Proliferative Diabetic Retinopathy

If you suddenly see a few specks or spots floating in your vision, this may indicate you are at risk for proliferative diabetic retinopathy, the growth of abnormal new blood vessels on your retina and optic nerve. Diabetic retinopathy is a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious sight-threatening complication of diabetes.

 

Diabetes is a disease that interferes with the body's ability to use and store sugar, which can cause many health problems. Too much sugar in the blood can cause damage throughout the body, including the eyes. Over time, diabetes affects the circulatory system of the retina. Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.

 

Symptoms of diabetic retinopathy include:

• Seeing spots or floaters in your field of vision
• Blurred vision
• Having a dark or empty spot in the center of your vision
• Difficulty seeing well at night

In patients with diabetes, prolonged periods of high blood sugar can lead to the accumulation of fluid in the lens inside the eye that controls eye focusing. This changes the curvature of the lens and results in the development of symptoms of blurred vision. The blurring of distance vision as a result of lens swelling will subside once the blood sugar levels are brought under control. Better control of blood sugar levels in patients with diabetes also slows the onset and progression of diabetic retinopathy. Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

How is the Diagnosis of Proliferative Diabetic Retinopathy Made? The first step is a careful eye exam where both pupils are dilated. If new blood vessel growth is suspected, you may need a special test called a fluorescein angiogram. This is a photographic study of the back of the eye performed after an orange-colored dye is injected in a vein in the hand or arm. The dye circulates through the body into the eye to highlight abnormal vessels, or where treatment is needed. If the eye is too filled with blood to examine, your doctor can perform a quick and painless evaluation of the eye’s internal structure with sound waves. This kind of “sonar” for the eye is called an ocular ultrasound.

Treatment:
Treatment of diabetic retinopathy varies depending on the extent of the disease. It may require laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation or stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous, may be needed. A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, resulting from diabetic retinopathy, may also require surgical repair.

If you are a diabetic, you can help prevent or slow the development of diabetic retinopathy by taking your prescribed medication, sticking to your diet, exercising regularly, controlling high blood pressure and avoiding alcohol and smoking. If you have proliferative diabetic retinopathy, you'll need prompt surgical treatment. Sometimes surgery is also recommended for severe nonproliferative diabetic retinopathy. Depending on the specific problems with your retina, options may include:

• Focal laser surgery: Focal Laser treatments can effectively reduce further damage being caused by leaky vessels.  The procedure is both safe and effective, and can usually be done in just a few minutes without need for a hospital visit. Usually this is done in a clinic with only topical anesthesia.
• Scatter laser surgery: Scatter laser treatment is used to treat advanced stages of diabetic retinopathy or proliferative diabetic retinopathy. Scatter laser treatment is applied to the retina to slow or stop tiny blood vessels from leaking. During the procedure, up to 2,000 laser burns are carefully placed away from the central retina, causing abnormal blood vessels to shrink. Scatter laser treatment does not usually restore previous vision loss, but helps to prevent further vision loss or blindness from occurring.
• Vitrectomy: Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye camera. It may be done when there is a retinal detachment, because removing the vitreous gel gives your eye doctor (ophthalmologist) better access to the back of the eye. The vitreous gel may also be removed if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own. At the end of the surgery, silicone oil or a gas is injected into the eye to replace the vitreous gel and restore normal pressure in the eye. Vitrectomy may require an overnight hospital stay.

Be sure to check with your doctor to make sure you understand the risks and benefits of all eye surgery.

I’m Dr. Mike Morton, If you have any questions about Proliferative Diabetic Retinopathy, feel free to call my office and tell them you want to “Ask My Eye Doctor.” SB Eyecare Associates, your premier San Bernardino Optometry office, at (909) 963-1420 or stop by our office: 222 North G. Street, Suite 1 San Bernardino, CA 92410

Monday:	9am – 6pm
Tuesday:	9am – 6pm
Wednesday:	9am – 5pm
Thursday:	9am – 6pm
Friday:	9am – 6pm
Saturday:	9am–3:30pm
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Stages of Diabetic Retinopathy

What is Diabetic Retinopathy? Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. A healthy retina is necessary for good vision. In people with diabetic retinopathy, blood vessels swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

 

