Eye Health & Education

  • Amblyopia (Lazy Eye)

    Amblyopia is the clinical term for lazy eye.  An amblyopic eye is looks normal, but vision is poor, even with corrective glasses.  The extent of vision loss may range from very slight to severe. Amblyopia occurs when an infant's or child's vision system in one eye does not completely work together with the brain. The eye is not being used normally because the brain is favoring the other eye. This is often due to the brain suppressing a blurred or double image, caused by strabismus (eye turning in or out), anisometropia (excess difference in glasses prescription between the 2 eyes) or blockage in the line of vision.  Strabismus in a pre-verbal child can be diagnosed by determining which eye the child prefers.  If the child prefers looking at objects with one eye, then the fellow eye is the amblyopic eye.  Focusing devices such as brightly colored objects or toys and other eye covering tests are used for this purpose. If anisometropia is the underlying cause, the eye with the uncorrected larger refractive error usually becomes amblyopic.  Anisometropia is often diagnosed by two to three years of age by different techniques, depending on the cooperation of the child.

    Amblyopia affects approximately 2 out of every 100 children and develops sometime between birth and 8 or 9 years of age. This is the critical time period when the visual system develops and matures.  Amblyopia must be identified and usually needs to be treated by 8 or 9 years of age, or the vision loss becomes irreversible.  Even with successful treatment, amblyopia may recur if treatment is discontinued before 10 years of age. In many cases, the pediatrician or other health care provider is the first to suspect amblyopia during a visual acuity screening test at age three.  If there is any suspicious of abnormal vision, the child is typically referred for an ophthalmic and amblyopic evaluation.

    The most common and successful treatment of amblyopia may be to cover or patch the better eye, either full or part-time, until vision in the amblyopic eye recovers to the same level as the normal eye.  As a general rule, one-week of full-time patching is required for every year of life.  For example, a three year old with amblyopia in the right eye should wear a patch over the left eye for three weeks, and then be re-evaluated.  This guideline is a conservative estimate, since most children must wear a patch for a longer time to achieve a full recovery.  A recent study has determined that amblyopia may also be successfully treated with eye drops to slightly blur the near vision of the non-amblyopic eye, which forces the amblyopic eye to focus on objects, especially at near. The drops are used daily until vision in the amblyopic eye is the same or nearly the same as the vision in the opposite eye. The extent of the recovery, if any, depends on the age when the treatment is started and the underlying cause of the amblyopia.  Many children also require glasses as part of their visual therapy.  This is usually determined by examining the child's eyes while they are dilated.

    Patching the eye during visual activities
    Patching the eye during visual activities

    Some children do not tolerate patching because vision in the amblyopic eye is so poor that they continually remove the patch from the "good" eye.  For others, the adhesive in the patch may cause irritation.  In these cases, an alternative method of occlusion may be recommended such as a "pirate's patch," (some children enjoy wearing this type), occlusive or opaque tape on the spectacle lens of the better eye.  It is important for the child to use the amblyopic eye during times of maximum visual stimulus, such as during reading, watching television or drawing and not at bed time. Generally, the earlier the amblyopic treatment is initiated, the better the prognosis for correcting the amblyopia. Parent's cooperation and assistance in helping their child through amblyopia therapy is very important in determining the final outcome of the treatment.

    Amblyopia associated with strabismus cannot be corrected only by strabismus surgery (realignment of the eyes).  Patching or eye drops therapy to reverse the amblyopia is generally completed first.  Strabismus surgery is performed afterward to improve eye alignment.  Some children require additional amblyopia therapy following strabismus surgery.

  • Astigmatism

    An eye without astigmatism will focus the image at one point on the Retina.
    An eye without astigmatism will focus the image at one point on the Retina.

    An eye with astigmatism will focus the images at multiple points on the Retina.
    An eye with astigmatism will focus the images at multiple points on the Retina.

    In order for the eye to work properly, light coming into the eye must be properly focused on the retina (or the back of the eye). When the image is not focused, there is an irregularity in the eye. This irregularity can be the overall shape of the eye or the curvature of the cornea (the clear outer covering of the eye), or both. The cornea should be curved equally in all directions. Astigmatism occurs when the cornea is curved more in one direction than another.

    Astigmatism is quite common and, in the vast majority of cases, it is due simply to variations between people. Just as different people have different shaped feet or hands, people also have different shaped corneas. Rarely astigmatism is caused by chronic lid swellings, benign growth or lesions, and corneal scars, or by keratoconus (a rare condition in which the cornea becomes misshapen and pointed rather than smooth and rounded).

    Astigmatism may cause blurred vision, eye strain or even headaches. It can also cause images to appear doubled, particularly at night. Small amounts of astigmatism can be ignored. But if any of its symptoms are present, astigmatism can be corrected by glasses or contact lenses. In most patients soft contact lenses do a good job of correcting for astigmatism, but occasionally, rigid gas permeable contact lens are needed.

    Surgery can also be use to help people correct their astigmatism. Surgical correction of astigmatism is done by creating one or more surgical incisions in the cornea or as part of laser vision correction. These procedures help eliminate the uneven curvature and "round out" the cornea. A rounder cornea means objects no longer appear blurred or distorted. Astigmatism correction is sometimes performed at the time of cataract surgery, to reduce or eliminate the patient's need for glasses after surgery.

  • Blepharitis

    Blepharitis is an infection of the eyelids. It is very common, and it is usually a chronic and permanent condition. Once it is present, it will always be present, but the severity may change over time with intermittent flare ups. In some cases, the symptoms can disappear for long time periods, months or years, before returning.

    Blepharitis can be controlled by careful cleaning of your eye lashes every day. This can be accomplished with warm water or mild shampoo (such as baby shampoo). Once the redness and soreness are under control, this cleaning may be decreased from a few times each day to twice weekly. However, if the symptoms return, daily cleansing must be resumed immediately. Medication is of secondary importance in the treatment. In some cases eye drops or ointment will be prescribed to be used along with the daily cleansing.

    However, medication alone is not sufficient; keeping the eyelids clean is essential. Warm, moist compresses can also help relieve the symptoms of blepharitis when used in conjunction with regular eyelid cleansing.

    There are two main causes of blepharitis: bacteria and seborrhea. Bacteria related blepharitis commonly begins in childhood and continues throughout adulthood. Common symptoms include collar scales on lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, styes, and chalazia also occur. Treatment is very important. In addition to eliminating the redness and soreness, treatment can prevent potential infection and scarring of the cornea and conjunctiva.

    Seborrhea blepharitis is secondary to overactive glands, causing greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea. Some systemic conditions such as Rosacea may exacerbate or cause bleparitis condition and inflammation of the oil glands around the eyelids.

    If your eye lid symptoms persist or appear very different between eyes, it is important to consult with your eye doctor to rule out other more serious eyelid diseases such as cancer or abnormal pre-malignant lesions.

  • Cataract

    Image of the eye

    eye image
    eye image
    Cataract is a clouding of the whole or parts of our lens

    eye image
    The lens becomes yellow and cloudy as the cataract matures

    Cataracts occur as part of the normal aging process. It can be compared to a window that is frosted or fogged with steam. Studies show that virtually everyone over age 65 has some cataract formation in their eyes. Cataracts can severely reduce your vision. At one time, cataracts were a leading cause of reversible blindness in the world. But today, most of the cataracts are successfully treated. Modern surgical techniques, intraocular lens implantation and "same day surgery" make cataract surgery safe, fast and effective.

