Glaucoma: Irreversible but preventable blindness

glaucoa visual field defect - croppedAfter reading Dr. Weiss’ article last week on early detection of glaucoma, I was back in my office seeing one of my patients that drives this point home. My patient, let’s call him Jim, is a 59 year old gentleman who has lost vision from glaucoma. My partner and I had been seeing Jim for his annual exams and providing glasses to correct his vision since 1999. Beginning in about 2004, the pressure in his eyes started to increase. Normal intraocular pressure (IOP) is between the range of 10 to 20 millimeters of mercury (mmHg). Over a few years, his IOP slowly increased until they were running in the 20 to 21 range – not too bad – but enough that we discussed that we needed to monitor this more closely. In 2008 Jim’s IOP was 20, so he decided to skip his 2009 exam.

When, Jim came in for his “annual” exam in 2010, he had a very different complaint. He complained that if he covered his right eye, he could not see the lower part of his vision.  This fast loss of vision could be caused by a retinal detachment, but would be a very unusual symptom for glaucoma.

Vision loss with glaucoma usually takes years, or decades to advance to the point where it is noticeable to the patient. After ruling out a retinal tear or detachment, I took some time to look at glaucoma. The pressure in his eyes was up to 30mmHg, and close examination of the back of the eye showed glaucomatous damage to the optic nerve consistent with his visual field loss. We started treatment right away, and luckily stopped the progression of vision loss.

Over the years, my partners and I have created a large practice with increasing population of glaucoma patients. I am always amazed with the fact that no two patients progress in the same way. I have seen “normal pressure” glaucoma patients who have damage to their optic nerves even with “normal” pressures. I have patients with significantly high pressures who have no damage to their optic nerves. I have patients that we are able to control with eye drop medications that are only used one time each day. And, I have patients that need surgery to lower their eye pressure to prevent blindness. I am treating as many patients who have a family history of glaucoma as who have no family history. I have patients with glaucoma from 21 to 94 year old. The only way to prevent blindness from glaucoma is to catch it early with annual eye exams.

~ Steven Sage Hider, OD
California Optometric Association

Blindness & Glaucoma: Early detection and treatment is the key

Photo of listentothemountains on Flickr

Photo of listentothemountains on Flickr

I often hear from patients- “Why do I need to come in each year, I see fine!”

Well, there are many reasons to follow your Optometrist’s yearly examination recommendation. One of them is for the early detection and treatment of glaucoma.  Glaucoma is a disease that affects the optic nerve in the eye- the structure responsible for conveying visual information from your eye to your brain.  The progression of glaucoma is very slow and hardly noticeable to the patient in the early stages, but causes blindness in the later stages.  It starts with peripheral vision loss and progresses centrally.  Once the cells in the optic nerve are lost, they do not regenerate. That is why early detection and treatment is the key.

In order to screen patients for glaucoma, optometrists with begin with a thorough health and lifestyle history. Family history of eye disease and lifestyle factors such as smoking and exercise can be risk factors for the development of the disease. The optometrist will most likely perform basic glaucoma screening tests including eye pressures and visual fields and sometimes more advanced imagery such as retinal photos, Optomap, or optic nerve imaging. All of these tests can aid in the early detection of the disease.

Each year, your optometrist can compare the new results of these tests with the tests from the previous years to determine if glaucoma exists and if so, is it progressing, and how quickly.  A determination can be made if treatment is necessary.

There is no cure for glaucoma, but treatment with eye drops, surgery or a combination can prevent the permanent vision loss.

Just remember, early detection is the key. Visit your optometrist regularly!

~ Lisa M. Weiss, O.D.
California Optometric Association

You’re losing your vision and there’s nothing more to be done

It’s devastating to hear that you’re losing your vision. Worse yet is being told, “There’s nothing more to be done.” Unfortunately, millions of Americans are given this sad news every year, and although medical treatment may not restore one’s vision, low vision rehabilitation can often help to increase visual function.

What is low vision rehabilitation?

Low vision rehabilitation refers to a field of optometry that focuses on making use of the remaining vision that you have. Often when patients lose vision, they do not become entirely blind, but rather lose only portions of their vision. For example, a patient with macular degeneration will lose their central vision whereas a patient who has suffered a stroke might lose all vision on their right visual field. If you or someone you know is suffering from low vision, it’s best to refer them to a low vision optometrist who can spend time uncovering the specific needs of the patient, and subsequently provide a thorough evaluation to determine what aids are best suited to meet those needs. To read more on low vision rehabilitation, click here.

