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Introduction |
NEOS was founded in 1884 for the study and advancement of ophthalmology and to provide for the mutual education of members, today totalling some 700 ophthalmologists from throughout New England. NEOS is organized exclusively for charitable, educational, and scientific medical research purposes in connection with treatment and diseases of the eyes. A major focus of NEOS is continual ongoing learning programs for practitioners carried out primarily in quarterly educational sessions. Equally important is NEOS's programs to educate the public about diseases and conditions of the eye through detection, treatment, and prevention.
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FAQs about eyes |
The following are questions most frequently asked of ophthalmologists. The answers are intended as general summaries of typical conditions and illnesses of the eye, not as individual medical advice. For specific, personal information, please consult your ophthalmologist or use our member directory to locate one in your area.
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On occasion, I see little wavy lines or dots that seem to swim in my eyes. What is this, and should I be concerned? |
What is glaucoma and can it cause blindness? |
How are diabetes and blindness related? |
Can cataracts be removed by lasers? |
When should an adult with diabetes first be seen by an eye care provider and how often should they be evaluated thereafter? |
Are there situations where a patient with diabetes should be evaluated more or less often? |
What is amblyopia? |
What is keratoconus? |
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What is an ophthalmologist? |
An ophthalmologist is a physician who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. |
An ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship, and three or more years of specialized medical and surgical and refractive training and experience in eye care. |
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An ophthalmologist is a specialist who is qualified by lengthy medical education, training and experience to diagnose, treat, and manage all eye and visual systems, and is licensed by a state regulatory board to practice medicine and surgery. |
An ophthalmologist is a medically trained specialist who can deliver total eye care: primary, secondary and tertiary (i.e., vision services, contact lenses, eye examinations, medical eye care and surgical eye care), diagnose general diseases of the body and treat ocular manifestations of systemic diseases.
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Definition courtesy of the American Academy of Ophthalmology |
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Sports Eye Injuries and Prevention |
The Mechanisms and Prevention of Sports Eye Injuries |
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Paul F. Vinger, MD
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Risk of Eye Injury and Effectiveness of Protective Devices for Specific Sports: Small Projectiles, Golf, and Racket Sports |
Clinical Professor of Ophthalmology
Tufts University School of Medicine
Dr. Vinger has been called "the doctor who has saved more eyes than a roomful of eye surgeons" due to his success in requiring hockey players to wear protective helmets in the 1970s. |
Stick and Ball (or Puck), Large Ball, Combat, and Water Sports |
Other Sports, Vision Performance and Training, Ethics |
Safety Recommendations |
NEOS' Public Education Committee wishes to thank Dr. Paul F. Vinger for generously providing these articles. |
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Seasonal Tips |
Contributed by Jean Ramsay, MD |
Summer |
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Fireworks – Eye Safety Eye M.D.s across the country encourage families to attend local public fireworks displays in place of using fireworks at home. The reasons for this recommendation can be seen in the following statistics: |
• Of the approximately 12,000 fireworks-related injuries each year in the U.S., about 2,400 are eye injuries cause by consumer fireworks.
• About a third of these injuries result in permanent eye damage, and one-fourth in permanent vision loss or blindness. Almost one in twenty victims lose all useful vision, or require removal of the eye.
• One-fourth of all eye injuries caused by consumer fireworks are inflicted on bystanders.
