ECP is often combined with cataract surgery to help reduce intraocular pressure. The procedure involves coagulation of the ciliary processes under direct visualization so as to cause inflammation and scarring with subsequent decrease in the amount of intraocular fluid produced within your eye. Since glaucoma usually involves a drainage problem, reducing the amount of fluid being made helps with the intraocular pressure.
After cataract surgery is completed a special probe is introduced into the eye through the same cataract incision. This probe has both a special camera as well as fiberoptic cables that will help deliver the laser energy. Your surgeon will observe the internal structures of your eye on a TV monitor and will direct the laser energy to the ciliary processes under direct visualization. The amount of energy delivered is titrated to achieve a blanching of the processes. An attempt is made to treat about 270 to 360 degrees around the eye to achieve maximal effect.
After the procedure an eye patch will be placed over your eye for the first 24 hours. Your doctor will want to examine you in the office the following morning when the patch will be removed and your eye pressure checked. You will be prescribed a regimen of postoperative drops for the next four to six weeks.
If the procedure is successful you can expect a decrease in the intraocular pressure and you possibly may come off some of your glaucoma medications. It takes about 6 to 8 weeks before the outcome of the laser procedure is known.
Benefits of the laser include no adverse events from added medications and the delay of a surgical procedure. Please feel free to discuss this laser or other procedures with your physician.
iStent® Trabecular Micro-bypass is a minimally invasive surgical treatment for the management of open angle glaucomas.
The iStent® is the first minimally invasive FDA-approved implantable device for the treatment of open angle glaucomas. The iStent ® is a Micro-Invasive Glaucoma Surgery (MIGS) approved to be done in conjunction with cataract surgery. Since it is done at the same time as cataract surgery, no additional incisions are necessary. The surgical procedure involves placement of a tiny 1mm long titanium device through the trabecular meshwork and into Schlemm’s canal to enhance aqueous outflow from the anterior chamber and lower intraocular pressure. Although the iStent® is made of titanium, patients can safely undergo MRI scans in most circumstances; please visit the iStent® MRI Safety page for more information.
This procedure does not involve opening up the conjunctival tissues to access Schlemm’s canal. This is a major advantage of this procedure as it makes future glaucoma surgery (if needed) a lot simpler with less risk of failure.
Who is a good candidate for iStent® Trabecular Micro-bypass?
iStent® is indicated for the surgical treatment of mild to moderate open angle glaucomas. It is contraindicated in patients with primary or secondary angle closure glaucoma, neovascular glaucoma, patients with thyroid eye disease, retrobulbar tumors, Sturge-Weber Syndrome, and/or any other condition causing elevated epislceral venous pressure.
How does the iStent® Trabecular Micro-bypass work?
The iStent® reduces IOP by increasing outflow through the trabeculocanalicular outflow pathway. It increases the flow of aqueous humor from the anterior chamber, directly into Schlemm’s canal, and out through the collector channels. This procedure does not create a ‘bleb’ on the surface of the eye as fluid is routed through normal physiological pathways.
What is involved with an iStent® Trabecular Micro-bypass procedure?
When you and your doctor make a decision to proceed with an iStent® you will meet with our preoperative scheduler who will give you detailed instructions on how to prepare yourself for your upcoming surgery and what is involved in getting to the operating room for the procedure.
This is an outpatient procedure performed in an ambulatory surgery center. In most cases, the surgery takes less than 1 hour, though you will be at the surgery center for about 3 hours. The surgery is usually done under local anesthesia with intravenous sedation. After surgery, the eye is covered by a plastic shield overnight. On the morning following the surgery, the patch/shield is removed and the eye is examined by your ophthalmologist. Eye drops are then prescribed to prevent infection and reduce inflammation.
For several weeks following the surgery, your ophthalmologist will observe your eye closely and examine you frequently. It may take up to 12 weeks after your surgery for the healing to be complete. During this time it is not unusual for your intraocular pressure, as well as vision, to fluctuate. You will be ready to change your glasses prescription at around 6-8 weeks after surgery.
Mechanism of Action: Restoring the Natural Outflow Pathway
The Kahook Dual Blade (KDB) is a single-use ophthalmic blade with a micro-engineered profile which allows for insertion into the eye through a clear cornea micro-incision. It can be done with or without cataract surgery, and when done in conjunction with cataract surgery it utilizes the same incision as the cataract removal. The device is made of surgical grade stainless steel body with a long, thin shaft that allows for access across the anterior chamber to the trabecular meshwork (TM). Using a special mirrored lens, the surgeon uses the Kahook Dual blade to make parallel incisions in the trabecular meshwork (TM), unroofing it and opening up the inner wall of Schlemm’s Canal to improve aqueous humor outflow from the eye – which often reduces eye pressure. This procedure does not involve opening up the conjunctival tissues; this is a major advantage of this procedure, as it makes future glaucoma surgery (if needed) a lot simpler with less risk of failure.
