Fouad Melamed, OD Los Angeles Eye Doctor

Glaucoma is not just one disease that affects the eye, but rather, a group of diseases. The one common factor is the damage to the optic nerve. It is this damage that leads to impaired vision or even blindness. Glaucoma is one of the leading causes of blindness.

In the early stages of glaucoma there are almost no warning signs. Glaucomatous damage first steals the far peripheral vision, thus explaining why most patients with the early disease have no symptoms. For roughly half the patients diagnosed with glaucoma the disease is discovered on a routine eye examination. Early diagnosis and treatment is essential to saving vision. An example of the view of the glaucoma patient is depicted on the right.

In the early days of glaucoma research, it was thought that the rising intraocular pressure caused the optic nerve damage. As treatments and research have progressed over the years it is understood that this is only part of the problem. Increased intraocular pressure a known risk factor, but there are other issues involved too.

Glaucoma that affects adults’ falls into two broad categories: open angle glaucoma and closed angle glaucoma. Open angle glaucoma is the most common form and also the easiest to treat. Angle closure glaucoma is a more devastating disease, because of its fast progression, but thankfully it only affects 5% of glaucoma cases in the U.S.

In glaucoma, the pressure of the inside of the eye is too high for that specific patient and causes damage to the optic never. So there is nothing for the patient to notice externally. This is a completely different mechanism than tears. Tears are actually produced outside of the eyeball. The process is gradual and most patients have no symptoms in the early stages when treatment is the most successful at vision retention.

The good news is because it is a gradual process; regular eye exams will detect the disease early. This form of glaucoma usually responds very well to medication. Optic nerve damage can be usually stopped as the intraocular pressure decreases. Patients will need to be diligent about using their glaucoma drops and having regular eye exams to ensure that the pressure in the eye remains normal.

Closed angle glaucoma is much less common than open angle glaucoma.  The iris of the eye is not as open as it should be and as it closes or bunches up at the edges the drainage system of the eye gets clogged. When this happens the intraocular pressure increases rapidly. Surgery will be done to increase the opening of the iris. This will allow the fluid to drain again. Although yearly exams are still needed to monitor the pressure, reoccurrence of increased pressure is rare.

Normal tension glaucoma is a bit of a mystery. This type of glaucoma causes nerve damage even though the pressure in the eye is normal. While the cause is poorly understood, treatment involves the use of eye drops to keep the pressures as low as possible. People that have a family history of normal tension glaucoma need to be diligent about yearly eye exams.

Risk factors for glaucoma include being over age 40.  African Americans are at the highest risk than the general population to develop glaucoma. Older Hispanic populations are also at an increased risk for developing glaucoma. Interestingly, patients with sleep apnea are also at higher risk. Researchers are recently coming out with results of nutritional supplements that can possible reduce the risks of glaucoma. Finals results have not yet been published.

Even if you are not in a high risk group, yearly eye examinations are essential. Early detection and early treatment is the cornerstone to preserving eye sight where this insidious disease is concerned. The tests are a painless part of a thorough yearly eye examination.

Hordeolum is the medical term for a stye (sometimes spelled sty- both are correct). Hordeolum treatment can be very simple or invasive depending upon the extent of the stye. Anyone who has had a stye will tell you for such a little bump, the pain can be intense.

Hordeolum (or hordeola if there is more than one) is caused by the Staphylococcus aureus bacteria in fully 90 per cent of cases. Unfortunately, MRSA or methicillin-resistant Staphylococcus aureus can also be the causative agent in some cases of styes. Hordeolum can be more than just a minor irritation so if there are any questions as to the severity of the stye call your eye care professional immediately.

Hordeolum generally occur in one of two places. Those that are along the eyelash line are called external hordeolum. Those that occur under the eyelid are referred to as internal hordeolum. Both are a result of an impacted oil gland which then gives the bacteria a place to grow.

The hordeolum will begin as a reddened and swollen area on the eye lid or below the eye. As the pressure builds from the bacteria and the growing accumulation of white cells a bump will appear. As it matures it will develop a whitish yellow spot called the point. This is where the stye will rupture allowing the purulent material or pus to escape.

