Online Health Chat with Dr. Richard Gans
January 18, 2012
The key to protecting your vision is good eye health and eye care, as well as early diagnosis and treatment of ophthalmic conditions. As people get older, this becomes increasingly important. Cole Eye Institute ophthalmologist Richard Gans, MD, FACS, answers questions concerning adult general ophthalmology, including topics such as eye injury, cataracts, glaucoma, diabetic eye disease, and refractive conditions.
Dr. Gans joined The Cleveland Clinic Cole Eye Institute in 2004. He is a comprehensive ophthalmologist with specialty interests in cataracts, corneal diseases, diabetes and diabetic retinopathy, eye injuries, and glaucoma, as well as an accomplished surgeon. In addition to his clinical practice, Dr. Gans is an Assistant Professor with the Department of Ophthalmology at The Lerner College of Medicine of Case Western Reserve University in Cleveland.
Dr. Gans has been an ophthalmologist in the Cleveland area for more than 20 years. Prior to his coming to Cleveland Clinic, he was on staff at University Hospitals of Cleveland and at the Mt. Sinai Medical Center in Cleveland. Dr. Gans is a graduate of Case Western Reserve University School of Medicine in Cleveland, where he also completed his ophthalmology residency.
Cleveland Clinic’s Cole Eye Institute is ranked among the top ophthalmology programs in the country by U.S.News & World Report, making us the top-ranked program in Ohio. We are among an elite group of dedicated, comprehensive eye institutes. Our fully integrated model helps us provide patients with quick and easy access to specialty and subspecialty care for a wide spectrum of eye conditions – from the routine to the complex. Cole Eye Institute has extended its quality ophthalmic care to several locations throughout Northeast Ohio, allowing patients access to ophthalmologists closer to their homes.
Cleveland_Clinic_Host: To make an appointment with Dr. Gans or any of the specialists at the Cole Eye Institute, please call 216.444.2020 or call toll-free at 800.223.2273, ext. 42020. You can also visit us online at www.clevelandclinic.org/eye.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Richard Gans. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.
Glaucoma and Cataracts
adourian: I am a 71-year-old Caucasian male without diabetes or cardiovascular disease and without a family history of glaucoma. Recent tests have shown my visual field to be excellent and my optic nerve, cup, nerve fibers, etc. to be normal. I have had OH for several years with IOP in 20-24 range. As a precautionary measure, I took a prostaglandin analog (Travatan® [travoprost]) for 7 months with no apparent benefit. My corneal thickness is 602/605. Is it worth continuing to pursue active measures to reduce pressure or move back to a 6 month monitoring routine?
Dr__Gans: This is a decision that you would have to make along with your ophthalmologist. I cannot give out specific medical recommendations online. It is certainly encouraging that your visual fields and optic nerves are reported to be normal. The fact that your corneas are relatively thick suggests that our standard measuring devices might be over-estimating your true intraocular pressure. Regardless, you should contact your ophthalmologist to discuss your treatment and follow-up plans. Thank you for writing in.
bebe: I have a 4-5 stage cataract and was wondering if a laser treatment for neovascular glaucoma can be done even with this condition? Or does the cataract have to be removed first?
Dr__Gans: The laser treatment for neovascular glaucoma is applied to the retina. If the cataract is so dense that the laser cannot penetrate through it, the cataract might need to be removed. Neovascular glaucoma tends to progress very rapidly, within days, causing permanent problems. The decision to treat must be made promptly.
flrp: I have a cataract developing in my right eye; and when the time comes to have it operated on, what is the best lens in your opinion to be inserted in that eye?
Dr__Gans: There is no "best" lens for everyone. Different lens implants serve different purposes. It is best to discuss the lens implant with your surgeon.
platty: What is a pseudoexfoliatized cataract and are there any risks to having it removed?
Dr__Gans: Pseudoexfoliation is a condition within the eye that can predispose to glaucoma. It is a problem during cataract surgery as well, because the support structures for the lens are not as strong as they should be. Lens dislocation during or after surgery can occur. You should have cataract surgery by a surgeon who is familiar with this problem and is comfortable dealing with the potential problems that can arise.
tbird: My mother is in her late-70s and was diagnosed with cataracts. Her ophthalmologist said that surgery was the only treatment option. Are there any other treatment options?