This is an outpatient procedure performed in an ambulatory surgery center. The surgery is usually done under local anesthesia with intravenous sedation. Your doctor will want to examine you in the office the following day and you will be prescribed a regimen of postoperative drops for the next four to six weeks. If the procedure is successful you can expect a decrease in the intraocular pressure and you possibly may come off some of your glaucoma medications. It takes about 6 to 8 weeks before the outcome of the procedure is known.
Glaucoma drainage implants are small prosthetic devices that are placed to help lower the intraocular pressure and prevent further optic nerve damage. Glaucoma drainage implant surgery is an alternative to traditional filtration surgery (Trabeculectomy). In some patients, particularly those with certain types of glaucoma such as aphakic glaucoma, neovascular glaucoma, and uveitic glaucoma, trabeculectomies are known to be less successful at reducing intraocular pressure due to an aggressive healing response. Also, in patients who have had other eye surgeries, a glaucoma drainage device often works better than a trabeculectomy procedure to control the intraocular pressure. It should be noted that the glaucoma implant is not used to improve vision, but rather to lower intraocular pressure and prevent further vision loss from glaucoma. In this respect, this implant is completely different from the type of implant used during cataract surgery.
Glaucoma drainage implants are also successfully used as an initial surgical procedure for glaucoma. Various factors may influence the surgery recommended by your doctor. Sometimes an implant is necessary because there is expected to be extensive scarring in the outer layers of the eye. Compared to the channel made with trabeculectomy, the tube of a glaucoma implant is less likely to become blocked by this scar tissue.
How do drainage implants work?
Glaucoma drainage implants come in different shapes and sizes. There are two general types of implants: Valved and Non-valved implants. All these implants have a tube and plate design. Regardless of which type of implant is used, a silicone tube is inserted into the front of the eye, usually between the cornea and iris, but other locations are occasionally used. The tube is like an artificial drain, allowing fluid to pass through it to a plate, which has been placed on the surface of the eye and acts as a reservoir.
The fluid then slowly percolates through this reservoir and is absorbed into the body fluids. The implant plate is usually placed in the area underneath the upper eyelid. Unless the lid is pulled back, neither you nor your family will notice it. With the upper lid retracted, a clear or white patch may be noted. This is a patch that covers the tube and prevents irritation. With all drainage implants, it can take 3 months or longer after surgery for the intraocular pressure to stabilize, as the capsule surrounding the plate of the implant needs time to mature in the eye.
What is my chance of success with after Glaucoma Drainage Implant Surgery?
Studies have shown that the success of glaucoma drainage implants is similar to those of trabeculectomy. It should be noted that glaucoma implants are sometimes used in patients with more complicated problems, and therefore the success rate in these patients may be lower than trabeculectomy in a standard eye. However, in many patients, these implants may be the best remaining available option. In about 5-10% of cases a second tube implant is necessary to adequately control intraocular pressure. When a second tube is necessary it is usually place in the lower part of the eye under the lower eyelid.
Remember that the goal of glaucoma implant surgery is to lower intraocular pressure and preserve vision. It will not restore vision that has already been lost. By lowering eye pressure, it is hoped that the operated eye will be spared further glaucomatous damage and can maintain its vision. As with any eye surgery, there is a risk of loss of vision, though this risk is low. Sometimes your doctor will combine the tube implant surgery with cataract surgery. In these cases there may be some visual improvement from clearing of the cataract and replacing it with a clear intraocular lens implant.
What is involved with a Glaucoma tube procedure?
After discussing the risk, benefits, and alternatives to surgery, your doctor will decide on the appropriate type of tube implant to be placed in your eye. When you and your doctor make a decision to proceed with placement of a glaucoma drainage implant, you will meet with our preoperative scheduler who will give you detailed instructions on how to prepare yourself for your upcoming surgery and what is involved in getting to the operating room for the procedure.
The surgery is an outpatient procedure performed in an ambulatory surgery center. In most cases, the surgery takes about one hour, though you will be at the surgery center for about 3-4 hours. The surgery is usually done under local anesthesia with intravenous sedation. An injection of local anesthetic numbs the eye completely so there is no discomfort and the eye will not move during surgery. Uncommonly a general anesthetic is used and the patient is put to sleep for the operation. Local anesthesia offers several advantages including less pain post-operatively, no sore throat from the airway tube used in general anesthesia, and quickly returning to normal alertness without the nausea often felt after general anesthesia. With local anesthesia, there is less risk than with a general anesthetic, especially in the elderly or those with health problems.