    A cataract occurs when the normally clear lens of the eye becomes cloudy. As the cataract develops, the cloudiness no longer allows the lens to properly focus light on the back of the eye. This unfocused light causes the vision to look blurry or hazy. Development of cataracts are commonly associated with age, Diabetes, trauma, medications such as steroids, family history, long term exposure to ultraviolet radiation, previous eye surgery and others. There is no proven or FDA approved medication available at this time to prevent or treat cataracts.

    normal vision vs. cataract

    The symptoms of cataract include: a painless blurring of vision; glare or light sensitivity; frequent eyeglass prescription change; double vision in one eye; poor night vision; starbursts and halos around headlights; fading or yellowing of colors. Most cataracts develop slowly, but the progression may vary between individuals and even between eyes. In a few eyes, especially in younger and diabetic patients, the cataract may progress rapidly over a few months. It is not possible to predict exactly how fast cataract will develop or grow in any person.

    Treatment is indicated when decreased vision affects your everyday activities or hobbies. To determine how much your vision is decreased, your doctor may perform different tests to determine how much your everyday vision has been affected by the cataract and whether you are a good candidate for cataract surgery.

  • Cataract Surgery and Lens Implantation

    The eye is a marvelous optical instrument which takes the images from the real-world and focuses them on a tiny spot in the back of the eye. The ability to focus these images comes from two parts of the eye, the lens of the eye and the front cover of the eye, or the cornea. The lens accounts for about one third of the focusing power.

    A cataract occurs when the lens of the eye becomes cloudy so that it can no longer focus the real-world images. Patients with cataracts see the world as very hazy, because light cannot pass freely through the lens to be focused on the back of the eye. If glasses do not help improve the vision or reduce the other symptoms of cataracts, the most likely option is to remove the cataract by surgery. The indications for cataract surgery is different for everyone, but the most common reason is blurred vision for driving, reading, watching television or any activities you performed on a daily or weekly basis. Another common indication is glare and halo effects which make driving difficult.

    Modern Cataract Surgery Procedure

    Cataract surgery has change much over the past 20 years. It is still a procedure that removes the cloudy lens from the eye. However, modern surgical techniques and equipments have enabled this procedure to be performed very efficiently and with much less risk than previous surgical techniques. A local anesthetic is used and the surgeon makes a small incision in the outer covering of the eye. Then a common technique, called phacoemulsification, is used to remove the lens through a small incision, around 1/8th of an inch, and leaves the outer capsular bag.

    At least 99% of the patients receive an artificial lens implant after the cataract is removed. This lens is called an intraocular lens or IOL and is made from the same plastic as certain types of contact lenses. In most cases, a special tiny foldable IOL is used for implantation. This type of lens is inserted into the eye through the small cataract incision site. Once in the eye, the lens unfolds to its full size.


    The intraocular lens is inserted into the eye through a small incision.

    The IOL replaces the eye's focusing power of the natural lens. Without this lens, the eye cannot focus. In a small number of cases, usually in pediatric cataract surgery, an IOL is not used and the patients must wear glasses or contact lenses to help them see. IOLs are beneficial because they are permanent in the eye. The IOL is fixed and held in place by the capsular bag. Sometimes, the IOL is placed on top of the capsular bag. In either case, the IOL do not get lost, like glasses, or have to be replaced, like contact lenses. In most cases, the focusing power of the IOL can be determined so that it closely matches your eye. With an IOL, glasses for distance vision may not be needed, but glasses will still be necessary for near vision or correction of any astigmatism. Some patients prefer monovision, where the IOL is carefully selected to enable the patient to see distance with one eye and up close with the other eye.

    New advances in IOL have created lens which enables patients to see up close and distance without glasses. These are called presbyopia correcting or accommodative IOL. Please consult with your eye surgeon to see if you are a good candidate for these special IOL.


    The intraocular lens is placed in the capsular bag.

    Risk and Benefits of Surgery

    This type of small incision, no stitch, no needle cataract surgery technique has many benefits. It allows quicker vision rehabilitation, more patient comfort and reduces surgical risks and complications.

    There are some risks as with any surgical procedures. The major risks include infection, bleeding, swelling and retina problems. Your eye surgeon will discuss potential complications of cataract surgery and IOP implantation with you. The FAQ section on surgery can provide additional answer for many of your questions on cataract surgery.

  • Color Vision

    The human eye has receptors that are sensitive to three primary colors, red, green and blue. The brain is able to blend these three primary colors so that the eye is able to discriminate very slight differences. A person with normal color vision can see approximately 8,000 colors in nearly 8 million different shades and tints.

    The retina is made up of 10 layers of different kinds of cells. These cells are connected to the brain by approximately 1 million tiny nerve fibers. When stimulated by light, these nerve fibers transmit electrical impulses from the eye to the brain, where the signals are interpreted to give vision. The retina is the focus of our "color receptors".

    The very back layer of cells in the retina is called the photoreceptors. There are two types of these cells; rods and cones. Rods function well in dimly lit situations and can perceive only black, white and shades of gray. Rods are located in the outer parts of the retina, away from central vision. Cones are the second type of receptor and they are located primarily in the central part of the retina. This type of receptor functions to provide daytime vision and the important central detail vision, such used for reading small print. There are three types of cones; red, green and blue cones. These three types of cones combine to provide for the wide range in color vision. There are only about 1/3 as many cones as rods.

    Color vision testing can be used to identify color defects in your vision. There are many types of color vision tests, from the general screening methods that test your gross perception of color, to other more sensitive tests, which are much more time consuming. The most common type of color vision loss is inherited and occurs from birth. But several diseases are also known to cause color vision losses later in life. There is no treatment for color deficiency.

  • Conjunctivitis (Pink Eye)

    The conjunctiva is a clear membrane which is considered the outer coat of the eye. The white of the eye actually lies behind the conjunctiva. The conjunctiva has many small blood vessels and it serves to lubricate and protect the eye while the eye moves in it's socket.

    When the conjunctiva becomes inflamed, this is called "Conjunctivitis". This condition can have many causes, such as bacteria, viruses, chemicals, allergies, and more. One of the most common is bacterial or viral conjunctivitis which is often called "Pink Eye". In many cases it is difficult to determine the primary cause for the inflammation.

    Bacterial conjunctivitis is associated with swelling of the lid and a yellowish discharge. Sometimes it causes the eye to itch and a mattering of the eyelids, particularly upon waking. The conjunctiva appears red and sometimes thickened with both eyes often being involved at the same time.

    If the conjunctivitis is caused by bacteria or a virus, the disease may be contagious, and can be easily transmitted by rubbing the eye and then infecting household items, such as towels or handkerchiefs. It is common for entire families to become infected if precautions are not taken. Frequent hand washing and avoiding contaminated materials help in limiting the spread of infectious conjunctivitis.

    Mild conjunctivitis can treated conservatively. Usually antibiotic drops and cool compresses ease the discomfort and clear up the infection in just a few days. In a few cases, the inflammation does not respond well to the initial treatment with eye drops and additional stronger medications are necessary. Your eye doctor will be able to address the most appropriate treatments for your eyes. In severe infection, oral antibiotics and steroid drops may be necessary. Covering the eye is not a good idea because a cover provides protection for the germs causing the infection. If left untreated, severe conjunctivitis can create serious complications, such as infections in the cornea, lids, and tear ducts or permanent scarring.

  • Contact Lens

    There are many different brands and types of contacts lenses available today. With so many options, most people are great candidates for contact lenses.