If the point is on the inside of the eye lid, every time the eye is blinked it can cause a scratching sensation. As the stye grows, just the mass itself will cause discomfort. Plus as the hordeolum grows it looks painful and infected, which it is. The eye may also become sensitive to light and water frequently.

During an examination the optometrist or eye doctor can evaluate the status of the hordeolum and prescribe the necessary course of treatment. Most of the time, topical antibiotic drops will not enter the eyelid where the hordeolum presides. Therefore, at times, oral antibiotics are given to treat the infection with topical drops to prevent any secondary infection of the eyeball itself.  Be sure to finish all antibiotics as prescribed.

Occasionally, surgical intervention will need to take place. This will be done under a local anesthetic unless the patient is a young child who will need sedation for the procedure. The area will be anesthetized and a very small stab wound will be made to allow the purulent material to be released.

If the stye is along the lashes care will be taken to not interrupt eye lash growth. Internal hordeolum stab wounds will be made inside the lid if possible for the best cosmetic affect. Usually, external stab wounds can be made in naturally occurring skin folds to provide for excellent cosmesis.

The cause of hordeolum is not well understood but there are a few precautions that can help reduce risks. Never share eye makeup with anyone. Any eye care products that are suspected of contamination should be discarded. Eye make-up and eye care solutions have a shelf life once opened. Do not keep these products indefinitely. Always wash hands thoroughly before working with the eyes. A diet full omega-3s, such as fish oil or flax oil will also help. Patients with recurrent styes can be put on prescription omega-3 dosage to prevent future outbreaks.

Diabetics are more prone to stye formation, as are people that have chronic inflammation of the eye lids. Stress also seems to be a causative factor in some patients. High blood lipids also seem to predispose some people to stye development.

Contact lenses should generally not be worn while there is a hordeolum present, unless ok’ed by your eye doctor. If the patient wears contacts and a stye develops, remove the contact lens, and call your eye care professional immediately for instructions. Never pinch or squeeze a stye to speed the rupture process. This can damage the delicate tissue around the eye.

Complications from a hordeolum are rare but they do occur. A chalazion is the most common complication. This is a cyst that forms in the oil gland where the stye occurred. Hordeolums seem very small and simple, but should be checked out by an optometrist for treatment, whether it is warm compresses, oral antiobiotics and/or topical antiobiotics drops. They can help you with symptomatic relief and complication prevention. You can find out more at http://melamedeyecare.com

Fouad Melamed, O.D.

Many of my patients ask if dietary supplements can help in the health of their vision and eyes. Here is a list of the foods with nutrients helpful for a healthy eye. Keep in mind that the following nutrients are important to the health of the eyes but will not change the status of any refractive error one may have (nearsightedness, farsightness, presbyopia . . ).

Punctal plugs are a very effective treatment for dry eyes, when other treatments have been less than effective. Dry eyes can be more than a minor inconvenience for patients. It can be very painful.

Punctal plugs are not generally a first line treatment for dry eyes. Your eye care professional will need to make a definitive diagnosis first. Then other treatments may be tried to evaluate your response.

If these other treatments aren’t giving you the relief you need, you may be a candidate for punctual plugs. Here is how they work. Your eyes have lacrimal glands that produce the liquid or “tears” that bath the eye. Tears keep the eyes moist and help rid the eye of small particles of dust, dirt and pollutants.

These tears normally exit the eye through the tear ducts that are located in the upper and lower lids of the eyes at the bridge of the nose. You can see the puncta or openings on the inside of the lids. A small portion of tears are lost to evaporation also.

Punctal plugs are placed in these tear duct openings to keep the tears in the eyes. This dramatically decreases the amount of tears lost due to drainage. Increasing the amount of tears in the eyes and thus the lubrication will make the eye feel better.

Punctal plug insertion generally involves two different insertion procedures. The first insertion will be temporary plugs. This temporary plug will allow your doctor to evaluate how well this procedure is going to work for you. Occasionally, patients will have excessive tearing of the eyes when the puncta are plugged.

These temporary plugs will generally last 10 days to a few months. This is enough time for both you and your doctor to evaluate the effectiveness of punctal plugs for you. Punctal plugs are easily inserted and can easily be removed if necessary in your doctor’s office.

