1855 West City Dr.
Elizabeth City, NC
27909
Monday - Thursday 8:00-5:00
Friday - 8:00-12:00
Phone: 252-338-3909
Fax: 252-331-1213
“Your Eyes Are Our Focus”
Eye Conditions
Click on a topic below to learn more
Blepharitis
Astigmatism
Astigmatism occurs when the cornea, the front surface of the eye, is curved slightly in one direction and causes blurred
vision. The cornea refracts (bends) light so it focuses on the retina in the back of the eye. With astigmatism some of that light
focuses in front of or behind the retina, so your vision may be blurry for nearby (hyperopia), far-away (myopia) or all objects.
Indications of astigmatism can include headaches, eye strain, fatigue, and blurred or distorted vision. The severity of
symptoms depends on the degree of astigmatism in your eyes.
Routine eye exams include testing for astigmatism, which affects many people. Once diagnosed, astigmatism can usually be
corrected with prescription eyeglasses or contact lenses. Corneal modification techniques such as LASIK (laser vision
correction) are also useful treatment options.
Amblyopia, commonly known as lazy eye, is an eye condition that results in
reduced vision in one eye. This condition affects two to three percent of the
population as a result of genetic causes, related conditions or trauma. When
this condition occurs, the unaffected eye usually becomes stronger and
suppresses the amblyopic eye, often rendering it useless.
Patients with amblyopia may experience eyestrain, squinting, headaches and
overall poor vision. This condition usually develops in children before the age
of six, and can significantly affect central vision if left untreated. While many
cases are caused by a misalignment of the eyes, such as strabismus or crossed
eyes, amblyopia can also be caused by trauma to the eye or a very strong
refractive error.
Effective treatment for amblyopia depends on the underlying cause of the condition, but may include glasses to improve
focusing or eye exercises to correct improper vision habits. Eye drops and patching may also be prescribed. More serious cases
or those that do not respond to conservative treatment may need surgery to straighten the eyes so that they can focus
together and see properly.
Amblyopia
Dull Vision
Yellow Vision
Blurry/Cloudy Vision
Diabetic Retinopathy
Diabetic retinopathy is the most common diabetic eye disease and is a leading cause
of blindness in adults. Diabetic retinopathy develops as a result of changes in blood
sugar levels or simply the presence of long-term diabetes. Most patients don't develop
this condition until they have had diabetes for at least 10 years. If high blood sugar
levels cause blood vessels in the retina to leak blood or fluid, the retina may become
swollen and form deposits. ?Patients who develop diabetic retinopathy may not notice
any changes to their vision at first. In its earliest stages, this condition causes tiny
areas of swelling in the small blood vessels of the retina. More and more blood vessels
can become blocked, and the retina may send signals for new blood vessels to be
grown.
Early stages of diabetic retinopathy do not usually require treatment, just that
patients monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, treatment may be
necessary to preserve your vision.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy is the most advanced stage of diabetic retinopathy,
and is classified by the growth of new blood vessels on the retina. These blood vessels
are abnormal and fragile, and are susceptible to leaking blood and fluid onto the
retina, which can cause severe vision loss and even blindness.
If blood leaks onto the retina, patients may begin to notice floaters in their vision,
which are actually specks of blood that appear in front of your vision. While floaters
can sometimes clear up on their own, it is important to see your doctor as soon as you
notice them, as they can recur and lead to severely blurred vision and vision loss.
Patients with proliferative diabetic retinopathy usually seek laser surgery to treat
their condition. This treatment is known as scatter laser treatment and is used toshrink the newly developed abnormal blood
vessels using up to 2,000 laser burns in the area of retina. This treatment is usually performed in two or more sessions because
of the high number of laser burns necessary. Scatter laser treatment is most effective before new blood vessels have started to
leak, and may slightly reduce patients' color and night vision, while preserving your central vision. Severe bleeding may require a
vitrectomy, or removal of the vitreous, to remove blood from the center of the eye.
Diabetic Macular Edema
Diabetic Macular Edema is a serious condition that can occur at any stage of diabetic retinopathy and involves a buildup of fluid
in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. Macular edema can cause
difficulty reading or doing close work, and can often greatly affect a patient's quality of life by interfering with regular
activities. Your doctor can diagnose macular edema during your regular eye exam before symptoms are present, but you should
seek prompt medical attention at the earliest signs of this condition. Retinal swelling may indicate an early sign of macular
edema. Treatment for macular edema usually includes a laser procedure called focal laser treatment. During this procedure,
several hundred small laser burns are placed in the areas of retinal leakage around the macula to prevent leakage from
occurring and reduce the amount of fluid in the retina. This helps reduce the risk of vision and can even improve lost vision in a
small number of cases. Focal laser treatment is performed in your doctor's office and can usually be completed in just one
session.
