“ I see fine!““Why do I need an Eye Exam?”Darrin G. Vits, OD Optometrist

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Darrin G. Vits, OD

• Doctor of Optometry degree, 1995– University of Missouri St. Louis

• Bachelor of Science/Bachelor of Arts, 1991– Illinois College, Jacksonville Illinois

– Have practiced in the Springfield area from 1995 to 2004 and Northern IL from 2004 to 2010

– Joined Springfield Clinic in January 2011

Taking things for granted

• The American Way?

• A roof over our heads

• Our health

• Our vision

• UNTIL …

When does vision matter?

• Can’t see the board

• Can’t read the paper

• Can’t pass the driver’s test

So why is everyone shocked that they should have a

yearly eye exam?

Hopefully by the end of my talk you will “see” why you should have regular eye exams.

20/20, 20/40, 80/200? What???

• Good vision

• Visual Acuity– The smallest letter that you can

see at 20 feet can be seen by a normal eye at XX feet

• Legally Blind– A best corrected acuity of

20/200 or less in the better seeing eye

Legal to Drive

• 20/40 or better uncorrected

• Daylight restriction: 20/100

• Visual field greater than 140 or 105

• Mirrors, telescopes, & rehab.

What is “normal” vision?

• Light enters the eye through the cornea, the clear, dome-shaped surface that covers the front of the eye.

• From the cornea, the light passes through the pupil. The amount of light passing through is regulated by the iris, or the colored part of your eye.

• From there, the light then hits the lens, the transparent structure inside the eye that focuses light rays onto the retina.

• Next, it passes through the vitreous humor, the clear, jelly-like substance that fills the center of the eye and helps to keep the eye round in shape.

• Finally, it reaches the retina, the light-sensitive nerve layer that lines the back of the eye, where the image appears inverted.

• The optic nerve is then responsible for interpreting the impulses it receives into images.

“Doc why do I have to get glasses”

• Myopia– Nearsighted– Can see near but not

far– The eye is too long

from front to back and the image is focused in front of the retina

“Doc why do I have to get glasses”

• Hyperopia– Farsighted– Can see far but not up

close, but not really– The eye is too short from

front to back and the image is focused behind the retina

– The eye must constantly focus and doesn’t have enough power

“Doc why do I have to get glasses”

• Astigmatism– Neither nearsighted or

farsighted– Objects near and far

appear distorted or blurry– An abnormal curvature of

the cornea causes 2 focal points to fall on 2 locations

– Tends to cause eyestrain and headaches from squinting

– Can be in combination with other refractive errors

“Doc my arms are too short”

• Presbyopia– A type of farsightedness where the lens

inside the eye hardens and can no longer focus or accommodate to see near objects

– Tends to happen to all persons between the ages of 40 & 50

– Commonly corrected with multifocal glasses, bifocals, or drugstore readers

None of the previous conditions are static and they will change throughout one’s lifetime. This should be checked regularly by getting a refraction to determine the spectacle or contact lens prescription and then updated as needed.

Now let’s move on to the most important reason for your yearly eye exam and that is for your eye health.

The 4 silent stalkers of your vision

• Cataracts

• Glaucoma

• Diabetes

• Macular Degeneration

Cataracts

• The lens inside the eye becomes cloudy or milky physically blocking or reducing the image being projected onto the retina

• Symptoms may be reduced vision, hazy or foggy vision, increased glare, halos or starbursts

• There are several types of cataracts, some which develop slowly with age and others which may develop quickly or be congenital

Nuclear

Cortical

Congenital

Subcapsular

Traumatic

Cataract Surgery

• Advanced microsurgical procedure

• Outpatient

• No shot/no stitch

• Phacoemulsification

• Intraocular implants

• Short recovery time

Glaucoma

• Typically a very slowly progressive disease caused by too much pressure on the optic nerve causing it damage which in turn damages a person’s peripheral vision

Types of Glaucoma

1. Open-angle glaucoma2. Low-tension or normal-tension glaucoma3. Angle-closure glaucoma4. Childhood glaucoma5. Congenital glaucoma6. Primary glaucoma7. Secondary glaucoma

Symptoms

• Few if any until significant vision loss except for angle closure glaucoma

• Angle Closure– Headache– Nausea– Vomiting– Severe Eye Pain– Halos and/or blurred vision

Diagnosis of Glaucoma

• Yearly Eye Exams!!!!!!– Eye pressure measurement– Direct examination of the optic nerves

• Family History

• Visual Field Testing

• Photography

• Optic Nerve Scanning

• Gonioscopy

Treatment

• Medication

• Laser trabeculoplasty

• Filtering surgery

• Success depends on you and your doctor working together

Diabetes

• The New American Epidemic

• In a nutshell– The body or pancreas produces insulin to

breakdown the glucose that comes from what we eat. Diabetes is basically when there is something wrong with this process.

