Eye Movements Reveal Reading Impairments in Schizophrenia

A study of eye movements in schizophrenia patients provides new evidence of impaired reading fluency in individuals with the mental illness.

The findings, by researchers at McGill University in Montreal, could open avenues to earlier detection and intervention for people with the illness.

While schizophrenia patients are known to have abnormalities in language and in eye movements, until recently reading ability was believed to be unaffected. That is because most previous studies examined reading in schizophrenia using single-word reading tests, the McGill researchers conclude. Such tests aren't sensitive to problems in reading fluency, which is affected by the context in which words appear and by eye movements that shift attention from one word to the next.

The McGill study, led by Ph.D. candidate Veronica Whitford and psychology professors Debra Titone and Gillian A. O'Driscoll, monitored how people move their eyes as they read simple sentences. The results, which were first published online last year, appear in the February issue of the Journal of Experimental Psychology: General.

eye movement measures provide clear and objective indicators of how hard people are working as they read. For example, when struggling with a difficult sentence, people generally make smaller eye movements, spend more time looking at each word, and spend more time re-reading words. They also have more difficulty attending to upcoming words, so they plan their eye movements less efficiently.

The McGill study, which involved 20 schizophrenia outpatients and 16 non-psychiatric participants, showed that reading patterns in people with schizophrenia differed in several important ways from healthy participants matched for gender, age, and family social status. People with schizophrenia read more slowly, generated smaller eye movements, spent more time processing individual words, and spent more time re-reading. In addition, people with schizophrenia were less efficient at processing upcoming words to facilitate reading.

The researchers evaluated factors that could contribute to the problems in reading fluency among the schizophrenia outpatients -- specifically, their ability to parse words into sound components and their ability to skillfully control eye movements in non-reading contexts. Both factors were found to contribute to the reading deficits.

"Our findings suggest that measures of reading difficulty, combined with other information such as family history, may help detect people in the early stages of schizophrenia -- and thereby enable earlier intervention," Whitford says.

Moreover, fluent reading is a crucial life skill, and in people with schizophrenia, there is a strong relationship between reading skill and the extent to which they can function independently, the researchers note. "Improving reading through intervention in people with schizophrenia may be important to improving their ability to function in society," Titone adds.


Article republished from http://www.sciencedaily.com/releases/2013/02/130219121451.htm

Vitreous Detachment

What is vitreous detachment?

Most of the eye's interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is avitreous detachment.
In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.

Risk Factors

Who is at risk for vitreous detachment?

A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.

Symptoms and Detection

What are the symptoms of vitreous detachment?

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.
One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

How is vitreous detachment detected?

The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.

Treatment

How does vitreous detachment affect vision?

Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they create amacular hole to or lead to a retinal detachment. Both of these conditions are sight-threatening and should be treated immediately.
If left untreated, a macular hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience a sudden increase in floaters or an increase in flashes of light in peripheral vision should have an eye care professional examine their eyes as soon as possible.
Article republished from http://www.nei.nih.gov/health/vitreous/vitreous.asp#a

Who is likely to develop Dry Eye?

Who is likely to develop Dry Eye?

Elderly people frequently experience dryness of the eyes, but Dry Eye can occur at any age. Nearly five million Americans 50 years of age and older are estimated to have Dry Eye. Of these, more than three million are women and more than one and a half million are men. Tens of millions more have less severe symptoms. Dry Eye is more common after menopause. Women who experience menopause prematurely are more likely to have eye surface damage from Dry Eye.

Treatment

How is Dry Eye treated?

Depending on the causes of Dry Eye, your doctor may use various approaches to relieve the symptoms.

Dry Eye can be managed as an ongoing condition. The first priority is to determine if a disease is the underlying cause of the Dry Eye (such as Sjögren's syndrome or lacrimal and meibomian gland dysfunction). If it is, then the underlying disease needs to be treated.

Cyclosporine, an anti-inflammatory medication, is the only prescription drug available to treat Dry Eye. It decreases corneal damage, increases basic tear production, and reduces symptoms of Dry Eye. It may take three to six months of twice-a-day dosages for the medication to work. In some cases of severe Dry Eye, short term use of corticosteroid eye drops that decrease inflammation is required.

If Dry Eye results from taking a medication, your doctor may recommend switching to a medication that does not cause the Dry Eye side effect.

