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Often appearing in the teens or early twenties, keratoconus is a progressive disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.

Keratoconus Symptoms and Signs

Keratoconus can be difficult to detect, because it usually develops so slowly. However, in some cases, it may proceed rapidly. Nearsightedness and astigmatism also may accompany this disease, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may be noticed. Keratoconic patients often have prescription changes each time they visit their eyecare practitioner. It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is not familiar with the early-stage symptoms of the disease.

What Causes Keratoconus?

New research has demonstrated a relationship between malfunction of beneficial enzymes found within the eye's surface and an accompanying chemical imbalance that leads to toxic damage and thinning of eye tissue. Because keratoconus can be found in extended families, this improper functioning of beneficial enzymes appears to have genetic causes about 5% of the time. Eye damage from keratoconus also can be linked to factors such as overexposure to sunlight, improper fittings of contact lenses, excessive eye rubbing, and continual (chronic) eye irritation.

New research has demonstrated a relationship between malfunction of beneficial enzymes found within the eye's surface and an accompanying chemical imbalance that leads to toxic damage and thinning of eye tissue. Because keratoconus can be found in extended families, this improper functioning of beneficial enzymes appears to have genetic causes about 5% of the time. Eye damage from keratoconus also can be linked to factors such as overexposure to sunlight, improper fittings of contact lenses, excessive eye rubbing, and continual (chronic) eye irritation.

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and changes shape even more, glasses or soft contacts will no longer correct your vision.

Other keratoconus treatments include:

Rigid gas permeable contact lenses: If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable contact lenses are an option to consider. The firmer material of a rigid contact lens vaults over the irregular cornea better than a soft contact lens to improve vision. But rigid contact lenses can be more uncomfortable to wear than a soft lens. Fitting contact lenses on a keratoconic cornea is delicate and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription. The process will begin again when the cornea thins and distorts even more, altering the contact lens fit and prescription needed for clear, comfortable vision.

Intacs: (Addition Technology, Des Plaines, Ill.) Intacs or corneal inserts received U.S. Food and Drug Administration approval for treating keratoconus in August 2004, although the first cases in the United States were performed for keratoconus in 1999. These plastic inserts are placed just under the eye's surface in the periphery of the cornea, which helps achieve a flatter cornea leading to clearer vision. Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies have found that Intacs improved keratoconic participants' eyeglass-corrected vision by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The procedure takes only about 10 minutes. Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress. Potential risks of Intacs are infection, little or no improvement in vision, glare and halos, and foreign body sensation, so it is important to discuss the procedure in detail with a surgeon to make sure you are a good candidate.

C3-R: (Advanced Vision Education, Los Angeles) Another new procedure for treating keratoconus, known by the brand name of C3-R (corneal collagen cross-linking riboflavin), is a non-invasive method of strengthening corneal tissue to halt bulging of the eye's surface. Specifically formulated eye drops containing riboflavin (vitamin B2) are placed on the cornea, and then activated by a special light to strengthen connective tissue (collagen) within the eye. C3-R may be combined with Intacs to treat keratoconus.

Early results showing benefits of using this method have been promising. In one small German study reported in the May 2003 issue of American Journal of Ophthalmology, progression of keratoconus was stopped in all 23 eyes of 22 patients. Most patients also had some reversal of keratoconus and minor vision improvement. Researchers concluded that this simple method of treatment might have implications for greatly reducing the need for corneal transplants for keratoconus patients.

Corneal transplant: Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty. Even after a transplant, you most likely will need glasses or contact lenses for clear vision.

Macular Degeneration

Macular degeneration, often called AMD or ARMD (age-related macular degeneration), is the leading cause of vision loss and blindness in Americans aged 65 and older. Because older people represent an increasingly larger percentage of the general population, vision loss associated with AMD is a growing problem.

AMD occurs with degeneration of the macula, which is the part of the retina responsible for the sharp, central vision needed to read or drive. Because the macula primarily is affected in AMD, central vision loss may occur.

Macular Degeneration Symptoms and Signs

Macular degeneration usually produces a slow, or rarely, sudden painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision.

Viewing a chart of black lines arranged in a graph pattern (Amsler grid) is one way to tell if you are having these vision problems.

An eyecare practitioner often detects early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination. When macular degeneration is suspected, a brief test using an Amsler grid that measures your central vision may be performed. If the eyecare practitioner detects some defect in your central vision, such as distortion or blurriness, he or she may order a fluorescein angiography to specifically examine the retinal blood vessels surrounding the macula.

How Macular Degeneration is treated

There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.

Treatments for macular degeneration depend on whether the disease is in its early stage or dry form or more advanced, wet form that can lead to serious vision loss. There are no FDA-approved treatments for dry macular degeneration, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.

For wet AMD, treatments aimed at stopping abnormal blood vessel growth include FDA-approved drugs of Macugen and Visudyne used with Photodynamic Therapy or PDT. Some new investigative treatments such as Lucentis and Avastin are showing promise for possibly even reducing vision loss in a significant number of macular degeneration patients.


Glaucoma is a group of diseases in which the pressure in the eye is higher than that particular eye can tolerate. A higher than normal pressure causes damage to the very sensitive optic nerve at the retina. Loss of sight may occur gradually or in rare cases, suddenly if glaucoma is not controlled.

In a rare form of glaucoma, acute glaucoma, there is severe pain, headache and nausea. In the more common chronic form, symptoms are rare and loss of sight occurs so gradually that the patient is not aware of any changes.

Glaucoma is the leading cause of blindness in people over age 40. Half the people who have glaucoma don't know it because it usually destroys eyesight without any symptoms of pain. Glaucoma occurs when the body produces too much fluid (aqueous humor) inside the eye or when normal drainage of the fluid does not filter out of the eye adequately.

Early diagnosis and treatment is imperative. If glaucoma is discovered early, treatment usually keeps it from getting worse. Eye Care Associates has acquired a GDX nerve fiber analyzer which allows our doctors to identify glaucoma much earlier than ever before. Regular eye exams are necessary to measure intra-ocular eye pressure, to evaluate the integrity of the optic nerve and to study a patient's peripheral field of vision. It is advised that persons having a family history of glaucoma or other factors indicating predisposition to this disease should be especially cautious. To learn more about the different types of glaucoma, please visit WebMD.

Dry Eyes

The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection. These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience dry eyes.

When tears do not adequately lubricate the eye, a person may experience:

  • Pain
  • Light sensitivity
  • A gritty sensation
  • A feeling of a foreign body or sand in the eye
  • Itching
  • Redness
  • Blurring of vision


A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. A cataract may make light from the sun or a lamp seem too bright or glaring. Or you may notice when you drive at night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once did.

The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur. When a nuclear cataract first develops it can bring about a temporary improvement in your near vision, called "second sight." Unfortunately, the improved vision is short-lived and will disappear as the cataract worsens. Meanwhile, a subcapsular cataract may not produce any symptoms until it's well-developed.

Watch Dr. Michael Sandler speak about cataract surgery here.

Cataract Treatment

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids. Think about surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with over 1.5 million cataract surgeries done each year. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40. During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. One example is a new IOL that lets patients see at all distances, not just one. Another new IOL blocks both ultraviolet and blue light rays, which research indicates may damage the retina. An intraocular lens (IOL) is implanted in the eye in place of the patient's clouded natural lens. Shown is Alcon's new AcrySof Natural IOL; the lens material is yellow because it filters out blue light, which may be harmful to eyes. (see illustration).

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