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Diabetes (diabetes mellitus) is a common disease in which blood-sugar levels are chronically and excessively high. The disease has many related complications, and several eye diseases among them. The most common eye complication of diabetes is diabetic retinopathy, a leading cause of adult blindness.

Diabetic retinopathy occurs when high blood-sugar levels affect the functionality of blood vessels in the retina (light-sensing cells in the eye). In early phases of the disease, capillaries will leak blood or fluid. This can cause swelling in the retina (which may result in blurring of central vision), and it can leak into the vitreous humor (the fluid surrounding the retina) causing floaters or obscuring vision.

During the beginning stage serious vision damage is less likely; however, it can lead to a more advanced stage of the disease, called proliferative diabetic retinopathy. In this form, blood vessels in the retina actually close off. New blood vessels grow to make up for the lack of blood flow to the retina. The new blood vessels unfortunately are accompanied by scarring and more leakage and bleeding in the back of the eye. This can lead to serious vision loss and blindness.

Early symptoms of diabetic retinopathy may include:

• Decreased night vision
• Floaters or obscured vision
• Blurry vision
• No symptoms at all significant disease may exist even without any vision changes

The condition can typically be diagnosed by an ophthalmologist during an eye exam, long before noticeable vision symptoms occur and when more treatment options are still available. Thus it is very important for those suffering from diabetes to have regular eye exams, to monitor for diabetic retinopathy and other complications.

Treatment:

Treatments for diabetic retinopathy vary based upon the nature and progression of the condition. The best way to preserve good vision is to vigilantly control blood-sugar levels, lessening the chance of retinopathy, and impeding its rate of advancement. Blood pressure control, cholesterol control, and weight control with proper diet and exercise are all crucial, particularly in those with diabetes, not only to preserve vision, but also to reduce the risk of heart disease, stroke, kidney failure, and other systemic complications.

Once the disease is in advanced stages, the ophthalmologist may choose a type of laser surgery, called pan-retinal photocoagulation. This technique burns many tiny dots across the retina, with the aim of sealing off leaky blood vessels and discouraging further blood vessel growth. This surgery does not cure diabetic retinopathy, but it can help to save remaining vision.

If the vitreous humor has become clouded by blood leakage, there is a chance it may be naturally purged by the eye. If clouding persists, however, a vitrectomy, a surgical removal of the vitreous humor, may be necessary. The ophthalmologist replaces it with a saline solution, and the eye naturally replenishes the vitreous fluid over time. This procedure can restore vision that has been obscured in the vitreous, however, any vision loss due to retinal damage or detachment is not restored.

If you have diabetes or are experiencing any symptoms of diabetic retinopathy, we encourage you to contact us today to schedule a consultation.

Glaucoma is an extremely common cause of irreversible blindness that can affect even the healthiest person. It is a disease of the optic nerve. It is particularly worrisome because there are no symptoms and no cure. It slowly and silently steals away your vision. Peripheral vision is typically lost first, but total blindness can occur in end-stage glaucoma. Once damage has occurred, it cannot be undone. However, there is treatment, and early detection is essential to prevent permanent loss of vision.

Glaucoma is an umbrella term, and there are various different types of glaucoma, such as open angle glaucoma (OAG), normal tension glaucoma (NTG), angle closure glaucoma (ACG), angle recession glaucoma (ARG), inflammatory glaucoma, and neovascular glaucoma. The most common type that we see in the United States is OAG.

Risk factors for glaucoma include:

• Age
• Family history
• Ethnicity – glaucoma is more common in African Americans, black Africans, and Latinos
• A history of trauma to the eye, particularly blunt force trauma
• High myopia (near-sightedness)
• Elevated intraocular pressure (IOP)
• Thin central corneas (this and IOP are quick, painless measurements that are done in our office)

There is one treatment for glaucoma: reduction of intraocular pressure (IOP). There are 3 ways that this can be accomplished: daily prescription eye drops, laser trabeculoplasty (a painless, in-office light-based therapy), and intraocular surgery (typically reserved for severe cases in which a safe IOP cannot be achieved with eye drops and/or laser). Treatment does not improve vision, but is essential to preserve vision and prevent blindness.

Although the only known treatment is to reduce IOP, glaucoma does NOT simply mean “high eye pressure.” This is a common misconception. In fact, many people with glaucoma have never had elevated IOP, so-called “normal tension glaucoma.” Glaucoma slowly and silently damages the optic nerve and steals away your vision.

