Astigmatism occurs when the cornea is shaped like a football (more curved in one direction than the other) and often occurs in combination with myopia (nearsightedness) and hyperopia (farsightedness). This causes light to focus in more than one point on the retina, resulting in blurry and distorted vision. It is a very common type of refractive error in the eye, and not a disease.
Blurry, distorted vision at all distances
Straight lines appear wavy
Lid swelling such as caused by a stye
The doctors at Karlik Ophthalmology can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina. A visual acuity test will determine your ability to see sharply and clearly at all distances.
Glasses and contact lenses are used by many for the correction of astigmatism. Special toric or astigmatic soft lenses can be used, along with gas permeable hard lenses for higher degrees of astigmatism.
If you are about to undergo cataract surgery, a relaxing incision can be made to reduce the amount of astigmatism after surgery, thus making your distance vision clearer without any glasses.
Refractive surgery (LASIK or PRK) can correct most degrees of astigmatism, nearsightedness, or farsightedness. The doctors at Karlik Ophthalmology can work with you to determine if you are a candidate for these procedures.
Other types of refractive errors include: nearsightedness, farsightednessand presbyopia.
Limbal Relaxing Incisions (LRIs)
Blepharitis is an infection of the eyelids. Some patients call it granulated eyelids. Almost everyone has some form of blepharitis. It is caused by bacteria that is part of our normal makeup but then gets out of hand and concentrates on the eyelids and eye. Blepharitis causes problems for some people but not for others. Fortunately, blepharitis is relatively easy to treat. However, it is a chronic condition and needs to be taken care of on an ongoing basis, like brushing or flossing your teeth.
Staphylococcus blepharitis is caused bacteria called Staphylococci, commonly known as "staph." It often begins in childhood and continues throughout adulthood. This form of the condition results in dandruff like debris and scales on the lashes along with crusting and chronic redness at the lid margin. If left untreated, loss of eyelashes can result along with red inflamed eyelids. Eventually a blockage of the oil glands along the eyelid margins can lead to styes, also known as hordeolum or chalazia. In severe cases, the cornea, the transparent covering of the front of the eyeball, may also become inflamed and vision affected.
Seborrheic blepharitis is a common form of this condition as well. It is not an infection but is caused by improper function of the oil glands, which causes greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Dandruff of the scalp, hormones, nutrition, general physical condition and stress are factors in seborrhea.
Ocular Rosacea is the term used to describe blepharitis in its most severe form. Once diagnosed with Ocular Rosacea, oral medications are often required in addition to the topical measures used to treat blepharitis.
Itchy, burning, watery eyes
Matter in the corners of the eyes on awakening
Redness of the eyelids
Frequent sty formation
Tiny pimples on the eyelid edges
Scaly skin flakes along the eyelid margins
Gritty sensation leading to irritated eyes and light sensitivity
Poor eyelid hygiene
Excess oil produced by the glands in the eyelid
Bacterial infection (often staphylococcal)
Dietary factors in some individuals (caffeine, alcohol, spicy foods, tobacco)
In addition to eliminating redness and soreness, treatment can prevent potential infection and scarring of the cornea. You doctor will perform a complete eye examination to determine the most effective treatment.
Usually, blepharitis can be controlled by careful, daily cleaning of the eyelashes. Warm compresses (a wash cloth moistened with warm water) placed on the eyes several times a day is the best initial treatment for blepharitis. The wash cloth should be placed over both eyes until it begins to cool (five to ten minutes). This softens the accumulated oils and reduces the bacterial content of the eyelids. Artificial tears can be instilled into the eyes after each warm soak to increase the aqueous content of the tears and reduce the accumulation of the oil components of the tears on the eyelids.
If the warm soaks and artificial tears fail to control the blepharitis alone, the eyelid margins can be cleansed with lid scrubs. A few drops of baby shampoo in lukewarm water should be mixed in one's hand. Being careful to avoid getting shampoo in your eye, scrub back and forth along the eyelashes of all eyelids, either with a washcloth draped over your finger or a cotton swab (Q-tip). Rinse with plain tap water.
Once the redness and soreness are under control, this cleaning may be decreased from daily (usually at bedtime) to every other night. However, if the symptoms return, return to daily cleansing immediately.
It is important to understand that blepharitis is a chronic condition that usually requires continuous care. Therefore, it is important to continue the warm eyelid soaks and artificial tears from two to four times a day as part of one's normal hygienic routine to prevent a recurrence of eye irritation. If eye irritation reoccurs while performing the warm soaks and lid scrubs, it is important to call the doctors at North Hill Eye Associates to be evaluated for a possible more serious eye condition.
In some cases, your doctor may prescribe eye drops or ointment to be used along with the daily cleansing regimen. For ointments, use a clean fingertip to rub a small amount into the eyelashes. Be careful to follow recommended dosages; excess medication will cause temporary blurring of vision. And with any medication, there is a small possibility of allergy or other reaction. If you think this is happening, stop the medication and contact your doctor immediately.
For certain types of blepharitis or ocular rosacea, prescription medications taken by mouth are helpful. Most of these medications are antibiotics that also improve or alter the oil composition of the eyelid oil glands. When taken properly, they are safe. However, side effects may occur in some individuals, including skin rash, slight nausea and increased sensitivity to sun.
Although medications may help control the symptoms of blepharitis, they alone are not sufficient; keeping the eyelids clean is essential.
If you think you may have blepharitis, your eye doctor can determine the cause and recommend the right therapy specifically designed for you.
Over fifty percent of people over the age of 60 (and quite a few younger than that) develop cataracts. Almost everyone will eventually develop cataracts as they grow older. Cataract formation occurs at different rates in different people, and can affect one, or in most cases, both eyes.
A cataract is a progressive clouding of the eye's natural lens. It interferes with light passing through the eye to the back of the eye, the retina. Aging and other factors cause cells in the eye's lens to clump together, forming these cloudy areas. Early changes may not disturb vision, but over time cataracts typically result in blurred or fuzzy vision and sensitivity to light. People with advanced cataracts often say they feel as if they are looking through a waterfall or a piece of wax paper.
Decreasing vision with age
Blurred or double vision
Seeing halos around bright lights
Difficulty seeing at night
Vision that worsens in sunlight
Difficulty distinguishing colors
Poor depth perception
Frequent prescription changes for glasses
Some medications including long-term use of oral steroids
Certain metabolic conditions
Your eye doctor can perform a variety of tests to determine how much your vision has been affected by a cataract. But typically, when decreased vision affects your everyday activities or hobbies, a cataract should be treated.
Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery.
The cornea is the clear, outer window of the eye. A corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea very painful.
History of recent eye trauma
Sensitivity to light
The feeling that there is something in your eye
Pain upon awakening in one's eye
Foreign object in the eye
Blow to the eye
Scratched eye (fingernails, hairbrushes, tree branches, etc).
Only your eye doctor can identify corneal abrasions by examining your eyes with special instruments. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present.
Occasionally the eye will have to be patched, but modern day therapy for abrasions usually involves leaving the eye open and prescribing antibiotics to help prevent infection and pain medication for comfort. Sometimes a contact lens is placed in the eye as a temporary bandage to help the abrasion resolve more quickly. It is important that you do not rub your eye, especially during the healing process. Following specific doctor instructions is also critical, including keeping follow up appointments.
Care examination and close follow-up is essential to ensure a corneal abrasion does not develop into a corneal ulcer.
The cornea is the clear front window of the eye. It transmits light to the interior of the eye allowing us to see clearly. Corneal disease can cause clouding, distortion and eventually blindness. There are many types of corneal disease.
Ghost images or halos around lights
Sensitivity to bright lights especially outdoor sunlight
Sensation of a foreign body or object in the eye
Moderate to severe pain
Infection: Bacterial, fungal and viral infections are common causes of corneal damage
Herpes simplex in the eye
Foreign material in the eye such as grass, debris, or metal
Chemical injury, such as the wrong contact lens solution or household cleaners
Hereditary corneal dystrophies like Anterior Basement Membrane, Granular or Lattice dystrophy
Contact lens overwear or poor cleaning techniques
Eye trauma from a blunt blow to the eye
Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity. Progression can be rapid, gradual or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.
Fuchs' endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. The purpose of this layer is to pump fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and decrease vision.
Bullous keratopathy is a condition in which the cornea becomes permanently swollen. This occurs because the inner layer of the cornea, the endothelium, has been damaged and is no longer pumping fluids out of the tissue.
Your eye doctor can check for corneal disease and trauma by examining your eyes with magnifying instruments. Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease.
As with any serious eye infection, corneal disease should be treated immediately. Foreign bodies can be removed in the office, and infections treated with new generation antibiotics, steroids, and antiviral agents. Rarely, corneal transplant may be necessary to restore vision when the cornea becomes clouded.
The front of the eye is covered with a thin, transparent membrane called the cornea, which protects the interior of the eye. If there is a break or defect in the surface layer of the cornea, called the epithelium, and damage to the underlying stroma, a corneal ulcer results. The ulcer is usually caused by microorganisms, which gain access to the stroma through the break in the epithelium.
Corneal ulcers generally heal well if treated early and aggressively. However if neglected, corneal clouding and even perforation (a hole in the cornea) may develop, resulting in serious loss of vision and possibly loss of the eye. Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. DO NOT WAIT to see your eye doctor if you experience any of the symptoms below.
