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Eye Problems and Down’s Syndrome

Down’s syndrome is a condition in which chromosome 21 is duplicated, resulting in three copies rather than just two. It is associated with intellectual, developmental, and physical changes.

The eyes are one component and there are a variety of conditions that individuals diagnosed with Down syndrome may be affected by or more susceptible to. Read on to learn about some of the most common ocular findings.

 

Refractive Error and Glasses

This refers to an individual’s prescription in corrective eyewear such as glasses or contact lenses in order to see as clearly as possible. Patients with Down syndrome are more likely to need corrective eyewear whether for nearsightedness, farsightedness, or astigmatism.

 

Strabismus is a Common Feature in Down Syndrome

Strabismus refers to an eye turn that the individual may have. This could be one eye turning in and out, or both eyes turning and switching back and forth. It could also be present at all times or only at some points in the day and associated with certain activities.

An eye more often turns inward, but in either case amblyopia or lazy eye may develop. This means that because the turned eye is not being used as frequently, it will not receive as much visual stimuli and its pathways to the brain will not fully develop, leading to permanent vision reduction in that eye if the eye turn is not fixed in childhood.

 

Down’s Syndrome Can Cause Keratoconus

At the very front of the eye is the clear cornea, which is thinned in this condition, causing the fluid from inside the eye to push outwards. This causes the cornea to bulge outwards into a cone shape and distorts the curvature, affecting vision. This condition has been shown to be associated with eye rubbing and our optometrist will check to make sure that there are no underlying causes inducing this.

Cataracts

A cataract refers to the clouding of the lens within the eye, causing blurry vision or a spot in vision. If noted, our optometrist will assess to see how severe the cataract is and, if needed, refer the patient to receive surgical treatment to replace the lens. Patients with Down syndrome are at higher risk for either congenital cataracts (present at birth) or developing cataracts as they age earlier than the general population.

Glaucoma

This is a group of disorders that refer to the death of the nerve cells at the back of the eye, which are responsible for providing peripheral vision. This is often associated with higher eye pressure but this is not the only variable.

Treatment includes eye drops, instilled everyday, to lower eye pressure or certain laser procedures that help with outflow of the fluid within the eye to lower the pressure. Individuals with Down syndrome are at higher risk for higher eye pressures and glaucoma.

Blepharitis

This is a condition that leads to inflammation of the eyelids and the glands within them. It is often associated with a dry or burning feeling in the eyes and redness. Eyelid hygiene is an important component for this condition and it can be treated with eyelid cleaning, warm compresses, steroids, or antibiotics.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how Down’s syndrome can affect the eyes.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

How Pregnancy Can Affect Your Eyes

In addition to the many other bodily changes taking place during pregnancy, a mom-to-be can also have changes in the eyes. These are usually transient and go back to normal after the pregnancy, but it is wise to keep a close watch on them with an eye examination if changes to vision are occurring. This article will outline some of these possible changes.

Your Glasses Prescription May Change When Pregnant

It is common for the mother to experience blurry vision due to a change in her refractive error, which can also be understood as a change in her degree of nearsightedness, farsightedness, or astigmatism as measured in her glasses prescription.

This is due to increased fluid retention throughout the body during pregnancy, including within the eye. One location for this is within the cornea, the clear front surface of the eye, causing a change in its thickness and curvature. It can also occur in the natural lens within the eye as well.

This would in turn alter the prescription needed to allow one to see clearly. This change is temporary and will likely return to normal after delivery.

It is common that our optometrist will wait six to nine weeks after delivery to update your prescription for glasses or contact lenses.

 

Gestational Diabetes Can Occur During Pregnancy

During pregnancy, women can develop gestational diabetes, defined as an increase of glucose in the blood during pregnancy that usually resolves after delivery.

Diabetes on its own can have detrimental effects to the health of the eyes in addition to the rest of the body if it is not well controlled for long periods of time.

Gestational diabetes usually does not get bad enough to cause these changes or symptoms, but it may exacerbate pre-existing diabetes by making blood sugar more difficult to control and regulate.