After surgery, the eye is covered by an eye patch and protected by a plastic shield overnight. On the morning following surgery, the patch/shield is removed and your ophthalmologist examines the eye. Eye drops are then used to prevent infection and reduce inflammation. It is important to take these as directed by your ophthalmologist since they can make a great deal of difference in the success of the procedure.
It may take several months after your surgery for the healing to be complete and for the implant to mature in your eye. During this time it is not unusual for your intraocular pressure, as well as your vision, to fluctuate. You will be ready to change your glasses prescription approximately 2-3 months after surgery.
Selective laser trabeculoplasty (SLT) is an in-office procedure that reduces intraocular pressure in patients with glaucoma. The laser is applied through a special contact lens to the trabecular meshwork of the eye, where it stimulates a biochemical change that improves the outflow of fluid from the eye.
SLT has been used since 1995 and has a proven track record for efficacy. On average, SLT can lower eye pressure by 20 to 30%. The laser is successful in about 80% of patients. In addition, studies have shown that SLT has a similar outcome compared to the most effective glaucoma eye drops. The treatment effect may last 3 to 5 years and SLT can be repeated when the original treatment effect diminishes.
Usually, eye drops are offered before laser for initial treatment of glaucoma. This stems from the era prior to SLT when laser trabeculoplasty was a relatively riskier procedure. Argon laser trabeculoplasty (ALT), the predecessor of SLT, delivered significantly higher laser energy to the eye resulting in structural damage and higher complication rates. By comparison, SLT has an improved safety profile where complications are typically infrequent, mild and short-lived. Although uncommon, side effects such as a “pressure spike” or inflammation can usually be successfully treated with a short course of medication.
Excellent Benefit-to-Risk Profile
Due to its excellent benefit-to-risk profile, SLT is being offered earlier in the treatment strategy of glaucoma, including as primary therapy. Studies comparing SLT and eye drops as primary therapy have found similar treatment effects between the two groups. Although some patients still required eye drops following SLT, they required fewer drops to control their glaucoma. In addition, there were significant cost savings for those getting SLT.
Many patients have difficulty with their eye drops. It is estimated that less than half of patients use their medications as regularly as directed. Medication costs, side effects, allergies, forgetfulness and complicated eye drop schedules contribute to this problem. As a result, there is a strong case for SLT as primary therapy for many new glaucoma patients. Glaucoma treatment is individualized for each patient, and SLT is not effective for all types of glaucoma. It is important to discuss your options with your eye care provider.
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 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
What to expect on procedure day:
Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. It is usually performed without anesthesia, although some will want a local anesthetic.
Before your procedure begins, an eyelid holder will be placed between your eyelids to keep you from blinking. Next, your ophthalmologist 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 two or more sessions.
Your vision will be poor 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.
If you and your doctor decide that pan-retinal photocoagulation 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.
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. The 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
whose doctor has determined that this test is needed for diagnosis of retinal conditions
What to expect on testing day:
Your doctor may ask you not to eat the morning of your angiography. Your testing will most likely be performed in a specially equipped examination room. It does not require a surgery center or anesthesia. Prior to your procedure, your eye will be dilated.
During the test, a harmless orange-red 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 to an hour, including the time for dilation of your eye. 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 and 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 that goes away quickly.
There are veins in the retina that drain blood out of the retina, back to the heart. If those veins become blocked, this can cause fluid leakage, which can lead to vision loss. If you experience sudden loss of your central vision or a blurry or missing area of vision, call our office at once.
Symptoms of retinal vein occlusion
Sudden, painless loss of vision
Sudden increase in floating spots or flashing lights
Blurred or missing area of vision
Causes of retinal vein occlusion
High blood pressure
Glaucoma, diabetes and other conditions
Treatment for retinal vein occlusion
The type of treatment depends on the cause of the blockage and the extent of damage. A laser can be used to reduce leakage and the growth of abnormal new blood vessels.
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 office immediately.
Symptoms of retinal detachment
The appearance of a curtain over the field of vision.
Seeing light flashes
Wavy or watery vision
A sudden decrease in vision
A sudden increase in the number of floaters in the field of vision
Who is most at risk for retinal detachment?
Those who are very nearsighted
People with a family history of retinal detachment
Those who have had cataract surgery
Patients with diabetes or other eye disorders
Treatment for retinal tear and/or detachment
Retinal tears and/or detachments may be treated, particularly if caught early, with an in office laser procedure called laser retinopexy. The laser is used to “weld” the area around the retinal tear to prevent retinal detachment or prevent progression of the retinal detachment. In more advanced cases, an operative procedure such as a vitrectomy or scleral buckle may be required.