    Types of Soft Contact Lenses:

    Disposable:
    Most contact lenses used today are disposable. By disposing of the lenses on a regular basis, the risk of complications like eye infections are greatly reduced. This is very important for the health of the eyes. Also it is more comfortable to have a new lens on the eye on a regular basis. Contact lenses are available in daily, 2 weeks, monthly or quarterly replacement schedules. Most lenses today are 2 weeks replacement lenses.

    Toric:
    Toric soft contact lenses are available to correct for astigmatism. Astigmatism is when the curvature of the front surface of the eye, the cornea, is shaped irregularly. With astigmatism, the cornea is shaped more like a football instead of being perfectly round. In the past, having astigmatism made it difficult to wear contacts and see well out of them. With new technology in contact lenses, most people with astigmatism are now able to comfortably wear contacts that provide good vision.

    Continuous Wear:
    Several new contacts lenses are now available to wear continuously for one week to one month, depending on the material of the lens. These new lenses allow significantly more oxygen through to the cornea compared to other lenses. This increased oxygen permeability is extremely important when a lens is worn while sleeping. You should not sleep in contact lenses that are not approved for continuous or extended wear.

    Monovision:
    For patients over age forty-five, focusing up close with contact lenses or glasses often becomes a problem. This condition is called Presbyopia. Monovision contacts can be used to eliminate the need for reading glasses. With monovision contacts, one eye is fit with a contact lens for distance and the other eye is fit with a contact lens for reading. This allows vision at all distances with contact lenses.

    Bifocal or Multifocal:
    There are several new bifocal and multifocal contacts available for patients who need both a distance correction as well as a near correction. These lenses are designed with both prescriptions incorporated into one lens. Unlike monovision contacts, bifocal and multifocal contact lenses allow each eye to see distance and near together.

    Rigid Gas Permeable Contact Lenses:
    Rigid gas permeable, or RGP, contact lenses are a great option for some patients. RGP lenses work very well for patients who have significant amounts of astigmatism or irregular corneas. RGP lenses often allow patients to see sharper vision than soft lenses.

    Specialty Contact Lenses:
    There are several different types of specialty contact lenses available. There are colored contacts which can enhance or change the color of the eyes. We also fit contacts for patients who have certain eye conditions, such as keratoconus, with specialty contact lenses to help improve the vision.

  • Cornea Abrasion

    eye image

    A cornea abrasion occurs when the outer layer of the cornea, called the epithelium, is torn away. (The cornea is the clear outer coating of the front of the eye.)This can occur by a variety of means such as a finger in the eye, a tree limb, flying glass in an automobile accident, etc. It is one of the most common injuries to the eye.

    The cornea has more nerve endings than virtually any other part of the body. Because of these many nerve endings, any damage to the cornea is very painful. Abrasions usually heal in a short time period, sometimes within hours. But while they are healing they can cause excessive tearing, redness, blurred vision and light sensitivity. In many cases, the cornea will heal overnight during sleep.

    An antibiotic may be used following an abrasion because the open area of the epithelium invites infection. Small abrasions heal rapidly. However, if one covers more than one-third of the cornea, it may take an extra day or two for the epithelium to completely recover the front of the cornea. Sometimes a contact lens is used in poorly healing cases.

    Typically, an anesthetic is used in the eye doctor's office to ease the pain and to aid in the examination. After the examination, the pain typically returns. But, repeated use of anesthetic can harm the eye and is therefore not used in the treatment of abrasions. It may take several weeks for all the blurriness to resolve. Permanent loss of vision is very rare with superficial abrasions.

    Do not rub the eyes during the healing phase following an abrasion. New cells require time to re-connect to the non-damaged layers of the cornea. These new cells can be easily disrupted, delaying the cornea healing.

    Occasionally, long after an abrasion has healed; it recurs spontaneously, often upon awakening in the morning. This is called recurrent erosion and represents an area of the epithelium that is not reattached well to the deeper parts of the cornea.

    The treatment for recurrent erosion is similar to that for the abrasion. Sometimes the surface of the cornea is treated with a special instrument in order to help form better connections between the corneal layers. Extended use of bedtime ointments or lubricants may also help in preventing recurrent erosions.

  • Diabetic Retinopathy

    eye image

    Diabetes is a disease which affects the blood vessels throughout the body, particularly vessels in the kidney and eye. When the blood vessels in the eye are affected, this is called diabetic retinopathy.

    The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits these to the brain. There are major blood vessels which lie on the surface, or 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.

    Diabetic Retinopathy is the leading cause of new blindness among adults in the United States. If untreated, there is a risk of becoming blind. The longer one has diabetes, the higher the incidence of developing diabetic retinopathy. Approximately 80% of people who have diabetes for 15 years have some damage to their retinal vessels. With today's diagnostic equipment and new treatment, a smaller percentage of people are progressing to more serious vision problems and blindness.

    There are two types of diabetic retinopathy. Background retinopathy is considered the early stage. Vision is typically not affected, but it can advance and cause severe vision problems. There are usually no symptoms with background diabetic retinopathy. An exam is the only way to diagnose changes in the vessels of your eyes.

    Mild diabetes bleeding in the central part of the retina
    Mild diabetes bleeding in the central part of the retina

     

    Different types of diabetic changes in the retina
    Different types of diabetic changes in the retina

     

    Mild diabetic retinopathy and Severe diabetic retinopathy
    Mild diabetic retinopathy            Severe diabetic retinopathy

     

    The symptoms of diabetic retina changes can range from no symptoms to complete blindness
    The symptoms of diabetic retina changes can range from no symptoms to complete blindness

    When the retinopathy becomes advanced, new vessels may grow erratically, or proliferate, in the retina. These new vessels are the body's attempt to overcome and replace the vessels which have been damaged by diabetes. But these new vessels are not normal. They may bleed, which causes vision to become hazy and sometimes causing a total loss of vision. These new vessels can also damage the retina by forming scar tissue and by pulling the retina away from its proper location. This stage, called proliferative retinopathy, requires early medical attention. Treatment is necessary to prevent severe loss of vision. The central part of the retina, called the macula, can be damaged from swelling and bleeding of abnormal blood vessels. This can lead to vision loss, which may be permanent if left untreated. Regular eye exams are crucial for all persons with diabetes. The progressing damage to the blood vessels in the eye can be slowed with medications, laser or surgical treatment.

  • Droopy Eyelids

    There are two common eye lid condition known as "droopy eyelid" One is called ptosis, where there is an abnormality of the upper eyelid muscle. The other is called pseudo-ptosis or dermatochalasis, where there is excess sagging upper lid skin. These conditions can exist together and often required more extensive surgical treatment.

    PTOSIS

    Ptosis causes an upper eyelid droop where the eyelid covers part of the eye, impairing the vision and the superior field of vision. It can have many causes including age, injury or nerve malfunction. It can also occur at birth.

    ptosis

    ptosis

    Age is the most common cause of ptosis. The muscles that elevate the eyelid become thinned, resulting in a loss of muscle tone and the inability to hold the upper lid in the proper position above the eye.

    Injury is another common cause of ptosis. Patients who suffer traumatic injuries to the eye can sustain damages to the delicate eyelid structures, resulting in secondary ptosis. Sometimes ptosis can be noticed at birth. In these cases it is due to an abnormality in the development of the muscles that elevate the upper lid. Three-quarters of the time it affects only one eye. In newborns, this problem must be addressed and treated properly to insure normal maturation of the visual system and the avoidance of amblyopia (lazy eye).

