Ocular Conditions

Cataracts


What Is It?
The crystalline lens is near the front of the eye. Going from front to back, you have the cornea, the iris, and then the lens. The lens remains clear for most of our younger days, but over time it starts to become cloudy, resulting in hazy vision and glare problems. Exposure to ultraviolet light and other forms of radiation, nutrition deficiencies, certain medications, and just plain aging are known to be causes. In rare cases children can be born with cataracts and severe head trauma can also be a cause.


How Do We Diagnose It?
Our optometrists can spot a cataract forming at the very beginning stages through a comprehensive eye exam. Using the slit lamp they are able to see whether the lens is clear or if there is any opacity indicating a cataract.
How Do We Treat It?
There is a drop called Homocysteine being used in Europe, but its efficacy has been questioned in North America. When cataracts become troublesome, they can be removed and replaced by an implant through micro-surgery. Unfortunately, laser cannot remove age related cataracts. In some cases haze may develop after cataract surgery, and a quick laser procedure with an ophthalmologist can remove this. 
Can It Be Prevented?
A balanced diet, UV protection and choosing not to smoke will certainly help to slow the process. It is important to ensure that you are always wearing 100% UV protection sunwear whenever the sun is out in all types of weather to protect your eyes.


Diabetes
 

What Is It?
Diabetes is a chronic, often debilitating and sometimes fatal disease, in which the body either cannot produce insulin or cannot properly use the insulin it produces. Diabetes leads to high blood sugar levels, which can damage organs, blood vessels and nerves. If there is a blood vessel leak, it can leak into the retinal layers of the eye which, if not treated, can result in severe and permanent vision loss from scarring (Referred to as Diabetic Retinopathy). When sugars are not under control, it can also cause fluctuations in vision and/or cataracts.
How Do We Diagnose It?
Those who have diabetes will typically be diagnosed by their family doctor. These patients are covered by OHIP regardless of age for a full eye exam. During these comprehensive eye exams, our optometrist will look into the eye using a Slit Lamp to look for signs of diabetes affecting the inside of the eyeball.  

At Burlington Eyecare we use a sophisticated 3-D imaging device called an OCT (Optical Coherence Tomography) which will allow the Optometrists to view the Fundus and Macula to ensure no damage has been caused by the symptoms of diabetes. 


How Do We Treat It?
With laser treatments, injections, or a combination of both, depending on the severity and location of the leakage. 
Can It Be Prevented?
Most patients with diabetes have Type II Diabetes and the main cause is obesity. Living an active and healthy lifestyle can reduce the risk and even alleviate it. 

Some people inherit diabetes, and in spite of preventative measures, have difficulty controlling it. Medication helps to improve glucose uptake and regular monitoring of the blood for glucose levels and glycosylated hemoglobin aid in keeping the diabetes under control. Daily regulation of sugar, calorie intake and metabolism help to control blood sugar levels.


Glaucoma


What is it?
Glaucoma is a condition in which the pressure in the eye is increased. If left untreated and the pressure gets too high, progressive and permanent vision loss can occur.   


How Do We Diagnose It?
At Burlington Eyecare, our pre-testing procedures include various pre-screening tests for Glaucoma such as a visual fields test as well as NCT (Non-Contact Tonometry). If during this pre-screening there are any indications of high pressure or peripheral vision loss, the doctors will ask staff to do further screening tests. These can include a more detailed visual field test, further eye pressure monitoring, as well as an OCT (Optical Coherence Test).
How Do We Treat It?
Treating Glaucoma depends on how severe and how far it has progressed. In most instances of Glaucoma, treatment will be eye drops to reduce the intraocular pressure. There is no cure but the use of the eye drops can help control the pressure so there is no further damage. In some instances eye drops cannot control the pressure, and at times various surgical options are used to further increase fluid outflow and thus lower the eye pressures further. Any vision that is lost due to Glaucoma cannot be repaired, which is why regular Comprehensive exams from an Optometrist is integral to eye health. 

Can It Be Prevented?
In some families Glaucoma can have a hereditary link. Those with diabetes, high blood pressure or a history of injury to the eye have a higher risk of developing Glaucoma. Glaucoma cannot be detected without a comprehensive eye exam. It is often symptomless. 

Keratoconus

What Is It?
Keratoconus is a corneal disease that occurs when the normally round dome-shaped cornea (the clear outer area of the eye) progressively thins, causing a cone-like bulge to develop. It is typically diagnosed during adolescence and early adulthood with a variable rate of progression. Since the cornea is responsible for refracting most of the light coming into your eye, an abnormally-shaped cornea can create reduced visual acuity and affect the way you see. This reduced visual acuity can make even simple daily tasks, such as driving, watching television or reading, difficult to perform, even while wearing glasses or contacts.