Your eye will first be numbed with an eye drop. Then the punctal plug will gently be inserted in the puncta using a sterile instrument. The procedure takes about a minute to perform. Your doctor will discuss with you prior to the procedure which type of plugs will be inserted. Upper and lower tear ducts can be plugged in this manner. Your doctor may elect to do just the lower ducts, or all four may be plugged.

Patients generally have no discomfort with this procedure and tolerate the plugs well. Plugs are tiny and not visible to others.  Although the plugs are designed to be permanent, plugs do come out on occasion. Your Los Angeles eye doctor can insert another plug if this happens.

If you are bothered by dry eyes, be sure to discuss punctal plugs with your eye care professional. If your Los Angeles eye doctor does not put them in, a referral can be made to an eye care professional that places punctal plugs. Comfort can be one small procedure away.

Treatment of dry eyes in Los Angles is basically the same, regardless of which Los Angeles Eye Doctor you visit. Treatment will range from things as simple as eye drops, to a slight proceduresto correct the problem. As we discuss these options, though, it is important for you to realize that you need the counsel of a dry eye optometrist, prior to undergoing any treatment for your dry eyes.

Artificial tear drops and ointments.  The first plan of attack would be to use some tear drops for your eyes. This is an over the counter remedy.  This is a safe and effective way to keep the eye lubricated.  If you suffer from chronic dry eyes, then you will be using these a lot. Even when you are not experiencing the symptoms of dry eyes, you will keep those symptoms under control with a product like artificial tears for the eyes.  Ointments can also be used to help keep the eyes moist during periods of rest, when you are not necessarily “up and at it” to be putting tears in your eyes. The type and amount of lubricating drops should be discussed with your eye doctor after an appropriate dry eye work up is performed.

Temporary punctal occlusion.  Another effective treatment involves temporarily closing off the ducts that drain tears from your eyes.  A more permanent solution is possible, but this temporary solution is always used first, to see if plugging the duct can help keep enough moisture in the eyes to solve the dry eyes problem. The temporary plug dissolves in a couple of days. It will involve a couple of visits to your Los Angeles eye doctor.

Permanent punctal occlusion. As we have already mentioned, a permanent plug can be inserted in the tear duct. But this is only done after trying a temporary plug out. Patients typically do well with the plug, and do well over time. On occasion, the plug can come out. On great occasion, the plugs will migrate down the duct as well. These conditions would obviously need to be treated by a Los Angeles Optometrist. The plugs are typically made of silicon, and can be quite comfortable.  This treatment can really help reduce the need for ongoing artificial tear therapy.

Restasis. In 2002, the FDA approved the prescription eye drop Restasis for the treatment of chronic dry eye. It is currently the only prescription eye drop that helps your eyes increase their own tear production with continued use. I have included a link for you to use to get more information on Restasis.  Other medications, like topical steroids, can also be used in some instances.

Surgery. If needed, the ducts that drain tears  can be closed for good. This surgical procedure allows more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery.  Patients typically have a very quick recovery also. This is a kind of last step procedure for chronic dry eyes.

Well, there you have it. We have reviewed the treatment of dry eyes in Los Angeles, and given you some options. If you still have more questions, I invite you to contact me at  Melamed Eye Care. We are always glad to help.

Fouad Melamed O.D.

You may want to know more about what causes dry eyes in Los Angeles. This is a pick up from my last blog on dry eye syndrome. Apart from the natural irritants that come with living in a big city like Los Angeles, you might also experience issues with dry eyes from some of the following conditions as well.

Air conditioning can be a contributing factor to dry eye  syndrome. The constant flow of cooler air is designed to work by removing humidity. This can cause an imbalance in the amount of tears produced.  Heating can also cause the same issue.

For women, the natural aging process can also cause  problems with dry eyes. Menopausal women can experience issues with the production of tears, which is related to the change in hormones in the body.  Taking birth control pills, for some patients, can also cause the natural balance of tear production to be interrupted. Other medications such as anti-anxiety medications also are known to cause lower tear production. Your Los Angeles eye doctor can discuss these issues with you, and provide some possible treatment options.

In the larger population, rheumatoid arthritis is known to cause dry eyes. Less common conditions like collagen vascular disease and Siogren’s syndrome can produce  problems with the body’s natural ability to produce tears. These types of issues require the help of a Los Angeles Optometrist.

