1.

Age-Related Macular Degeneration (AMD)

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is a disease

associated with aging that gradually destroys sharp, central
vision. Central vision is needed for seeing objects clearly and for
common daily tasks such as reading and driving.

AMD affects the macula, the part of the eye that allows you to
see fine detail. AMD causes no pain.

In some cases, AMD advances so slowly that people notice little

change in their vision. In others, the disease progresses faster
and may lead to a loss of vision in both eyes. AMD is a leading
cause of vision loss in Americans 60 years of age and older. What is wet AMD?

AMD occurs in two forms: wet and dry.
Where is the macula?
The macula is located in the center of the retina, the light-
sensitive tissue at the back of the eye. The retina instantly
converts light, or an image, into electrical impulses. The retina
then sends these impulses, or nerve signals, to the brain.
Wet AMD occurs when abnormal blood vessels behind the retina
start to grow under the macula. These new blood vessels tend to
be very fragile and often leak blood and fluid. The blood and fluid
raise the macula from its normal place at the back of the eye.
Damage to the macula occurs rapidly.
With wet AMD, loss of central vision can occur quickly. Wet AMD
is also known as advanced AMD. It does not have stages like dry
AMD.

An early symptom of wet AMD is that straight lines appear wavy.

If you notice this condition or other changes to your vision,
contact your eye care professional at once. You need a
comprehensive dilated eye exam.

What is dry AMD?

Dry AMD occurs when the light-sensitive cells in the macula

slowly break down, gradually blurring central vision in the
affected eye. As dry AMD gets worse, you may see a blurred spot
in the center of your vision. Over time, as less of the macula
functions, central vision is gradually lost in the affected eye.
The most common symptom of dry AMD is slightly blurred vision.
You may have difficulty recognizing faces. You may need more
light for reading and other tasks. Dry AMD generally affects both
eyes, but vision can be lost in one eye while the other eye seems
unaffected.

One of the most common early signs of dry AMD is drusen.

What are drusen?

Drusen are yellow deposits under the retina. They often are
found in people over age 60. Your eye care professional can Normal vision The same scene as viewed by a person
detect drusen during a comprehensive dilated eye exam. with age-related macular degeneration

Drusen alone do not usually cause vision loss. In fact, scientists
are unclear about the connection between drusen and AMD. They
do know that an increase in the size or number of drusen raises a
person's risk of developing either advanced dry AMD or wet AMD.
These changes can cause serious vision loss.
Dry AMD has three stages, all of which may occur in one or both
eyes:
1. Early AMD. People with early AMD have either several
small drusen or a few medium-sized drusen. At this stage,
there are no symptoms and no vision loss.
2. Intermediate AMD. People with intermediate AMD have
either many medium-sized drusen or one or more large
drusen. Some people see a blurred spot in the center of
their vision. More light may be needed for reading and
other tasks.
3. Advanced Dry AMD. In addition to drusen, people with
advanced dry AMD have a breakdown of light-sensitive
cells and supporting tissue in the central retinal area. This
breakdown can cause a blurred spot in the center of your
vision. Over time, the blurred spot may get bigger and
darker, taking more of your central vision. You may have
difficulty reading or recognizing faces until they are very
close to you.
If you have vision loss from dry AMD in one eye only, you may
not notice any changes in your overall vision. With the other eye
seeing clearly, you still can drive, read, and see fine details. You
may notice changes in your vision only if AMD affects both eyes.
If blurriness occurs in your vision, see an eye care professional
for a comprehensive dilated eye exam.
Ninety percent of all people with AMD have this type. Scientists
are still not sure what causes dry AMD.
Frequently Asked Questions about wet and dry AMD
Which is more common-the dry form or the wet form?
The dry form is much more common. More than 85 percent of all
people with intermediate and advanced AMD combined have the
dry form.
However, if only advanced AMD is considered, about two-thirds of
patients have the wet form. Because almost all vision loss comes
from advanced AMD, the wet form leads to significantly more
vision loss than the dry form.
Can the dry form turn into the wet form?
Yes. All people who have the wet form had the dry form first.
The dry form can advance and cause vision loss without turning
into the wet form. The dry form also can suddenly turn into the
wet form, even during early stage AMD. There is no way to tell if
or when the dry form will turn into the wet form.
The dry form has early and intermediate stages. Does the
wet form have similar stages?
No. The wet form is considered advanced AMD.
Can advanced AMD be either the dry form or the wet
form?
Yes. Both the wet form and the advanced dry form are
considered advanced AMD. Vision loss occurs with either form. In
most cases, only advanced AMD can cause vision loss.
People who have advanced AMD in one eye are at especially high
risk of developing advanced AMD in the other eye.
Causes and Risk Factors
Who is at risk for AMD?
The greatest risk factor is age. Although AMD may occur during
middle age, studies show that people over age 60 are clearly at
greater risk than other age groups. For instance, a large study
found that people in middle-age have about a 2 percent risk of
getting AMD, but this risk increased to nearly 30 percent in those
over age 75.
Other risk factors include:
• Smoking. Smoking may increase the risk of AMD.
• Obesity. Research studies suggest a link between obesity
and the progression of early and intermediate stage AMD
to advanced AMD.
• Race. Whites are much more likely to lose vision from
AMD than African Americans.
• Family history. Those with immediate family members
who have AMD are at a higher risk of developing the
disease.
• Gender. Women appear to be at greater risk than men.
Can my lifestyle make a difference?
Your lifestyle can play a role in reducing your risk of developing
AMD.
• Eat a healthy diet high in green leafy vegetables and fish.
• Don't smoke.
• Maintain normal blood pressure.
• Watch your weight.
• Exercise.
Symptoms and Detection
What are the symptoms?
Both dry and wet AMD cause no pain.
For dry AMD: the most common early sign is blurred vision. As
fewer cells in the macula are able to function, people will see
details less clearly in front of them, such as faces or words in a
book. Often this blurred vision will go away in brighter light. If the
loss of these light-sensing cells becomes great, people may see a
small--but growing--blind spot in the middle of their field of
vision.
For wet AMD: the classic early symptom is that straight lines
appear crooked. This results when fluid from the leaking blood
vessels gathers and lifts the macula, distorting vision. A small
blind spot may also appear in wet AMD, resulting in loss of one's
central vision.

How is AMD detected?

Your eye care professional may suspect AMD if you are over age
60 and have had recent changes in your central vision. To look
for signs of the disease, he or she will use eye drops to dilate, or
enlarge, your pupils. Dilating the pupils allows your eye care
professional to view the back of the eye better.

AMD is detected during a comprehensive eye exam that includes:

1. Visual acuity test. This eye chart test measures how
well you see at various distances.
2. Dilated eye exam. Drops are placed in your eyes to
widen, or dilate, the pupils. Your eye care professional
uses a special magnifying lens to examine your retina and
optic nerve for signs of AMD and other eye problems.
After the exam, your close-up vision may remain blurred
for several hours.
3. Tonometry. An instrument measures the pressure inside
the eye. Numbing drops may be applied to your eye for
this test.
Your eye care professional also may do other tests to learn more
about the structure and health of your eye.
Amsler Grid
If your eye care professional believes you need treatment for wet
AMD, he or she may suggest a fluorescein angiogram. In this
test, a special dye is injected into your arm. Pictures are taken as
the dye passes through the blood vessels in your retina. The test
allows your eye care professional to identify any leaking blood
vessels and recommend treatment.
Treatment
How is wet AMD treated?