Sensitivity to light
The feeling that there is something in your eye
Discharge from the eye
Wearing contact lenses for excessive periods of time
Inadequate contact lens sterilization
Lack of tear production
Complications of herpes simplex keratitis, neurotrophic keratitis, chronic blepharitis, conjunctivitis
Corneal ulcers are a serious vision-threatening condition and require prompt medical attention. If left unattended, corneal ulcers may penetrate the cornea allowing infection to enter the eye, which can cause permanent loss of vision and possible loss of the eye. Your eye doctor can identify corneal ulcers by examining your eyes with magnifying instruments and if necessary by taking a culture to identify infection. Your doctor will check your eye, including under your eyelid, to make sure there are no foreign materials present.
If treated early, corneal ulcers are usually curable. They are typically treated with antibiotic eye drops, often several different types. Sometimes, topical steroids will also be used to decrease the risk of scarring and inflammation. Expect to be seen for frequent follow-up visits.
Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. When the blood vessels in the eyes are affected, this is called diabetic retinopathy.
The retina is the thin layer that lines the back of the eye. It detects visual images and transmits them to the brain. Major blood vessels lie on the front portion of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.
During the early stages of diabetic retinopathy, reading vision is typically not affected. However, when retinopathy becomes advanced, new blood vessels grow in the retina. These new vessels are the body's attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal. They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision. The growth of abnormal blood vessels on the iris of the eye can lead to glaucoma. Diabetic retinopathy can also cause your body to form cataracts more quickly.
The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called a retinal detachment and can lead to blindness if left untreated.
There are usually no symptoms in the early stages of diabetic retinopathy
Blurry or hazy vision
Difficulty reading or doing close work
Diabetes: Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Changes in blood sugar levels increase the risk.
keeping your blood sugar under control and seeing your medical doctor routinely
monitoring your blood pressure
maintaining a healthy diet
getting an eye exam at least once a year
There are usually no symptoms in the early stages of diabetic retinopathy. Vision may not change until the disease becomes severe. An exam is often the only way to diagnose changes in the vessels of your eyes. This is why yearly examinations with an ophthalmologist are extremely important for anyone with diabetes. If your vision changes and you feel you are not seeing clearly, get in to see your eye doctor immediately.
If any hemorrhages are detected on your eye examination, a test called fluorescein angiography will often be performed. During the test, a harmless yellow dye called fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. A special camera with a green filter will be used to take multiple photographs. The pictures will be analyzed to identify leaky blood vessels, damage to the lining of the retina or the formation of new blood vessels. Swelling from leaking blood vessels can also be evaluated by an non-invasive imaging test called OCT.
It is occasionally necessary to treat the retinal swelling produced by diabetic retinopathy with a laser treatment. Additionally, injection of medication into the vitreous of the eye is sometimes indicated. If proliferative retinopathy occurs (when abnormal new blood vessels bleed into the eye), pan-retinal photocoagulation is performed. During this procedure, a laser is used to destroy all of the dead areas of the retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.
If diabetic retinopathy has caused your body to form cataracts, they can be corrected with cataract surgery.
The term "dry eye" can be a little confusing since one of the most common symptoms is excessive watering or tearing! It makes more sense, though, when you learn that the eye makes two different types of tears.
The first type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.
The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you are cutting onions, when you cry, or when you accidentally scratch your eye. The reflex tears gush out in such large quantities that the tear drainage system cannot handle them all and they spill out onto your cheek. Still another cause of reflex tearing is irritation of the eye from lack of lubricating tears. If your eye is not producing enough lubricating tears, you have dry eye syndrome.
The feeling that there is sand or grit in your eyes
Burning sensation, worse in heated rooms or air conditioning
Vision that becomes blurred after periods of reading, watching TV, or using a computer
Aging can result in less oil production in the glands of the eyelids. Oil keeps tears from evaporating off the eye. Reduced oil production allows tears to evaporate too quickly, leaving the eye dry.
Diseases including Connective Tissue Disorders (Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren's Syndrome), Parkinson's and Diabetes
Hormonal changes, especially after menopause
Prescription medications: These include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids can also cause dry eyes.
Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eyes.
Reading, using a computer or watching TV
Eye surgery: Some types of eye surgery, including LASIK can aggravate dry eye.
Your eye doctor can check for dry eye by examining your eyes with a bio-microscope, measuring your rate of tear production, and checking the amount of time it takes for tears to evaporate between blinks. The doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special diagnostic dyes such as fluorescein or Rose Bengal.
The most common treatment is the use of artificial teardrops, which help make up for the lack of natural lubricating tears. Artificial tear products come in liquid form, longer lasting gelform, and long-lasting ointment form. Many different brands of artificial tears are available over-the-counter. Some contain preservatives and some do not. Unpreserved tears may be recommended for people whose eyes are sensitive to preservatives. Artificial tears can generally be used as often as needed, from a few times per day to every few minutes. You should follow the regimen your doctor recommends. Ask for samples of several different brands of tears so you can determine which helps you the most.
When infection, inflammation of the eyelids, or clogged oil glands contributes to dry eye, special lid cleaning techniques or antibiotics may be recommended (see section on Blepharitis). It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.
Anti-inflammatory medications such as Restasis have been shown to be effective. See our section on Restasis for more information. Research on nutrients called fatty acids as a treatment for dry eye is ongoing.
Punctal occlusion is a medical treatment for dry eye that may enable your eyes to make better and longer use of the few lubricating tears they do produce.
Hyperopia, unlike normal vision, occurs when the cornea is too flat in relation to the length of the eye. This causes light to focus at a point beyond the retina, resulting in blurry close vision and occasionally blurred distance vision as well. Usually this condition is undetected until later in life because the young eye is able to compensate for the hyperopia by focusing the internal lens of the eye.
Blurry close vision
Occasional distance blur
Many people are not diagnosed with hyperopia without a complete eye exam. This is especially critical in children. School screenings typically do not detect this condition because they test only for distance vision. It is important that any child experiencing difficulty with their vision, learning, or deviation of their eye alignment, to have an evaluation with an ophthalmologist.
Your eye doctor can conduct a refractive evaluation to determine whether the eyes focus light rays exactly on the retina at distance and at near. A visual acuity test will determine ability to see sharply and clearly at all distances. Your eye doctor will also check eye coordination and muscle control, as well as the eyes' ability to change focus. All of these are important factors in how the eyes see.
Glasses and contact lenses are the standard treatment for hyperopia. Other types of refractive errors include: nearsightedness and presbyopia.
Refractive Surgery (LASIK, PRK, refractive lensectomy) can be performed to correct hyperopia.
Flashes and floaters can be alarming. Usually, however, an eye examination will confirm that they are harmless and do not require any treatment.
Seeing small, floating spots
Seeing bright flashes of light
Aging of the eye: Most flashes and floaters are caused by age-related changes in the gel-like material, called vitreous, that fills the back of the eye.
When you are born, the vitreous is firmly attached to the retina. In the very young, the vitreous is rather thick, like firm gelatin. Within the vitreous, there may be clumps of gel or tiny strands of tissue debris left over from the eye's early development. These clumps or strands are firmly embedded in the thick, young vitreous and cannot move around much.
As you get older, the vitreous gradually becomes thinner or more watery. By the time you are in your twenties or thirties, the vitreous may be watery enough to allow some of the clumps and strands to move around inside the eye. This material floating inside the eye can cast shadows on the retina, which you see as small floating spots.
With time and aging, you may experience the onset of larger, more bothersome floaters or flashes of light. This is because with aging the vitreous gel becomes more watery. It jiggles around quite a bit when you move your eye, making flashes and floaters much more common.
Eventually, the aging vitreous can pull away from the retina and shrink into a dense mass of gel in the middle of the eyeball. Shadows cast onto the retina by the detached vitreous can cause you to see large floaters. This is a gradual process, but the symptoms are often noticed suddenly. It can be very alarming to the person experiencing it.
Flashes and floaters are very common. Almost everyone experiences them at one time or another. They become more frequent as we age. In rare cases, a doctor's exam may reveal a more serious problem called a retinal tear or retinal hole. Therefore, it is important to call North Hill Eye Associates to be examined with the onset of any change in floaters or onset of flashes.
Your eyes will be dilated to allow a better view of the retina. Using special instruments to look into your eyes, your doctor can distinguish between harmless floaters and flashes and more serious retinal problems such as holes, tears or a retinal detachment. The usual symptoms of these more serious problems include seeing hundreds of small floating spots, persistent flashing lights, or a veil-like blockage of a portion of the vision. If you experience any of these, you should contact your doctor immediately.
With time, floaters become less noticeable as the brain adjusts to its presence and can "tune out" the floaters. Some floaters may always be somewhat observable and present, particularly if one eye is covered and the patient looks at a light-colored background. The presence of floaters alone is not an indication for surgery.
Anyone with flashes or the sudden onset of a new floater should be examined promptly by an ophthalmologist. If a tear is present in the retina, it is important to find this prior to the development of a retinal detachment. A retinal tear can be closed by the doctors at North Hills Eye Associates by an in-office laser procedure. If a tear has progressed to a retinal detachment, surgery becomes necessary.
It is estimated that over two million Americans have some type of glaucoma and half of them do not know it. Ninety percent of glaucoma patients have open-angle glaucoma. Although it cannot be cured, it can usually be controlled. Vision loss may be minimized with early treatment. The eye receives its nourishment from a clear fluid that circulates inside the eye.
