What is a Cataract?
Cataracts are a clouding or opacification of the eyes’ native lens. The eye’s native lens begins to harden in people’s 40’s, and this is when most notice that they need reading glasses (or bifocals) for near vision. In the ensuing 10-20 years the lens continues to harden and opacify and this is when it is called a cataract. When the cloudiness affects activities of daily living such as driving at night (glare) or difficulty reading even with glasses it is usually time to consider cataract surgery.
Common symptoms of cataracts include:
- Cloudy or blurred vision
- Sensitivity to light and glare from headlights when driving
- Frequent prescription changes for glasses or contact lenses
- Color vision changes and overall dimming
- In the beginning stages of cataracts, glasses may be sufficient to maintain visual acuity. As the cataract becomes more advanced surgery may be required.
- Need for additional lighting for reading
During cataract surgery, your natural lens will be replaced with an IOL (intraocular lens). Technology advancements in this field have exploded over the last decade and patients have many options at the time of their procedure. One can choose to have a laser perform the most critical steps of the procedure, and there are many options for different “lifestyle lenses” people can choose to have implanted that are tailor made to meet specific visual needs.
Surgeries are performed at Red River Surgery Center or Eye Surgery Center both located in Ashley Ridge. These centers focus on patient care, comfort and privacy. The procedure usually takes no longer than 15 minutes.
The Highland Eye Clinic surgeons offer laser assisted cataract surgery with the use of a LenSx laser. The laser performs some of the most critical steps of cataract surgery with precision only a laser could provide. Once the cataract is safely removed the doctor will perform an additional measurement with the ORA intraoperative aberrometer. This is a device attached to the surgical microscope that takes additional measurements provide precise real time information to ensure your new lens will yield the best possible eyesight.
View LENSX ORA animation video
The Highland Eye Clinic surgeons offers a wide variety of premium lens technology and will spend time explaining them and matching the technology to your lifestyle. It is now possible to drastically reduce your dependence on glasses after cataract surgery with this technology.
- Panoptix Trifocal IOL
- Vivity Extended Depth of Focus IOL
Both Glaucoma and Cataracts?
Learn about MIGS (Minimally Invasive Glaucoma Surgery) procedures.
Cataract surgery alone can lower intraocular pressure, but this can be enhanced by adding a MIGS procedure to further lower the pressure in the eye. If you have both glaucoma and cataracts your surgeon will discuss with you which of the MIGS procedures he recommends for you. Some patients are able to achieve low enough pressure to get off of all glaucoma drops!
When should surgery be done?
Surgery should be considered when cataracts cause enough loss of vision to interfere with your daily activities.
- It is not true that cataracts need to be “ripe” before they can be removed or that they need to be removed just because they are present. Cataract surgery can be performed when your visual needs require it. You must decide if you can see well enough to do your job, drive safely, and read or watch TV in comfort. Does your vision allow you to perform daily tasks, such as cooking, shopping, doing yard work or taking medications without difficulty?
- Based on your symptoms, you and your ophthalmologist should decide together when surgery is appropriate.
What can I expect from cataract surgery?
Over 1.4 million people have cataract surgery each year in the United States, and more than 95% of those surgeries are performed with no complications.
- During cataract surgery, which is usually performed under topical anesthesia as an outpatient procedure, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.
- Your ophthalmologist performs this delicate surgery using a microscope, miniature instruments and other modern technology.
- After surgery, you will have to take eyedrops as your ophthalmologist directs. Your surgeon will check your eye several times to make sure it is healing properly.
- Cataract surgery is a highly successful procedure. Improved vision is the result in over 98% of cases, unless there is a problem with the cornea, retina, optic nerve or other structures. It is important to understand that rare complications can occur during or after the surgery, some severe enough to limit vision. If you experience even the slightest problem after cataract surgery, your ophthalmologist will want to hear from you immediately.
- In many people who have had cataract surgery (usually 1-3 years later) the natural capsule that supports the intraocular lens becomes cloudy. If this occurs, your ophthalmologist can perform a brief non-invasive outpatient laser procedure to open this cloudy capsule, restoring clear vision.
- https://www.youtube.com/watch?v=LIza4BiEoOk&feature=emb_logo (media gallery)
Both Glaucoma and Cataracts?
Learn about MIGS (Minimally Invasive Glaucoma Surgery) procedures.
Cataract surgery alone can lower intraocular pressure, but this can be enhanced by adding a MIGS procedure to further lower the pressure in the eye. If you have both glaucoma and cataracts Dr. Bundrick will discuss with you which of the MIGS procedures he recommends for you. Some patients are able to achieve low enough pressure to get off of all glaucoma drops!