Photo Courtesy of Optelec

Photo Courtesy of Optelec

Beyond having a low vision evaluation, there are a number of tips I often give my patients, which play an equally important role in improving vision function:

1. Increase lighting and use task lights: Lighting is crucial to seeing better. Even those of us who do not suffer from eye diseases know that we see better with brighter lighting. Patients who have eye diseases often have reduced contrast sensitivity, which means they have more difficulty seeing lighter colored objects. Increasing lighting will help with this. I often advise patients to read under a desk lamp and to replace any non-working light bulbs. Consider flashlights throughout the home for shining into pantries or closets that are more dimly lit. Dark hallways may need lighting for night trips to the restroom. Portable flashlights are also helpful for menus (magnifiers with illumination are even better). You may need to experiment with various color lights to determine which gives best illumination without causing too much glare.

2. Increase contrast: As mentioned earlier, poor contrast sensitivity will affect one’s ability to see lighter colored objects. A method for improving this

Photo Courtesy of

Photo Courtesy of

is to pair dark colored objects alongside lighter colored ones. For example, when plating meals, consider serving greens and beef on a white plate, and potatoes, rice and fish on a dark plate. Also, place a dark rug against lighter colored floors at the bottom of stairs to indicate the last of the steps. Write or print in dark bold markers on white paper and increase contrast.

3. Increase size: This option is self-explanatory. The larger it is, the easier it would be to see, and the closer you are to an object, the larger it will be. Therefore, if viewing television is difficult, sit closer or invest in a larger television. Some of my patients sit as close as to 2 feet away from the television. Optics plays a tricky part in the distance change though, so you may need your optometrist to help with glasses for a particular viewing distance. Increase computer monitor sizes or increase screen magnification. Some of my patients prefer two monitors, one to display the magnified image and the other to scroll around. For printed materials, increase the size of fonts and limit visual disturbance by avoiding irrelevant images and words. Your bank can also help by providing large print checks.

4. Make use of your tactile sense: Use raised dot stickers on commonly used items. For example, place one raised dot on the low heat setting on the stove dial and two raised dots on medium. Or place dots on commonly used microwave buttons. Occupational therapists have been able to help low vision patients significantly in this area.

5. Read at the right distance: Glasses are commonly prescribed for a certain viewing distance. For example, driving glasses are for 20 feet and further. Reading glasses are typically clearest around 16 inches. If you have low vision however, you will probably need a stronger pair of reading glasses, which may require you to read at ten inches or closer. If you are unsure, ask your optometrist. A tip that often works is to hold your reading material up close against your nose and find a word or letter to focus on. Bring the reading material out until it becomes clear and this will be the correct distance to read at. Any closer or further than that and the print will not be as clear.

6. Be patient and rely on others: I know this is easier said than done, but patients who do best with limited vision are those who understand that they need to relearn how to “see”. This requires adequate lighting, contrast, size, and viewing distance, which essentially depends upon one’s patience. Having a strong support system and relying on others are key to improving one’s function and outlook. Join a support group, see a counselor or confide in a trusted friend or family member. There are numerous support groups, some often found in a community senior center.

Losing one’s vision is a devastating, life-altering experience, but it’s not entirely hopeless. A recent blog article by Dr. Lisa Weiss, OD has some great resources for those suffering from vision loss. A great place to begin is to see a low vision optometrist. Check with the California Optometric Association’s to find one.


~ Cindy P. Wang, OD, FAAO
California Optometric Association

Coping with vision loss

Photo courtesy of

Photo courtesy of

Sometimes, it’s easy to take our vision for granted. Vision is our most dominant sense. We rely on it for just about everything and rarely need to think about what would happen if we lost this precious gift of sight. In the last few months, this topic has hit home with me in a very personal way. My close friend, who is a graduate student, suicide crisis counselor, avid reader, husband and father to two boys has recently lost his sight. I asked him to share his experiences first hand:

“Since the complete legally blind diagnosis only came to me less than a month ago, the coping is still coming. For me, it might have helped that I was already blind in my left eye from a previous retinal detachment. In the meantime, it has been key for me to keep busy and not dwell on the negative.  Contacting the Department for the Blind and Visually Impaired (DBVI) was one of the first things we did. The DBVI have been amazing with a turn around time of two to three days, at the most. They have given me access to technology such as a portable CCTV/video magnifier and a regular CCTV/video magnifier – both have made my life easier. They will be providing me with my white cane and mobility training, as well. I have signed up for bookshare and started using an on screen magnifier, which have also helped. 