Dr__Gans: Surgery is the only way to remove cataracts and the only way to improve the vision when a cataract is the problem. At the same time, cataracts only need to be removed if the patient is troubled by the limitation in vision.
bot: Is double vision associated with cataracts?
Dr__Gans: One can get double vision from a number of conditions. Cataracts can cause double vision, too. In fact, cataracts can even cause an individual to have monocular diplopia -- double vision out of just one eye.
fuzbuz: If you wait to have your cataract removed later then sooner – is it more difficult for you (the doctor) to remove it? What are the chances of putting the I.O.L. in crooked? And if that happens, what do you do?
Dr__Gans: Most cataracts can be removed at any time. Sometimes waiting for a long time can make a cataract tougher to remove. The fact of the matter is that no one sends easy cases to the Cleveland Clinic; we see the toughest problems. So far, I haven't come across a cataract that I couldn't remove.
Dr__Gans: If a lens implant is crooked, it can sometimes be straightened. If not, it could be removed and replaced.
nance: I am an 80-year-old woman who has recently been diagnosed with drusen and dry ARMD. Vision has not changed in a year and my doctor said, "Your dry macular degeneration is nothing to write home about. It goes with the territory." I am concerned and have started taking PreserVision® on my own. Can I expect this condition to worsen? Thanks Dr.
Dr__Gans: The dry form of macular degeneration does tend to progress, albeit slowly. Rarely, the dry type of the disease can turn into the wet type of the disease. At this time, we do recommend that people with dry macular degeneration take vitamin/mineral supplements such as PreserVision®, as they have been shown by a very well done study (Age-Related Eye Disease Study -- AREDS) to slow the progression of the disease in a substantial percentage of individuals. In addition, you should be checking your own vision at home using an Amsler Grid and staying in close contact with your ophthalmologist. Thank you for writing in.
GroKenHaMMer: Is there treatment for age-related macular degeneration?
Dr__Gans: Yes. The treatments for macular degeneration are much better now than ever before. We now have medications that, for the first time, can help to regain lost vision for some individuals, as well as preventing vision loss. Research is ongoing for even better treatments. There are seven retina specialists at the Cole Eye Institute of the Cleveland Clinic, all of whom are at the forefront of treatment for macular degeneration. Thank you for writing in.
nel: My mother is 82 and has macular degeneration. She's being treated with shots to the eye. Are there other ways to treat this condition other than the needle to the eye? Also, would other forms of treatment work better than the needle?
Dr__Gans: The shots inside the eye are the best and most effective treatments for wet macular degeneration at this time. Other treatments are not as effective and are associated with more vision loss and higher recurrence rates.
city_view: Is there any way to prevent macular degeneration?
Dr__Gans: Not that we know of at present. Treatments, however, are much better now than ever before in maintaining and even improving vision in some situations.
macwalsh: My mother, who is 64 years old, had a spontaneous detached retina, which they were able to repair in surgery. Am I at higher risk for this or is there a genetic component to this? If so, are there any preventive measures I can take?
Dr__Gans: Retinal detachments usually occur due to events inside the eye. The only genetic predisposition would be if you are severely nearsighted. In that situation, your risk would be increased.
mdea: What is the treatment for a torn retina? Would compresses on the eye help a torn retina heal? Warm or cold be best? Is there anything else recommended?
Dr__Gans: A torn retina can only be fixed with surgery. Compresses are not beneficial at all. Delaying treatment of a torn retina can result in permanent vision loss. Seek attention right away if a torn retina is suspected.
klanning: Approximately 30 years ago, I was hit in the eye with a ball and was taken to a physician at that time. All he did was clean the eye out, and I have had this problem since. It has worsened and I currently have a hard time passing my driver license eye exam. I can see fine when both eyes are open but cannot out of my left eye. Is there anything that can be done at this point?
Dr__Gans: It is impossible to determine the cause of your problem from your question, alone. You need a detailed eye examination by an experienced ophthalmologist to determine the source of the problem and if there is a way to fix it. Thank you for writing in.
john: How long does an abrasion to the cornea take to heal? I went to an urgent care and they gave me drops to use. However, I’m still experiencing severe pain and vision loss.
Dr__Gans: The time it takes to heal depends upon the size of the abrasion. Usually, they will heal in a day or two. If you are still having trouble, you should be examined again.
