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Macular degeneration, commonly referred to as age-related macular degeneration (AMD), is the single largest cause of sight loss in the developed world and affects more than 10 million Americans. It usually affects people over the age of 60, but has been known to affect those who are younger. It is a painless condition that usually affects both eyes with the loss being experienced in the central vision. It does not affect the peripheral vision, meaning that it does not cause total blindness.
 

What is the macula?

The macula is the most sensitive part of the retina and is responsible for our central vision and what allows us to see fine details with clarity.
 

Varieties of AMD

Wet AMD

Wet AMD is one variety of the condition in which abnormal blood vessels grow into the macula, leaking blood or fluid which then causes scarring and a rapid loss of central vision. Wet AMD can develop suddenly and rapid referral to a specialist is essential as it can be treated if caught quickly.
 

Dry AMD

Dry AMD is the most common variety of age-related macular degeneration and is a gradual deterioration of the retina as the cells die off over time and are not regenerated. Up to 15% of people with dry AMD go on to develop wet AMD, and so any sudden changes in your vision should be followed up with your optometrist as soon as possible.
 

The parts of a comprehensive eye examination vary according to the patient's age, date of last exam, and other factors. Not all parts of the eye exam may be needed or performed, but the first part of the eye exam will include documenting medical history. Here are some eye and vision tests that are likely to be encountered during a comprehensive eye exam:
 

Visual Acuity Tests

Visual acuity tests measure the sharpness of vision and are usually performed using a projected eye chart to measure the distance visual acuity and a hand-held small acuity chart to measure the near vision (for reading).
 

Color Blindness Test

A screening test that checks the color vision is often performed early in a comprehensive eye exam to rule out color blindness.
 

Cover test to check eye alignment.

A test used to assess strabismus or a more subtle binocular vision problem that could cause eye strain or amblyopia (lazy eye).
 

Ocular Motility (Eye Movements) Testing

Ocular motility testing is performed to determine how well eyes can follow a moving object and/or quickly move between and accurately fixate on two separate targets.
 

Stereopsis (Depth Perception) Test

This is used to test perception of depth and 3-dimensional structure obtained on the basis of visual information deriving from two eyes by individuals with normally developed binocular vision.
 

Retinoscopy

This test is used to estimate which lens powers will best correct distance vision. Based on the way the light reflects from the eye, the doctor is able to obtain an approximation of the eyeglass prescription. This test is useful for children and patients who are unable to accurately answer the doctor's questions.
 

Manual refraction with a phoropter.

This is the test used to determine the exact eyeglass prescription.

A refraction test, also called a vision test, is usually performed as a part of a routine eye examination. The purpose of this test is to determine if a person has a refractive error which would then mean the patient would need glasses or contact lenses.
 

What Is The Normal Value for Refraction Test?

A value of 20/20 is normal (optimum) vision. This means that individuals who have 20/20 vision are able to read letters that are 3/8-inch (1 centimeter) tall from 20 feet (6 meters) away. The normal uncorrected vision (without glasses or contact lenses) refractive error is zero (plano). Individuals who don’t have 20/20 vision, have what is called a refractive error. A refractive error means that the light is not bending properly when it passes through the lens of the eye. The refraction test will tell the doctor what prescription lens should be used in order to have 20/20 vision.

For people over age 40 who have normal distance vision but difficulty with near vision, a refraction test with a small type size is used to determine normal near vision and the correct power of reading glasses.
 

How Is The Refraction Test Performed?

The test is performed by having the patient seated in a chair that has a special device (called a phoropter or refractor) attached to it. The patient looks through the device and focuses on an eye chart 20 feet (6 meters) away. The device contains lenses of different strengths that can be moved into the patient’s view. The test is performed one eye at a time. If the patient is wearing contact lenses, they should be removed before the test.

In case the final vision is less than 20/20 even with lenses, then there is probably another non-optical problem with the eye. The vision level achieved during the refraction test is called the best-corrected visual acuity (BCVA).
 

What Are The Causes of Abnormal Refraction Test Results?