This fluid must be constantly returned to the bloodstream through the eye's drainage canal, called the trabecular meshwork. In the case of open-angle glaucoma, something has gone wrong with the drainage canal. When the fluid cannot drain fast enough, pressure inside the eye begins to build.
This excess fluid pressure pushes against the delicate optic nerve that connects the eye to the brain. If the pressure remains too high for too long, irreversible vision loss can occur.
In the early stages, there are no symptoms of blurred vision or pain
Gradual loss of peripheral vision (the top, sides and bottom areas of vision) that is not perceptible to most people until the disease is in the advanced stages
Glaucoma can occur in people of all races at any age. However, the likelihood of developing glaucoma increases if you:
are African American
have a family history of glaucoma
are very nearsighted
are over 40 years of age
Everyone should be checked for glaucoma at around age 35 and especially at age 40 and over. Those considered to be at higher risk, including those over the age of 60 should have their pressure checked every year or two. Ideally, you should have an eye exam every two years no matter what age you are.
Your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.
Eye pressure is not directly related to blood pressure. The "normal" pressure ranges from 10 to 21. However, it is important to know that many people with eye pressure in the normal range have glaucoma, and many with pressure above the normal range do not. There are many other factors that determine glaucoma, including:
The Optic Nerve: This is the structure in the eye that suffers damage from eye pressure that is too high for an individual eye to tolerate. An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. Cupping or atrophy of the optic nerve will be carefully evaluated. If the optic nerve appears to be cupped or is not a healthy pink color, additional tests will be run. At North Hill Eye Associates, all patients that are suspicious for glaucoma or diagnosed with glaucoma have the health of their optic nerves documented with digital retinal imaging. Imaging is repeated if any progressive damage to a patient's optic nerve is evident.
Optic Nerve Scanning is performed at North Hill Eye Associates using a Heidelberg Retinal Tomograph (HRT). This scanning laser measures the nerve tissue present in the optic nerve of each eye. Repeat measurements by the HRT can be obtained to document progressive optic nerve damage before they may be evident on examination. This technology assists the doctors at North Hill Eye Associates in diagnosing glaucoma at the earliest stages and ensures that each glaucoma patient's disease is being adequately treated.
Perimetry, or visual field testing, is a test that maps the field of vision. Looking straight ahead into a white, bowl-shaped area, you will indicate when you are able to detect lights as they are brought into your field of vision. This map allows your doctor to see any pattern of side or peripheral vision changes caused by the early stages of glaucoma. This is a somewhat tedious test for the patient, but with modern instruments can be done in 15 minutes or less. The results are extremely important in diagnosing and managing glaucoma.
Gonioscopy is used to check whether the angle where the iris meets the cornea is open or closed. This helps your doctor determine if they are dealing with open-angle glaucoma or narrow-angle glaucoma. Narrow angle glaucoma (please refer to the section on this condition) is a fairly uncommon condition. Most people with glaucoma have the open angle variety. Gonioscopy is the procedure that helps determine which type of glaucoma you have. Gonioscopy also helps determine how appropriate laser treatment (SLT) may be in a patient with glaucoma.
To control glaucoma, treatment has been traditionally started with medication. This typically requires the daily instillation of eye drops for life. With advancements made in laser treatment, initial treatment of open angle glaucoma can now be performed with a laser (SLT) in the office.
Glaucoma medicines come in eye drop form and medications to be taken by mouth. Oral medications (tablets and capsules) are rarely used anymore due to side effects, but are still an option. Drops work by either slowing the production of fluid within the eye or by improving the flow through the drainage meshwork. To be effective, most glaucoma medications must be taken once or twice every day, without fail. Some of these medications have some undesirable side effects, so your doctor will work with you to find a medication that controls your pressure with the least amount of side effects. Medicines should never be stopped without consulting your doctor, and you should notify all of your other doctors about the eye medications you are taking.
Selective Laser Trabeculoplasty (SLT) is an in-office laser procedure designed to open the drainage canal of the eye, resulting in a reduction of the pressure of the eye. Patients can typically drive home after having this laser procedure performed in the offices of North Hill Eye Associates. Requiring only numbing eye drops, the laser beam is applied to the trabecular meshwork resulting in an improved rate of drainage. When laser surgery is successful, it may reduce or eliminate the need for daily medications. For reasons of convenience, side-effects, and expense, many patients now choose this laser procedure (SLT) over the life-long daily requirement of eyedrops which was once necessary for the treatment of open angle glaucoma. The doctors of North Hill Eye Associates discuss this option with all patients diagnosed with open angle glaucoma.
Endoscopic CycloPhotocoagulation (ECP) is another type of laser procedure. Instead of treating the drainage canal, it treats the ciliary body. Treating the ciliary body reduces the amount of fluid production thereby reducing the intraocular pressure. ECP is most often performed along with cataract surgery, but can be done on an outpatient basis when in the best interest of the patient. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications.
Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.
Selective Laser Trabeculoplasty (SLT)
Filtration Surgery (Trabeculectomy)
Narrow-angle glaucoma is very different from open-angle glaucoma in that eye pressure usually goes up very fast. This happens when the drainage canals get blocked or covered over. The iris gets pushed against the lens of the eye, shutting off the drainage angle. Sometimes the lens and the iris stick to each other. This results in pressure increasing suddenly, usually in one eye. There may be a feeling of fullness in the eye along with reddening, swelling and blurred vision.
The onset of acute narrow-angle glaucoma is typically rapid, constituting an emergency. If not treated promptly, this glaucoma may produce blindness in the affected eye within hours to days. Symptoms may include:
Inflammation and pain
Pressure over the eye or extreme headache
Moderate pupil dilation that is non-reactive to light
Blurring and decreased visual acuity
Extreme sensitivity to light
Seeing halos around lights
Nausea and/or vomiting
Anything that causes the pupil to dilate -- dim lighting, dilation drops
Certain oral medications like cold medications, anti-histamines, incontinence medications, or abdominal medications
Diabetes-related growth of abnormal blood vessels
Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered at higher risk for narrow-angle glaucoma, including those who are Asian, farsighted or over the age of 60, should have their pressure checked every year or two.
Because of the rapid, potentially devastating results of narrow-angle glaucoma, you should consult your eye doctor immediately if you experience any of the above symptoms.
During eye exams, your doctor will use tonometry to check your eye pressure. After applying numbing drops, the tonometer is gently pressed against the eye and its resistance is measured and recorded.
A microscope is used to assess the angle structure of the eye, to determine if you are at risk for developing narrow-angle glaucoma. This is important because there is preventative treatment before the acute problem strikes.
An ophthalmoscope can be used to examine the shape and color of your optic nerve. The ophthalmoscope magnifies and lights up the inside of the eye. If the optic nerve appears to be damaged, or is not a healthy pink color, additional tests will be performed.
The management of narrow-angle glaucoma is strictly surgical, unlike the more common open angle glaucoma that is managed in most cases with eye drops. If you have a narrow-angle attack or are at risk for angle closure, a laser procedure called a laser iridotomy is required.
Laser iridotomy is a common treatment for narrow-angle glaucoma. During this procedure, a laser is used to create a small hole in the iris, restoring the flow of fluid to the front of the eye. This procedure is performed in the office. Patients are typically able to drive home after the procedure is performed.
Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.
Filtration Surgery (Trabeculectomy)
Headaches can be caused by many diverse medical conditions. Headaches often involve some degree of eye discomfort. Ophthalmic pathology or disturbances of vision can both cause headaches. Discomfort associated with less than optimal vision is referred to as astenopia ("eye strain"). Many patients with headaches are referred to North Hill Eye Associates by their primary care physician or neurologist to evaluate for an ophthalmic component contributing to their headaches.
Patients with headaches can expect to undergo a complete dilated evaluation with refraction to evaluate for any ophthalmic pathology or visual disturbance. Headaches associated with visual flashes, nausea, or vomiting are often associated with migraines.
Treatment of headaches requires cooperation and communication between the physicians of North Hill Eye Associates and the patient's other heath care providers.
Headaches or visual discomfort (astenopia) associated with visual disturbances may require treatment ranging from eyeglasses to cataract surgery.
Headaches associated with migraines are often treated jointly by the physicians at North Hill Eye Associates and a patient's primary care physician or neurologist.
Keratoconus is an eye condition that causes the cornea to become progressively thinner. A normal cornea is round or spherical in shape, but with keratoconus the cornea bulges forward, assuming more of a cone shape. As light enters the cone shaped cornea it is bent and distorted. Therefore, the light is unable to come to a point of clear focus on the light-sensitive retina.
Keratoconus usually affects both eyes, but the two eyes often progress at different rates. This disease typically begins during teenage years. In most patients, it progresses for several years before stabilizing in the third to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to thin and bulge outward. This can result in further blurring of vision. Scarring of the cornea can also develop.
bulging, cone-shaped cornea
glare and light sensitivity
the need for frequent prescription changes
Researchers believe that approximately 3 million people worldwide have keratoconus. It affects males and females of all races throughout the world. The causes are still being researched, but the likelihood of developing keratoconus is greater if you:
have a relative with keratoconus
have had excessive laser eye surgery
have hay fever, eczema, asthma or food allergies
In mild cases, glasses and soft contacts can be effective, but in more advanced cases, these no longer work well and custom contact lenses or surgery must be considered.
