What is pinguecula?

Pinguecula is a very common distortion of the eye, which consists of white and yellow depositions on the conjunctiva next to the corneal limbus, either from the side of the nose or the temples. It is not a tumor, but an alteration of the natural tissue that ends up in depositing proteins and lipids. Pinguecula can also be a reaction to chronic eye irritation or to intense sunlight. Contrary to pterygium, pinguecula does not move towards the cornea.

How is pinguecula treated?

It doesn't need treatment unless an inflammation is present. Pinguecula does not “invade” the visual axis and doesn't threaten vision. But if it becomes annoying, it can be removed surgically, even though this is rarely done.

Remember: Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

What is pterygium?

Pterygium is a triangular layer of fibrovascular tissue, that penetrates the cornea (the clear anterior segment of the eyeball). In its initial stages, some small gray opacity of the cornea is observed, nasally, near the corneal limbus. Subsequently, the conjunctiva covers the opacity and gradually expands over the cornea in a triangular shape. It may be small or can grow substantially enough to obstruct vision.

The exact cause of the pterygium is not yet established. It appears more frequently in people who spend most of their time outdoors, especially in warm climates with a lot of sunshine. Prolonged exposure to sunlight, especially UV rays, as well as chronic irritation of the eye from environmental dryness and increased dust seem to be a significant underlying cause.

How is pterygium treated?

In case the pterygium is irritated and becomes red, drops or ointments can be used locally to reduce the inflammation. Surgical removal is recommended either for cosmetic reasons (if the pterygium is large, expanding or causing deformation) or in cases that its progress threatens the visual axis which would result in decreased vision.

Despite a proper surgical removal, the pterygium may regress, especially in young people. Surface application of radiotherapy or medication can be used to avoid regression. A measure that also helps is protecting the eyes from excessive exposure to UV rays with appropriate glasses and avoiding environments with lots of dust and dryness.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

Learning difficulties are related to vision problems

Good eyesight for children is certainly a basic requirement for school success. When the child's vision falls short, the same happens with his school performance. According to a recent study, up to 25% of children experience eyesight problems that affect their learning ability.

Learning difficulties is another thing to worry about regarding children of school age. Even though learning difficulties usually appear in children up to 7 years old, they are often not detected until the child goes to school. Many times, however, learning difficulties can be the result of simple eyesight problems. A refractive fault may be the cause of these difficulties in school or a refractive fault can be combined with a learning problem. If your child reversed letters while reading or writing, his writing is sloppy, he doesn't like or has difficulties with reading, writing or mathematics, he often confuses his right and left hand or the opposite, he faces difficulties in oral communication or has frequent antisocial behavior, then you should consult with an expert. Consult with your ophthalmologist in order for him to diagnose a potential vision abnormality and visit your paediatrician in order to get proper information and a recommendation for a specialist.

What are the vision disorders for children of school age?

The most common vision disorders regarding school age are:

amblyopia at about 4%,
strabismus,
myopia , 5% until the age of 8, 26% until the age of 14 and 30% until the age of 20,
hyperopia at about 90% until 5 years of age and 15% over 5,
astigmatism.

What are the signs that should lead us to the ophthalmologist in time?

Parents should look their children in the eyes and observe their reaction in various visual stimuli, since their performance and subsequent success in life is mainly dependent on the proper function of their eyes. If a child that starts school has normal language development, but faces learning difficulties or difficulty in reading, then he might have an eyesight problem.

The symptoms that the parents need to look out for are:

The child always sits very close to the television or reads a book close to his eyes
He loses track of where he is in a text, or skips words and sentences

He uses his finger to follow the words when he reads

He writes sideways

His posture isn't proper when he studies
He easily loses attention and can't concentrate
He squints
He leans his head to see clearly
He is sensitive to light
He rubs his eyes or blinks excessively

He closes one eye to read or watch television
His eyes are unnaturally aligned. Their movement is unnatural
He doesn't easily comprehend what he reads
He is too slow to finish homework
He avoids activities that require close vision such as reading or distant vision such as sports participation or other activities.
He complains about headaches or tired eyes.
He avoids using a computer at school because “it is tiring for his eyes”.
His school performance is decreased compared to the past.

If your child presents one or more of the above signs, you should schedule an appointment with the ophthalmologist. This visit to the doctor will usually show that the child has myopia, hyperopia or astigmatism. These refractive abnormalities can be corrected very easily with glasses or contact lenses.

How often should the child visit the ophthalmologist?

Expertise and available technology today offers to ophthalmology diagnostic methods, which prevent many problems, before they become damaging. Some eye disorders may exist without any obvious symptoms and that is why children of all ages should do preventive examinations.