What are the four stages of Diabetic Retinopathy? Diabetic retinopathy has four stages:

1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Causes and Risk Factors How does Diabetic Retinopathy cause vision loss? Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

• Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
• Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Who is at risk for diabetic retinopathy? All people with diabetes--both type 1 and type 2--are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

Click here to read about Proliferative Diabetic Retinopathy

I’m Dr. Mike Morton, If you have any questions about Diabetic Retinopathy, feel free to call my office and tell them you want to “Ask My Eye Doctor." SB Eyecare Associates, your premier San Bernardino Optometry office, at (909) 963-1420 or stop by our office: 222 North G. Street, Suite 1 San Bernardino, CA 92410

Monday:	9am – 6pm
Tuesday:	9am – 6pm
Wednesday:	9am – 5pm
Thursday:	9am – 6pm
Friday:	9am – 6pm
Saturday:	9am–3:30pm
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Blurred Vision - One Symptom of Diabetes

Blurred Vision

Having blurred or distorted vision, seeing floaters or occasional flashes of light may be a direct result of high blood sugar levels which is one symptom of diabetes, known as Diabetes retinopathyn (damage to the retina due to diabetes). It is the most common, serious vision complication for people with diabetes. It occurs when the blood vessels leading to the retina of the eye become blocked and/or leak fluid or blood (hemorrhage) into the eye. According to the National Institutes of Health, diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. Despite these scary statistics, research indicates up to 90% of these new cases could be reduced with vigilant care of the eye.




Although most people with type 1 and type 2 diabetes will experience some degree of retinopathy eventually, early diagnosis and treatment can dramatically lower the chances of vision loss. The American Diabetes Association recommends that people with diabetes get a dilated eye exam at least annually to detect signs of eye disease early and to learn about the latest advances in eye disease prevention. The longer a person goes without being diagnosed and treated, the higher his or her chance of developing diabetic retinopathy is. Eye care is especially important for people with diabetes, as they are at increased risk of developing eye complications from the disease. In fact, according to the Mayo Clinic, diabetes is the leading cause of blindness in adults age 20 to 74. Often, there is little or no early warning signs.  All people with diabetes should take precautions to help reduce their risk of developing eye problems.

Here are some eye care tips:

• Schedule regular appointments with your eye doctor so that any eye problem can be detected early and treated
• Maintain control of your blood glucose levels
• Maintain a healthy blood pressure
• Eat a healthy diet
• Avoid smoking
• Exercise regularly

High blood pressure by itself can lead to eye disease, so if you have high blood pressure as well as diabetes, it is especially important that you take steps to control both conditions.

When Should I Call the Eye Doctor? If you have diabetes, you should see your eye doctor regularly, especially if you experience any visual problems or notice any changes in your vision. You should seek medical care for your eyes immediately if you experience any of the following symptoms:

• Blurring of vision
• Black spots
• Flashes of light
• Partial or complete loss of vision in one or both eyes

Diabetes symptoms Early diabetes symptoms, especially type 2 diabetes, can be subtle or seemingly harmless — if you have them at all. You could have diabetes for months or even years and not have any diabetes symptoms. In the United States alone, nearly 6 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don't need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health.

If you're experiencing any of the following diabetes signs and symptoms, see your doctor:

Excessive thirst and increased urination When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine along with fluids drawn from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more.

Fatigue You may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body's inability to function properly, since it's less able to use sugar for energy needs.

Weight loss Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells — leading to constant hunger. The combined effect is potentially rapid weight loss, especially if you have type 1 diabetes.

Blurred vision Diabetes symptoms sometimes involve your vision. High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes. This affects your ability to focus. Diabetes can cause new blood vessels to form in your retina in the back part of your eye, as well as damage established vessels. For most people, these early changes do not cause vision problems. However, if these changes progress undetected, they can lead to vision loss and blindness.

Click here to read about Diabetic Retinopathy.

"The good news is that this symptom is reversible once blood sugar levels are returned to normal or near normal. But letting your blood sugar go unchecked  will cause permanent vision problems and damage to the health of your eyes, possibly even blindness. And that's not reversible," Dr. Morton explains.