Dry Eye
Dry eye occurs when the eyes are not sufficiently moisturized, leading to itching, redness and pain from dry spots on the surface
of the eye. The eyes become dry and irritated because tear production is low or because the tears themselves have a chemical
imbalance.Non-surgical treatments for dry eye include over-the-counter artificial tears, gels and lubricating ointments.
Restasis®, a prescription eye drop, increases tear production and successfully relieves dry eye 80% of the time. Inserting plugs
into the tear drains in the corner of the lids in order to limit tear drainage is equally successful. Eyelid surgery is also a solution
if an eyelid condition is causing the eyes to dry out.
Dry Eye Syndrome
Dry Eye is a condition that commonly affects many of us, especially as we age. Tears are produced to lubricate the eyes and
provide a smooth surface for optical clarity. Tears are produced to lubricate the eyes and provide a smooth surface for optical
clarity. Tears are composed of three layers: the outer oily layer, the middle watery layer, and the inner mucous layer. Dry eye is
caused by either decreased tear production or poor tear stability (excessive tear evaporation).
Common conditions that may result in dry eye include certain medical problems such as Rheumatoid Arthritis, Lupus, Sjogren's
syndrome (associated with both dry eye and dry mouth), and Thyroid Disorders. Certain medications may also commonly cause
dry eye including antihistamines, decongestants, antidepressants, and oral contraceptives. Other problems such as poor blinking,
eyelid abnormalities, extended contact lens wear, dry climates, and previous ocular injuries or surgery may also result in dry
eye.
Symptoms of dry eye can include pain, redness and burning, itching, a gritty or foreign body sensation, blurred vision, and
tearing. Since the eye waters when it is irritated, the irritation caused by poor lubrication causes the eye to water as a result.
While there is no cure for dry eye, several options are available for treatment. Artificial tear drops and lubrication ointments are
often recommended for mild causes of dry eye. Other options may include prescription medications that may increase tear
production or actually improve the stability of the tear film. Lacrimal plugs to decrease tear drainage, ocular nutrition with
supplements, and rarely, surgery may be required for further alleviation of symptoms.
Entropion and Ectropion
Ectropion is a "turning out" of the eyelid that causes redness, irritation, tearing and an
increased likelihood of infection. Common causes of ectropion include aging, sun
damage, tumors, burns. Artificial tears can help provide temporary relief from
dryness. Ectropion can be corrected in a quick procedure in which the lid is tightened.
Occasionally, the surgeon needs to graft a small segment of skin to ensure that the
eyelid is fully repaired.
Entropion is a "turning in" of the eyelid. The lid and lashes rub painfully against the
cornea. Entropion usually occurs as a result of aging, but other causes can include
injury, congenital defect and various inflammatory conditions. A spasm can cause the
lid to turn inward. Entropion can be corrected with a brief surgical procedure under
local anesthesia.
Eye Anatomy
The eye is a complex organ that works much like a camera, focusing light rays and
forming an image. On the surface of the eye is the cornea, a thin, spherical layer of
tissue that provides a clear window for light to pass through. In a healthy eye, the
cornea bends or refracts light rays so they focus precisely on the retina in the back of
the eye.
Beneath the cornea is the iris, the colored part of the eye which we refer to when we
say a person has brown or blue eyes. In the center of the iris is the pupil, which is the
opening of the iris. The iris functions like a shutter, adjusting pupil size to control the
amount of light entering the eye.
Located behind theiris is the lens, which works together with the cornea and vitreous to focus light. Like the lens in a camera, it
adjusts light rays as vision shifts between nearby and distant objects in a process called accommodation. Light then passes
through the vitreous, the gelatinous substance that fills most of the eye and gives it its shape.
The back of the eye is lined with a thin layer of tissue containing millions of photoreceptor (light-sensitive) cells. This is the
retina, where light rays focus into an upside-down image. In the center of the retina is the macula. Less than 1/4 of an inch in
diameter, the macula is responsible for clear central vision. The retina converts the image into an electrical signal that travels
down the optic nerve to the brain.