MIGS – MINIMALLY INVASIVE GLAUCOMA SURGERY
The tiniest medical device is 20,000 times smaller than the intraocular lenses (IOL) used in cataract surgery. The iStent creates a permanent opening through the blockage to improve the eye’s natural outflow, restoring this mechanism and helping to control pressure within the eye.
Xen Gel Stent
Over the last decade, there have been significant advancements in surgical treatments of glaucoma and cataracts. The procedures all share a common thread of causing as little trauma as possible to the target tissue and improving aqueous drainage when treating mild to moderate glaucoma. The Xen Gel Stent is FDA approved as the first procedure that creates a low-lying, ab-interno bleb in refractory glaucoma. The stent provides controlled flow through lumen restriction, leaves tenon capsule adhesions intact, and undisturbed low-lying drainage space. A U.S. clinical trial to evaluate the safety and effectiveness of the procedure resulted in 76.3% of subjects achieving greater than or equal to 20% mean diurnal IOP reduction on the same or fewer number of medications versus baseline, and reduced IOP and medication use at month 12.
The Xen Gel Stent provides an opportunity to lower IOP and required medication use in refractory glaucoma patients. The medical advancements are sometimes life-changing, and our physicians are honored to provide patients with this surgical intervention.
KaHook Dual Blade
This uniquely designed stainless steel surgical instrument is used in minimally invasive glaucoma surgeries to enable even more precision.
CyPass / Trab360
The primary intent with the Cypass Micro-Stent is to conduct a safer, less invasive glaucoma surgery, as compared to the trabeculectomy and tube shunts. The Cypass Micro-Stent allows for intraocular pressure reduction, minimal tissue destruction, shorter surgical time and shorter post-operative recovery period for the patient, as well.
Over the last decade, there have been significant advancements in surgical treatments of glaucoma and cataracts. The procedures all share a common thread of causing as little trauma as possible to the target tissue and improving aqueous drainage when treating mild to moderate glaucoma. The Cypass Micro-Stent is a polyamide tube designed to be implanted for direct communication between the anterior chamber and suprachoroidal space. This is a potential space between the external surface of the choroid and the internal surface of the sclera. This space has long been identified as an intraocular location that can be modified to increase outflow facility. New treatments and techniques like the Cypass, are finding niche purposes in ophthalmology and particularly with glaucoma specialists and show a tremendous innovation and growth in the arena of glaucoma drainage devices. The Trab360 device is a manual trabeculotome instrument capable of cutting up to all 360 degrees of trabecular meshwork. It can be used in a stand-alone procedure or in conjunction with cataract surgery.
Elective Laser Trabeculoplasty (SLT) SLT is acronym for Selective Laser Trabeculoplasty.
Trabecular Meshwork or TM is the structure surrounding the edge of the iris.
Its function is to regulate the flow of aqueous fluid.
Drops are administered to numb eye and prepare it for the SLT procedure. You will sit at a slit lamp with your chin resting in the chin rest. A special microscope or slit lamp and a cone shaped contact lens are used to guide the laser beam to the trabecular meshwork where fluid drains from the eye. Following the procedure, the physician will put drops in your eye to prevent pressure from rising right away. Some people feel some pressure in the eye during the surgery.
SLT uses a process called “Selective Photothermolysis”. This process uses a laser to cause a biological effect on only pigmented cells (containing melanin). Since only these cells are affected, there is little to no damage to the surrounding tissue. The laser is applied to the trabecular meshwork.
SLT creates an effect called “biophotoactivation”. Cells stimulated by the laser recruit macrophages, which help clear cellular debris, and work to improve fluid outflow.
The final effect lowers eye pressure. Fluid flows less restricted through the eye.
LASIK was developed in the mid 1990’s and has helped millions of people achieve excellent vision without glasses or contacts. LASIK is short for Laser-Assisted in-SItu Keratomileusis and is the most common form of refractive surgery (surgery to reduce or eliminate glasses and contact lenses).
The procedure involves two different lasers. The femtosecond laser creates a thin flap in the cornea, and the excimer laser then reshapes the cornea to perfectly focus light onto the retina. The Wavelight EX500 is approved to treat a wide range of nearsightedness, farsightedness and astigmatism.
Most patients have excellent vision as early as the first postoperative day and have no trouble driving or returning to work!
Your vision is your most important sense, and it is important to do your homework and educate yourself about any procedure you are considering for your eyes. A non-biased starting point to go through the facts about LASIK is from the FDA’s website, click here to learn more. Your Highland Eye Clinic physicians will see you personally at your free LASIK evaluation, and explain your options in detail.
