Online Health Chat with Richard Gans, MD, FACS

August 22, 2013


The key to protecting your vision is good eye health and eye care, as well as early diagnosis and treatment of ophthalmic conditions. Vision can be affected by inherited refractive conditions, such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism and presbyopia. However, these are not the only conditions that can affect your eyes. Simple eye infections can turn serious quickly, affecting both your eye health and vision. Eye injuries can be dangerous to your eyesight and eye health. Several eye diseases are associated with aging, including cataracts, glaucoma and age-related macular degeneration, but can result from unknown causes. Other diseases that affect your health can impair your eyes as well, such as diabetic retinopathy. Eye health can be maintained with proper care, eyewear and nutrition. Various treatment options, from medicine to surgery, are routinely used to treat eye diseases. Technological advances, such as the femtosecond laser, have allowed better eye health and vision throughout life.

About the Speaker

Richard Gans, MD, FACS is a board-certified ophthalmologist in the Cole Eye Institute at Cleveland Clinic. 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 completed his residency in ophthalmology at University Hospitals of Cleveland after his internship at Mt. Sinai Medical Center, in Cleveland. He graduated medical school from Case Western Reserve University, in Cleveland.

Let’s Chat About Vision Health and Eye Disease Answers

Moderator: Welcome to our ‘Ask the Expert: Vision Health and Eye Diseases’ with Cleveland Clinic Cole Eye Institute ophthalmologist Richard Gans, MD, FACS. We are very excited to have him here today! Let's begin with the questions.

The Aging Eye

hilo323: Why do most people need to wear glasses when they get older? What happens to your eyes that causes the need for reading or distance glasses?

Richard_Gans,_MD,_FACS: There is a lens inside the eye that focuses the light that we see. There are muscles that pull and relax that lens, causing it to change shape. As the lens changes shape, it focuses different distances. As we mature, the lens gets rigid. As the hardness sets in, the lens can't change shape anymore and the eye becomes fixed to focus at a specific distance. Glasses are needed to fine-tune vision and focus other distances.

Ocular Symptoms

Grannyscott: For several weeks I have been experiencing discomfort in the lower left area of my left eye. It has been examined by my primary ophthalmologist, who was unable to find anything wrong, but since it continued to bother me he referred me to a specialist. This doctor fully dilated my eye and examined it thoroughly, but was unable to see anything that could cause the trouble. What I am experiencing is not exactly pain, but a tenderness to even a light touch with my finger that is not felt in the other eye. Could this be anything of concern, or should I just refrain from touching it? I have controlled glaucoma and have had cataracts removed from both eyes.

Richard_Gans,_MD,_FACS: It is certainly not normal to have tenderness as you describe. Perhaps another opinion would be prudent.

Tear Duct Blockage

come2me: My eyes tear constantly. I was in an automobile accident five years ago, and the air bag went off in my face. Ever since then I have had problems. Do you have any helpful suggestions?

Richard_Gans,_MD,_FACS: There could be a blockage of the tear drainage system in your eyelids. There are small tear ducts that drain the tears from your eyes and into the back of your throat. These possibly could have been damaged by the injury. There are oculoplastic surgery specialists who investigate and treat these conditions. Julian Perry, MD, at Cleveland Clinic Cole Eye Institute could be of help to you.

Scintillating Scotoma

safety1st: What causes flashing lights with colors that last about 10 minutes? What can you do about floaters?

Richard_Gans,_MD,_FACS: Ten to 20 minutes of a flashing pattern in vision can be a problem called scintillating scotoma—a variation of migraine headaches (with visual aura). Persistent flashing warrants an eye examination. Floaters are usually considered to be a nuisance. Ultimately, as the gel of the eye liquefies, they disappear. A new onset of floaters, however, should get you to schedule an immediate appointment with an ophthalmologist. New flashes and floaters can be a sign of a serious retina problem.

Symptoms of Vitreous Separation

Rebecca V: One year ago I was diagnosed with a vitreous separation in my right eye. I am still seeing flashes of light around the outside corner of my eye. Is this normal and to be expected?

Richard_Gans,_MD,_FACS: Usually, the flashes of light that people see from a posterior vitreous separation slowly go away within several weeks. If you are still having flashes of light after one year, I would suggest that you have your eyes checked once again to make sure there is no retina damage.