The question of what causes dry eyes in Los Angeles can be more complex than one might first think. If you live in the Los Angeles area, and would like the chance to have your dry eye condition evaluated by a Los Angeles eye doctor, you can get a consultation appointment by using the following link Los Angeles Optometrist.

Here’s to the health of your eyes in Los Angeles, or anywhere you go.

Fouad Melamed, O.D.

I live in the Los Angeles area, and I treat a lot of patients for dry eyes. Dry eye syndrome in Los Angeles is a very common problem. Put basically, it is a condition whereby the surface of the eye does not have enough moisture.  People who suffer from dry eye syndrome in Los Angeles can have problems ranging from minor, but constant, irritation to chronic inflammation of the anterior (front) tissues of the eyes. Having a good Los Angeles eye doctor can help you with the problem.

The medical term for dry eyes is keratitis sicca. It refers to the fact that some people develop a tendancy to produce less, or no, tears for moisture. Keratoconjuctivitis sicca refers to a dry eye condition that ends up affecting the cornea and conjunctiva. 

So, what are the symptoms of dry eyes? You may have a problem with dry eyes if you have persistent dryness in your eyes, and/or a persistent scratching and burning sensation. Often, people will have tried liquid tears to no complete effect.  Another symptom of dry eyes can be a nagging and persistent feeling of having a foreign body in the eye.

Dry eye syndrome in Los Angeles can be affected by our climate, our issues with the environment, and our issues with pollutants in the air. We live in a big city, and there are inherent issues like pollution, allergens, etc., that we live with. Whatever the case, dry eyes need to be treated by a competent Los Angeles eye doctor.

Are you suffering from World Cup blurry vision?  No,  I don’t mean the kind you get from watching too much World Cup Soccer, if that’s possible. What I am talking about is blurry vision that comes from your eyes losing that perfect 20/20 vison over time.

As we get older, suffer from certain diseases like diabetes, etc., we can slowly lose our 20/20 vision. Even our genetics can  play a role. The problem is, we may not notice right away, until we find ourselves starring at a blurry television screen, or perhaps notice we are getting more headaches than normal. The process can be slow.

Even when we are watching sporting events in the outdoors, we can suffer from blurry vision. The numbers on the uniforms get harder to read. We can’t keep up with the action. All of these things are signs that it is time to get your eyes checked.

Blurry vision may be corrected with  simple  solutions like glasses or contact lenses.  Getting your eyes checked by a qualified Optometrist can fix this problem quickly. But they can’t help if you don’t go in to have your eyes checked, at least once a year.

On a different note, your blurry vision could be a sign of something much worse.  There could be problems with your eyes  that require more in depth medical care.  Again, the problem cannot be corrected by staying at home and starring at the television.

World Cup blurry vision is bad. Missing your chidren’s soccer game, due to poor vision is even worse. Life is too short not to enjoy the best vision possible. Go see an eye doctor. If you live in the the Los Angeles, California area, and need an LA eye doctor, I would be pleased to help you with your blurry vision problem.  For more information, you can call 323-655-6582, or check out our website to make an appointment at Melamedeyecare.

Fouad Melamed, O.D.

With the coming of summer it is time to stress protection from the sun’s rays. While skin cancers and their prevention receive a large amount of attention, it is also just as important to protect your eyes from the sun. This is not to minimize the need for skin protection but rather to add eye protection to your summer routines.

Our sun emits powerful ultraviolet rays along with the visible light that we see and the heat that we feel. These ultraviolet rays can cause eye damage in several forms. Certain cataracts are thought to be formed when the eye is exposed to UV light. Cataracts are a clouding of the normally clear lens that covers the pupil of the eye. This cloudiness can drastically decrease vision.

Another form of eye damage is pterygium. This is a fibrovascular proliferation or overgrowth of cells. The pterygium grows from the corner of the eye closest to the nose and then over the lens. While the cause is not certain, the main culprits seem to be sand, dust, wind and exposure to UV rays from the sun. The thought is that as the sunlight passes through the cornea it is focused on the white of the eye or the sclera closest to the nose. It is this concentrated damage that may cause the pterygium to form.

Pingueculae is another growth that forms in the whites of the eye. These are usually small yellowish growths that generally cause few problems. However, some people feel like there is something in their eye with these growths or scratchy eyes.