Imagine in just minutes permanently improving your eyesight eliminating the need for contact lenses or glasses. If you are found to be a suitable all laser LASIK candidate this can become a reality for you. Highland Eye Clinic utilizes the most cutting edge and state of the art laser technology available anywhere in the world to consistently achieve outcomes that surpass patient expectations. LASIK utilizes a laser to reshape the cornea and correct the way light enters the eye to focus on the retina.
Not everyone is a candidate for LASIK. If you are interested in the procedure or have questions about what qualities are found in ideal LASIK candidates, we invite you to contact our office to speak with one of our staff members or to schedule an appointment with Dr. Bundrick.
Are You a Candidate?
A wide range of people of all ages are suitable candidates for LASIK. Some of the basic criteria include:
- Age- at least 19 years old (preferably 21)
- Do not suffer from cataracts or glaucoma
- Have had a stable glasses/contact lens prescription for a year or more
- Enjoy good overall and ocular health
- Have not had Radial Keratotomy (RK)
Some conditions may limit your eligibility to undergo LASIK such as keratoconus, thin corneas, extreme near or farsightedness. Women who are pregnant (or nursing) should wait until four months post-partum before undergoing LASIK. A diabetic patient’s candidacy is dependent on more specific factors; if you have diabetes, Dr. Bundrick will elaborate on these factors during your consultation.
Upper Eyelid Blepharoplasty
Upper lid blepharoplasty is the most common eyelid procedure performed by Dr. Bundrick for both functional and cosmetic reasons. Excess eyelid skin and prolapsed orbital tissue can start to droop over the eyelashes and become a problem both cosmetically and it can constrict your visual field.
Upper eyelid blepharoplasty surgery removes the bagginess of the upper eyelids and restores the youthful eyelid crease, which immediately conveys a youthful and rested appearance and can enhance peripheral vision in those with severe enough lid droop.
There is minimal discomfort from surgery and most people return to their daily activities within the first 5-10 days following surgery.
Upper Eyelid Ptosis Surgery
The most common reason for developing ptosis is improper functioning of the levator muscle, a major muscle responsible for elevating the upper lid. Some are born with a droopy eyelid but more frequently it is a result of aging, trauma or muscular or neurologic disease. Dr. Bundrick can surgically correct ptosis by reattaching stretched muscles to their proper anatomic location, restoring the natural position and contour of the upper eyelid. Surgery is performed either through a hidden eyelid crease incision or from the back side of the eyelid, which leaves no visible external scar. There is minimal discomfort from surgery and most people return to their daily activities within the first 5-10 days following surgery.
Lower Eyelid Malpositions
Aging and other factors can contribute to malpositions of the lower eyelids that can be quite bothersome. These problems such as ectropion and entropion can cause severe irritation of the cornea from the eyelashes rubbing it or from excess exposure to the air and wind. These problems can be fixed with a variety of lid tightening procedures that are done under local anesthesia.
Dysfunctional Lens Replacement (DLR)
A treatment for dysfunctional lens syndrome, which is the progressive loss of function of the natural lens inside your eye. The lens starts to lose both its clarity and flexibility. DLR is an all-in-one procedure that reduces your dependency on reading glasses and bifocals.
Diabetes can affect sight.
If you have diabetes mellitus, your body does not use and store sugar properly. High blood-sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.
Types of diabetic retinopathy.
There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected it is the result of macular edema and/or macular inschemia.
– Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral vision continues to function.
– Macular inschemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly.
PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels closed.
Unfortunately, the new abnormal blood vessels do not resupply the retina wit normal blood flow. The new vessels are often accompanied by scar tissue that may cause wrinkling or detachment of the retina.
PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision. Proliferative diabetic retinopathy causes visual loss in the following ways:
Vitreous hemorrhage: The fragile new vessels may bleed into the vitreous, a clear, gel-like substance that fills the center of the eye. If the vitreous hemorrhage is small, a person might see only a few new, dark floaters. A very large hemorrhage might block out all vision.
It may take days, months, or even year to reabsorb the blood, depending on the amount of blood present. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy surgery may be recommended.
Vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, vision may return to its former level unless the macula is damaged.
Traction retinal detachment: When PDR is present, scar tissue associated with neovascularization can shrink, wrinkling and pulling the retina from its normal position. Macular wrinkling can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached.
Neovascular glaucoma: Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris (colored part of the eye) and in the drainage channels in the front of the eye. This can block the normal flow of fluid out of the eye. This can block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.
