FORTY FORT EYE ASSOCIATES AND HOME EYE CARE
FORTY FORT EYE ASSOCIATES AND HOME EYE CARE
FFEA & HEC-THE SEVEN MOST IMPORTANT LETTERS THAT YOU
SHOULD SEE
CELEBRATING 57 YEARS OF PROVIDING QUALITY EYECARE TO THE RESIDENTS
OF
JOSEPH SMITH, OD,FAAO, RET.
JASON SMITH, OD,MS
The red star below shows the location of Forty Fort Eye
Associates and Home Eye Care
SECTION 1-HISTORY, SECTION 2-EDUCATIONAL
- PERSONALIZED
FAMILY OPTOMETRIC CARE
- HOME
EYE CARE AND NURSING HOME CARE
- GAS
PERMEABLE AND SOFT CONTACT LENS RESEARCH
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- REFRACTIVE
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REPAIRS
- VISION,
HEALTH, AND MEDICAL EDUCATION AND INFORMATION
- ON-SITE
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- HOUSE
CALL SERVICES TO HOMEBOUND RESIDENTS
- COLLEGE
EDUCATORS, CONTINUING EDUCATION PROVIDERS
SECTION
1-HISTORY
Forty Fort Eye Associates and Home Eye Care are located at
Dr. Jason Smith is a graduate of the New England College
of Optometry in
Dr. Smith has recently authored Chapter 10 in a book titled
CHILDREN'S HEALTH PROBLEMS, edited by Dr. Bernard Healey, the Director of the
Health Care Administration program at King's College. This chapter is titled
" Vision Problems Children Encounter: A Guide for Parents". This book
also includes other topics that parents would be interested in including
tobacco use, diabetes, nutrition, self esteem issues, drugs and alcohol, STD's, high-risk behaviors, and juvenile arthritis. The
ISBN # for this book is 0-9744131-7-8 and was published by Offset Paperback,
Dr. Smith
is a candidate for the
MY FAVORITE
LENSSHOPPER - CONTACT LENS PRICE COMPARISON
KING'S COLLEGE HEALTH CARE ADMINISTRATION
JASON'S TESTIMONIAL
TO KING'S COLLEGE
WYOMING SEMINARY COLLEGE PREPARATORY
SCHOOL
AMERICAN PUBLIC HEALTH ASSOCIATION
AMERICAN OPTOMETRIC ASSOCIATION
THE AMERICAN DIABETES ASSOCIATION
MACULAR DEGENERATION INTERNATIONAL
jhs824@epix.net--Dr.
Joseph Smith's e-mail
jasonffea@epix.net--Dr.
Jason Smith's e-mail (pictured below)
SECTION
2-EDUCATIONAL INFORMATION
THIS SECTION
OF THE WEBSITE IS CURRENTLY BEING DESIGNED
ANATOMY,
VISION DISORDERS, EYE DISEASES, INTERNET LINKS
Forty Fort
Eye Associates, Home Eye Care, and Dr. Smith provide this on-line information
for educational, academic, and communication purposes only. This information
should not be construed as personal medical advice. Information that is
published on this website is not intended to replace, supplant, or augment a
consultation with a physician, an ophthalmologist, or an optometrist regarding
the viewer or users own medical care. Forty Fort Eye Associates disclaims any
and all liability for injury or damages that could result from the use of the
information obtained from this website.
ANATOMY
The ability to see is dependent upon the actions of several structures
in and around the eyeball. The graphic below lists many of the essential
components of the eye's optical system.
When you look at an object, light rays are reflected from
the object to the cornea, which is where the miracle of sight begins. The light
rays are bent or refracted and focused by the cornea, the lens, and the
vitreous. The job of the lens is to make sure that the rays of light come to a
sharp focus on the retina. The resulting image on the retina is upside-down. At
the retina, the light rays are converted to electrical impulses which are then
transmitted to the optic nerve. These impulses are transmitted through the
optic nerve to the brain where the image is translated and perceived in an
upright position.
