LASIK (laser-assisted in situ keratomileusis), is the most popular refractive surgical procedure. In this procedure, a laser is used to permanently change the shape of the cornea (the clear covering on the front of the eye) to correct common vision problems such as nearsightedness, farsightedness, astigmatism, and presbyopia. This improves vision and reduces a person's need for glasses or contact lenses.
LASIK uses an excimer laser (an ultraviolet laser) to remove a thin layer of corneal tissue, giving the cornea a new shape, so that light rays are focused clearly on the retina. In the case of a nearsighted person, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.
LASIK is an outpatient surgical procedure with no need to stay at the surgery center overnight as it will take 10 to 15 minutes to perform for each eye. The procedure is done while the patient is awake, but the patient may request mild sedation. The only anesthetic used is eye drops that numb the surface of the eye. LASIK can be done on one or both eyes during the same session.
Before LASIK eye surgery, the eye surgeon will evaluate the patient’s medical history and perform a full eye examination, including measuring corneal thickness, refraction, corneal mapping, eye pressure, and pupil dilation. Afterward, the surgeon will discuss what to expect during and after the procedure.
On the day of the surgery, eat a light meal before going to the doctor and take all prescribed medications, if any. Do not wear eye makeup, creams, perfumes or lotions on the day before and the day of surgery, or have any bulky hair accessories that will interfere with positioning head under the laser.
Contact lenses shouldn't be worn for at least three days prior to the evaluation. In the case of, rigid gas permeable contact lenses, they should not be worn for at least three weeks before. Patients should arrange for a ride home from the place of surgery, as their vision might be blurry.
Eyelid rejuvenation surgery is a medical procedure that is designed to reduce the appearance of bagginess from the lower eyelids and sagging from the upper eyelids. This operation is often used for cosmetic surgery to reduce the appearance of aging.
This surgery can also be considered when the eyelids are interfering with a patient’s ability to see. Sometimes a sagging upper eyelid can partially obscure the eyeball, interfere with a person’s ability to look in certain directions or interfere with their peripheral vision.
As our skin ages, it often loses its elasticity. This doesn’t allow the skin to rebound back to its original shape and we see the appearance of wrinkles and bulges that aren’t due to weight gain. While these wrinkles can occur all over the body, they typically first appear in the face and eyes. Any additional skin on or near the eyelids can cause the eyelid to sag or droop over the eyelashes and into the frame of vision.
The eyelids also contain some fat to protect and cushion the eyeball. The fat is held in place by a thin membrane. As we age, the membrane can weaken and will no longer keep the fat in place. This fat can create bulges in the upper and lower eyelids.
There are several non-surgical treatments on the market to help treat sagging skin or reduce the appearance of wrinkles, but it is important to use additional caution when applying any product near the eyes. Always make sure that the product is designed to be used in the predetermined area. If you have questions about a specific product, you should contact your health care provider.
Many individuals find that non-surgical options don’t have enough or any effect on their eyelids. In these instances, they can consider working with a licensed medical professional to weigh their options. Eyelid rejuvenation (blepharoplasty) is also commonly called an eye lift.
There are several different methods for achieving your desired results. Typically, an incision is made into the eyelid, and then the excess skin or fat cells are removed by laser or scalpel. Additionally, your surgeon may suggest that you also get laser resurfacing done in combination with your surgery.
Eyelid surgery can be done in a local office or a surgery center. If you are completing the operation in an office environment, you can probably expect that you will be treated with a local anesthetic and an oral sedative. If you are in a surgery center, it’s likely that you will receive an intravenous anesthetic. The surgery takes about two hours to complete if you are getting all four eyelids done (upper and lower lids). When you are getting all four eyelids corrected, the surgeon will likely opt to work on both upper eyelids first and then move to the lower eyelids. While the upper eyelids will have three to six stitches, the lower eyelids may not have any. The stitches should remain in place for three to six days.
Millions of patients are diagnosed with diseases and conditions of the eye every year. Some of which may not display symptoms until there is irreversible damage to the patient’s vision. The outcome of eye disease can range from temporary discomfort to total loss of vision, which is why all eye problems and diseases should be taken seriously and regular eye check-ups are absolutely essential.
The main causes of eye problems can be divided into five groups:
Inflammation of the eye and surrounding structures caused by a bacterial, viral, parasitic or fungal infection.
Injuries to the eye and surrounding structures, either as a result of trauma or an object in the eye.