Other Eye Disorders
scout11: I have been diagnosed with ocular rosacea and have been using eye steroids for approximately 6 months. My vision in my affected eye is blurry and if I don't use the steroids, I have pain, redness, and excessive tearing. I have tried oral doxycycline but that did not help. My doctor says my cornea is starting to scar. Is there any other therapy other than steroids? (I also use AzaSite [azithromycin] for one week each month and warm soaks). Thank you.
Dr__Gans: There are multiple treatment modalities for ocular rosacea. Although steroids might make you feel better, long-term steroid use in the eye is associated with cataract development and glaucoma. You should not be using a steroid for that long. You should see a cornea specialist to look into alternative treatments. Thank you for writing in.
eagles: I was recently diagnosed with retinitis pigmentosa. Who can I see at the Clinic for this condition, and where do I go for genetic testing? Thank you
Dr__Gans: Elias Traboulsi, MD, is the person who could coordinate your care and the genetic testing. You could call 216-444-2020 to schedule an appointment with him.
flrp: In my last eye exam (12/20/2011), the doctor told me I had macular pseudohole in my left eye but not to worry too much about it. When looking at a straight line it appears wavy in some parts of the line. While it doesn't seem to bother me too much, there are times I am unable to see all the letters of a word from that eye. The question - is this something I should seek treatment for or continue on until it gets worse? I am making an assumption that it will continue to deteriorate, to what point I am not sure.
Dr__Gans: A macular pseudohole usually does not require treatment. A full-thickness macular hole must be corrected by surgery. The distortion in your vision may be from scar tissue surrounding the center of your vision. Treatment would be up to your doctor.
lee: I have had an eye infection for a while. My doctors (ophthalmologist and cornea specialist) have prescribed Viroptic (trifluridine), fluormetholone, and prednisolone, along with drops to bring the pressure down. There are conflicting numbers regarding the critical high for eye pressure; e.g., anything over 28, 21, and 18 are dangerous because of glaucoma. QUESTION: What is the danger zone for eye pressure? I am very concerned about this. Thank you
Dr__Gans: Unfortunately, there is no simple answer to this question. Historically, we used to say that a pressure over 22 mmHg was a risk factor for glaucomatous nerve damage. But that was too simplistic a view. There are some people who can tolerate higher pressures without developing nerve damage. There are some who develop nerve damage even when the pressure is low.
Dr__Gans: In order to ensure that you don't develop glaucomatous nerve damage, you must be monitored by evaluating your optic nerves and visual fields, regardless of what your pressure is.
eagles: I'm a 64-year-old male recently diagnosed with retinitis pigmentosa. Can anything be done to slow the progress of the disease?
Dr__Gans: You are best off consulting with a retina specialist or an ophthalmologist that specializes in genetic eye disease.
Dr__Gans: In the past, we talked about vitamin A supplements for people with RP, but since I don't routinely treat patients with this disorder, I don't know if it is currently advised.
LindaSowden: Is there an association between optical migraines and pituitary adenomas?
Dr__Gans: I am unaware of any association. Thank you for writing in.
want_more: What kind of treatment is available for a blocked tear duct? My left tear duct has been blocked for some time and it bothers me almost every day.
Dr__Gans: Surgery is usually required to correct a blocked tear duct. The surgery is done by an oculoplastic surgeon. You could contact J.D. Perry, MD, at the Cole Eye Institute 216.444.2020 for consultation.
jellyb333: Can anything be done about floaters?
Dr__Gans: Most floaters will eventually go away. Only in the most severe of situations would surgery be indicated to remove them. The risks of the surgery might outweigh the benefits.
Liesel: I am a 72-year-old female. On 1/3/2012 I had surgery to repair a detached retina. A laser buckle surgery was performed–NO gas bubble. What is the general outcome from such a surgery? Now on day 15, I am still in a lot of pain. I still have double and distorted vision. I was told that would get better. Any suggestions? I am also not sure what my restrictions are for the next few weeks or months.
Dr__Gans: These are questions best addressed to your surgeon. In general, the healing process from a scleral buckle is a prolonged process and can take several weeks for the pain to go away. The amount of vision that is restored depends upon the nature of the retinal detachment that you had. Please discuss with your doctor directly.
GrannyScott: If it is possible with cataract surgery to eliminate the need for glasses by replacing the lens, why would this not be done whenever the procedure is required? Is it only possible if both eyes need the surgery at the same time?