Glaucoma is diagnosed by a careful evaluation of the appearance and function of the optic nerve. Having a “puff test” and being told that your eye pressure is normal does not mean that you do not have glaucoma or that you are not at risk for it. Having regular eye exams can literally save your sight.

If you have a family history of glaucoma, if you have ever been diagnosed as a glaucoma suspect, or if you have been diagnosed with glaucoma but have seen an ophthalmologist for over one year, please call our office for an appointment.

We are all born with a lens in our eye, behind the iris. It is clear when we are born, and it is called the crystalline lens. As we get older, it gradually clouds, and then it is called a cataract. It is a natural change in a normal structure with which we are born. It is not a growth or a tumor, and its presence does not threaten the health of the eye. A cataract is a normal and inevitable consequence of aging. Just as gray hair and wrinkles naturally occur as we age, so do cataracts.

There are certain factors that predispose to development of cataracts at an earlier age, such as eye trauma, diabetes, or a long history of chronic systemic treatment with corticosteroids (i.e. prednisone). Smoking will also accelerate the development of cataracts.

Simply having a cataract does not mean that cataract surgery is necessary. The reason to remove a cataract is to improve your vision. When the cataract interferes with your ability to see well enough to do the things you want and need to do, then it is time to consider cataract surgery. In cataract surgery, the cloudy lens (cataract) is removed, and a man-made lens is implanted in its place. This synthetic lens remains, and the cataract does not grow back. Everyone develops some amount of scarring behind the lens implant after cataract surgery, and this can occur months to years after surgery. Occasionally, this scarring, called posterior capsule opacification, causes blurred vision and/or problems with glare. If and when the symptoms interfere with the quality of vision, a painless laser procedure can be done in the office to break up the scar tissue and restore better vision.

Cataract surgery is still always done in an operating room, at a hospital or in a surgery center, on an outpatient basis. You receive intravenous anesthesia to relax you, but you are not knocked out or put on a ventilator. The procedure takes approximately 10-15 minutes, and you return home the same day. Generally, an eye patch is not even necessary, and you start using post-operative eye drops (antibiotic and anti-inflammatory drops) the same day. You return to see your doctor the following day, at which time he or she will inform you when it is safe to resume driving.

For cataract surgery, both eyes are never operated on at the same time. One can be done, and it may be years before the other eye is done; or they may be done as close to one week apart, depending on your individual circumstances. These are details that your doctor will discuss with you.

Your doctor will also discuss your options for intraocular lens implantation. The lens implant is standard (prior to the availability of these lens implants, the eye was left without anything to replace its natural lens, and this necessitated the Coke-bottle glasses that you may have seen before). There are various types of lens implants: traditional monofocal implants, toric or astigmatic implants, and multifocal or accommodative implants (so-called premium implants). This is a very individual decision, the details of which your doctor will discuss with you to help you choose the most appropriate option for your needs.

If you are concerned that you may have a cataract that is interfering with your quality of life and quality of vision, please call our office to make an appointment.

Macular degeneration affects cells in the macula, which is the part of the retina responsible for central vision. Central vision is essential for most basic tasks like reading, driving, recognizing people, etc. Thus, although macular degeneration leaves peripheral vision un-impaired, it can be quite debilitating in its advanced state.

The disease exists in two forms, dry and wet.Dry macular degeneration is by far the most common (roughly 90% of all cases). However, it is the milder of the two forms, develops gradually, and usually leads to only minor vision loss. Dry macular degeneration tends to occur when yellow fatty particles called drusen accumulate in the retina underneath the macula. This build-up results in thinning and drying-out of the macular cells.

Wet macular degeneration is less common, but the vast majority of severe vision loss cases result from this form. First, abnormal blood vessels form underneath the surface of the retina. Leakage of blood and other fluids from these blood vessels permanently damages the outside cells (which detect incoming light). As these cells are damaged, vision is lost.

The primary cause of macular degeneration remains unknown. Macular degeneration typically occurs more frequently in the aging population with patients over 60. Research has shown there are many other factors such as family history, smoking, hypertension, obesity, and/or a high cholesterol, high fat diet that may contribute to the development of macular degeneration.

Macular degeneration symptoms may include:

• Shadows, blurriness, distortion, or holes in the center of vision
• Straight lines appear wavy
• Trouble seeing details both up close and at a distance
• Difficulty telling colors apart, especially ones close in hue
• Vision can be slow to come back after bright light exposure

Treatment for dry macular degeneration:

Unfortunately, there is no cure for the dry form of macular degeneration. Studies have shown than vitamin and/or dietary supplementation with antioxidants and zinc (and possibly lutein and omega-3 fatty acids) help slow the progression of the disease. Those at high risk should schedule a checkup with their ophthalmologist at least once every one to two years, to catch the disease in its infancy.