Flashes and Floaters
Flashes and floaters are common eye symptoms that occur as a result of age-related changes to the vitreous gel. At birth, the
vitreous is firmly attached to the retina and is a thick, gelatinous substance without much movement. But as we age, the
vitreous
begins to liquefy and debris that was once secure in the gel can now float around, casting shadows on the retina. Floaters can be
specks, strands or webs and most visible when looking at a uniform light background like the sky or lightly-colored wall.
Eventually the vitreous get begins to shrink and separate from the retina. At this point, head or eye movement can cause the
vitreous to make intermittent contact with the retina, resulting in occasional light flashes or lightening streaks. As the vitreous
continues to peel free, it might reach a point where it is firmly attached to the retina and the traction can cause rapid-fire
flashes like a strobe. Sometimes, the vitreous tugs so forcefully that it causes a tear in the retina.
If you experience an increase or onset of floaters of if you see flashing lights, it is important to be examined promptly. Although
most eyes with these symptoms do not have a retinal tear, those that do require treatment to seal the tear and prevent a more
serious problem.
Glaucoma
Glaucoma is the leading cause of blindness and visual impairment in the US, and can
affect patients of all ages, many of whom do not experience any symptoms and may
not be aware that they have the disease. Glaucoma actually refers to a group of
diseases that cause damage to the optic nerve as a result of increased pressure within
the eye, but can also be caused by a severe eye infection, injury, blocked blood
vessels or inflammatory conditions of the eye.
There are two main types of glaucoma, open-angle and angle-closure. Open-angle
glaucoma is the most common type of glaucoma and involves fluid in the eye not
draining properly through the trabecular meshwork. Angle-closure glaucoma involves a
sudden buildup of pressure in the eye and poor drainage because the angle between
the iris and the cornea is too narrow. Many patients do not experience any symptoms during the early stages of glaucoma,
including no pain and no vision loss. This makes it difficult for many patients to know if they have the disease. But as glaucoma
progresses, patients may experience a loss of peripheral or side vision, along with sudden eye pain, headache, blurred vision or
the appearance of halos around lights.
Diagnosing Glaucoma
While some patients may experience symptoms from glaucoma as the disease
progresses, others do not learn they have the condition until they undergo a routine eye
exam. There are several different exams performed to diagnose glaucoma, including a
visual field and visual acuity test. These tests measure peripheral vision and how well
patients can see at various distances. Other tests may also be performed, such as
tonometry to measure the pressure inside the eye and pachymetry to measure the
thickness of the cornea, and optic nerve scans to evaluate the health of the nerve.
Treatment for Glaucoma
Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision
loss. There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage from occurring.
Most cases of glaucoma can be treated with eye drops, laser surgery or microsurgery. The best treatment for your individual case
depends on the type and severity of the disease, and can be discussed with your doctor.
Eye drops are used to reduce fluid production in the front of the eye or to help drain excess fluid, but can lead to redness,
stinging, irritation or blurry vision. Patients should tell their doctor about any drug reactions to minimize the risk of side effects.
Laser surgery for glaucoma aims to increase the outflow of fluid from the eye or eliminate fluid blockages (such as laser
trabeculoplasty, iridotomy and cyclophotocoagulation.)
Preventing Glaucoma
While there are no surefire ways to prevent glaucoma from developing, regular screenings and early detection are the best
forms of protection against the harmful damage that the disease can cause. While anyone can develop glaucoma, some people
are at a
higher risk for developing disease. These people may include those who:
•
Are over the age of 60
•
African Americans over the age of 40
•
Have a family history of glaucoma
•
Have poor vision
•
Have diabetes
Patients should have a comprehensive, dilated eye exam at least once every two years, especially if they have a higher risk of
developing glaucoma. Older patients may be encouraged to be tested more frequently.
To learn more about glaucoma and how you can be tested for this serious condition, please call us today to schedule an
appointment with one of our doctors.
Hyperopia
Farsightedness, or hyperopia, is a condition in which the eye focuses on distant objects better than on objects closer to the eye,
so nearby objects appear blurry. This happens when light rays refract, or bend, incorrectly in the eye. The eye is designed to
focus images directly on the surface of the retina; when the cornea is incorrectly curved or the eye is small, light rays focus
behind the surface of the retina, producing a blurry image. Hyperopia can be treated in a variety of ways. The most common is
with glasses or contact lenses. Hyperopia can also be treated with non-invasive medical procedures, including the laser surgeries
PRK (photorefractive keratectomy) and LASIK (laser-assisted in situ keratomileusis).
Hypertensive Retinopathy
The patient with hypertensive retinopathy, as expected, suffers from hypertension.