Dr__Gans: The lens implants used at cataract surgery approximate normal vision, but cannot always correct the vision to perfection at all distances. Lens implants are almost always used during cataract surgery, even if only one eye is operated on.
pirates: I had glaucoma and cataract surgery performed, and am now experiencing foggy vision. Why might this be occurring, and is there anything I can do to help treat this?
Dr__Gans: If the vision was clear after surgery and has gotten progressively cloudy again, it could be due to what is called "posterior capsule opacification." The posterior capsule is a membrane, left intact at the time of cataract surgery to hold the lens implant in position. Occasionally, it will get cloudy after surgery, resulting in clouding of the vision. A very quick and simple laser procedure in the ophthalmologist’s office can clear the vision, again.
quaker: Is there a minimum recommended age for LASIK surgery?
Dr__Gans: One has to be at least 18 years old to have LASIK, and the vision must be stable.
field_test: My mother is in her 70s and had cataract surgery, which was said to be successful. But now light really bothers her. She can see fine until she is in the light and then she says it basically blinds her vision. Do you know what might be causing this and if there is anything that can be done to correct it?
Dr__Gans: Light sensitivity is sometimes a sign of inflammation in the eye. She should be evaluated to make certain that any inflammation from the surgery has resolved. Most lens implants used during cataract surgery have UV filters built into them, so there is nothing about the brightness that could damage her eyes. Tinted lenses are always a possibility, assuming everything is okay within her eyes.
lifetimelearner: I have just noticed yesterday a blurry spot in the vision of my right eye, in the center. My most recent eye exam was just 3 weeks ago, and everything was fine. This has not lessened in 2 days. What could this be, and what are my next steps to solving this issue? Thanks
Dr__Gans: You should be seen by an ophthalmologist right away. Depending upon your age and eye health, a central area of blurring could be a sign of macular degeneration. It could be a floater. Some neurologic conditions can cause a central area of blurring in one eye. Regardless, this requires rapid evaluation.
grant2: Is there any other cause besides glaucoma that causes the optic nerve to deteriorate?
Dr__Gans: There are a multitude of problems that can cause optic nerve degeneration. Glaucoma is certainly one. There are vascular conditions, inflammatory conditions, and hereditary conditions that can all cause this. There are two neuro-ophthalmologists at the Cole Eye Institute who could help you with sorting out the cause and potential treatment.
cgraf: Can you continue to take Plaquenil® (hydroxychloroquine) during pregnancy safely? My daughter has been taking it for 10 years for lupus. She is 24 years old and is thinking of starting a family. Both her rheumatologist and her retinal specialist at Cole never really answer our question. Some articles state it's safe and other articles say to stop it during pregnancy. Thank you.
Dr__Gans: I'm sorry, but I don't know the answer to that question off hand. To be honest, the best resource for an answer would be your obstetrician. He/she would be most familiar with which medications are safe during pregnancy.
Gatorfrog5: I have several medical issues/conditions, including peripheral neuropathy, microvascular disease, fibromyalgia, chronic fatigue syndrome, and CVI. Recently, my eyes have become very dry and they are painful -- by the end of the day, especially. I am using drops in them and it helps a little. I would like to know if any of my diseases cause this and if I should see a doctor? Thank you!
Dr__Gans: Many of these conditions can be associated with dry eye problems. Dry eye problems can come up on their own without associated medical problems as well. There are a number of treatment modalities for dry eyes, in addition to lubricating eye drops. Seeing an ophthalmologist would be helpful in determining the severity of your condition and deciding on the appropriate treatment.
iris: How and why does prednisone affect the eye?
Dr__Gans: Prednisone is used to reduce inflammation. Unfortunately, all medications have side effects. With regard to the eye, prednisone can cause cataracts and glaucoma.
Diet and Eye Health
quaker: How does diet influence the general health of our eyes as we age? Any particular foods proven to be beneficial for good eye health?
Dr__Gans: Vitamin deficiencies are associated with a number of eye problems, so it is a good idea to make sure that one has a healthy diet or considers a daily multiple vitamin if the diet is not complete. The only condition in which extra vitamins/minerals have been shown to be beneficial is in macular degeneration, where specific extra elements have been shown to slow the progression of the disease in a significant number of patients. Green leafy vegetables are often recommended for patients with macular degeneration as well.
