocular Disease Testing & Treatment

Cataracts

What is a cataract?
A cataract is a clouding of all or part of the crystalline lens within your eye. The crystalline lens is a normally clear lens, which sits behind the colored part of your eye (the iris) and is responsible for focusing.

What causes a cataract?
No one knows exactly what causes cataracts, but it is known that a chemical change occurs within your eye to cause the lens to become cloudy. Cataracts are most often found in persons over age 50, but they are also occasionally found in younger people. They can also be hereditary or the result of an injury or disease. Risk factors include: excessive exposure to ultraviolet radiation in sunlight, cigarette smoking, or the use of certain medications.

How do I know if I am getting a cataract?
Although cataracts develop without pain or discomfort, there are some indications that a cataract may be forming. Symptoms include:

• Blurred or hazy vision,

• The appearance of spots in your vision,

• Increased sensitivity to glare, or

• The feeling of having a film over the eyes.

• A temporary improvement in near vision may also indicate formation of a cataract.

What can I do to prevent cataracts from forming?
Currently, there is no proven method to prevent cataracts from forming although wearing eyeglasses and sunglasses with UV protection and wide brimmed hats is often recommended. During a comprehensive eye examination, we can diagnose a cataract and monitor its development and prescribe changes in eyeglasses or contact lenses to maintain good vision.

If your cataract develops to the point that it affects your daily activities, we can refer you to an eye surgeon who may recommend surgery. During the surgery, the eye’s natural lens is removed and usually replaced with an artificial lens. After surgery, you can return to our office for continuing care.

Macular Degeneration

What is Macular Degeneration?
Macular Degeneration, also known as Age-related Macular Degeneration or AMD is the leading cause of blindness in Americans over the age of 50. The Centers for Disease Control and Prevention estimate that 1.8 million people have AMD and another 7.3 million are at substantial risk for vision loss from AMD. It results from changes to the macula, which is part of the retina. The retina is the light sensitive tissue that lines the back of the eye, and the macula is the portion of the retina that is responsible for clear, sharp vision, and is located at the center of the retina.

CLICK HERE to learn more about our Age-related Macular Degeneration Center of Excellence®!

What symptoms are associated with AMD?
Symptoms of macular degeneration are subtle at first, but include:

• A gradual loss of ability to see objects clearly,

• Distorted vision,

• A gradual loss of color vision and

• Dark or empty areas appearing in the center of vision.

If you experience any of these, contact our office immediately for a comprehensive examination.

How is AMD diagnosed?
AMD is diagnosed by having a thorough eye examination which includes dilation and retinal photos. Retinal photos lead to earlier detection of AMD in the beginning stages resulting in improved recommendations to modify lifestyle and prevention of greater loss of vision. An OCT which images the internal retinal structure may also be used for diagnosis and monitoring for progression. Genetic testing may also be recommended, not necessarily for diagnosis, but to help determine your risk of progression and also to help determine the most appropriate supplement to take.

What types of AMD are there?
Macular degeneration is divided into two types: a “dry” or atrophic and a “wet” or exudative form. Most people with macular degeneration have the dry form. With the dry form, the macular tissue gradually thins and stops functioning properly. Although the dry form is less likely to lead to severe vision loss, it still has the potential to ‘burn out’ leading to vision loss that cannot be restored. There is no known cure for the dry form of macular degeneration, but improving nutrition through diet and/or nutritional supplements can slow the progression of the disease. Dietary changes favoring low-fat content and dark green leafy vegetables and dark red and blue berries can slow vision loss. On a yearly basis, about 10% of those who have the dry form of AMD will transition to the wet form of AMD.

Wet Macular degeneration is the less common form of the disease and occurs when fluid leaks from newly formed blood vessels under the macula. This leakage results in blurred central vision leading to more severe vision loss. This is the more advanced form of the disease.

Is wet macular degeneration treatable?
Fortunately there are treatments for wet macular degeneration. The wet form may respond to laser procedures, as well as certain medications that are injected into the eye, if diagnosed and treated early. These are not permanent cures, but help slow the rate of central vision loss.
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In cases where vision is decreased or when treatment has not been successful, the vision that is lost to macular degeneration cannot be restored. However, there are specialized optical devices (called low vision devices), such as telescopic and microscopic lenses that can be prescribed to make the most out of remaining vision.

What are the risk factors for AMD?
Risk factors include age, light skin color (Caucasians), blue eyes, history of sunlight exposure, exposure to short wavelength blue light, smoking, diabetes, hypertension, and nutrition. Genetics also play a role in the development of AMD.