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.
Symptoms of macular degeneration:
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
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 equally.
Causes of or contributing factors to macular degeneration:
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.
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
High blood pressure
Diagnosing macular degeneration:
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.
Please go to Patient Forms to download the Amsler Grid test and receive instructions on how to test your vision at home.
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.
Treatment for macular degeneration:
In the early stages of macular degeneration, regular eye check-ups, attention to diet, in-home monitoring of vision and possibly nutritional supplements may be all that is recommended.
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 that are high in these and other antioxidants.
Low Vision Aids
Unfortunately, the vast majority of cases of wet macular degeneration and virtually all cases of dry macular degeneration are not treatable. In these cases, low vision aids may help make it easier to live with the decreased vision of macular degeneration. 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.
LUCENTIS and Macugen are new treatments for the wet form of age-related macular degeneration. These injections block abnormal blood vessel growth and leakage.
In rare 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 it will not damage it. 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 but is generally not expected to bring back any vision that has already been lost.
Some cases of wet macular degeneration can be treated with 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.
Flashes and floaters can be alarming. Usually, however, an eye examination will confirm that they are harmless and do not require any treatment.
Symptoms of flashes & vitreous floaters:
Seeing small, floating spots
Seeing bright flashes of light
Causes of flashes and floaters:
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.
Sometime after about age 55, you may experience the onset of larger, more bothersome floaters or flashes of light. By this age, the vitreous gel has usually become much 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.
Who is at risk?
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, so it’s important to get regular eye exams and inform your doctor if you’re experiencing flashes or floaters.
Diagnosing flashes and floaters:
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 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.
Treatment for flashes and floaters:
There is no way to eliminate the floater through surgery, laser treatment or medication. With time, the floater will become less noticeable as the brain adjusts to its presence and can “tune out” the floater. The floater will always be somewhat observable and present, particularly if one eye is covered and the patient looks at a light-colored background.
Anyone with flashes or the sudden onset of a new floater should be examined promptly by an ophthalmologist. The ophthalmologist will perform a dilated exam and look at the vitreous and retina with specialized equipment. Sudden flashes or floaters could be symptoms of a vitreous detachment, which is a benign condition that carries the risk of developing into a retinal tear and/or retinal detachment.
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 in 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, 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.
The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called retinal detachment and can lead to blindness if left untreated.
Symptoms of diabetic retinopathy:
There are usually no symptoms in the early stages of diabetic retinopathy
Difficulty reading or doing close work
If left untreated, severe vision loss can occur
Causes of diabetic retinopathy:
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. Generally, diabetics don’t develop diabetic retinopathy until they’ve had diabetes for at least 10 years.
You can reduce your risk of developing diabetic retinopathy by:
keeping your blood sugar under control.
monitoring your blood pressure.
maintaining a healthy diet.
getting an eye exam at least once a year.
Diagnosing diabetic retinopathy:
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 regular examinations for people with diabetes are extremely important.
Your eye doctor may perform a test called fluorescein angiography. During the test, a harmless orange-red 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. The pictures will be analyzed to identify any damage to the lining of the retina or atypical new blood vessels.
Treatment for diabetic retinopathy:
Diabetic retinopathy does not usually impair sight until the development of long-term complications, including proliferative retinopathy (when abnormal new blood vessels bleed into the eye). When this advanced stage of retinopathy occurs, pan-retinal photocoagulation is performed. During this procedure, a laser is used to destroy all of the dead areas of 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.
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, intra-ocular pressure can build rapidly causing damage to the delicate optic nerve, and permanent loss of vision. In most patients, the iridotomy is placed in the upper portion of the iris, under the upper eyelid, where it cannot be seen
The purpose of an iridotomy is to preserve vision, not to improve it.
Laser iridotomy is for those:
who have been diagnosed with narrow-angle glaucoma.
whose doctor has determined that laser iridotomy is the appropriate treatment for their condition.
What to expect on procedure day:
Your treatment will be performed in a specially equipped laser room. 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.
First, your ophthalmologist will place a drop in your eye to make your pupil smaller. This stretches and thins your iris, which makes it easier for the laser to make the pinhole sized puncture. Next 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 won’t blink during treatment. It also reduces small eye movements so that you don’t have to worry about your eye moving during the treatment. To ensure that the contact lens doesn’t scratch your eye, a special jelly will be placed on the surface of your eye. This jelly may remain on your eye for about 30 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. Other than that, the treatment should be painless.
Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside your eye. Follow-up visits are necessary to monitor your eye pressure.