During an eye exam, you may be asked to look at an Amsler
grid. The pattern of the grid resembles a checkerboard. You will
cover one eye and stare at a black dot in the center of the grid.
While staring at the dot, you may notice that the straight lines in
the pattern appear wavy. You may notice that some of the lines
are missing. These may be signs of AMD.
Do NOT depend on the grid displayed below for any diagnoses-
check with your eye care professional.
Wet AMD can be treated with laser surgery, photodynamic
therapy, and injections into the eye. None of these treatments is
a cure for wet AMD. The disease and loss of vision may progress
despite treatment.
1. Laser surgery. This procedure uses a laser to destroy
the fragile, leaky blood vessels. A high energy beam of
light is aimed directly onto the new blood vessels and
destroys them, preventing further loss of vision. However,
 laser treatment may also destroy some surrounding
healthy tissue and some vision. Only a small percentage
of people with wet AMD can be treated with laser surgery.
Laser surgery is more effective if the leaky blood vessels
have developed away from the fovea, the central part of
the macula. (See illustration at the beginning of this
document.) Laser surgery is performed in a doctor's office
or eye clinic.
The risk of new blood vessels developing after laser
treatment is high. Repeated treatments may be
necessary. In some cases, vision loss may progress
despite repeated treatments.
2. Photodynamic therapy. A drug called verteporfin is
injected into your arm. It travels throughout the body,
including the new blood vessels in your eye. The drug
tends to "stick" to the surface of new blood vessels. Next,
a light is shined into your eye for about 90 seconds. The
light activates the drug. The activated drug destroys the
new blood vessels and leads to a slower rate of vision
decline. Unlike laser surgery, this drug does not destroy
surrounding healthy tissue. Because the drug is activated
by light, you must avoid exposing your skin or eyes to
direct sunlight or bright indoor light for five days after
treatment.
Photodynamic therapy is relatively painless. It takes about
20 minutes and can be performed in a doctor's office.
Photodynamic therapy slows the rate of vision loss. It does
not stop vision loss or restore vision in eyes already
damaged by advanced AMD. Treatment results often are
temporary. You may need to be treated again.
3. Injections. Wet AMD can now be treated with new drugs
that are injected into the eye (anti-VEGF therapy).
Abnormally high levels of a specific growth factor occur in
eyes with wet AMD and promote the growth of abnormal
new blood vessels. This drug treatment blocks the effects
of the growth factor.
You will need multiple injections that may be given as
often as monthly. The eye is numbed before each
injection. After the injection, you will remain in the
doctor's office for a while and your eye will be monitored.
This drug treatment can help slow down vision loss from
AMD and in some cases improve sight.
How is dry AMD treated?
Once dry AMD reaches the advanced stage, no form of treatment
can prevent vision loss. However, treatment can delay and
possibly prevent intermediate AMD from progressing to the
advanced stage, in which vision loss occurs.
The National Eye Institute's Age-Related Eye Disease Study
(AREDS) found that taking a specific high-dose formulation of
antioxidants and zinc significantly reduces the risk of advanced
AMD and its associated vision loss. Slowing AMD's progression
from the intermediate stage to the advanced stage will save the
vision of many people.
Age-Related Eye Disease Study (AREDS)
What is the dosage of the AREDS formulation?
The specific daily amounts of antioxidants and zinc used by the
study researchers were 500 milligrams of vitamin C, 400
International Units of vitamin E, 15 milligrams of beta-carotene
(often labeled as equivalent to 25,000 International Units of
vitamin A), 80 milligrams of zinc as zinc oxide, and two
milligrams of copper as cupric oxide. Copper was added to the
AREDS formulation containing zinc to prevent copper deficiency
anemia, a condition associated with high levels of zinc intake.
Who should take the AREDS formulation?
People who are at high risk for developing advanced AMD should
consider taking the formulation. You are at high risk for
developing advanced AMD if you have either:
1. Intermediate AMD in one or both eyes.
OR
2. Advanced AMD (dry or wet) in one eye but not the other eye.
Your eye care professional can tell you if you have AMD, its
stage, and your risk for developing the advanced form.
The AREDS formulation is not a cure for AMD. It will not restore
vision already lost from the disease. However, it may delay the
onset of advanced AMD. It may help people who are at high risk
for developing advanced AMD keep their vision.
Can people with early stage AMD take the AREDS
formulation to help prevent the disease from progressing
to the intermediate stage?
There is no apparent need for those diagnosed with early stage
AMD to take the AREDS formulation. The study did not find that
the formulation provided a benefit to those with early stage AMD.
If you have early stage AMD, a comprehensive dilated eye exam
every year can help determine if the disease is progressing. If
early stage AMD progresses to the intermediate stage, discuss
taking the formulation with your doctor.
Can diet alone provide the same high levels of
antioxidants and zinc as the AREDS formulation?
No. The high levels of vitamins and minerals are difficult to
achieve from diet alone. However, previous studies have
suggested that people who have diets rich in green leafy
vegetables have a lower risk of developing AMD.
Can a daily multivitamin alone provide the same high
levels of antioxidants and zinc as the AREDS formulation?
No. The formulation's levels of antioxidants and zinc are
considerably higher than the amounts in any daily multivitamin.
If you are already taking daily multivitamins and your doctor
suggests you take the high-dose AREDS formulation, be sure to
review all your vitamin supplements with your doctor before you
begin. Because multivitamins contain many important vitamins
not found in the AREDS formulation, you may want to take a
multivitamin along with the AREDS formulation. For example,
people with osteoporosis need to be particularly concerned about
taking vitamin D, which is not in the AREDS formulation.
How can I take care of my vision now that I have AMD?
Dry AMD. If you have dry AMD, you should have a comprehensive
dilated eye exam at least once a year. Your eye care professional
can monitor your condition and check for other eye diseases.
Also, if you have intermediate AMD in one or both eyes, or
advanced AMD in one eye only, your doctor may suggest that
you take the AREDS formulation containing the high levels of
antioxidants and zinc.
Because dry AMD can turn into wet AMD at any time, you should
get an Amsler grid from your eye care professional. Use the grid
every day to evaluate your vision for signs of wet AMD. This quick
test works best for people who still have good central vision.
Check each eye separately. Cover one eye and look at the grid.
Then cover your other eye and look at the grid. If you detect any
changes in the appearance of this grid or in your everyday vision
while reading the newspaper or watching television, get a
comprehensive dilated eye exam.
Wet AMD. If you have wet AMD and your doctor advises
treatment, do not wait. After laser surgery or photodynamic
therapy, you will need frequent eye exams to detect any
recurrence of leaking blood vessels. Studies show that people
who smoke have a greater risk of recurrence than those who
don't. In addition, check your vision at home with the Amsler
grid. If you detect any changes, schedule an eye exam
immediately.
What can I do if I have already lost some vision from
AMD?
If you have lost some sight from AMD, don't be afraid to use your
eyes for reading, watching TV, and other routine activities.
Normal use of your eyes will not cause further damage to your
vision.
If you have lost some sight from AMD, ask your eye care
professional about low vision services and devices that may help
you make the most of your remaining vision. Ask for a referral to
a specialist in low vision. Many community organizations and
agencies offer information about low vision counseling, training,
and other special services for people with visual impairments. A
nearby school of medicine or optometry may provide low vision
services.
Current Research
What research is being done?
The National Eye Institute is conducting and supporting a number
of studies to learn more about AMD. For example, scientists are:
• Studying the possibility of transplanting healthy cells into
a diseased retina.
• Evaluating families with a history of AMD to understand
genetic and hereditary factors that may cause the
disease.
• Looking at certain anti-inflammatory treatments for the
wet form of AMD.
This research should provide better ways to detect, treat, and
prevent vision loss in people with AMD.
2. Amblyopia
What is amblyopia?
The brain and the eye work together to produce vision. Light
enters the eye and is changed into nerve signals that travel along
the optic nerve to the brain. Amblyopia is the medical term used
when the vision in one of the eyes is reduced because the eye
and the brain are not working together properly. The eye itself
looks normal, but it is not being used normally because the brain
is favoring the other eye. This condition is also sometimes called
lazy eye.
How common is amblyopia?
Amblyopia is the most common cause of visual impairment in
childhood. The condition affects approximately 2 to 3 out of
every 100 children. Unless it is successfully treated in early
childhood, amblyopia usually persists into adulthood, and is the
most common cause of monocular (one eye) visual impairment
among children and young and middle-aged adults.
Cause
What causes amblyopia?
Amblyopia may be caused by any condition that affects normal
visual development or use of the eyes. Amblyopia can be caused
by strabismus, an imbalance in the positioning of the two eyes.
Strabismus can cause the eyes to cross in (esotropia) or turn out
(exotropia). Sometimes amblyopia is caused when one eye is
more nearsighted, farsighted, or astigmatic than the other eye.
Occasionally, amblyopia is caused by other eye conditions such
as cataract.
Treatment
How is amblyopia treated in children?
Treating amblyopia involves making the child use the eye with
the reduced vision (weaker eye). Currently, there are two ways
used to do this:
Atropine
A drop of a drug called atropine is placed in the stronger eye
once a day to temporarily blur the vision so that the child will
prefer to use the eye with amblyopia. Treatment with atropine
also stimulates vision in the weaker eye and helps the part of the
brain that manages vision develop more completely.
Patching
An opaque, adhesive patch is worn over the stronger eye for
weeks to months. This therapy forces the child to use the eye
with amblyopia. Patching stimulates vision in the weaker eye and
helps the part of the brain that manages vision develop more
completely.
Previously, eye care professionals often thought that treating
amblyopia in older children would be of little benefit. However,
surprising results from a nationwide clinical trial show that many
children age seven through 17 with amblyopia may benefit from
treatments that are more commonly used on younger children.
This study shows that age alone should not be used as a factor to
decide whether or not to treat a child for amblyopia.
Can amblyopia be treated in adults?
Studies are very limited at this time and scientists don’t know
what the success rate might be for treating amblyopia in adults.
During the first six to nine years of life, the visual system
develops very rapidly. Complicated connections between the eye
and the brain are created during that period of growth and
development. Scientists are exploring whether treatment for
amblyopia in adults can improve vision.
Current Research
What research is being done?
Findings from the clinical study, An Evaluation Of Treatment Of
Amblyopia In Children 7 To < 18 Years Old (ATS3), show that
many children age seven through 17 with amblyopia (lazy eye)
may benefit from treatments that are more commonly used on
younger children. Previously, eye care professionals often
thought that treating amblyopia in older children would be of
little benefit. Read more about the ATS3.
The NEI is currently supporting the Amblyopia Treatment Study:
Occlusion Versus Pharmacologic Therapy for Moderate Amblyopia
(ATS) to determine whether patching or eyedrops is a better
treatment for amblyopia. Recent results for the ATS found that
the atropine eyedrops, when placed in the unaffected eye once a
day, work as well as eye patching and may encourage better
compliance. The study was conducted at 47 clinical sites
throughout North America. Read more about the ATS.
In addition, A Randomized Trial Comparing Part-time Versus
Minimal-time Patching for Moderate Amblyopia (Two v. Six) is
being conducted to determine whether the visual acuity
improvement obtained with part-time (6 hours) patching is
equivalent to the visual acuity improvement obtained with
minimal patching (2 hours) for moderate amblyopia. Recent
findings show that patching the unaffected eye of children with
moderate amblyopia for two hours daily works as well as
patching the eye for six hours. Shorter patching time should lead
to better compliance with treatment and improved quality of life
for children with amblyopia. Read more about the Two v. Six
study.
The NEI is also supporting other clinical studies on amblyopia.
3. Cataract
What is a cataract?
A cataract is a clouding of the lens in the eye that affects vision.
Most cataracts are related to aging. Cataracts are very common
in older people. By age 80, more than half of all Americans either
have a cataract or have had cataract surgery.
A cataract can occur in either or both eyes. It cannot spread from
one eye to the other.
What is the lens?
The lens is a clear part
of the eye that helps to
focus light, or an image,
on the retina. The retina
is the light-sensitive
tissue at the back of the
eye.
1. Secondary cataract. Cataracts can form after surgery
for other eye problems, such as glaucoma. Cataracts also
can develop in people who have other health problems,
such as diabetes. Cataracts are sometimes linked to
steroid use.
2. Traumatic cataract. Cataracts can develop after an eye
injury, sometimes years later.
3. Congenital cataract. Some babies are born with
cataracts or develop them in childhood, often in both
eyes. These cataracts may be so small that they do not
affect vision. If they do, the lenses may need to be
removed.
4. Radiation cataract. Cataracts can develop after
exposure to some types of radiation.