• Three-fourths of all fireworks-related eye injuries are to boys between the ages of 13 and 15 years. |
The single most dangerous type of firecracker is the small, explosive "bottle rocket." Bottle rockets are the most dangerous because they fly erratically, causing bystander injuries. The bottles and cans used to launch them often explode, showering fragments of glass and metal. Twenty-five states have banned bottle rockets, including Connecticut, Massachusetts, Maine, Rhode Island, and Vermont, but 25 states continue to allow the use and sale of bottle rockets. |
Sparklers, often given to young children, burn at 1800 degress Fahrenheit, hot enough to melt gold! |
To ensure health and safety, firework displays should be viewed from at least 500 feet (1/4 mile). The safety barriers set up by the pyrotechnicians should be respected. Let only trained professionals light fireworks, and do not touch unexploded fireworks. |
Baseball and Golf Require Eye Safety – Among the 5 to 14 year old age group, the number one cause of sports-related eye injuries is baseball. While most injuries in the major leagues are caused by batted balls, the younger the batter the greater the risk of being hit by a pitched ball. |
Those participating in such activities should protect themselves with polycarbonate sports lenses. Polycarbonate is the most impact-resistant material available. Anyone with only one "good" eye needs to pay particular attention to such recommendations. |
With the rising interest in golf, it is important to realize that golf eye injuries, while infrequent, are often severe. The size of the golf ball and the golf club allows either to enter the orbit and strike the eye directly, with often devastating consequences. In all recreational activities, proper attention should always be given to safety and eye health. |
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Autumn |
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Back to School...Can Your Child See? – One of the best ways to make sure your child is ready to go back to school this September is to give her/him a test - an eye test. About one-quarter of school-aged children have vision problems. Of children age 5, nearly one in 20 has a problem that could result in permanent vision loss, even blindness, if left untreated. And yet, nearly 80% of preschoolers do not receive a vision-screening exam. |
One common reason for vision problems to develop is misalignment of the eyes (strabismus). Even a tiny eye turn can lead to loss of vision in the turning eye. |
Another reason for visual loss is focusing problems. When a child has a lot of far-sightedness, near-sightedness, or astigmatism, the eye may not focus clearly, and the brain will receive a blurred image. Since the brain needs a clear, crisp image to develop good visual acuity, poor vision will result. Even with glasses on, the vision in these children may initially remain poor (amblyopia), but with treatment the vision will gradually improve. If the two eyes are different, i.e. one eye is much more far-sighted than the other, or one eye is far-sighted and one is near-sighted, the brain is not able to use both of the eyes together. As a result, one eye often becomes "turned off", and that eye will not develop good vision. |
The good news is that many of the causes of childhood visual loss are treatable, but only IF DETECTED EARLY!! Treatment may involve glasses, patching, and sometimes surgery. After the age of 8 or 9, however, effective treatment is rarely achieved. For this reason, it is important that your child have a vision-screening exam performed during the preschool years. This exam measures visual acuity and checks for misalignment of the eyes. If a problem is detected, the child is then referred for a comprehensive eye examination by an eye MD (ophthalmologist). If there is a family history of any eye problems such as wandering or crossed eyes, or "lazy eye", your child needs to be seen by an eye MD for a comprehensive eye examination. |
A comprehensive eye exam is also needed if any of the following signs are noticed:
• Your child squints often
• The eyes are very sensitive to light
• The eyes are frequently watery
• Your child often tilts (or turns) his/her head
• Your child complains of seeing double
• An eye turn is observed, even if intermittent
• The eyelid droops on one or both sides |
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Winter |
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Basketball Requires Protective Eye Wear – With the New England winter comes the move to indoor fun and fitness activities, such as basketball. This popular sport can be an unrecognized threat to eye health when proper precautions are not taken. |
Basketball is the most common cause of eye injuries in the 15 to 64 year old age group, and accounts for nearly a third of all sports-related eye injuries. The ball itself, because of its large size and hardness, generally does not directly strike the eye, unlike a baseball or racquetball. |
Most of the injuries in basketball are caused by the opponent's finger or elbow while rebounding. Shooting and rebounding occur above the athlete's head and such inadvertent contact is unavoidable. While the common basketball injuries are eyelid lacerations, lacerations around the eye, corneal abrasions, and orbital fractures, more severe and blinding injuries do occur. |
Those participating in such activities should protect themselves with polycarbonate sports lenses. Polycarbonate is the most impact-resistant material available. Anyone with only one "good" eye needs to pay particular attention to such recommendations. |
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Spring |
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Itchy Eyes – With the budding trees and shrubs comes for many people a recurring health problem...red, itchy eyes. This is allergic conjunctivitis and it is one of several types of conjunctivitis. |
"Conjunctivitis" refers to inflammation or infection of the membrane lining the "white" of the eye and the inside of the eyelids. It is very common, and can vary from a mild redness to a severe condition causing damage to the eye. |
The most common type of conjunctivitis is viral. This will disappear on its own but is very contagious and can spread rapidly, especially among children. It is important that hands be washed frequently and kept away from the face. Towels should not be shared. |
Bacterial conjunctivitis is much less common and is treated with antibiotics. Bacterial conjunctivitis generally has a lot of purulent (pus-like) drainage from the eye. |
The hallmark of allergic conjunctivitis is ITCH. When a material that a person is allergic to makes contact with the eye, a reaction is set up that leads to redness, itching and tearing of the eyes with puffy eyelids. Rubbing the eyes, which gives momentary relief from the itch, only makes the inflammation and itching worse. The best treatment is to avoid the cause of the itch, if possible. But oftentimes this is not possible since the inciting material may be present everywhere, such as grasses, dust and mold. Cool compresses may offer some relief. Also effective are lubricating eye drops and antihistamine eye drops, both of which are over-the-counter medicines. For more severe conditions, examination and treatment by an Eye MD may be necessary. There are many prescription medications now available that give substantial relief to most people. |
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FAQs about eyes |
On occasion, I see little wavy lines or dots that seem to swim in my eyes. What is this, and should I be concerned?