Can I prevent macular degeneration?
Although we have no control over certain risk factors such as age, race and genetics we certainly have control over other risk factors such as whether we choose to smoke or not, what foods we eat, whether we choose to take appropriate supplements, if we exercise and control our weight and monitor any diabetes or hypertension, if we wear proper sun protection when outdoors and if we protect our eyes against short wavelength blue light radiation (which has been shown to cause AMD) both indoors and outdoors. Our actions can make a difference resulting in a lower risk of getting macular degeneration.

Here are some things that you can do to lower your risk of getting macular degeneration, including:

• A healthy diet

• low in salt intake

• Eating plenty of green leafy vegetables, such as spinach, cabbage, kale, turnip greens, etc.,

• Brightly colored vegetables, such as beets, carrots, etc.

• Eating dark red and blue berries

• No smoking (smoking is the single biggest risk factor for macular degeneration)

• Exercise

• Wear proper sun protection (especially blue filtering lenses)

• Wear blue filtering lenses when using the computer, smart phone and tablet

• Take eye-friendly supplements containing lutein, zeaxanthin and/or mesozeaxanthin such as MacuHealth

Glaucoma

Glaucoma Treatment By St. George Eye Doctor, Dr. Fife

What is glaucoma?
Glaucoma is a group of eye disorders leading to progressive damage of the optic nerve, and is characterized by loss of nerve tissue resulting in loss of vision. The optic nerve is the nerve that connects the eye to the brain.

What are the risk factors for glaucoma?
People with a family history of glaucoma, African Americans, and those who are very nearsighted or diabetic are at a higher risk of developing the disease. It most often occurs in people over age 40.

What symptoms will I notice if I have glaucoma?
Unfortunately glaucoma, known as the ‘Silent Thief of Sight’, usually does not have any symptoms until the disease is in the end stage. This makes it important to have your eyes examined regularly and tested as directed by your doctor. Although there typically are no noticeable symptoms, that may depend on the type of glaucoma. There are several types of glaucoma.

The most common type, open angle glaucoma, develops gradually and painlessly, without symptoms. The pressure inside the eye becomes too great and slowly crushes the optic nerve which leads to a loss of peripheral (side) vision.

In normal tension glaucoma, eye pressure may be normal, yet damage still occurs to the optic nerve. We’re not quite sure why this occurs, but it is thought that it may be due to poor perfusion pressure or inadequate nutrients reaching the optic nerve from the blood supply. A recent study has shown that if you subtract your diastolic pressure from your eye pressure and the number totals less than 50, you may be at a higher risk of glaucoma progression. Additionally, breathing disorders such as sleep apnea may be a risk factor for this type of glaucoma.

A rarer type, closed angle glaucoma, occurs rapidly and its symptoms may include blurred vision, loss of side vision, seeing colored rings around lights and pain or redness in the eyes.

End stage glaucoma, regardless of the cause, has symptoms of significantly decreased peripheral (side) vision which may lead to complete loss of vision.

What will happen if I have glaucoma and don’t know?
Untreated glaucoma can cause complete and irreversible blindness. This makes glaucoma a serious eye disease and is the second leading cause of blindness in the U.S. Glaucoma cannot be prevented, but if diagnosed and treated early, it can be controlled. Vision lost to glaucoma cannot be restored. That is why the American Optometric Association recommends annual eye examinations for people at risk for glaucoma. Dr. Fife will discuss his findings with you and partner with you in monitoring and treating as needed. Depending on your condition, he may recommend more frequent examinations.

How is glaucoma diagnosed?
Even in the early stages, glaucoma can be detected during a thorough eye exam. A comprehensive optometric examination will include taking a thorough medical and family history, measuring the pressure of the fluid inside the eye, direct visual examination of the optic nerve with a special microscope and lens, and assessment of central and side vision.

What if the doctor suspects I have glaucoma?
Additional testing may be ordered when suspicious findings are noted during an eye examination. These tests often include:

• OCT – this instrument scans the optic nerve for loss of nerve fiber. Nerve fiber loss is one of the earliest signs of glaucoma

• Retinal Photo – taking an image of the optic nerve and the surrounding nerve fiber layer can aid in initial documentation as well as monitoring for progression

• Pachymetry – measurement of the thickness of the cornea (the front surface of the eye). Cornea thickness affects measurement of pressure inside the eye, so it is important to know corneal thickness to accurately monitor intraocular pressure

• Visual Field Testing – measurement and mapping of the peripheral (side) vision. Glaucoma has very characteristic patterns of side vision loss. Visual field testing can pick up these losses very early, even when they are not apparent to you.