I’m Dr. Mike Morton, If you have any questions about blurred vision, feel free to call my office and tell them you want to “Ask My Eye Doctor” about blurred vision and diabetes. SB Eyecare Associates, your premier San Bernardino Optometry office, at (909) 963-1420 or stop by our office: 222 North G. Street, Suite 1 San Bernardino, CA 92410

Monday:	9am – 6pm
Tuesday:	9am – 6pm
Wednesday:	9am – 5pm
Thursday:	9am – 6pm
Friday:	9am – 6pm
Saturday:	9am–3:30pm

Are There Thinner Eyeglasses for People who are Nearsighted?

A patient of mine recently asked me: I am very nearsighted, so the lenses in my eyeglasses are pretty thick. The eyeglasses I have purchased in the past just don't look nice due to the thickness/distortion of the lenses. I have done everything the optician suggested to minimize the thick appearance of the lenses (rounding the edges, etc.), but I am still not pleased with the look of my eyeglasses. I really want to move away from wearing my contacts so much and want to find a flattering set of eyeglasses. I have an oval-shaped face. 

What's style of eyeglasses should I look for? Any other suggestions that I should take into account when looking for a new pair of glasses?

 

There is good news for those who must wear thick lenses. Depending on the strength of the prescription will depend on how thin your lenses can be thinned down. If you have a strong complex prescription they can accommodate for them also. If your concerned about the thickness of your glasses, then you need to speak to your optician before they make the glasses and ask them for your lenses to be thinned down. These lenses do cost slightly more than normal lenses but in the long run are well worth it. You can go for aspheric or high-index lenses if you don't want regular (thicker) lenses.

 High-index lenses are an alternative choice to standard, plastic eyeglass lenses. Although high-index lenses are more expensive than plastic lenses, they can reduce the thickness and weight of an eyeglass lens, particularly for individuals with a strong prescription. For most prescriptions, high-index lenses offer the same optical clarity as plastic lenses in a significantly smaller package. An eye care professional or optical laboratory is the best source for determining what lens index should be used for a given prescription and eyeglass frame.

 If you would like to know more about reducing the thickness of your eyeglasses, feel free to call my office: SB Eyecare Associates, the premier San Bernardino Optometry office, for an appointment. (909) 963-1420. Or stop by:

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222 North G. Street, Suite 1 San Bernardino, CA 92410

The Latest Advances in Eyeglasses and Lenses

A patient’s granddaughter recently came to her and said she wanted to wear glasses. My patient asked why she wanted to wear glasses. The little girl responded “Because they make YOU look smart, and I want to look smart too!” I asked my patient if the little girl needed glasses and her response was “thankfully, no.” She then proceeded to tell me how she took the little girl to the dollar store and allowed her to pick up two pairs of inexpensive frames that the little girl liked. She took them home, popped the lenses out and now the little girl has glasses to wear so she feels smart too.

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This story is so cute that we just knew we had to share it and, unlike the eyeglasses of several generations ago, manufacturers are now making glasses, and lenses, for children. Additionally, movies like Harry Potter or television shows that feature popular kids wearing glasses have helped children overcome their fears of being “different”. One reason for the enduring popularity of eyeglasses can be found in new lens designs, which help eyes to see better or appear more attractive even when stronger prescriptions are needed.

Because these new types of lenses are thinner, the old days of thick, Coke bottle style glasses have virtually disappeared.

Among the most popular types of lenses prescribed today are:

• Aspheric lenses, which are not perfectly rounded on the surface, recently have been designed as a way to correct for small distortions in vision that can be associated with more traditional lenses. These types of designs also make lenses thinner and lighter.
• High-index materials also are associated with thinner, lighter lenses, because of the more efficient way this special plastic refracts light to help you achieve focus. Because less plastic is needed with high-index materials, lens thickness is reduced.
• Wavefront technology lenses are fabricated based on very precise measurements of the way light travels through your eye, which helps sharpen visual clarity.
• Polycarbonate and Trivex lenses are thinner, lighter and up to 10 times more impact-resistant than regular plastic lenses, making them the perfect choice for safety glasses, sports eyewear and eyeglasses for children and active adults.
• Photochromic lenses have chemical coatings or special internal changes allowing them to quickly darken in bright conditions, and quickly return to normal in ordinary indoor lighting or at night.
• Polarized lenses diminish glare from flat, reflective surfaces (like water) and also reduce eye fatigue.
• Anti-reflective coating is a popular add-on for lenses. AR (anti-reflective) coating can dramatically improve the look and comfort of your glasses by reducing distracting lens reflections that interfere with eye contact and make your lenses look thicker. AR-coated lenses also reduce glare and allow more light into your eyes for better night vision.
• Other lens coatings include scratch-resistant coating, anti-fog coating and UV-blocking lens treatments.