If contact lens wear is the problem, your eye care practitioner may recommend another type of lens or reducing the number of hours you wear your lenses. In the case of severe Dry Eye, your eye care professional may advise you not to wear contact lenses at all.

Another option is to plug the drainage holes, small circular openings at the inner corners of the eyelids where tears drain from the eye into the nose. Lacrimal plugs, also called punctal plugs, can be inserted painlessly by an eye care professional. The patient usually does not feel them. These plugs are made of silicone or collagen, are reversible, and are a temporary measure. In severe cases, permanent plugs may be considered.

In some cases, a simple surgery, called punctal cautery, is recommended to permanently close the drainage holes. The procedure helps keep the limited volume of tears on the eye for a longer period of time.

In some patients with Dry Eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary medical doctor.

What can I do to help myself?

• Use artificial tears, gels, gel inserts, and ointments - available over the counter - as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency. Avoid artificial tears with preservatives if you need to apply them more than four times a day or preparations with chemicals that cause blood vessels to constrict.
• Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces. Indoors, an air cleaner to filter dust and other particles helps prevent Dry Eyes. A humidifier also may help by adding moisture to the air.
• Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.

Article republished from: http://www.nei.nih.gov/health/dryeye/dryeye.asp

Conjunctivitis: Do antibiotics help?

In more than half of all people who have conjunctivitis, the infection goes away without treatment within a week. Antibiotic eye drops or ointment can speed up recovery. Adverse effects are very rare.

Conjunctivitis makes people’s eyes red and inflamed. It often affects both eyes because the infection can easily spread from one eye to the other. Your eyes get watery and produce a yellowish-white discharge that makes your eyelids stick together. They may become very sore too. Conjunctivitis is contagious but often gets better within a week, even without any treatment. So it is often enough to simply wait.

Conjunctivitis is usually caused by bacteria or viruses.  Because conjunctivitis usually goes away so quickly, though, it is generally not worth doing tests to find out if it is a bacterial or viral infection. Doctors often prescribe antibiotics just in case, in the form of eye drops or ointments. Antibiotics only work against bacteria, though, and not against viruses, so they are not always effective.

Some people use non-antibiotic eye drops. The use of cold or warm compresses is common too. But there is not enough research on these approaches to be able to say whether they have a benefit, no effect, or are possibly even harmful. Sometimes conjunctivitis is linked to an allergy. Then it is treated with allergy medicines like antihistamines.

Research on antibiotics in the treatment of conjunctivitis

Two groups of researchers from the Cochrane Collaboration (an international network of researchers) and from various universities in England, the Netherlands and Australia analyzed the results of trials on the treatment of conjunctivitis with antibiotics. They wanted to find out whether antibiotics help in the treatment of ordinary conjunctivitis, as well as which possible disadvantages they have.

The researchers only analyzed the results of studies that compared at least two groups of people. One group of people used antibiotic eye drops or ointments. The other group used non-antibiotic eye drops or ointments, or did not have any treatment at first. The researchers were only interested in studies in which the participants were randomly assigned to one of the treatment groups. This kind of study, called a randomized controlled trial, delivers the most reliable results. Read our information "Evidence-based medicine" to find out more about how good-quality trials are carried out.

The researchers found 12 trials, involving a total of about 4,000 people with conjunctivitis. Both children and adults participated in the trials.

Antibiotics can speed up recovery

Overall, the analysis of the trial results showed that conjunctivitis goes away somewhat faster if antibiotics are used. This is what was found for people who went to see their family doctor because they had conjunctivitis:

• The infection cleared up within one week in 71 out of 100 people who did not use antibiotics.

• The infection cleared up within that same amount of time in 80 out of 100 people who used antibiotics.

In other words, antibiotics were found to speed up recovery in 9 out of 100 people.

In studies that were carried out in a specialist practice, it took a little longer for the infection to clear up – both in the people who used antibiotics and in those who did not use antibiotics. One possible explanation for this is that people who go to see a specialist doctor probably have more severe cases of conjunctivitis. But the antibiotics had a similar beneficial effect to that found in the family doctor trials.

None of the trials reported that antibiotics had adverse effects. The trials did not look into whether antibiotics helped lower the risk of the infection spreading.