Gas Permeable (GP) contact lenses: This is the primary treatment for keratoconus. To counteract the distortion of the cornea, most keratoconus patients require special hard lenses that help mold the corneal surface so that light can be focused clearly. Because the pattern of distortion in keratoconus is as unique as a fingerprint, the GP lenses are custom prescribed and manufactured. A proper contact lens fitting is crucial to ensure optimal vision, comfort, and eye health. Poor fitting lenses can lead to corneal abrasions, scarring, and infection.
Surgery: Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. Treatment is the performance of corneal transplantation. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. About 10 to 20% of keratoconus patients will eventually require a corneal transplantation. However, corneal transplantation is not a cure in and of itself. Following a successful corneal transplant, most patients still need glasses, soft contacts, or GP lenses for adequate vision.
Patients with keratoconus must not have LASIK or PRK laser eye surgery due to an unacceptable risk of a poor outcome. The cornea in keratoconus is unusually thin and weak. For patients with keratoconus, LASIK surgery thins and weakens their corneas further. This can irreversibly destabilize the cornea and accelerate its distortion. Rubbing the eyes may also increase the progression of keratoconus.
Macular degeneration is a disease of the macula, an area of the retina at the back of the eye that is responsible for fine detail vision. Vision loss usually occurs gradually and typically affects both eyes at different rates. Even with a loss of central vision, however, color vision and peripheral vision may remain clear.
There are two forms of age-related macular degeneration, wet and dry.
Wet Macular Degeneration: Wet macular degeneration occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula. These changes can lead to distorted or blurred vision and, in some cases, a rapid and severe loss of straight ahead vision.
Dry Macular Degeneration: The vast majority of cases of macular degeneration are the dry type, in which there is thinning or deterioration of the tissues of the macula or the formation of abnormal yellow deposits called drusen. Progression of dry macular degeneration occurs very slowly and does not always affect both eyes in the same way.
Early macular degeneration may cause little, if any noticeable change in vision
Difficulty reading without extra light and magnification
Seeing objects as distorted or blurred, or abnormal in shape, size or color
The perception that objects "jump" when you try to look right at them
Difficulty seeing to read or drive
Inability to see details
Blind spot in center of vision
Any Amsler Grid changes
The root causes of macular degeneration are still unknown. Women are at a slightly higher risk than men. Caucasians are more likely to develop macular degeneration than African Americans. Risk factors include:
Age: Macular degeneration is the leading cause of decreased vision in people over 65 years of age.
Heredity: Macular degeneration appears to be hereditary in some families but not in others
Long-term sun exposure
Your eye doctor can identify changes of the macula by looking into your eyes with various instruments. A chart known as an Amsler Grid can be used to pick up subtle changes in vision.
Digital Angiography is the most widely used macular degeneration diagnostic test. During the test, a harmless orange-red dye called Fluorescein will be injected into a vein in the arm. The dye travels through the body to the blood vessels in the retina. A special camera takes multiple photographs. The pictures are then analyzed to identify damage to the lining of the retina or atypical new blood vessels. The formation of new blood vessels from blood vessels in and under the macula is often the first physical sign that macular degeneration may develop.
Optical Coherence Tomography (OCT) uses light waves to create a contour map of the retina and can show areas of thickening or fluid accumulation.
In the early stages of macular degeneration, treatment is accomplished by:
scheduled eye examinations (usually every six months)
attention to diet
in-home monitoring of vision with an Amsler Grid
nutritional supplements (multivitamins)
Diet and Nutritional Supplements: There has been active research on the use of vitamins and nutritional supplements called antioxidants to try to prevent or slow macular degeneration. Antioxidants are thought to protect against the damaging effects of oxygen-charged molecules called free radicals. A potentially important group of antioxidants are called carotenoids. These are the pigments that give fruits and vegetables their color. Two carotenoids that occur naturally in the macula are lutein and zeaxanthin. Some research studies suggest that people who have diets high in lutein and zeaxanthin may have a lower risk of developing macular degeneration. Kale, raw spinach, and collard greens are vegetables with the highest amount of lutein and zeaxanthin. You can also buy nutritional supplements (multivitamins) that are high in these and other antioxidants.
Low Vision Aids: In patients that experience significant progression of their macular degeneration, low vision aids may be of benefit. Low vision aids range from hand-held magnifying glasses to sophisticated systems that use video cameras to enlarge a printed page. Lifestyle aids such as large print books, tape-recorded books or magazines, large print playing cards, talking clocks and scales and many other devices are available.
The doctors at North Hill Eye Associates refer patients to specialists which work with patients to maximize their available vision (low vision specialists), when appropriate.
In some cases of wet macular degeneration, laser treatment may be recommended. This involves the use of painless laser light to destroy abnormal, leaking blood vessels under the retina. This form of treatment is only possible when the abnormal blood vessels are far enough away from the macula that the laser will not produce further damage. Only rare cases of wet macular degeneration meet these criteria. When laser treatment is possible, it may slow or stop the progression of the disease. However, it is generally not expected to recover any of the vision that has already been lost.
A relatively new form of treatment for some cases of wet macular degeneration is called photodynamic therapy or PDT. In those cases where PDT is appropriate, slowing of the loss of vision and sometimes, even improvement in vision are possible.
Anti-VEGF Therapies (Lucentis of Avastin) are medications that can regress the abnormal bleeding and swelling caused by wet macular degeneration. When indicated, these medications can be injected into or around the eye to help stabilize or even improve the vision of a patient with macular degeneration.
To have any chance of the newer treatments for macular degeneration providing any benefit, it is important that patients contact the doctors of North Hill Eye Associates immediately if they notice any change in their vision or Amsler Grid changes.
Anti-VEGF Therapy (Lucentis/Avastin)
During childhood, people with normal vision have the ability to focus on objects as close as their nose and also on objects very far away. They can rapidly, without conscious thought, switch focus from near to far vision. This process of focusing at different distances is called accommodation. As each year passes, that ability to focus and to switch focus decreases. By the time most people reach their forties, they need an aid, such as reading glasses or bifocals, to focus on objects close up. This condition is called presbyopia.
Monovision is a technique where one eye (usually the dominant eye) is corrected for clear distance vision, and the other eye is corrected for comfortable near vision. Monovision allows a person to see close objects clearly with one eye and distance objects clearly with the other eye. The vision part of the brain tends to filter out the image from the eye that is not in clear focus, so those who have monovision eventually do not pay attention to the eye that is not as clearly focused. Those who have monovision are often able to see well enough both at distance and near to do things at any age without corrective lenses.
Monovision can be achieved with contact lenses, cataract surgery, or laser vision correction (LASIK or PRK). If you are considering a vision correction procedure, your doctor can trial monovision with you through the use of contact lenses prior to undergoing a permanent laser vision correction procedure.
For those undergoing cataract surgery who are considering the intraocular lens for monovision, an in depth discussion with your surgeon is necessary to be sure that this is the correct decision for you.
Myopia, unlike normal vision, occurs when the cornea is too curved or the eye is too long. This causes light to focus in front of the retina, resulting in blurry distance vision.
Myopia is a very common condition that affects a large portion of the U.S. population. It normally starts to appear between the ages of eight and twelve, and almost always before the age of twenty. As the body grows, the condition often worsens. It typically stabilizes in adulthood.
Blurry distance vision
Light focuses in front of the retina causing blurry distance vision
In young people, myopia is diagnosed during school screenings. Sometimes parents notice that their children are having difficulty seeing street signs or the television. A visual acuity test will determine your ability to see sharply and clearly at all distances.
Glasses and contact lenses are used by many for the correction of myopia. There are also a number of surgical procedures available for reducing or eliminating myopia.
Refractive surgery (LASIK, PRK, or Clear Lens Extraction) is appropriate for patients that wish to reduce or eliminate their dependence on eyeglasses or contact lenses.
Other types of refractive errors include: farsightedness and presbyopia.
The human eye gives us the sense of sight, allowing us to learn more about the surrounding world than any of the other five senses. The eye allows us to see and interpret the shapes, colors and dimensions of objects by processing the light they reflect or give off.
The cornea (the clear window on the front of the eye) and the lens of the eye (the transparent structure inside the eye) are both critical to normal vision. The goal of these two lenses is to focus light onto a layer on the back of the eye known as the retina. As light enters into the eye it is focused by the cornea and the lens so that images appear clearly on the retina. The retina then transmits these images to the brain where they are processed. If the images focus perfectly on the retina, the result is 20/20 vision; focusing in front or behind the retina results in nearsightedness or farsightedness. If the cornea is shaped like a football instead of a sphere, this is called astigmatism. When any of these conditions occur, images are perceived by the brain as being blurry. This is due to "refractive error" which means the eyeball is not the right size or the cornea does not have the right curve. Presbyopia is a vision condition in which the lens loses its flexibility, making it difficult to focus on close objects. Your ophthalmologist is the physician qualified to check and correct your vision, and perform regular eye health examinations.
Conjunctivitis is an infection or inflammation of the conjunctiva, the thin, transparent membrane covering the surface of the inner eyelid and the front of the eye. The conjunctiva has many small blood vessels. It lubricates and protects the eye. When the conjunctiva becomes inflamed, this is called conjunctivitis. There are many causes of conjunctivitis. The most common forms are bacterial and viral.
Bacterial conjunctivitis typically causes swelling of the eyelid and a yellowish discharge. Sometimes it causes itching and/or matting of the eyelids. It can be accompanied by a sty.