    Ptosis can also be caused by a malfunction of the nerves which control and activate the eyelid muscles. These cases are rare and proper diagnosis is important in order to avoid unnecessary surgery. When a neurological disorder is present, symptoms typically include visual complaints independent of the droopy eyelid. Difficulty reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well.

    The most common treatment for ptosis is surgical, and there are a number of possible approaches. The goal is to tighten the muscles so that the lid is elevated to match the lid on the other side, but with a minimum of scars and side effects. One possible complication is that the muscles can be over tightened. This results in the inability to close the eye completely after surgery. Such a situation creates a dry eye condition that needs to be treated.

    In the age-related form, both eyelids may be drooping, but only one is low enough to require surgery. Almost invariably in these cases, the unoperated eyelid will appear lower after a successful repair of the first eye. In these cases, the second eye will eventually require surgery.

    DERMATOCHALASIS

    Dermatochalsis is a age-related condition where the excess upper eyelid skin droops down and interferes with the patients superior field of vision. The eyelid muscle usually functions well. Some people call eyes with this condition "baggy eyes." The excess sagging upper lid skin can become symptomatic.

    Excess upper lid skin sags and creates a hooding effect
    Excess upper lid skin sags and creates a hooding effect

    The usual treatment for symptomatic dermatochalasis is a blepharoplasty procedure, which is a surgical excision of the excess skin and some of the underlying fat tissue.

  • Eyedrop Tips

    Prescription and non-prescription eye drops are important to treat many ocular disease and conditions. The following are some tips to help you administer your drops and increase your compliance with your medication schedule.

    Remember:

    • Follow your doctor's orders.
    • Be sure your doctor knows about any other medication you may be taking (including over-the-counter items like vitamins, aspirin, and herbal supplements) and any allergies you may have.
    • Wash your hands before putting in your eye drops.
    • Be careful not to let the tip of the dropper touch any part of your eye.
    • Make sure the dropper stays clean.
    • If you are putting in more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.
    • Keep all eye medicines out of the reach of children.

    eye drop image

    Steps For Putting In Eye Drops:

    1. Start by tilting your head backward while sitting, standing, or lying down. With your index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket.
    2. Let a drop fall into the pocket.
    3. Slowly let go of the lower lid. Close your eyes but try not to shut them tight or squint. This may push the drops out of your eye.
    4. Gently press on the inside corner of your closed eyes with your index finger and thumb for two to three minutes. This will help keep any drops from getting into your system and keep them in your eye, where they are needed.
    5. Blot around your eyes to remove any excess.

    If you are still having trouble putting eye drops in, here are some additional tips that may help.

    If Your Hands Are Shaking:

    Try approaching your eye from the side
    so you can rest your hand on your face to help steady your hand.

    If shaky hands are still a problem, you might try using a 1 or 2 pound wrist weight (you can get these at any sporting goods store). The extra weight around the wrist of the hand you're using can decrease mild shaking.

    If You Are Having Trouble Getting The Drop Into Your Eye:

    Try This. With your head turned to the side or lying on your side, close your eyes. Place a drop in the inner corner of your eyelid (the side closest to the bridge of your nose). By opening your eyes slowly, the drop should fall right into your eye.

    If you are still not sure the drop actually got in your eye, put in another drop. The eyelids can hold only about one drop, so any excess will just run out of the eye. It is better to have excess run out than to not have enough medication in your eye.

    Having Trouble Holding Onto The Bottle?

    If the eye drop bottle feels too small to hold (in cases where a dropper isn't used and the drop comes directly from the bottle), try wrapping something (like a paper towel) around the bottle.

    You can use anything that will make the bottle wider. This may be helpful in some mild cases of arthritis in the hands.

    Assistive devices are available to help you put in your eye drops.

  • Eyelid Problems (Ectropion, Entropion)

    Outward Turning Eyelid (ECTROPION)

    Ectropion is an abnormal sagging and outward turning of the eyelid that usually affects the lower eye lids. This condition occurs with age and is usually due to laxity of the eyelid muscles. Other causes of outward turning eyelid include trauma, paralysis, inflammation and scarring processes.

    Mild Ectropion of the lower lid
    Mild Ectropion of the lower lid

     

    Moderate to severe Ectropion of the lower lid
    Moderate to severe Ectropion of the lower lid

    Patients typically complain of red eyes, irritation, pain, tearing, crusting and discharge. Besides the typical tearing problem, the surface of the eye may be exposed to air and can become dry, irritated and inflamed. If left untreated, permanent damage, eye infection and impaired vision can occur.

    Treatment includes lubrication ointment and drops, but surgical repair is often required for definitive repair.

    Inward Turning Eyelid (ENTROPION)

    Entropion is a condition in which the lower eyelid turns inward, rubbing against the eye. This eye lid condition most commonly occur as a result of age-related weakness of eyelid tissues. Infection and scarring inside the eyelid are other causes of entropion. When the eyelid turns inward, the eyelashes and skin rub against the eye, making it red, irritated and sensitive to light and wind. Patients may complaint of tearing and irritating when they read or look down. In severe cases, the lashes may scratch the cornea, causing an infection, scarring and impaired vision.

    The lower eyelid lashes are turned inward and rub against the eye surface
    The lower eyelid lashes are turned inward and rub against the eye surface

    Entropion can also occur intermittently. In such cases, you may notice that the lashes tend to turn in toward the eye with forcible blinking or when you tightly squeeze your eyelids shut.

    Treatment for entropion typically includes artificial tears and ointments. Temporary relief may be provided by placing a small stripe of adhesive tape on the skin of the lower lid near the lashes and placing the other end to the upper cheek. This may help prevent the eyelid from rolling inward. Definitive treatment for entropion is surgery.

  • Flashes and Floaters

    Diagram of a normal eye
    Diagram of a normal eye

    The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits these to the brain. In front of the retina lies the vitreous gel. The vitreous is the jelly-like material that fills the large central cavity of the eye. It is composed primarily of water, but it is also made up of proteins and other substances which are more fibrous. The water and fibrous elements together give the vitreous the consistency of gelatin.

    The vitreous is normally connected to the retina. During aging, the watery portion of the vitreous separates from the fibrous portions. As this occurs, the fibrous elements contract and can pull the vitreous away from the retina. This is called a Posterior Vitreous Detachment. This contraction on the retina is responsible for the characteristic "flashes" that often accompany the Posterior Vitreous Detachment. The "floaters" are frequently caused by the fibrous elements changing position during the Posterior Vitreous Detachment. They can also be caused by pieces of the retina being dislodged as the vitreous contracts. Besides aging, flashes and floaters are also associated with nearsightedness and injuries to the eye.

    All patients who experience a recent onset of flashes and floaters should be examined immediately by their eye doctor. Most of the time nothing unusual is found, and simple reassurance is all that is needed. The flashes eventually go away, and the floaters diminish and become less bothersome with time. These floaters may clump together and form larger cloudy areas which move in and out of your line of vision.

    However, in about 5% of the patients with a Posterior Vitreous Detachment, a tear of the retina is found. If left untreated, these tears may lead to a full retinal detachment. A full retinal detachment is a very serious sight threatening condition requiring a major surgical procedure to repair. When symptoms appear, it is important to examine the eye within a short period of their onset. Changes can occur rapidly, and time can be of the essence if a retinal detachment is present.

  • Fuch's Dystrophy

    Normal eye
    Normal eye

    Fuch's dystrophy is a disorder of the front surface of the eye. This surface is called the "cornea" and is comprised of three layers, the outer layer called the epithelium, the middle layer called the stroma and an inner layer called the endothelium. The inner delicate layer acts as a barrier to prevent water inside the eye from moving into and swelling the other layers of the cornea. The cells of the endothelium actively pump water from the cornea back into the eye. If the endothelium does not function normally, then water moves into the cornea. This leads to swelling of the cornea, resulting in a cloudy cornea and blurry vision.