In a normal eye, light

passes through the
transparent lens to the
retina. Once it reaches
the retina, light is
changed into nerve
signals that are sent to Normal vision
the brain.

The lens must be clear for the retina to receive a sharp image. If
the lens is cloudy from a cataract, the image you see will be
blurred.

Are there other types of cataract?

Yes. Although most cataracts are related to aging, there are

other types of cataract:

The same scene as viewed by a person with cataract


Causes and Risk Factors
What causes cataracts?
The lens lies behind the iris and the pupil (see diagram). It works
much like a camera lens. It focuses light onto the retina at the
back of the eye, where an image is recorded. The lens also
adjusts the eye's focus, letting us see things clearly both up close
and far away. The lens is made of mostly 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. Over time,
the cataract may grow larger and cloud more of the lens, making
it harder to see.
Researchers suspect that there are several causes of cataract,
such as smoking and diabetes. Or, it may be that the protein in
the lens just changes from the wear and tear it takes over the
years.
How can cataracts affect my vision?
Age-related cataracts can affect your vision in two ways:
1. Clumps of protein reduce the sharpness of the image
reaching the retina.
The lens consists mostly of water and protein. When the
protein clumps up, it clouds the lens and reduces the light
that reaches the retina. The clouding may become severe
enough to cause blurred vision. Most age-related
cataracts develop from protein clumpings.
When a cataract is small, the cloudiness affects only a
small part of the lens. You may not notice any changes in
your vision. Cataracts tend to "grow" slowly, so vision gets
worse gradually. Over time, the cloudy area in the lens
may get larger, and the cataract may increase in size.
Seeing may become more difficult. Your vision may get
duller or blurrier.
2. The clear lens slowly changes to a yellowish/brownish
color, adding a brownish tint to vision.
As the clear lens slowly colors with age, your vision
gradually may acquire a brownish shade. At first, the
amount of tinting may be small and may not cause a
vision problem. Over time, increased tinting may make it
more difficult to read and perform other routine activities.
This gradual change in the amount of tinting does not
affect the sharpness of the image transmitted to the
retina.
If you have advanced lens discoloration, you may not be
able to identify blues and purples. You may be wearing
what you believe to be a pair of black socks, only to find
out from friends that you are wearing purple socks.
When are you most likely to have a cataract?
The term "age-related" is a little misleading. You don't have to be
a senior citizen to get this type of cataract. In fact, people can
have an age-related cataract in their 40s and 50s. But during
middle age, most cataracts are small and do not affect vision. It
is after age 60 that most cataracts steal vision.
Who is at risk for cataract?
The risk of cataract increases as you get older. Other risk factors
for cataract include:
• Certain diseases such as diabetes.
• Personal behavior such as smoking and alcohol use.
• The environment such as prolonged exposure to sunlight.
What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet
sunlight may help to delay cataract. If you smoke, stop.
Researchers also believe good nutrition can help reduce the risk
of age-related cataract. They recommend eating green leafy
vegetables, fruit, and other foods with antioxidants.
If you are age 60 or older, you should have a comprehensive
dilated eye exam at least once every two years. In addition to
cataract, your eye care professional can check for signs of age-
related macular degeneration, glaucoma, and other vision
disorders. Early treatment for many eye diseases may save your
sight.
Symptoms and Detection
What are the symptoms of a cataract?
The most common symptoms of a cataract are:
• Cloudy or blurry vision.
• Colors seem faded.
• Glare. Headlights, lamps, or sunlight may appear too
bright. A halo may appear around lights.
• Poor night vision.
• Double vision or multiple images in one eye. (This
symptom may clear as the cataract gets larger.)
• Frequent prescription changes in your eyeglasses or
contact lenses.
• These symptoms also can be a sign of other eye
problems. If you have any of these symptoms, check with
your eye care professional.
How is a cataract detected?
Cataract is detected through a comprehensive eye exam that
includes:
1. Visual acuity test. This eye chart test measures how
well you see at various distances.
2. Dilated eye exam. Drops are placed in your eyes to
widen, or dilate, the pupils. Your eye care professional
uses a special magnifying lens to examine your retina and
optic nerve for signs of damage and other eye problems.
After the exam, your close-up vision may remain blurred
for several hours.
3. Tonometry. An instrument measures the pressure inside
the eye. Numbing drops may be applied to your eye for
this test.
Your eye care professional also may do other tests to learn more
about the structure and health of your eye.
Treatment
How is a cataract treated?
The symptoms of early cataract may be improved with new
eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying
lenses. If these measures do not help, surgery is the only
effective treatment. Surgery involves removing the cloudy lens
and replacing it with an artificial lens.
A cataract needs to be removed only when vision loss interferes
with your everyday activities, such as driving, reading, or
watching TV. You and your eye care professional can make this
decision together. Once you understand the benefits and risks of
surgery, you can make an informed decision about whether
cataract surgery is right for you. In most cases, delaying cataract
surgery will not cause long-term damage to your eye or make the
surgery more difficult. You do not have to rush into surgery.
Sometimes a cataract should be removed even if it does not
cause problems with your vision. For example, a cataract should
be removed if it prevents examination or treatment of another
eye problem, such as age-related macular degeneration or
diabetic retinopathy. If your eye care professional finds a
cataract, you may not need cataract surgery for several years. In
fact, you might never need cataract surgery. By having your
vision tested regularly, you and your eye care professional can
discuss if and when you might need treatment.
If you choose surgery, your eye care professional may refer you
to a specialist to remove the cataract.
If you have cataracts in both eyes that require surgery, the
surgery will be performed on each eye at separate times, usually
four to eight weeks apart.
Many people who need cataract surgery also have other eye
conditions, such as age-related macular degeneration or
glaucoma. If you have other eye conditions in addition to
cataract, talk with your doctor. Learn about the risks, benefits,
alternatives, and expected results of cataract surgery.
What are the different types of cataract surgery?
There are two types of cataract surgery. Your doctor can explain
the differences and help determine which is better for you:
1. Phacoemulsification, or phaco. A small incision is made
on the side of the cornea, the clear, dome-shaped surface
that covers the front of the eye. Your doctor inserts a tiny
probe into the eye. This device emits ultrasound waves
that soften and break up the lens so that it can be
removed by suction. Most cataract surgery today is done
by phacoemulsification, also called "small incision
cataract surgery."
2. Extracapsular surgery. Your doctor makes a longer
incision on the side of the cornea and removes the cloudy
core of the lens in one piece. The rest of the lens is
removed by suction.
After the natural lens has been removed, it often is replaced by
an artificial lens, called an intraocular lens (IOL). An IOL is a clear,
plastic lens that requires no care and becomes a permanent part
of your eye. Light is focused clearly by the IOL onto the retina,
improving your vision. You will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye
disease or have problems during surgery. For these patients, a
soft contact lens, or glasses that provide high magnification, may
be suggested.
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as
infection and bleeding. Before cataract surgery, your doctor may
ask you to temporarily stop taking certain medications that
increase the risk of bleeding during surgery. After surgery, you
must keep your eye clean, wash your hands before touching your
eye, and use the prescribed medications to help minimize the
risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases your risk of retinal
detachment. Other eye disorders, such as high myopia
(nearsightedness), can further increase your risk of retinal
detachment after cataract surgery. One sign of a retinal
detachment is a sudden increase in flashes or floaters. Floaters
are little "cobwebs" or specks that seem to float about in your
field of vision. If you notice a sudden increase in floaters or
flashes, see an eye care professional immediately. A retinal
detachment is a medical emergency. If necessary, go to an
emergency service or hospital. Your eye must be examined by an
eye surgeon as soon as possible. A retinal detachment causes no
pain. Early treatment for retinal detachment often can prevent
permanent loss of vision. The sooner you get treatment, the
more likely you will regain good vision. Even if you are treated
promptly, some vision may be lost.
Talk to your eye care professional about these risks. Make sure
cataract surgery is right for you.
Is cataract surgery effective?
Cataract removal is one of the most common operations
performed in the United States. It also is one of the safest and
most effective types of surgery. In about 90 percent of cases,
people who have cataract surgery have better vision afterward.
What happens before surgery?
A week or two before surgery, your doctor will do some tests.
These tests may include measuring the curve of the cornea and
the size and shape of your eye. This information helps your
doctor choose the right type of IOL.
You may be asked not to eat or drink anything 12 hours before
your surgery.
What happens during surgery?
At the hospital or eye clinic, drops will be put into your eye to
dilate the pupil. The area around your eye will be washed and
cleansed.
The operation usually lasts less than one hour and is almost
painless. Many people choose to stay awake during surgery.
Others may need to be put to sleep for a short time.
If you are awake, you will have an anesthetic to numb the nerves
in and around your eye.
After the operation, a patch may be placed over your eye. You
will rest for a while. Your medical team will watch for any
problems, such as bleeding. Most people who have cataract
surgery can go home the same day. You will need someone to
drive you home.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery.
Some fluid discharge is also common. Your eye may be sensitive
to light and touch. If you have discomfort, your doctor can
suggest treatment. After one or two days, moderate discomfort
should disappear.
For a few days after surgery, your doctor may ask you to use
eyedrops to help healing and decrease the risk of infection. Ask
your doctor about how to use your eyedrops, how often to use
them, and what effects they can have. You will need to wear an
eye shield or eyeglasses to help protect your eye. Avoid rubbing
or pressing on your eye.
When you are home, try not to bend from the waist to pick up
objects on the floor. Do not lift any heavy objects. You can walk,
climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your
doctor will schedule exams to check on your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can occur. These
problems can include infection, bleeding, inflammation (pain,
redness, swelling), loss of vision, double vision, and high or low
eye pressure. With prompt medical attention, these problems can
usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy
and may blur your vision. This condition is called an after-
cataract. An after-cataract can develop months or years after
cataract surgery.
An after-cataract is treated with a laser. Your doctor uses a laser
to make a tiny hole in the eye tissue behind the lens to let light
pass through. This outpatient procedure is called a YAG laser
capsulotomy. It is painless and rarely results in increased eye
pressure or other eye problems. As a precaution, your doctor
may give you eyedrops to lower your eye pressure before or after
the procedure.
When will my vision be normal again?
You can return quickly to many everyday activities, but your • Genetic studies, which show promise for better
vision may be blurry. The healing eye needs time to adjust so understanding cataract development.
that it can focus properly with the other eye, especially if the
other eye has a cataract. Ask your doctor when you can resume
4. Diabetic Retinopathy
driving.
What is diabetic eye disease?
If you received an IOL, you may notice that colors are very bright.
The IOL is clear, unlike your natural lens that may have had a
yellowish/brownish tint. Within a few months after receiving an Diabetic eye disease refers to a group of eye problems that
IOL, you will become used to improved color vision. Also, when people with diabetes may face as a complication of diabetes. All
your eye heals, you may need new glasses or contact lenses. can cause severe vision loss or even blindness.