Think of the eye as a camera. A camera needs a lens and film
to produce an image. In the same way the eye needs a lens (the cornea, the
lens, and the vitreous) to refract or to focus rays of light. If any one of
these components do not function correctly, the result
is a poor picture. The retina represents the film in our camera. It captures
the image and sends the information to the brain to be developed. The macula is
the highly sensitive area that is responsible for focusing our vision. It is
the part of the retina most often used to see.
Other websites that you can visit include:
www.lib.berkeley.edu/OPTO/eyeanat.html
www.brainseye.com/anatomy.htm
www.wa-eyemd.org/anatomy%20tool.htm
AMBLYOPIA
Amblyopia is a term used to describe an uncorrectable loss
of vision in an eye that appears to be normal. It is commonly referred to as a
"lazy eye" and can occur for a variety of reasons. A child's visual
system is usually fully developed by the ages of 9-11. Until that age, children
readily adapt to visual problems by suppressing or blocking out a blurry image.
If it is found early enough, amblyopia can often be corrected and vision can be
preserved. However, after the age of 11, it is difficult if not impossible to
train the brain to use the eye normally. The treatment for amblyopia depends
upon the underlying problem. In some cases, the stronger eye can be temporarily
patched so that the child is forced to use the weaker eye. Patching therapy can
also require the good eye to be patched to help balance the vision in both
eyes. Sometimes special eyeglasses with prisms or muscle surgery may be needed.
Some causes of amblyopia include strabismus, crossed eyes, esotropia,
exotropia, congenital cataracts, a cloudy cornea, droopy eyelids, ptosis,
unequal vision, uncorrected astigmatism, and hyperopia
(farsightedness). Amblyopia may occur in various degrees depending on the
severity of the underlying problem. Some patients experience just a partial
loss of vision, while others have a more significant loss of vision. Patients
with amblyopia lack binocular vision, depth perception, or stereopsis. This
involves an inability to blend the images of both eyes together. Stereopsis is
what allows us to appreciate depth. Without stereopsis, the ability to judge
distance is impaired.
Other websites that you can visit include:
www.preventblindness.org/children/amblyopiaFAQ.html
www.aoanet.org/cpg-4-cpa.html
www.strabismus.org/amblyopia_lazy_eye.html
ASTIGMATISM
Astigmatism is a condition of refraction where light rays
coming from a single point are not focused at one point but instead are focused
as two images. When astigmatism is corrected in eyeglasses or contact lenses,
the lens surface resembles a football (toric shaped).
If one does not have astigmatism, then the lenses would resemble the shape of a
baseball (round shaped). Astigmatism may be caused by the shape of the cornea
and the shape of the lens. Most astigmatic corneas have 2 curves; a steeper
curve and a flatter curve. This causes light to focus on more than one point in
the eye causing blurred or distorted vision in the distance, at reading
distances, or both. It can occur in combination with farsightedness or with
nearsightedness.
Below is an anatomical representation as to how light
focuses in a normal eye and when astigmatism is present.
Other websites that you can visit include:
www.lasersurgery for
eyes.com/myopiawastig.html
www.umsl.edu/~fraundor/epc/
www.aonet.org/CVC-astigmatism.html
BLEPHARITIS
Blepharitis is a common inflammatory condition that affects
the eyelids. It usually causes irritation of the eyelid margins, burning,
tearing, itching, or crusting around the eyelids upon awakening. Inflammation
of the white of the eye related to conjunctivitis, superficial inflammation of
the cornea called keratitis, and styes are often associated with blepharitis.
Treatment is usually scrubbing the eyelid margins with a mild shampoo like
Johnson's baby shampoo twice a day using a warm washcloth. Warm compresses can
be applied to the eyelids for 15 minutes 4 times a day. If there is an
associated dry eye syndrome, preservative-free artificial tears can be used as
often as 4-8 times a day. If the condition is moderately severe, erythromycin
or bacitracin ointment can be used 3 times a day and at bedtime. Eyelid
cleansing and the use of warm compresses can be reduced as the condition
improves. Like dandruff, there is no cure for blepharitis but it can be
controlled.