Other risk factors for diabetic retinopathy include coexisting hypertension, preeclampsia, greater severity and duration of diabetes, etc.

If you have an eye examination during your pregnancy, our eye doctor will find anything out of the ordinary if it is present and manage it accordingly or inform your other doctors of the changes.

Dry Eyes May Also Worsen

As mentioned previously, fluid can accumulate in the cornea during pregnancy, causing a decrease in sensitivity at the front of the eye.

The eyes are thus less responsive to debris or dryness in the eyes, exacerbating the effects of dry eyes due to a lack of activation of the body’s defense responses like tearing.

In addition, pregnancy and its associated hormonal changes disrupt the cells that are responsible for creating the watery fluid that makes up the tear layer.

This is key as it helps keep the eye moisturized, nourished, and healthy overall. Common symptoms of dry eye disease include a gritty, burning feeling and are often transient as well.

Mild dry eyes experienced during pregnancy can be managed with interventions like artificial tears and hot compresses, but there is a lot that can be done if the signs and symptoms are more intense and pose a risk of eye damage. 

Contact lens intolerance may also be experienced, secondary to symptoms associated with dry eye disease. For this reason, it is common to wait six to nine weeks after delivery to get fitted for contact lenses again.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about more ways pregnancy can affect your eyes.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

The Causes and Treatments of Uveitis

If you have ever visited an eye doctor for light sensitive and sore eyes, you may have been diagnosed with uveitis, prescribed various medications for treatment, and possibly undergone laboratory testing to find an underlying systemic cause, if present. You may have visited the optometrist several times during the course of your treatment. Uveitis is common and can be caused by various factors. This article explains classifications, causes, and treatment of uveitis.

The Types of Uveitis

Uveitis means inflammation of the uvea, the vascular layer of the eye that houses the iris (colored portion), ciliary body (focusing muscle and fluid producer), and choroid (full of blood vessels). This inflammation results from an immune reaction carried out by the body inside these tissues, where immune cells and other mediators cause swelling and pain.

Swelling is what causes the extreme light sensitivity commonly reported in certain types of uveitis. The iris houses the pupil, the dark hole in its center, which the iris is causing to constantly increase or decrease in size in response to light and other stimuli.

If the iris becomes inflamed and swollen, these movements will cause great pain, just like moving a broken arm would. If uveitis is located further back in the eye and is not affecting the iris, there may be minimal pain but reduced vision because of inflammatory cells affecting structures needed for seeing and causing cloudiness of the fluids inside the eye.

Uveitis is classified through several means and there are many forms. It can be taking place in just one part of the uvea, at the front, middle, or back, or all of them at once. It can happen just once or recur several times. It might last days to weeks or become chronic for months.

What Causes Uveitis to Ocurr?

Uveitis might have an autoimmune cause, where the body attacks its own cells because it recognizes them as foreign and hostile tissue. It might also be caused by infections, trauma, or, rarely, cancer.

Usually, however, a uveitic episode has no identifiable cause, and if it is not severe or does not recur, no further testing will be done to look into it. Uveitis with an unknown cause that is localized to the iris is the most common type of all.

 

How Do We Treat Uveitis?

Uveitis is treated by reducing the inflammatory response within the eye, as this inflammation can lead to other problems if left alone. This reduction in inflammation is usually brought about with antiinflammatory corticosteroid eye drops, dosed every hour or two to rapidly calm down the immune response.

If severe or located at the back of the uvea, oral or injected steroids might be needed. After the uveitis is nearly gone, the frequency of taking these drops will be decreased very slowly so that the uveitis does not suddenly flare up again. For this reason, it is vital to follow our eye doctor’s instructions exactly.

In addition to the steroid drops, our optometrist will likely prescribe drops to make your pupils bigger, which will stop the iris moving in response to light and reduce the amount of immune cells entering the eye. This will decrease pain, speed healing, and prevent the inflammation from damaging other parts of the eyes.