Genetically inherited eye diseases, many of which may only manifest later in life and affect the structures and the functioning of the eye which therefore can impair visual abilities. In some cases, however, children are born with these conditions.
Diseases or conditions, such as migraine or diabetes, which can affect other organs of the body, such as the eyes.
External causes, such as allergies or eye strain due to over-use, or as a side effect of medication.
The three symptoms indicative of eye disease are changes in vision, changes in the appearance of the eye, or an abnormal sensation or pain in the eye.
Changes in vision can include the following symptoms:
Nearsightedness is caused by an elongation of the eyeball over time, making it difficult to clearly see objects far away.
Farsightedness is caused by the shortening of the eyeball, making it difficult to see objects that are close-by clearly.
Blurry or hazy vision, or loss of specific areas of vision, which can affect one or both eyes and is the most common vision symptom. Any sudden changes in vision should be a cause of concern.
Double vision means a single clear image appears to repeat itself. This could be accompanied by other symptoms like headaches, nausea, a droopy eyelid, and misalignment of the eyes.
Floaters are specks or strands that seem to float across the field of vision. These are shadows cast by cells inside the clear fluid that fills the eye. These are usually harmless, but should be checked out as they could point to something serious such as retinal detachment.
Eye disease that is caused by diabetes is currently the number one cause of blindness and vision loss. Due to the increased risk in diabetic patients, doctors recommend that people over 30 with diabetes get an annual dilated eye exam. Diabetic patients under 30 should get this exam five years after they have been diagnosed.
Diabetic retinopathy is a condition that is caused by damage to the retina. Patients that have diabetes may also have experienced extended periods of time where their blood sugar was elevated. The high levels of blood sugar damage the retina’s walls which leave them susceptible to leaking. When fluid accumulates in the retina or macula, it causes vision loss.
To make these matters worse, if prolonged high blood sugar levels are seen again, the retina will be oxygen-depleted. This causes the abnormal growth of new blood vessels. This condition is called neovascularization. This blood vessel type is weak and prone to leaking. As these blood vessels leak, they introduce blood into the eye. Excessive bleeding into the eye can cause blindness.
While a healthy diet and exercise can be beneficial to your optical health, diabetic retinopathy is a condition that is caused by damage to the retinal wall. While this damage can sometimes be corrected, simple diet changes won’t reverse the effects.
It is essential to catch the condition in the earlier stages to reduce the effects. This can also help patients understand the importance of monitoring their blood sugar so that repeat events can be limited. Treatment options are even more successful when diabetic retinopathy is caught early. These options include vitrectomy, scatter photocoagulation and focal photocoagulation.
During both scatter, and focal photocoagulation the doctor will use lasers to help alleviate the condition. The lasers make small burns on the retina aimed at the blood vessels. These burns will help to seal the blood vessels to prevent more leakage and stop them from growing larger.
When using scatter photocoagulation, hundreds of small burns are made in a specific pattern during two additional appointments. Scatter coagulation should be used on patients who do not have advanced diabetic retinopathy.
Focal photocoagulation specifically targets the leaking blood vessels that are in the macula. Unfortunately, this procedure is not aimed to correct the blurry vision associated with diabetic retinopathy, but it does stop it from progressing further. Once the retina has detached, neither form of photocoagulation can be used.
Vitrectomy is a surgery that helps to remove scar tissue and/or the fluid that is clouded with blood that has been leaked into the eye. This operation is the most successful when performed before the disease has progressed too far. When the operation only targets removing the fluid, success rates are very high for the procedure. When the procedure also aims to reattach the retina, the failure rate is around 50%.
Premium IOLs or intraocular lenses are lenses that are placed in the eye during cataract surgery. The lens placement is designed to restore the natural lens shape. These lenses can also be placed as a vision correction device called refractive lens exchange. Premium IOLs offer advanced features beyond the single vision IOL’s that are also offered. These features include aspheric, toric, accommodating, and multifocal IOL’s.
These lenses closely match the natural curve of the eye. Typical lenses were uniformly curved making it easier to manufacture, but at the same time increasing the chance of causing imperfections in vision. Aspheric lenses help to reduce imperfections and improve clarity, especially at nighttime.
These lenses are specifically designed to help correct nearsightedness, farsightedness, and astigmatism.