So the all-important question is: what type of lens is right for you? The best answer would be to see an optometrist you know and trust, one who has been in business for a many years with a solid reputation in their community. If you have any questions at all, please feel free to call my office. I’m Dr. Mike Morton of SB Eyecare Associates, the premier San Bernardino Optometry office.

Monday:	9am - 6pm
Tuesday:	9am - 6pm
Wednesday:	9am - 5pm
Thursday:	9am - 6pm
Friday:	9am - 6pm
Saturday:	9am–3:30pm
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222 North G. Street, Suite 1 San Bernardino, CA 92410 (909) 963-1420

Are Polycarbonate Lenses Worth it?

As an optometrist, one of the questions I get asked frequently is: "What type of lenses do I need?" What our patients are really asking is: “How much is it going to cost me?” The fact of the matter is, the type of lens you have in your eyeglasses matters a great deal both in terms of the type of vision problem you have as well as your lifestyle. Cost is actually a small factor in the type of lens a person should have in their glasses.

Today, my blog will be on polycarbonate lenses. Here’s the short version:

Polycarbonate Lenses offer lightweight comfort, UV protection and are impact resistant.

• They are less than half the weight of glass for extended hours of use without fatigue
• They offer the best scratch and impact resistant option for those who are rough on their gear
• They are shatter-resistant for extreme sports and other outdoor activities

Back in 2002, the Guideline Polarized Eyegear brand was introduced to the fishing industry as a premium sunglass brand made with a lightweight polycarbonate lens. Today, this is still a quality alternative to the more expensive sunglass options on the market using a glass lens.

Polycarbonate lenses are up to 10 times more impact-resistant than plastic or glass lenses and they provide 100% protection from the sun’s harmful UV rays. They are also lightweight, adding to the comfort of your eyeglasses, sunglasses, and sports eyewear.

A Brief History of Polycarbonate

Originally designed for canopies covering cockpits in fighter planes, polycarbonate offered an impact-resistant, optically clear window. This enabled pilots a full-field of vision without compromising safety. In the 1970s, the popularity of polycarbonate soared–literally soared to outer space as it began being used for astronaut helmet visors and space shuttle windshields.

Clearly, polycarbonate is a most durable material. However, it wasn’t until the 1980s that polycarbonate was introduced to consumers as a safe, affordable alternative to standard plastic or glass eyewear. Today, polycarbonate lenses set the standard in eyewear safety. These lenses are a smart choice for people active in sports, those who work in hazardous job environments, and especially for children.

Because of its durability, polycarbonate lenses are also ideal for people who prefer rimless eyewear designs because they are less likely to fracture than plastic or glass lenses. Those with a blind or lazy eye often utilize polycarbonate lenses, too.

What Makes Polycarbonate the Safest Lens Choice?

Polycarbonate lenses are the most impact-resistant lenses on the market because of their manufacturing process. The majority of other plastic lenses utilize a cast molding process. This is when a liquid plastic material is baked for long periods, in lens form, until the liquid plastic solidifies into a lens.

On the other hand, polycarbonate is a thermoplastic material produced from small pellets. Therefore, the earliest phase of polycarbonate lenses begin from a solid source, eliminating the cast molding process and instead use a process called injection molding in which the pellets are heated to a melting point. Once in liquid form, the polycarbonate is rapidly injected into lens molds. At this phase in the process, the lens molds are compressed under high pressure and cooled to form a final lens product–in a matter of minutes.

The difference in the manufacturing process is what makes polycarbonate a stronger, more impact-resistant lens.

