 Look at this

1.  Look at this What if it became this?  Or this?

2. Ocular Disease as a Result of Diabetes and Aging By: Sandra

3. Overview of the Eye • Provides sight • Eye is a ball a little over one inch in diameter • Located in the inner orbit of a cone-shaped socket in skull • Has interior and exterior • Outer parts of the eye include eyelids, conjunctiva, lacrimal glands • Primary function of exterior is to keep eye clean • Interior of eye controls sight

4. Exterior Structures of the Eye • Eyelids – Keep dust and foreign particles out of eye • Conjunctiva – Keeps the eye clean and lubricated • Lacrimal Gland – Produce tears to moisten eye • Lacrimal Sac – Location that leads to the nose into where tears drain

5. Interior Structures of the Eye • Sclera – Tough tissue that composes outer layer of eyeball (white portion) • Cornea – Clear portion of the eye • Uveal tract – Middle layer of the eyeball, consisting of iris, ciliary body, and choroid • Iris – Colored portion of the eye • Ciliary Body – Portion of eye that surrounds iris • Choroid – Thin membrane in eye, giving nutrients to eye • Vitreous Humor – jelly-like substance that keeps the eye’s shape • Retina – Innermost layer of eyeball wall • Pupil – Dark dot in middle of the eye that allows for vision

6. Functions of those Structures • Eye’s power of sight comes primarily from interior structures • Iris houses the pupil • Muscles in iris cause pupil to contract or expand to adjust amount of light that enters eye • Behind the pupil is a lens that is adjusted for clearer vision • Vision comes from absorption of light • Rods and cones in retina absorb light that are converted to colors, then converted into electrical signals • Electric signals are converted into images by way of the optic nerve

7. Effect of Diabetes on the Eyes • Diabetes causes diseases of the body’s blood vessels • Blood is supplied to retina through central retinal artery • When blood vessels do not function correctly, nutrients cannot reach retina • That leads to risk of developing diseases like diabetic retinopathy and glaucoma • May sometimes even lead to blindness • “Diabetes is leading cause of new cases of legal blindness in US”

8. Diabetic Retinopathy • There are three stages: • Background Diabetic Retinopathy • Diabetic Macular Edema • Proliferative Diabetic Retinopathy • Affects the retina, primarily the macula • Blood vessels blocked and small hemorrhages in retina • New blood vessels – microaneurysms – form and leak • Can cause retina to swell and damage vision • Vessels may block blood to central vision, leadingto permanent vision loss

9. Symptoms & Diagnosis of DR • No symptoms, so early detection is key • Diagnosis: • flourescein angiogram performed to determine source of leakage • Pigmented dye injected into arm vein • Dye is photographed 30 times within ten minute span • Dilated Retinal Eye Exam • Dilation – best way to see clearly into eye • Every two years is best for this exam

10. Treatment of DR • Laser Surgery • Light aimed into retina to seal leaking blood vessels • Also prevents further formation of abnormal blood vessels • 25 minute procedure • Only eye drop anesthesia necessary • For Proliferative Diabetic Retinopathy • Laser process called “focal” or “gridphotocoagulation” • Seals leaking blood vessels • Prevent further abnormal growth

11. Glaucoma • Causes gradual degeneration of optic nerve cells due to pressure • Several types: • Chronic open-angle, acute closed-angle, low-tension, congenital • Acute glaucoma – vision loss comes rapidly, can be 24 hours • Chronic open-angle – most common • Caused by open angle in front chamber of eye • Vision loss is not as rapid • Low-tension – only the optic nerve is damage, pressure is normal • Congenital – inherited and affects infants

12. Symptoms & Diagnosis of Glaucoma • Symptoms in the eye include: • Increased intraocular pressure due to poor drainage of aqueous humor • Trabecular meshwork (drainage system) functions incorrectly • Optic nerve suffers increased pressure and nerve fibers die • Visible symptoms: • Short-term dimmed or fogged vision, colored ring around artificial lights, pain in forehead, ears, teeth, eye looks inflamed • Diagnosis: • Examination with tonometer from ophthalmologist • Check pressure in eye • Slit lamp – examines optic nerve after pupil dilation • Optic disk appears indented and looks pale yellow – lack of blood

13. Treatments of Glaucoma • Traditional medicines: • Reduce intraocular pressure • Prostaglandins, beta blockers, miotics, adrenergics • Decrease pressure in eye by reducing aqueous humor production • Miotics enhance capacity of drainage system • Laser surgery: • Laser trabeculoplasty, necessary if too much pressure is there • Sparks fluid drainage by expanding existing holes in drainage • Laser Iriditomy – Small opening made outside iris for drainage • Conventional Incisional Surgery: • New drainage system created in eye to replace old one

14. Effects of Aging on the Eyes • Aging makes eye more vulnerable to developing diseases • Minor conditions include: • Presbyopia – ability to see close objects starts to deteriorate • Lens gets hard and less flexible • Floaters – pieces of vitreous humor break away and float in eye • Usually pretty common in those over age of 50 years of age • More serious diseases include: • Cataracts, Age-Related Macular Degeneration, Corneal Disease