The picture below shows an eyelid margin with scaling of the
eyelashes, pus, redness, and edema.
Other
websites that you can visit include:
www.aoanet.org/ed-blepharitis.html
www.eyemdlink.com/conditions/blepharitis.htm
www.blepharitis.org
BRANCH
RETINAL VEIN OCCLUSION
A branch retinal vein occlusion can have symptoms of a blind
spot in the visual field or a loss of vision usually occurring in one eye.
Superficial hemorrhages can develop in a sector of the retina along a retinal
vein as shown by the blue arrows. Sometimes central vein occlusions occur when
the circulation of the central retinal vein becomes obstructed by an adjacent
blood vessel. This can also cause the vein to hemorrhage. Swelling and retinal
ischemia (a lack of oxygen) are secondary complications. Treatment can involve
the use of retinal laser photocoagulation if there is edema in the macula of
3-6 months duration or if vision is less than 20/40. Treatment of any
underlying medical problems is also necessary.
The picture
below is a normal, healthy retina
Other websites that you can visit include:
www.vrmny.com/venous.htm
www.revoptom.com/handbook/sect5f.htm
www.neec.com/messages/1798.html
BASAL CELL
CARCINOMA
A basal cell carcinoma is a type of cancer that occurs most
commonly on the face or on the neck. It is commonly seen on or near the eyelid
margins as seen in this photograph. The tumor cells are thought to originate
from the basal, or innermost layer of the skin. Two
types of basal cell carcinoma are seen; a nodular type which has a firm mass
with telangiectasia (dilated blood vessels) over the
tumor margins. Sometimes the center of the lesion is ulcerated. The other type
is a morpheaform type which has appears as a firm,
flat subcutaneous lesion with indistinct borders. Basal cell carcinoma is the
most common skin cancer in the
Other websites that you can visit include:
www.skinsite.com/info_basal_cell_carcinoma.htm
www.aafp.org/afp/980415ap/english.html
www.netautopsy.org/basalcel.htm
BRANCH
RETINAL ARTERY OCCLUSION
A branch retinal artery occlusion (BRAO) occurs when an
artery branching from the central retinal artery becomes blocked. This blockage
is usually caused by an embolus (blood clot) in the blood stream. The occlusion
decreases the blood supply to the area of the retina nourished by the affected
artery. The classic symptoms of BRAO include a sudden, painless loss of vision
in one eye. In the photograph below, the affected area of the retina is the
pale, whitish-yellow area marked by the blue arrows. The surrounding
reddish-orange area remains as healthy retinal tissue. Patients may have a
history of a transient visual loss referred to as amaurosis fugax.
This picture
below is of a normal, healthy retina
Other websites that you can visit include:
www.medinfo.ufl/year2/ophthal/slide27.html
www.revoptom.com/handbook/sect5g.htm
www.emedicine.com/EMERG/topic777.htm
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CATARACTS
The term cataract refers to the clouding of the normally
transparent crystalline lens of the eye. The lens is located behind the pupil
and focuses light onto the retina in the back of the eye so that we can see
clearly. The word cataract comes from the Greek word for waterfall. It was
thought that a cataract was formed by opaque material flowing, like a waterfall
into the eye. Cataracts are actually formed as a result of aging, injury,
ultraviolet light, drugs, systemic and ocular disease. People with cataracts
and blurred vision often find that their everyday activities like driving,
reading, watching TV, and even walking become increasingly difficult. To
improve their quality of life, sometimes a new eyeglass prescription may help.