Viral conjunctivitis, also known as EKC or epidemic kerato-conjunctivitis, is very contagious and can be easily transmitted by rubbing the eye and then infecting household items such as towels or handkerchiefs. It is common for entire families to become infected.
Red, watery eyes
Inflamed eye lids
Blurred vision and a sandy or scratchy feeling in the eyes
Pus-like or watery discharge around the eyelids
Matting of the eyelids
Possible swollen gland in front of the ear
Certain precautions can be taken to avoid the disease and stop its spread. Careful washing of the hands, cutting hair so it does not contact the eyes, and avoiding contagious individuals are all helpful. Children frequently get conjunctivitis because of their their close contact with other children while in school.
If you or someone in your household has contracted conjunctivitis, follow these steps to prevent the spread of the infection:
Do not touch the infected eye.
If you do touch your eyes or face, including when using medicine in your eye(s), wash your hands thoroughly.
Wash any clothing touched by infected eyes including clothes, towels and pillowcases.
Do not share make-up or eye drops. If the infection is caused by bacteria or a virus, you must throw away your used make-up or contact lens solution and buy new make-up or solution.
The doctors at North Hill Eye Associates can diagnose the type of conjunctivitis with a careful case history and eye exam. A medical history will also be taken because some conjunctivitis is caused by underlying disease conditions like herpes or the flu.
Antibiotic drops and compresses can ease discomfort and clear up most bacterial infections, normally within just a few days. Sometimes, the inflammation does not respond well to the initial treatment with eye drops. In those cases, additional medication may be prescribed. Keep all follow-up visits with your doctor. If left untreated, conjunctivitis can create serious complications such as infections in the cornea, eyelids and tear ducts.
There are no effective treatments for some forms of conjunctivitis like viral EKC mentioned above. In this case your doctor will prescribe a regimen to make you more comfortable, but the viral condition will need time to resolve on its own.
Presbyopia is a visual condition in which the lens loses its flexibility. This results in difficulty focusing on close objects. During the early and middle years of life, the crystalline lens of the eye has the ability to focus both near and distant images by getting thicker for near objects and thinner for distant objects. When this ability is lost, presbyopia results.
Blurry close vision that starts after age 40
Difficulty adjusting focus when switching from near to distance vision
Eye fatigue along with headaches when doing close work
A comprehensive examination will include testing for presbyopia. Your eye doctor can conduct a refractive evaluation to determine whether your eyes focus light rays exactly on the retina at distance and at near. A visual acuity test will determine your ability to see sharply and clearly at all distances.
Reading glasses and contact lenses are used by many for the treatment of presbyopia. Some presbyopic patients like monovision, which allows them to see distance clearly in one eye and close-up clearly with the other eye.
Laser vision correction (LASIK or PRK) can be performed to provide monovision in patients that desire to reduce their dependence on reading glasses or contact lenses.
Patients undergoing cataract surgery or refractive lensectomy have the option of obtaining multifocal or accommodative intraocular lenses, which can reduce dependence on reading glasses. The surgeons of North Hill Eye Associates discuss these options with all of our surgical patients.
Presbyopia can be present in combination with other types of refractive errors such as nearsightedness, farsightedness and astigmatism.
A pterygium is a fleshy triangular area of tissue, usually on the inner corner of the eye, which can also grow onto the cornea. Sometimes, it extends toward the center of the cornea so that it interferes with vision. As the pterygium develops, it may warp the cornea, causing astigmatism.
Visible tissue growing over the eye
Irritation of the eye
Redness localized in the corner
Possible blurred vision
The causes of a pterygium are multifactorial. Associated factors include:
Long-term exposure to sunlight
Dry, dusty conditions
Age: Pterygia are typically found in adults over the age of 30.
Chances are, you will notice a pterygium when you look in the mirror. It will look something like the photograph above. Your eye doctor can also diagnose it during a routine eye exam.
Eye drops or ointment can be used to reduce the irritation caused by a pterygium. If the pterygium grows toward the central cornea, it often needs to be removed surgically. Outpatient surgery is very successful but there is a chance that the growth will recur.
Retinal detachment occurs when the retina is lifted or pulled from the wall of the eye. If not treated immediately, a retinal detachment can cause permanent vision loss. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should call the offices of North Hill Eye Associates immediately.
The appearance of a curtain over the field of vision
Seeing light flashes or sparks
Wavy or watery vision
A sudden decrease in vision
A sudden increase in the number of floaters or cobwebs in the field of vision
Those who are very nearsighted (myopic)
People with a family history of retinal detachment
Patients with a history of eye injury or surgery
Patients with diabetes or other eye disorders
Patients with a previous history of a retinal tear or detachment
Retinal detachments are treated with surgery that may require a hospital stay. In some cases, a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. Vitrectomy is a procedure in which the vitreous humor is removed and replaced with a gas or silicone oil that pushes the retina back onto the wall of the eye. Over time the eye produces fluid that replaces the gas. In both of these procedures either a laser or a cryopexy (a freezing device) is used to “weld” the retina back in place. Visual recovery depends on how long the retina has been detached and the particular circumstances related to the detachment. Regardless, the doctors at North Hill Eye Associates should be contacted without delay if the signs of a retinal tear or retinal detachment are evident.
Temporary loss of vision in one eye (transient monocular blindness) is termed amaurosis fugax. This condition can be very serious and a precursor to permanent visual loss or stroke.
If you experience sudden loss of your central (reading or straight-ahead) vision, or a blurry or missing area of vision, call your family doctor or the offices of North Hill Eye Associates at once.
Sudden, painless loss of vision
Sudden increase in floating spots or cobwebs
Blurred or missing area of vision
High blood pressure
Glaucoma, diabetes and other conditions
The type of treatment depends on the cause. Further evaluation with tests including evaluation of heart rhythm, cerebral blood flow, or blood coagulation may be indicated. Therapy with anti-coagulant medication may be necessary in some patients.
Dr. Jeffrey Karlik is one of the busiest and most experienced LASIK surgeons in Western Pennsylvania. He has performed LASIK since 1999 and has performed over 10,000 vision corrective surgeries. He has experience performing a high volume of cases using three different laser systems.
LASIK is an acronym for LASer In-situ Keratomileusis, which simply means "to shape the cornea by using a laser". It corrects vision by reshaping the cornea (outer window of the eye) so that light rays focus more precisely on the retina, thereby reducing or eliminating refractive errors (nearsightedness, farsightedness, or astigmatism).
LASIK is for those who:
want to reduce or eliminate their dependence on glasses or contacts
are at least 18 years of age
have had a stable eye prescription for at least one year
have no health issues affecting their eyes
have no signs of glaucoma or cataracts
You will arrive at the laser center about an hour prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery.
Anesthetic eye drops will be used to numb your eyes; no injections or needles will be used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure. A sterile drape will then be applied around your eye.
Next, an instrument called a microkeratome will create a hinged flap of thin corneal tissue. During this process, you may feel a little pressure, but no pain. It is expected that your vision will darken or "fade-out" at this time of the procedure. It is an indication the procedure is proceeding as expected.
The pressure will then ease and vision will slowly return. Dr. Karlik will then gently fold the flap out of the way. Your vision will blur slightly at this time.
You will then be asked to look directly at a target light while the laser reshapes your cornea. The Excimer laser will be programmed with the information gathered in your pre-operative exam.
The laser treatment will be completed in less than a minute or two, depending on the amount of correction needed. To finish the procedure, the protective layer will be folded back into place where it will bond without the need for stitches.
Following your procedure, your eye(s) will be examined with a slit lamp microscope. Then you will be given additional eye drops and your eyes may be shielded for protection. Your vision will probably be a little blurry at first, so someone will need to drive you home. You should relax for the rest of the day. You may experience some discomfort for 12 to 24 hours, but this is usually alleviated with an over-the-counter pain reliever. Some people experience sensitivity to light and watering or swelling of their eyes for a few days following their procedure.
You will be asked to come back the next day for another examination of your eye(s). Most people can actually see well enough to drive the next day but it is best not to drive until you have been examined. You should be able to resume your normal activities the day after surgery.
The decision to have LASIK is an important one that only you can make. The goal of any refractive surgical procedure is to reduce your dependence on corrective lenses (eyeglasses or contact lenses). However, we cannot guarantee you will have the results you desire. Nearly all Dr. Karlik's patients are extremely happy with their vision after LASIK and can do most activities without dependence on corrective lenses.
Serious complications with LASIK are extremely rare. LASIK is a safe, effective and permanent procedure, but like any surgical procedure, it does have some risks. Many of the risks and complications associated with this procedure can be reduced or eliminated through careful patient selection and thorough preoperative testing using the latest diagnostic technology.
After LASIK, you may experience some visual side effects. These visual side effects are usually mild and diminish over time. But there is a slight chance that some of these side effects will not go away completely, such as feelings of dryness, glare and halos.
Since everyone heals somewhat differently, some patients may overreact to the procedure and some may underreact resulting in over corrections and under corrections. Once the eye has stabilized (3 to 6 months) you and your doctor can discuss whether a re-treatment (sometimes termed an enhancement) could help fine tune your vision if you are over or under corrected.
After a thorough eye exam, you and your doctor will determine if LASIK is an option for you. If you are a good candidate, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.
During PRK, laser treatment is performed on the surface of the cornea without cutting a flap
Some patients with thinner corneas, high prescriptions, certain occupations, or certain eye conditions may not be candidates for LASIK. For these patients photorefractive keratectomy (PRK) may be the best option.
