Stargardt’s disease is an inherited disorder of the retina. This disease starts to develop visual changes in patients in their childhood or teenage years. The changes are gradual but constant until their vision is decreased approximately to 20/200 or worse uncorrected. This condition is also called Stargardt’s macular dystrophy, juvenile macular degeneration, or fundus flavimaculatus. This disease damages or degenerates the macula, which is in the retina. The macula is the area in the eye that delivers sharp straight-ahead vision.
Patients with Stargardt’s experiences a slow and constant central vision loss, hence, becoming sensitive to bright lights. The retina contains light-sensing cells called photoreceptors. These are called rods and cones. Both rods and cones photoreceptors gradually die due to this disease.
As we mentioned earlier, this disease is inherited in most instances due to a mutation in a gene called ABCA4. The ABCA4 gene created a protein that clears Vitamin A byproducts inside the photoreceptors. Due to the cells not being cleansed, the cells become full of fatty substances and consequently the cell dies. This degeneration starts to happen around the macula which is the reason why patients start losing their central vision.
To diagnose Stragardt’s disease, an eye physician needs to do a thorough and complete eye exam.
The following tests are recommended:
- Slit eye exam. An eye physician will see the fatty deposit in the macular under the microscope if Stargardt’s is present
- Visual field testing to determine the areas and progression of the disease
- Color testing determine if the patient is becoming color blind
- A fundus photo which is a detailed picture of the retina
- An electroretinography (ERG) measures the response of cones and rods to light
- Optical Coherence Tomography (OCT) which is a light wave scanning device of the retina
Unfortunately, there is no treatment for Stargardt’s. Patients are encouraged to wear dark sunglasses, not to smoke, and not to take Vitamin A supplements. Low vision aids are quite sophisticated right now and they can lend a lot of help by magnifying images or providing voice commands. Many Stargardts patients become visually disabled in their 20s which can take a significant emotional toll on the individual and their loved ones. Good medical eye care, counseling, and a supportive circle of friends and family are necessary to best confront this disease. There are multiple studies and research worldwide in the works addressing the degeneration of the macula. We look forward, with anticipation, to a new treatment in the medical field to aid all our patient’s with Stargardt’s and Macular Degeneration.
Happy New Year! May 2021 bring us all health, peace and happiness.
Glaucoma is called “The Thief of Sight” because it occurs so gradually that you may not even be aware that you are experiencing vision loss due to glaucoma. Glaucoma occurs when pressure in the eye becomes higher than normal resulting in increased pressure on the optic nerve, pinching the blood vessels that carry blood to the retina and optic nerve.
While many people schedule a baseline screening every year or so, the BEST way to prevent glaucoma is with a comprehensive eye exam. Some people have a higher risk of developing glaucoma. If you are in any of these categories, please call us for a full eye exam:
- Relatives with glaucoma
- African, Asian, or Hispanic background
- Farsighted or nearsighted vision
- High eye pressure on previous exam
- Have diabetes, migraines, or high blood pressure
- Long term use of steroids
Glaucoma is one of the leading causes of blindness but it does not have to happen to you. Early testing and prevention are extremely important, especially since there is no known cure. For vision already lost due to glaucoma these are three procedures that can help to stop glaucoma in its tracks. If you are diagnosed with glaucoma, we can explain these options thoroughly and choose which is best suited for your condition. The goal of any treatment is to lower your eye pressure to a safe level.
- Prescription eye drops
- Laser glaucoma surgery
- Filtration surgery
Anyone can be at risk from glaucoma; everyone from babies to senior citizens can be at risk. Actually, 1 out of every 10,000 babies is born with glaucoma.
Here is the key: When glaucoma is diagnosed and treated adequately, vision can be preserved rarely ending in blindness, hence, the upmost importance of regular eye exams.
Dry eye disease is more common than you might realize, with over 16 million Americans carrying the diagnosis. Many more patients may suffer from these symptoms without a diagnosis, and it has been suggested that one out of every two American adults may experience symptoms of dry eye. About one-third of all the patients I see have complaints that relate to dryness. These symptoms may include blurry vision, glare or light sensitivity, eye pain or foreign body sensation, itching, redness, burning, and tearing. Some patients may have difficulty wearing contact lenses, or notice eye fatigue after reading of watching television. These symptoms can occur in isolation or in any combination.
Most people think that dry eye is just not having enough tears. For some people this is true, but for most people, they might make enough water for the tears, but the tears do not stay on the eye long enough to coat the surface well. These individuals have tears that evaporate too quickly, or perhaps they have excessive tearing – meaning that the tears that are supposed to coat the eye instead run down the cheek. The reason for this is that there is another important part of a healthy tear film – the oil component – which helps the tears stick to the eye. These oils come from the Meibomian glands, tiny glands along the edge of the eyelids that release beads of oil with the force of each blink. If the Meibomian glands are inflamed from blepharitis or Meibomian Gland Dysfunction (MGD) – inflammation of the eyelids, the oil becomes thick and clogs the glands, preventing healthy oil from being released onto the surface of the eye.
Normal oil from the Meibomian glands is free flowing, like olive oil. Inflammation leads to oil that looks like toothpaste, or butter straight out of the refrigerator. When we treat blepharitis, we focus on warm compresses which help to “melt the butter” and improve the flow of oil out of the glands by using heat to liquefy the oil. This is used at least twice daily to maintain healthy Meibomian glands. At the Rand Eye Institute, we have the ability to use state of the art imaging technology called Lipiview, which can directly produce an image of the glands, so that our doctors and patients can see the health of the oil glands and decide on the appropriate treatment plan.
We are very excited to offer our patients who have MGD an additional therapy that is in addition to the traditional dry eye therapies that can be used at home. Lipiflow thermal pulsation technology is available at the Rand Eye Institute. Lipiflow uses a novel device to heat and massage the blocked glands in a 12-minute procedure as part of the exam in the doctor’s office. The system’s activators, which are single use and sterile, are placed on the eye, after numbing drops have been instilled. The procedure is not painful. Most patients say that it’s not only comfortable, but feels good, just like an extended warm compress in a spa-like environment. There is no downtime, and patients start to feel an improvement in symptoms within 4-6 weeks.
This procedure is perfect for patients who are symptomatic with dry eye disease, with Meibomian gland dysfunction that are doing all the correct treatments daily, but looking for something a little stronger to help with their symptoms. The analogy is that you may be brushing your teeth every day, but still want to go to the dentist for a deep cleaning. Lipiflow can be repeated as needed, and many patients choose to have touch up treatments once a year.
We are thrilled with how happy our patients are with the results of their Lipiflow treatments. Receiving proper treatment for dry eye can be life-changing. Please let us know if you are having dry eye symptoms so that we can select the right treatment plan for your individual needs. Give us a call for a dry eye consultation. Dry Eye relief is just a call away to Rand Eye Institute.
Image Enclosed from J&J.