How is diabetic retinopathy treated?
The best treatment is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.
Medical Treatment: In certain cases, your ophthalmologist (Eye M.D.) may choose to treat your macular edema with injections of medicine in your eye. These special shots of medicine-called intravitreal injections- may be steroids or other medications. They are designed to shrink the swelling of the macula.
Laser surgery: Laser surgery is often recommended for people with macular edema, PDR, and neovascular glaucoma.
For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see the laser spots near the center of their vision following treatment. The spots usually fade with time but may not disappear.
For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur.
Multiple laser treatments over time are sometimes necessary. Laser surgery does not always prevent further loss of vision.
Vitrectomy: In advanced PDR, your ophthalmologist (Eye M.D.) may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. Your ophthalmologist (Eye M.D.) may wait for several months to see if the blood clears on its own before performing a vitrectomy.
Vitrectomy often prevents further bleeding by removing he abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should usually be done early because macular distortion or traction retinal detachment will cause permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be.
Vision loss is largely preventable
If you have diabetes, it is important to know that today, with improved methods of diagnosis and treatment, a smaller percentage of people who develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision.
You can significantly lower your risk of vision loss by maintaining strict control of your blood sugar and visiting your ophthalmologist (Eye M.D.) regularly.
PKR / Advanced Surface Ablation (Laser Vision Correction)
PRK and Refractive Lens Exchange
For those who do not qualify for LASIK, there are several LASIK alternatives that exist. Most patients who are over the age of 21 and in good heath with no other eye conditions or diseases are generally considered good candidates for LASIK. LASIK is approved by the FDA to treat a broad range of vision problems, including nearsightedness, farsightedness, and astigmatism. However, some people may not be good candidates for LASIK because of their unique visual imperfections or because of the results of a comprehensive eye examination.
What Is PRK (Photorefractive Keratectomy)?
PRK stands for Photorefractive Keratectomy is a great option for those patients that cannot have LASIK for a variety of reasons. Instead of making a flap in the cornea, the most superficial layer of the cornea (the epithelium) is gently removed and the exact same excimer laser is used to treat the underlying cornea. This eliminates the potential for complications with the flap. PRK and LASIK are both now approved for military personnel, but a high percentage of them still choose PRK over LASIK because of their active lifestyle. Those without adequate corneal thickness for LASIK can still be candidates for PRK.
PRK (see also LASIK) PRK or Photo-Refractive Keratectomy treats refractive errors by removing tissue from the surface of the cornea. First, your eye is completely numbed using “eye drop” anesthesia and an instrument is placed between the eyelids to prevent blinking. Then, the surgeon removes the epithelium, a thin layer of protective skin that covers the cornea. The patient is told to look directly at a target light during the procedure. In less than a minute or two, the laser removes the proper amount of tissue while it reshapes the surface of the cornea. By altering the shape or placement of the laser beam, the cornea is made flatter to treat nearsightedness, steeper to treat farsightedness and/or more spherical to treat astigmatism.
PRK recovery time- A contact lens is placed onto the eye after PRK and it takes 4-7 days for the epithelium to be restored on the surface of the eye. During this time there is some discomfort that is addressed with eye drops and medicine. Visual recovery is delayed compared to LASIK. The majority of patients can resume work and acitivities by day 4-5, and the vision generally continues to sharpen over the ensuing days to weeks.
The decision to have Laser Vision Correction is an important one that ultimately, only you can make. It is important that you have realistic expectations and that your decision is based on facts, not hopes or misconceptions. The goal of any refractive surgical procedure is to reduce your dependence on corrective lenses. Laser Vision Correction does not always create 20/20 or even 20/40 vision. It cannot correct a condition known as presbyopia, or aging of the eye, that normally occurs around age 40 and may require the use of reading glasses. In fact, people over 40 who have their nearsightedness reduced with surgery may find they need reading glasses after the procedure. Your doctor will provide you with additional information that will allow you to make an informed decision.
Refractive Lens Exchange
Unlike LASIK which alters the shape of the cornea, RLE puts your eye into focus by removing your native lens and replacing it with an implant selected specifically for your eye much like modern cataract surgery. Dr. Bundrick will discuss advanced technology lens implant options with you that have the potential to reduce your need for glasses or contacts.
Who Benefits Most From Refractive Lens Exchange?
Patients with signs of early cataract development and patients over 55 years of age who are dependent on corrective lenses for distance vision but not LASIK candidates benefit the most from Refractive Lens Exchange.