Glaucoma and Cataracts: Diagnosis and Symptoms

ctd3: Is double vision associated with cataracts?

Richard_Gans,_MD,_FACS: Individuals with cataracts can get double vision because of irregularities in the lens that can split the image coming into the eye. This type of double vision is present when only the affected eye is open. If the double vision is present when both eyes are open, but goes away when one eye is closed, it is probably not due to a cataract.

lachell: I am a 51-year-old female who was diagnosed with glaucoma and cataracts six months ago, but neither condition existed the previous year. I always thought that most older people between the ages of 60 and 70 years old or more have such problems. I am nearsighted and have worn glass practically my entire life.

Richard_Gans,_MD,_FACS: Both glaucoma and cataracts can develop at any age. If you have doubts about your diagnoses, a second opinion is always reasonable.

Corneal Dystrophy

smbart: Would you explain what corneal dystrophy is? What are things to watch for, and is any special care needed?

Richard_Gans,_MD,_FACS: Corneal dystrophy is a disease involving the front surface of the eye—the cornea. It is a hereditary problem. There are a number of different types of corneal dystrophies. Each specific dystrophy has its own characteristic signs, symptoms and potential treatments. You would need to be seen by a cornea specialist who could determine the specific type of corneal dystrophy you have and recommend the appropriate course of action. There are several cornea specialists at Cleveland Clinic's Cole Eye Institute.

Narrow Angle Glaucoma Diagnosis

hilo323: How can a specialist determine if you have narrow angle glaucoma?

Richard_Gans,_MD,_FACS: Often the diagnosis can be made just by examining the eye. If there is a question as to whether the narrow angle is causing trouble, special imaging techniques are available to aid in the diagnosis.

hilo323: Is narrow angle glaucoma serious?

Richard_Gans,_MD,_FACS: Yes, narrow angle glaucoma is very serious. An acute attack of narrow angle glaucoma can cause permanent vision damage within hours. Chronic narrow angle glaucoma needs to be managed with medication, laser and/or surgery to prevent long-term vision damage.

Oscillopsia Diagnosis

smiller: I am experiencing scrolling of words (where words appear to be moving ticker style, but back and forth on the page horizontally) both on computer and in print, although mostly on computer. It does not happen frequently, but seems to be increasing. I also have neurosarcoidosis. Can you tell me what maybe is causing this, and is there something that can be done?

Richard_Gans,_MD,_FACS: You may be experiencing a condition called oscillopsia (a visual disturbance where objects travel back and forth between two points).

In order to best determine the cause of your problem, you should be evaluated by a neuro-ophthalmologist. There are two neuro-ophthalmologists at Cleveland Clinic’s Cole Eye Institute. You can schedule an appointment by calling 216.444.2020.

Ocular Symptoms with Thyroid Disease

sugarcookie: I was diagnosed with hyperthyroidism about nine months ago and am being treated with methimazole. I have developed mild exophthalmos, tearing, intermittent bullae on my conjunctivae (what I call ‘water blisters’), and bloodshot conjunctivae. I have the sensation of eyeball pressure from the bulging. I have never been a smoker. I have read that selenium can help, but can't find a dosage. Is there anything that will arrest or reverse any of these symptoms? My ophthalmologist seems to know very little about my condition.

Richard_Gans,_MD,_FACS: There are a number of problems that can develop with the eye, related to thyroid disease—some of which can be severe and vision-threatening. The fact that you are noticing these signs and symptoms means that you need to be seen by an ophthalmologist who is experienced in treating eye problems associated with thyroid disease. At Cleveland Clinic's Cole Eye Institute, we have oculoplastic surgeons who are experts in managing this type of condition.

N3: I have hypothyroidism and am being treated with Synthroid® (levothyroxine sodium). Could this condition contribute to a detached retina?

Richard_Gans,_MD,_FACS: It would be unlikely.

Blurred Vision Symptoms

Mystdad: Once a month, I develop a blurry spot in my peripheral field of vision. The spot has different shapes and takes up perhaps two percent of my total vision. It lasts 10 to 20 minutes. It is usually in my right eye, and its outline is even visible if I close my eye. Also, my dominant right eye has a tendency about once a week to lose about 20 percent of its focus in both near and far vision. It usually regains its original focus after about a day. I currently do not need glasses, except for reading. The only medication I currently take is an aspirin (80 mg once per day). The last time I visited the optometrist, about two years ago, he did not detect anything unusual. Do you think I need to visit a specialist who deals with disorders of the visual cortex?

