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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Elena Drudy for taking part in the program.

September : Eye Diseases (such as cataracts and glaucoma)

Question 1
My Daughter was just referred to a vision therapist? What is that and what do they do?

Learning disabilities, including dyslexia, are common in the pediatric population and often only become apparent after a child has problems in school. Because of the potential long-term educational, social, and economic consequences of chronic academic difficulties, there is increasing interest in the development of diagnostic and therapeutic procedures that can help individuals who suffer from learning disabilities.

Vision therapy, also known as visual training or vision training, attempts to correct or improve presumed ocular disorders, visual processing, and perceptual disorders. Vision therapy can be divided into two broad categories: (1) orthoptic techniques (“eye exercises”) to correct focusing, eye misalignment, or refractive errors and (2) behavioral vision therapy that focuses on eye movement and hand-eye coordination training to improve visual processing and visual-motor integration. Tinted lenses are sometimes used to alter contrast.

Although the eyes are obviously necessary for vision, the brain performs the complex function of interpreting visual images and processing language. The majority of patients with reading difficulties experience problems with language that stem from altered brain function rather than altered visual function. Of note, the vast majority of individuals with known eye movement defects appear to read and comprehend normally, and many even excel in reading and academics. Thus, it is generally felt that eye problems are rarely the cause of a learning disability. Likewise, there is very little data based on well-designed scientific studies that support the claims that vision therapy can improve the performance of learning disabilities.

It is obvious that learning disabilities are complex problems without simple solutions. A multidisciplinary approach that involves educators, psychologists, and physicians is ideal for the early diagnosis and educational management of learning disabilities.

Question 2
I was diagnosed with cataracts last year, but my doctor said it's too soon to treat, and to wait until the situation became worse. When would she recommend that kind of wait and see approach? I'm a 50 year old man.

The lens of your eye is located just behind the iris (the colored part of your eye) and works like a camera lens. It picks up images, focusing the lights, colors, and shapes on the retina (the transmitter at the back of your eye – like camera film).

The lens, made mostly of protein and water, can become clouded over time. Eye injury, certain diseases, or even some medications can cause clouding, but in the majority of cases clouding is caused by the natural aging process. A cataract can be the reason sharp images become blurred and seeing at night is more difficult.

Although modern cataract surgery is one of the safest and most successful surgical procedures, there are always risks involved with any surgery. Risks may include infection, bleeding, or loss of vision or the eye. Fortunately, these risks are relatively rare. Still, if your vision (even with cataracts) can be improved enough with glasses or contact lenses so that you are still able to perform your daily activities (reading, driving, etc.), your doctor may feel that the risks of surgery still outweigh the benefits and thus recommend a “wait and see” approach until your daily activities are impaired enough and cannot be improved by glasses/contacts. At that point, your doctor may then recommend consideration of cataract surgery.

Question 3
If someone as an astigmatism, would they be a candidate for laser surgery?

Astigmatism means that the cornea (the transparent, dome- shaped window covering the front of the eye) is oval like a football rather than spherical like a basketball. Most astigmatic corneas have two curves: a steeper curve and a flatter curve. This causes light to focus on more than one point in the eye, resulting in blurred vision at distance or near. Astigmatism often occurs along with nearsightedness or farsightedness, and these conditions are often grouped together under the term “refractive error.” Astigmatism can be corrected with glasses, contact lenses, or refractive surgery.

Refractive surgery includes several procedures designed to eliminate or reduce the need for glasses or contact lenses by changing the focus of the eye. While several refractive surgery procedures (LASIK, Epi-LASIK, LASEK, and PRK) vary slightly in technique, they all use a laser to reshape the corneal bed to move the point at which light is focused onto the retina (light-sensitive tissue lining the back of they eye) to make a clear image and eliminate the need for glasses or contacts.