With PRK, the front surface is prepared by cleaning the front corneal surface free of cells before applying the laser treatment. Following this, the laser is used to reshape the cornea. Dr. Karlik often uses a medication called mitomycin to modulate the healing of the cornea and reduce the incidence of corneal haze or scarring. A bandage contact is worn afterwards for the first few days to allow healing of the surface. Vision improves several days after surgery once the surface cells have had some time to heal and recover after PRK.
PRK uses the exact same laser as used with LASIK. The ultimate results of LASIK and PRK are essentially identical. The difference between the two procedures is primarily the post-operative recovery time.
If appropriate, the doctors at North Hill Eye Associates with discuss the option of PRK with you.
LASIK technology is constantly changing and improving. Dr. Karlik's affiliation with the LASIK Vision Institute in Pittsburgh insures the latest technology will always be available to Dr. Karlik's refractive surgery patients.
The LASIK Vision Institute has recently upgraded to the WaveLight Ex 500 Excimer Laser.
The surgeons at North Hill Eye Associates perform hundreds of cataract surgeries every year. With the region's aging population, cataract surgery promises to become even more prevalent. Over fifty percent of people over the age of 60, and quite a few younger than that, suffer from cataracts. Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only way to see clearly again is to have them removed from within the eye.
In your parents' or grandparents' day, cataract surgery was considered risky, required a lengthy hospital stay, and was usually postponed for as long as possible. Today, cataract surgery is performed on an outpatient basis and takes only a few minutes. It is now one of the most common and successful medical procedures performed. In fact, following cataract surgery, many patients experience vision that is actually better than what they had before they developed cataracts. Cataract surgery is for those who:
believe that their quality of life has been impaired by poor vision
have been diagnosed with cataracts by their ophthalmologist
You will arrive at the surgery center about an hour or two prior to your procedure.
We tell patients to plan on spending up to 4 hours at the hospital surgery center, but it is often much less than that. You must bring a driver with you on the day of surgery.
Once you have been checked into the surgery center, your medical history will be reviewed and you will be prepped for surgery. You will be offered a sedative to help you relax. The area around your eyes will be cleaned and a sterile drape applied around your eye.
Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.
A very small incision will be made and a tiny ultrasonic probe will be used to break up the cataract into microscopic particles using high-energy sound waves. This is called phacoemulsification.
The cataract particles will be gently suctioned away. Then, a folded intraocular lens (IOL) will be inserted through the micro-incision, then unfolded and locked into permanent position. The small incision is "self-sealing" and usually requires no stitches. It remains tightly closed by the natural outward pressure within the eye. This type of incision heals fast and provides a comfortable recuperation.
If your eye has pre-existing astigmatism, your surgeon may elect to make micro-incisions in the cornea to reduce your astigmatism. These are called limbal relaxing incisions (LRIs). Alternatively some IOLs are now available which correct for astigmatism. These astigmatism correcting lenses are called toric IOLs.
You will go home soon after the surgery and relax for the rest of the day. Everyone heals somewhat differently, but many patients report improvement in their vision almost immediately after the procedure. Most patients return to their normal activities within a day or two. The only limitation is heavy lifting. You must be driven to North Hill Eye Associates the next day to be checked. You will then be seen again in one week and in one month. Glasses will be changed at the appropriate time. Often, many patients elect to have cataract surgery completed in both eyes prior to obtaining eyeglasses (if they are required).
The decision to have cataract surgery is an important one that you will make along with your Doctor at North Hill Eye Associates. The goal of any vision restoration procedure is to improve your vision. Once removed, cataracts will not grow back. But some patients may experience clouding of a thin tissue, called the capsular bag. This thin tissue holds the intraocular lens in position. If this tissue develops some cloudiness over time, a laser is used to painlessly open the clouded capsule to restore clear vision. This procedure is called a capsulotomy and is performed in the office of North Hill Eye Associates.
Serious complications with cataract surgery are extremely rare. It is a safe, effective and permanent procedure, but like any surgical procedure, it does have some risks. Going to an eye specialist experienced with the procedure can significantly minimize the risks involved with cataract surgery.
After a thorough eye exam, you and your doctor will determine if cataract surgery is an option for you. You will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.
Deluxe IOLs are an option which may be appropriate for some patients. If appropriate, this option may be discussed with you by the doctors of North Hill Eye Associates. For more information, please refer to our section discussing Deluxe IOLs.
A posterior capsulotomy is a non-invasive laser procedure to eliminate the cloudiness that occasionally interferes with a patient's vision after cataract surgery. In modern cataract surgery, the cataract is removed, but a thin membrane that held the cataract is left in place to hold the implanted artificial lens. Leaving the capsule in place during cataract surgery is a great advancement because it allows the vision after surgery to be more stable and ensures fewer surgical complications. However, sometimes the posterior or back portion of the capsule becomes cloudy over time. This is called posterior capsular opacification (PCO), or sometimes referred to as a “secondary cataract”. This can be resolved with an in-office laser procedure.
A posterior capsulotomy are for those who:
Have had cataract surgery
Believe that their vision is gradually getting worse
Drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, you will be positioned behind the laser and the short procedure will be completed in the offices of North Hill Eye Associates.
Your doctor will use a YAG laser to create an opening in the center of the cloudy capsule. The opening allows clear passage of the light rays and eliminates the cloudiness that was interfering with your vision.
The entire procedure usually takes less than five minutes and you can leave soon afterward. The results of the procedure are almost immediate. Most patients are able to drive home after the procedure. Your doctor may prescribe anti-inflammatory drops for you to use for a few days following the procedure. Most patients resume their normal activities immediately.
Serious complications with posterior capsulotomy are extremely rare. It is a safe and effective procedure, but like any medical procedure, it does have some risks. Going to an eye specialist experienced with the procedure can significantly minimize the risks involved with posterior capsulotomy.
The outer layer of the eye can be divided into three areas: the cornea, the sclera and the limbus. The cornea is the clear part, or the window, that covers the iris and the pupil. The sclera is the white part of the eye. The limbus is the thin area that connects the cornea and the sclera.
Limbal relaxing incisions (LRIs) treat low to moderate degrees of astigmatism. As the name suggests, the surgeon makes small relaxing incisions in the limbus, which allows the cornea to become more rounded when it heals. LRIs are placed at the very edge of the cornea (in the limbus) on the steepest meridians.
Limbal Relaxing Incisions are for those:
who have astigmatism
want to reduce or eliminate their dependence on glasses or contacts
have no health issues affecting their eyes
These incisions are usually made at the time of cataract surgery to reduce or eliminate the astigmatism and thus increase the chances for better vision without eyeglasses. A prescription for near vision will usually still be necessary to read and do close work. The doctors of North Hill Eye Associates will discuss the options that make the best sense for you.
Selective Laser Trabeculoplasty (SLT) is a relatively new laser treatment for open-angle glaucoma. SLT uses short pulses of low energy laser light to target melanin-containing cells in a network of tiny channels, called the trabecular meshwork. The objective of the surgery is to help fluids drain out of the eye, reducing intraocular pressure that can cause damage to the optic nerve and loss of vision.
The selective technique is much less traumatic to the eye than an older laser procedure called Argon Laser Trabeculoplasty (ALT). ALT can cause tissue destruction and scarring of healthy cells in the trabecular meshwork structure. SLT reduces intraocular pressure without this risk. SLT can be used to effectively treat some patients who could not benefit from ALT. This includes patients who have already been treated with ALT.
SLT has a very low risk and is highly effective, more and more patients are electing to have SLT performed as initial treatment for open angle glaucoma. Reasons for deciding to proceed with SLT include the side effects, inconvenience, and expense which can be associated with medications (eye drops). However, some patients may still require glaucoma drops after surgery.
SLT is for those:
who have been diagnosed with glaucoma
whose doctor has determined that SLT is appropriate for controlling their intraocular pressure
patients with side effects or allergies due to glaucoma medications
patients with glaucoma which is unable to be controlled with medications
patients with a history of poor compliance with glaucoma medications
patients with disorders making daily instillation of eye drops difficult or impractical (for example, patients with rheumatoid arthritis or a history of stroke)
patients for which the expense of life long eye drops are a financial distress
Your treatment will be performed in a standard exam room at North Hill Eye Associates. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, a contact lens will be placed on your eye to keep you from blinking and assist with the focusing of the SLT laser. You may see flashes of bright green or red light. Most patients do not feel any pain during the procedure. It takes less than 5 minutes.
Anti-inflammatory drops may be prescribed to alleviate any soreness or swelling inside the eye. You should relax for the rest of the day. Most patients can drive home following the procedure. Follow-up visits are necessary to monitor your eye pressure. While it may take a few weeks to see the full pressure-lowering effect of this procedure, many patients are eventually able to discontinue some or all of their medications. Most patients resume activities within a few days.
The effect of the SLT surgery may wear off over time. However, SLT can be repeated safely when necessary. Serious complications with SLT are extremely rare, but like any surgical procedure, it does have some risks.
If you and your doctor decide that SLT is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.
Laser iridotomy is a treatment for narrow-angle glaucoma. In laser iridotomy, a small hole is placed in the iris to create a hole for fluid to drain from the back of the eye to the front of the eye. Without this new channel through the iris, intraocular pressure can increase rapidly in patients with narrow-angles. This can result in damage to the delicate optic nerve, and permanent loss of vision. The opening created in the iris by the laser is microscopic and only seen with microscopic evaluation of the eye.