    Fuch's dystrophy affects both eyes and is slightly more common in women than men. On average, half of the family members of an affected person may carry or suffer from the condition. Patients often exhibit early signs of Fuch's dystrophy in their 30s and 40s, but the condition rarely affects vision until people reach their 50s and 60s. The exact cause of Fuch's dystrophy is unknown. Hereditary, hormonal and inflammatory factors probably all play a role.

    In the early stages of Fuch's dystrophy, patients may not have any symptoms. As the disease progress, patients may wake up with blurry vision, which gradually clears over the day. This occurs because water continuously evaporates from the surface of the eye and is replaced with water drawn from the inside the eye. Overnight, when we sleep with closed eyes, water cannot evaporate from the surface of the eye and accumulates in the cornea, causing slight swelling which blurs vision. Once eyes are opened throughout the day, evaporation reduces the water content and the thickness of the cornea, allowing for clearing of the vision. In later stages, evaporation is not enough to remove accumulated water in the cornea, and swelling and blurred vision last all day. Patients may complain of hazy vision that is worst in the morning, fluctuating vision, glare, light sensitivity, episodes of sharp pain, sandy and gritty sensation.

    Fuch's dystrophy is detected by examining the cornea with a microscope and the health of the cornea can be further evaluated with a pachymeter and specular microscopy. Fuch's dystrophy cannot be cured. The blurred vision in the early stages of the disease can be treated with medication to reduce the normal cornea swelling and inflammation. Another simple technique that reduces moisture in the cornea is to hold a hair dryer at arm's length, blowing air towards the face with the eyes open. This warm air flow increases evaporation of water from the cornea, temporarily decreases swelling, and may improve vision. This technique may not be effective in more advance stages of the disease. If the disease causes significant vision lost or discomfort, then a cornea transplant is recommended to improve vision and relief any adverse symptoms.

  • Glaucoma

    Diagram of the normal eye
    Diagram of the normal eye

    Glaucoma is one of the leading causes of irreversible blindness in the United States and in the world. It is a disease that typically affects older people, but it can occur at any age. Loss of vision is preventable if the disease is detected early and treatment is started.

    The final pathway in this disease is the damage to the optic nerve. The eye has about 1 million tiny nerve fibers in the optic nerve, which run from the back of the eye to the brain. These nerve fibers allow us to see and provide us with full side or peripheral vision. Glaucoma is a disease which causes the destruction of these fibers. In the past, the loss of these nerve fibers was thought to be solely caused by high pressure in the eye. But now we recognized that there may be other causes of glaucoma because some patients with normal eye pressure can have glaucoma and loss of these nerve fibers.

    In many patients, the disease is not noticed in the early stages, because there is no pain and no noticeable change in vision. The central vision is usually normal until the end stages and most patients are unaware of the slow and subtle loss of their peripheral vision. Early detection by an eye doctor is the key to the prevention of vision damage from glaucoma. Routine eye examinations, pressure check and evaluation of the optic nerve are recommended to treat and monitor glaucoma. Glaucoma cannot be totally cured; the treatment goal is to slow the progression of the disease to enable you to maintain useful vision in your life time.

    Normal Vision vs. Glaucoma

    Types of Glaucoma

    The reason that eye pressure becomes elevated in glaucoma patients is that the drainage system in the glaucoma eye is not working properly. The fluid in the eye does not exit out of the eye as quickly as it should. The drainage system lies in a part of the eye called the angle, which is between the outer layer and the iris of the eye. The configuration of the angle helps determine the two general types of glaucoma; open or close angle.

    The most common type of glaucoma is called primary or chronic open angle glaucoma. The drainage angle is open in these patients, but the eye fluid does not drain as quickly as it should. The pressure inside the eye builds up to a level which can damage the optic nerve and if left untreated, can lead to blindness.

    Normal eye, fluid exits at the angle
    Normal eye, fluid exits at the angle

     

    In an open angle glaucoma eye, fluid is unable to exit at the angle
    In an open angle glaucoma eye, fluid is unable to exit at the angle

    Closed-angle or narrow glaucoma occurs when the drainage angle closes, and almost no eye fluid can escape. During acute closed-angle glaucoma, eye pressure can get very high over a short period of time and there is severe pain. Angle closure glaucoma is an emergency and must be treated immediately. If the high pressure is allowed to continue for too long, permanent damage and even blindness can result. People who are at risk for angle closure glaucoma need to consult their eye doctor before taking certain system medications.

    There are many other types of glaucoma, some responding better to certain medications and modalities of treatments. Your eye doctor or glaucoma specialist can help determine the type of glaucoma and prescribe the appropriate course of treatment.

    Some people are more likely to have glaucoma. These include people who are older, nearsighted, diabetic, have a family history of glaucoma, have had past eye trauma, and other eye characteristics which your eye doctors can measure using sophisticated diagnostic instruments. Also, African-Americans are 5-7 times more likely to develop glaucoma.

    Glaucoma is treated with eye drops that lower the pressure. If the pressure does not fall to a low enough level with drops, then laser or incision surgery may be necessary to achieve a pressure level that is safe for your eye.

  • Glaucoma Surgery

    There are many types of glaucoma surgery available and which type to use depends on severity of the glaucoma and the eye pressure. If medication is unable to control the eye pressure, your doctor will usually recommend laser or incision surgery to lower the pressure.

    Glaucoma laser surgery tries to open up the meshwork at the angle to allow more fluid to exit, leading to lower eye pressure. Different types of lasers allow for better results and opportunities for re-treating the angle.

    Normal eye and Laser treatment to the angle
    Normal eye and Laser treatment to the angle

    The most common type of incision glaucoma surgery is called a trabeculectomy. This surgery creates an opening which allows fluid to flow out of the eye. There are variations to the trabeculectomy but each variation will lower the pressure by proving an alternative pathway for the fluid to exit the eye.

    Trabeculectomy lowers the pressure by allowing fluid to escape through a new opening.
    Trabeculectomy lowers the pressure by allowing fluid to escape through a new opening

    In more complicated glaucoma or in eyes with previous intraocular surgery, failed trabeculectomy, young patients or eyes with significant scarring, a drainage device is used. These devices are known as shunts or tube glaucoma implants (see diagram below), and are designed to maintain an artificial drainage pathway in eyes with uncontrolled glaucoma.

    Glaucoma Tube Shunt Implantation

    There are other more unusual types of glaucoma surgery available to help control the intraocular pressure. Your eye doctor or glaucoma specialist will be able to discuss all the options and plans available to help you control the pressure. All glaucoma surgery has risks and complications. It is much different than cataract surgery where much of the risk occurs early in the post-op period. Glaucoma surgical risks occur early and late and it is important that all patients discuss all the risk and benefits associated with any type of glaucoma surgery.

  • Hyperopia (Farsightedness)

    A normal eye will focus the image on the Retina
    A normal eye will focus the image on the Retina

     

    A farsighted eye will focus the image behind the Retina
    A farsighted eye will focus the image behind the Retina

    The cornea and the lens work together to properly focus visual images on the retina (the back surface of the eye). If an image is out of focus, it is typically because the overall shape of the eye is incorrect or the cornea does not have the proper curvature. Farsightedness or hyperopia occurs when the eye is too short or the cornea is too flat. When this happens, visual images are focused behind the retina.