Refractive Lens Exchange has a long history of predictable and successful outcomes, fast visual stabilization, and minimal side effects. Refractive Lens Exchange procedures can be combined with laser or incision options to correct astigmatism. Additionally, Refractive Lens Exchange eliminates the need for cataract surgery in the future, allowing patients to enjoy good vision for many, many years, without ever needing cataract surgery.
PRK Vision Correction- What is nearsightedness
In the normal eye, light bends through the cornea and lens to focus on the retina. With nearsightedness the eye is longer (or cornea is steeper) causing light to focus in front of the retina. The image is therefore out of focus on the retina and vision is blurred
Treating Nearsightedness using PKR Vision Correction
- The corneal epithelium is removed in the treatment area.
- Excimer laser is applied reshape (ablate) the cornea.
- The corneal epithelium grows over the treated area.
- The “flatter” cornea bends light to become focused on the retina.
What is Farsightedness?
In the normal eye, light bends through the cornea and lens to focus on the retina. With Farsightedness the eye is shorter (or cornea is flatter) causing the focal point of light to be behind the retina. The image is therefore out of focus on the retina and vision is blurred.
- Excimer laser is applied to reshape (ablate) the cornea.
- The “steeper” cornea now bends light to become focused on the retina.
Are You a Candidate for Laser Vision Correction?
In general, the ideal patient has a healthy cornea, and must not have had a significant increase in their prescription in the last year. People with certain medical conditions or pregnant women may not be good candidates.
The First Step
Finding out more about the health of your eye and your refractive error is your first step towards visual independence. This is accomplished by calling your Highland Eye Clinic doctor and scheduling a personal consultation. Should your refractive error fall within the range of correction for Laser Vision Correction, more comprehensive tests will be necessary. This information will help you and your doctor determine which procedure is in your best interest.
TORIC IOL (Astigmatism)
Astigmatism is a common eye condition most often caused by a misshaped or irregular cornea. Astigmatism is a refractive error which results in blurred or distorted vision. In most cases, astigmatism is correctable with glasses or contact lenses. A proper diagnosis will determine the treatment or possible surgery.
How is Astigmatism treated?
A small amount of astigmatism is common and does not need correction. However, in cases where the problem is more severe, glasses and contact lenses are used to correct vision. To correct astigmatism, glasses or contact lenses are ground to neutralize the defective curvature of the cornea. Hard or gas permeable contact lenses generally improve astigmatism better than soft contact lenses. In some cases, however, soft contact lenses may be helpful.
Astigmatism can also be treated with refractive surgery and laser vision correction. Toric IOL, corneal transplant and laser surgery are procedures used to correct the path of light as it enters the eye. The cornea is reshaped to allow light to focus properly on the retina. With refractive surgery and laser vision correction, the eye regains its proper focusing ability and astigmatism is corrected. Astigmatism is often connected at the time of cataract surgery, either with special small incisions or with a special toric implant.
What is a Refractive Error?
A refractive error is an irregularity in the way light passes through the eye. Normally, light rays enter the eye and are focused at a single point on the retina, the layer of light sensitive tissue at the back of the eye. The cornea (clear portion at the front of the eye) and the lens inside the eye bend or refract the light rays so that they focus properly. The retina receives the images formed by the focused light rays and transmits them to the brain through the optic nerve.
In an eye with a refractive error, the light rays do not bend properly to achieve a single focus point on the retina. Instead, light rays either focus in front of the retina, behind the retina, or do not focus at a single point. Refractive errors, which include nearsightedness, farsightedness, and astigmatism, result from a defect in the shape of the eye.
How does Astigmatism affect vision?
For normal, undistorted vision, the cornea should be smooth and equally curved in all directions. When astigmatism is present, the cornea is warped and curved more in one direction than the other. In other words, the cornea is shaped more like a football than a basketball.
Normally light enters the eye and is focused precisely on the retina. With astigmatism, the warped cornea causes the light rays to bend improperly. They are not refracted equally in all directions and one focus point on the retina is not attained. Some light rays are not focused on the retina but are focused in front of or behind the retina. The result of multiple focal points is blurred vision. Objects appear somewhat indistinct and slanted.
What are the symptoms of Astigmatism?
- Blurred Vision
- Distorted Vision
- Eye Strain
- A person with astigmatism normally experiences difficulty focusing on both near and distant objects. Patients may also experience headaches and eye fatigue.
Astigmatism is diagnosed with a routine eye exam. A visual acuity test is performed to determine the focusing power of the eye at different distances. A process called refraction is used to measure the refractive error of the eye and determine the prescription for corrective lenses.