There is also no cure for wet macular degeneration. There are, however, several treatments designed to combat the disease. Early detection is very important because once vision is lost there is no treatment to regain it.

Treatments for wet macular degeneration:

• Laser photocoagulation: Seals abnormal blood vessels with a heated laser. This treatment will sometimes halt the disease, thus saving the remaining vision of a patient. However, the laser leaves a scar, creating a permanent blind spot in the patient’s vision. The treatment is only applicable to a small segment of cases, in which some vision is sacrificed to save remaining vision.
• Photodynamic therapy: Employs a light-activated drug and a “cold” laser. The drug is injected intravenously. Then the doctor shines the laser on the affected area, which activates the drug in the targeted tissue and blocks the leaking blood vessels. This procedure leaves no scar, and may be repeated several times as necessary.
• Anti-angiogenesis drugs: These inhibit proteins which contribute to abnormal blood vessel growth. They are known as anti-VEGF (anti-vascular endothelial growth factor) drugs. There are a variety of drugs that can be applicable for this purpose, some FDA approved, and some off-label (officially approved for a different application).
• Other pharmaceutical treatments: For example, angiostatic treatments, which combat blood vessel growth with steroid injections.

If you are experiencing any symptoms of macular degeneration, we encourage you to contact us today to schedule a consultation.

Before you skip this section because you may think, My eyes are not dry – they are wet and watery, please read on . . . This may apply to you!

Dry eyes often feel anything but dry.In fact, one of the most common complaints of people who do, in fact, have dry eyes, is that they water too much. Dry eye syndrome (DES) is not simply caused by insufficient tears. It is actually an inflammatory condition, and can cause any one or combination of the following:

• watery eyes
• fluctuating vision – sometimes your vision (with the appropriate glasses or contact lenses) seems normal, and other times it is difficult to see, and you may feel you have to blink a lot to clear up your vision – particularly with prolonged periods of visually demanding activities (computer work, reading, needlepoint)
• red eyes
• burning eyes
• sandy or gritty feeling – the feeling as if something is in your eyes
• eye pain
• light sensitivity
• tired eyes or eye strain

Symptoms typically get worse as the day goes on, as well as with visually demanding activities such as reading and computer use.

DES is particularly common in women, especially post-menopausal women. The hormone shifts that cause lots of dryness in the body, also contribute to dry eyes. It can also be exacerbated by certain medications, diuretics for example. It is also quite common in people with systemic inflammatory disease, such as rheumatoid arthritis and lupus.

Although DES is a chronic condition for which there is no cure, there are many different treatment options to control the symptoms of DES. If you have been diagnosed with DES, or you feel your symptoms may be caused by DES, please call us for an appointment.

Blepharitis is an extremely common, chronic condition that affects people of all ages, including young children. Anterior blepharitis involves crusting and flakiness of the lashes, and posterior blepharitis involves the oil glands on the eyelid margin – the flat stripe of tissue just behind the lashes. It is not uncommon to have both anterior and posterior blepharitis. In any of the types, the eyelids become inflamed which can, in turn, cause irritation of the eyes and many symptoms similar to dry eye syndrome.

Common symptoms of blepharitis include:

• Crust or “grit” in the eyes, particularly in the morning upon awakening, and often in the inner corners of the eyes
• Red eyelids near the base of the lashes, which can also cause eyelid swelling
• Intermittent blurred vision, particularly in the morning and/or with prolonged reading or computer use
• Stye, or chalazion – a clogged oil duct in the eyelid, which can be large or small, painful or not, anywhere along the upper or lower eyelid near the lashes, and there can be more than one at the same time
• Red eyes
• Foreign body sensation – the feeling that something is in the eye, such as sand or a loose eyelash
• Posterior blepharitis can cause an evaporative type of dry eye in which the tear film evaporates too quickly, necessitating frequent blinking in an attempt to see more clearly
• Can be asymptomatic for months or years at a time until it flares up

Blepharitis is a chronic condition for which there is no cure. However, there are various treatments and combinations of treatments that Dr. Oser or Dr. Wertlieb can customize for you in order to find the appropriate treatment regimen that controls your symptoms and minimizes flare-ups.

If you think you may be suffering from blepharitis or a chalazion, please call us for an appointment.

Floaters are translucent specks that seem to float about in your field of vision. Most people have some floaters normally, but they do not notice them until they become numerous or more prominent.