But ultimately in order to improve the quality of life, cataract surgery can
restore the ability to perform these activities. As the lens becomes increasingly
opaque, light rays entering the eye are prevented from focusing onto the
retina, the light sensitive tissue lining the back of the eye. Symptoms of
cataracts include blurred vision, sensitivity to light, glare, and a dimming of
colors and of vision.
The picture
below shows the development of a cataract. In the picture, the center of the
pupil has a whitish, cloudy appearance. This is a cataract that is developing
within the lens. Under other lighting conditions, this may appear as a yellow
color which is referred to as nuclear sclerosis.
The pictures below show cataract development.
Nuclear
sclerosis
Cortical
Anatomical-side view.
Picture to the left is a posterior subcapsular
cataract seen by the white shaded area. The picture to the right is an anterior
and posterior subcapsular cataract seen as the white
shaded area.
Other websites that you can visit include:
http://www.nei.nih.gov/publications/cataracts.htm
http://Blindness.about.com/cs/cataracts/
http://www.drkoop.com/dyncon/toc.asp?id=1110
CENTRAL
RETINAL VEIN OCCLUSION
A central retinal vein oclusion(CRVO) occurs when the circulation of the central retinal
vein becomes obstructed by an adjacent blood vessel. This causes the vein to
hemorrhage into the layers of the retina. As seen in the picture below,
hemorrhages are seen on the retina. Other signs that can be seen include cotton
wool spots. These are white, fluffy lesions with feathered edges also seen in
the photograph below. Cotton wool spots lie in the nerve fiber layer of the
retina and represent a micro-infarct, implying an ischemic microvascular
disease. Other signs of CRVO include optic disc edema, retinal edema, and neovascularization of the optic disc. CRVO may occur due to
hypertension, glaucoma, vasculitis, abnormal platelet
function, thyroid disease, or polycythemia. CRVO
causes a marked decrease in vision and requires immediate attention.
Other websites that you can visit include:
www.revoptom.com/handbook/sect5f.htm
www.retinamd.com/data/centralretveinocclusion.html
www.qis.net/~ajrein/album/central.htm
CHALAZION
A chalazion is an eyelid lump
which can cause swelling, pain, and tenderness. It is caused by the blockage of
an oil-producing gland and can occur on the outside or the inside of the upper
or lower eyelid. The picture below shows a chalazion
on the lower eyelid. Treatment for chalazia includes
warm compresses for 15-20 minutes 4 times a day. Light eyelid massage over the
nodule can tend to loosen the pyogenic granules that
accumulate within the nodule. Chalazia usually do not
cause pain because this is not an infectious process compared to the appearance
of a stye which is usually painful. A topical
antibiotic ointment such as bacitracin or erythromycin ointment used twice a
day over the nodule is sometimes helpful. Steroid injections consisting of triamcinolone 40 mg/ml is sometimes injected into and
around the chalazion, although steroid injections can
lead to permanent depigmentation of the skin around
the injection site. If the chalazion does not
disappear after 3-4 weeks of appropriate medical therapy, the patient can
choose to have this removed. Surgical incision and drainage of the lipid
globule material and multinucleated giant cells will resolve the chalazion.
Other websites that you can visit include:
www.chalazion.com/
www.revoptom.com/handbook/sect1d.htm
www.health-md.net/chalazion.htm
CHOROIDAL
NEVUS
A choroidal nevus is a flat,
benign, pigmented area in the choroid which is a layer behind the retina. In
the photograph below, it appears as the darker brown area. Nevi are similar to
freckles on your skin and do not typically change or grow. Retinal photographs
are usually taken to monitor any changes over time.
Other websites that you can visit include:
www.nevus.org/about/aboutnevi.html
www.revoptom.com/handbook/sect5j.htm
www.retinaconsultations.com/texts/choroidalnevus.html
CONJUNCTIVITIS
Conjunctivitis
is commonly referred to as pink eye. It is an inflammation or an infection of
the outer layer or outer covering of the eye called the conjunctiva.