Your doctor may ask you to continue using eye drops to make your pupil smaller for a few days following your laser treatment. These drops can temporarily cause blurred vision (especially at night) and may also give you a slight headache. Your doctor may use other drops, both before and after your treatment to control your eye pressure. Still other eye drops may be used to reduce inflammation.
Everyone heals differently, but most people resume normal activities immediately following treatment, although you’ll need to have someone drive you home after your 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. This happens in less than one-third of the cases.
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 closed-angle type.
If you and your doctor decide that laser iridotomy 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.
If you would like more information about this procedure you can make an appointment or contact the office for additional information.
Optical Coherence Tomography (OCT) uses light waves to create detailed images of underlying retinal structures. Using this scanner, doctors can more specifically diagnose, treat and manage glaucoma and retinal diseases including diabetic retinopathy and macular degeneration.
Why we’ve invested in OCT:
The advanced OCT technology provides detailed images of the retina not observable by any other means.
This non-contact, non-invasive tool can lead to earlier confirmation of damage so doctors can provide earlier treatment.
The scanner produces high-resolution (10 times greater resolution than any other technique available), cross-sectional images of the retina.
This equipment does not require injections or exposure to painful, high-intensity light, which means improved patient comfort and safety.
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 blood stream 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.
Symptoms of open-angle glaucoma:
In the early stages, there are no symptoms. There is no pain or outward sign of trouble.
Mild aching in the eyes
Gradual loss of peripheral vision (the top, sides and bottom areas of vision)
Seeing halos around lights
Reduced visual acuity (especially at night, that is not correctable with glasses)
Who is at risk
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 relative with glaucoma
are very nearsighted
are over 35 years of age
Diagnosing open-angle glaucoma:
Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be at higher risk, including those over the age of 60 should have their pressure checked every year or two.
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.
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 cupped or is not a healthy pink color, additional tests will be run.
Perimetry is a test that maps the field of vision. Looking straight ahead into a white, bowl-shaped area, you’ll indicate when you’re able to detect lights as they are brought into your field of vision. This map allows your doctor to see any pattern of visual changes caused by the early stages of 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.
Treatments for open-angle glaucoma:
To control glaucoma, your doctor will use one of three basic types of treatment: medicines, laser surgery, or filtration surgery. The goal of treatment is to lower the pressure in the eye.
Medicines come in pill and eye drop form. They 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 between one to four times 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 medications you are taking.
Argon Laser Trabeculoplasty and Selective Laser Trabeculoplasty surgery treat the drainage canal. 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 the need for daily 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.
Narrow-angle glaucoma is much more rare and 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.
Symptoms of narrow-angle glaucoma:
The onset of acute narrow-angle glaucoma is typically rapid, constituting an emergency. If not treated promptly, this glaucoma produces blindness in the affected eye in three to five days. Symptoms may include:
Inflammation and pain
Pressure over the eye
Moderate pupil dilation that’s non-reactive to light
Blurring and decreased visual acuity
Extreme sensitivity to light
Seeing halos around lights
Nausea and/or vomiting
Causes of narrow-angle glaucoma:
Defect in the eye structure
Anything that causes the pupil to dilate — dim lighting, dilation drops
Certain oral or injected medications
Blow to the eye
Diabetes-related growth of abnormal blood vessels over the angle
Diagnosing narrow-angle glaucoma:
Everyone should be checked for glaucoma at around age 35 and again at age 40. Those considered to be 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 seek medical treatment 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
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 cupped or is not a healthy pink color, additional tests will be run.
Gonioscopy is used to determine whether the angle where the iris meets the cornea is open or closed, a key difference between open-angle glaucoma and narrow-angle glaucoma.
Treatment for narrow-angle glaucoma:
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. In most patients, the iridotomy is placed in the upper portion of the iris, under the upper eyelid, where it cannot be seen.
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.
Eye Physicians of Virginia is proud to offer our patients Focus Relief® by Focus Vision Suppliments for treatment of Dry Eye. Focus Relief® is a supplement which contains Omega fatty acids and other beneficial nutrients for relief from the symptoms of occasional dry eyes.*
A clinical study published in 2012† reported that consumption of Omega fatty acids helped alleviate the symptoms of occasional dry eyes and increased moisture in the eye.
Focus Relief is made in the United States (of domestic and imported materials) and extensively tested in an FDA-registered facility to ensure a premium product.
Other therapies, such as ocular lubricants, are commonly used in conjunction with Focus Relief. Ask us if Focus Relief is the best choice for you.
Restasis is an exciting new treatment for Dry Eye Disease, a painful and irritating 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 drug proven to effectively treat a cause of Dry Eye Disease rather than only temporarily alleviate symptoms.