A small hole is created in the iris by the laser so that fluid can drain from the back to the front of the eye.
The purpose of an iridotomy is to lower pressure and preserve vision.
Laser iridotomy is indicated for patients:
diagnosed with closed-angle glaucoma.
with narrow-angles which are at risk for angle closure.
Your treatment will be performed in a standard exam room at the office of North Hill Eye Associates. It does not require a surgery center. Drops will be used to numb your eye; no injections or needles are used.
Your doctor will place a special contact lens on your eye to focus the laser light upon the iris. This lens keeps your eyelids separated so you will not blink during treatment. It also reduces small eye movements so that you do not have to worry about your eye moving during the treatment. To ensure that the contact lens does not scratch your eye, a special jelly will be placed on the surface of your eye. This jelly may remain on your eye for about thirty minutes, leading to blurred vision or a feeling of heaviness.
During the laser treatment, you may see a bright light, like a photographer's flash from a close distance. Also, you may feel a pinch-like sensation. The treatment lasts a very short time.
Drops may be prescribed to alleviate any soreness or swelling inside your eye. Follow-up visits are necessary to monitor your eye pressure.
Everyone heals differently, but most people resume normal activities immediately following treatment. Most patients are able to drive home following the procedure. For the next few days your eyes may be red, a little scratchy and sensitive to light.
Serious complications with laser iridotomy are extremely rare, but like any medical procedure, it does have some risks. The chance of losing vision following a laser procedure is extremely small. The main risks of a laser iridotomy are that your iris might be difficult to penetrate, requiring more than one treatment session. Another risk is that the hole in your iris will close.
Following your procedure, you may still require medications or other treatments to keep your eye pressure sufficiently low. This additional treatment will be necessary if there was damage to the trabecular meshwork prior to the iridotomy or if you also have another type of glaucoma in addition to the narrow-angle type.
Filtration surgery, also called trabeculectomy, is a treatment for several types of glaucoma including open-angle and narrow-angle glaucoma. It is often performed on patients who have not responded well to medication or laser treatment. Filtration surgery usually provides a dramatic reduction in pressure within the eye.
Filtration surgery is for those:
who have been diagnosed with glaucoma
in whom medical treatment is no longer effective
whose doctor has determined that filtration surgery is an appropriate treatment for their condition
You will arrive at the hospital several hours prior to your procedure. Once you have been checked-in, you will be prepared for surgery. The area around your eyes will be cleaned and a sterile drape will be applied. You may be given a sedative to help you relax. Your eye will be numbed with topical or a local anesthesia.
Using advanced microsurgical techniques and equipment, your doctor will create a tiny new channel between the inside of your eye and the outside of your eye.
A small section of tissue will be removed, creating a channel, to allow fluid to pass through the blocked drainage network onto the white (sclera) of the eye. The incision will be closed with small stitches and covered with the thin outer tissue of the eye, called the conjunctiva.
A small area under the conjunctiva will collect a pool of fluid called a bleb. Blood vessels in the conjunctiva will carry the draining fluid away.
To keep the drainage channel open, your doctor may apply an extremely small dose of a chemotherapeutic agent to the new filter. Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside the eye. You should go home and relax for the rest of the day. Most patients resume normal activities within a few days.
Follow-up visits are necessary to monitor your eye pressure. It may take a few weeks to see the full pressure-lowering effect of this procedure, and adjustments may need to be made to the filter during this period. These adjustments may include:
injection of small amounts of chemotherapeutic agents
loosening or removal of one or more stitches
finger pressure to the eye to force fluid through the filter
numbing the eye and opening the channel slightly with a fine instrument
placing a contact lens over the eye
The success rate for this type of surgery is approximately 80 percent in cases where no surgery has been done on the eye before. However, everyone's eyes are unique and many people do require further treatments. In more difficult cases where even filtration surgery does not prevent damage to the ocular nerve, it may be necessary to perform other types of procedures.
Serious complications with filtration surgery are extremely rare, but like any surgical procedure, it does have some risks.
Diabetic retinopathy does not usually impair sight until the development of long-term complications, including proliferative retinopathy, a condition in which abnormal new blood vessels may rupture and bleed inside the eye. When this advanced stage of retinopathy occurs, pan-retinal photocoagulation is usually recommended.
During this procedure, a special laser is used to make tiny burns that seal the retina and stop vessels from growing and leaking. Hundreds of tiny spots of laser are placed in the retina to reduce the risk of vitreous hemorrhage and retinal detachment. Targeted laser applications can treat specific areas in the central vision that are leaking. The laser is used to destroy all of the dead areas of the retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.
The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere, not to regain lost vision.
Pan-retinal photocoagulation is for those:
who have been diagnosed with proliferative retinopathy
whose doctor has determined that pan-retinal photocoagulation is the appropriate treatment for their condition
Your treatment will be performed in a specially equipped laser room. It does not require an operating room. It is usually performed without anesthesia, although some will want a local anesthetic.
Before your procedure begins, a contact lens will be placed between your eyelids to keep you from blinking and to focus the laser on your retina. Next, your doctor will begin laser treatment with an argon or diode laser. The laser treats the peripheral (outside) and middle portions of your retina. It does not treat the central or macular region because this would likely cause serious loss of vision.
The initial treatment usually consists of approximately 1,500-2,000 spots of laser per eye. This will be done in one or more sessions.
Your vision will be blurred immediately after the treatment, but will recover to the pre-treatment level over time. You should plan to have someone drive you home, and you should relax for the rest of the day. Most patients resume activities within a few days. Regular follow-up visits are required.
The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere, not to regain lost vision. There is no improvement in vision after the laser treatment. Vision may decrease due to edema/swelling of the retina, after the laser treatment. It may improve to its previous level in two to three weeks or may remain permanently deteriorated. Recurrences of proliferative retinopathy may occur even after an initial satisfactory response to treatment.
This procedure sacrifices peripheral vision in order to save as much of the central vision as possible and to save the eye itself. Night vision will be diminished. After pan-retinal photocoagulation, blurred vision is very common. Usually, this blur goes away, but in a small number of patients some blur will continue forever.
Serious complications with pan-retinal photocoagulation are extremely rare, but like any surgical procedure, it does have risks. These risks can be minimized by going to a specialist experienced in pan-retinal photocoagulation.
Fluorescein angiography is a clinical test to look at blood circulation in the retina at the back of the eye. It is used to diagnose retinal conditions caused by diabetes, age-related macular degeneration, and other retina abnormalities. This test can also help follow the course of a disease and monitor its treatment. It may be repeated on multiple occasions with no harm to the eye or body.
Fluorescein angiography is for those:
who have indications of retinal conditions
who have leakage of blood vessels such as in macular degeneration or diabetes
During the test, a harmless yellow dye called Fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. Your doctor will use a special camera with a green filter to flash a blue light into your eye and take multiple photographs. He will analyze the pictures and identify any damage to the lining of the retina or to spot the growth of new blood vessels.
This diagnostic test takes about 30 minutes. You can go home immediately after the procedure. After your angiography, your skin and urine may appear discolored for a short time until the Fluorescein is completely out of your system.
There is little risk in having fluorescein angiography, though some people may have mild allergic reactions to the dye that can cause itching, excessive sneezing, flushing of skin, or nausea. Severe allergic reactions have been reported, but very rarely. Occasionally, some of the dye leaks out of the vein at the injection site, causing a slight burning sensation.
There are two general classes of IOLs (Intraocular Lens Implants) now available. When cataract surgery is performed, the natural lens inside the eye is removed because it is cloudy and interferes with vision. Once this cataract is removed, a new lens implant must be placed inside the eye to restore vision.
For the last 20 years, millions of patients have received Standard or Conventional (single vision) IOLs with great success. These IOLs are typically set to provide distance vision and do not have the ability to change focus. Therefore, patients receiving these types of lenses require glasses for many functions after surgery, particularly reading.
Within the last few years, newer Deluxe IOLs have become available. These IOLs are distinguished by their ability to provide a greater range of vision for some patients. Instead of only having crisp distance vision, many of these patients demonstrate good distance and near vision. This further reduces the need for glasses or contact lenses.
As you might expect, these lenses are more expensive than the conventional IOLs. Private insurance and Medicare do not typically pay for the added cost. Recent rulings by Medicare, however, have made it possible for Medicare recipients to obtain Deluxe IOLs and pay only the additional cost out of pocket. Medicare will still cover the cost of the surgery itself as in the past. Private insurance recipients will be considered on a case by case basis depending on the policy.
Several lenses qualify as Deluxe IOLs. Two such IOLs are the CrystaLens and the Acrysof Restor Lens. If a Deluxe IOL has the potential to be appropriate for your needs, the doctors of North Hill Eye Associates may present this option to you.
The CrystaLens is one type of Deluxe intraocular lens (IOL) implanted during cataract surgery. As mentioned above, Standard (single vision) IOLs typically are set to provide distance vision and do not have the ability to provide a full range of vision. Most people who have single vision lens implants MUST wear glasses for middle and near vision.
In contrast, the CrystaLens is thought to use the eye's natural focusing muscles to change focus. This means that the CrystaLens may not only restore distance vision, but may also reduce dependence on reading glasses.
