According to the Centers for Disease Control, an estimated 93 million adults in the United States are at high risk for serious vision loss, but only half had visited an eye doctor in the past year. Another study estimates that more than 1.6 million people living with vision loss or blindness are younger than 40, and vision disability is already one of the most prevalent disabling conditions among children.

 

This month, AY About You caught up with a few authorities in the field of vision to learn more about common issues, how they’re treated and how to maintain your eye health for as long as possible.

 

Cataracts

 

“If you live long enough, you’ll probably get cataracts to some degree,” said Austin Bell, an ophthalmologist with BoozmanHof in Rogers, who specializes in cataract and glaucoma surgery. “Cataracts are the natural lens of the eye going through an aging process, kind of like wrinkles in your skin.”

 

As you get into your 40s and 50s, the lenses of your eyes are less able to change shape, making it harder to adjust to see at different distances, an early precursor to cataracts.

 

“In another 10 or 20 years, not only is [the lens] stiff and doesn’t change shape anymore, it’s starting to get cloudy,” he said. “That’s what a cataract is.”

 

Dr. Austin Bell

 

Cataracts come with a number of other symptoms that are hard to miss from both a patient and provider standpoint. Bell often hears from patients who no longer drive at night because they don’t see as well because the cataract is scattering the light from oncoming headlights. As time goes on, other activities can take a hit as well.

 

 

“I get a lot of folks who have trouble seeing a golf ball, trouble fishing, things like that,” Bell said.

 

Thankfully, the procedure to treat cataracts is about as quick and easy as they come. Bell said cataract surgery has come a long way since the 1980s and 1990s, with better procedures, faster healing times and more advanced lens technology.

 

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“We take the cataract out, we put a new lens in the eye, and the eye sees better than before – almost as good as new,” he said. “It’s a fun thing, as a surgeon, to take care of folks with cataracts. They see better within a day or so, no pain, and they’re just thrilled.”

 

Goodbye, Glasses

 

Among the most widespread vision issues are problems including nearsightedness, farsightedness and astigmatism. These so-called “refractive errors,” happen when the cornea (the front of the eye) causes light to focus in front of or behind the retina (the back of the eye). Refractive errors cause blurry vision and are usually treated with glasses or contact lenses.

 

For those wanting to avoid the hassle of prescription lenses, there are a number of surgical options, arguably the most common of which is LASIK surgery. This involves using a laser to reshape the cornea, removing the refractive error and allowing the eye to focus correctly on its own.

 

Evan Newbolt, MD, a board-certified cataract and LASIK surgeon with McFarland Eye Care, described LASIK as “low-risk, high-reward,” and he should know. He underwent LASIK surgery himself a decade ago and is able to give prospective patients a firsthand account of his experience.

 

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Dr. Evan Newbolt

 

“The surgery is an approximately 10-minute procedure that is done in our office. The patient is relaxed with oral medication, and there is minimal discomfort,” Newbolt said. “The patient goes home with eye drops to help heal and prevent infection and instructions to take a nap.”

 

According to Newbolt, the best candidates for LASIK are those in their 20s and 30s with a mild to moderate refractive error. Another key consideration for refractive surgeries is the thickness of the cornea itself, as the cornea must be thick enough to withstand the procedure and heal correctly.

 

A concern prospective patients often have is whether the results of LASIK surgery wear off with time. While not impossible, Newbolt said only about 3 percent of U.S. patients will need a followup procedure.

 

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“Long term, our eyes can slowly change, which can decrease the effectiveness of the procedure,” he said. “Typically, if this occurs, it is 10 to 20 years after the initial surgery.”

 

As with any procedure, there are potential complications, which is why Newbolt only performs LASIK surgery on patients he expects to have a good outcome. The most common issues are dry eyes and halos or glare after the procedure, but even these side effects have decreased over the last 25 years, thanks to continued technological improvement.

 

“While no surgery is without risk, LASIK is a very safe surgery with a great long-term track record,” Newbolt said. “Patients who had their LASIK procedure years ago tell me it is the best thing they’ve ever done.”