Recognizing signs of complications and avoiding the spread of infection

As already mentioned, conjunctivitis usually goes away without treatment. But some symptoms could be signs of more serious problems. These symptoms include worsening vision, increased sensitivity to light, the feeling that you have something in your eye, and a severe headache together with nausea. It is important to see a doctor if you have any of these symptoms.

In people who wear contact lenses, the infection can spread to the cornea (the clear surface of the eye itself). Inflammation of the cornea, also known as keratitis, is not common though: it is estimated that conjunctivitis leads to keratitis in about 3 out of every 10,000 contact lens wearers. In the trials that the researchers included in their analysis, none of the participants developed keratitis.

If conjunctivitis is caused by viruses it can be highly contagious and hard to get rid of. But there are several things that can be done to try to stop viral infections from spreading. Because the virus is easily spread through finger contact, it is important to avoid touching your eyes with your hands, and to wash your hands if you do accidentally touch your eyes. It is also a good idea to have your own towels and washcloths, and not to share them with other people. Another important way to protect others from infection is by not shaking hands with them and not touching their face.

 

Original Article found at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005040/

Published by the Institute for Quality and Efficiency in Health Care (IQWiG)Next planned update:
October 2015. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced".

References

• IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews”. These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information "Evidence-based medicine". We also have our health information reviewed to ensure medical and scientific accuracy.
• Jefferis J, Perera R, Everitt H, van Weert H, Rietveld R, Glasziou P et al. Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis. Br J Gen Pract 2011; 61(590): e542-548. [Full text]
• Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev 2012; (9): CD001211. [Summary]

 

Glaucoma

For many people, vision will worsen with age. And besides this normal process, some eye diseases may also develop that make it more difficult to see well, or that can even lead to blindness. One such common eye disease is Glaucoma. It is estimated that in the industrialized world about 1 to 2 out of 100 people over the age of 40 years have Glaucoma.

You can find more information on this topic in our feature.

If your doctor diagnoses Glaucoma, or believes you to have an increased risk of developing it, you will most likely have a lot of questions you would like answered: What does this diagnosis mean for my vision? Which medications might help? Will I still be able to work, go out, read, and drive as I have up to now? This fact sheet has information about what causes Glaucoma as well as options for treatment and prevention.

What is Glaucoma?

The term “Glaucoma” covers a number of different eye conditions, all of which involve damage to the optic nerve. This damage leads to the field of vision having ever larger gaps, which mostly remain unnoticed at first. Your field of vision is the range of what you can see when your eyes are looking straight ahead. In advanced stages, your ability to see things sharply (visual acuity) also gets worse. One common cause is that there is too much pressure inside the eye. This pressure is called intraocular pressure. Intraocular pressure is caused by a fluid in the chambers of the eye between the cornea and the lens. This fluid is called aqueous humor and is produced by the eye itself. It flows continuously from the back (posterior) chamber to the front (anterior) chamber and then back out through a very thin tube (Schlemm’s canal). This cycle helps to maintain constant pressure in a healthy eye. The aqueous humor also provides nutrients to the cornea, the iris and the lens.

If the aqueous humor is prevented from draining properly, it starts to collect and pressure within the eye builds up. This presses against the optic nerve and there is a risk that nerve cells die. Whether the increased intraocular pressure does cause damage depends on, among other things, how well the optic nerve can resist this pressure: only some people with high intraocular pressure have an optic nerve that is susceptible to damage. Intraocular pressure is measured in mm Hg (millimeters of mercury), the same unit used for blood pressure. Readings between 10 and 21 mm Hg are considered normal.

Someone who has Glaucoma does not always have above-average intraocular pressure. About 40 out of 100 people who have Glaucoma do not have high intraocular pressure, but they do have damage to the optic nerve. It might be that normal pressure is already too high for these people. Another possible cause might be poor circulation of blood to the optic nerve. In this case, not enough oxygen and nutrients reach the nerve cells.

Because not all causes of Glaucoma are known it is not always possible to find a cause of Glaucoma. It is likely that the different factors also influence one another.

What different forms of Glaucoma are there?

The most common form of Glaucoma is primary open-angle Glaucoma. It progresses slowly, and damage to the optic nerve will not cause visual disturbance until many years later. One of the main risk factors for primary open-angle Glaucoma is high intraocular pressure. But age (people over 50 are more likely to develop it), family history, severe nearsightedness and circulation problems are all factors that can also increase risk. And people with dark skin are also more likely to develop Glaucoma. One special type of Glaucoma is called normal-tension Glaucoma: in this kind of Glaucoma the optic nerve is damaged even though intraocular pressure is normal.