If there is a clear underlying cause of the uveitis, such as an infection in the eye, that underlying cause will be treated by our eye doctor or referred as necessary to the appropriate medical provider.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about uveitis.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

When Should My Child Get an Eye Exam?

There are many recommended health care appointments for children, and a comprehensive eye examination with an eye doctor is an important part of these. It may be confusing as to when you should bring your child for an eye examination and what can be done at each age.

This article will explore expert recommended guidelines for children’s eye examination intervals and what to expect from these appointments. In addition, the information here may be different if our optometrist finds certain conditions that they want to watch more closely.

0 – 2 Years: One Eye Examination Between 6 – 12 Months of Age

Although young and unable to do a typical eye examination, infants are able to have their eyes examined for various entities that can affect their development. After birth, hospital staff check for basic eye functioning and any noticeable diseases, like infections or the media of the eyes not being clear.

Our optometrist can check the eyes again between 6 – 12 months of age, where they are doing simple objective tests to check again for opacities in the eyes, glasses prescriptions that are outside of normal levels and can impact development, eye turns that require prompt treatment, etc.

These are short appointments that can do a great deal for a child if an issue is found.

 

3 – 5 Years: At Least One Eye Exam Between 3 – 5 Years of Age

As the child grows older, a more thorough eye examination is possible that can more precisely determine variables like the glasses prescription, which can be increasingly important as the child begins school.

This can be quite important as changes in the eyes that are not likely to be noticed by parents, like different refractive errors between the two eyes, can lead to amblyopia, or “lazy eye.” Amblyopia results when an eye does not have a clear image during the childhood years until age 9, causing the brain to not develop proper connections to that eye.

If the problem is corrected before age 9, proper function can develop, but if correction occurs afterwards, then there may be residual lack of vision in that eye.

 

6 – 18 Years: Once Before First Grade Then Annually Thereafter

As kids grow older into school, sports, and other activities, closely looking after their vision remains important. Even once we are beyond the ages where amblyopia could be a problem, optional correction of refractive error is important to optimize learning.

Treatment of errors in how the eyes focus, and how they work and move together, are also important for school and, especially, homework. Contact lenses may become important for sports and other extracurriculars like performances.

If a child is nearsighted, methods exist to reduce the rate that their prescription grows, leading to a smaller prescription overall when they finish growing.

Parents sometimes believe that if there is an issue with their child’s vision, they will be able to see it themselves, and put off routine eye care for their kids.

On the other hand, when an issue is found in an eye examination that was not previously known about, some parents blame themselves for not bringing their children in sooner. The best way to avoid this feeling, and to maintain the eye health of our kids, is to just simply get their eyes examined at proper intervals.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to set up an eye exam for your child.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, Montrose, East Downtown, and Southside Commons (Southside Place) vicinities of Houston, Texas.

How Do Your Eyes Work?

Have you ever wondered how your eyes actually see? It is an incredibly complex and intricate process that allows light rays to contact your eyes and transmit signals to the brain in an instant.

Beyond simply getting through all the structures of the eye and being properly focused on the back of the eye, the retina, these signals must then be propagated throughout the entire length of the brain to be processed at the very back of the brain and skull and fed into many other brain areas. Read on to learn more about this process.

Front to Back of Your Eye

Light rays first contact the transparent tear film and cornea at the front of the eye. These structures bend or refract the light for the first time as it enters the eye. It proceeds through the aqueous humour, a watery substance surrounding the colored iris, and is refracted further as it transmits through the natural lens behind the iris.

It carries on through the gel-like vitreous humor near the back of the eye before contacting photoreceptor cells near the most outer layer of the retina at the back of the eye.

These photoreceptor cells finally change these light signals into electrochemical signals that are then transmitted forward through the retina along various cell types.

At the front edge of the retina, ganglion cells transmit the signals along their nerve lengths which run from the eyes back into the middle of the brain. These are cells with very long nerves attached to them, similar to cells in the spinal cord with long lengths to transmit signals throughout the body.

In the eye, the visual signals travel along the ganglion cells as they join together in the optic nerve as they exit the eye.