    In general, a person with hyperopia is able to see objects at a distance, but has trouble with objects up close, like books or newspapers. However, patients with moderate or severe hyperopia will not be able to see distance or near without glasses. Many people are not diagnosed with hyperopia without a complete eye exam. School screenings typically do not discover this condition because they test only for distance vision.

    Treatment includes contact lenses or glasses which correct for near vision. Corrective lenses should be worn for near tasks, such as reading, and in some cases, need to be worn full time.

  • Keratoconus

    Keratoconus is a degenerative eye disease that causes the cornea to become progressively thinner. A normal cornea is round or spherical in shape, but with keratoconus, the cornea bulges forward, assuming more of a cone shape. This causes progressive steepening of the cornea shape and creates abnormal shape or "irregular astigmatism" of the cornea. As light enters the cone shaped cornea, it is bent and distorted and unable to come to a point of clear focus on the retina.

    Normal eye
    Normal eye

     

    Keratoconus eye with a cone shape cornea
    Keratoconus eye with a cone shape cornea

    Keratoconus usually affects both eyes, but the two eyes often progress at different rates. This disease typically begins during teenage years and in the early stages, the diagnosis may be difficult to make. Most patients at this early stage can achieve good vision with glasses or contact lenses. In most patients, the disease progresses slowly for several years before stabilizing in the third to fourth decade of life. In some patients with more advance disease, there can be a sudden swelling of the cornea with pain and subsequent vision loss from corneal scarring.

    It is believed that more than 3 million people world wide is afflicted with this eye disease. Many more are affected, but are unaware of the disease because they have such mild symptoms. The causes are still unclear, but there are some risk factors. These include family history, excessive laser eye surgery, hay fever, eczema and asthma. The signs and symptoms of keratoconus include: a bulging or a cone shape cornea, progressive nearsightedness and astigmatism, monocular double vision, glare and light sensitivity and the need for frequent prescription changes.

    In mild cases, glasses and soft contact lenses can be effective, but in more advance cases, rigid gas permeable contact lenses are used. The rigid contact lens counteract the distortion of the cornea by providing a smooth surface that can focus light clearly on the retina. Because the pattern of distortion in keratoconus is unique for each case, the contact lenses are custom prescribed and manufactured. A proper contact lens fitting is crucial to ensure optimal vision, comfort, and eye health. Poor fitting contact lenses can lead to corneal abrasion, scarring and infection.

    In advance cases of keratoconus, surgical intervention is necessary. If your eye doctor determines that you have significant scarring of the cornea or loss of vision from uncorrectable cornea distortion, a corneal transplant surgery may be recommended. In this procedure, a donor normal clear cornea replaces your diseased cornea. About 10 to 20% of keratoconus patients will eventually require a cornea transplant. Following a successful surgery, most patients still need glasses or contact lenses for adequate vision. There are other new procedures which may help stabilize the disease, but these and other unusual treatments should be discuss with your eye doctor to enable you to attain the best possible vision.

  • LASIK / PRK

    The cornea and lens combine to focus visual images on the back of the eye.

    A normal image is focused on the Retina
    A normal image is focused on the Retina

    When the overall length of the eye is too long, too short or if the cornea is not perfectly round, a refractive error occurs and the visual images are not in focus.

    A blurred image forms when there is a refractive error
    A blurred image forms when there is a refractive error

    The cornea accounts for approximately two third of the focusing power of the eye. By surgically changing the corneal shape or curvature, most or all of the entire blur can be eliminated.
    Laser In Situ Keratomileusis (LASIK) and Photo-Refractive Keratectomy (PRK) are two surgical techniques which utilize lasers to reshape or change the curvature of the cornea.

    LASIK

    LASIK had its origins about thirty years ago and was originally developed to treat patients who had poor vision due to corneal disease and scarring. It has now evolved into a successful technique for correcting refractive errors. The current procedure, done on an outpatient basis, involves both the use of conventional and custom laser surgery to correct nearsightedness, farsightedness and astigmatism. LASIK can correct a high degree of nearsightedness with or without astigmatism with excellent results (95% of patients achieve 20/40 vision or better).

    In performing LASIK, anesthetic eye drops are used to numb the eye. The surgeon then uses a special instrument or laser to create a thin flap with a hinge in the cornea.

    A flap is created with an instrument or a special laser
    A flap is created with an instrument or a special laser

    The flap is lifted back and the underlying cornea surface is prepared for laser treatment. The area of this surface and the depth of the remaining cornea tissue are precisely measured before the procedure to ensure proper treatment and patient's safety.

    The flap is lifted back and a treatment surface is prepared
    The flap is lifted back and a treatment surface is prepared

    The eye is then positioned under the excimer laser which has been computer programmed to remove a precise and microscopic amounts of the internal cornea tissue. Removal of the tissue changes the curvature of the cornea. If the patient is nearsighted, tissue closer to the central part of the cornea is removed to decrease the curvature or flatten the cornea. If a patient is farsighted, tissue in the peripheral part of the cornea is removed to increase the curvature of the cornea.

    Excimer laser is used to reshape the cornea
    Excimer laser is used to reshape the cornea

    To correct for astigmatism, certain amount of cornea tissues at specific angles are removed to create a round and even cornea in all directions.

    Astigmatism can also be corrected during the laser treatment
    Astigmatism can also be corrected during the laser treatment

    After the laser has been used, the flap is returned to its original position. The cornea tissue has extraordinary natural bonding qualities that allow effective healing without the use of stitches.

    The flap is placed back and allowed to sealed down
    The flap is placed back and allowed to sealed down

    Since only local anesthetic is used, patients remain awake during the procedure. The entire procedure takes only a few minutes. Improved vision is often possible on the day following the surgery. Eye drops and night protection are necessary for designated periods of time.

    Advantages of LASIK include:

    • Faster healing time
    • Rapid visual recovery
    • Less risk of scarring
    • Less risk of corneal haze
    • Less post-op discomfort
    • Both eyes are usually performed at the same time
    • Treatment of a wider range of nearsightedness

    PRK

    Photo-Refractive Keratectomy, PRK, is another method of surgically reshaping the cornea using the excimer laser. The difference between LASIK and PRK is that for PRK, the corneal flap is not created before the laser treatment.

    The outer layer of the cornea remains in place and the laser removes tissue directly from this outer layer
    The outer layer of the cornea remains in place and the
    laser removes tissue directly from this outer layer.

    PRK is used for low to moderate amounts of nearsightedness.

    Just as in LASIK, the laser treatment requires less than a minute. But unlike LASIK, the healing period time is longer and there may be slightly more discomfort during the first few days after surgery. The correction for nearsightedness, farsightedness and astigmatism is the same as in LASIK. The corneal curvature is changed so that the visual images are properly focused on the back of the eye. PRK is often performed when patient's natural inner cornea layer is too thin to remove for LASIK surgery.

    Refractive surgery decrease the glasses need for most patients, but if you are in your forties and older, you may still need reading glasses after surgery. The vast majority of patients are happy with their vision after refractive surgery. Like any surgical procedures, there are some risks, but these are low and should be discuss and thoroughly reviewed before any procedure.

  • Macular Degeneration

    The macula is the tiny central part of the retina which is responsible for fine detail vision and for color perception. Macular degeneration is a disease of this very important portion of the retina. It usually affects both eyes, but often begins in one eye.