Angle-closure Glaucoma (acute Glaucoma attack) is less common. It is caused by an acute blockage of the outflow of aqueous humor, whereby intraocular pressure rises steeply. Typical symptoms are acute visual disturbance, reddening of the eye, intense pain in the head and eye, or nausea. Angle-closure Glaucoma must be treated quickly to avoid any damage to the optic nerve.

Glaucoma may also result from an inflammation, injury or vascular disease. If this is the case, it is called secondary Glaucoma. In very rare cases, babies are born with Glaucoma.

This fact sheet is concerned only with primary open-angle Glaucoma.

How will this condition affect me?

Damage to the optic nerve causes the field of vision to become progressively impaired over the years, and can even eventually cause blindness. At first, people with Glaucoma can no longer see certain areas within their field of vision, or can only see them to a limited degree. Blind spots appear most often near the point of sharpest vision, but also outwards to the edges of the field of vision. These blind spots can make it increasingly difficult to get around in day-to-day life. When looking straight ahead, for example while driving, it is possible to have a clear view of the street, but people and objects to the right and left on the sidewalks will be indistinct. Adjusting to different amounts of light may also be difficult, like stepping into the light from a darkened room, or it can be hard to judge obstacles like steps or the curb. Because central vision is not affected from the start, these impairments are often not readily apparent.

Damage to the optic nerve is irreversible. By the time the first symptoms appear, this damage is usually already quite extensive. Glaucoma usually develops gradually, but can sometimes progress very rapidly as well. The blind spots may continue to spread over time, until it is only possible to see the very center of the visual field. Some people go completely blind – it is estimated that about 1,100 people go blind due to Glaucoma (all forms) in Germany every year.

How is Glaucoma diagnosed?

No longer being able to see certain parts of the field of vision or only seeing them as blurred may be a sign of Glaucoma. But an eye doctor can diagnose Glaucoma even before the first symptoms become noticeable.

Your eye doctor will first ask about any existing symptoms and then examine the eye. A special instrument called an ophthalmoscope is used to check the inside of the eye to spot possible damage to the optic nerve. Intraocular pressure is also measured, usually with a technique called applanation tonometry. The eye is first numbed using a drop of liquid. Then the doctor sets a small probe on the cornea to measure the pressure inside the eye.

If Glaucoma is suspected, your eye doctor will also measure your field of vision. This is done to see whether particular parts of your field of vision have been affected and whether you already have blind spots.

Screening

To diagnose high intraocular pressure or Glaucoma early on, many eye doctors offer screening exams that must be paid for out-of-pocket in Germany because they are not covered by statutory health insurance funds. Screenings involve checking the optic nerve, measuring intraocular pressure and examining the eye with a slit lamp. If there is good reason for suspecting Glaucoma, or if certain risk factors do exist, the statutory health insurance funds in Germany will pay for the screenings. Not enough research has been done to tell whether a general screening is a good idea for particular age or risk groups. You can read more about this in our research summary on Glaucoma screening.

How can Glaucoma be treated?

Glaucoma can be treated with medication (eye drops), laser therapy or surgery. This treatment aims to lower intraocular pressure, thereby reducing the risk of impaired vision or blindness. It is estimated that 4 to 20 out of 100 people with high intraocular pressure will have loss of vision within five years. The risk will depend on different things like the amount of intraocular pressure, the thickness of the cornea and a person’s age. People with very high intraocular pressure run a substantially higher risk than people whose intraocular pressure is only slightly elevated.

Lowering high intraocular pressure can help to delay or stop the gradual progression of loss of vision. Glaucoma cannot be cured, however, because existing damage to the optic nerve cannot be reversed. Eye drops are used both as prevention and treatment to lower the intraocular pressure. Depending on the specific product, you use them either once or several times a day. If eye drops are not enough, or if they are not well tolerated, surgery can be an option for permanently lowering intraocular pressure to certain target levels.

What benefit does the prevention and treatment of Glaucoma have?

This medication can be used to prevent Glaucoma if intraocular pressure is too high, but there is no damage to the optic nerve or visual field impairment. Trials show that people who had high intraocular pressure, but who had not yet had Glaucoma, were less likely to develop visual field impairment if they took eye drops:

• Vision got worse in 5 out of 100 people who used eye drops after about five years.
• In contrast, vision got worse in 8 out of 100 people who did not take medicine or who only had a fake treatment.