Make the Most of Your Polycarbonate Lenses

To make the most out of polycarbonate lenses, you should seriously consider these other complimentary products:

Scratch Resistant Coating: Polycarbonate is an impressive impact resistant lens. However, part of the reason it’s so strong is because it’s, ironically, a relatively ‘soft’ material. Being flexible is what enables it to absorb energy without fracturing. But being a soft material requires a scratch-resistant coating to prevent surface scratches. Once a scratch-resistant coating is applied, your polycarbonate lenses will be nearly as hard as glass–yet remain highly impact-resistant.

Proper Frames: To ensure the safest eyewear at work and during sporting activities, frames specifically designed for safety are more than strongly recommended; putting polycarbonate lenses into frames not rated for use as safety glasses can actually be detrimental and dangerous. Your eyecare professional can advise you which frames are safety-rated and best suited for your lifestyle – at work and at home.

Because kids have a greater tendency to drop their glasses and play rough even when not actively participating in sports, all children’s frames should have polycarbonate lenses.

I'm Dr. Mike Morton, If you have any questions about Polycarbonate Lenses, feel free to call my office and tell them you want to "Ask My Eye Doctor" about Polycarbonate Lenses. SB Eyecare Associates, your premier San Bernardino Optometry office, at (909) 963-1420 or stop by.

Monday:	9am - 6pm
Tuesday:	9am - 6pm
Wednesday:	9am - 5pm
Thursday:	9am - 6pm
Friday:	9am - 6pm
Saturday:	9am–3:30pm
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222 North G. Street, Suite 1

San Bernardino, CA 92410

Eye Floaters. What are those things?

Eye Floaters. What are those things?

The inside of your eye is filled with a gel-like substance called the vitreous, which makes up over 2/3 of your total eye. This substance is actually what gives your eye its shape and form. What happens over time is that some debris - caused by blood, torn retinal tissue, inflammation or just simple "wear and tear" – begins to float around your eye inside the vitreous.

These tiny and microscopic foreign objects may seem like they are in front of your eye, but they are actually just casting shadows. These shadows are what you see as spots, lines or clouds. Sometimes people may momentarily confuse them with dust or tiny insects floating across in front of the eye. However, they are within the eyeball and are not eliminated by rubbing the front of the eye. They follow the rapid movements of the eye while drifting slowly from one place to another. If floaters didn't move, they would be invisible due to a process called neural adaptation.

Most doctors consider these eye floaters to be a natural part of aging. Since eye floaters are rarely painful – or dangerous –their typical response is to tell you not to worry!!

But you know how annoying and troublesome these spots can be. You know that reading, watching TV, using the computer, or even taking a walk in the sunshine can be unpleasant and irritating.
Eye floaters look like black or gray specks, strings or cobwebs that drift about when you move your eyes.

Are Eye Floaters Serious?
Under normal circumstances, eye floaters are absolutely nothing to worry about. Everyone experiences them from time to time and they cause no ill effects.

When Should I Start to get Worried?
Specks in front of the eyes are normally clearly visible when looking into a light background. However, if they start becoming visible in every background, suddenly increase in number and are accompanied by any loss of vision, it is vital that immediate medical advice is sought. This could be an early sign of retinal detachment.

If the retina has become detached or has a hole in it, you will begin to experience flashing lights before your eyes and you will also be aware of numerous floaters. These two symptoms will be accompanied by a loss of vision, so urgent medical advice is necessary. Surgery is required to seal any holes in the retina, or to re-attach the retina to the back of the eyeball.

Is There a Cure for Eye Floaters?
Most of us want to avoid dangerous surgeries at all costs. There is no real way, as of yet, to cure one's eyes from floaters completely. However, the eye's natural healing process is much more powerful than some people want to believe.

Floaters may cause depression, anxiety and many other related problems. Even saying that, I want to say something very important: Avoid surgery at all costs. If your eyes are not in pain and you do not see any flashes of light, then please do yourself a favor and never subject yourself to surgery. Even if you do see occasional flashes of light, go see your doctor and don't insist on having surgery. Ask many questions and consult at least two doctors. It's your eyes we are talking about: you only have two and you must take care of them.

If you live in the Inland Empire, feel free to give us a call or stop by our office. We'll be more than happy to answer any questions you may have about floaters, or any other vision topic.

As always, if the symptoms persist, see your doctor. If you have any questions, please feel free to Ask My Eye Doctor here. Or call us at 909-885-1134