What can I do if I already have lost some vision from Diabetic eye disease may
cataract? include:

If you have lost some sight from cataract or cataract surgery, ask • Diabetic retinopathy
your eye care professional about low vision services and devices —damage to the
that may help you make the most of your remaining vision. Ask blood vessels in the
for a referral to a specialist in low vision. Many community retina.
organizations and agencies offer information about low vision • Cataract—clouding
counseling, training, and other special services for people with of the eye's lens.
visual impairments. A nearby school of medicine or optometry Cataracts develop at
may provide low vision services. an earlier age in
people with
diabetes.
• Glaucoma—increase in fluid pressure inside the eye that
leads to optic nerve damage and loss of vision. A person
Current Research with diabetes is nearly twice as likely to get glaucoma as
other adults.
What research is being done?
What is diabetic retinopathy?
The National Eye Institute is conducting and supporting a number
of studies focusing on factors associated with the development of Diabetic retinopathy is the most common diabetic eye disease
age-related cataract. These studies include: and a leading cause of blindness in American adults. It is caused
by changes in the blood vessels of the retina.
• The effect of sunlight exposure, which may be associated
with an increased risk of cataract. In some people with diabetic retinopathy, blood vessels may
• Vitamin supplements, which have shown varying results in swell and leak fluid. In other people, abnormal new blood vessels
delaying the progression of cataract. grow on the surface of the retina. The retina is the light-sensitive
tissue at the back of the eye. A healthy retina is necessary for
good vision.
If you have diabetic retinopathy, at first you may not notice
changes to your vision. But over time, diabetic retinopathy can
get worse and cause vision loss. Diabetic retinopathy usually
affects both eyes.
What are the stages of diabetic retinopathy?
Diabetic retinopathy has four stages:
1. Mild Nonproliferative Retinopathy. At this earliest
stage, microaneurysms occur. They are small areas of
balloon-like swelling in the retina's tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the
disease progresses, some blood vessels that nourish the
retina are blocked.
3. Severe Nonproliferative Retinopathy. Many more
blood vessels are blocked, depriving several areas of the
retina with their blood supply. These areas of the retina
send signals to the body to grow new blood vessels for
nourishment.
4. Proliferative Retinopathy. At this advanced stage, the
signals sent by the retina for nourishment trigger the
growth of new blood vessels. This condition is called
proliferative retinopathy. These new blood vessels are
abnormal and fragile. They grow along the retina and
along the surface of the clear, vitreous gel that fills the
inside of the eye. By themselves, these blood vessels do
not cause symptoms or vision loss. However, they have
thin, fragile walls. If they leak blood, severe vision loss
and even blindness can result.
Causes and Risk Factors
How does diabetic retinopathy cause vision loss?
Blood vessels damaged from diabetic retinopathy can cause
vision loss in two ways:
1. Fragile, abnormal blood vessels can develop and leak
blood into the center of the eye, blurring vision. This is
proliferative retinopathy and is the fourth and most
advanced stage of the disease.
2. Fluid can leak into the center of the macula, the part of
the eye where sharp, straight-ahead vision occurs. The
fluid makes the macula swell, blurring vision. This
condition is called macular edema. It can occur at any
stage of diabetic retinopathy, although it is more likely to
occur as the disease progresses. About half of the people
with proliferative retinopathy also have macular edema.
Normal vision Same scene viewed by a
person with diabetic
retinopathy
Who is at risk for diabetic retinopathy?
All people with diabetes--both type 1 and type 2--are at risk.
That's why everyone with diabetes should get a comprehensive
dilated eye exam at least once a year. The longer someone has
diabetes, the more likely he or she will get diabetic retinopathy.
Between 40 to 45 percent of Americans diagnosed with diabetes
have some stage of diabetic retinopathy. If you have diabetic
retinopathy, your doctor can recommend treatment to help
prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for
women with diabetes. To protect vision, every pregnant woman
with diabetes should have a comprehensive dilated eye exam as
soon as possible. Your doctor may recommend additional exams
during your pregnancy.
What can I do to protect my vision?
If you have diabetes get a comprehensive dilated eye exam at
least once a year and remember:
• Proliferative retinopathy can develop without symptoms.
At this advanced stage, you are at high risk for vision loss.
• Macular edema can develop without symptoms at any of
the four stages of diabetic retinopathy.
• You can develop both proliferative retinopathy and
macular edema and still see fine. However, you are at
high risk for vision loss.
• Your eye care professional can tell if you have macular
edema or any stage of diabetic retinopathy. Whether or
not you have symptoms, early detection and timely
treatment can prevent vision loss.
If you have diabetic retinopathy, you may need an eye exam
more often. People with proliferative retinopathy can reduce their
risk of blindness by 95 percent with timely treatment and
appropriate follow-up care.
The Diabetes Control and Complications Trial (DCCT) showed that
better control of blood sugar levels slows the onset and
progression of retinopathy. The people with diabetes who kept
their blood sugar levels as close to normal as possible also had
much less kidney and nerve disease. Better control also reduces
the need for sight-saving laser surgery.
This level of blood sugar control may not be best for everyone,
including some elderly patients, children under age 13, or people
with heart disease. Be sure to ask your doctor if such a control
program is right for you.
Other studies have shown that controlling elevated blood
pressure and cholesterol can reduce the risk of vision loss.
Controlling these will help your overall health as well as help
protect your vision.
Symptoms and Detection
Does diabetic retinopathy have any symptoms?
Often there are no symptoms in the early stages of the disease,
nor is there any pain. Don't wait for symptoms. Be sure to
have a comprehensive dilated eye exam at least once a year.
Blurred vision may occur when the macula—the part of the retina
that provides sharp central vision—swells from leaking fluid. This
condition is called macular edema.
If new blood vessels grow on the surface of the retina, they can
bleed into the eye and block vision.
What are the symptoms of proliferative retinopathy if
bleeding occurs?
At first, you will see a few specks of blood, or spots, "floating" in
your vision. If spots occur, see your eye care professional as soon
as possible. You may need treatment before more serious
bleeding occurs. Hemorrhages tend to happen more than once,
often during sleep.
Sometimes, without treatment, the spots clear, and you will see
better. However, bleeding can reoccur and cause severely
blurred vision. You need to be examined by your eye care
professional at the first sign of blurred vision, before more
bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision
loss and even blindness. Also, the earlier you receive treatment,
the more likely treatment will be effective.
How are diabetic retinopathy and macular edema
detected?
Diabetic retinopathy and macular edema are detected during a
comprehensive eye exam that includes:
1. Visual acuity test. This eye chart test measures how
well you see at various distances.
2. Dilated eye exam. Drops are placed in your eyes to
widen, or dilate, the pupils. This allows the eye care
professional to see more of the inside of your eyes to
check for signs of the disease. Your eye care professional
uses a special magnifying lens to examine your retina and
optic nerve for signs of damage and other eye problems.
After the exam, your close-up vision may remain blurred
for several hours.
3. Tonometry. An instrument measures the pressure inside
the eye. Numbing drops may be applied to your eye for
this test.
Your eye care professional checks your retina for early signs of
the disease, including:
• Leaking blood vessels.
• Retinal swelling (macular edema).
• Pale, fatty deposits on the retina--signs of leaking blood
vessels.
• Damaged nerve tissue.
• Any changes to the blood vessels.
If your eye care professional believes you need treatment for
macular edema, he or she may suggest a fluorescein
angiogram. In this test, a special dye is injected into your arm.
Pictures are taken as the dye passes through the blood vessels in
your retina. The test allows your eye care professional to identify
any leaking blood vessels and recommend treatment.
Treatment
How is diabetic retinopathy treated?
During the first three stages of diabetic retinopathy, no
treatment is needed, unless you have macular edema. To
prevent progression of diabetic retinopathy, people with diabetes
should control their levels of blood sugar, blood pressure, and
blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This
procedure is called scatter laser treatment. Scatter laser
treatment helps to shrink the abnormal blood vessels. Your
doctor places 1,000 to 2,000 laser burns in the areas of the retina
away from the macula, causing the abnormal blood vessels to
shrink. Because a high number of laser burns are necessary, two
or more sessions usually are required to complete treatment.
Although you may notice some loss of your side vision, scatter
laser treatment can save the rest of your sight. Scatter laser
treatment may slightly reduce your color vision and night vision.
Scatter laser treatment works better before the fragile, new
blood vessels have started to bleed. That is why it is important to
have regular, comprehensive dilated eye exams. Even if bleeding
has started, scatter laser treatment may still be possible,
depending on the amount of bleeding.
If the bleeding is severe, you may need a surgical procedure
called a vitrectomy. During a vitrectomy, blood is removed from
the center of your eye.
How is a macular edema treated?
Macular edema is treated with laser surgery. This procedure is
called focal laser treatment. Your doctor places up to several
hundred small laser burns in the areas of retinal leakage
surrounding the macula. These burns slow the leakage of fluid
and reduce the amount of fluid in the retina. The surgery is
usually completed in one session. Further treatment may be
needed.
A patient may need focal laser surgery more than once to control
the leaking fluid. If you have macular edema in both eyes and
require laser surgery, generally only one eye will be treated at a
time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser
treatment reduces the risk of vision loss by 50 percent. In a small
number of cases, if vision is lost, it can be improved. Contact
your eye care professional if you have vision loss.
What happens during laser treatment?
Both focal and scatter laser treatment are performed in your
doctor's office or eye clinic. Before the surgery, your doctor will
dilate your pupil and apply drops to numb the eye. The area
behind your eye also may be numbed to prevent discomfort.
The lights in the office will be dim. As you sit facing the laser
machine, your doctor will hold a special lens to your eye. During
the procedure, you may see flashes of light. These flashes
eventually may create a stinging sensation that can be
uncomfortable. You will need someone to drive you home after
surgery. Because your pupil will remain dilated for a few hours,
you should bring a pair of sunglasses.
For the rest of the day, your vision will probably be a little blurry.
If your eye hurts, your doctor can suggest treatment.
Laser surgery and appropriate follow-up care can reduce the risk
of blindness by 90 percent. However, laser surgery often cannot
restore vision that has already been lost. That is why finding
diabetic retinopathy early is the best way to prevent vision loss.
What is a vitrectomy?
If you have a lot of blood in the center of the eye (vitreous gel),
you may need a vitrectomy to restore your sight. If you need
vitrectomies in both eyes, they are usually done several weeks
apart.
A vitrectomy is performed under either local or general
anesthesia. Your doctor makes a tiny incision in your eye. Next, a
small instrument is used to remove the vitreous gel that is
clouded with blood. The vitreous gel is replaced with a salt
solution. Because the vitreous gel is mostly water, you will notice
no change between the salt solution and the original vitreous gel.
You will probably be able to return home after the vitrectomy.
Some people stay in the hospital overnight. Your eye will be red
and sensitive. You will need to wear an eye patch for a few days
or weeks to protect your eye. You also will need to use medicated
eyedrops to protect against infection.
Are scatter laser treatment and vitrectomy effective in
treating proliferative retinopathy?
Yes. Both treatments are very effective in reducing vision loss.
People with proliferative retinopathy have less than a five
percent chance of becoming blind within five years when they
get timely and appropriate treatment. Although both treatments
have high success rates, they do not cure diabetic retinopathy.
Once you have proliferative retinopathy, you always will be at
risk for new bleeding. You may need treatment more than once
to protect your sight.
What can I do if I already have lost some vision from
diabetic retinopathy?
If you have lost some sight from diabetic retinopathy, ask your
eye care professional about low vision services and devices that
may help you make the most of your remaining vision. Ask for a
referral to a specialist in low vision. Many community
organizations and agencies offer information about low vision
counseling, training, and other special services for people with
visual impairments. A nearby school of medicine or optometry
may provide low vision services.
What is the optic nerve?
The optic nerve is a bundle of more than 1 million nerve fibers. It
connects the retina to the brain. (See diagram below.) The retina
is the light-sensitive tissue at the back of the eye. A healthy optic
nerve is necessary for good vision.