Accommodating IOL’s can tilt slightly forward when you look at objects that are close to the eye. This helps to improve visibility when you are performing actions like reading a book. While they are not necessarily as sharp as bifocals, patients have a reduced need to use reading glasses while still maintaining excellent distance vision.
If you require a bifocal or trifocal lens in your glasses, this may be a likely choice for you. Different portions of the lens allow for better vision at different ranges. However, there are some overall sacrifices with vision clarity at a distance.
Premium IOLs have been approved by the Food and Drug Administration (FDA) since the 1980s. Prior to FDA approval, when patients had cataract surgery, they were required to wear very thick eyeglasses or specialized contact lenses to correct their vision. New technologies in the optical world have allowed for a wide variety of available premium IOLs and figuring out which specific type that suits you best will depend on some different factors.
Physicians are careful to discuss the realities of this procedure with their patients. After recovering from cataract surgery, many patients expect that their vision will be completely restored to their peak performance. However, doctors are careful to warn against this and explain the realities of the surgery and as well as likely expectations of what will result from the surgery. For this reason, surgeons are likely to have some initial concern about the desired outcome for the patient to make sure that their hopes are grounded.
Surgeons will also have an eye toward the patient's desire to not wear eyeglasses. If the patient does not mind wearing corrective lenses without the need for surgery, this may be the best option. These lenses may also not be an ideal fit for the elderly population. Eyes in the geriatric population are often rapidly deteriorating requiring a lens replacement more quickly than would be recommended.
Patients with certain medical histories may also be poor candidates for premium IOL surgery. Some of these conditions include:
Advanced macular degeneration
Anterior basement membrane dystrophy
Post-refractive surgery patients
This list is not comprehensive, so it’s important to consult with your physician and bring a detailed medical history for their review.
Finally, patients may also want to consider their careers when weighing the value of this surgery. Patients who are required to read on computer screens for extended periods of time (i.e., print editors, office jobs) may be ideal candidates.
In contrast, individuals that require long-distance acuity like truck drivers, pilots, or even photographers may find that some of the issues with these lenses are not suited to their needs. Individuals often complain of “halos” during the night when looking toward a light, glare, or general acuity issues at longer distances.
While premium IOLs do have some limitations, they offer an excellent choice for many individuals. However, it is important to meet with your eye care professional to fully discuss all of the available options to find your best fit as well as to make sure that you understand all of the potential risks and restrictions that this operation poses.
Understanding PRK: Is It Right for You?
PRK or photoreactive kerectomy is a surgical procedure that was the precursor for the surgery known as Lasik. The biggest difference between the two procedures is how the first portion of the operation is conducted. Additional variability between the two procedures includes recovery, risk factors, and the patient’s overall needs. Understanding these differences can help you decide if PRK is an appropriate solution for your vision issues.
PRK utilizes a laser to correct farsightedness (hyperopia), nearsightedness (myopia), and astigmatism. During a PRK operation, a laser is used to remove the exterior epithelial cells from the cornea. This procedure uses an excimer laser to remove the cells which are then discarded. A contact “bandage” is placed over the eye, and the cells can heal over the course of a few days. Your doctor will then remove the contact lens when the eye has healed enough to be exposed.
While the results are like that of Lasik, PRK does take some additional healing time. This is due to the time that must be allowed for the epithelial cells to heal and regrow on the eye. Additionally, Lasik patients generally experience less discomfort and faster results. PRK results can take a few weeks to fully materialize.
This isn’t to say that PRK doesn’t have its own benefits too. This procedure is well-suited for patients that have had previous eye surgeries and may have thin corneas. Because PRK does not make an incision into the cornea and only removes the epithelial cells, it leaves more of the stromal tissues which underly the epithelial tissue. PRK does not run the risk of “flap” issues that can arise from Lasik, and the risk of removing too much of the cornea is reduced. However, if you are considering PRK, you should consult with your medical professional to identify the right procedure for your specific case.
When you meet with your eye specialist to discuss your options, there are several factors that they will consider. Your potential surgeon should conduct a thorough eye exam during which they will measure your eye moistness, pupil size, corneal thickness, and corneal curvature. Your doctor should also review your medical and family history to identify any possible concerns about your suitability. Make sure that you bring a list of your medications and previous operations. Finally, you may be required to stop wearing contact lenses for a period before the operation. This can allow your cornea to return to its natural shape before the operation.