Your child should definitely be examined by an ophthalmologist for the first time no later than 6 years of age. All babies, and especially infants, mainly those that are considered “high risk” (premature labor, family history of eye disorders) should be examined by a specialist pediatric ophthalmologist. This examination is done to verify the good health of the eyes and detect potential problems that may be rare, yet important, like congenital cataract, glaucoma, microphthalmia etc. After that, again in the age of 3 and again when he is starting school. Children of school age need an ophthalmological examination once every 2 or 3 years if they present no problems. But if your child needs glasses or contact lenses, you should schedule the visits to the ophthalmologist every 12 months. We should keep in mind that just as the child grows, so does his vision change which results in a need to also change prescription. Furthermore, your visit to the ophthalmologist will ensure that your child can have proper central and peripheral vision, use both his eyes and easily adjust from close to far distances and the opposite.

We should point out that an ophthalmological examination alone is not enough. The paediatrician will examine the child's vision to detect a possible problem, but he can't replace the ophthalmologist. So, while a paediatrician's examination can be useful, there is always a chance for this examination not to show any serious problems. Parents are mainly those who will need to take initiative and schedule the visits to an ophthalmologist, who will examine the vision of the child thoroughly.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

The existence of a refractive abnormality was and still is a reason for rejection from Military Academies. Even if the candidate fulfills all requirements to enter such a school, the existence of a refractive fault, even if it is corrected with glasses or contact lenses (visual acuity 10/10), will not allow him to participate in the examinations.

Each of these Military Academies has its own criteria regarding the required visual acuity and in some of them, candidates will be accepted even if they wear glasses or contact lenses, as long as their corrected acuity is not lower than what is required.

In particular, in the table below you can see the visual requirements for the candidates of every Military Academy. It is worth noting that except for the Hellenic Air Force Academy (Pilots), none of the other schools mention restrictions or exclusions due to correction with refractive surgery.

 

Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 6 diopters (spherical equivalent)

Hellenic Military Academy (Arms)	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent)
Hellenic Air Force Academy (Engineers)	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent)
Noncommissioned Officers Army Academy	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent)
Hellenic Air Force Academy (Technical NCO School)	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent)
Hellenic Air Force Academy (Administrative NCO School)	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent)
Hellenic Military Academy (Corps)	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 6 diopters (spherical equivalent)
Corps Officers Military Academy
Officers' School of Nursing	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 6 diopters (spherical equivalent)
Naval Cadets Academy (Combatants)	Visual acuity with or without correction 10/10 in each eye without correction
Naval Cadets Academy (Engineers)	Visual acuity without correction 1/10 in each eye, 10/10 with correction, myopia should not be above 2.5 diopters, hyperopia 3 diopters and astigmatism 2 diopters. All candidates for naval schools should not have undergone refractive surgery with radial keratotomy
Hellenic Navy's Petty Οfficers' Academy	Visual acuity without correction 1/10 in each eye, 10/10 with correction, myopia should not be above 2.5 diopters, hyperopia 3 diopters and astigmatism 2 diopters. All candidates for naval schools should not have undergone refractive surgery with radial keratotomy
Hellenic Air Force Academy (Pilots)	Visual acuity in close or in a distance no less than 10/10 for each eye without correction and they should not have undergone any refractive surgery. Their myopia should not be higher than 0.25 diopters, hyperopia higher than 1.75 diopters and astigmatism higher than 0.75 diopters for each meridian. Also, esotropia up to 10 diopters, exotropia up to 5 diopters and hypertropia up to 1 diopter and close convergence point no lurther than 70cm.
Hellenic Police Academy	Visual acuity with or without correction 10/10 in each eye and refractive anomaly should not be above 4.5 diopters (spherical equivalent). Astigmatism should not exceed 5 diopters.

It is evident that even if visual acuity with correction is adequate, the degrees of refractive abnormality are an obstacle for the participation of the candidates in some schools.

In the past, the only ways to correct these refractive abnormalities were glasses and contact lenses. In some of those schools, however, vision should be perfect without correction. In others, even if corrected visual acuity was 10/10, if the refractive anomaly was above the accepted limit, the candidate was rejected.

The problem of refractive abnormalities can now be surpassed with refractive surgery (LASIK and PRK), which are considered routine surgeries in the hands of an experienced ophthalmologist surgeon. The improvement of laser technology and surgical techniques used today provide painless, safe procedures with excellent, predictable and stable in time results. Refractive surgeries are now undoubtedly an excellent application of advanced technology, which can open the doors of a secure profession to many young people who thought their options limited due to the condition of their eyes, while they were fully qualified for a brilliant career.

Remember: Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

All drivers are responsible for their own safety, their passengers' safety and certainly the safety of everyone on the streets. Our ability to see clearly is part of this responsibility. About 85-95% of everything we apprehend during driving comes from our eyes. Poor visual perception means bad driving.

 

How important is good eyesight for safe driving?

The past few decades, more and more people are able to own a vehicle and drive it. Despite the disadvantages of increased traffic, we have to accept the fact that driving gives a feeling of independence to the person who owns and drives it. Also, car use has been proven crucial in many cases. As cars and drivers become more, however, accidents increase as well.