 

 

In addition to LASIK, breakthroughs in technology and surgical techniques have given patients other options in recent years. One of these innovations, known as SMILE, is quickly making a name for itself as a popular alternative to LASIK.

 

“I think it’s going to transform refractive surgery,” said Dr. Steven Vold of Vold Vision in Fayetteville. “That doesn’t mean LASIK is going to go completely away, but [SMILE] is becoming more of a dominant force in corneal and refractive surgery.”

 

A fellowship-trained glaucoma subspecialist who also specializes in corrective vision surgeries, Vold was among the first surgeons in the country to perform SMILE after it gained FDA approval in 2016. His practice, Vold Vision, was also the first in the state to offer SMILE.

 

“In LASIK, you basically cut the corneal flap, lift up the flap and then laser underneath it. With this, we make a tiny incision with the laser, and then we remove a little sliver inside the middle of the cornea,” Vold explained.

 

“Just think about this: The cornea is about half a millimeter thick. We’re able to change all these prescriptions by removing something that’s just a fraction of a millimeter, and we can correct vision almost overnight. It’s unbelievable.”

 

Another option, known as PRK (photorefractive keratectomy), does not use incisions at all but reshapes the cornea on the surface of the eye itself. However, PRK does have a longer recovery time, making SMILE a kind of happy medium between the PRK and LASIK procedures.

 

With any of these procedures, overall eye health determines whether one is a good candidate for surgery. When interviewing prospective surgeons or medical practices, both Newbolt and Vold stressed the importance of asking the right questions.

 

“I suggest asking about both the surgeon and the laser. I think it’s important to know if the laser being used is the most advanced available, and if the surgery is completely done by laser, rather than a portion of the surgery utilizing a metal blade,” Newbolt said.

 

“When choosing a surgeon, I suggest asking how many surgeries of this type the surgeon has done, and if the surgeon lives in-state and is available to see their own patients for aftercare and follow-ups.”

 

More Serious Problems

 

For more serious eye conditions, the overwhelming message from ophthalmologists, including Bell and Vold, is that time is of the essence. Diseases such as glaucoma require constant management to preserve as much vision as possible.

 

“Glaucoma is optic nerve damage related to the pressure in the eye,” Bell said. “The eye makes fluid and drains fluid, and that fluid goes back to your bloodstream; it doesn’t come out, like with tears. For folks who have high eye pressure, their drain system is not working properly.”

 

Dr. Steven Vold and staff

 

As we age, we’re at higher risk of that drain system slowing down. The more fluid in the eye, the more pressure there is on the optic nerve, eventually leading to vision loss and, if left unchecked, blindness.

 

“I tell patients all the time, ‘I’m a glorified plumber. Your eye is like a sink,’” Bell said. “Eye drops are kind of like turning the faucet down. When you get lots of fluid that builds up in the sink, we have some lasers that are kind of like putting Drano in the sink. There are a lot of plumbing analogies, but basically, there’s only one treatment for glaucoma, and that’s to lower the eye pressure.”

 

One of the most dangerous aspects of glaucoma is the very slow pace at which it works in the vast majority of cases. Vision loss associated with glaucoma begins peripherally and works towards the center, making it easy to miss in the beginning.

 

“I’ve had patients who were referred to me for really severe glaucoma, and they’re 20/20, but it’s like looking through straws,” Bell said. “They have no peripheral vision at all, and they’re weeks or months away from losing their vision totally.”

 

Vold and Bell emphasized the crucial role of early detection, since vision lost to glaucoma is irreversible. Anyone older than 40 should be screened on a yearly basis, especially if they have a family history of the disease. Some people can have glaucoma even younger, making regular checkups with an optometrist a must.

 

“The folks I see that have severe cataracts or severe glaucoma are folks who said, ‘I’ve always been able to see pretty well, and I’ve never been to an eye doctor for 20 years,’” Bell said. “Screening, and having a good relationship with your optometrist, is a wise thing to do, just like seeing your primary care doctor every year.”