Until recently, patients undergoing lens implant surgery received a monofocal, or single focus IOL. Monofocal IOLs implanted in both eyes generally provide excellent distance vision, while patients often need spectacle correction for near and intermediate vision. In the late 1990s, Advanced Medical Optics (AMO) introduced its first multifocal IOL designed to provide multiple points of focus, thereby dramatically reducing the need for bifocals or trifocal glasses after surgery.
Today, with many optical design enhancements, Multifocal IOL’s are providing patients with a full range of vision and greater independence from glasses or contact lenses than ever before. Clinical studies show that 92% of those receiving multi-focal technology “never”, or “only occasionally,” need to wear glasses.
If you suffer from poor vision, or think you might have a cataract, you should make an appointment to have a complete eye examination. Once it is determined that you are a good candidate for the multifocal IOL, you will be given additional information about the possible risks, complications, and costs involved with the procedure. Be sure to have all of your questions answered before giving your consent to have surgery.
What is macular degeneration?
Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function correctly, blurriness, dark areas or distortion can affect your central vision. Macular degeneration affects your ability to see near and far, and can make some activities-like threading a needle or reading-difficult or impossible.
Although macular degeneration reduces vision in the central part of the retina, it usually does not affect the eye’s side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is.
Macular degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves. In many cases, macular degeneration’s impact on your vision can be minimal.
What causes macular degeneration?
Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why it develops is not known, and no treatment has been uniformly effective. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65.
The two most common types of AMD are “dry”(atrophic) and “wet” (exudative):
“DRY” Macular degeneration (atrophic)
Most people have the “dry” form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.
“Wet” Macular degeneration (exudative)
The “wet” form of macular degeneration accounts for about 10% of all AMD cases. It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
Deposits under the retina called drusen are a common feature or macular degeneration. Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessel under the macula in one eye (“wet”form).
What are the symptoms of macular degeneration?
Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. But when both eyes are affected, the loss of central vision may be noticed more quickly.
Following are some common ways vision loss is detected:
- words on a page look blurred;
- a dark or empty area appears in the center of vision;
- straight lines look distorted.
How is macular degeneration treated?
Although the exact causes of macular degeneration are not fully understood, antioxidant vitamins and zinc may reduce the impact of AMD in some people.
A large scientific study found that people at risk for developing advanced stages of AMD lowered their risk by about 25% when treated with a high dose combination of vitamin C, vitamin E, beta-carotene and zinc. Among these who have either no AMD or very early AMD, the supplement did not appear to provide an apparent benefit.
It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision that you may have already lost from disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should speak with your ophthalmologist to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.
Laser surgery, PDT, and Anti VEGF Treatments
Certain types of “wet” macular degeneration can be treated with laser surgery, a brief outpatient procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels.
Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.
These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, many people with macular degeneration still experience some vision loss. Early detection and treatment may minimize vision loss.
Eye Conditions / Hyperopia / Farsightedness
Hyperopia, or farsightedness, has been one of the most challenging problems that we have faced. Also hyperopia is sometimes difficult for patients to understand. It is important to remember that hyperopia is basically opposite from myopia or nearsightedness. The things that cause an individual to become hyperopic are as follows:
The corneal curvature is too flat and/or the axial length of the eye is too short. Therefore we have an eye that usually has a combination of both a flat corneal surface and a small globe. The cornea of course is the front surface of the eye that is clear or transparent.
In a hyperopic individual, light rays that enter the eye are focused behind the retina instead of directly on the retina as in a normal eye. It is an inherited condition. It is present in childhood, but it does not usually become apparent to most people until they are in the late 30’s, when they can no longer use their own muscles inside the eye to overcome it. Patients with hyperopia begin to have difficulty seeing things clearly in the distance or near unless they wear glasses or contact lenses or some other type of optical correction. As we grow older, we all start to have difficulty reading and may require reading glasses or a bifocal. This condition is known as presbyopia.
If a person has a very mild degree of hyperopia, this individual usually gets along fine until they reach 38-40 years of age.This is the origin of the term “farsightedness.” At that time they will start noticing that their reading will become more difficult, and reading glasses will help this situation. However, if one is moderately or highly hyperopic, this can affect both near and distance vision. As you get older and older, your distance and near vision gets worse and worse. Basically what happens involves the accommodating process of the eye. The crystalline lens inside of the eye is involved in focusing the light rays onto the retina. When a person is farsighted, the crystalline lens has to be focused even for distance in order to pull the focal point back onto the retina in order to achieve clear vision. Therefore people who have moderate to high degrees of hyperopia can have “brow ache” or “eye strain” because the ciliary muscles that suspend the crystalline lens by tiny zonules (or strings) have to constantly flex in order to focus the light rays onto the retina.