15. Age-Related Macular Degenration • Damages central vision at macula • Most common cause of blindness in United States • Affects Retina • Two forms: Wet AMD and Dry AMD • Dry AMD – less serious and more common – 90% of all cases • Fatty deposits seen under retina’s light-sensing cells • Supportive layer becomes smaller • Wet AMD – more serious and also more rare case • Neovascularization occurs – new blood vessel growth • They can break or leak to cause damage to eye

16. Symptoms & Diagnosis of AMD • Generally affect Caucasian males over age of 50 and smokers • Dry AMD: • Cause is unknown • Symptoms include: Distorted reading vision, blurred vision, distorted vision • Wet AMD: • Symptoms include: Distorted vision, quick vision loss, seeing colors that appear faded • Blind spot at center of field of vision • Symptoms of dry AMD evident, at greater extent • Diagnosis: Pupil dilation and Amsler Grid Test

17. Treatments of AMD • No treatment for dry AMD • Treatment for wet AMD includes: • Laser photocoagulation – laser heat beam seals broken vessels • May lead to vision loss from blind spots • Visudyne Therapy – Two-part process • Visudyne injected into arm and goes to spot of eye where blood vessels do not belong • Laser then activates visudyne to kill abnormal cells • Slows damage to retina

18. Cataracts • Characterized by clouding of eye’s lens • Almost like looking through frosted / yellow-tinted window • Not a film, not caused by overuse of eye, does not cause irreversible blindness • Caused by sclerosis in lens • Lens is less transparent and thickened • Could be caused by lifetime of exposure to ultra-violet radiation • Smoking and alcohol also increase risk • Medical problems, diabetes, and family history also increases risk

19. Symptoms & Diagnosis of Cataracts • Symptoms: • Blurred vision, bad night vision, double vision in one eye • Increased sensitivity to light • Need brighter light for reading • Seeing faded colors • Diagnosis: • Check sharpness of vision with Snellen Chart • Pupil dilation test – examine lens and optic fibers • Slip lamp – look inside eye to see cataract up close

20. Treatment of Cataracts • Less severe cases: • Increased eyeglass prescription • Eye drops can allow more light to enter eye • More serious cases: • Three types of cataract removal surgery • Extracapsular surgery & intracapsular surgery • Incision is made in eye, cataract is then removed and plastic lens, called intraocular lens, inserted • Phacoemulsification • Uses high-frequency ultrasound • Breaks cataract apart for easy removal

21. Fuch’s Corneal Dystrophy • More prevalent in women than men • Progresses slowly and affects both eyes • Inherited • Affects 50 – 60 year-olds, but can be detected in 30 – 40 year-olds • Caused by deterioration of endothelial cells • Lack of endothelial cells leads to bad water drainage • Leads to swelling and shape-change of cornea • Exact cause of endothelial cell loss is unknown • Could be caused by inflammation in eye

22. Symptoms & Diagnosis of FCD • No visible symptoms until later in stage of disease • Vision becomes blurred and distorted • Typically wake up with distorted and blurred vision • When eyes are closed, liquid cannot be evaporated • As day progresses, vision clears up • Diagnosis: • Slit lamp used to magnify cornea • Like an “optical microscope” • Small bumps seen on cornea

23. Treatment of Fuch’s Corneal Dystrophy • Treatments vary depending on severity of disease • Early stages: • Salt-water eye drops to soak up excess water before entering cornea • Blow hot air into eye to dehydrate it • Soft-bandage contacts lens – relieve corneal blisters • More serious cases: • Corneal surgery may be necessary • Cornea transplant to restore vision

24. Prevention • Eyes are important and provide precious sense of sight • Though eye disease cannot fully be prevented, you can lower the risk • Keep good health and good nutrition • Get lots of vitamins, beta-carotene, anti-oxidants • Protect eyes from sunlight and ultra-violet radiation • Get eye checks frequently • Every two years in young age • Every year at age 30 or older • Every six months if family history of certain diseases

25. Works Cited “Aging and Your Eyes.” Sep. 2002. AgePage. National Institute on Aging. 19 Oct. 2004. <http://www.niapublications.org/engagepages/eyes.asp>. “Cataract.” Medical Library. Jan 2003. 9 Nov 2004. <http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZS XEVUF4C&sub_cat=119>. Chang, Maragret, M.B. Personal Interview. 28 Oct. 2004. “Ocular Symptoms and Diagnosis.” Diabetic Eye Disease. Richmond Eye Associates. 19 Oct. 2004 <http://www.richmondeye.com/diab1.htm>. Forrest, James, M.B. The Recognition of Ocular Disease. 7th ed. London: The Hatton Press Ltd, 1952. “Fuch's Corneal Endothelial Dystrophy.” 23 Nov. 2004. <http://www.wa- eyemd.org/W_Fuch's_corneal_dystrophy.htm>. “Fuch's Dystrophy.” 2001. VisionWorks, Inc. 19 Nov. 2004. <http://www.visionworksusa.com/disease.asp?d_num=31>. Harvard Medical School. The Aging Eye. New York: Simon & Schuster, 2000. “If You Thought Eyeglasses Could Solve All Eye Problems, Read On.” Eye Disease. The WhyFiles. 25 Oct. 2004. <http://whyfiles.org/003eye/statistics.htm>. Vision Problems in the United States. Bethesda: National Eye Institute, 2002.