Astigmatism can also be corrected by a procedure called astigmatic keratotomy, where microscopic incisions are strategically placed on the steepest curves of the cornea. The steep areas relax, or flatten, and the cornea heals in a more spherical shape. This can be performed alone or in conjunction with other refractive procedures.

Because patients and their eyes vary, different refractive surgery procedures may be indicated for different patients. In addition, the surgeries have different limitations at to how much nearsightedness, farsightedness, or astigmatism they can correct. It is important to go over all of these things with the refractive surgeon during your evaluation.

Question 4
Can sitting in front of a computer all day damage your eyes? I get headaches at the end of the day and I wonder if it's from eye strain.

Eyestrain associated with computer work includes symptoms such as sore, tired, burning, dry, watery, or itching eyes. It can also include blurry vision, headache/sore neck, or difficulty shifting focus between monitor and paper documents in your work area. Although this type of eyestrain is not thought to have serious or long-term consequences, it can certainly be unpleasant and uncomfortable.

A few simple adjustments can provide significant relief:

1. Take eye breaks - Focus on something other than your screen, such as an object on a bookshelf or out the door or window. Stand up and move, lean back and close your eyes for a few moments every hour, or take a few minutes to do other work (filing, phone calls, etc.)
2. Keep your eyes moist – Blink often. People tend to blink less than normal when working on a computer (or while driving or reading), because of an increase in concentration. Dry eyes can result and be uncomfortable. Consider using artificial teardrops, which are available over the counter.
3. Stretch and relax – Pay attention to posture while at your desk and working on the computer. Take time to stretch upper body and neck muscles, which can help relieve neck strain and tension headaches.
4. Get appropriate eyewear – If you wear glasses or contacts, make sure the correction is appropriate for computer work. Consider investing in progressive (no-line) lenses, trifocals, or glasses specifically for the computer.
5. Adjust the lighting and reduce glare – Bright lighting and too much glare can make it difficult to see objects on your screen and strain your eyes. Use an adjustable desk lamp to provide adequate lighting for writing/reading while minimizing glare, which often comes from light sources above or behind you.
6. Adjust your monitor – Many people find that putting the screen at arm’s length (generally 20-28 inches) is a good distance. Consider increasing font size to make icons, etc. easier to see. Make sure that the top of your screen is at eye level or below so that you are not looking up or straining your neck backwards.
   

If problems still persist, a more serious problem may be present. See your doctor if you have a noticeable change in vision, double vision, or prolonged eye discomfort.

Question 5
Due to macular degeneration my husband lost all central vision in one eye. The remaining eye has macular degeneration but he is able to function with it. This eye has a cataract which he would like to have removed. He takes coumadin daily. Can he have cataract surgery done safely while taking coumadin???

As you know, coumadin is commonly referred to as a “blood thinner.” Patients who take coumadin tend to bruise and bleed easier, which can potentially make most surgeries more challenging.

Fortunately, cataract surgery generally does not involve much bleeding, and many patients can have successful cataract surgery even if they are taking coumadin. However, there are a few aspects of cataract surgery that you may want to discuss with your ophthalmologist specifically.

For example, what type of anesthesia will be used? Patients are generally awake but slightly sedated during surgery to decrease anxiety. In addition to sedation provided by the anesthesiologist, the ophthalmologist will decide whether topical (eye drops only) anesthesia will be used to numb the eye during the surgery or if an injection of local anesthesia (to numb the eye and immobilize the eye muscles) will be used. Obviously, an injection would pose a greater risk of bleeding than topical eye drops. Also, sometimes iris retractors to stretch the pupil (if the pupil does not dilate enough to allow adequate visualization of the cataract) are used. This could theoretically cause bleeding that may be more problematic (but still manageable) during or after surgery. Even if neither an injection nor iris retractors are used, some surgeons choose to have patients stop coumadin for a few days prior to surgery (as long as it is allowed by the patient’s medical doctor who prescribed it). These are all things that you would want to discuss with your ophthalmologist before the surgery.

Dr. Drudy's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.