Myopia / Nearsightedness
In the Normal Eye, light rays pass through the cornea (clear front portion of the eye), through the lens, and are focused on the retina (back portion of the eye). Once focused on the retina, information is transmitted by millions of tiny nerve bundles via the optic nerve to the brain where these images are translated into what we know as “sight.” When light rays are focused in front of, instead of on, the retina, we describe this condition as myopia, or nearsightedness. When the light rays are focused behind the retina, then hyperopia, or farsightedness, results.
Refractive errors may be corrected with glasses or contact lenses to give the wearer good vision by changing the way light is focused on the retina.
- Vision is blurry at a distance
- Vision at near is good.
- The eye is anatomically too long, and light focuses in front of, instead of on, the retina.
To surgically correct myopia, or nearsightedness, the cornea must be flattened. Laser correction of certain visual problems is the most technologically advanced method available today to reduce your dependence on glasses and contact lenses. The outpatient procedure can correct nearsightedness, farsightedness, and astigmatism by gently reshaping the front surface of your eye with a cool, ultraviolet beam of laser light.
It is estimated that over one million laser procedures have been performed in 52 countries around the world. In fact, Laser Vision Correction is expected to become the most common procedure performed worldwide within the next three years.
Presbyopia (Greek word “presbys” (πρ?σβυς), meaning “old person”) describes the condition where the eye exhibits a progressively diminished ability to focus on near objects with age. Presbyopia’s exact mechanisms are not known with certainty, however, the research evidence most strongly supports a loss of elasticity of the crystalline lens, although changes in the lens’s curvature from continual growth and loss of power of the ciliary muscles (the muscles that bend and straighten the lens) have also been postulated as its cause.
Similar to grey hair and wrinkles, presbyopia is a symptom caused by the natural course of aging. The first symptoms (described below) are usually first noticed between the ages of 40-50. The ability to focus on near objects declines throughout life, from an accommodation of about 20 dioptres (ability to focus at 50 mm away) in a child to 10 dioptres at 25 (100 mm) and leveling off at 0.5 to 1 dioptre at age 60 (ability to focus down to 1-2 meters only).
The first symptoms most people notice are, difficulty reading fine print, particularly in low light conditions, eyestrain when reading for long periods, blur at near or momentarily blurred vision when transitioning between viewing distances. Many advanced presbyopes complain that their arms have become “too short” to hold reading material at a comfortable distance.
Presbyopia, like other focus defects, becomes much less noticeable in bright sunlight. This is not the result of any mysterious ‘healing effect’ but just the consequence of the iris closing to a pinhole, so that depth of focus, regardless of actual ability to focus, is greatly enhanced, as in a pinhole camera which produces images without any lens at all. Another way of putting this is to say that the circle of confusion, or blurredness of image, is reduced, without improving focusing.
A delayed onset of seeking correction for presbyopia has been found among those with certain professions and those with miotic pupils. In particular, farmers and housewives seek correction later, whereas service workers and construction workers seek eyesight correction earlier.
Presbyopia is not routinely curable – though tentative steps toward a possible cure suggest that this may be possible – but the loss of focusing ability can be compensated for by corrective lenses including eyeglasses or contact lenses. In subjects with other refractory problems, Convex lenses are used. In some cases, the addition of bifocals to an existing lens prescription is sufficient. As the ability to change focus worsens, the prescription needs to be changed accordingly.
Around the age of 65, the eyes have usually lost most of their elasticity. However, it will still be possible to read with the help of the appropriate prescription. Some may find it necessary to hold reading materials farther away, or require larger print and more light to read by. People who do not need glasses for distance vision may only need half glasses or reading glasses. Another approach is TruFocals, where the user moves a slider to choose between focusing on near and far objects.
In order to reduce the need for bifocals or reading glasses, some people choose contact lenses to correct one eye for near and one eye for far with a method called “monovision”. Monovision sometimes interferes with depth perception. There are also newer bifocal or multifocal contact lenses that attempt to correct both near and far vision with the same lens.
New surgical procedures may also provide solutions for those who do not want to wear glasses or contacts, including the implantation of accommodative intraocular lenses (IOLs).
What is Dry Eye?
Normally, the eye constantly bathes itself in tears. By producing tears at a slow and steady rate the eye stays moist and comfortable.