Richard_Gans,_MD,_FACS: It would be best for you to be evaluated by a neuro-ophthalmologist. Neuro-ophthalmology is the subspecialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system.

6grandkids: Following treatment with Restasis® and liquid tears, will my blurred vision subside?

Richard_Gans,_MD,_FACS: It depends on the cause of the blurring. If it is strictly due to dryness, I would expect the vision to improve. Blurring from dryness tends to be variable and intermittent. It’s worse later in the day, worse when reading or watching TV, and worse in dry and windy areas. If your blurring is constant, there might be another cause.

Pediatric Ophthalmologic Conditions

Jarredsmom: My son Jarred was taken to the first eye doctor when he was one-and-one-half years old. He had a lazy eye. When he was about four years old, we were directed to a specialist with the University of Wisconsin Eye Clinic, in Madison. There is no family history of eye problems other than age related. Our son was first diagnosed with macular degeneration. This year we had to switch doctors, and his new doctor sent us to a retinal specialist. We have now been told there is no macular degeneration, but the doctor believes my son has gestational night blindness. He is 15 years old now. Can you explain to me why we would go from a diagnosis of macular degeneration to gestational night blindness?

Richard_Gans,_MD,_FACS: Without examining your son, it would be impossible to know. At the Cole Eye Institute at Cleveland Clinic, we have a number of pediatric ophthalmologists—all more familiar with these problems than I. Perhaps they might be of benefit to contact.

Jarredsmom: Can you explain what gestational night blindness is?

Richard_Gans,_MD,_FACS: I think you might have the wrong term. To my knowledge, ‘gestational’ is not associated with night blindness. You might mean ‘juvenile’ night blindness. Again, I am not an expert in this area; I’m sorry.

Dry Eye Treatment

willow: If drops aren't working, is there anything else I can do to treat dry eyes?

Richard_Gans,_MD,_FACS: You can try prescription medications like Restasis® (cyclosporine ophthalmic emulsion). Try adding omega-3 fatty acids to your diet, and use a humidifier in your home. A surgery called punctal occlusion can also help. This procedure surgically blocks the tear drainage ducts to keep tears in your eyes longer.

Prednisone Treatment

metro: How and why does prednisone affect the eye?

Richard_Gans,_MD,_FACS: Prednisone is an anti-inflammatory medication. It can reduce inflammation within the eye. Chronic use of prednisone, however, can cause glaucoma and cataracts.

Treatment for Detached Retina

N3: I had a detached retina diagnosed in September 2012, and surgery to repair it one week later. My iris was damaged and now my pupil always remains dilated. I experience very poor vision in that eye and have been to several specialist eye doctors here in New York. I believe the condition is called anisocoria. My retina remains attached now. My vision is very hazy though. It's painful all of the time and more so in bright light. Is there a treatment to help with this?

Richard_Gans,_MD,_FACS: There are surgical procedures that can be performed to either stitch the iris together to make the pupil smaller, or to insert a prosthetic iris into the eye. The real question is whether the dilated pupil is the source of the hazy vision or if there is another potential cause.

lorijane27: I was diagnosed about 15 years ago with a detached retina in my left eye. The damage caused me to lose center vision in my eye—basically, leaving me legally blind in that eye. I am also nearsighted. Every year when I have my eyes examined, I ask if there has been any medical advances to correcting the damage in my left eye. I receive the same answer year after year—‘no.’ Is there a medical treatment available now for a damaged detached retina?