Dr__Gans: My father, an ophthalmologist, always told me that one never sees a rabbit wearing glasses, but I don't know if eating carrots alone is the answer.
irish21: I have macular degeneration and would like to know which PreserVision® eye vitamin you recommend I take? I am taking the formula with lutein, but I am wondering if the new PreserVision® Areds 2 Formula would be better? I am currently taking a fish oil vitamin supplement that I purchase from Purity Products.
Dr__Gans: At this time, the standard recommendation for dietary supplements in macular degeneration is still the AREDS formula. The AREDS 2 study has not yet been published, and so we don't know if the changes in the formula will hold any significant improvements.
Dr__Gans: Lutein and fish oil supplements are unlikely to cause any harm. They have been shown to have beneficial effects in other areas. Thank you for writing in.
Sara: I've noticed that Ocuvite® is being advertised on television. Does it really work for eye health?
Dr__Gans: Ocuvite is one of several supplements that are designed for people at high risk for macular degeneration. There is no solid evidence that it is helpful in other conditions.
katesmom: My daughter does not need glasses, but wears colored contact lenses she has bought (not through an eye doctor). Can this hurt her eyes? Also, glasses today are a fashion statement among teens. My daughter wears them (no prescription - just clear lenses) as an accessory. Can this hurt her eyes?
Dr__Gans: Clear glasses cannot hurt the eye.
Dr__Gans: Non-prescription contact lenses, however, are terrible and pose a very serious risk for permanent vision loss. People forget that contact lenses are a foreign object on a very sensitive part of the body. If the lens does not fit properly or was not sterilized, the risk of infection and loss of vision are great. I would strongly encourage her not to wear non-prescription contact lenses.
left_field: What is the effect of wearing sunglasses or not wearing sunglasses on the eyes? Does this have anything to do with vitamin levels, such as the ability to absorb vitamin D?
Dr__Gans: Vitamin D is absorbed through the skin, not the eye. Wearing sunglasses with UV protection is a good idea (even in cloudy Cleveland), as ultraviolet light is associated with damage to the eye.
joker2: How important is eye protection from the sun? Can this cause macular degeneration? Is it important to wear a hat or visor when doing outdoor sports?
Dr__Gans: Eye protection from the sun is very important. The ultraviolet from the sun can cause permanent damage to the eye and put one at risk for damage later in life.
MaryRose: I work with raw onions on a daily basis and I was wondering why slicing and pealing them hurts my eyes so much and causes them to water? Also, is there anything I can do to prevent this (besides avoiding onions)? Will prolonged exposure have lasting effects or even cause damage?
Dr__Gans: Onions contain a compound called propanethial-S-oxide, which is a sulfur-containing substance. This compound was first discovered in 1985 at the University of Missouri St Louis (UMSL). They found that when this substance comes in contact with water, part of it is converted to sulfuric acid. It is this dilute quantity of sulfuric acid that causes your eyes to tear. The substance is liberated when you cut the onion; and when it comes in contact with the tear-film on the front surface of the eye, it turns into sulfuric acid, which burns and irritates your eye and cause a reflex to occur, which creates more tears.
Dr__Gans: This small amount of sulfuric acid is irritating, but it is not enough to cause damage to the eye.
Dr__Gans: I am told that if you chill the onion for one hour in the refrigerator before slicing it or if you soak the onion in water so that the acid is diluted before slicing it, your eye irritation will be lessened.
lifetimelearner: Thank you for answering my pre-submitted question. I am 54 years old, have always had 20/20 or better, and am just using reading glasses these days. I understand I need to see an ophthalmologist, can you recommend one who would be able to see me soon?
Dr__Gans: The Cole Eye Institute at the Cleveland Clinic has a "Same Day Clinic." If you were to walk in the door Monday through Friday between 8 am and 3 pm, you would be seen on that day. Alternatively, if you call 216.444.2020, they can set up an appointment for you within a day or a few days.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Richard Gans is now over. Thank you again, Dr. Gans, for taking the time to answer questions about 'Ask the Eye Doctor – Comprehensive Ophthalmology.'
Dr__Gans: Thank you all for participating in our Cleveland Clinic web chat today. If we can be of any service to you, please feel free to call the Cole Eye Institute at 216.444.2020.
Cleveland_Clinic_Host: To make an appointment with Dr. Gans or any of the specialists at the Cole Eye Institute, please call 216.444.2020 or call toll-free at 800.223.2273, ext. 42020. You can also visit us online at www.clevelandclinic.org/eye.
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This chat occurred on 1/18/2012
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