Whether it makes sense to have preventative treatment also depends on possible risk factors. If there is no damage to your eyes and you only have slightly high intraocular pressure and no additional risk factors, your eye doctor may advise you to not have any treatment. But if your values are very high and you also have close relatives with Glaucoma, odds are much higher that you will benefit from treatment.

If Glaucoma has already developed, it is also important to keep intraocular pressure down by using medication in order to minimize loss of sight as much as possible. Medication is also used to treat people who have Glaucoma, but whose intraocular pressure is normal. Sometimes surgery may also help to lower the intraocular pressure. A trial looked at how newly diagnosed Glaucoma develops with and without treatment. The participants were divided into two groups: One group had laser therapy and took beta blockers. The other group did not have any treatment. The results after two years:

• Glaucoma advanced in 30 out of 100 people in the treatment group.
• Glaucoma advanced in 49 out of 100 people who did not receive treatment.

In other words, treatment stopped Glaucoma from getting worse in 19 out of 100 participants over two years. Yet even with therapy, vision and impairment of the visual field may still get worse.

Which medications are used?

These medications can be used for treatment:

• Beta blockers reduce production of aqueous humor. Beta blockers have been in use for quite some time and are often prescribed as first-line therapy.
• Cholinergic agents increase outflow of aqueous humor. Cholinergic agents have also been in use for treating Glaucoma for a long time.
• Prostaglandins increase outflow of aqueous humor and are often prescribed as first-line therapy. They have only been on the German market since the late 1990s.
• Alpha-agonists lower production of aqueous humor and increase its outflow.
• Carbonic anhydrase inhibitors lower production of aqueous humor.

Which medication is best in a particular case depends on different factors. The extent of optic nerve damage, the amount of intraocular pressure, possible adverse effects, age and other factors will influence which medication suits you best. If intraocular pressure cannot be lowered enough by using one medication or there are side effects, it is also possible to switch medications.

It is a subject of debate whether neuroprotective drugs could be used as an alternative treatment. These drugs aim to protect the cells in the retina and in the optic nerve. But there has not yet been any research showing the benefit of this medication for people who have Glaucoma.

Adverse effects

These medications can have various adverse effects. All of them can irritate the eye and cause itching and redness, for example. Some, such as the beta blockers, can affect the cardiovascular (heart and circulation) system and make breathing difficult. Closing your eyes for three minutes after using the eye drops is recommended to lower the probability of adverse effects. You can also lightly press the inside corners of your eyes with your fingers. Both of these things are done to make sure that the eye drops act on the eye, and do not flow down into your nose and throat where they can be absorbed into the body through mucous membranes.

What problems can occur during use?

Many people have a difficult time using eye drops up to several times a day for many years at a time. Some find it inconvenient to have to search for a quiet spot at work or while going somewhere so that they can take the eye drops. Others often forget to use the medicine. Some people have the feeling that the eye drops are not helping much anyway, so they do not use them consistently. Because things do not get worse immediately if you forget to take the medication once, quite some time may go by before you realize that you have not been taking the medicine on a regular basis. And its benefit becomes apparent only after a longer time period, so it will not be noticeable immediately. You can read more about strategies that may help you to take medicine over longer periods of time in our fact sheet on managing medicines for long-term conditions.

Keeping regular appointments with your eye doctor can help you remember to take your eye drops. It might also be helpful to take the medication at fixed times or in connection with daily rituals (for example at breakfast, dinner, or bedtime). Some people say that it helps them to stay motivated knowing that the medication can help them to keep their sight over the long term. Others work out a plan together with their doctor so that they only have to take the drops three times a day instead of six, for example. Then they do not have to remember so often.

Some people mostly have trouble combining taking the eye drops with their daily routine. If you have never taken eye drops before, it is not always that easy to handle them. Older people also often have trouble using eye drops on their own. If you are not sure that you are using the drops correctly, it is a good idea to go to your doctor’s office and have them carefully explain what you need to do. Self-help groups can also provide support here: many offer assistance in proper use of eye drops. This illustration demonstrates the best way to apply eye drops.

Can surgery, laser therapy or acupuncture help?