Richard_Gans,_MD,_FACS: Even after successful surgery to fix a retinal detachment, there may be a residual visual deficit. Without examining you, there is no way to know if there might be a new technique available to help you. You should be seen by a retina specialist.

nlwagner: On September 5, 2012 I was diagnosed with a detached retina in my right eye that was repaired on September 13, 2012. I had a YAG laser procedure almost two weeks later on September 24 to relieve extreme pain. On December 10, 2012, I had cataract surgery to clear a cataract that had not been there prior to the detached retina. I now have an implanted ocular lens in my right eye. The iris in my right eye no longer works since September 13, 2012, and the pupil is always dilated. My vision is poor in the right eye, and I have constant pain made worse by bright light. I am 49 years old, and need my vision to work and drive. Is there anything I can do to decrease the pain and improve the vision in my right eye? Also, is there anything I can do to decrease my odds for another detached retina? I'm very nearsighted. I can email pictures of my eyes if that would be helpful. I am willing to travel for appointments to help with my vision. I'm an avid reader and my goal is to have good vision for the remainder of my life.

Richard_Gans,_MD,_FACS: The purpose of a chat such as this is to provide general medical information. I’m sorry, but it is not possible for me to give specific medical advice about an individual condition. For this, a face-to-face consultation with an ophthalmologist experienced in managing retinal conditions is advised.

Dry Macular Degeneration Diagnosis

9Grumpah42: Is the development of ‘alpine’ profiles and a drusen layer behind each of my macula a sure sign of impending dry macular degeneration?

Richard_Gans,_MD,_FACS: I am not familiar with that term. Please check with a retina specialist.

9Grumpah42: How high is the risk inferred by the drusen abnormality?

Richard_Gans,_MD,_FACS: Sorry, this is a better question to address to a retina specialist.

Wet Macular Degeneration Treatment

Sierra: I am 70 years old with wet age-related macular degeneration (AMD) in one eye. I have been given Avastin® (bevacizumab) injections as needed since 2007. I underwent a new methodology for the injection last month. What is the purpose, advantages and disadvantages of irrigating the eye with water (I was told it was sterile) during the Avastin® injection? Could I safely opt out of the water wash? Do you prefer numbing the eye with drops only or injection? How should one decide whether to use Avastin® from a compounding pharmacy or to opt for Lucentis® (ranibizumab)?

Richard_Gans,_MD,_FACS: The irrigation might just be to remove some of the bacteriostatic prepping solution that is used to clean the eye. The method that is used to numb the eye is the preference of the patient and the surgeon. Either drops or injection is acceptable. A landmark study by Daniel Martin, MD, chairman of Cleveland Clinic Cole Eye Institute, and colleagues showed that Avastin® and Lucentis® are equally effective.

Sierra: I am concerned about receiving Avastin® (bevacizumab) injections in my eye when that drug is prepared by a compounding pharmacy. Would you consider Lucentis® (ranibizumab) safer?

Richard_Gans,_MD,_FACS: I am aware of the issues with some compounding pharmacies, but I cannot address that issue specifically. Lucentis® and Avastin®, however, are therapeutically equivalent.

murizya05: I have had wet macular degeneration in my left eye for about two years. I underwent more than 10 injections, but nothing changed. Should I continue the injection or is it better to stop? Is there any research for the treatment of this illness? Is there hope?

Richard_Gans,_MD,_FACS: This question is best answered by a retina specialist in a face-to-face examination. In general, the injections are very effective to prevent the worsening visual symptoms of macular degeneration. In some situations, the vision improves, but not in all situations. Research in this area is very active. There is always hope!

Dry Macular Degeneration Treatment

amy92: I have dry macular degeneration, but my retina doctor said there is no treatment. However, I understand that if it would be the wet type, there is an injection I can take to make my vision better. Why can't the injection work for the dry kind? Is there anything I can do?

Richard_Gans,_MD,_FACS: There is no evidence that the injections help dry macular degeneration. The injections reduce fluid swelling in the retina from abnormal blood vessels that are the hallmark of the wet-type age-related macular degeneration (AMD). In the dry type, there are no abnormal vessels and no swelling. The AREDS 2 vitamins have been shown to slow the progression of the dry type of AMD in a large percentage of individuals.

Treatment for Macular Degeneration with Cataracts

opus: I have macular degeneration. About a year and a half ago I had cataract surgery on my left eye (the eye that has some vision left). After a few days, my vision improved immensely. After two weeks, it drastically diminished. The reason was fluid behind the retina. I was treated for about six months with eye drops, including Nevanac® (nepafenac ophthalmic suspension) and prednisolone, with no improvement. My doctor is once again treating me with these drops. My concern is, according information of package, they should not be used for more than 10 days. I am going into my second month on these drops again, and I am uneasy about the wisdom of this. There must be some reason this fluid is accumulating. The doctor does refer to the cataract surgery as a possible cause. What would the cause be, and can it be remedied? I would appreciation any information you can give me. I am deeply depressed about the deteriorating condition of my eye(s) and lack of any answers.