Restasis is for those:
whose tear production is suppressed due to inflammation caused by dry eye disease
whose doctor has determined that Restasis is the appropriate treatment for their condition
About the treatment:
If your doctor prescribes Restasis, you’ll probably use one drop in each eye every 12 hours. There is presently no cure for Dry Eye Disease; however, 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 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.
If you would like more information about this treatment you can make an appointment, contact the office or visit the Allergan website.
The name “dry eye” can be a little confusing since one of the most common symptoms is excessive watering! 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’re cutting onions, when you’re around smoke, or when you accidentally scratch your eye. The reflex tears gush out in such large quantities that the tear drainage system can’t 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.
Symptoms of dry eye:
The feeling that there’s sand in your eyes
Eyes that itch and burn
Vision that becomes blurred after periods of reading, watching TV, or using a computer
Red, irritated eyes that produce a mucus discharge
Causes of dry eye:
Age: As we get older, glands in the eyelid produce less oil. Oil keeps tears from evaporating off the eye. Decreased oil production allows tears to evaporate too quickly, leaving the eye too dry.
Diseases including diabetes, Sjogren’s and Parkinson’s
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 eye.
Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eye.
Reading, using a computer or watching TV
Eye surgery: Some types of eye surgery, including LASIK can aggravate dry eye.
Inflammation: Recent research suggests that dry eye may be caused by inflammation due to an imbalance of “good” fats and “bad” fats.
Diagnosing dry eye:
Your eye doctor can check for dry eye by examining your eyes with magnifying instruments, 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, colored eye drops call fluorescein or Rose Bengal.
Treatments for dry eye:
The most common treatment is use of artificial teardrops that 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, which is most often recommended for nighttime use. 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.
When infection, inflammation of the eyelids or clogged oil glands contribute to dry eye, special lid cleaning techniques or antibiotics may be recommended. It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.
Restasis is an exciting new treatment for Dry Eye Disease. 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 drug proven to effectively treat a cause of Dry Eye Disease rather than only temporarily alleviate symptoms.
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.
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 can be resolved with a quick in-office laser procedure.
A posterior capsulotomy is for those who:
have had cataract surgery
believe that their vision is being affected by cloudiness
What to expect on procedure day:
Once you have been checked-in, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.
Your ophthalmologist 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 takes only about five minutes and you can leave soon afterward. The results of the procedure are almost immediate, however your vision will probably be a little blurry from the drops so someone will need to drive you home. 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.
If you and your doctor decide that posterior capsulotomy 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.
If you would like more information about this procedure you can make an appointment or contact the office for additional information.
Eye Physicians of Virginia offers high-quality frames and lenses in a variety of price ranges for every age group, from proprietary brands crafted in Italy, to well-known brands.
We understand – fashion, style and feeling good about your frames matter. But seeing well should be equally important to you. If your eyeglass frames make a statement about you and your world, then your lenses should make a statement about how you see it. And for that, you need a guide. Our competent and caring staff of trained professionals give you personalized care to suit your needs from frame selection to explanations of lens options. Patients comfort and satisfaction are important to us. We will do all we can to make sure you’re happy with your glasses. Please contact our Licensed Optician for an appointment at 703-435-8725.
Products & Services Disclaimer
*Eye Physicians of Virginia is an independently owned and operated care center that may promote, sell, or provide eyewear products. Privia Medical Group is not responsible for these products or services. Privia’s Authorization & Consent to Treat, Financial Policy and HIPAA Notice of Privacy Practices are not applicable to these services or products.
The retina is the film in the back of the eye that light rays and images are focused on. Tiny photoreceptor cells pick up those images and transmit them to electrical impulses that are sent via the optic nerve to the brain, where visual images are interpreted. The center of the retina is called the macula. This is the most sensitive area of the retina used for reading vision, and straight ahead vision. Retinal and specifically macular diseases can cause clouding and distortion of vision, loss of peripheral vision and eventually blindness. There are many types of retinal disease
Symptoms of retinal disease:
Any condition that disturbs the center of the retina, called the macula, will result in the onset of blurred vision. Sometimes subtle vision loss is difficult to detect unless you happen to close the good eye.
Waviness when looking at straight lines, such as a grid like this one
A curtain coming over your vision, from above, below or either side
Flashes of light in your side vision, especially noticeable at night
Floaters, cobwebs, or worm like shadows that move as you move your eye, especially noticeable against a solid blue or white background
Causes of retinal disease:
Infection: Bacterial, fungal and viral infections
Age: Aging processes can affect the macula, the very center and most sensitive part of the retina
Heredity: there are conditions such as retinal dystrophies that cause night vision loss, color vision loss, light sensitivity or generalized blur from a young age. There conditions are often progressive.
