Dr. Angela F. Acedera

LASIK is an acronym for Laser-Assisted in situ Keratomileusis. It is the procedure wherein the Excimer laser treatment to correct errors of refraction is applied on the bed of the cornea under a hinged corneal flap.

Thyroid Eye Disease

What is Thyroid Eye Disease (TED)?
Thyroid eye disease (TED) is an eye condition in which the eye muscles and fatty tissue behind the eye become inflamed. This can cause the eyes to be pushed forward (‘staring’ or ‘bulging’ eyes) and the eyes and eyelids to become swollen and red. In some cases there is swelling and stiffness of the muscles that move the eyes so that the eyes are no longer in line with each other; this can cause double vision. Rarely TED can cause blindness from pressure on the nerve at the back of the eye or ulcers forming on the front of the eyes.

TED is an autoimmune disease. It occurs when the body’s immune system attacks the back of the eye and causes inflammation. It is mainly associated with an over-active thyroid due to Graves’ disease, although it does sometimes occur in people with an under-active or normally functioning thyroid. Graves’ disease is the most common cause of an over-active thyroid (hyperthyroidism) in the UK. TED is also known as Graves’ orbitopathy (GO).

What is the chance that I will develop TED?
Overall, about a quarter of people with Graves’ disease develop TED either before, during, or after their thyroid disorder is diagnosed. In most cases the eye disease is mild. If you have no features of TED by the time the Graves’ disease is diagnosed and you are a non-smoker or ex-smoker then your chance of developing TED is less than one in ten. But if you smoke your chance of developing TED is doubled. If you are a heavy smoker, the chances of developing TED is increased eight times compared to non-smokers.

What are the symptoms of TED?
These are the most common symptoms. See your doctor if you have any of the following:

Change in the appearance of the eyes (usually staring or bulging eyes)
A feeling of grittiness in the eyes
Dry or watery eyes
Dislike of bright lights
Swelling or feeling of fullness in one or both upper eyelids
Bags under the eyes
Redness of the lids and eyes
Blurred or double vision
Pain in or behind the eye, especially when looking up, down or sideways
Difficulty moving the eyes
If you have puffy eyelids and skin around and under the eyes and you have a severely under-active thyroid, this is probably not TED. It should improve once you are adequately treated with levothyroxine.

TED can sometimes be difficult to diagnose and patients may be treated for conjunctivitis, allergy or hay-fever for months before the diagnosis is made. The clues that the diagnosis may be TED rather than the above are:

Symptoms may occur in the wrong season for hay-fever
Allergies usually cause itchy eyes, whereas TED does not
Conjunctivitis usually causes sticky eyes, whereas TED usually does not
TED often is associated with an ache or pain in or behind the eye, especially when trying to look up or sideways, whereas the other above causes do not
TED is sometimes associated with double vision, whereas the other causes are not
Can I do anything to prevent TED from getting worse?
Three things you can do are:

If you are smoker, give it up - ask your doctor for advice on how to stop, or enrol on a quit-smoking programme. Patients with TED who continue to smoke respond less well to treatments, but this disadvantage seems to disappear soon after giving up smoking. Also non-smokers or ex-smokers are more likely to be cured of their thyroid over-activity after a course of Carbimazole (CMZ) or Propylthiouracil (PTU) treatment, than smokers.

See also information about Smoking and Graves’ disease on the BTF website.

Avoid fluctuations in your thyroid levels - particularly hypothyroidism. Make sure that you have thyroid blood tests regularly, and follow the advice given by your doctor about when and how to take your medication. This will make sure that your thyroid levels remain normal and steady, which will give your eyes the best chance of healing and improve the way you feel.

Selenium supplements - evidence suggests that patients with mild active TED may benefit from a six month course of selenium supplements at a dose of 100mcg twice daily which you can buy over the counter.

Can TED affect my quality of life?
Yes, doctors are increasingly aware that TED can affect your psychological and social well-being. If you have fluctuating thyroid levels you may feel anxious and/or irritable and suffer from mood swings until your hormone levels are stabilised. You may also feel anger, loss of self-esteem or confidence, or socially isolated, because of the change in the appearance of your eyes. Treatment - including surgery - can often improve this; and counselling, or contact with fellow TED sufferers, can help you find coping strategies. Contact the British Thyroid Foundation, The Thyroid Eye Disease Charitable Trust, or your local eye centre for help in locating a support group.

What treatments are available for people with TED?
In mild cases, if your eyes feel gritty, water a lot and feel uncomfortable in bright lights, then artificial tear drops will help your eyes feel more comfortable. Selenium supplements (100mcg twice daily for six months) are beneficial in patients with mild TED. If you have other symptoms ask your GP or endocrinologist (the specialist looking after your thyroid) to refer you to an ophthalmologist (an eye doctor). Ask for a referral if you have other symptoms even if you have not yet been diagnosed with Graves’ disease. The ophthalmologist will be able to confirm whether you have TED and look at treatments to help your eyes.

The symptoms may worsen for the first six to 12 months or so but after that your eyes should improve. It can take up to two years before the inflammation has gone.

Unfortunately, many people with TED are left with a permanent change, usually in the physical appearance of their eyes or sometimes double vision. Surgery can improve appearance. In more severe cases it can be combined with other treatments such as steroids and radiotherapy. Rehabilitative surgery may involve:

'Decompression' surgery to create more space behind the eyes when there is pressure on the nerve or if there is a lot of protrusion of the eyeballs, in order to improve a person’s appearance
Eye muscle surgery to treat double vision; and/or
Eyelid surgery to improve the appearance of the eyelids
Other treatments for TED include:

Prisms attached to spectacles (to help the double vision)
High dose steroids, to improve double vision
What should I do if the symptoms get worse?
In less than 5% of people TED becomes very severe. You might experience disabling double vision; the delicate covering of the coloured part of the eye known as the ‘cornea’ can develop ulcers and interfere with vision; and - rarely - the ‘optic nerve’ carrying messages to the brain can be compressed, leading to loss of vision. If these complications are diagnosed early the treatment can still be successful.