However, the hypertension may be unknown to th e patient and the eye exam may
yield the first clue to this relative asymptomatic systemic disease. Most commonly, the
patient is middle age or older. In addition, hypertension is more common in African-
Americans than Caucasians. Patients with only hypertensive retinopathy are nearly
always visually asymptomatic.
Findings in hypertensive retinopathy include cotton wool spots and flame shaped
hemorrhages. Only rarely will there be retinal or macular edema. In advanced cases,
there will be a macular star (ring of exudates from the disc to the macula) and disc
edema. Arteriolosclerosis (arteriolar narrowing, arterio-venous crossing changes with
venous constriction and banking, arteriolar color changes, vessel sclerosis) is often found concurrently.
The findings in hypertensive retinopathy all stem from hypertension-induced changes to the retinal microvasculature.
Hypertension leads to a laying down of cholesterol into the tunica intima of medium and large arteries. This leads to an overall
reduction in the lumen size of these vessels. In arteriolosclerosis, hypertension leads to focal closure of the retinal
microvasculature. This gives rise to microinfarcts (cotton wool spots) and superficial hemorrhages. In extreme cases, disc edema
develops. The mechanism behind this phenomenon is poorly understood, but it may be related to a hypertension-related
increase in intracranial pressure, and hence is considered true papilledema.
Arteriolosclerotic changes in the retinal microvasculature persist even with the reduction of systemic blood pressure. However,
hypertensive retinopathy changes resolve over time with the reduction of systemic blood pressure (BP). Cotton wool spots
develop in 24 to 48 hours with the elevation of BP, and resolve in two to 10 weeks with the lowering of BP. A macular star
develops within several weeks of the development of elevated BP and resolves within months to years after the BP is reduced.
Papilledema develops within days to weeks of increased BP and resolves within weeks to months following BP lowering.
Management
Management of hypertensive retinopathy involves appropriate treatment of the underlying hypertension. Medical co-
management with the primary physician is of paramount importance. However, if a patient presents with papilledema from
hypertension, then the patient has malignant hypertension and should be considered to be in medical crisis. This patient needs
immediate consult with a primary care physician and, most likely, immediate transport to a hospital emergency room.
It must be reiterated, however, that there are many causes of papilledema. Other causes of papilledema, such as an intracranial
mass lesion, must also be considered in the patient with hypertension. However, in a case where blood pressure is extremely
elevated (e.g. 250/150mmHg) and there is disc edema with a macular star, malignant hypertension is the likely cause.
Macular Degeneration
Macular degeneration, also known as age-related macular degeneration (AMD) is a
common condition in older adults and the leading cause of vision loss and blindness in
people over the age of 65. Macular degeneration affects the macula, the part of the
retina responsible for the crisp, detailed vision needed for reading or driving. As we
age, the tissue in the eye responsible for central vision slowly begins to deteriorate
which can significantly affect a patient's quality of life.
Types
Macular degeneration can be classified as either wet (neovascular) or dry (non-neovascular). Dry macular degeneration is the
more common diagnosis, and is considered to be an early stage of the disease. This type of the disease usually develops as a
result of aging and thinning of macular tissues and the depositing of pigment within the macula.
Only about 10% of patients see their condition progress to the more advanced and damaging wet macular degeneration. In wet
macular degeneration, new blood vessels develop beneath the retina and cause a leakage of blood and fluid. This leakage can
lead to permanent damages in the central vision and the creation of blind spots. Although less common, wet macular
degeneration accounts for 90% of the blindness caused by all cases of this condition.
Symptoms
Patients with macular degeneration may notice gradual changes to their vision, including shadowy areas in the central vision, or
fuzzy and distorted vision. These areas grow larger as the disease progresses, and can eventually turn into blind spots. Patients
may also have difficulty seeing color and fine details. If the disease progresses to the wet form, patients may also see straight
lines as wavy. With wet macular degeneration, central vision loss can occur rapidly, sometimes in as little as a few days or
weeks.
Your doctor may be able to detect early signs of macular degeneration, before any symptoms occur, through a regular eye exam.
Any signs of this condition can be further confirmed by testing your central vision with an Amsler grid test. Regular eye exams
are important in detecting macular degeneration and other serious eye conditions as early as possible, so that permanent side
effects can be avoided.
Causes and Risk Factors
Many cases of macular degeneration are a result of aging and the natural
deterioration of the eye tissue that is needed for clear vision. This disease can also be
related to a genetic factor in patients who have a gene variant known as complement
factor H. Nearly half of the blinding cases of macular degeneration are linked to this
genetic deficiency.
