Iritis and Uveitis

Patients often present with signs of a red eye thinking they have a “pink eye” or some type of conjunctivitis. Following a detailed examination by the doctor, the patient may be informed that the pink eye they thought they had has been diagnosed as an iritis or uveitis. So, what is an iritis or uveitis?

The uvea consists of three internal ocular structures: iris, ciliary body and the choroid. The iris is the colored segment which includes the circular opening in the center known as the pupil. The pupil’s size is contingent upon the amount of available light and changes its size accordingly as the light intensity changes. Thus, a smaller pupil is present when the light is very bright and subsequently enlarges as the amount of light diminishes. The ciliary body produces aqueous humor which provides nutrition to various internal structures as well as contributing to the eye’s intraocular pressure while the choroid is the vascular layer of the eye sandwiched between the sclera (the white outer coat) and the retina (photoreceptive layer) which permits the eyeball to visualize an object. It too, provides nutrition to important structures of the eye. So, an inflammation to one or all of the components of the uvea constitiutes a uveitis. The term “iritis” is technically a misnomer although it is frequently used and accepted in most medical establishments.
Uveitis can be unilateral or bilateral in presentation and usually patients present with similar symptoms. They are the following: photophobia or light sensitivity, possible blurred vision depending upon the severity of the inflammation, pain in and around the eye, smaller pupil in the involved eye in unilateral cases, irregularly-shaped pupils and a circular pattern of injection (redness) around the iris structure. Clinically, the diagnosis is made when the doctor evaluates the region of the eye directly behind the cornea (outer clear covering of the eye) and just in front of the iris known as the anterior chamber. The presence of white blood cells referred to as “cells” and protein leakage from the blood vessels known as “flare” into the anterior chamber confirms the diagnosis of uveitis.
Uveitis has a multitude of causes, the most common of which is trauma. However, uveitis can be an initial or an accompanying sign of systemic diseases such as ankylosing spondylitis, arthritis, tuberculosis, sarcoidosis, syphilis, inflammatory bowel disease (Crohn’s or ulcerative colitis), herpes or cancer to name just a few. The ocular treatment for uveitis is usually topical steroid drops and dilating drops, similar to those used to examine the internal contents of the eye during routine eye examinations. Steroids essentially calm the inflammatory process while the dilating drops assist in decreasing pain and spasming of the eye. Oral steroids may be necessary for severe ocular cases that do not resolve with only topically applied medications or if a systemic cause is uncovered during laboratory testing for recurrent uveitis.

DRY EYE TREATMENT; BEYOND ARTIFICIAL TEARS

Steven R. Corwin, Ophthalmologist and Cornea Specialist at the Marietta Eye Clinic discusses dry eye syndrome treatment:

In a previous blog I discussed the various artificial tears options for the dry eye patient. But what if tears are not adequately controlling your symptoms? Here I will discuss other possible non-prescription medication options. One of the first things the dry eye sufferer must examine is risk factors. Some like age or gender you have no control over. However, numerous oral medications can also contribute to dry eye symptoms. The most obvious are antihistamines and diuretics. Decreasing or discontinuing antihistamines often make a big difference. Some high blood pressure medications such as hydrochlorthiazide are weak diuretics. You may want to ask your primary care physician about trying a different anti-hypertensive.

  The actual discomfort you experience with dry eyes is due to chronic inflammation of the cornea (the clear dome over the colored part of your eye). Normally the lids glide up and down along the lubricating tear film that covers the cornea every time you blink. If you don’t have enough tears or the composition of the tears is abnormal, the lids instead rub the cornea itself. This constant rubbing causes the cornea to become irritated and inflamed which you feel as grittiness or burning.