How Do We Diagnose It?
Various signs can be noted on slit lamp examination, and corneal topography – a map of the shape of the cornea, are both used in diagnosing keratoconus.  
How Do We Treat It?
Keratoconus cannot be cured, but there are several methods for managing Keratoconus to help slow its progression and help improve vision. Hard contact lenses are often used to give the eye a new smooth surface which helps refract the light in a more uniform manner. This gives one much clearer vision.  
There are also various treatments including Intra-Corneal Ring Segments (INTACs) which can surgically alter the corneal surface to minimize the severity of central steepening. Corneal Crosslinking is a newer treatment that uses Riboflavin and UV light to strengthen the collagen fibers of the cornea. This helps to slow or even stop the progression of corneal bulging, and when treated early enough, will make future correction with glasses or contact lens wear more successful. At Burlington Eyecare, we have teamed up with the Bochner Eye Institute and TLC to provide this remarkable therapy. In more severe cases, patients may require a corneal transplant. 


Can It Be Prevented?
Keratoconus is very difficult to prevent. It can be hereditary and has shown some link to excessive eye rubbing and those with Down Syndrome.

Macular Degeneration

What Is It?
The macula is a small yet very important area of the retina. We use it to see very fine detail. It’s our 20/20 vision area. Macular degeneration (also referred to as AMD) is the number one cause of vision loss in the western world. Because the macula is so small, it doesn’t take much to cause severe vision loss. Typically, central vision loss is associated with macular degeneration.

There are two “stages” of Macular Degeneration. The early form is referred to as “dry” because no fluid is involved. Unfortunately, it can progress to the “wet” form, where leakage of fluid inside the eye causes swelling and scarring. 
How Do We Diagnose It?
In early stages, AMD is symptom free but can be diagnosed in a routine Comprehensive Eye Exam. Initially, patients will typically report blurred central vision while trying to see fine detail. Glasses or contacts are unable to correct this and overtime the area may become larger interfering with reading and recognizing faces. AMD can also cause distortion making straight lines appear wavy and dark spots can obscure parts of the central vision. There is no pain associated with AMD.
When AMD is present, we take digital fundus photographs of the macula to monitor and, when necessary, we will use an OCT (Optical Coherence Tomographer), which will detect more subtle changes. These tests will also tell us if/when wet AMD is starting. 


How Do We Treat It?
Most treatments for “dry” AMD are lifestyle changes such as exercise, discontinuing smoking, wearing sunglasses to reduce UV radiation and Vitamin Supplements made specifically for ocular health. 
Cases of wet AMD can be treated with a medication which is injected into the eye in an attempt to stop blood vessels from leaking and also to reduce the eyes ability to build new blood vessels (which can result in more leakage and scarring).  
It is extremely important to intervene with wet AMD as soon as possible in order to retain vision. Regular eye examinations and counselling from your Doctor of Optometry will let you know when new treatments become available.


Can It Be Prevented?
As is the case with most Eye Diseases, UV protection and nutrition are critical for prevention. Lack of UV protection and poor nutrition result in free radicals which damage receptor function. Again, cigarette smoking is very harmful. A balanced diet with emphasis on antioxidants like beta carotene and lutein, along with omega 3 fatty acids can help to prevent or stop the progression of, and in some instances mildly reverse the condition. Ocular vitamins can also help stop or reduce further degeneration.  



Low Vision Aids

What Is It?
Low vision, or visual impairment, is reduced vision despite using the best-possible spectacle or contact lens correction available. It can result from congenital eye conditions, such as retinitis pigmentosa, or acquired eye conditions, such as diabetic retinopathy or macular degeneration. 


How Do We Diagnose It?
In order to determine which types of aids would benefit a patient, a low vision specialist performs an assessment to establish the patient's best possible vision, baseline glasses prescription and the patient's goals and expectations. The optometrist selects aids based on the aforementioned factors and provides instruction and direction as to how to use these aids.
How Do We Treat It?
The role of a low vision specialist is to maximize the functional level of a patient's vision through optical and non-optical means. This is done primarily through magnification, filters and proper lighting. For distance tasks, like recognizing faces, watching TV or reading signs, a low vision optometrist may suggest telescopes, either hand-held or mounted on the glasses. For near tasks, such as reading books or needle work, they may suggest one of many types of magnifiers.
At Burlington Eyecare, we perform assessments using only the best products available by Eschenbach. Their assortment of spectacle and clip-on magnifiers, hand-held magnifiers, stand magnifiers, telescopes, absorptive filters, video magnifiers and many non-optical tools such as lighting and reading stands, help us to meet the needs of our patients with visual impairments.
About ADP
The Assistive Device Program (ADP) through the Government of Ontario provides support and funding to Ontario residents who have long-term physical disabilities and provides access to personalized assistive devices appropriate for the individual's basic needs. Individuals with long-term low vision qualify for support through ADP, and your optometrist is able to determine whether you have low vision. Dr. Germain of Burlington Eyecare is an ADP-Registered Authorizer and he will work with patients to seek funding through ADP.
Please do not hesitate to contact Burlington Eyecare if you have any questions regarding our Low Vision Services (commonly referred to as Low VA), the Assistive Devices Program, or low vision in general.
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