 

“I think people think you don’t have glaucoma if you don’t have symptoms,” Vold added. “The reality is most people that have glaucoma don’t have any symptoms at all. That’s what I worry about, because if you don’t take something seriously, it can be a problem.”

 

Surgical options for managing glaucoma have also benefitted from technological innovations including minimally invasive procedures that have proven effective in treating milder cases.

 

“You need to find a glaucoma surgeon who can do it all, who’s not just going to pigeonhole you into something new and fancy if it’s not going to work very well. Even the gold-standard surgical options for glaucoma aren’t a cure,” Bell said. “You’ll always have to have your pressure checked, you’ll always have to make sure that the glaucoma is not getting worse.”

 

Another serious eye condition is macular degeneration, which progresses from the center of the eye outward. The leading cause of blindness in the United States, there are a number of medications and treatments in development to help prevent vision loss from the disease. Additionally, wearing UV eye protection, such as sunglasses, can help mitigate both minor and major eye issues.

 

Prosthetic Eyes

 

In even more severe cases, such as an eye that no longer sees or must be removed due to injury or disease, there are a multitude of considerations that go into keeping the remaining eye healthy. That is where specialists like Michael Kaczkowski come in. Kaczkowski is the lead ocularist and anaplastologist at Real Life Faces Artificial Eye Clinic & Alloplastic Facial Reconstruction, where he designs and creates custom, lifelike prostheses for patients of all ages.

 

“Stabilizing a socket by putting a prosthesis in helps the sight of the sighted eye, because the eyes are connected,” Kaczkowski said. “If you get poked in one eye, what happens to the other one? It closes and waters in ‘sympathy’ of the other. If one socket is affected it’s going to take that energy from the sighted eye.”

 

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Michael Kaczkowski

 

There are other problems associated with a missing eye that can be remedied by an ocular prosthesis. The lack of weight and asymmetry can cause migraines and sinus problems. In children especially, prostheses are essential to ensure proper growth of the skull as they age.

 

Then, of course, there are the social and emotional aspects of having a lifelike prosthesis, which can give patients a huge psychological boost.

 

“I have patients that have walked around with a cloudy, unsightly eye for their whole life and have had to deal with the reactions from that,” Kaczkowski said. “It’s a huge thing; it becomes part of their identity.

 

“I just fitted a nurse with a prosthesis where the whole thing is less than a millimeter thick. Her [affected] eye is about the same size as her sighted eye, so we just make it that thin. The appearance is slightly bigger, but when you’re talking to her, no one notices. It’s critical for her profession.”

 

Maintaining the health of the socket becomes even more important as a patient ages. The prosthesis needs to be changed every so often, and patients often report that the vision in their sighted eye improves after the new prosthesis is put in.

 

Though rare, eye-threatening injuries can and do happen. Even in cases where you don’t notice any serious symptoms or vision loss, it’s important to get checked out by a professional to avoid potential long-term effects.

 

“If you don’t think it’s that bad of an injury, it doesn’t matter. Schedule an appointment with an ophthalmologist, number one,” Kaczkowski said. “Have them do scans, check the retina, make sure that there’s no internal damage that manifests later.”

 

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For more acute injuries, an oculoplastic surgeon will determine how much of the damaged eye, if any, should be saved. Kaczkowski’s role comes in after those procedures, but since ocular prostheses make up only a small number compared to other areas of the body, he is able to be involved very early on in the process.

 

“I work with all the hospitals here in town,” he said. “Lots of times, when these patients come, we have communication: ‘I’m going to send them over; they were in the ER, we just did ABC and D. Take a look, see if there’s anything else you recommend for surgeries.’”

 

When it comes to the future of ocular prostheses, Kaczkowski said, the real work is in tissue engineering. That involves using human stem cells to grow an eye or regrow damaged nerves. Paired with advancements in neural surgery, there could come a time when surgeons are able to reconnect and repair the optic nerve itself.

 

With that kind of breakthrough still a ways off at best, though, it’s worth taking care of the eyes you have now, since odds are they’re the only ones you’re going to get.

 

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