The actual PRK surgery is a short procedure that will only take about 15 minutes. The patient will not be sedated during the operation but may be given an oral sedative that helps to relax the eye. Numbing drops are applied to your eyes and a small speculum is also used to hold the eyelids open for the procedure. The excimer laser is programmed for your exact eye prescription. Patients are instructed to look at a certain object or target while the laser is operating. The surgeon will watch the procedure through a microscope and can stop the procedure at any time. Most patients do not report discomfort, although there may be some pressure.
You will be observed for a short time after your operation to make sure that you don’t have any severe immediate reactions. After this observation, you will be sent home. It is important to have someone else drive you after any procedure that may impact your vision or ability to drive safely. You should make sure to follow all of the doctor’s recommendations to facilitate a speedy recovery. You should also expect several follow up appointments to make sure that the operation was successful and that there are no additional concerns.
Your full results may take several weeks, but almost all patients have vision that is 20/40 or better. Over time, as the eye ages, vision may naturally degrade. At this time, you should consult with your medical professional to see if an additional operation is a good option for you.
If you’ve been diagnosed with glaucoma, you’re probably already familiar with the typical options in glaucoma treatment – eye drops, laser treatment or traditional surgery. While these are certainly effective, especially when glaucoma is diagnosed early, researchers have been working hard to offer new glaucoma treatments. Their goal is not only to improve outcomes but also reduce the treatment’s side effects and frequency of use.
Before we dive into the new options, it’s important to understand the goal of any glaucoma treatment. At present, glaucoma is not curable. However, treatment can significantly slow the progression of the disease. Glaucoma damages your eye's optic nerve. Extra fluid builds up in the front part of your eye (cornea), which increases the pressure in your eye. Reducing this pressure is the primary objective of any glaucoma treatment. This is often referred to as intraocular pressure or IOP.
Eye drops for glaucoma treatment seem like an easy option but there are several challenges that can reduce its effectiveness. It can be difficult to get all the medicine in the eye, especially for older adults with less of a steady hand. In addition, since it must be applied daily, individuals may forget. Since the drops have no perceivable benefit because early stages of glaucoma have no symptoms, patients might make it a lower priority which is understandable since it may also have unpleasant side effects like burning, red eyes.
Beyond eye drops, laser surgery is a less invasive option. The laser opens clogged tubes and drains fluid. It can take a few weeks to see the full results. If laser surgery or drugs don’t relieve your eye pressure, you may need a more traditional operation. You would have to go into the hospital and will need a few weeks to heal and recover. Although usually effective, glaucoma surgery can make you more likely to get cataracts later on. It can also cause eye pain or redness, infection, inflammation, or bleeding in your eye.
Alternatives or Improvements to Eye Drops
The Glaucoma Research Foundation reported several new developments on the horizon. These technologies focus on reducing patient error in applying eye drops which would make the medication more effective and improve the quality of life for the patient. Here are some of the products underway:
A polymer, like a contact lens, would contain the drug; it would sit under the eyelid and release the medication over several months
Microneedles would inject medication into a specific spot to be most effective
Implantable extended-release devices using engineered highly precise microparticles and nanoparticles
Polymer-based intraocular delivery technologies that would allow customizable sustained release
Drops that allow the medication to get into the eye more easily
Tear duct plugs that release medication
In addition, people with glaucoma who take more than one eye drop per day are beginning to see those medications available as a single, combined eye drop. New products include Cosopt (timolol and dorzolamide), Combigan (timolol and brimonidine) and Simbrinza (brinzolamide and brimonidine).
Wearing contact lenses gives patients the flexibility and freedom to live life to the fullest, without some of the difficulties presented by wearing glasses. Many people who choose contact lenses do so because they don’t like the way that glasses look or feel, or because wearing glasses compromises their ability to perform certain tasks or activities, such as sports or jobs that require the use of safety goggles.
There are lots of different contact lenses to choose from, with two of the most popular being daily disposables and toric lenses.
As their name suggests, these daily contact lenses are disposable. This means that they can and should be discarded at the end of each day rather than re-worn. Disposable lenses do tend to be a little more expensive than some repeat-wear varieties, but the benefits usually outweigh the cost.
Some of the advantages of choosing daily disposable contact lenses include:
You don’t have to clean them, which saves patients a great deal of time and hassle. It also helps save money in terms of the ongoing cost of cleaning solution.