 

From Your Eye to Your Brain

The optic nerve from each eye runs backwards from the eye and joins together with the other optic nerve near the front of the brain. At this point, some fibers cross over from each nerve to the other, meaning that some visual information from each eye is actually processed on the complete other side of the brain.

All of these nerves run further back and come to the thalamus, a sensory relay station for the entire brain. They connect with new cells that begin processing of the visual information being received, and these cells in turn pass the signal further back.

Nerve fibers then run primarily through other parts of the brain until they reach the primary visual cortex near the extreme backwards edge of the brain and skull. At this point, information from each eye is processed together for the first time.

 

How the Brain Processes What the Eye Sees

Depending on the type of visual information reaching the primary visual cortex, it is then sent to different areas of the brain for final processing. For example, highly detailed or color oriented information is sent to the temporal lobe of the brain for form information processing.

Spatial or motion oriented information might be sent to the parietal lobe. There is also feedback to previous points in the visual pathway like the thalamus to determine how further visual information is filtered and stored.

All of this occurs in an instant to provide us with incredible amounts of visual information about our world, and it is a process that is still under study.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how your eyes see and work to provide information to your brain.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services and eye exams in the Midtown, Downtown, Museum District, and Southside Commons (Southside Place) vicinities of Houston, Texas.

 

Glaucoma and Eye Pressure Testing

One of the most common tests completed at the optometry office is the Non-Contact Tonometer (NCT), more often known as the “air puff test” or “glaucoma test”. To many patients, it is a mystery what this test is truly measuring but here is a quick run-down of the purpose of this test and its importance. 

 

Eye Pressure and Glaucoma

At your eye exam, our optometrist will often want to keep a record of your eye pressure, which is the pressure exerted in the eye from the fluids acting within/ around it. The importance of this measure is that, like other parts of the body, it is important to maintain a normal value. 

Eye pressure can have small fluctuations in the short term due to a variety of factors (i.e. body posture, exercise, eye movement, time of day) that do not have a detrimental effect on the body. The most important change that your optometrist would find significant would be a large increase or decrease in eye pressure. Low pressure could indicate leakage of internal fluid or intraocular inflammation. A pressure that is too high could indicate changes in blood pressure, disease, or injury. High IOP is also a strong risk factor for glaucoma, a disease that can decrease the size of your visual world slowly without your awareness.  

 

There are a variety of ways that your eye pressure can be measured: 

 

Indentation Tonometry

This refers to a method of indenting a small area on the cornea, the front surface of the eye. The amount of force needed to indent a specific amount of the cornea is measured, but this technique is rarely done today.

 

Applanation Tonometry

This method uses a force (air or physical pushing) to applanate (or flatten) a specific small area of the cornea. The force and area flattened is measured and used to determine the pressure. 

The Goldmann Applanation Tonometer, Perkins Tonometer, Tonopen and i-Care are all instruments that utilize a probe to physically push into the cornea a small depth. Our optometrist will be looking to see how much pressure needs to be exerted on the front surface in order to flatten the cornea a specific amount. Our optometrist may instill an eye drop prior to the procedure to numb the eye so you will not feel any sensation of the probe. This also does not affect the health of the eye.

The Non-Contact Computerized Tonometer is commonly used for assessing eye pressures. This is an automated test that produces a puff of air that flattens the cornea. The value that is measured is the amount of time it takes for the cornea to be flattened a specific amount, meaning that the longer it takes for the air puff to flatten the eye, the higher the internal pressure. The thickness of the cornea can affect the measurement of the eye pressure so this is often automatically accounted for after the air puff is delivered and the final IOP is calculated.

 

Our eye doctors at Eye Theory in Houston, TX excel in the prescription of contact lenses, glasses and various eye diseases.  Call our optometrist at 832.831.7386 or schedule an appointment online if you would like to learn more about how we use eye pressure to assess your risk of glaucoma.  Our eye doctor, Dr. Jonathan Tsao, provides the highest quality optometry services  and eye exams in the Midtown, Downtown, Museum District, and Southside Commons (Southside Place) vicinities of Houston, Texas.