  Omega-3 fatty acids have been touted as a cure for everything from heart disease to dry skin. However, several studies have shown a definite positive effect from them on dry eyes through two mechanisms, actually increasing the tear volume and also exerting an anti-inflammatory effect on the cornea. What is the “optimal” dose of fish oil and flaxseed oil you should be taking has not definitively been determined yet but I usually recommend approximately 1000 mg of omega-3’s from each source per day. There is a belief among many nutritional scientists that ingesting desired nutrients through whole foods rather than through supplements is healthier and I tend to agree. Therefore, try and increase the number of times per week you eat fish and don’t bother taking fish oil capsules on those days. (Interesting factoid I just found out: Tilapia is a vegetarian fish and there is no omega-3 fatty acids in its flesh). Ground flaxseed is now found in the organic or natural foods department of most grocery stores. I have even found it at Costco. Sprinkle two tablespoons of this almost tasteless powder on your cereal, in your smoothie or even on a salad each day rather than taking an oil-filled capsule.

  Another extremely effective non-prescription treatment for dry eyes are punctal plugs. I explain them by using the analogy that your eye is like a sink. If you are trying to fill a sink with water and the tap is up all the way but you are unsuccessful, what can you do? Put a stopper in the drain and the water backs up and fills the sink. Your eye has a “drain” in both the upper and lower lids. These small holes called “puncta” are located on the edge of the lid near the nose. If we place a small soft plastic stopper the size of a pinhead (called a punctual plug) in one of these drain holes, instead of two drains draining the tears from your eye, there is now only one doing the job. This causes the tears to take longer to leave your eye and they therefore back up in your eye giving you more tear volume. Your Marietta Eye Clinic doctor can painlessly insert these plugs in your lids in the office in about a minute. Most people tolerate them very well. Rare side effects include excessive tearing and foreign body sensation but if this occurs, they can be removed in a few seconds. Personally, I am a dry eye sufferer and have had punctal plugs in my lower lids for over 15 years and I don’t even know they are there.

  So, if artificial Tears are not doing it for you, maybe try taking some omega-3’s or if that fails, make an appointment at Marietta Eye Clinic and ask your doctor about punctal plugs. In future blogs I will discuss prescription options for treating dry eyes, some non-traditional options you may want to try and future treatment possibilities.

–Steven R. Cowin, M.D.

Marietta Eye Clinic

Marietta, GEORGIA   www.mariettaeye.com

MARIETTA EYE CLINIC IN CANTON, GA VOTED “BEST EYE DOCTOR”

 

Marietta Eye Clinic’s office in Canton, Cherokee County, Georgia was recently voted “Best Eye Doctor” by Around and About Canton Magazine.  To learn more, to get directions or to schedule an appointment, call (770) 479-2195 or go to http://www.mariettaeye.com/georgia/cherokee.htm

 

 

 

 

DUETTE MULTIFOCAL CONTACT LENS

MARIETTA EYE CLINIC IN MARIETTA, GEORGIA NOW OFFERS NEW DUETTE MULTIFOCAL CONTACT LENS a New Technology Solution for Eyes Over Age 45.

 More than 100 million people in the United States have presbyopia, an age-related eye condition that eventually affects everyone over 45, even those who never needed vision correction before. Presbyopia is caused by a loss of elasticity within the natural lens of the eye that makes it more difficult for the eye to focus up close. The result is blurred near vision. Until now, contact lenses for people over 45 required wearers to compromise their distance vision in order to see near.  The Marietta Eye Clinic is excited to announce that it is one of the first eyecare practices in the nation to offer Duette Multifocal, a new state-of-the art hybrid contact lens from SynergEyes, Inc. For the first time, patients over age 45 can wear a hybrid contact lens that delivers clear, crisp binocular vision so they can see near and far and everywhere in-between. “Duette Multifocal contact lenses provide the best quality of vision available in a contact lens,” GREG RUSSELL, O.D., of Marietta Eye Clinic.  Duette Multifocal offers great vision due to new hybrid technology that combines two types of materials into one lens: a rigid gas permeable or “hard” lens center and a soft skirt. The rigid center of the lens uses a proprietary MultiPro² technology that delivers “simultaneous vision” which allows the eye to easily focus back-and-forth between all distances. The soft skirt around the center provides the all-day comfort of a soft lens. “Duette contacts are like progressive glasses,” said Dr. Russell, “but instead of carrying around a pair of glasses, our patients wear comfortable contacts lenses that allow them see at all distances.” Approved for marketing by the U.S. Food and Drug Administration (FDA), the Duette family of lenses are the first hybrid contact lenses with a silicone hydrogel skirt, a MaxVu rigid center with high oxygen permeability and a class II UV blocker. “We pride ourselves on offering our patients the very latest in vision correction technology and the Duette Multifocal lens allows us to do just that,” said Dr. Russell. 