If you develop any of the following symptoms you should see your doctor without delay and ask for immediate referral to a specialist eye centre with experience of treating TED:

Your symptoms get increasingly worse over a period of several days or weeks
You have blurred vision which does not improve by blinking or covering each of the two eyes in turn
You become aware that colours do not appear as bright as they used to, or there is a difference in how bright colours seem when you compare one eye with the other
You see double on looking forwards or downwards
You have to keep your head tilted sideways or backwards to avoid seeing double
Some important points….
There is now a lot that can be done to help people with TED, from artificial tear drops to surgery
Smoking increases your chance of getting TED. Patients with TED who continue to smoke respond less well to treatments. Ask your doctor for advice on how to stop
Avoid fluctuations in your thyroid levels – have regular blood tests and take your medication regularly
TED can affect your psychological and social well-being. Don’t hesitate to ask your doctor for advice
Ask your doctor to refer you to a specialist eye centre (Ophthalmologist) which has experience of thyroid eye disease, especially if the symptoms become more severe.

Alam mo ba na 60% na mas mataas ang tsansa na magkaroon ng katarata kung may diabetes kumpara sa mga taong walang diabetes?

Kaya kung nais makaiwas sa katarata ay dapat panatilihing nasa target ang asukal sa dugo. Sa mga pag-aaral sa mga taong may type 2 diabetes, nababawasan ng 19% ang tsansa na magkaroon ng katarata sa bawat 1% na pagbaba ng HbA1c. Kaya mas malapit sa target ang asukal sa dugo ng may diabetes, ay mas makakabuti para sa mata.

Para sa karagdagang impormasyon tungkol sa katarata, magpakonsulta Kay Dr. Angela F. Acedera isang Board Certified Ophthalmologist.

🙏🙏🙏

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For consultation, please contact 0975-1167528, (02)871-4674
Dr. Angela F. Acedera (Board Certified Ophthalmologist)
Las Piñas Doctors Hospital - MWF 9:00-11:00am
Acedera Eye Clinic - TTH 1:00-3:00pm, Saturday 10:00am-12nn/by appointment
Alabang Medical Center-by appointment
Manila Doctors Hospital-by appointment

Over time, many people will become more susceptible to certain eye diseases, including glaucoma. Glaucoma occurs when pressure in the eye rises, and it can often lead to decreased vision and even blindness. With more than 200,000 cases reported each year, it is one of the most common eye problems in the world. If you are wondering what glaucoma is, here’s everything you need to know.
Glaucoma Types and Symptoms
There are two main types of glaucoma: open-angle and closed-angle.
Open-angle glaucoma is the most common of the two types and occurs when the eye is unable to drain fluid properly. Because of this, the pressure in the eyes builds and causes damage to the optic nerve.
Typically, symptoms for this type of glaucoma are minor and often go unnoticed, especially in its early stages. Eventually, however, those with open-angle glaucoma will experience changes in overall vision, loss of peripheral vision, and even blindness.
The best way to avoid this is to schedule routine eye doctor appointments.
Closed-angle glaucoma happens when the angle between the iris and cornea is too narrow and blocks fluid from draining from the eye. This causes the pressure to rise quickly and results in more noticeable symptoms than those experienced with open-angle glaucoma.
Early signs of closed-angle glaucoma are quite severe. With that said, if you notice the following symptoms, contact your eye doctor immediately to avoid additional optic nerve and vision damage.
Eye pain and severe headaches
Sudden changes in overall eyesight
Blurry or hazy vision
Nausea or vomiting due to eye pain and headaches
Glaucoma Risk Factors
Everyone has a risk of getting glaucoma, but those with certain risk factors may have an even higher chance of developing the disease.

Here are some risk factors that can heighten your chances of getting glaucoma:
Family history of glaucoma
Diabetes, migraines, or poor blood circulation
Thinning optic nerve
Thin corneas
Previous eye injuries
Diagnosing Glaucoma
Glaucoma is diagnosed with a comprehensive dilated eye exam during routine eye doctor appointments. Your eye doctor will measure the pressure in each eye and the drainage angle. They will also check the optic nerve for damage and test your peripheral vision.
If early signs of glaucoma are spotted, the doctor will administer the appropriate treatment to save your vision and ensure proper eye health.
How to Treat Glaucoma:
Glaucoma is an incurable disease, but there are treatments available that can help slow its progression. One of the most common ways to treat glaucoma is with special eye drops prescribed by a doctor.
These drops should be taken every day because they help drain fluid from the eye through the drainage angle between the cornea and the iris. They also assist in regulating the amount of fluid produced in the eye which helps alleviate pressure and preserve vision.
Surgical treatments are available for those with more severe cases of glaucoma.
Glaucoma is one of the most severe and common eye diseases in the region. While it cannot be cured, early detection and treatment can make it possible to reduce its progression and save your vision.
To learn more about glaucoma and our available treatments, schedule a consultation at Acedera Eye Clinic now.

Disclaimer:The information mentioned is not medical advice or suggestions regarding your condition. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. Please discuss any medical concerns with your eye doctor.

Better to consult :)

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Dr. Angela Florentino-Acedera (Ophthalmologist)
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