• Gonioscopy – measurement of the anterior chamber angle. This is the area inside the eye where the fluid drains back into the body’s circulatory system.

How do you treat glaucoma?
Glaucoma is treated by trying to decrease the pressure inside the eye. Prescription eye drops are usually very effective and often only have to be administered once or twice a day. However some cases of glaucoma require surgical intervention.

Diabetic Retinopathy

What is Diabetic Retinopathy?
Diabetic retinopathy is a complication of diabetes that results in damage to the back surface of the eye (the retina). In diabetic retinopathy, the small blood vessels that supply blood to the retina become damaged and leak and even rupture. This causes damage to the retina in much the same way that a leaky pipe in your home would cause damage to the walls and floor.

Is Diabetic Retinopathy serious?
Diabetic retinopathy is a very serious complication of diabetes and is the leading cause of blindness in Americans under the age of 65. A comprehensive eye examination including photos of the retina and dilation of the eyes is very effective at catching this disease in the early stages.

How often should I be seen?
The degree of retinopathy due to diabetes will determine how frequently you will need to be monitored. Early stages of diabetic retinopathy have few symptoms but can easily be detected in a thorough eye examination and is usually monitored yearly, but may require more frequent visits. Later stages of the disease can include symptoms of missing spots in your vision, poor acuity (blurry vision even with glasses), and hazy vision or color vision changes.

What can be done if I have Diabetic Retinopathy?
There are treatments for diabetic retinopathy, the most common of which is laser photocoagulation. Laser treatment involves sealing off the leaking blood vessels to stop them from bleeding, but the most effective treatment is actually good management of your blood sugar and coordination of care with your diabetic doctor (endocrinologist or family physician). Diabetes is a disease that can be managed very effectively with proper diet and exercise and is a disease where you can play a very important role in management of the disease.

Giant Papillary Conjunctivitis

What is Giant Papillary Conjunctivitis?
Conjunctivitis is an inflammation of the conjunctiva—the clear mucous membrane lining the eyelids and the white structures of the eye. Giant papillary conjunctivitis, also known as GPC, is a condition of the conjunctiva in which lid structures known as papillae become very large. In most cases, the enlargement of papillae is accompanied by itching and mucous discharge.

What Causes GPC?
GPC is most commonly associated with wearing contact lenses ESPECIALLY OVERWEARING CONTACT LENSES. Having first become a major concern of eyecare professionals in the 1970’s, it is considered a relatively “new” eye condition. In addition to contact lens wear, GPC may result from another foreign object on the eye’s surface such as an exposed suture from previous surgery.

What are the Symptoms of GPC?
In the mild stage, discomfort with normal contact lens wearing time is the most common symptom. Many factors can affect comfortable wearing time, such as lack of sleep, environmental irritants, or dry eyes. However, persistent loss of wearing time, in the absence of identifiable reasons, may indicate an early stage of giant papillary conjunctivitis.

GPC is a Major Disappointment to Many Contact Wearers
Giant papillary conjunctivitis can be a disappointing, discouraging condition since it is primarily caused by long-term use of contact lenses. Some contact lens wearers who have enjoyed lenses for many years become intolerant and must return to glasses. Preventive measure for those who wear contact lenses should include good care of your lenses, with cleaning, disinfecting and soaking with solutions recommended by Dr. Fife. Generic and sale brands are not recommended, and neither is switching solutions between many different care systems. Stick to the solutions and care system recommended in our office. Routine measures should be taken such as daily cleaning with a surface rub of at least 15 seconds with either your cleaning or disinfection solution. Occasionally a weekly cleaning with enzymatic protein deposit remover will be added to the cleaning regimen.

What Treatment Options Are Available?
Giant papillary conjunctivitis is quite difficult to treat. Discontinuing lens wear is usually required to treat patients that are in stage 3 or 4 of the disease. Decreased wearing time, more frequent lens replacement, or diligent cleaning may be all that is needed in stage 1 disease. The most effective, easiest treatment of giant papillary conjunctivitis is simply to discontinue contact lens wear. Of course, many contact lens wearers find this an unacceptable solution. If the eyes are given an opportunity to recover, contact lens wear may be possible at a later time. However, even after a break, the problem may recur when lens wear is resumed. Working with Dr. Fife, alternatives can be explored such as a change in the type of lens worn. Simply replacing the lenses on a more frequent schedule is often helpful. Disposable lenses with shorter replacement intervals may be a good option for those who experience problems.

GPC is Easier to Prevent than Cure.
Even though we do not know exactly what causes giant papillary conjunctivitis, we do know that protein levels are likely a contributing factor and protein deposits build up and are more difficult to remove the longer the contact lenses are worn. This means that replacing contact lenses at their scheduled replacement and meticulous attention to cleaning is important.