 About Marietta Eye Clinic: For more than 40 years, the Marietta Eye Clinic has been serving as the premier eye care center in the northwest suburbs of Atlanta. With seven convenient locations, it has faithfully served the needs of patients in Cobb, Cherokee, Douglas, Fulton and Paulding counties. Its range of services extends from routine eye exams to complex surgical care for eye care needs. For more information, visit www.mariettaeye.com.

 About SynergEyes, Inc. SynergEyes is the leader in hybrid contact lens technology, combining a rigid gas permeable center and a soft outer skirt. The result is a contact lens for patients seeking crisp, clear vision and the all-day comfort of a soft lens. SynergEyes lenses with FDA market-clearance include Duette .for naturally occurring ametropia, targeting patients with astigmatism, current soft toric lens wearers, and patients demanding optimized vision. For more information, visit www.synergeyes.com..

 “Finally, our patients over 45 are getting 20/20 vision at all ranges: distance, near, and intermediate. And, they rave about the all-day comfort as well” says Marietta Eye Clinic’s Dr. Gregg Russell.

Diabetic Eye Exams, Marietta, GA

Diabetes is a common medical problem, effects millions of people. Diabetes affects the body’s ability to effectively to control blood sugar (glucose) levels. Although glucose is an important source of energy for the body’s cells, too much glucose in the blood for a long time can cause damage in many parts of the body, including the heart, kidneys, blood vessels and the small blood vessels in the eyes.

It is called DIABETIC RETINOPATHY, when the blood vessels in the eye’s retina (the light sensitive tissue lining the back of the eye) swell, leak or close off completely — or if abnormal new blood vessels grow on the surface of the retina. People who are at greater risk of developing diabetic retinopathy are those who have poor blood sugar control, women who are pregnant, and people with high blood pressure, high blood lipids or both. Also, people who are from certain ethnic groups, such as African-Americans, Hispanics and Native Americans, are more likely to develop diabetic retinopathy.

Diabetic retinopathy in early stage of disease, damages blood vessels in the retina, which causes leakage of  fluid and small amounts of blood into the macula (critical central portion of retina for seeing) causing macular edema. The macula doesn’t function properly when it is swollen. Macular edema is the most common cause of vision loss in diabetes . As the diabetes advances, eye develops abnormal blood vessels on the retina which lead to multiple problems including bleeding in the back of the eye, development of scar tissue and detachment of retina. In addition it can cause special type of glaucoma, where eye pressure is significantly increased. All these problems if not corrected in time will ultimately leads to blindness.

In the early stages of the diabetic eye disease, often don’t notice changes in vision.   As the disease progresses, diabetic retinopathy symptoms may include – spots, dots or floaters; blurred vision; blank or dark areas in your field of vision; poor night vision; colors appear washed out or different. In some people, it causes sudden loss of vision, in some cases cannot be reversed.

 

To detect early stages of diabetic retinopathy when it can be controlled with good success, it is very crucial that patients are screened during that stage; The American Academy of Ophthalmology recommends the following diabetic eye screening schedule for people with diabetes: 

Type 1 Diabetes: Within five years of being diagnosed and then yearly.

Type 2 Diabetes: At the time of diabetes diagnosis and then yearly.