    Normal eye
    Normal eye

    Many patients in their 60's and older develop macular degeneration as part of the body's natural aging process. There are two types of age-related macular degeneration, the dry (atrophic) and the wet (exudative). Most people with macular degeneration have the dry type, which is a thinning of the tissues of the macula. Vision loss is usually gradual. Some people have the wet type of macular degeneration. It results when abnormal blood vessels form at the back of the eye. These new blood vessels leak fluid and blood, causing a rapid and severe loss of central vision.

    Dry Macular Degeneration
     
    Wet Macular Degeneration
    Dry Macular Degeneration
     
    Wet Macular Degeneration

    In many cases, patients are not aware of macular degeneration in one eye, because the other eye compensates for the weaker one. The most common symptoms include; difficulty reading, seeing up close or far away, seeing distortions of straight lines, missing parts of people's faces or central vision. If you notice a dimness of vision in one or both eyes or if straight lines appear distorted, you should see an eye doctor immediately.

    Normal Vision and Age-related Macular Degeneration

    There is no cure for macular degeneration, but recent research suggests that certain vitamins and nutrients may slow the progress of the disease in certain patients. If there is bleeding or swelling from abnormal blood vessels, there are some new modalities of treatments. Recent advances in laser surgery and medications have improved the ability to stop the progression and visual deterioration of this disease. Some medications have even shown to improve vision in eyes with wet macular degeneration.

    If you are over fifty, have your eyes examined regularly. If you have symptoms, report them to your eye doctor immediately before the disease progresses too far. If you have vision loss from macular degeneration, low vision aids and other optical devices can help you maintain a functional lifestyle.

  • Myopia (Nearsightedness)

    Normal eye will focus the image on the Retina
    Normal eye will focus the image on the Retina

     

    Nearsighted eye will focus the image in front of the Retina
    Nearsighted eye will focus the image in front of the Retina

    The cornea and lens of the eye work together to properly focus visual images on the retina (the back surface of the eye). If an image is out of focus, it is because the overall shape of the eye is incorrect or because the cornea does not have the proper curvature. When the eye is too long or the cornea is too steep, visual images are focused in front of the retina. This condition is called nearsightedness or myopia.

    Myopia commonly starts to appear between the ages of eight and twelve years old, and almost always before the age of twenty. Once myopia starts, the myopia often increases as the body grows. It typically stabilizes in adulthood. Changes in glasses or contact lens prescriptions are necessary during growth periods.

    Someone with myopia has an inability to see objects at the distance, such as street signs, chalk boards and television. Many times, myopia is diagnosed during school screenings.

    The treatment for nearsightedness includes lenses which allow visual images to be focused on the retina. These lenses can be in the form of contact lenses or glasses. Once the eye has stabilized and myopia is no longer progressing, laser vision correction is an option for many.

  • Ocular Migraine

    The classic or common migraine is a severe headache, which in some instances may be accompanied by nausea. Ocular migraines are a variant of classic migraine in which the episodes presents with only visual disturbances. The cause is not clearly understood. The ocular migraine may be related to vasospasm or abnormal stimulation of nerve cells. Patients experience visual images which can have a wavy, jagged appearance with shimmering lights. They can occur in one or both eyes. Other common symptoms are temporarily blurring of vision, particularly in one eye, and increased sensitivity to bright lights. The visual distortions usually start near the central part of the vision and then moves off to one side.

    In some cases, the ocular migraine patient will eventually develop a corresponding headache and becomes part of a migraine headache. Generally, when it accompanies the common migraine, the visual disturbances happen before the onset of headache symptoms. In younger people with common migraine, it is typical for visual disturbances to accompany the headache. As people age, it becomes more common to experience ocular migraines without headache symptoms. In a typical episode, the visual disturbance last 15 to 30 minutes and then disappears.

    In general there are no serious complications caused by ocular migraine. Treatment, in most instances, is not necessary unless the ocular migraine is linked to the common migraine.

  • Optic Neuritis

    normal eye

    The retina lies in the back of the eye and is a multi-layered tissue which detects visual images. These images are transmitted to the brain through approximately 1 million tiny nerve fibers. These nerve fibers converge in the back of the eye, before going to the brain, into a bundle called the optic nerve. If some or all of the nerve fibers are damaged, visual capability deteriorates.

    When the optic nerve becomes inflamed, this condition is called optic neuritis. The nerve tissue becomes swollen and red, and the nerve fibers do not work properly. If many of the nerve fibers are involved, the vision may be dramatically affected, but if the optic neuritis is mild, vision is nearly normal. Optic neuritis can be caused by other diseases and conditions and may affect the optic nerve of one or both eyes.

    Some people, especially children, develop optic neuritis following a viral illness such as mumps, measles, or a cold. In others, optic neuritis may occur as a sign of a more serious neurological disease affecting nerves in various parts of the body, such as multiple sclerosis. In a rare condition called Leber's optic neuropathy, which often runs in families, a special kind of optic neuritis may appear in both eyes within a short span of time. Often, the cause for optic neuritis is unknown.

    Optic neuritis usually comes on suddenly, and the patient notices blurred vision in one or both eyes. The vision is dim, like somebody turned down the lights, and colors may appear to be washed out. There may be pain in the area of the eye socket, especially when moving the eyes. The vision may continue to get worse over a week or two, and may seem worse after exercising or a hot bath.

    A careful description of these symptoms is important to your doctor for the diagnosis of optic neuritis. The optic nerve enters the back of the eye where it appears as a small disc. Your eye doctor can examine the optic nerve inside the eye by using a special diagnostic instruments or lens. Swelling of the optic nerve may or may not be visible. If the optic nerve inflammation occurs inside the eye, it can be readily detected. If swelling of the nerve occurs behind the eye, the doctor may not be able to see the swollen nerve tissue.

    Since optic neuritis can be confused with many other causes of poor vision, an accurate medical diagnosis is important. MRI, CT scans, visual brain wave recordings or laboratory blood tests may be ordered to rule out other systemic diseases. Other vision tests which may be performed include color vision, side vision, and pupil reactions to light.

    The treatment for optic neuritis can sometimes vary. Steroid is the treatment of choice and is usually given as an initial high dose intravenous form followed by an oral form. This may accelerate the healing process and lessen the chance of developing other associated neurological disease later. In many cases, patients with optic neuritis improve without treatment. The vision and the peripheral field of vision may return to normal or suffer some residual and permanent damages.

  • Plaquenil (Hydroxychloroquine)

    Plaquenil (Hydroxychloroquine) is a common medication used to treat systemic conditions such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Sarcoidosis, and other autoimmune disorder. The drug has a low potential to cause damage to the retina, known as "Plaquenil retinopathy." The most commonly prescribed dosage of this medication is 400 mg per day, which carries a low risk of retinopathy. However, most patients are still followed by ophthalmologists to evaluate for the rare possibility of retinopathy.

    eye diagram

    The Macula or the central part of the retina is affected by this medication. Patients with Plaquenil retinopathy may complaint of "blind spots" in their central or para-central vision. Other possible symptoms include flashes of light, light sensitivity, night blindness and color distortion. To monitor patients on plaquenil, Ophthalmologist typically test a combination of visual acuity, color vision, dilated retinal exam and central visual field. The interval of evaluation depends mostly on the daily dose of the drug being administrated. Usually semi-annual or annual examination can detect signs of retinopathy. If Plaquenil retinopathy occurs, the drug is stopped, and vision tends to stabilize, though it may be permanently affected.

  • Posterior Capsulotomy

    What is the Capsule?