Remember:
Giant papillary conjunctivitis is treatable and there are many options to explore before “giving up” on your contact lenses. Working together, you and Dr. Fife can explore alternatives for care and develop a plan for continued clear and comfortable vision.

Corneal Foreign Body

Foreign Body Removal At Paradise Canyon Eye Care​​​​​​​

What is a corneal foreign body?
The cornea is the front surface of your eye. It is a clear, dome shaped structure that sits in front of the colored part of your eye (the iris). The main function of the Cornea is to focus light onto the back surface of the eye (the retina). The cornea is very soft and flexible and therefore small objects that strike the eye, even with a small amount of force, can easily become embedded in the cornea. Anything from a small piece of metal from grinding to a speck of dust in the wind can become embedded into the cornea.

What are the Symptoms?
Symptoms may not be immediate, but typically range from a mild irritation to extreme pain and may be associated with redness and watery eyes. An individual who has a corneal foreign body can typically identify where they were and what they were doing when it began.
What risks are associated with a corneal foreign body?

Corneal foreign bodies cause an abrasion (a scratch) to the area of the cornea where the foreign body is embedded. Many foreign bodies do not go any deeper than the surface layer of the cornea (the epithelium) and once the foreign body is removed the abrasion will usually heal within a day or two. Larger foreign bodies, or foreign bodies that strike the eye with considerable force can penetrate into the middle layer of the cornea (the stroma). These corneal abrasions take longer to heal and have the potential to scar. Scars in the center of the cornea (within the line of sight) can result in reduced vision, or even blindness in extreme cases.

Should I wait to see if it will work itself out?
Corneal foreign bodies that have been in the eye for several days tend to be much more difficult to treat. The eye becomes very irritated and the cornea tends to become cloudy as inflammation sets in, which can cause blurred vision. Metallic foreign bodies begin to rust if they stay embedded in the cornea for more than a day. This rust seeps into the surrounding tissue and causes more inflammation as well as a “rust ring”. Rust rings are difficult to remove because they tend to be very firmly embedded into the corneal tissue and because corneal tissue will often try to grow over the rust ring.

What should I expect?
The doctor will remove as much of the foreign body as possible at the initial visit. If the doctor is unable to remove all of the foreign body, you will be scheduled for a follow up visit (usually within 2 days). The cornea will typically try to push foreign material to the surface, so whatever could not be removed at the initial visit can often be removed at the follow up visit. Severe corneal abrasions may be bandaged with a contact lens to increase comfort.

Will I be prescribed medications?
Typically an antibiotic drop will be prescribed to prevent or treat infection. It is important that you use this drop as prescribed.
In addition we recommend that you use a thick artificial tear drop like Refresh Liquigel as often as possible during the healing process. Artificial tears will help to keep the cornea rinsed, clean, and help to protect and coat the abrasion as it heals. Artificial tears are also very effective at reducing pain.
Should you have significant pain, oral pain medication may be prescribed.

What precautions should I take?
The best thing that you can do to help speed up your recovery is to go home and relax in a darkened room. Sleeping is helpful, but you can watch TV as this does not generally irritate the eye. Try to avoid computer use, reading, bright lights, and working in dirty environments. If you were given a bandage lens it is very important that you return for a follow up visit to have the bandage lens removed and not remove it yourself. If you experience severe pain, increased redness, increased discharge from the eye, increased cloudy or blurred vision, or any other unusual symptoms please contact our office immediately.

Anterior Uveitis

What is Anterior Uveitis?
Anterior uveitis is an inflammation of the middle layer of the eye, which includes the iris (colored part of the eye) and adjacent tissue, known as the ciliary body.

What causes anterior uveitis?
Anterior uveitis can occur as a result of trauma to the eye, such as a blow or foreign body penetrating the eye. It can also be a complication of other eye disease, or it may be associated with general health problems such as rheumatoid arthritis, rubella and mumps. In most cases, there is no obvious underlying cause.

How serious is anterior uveitis?
If untreated, it can cause permanent damage and loss of vision from the development of glaucoma, cataracts or retinal edema (fluid under the retina). It usually responds well to treatment; however, there may be a tendency for the condition to recur. Treatment usually includes prescription eye drops, which dilate the pupils, in combination with anti-inflammatory drugs. Treatment usually takes several days, or up to several weeks, in some cases.