What you are describing could be either floaters or flashes, both of which might be an indication of a quite serious problem, or it could be nothing! Floaters are tiny clumps of cells in the clear jelly-like fluid (the vitreous gel) inside your eye that cast shadows on the retina, the part of the eye that allows us to see. Sometimes floaters resemble dots, circles, clouds, or cobwebs. Flashes resemble streaks of lightning or bursts of light, indicating that the vitreous gel is tugging on the retina. Floaters and flashes become more common as people age, and they should always be examined immediately by an ophthalmologist to rule out bleeding in the eye from a retinal tear--a critical problem that might lead to retinal detachment and loss of sight. Often floaters and flashes are more a nuisance than a serious problem, and they may fade with time, but if you notice new ones, always have an eye examination immediately to rule out the need for immediate surgery to repair tearing.
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What is glaucoma and can it cause blindness?
While glaucoma is the second leading cause of blindness in the United States, loss of sight from glaucoma is preventable, but only if detected early enough. Glaucoma is a disease of the optic nerve (the part of the eye that carries the images we see to the brain), caused when pressure in the eye builds up because the eye's usual drainage capability becomes blocked. Consequently, if the pressure inside the eye becomes too high, the optic nerve may become damaged, causing blind spots. If the glaucoma either has gone undetected for a while or the pressure increases rapidly, the entire nerve can be destroyed, and blindness results. Glaucoma can strike at any age, but at greatest risk are African Americans, people with a family history of glaucoma, those aged 40 or older, or anyone who suffered a serious eye injury. Most forms of glaucoma are painless, so early detection and treatment by your ophthalmologist are the keys to prevention. Treatment commonly consists of medicated eye drops, but laser surgery is beginning to be used as well.
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How are diabetes and blindness related?
One of the complications of diabetes that affects the eyes is called diabetic retinopathy, caused by deterioration of the blood vessels that nourish the retina. If these weakened vessels leak fluid or blood, they can damage or scar the retina and ultimately blur vision. About 60 percent of people with diabetes more than 15 years have some blood vessel damage in their eyes. However, only a small percentage of those people have serious vision problems, and even fewer ever become blind. Nonetheless, diabetic retinopathy is the leading cause of new blindness among adults in the U.S., and diabetics are approximately 25 times more prone to blindness than non-diabetics. Pregnancy and high blood pressure may worsen this condition in diabetic patients. The best protection against the progression of diabetic retinopathy is awareness of the risks of developing sight disturbances and having regular exams by an ophthalmologist. When treatment is necessary, the most common method is laser surgery to seal the leaking blood vessels.
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Can cataracts be removed by lasers?
Cataracts are cloudy areas in the lens of the eye--which is normally clear, letting light pass through. When cataracts are present, vision becomes hazy because light no longer passes through easily. If cataracts progress and become large and dense, they can be surgically removed in what is usually a safe, outpatient procedure. Cataract surgery is a personal choice and should be considered when cataracts cause enough loss of vision to interfere with daily activities. More than 1.4 million people have cataract surgery each year in the U.S., 95 percent without complications. A cataract can only be removed using surgical techniques, although cataract surgery by lasers is being done experimentally. Intraocular lens implants often replace the natural lens, and about one-fifth of people later develop a clouding in the lens area; in this situation, laser surgery is used to create a "window" to help restore clear vision. This may be the reason for the public's confusion about whether laser surgery is used for cataract removal! By the way, while cataracts are most common in the aging eye, they also occur in younger people and people with diabetes. Also, cataracts may develop slowly, or quickly, and at differing rates in each eye. Protection from excessive sunlight may help prevent, or slow, progression.
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When should an adult with diabetes first be seen by an eye care provider and how often should they be evaluated thereafter?