Most countries, aiming towards the common good and willing to decrease the number of road accidents, pose restrictions, among other things, to the driving rights of people with certain disorders. For example, a person with decreased reflexes is a dangerous driver and so incapable of safe driving. One of the most important parameters for safe driving is, undoubtedly, good eyesight. Eye disorders, if left untreated, frequently become a significant reason for the restriction of the driver's abilities. 

 

These results came after comparing them with drivers with no eye disorders. Research has shown that the more severe the eye disorder of the drivers that were in an accident, the more possible it was that they were responsible for the accident. odigisi4

 

 

The solution of the problem initially focuses on raising the widest possible awareness as regards to the problem and secondly on the huge chances of treating the various eye disorders. It should be made clear that the past few years advances in ophthalmology technology offer impressive results, for example, the successful correction of high myopia, hyperopia or astigmatism with the latest laser applications in refractive surgery. Furthermore, there have been many important steps in the treatment of cataract, due to the application of new microsurgical techniques for its removal. With proper information and successful treatment of an eye disorder, driving can be rendered safe both for the driver and the rest of the people.

 

 

 

 

Useful information for drivers

You should know that...

Between ages 40 and 60, vision at night becomes harder. Our pupils become larger, the muscles lose elasticity and our vision becomes less clear. A 60-year-old driver needs 10 times more light than a 20-year-old!
Older people are more sensitive to “glare” from lights, which makes driving at night difficult. A 55-year-old person needs eight times more time to recover after an intense glare than a 16-year-old.
Weaknesses in our visual system increase after the age of 55. We fail to record objects that don't move, like pedestrians waiting to cross the street.
Around the age of 70, peripheral vision presents problems, which results in increased chances of accident. It is important to know that 95% of a driver's ability comes from peripheral vision.
As years go by, colors lose their brightness for a lot of “elderly” eyes, which results in decreased by half ability to see traffic lights, in relation to younger ages.
Another visual ability that decreases with time is depth perception: how close or how far our car is, in relation to an object in front of us. This ability is especially important for someone to judge the speed with which a car comes, in order to overtake it or turn left.
Cataract, glaucoma and diabetes are conditions that affect vision and the drivers that suffer from these should follow the advice of their ophthalmologist.

Useful advice for safe driving

Turn on the lights early in the evening and inside fog. These are the hours where difficulty in seeing and be seen is large. Avoid, if possible, driving at sunrise and sunset since the “glare” may be blinding and make it difficult to distinguish details on the road. But if you do drive during these hours, you should take precautions and keep longer distances from the car ahead. Decrease your speed if you're driving at night.
If your ophthalmologist gives you corrective glasses or contact lenses, you should be wearing them while driving. If you have difficulties in driving at night, you should discuss this with him. Avoid driving at night on roads that aren't well-lit or you're not familiar with. Elderly drivers need more light to see and they should avoid driving at night.
Wear sunglasses during the day. With sunglasses your eyes adjust easier from light to darkness. Don't wear sunglasses when you drive at night.
It is really important for the headlights of your car to be properly adjusted so that they offer proper illumination without blinding the others.
Visit your ophthalmologist at least once a year and ask for a full ophthalmological examination that will allow you to be certain that you fulfill the requirements for safe driving.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

Do computers affect our vision?

Problems caused by computers are the second most frequent reason for young healthy people to visit their ophthalmologist. What happens to people that use computers for long hours during the day is basically what is called “asthenopia”, that is difficulties in vision. The second problem is of course problems caused by repetitive movements of the fingers and of the muscles of the arm.

The consequences of computers on vision and the eyes are still under general observation, but any kind of permanent damage hasn't yet been verified.

More than 50% of computer users suffer from eye fatigue, headaches and blurry vision. These symptoms sometimes affect the person's general health, creating a sense of fatigue, which leads to decreased work performance.

There are also some indications that, in rare cases, people working long hours in front of a computer, face an increased risk for glaucoma.

 

How do computers affect our vision?

When we are viewing a computer screen, what happens is that we lose depth perception, i.e. stereopsis, and our focus is always on a single point. Also, our eye convergence (what happens when we're looking at something really close) is continuously hyperactive and the frequency of blinking is decreased. This is completely different from reading a printed page, since most computer monitors, especially those with a CRT, do not emit a single image, but an image that passes frame by frame and our brain connects it so we can see a continuous image; it is an image with diffused light and has very different contrast and clarity. After using a computer for many hours, what happens is that the cones, the cells we use to perceive colors, are always hyperactive and the image from the cones' hyperactivity stays in our brain, despite the change of image on the computer screen. This is called “after effect” or McCollough effect and sometimes color perception is reversed.