• Abnormal results may be due to:

• Astigmatism (abnormally curved cornea causing blurred vision)

• Hyperopia (farsightedness)

• Myopia (nearsightedness)

• Presbyopia (inability to focus on near objects that develop with age)
   

Other conditions under which the test may be performed:

• Corneal ulcers and infections

• Loss of sharp vision due to macular degeneration

• Retinal detachment (separation of the light-sensitive membrane (retina) in the back of the eye from its supporting layers)

• Retinal vessel occlusion (blockage in a small artery that carries blood to the retina)

• Retinitis pigmentosa (an inherited disorder of the retina)
   

There is an art to refraction and the optometrist will always answer the patient’s questions and as well as discuss their findings. Based on the results of the refraction test, they can determine the amount of myopia, hyperopia or astigmatism.
 

Medical eye exams are comprehensive evaluations of the health and function of the eyes, essential for maintaining optimal vision and preventing potential eye conditions. Regular medical eye exams are fundamental for proactive eye health management and ensuring ongoing visual wellness.
 

What is a Medical Eye Exam?

A medical eye exam is a comprehensive examination of your eyes conducted by an optometrist. This examination goes beyond a routine vision test and delves into the overall health of your eyes. During a medical eye exam, various tests will be performed to assess your visual acuity, peripheral vision, eye movement, and the health of your eye structures.
 

Medical eye exams can detect early signs of eye conditions that may not present noticeable symptoms in their initial stages. By diagnosing these conditions early, you have a greater chance of successful treatment and preventing further deterioration of your vision.
 

Medical eye exams can also identify underlying health conditions that may manifest in your eyes, providing an opportunity for early intervention and management.
 

Common Conditions Detected During a Medical Eye Exam

During a medical eye exam, several common eye conditions can be detected, even before noticeable symptoms occur. One such condition is age-related macular degeneration (AMD), which affects the central part of the retina responsible for sharp, central vision. By examining the retina, your optometrist can identify early signs of AMD and recommend appropriate treatment to slow its progression.
 

Another condition that can be detected during a medical eye exam is cataracts. Cataracts occur when the lens of your eye becomes cloudy, leading to blurred vision. Through a comprehensive examination, your eye doctor can assess the severity of your cataracts and recommend the most suitable treatment option, which may include surgery to remove the cloudy lens.
 

Hypertension is a common health condition that can have serious consequences if left untreated. The health of your eyes can provide valuable insights into your cardiovascular health. During a medical eye exam, an optometrist can observe changes in the blood vessels of your retina, such as narrowing or leaking. These changes can indicate underlying hypertension.

Senior eye care is crucial for maintaining optimal vision and overall eye health as we age. As individuals grow older, they become more susceptible to age-related eye conditions. Regular comprehensive eye exams play a key role in early detection and management of these conditions, helping to preserve vision and prevent potential vision loss. By staying proactive with eye care and seeking timely professional assistance, seniors can enjoy clear, comfortable vision and ongoing eye health for years to come.
 

Common Eye Conditions in Seniors

As we reach our golden years, there are several eye conditions that become more prevalent. These conditions can have a significant impact on our vision and overall quality of life.
 

• Presbyopia: This condition affects near vision, making it difficult to focus on close objects. It is a normal part of aging and is typically addressed with reading glasses or multifocal lenses.

• Floaters and Flashes: As the vitreous inside the eye changes with age, it can lead to the perception of floaters (small dark spots or lines) and flashes of light. While often harmless, sudden onset of floaters and flashes may indicate a retinal tear or detachment and should be promptly evaluated.

• Age-Related Macular Degeneration (AMD): AMD is a leading cause of vision loss in older adults. It affects the macula, the central part of the retina, leading to blurred or distorted central vision. There are two forms of AMD, dry AMD, and wet AMD, with the latter being more severe.

• Cataracts: Cataracts are a common age-related condition characterized by the clouding of the eye's natural lens. This can lead to blurry vision, glare, and difficulty seeing in low-light conditions.

• Glaucoma: Glaucoma is a group of eye conditions that damage the optic nerve, often due to elevated intraocular pressure. It can result in peripheral vision loss and, if left untreated, may lead to total blindness.

• Diabetic Retinopathy: For seniors with diabetes, diabetic retinopathy is a concern. It occurs when high blood sugar levels damage the blood vessels in the retina, leading to vision problems and potential blindness if not managed.

• Dry Eye Syndrome: Seniors may experience dry eye syndrome, characterized by insufficient lubrication and moisture on the surface of the eye. It can cause discomfort, redness, and fluctuating vision.
  
   

Urgent eye care encompasses prompt evaluation and treatment of sudden or severe eye-related issues, including foreign object removal, chemical exposure, corneal abrasions, sudden vision loss, eye trauma, acute glaucoma, chemical burns, and eye infections. Seeking immediate professional attention from an optometrist is vital to prevent further damage and preserve vision.
 

