Diabetes Mellitus has been diagnosed in over 14 million individuals in the United States. There are two basic forms of diabetes. Type II diabetes or non-insulin dependent diabetes (NIDDM) is also known as adult onset diabetes. It is most typically diagnosed in adults who tend to be overweight. Type II diabetes is most typically treated with oral medications; however a significant number of these individuals do require insulin therapy.

A more severe form of diabetes is termed Type I diabetes, or insulin dependent diabetes. Also known as juvenile onset diabetes, this form tends to require insulin therapy. Although eye complications can be found with both forms of diabetes, Type I diabetes has more frequent and severe ocular complications.

Our Optometrist Treats Eye Complications Related To Diabetes

There are numerous complications that can occur in the eye secondary to diabetes, some of which are mild, insignificant, or transient and others of which are severe and vision threatening. Diabetes is the leading cause of blindness among patients under the age of 65. Eye complications of diabetes include:

• Significant and sudden shifts in vision prescription (large increases in nearsightedness or farsightedness). This is associated with changes in blood sugar levels and its effect on the focusing lens of the eye.
• Acute diplopia (double vision). Double vision associated with diabetes tends to be binocular (one of the two images will go away if you close or cover one eye). It tends to be transient, lasting generally days to weeks at most. It is due to compromised blood flow to the nerves that control the external eye muscles.
• Cataract development. Cataracts tend to develop earlier and more significantly in people with diabetes.
• Glaucoma. Diabetes is a relative risk factor for the development of glaucoma. A rare, but very severe form of glaucoma called “neovascular glaucoma” is found in advanced diabetics.
• Diabetic Retinopathy is the most feared complication of diabetes.

Cataracts are part of the normal aging process. A cataract forms when the natural lens of the eye becomes clouded. The cause is usually unknown but can result from exposure to ultraviolet light, injury, heredity, disease and advancing age.

Cataract Diagnosis

Utilizing advanced diagnostic technologies and our ability to maximize visual function prior to surgery; we have enabled patients to function wonderfully with early stage cataracts for years before they need surgery. Initial diagnosis of cataracts can be made with the slitlamp biomicroscope.

Get Treatment From Our Cataract Surgery Specialist In Fort Lauderdale, FL

Eventually, changing the eyeglass prescription is no longer sufficient to maintain good vision. Surgical removal of the cataract may be indicated if blurring of the vision interferes with normal daily activities (reading, driving, etc.).

A cataract is removed using microsurgical techniques. This incision is so small that, in almost all cases, it is self-sealing and sutures are not required. Once the cataract (clouded lens) has been removed it is replaced with a new, clear lens.

Modern advances in intraocular lens technology has enabled us to treat vision conditions such as astigmatism with new “toric” intraocular lenses, and near vision correction with “multifocal” and “accommodating” intraocular lenses. Your doctor will discuss these options with you in advance of surgery.

The cataract procedure is most frequently performed under local anesthesia in an outpatient surgery facility. It does not require a stay in the hospital. Sedation is given to most patients to help them relax. The procedure is performed in about 30 to 45 minutes. Thanks to the anesthetic, patients do not feel or see the surgery.

After the procedure patients are instructed to spend a day relaxing at home. Most patients return to normal activities the day following the surgery.

Cataract FAQ

Can a cataract be removed with a laser?

This is a very common misconception. The most advance technique for removing a cataract (phakoemulsification) uses ultrasound, not laser. Currently, there are clinical trials being done to determine whether the laser can be used to remove a cataract. As of this writing, it appears that the laser technique has no advantages over the ultrasound technique. In fact, laser may not work as well as ultrasound at removing more advanced cataracts.l>

Will a cataract recur after surgery?

A cataract does not recur. However, behind the pupil there is a thin, clear membrane called the lens capsule. In approximately 30% of patients this membrane can become clouded. This may occur anytime from several weeks to many years following the cataract procedure. If the membrane becomes clouded, we often call it a secondary cataract, although that is not entirely accurate. The clouded membrane can be opened using a Yag laser. This painless, outpatient procedure is usually performed in the office.

When is a cataract “ripe”?