Certain systemic diseases, like diabetes or hypertension
Diagnosing retinal disease:
Your Ophthalmologist or Optometrist check for chronic conditions like macular degeneration and diabetic eye changes (retinopathy) by doing a complete eye exam, which includes dilation and examination using special magnifying instruments. Photographs may be taken, a dye test such as fluorescein angiography can be performed to determine leakage of blood vessels. Your doctor may also perform an Optomap non-dilated retinal exam which provides a permanent digital record of your eye health and provides your doctor an ultra-wide field view of your retina.
Treatment for retinal disease:
There are a variety of treatments for retinal disease, ranging from preventative therapy with vitamins to surgery for retinal detachment that is either done in the office or the hospital to laser treatment for diabetes to seal leaky blood vessels, and injections such as LUCENTIS® and Avastin to stop abnormal blood vessels from growing in the retina and doing damage to central vision.
The Eye Physicians of Virginia clinic is equipped with state-of-the-art instruments that are used to diagnose, follow and treat glaucoma. This includes visual field testing, optic nerve analysis (OCT) and photos, corneal thickness (pachymetry), and gonioscopy. Special treatment options include eye drops, SLT laser, laser iridotomy, trabeculectomy, and more.
Most glaucoma is open-angle glaucoma. The disease is a result of pressure inside the eye that is too high for the optic nerve to tolerate. This results in damage to the nerve which then causes a loss of side or peripheral vision. Unfortunately, there is no pain or other symptoms until after vision loss has occurred. It is a leading cause of blindness, but if caught early it can be controlled. If you are over 40, you should have an eye exam by a doctor every year. If you are African-American, or you have a family member with glaucoma, you are at a higher risk for developing glaucoma. You should have your eyes examined and eye pressure checked every year.
Narrow-angle glaucoma is much less common and is very different from open-angle glaucoma in that eye pressure usually goes up very fast. There is usually severe pain in the eye or brow ache over the eye, along with redness, swelling, halos around lights and blurred vision. If not treated promptly, this glaucoma can produce blindness in the affected eye in a short period of time.
Early diagnosis is the key to successful treatment and control of glaucoma and the prevention of blindness. A complete eye exam including eye pressure evaluation and optic nerve evaluation is essential. The best way to prevent vision loss from glaucoma is by having regular eye exams with one of our doctors. Schedule your exam today by calling our McLean Office: 703.356.6880 or Reston Office: 703.437.3900.
Monofocal IOLs provide clear vision at one point of focus, usually distance. Manual cataract surgery at Eye Physicians of Virginia includes the AcrySof IQ Aspheric Monofocal IOL to restore vision after their cataract is removed. Standard Monofocal IOLs can produce glare and haloes around lights, especially at night and can interfere with driving. However, the AcrySof IQ Aspheric Monofocal IOL reduces glare and haloes and can make driving much safer.
In the past, all cataract patients had to wear reading glasses and/or bifocals after cataract surgery because only monofocal IOLs were available. But thanks to recent advances in lens implant design, our doctors can now provide you a broader range of vision the AcrySof ReSTOR Multifocal implant. This lens is designed to enable you to see both near and far with little or no dependence on glasses.
Which lens you choose will affect how you see for the rest of your life so it is important that you fully understand your options. Your surgeon or a member of our staff will be happy to discuss these options with you and the associated costs to upgrade to one of our premium IOLs.
Over fifty percent of people over the age of 60 (and quite a few younger than that) suffer from cataracts. Almost everyone develops cataracts as they grow older. Cataract formations occur at different rates and can affect one or both eyes.
A cataract is a progressive clouding of the eye’s natural lens. It interferes with light passing through the eye to the retina. Aging and other factors cause proteins 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 progressed cataracts often say they feel as if they’re looking through a waterfall or a piece of wax paper.
Symptoms of cataracts:
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
Causes of cataracts:
Some medications including long-term use of oral steroids
Certain metabolic conditions
Your eye doctor can perform a contrast sensitivity test 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.
Eye Physicians of Virginia is excited to offer cataract patients laser cataract surgery with the CATALYS® Laser System. The CATALYS® Laser System is a technologically advanced laser designed to administer an extremely gentle cataract surgery that aids recovery time. And, as an advanced technology, it provides an unparalleled level of accuracy and precision to some of the more challenging steps of cataract surgery such as:
Capsulotomy – a centrally placed and tightly controlled circular incision allowing access to the cataract.
Lens Segmentation and Softening – treatment of the cataract itself to aid removal and minimize or eliminate ultrasonic energy delivered into the eye.