Things that worry us with computer use is if we are exposed to radiation and UV radiation and how much, and if this can potentially lead to cataract. It should be noted that there is proof that the radiation we receive, especially when it comes to UV radiation, is less than that of a fluorescent bulb, so there is no dangerous radiation for the eye and no proof that this can lead to cataract.

 

Ophthalmological symptoms caused by PC use

Headache during and after PC use
Pain between the eyes
Dry and/or irritated eyes
Blurry vision
Slow focus during screen use
After long hours of PC use there is difficulty in viewing distant objects

Occasional diplopia
Poor color perception

General physical symptoms caused by PC use

Pain in the neck and the shoulders
Back pain
Fatigue, maybe even pain, of the hands and wrists
Decreased work performance, frequent mistakes, fatigue

Ways to avoid such symptoms

The computer monitor should be on a lower level than the eyes.
The keyboard should be in such a position that the bottom of our arms and wrists is parallel to the ground.
The seat should be adjustable, so it can cater to the user's needs.
The thighs, like the arms, should be parallel to the ground.

Contrast and brightness of the screen should be adjusted to the desired setting, so that the user feels comfortable and doesn't tire his eyes.
The lighting in the room must be three times brighter than the monitor.
A screen filter should be used

It is important to work on a big screen, so it isn't tiring to read or write a text
The screen shouldn't reflect light from a window or another light source
It is necessary to clean your screen regularly.
Adjust the font size on your screen, choosing a setting which is comfortable, if the software gives you that choice.
Adjust brightness and contrast on your screen.
People who use computers all the time may experience some refractive anomalies, like slight myopia, slight astigmatism, slight hyperopia; if this is corrected with the use of glasses or contact lenses, it will help them use these devices easier.
Use of artificial tears may help with xerophthalmia that long hours in front of the PC might cause, due to the decrease in blinking speed and frequency; proper moisturizing of the atmosphere, in which the person works and uses the PC, may also help.
The most important thing of all is to have short and frequent breaks of 2-3 minutes every 15-20 minutes of work or 5 minutes for every 30 minutes or 10 minutes for every hour.

 

What problems can excessive PC use cause during childhood?

The past few years in America, Europe, even in Greece, children spend 1 to 3 hours daily in front of a computer screen, either for their school work or to play. Many times, it is the parents who encourage their children from an early age of 2 or 3 to access the PC at home or at school.

Many pediatric optometrists believe that excessive use of PC during childhood can increase the risk of myopia. They refer to studies that have been done and which show that computers have a negative impact on a child's vision.

Particularly, various studies claim that:

25% of the children that use computers need corrective glasses in order to work on the computer with comfort and without danger at home or at school.
The percentage of children in the first stage of myopia has increased from 12% to 20% from 1995 until today.
The percentage of children between 7 and 9 years of age with myopia has doubled the past three years, reaching 34%.

Twenty years ago, most children played in open spaces and their distant vision was more important. Today, most children work in front of the PC either at home or at school. Sitting in front of the PC, looking intently at the screen creates problems that weren't known a few years ago. With PC use, the child's visual system is more focused and more pressured than with other activities. PC use requires high-level skills from the eyes of small children, whose visual system has not yet been fully developed. Only when it is mature enough, can the child manage the pressure and stress caused by PC use.

According to the American Academy of Ophthalmology, the impact of PC use in childhood includes the following factors:

Children have a diminished degree of self-protection. They can work in front of the PC for hours with little to no breaks. This extended activity can cause focusing and attention problems.
Children are especially adaptive. They believe what they see and the way they see things is always the norm for them, even if they have eyesight problems. That's why it's important for the parents to monitor the time their children spend in front of a PC.
Children are by definition smaller than adults. Most of the times, the work space in front of the PC is designed to be used by adults. This may change the children's visual angle. PC users should keep the monitor at a lower lever than their eyes, by about 15 degrees. Also, as a result of the difficulty with which the children reach the keyboard or touch their feet on the ground, they may feel pain in the neck, the shoulders or the back.

 

Advice to avoid problems from PC use in childhood
Many pediatric optometrists claim that children who use a computer long before their visual system is fully developed are at the heart of the problem known as “computer vision syndrome”, which is a visual syndrome caused by excessive PC use.

In order to protect your children from this syndrome, you should follow the following advice:

Before school starts, every child should have already had a full ophthalmological examination, including tests for distant and close vision.
Work space for the computer should be adjusted for a child, not for an adult.
Suggested distance between the monitor and the child's eyes is 50-60 cm. Looking at the computer screen from a closer distance endangers their vision due to excessive visual adjustments.
The time children work in front of the PC should always be monitored and, if possible, discontinuous, so that there are breaks when the visual and the musculosceletal system may rest.
Parents and teachers should recognize every behavior that shows possible problems such as: red eyes, frequent eye rubbing, head leaning or other unusual body stances and, finally, complaints about blurry vision or tired eyes. If any of this is observed they should immediately visit their ophthalmologist.