Glaucoma can also be treated with lasers or surgery. These treatments are an option particularly if it has not been possible to keep intraocular pressure under control by using just medicine or if the drops are not well tolerated.

Acupuncture is also sometimes used as complementary treatment for Glaucoma. The acupuncture needles are not used directly on the eye, but between the eyebrows or at other points on the body. There is not yet any scientific proof of a benefit from this treatment, however.

Trabeculectomy

Glaucoma surgery is done to lower intraocular pressure permanently. The most common procedure is called trabeculectomy, which involves cutting out a bit of the sclera (the white outer layer of the eye) and the iris in order to improve outflow of aqueous humor, thereby lowering pressure inside the eye. Possible adverse effects of this type of surgery include vision problems immediately after surgery, scarring and, over the long term, cataracts.

Laser therapy

Intraocular pressure can also be lowered by using lasers, but usually not by as much as is possible in surgery. In early stages of Glaucoma, laser therapy can improve the outflow of aqueous humor. It is also possible as supplementary therapy to eye drop treatment. In later stages a laser can sometimes be used to destroy part of the tissue producing the aqueous humor, which will lower intraocular pressure. Laser therapy can cause red or dry eyes and blurry vision immediately after treatment.

How can I cope with losing my vision and fear of sight loss?

If an examination finds high intraocular pressure, many people will feel quite nervous about it, even though their vision is still perfectly fine. Just knowing that you have high intraocular pressure, and therefore a higher risk of developing Glaucoma, may cause you to worry if you have even the slightest trouble with your vision, although it most likely has nothing to do with Glaucoma. Frequently, people with Glaucoma are very afraid to go blind at some point. Especially at the start, many people want to have detailed information on their treatment and about what implications the diagnosis has for their own life.

People whose vision continues to worsen despite treatment find themselves in a very different situation. Glaucoma-report.974.en.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri" style="margin: 0px; padding: 0px; border: 0px; font-size: 13px; font: inherit; vertical-align: baseline; color: rgb(100, 42, 143); ">People with Glaucoma report

that they find it very difficult to deal with this loss.

This means that, sooner or later, changing your daily activities to suit your new situation is inevitable. For example, you may have to rearrange things in or around your home to help give you a better orientation. It may also affect your professional life. And you might not be able to do such everyday things as sports, shopping or reading the way you used to do them. It may then be a good idea to get support and find out about different aids to make your day-to-day life a bit easier. The first place to go might be your doctor or health insurer. People who have Glaucoma also say that it helps them to get information about the condition and ways of coping with it or to talk with others who also have Glaucoma, for example in a self-help group or on an internet forum.

It is difficult for many people to realize the point at which this condition makes it impossible to drive a car safely. At first, people with Glaucoma often start making changes to their driving habits and stop driving at night or only stay on familiar streets. It is important for family and friends to be aware of this and help pay attention to when these limitations are too great, and the person possibly becomes a danger to him or herself and others. German law prohibits driving once impairment to the visual field becomes too great. Your eye doctor can give you more concrete information and advice.

It is often not easy to deal with becoming more dependent on help from others due to problems with your vision. Giving up control over some things and trusting other people might become necessary, however.

Talking over your worries and fears with family and friends early on can be a great relief. Together you can develop strategies for dealing with how your condition develops. Having people who are there for you and understand and support you can really make things easier in any circumstances – and this is especially true if you are dealing with a difficult health condition and want to continue to stay as active as you can.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

Amblyopia in Children

Fact sheet: Amblyopia in children – when one eye sees better than the other

Normally, the brain processes the information coming in from both eyes equally. This is needed for the best possible vision. In some children, however, one eye is favored by the brain because it provides a better image. If this happens, the other eye is neglected from childhood on, and it does not get the chance to develop well. This is known as Amblyopia or “lazy eye”.

Amblyopia cannot be fixed instantly by putting on prescription glasses that correct the problem. But there are different ways to help the affected eye catch up with its partner, or at least help make sure that the problem does not get worse over time. Treatment might only be needed for a few weeks, but sometimes it needs to continue for quite a long time to get the best results.

Until recently it was thought that treatment could only make a difference when children are very young. A trial has now shown, though, that Amblyopia can probably still be treated in teenagers too. This fact sheet explains what Amblyopia is and describes the treatment options.

What is Amblyopia and why has the brain chosen a favorite eye?