What are some other forms of glaucoma?

Current Research

Open-angle glaucoma is the most common form. Some people

What research is being done?
have other types of the disease.
The National Eye Institute (NEI) is conducting and supporting
research that seeks better ways to detect, treat, and prevent
vision loss in people with diabetes. This research is conducted
through studies in the laboratory and with patients.
For example, researchers are studying drugs that may stop the
retina from sending signals to the body to grow new blood
vessels. Someday, these drugs may help people control their
diabetic retinopathy and reduce the need for laser surgery.
5. Glaucoma
What is glaucoma?
1. Low-tension or normal-tension glaucoma. Optic
nerve damage and narrowed side vision occur in people
with normal eye pressure. Lowering eye pressure at least
30 percent through medicines slows the disease in some
people. Glaucoma may worsen in others despite low
pressures.
A comprehensive medical history is important in
identifying other potential risk factors, such as low blood
pressure, that contribute to low-tension glaucoma. If no
risk factors are identified, the treatment options for low-
tension glaucoma are the same as for open-angle
glaucoma.

Glaucoma is a group of diseases that can damage the eye's optic

nerve and result in
vision loss and 2. Angle-closure glaucoma. The fluid at the front of the
blindness. eye cannot reach the angle and leave the eye. The angle
Glaucoma occurs gets blocked by part of the iris. People with this type of
when the normal glaucoma have a sudden increase in eye pressure.
fluid pressure inside Symptoms include severe pain and nausea, as well as
the eyes slowly redness of the eye and blurred vision. If you have these
rises. However, with symptoms, you need to seek treatment immediately.
early treatment,
you can often This is a medical emergency. If your doctor is unavailable,
protect your eyes go to the nearest hospital or clinic. Without treatment to
against serious improve the flow of fluid, the eye can become blind in as
vision loss.
 few as one or two days. Usually, prompt laser surgery and open angle where the cornea and iris meet. (See diagram below.)
medicines can clear the blockage and protect sight. When the fluid reaches the angle, it flows through a spongy
meshwork, like a drain, and leaves the eye.

Sometimes, when
3. Congenital glaucoma. Children are born with a defect in the fluid reaches
the angle of the eye that slows the normal drainage of the angle, it passes
fluid. These children usually have obvious symptoms, such too slowly through
as cloudy eyes, sensitivity to light, and excessive tearing. the meshwork
Conventional surgery typically is the suggested drain. As the fluid
treatment, because medicines may have unknown effects builds up, the
in infants and be difficult to administer. Surgery is safe pressure inside the
and effective. If surgery is done promptly, these children eye rises to a level
usually have an excellent chance of having good vision. that may damage
the optic nerve.
When the optic
nerve is damaged
from increased
4. Secondary glaucomas. These can develop as pressure, open-
complications of other medical conditions. These types of angle glaucoma--
glaucomas are sometimes associated with eye surgery or and vision loss--may
advanced cataracts, eye injuries, certain eye tumors, or result. That's why
uveitis (eye inflammation). Pigmentary glaucoma controlling pressure inside the eye is important.
occurs when pigment from the iris flakes off and blocks
the meshwork, slowing fluid drainage. A severe form, Does increased eye pressure mean that I have glaucoma?
called neovascular glaucoma, is linked to diabetes.
Corticosteroid drugs used to treat eye inflammations and Not necessarily. Increased eye pressure means you are at risk for
other diseases can trigger glaucoma in some people. glaucoma, but does not mean you have the disease. A person
Treatment includes medicines, laser surgery, or has glaucoma only if the optic nerve is damaged. If you have
conventional surgery. increased eye pressure but no damage to the optic nerve, you do
not have glaucoma. However, you are at risk. Follow the advice
of your eye care professional.

Causes and Risk Factors Can I develop glaucoma if I have increased eye pressure?