Richard_Gans,_MD,_FACS: Swelling of the center of the retina can occur after cataract surgery. Treatment can sometimes be prolonged. The real question that needs to be confirmed is the source of the fluid. It could be related to conditions unrelated to the cataract surgery and thus, would require a different type of treatment. There are special tests that can be performed that confirm the source of the swelling. You should be seen by a retina specialist who could use optical coherence tomography and angiography to determine the cause of your problem and the best treatment course. There are many retina specialists at Cleveland Clinic's Cole Eye Institute—all of whom could help you with this situation.

Supplements for Macular Degeneration

19Grumpah42: For impending dry macular degeneration, would you recommend taking two Macuhealth® with LMZ (20 mg Meso-Zeaxanthin, 20 mg lutein and 4 mg zeaxanthin) daily?

Richard_Gans,_MD,_FACS: The current recommendation for patients at high risk for macular degeneration is a vitamin that contains the AREDS2 (age-related eye disease study 2) formula.

siti: My husband is 77 years old, and has been diagnosed with early macular degeneration. He was a smoker until six years ago. There are so many eye vitamins on the market and he has tried Preservision® and Ocuvite® 50+. What is the most lutein that can be taken if he were to get lutein alone with and without taking the other vitamins. The lutein in these two brands is only 5 mg.

Richard_Gans,_MD,_FACS: The current recommendation is to take a vitamin that is listed to have the AREDS 2 formula. He should stay away from vitamins that have high vitamin A levels because of his smoking history.

yoko: I have age-related macular degeneration. My right eye is dry and my left eye is wet. I take shots in my left eye, and take vitamins for my right eye—which seems to be o.k. Is there anything else that can be done for macular degeneration? I am 71 years old. I stopped eating sugar, and eat a low carbohydrate and high protein diet. I eat almost a vegan diet, and walk every day. I have had macular degeneration for about four months.

Richard_Gans,_MD,_FACS: The shots and the vitamins are the current standard of care. Nothing else is required to treat macular degeneration. A healthy lifestyle is certainly important for your overall health. Included in a healthy lifestyle is avoiding smoking and ultraviolet light, which are both risk factors for macular degeneration.

Marijuana Use and Macular Degeneration

yoko: Since I am an old hippie, I still smoke marijuana. Does this affect macular degeneration?

Richard_Gans,_MD,_FACS: I am not aware of any association between marijuana use and macular degeneration.

Cataract Treatment

hilo323: Do cataracts ever get better or will you eventually need surgery?

Richard_Gans,_MD,_FACS: Cataracts do not get better with time. They always progress, but can do so very slowly. The need for surgery is determined by how much the cataracts interfere with your activities of daily living.

kriptky: What are my options for cataract surgery?

Richard_Gans,_MD,_FACS: There are a number of options. The first option is your decision to have surgery. Your choice on whether to have surgery depends on how much the cataract interferes with your daily vision. Then there are different types of procedures, different types of lens implants, and premium options to enhance vision over-and-above removing the cataract. A discussion with your cataract surgeon is warranted.

knowitall: If you wait to have your cataract removed later then sooner—is it more difficult for the doctor to remove it? Also, what are the chances of putting the intraocular lens in crooked? And if that happens, what do you do?

Richard_Gans,_MD,_FACS: We have the technology that allows us to remove cataracts at any stage in their development. If a cataract progresses to a very severe stage, it can be more challenging for the surgeon to remove. Lens implants are held in place by a structure inside the eye that is only 2/1000 mm thick. If not inserted properly or if the support isn't adequate, a lens could be crooked. Experienced cataract surgeons have ways to cope with both of these situations.

adamneve: In 2007 I had eye surgery for a detached retina and macula. I currently have cataracts in both eyes. What can I expect to happen when I have cataract surgery?