 

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

 

Pregnancy is a very important period in every woman's life. During these nine months, her body undergoes a plethora of changes which result in the occasional creation of various problems related to the normal function of individual systems of her organism. Among those changes, there is a chance for her eyesight to be affected, a fact that compels us to systematically monitor the pregnant woman.

A possible complication of the hormonal changes during pregnancy is the appearance of myopia or the aggravation of already existent myopia. It is also possible to see a transient change in the adjustment of focus. These problems are usually not permanent and eyesight is restored to its natural state after labor.

 

If we consider that changes in eyesight may indicate other health problems, an ophthalmological examination during pregnancy is a reasonable and necessary procedure. Most future mothers, however, do not include it in the prenatal examinations, usually due to the myth that they are not allowed to use eye drops that dilate the pupil. An examination with pupil dilation is not only a safe procedure, but in some cases it is the best preventive action.

Possible changes in the eye during pregnancy

 

1) Cornea : Cornea is the transparent membrane in the anterior segment of the eye. Due to hormonal changes, small changes in its curvature and thickness (edema) may occur, causing an intolerance to contact lenses. Furthermore, the use of contact lenses becomes harder due to xerophthalmia caused by reduced tear production. Xerophthalmia usually causes blurry vision and its symptoms may decrease with the use of artificial tears. In addition, the use of contact lenses during pregnancy may pose some risks. The changes that occur naturally in the cornea, in its decreased sensitivity, may make putting on contact lenses difficult and hide a potential infection or some minor injury in places where it is not easy to detect. After birth and lactation, these symptoms subside completely and most women can continue using contact lenses.

2)Visual acuity: Some changes in refraction are possible and a change in glasses may be needed, if it is considered necessary. Changes in refraction are caused by hormonal changes and they are usually reversed, that is why we usually avoid changing glasses. We should mention, however, that blurry vision may occur because of gestational diabetes and for this reason, the physician should be informed immediately about any changes in vision.

3) Photophobia: Headaches and migraines due to hormonal changes may cause great sensitivity to light.

4) Visual Fields: Some cases of change in visual fields in pregnant women have been reported, like partial loss of visual field temporally or magnification of the blind spot, but all these changes are completely reversible and require closer inspection.

5) Pre-eclampsia – Eclampsia: If women that never had high blood pressure suddenly present hypertension, then this is an immediate diagnosis of pre-eclampsia. It appears in about 5% of women and usually after the 20th week of gestation. If hypertension is accompanied by shivers, then it is called eclampsia. The most common symptom is blurry vision that might also be accompanied by headaches, photopsias and diplopia. 10% of women with eclampsia may present edema in the retina, serous detachment and acute ischemic optic neuritis. All these conditions are reversible 1 to 2 weeks after reducing blood pressure or after labor.

6) Central serous retinopathy: It has been reported during pregnancy, mainly in the third trimester. It is reversed automatically and rapidly the first few months after birth.

7) High myopia: All women with medium to high myopia are worried about the consequences on their eyes of a difficult or even a normal labor, that's why they resort to c-section. For years, however, research has shown that this is a myth. Statistics in groups of women with -4.5 to -15.0 diopters, even those with pre-existing myopic damage of the fundus, tears or detachments that were restored with laser or surgically, presented no deterioration or reappearance of these problems after natural birth.

 

Pathologies that exist before pregnancy and can cause changes in eyesight

 

1) Diabetic retinopathy: Pregnancy may have negative effects on pre-existing diabetic retinopathy. Its deterioration depends on other factors, such as the severity of the condition before pregnancy, the duration of the disease and if it coexists with high glycated hemoglobin and hypertension. The percentage of women with diabetes that hadn't been diagnosed with retinopathy and it appears during pregnancy is about 10%, but only 0.2% presents degenerative symptoms which, in both cases, are reversed after birth. Depending on the severity and the type of retinopathy, an ophthalmological examination with ophthalmoscopy is necessary in regular intervals.

2) Hypertension: Monitoring blood pressure during the entire pregnancy is necessary, since, in several cases, it has been observed to rise. High blood pressure is accompanied by blurry vision and a sensation that we see bright spots or deformed objects in our visual field. When arterial pressure is not controlled, it may cause damage to the vessels, as well as make other conditions worse.

3) Glaucoma: Some cases, where the intraocular pressure has been reduced and the condition has improved, have been reported, but these observations require further evidence, since all changes during pregnancy are reversible.

4) PURTSCHER retinopathy: he symptoms are decrease in visual acuity, floaters (black spots) and hemorrhage in the back of the eye. All changes in vision subside after several weeks and no treatment is needed.

5) Pituitary adenoma: The adenoma may increase in size, causing changes in our visual field (usually temporally) or headaches and a decrease in visual acuity. A possible cause of the increase of the pituitary adenoma is pituitary apoplexy, which can endanger the person. Women whose adenoma tends to increase and also have headaches, should do an MRI and if this shows subarachnoid hemorrhage, then it is advisable to prefer a c-section. These adenomas reduce in size after birth and leave no eye problems behind.