How does open-angle glaucoma damage the optic nerve? Not necessarily. Not every person with increased eye pressure
will develop glaucoma. Some people can tolerate higher eye
pressure better than others. Also, a certain level of eye pressure
In the front of the eye is a space called the anterior chamber. A
may be high for one person but normal for another.
clear fluid flows continuously in and out of the chamber and
nourishes nearby tissues. The fluid leaves the chamber at the
Whether you develop glaucoma depends on the level of pressure
your optic nerve can tolerate without being damaged. This level
is different for each person. That's why a comprehensive dilated
eye exam is very important. It can help your eye care
professional determine what level of eye pressure is normal for
you.
Can I develop glaucoma without an increase in my eye
pressure?
Yes. Glaucoma can develop without increased eye pressure. This
form of glaucoma is called low-tension or normal-tension
glaucoma. It is not as common as open-angle glaucoma.
Who is at risk for glaucoma?
Anyone can develop glaucoma. Some people are at higher risk
than others. They include:
• African Americans over age 40.
• Everyone over age 60, especially Mexican Americans.
• People with a family history of glaucoma.
Among African Americans, studies show that glaucoma is:
• Five times more likely to occur in African Americans than
in Caucasians.
• About four times more likely to cause blindness in African
Americans than in Caucasians.
• Fifteen times more likely to cause blindness in African
Americans between the ages of 45-64 than in Caucasians
of the same age group.
A comprehensive dilated eye exam can reveal more risk factors,
such as high eye pressure, thinness of the cornea, and abnormal
optic nerve anatomy. In some people with certain combinations
of these high-risk factors, medicines in the form of eyedrops
reduce the risk of developing glaucoma by about half.
Medicare covers an annual comprehensive dilated eye exam for
some people at high risk for glaucoma.
What can I do to protect my vision?
Studies have shown that the early detection and treatment of
glaucoma, before it causes major vision loss, is the best way to
control the disease. So, if you fall into one of the high-risk groups
for the disease, make sure to have your eyes examined through
dilated pupils every two years by an eye care professional.
If you are being treated for glaucoma, be sure to take your
glaucoma medicine every day. See your eye care professional
regularly.
You also can help protect the vision of family members and
friends who may be at high risk for glaucoma--African Americans
over age 40; everyone over age 60, especially Mexican
Americans; and people with a family history of the disease.
Encourage them to have a comprehensive dilated eye exam at
least once every two years. Remember: Lowering eye pressure in
glaucoma's early stages slows progression of the disease and
helps save vision.
Symptoms and Detection
What are the symptoms of glaucoma?
At first, there are no symptoms. Vision stays normal, and there is
no pain.
However, as the disease progresses, a person with glaucoma
may notice his or her side vision gradually failing. That is, objects
in front may still be seen clearly, but objects to the side may be
missed.
 As glaucoma remains untreated, people may miss objects to the
side and out of the corner of their eye. Without treatment, people
with glaucoma will slowly lose their peripheral (side) vision. They
seem to be looking through a tunnel. Over time, straight-ahead
vision may decrease until no vision remains.
Glaucoma can develop in one or both eyes.
Normal vision Same scene as viewed by a person withconventional surgery, or a combination of any of these. While
glaucoma
How is glaucoma detected?
Glaucoma is detected through a comprehensive eye exam that
includes:
1. Visual acuity test. This eye chart test measures how
well you see at various distances. A tonometer measures
pressure inside the eye to detect glaucoma.
2. Visual field test. This test measures your side
(peripheral) vision. It helps your eye care professional tell
if you have lost side vision, a sign of glaucoma.
3. Dilated eye exam. Drops are placed in your eyes to
widen, or dilate, the pupils. Your eye care professional
uses a special magnifying lens to examine your retina and
optic nerve for signs of damage and other eye problems.
After the exam, your close-up vision may remain blurred
for several hours.
4. Tonometry. An instrument (right) measures the pressure
inside the eye. Numbing drops may be applied to your eye
for this test.
5. Pachymetry. A numbing drop is applied to your eye. Your
eye care professional uses an ultrasonic wave instrument
to measure the thickness of your cornea.
Treatment
Can glaucoma be treated?
Yes. Immediate treatment for early stage, open-angle glaucoma
can delay progression of the disease. That's why early diagnosis
is very important.
Glaucoma treatments include medicines, laser trabeculoplasty,
these treatments may save remaining vision, they do not
improve sight already lost from glaucoma.
1. Medicines. Medicines, in the form of eyedrops or pills,
are the most common early treatment for glaucoma.
Some medicines cause the eye to make less fluid. Others
lower pressure by helping fluid drain from the eye.
Before you begin glaucoma treatment, tell your eye care
professional about other medicines you may be taking.
Sometimes the drops can interfere with the way other
medicines work.
Glaucoma medicines may be taken several times a day.
Most people have no problems. However, some medicines
can cause headaches or other side effects. For example,
drops may cause stinging, burning, and redness in the
eyes. Many drugs are available to treat glaucoma. If you
have problems with one medicine, tell your eye care
professional. Treatment with a different dose or a new
 drug may be possible. wear off over time. Your doctor may suggest further
treatment.
Because glaucoma often has no symptoms, people may 3. Conventional surgery. Conventional surgery makes a
be tempted to stop taking, or may forget to take, their new opening for the fluid to leave the eye. (See diagram.)
medicine. You need to use the drops or pills as long as Your doctor may suggest this treatment at any time.
they help control your eye pressure. Regular use is very Conventional surgery often is done after medicines and
important. Make sure your eye care professional shows laser surgery have failed to control pressure.
you how to put the drops into your eye. See tips
(hyperlink to "How should I use my glaucoma eyedrops?") Conventional
on using your glaucoma eyedrops. surgery is
performed in
an eye clinic
or hospital.
2. Laser trabeculoplasty. Laser trabeculoplasty helps fluid Before the
drain out of the eye. Your doctor may suggest this step at surgery, you
any time. In many cases, you need to keep taking will be given
glaucoma drugs after this procedure. medicine to
help you
Laser trabeculoplasty is performed in your doctor's office relax. Your
or eye clinic. Before the surgery, numbing drops will be doctor will
applied to your eye. As you sit facing the laser machine, make small
your doctor will hold a special lens to your eye. A high- injections
intensity beam of light is aimed at the lens and reflected around the
onto the meshwork inside your eye. You may see flashes eye to numb
of bright green or red light. The laser makes several it. A small
evenly spaced burns that stretch the drainage holes in the piece of
meshwork. This allows the fluid to drain better. tissue is removed to create a new channel for the fluid to
drain from the eye.
Like any surgery, laser surgery can cause side effects,
such as inflammation. Your doctor may give you some For several weeks after the surgery, you must put drops in
drops to take home for any soreness or inflammation the eye to fight infection and inflammation. These drops
inside the eye. You need to make several follow-up visits will be different from those you may have been using
to have your eye pressure monitored. before surgery.

If you have glaucoma in both eyes, only one eye will be
treated at a time. Laser treatments for each eye will be
scheduled several days to several weeks apart.
Studies show that laser surgery is very good at reducing
the pressure in some patients. However, its effects can
As with laser surgery, conventional surgery is performed
on one eye at a time. Usually the operations are four to
six weeks apart. Conventional surgery is about 60 to 80
percent effective at lowering eye pressure. If the new
drainage opening narrows, a second operation may be
needed. Conventional surgery works best if you have not
had previous eye surgery, such as a cataract operation.

In some instances, your vision may not be as good as it
was before conventional surgery. Conventional surgery
can cause side effects, including cataract, problems with
the cornea, and inflammation or infection inside the eye.
The buildup of fluid in the back of the eye may cause
some patients to see shadows in their vision. If you have
any of these problems, tell your doctor so a treatment
plan can be developed.
Conventional surgery makes a new opening for the fluid to leave
the eye.
How should I use my glaucoma eyedrops?
If eyedrops have been prescribed for treating your glaucoma, you
need to use them properly and as instructed by your eye care
professional. Proper use of your glaucoma medication can
improve the medicine's effectiveness and reduce your risk of side
effects. To properly apply your eyedrops, follow these steps:
• First, wash your hands.
• Hold the bottle upside down.
• Tilt your head back.
• Hold the bottle in one hand and place it as close as
possible to the eye.
• With the other hand, pull down your lower eyelid. This
forms a pocket.
• Place the prescribed number of drops into the lower eyelid
pocket. If you are using more than one eyedrop, be sure
to wait at least five minutes before applying the second
eyedrop.
• Close your eye OR press the lower lid lightly with your
finger for at least one minute. Either of these steps keeps
the drops in the eye and helps prevent the drops from
draining into the tear duct, which can increase your risk of
side effects
What can I do if I already have lost some vision from
glaucoma?
If you have lost some sight from glaucoma, ask your eye care
professional about low vision services and devices that may help
you make the most of your remaining vision. Ask for a referral to
a specialist in low vision.
Many community organizations and agencies offer information
about low vision counseling, training, and other special services
for people with visual impairments. A nearby school of medicine
or optometry may provide low vision services.
Current Research
What research is being done?
A large amount of research is being done in the U.S. to learn
what causes glaucoma and to improve its diagnosis and
treatment. For instance, the National Eye Institute (NEI) is
funding a number of studies to find out what causes fluid
pressure to increase in the eye. By learning more about this
process, doctors may be able to find the exact cause of the
disease and learn better how to prevent and treat it. The NEI also
supports clinical trials of new drugs and surgical techniques that
show promise against glaucoma.
Retinal Detachment Defined
What is retinal detachment?
The retina is the light-sensitive layer of tissue that lines the
inside of the eye and sends visual messages through the optic
nerve to the brain. When the retina detaches, it is lifted or pulled
from its normal position. If not promptly treated, retinal
detachment can cause permanent vision loss.
In some cases there may be small areas of the retina that are
torn. These areas, called retinal tears or retinal breaks, can lead
to retinal detachment.