Although approximately 80% of Type 1 diabetics (i.e., insulin-dependent) have retinopathy after 15 years of disease, only about 25% have any retinopathy after 5 years. The prevalence of proliferative diabetic retinopathy (PDR) is less than 2% at five years and 25% by 15 years. For Type 2 diabetes (non-insulin-dependent), however, the onset date of diabetes is frequently not precisely known and thus more severe disease can be observed soon after diagnosis. Up to 3% of patients first diagnosed after age 30 (Type 2) can have clinically significant macular edema or high-risk PDR at the time of initial diagnosis of diabetes. |
Thus, in patients over the age of 10, initial ophthalmic examination is recommended beginning 5 years after the diagnosis of Type 1 diabetes mellitus and upon diagnosis of Type 2 diabetes mellitus. |
Even if there is no or minimal retinopathy, annual follow-up is required since 5-10% of patients with no retinopathy will develop retinopathy within one year and existing retinopathy will be exacerbated by a similar percentage. Extensive retinopathy can exist even without symptoms. This minimum annual follow-up requirement assumes no abnormal findings. Abnormal findings necessitate more frequent follow-up. Symptoms and findings which suggest a higher risk of complication and should trigger more rigorous follow-up include floaters, distortion of vision, difficulty with night vision or reading vision, poor systemic control, advanced nephropathy, and concurrent hypertension.
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Are there situations where a patient with diabetes should be evaluated more or less often?
Puberty and pregnancy can accelerate retinopathy progression. The onset of vision-threatening retinopathy is rare in children prior to puberty regardless of the duration of diabetes. However, if diabetes is diagnosed between the ages of 10 and 30, significant retinopathy may arise within six years of disease. However, there is as yet no published data demonstrating that there is a statistically significant increased risk of retinopathy at 5 versus 3 years after diabetes diagnosis in this age group. |
Thus, the current recommendation is for initial ophthalmologic examination within 3-5 years after diagnosis of diabetes once patients are age 10 years of age or older. |
Diabetic retinopathy can also become particularly aggressive during pregnancy in patients with diabetes. Ideally, patients with diabetes who are planning pregnancy should have a comprehensive eye examination within one year prior to conception. Patients who become pregnant should have a comprehensive eye examination in the first trimester of pregnancy. Close follow-up throughout pregnancy is indicated with subsequent examinations determined by the findings present at the first trimester examination. This guideline does not apply to women who develop gestational diabetes, because such individuals are not at increased risk of developing diabetic retinopathy.
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What is amblyopia?
Amblyopia or "lazy eye" is reduced vision in an eye due to a lack of normal visual development during childhood. An amblyopic eye that does not see well early in life does not develop normal vision even with glasses. Amblyopia affects 3-4% of children and usually involves one eye though rarely can involve both. It may be the result of needing a different spectacle prescription in each eye, an opacity such as a cataract, or misalignment of the eyes. After the first nine years of life, the visual system is usually fully developed and cannot be significantly changed. The best time to correct amblyopia is during infancy or early childhood. |
The presence of amblyopia is not always easy to recognize. Children should have their vision tested by their pediatrician or ophthalmologist before the age of four or earlier if there is any "wandering" of the eyes. Children with a family history of amblyopia should be checked even earlier within the first two to three years of life. Failing a vision screening does not always mean there is amblyopia as vision is often improved back to normal by prescribing glasses. |
Amblyopia is treated by patching the stronger eye to strengthen the weaker eye. Patching may vary from a few hours a day to almost the entire day depending upon the visual acuity. Sometimes drops are used instead of patching to blur the better eye if cooperation is a problem. If amblyopia is not treated, the weaker eye may permanently have poor vision which is uncorrectable with glasses. If the problem is detected early, patching can help to improve vision in most children.
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What is keratoconus?
The word "keratoconus" literally means "cone-shaped cornea." The normal cornea is the clear dome on the front of the eye. The cornea bends, or refracts, the incoming light to help focus it on the retina. In order for you to see clearly, the cornea must be perfectly smooth and round, much like the surface of a billiard ball.
In keratoconus, the cornea is shaped more like the end of a football. This abnormal curvature makes the image formed on the retina quite blurry. |
We do not know the cause of keratoconus but keratoconus is more common in people who have eye allergies and rub their eyes a lot. |
In patients with mild keratoconus, often just a pair of glasses is all that is needed. |
If the cone shape becomes more severe, however, glasses will not correct the problem. It is then necessary to use rigid contact lenses. These lenses sit on the tip of the cone and--while they're in place--create an optically smooth round surface, so the patient can see. |
If keratoconus becomes very severe, the cone protrudes quite a bit, and contact lenses can no longer stay in place or become very uncomfortable. At this stage,a corneal transplant would be very likely to help the condition. In a corneal transplant, most of the cone-shaped cornea is removed and replaced with a normal donor cornea from a deceased person. The success rate of corneal transplants for keratoconus is excellent: about 95%. |
Not everyone who has keratoconus will progress through these stages and need a transplant. Many patients have very mild disease and require just glasses.
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