What are the symptoms of anterior uveitis?
Signs/symptoms may include a red, sore and inflamed eye, blurring of vision, sensitivity to light and a small pupil. Because the symptoms of anterior uveitis are similar to those of other eye diseases, Dr. Fife will carefully examine the inside of your eye, under bright light and high magnification, to determine the presence and severity of the condition. If anterior uveitis continues to recur, Dr. Fife may also perform or arrange for other diagnostic tests to help pinpoint the cause.

Posterior Vitreous Detachment

What is a Posterior Vitreous Detachment (PVD)?
A posterior vitreous detachment is more commonly found in adults over the age of 50. The vitreous is the clear gel (about the consistency of jello) which fills the center of the eye. It provides a cushion for the eye in cases of injury where the eye is jarred by an outside force, such as being hit in the head, being in a car accident, or falling down.

Over the course of many years, this gel inside the eye begins to become more and more fluid and less gel-like. This progression from gel to liquid causes the vitreous to weigh more, and thus the liquid tends to pull downward (due to gravity) on the inner lining of the eye. As the vitreous weighs more and more, it can pull away from the inner lining of the eye and float freely inside the globe of the eye. This pulling away from the lining is called vitreous detachment.

If I have a floater in my vision does that mean I have a PVD?
Floaters by themselves are not a sign of eye disease or a sign of vitreous detachment. It is normal for someone to see a few floaters in their vision occasionally. Although, after a vitreous detachment, it is common to see a small increase in the number of black spots or specks you notice in your vision. These specks, spots, or other shapes, are also called floaters. Floaters in general, are caused by folds and debris in the vitreous, casting a shadow on the inside of the eye.

Is a PVD vision threatening?
It is important to note that vitreous detachment is not a painful experience…usually there is no feeling associated with vitreous detachment, there is only a change in vision. A posterior vitreous detachment is usually not a vision threatening eye condition.

In cases of posterior vitreous detachment, the eyes should be seen frequently for a period of six to twelve weeks, so that any pulling forces can be monitored. If these forces are strong enough, they can also cause a retinal detachment. Once the vitreous detachment is “old” and there is a clear separation between the vitreous and retina, the likelihood of retinal detachment caused by vitreous detachment is very small.

What risks are associated with a PVD?
Since there is some risk of retinal detachment after having vitreous detachment, the following warning signs of retinal detachment include:

• a sudden increase in the number of floaters.

• flashes of light in your side vision.

• a shadow, veil or curtain coming over or across your side vision.

• lines which should look straight look bent or wavy.

• central vision is blurry, and it cannot be improved in any way.

​​​​​​​If you notice any warning sign of retinal detachment you should contact our office immediately.

Will this floater in my vision ever go away?
Immediately following the PVD, the floater may appear fairly large and bothersome, but over time it tends to shrink up on itself and become less bothersome and less noticeable.

Retinal Detachment

What is a Retinal Detachment?
Retinal detachment is a condition where damage is found on the inside of the eye. The retina is a thin coating of tissue on the inner walls of the eye, and it is actually responsible for vision. This thin lining is at risk for damage in cases of trauma and when vitreous changes are occurring. The retina may become torn or may have a hole formed in it. If a tear, hole, or other injury causes a buckle or bubble of fluid to get under the retina, the entire retina can peel away from the inner walls of the eye, causing blindness. This process is much like wallpaper which loosens and peels away from the wall.

How serious is a retinal detachment?
If you are found to have a retinal detachment, treatment is required immediately. The longer your retinal detachment goes untreated, the greater your loss of vision. In addition, the length of time the retina is detached is directly related to the amount of vision which can be restored with treatment. If you think you may be experiencing a retinal detachment, you should seek immediate eye care either by contacting our office or by reporting to an emergency room or other retinal eye care specialist. Our office has 24 hour emergency service response by calling the office number and if after hours, following the directions to page the doctor.

What are the symptoms of a retinal detachment?
There are specific warning signs which are related to retinal detachment. These are:

• you see a sudden increase in the number of floaters in your vision.

• you see flashes of light in your side vision which you cannot explain.

• you notice a shadow, veil or curtain coming over or across your side vision (this could be in any direction).

• you notice that lines which should look straight (such as a door frame or street curb) look bent or wavy.

• you notice that your central vision is blurry, and it cannot be improved in any way (either by moving closer, moving farther away, cleaning your glasses, rubbing your eyes, etc.).

IF YOU NOTICE ANY SIGN OF RETINAL DETACHMENT, EVEN IF IT IS ONLY ONE OF THE SIGNS MENTIONED ABOVE, YOU SHOULD CONTACT OUR OFFICE OR OTHER EMERGENCY SERVICE PROVIDER IMMEDIATELY!