Looking like cobwebs or squiggly lines or floating bugs, floaters become apparent when you look at something evenly bright, such as white paper or a blue sky, and are more evident when you move your eyes. They are especially noticeable when looking through an optical instrument, such as a microscope or binoculars. They are more common and seem to be more annoying to people who are nearsighted or who have had a cataract operation.

What Are These Floating Specks?

Much of the interior of the human eyeball is filled with vitreous gel (also called the vitreous), a clear, thick substance that helps in maintaining the eyes round shape. Light passes through the vitreous (after being focused by the cornea and lens) to reach the retina, where images are formed. Any bits of tissue in the vitreous cast shadows onto the retina, and you see those shadows as something floating in your field of vision.

How do Floaters Get There?

Before Birth, there is a large blood vessel in the vitreous, but by birth the vessel is no longer required and it disintegrates – but not completely. The broken-up particles remain for life and float around. These are the “floaters” that everyone has.

Other occurrences can add more floaters. As your eyes age, the vitreous may become stringy, and the strands cast tiny shadows on the retina. Bits of debris from other tissue in the eye may fall into the vitreous. Floaters may come from old or new bleeding within the eye. They may be the result of a disease that causes opaque deposits in the vitreous or of an ocular inflammation that causes cellular debris, or they may be residual from an old injury.

Are Floaters Serious Problems?

In most cases floaters are simply an annoyance. An eye examination will usually reveal if there is something serious that needs medical attention. The sudden appearance of new floaters, sometimes accompanied by apparent flashes of light in the peripheral (side) vision, can be a sign that a vitreous detachment has occurred, a frequent consequence of aging that is not usually serious. On rare occasions, however, these symptoms can be a danger sign that a retinal tear has occurred. The only way to diagnose the actual cause of the problem is by a complete eye examination, followed by another one a few weeks later.

Can Floaters be treated?

Whenever floaters interfere with vision, you can shift them out of your line of sight by moving your eyes around quickly, side-to-side or up and down.

The only way to get floaters out of the vitreous gel is by surgical removal, and since they are rarely more than a nuisance, the benefit of surgery would not warrant the risks. Surgery might be considered necessary only if the cells and debris are extremely dense and numerous – enough to interfere with useful vision – but this is very rare.

We diagnose and treat a wide range of eye conditions, including infections, inflammation, and vision changes. Whether your concern is acute or chronic, we provide personalized medical care tailored to your needs.

We provide precise refractions to determine your optimal vision correction. Whether you need new glasses or an updated prescription, we ensure clear and comfortable vision.

Our contact lens services include fittings, training, and ongoing care. We offer options for both routine and specialty lenses, ensuring proper fit, comfort, and eye health.

SLT is a safe, effective laser treatment used to lower eye pressure in patients with glaucoma. This procedure improves fluid drainage within the eye and can reduce or eliminate the need for daily medications. SLT is quick, minimally invasive, and performed in the office.

After cataract surgery, some patients may develop clouding of the lens capsule (posterior capsule opacification). A YAG laser capsulotomy is a fast, painless procedure that restores clear vision by removing this cloudiness. The procedure is performed in-office with no incisions required.

CAM360 is an advanced treatment that uses a cryopreserved amniotic membrane to promote healing on the surface of the eye. It is commonly used for conditions such as severe dry eye, corneal defects, inflammation, and delayed healing after injury or surgery.

The amniotic membrane contains natural anti-inflammatory and healing properties that help reduce pain, protect the eye, and support tissue regeneration. The procedure is performed in-office and typically involves placing a soft, protective membrane over the eye, where it remains in place temporarily as the eye heals.

The iWellness Exam with Optomap at Laurel Eye Physicians is an advanced, non-invasive screening designed to evaluate the overall health of your eyes using state-of-the-art imaging technology, including the Visionix/Solix OCT (Optical Coherence Tomography). This technology provides high-resolution cross-sectional images of the retina, optic nerve, and surrounding structures, allowing for early detection of eye conditions that may not be visible during a routine comprehensive eye exam. The Optomap portion of the screening
provides ultra-widefield retinal imaging for a more comprehensive evaluation of the retina.
The initial exam serves as a baseline assessment of your eye health and may assist in the early detection of
conditions such as:
Macular degeneration
Glaucoma
Retinal disease
Other ocular health concerns
Your results of the iWellness Exam with Optomap are saved digitally so that your doctor has an electronic record that can be compared every year with previous years. This further helps with detection, as significant changes in your retina and optic nerve from year to year can often signal the beginnings of certain diseases.