Macular degeneration is most common in females and whites, and the risk for all
patients increases with age. This condition is the leading cause of blindness in the US
for patients over the age of 65. Over 14% of adults between the ages of 70 and 79
have been diagnosed with advanced or intermediate age-related macular
degeneration.
Other factors that may increase your risk of macular degeneration include:
•
Obesity
•
Smoking
•
Heredity
•
High fat diet
•
Prolonged sun exposure
•
High blood pressure
•
Lighter eye color
•
Side effects of certain drugs
Patients can minimize their risk of macular degeneration by practicing a healthy, active life and getting regular eye exams. It is
important for all patients to exercise regularly, avoid smoking, and eat a balanced diet that includes foods known to preserve
vision and prevent eye diseases.
Treatment
While there is no cure for macular degeneration, there are several treatment options available to help patients manage this
condition and preserve their vision. The best treatment option for each patient depends on the severity and type of the
condition, as well as how much, if any, permanent vision loss has occurred.
Intraocular injections of Avastin, Lucentis and Macugen are often successful in stopping abnormal blood vessel growth in wet
macular degeneration. These FDA-approved medications are injected into the vitreous of the eye on a monthly basis to control
the damaging effects of wet macular degeneration. Photodynamic therapy is also effective in removing newly developing
abnormal blood vessels that are characteristic of wet macular degeneration. Many patients also benefit from vitamin and
mineral supplements, which can clear out toxic substances that may build up in advanced cases of this condition.
It is essential for patients with macular degeneration, wet or dry, to seek continuous medical treatment to manage their
condition and prevent permanent vision loss from occurring. Our doctors have extensive experience in the treatment of these
conditions, and can offer patients the latest, most advanced treatments to help preserve your vision and your overall quality of
life. To learn more about our services, call us today to schedule an appointment.
Macular Hole
The macula is a small spot in the center of the retina that focuses light at a sharp
point and allows us to see objects in detail. This is especially useful for reading,
driving and other everyday activities that require clear vision. A macular hole often
develops as part of the natural aging process, when the vitreous gel thins and
separates from the macula. This can pull on the macula and cause a hole to form.
Macular holes can also develop from injury, inflammation, retinal detachment or other
eye diseases.
In its early stages, a macular hole may cause a small blurry or distorted area in the
center of vision. As the hole grows over time, central vision progressively worsens, and
peripheral vision may also be affected. There are three different stages of macular
holes, including foveal detachments, partial-thickness holes and full-thickness holes.
Each stage can progress to the next if left untreated. Most macular holes can be successfully treated through vitrectomy, a
surgical procedure to remove the vitreous gel and stop it from pulling on the retina. The doctor then inserts a mixture of air and
gas into the area to keep its shape. Vitrectomy is performed on an outpatient basis under local anesthesia and is considered a
safe and effective treatment for a macular hole.
Myopia
Nearsightedness, or myopia, is a vision condition in which nearby objects are clear and distant objects appear blurry. This may
be caused by excess corneal curvature or an oblong rather than a spherical shape to the eye, both of which affect the way light
is bent upon entering the eye and whether it focuses properly on the retina.
Almost a third of people in the U.S. experience some degree of nearsightedness, which normally emerges by age 20. Symptoms
include difficulty focusing on objects in the distance, such as a chalkboard or television. There is some evidence that it is caused
or worsened by sustained focus on nearby objects. Nearsightedness may also be hereditary.
Eyeglasses and contact lenses are common methods of correcting nearsightedness. Eyewear may be used for certain activities,
like watching television or driving, or for all activities. Alternatively, vision correction procedures such as refractive and laser
surgery are available depending on your doctor's recommendation.
Presbyopia
You may have noticed that you need to hold reading materials further away than usual, or that your vision is blurry at a distance
that never used to be a problem. Or maybe you've been suffering from eye fatigue and headaches when working with materials
at a close range. These are classic symptoms of presbyopia.Presbyopia is a natural change in our eyes' ability to focus. It occurs
when the crystalline lens of the eye loses its flexibility, causing objects to appear blurry. Symptoms take years to develop and
typically begin to show in the early- to mid-40s.
The effects of presbyopia can be corrected with bifocal or progressive glasses, multifocal or monovision contact lenses,
conventional surgery with multifocal or monovision intraocular lenses or laser surgery with PRK or LASIK.Retinal Detachment
