Dr. Nicholas Donas Talks Aging Eye Disorders and the Latest Treatment Options to Improve Vision
Dr. Nicholas Donas
Dr. Nicholas Donas, an ophthalmologist at St. John’s Rivertown Ophthalmology, performs the latest procedures and treatments for age-related vision problems, including glaucoma, macular degeneration, and cataracts. He says these conditions can have a genetic component, but in many cases, they are simply due to the typical aging process.
“It’s a natural process,” Dr. Donas explains. “The main cause of cataracts is aging. So just the way that our skin develops wrinkles and our hair turns white, the lens in the eye gets a little cloudy and yellow as we grow older.”
As the lens becomes cloudy and less transparent, a patient may begin having difficulty seeing.
“Cataracts eventually get to a point where they start to affect activities of daily living like driving, reading, or in some cases, even recognizing faces from across the room,” says Dr. Donas. “For instance, some patients will say they can’t read the scroll on the bottom of the TV screen. That’s a big complaint people have. And of course, you know, driving at night, that’s probably one of the most common complaints, especially when cataracts first start to develop. It doesn’t mean necessarily that you have to have your cataracts removed, but if it gets to a point where either your doctor strongly recommends it, or you feel your vision should be better, that is an option.”
The surgery is typically done while the patient is awake. Many patients have concerns about cataract surgery, but Dr. Donas explains that it’s a fast, safe, and very common procedure.
“It’s probably the most commonly performed surgery in the United States, and also one of the safest procedures,” he says. “It’s about a 10- to 15-minute procedure where tiny incisions are made on the front part of the eye, the cornea. We gain access, and the lens or the cataract is removed, and an artificial lens is placed where the cataract used to be.”
Understandably, patients may also worry about pain or discomfort during the procedure.
“It’s painless in the sense that we do use topical anesthesia,” Dr. Donas notes. “And patients often get some sedation, so they’re comfortable and relaxed. One of the biggest concerns is that the patient will see what I’m doing. So they’ll ask me, ‘Will I see what you’re doing?’ You can imagine that it wouldn’t be very comfortable to see instruments coming at your eye, but that’s not what happens. You don’t see that, because you can’t focus on what the doctor’s doing. Most patients will say that they don’t really experience pain, and for the most part, are very comfortable with the sedation they get.”
Another common condition associated with aging is macular degeneration.
“The macula is the central part of the retina that is responsible for sharp vision,” explains Dr. Donas. “What happens with macular degeneration is that the cells of the macula lose their ability to clear themselves of metabolic waste. So it accumulates, forming what we call drusen or deposits in the retina.”
These deposits trigger changes in the retina that can lead to two types of macular degeneration: dry and wet. The dry type is the early phase of the disease, and the wet type is more advanced. Dr. Donas notes that there are different treatment options for these phases.
Slowing progression is key with early or dry-type macular degeneration.
“In all cases, we recommend that patients with macular degeneration protect their eyes from the sun,” says Dr. Donas. “We know that UV damage can cause progression of the disease, so we do recommend sunglasses always. We also recommend anything good for your health, like quitting smoking. If you have diabetes, make sure your diabetes and blood pressure are under control. In addition, some vitamins have been shown to really slow the progression of macular degeneration. The AREDS2 vitamin formula is available over the counter. It’s based on an extensive study that has found a specific combination of vitamins to help slow down the progression of the disease.”
When the disease progresses, it can lead to bleeding and swelling under the retina.
“When you develop bleeding, it’s called wet because you develop hemorrhages in the back of the eye,” Dr. Donas explains. “And those hemorrhages can eventually lead to scarring and even cause patients to lose their vision. Fortunately, there are injection treatments for that type of macular degeneration as well. Of course, it’s not something you take lightly, but these injections are very helpful. They’ve really been a game changer, and we’ve seen patients maintain their vision much longer.”
Dr. Donas also discussed glaucoma, a third aging-related eye condition that can cause vision difficulties.
“Glaucoma is caused by elevated pressure inside the eye,” he says. “So if you can imagine, the eye is a closed compartment. It’s like a basketball, right? If you could overinflate the basketball, it would feel firm. So we measure the pressure in the eye. Elevated pressure can damage various parts of the eye. When it causes damage to the optic nerve, that’s glaucoma.”
This nerve damage is irreversible, but the progression of glaucoma can be slowed with treatments like eye drops, laser treatments, and occasionally surgery. However, glaucoma can cause damage and loss of vision very quickly, before the patient is aware of a problem.
“It’s something you don’t feel, and that’s why glaucoma is often referred to as a silent thief of sight,” Dr. Donas explains. “You could walk around with glaucoma for a long time, have sharp vision, and eventually lose some of your field of vision and not be aware of it. This is one reason why it’s essential to have your eyes examined regularly, because most people with glaucoma are diagnosed at a routine eye exam.”
Dr. Donas’ father struggled with glaucoma, which inspired him to choose ophthalmology as a specialty. “I knew I could make a difference in the lives of patients like my father.”
Today, Dr. Donas sees patients at Rivertown Ophthalmology in Ardsley. For more information or to book an appointment, please visit their website.