I think for me, the biggest things that have helped me cope will be returning back to school, work and my internship. It will be good to keep busy so I don’t  dwell on the topic of my blindness all the time. It has been suggested I also see a counselor, which I may do in the future.

One thing most people don’t realize is that this is a loss. I have been going through the different stages of grief, mostly anger and sadness. I think of all the things I am never going to see. I am not going to get to teach the boys how to drive or “see” them graduate high school. Then, I remind myself that it could be a lot worse. There are always worse scenarios and I just keep reminding myself of that. Of course, my wife and the boys have been very supportive and encouraging.  

No matter what, life goes on, and sometimes you get hit with a curve ball, but that doesn’t mean life has to stop.

If something is bothering your eyesight, don’t delay.  I assumed the black patch and flashing light in my eye was due to being tired and stressed. Instead, it was a retinal detachment.

Go to your eye doctor immediately. Had I done that, then I might still have vision in my left eye.

I have found the following resources helpful: | |


If you are facing this challenge either for yourself or a loved one, contact your COA Optometrist for available resources in your area.  And remember to have your eye exam every year, so that your doctor can detect any potential vision threatening conditions early.

~ Lisa M. Weiss, O.D.
California Optometric Association

Winter eye care – How can I protect my eyes during winter?

Photo credit: adwriter from Flickr

Photo credit: adwriter from Flickr

Got dry eyes?

We are now in the heart of winter, which means I have seen a number of patients come in with complaints associated with the season.  A common complaint? Dry eyes.  With cold weather comes increased use of heating systems both in our houses and cars. While the  warm air certainly feels great, the heat and decreased humidity dry your skin and eyes.  This is particularly true for my contact lens patients. An easy way to stay comfortable is to keep artificial tears handy and to point vents away from your face.  Also, a humidifier can come in very handy for both your eyes and other sensitive tissues like the inside of your nose.

Playing in the snow?

Photo credit: LaRimdaME from Flickr

Photo credit: LaRimdaME from Flickr

I also had a couple patients tell me they were going on a winter sports trip in the mountains. While playing in the snow is definitely fun, it can be unhealthy for your eyes.  Ultraviolet light is even more powerful when reflected off of snow and with increased altitude.  Too much exposure to ultraviolet light can cause a condition called photokeratitis.  Unfortunately, I had a mild case of this after building a snow fort as a child.  While the fort turned out great, my eyes did not.  My eyes stung and my vision was blurry for about a day.  Some people suffer much worse, so it is very important to use UV-protecting sun glasses when hitting the slopes.

Interestingly, a new coating for your glasses has been invented that eliminates fogging.  So, if you find yourself going from hot to cold environments quickly for work or play, or eating a hot bowl of soup on a cold day, you may want to ask your doctor about this new technology. As you can see with a few simple steps, your eyes can be healthier and better protected in winter. So get out there, stay protected and have a great time!

~David C. Ardaya, OD
California Optometric Association

Color blindness – the causes and the effects

When we think of someone being color blind, we may think that he sees the world in black and white, or shades of gray.  But that is extremely rare.  In fact, almost 8% of men have some form of color vision deficiency where certain colors are more difficult to distinguish, or do not appear as vivid as other colors.  (Perhaps that explains the questionable wardrobe choices my husband sometimes makes.)

What causes it?

Most cases of color vision deficiency are inherited and passed down from the mom.  The photoreceptors in the retina responsible for color are called cones.  Each cone is sensitive to a certain color, in particular, red, green or blue.  If a person has inherited a recessive gene that causes one or more of the cones to be absent or to not function properly, then he will have abnormal color perception.

Photo courtesy of entirelysubjective on Flickr

Photo courtesy of entirelysubjective on Flickr

Some cases of color vision deficiency are acquired later in life as a result of a disease.  More common causative diseases are glaucoma, macular degeneration, and diabetes.  If you notice a change in your color vision, make sure to be evaluated by your optometrist. For eyecare providers, we tend to distinguish color vision deficiency into two broad categories.  Red-green and blue-yellow.  Red-green is inherited and the most common deficiency.  Those with this defect can still see red and green, but the colors are more difficult to distinguish and they may not appear as vivid as to the normal eye.  For example, red and green signal lights may look the same.  One may appear brighter but the lights may both look white.  (For this reason, I’m not a fan of the horizontal traffic lights in some smaller towns.)  Most people who have color vision deficiency have a mild form and are not disabled by this condition.