Common Eye Emergencies or Urgent Eye Care Appointments

Eye emergencies can manifest in various forms, and it is essential to be able to identify them quickly. Some common eye emergencies include:
 

• Foreign Object in the Eye: Particles, debris, or small objects can become lodged in the eye, causing pain, redness, tearing, and potential damage to the eye's surface.

• Corneal Abrasions or Scratches: Injuries to the cornea, such as abrasions or scratches, can cause severe eye pain, light sensitivity, and a feeling of something in the eye.

• Sudden Loss of Vision: Any sudden and unexplained loss of vision requires immediate attention to determine the underlying cause and initiate appropriate treatment.

• Eye Trauma or Blunt Force Injury: Injuries to the eye from impact, trauma, or accidents can lead to serious complications, including retinal detachment, hemorrhage, or intraocular foreign bodies.

• Chemical Burns: Exposure to caustic substances or chemicals can cause serious damage to the eyes, resulting in pain, redness, and potential vision loss.

• Eye Infections: Infections such as conjunctivitis (pink eye) can cause redness, discharge, and discomfort in the eyes.
   

Recognizing these symptoms and seeking urgent care can prevent further complications.
 

The Importance of Basic Red Eye Exams in Urgent Care

Red eye exams are a fundamental part of urgent eye care. They help identify the cause of redness and determine the appropriate treatment. Basic red eye exams involve a comprehensive evaluation of the eye, including examining the eyelids, conjunctiva, cornea, and iris. These exams aid in the diagnosis and treatment of various conditions, such as conjunctivitis, uveitis, dry eyes, and corneal abrasions.

If you’ve been diagnosed with glaucoma, you’re probably already familiar with the typical options in glaucoma treatment – eye drops, laser treatment or traditional surgery. While these are certainly effective, especially when glaucoma is diagnosed early, researchers have been working hard to offer new glaucoma treatments. Their goal is not only to improve outcomes but also reduce the treatment’s side effects and frequency of use.
 

What is the Goal of Glaucoma Treatment?

Before we dive into the new options, it’s important to understand the goal of any glaucoma treatment. At present, glaucoma is not curable. However, treatment can significantly slow the progression of the disease. Glaucoma damages your eye's optic nerve. Extra fluid builds up in the front part of your eye (cornea), which increases the pressure in your eye. Reducing this pressure is the primary objective of any glaucoma treatment. This is often referred to as intraocular pressure or IOP.
 

What are the Limitations of Standard Glaucoma Treatments?

Eye drops for glaucoma treatment seem like an easy option but there are several challenges that can reduce its effectiveness. It can be difficult to get all the medicine in the eye, especially for older adults with less of a steady hand. In addition, since it must be applied daily, individuals may forget. Since the drops have no perceivable benefit because early stages of glaucoma have no symptoms, patients might make it a lower priority which is understandable since it may also have unpleasant side effects like burning, red eyes.

Beyond eye drops, laser surgery is a less invasive option. The laser opens clogged tubes and drains fluid. It can take a few weeks to see the full results. If laser surgery or drugs don’t relieve your eye pressure, you may need a more traditional operation. You would have to go into the hospital and will need a few weeks to heal and recover. Although usually effective, glaucoma surgery can make you more likely to get cataracts later on. It can also cause eye pain or redness, infection, inflammation, or bleeding in your eye.

What are Recent Advances in Glaucoma Treatment?

Alternatives or Improvements to Eye Drops
The Glaucoma Research Foundation reported several new developments on the horizon. These technologies focus on reducing patient error in applying eye drops which would make the medication more effective and improve the quality of life for the patient. Here are some of the products underway:

• A polymer, like a contact lens, would contain the drug; it would sit under the eyelid and release the medication over several months

• Microneedles would inject medication into a specific spot to be most effective

• Implantable extended-release devices using engineered highly precise microparticles and nanoparticles

• Polymer-based intraocular delivery technologies that would allow customizable sustained release

• Drops that allow the medication to get into the eye more easily

• Tear duct plugs that release medication

In addition, people with glaucoma who take more than one eye drop per day are beginning to see those medications available as a single, combined eye drop. New products include Cosopt (timolol and dorzolamide), Combigan (timolol and brimonidine) and Simbrinza (brinzolamide and brimonidine).