Macular degeneration is the leading cause of blindness in older populations. While exposure to UV rays has not been proven to be a causative factor in developing macular degeneration, there is some thought that frequent unprotected exposure to the sun can be a contributing factor.  Smoking, hypertension, obesity, family history and a sedentary lifestyle are also thought to be culprits in this devastating affliction.

Intraocular melanoma may have a link to unprotected exposure of the eyes to the sun or tanning beds. Although the connection has not been proven, there is still sufficient concern, and precautions should be taken. Skin cancers of the eye lid and around the eye do have a direct connection to sun exposure. These areas are often under protected when sun screen is applied.

How can you protect your eyes from the harmful rays of the sun? Good sunglasses are a must for starters. If you are unsure of how good your sunglasses are, take them to your eye care professional. They can let you know how effective they will be at blocking the UV rays. If you are pretty sure you bought your sunglasses based on looks rather than effectiveness, it may be time for a new pair. There are great looking sun glasses that also block 99-100% of UV rays.

In addition to blocking UV rays, (both UV-A and UV-B) the sunglasses need to block out at least 80% of visible light. If you are out in the sun frequently, you should consider wrap around lenses. These will block out the sunlight from all portions of your eye. Don’t forget to get proper sunglasses for your kids. The effect of the sun on the eye is cumulative. This means the more eye protection you have over the course of your life; the less likely you will be to develop sun related issues.

In addition to good sunglasses, a wide brimmed hat can also block a large amount of the sun from reaching your eyes. Interestingly, while you may be tempted to take your sunglasses off in the shade, you may still need to wear them to protect your eyes from reflected light. The lesson here is leave all your protective gear on until it is too dark to see with them on or you are totally out of the suns rays.

If you have any questions about any possible eye damage from the sun, make an appointment to see your eye care professional. Your eye care professional has special training to see damage at a very early stage. This is the best time to catch a problem and receive treatment if needed. Simple changes at an early stage can have big payoffs in the long run.  Don’t forget to wear your sunglasses anytime you are out in the sun regardless of the season.

Recent studies have some very positive news to report regarding diabetes and vision. Today’s diabetics can expect to have better vision than those people who were diagnosed in the late 1960’s. There have been significant strides made in finding optimal ways to control blood sugars and in treatment of diabetic eye disorders as they occur.

Each decade that has passed since 1970 has found fewer diabetic eye complications. This is strictly due to the increased diligence of keeping blood sugars at a lower level to prevent eye tissue damage and yearly eye exams to monitor even minute changes in the eye.

The decreased levels of diabetic eye complications are certainly great news for all those who have diabetes or those who will have the disease. If you have diabetes, the evidence is clear. Keeping your sugars under tight control is crucial as is keeping your yearly appointment to have your eyes examined.

In today’s busy world it is easy to let that eye appointment slip by. It can be a bit of a bother to find someone to drive you home after you have your eye dilated. However, the diabetic eye exam is so important in finding early diabetic changes in the eye. It is at this early stage in the progression of the disease that treatment can be the most effective.

New progressive treatments and therapies for diabetic eye complications are decreasing the number of diabetic eye visual impairments. Laser therapy and steroid injections are just two of the treatments that have helped to decrease visual loss from diabetic retinopathy.

So what can you expect at your yearly eye exam? Your eye care professional will check your visual acuity with the eye chart. Then there will be a general inspection of your eye to get a feel for the overall health of your eye. Some general questions will be asked about any vision problems, any eye discomfort you might be having. Your eyes will also be checked for glaucoma and cataracts.

Your eye care professional will then do the dilated exam. Drops will be placed in your eyes to dilate the iris or colored part of the eye. This will allow a thorough examination of the back of the eye. While cursory exams of the eyes are done before the dilating drops are inserted, it is this part of the exam that will really let your doctor check the health of your eye.

It is this part of the exam that is so important for not only diabetics but other patients as well. Your doctor will check for any damage or changes that are out of the ordinary.

After the dilated exam your eyes will be sensitive to light for several hours and focusing on objects will be very difficult initially. Be sure to bring sun glasses with you to your visit as well as someone to drive you home. The inconvenience of having your eyes dilated will last for a few hours as compared to the health benefits, which will last for your lifetime. This is one essential examination you can’t afford to miss.