Amblyopia, the medical term for lazy eye, is taken from ancient Greek and literally means “dull vision”. Amblyopia is a common eye problem in childhood. In European countries like Germany, it is estimated that about 4 to 6% of children are affected (4 to 6 out of every 100). It usually does not develop after the age of 7 or 8.

Squinting often leads to Amblyopia

One main reason why Amblyopia develops is a squint (strabismus or “crossed eyes”). If a child has a squint, one of his or her eyes will look straight ahead while the other looks up, down or to the side. It is normal for babies to squint in the first few months of life. It is not completely clear why some children have squints and others do not.

If the eyes send two different images to the brain, the brain cannot combine these images to form one picture, and we see double. In order to see more clearly, the brain might then ignore the images that are coming from the weaker eye.

Most children who have a squint have Amblyopia: somewhere around 60 to 70 out of 100 children with a squint are affected by it (60 to 70%). Amblyopia is much less common in children who do not have squints: only about 2 out of 100 children who do not have a squint have Amblyopia (2%).

Other causes of Amblyopia

Another common cause of Amblyopia is refractive errors (focusing problems). These problems are the most common cause for having to wear glasses. There are 3 different kinds of refractive error:

• Near-sightedness (or short-sightedness), where the eye can only focus clearly on objects that are close

• Far-sightedness, where the eye can only focus clearly on objects that are far away

• Astigmatism, where everything that the affected eye sees looks blurred. This is usually because the lens or cornea is not shaped exactly as it needs to be to send sharp images to the brain. You can read more about the different parts of the eye and how the eye works here.

The chances of a child developing Amblyopia are higher if he or she has a refractive error in one eye and not in the other, or if one eye is far-sighted and the other is near-sighted

In rare cases Amblyopia could be caused by a certain eye disease – for example, when a cataract develops and makes the eye cloudy, or because the child has developed a droopy eyelid (called ptosis) or does not have a lens in an eye (aphakia).

How can I find out whether my child has Amblyopia?

If your child has a squint or you think he or she may have an eye problem, it is important to have it checked out by an ophthalmologist (specialist eye doctor). Difficulties recognizing objects could be a sign of Amblyopia too. For example, if your child has to hold toys and other things very close to their eyes or turn their head to one side to see them.

There are several tests that can be done to find out whether your child has Amblyopia:

• The doctor can use eye charts to see how good your child’s vision is. The exact kind of test will depend on several factors, including your child’s age. There are special tests for babies and toddlers.

• A physical check-up can be done to see whether the poor eyesight is caused by something else, like a cataract. A test can also be done to see whether your child’s eyes are aligned properly. A slight squint is not always visible to the naked eye.

• The exact refractive power of your child’s eyes can be determined using a special instrument called a retinoscope. This involves shining light into the eye and seeing how the light reflects off the retina at the back of the eye. By holding different corrective lenses in front of the light, it is possible to determine exactly how well the eye can focus.

• Once the refractive power has been determined, a further eye test can be done using an eye chart. This time the child wears glasses that correct any focusing problems he or she may have.

These tests are generally safe. People are usually given eye drops to dilate (open) their pupils before having a retinoscopy examination. The eye drops can sometimes make their eyes burn or irritate their skin.

In Germany, each child is routinely offered eye-screening tests as part of some of the health screening programs (“U-Untersuchungen”). Signs of Amblyopia or risk factors are some of the main things that the doctors will be looking for. Researchers at the German Institute for Quality and Efficiency in Health Care (IQWiG) – the publisher of this website – assessed the research on routine screening for vision problems in small children. They found that there are still many unanswered questions about this screening program. For example: which tests are best for detecting vision problems? And what is the best age at which to have these tests? We have summarized the results of their research here, including more information about research on treatment in older children.

What are the treatment options?

There are different treatments for Amblyopia, depending on the type and severity of the problem, as well as other factors. The standard treatment options are:

• Glasses to correct refractive errors.

• Occlusive therapy (eye patch): The word occlusion comes from Latin and means “closure”. In occlusive therapy the better eye is covered for several hours a day using a patch over the eye, or over one side of the glasses if the child wears glasses. The idea is to encourage the weaker eye to work harder so that vision improves in that eye.

• Medication: Eye drops that have a drug such as atropine in them are used to temporarily blur vision in the “good” eye. They relax the muscles in the eye, which means that the lens of the eye cannot focus for a few hours.