Sometimes people do not produce enough tears or the appropriate quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.
The eye uses two different methods to produce tears. It can make tears at a slow, steady rate to maintain normal eye lubrication. It can also produce large quantities of tears in response to eye irritation or emotion. When a foreign body or dryness irritates the eye, or when a person cries, excessive tearing occurs.
What are the symptoms of dry eye?
The usual symptoms include:
– stinging or burning eyes;
– stringy mucus in or around eyes;
– excessive irritation from smoke or wind;
– excess tearing;
– discomfort when wearing contact lenses.
– blurring with prolonged reading (starts clear, blurs after 15 – 20 minutes)
Excess tearing from “dry eye” may sound illogical, but it can be understood as the eye’s response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal gland) to release a large volume of tears, overwhelming the tear drainage system, these excess tears then overflow from your eye.
What causes dry eye?
Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected. This is especially true after menopause.
Dry eye can also be associated with other problems. For example, people with dry eyes, dry mouth, and arthritis are said to have Sjogren’s syndrome.
A wide variety of common medications-both prescription and over-the-counter-can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist (Eye M.D.) the names of all the medications you are taking, especially if you using:
– sleeping pills;
– medications for “nerves”; or
– pain relievers
Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with eyedrops called artificial tears.
People with dry eye are often more prone to the toxic side effects of eye medications, including artificial tears, For example, the preservatives in certain eyedrops and artificial tear preparations can irritate the eye. These people may need special preservative-free artificial tears.
How is dry eye treated?
Eyedrops called artificial tears are similar to your own tears are similar to your own tears. They lubricate the eyes and help maintain moisture.
Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best.
Preservative-free eyedrops are available for people who are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you.
You can use the artificial tears as often as necessary-once or twice a day or as often as several times an hour.
Conserving Your Tears
Conserving your eyes’ own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). Your ophthalmologist may close these channels either temporarily using PUNCTAL PLUGS or permanently. The closure conserves your own tears and makes artificial tears last longer.
Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heating is in use, a humidifier or a pan of water on the radiator adds moisture to dry air. Wrap-around glasses may reduce the drying effect of the wind, but you should note that they are illegal to wear while driving in some states.
A person with dry eye should avoid anything that may cause dryness, such as an overly warm room, hair dryers, or wind. Smoking is especially bothersome.
Some people with dry eye complain of “scratchy eyes” when they wake up. This symptom can be treated by using an artificial tear ointment or thick eyedrops at bedtime. Use the smallest amount of ointment necessary for comfort, since the ointment can cause your vision to blur.
Dry eye due to lack of vitamin A in the diet is rare in the United States but is more common in poorer countries, especially among children. Ointments containing Vitamin A can help dry eye if it is caused by unusual conditions such as Stevens- Johnson syndrome or pemphigoid. Vitamin A supplements do not seem to help people with ordinary dry eye.
Floaters and Flashes
What are Floaters?
You may sometimes see small specks or clouds moving in your vision. These are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky.
Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear gel-like fluid that fills the inside of your eye.
While these objects look like they are in front of your eye, they are actually floating inside it. What you see are the shadows they cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see. Floaters can appear as different shapes such as little dots, circles, lines, clouds, or cobwebs.
What causes Floaters?
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters.
Posterior vitreous detachment is more common in people who:
- are nearsighted;
- have undergone cataract operations;
- have had YAG laser surgery of the eye;
- have had inflammation inside the eye.
The appearance of floaters may be alarming, especially if they develop very suddenly. You should contact your ophthalmologist (Eye M.D.) right away if you develop new floaters, especially if you are over 45 years of age.
Are floaters ever serious?
The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters.
A torn retina is always a serious problem, since it can lead to retinal detachment. You should see your ophthalmologist as soon as possible if:
- even one new floater appears suddenly;
- you see sudden flashes of light.
If you notice other symptoms, like the loss of side vision, you should see your ophthalmologist.
Can floaters be removed?
Floaters may be a symptom of a tear in the retina, which is a serious problem. If a retinal tear is not treated, the retina may detach from the back of the eye. The only treatment for a detached retina is surgery.
Other floater are harmless and fade over time or become less bothersome, requiring no treatment, Surgery to remove floaters is almost never required. Vitamin therapy will not cause floaters to disappear.
Even if you have had floaters for year, you should schedule an eye examination with your ophthalmologist if you suddenly notice new ones.
What cause flashing lights?
When the vitreous gel rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen “stars”.
The flashes if light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. If you notice the sudden appearance of light flashes, you should contact your ophthalmologist immediately in case the retina has been torn.