The term “ripe” is obsolete. The last couple of decades have seen a tremendous improvement in the results of cataract surgery. Before these advances were made, patients had to be hospitalized for a week to ten days for a cataract procedure. The complication rate was higher and there were no intraocular lens implants. After the surgery patients had to wear thick “Coke bottle” type spectacles. In the past, “ripe” was a term used to describe a cataract that had become so advanced that the patient was nearly blind. In those cases the risks and inconveniences of cataract surgery were justified. With the modern techniques that we now use to remove a cataract the term “ripe” has become outdated. Patients are no longer hospitalized and the complication rate is one of the lowest in all of medicine. With the advent of intraocular lens implants, patients are no longer required to wear thick, heavy eyeglasses. Today, after cataract surgery many patients are now able to see well (for most activities) without wearing any glasses.

How do I know when my cataract is ready to be removed?

A. Thanks to recent advances in cataract surgery, we no longer have to wait until a patient is nearly blind before removing a cataract. We now let the patient decide when they would like to have their cataract removed. In most cases we recommend waiting until your vision has become blurred to the point where it is interfering with work, reading, driving or other daily activities. This will be different for each patient. For instance, an airline pilot may want to undergo the procedure at a much earlier stage than someone whose daily activities are less visually demanding. After a thorough examination, your eye doctor will let you know if your vision can be improved with new spectacles or by other means. If that is not possible then it may be time to consider removing the cataract.

Primary glaucoma is a progressive disease of the optic nerve characterized by specific loss of optic nerve fibers and associated vision loss. It is commonly, but not always associated with increased intraocular pressure.

Detecting Glaucoma

Early stages of glaucoma can fortunately be detected with simple, painless tests. A number of screening tests are performed as part of your annual comprehensive eye examination. Broward Eye Care doctors measure the internal eye pressure or intraocular pressure (IOP) with an instrument called a tonometer.

An evaluation of the optic nerve for signs of glaucoma damage is also performed during the comprehensive eye examination. A variety of methods may be used for this evaluation including the use of the retina imaging system, which allows for detailed imaging of the retina and optic nerve. If your doctor feels that there is a risk of having or developing glaucoma further testing may be ordered. Of greatest concern is the fact that over 50% of optic nerve fibers must be lost to glaucoma before current visual field procedures shows abnormalities! The very earliest abnormalities in glaucoma show up as changes in the physical appearance and structure of the optic nerve. In the past doctors had to depend on diagrams or photos of the nerve to document its appearance and to detect change over time. This method was very subjective and not very sensitive. Today great advances in optic nerve imaging have been developed. Broward Eye Care has been a leader in performing the newest technologies in optic nerve analysis.

We utilize OCT (Optical Coherence Tomography) of the nerve fiber layer and the optic nerve head. OCT allows us to evaluate the thickness of the nerve fibers surrounding the optic nerve head.

Get Glaucoma Treatment From Our Glaucoma Specialist In Fort Lauderdale, FL

Until there is a cure for glaucoma, the best weapon against this potentially blinding disease is early detection, leading to a well-planned course of treatment. Predicated on evidence based medicine and contemporary research results, we can now begin preventative treatment in regard to glaucoma.

Treatment for glaucoma may begin if your doctor feels the pressure in the eye is high enough to pose a threat to your optic nerve, or if the risks factors for glaucoma are too great. Typical treatment for glaucoma involves controlling your IOP with drug therapy in the form of prescription eye drops. Modern glaucoma drugs are extremely effective in lowering IOP to acceptable levels. In comparison with therapies used a number of years ago, they are more effective, easier to use (due to less frequent administration per day needed), and have fewer side effects. At Broward Eye Care our goal is to control your glaucoma and prevent vision loss. With the use of the most up to date advances in diagnosis and treatment we are able to achieve this goal consistently.

Some of the most commonly used topical medications for the management of glaucoma include:

• • Prostaglandin Drugs: Travatan, Lumigan, and Xalatan
  • Beta Blocker Drugs: Timoptic, Betoptic, etc.
  • Alpha Adrenergics Drugs: Alphagan-P
  • Carbonic Anhydrase Inhibitor Drugs: Trusopt, Azopt
  • Combination Agents: Cosopt, Combigan

For the small percentages of patients that do not lower their IOP sufficiently though drug therapy, there are other options. Laser treatment may be tried to open channels for fluid to escape. Laser therapy is relatively painless and is usually performed in the physician’s office in two sessions over the course of a month. Some patients may require additional laser treatments or a third form of treatment, filtration surgery. During this procedure, the physician surgically creates a valve in the wall of the eye using existing eye tissue, allowing the aqueous humor to drain. This therapy, combined with close follow-up, can halt the progression of glaucoma. At Broward Eye Care our goal is to prevent vision loss and provide new therapies and treatments as they become available.