The other form of color deficiency is blue-yellow where patients have a difficult time distinguishing blue from green or yellow from violet.  This is less common and is usually caused by certain eye diseases.  Unfortunately, for many of these patients, color deficiency is just one visual problem among others.  These patients may also suffer from dimming of vision or distortion of vision.  Often times, bright lighting is helpful for these patients, and occasionally tinted lenses. 

How can I help someone that’s color deficient?

Of course, a comprehensive eye examination is important to rule out any causes of color vision deficiency other than genetics.  This also helps to determine the severity.  Most color deficient individuals carry on like normal without it interfering with their daily lives.  A helpful tip would be to not use the colors red and green as markers because the two colors may appear very similar.  Blue and red will be easier to distinguish.  Unfortunately, those with color vision deficiency should avoid careers that require distinguishing color differences such as airplane pilots, paint mixer, interior designer, etc.

Recently, new developments in tinted lenses have been able to allow some color vision deficient patients be able to see colors they have never seen before.  Sounds promising!

~Cindy P. Wang, OD, FAAO
California Optometric Association

Hitting the slopes? Be prepared for snow blindness.

Courtesy of kasiat on Flickr.

Courtesy of kasiat on Flickr.

Tis’ the season to go skiing and snowboarding.  Ski resorts all over the state are opening this month.  It is a well-known fact that spending time outdoors is healthy for not only your body, but your eyes too.  So get ready, get set, and go!  But before you swish down the mountain, ask yourself if you have taken the necessary steps in protecting your eyes from developing snow blindness – a specific form of something called Photokeratitis or Ultraviolet Keratitis.

Snow blindness can be thought of as a really bad sunburn of your eyes (cornea and conjunctiva).  It is caused by exposure of your unprotected eyes to natural sunlight that is reflected off of the snow or ice.  With just the right mix of high altitude and freshly packed snow, your eyes may be subjected to as much as 80% of UV radiation damage in a very short period of time.

After exposure to ultraviolet (UV) radiation, the white part of your eyes (conjunctiva) may look extremely red and the clear covering of your eyes (cornea) may take on a glassy appearance.

Overall, your eyes will not be feeling too great.  With every blink, you may experience unrelenting pain, intense tearing, sandy and gritty feeling, eyelid twitching, discomfort with bright lights and a natural tendency to want to blink more rapidly or shut your eyes tight.  Your vision may be reduced to varying degrees.

The best way to prevent snow blindness is to wear UV-blocking sunglasses or goggles that only allow a certain amount of visible light through. Also, remember to don that protective eyewear whether it is a sunny or a gloomy, overcast day – UV rays can reach your eyes under any condition.

Courtesy of tk-link on Flickr

Courtesy of tk-link on Flickr.

In the event that you forget to bring your sunglasses or you lose them on the way down the slopes and sustain subsequent sun damage to your eyes, your friendly optometrist can promptly treat your symptoms and provide comfort and relief.

While snow blindness is a one form of Photokeratitis,  there are also other forms of which you should be aware, including artificial lights from suntanning beds, electric sparks, halogen desk lamps, flood lights, and arc welding (welder’s flash, arc eye, flash burn) just to name a few.  The prevention is the same.  Wear your UV-blocking sunglasses or goggles to not only look stylin’, but to preserve the health of your eyes and sight.

See you on the slopes!

~Judy Tong, OD, FAAO, FAAO
California Optometric Association

I have an astigmatism. What is that?

Courtesy of Greece Trip Admin on Flickr

Courtesy of Greece Trip Admin on Flickr

Astigmatism is a term used by optometrists to describe a prescription for one eye that needs two powers to bring it into focus. It is not a disease or something that will make you go blind, but it can make things blurry at distance and at near.
Most people are familiar with the terms “near-sighted” and “far-sighted.” In the eye care world we use the term “myopia” for near-sightedness and “hyperopia” or “hypermetropia” for far-sightedness. These terms are used to describe the power (+ or -) of the lens needed to make you see clearly.
If your prescription needs only one power to bring your eye into focus then you can think of it as being simple. So if your prescription has a number like -4.00, then you have simple myopia. Similarly, if you have a prescription of +2.25, then you have simple hyperopia.
If you have an astigmatism in your eye, then you have two powers that need to be corrected for you to see clearly. Having an astigmatism in your eye is our way of describing a compound prescription. Instead of just one simple power like we described earlier, there are two powers together. Depending on your prescription, you can have myopia with astigmatism or hyperopia with astigmatism.