Symptoms that require an immediate visit to the ophthalmologist

 

All women that, during pregnancy, have headaches, blurry vision and changes in their visual field should do an ophthalmoscopy and a visual field test with their ophthalmologist.

Refractive surgeries

 

Refractive surgeries (myopia, hyperopia and astigmatism correction with laser) should be avoided during pregnancy and lactation. The main reason is changes in the cornea, due to hormonal changes, which renders the results impossible to predict. After lactation, when the cornea returns to its natural state, the lacrimal layer is restored, along with any other ophthalmological problem may have appeared, then such a procedure can be scheduled. In case there has been a surgery before pregnancy, there is no risk for the pregnant woman to have natural labor, since all changes, as in the previous case, subside after lactation.

Eye drops use

 

1)Medication against glaucoma and especially beta blockers should be used in the smallest possible dosage during the first trimester and be completely stopped 2 or 3 days before labor. Local and systemic carbonic anhydrase inhibitors are not recommended during pregnancy and lactation.

2) Eye drops that are used for pupil miosis and dilation, as well as local anesthetics that are used during eye exams are completely safe.

3)Local steroids and antibiotics like erythromycin and quinolones are not recommended.

4) Systemic antibiotics should be avoided during pregnancy and especially during lactation.

The ophthalmological examination should be part of prenatal examinations, not only because it is a very safe process for the future mother and the embryo, but, considering that changes in eyesight warn about other more serious conditions during pregnancy, it may constitute the first step of prevention.

Remember:our ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

What is optic neuritis?

Optic neuritis is an acute demyelinating inflammation of the optic nerve. The optic nerve is responsible for our vision by transferring the image from the eye to our brain. It can be compared to a cable that includes many, very thin, “electrical wires”, about 1,200,000 of them, called nerve fibers. Each fiber transfers part of the visual information to the brain.

 

In optic neuritis, the nerve tissue gets inflamed and the nerve fibers stop working properly. If a lot of the fibers are affected, then vision is decreased significantly, but if optic neuritis is mild, then our vision remains almost normal.

Normal optic nerve	Optic neuritis	Optic neuritis

  

Typical clinical image of the disease includes sudden decrease in vision and visual fields, which is followed, in most cases, by an automatic improvement.

What causes optic neuritis?

Many diseases and conditions can cause optic neuritis, but in many cases the cause of optic neuritis remains unknown. The causes of optic neuritis might be:

Demyelination
Infection (syphilis, cat-scratch disease, spreading of the infection from the orbit of the eye, the nearby paranasal sinuses or the meninges)
After a viral infection (measles, mumps, rubella, chicken pox etc.)
Systemic autoimmune diseases
However, when we talk about optic neuritis, we mean partial or total loss of vision caused by demyelination, during which the nerve fibers lose their insulating myelin sheath that surrounds them, which results in problematic conduct of nerve impulses. The most frequent form is the one related to multiple sclerosis (MS).
It has been calculated that patients who develop optic neuritis, but everything appears normal in a brain MRI, have 16% chances to develop MS within 5 years. Furthermore, of those that have a first episode of optic neuritis, 50% of them show lesions in the MRI and it is them with higher risk of developing MS in 5-10 years.

  

What are the symptoms of optic neuritis?

Optic neuritis usually appears suddenly. The patient who presents symptoms of neuritis usually:

is 15-45 years old
is a woman
has one-sided decrease in vision that worsens for 5-8 days
complains about pain in or around the eye, that worsens with eye movements
has blurry vision in one or both eyes, especially after physical exercise or a warm bath
starts seeing improvement in his or her vision after 3-4 weeks and this continues for a period of 6 months when maximum restoration is reached
shows other symptoms like sudden disturbance in color perception by the afflicted eye (acquired color blindness) and distortions in the visual fields.

How can optic neuritis be diagnosed?

For the doctor to diagnose optic neuritis it is important to give him a detailed account of the symptoms and he will move on to a full ophthalmological examination. By examining the fundus, the doctor seeks for an edema of the optic nerve at the posterior segment of the eye.

If optic neuritis does not affect the optic nerve near the eye, then the nerve might appear normal. Since optic neuritis may be confused with a lot of other causes of diminished vision, a precise diagnosis is necessary.

Other tests that the ophthalmologist can use include chromatic perception, peripheral vision (visual field) tests, as well as the pupil's reaction to light. Visual and somatosensory evoked potential, ultrasounds, and brain/cervical spine MRI, electroencephalography (EEG) or lumbar puncture (shows increase in IgG immunoglobins) may also be suggested by the ophthalmologist. If the cause is found and treated, it is possible to prevent further damage.

    

  

How is optic neuritis treated?