Age related macular degeneration or AMD is the most common cause of irreversible vision loss for people over the age of 60. It is estimated that 2.5 million people in developed countries will suffer visual loss from this disorder and that there are approximately 200,000 new cases diagnosed every year. The macula is the small portion of the retina located at the center of this light sensitive lining at the back of the eye. The macula is responsible for sharp straight ahead vision necessary for functions such as reading, driving a car and recognizing faces.

The effect of this disease can range from mild vision loss to central blindness. That is, blindness “straight ahead” but with normal peripheral vision from the non macular part of the retina which is undamaged by the disease.

Ninety percent of AMD is of the atrophic or dry variety. It is characterized by a thinning of the macular tissue, develops slowly and usually only causes mild visual loss. The main symptom is often only a dimming of vision when reading.

The second form of AMD is called exudative or wet because of the abnormal growth of new blood vessels under the macula where they leak and eventually create a large blind spot in the central vision. This form of the disease is of much greater threat to vision than the more common dry type.

Macular degeneration is most common in people over the age of 60 but there have been some cases affecting people as young as their 40s and 50s. Symptoms include blurry or fuzzy vision, straight lines like telephone poles and sides of buildings appearing wavy and a dark or empty area appearing in the center of vision.

Unfortunately, the cause of this eye condition is not fully understood but it is associated with the aging process. As we age, we become more susceptible to numerous degenerative processes like arthritis, heart conditions, cancer, cataracts and macular degeneration. These conditions may be caused by the body’s overproduction of free radicals. These extra electrons are quite destructive and cause cellular damage, alter DNA and are thought to be at least partially responsible for many of the degenerative diseases mentioned above. The production of these free radicals is normal during metabolism but the body produces its own “anti-oxidants” to neutralize them.

Some of the vitamins in the food we eat also have anti-oxidant properties. These are vitamins A, C, E and beta carotene. Unfortunately, smoking, poor nutrition and other lifestyle factors result in the body producing too many free radicals. For this reason, lifestyle factors may contribute to the risk of AMD. There is some evidence to suggest that AMD has a genetic basis as the condition does tend to run in families. Exposure to certain types of light may also play a role. Studies done on fishermen in the Chesapeake Bay suggest that long term exposure to ultraviolet light from the sun may increase the risk of AMD and other eye conditions such as the development of cataracts It has also been hypothesized that hyperopia or farsightedness may also play a role in the development of the disease. It is thought that the shortening of the eye in hyperopia may cause changes in the membrane below the macula and in its blood vessels. In the dry type of the disease, some form of inflammation may also be a factor although what causes the inflammation is not known.

Get Treatment From Out Macular Degeneration Specialist In Fort Lauderdale, FL

Although researchers are spending a great deal of time investigating the cause and treatment of AMD, there is no real cure available The goal of current treatment efforts is to attempt to stabilize the condition.

For the more severe wet form of the disease, doctors try laser photocoagulation. This treatment, however, is not without dangers and is only beneficial in the very early stages of the condition. That is why early detection is so important. This technique involves directing a beam of laser light at the abnormal blood vessels in order to destroy them and prevent their leaking. Provided that the blood vessels have not grown under the macula, this treatment can be helpful in arresting the progress of the disease. If the blood vessels are already under the macula, the laser may cause scarring and permanent vision loss.

A new type of treatment called photodynamic therapy is presently under investigation and shows considerable promise. A drug called BPD is put into the affected eye and in only a few minutes the eye is exposed to a non thermal red light. This light activates the drug to close and seal off the abnormal blood vessels. The entire treatment only takes about 30 minutes and requires no anesthetic. Preliminary results have been quite promising.

No treatment exists for the dry form but many doctors are convinced that a combination of specific vitamins and minerals helps slow the progression of the disease. This has yet to be confirmed scientifically but there are valid reasons for attempting this therapy. Anti-oxidant vitamins containing the pigment Zeaxanthin such as EyePromise may help to neutralize the free radicals that are associated with this degenerative process.

Zinc, one of the most common trace minerals in our body, is highly concentrated in the retina and surrounding tissues and is a requirement for chemical reactions in the retina. Fat soluble anti-oxidant vitamins like vitamin A and vitamin E are stored in the body and can increase to toxic levels if over used and zinc may interfere with other trace minerals like copper. Caution should therefore be exercised in the use of vitamins and minerals.
Next time your in the office ask our Doctors about Ocuvite vitamins to prevent macular degeneration. All patients who are at high risk of developing or patients who have the beginning signs of the disease should be on specific vitamin dosage to help prevent the degenerative process.