Frequently Asked Questions about Retinal Detachment
What are the different types of retinal detachment?
There are three different types of retinal detachment:
Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the
retina allows fluid to get under the retina and separate it from
the retinal pigment epithelium (RPE), the pigmented cell layer
that nourishes the retina. These types of retinal detachments are
the most common.
Tractional -- In this type of detachment, scar tissue on the
retina's surface contracts and causes the retina to separate from
the RPE. This type of detachment is less common.
Exudative -- Frequently caused by retinal diseases, including
inflammatory disorders and injury/trauma to the eye. In this type,
fluid leaks into the area underneath the retina, but there are no
tears or breaks in the retina.
Causes and Risk Factors
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more
common in people over age 40. It affects men more than women,
and Whites more than African Americans.
A retinal detachment is also more likely to occur in people who:
• Are extremely nearsighted
• Have had a retinal detachment in the other eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have other eye diseases or disorders, such as
retinoschisis, uveitis, degenerative myopia, or lattice
degeneration
• Have had an eye injury
Symptoms and Detection
What are the symptoms of retinal detachment?
Symptoms include a sudden or gradual increase in either the
number of floaters, which are little "cobwebs" or specks that float
about in your field of vision, and/or light flashes in the eye.
Another symptom is the appearance of a curtain over the field of
vision. A retinal detachment is a medical emergency.
Anyone experiencing the symptoms of a retinal detachment
should see an eye care professional immediately.
Treatment
How is retinal detachment treated?
Small holes and tears are treated with laser surgery or a freeze
treatment called cryopexy. These procedures are usually
performed in the doctor's office. During laser surgery tiny burns
are made around the hole to "weld" the retina back into place.
Cryopexy freezes the area around the hole and helps reattach
the retina.
Retinal detachments are treated with surgery that may require
the patient to stay in the hospital. In some cases a scleral buckle,
a tiny synthetic band, is attached to the outside of the eyeball to
gently push the wall of the eye against the detached retina. If
necessary, a vitrectomy may also be performed. During a
vitrectomy, the doctor makes a tiny incision in the sclera (white
of the eye). Next, a small instrument is placed into the eye to
remove the vitreous, a gel-like substance that fills the center of
the eye and helps the eye maintain a round shape. Gas is often
injected to into the eye to replace the vitreous and reattach the
retina; the gas pushes the retina back against the wall of the eye.
During the healing process, the eye makes fluid that gradually
replaces the gas and fills the eye. With all of these procedures,
either laser or cryopexy is used to "weld" the retina back in
place.
With modern therapy, over 90 percent of those with a retinal
detachment can be successfully treated, although sometimes a
second treatment is needed. However, the visual outcome is not
always predictable. The final visual result may not be known for
up to several months following surgery. Even under the best of
circumstances, and even after multiple attempts at repair,
treatment sometimes fails and vision may eventually be lost.
Visual results are best if the retinal detachment is repaired
before the macula (the center region of the retina responsible for
fine, detailed vision) detaches. That is why it is important to
contact an eye care professional immediately if you see a sudden
or gradual increase in the number of floaters and/or light flashes,
or a dark curtain over the field of vision.
Current Research
What research is being done?
The NEI supported The Silicone Study, a nationwide clinical
trial that compared the use of silicone oil with long-acting
intraocular gas for repairing a retinal detachment caused by
proliferative vitreoretinopathy (PVR). With PVR, cells grow on the
surface of the retina causing it to detach. This is a serious
complication that sometimes follows retinal detachment surgery
and is difficult to treat. The results indicate that both treatments
are effective and give the surgeons more options for treating
these difficult cases. More information on The Silicone Study is
available at http://www.nei.nih.gov/neitrials/static/study39.asp.
6. Vitreous Detachment
What is vitreous detachment?
Most of the eye's interior is filled with vitreous, a gel-like
substance that helps the eye maintain a round shape. There are
millions of fine fibers intertwined within the vitreous that are
attached to the surface of the retina, the eye's light-sensitive
tissue. As we age, the vitreous slowly shrinks, and these fine
fibers pull on the retinal surface. Usually the fibers break,
allowing the vitreous to separate and shrink from the retina. This
is a vitreous detachment.
In most cases, a vitreous detachment, also known as a posterior
vitreous detachment, is not sight-threatening and requires no
treatment.
Risk Factors
Who is at risk for vitreous detachment?
A vitreous detachment is a common condition that usually affects
people over age 50, and is very common after age 80. People
who are nearsighted are also at increased risk. Those who have a
vitreous detachment in one eye are likely to have one in the
other, although it may not happen until years later.
Symptoms and Detection
What are the symptoms of vitreous detachment?
As the vitreous shrinks, it becomes somewhat stringy, and the
strands can cast tiny shadows on the retina that you may notice
as floaters, which appear as little "cobwebs" or specks that seem
to float about in your field of vision. If you try to look at these
shadows they appear to quickly dart out of the way.
One symptom of a vitreous detachment is a small but sudden
increase in the number of new floaters. This increase in floaters
may be accompanied by flashes of light (lightning streaks) in
your peripheral, or side, vision. In most cases, either you will not
notice a vitreous detachment, or you will find it merely annoying
because of the increase in floaters.
How is vitreous detachment detected?
The only way to diagnose the cause of the problem is by a
comprehensive dilated eye examination. If the vitreous
detachment has led to a macular hole or detached retina, early
treatment can help prevent loss of vision.
Treatment
How does vitreous detachment affect vision?
Although a vitreous detachment does not threaten sight, once in
a while some of the vitreous fibers pull so hard on the retina that
they create a macular hole to or lead to a retinal detachment.
Both of these conditions are sight-threatening and should be
treated immediately.
If left untreated, a macular hole or detached retina can lead to
permanent vision loss in the affected eye. Those who experience
a sudden increase in floaters or an increase in flashes of light in
peripheral vision should have an eye care professional examine
their eyes as soon as possible.
7. Dry Eye
What is dry eye?
Dry eye occurs when the eye does not produce tears properly, or
when the tears are not of the correct consistency and evaporate
too quickly.
In addition, inflammation of the surface of the eye may occur
along with dry eye. If left untreated, this condition can lead to
pain, ulcers, or scars on the cornea, and some loss of vision.
However, permanent loss of vision from dry eye is uncommon.
Dry eye can make it more difficult to perform some activities,
such as using a computer or reading for an extended period of
time, and it can decrease tolerance for dry environments, such as
the air inside an airplane.
Other names for dry eye include dry eye syndrome,
keratoconjunctivitis sicca (KCS), dysfunctional tear syndrome,
lacrimal keratoconjunctivitis, evaporative tear deficiency,
aqueous tear deficiency, and LASIK-induced neurotrophic
epitheliopathy (LNE).
What are the types of dry eye?
1) Aqueous tear-deficient dry eye is a disorder in which the
lacrimal glands fail to produce enough of the watery component
of tears to maintain a healthy eye surface.
2) Evaporative dry eye may result from inflammation of the
meibomian glands, also located in the eyelids. These glands
make the lipid or oily part of tears that slows evaporation and
keeps the tears stable.
Dry eye can be associated with:
• inflammation of the surface of the eye, the lacrimal gland,
or the conjunctiva;
 • any disease process that alters the components of the
tears;
• an increase in the surface of the eye, as in thyroid disease
when the eye protrudes forward;
• cosmetic surgery, if the eyelids are opened too widely.
Frequently Asked Questions About Dry Eye
What is the cornea?
The cornea is the clear, dome-shaped outer surface that covers
the eye in front of the iris, the colored part of the eye. The cornea
helps protect the rest of the eye from germs, dust, and other
harmful matter. The cornea bends, or refracts, light entering the
eye, and accounts for most of the eye's total focusing power. It
also serves as a filter to screen out most of the damaging
ultraviolet (UV) wavelengths in sunlight.
The cornea is a highly organized, clear structure made up of a
group of cells and proteins precisely arranged in layers, but it has
no blood vessels to nourish or protect it against infection.
Instead, it receives its nourishment from the tears and the watery
fluid (aqueous humor) that fills the chamber behind it.
What are tears,
and how do they
relate to dry eye?
Tears, made by the
lacrimal gland, are
necessary for overall
eye health and clear
vision. Tears bathe
the surface of the
eye, keeping it moist,
and wash away dust and debris. They also help protect the eye
from bacterial and other types of infections.
Tears are composed of three major components: a) outer, oily,
lipid layer produced by the meibomian glands; b) middle, watery,
lacrimal layer produced by the lacrimal glands; and c) inner,
mucous or mucin layer produced by goblet cells located within a
thin transparent layer over the white part of the eye and covering
the inner surface of the eyelids. Tears are made of proteins
(including growth factors), electrolytes, and vitamins that are
critical to maintain the health of the eye surface and to prevent
infection.
Tears are constantly produced to bathe, nourish, and protect the
eye surface. They are also produced in response to emergencies,
such as a particle of dust in the eye, an infection or irritation of
the eye, or an onset of strong emotions. When the lacrimal
glands fail to produce sufficient tears, dry eye can result.
Any disease process that alters the components of tears can
make them unhealthy and result in dry eye.
Symptoms
What are the symptoms of dry eye?
Dry eye symptoms may include any of the following:
• stinging or burning of the eye;
• a sandy or gritty feeling as if something is in the eye;
• episodes of excess tears following very dry eye periods;
• a stringy discharge from the eye;
• pain and redness of the eye;
• episodes of blurred vision;
• heavy eyelids;
• inability to cry when emotionally stressed;
• uncomfortable contact lenses;
 • decreased tolerance of reading, working on the computer,
or any activity that requires sustained visual attention;
• eye fatigue.
NOTE: If symptoms of dry eye persist, consult an eye care
professional to get an accurate diagnosis of the condition and
begin treatment to avoid permanent damage.
Causes and Risk Factors
What are the causes of dry eye?
Dry eye can be a temporary or chronic condition:
• Dry eye can be a side effect of some medications,
including antihistamines, nasal decongestants,
tranquilizers, certain blood pressure medicines,
Parkinson's medications, birth control pills and anti-
depressants.
• Skin disease on or around the eyelids can result in dry
eye.
• Diseases of the glands in the eyelids, such as meibomian
gland dysfunction, can cause dry eye.
• Dry eye can occur in women who are pregnant.
• Women who are on hormone replacement therapy may
experience dry eye symptoms. Women taking only
estrogen are 70 percent more likely to experience dry
eye, whereas those taking estrogen and progesterone
have a 30 percent increased risk of developing dry eye.
• Dry eye can also develop after the refractive surgery
known as LASIK. These symptoms generally last three to
six months, but may last longer in some cases.
• Dry eye can result from chemical and thermal burns that
scar the membrane lining the eyelids and covering the
eye.
• Allergies can be associated with dry eye.
• Infrequent blinking, associated with staring at computer or
video screens, may also lead to dry eye symptoms.
• Both excessive and insufficient dosages of vitamins can
contribute to dry eye.
• Homeopathic remedies may have an adverse impact on a
dry eye condition.
• Loss of sensation in the cornea from long-term contact
lens wear can lead to dry eye.
• Dry eye can be associated with immune system disorders
such as Sjögren's syndrome, lupus, and rheumatoid
arthritis. Sjögren's leads to inflammation and dryness of
the mouth, eyes, and other mucous membranes. It can
also affect other organs, including the kidneys, lungs and
blood vessels.
• Dry eye can be a symptom of chronic inflammation of the
conjunctiva, the membrane lining the eyelid and covering
the front part of the eye, or the lacrimal gland. Chronic
conjunctivitis can be caused by certain eye diseases,
infection, exposure to irritants such as chemical fumes
and tobacco smoke, or drafts from air conditioning or
heating.
• If the surface area of the eye is increased, as in thyroid
disease when the eye protrudes forward or after cosmetic
surgery if the eyelids are opened too widely, dry eye can
result.
• Dry eye may occur from exposure keratitis, in which the
eyelids do not close completely during sleep.
Who is likely to develop dry eye?
Elderly people frequently experience dryness of the eyes, but dry
eye can occur at any age. Nearly five million Americans 50 years
of age and older are estimated to have dry eye. Of these, more
than three million are women and more than one and a half
million are men. Tens of millions more have less severe
symptoms. Dry eye is more common after menopause. Women
who experience menopause prematurely are more likely to have
eye surface damage from dry eye.