Arcuate Incisions or Limbal Relaxing Incisions – used to treat astigmatism. The laser can produce these within pockets to help offset dry eye conditions.
Cataract Incisions – precisely located and sized incisions normally done with blades to allow access to the cataract.
How Does The Laser Differ From Traditional Cataract Surgical Techniques?
Traditionally the eye surgeon uses blades to create incisions for lens treatment and removal. The laser uses computer guided imaging with over 10,000 scans to produce a highly detailed and customized image of your eye. This image is the basis for the treatment plan and laser control to produce incredibly precise incisions instead of manual incisions with blades.
Usage of the laser to pre-treat the lens prior to its removal can minimize and in many cases eliminate the usage of phacoemulsification (ultrasonic) energy used within the eye, minimizing ocular trauma and aiding recovery.
Astigmatism is an irregular curvature of the cornea. When light enters the front part of the eye this irregularity can bend light in one direction more than another which can lead to a blurred, distorted vision. This condition can be treated with the CATALYS® Laser with the creation of Limbal Relaxing Incisions placed strategically to address the corneal irregularity.
Learn how we can maximize your visual outcome and get you on the road to being glasses-free. Speak to our surgical staff to discuss implementation of a treatment plan tailored to your needs with the CATALYS® Precision Laser System. Call us today at 703.437.3900!
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 fifteen to twenty 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.
What are Cataracts?
Cataract Surgery Basics
What to Expect of Surgery Day:
You will arrive at the surgery 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. The area around your eyes will be cleaned and a sterile drape may be 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 intra-ocular 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 much more comfortable recuperation.
The decision to have cataract surgery is an important one that only you can make. The goal of any vision restoration procedure is to improve your vision. However, we cannot guarantee you will have the results you desire.
Once removed, cataracts will not grow back. But some patients may experience clouding of a thin tissue, called the capsular bag, that holds the intra-ocular lens. In most cases, a laser is used to painlessly open the clouded capsule and restore clear vision with a procedure called a capsulotomy.
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.
A comprehensive eye exam will evaluate not only how well you see, but also identify potential eye diseases. Some eye diseases, such as glaucoma and macular degeneration, can result in serious vision loss if not detected and treated early. Often patients with these diseases don’t experience any visual symptoms before vision loss occurs.
If you are over 35, you should have a comprehensive eye exam every two years. Patients over 65 or with a family history of glaucoma,diabetes or diabetic retinopathy should have a yearly eye exam.
What to Expect at Your Eye Exam:
Your doctor will most likely dilate the pupils of your eyes, in order to better see the retina at the back of your eye. You may want to consider making transportation arrangements, as your vision may be blurry for a few hours after dilating.
Your Exam may Include a:
visual acuity or refraction test to determine the degree to which you may be nearsighted, farsighted or have astigmatism.
muscle function test to check the movement of your eyes in each direction and at specified angles. This test will identify any muscle weakness or involuntary eye movement.
binocular vision skills assessment to ensure that your eyes work together properly as a team. This is important for proper depth perception, eye muscle coordination and the ability to change focus from near to far objects.
visual field test to measure your peripheral vision, the width of the area you can see when you’re looking straight ahead. This test may also detect diseases of the eyes or neurological disorders.
eye pressure test. Your doctor may administer one or more tests to evaluate your intra-ocular pressure. High intra-ocular pressure may be a sign of glaucoma.
color vision screening to see if you perceive colors properly.
eye health assessment using an ophthalmoscope. This tool allows the doctor to evaluate your pupil responses, optic nerve, retina, cornea and lens.
Treatment options, if necessary will be presented at the conclusion of your examination.
The doctors at Eye Physicians of Virginia are totally committed to remaining on the cutting-edge of ophthalmic innovation and technology. We continually invest in state-of-the-art diagnostic and surgical equipment. Our doctors go through rigorous, ongoing training to ensure that we’re doing everything we can to improve our patients’ vision and quality of life. We know our focus on technology is worth the investment and our patients tell us they can truly see the difference.
Our commitment to our patients, evidenced by our investment in technology, is why we have so much information on our Web site. We want our patients to recognize that there is a difference in eye care providers. Eye care and vision correction have come a long way since the days when an individual’s only option was a new pair of glasses. Our doctors are now using breakthrough treatments that have improved vision for millions of patients of all ages and from all walks of life.
Ophthalmic surgery is now a precise, sophisticated science, where surgeons rely on advanced technology to diagnose and treat problems such as glaucoma, corneal disease, macular degeneration, diabetic retinopathy and cataracts. Many procedures that used to require a hospital stay and lengthy recovery are now performed on an outpatient basis with most patients returning to their normal activities the next day.