Fortunately, most patients return to normal vision without any treatment. Even though some people may experience visual distortions from neuritis, these are usually very mild.

Research has shown that steroids (cortisone) taken orally do not help with optic neuritis. In some people with significant loss of vision, however, treatment with cortisone injected intravenously might prove beneficial.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.

What does the frequency of visits to the ophthalmologist depend on?

It depends on

the patient's age
the existence of pathological factors that pose a risk to vision and
the presence of other ophthalmological symptoms.
Thus, people who present ophthalmological symptoms need immediate ophthalmological examination. Those who don't have any symptoms but are in high risk of presenting an ophthalmological condition should be occasionally examined by their ophthalmologist. Finally, patients who are on medication that might affect vision, like corticosteroids, should also be examined regularly.

What ophthalmological signs and symptoms require immediate ophthalmological examination, regardless of age?

 

Sudden decrease in vision, loss or deformation of observed objects
Pain inside and around the eyes
Excessive lacrimation or eye excretions Swelling of the eyelids or eye proptosis (exophthalmic)
Diplopia
Flashes, bright circles around lights or perception of moving formations (spots, spiders, net, smoke etc.)
Sudden strabismus or eye drifting
Change of the color of the iris

What are the risk factors for the appearance of an eye disorder?

Diabetes
Hypertension
Family history of glaucoma, retinal detachment or other hereditary or “family” eye disorders
High myopia
65 years of age and over

What is the frequency of an ophthalmological examination for infants, children, young adults and the elderly?

 

Some hereditary, congenital or infectious eye disorders appear in the newborn and require immediate ophthalmological examination. Some of these conditions, like congenital cataract may be treated successfully if treatment starts within the first few weeks after birth.

Risk factors for eye disorders in a newborn are:

1) Rubella (German measles) in the mother
2) Aphrodisiac or AIDS related diseases
3) Long stay in an incubator
4) Family history of retinoblastoma
5) Genetic or congenital diseases such as cataract and glaucoma

 

High risk newborns: Ophthalmological examination in infancy

 

Premature babies that spent time in the incubator and are underweight
Children with family history of retinoblastoma, congenital cataract or with genetic diseases
Rubella in the mother, aphrodisiac or AIDS related diseases

Children who do not belong in any high risk groups to present eye disorders should also be examined in the eyes by a paediatrician or the family doctor the first few days after their birth.

Every child should have visited the ophthalmologist during his or her preschool years at the latest. . Amblyopia, which is one of the most common problems during the preschool years (about 2%) can be satisfactorily corrected if it is diagnosed early. Decreased visual acuity that is found out in the clinic or during examinations performed in school requires further assessment.

During the school years, the major ophthalmological condition that affects children is refractive disorders, such as myopia that hasn't been corrected. For children that are examined once a year and don't have any symptoms or don't belong in any high risk groups for eye disorders, their ophthalmologist will determine the frequency of their visits.

  

Frequency of ophthalmological examinations to newborns and children not in any high risk groups

 

All newborns should be examined by the paediatrician or the family doctor.
All babies until 6 months old should be examined by the paediatrician or the family doctor.
All children in the age of 3.5 years old should be examined by the paediatrician or the family doctor.
Yearly regular examinations during school years.

Young people under 35 have a relatively low frequency to present significant eye disorders. A routine examination should be done around 35 years of age in order to explore the possibility of glaucoma. Periodical eye exams should be repeated every two to five years.

Patients who belong in high risk groups for eye disorders, like those who suffer from diabetes, hypertension or have a family history of glaucoma should be examined every year by their ophthalmologist.

  

Frequency of ophthalmological examinations to people in high risk groups

 

Diabetics: At least once a year from the diagnosis
Hypertensives: At least once a year from the diagnosis
People with high risk of glaucoma: every year
Everyone over 65: every two years

Frequency of preventive ophthalmological examinations to people not in high risk groups

Every two to five years

Remember: Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information

 

Xerophthalmia laser   

What is xerophthalmia?

 

Our natural tears protect our eyes and moisten them; this is necessary for a clear vision without irritations. Some people don't produce a normal quantity of tears or have problematic quality of tears, which cause the eyes to be dry and easily irritated, to be stinging and in pain, while vision may often become blurry. In some more severe cases, xerophthalmia might even be dangerous for the eye.

What are tears needed for?

 

The thin layer of tears of the human eye is a very complex fluid. It is excreted from various glands around the eye. It has mechanical and lubricating action and protects the eye from damaging bacteria, allergens and others infectious substances. This layer is renewed every time we blink. Our tears also have a functional role, i.e. our vision is clear only if the tear layer is intact. It is important to note that besides eye moisturizing, tear production is a reflex to external stimuli like injuries or intense emotions. However, these reflex tears help very little in mitigating xerophthalmia and that is the reason why people with “wet” eyes may often feel irritation.

What is the structure of the tears?