Treatment
How is dry eye treated?
Depending on the causes of dry eye, your doctor may use various
approaches to relieve the symptoms.
Dry eye can be managed as an ongoing condition. The first
priority is to determine if a disease is the underlying cause of the
dry eye (such as Sjögren's syndrome or lacrimal and meibomian
gland dysfunction). If it is, then the underlying disease needs to
be treated.
Cyclosporine, an anti-inflammatory medication, is the only
prescription drug available to treat dry eye. It decreases corneal
damage, increases basic tear production, and reduces symptoms
of dry eye. It may take three to six months of twice-a-day
dosages for the medication to work. In some cases of severe dry
eye, short term use of corticosteroid eye drops that decrease
inflammation is required.
If dry eye results from taking a medication, your doctor may
recommend switching to a medication that does not cause the
dry eye side effect.
If contact lens wear is the problem, your eye care practitioner
may recommend another type of lens or reducing the number of
hours you wear your lenses. In the case of severe dry eye, your
eye care professional may advise you not to wear contact lenses
at all.
Another option is to plug the drainage holes, small circular
openings at the inner corners of the eyelids where tears drain
from the eye into the nose. Lacrimal plugs, also called punctal
plugs, can be inserted painlessly by an eye care professional. The
patient usually does not feel them. These plugs are made of
silicone or collagen, are reversible, and are a temporary
measure. In severe cases, permanent plugs may be considered.
In some cases, a simple surgery, called punctal cautery, is
recommended to permanently close the drainage holes. The
procedure helps keep the limited volume of tears on the eye for a
longer period of time.
In some patients with dry eye, supplements or dietary sources
(such as tuna fish) of omega-3 fatty acids (especially DHA and
EPA) may decrease symptoms of irritation. The use and dosage
of nutritional supplements and vitamins should be discussed with
your primary medical doctor.
What can I do to help myself?
• Use artificial tears, gels, gel inserts, and ointments -
available over the counter - as the first line of therapy.
They offer temporary relief and provide an important
replacement of naturally produced tears in patients with
aqueous tear deficiency. Avoid artificial tears with
preservatives if you need to apply them more than four
times a day or preparations with chemicals that cause
blood vessels to constrict.
• Wearing glasses or sunglasses that fit close to the face
(wrap around shades) or that have side shields can help
slow tear evaporation from the eye surfaces. Indoors, an
air cleaner to filter dust and other particles helps prevent
dry eyes. A humidifier also may help by adding moisture
to the air.
• Avoid dry conditions and allow your eyes to rest when
performing activities that require you to use your eyes for
long periods of time. Instill lubricating eye drops while
performing these tasks.
Presbyopia

What is presbyopia?

Presbyopia is a common type of vision disorder that occurs as

you age. It is often referred to as the aging eye condition.
Presbyopia results in the inability to focus up close, a problem
associated with refraction in the eye.

How does presbyopia occur?

Presbyopia happens naturally in people as they age. The eye is

not able to focus light directly on to the retina due to the
hardening of the natural lens. Aging also affects muscle fibers
around the lens making it harder for the eye to focus on up close
objects. The ineffective lens causes light to focus behind the
retina, causing poor vision for objects that are up close.

When you are younger, the lens of the eye is soft and flexible,
allowing the tiny muscles inside the eye to easily reshape the The cornea and lens bend (refract) incoming light rays so they
lens to focus on close and distant objects. focus behind the retina.

Who is at risk for presbyopia?

Anyone over the age of 35 is at risk for developing presbyopia.

Everyone experiences some loss of focusing power for near
objects as they age, but some will notice this more than others.

What are the signs and symptoms of presbyopia?

Signs and symptoms include:

• Hard time reading small print

• Having to hold reading material farther than arm's
distance
• Problems seeing objects that are close to you
• Headaches
• Eye strain
If you experience any of these symptoms you may want to visit
an eye care professional for a comprehensive dilated eye
examination. If you wear glasses or contact lenses and still have
these issues, a new prescription might be needed.
Can I have presbyopia and another type of refractive
error at the same time?
Yes. It is common to have presbyopia and another type of
refractive error at the same time. There are several other types
of refractive errors: nearsightedness (myopia), farsightedness
(hyperopia), and astigmatism. An individual may have one type
of refractive error in one eye and a different type of refractive
error in the other.
How is presbyopia diagnosed?
What are refractive errors?
Refractive errors include myopia, hyperopia, presbyopia, and
astigmatism, eye conditions that are very common. Most people
have one or more of them. Refractive errors can usually be
corrected with eyeglasses or contact lens.
What is myopia (nearsightedness)?
If you have myopia you can clearly see close objects, but distant
objects are blurry. Myopia is caused by the eyeball being too
long. Myopia occurs in different degrees from minimal to
extreme. The more myopic you are the blurrier your vision is at a
distance and objects will have to be closer to you so you can see
them clearly.

Presbyopia can be found during a comprehensive dilated eye

exam. If you notice any changes in your vision, you should visit
an eye care professional. Exams are recommended more often What is hyperopia (farsightedness)?
after the age 40 to check for age-related conditions.
If you have hyperopia, you can see distant objects clearly, but
How is presbyopia corrected? close ones are blurry. Hyperopia occurs when the eyeball is too
short for the light rays to focus clearly on the retina.
Eyeglasses are the simplest and safest means of correcting
presbyopia. Eyeglasses for presbyopia have higher focusing
power in the lower portion of the lens. This allows you to read
through the lower portion of the lens and see properly at distant What is astigmatism?
through the upper
portion of the lens. It is
If you have an astigmatism, the surface of the eye (cornea) is not
also possible to purchase
perfectly round, rather it is more oval and doesn’t allow the eye
reading eyeglasses.
to focus clearly. The cornea is very important in helping the eye
These types of glasses
focus light rays on the retina. Astigmatism rarely occurs alone. It
do not require a
is usually accompanies myopia or hyperopia.
prescription and can help
with reading vision.

Refractive Errors
Defined What is presbyopia?
If you have presbyopia, you have the loss of the ability to focus
up close that occurs as you age. Most people are between 40 and
50 years when they realize for the first time that they can’t read
objects close to them. The letters of the phonebook are “too
small” or you have to hold the newspaper farther away from your
eye to see it clearly. At the same time your ability to focus on
objects that are far way remains normal.