Richard_Gans,_MD,_FACS: Cataracts can develop much more rapidly after having undergone retinal detachment repair surgery. Removing cataracts after retina surgery is technically more difficult for the surgeon. It is likely that the vision will improve after cataract surgery, but the vision can only improve as much as the retina is capable of seeing. After a retinal detachment, there is frequently a permanent limitation of vision in that eye.

Laser Cataract Surgery

sheldon22: I had heard that some eye organizations were now doing laser cataract surgery. What is this and how does it work? How is this better than normal cataract surgery? Does it have better results?

Richard_Gans,_MD,_FACS: Yes. There is a new technology, using a femtosecond, computer-guided laser that helps to perform elements of the cataract surgery, as well as correct astigmatism. The precision of the computer-guided laser is far better than the prevision of any human hands. The laser part of the procedure is done first, and then the patient is brought to the operating room for the remainder of the cataract procedure. The laser adds about five minutes to the procedure and the results are superb! I have been doing femtosecond laser-assisted cataract surgery at the Cole Eye Institute for about a year and have been very pleased with the results—as are the patients!

Corneal Transplant

kfactor: I had cataract surgery several years ago and now have clouding of the eye. My physician mentioned a corneal transplant might help. How successful are corneal transplants, and how do I know if it will help? I'm worried about undergoing another surgery.

Richard_Gans,_MD,_FACS: Corneal transplants have been around for a long time and are successful. They do require a skilled surgeon and take a long time to heal. If the need for cornea surgery is just some swelling in the cornea, a newer procedure called DSAEK (Descemet's stripping automated endothelial keratoplasty) can treat the same problem by transplanting only certain layers of the cornea. The newer procedure heals much faster and visual recovery is faster.

Glaucoma and Cataract Treatment

cathy2: Does cataract surgery have any effect on glaucoma?

Richard_Gans,_MD,_FACS: In general, cataract surgery and glaucoma are two completely separate processes. There is some evidence that cataract surgery will cause a slight reduction in the pressure inside the eye. Usually, this is not enough of a drop in pressure to control glaucoma. Glaucoma treatment usually needs to continue after cataract surgery.

RonW: I am a 63-year-old male who has been diagnosed with glaucoma and cataracts in both eyes. I take drops for the glaucoma. At my last exam, the ophthalmologist was happy with my continued measure of 17 or below. I am scheduled for cataract surgery in early September. The doctor also wants to implant an eye stent (CPT Code 0191T) which supposedly should help correct my glaucoma—but there is no guarantee, I'm told. I have some questions regarding the second procedure. I am wondering whether it would be best to forego it at this time. What impact would my decision to delay this procedure have on my vision—both short term and long term?

Richard_Gans,_MD,_FACS: In general, if glaucoma is controlled on medication, there is no harm in delaying a surgical procedure. The purpose of surgery in that setting would be an attempt to get you off of the medication. If the surgery is being considered because the intraocular pressure is not adequately controlled, delay could result in further glaucomatous nerve damage.

Intraocular Lenses

kazba: In September 2012, I had cataracts removed and a toric intraocular lens implanted (with the left eye for close vision and the right eye for distance). I have been experiencing dry eyes and using TheraTears® every day. Do these type of lens promote dry eyes?

Richard_Gans,_MD,_FACS: No. Intraocular lenses have no effect on dry eyes.

Treatment for Dry Eyes with Sjögren Syndrome

6grandkids: I have a great deal of buried drusen. I have about a 10 percent visual field. Recently I was diagnosed with Sjögren syndrome. I have really dry eyes now. My vision is blurred and I have a great sensitivity to light. My eye doctor is currently treating me with a six-week program of Lotemax® (loteprednol etabonate), artificial tears, and Restasis® (cyclosporine ophthalmic emulsion). I feel like I have a full-time job with the drops. Do you have any suggestions, or other information that I need to know? This is my fourth eye doctor. The rest of the doctors just said you have Sjögren syndrome, and there is nothing else to be done. I was quite discouraged by that. I am glad at least that my current physician has prescribed a course of action, and a follow up in three months.

Richard_Gans,_MD,_FACS: It sounds as though you are being treated appropriately. Restasis® is a good medicine to help stimulate tear production. It doesn't work right away. It often takes two months of use before you will notice any relief. Lotemax® is to help make you more comfortable until the Restasis® starts working. You should not stay on Lotemax® (a steroid) any longer than your doctor advises.