– Diabetes can and will affect every organ and system in the body and the eye is particularly susceptible

• A simple effect from the blood sugar levels being too high is that the lens inside the eye swells causing a temporary “myopic” shift in the eye which is seen as fluctuating vision or spells of blurred vision

• This often means that the eye doctor is the first doctor that a patient with early diabetes may see and often results in a referral to a primary care physician for testing

More Complicated Eye Problems

• Early development of cataracts

• Diabetic Retinopathy– Background– Proliferative– Edema– Neovascularization

Diabetic retinopathy is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid, while in others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Diabetic retinopathy cannot be completely avoided, but the risk can be greatly reduced. Better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

What is Diabetic Retinopathy?

Nonproliferative/Background Retinopathy Proliferative Retinopathy

Advanced Proliferative Retinopathy Retinopathy with Macular Edema

Treatment

Take Home Message

• Work with your Doctors

• Stick to the treatment and control your blood sugar

• Keep your follow up appointments

• The more under control your diabetes is the less likely you will have any of these problems

• The longer you are diabetic the more likely you are to have problems

Last But Not LeastMacular Degeneration

What is it?

Age-related macular degeneration (AMD) is a disease that affects an individual's central vision. AMD is the most common cause of severe vision loss among people over 60. Because only the center of vision is affected, people rarely go blind from this disease. However, AMD can make it difficult to read, drive, or perform other daily activities that require fine, central vision.

AMD occurs when the macula, which is located in the center of the retina and provides us with sight in the center of our field of vision, begins to degenerate. With less of the macula working, central vision – which is necessary for driving, reading, recognizing faces, and performing close-up work – begins to deteriorate.

The Retina

• Part of the nervous system

• An extension of the brain

• Limited number of cells

• Cells get sick and die

• Cells more concentrated in the macula

• Thus macular degeneration

Wet or Dry?Dry AMD

This type of AMD is the most common. While its cause is unknown, it occurs as the light sensitive cells in the macula slowly deteriorate, generally occurring in one eye at a time.

Wet AMD

This type of AMD is less common, but accounts for almost all severe vision loss caused by either type of AMD. Wet AMD occurs when new blood vessels behind the retina start to grow beneath the retina where they leak fluid and blood and can create a large blind spot in the center of the visual field. If this happens, there is a marked disturbance of vision in a short period of time.

Theories about Macular Degeneration

• Old age/Old eyes?– We are living longer these days and cells just

die– Something speeds up the process

• Genetics• UV light• Other diseases

• Macular pigment

Treatment for Dry AMD

• None

• Prevention

• Slow progression

• Vitamins– Why– The role of antioxidants, Lutein, Zeaxanthin, &

Omega-3s– Different types of vitamins & who should take

what

Treatment for Wet AMD

• Used to be nothing

• Laser

• Photodynamic Therapy (PDT)

• Intravitreal Injections– Lucentis, Avastin, Eyelea

• Goal of treatment is to stop leaking and stop progression not restore vision

Wet AMD

Dry AMD (drusen)

What are the symptoms of AMD?

The following are the most common symptoms of AMD. However, each individual may experience symptoms differently.

1)Blurry or fuzzy vision2)Difficulty recognizing familiar faces3)Straight lines, such as sentences on a page, telephone poles, and the sides of buildings, appear wavy4)A dark or empty area (blind spot) appears in the center of vision5)Rapid loss of central vision - vision necessary for

driving, reading, recognizing faces, and performing close- up work

The presence of drusen, tiny yellow deposits in the retina, is one of the most common early signs of AMD. These will be visible to your physician during an eye examination. While the presence of drusen alone does not indicate the disease, it may mean the eye is at risk for developing more severe AMD.

In Summary

• Yes vision is important but eye health wins the game

• Many eye diseases are undetectable in the early stages when loss of vision can be prevented so regular yearly eye exams are the only way to catch them

• So make sure that you are getting your yearly comprehensive eye exam to check your eye health and not just a refraction

Your Eyes Depend on You to See Me Once a Year.

Let’s See Each Other for Your Eye Health!

QUESTIONS?

Thank you

&

Good Night!