The Acrysof Restor Lens in another type of Deluxe IOL. It also has the ability to reduce dependence on glasses and contact lenses for distance and near viewing. In contrast to the change in position thought to account for the CrystaLens’ action, the Restor Lens is manufactured in such a way as to provide multiple levels of vision. It is not thought to flex or change focus within the eye.
Another category of Deluxe IOLs are available which can correct a patient’s pre-existing astigmatism. These Deluxe IOLs are called toric IOLs. The doctor’s at North Hill Eye Associates may discuss this option with you if it is appropriate.
One way to alleviate dry eye is to help the eyes retain the small amount of lubricating tears they do produce. This is accomplished by closing off the small funnel-like drain hole found in the inner corner of the upper and lower eyelids. The drain hole, called the punctum, can be closed with tiny plugs called punctal plugs. These plugs are either made of collagen, which are temporary and dissolve after a period of time, or of silicone, which are more permanent. The plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts. The punctum can also be permanently closed with a heat or laser procedure.
If dry eye symptoms lessen when the temporary plugs are inserted, your doctor may consider permanent punctal occlusion.
Punctal occlusion is for those:
who have been diagnosed with dry eye
whose doctor has determined that punctal occlusion is the appropriate treatment for their condition
Your treatment will be performed in an examination room. It does not require a surgery center. Drops will be used to numb your eye; no injections or needles are used.
Your doctor will place the plug into the corner of your eyelid using a forceps-like applicator. The entire procedure takes only a few minutes. Many patients report immediate relief from dry eye symptoms and resume normal activities immediately. For others it will take several days or weeks to see the results.
Serious complications with punctal occlusion are extremely rare, but like any medical procedure, it does have some risks. If you experience side effects, your doctor can usually remove the plugs.
If the cornea becomes cloudy as a result of corneal disease, the only way to restore sight is to replace or transplant the cornea. Corneal transplantation (penetrating keratoplasty) is the most successful of all tissue transplants. An estimated 20,000 corneal transplants are performed each year in the United States.
Corneal tissue for transplant comes from an eye bank. Due to advances in Eye Banking technology, donor tissue is usually readily available when a patient requires a transplant. The cornea is tested thoroughly to make sure it is safe for transplantation.
Corneal transplant is for those who:
have lost vision due to corneal disease
You will arrive at the hospital surgery center 30-60 minutes prior to your procedure. The area around your eyes will be cleaned and a sterile drape will be applied around your eye. Your eye will be numbed with topical or local anesthetics. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.
Your diseased cornea will be removed with a special round tool called a trephine. Then the donor cornea will be cut to a matching size, placed upon your eye and secured in place with very fine sutures. Your eye will be patched or shielded after surgery.
The surgery itself is painless and usually done on an outpatient basis. The operating time is approximately 60-90 minutes. You will be allowed to go home soon afterward. You should relax for the rest of the day. You may experience some discomfort for a few days. Eye drops and pain medication can be used to minimize this discomfort.
Everyone heals differently, but most patients resume activities within a few days. Strenuous activity such as lifting, bending or straining should be avoided for several weeks. To protect your eyes from inadvertent trauma, you will be advised to wear shields, glasses, or sunglasses while your eye heals.
The healing process can take many months. Often, the stitches are not removed until six to nine months after surgery. During that time, medicated eye drops will be used to make sure the transplant heals properly.
Return of best vision after corneal transplant surgery may be recognized in three or four months for some, while it may take up to a year after the operation for others. As in any kind of transplant, rejection of the donated tissue can occur. The major signs of rejection are redness of the eye or worsening of vision. Rejection of a donor cornea is rare, but it is very important to contact your eye doctor immediately if the signs of rejection occur.
The success rate for corneal transplants depends on the cause of the clouding. For example, corneal transplants for degeneration following cataract surgery, and those for keratoconus both have high success rates, while corneal transplants for chemical burns have lower success rates.
If you decide that a corneal transplant is an option for you, you will be given additional information that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.
Most vision correction procedures attempt to change the focusing power of the cornea (LASIK or PRK). Refractive lensectomy, on the other hand, corrects nearsightedness or farsightedness by replacing the eye's natural lens with an artificial intraocular lens (IOL) implant that has the correct power for the eye.
Refractive lensectomy is a surgical procedure that uses the same successful techniques of modern cataract surgery. These surgical techniques have evolved and improved dramatically over the last twenty years. Cataract surgery is now the most common surgical procedure performed in medicine today.
The main difference between standard cataract surgery and refractive lensectomy is that cataract surgery is primarily performed to remove a patient's cataract that is obstructing and clouding their vision, while refractive lensectomy is performed to reduce a person's dependence on glasses or contact lenses. Refractive lensectomy can be combined with other procedures that treat astigmatism. Patients that elect to undergo refractive lensectomy will avoid the development of cataracts, which is a normal result of aging.
Refractive Lensectomy is for those who:
want to reduce or eliminate their dependence on glasses or contacts
may not be a good candidate for laser vision correction (LASIK or PRK)
are 18+ years of age
For a detailed description of refractive lensectomy, please refer to the cataract surgery area of the procedure section of the North Hill Eye Associates website. Additionally, information regarding placement of a Deluxe IOL may be referenced on our web site, if appropriate.
Restasis is a treatment for Dry Eye Disease, a chronic and sometimes debilitating condition. Restasis drops help the eyes produce more tears by reducing inflammation, which is often a cause of dry eye. Unlike artificial tears, Restasis is the first prescription drug proven to effectively treat the underlying cause of Dry Eye Syndrome rather than to just temporarily alleviate symptoms.
Restasis is for those:
whose tear production is suppressed due to inflammation caused by dry eye disease
who suffer from moderate to severe dry eye
whose doctor has determined that Restasis is the appropriate treatment for their condition
If your doctor prescribes Restasis, you will initially use one drop in each eye twice a day, morning and night. It can take a month or more before any results are seen. Your doctor may prescribe a steroid drop along with Restasis for the first month. You will receive benefits from Restasis for as long as you continue its use. Restasis can be used with artificial tear products, but your need for these will most likely decrease as your eyes improve.
The most common side effect of Restasis is a temporary stinging or burning sensation. Patients with an active eye infection or those who have allergies to any of the ingredients should not use Restasis. Keep in mind that Restasis is a treatment, not a cure. There is presently no cure for Dry Eye Disease.
If you and your doctor decide that Restasis is an option for you, you will be given additional information about the treatment that will allow you to make an informed decision about whether to proceed.
Photodynamic therapy (PDT) was the first treatment for some cases of the wet form of age-related macular degeneration that provided hope of improvement of vision with treatment. It involves injecting a light-sensitive chemical into the arm. The chemical travels to abnormal blood vessels in the retina where it is activated with a special light. The activated chemical destroys the abnormal blood vessels without causing damage to the normal retinal tissues nearby. This allows PDT to be used in some cases where conventional laser treatment would cause too much damage to surrounding retinal tissue.
PDT can slow the loss of vision and sometimes improve vision.
Now there are drugs available that, when appropriate, can be injected into the vitreous cavity of the eye to stabilize or even improve the vision in patients with macular degeneration. Studies have revealed they provide a greater benefit than PDT. This class of medication is referred to as Anti-VEGF Therapy and includes both Lucentis and Avastin.
Anti-VEGF Therapy is for those:
who have been diagnosed with the wet form of age-related macular degeneration
whose doctor has determined that Anti-VEGF Therapy is the appropriate treatment for their condition
Following treatments, some patients experience a temporary reduction of vision, which will improve over the next few weeks. This is a relatively new procedure. Serious complications with Anti-VEGF Therapy are extremely rare, but like any medical procedure, it does have some risks.
The greatest concern in any patient with macular degeneration is continued progression of retinal damage with additional loss of vision. The doctors of North Hill Eye Associates will determine when Anti-VEGF Therapy is indicated. However, it is vital that all patients with macular degeneration monitor their vision for any change from baseline (with use of an Amsler Grid) and report any change immediately to the office of North Hill Eye Associates.
Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), dermatochalasis (excessive eyelid skin), and some eyelid tumors.
The surgeons of North Hill Eye Associates work with their patients to determine when eyelid surgery is necessary. Eyelid surgery is usually an outpatient procedure with local anesthesia. Risks of surgery are rare, but include asymmetry of the eyelids. Differences in healing between the eyes may cause some unevenness after surgery.
After eyelid surgery, a black eye is common but goes away quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as the surgery heals. Serious complications are rare but include vision loss, scarring, and infection. To most people, the improvement in vision, comfort and appearance after eyelid surgery is very gratifying.
The iStent Trabecular Micro-Bypass stent is a new surgical therapy for glaucoma that is designed to improve aqueous outflow to safely lower IOP and may reduce medication burden; but this will be at the discretion of your physician.
iStent is the smallest medical device ever approved by the FDA and is placed in your eye during cataract surgery. It is so small, you won’t be able to see or feel it after surgery but it will be continuously working to help reduce your eye pressure.
Every day, you are probably taking one or more eye drops to control your eye pressure. By improving the outflow of fluid from your eyes, iStent works to help control your eye pressure. After implantation of iStent, many patients are able to control their eye pressure.
Controlling eye pressure is extremely important to reduce the risk for vision loss due to glaucoma. If you forget to take your eye drops or ‘skip a dose’, this can cause large changes in your eye pressure. Large changes in eye pressure can increases the risk for vision loss.
You will receive important news and updates from our practice directly to your inbox.