During pregnancy: Pregnant women with diabetes should schedule an appointment with their ophthalmologist in the first trimester because retinopathy can progress quickly during pregnancy.  

The only way to detect diabetic retinopathy and to monitor its progression is through a complete eye examination. Either Ophthalmologist or Optometrist usually does this eye exam. During the visit, vision is checked, the front of the eye examined with slit lamp and then pupils are dilated with eye drops. After dilation of the eyes, back of the eye is examined with an ophthalmoscope to see the details of retina where the damage from diabetes occurs.. If any significant damage is detected, then they refer to retina specialist for further evaluation.

Retina specialist is an ophthalmologist with special training in taking care of various medical and surgical problems of retina. Diabetic retinopathy is one of the common condition retinal specialist manage. They not only exam the patients in detail but also use specialized instruments to evaluate the retina including –

·         Fluorescein angiography – uses a special camera to take a series of photographs of the retina after a small amount of yellow dye (fluorescein) is injected into a vein. The photographs of fluorescein dye traveling throughout the retinal vessels show: details of blood vessel leakage, blood vessel closure and presence of abnormal blood vessels.   

·         Optical coherence tomography (OCT) – is a non-invasive test that provides high-resolution images of the retina giving detailed information about the presence and severity of swelling of retina. It is helpful to diagnose and follow up with new treatments.

·         Ultrasound –If ophthalmologist cannot see the retina because of bleeding in the back of the eye, an ultrasound test may be done in the office. The ultrasound can “see” through the blood to determine if retina has detached. If there is detachment near the macula, this often calls for prompt surgery

Treatment: The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses to advanced stages ultimately leading to blindness.

Retinal specialists use various treatment modalities including –

Laser surgery- The laser is a very bright, finely focused light. Laser treatment is recommended to control macular edema (swelling of retina)and to decrease problems due to growth of  abnormal blood vessels.   Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.  

Medication injections – recently medications are used to help treat diabetic retinopathy and its complications. These medications reduce or control swelling or bleeding in the eye.   These medications include steroids, anti-vascular endothelial growth factors. These medications are injected into the vitreous or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve vision. . Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks.

Vitrectomy surgery– Diabetic retinopathy in advanced stages develops scar tissue in the back of the eye, which leads bleeding and detachment of retina. Vitrectomy is a surgical procedure to remove blood and scar tissue from the back of the eye and to fix the retina if it is detached.  

Diabetic eye disease is easily controllable in early stages and treatments are excellent. In spite of advances in treatment, due to delayed presentation of patients to eye examinations, often retinal specialists see patients in incurable stages. So, eye examination should be part of the comprehensive diabetic care and strictly followed by patients and their families.

If you are diabetic, you should have your eyes checked once a year for DIABETIC RETINOPATHY.  Dr. Lakshmana Kooragayala of the Marietta Eye Clinic in Marietta Georgia specializes in the management and treatment of diabetic eye disease.  He can be reached for an appointment at (770)427-8111 (www.mariettaeye.com) 

iLASIK NOW AVAILABLE WITH DR. STEVEN CORWIN AT MARIETTA EYE CLINIC

We are happy to announce a NEW and EXCITING step forward at Marietta Eye LASIK. We are now doing LASIK procedures with Intralase and CustomVue! The procedure now being done at MARIETTA EYE LASIK by DR. STEVEN CORWIN, in our exclusive LASIK Suite, is called I-LASIK (IntraLASIK). This is the same technology approved for and used on Navy SEALS, NASA astronauts, and Naval aviators.

The first step in LASIK is to create a thin flap in the center of the cornea. Intralase is an amazing technology that allows us to create this flap with a high energy laser instead of the older blade technology. It is also called “BLADE-FREE” LASIK. Because the Intralase laser replaces the hand-held microkeratome metal blade with a computer guided laser, safety and precision are the major advantages of this new and exciting technology.

The second step in LASIK involves the use of the CustomeVue excimer laser to permanently change the shape of the cornea. After taking a “Fingerprint” of the eye, the laser is “customized” to remove the Exact amount of corneal tissue to achieve the desired result of correction leaving our patients Spectacle free.