 

Tears consist of three layers. The mucus layer covers the cornea (the outside surface of the eye) by creating a low agglutination with it, so that the tear can remain on the eye. The middle layer is called aqueous layer, provides moisture and carries oxygen and nutrients to the cornea. This layer is 98% water along with small quantities of sodium chloride (salt), proteins and other ingredients. The outer lipid layer creates an oily membrane that covers the lacrimal layer and protects it from evaporation. Tears are produced in many glands around the eye. The aqueous layer is produced in the lacrimal gland, which is situated in the base of the upper eyelid. Many small glands between the walls of the eyelids produce the mucus and the lipid layer. With every blinking the eyelids spread tears on the eye. Excess tears flow towards two small ducts at the edge of the eye near the nose. These ducts lead to lacrimal tubes which end up in the nasal cavity. Communication between tear ducts and nasal cavity is the reason why, when we cry, we have a runny nose.

Who is affected by xerophthalmia?

 

Xerophthalmia syndrome has many causes. One of the most common causes is aging. As we grow older, our body produces less lipid substances – 60% less in the age of 65 compared to the age of 18. This is more evident in women, who tend to have drier skin than men. This lack of oil affects the tear layer. Without the oil needed, the lipid layer cannot cover entirely the other layers, which evaporate faster and leave some areas of the cornea dry. There are many other factors, like heat, dryness in the atmosphere and wind, high altitude and cigarette smoke, that also cause xerophthalmia. Many people feel that their eyes are dry when they read or work at the computer. Frequent breaks for blinking can moisturize the eyes and alleviate the symptoms. Contact lens users may also suffer from dryness, since contact lenses absorb the lacrimal layer, creating a long-term formation of protein sediments on the lens. Furthermore, some medicines, thyroid problems, vitamin A deficiency and diseases such as Parkinson's, lupus erythematosus and rheumatoid arthritis, Sjogren's syndrome (except for xerophthalmia that causes xerostomia and dryness of the mucous membrane), and Mickulizc syndrome can also cause dryness. Women often present dryness problems during menopause, due to hormonal changes. In addition, after a stroke, it has been observed what is known as lagophthalmos, that is the inability to shut the eye properly, which results in more rapid evaporation of tears and xerophthalmia.

What are the symptoms of xerophthalmia?

 

Xerophthalmia symptoms are foreign object sensation, itching and burning sensation. These symptoms are similar to those of chronic conjunctivitis, but a clinical exam can show the cause of the problem. Our eyes might be slightly red, without eye gums. They make us suffer without understanding why. The cornea might present pigment epitheliopathy, that is small lesions like point scrapes. In more severe cases that haven't been treated, there is a chance to lose the eye, if there is an infection (keratitis) or of corneal melt in case of total lack of tears.

Simple irritation
Burning sensation
Redness
Itch – Sustained sensation of sand in the eyes
Blurry vision that improves with blinking
Increase in symptoms after reading, watching TV or working at a computer
Difficulty in wearing contact lensesLacrimation
Lacrimation
Intense eye irritation from smoke or wind

How can xerophthalmia be diagnosed?

 

The ophthalmologist can diagnose xerophthalmia in the slit lamp and ascertain the quantity of tears produced. Sometimes, tests that measure tear production are necessary. Among these, Schirmer's Test is included, where the ophthalmologist places small paper filters inside the eyelids in order to measure the quantity of tears produced.

How is xerophthalmia treated?

 

Xerophthalmia treatment includes local use of eye drops and ointments without prescription that relieve the eyes; for example, artificial tears with similar composition to the natural ones that are preservative free.

It is important to know that all tear products are not the same and the needs of the patients are a little different in each one. Some of these products are aqueous and relieve the symptoms for a short time. Artificial tears that are preservative free are recommended more often, since they offer more relief and don't cause further irritations. You should avoid products that remove redness or “whiten” the eyes, because they don't have the necessary moisturizing quality and often make the problem worse. In more serious cases, the ophthalmologist may place special caps in the lacrimal punctum to prevent natural and artificial tears from draining out of the eyes (with either temporary collagen caps that will be absorbed or permanent silicone caps).

There are also cases when the doctor provides the patient with special soft contact lenses that help retain moisture. Furthermore, if the eyelids don't close during sleep, the use of protective covers for the eyes is recommended, in order to minimize tear evaporation.

In any case, people who suffer from xerophthalmia should avoid exposure to dust, pollen, smoking and other environment polluting factors. In addition, their stay in a very hot environment will worsen xerophthalmia. On the other hand, interior moisturizers can help since they add moisture that helps against tear evaporation.

There are also simple everyday habits, whose change can improve the problem of xerophthalmia. For example, 8-10 glasses of water daily can keep our body well hydrated and remove metabolized waste. Also, a conscious effort to blink more often, especially when we read or watch TV can help significantly. Finally, it is advisable to avoid rubbing the eyes which might worsen the problem.

Remember:Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.