The child usually wears glasses for several weeks and then starts wearing an eye patch too. This treatment typically takes a few months, during which regular eye tests are done. If the child has poor vision due to a refractive error, he or she will have to continue wearing glasses after treatment has finished in order to see well.

If Amblyopia is caused by another problem, such as a cataract, that problem is treated first. Children who have a severe squint sometimes have surgery. This kind of surgery involves tightening or relaxing the eye muscles to correct the misalignment of the eyes so that they move parallel to each other again, as far as possible. The aim is to improve spatial vision and make the squint less obvious. This surgery generally does not have anything to do with treatment for Amblyopia. Sometimes Amblyopia gets better on its own, but it is not clear how common this is.

For a long time, it was widely believed that treatment is only successful if it is started early. However, a comparison of two small trials involving children and teenagers aged 7 to 17 showed that later treatment can probably improve eyesight too. Vision problems can get worse and become permanent if Amblyopia is not treated.

Which treatments can improve vision?

Researchers from the Cochrane Collaboration – an international network of researchers – analyzed the trials testing different treatments for Amblyopia. They found that there is hardly any research on treatments for Amblyopia caused by a squint. Still, there is some evidence that wearing glasses and an eye patch could improve children’s vision more than wearing glasses alone.

Wearing an eye patch as well as glasses has been shown to improve the vision of children who have one amblyopic (“lazy”) eye and whose eyes have different refractive powers. Generally speaking, they only have to wear the eye patch for 2 to 6 hours a day, depending on how poor their eyesight is. Sometimes wearing glasses is enough and no eye patch is needed.

Some people worry that patching could make the healthy eye weaker, because it is used less during the treatment. But this has not been shown to be a problem in the trials that have tested eye patching treatment for Amblyopia. Eye patches can irritate some children’s skin, however.

Two trials compared eye patches with drug therapy, where eye drops are used once a day to numb the muscles of the healthy eye. The lens is then no longer able to focus for some time. These trials showed that the results of both treatments did not vary much.

Eye drops can have adverse effects like sensitivity to light or burning eyes. Sometimes treatment with eye drops leads to the child not being able to see quite as well with the healthy eye for some time after the treatment. In the trials this effect was only temporary. Drug treatment can be an option especially for children who find it difficult to wear an eye patch.

Sometimes children are encouraged to train the affected eye by doing activities like drawing or making things while wearing the eye patch. In a recent trial, this was not shown to lead to a greater improvement in vision in most children. However, it cannot be ruled out that children who have a very “lazy” eye could benefit from such activities.

Whether or not the treatment will work depends on many factors, and cannot be predicted for individual people. For example, the child’s age, the time of treatment and the type and severity of the Amblyopia could influence how successful treatment is. It can take quite a long time until treatment shows some benefit, and that can be very frustrating for the child and their parents.

What can I do to help my child?

Most children do not have any problems wearing their eye patch in everyday life. But some find it hard to wear it as much as they are meant to. There are several reasons for this. For instance, they can only see with their weaker eye if their “good” eye is covered up, so they cannot see as well as usual during treatment, which may cause problems when they are playing or doing school work. They may also be teased about their eye patch in kindergarten or at school, or by their friends and siblings.

Children who have to wear their eye patch for longer may feel more self-conscious than children who only have to wear it for a few hours a day, so you can talk to the doctor to find out what is the least amount of time to improve your child’s vision. Parents use different strategies to try to help their child cope with a patch. Some find it helpful to make sure their child understands why the patch is important, or carefully explain the results of eye tests to show that the eye is really getting stronger.

Children like to know that they are “normal”. Some parents have reported that doing things like putting eye patches on toys – or even wearing patches themselves – helps make eye patches “normal”.

Some parents find it helpful to also use praise or small gifts to encourage their child to wear the patch, while other parents find it better to not make a big deal out of it.

The patches can be unattractive or boring. Some children like it better if they can cover up their glasses with something more interesting that they choose themselves. And as with so many things, having a regular daily routine with wearing the patch can be important to children. And the good news is that in a few months’ time this ritual will most likely be a thing of the past.

To visit the original article click here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015942/

German Institute for Quality and Efficiency in Health Care (IQWiG).

Created: May 29, 2009; Last Update: September 26, 2011.