In Summary, with I-LASIK we are achieving amazing results while using a “BLADE-FREE” and HIGHLY PRECISE procedure that greatly reduces the chance of complications.

Find out how this advanced technology can change your life- Contact us today at http://www.mariettaeye.com to schedule your complementary iLASIK consultation with Dr. Steven Corwin. Get the same LASIK procedure as NAVY PILOTS AND NASA ASTRONAUTS.

Eye Doctor Douglasville Georgia

 

As our name ‘Marietta Eye Clinic’ denotes, we have several office locations in the Marietta area and throughout Cobb County. However, you may not know that we also have an office in Douglas County for your eye exams and eyecare needs?

Our DOUGLASVILLE office is located at 4645 Timber Ridge Drive near the Douglas WellStar Hospital. This location has a full-service optical boutique, which carries a wide selection of economy and designer frame choices as well as the latest technology in contact lenses. Our highly skilled licensed optician, Jim Cook, will ensure that you have the best visual outcome possible.

Andre Cohen, MD practices in our Douglasville office two days per week. Dr. Cohen is a Board Certified Ophthalmologist who graduated from Emory University School of Medicine . He has also completed a corneal fellowship at the University of California-Irvine . In addition to performing no-stitch cataract surgery, Dr. Cohen is a Cornea and bladeless LASIK and PRK surgery sub-specialist. He routinely manages patients with corneal related diseases such as Fuchs’ Dystrophy, dry eye syndrome, keratoconus, and pterygiums. He also performs complete eye exams and offers other routine eye care for the entire family. In his free time, Dr. Cohen enjoys spending time with his wife and three young children.

Christa Lows, OD also practices in our Douglasville location, she is there three days per week. Dr. Lows is a graduate from the School of Optometry at the University of Missouri and remains an active member of the American Optometric Association. She treats patients of all ages for a variety of medical eye conditions and also performs eye exams and other routine eye care. When not working, Dr. Lows loves planting in her garden and being with her son, daughter, and husband.

If you would like to schedule a visit with an EYE DOCTOR at our Douglasville Marietta Eye Clinic location, please call our office at (770) 577-2220 or

MARIETTA EYE CLINIC-DOUGLASVILLE LOCATION

4645 Timber Ridge Drive

Douglasville, GA 30135

Eye Exams Marietta, Georgia

Marietta Eye Clinic’s Patient Services Include:
Routine EYE EXAMS
Pediatric eye care
Eyeglasses
Contact lens fitting
Cataract and lens implant surgery
Glaucoma management
Diabetic retinopathy care
Macular degeneration treatment
Eye muscle problem management
LASIK
Corneal transplants
Dry eye treatment
Cosmetic eyelid surgery
Botox cosmetic treatment
Latisse eyelash enhancement
Uveitis management
Marietta Eye Clinic’s Patient Services Include:
Routine eye exams
Pediatric eye care
Eyeglasses
Contact lens fitting
Cataract and lens implant surgery
Glaucoma management
Diabetic retinopathy care
Macular degeneration treatment
Eye muscle problem management
LASIK
Corneal transplants
Dry eye treatment
Cosmetic eyelid surgery
Botox cosmetic treatment
Latisse eyelash enhancement
Uveitis management

Marietta Eye Clinic, Marietta, GA

Welcome to Marietta Eye Clinic, for over 40 years the premier eye care center located in the northwest suburbs of Atlanta. We have multiple offices, convenient for residents of Cobb, Cherokee, Douglas, Fulton and Paulding counties. Our range of services extends from routine eye exams and spectacles all the way to complex surgical care for all your eyecare needs. The Marietta Eye Clinic continually strives to provide you with better service and to deliver a premium eyecare experience. Please feel free to visit our website www.mariettaeye.com for more information or call us at (770)427-8111 to schedule an appointment.

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