    The natural lens of the eye is held in place by a thin clear membrane called the lens capsule. The capsule completely surrounds the lens and separates it from the thick fluid in the back of the eye, called the vitreous, and the thinner fluid in the front of the eye, called the aqueous.

    Posterior Capsule Opacity
    Posterior Capsule Opacity

    Cataract Surgery Effects the Capsule

    Cataract surgery is necessary when the natural lens become cloudy and must be removed. When cataract surgery was originally performed, surgical techniques were not as refined as today, and both the natural lens and the capsule were removed during surgery. Newer techniques allow the capsule to remain in the eye and hold the implanted lens (or intraocular lens, IOL) in place. Leaving the capsule in place during surgery is a great advancement because it allows the vision after surgery to be more stable and provides for less surgical complications.

    Sometimes the posterior, or back, portion of the capsule becomes cloudy after cataract surgery. This is known as a secondary membrane or a cloudy posterior capsule. The reasons for this cloudiness are unknown. If the posterior capsule becomes so cloudy that it becomes symptomatic and affects vision, then a laser capsulotomy is performed.

    What is a Capsulotomy?

    A capsulotomy is a procedure in which an opening is created in the center of the cloudy capsule. The opening allows clear passage of the light rays and eliminates the cloudiness that was interfering with the vision. A laser beam is used to create this opening. This procedure is painless, very safe and typically the results can be seen immediately. For capsulotomy, as with any surgery, rare complications can occur, such as swelling or retinal detachment. These complications can cause loss of vision.

    A cloudy capsule will may times appear the same way as the original cataract. The vision is cloudy or hazy and the patient is heavily bothered by glare. In fact, vision is so similar that some patients think that the cataract has come back. This is impossible, cataracts cannot return once the natural lens has been removed.

    Laser opens the posterior cloudy capsule
    Laser opens the posterior cloudy capsule

    If your vision is getting worse after cataract surgery, it could be that your capsule is becoming cloudy. Your eye doctor should give you a thorough eye examination to determine the cause of your vision loss. If your capsule is becoming cloudy, your eye doctor can then determine whether a laser capsulotomy is necessary to improve your vision.

  • Presbyopia

    During the early and middle years of life, the lens of the eye provides for the capability to focus both near and distant images. To accomplish this feat, the lens changes shape, getting thicker for near objects and thinner for distant objects.

    Presbyopia occurs when the lens of the eye is no longer able to change shape. This typically takes place around age forty. Some people may be older, closer to fifty and some younger, less than thirty-five, when the lens loses its flexibility to focus near images. For people who have presbyopia, vision is blurred when looking at near objects, such as during reading and computer work. Also, it may become more difficult adjusting focus when switching from near to distance vision.

    The amount of power that is needed in glasses to correct for presbyopia is dependent on the strength of the glasses needed for distance vision. For people who are nearsighted, removal of the glasses may make it easier to read up close. For those not nearsighted, glasses or bifocals are needed to see well up close. If bifocals are needed, there is an option of line bifocals or no line progressive bifocals. A complete eye examination will determine the strength and type of lenses needed to see well at all distances.

  • Retinal Detachment

    The retina lies in the back of the eye. It is a multi-layer tissue which is responsible for detecting visual images and transmitting these to the brain. The retina is similar to the film inside a camera. A retinal detachment occurs when it pulls away from the back of the eye.

    Retinal tear and Retinal detachment

    Retinal tear with detachment
    Retinal tear with detachment

    Typically following a retinal detachment, patients may experience different symptoms. These include flashing lights, an apparent covering or curtain over part of the visual field or many floaters. Importantly, these symptoms can also be present without a retinal detachment. If you experience these symptoms, you should contact your eye doctor as soon as possible.

    Sometimes the retina does not fully detach, but only tears. In these cases, treatment is done with a laser or freezing technique (cryotherapy) that seals the tear. If the retina is fully detached, surgery or special gas injections are performed to place the retina back into position. With modern therapy, over 90 % of those with retinal detachment are successfully treated, although sometimes a second treatment is needed.

    Retinal detachment are more likely to occur in people who are: extremely nearsighted, have had a retinal detachment in the other eye, have a family history of retinal detachment, have had previous intraocular surgery, have had a traumatic eye injury, have other significant eye disease.

  • Retinitis Pigmentosa

    The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits them to the brain. Retinitis pigmentosa (RP) refers to a group of related diseases which tend to run in families and cause slow but progressive loss of vision. In retinitis pigmentosa, there is gradual destruction of some of the nervous sensors in the retina.

    The first symptoms usually occur in youth or young adulthood, although it may be first seen at any age. Retinitis pigmentosa causes night blindness and loss of side vision. In normal people, the visual system adjusts to darkness after a short period of time. People with night blindness adjust to darkness very slowly, or not at all. Due to the loss of side vision (peripheral vision) in patients with retinitis pigmentosa, mobility becomes more difficult.

    Most forms of retinitis pigmentosa are inherited. Different patterns of heredity are associated with different degrees of progression. An attempt to know more about how severely the disease has affected other family members may help predict how a specific person might ultimately be afflicted, though variability exists within each family. Such knowledge is also helpful in making decisions about such things as marriage, family and occupation.

    In general, there is no specific treatment. Recent research suggests that some patients may benefit from certain kinds of vitamin therapy. But these studies are not conclusive. Much research is directed toward solving this problem. Periodic examinations by an eye doctor are advised.

    It is important to keep in mind that patients with retinitis pigmentosa may develop other treatable disease, such as glaucoma, cataracts and retina swelling. Low vision aids may be prescribed. In some cases, retinitis pigmentosa may be associated with other disease processes which might need evaluation by other medical specialists.

    Despite visual impairment, the many rehabilitative services that are available today allow patients with retinitis pigmentosa to live meaningful and rewarding lives.

  • Uveitis


    Uveitis often presents as a red eye

    Uveitis is an inflammation of a part of the eye called the uvea. This is the eye's middle layer which includes the iris, ciliary body and choroid. The disease is classified into three types based on locations of the inflammation. Anterior uveitis, more commonly known as "iritis", refers to inflammation in the front part of the eye and it is the most common type. Intermediate uveitis is inflammation of the middle part of the eye. Posterior uveitis is inflammation of the back of the eye. Sometimes multiple parts of the eyes are involved in uveitis.

    There are many identifiable causes of this disease, including viruses, fungus and bacteria infections, but in most cases, the cause is unknown. Other system disorders can be associated with uveitis and your doctor may order additional diagnostic blood test when you present with uveitis.

    The signs and symptoms of uveitis include red eye, blurred vision, increase sensitivity to lights, floaters, eye pain, and sometimes high intraocular pressure. Uveitis is diagnosed with a thorough internal examination of the eye. The treatment for uveitis is determined by the severity and location of the disease. Steroid is usually the medication of choice and can be administer in eye drops, pills or injections. Other medications are often used in conjunction with steroids or as a substitute for steroid. Recent developments have focused on implanting small devices in the eye to allow for long term and slow release of new medications. Sometimes, medication is also required to lower the intraocular pressure. Cataracts, glaucoma and intraocular scarring may occur as a result of recurrent uveitis and chronic medication usage.

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For an appointment or information,
e-mail us or call:

Medina Office 330-722-8300
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Our office hours are:

Medina Office
Mon & Wed – Fri 8:00am – 5:00pm
Tuesday 8:00am – 7:00pm
Saturday Call For Avail.
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Mon – Wed & Fri 8:00am – 5:00pm
(Call for Evening Hours)
Thursday 8:00am – 12:00pm

We have evenings, lunch time and Saturday appointment times available for your convenience.