Stargardt Disease Treatment

pragati: I am a 20-year-old college girl. For the past two years I have been suffering from a long sight vision problem. My optical coherence tomography report shows the impression of foveal atrophy in both eyes. My fluorescein angiography reports shows the impression of possible cone dystrophy and juvenile Stargardt disease in both eyes. Can you prescribe me treatment, please?

Richard_Gans,_MD,_FACS: It is unfortunate that you are having such problems at a young age. No treatment can be prescribed based upon a description. You need to be examined by an experienced ophthalmologist, who is familiar with these conditions. Any of the retina specialists at the Cole Eye Institute would be able to examine you, diagnose your problem and recommend the appropriate course of action.

madygaby98: While there is no cure for Stargardt disease, is there a course a treatment that is recommended? My 12-year-old daughter has recently been diagnosed with two mutations of ABCA4. We have been told to have her wear sunglasses when outside, to avoid consuming foods high in vitamin A, and to take a supplement of vitamin C, vitamin E and 6 mg lutein. We would like to do more to slow the progression of this disease in hopes of stem cell therapy or gene therapy becoming available before all of her vision is lost. Her visual acuity is currently 20/70. How do you feel about saffron supplements? A current trial is coming to an end in Rome. While the results are not yet published, what I can find looks promising. They recommend Zaffit Plus. Alkeus Pharmaceuticals has had a promising find in their mouse model of ALK-001. They hope to have trials in 2014. Any direction you can provide would be very helpful.

Richard_Gans,_MD,_FACS: I'm sorry, but I am not an expert in the management of Stargardt Disease. You would be best to contact one of the retina specialists at the Cole Eye Institute or an ophthalmologist experienced in genetic diseases of the eye. I would recommend seeing Elias Traboulsi, MD at Cleveland Clinic Cole Eye Institute.

Meibomian Gland Dysfunction Treatment

robtoby: I have been diagnosed via slit lamp examination with MGD (Meibomian Gland Dysfunction). I have no symptoms, such as burning, itching, vision problems, etc. What are the best things I can do at home to try and remedy (or ease) this condition? If that doesn't work, what are the best medical treatment(s) available? How invasive and expensive are they? (I've heard they might not be covered by insurance.)

Richard_Gans,_MD,_FACS: Meibomian Gland Dysfunction causes inflammation on the margin of the eyelids. If you have no symptoms, treatment may not be needed at all. Most people manage this inflammation with daily, gentle scrubbing of their eyelashes and eyelids with dilute baby shampoo. There are some commercial items that work in place of baby shampoo. In more severe cases, there is medication that can be prescribed.

robtoby: Back to my MGD (Meibomian Gland Dysfunction) question from earlier. I have also heard that warm-to-hot compresses 10 minutes per day are helpful, and also mineral oil on a Q-tip for scrubbing where the lid meets the lash. Any additional thoughts here?

Richard_Gans,_MD,_FACS: Warm compresses help to dissolve the oils that stir up the inflammation. I don't know of any specific benefit or potential harm of mineral oil though.

Eye Protection

olives: How important is eye protection from the sun? Can this cause macular degeneration? Is it important to wear a hat or visor when participating in outdoor sports?

Richard_Gans,_MD,_FACS: Ultraviolet light from the sun is a significant risk factor for the development of macular degeneration. Eye protection is very important.

Stem Cell Transplant

N3: Have there been any advances in the use of stem cells for eye injury or inflammation?

Richard_Gans,_MD,_FACS: Yes. Stem cell transplants are used in some cornea conditions. Other uses are investigational.


Moderator: I'm sorry to say that our time is now over. Thank you again, Dr. Gans, for taking the time to answer our questions today about vision health and eye diseases.

Richard_Gans,_MD,_FACS: It has been a pleasure chatting with all of you, today. If we, at Cleveland Clinic Cole Eye Institute can be of service, please don't hesitate to contact us. Same day appointments are available. We have experts in all areas of eye care to meet your needs.

For Appointments

To make an appointment with Dr. Gans or any of the other 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

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On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to:

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit

Contact Information

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

Some participants have asked about upcoming web chat topics. If you would like to suggest topics, please use our contact link

Reviewed: 09/13

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.