Conjunctivitis may be characterized by redness, tearing, itching, or a
discharge that causes the eyelids to stick together especially in the morning.
The three most common types of conjunctivitis are viral, allergic, and
bacterial.
Viral conjunctivitis is often associated with an upper
respiratory tract infection, flu, colds, rhinovirus, or sore throats. The virus
can be very contagious and easily spread with human contact. Disinfecting
surfaces such as doorknobs and counter tops, avoiding touching the nose or
face, not sharing washcloths or towels, and frequent hand washing can reduce
the spread of any infection. Like the common cold, there is no cure for viral
conjunctivitis. Visual symptoms can be relieved by using cool compresses around
the eyes or by using artificial tears. In certain cases, topical steroid drops
will help to reduce the inflammation and will increase comfort. Most viral
conjunctivitis resolves within 3 weeks or less.
Allergic conjunctivitis causes symptoms such as watery,
itchy eyes which may include swollen eyelids. Symptoms are usually seasonal and
can be at their worst during the hay fever season in the spring or early
summer. Cool compresses and artificial tears may help relieve some discomfort
in mild cases. In more severe cases, non-steroidal anti-inflammatory drops and
ocular antihistamines can be used.
Bacterial conjunctivitis is characterized by swollen
conjunctiva, redness, tearing, irritation, and a discharge that often causes
the eyelids to stick together. This may only affect one eye but can spread to
both eyes. The most common bacteria causing this type of conjunctivitis are
staphylococcus and streptococcus. Antibiotic drops or antibiotic ointments are
prescribed and this can sometimes be used in conjunction with a
steroid-antibiotic combination drug.
The two
photographs below show the redness and watery eye associated with
conjunctivitis
Other websites that you can visit include:
www.aafp.org/afp/980215ap/morrow.html
www.eyemdlink.com/conditions/conjunctivitis.htm
www.revoptom.com/handbook/section2c.htm
CORNEAL DYSTROPHIES
Corneal dystrophies are a rare group of slowly progressive,
usually bilateral, degenerative disorders which usually appear in the second or
third decades of life. Some corneal dystrophies are hereditary and can be
classified according to their anatomical site within the cornea. Meesman's dystrophy is an autosomal
dominant hereditary condition in which cysts are present between the epithelial
cells. The dystrophy of Reis and Bucklers is an autosomal
dominant condition characterized by the fragmentation of the collagen of
Bowman's layer and a recurrent corneal
erosion. Other dystrophies include Granular, where milky, white spots occur in
the superficial stroma. Lattice dystrophy gives the
cornea a ground glass appearance due to surface irregularity and lesions
occurring within the stroma. Macular dystrophy
presents as greyish-whites spots that are found in
the stroma which tend to be superficial centrally and
deep peripherally. In Fuch's dystrophy, the basic
lesions lie within the gutatta of the corneal
endothelium. This condition is inherited as an autosomal
dominant trait and tends to affect women more so than men. The gutatta are more numerous in the central cornea and spread
peripherally as the condition advances. Patients with Fuch's
dystrophy have a deficiency in their endothelial cells. If these cells are lost
or damaged, they do not regenerate. The endothelial cells that remain tend to
"spread out" to fill the existing empty spaces created by the loss of
endothelial cells. This results in a less efficient pumping system that can
lead to corneal swelling and a loss of vision. This swelling may be more
noticeable in the morning and may clear up to some degree as the day
progresses. Sodium chloride or salt solution drops or ointment can be prescribed
to reduce the swelling. If these dystrophies progress to the point that vision
is severely compromised, corneal transplant surgery may be necessary to restore
lost vision.
The picture below is a magnified photograph of the cornea.
The "edema" that is seen under bright light is caused by Fuch's corneal endothelial dystrophy and is seen as this
"mottled" appearance.
Other websites that you can visit include:
www.fuchs-dystrophy.com
www.fuchs-dystrophy.org/links1.html
www.dog.org/2000/e-abstract_2000/35.html