Courtesy of Ciro Boro - photo on Flickr

Courtesy of Ciro Boro – photo on Flickr

A common example optometrists use to describe astigmatism to patients is the difference between a basketball and a football. A basketball is nice and round, and has only one curve for the entire ball. You can think of that curve as a lens power. A basketball is a good example of a simple prescription. A football, on the other hand, has two curves. This is like an eye that has two powers or an astigmatism.
Astigmatism is not an eye disease, but rather a term we optometrists use to describe a compound prescription in one eye. So don’t be alarmed if your optometrist tells you that you have some astigmatism in your eyes. You are not alone – I have an astigmatism in both of my eyes and I see extremely well!

~Ranjeet S. Bajwa, OD, FAAO
California Optometric Association

Night blindness 101

The term night blindness sounds alarming, as though some people are actually blind at night.  There is a small percentage of the population that does in fact experience true night blindness, but it is rare and often the result of late stage eye disease.  In optometry, it is not common to use the term night blindness although we do encounter a significant number of patients who complain of poor night vision.  The symptoms are usually blur and dimming of vision at night, glare and haloes around lights and poor adaptation from light to dark environments.  How do you know if what you are experiencing is normal or a result of something more serious?

There are a handful of eye conditions that can create symptoms of poor night vision.

Photo Courtesy of kenleewrites on Flickr

Photo Courtesy of kenleewrites on Flickr

  1.  Patients who have had surgery to the corneas such as LASIK or corneal transplants may notice glare and haloes around light.  They may also experience diminished contrast sensitivity which can cause images in the evening to appear more dim.  Unfortunately, surgical results usually cannot be reversed.
  2. Cataracts are the number one cause of decreased night vision.  Patients over the age of 40 will begin developing mild cataracts.  This is when the natural lens inside the eye becomes more yellow and opaque as a result of age and ultraviolet exposure.  Cataracts can cause haloes and dimming of vision in the dark and decreased contrast sensitivity.  Fortunately, cataracts are easily removed thereby restoring problems with night vision.
  3. Corneal diseases such as keratoconus and severe dry eyes may also affect one’s vision in the evenings causing double vision or haloes.  For some of these patients, specialty contact lenses or eyedrops will alleviate these symptoms.
  4. Newer technology has also allowed optometrists to detect higher order aberrations in some patients.  For these patients, standard spectacle lenses may not improve night vision problems.  An instrument to detect higher order aberrations will determine whether a patient requires a specialty custom-made spectacle lens to improve night vision.

Some patients do in fact have true night blindness caused by an eye disease in its late stage.  Usually, symptoms begin slowly over time and progress to an inability to see in the dark.  These patients usually suffer from one of two eye conditions.

  1.  Retinitis pigmentosa is an inherited eye disease of the retina, the tissue that lines the back wall of the eye and captures visual images.  Retinitis pigmentosa affects the rods of the retina and causes slow deterioration of these structures.  The rods (unlike the cones) are responsible for night vision and for peripheral vision.  As the disease progresses, patients will notice a decrease in their ability to see in the dark and in the periphery.  Unfortunately, there is no current cure for retinitis pigmentosa.
  2. Glaucoma is an eye disease where the optic nerve slowly degenerates.  Patients with glaucoma usually have no symptoms in the early stages of the disease.  As the disease progresses, nerve fibers in the retina begin to deteriorate resulting in a decrease in peripheral vision as well as night vision.  Usually, patients do not experience symptoms of poor night vision and poor peripheral vision until the late stages of the disease.

Now that you know the causes, what are some ways to alleviate or improve poor night vision?  The simplest solution is to wear an updated pair of prescription glasses (if you have a prescription) with higher index lenses and an anti-glare coat.  Your optometrist can also inform you if you require customized lenses to correct for higher-order aberrations.  If your night vision problems are not a result of surgery or any eye diseases that you are aware of, then it is important that you visit your optometrist for a comprehensive eye examination.

– Cindy P. Wang, O.D., F.A.A.O.
California Optometric Association