Disposable lenses are also great for people with eye allergies. This is because with ordinary lenses, there’s an opportunity for deposits and microorganisms to build up. With daily disposables, allergens have less chance to attach themselves to the lenses and cause irritation and other allergy symptoms.
You don’t need to schedule regular replacements either, which makes wearing contact lenses easier on your schedule.
Disposable contact lenses are particularly good for people who have busy lives and are likely to cut corners when it comes to caring for their eyes or contacts since there is no cleaning or maintenance required.
Daily disposable contact lenses are available in a wide range of prescriptions, including those for patients with nearsightedness and farsightedness. Your eye doctor will be able to advise you if you are a candidate for disposable contact lenses.
Toric contact lenses are recommended for patients who have a refractive eye problem called astigmatism. Patients with astigmatism have corneal abnormalities that cause the refraction of the eye to be different between the vertical and horizontal planes, causing blurred vision and difficulty seeing fine details. Toric contact lenses are shaped in a particular way that creates the different focusing powers needed in each part of the lens to correct your vision. For this reason, it’s essential that Toric lenses are placed into the eyes in the correct position.
Fortunately, manufacturers design Toric lenses with features that help them to stay in place, including:
Creating areas of the lens that are thicker or heavier which helps secure it in position
An area where the bottom of the lens is slightly cut off
To keep them stable, Toric lenses are a little firmer than conventional soft lenses. This means that some patients can find them a little less comfortable, but the superior vision they obtain outweighs this. Your eye doctor will be able to advise you if you are a good candidate for Toric contact lenses and which variety would best suit you.
To find out more about daily contact lenses, speak to our friendly and knowledgeable team.
Optomap is an innovative new technology that gives eye doctors the ability to perform ultra-wide retinal imaging that is far superior to what can currently be achieved using conventional retinal imaging options. In contrast to conventional retinal imaging, Optomap captures at least 50% more of the retina in a single capture, and with Optomap’s multi-capture function, up to 97% of the retina can be viewed. This gives eye care professionals greater opportunity to monitor the health and condition of patient vision.
Optomap is another great preventative eyecare technology tool. By allowing your eye doctor to have a comprehensive view of your retina, they will be able to detect any developing eye diseases early on, before they have a detrimental impact on your vision and day to day life. Not only can Optomap detect eye conditions such as retinal holes, retinal detachment, macular degeneration and diabetic retinopathy, but it can also be used to identify some general health conditions such as cardiovascular disease, stroke and cancer.
Optomap is a fast, painless and non-invasive procedure that is suitable for patients of all ages, even children and pregnant women. Many patients require their eyes to be dilated ahead of the scan and will be given eyedrops which will widen their pupils and make it easier for the camera to see the structures inside the eye. Pupil dilation is painless, but patients may feel more sensitive to light both during their Optomap scan and afterwards for up to 24 hours. You may also have slightly blurred vision for a few hours. Once your eyes are dilated, you’ll be sat down and asked to look into a small device that will take the pictures of your retina. A short flash of light will let you know that the image has been taken, and the entire imaging is over in just a few seconds. The results will be sent digitally to your eye doctor who will then evaluate them. The results will also be stored on your personal optical record for future information.
If you would like more information about what is involved in Optomap, or to schedule an appointment for this effective screening technology, please contact our eyecare team.
Visual field testing is an important part of most standard comprehensive eye exams. Also sometimes known as perimetry testing, Visual field testing is a method to measure the entire scope of vision of an individual, including their peripheral/side vision.
Visual field testing is one of the most effective diagnostic treatments in the detection of glaucoma. This is because when patients are affected by glaucoma, it is usually the peripheral vision that is affected by their condition first. However, it can also be used to detect central or peripheral retinal diseases, eyelid conditions such as drooping, optic nerve damage and conditions that affect the visual pathways from the optic nerve to the area of the brain where this information is processed into vision.
Visual field testing is also an important part of monitoring for people who are considered to be at risk for vision loss from disease and other problems, including those who have been diagnosed with the following:
Pituitary gland disorders
Central nervous system problems (such as a tumor that may be pressing on the brain)
High blood pressure
There are a variety of methods that can be used to perform visual field testing, including:
Static automated perimetry. This is where a machine is used to quantify how well the patient is able to detect flashing lights of varying size and brightness in different areas of their visual field, while they concentrate on a central point. The patient responds by pushing a button when they see the light.
Kinetic perimetry. This involves points of light that are fixed in size and intensity and are presented along the patient’s peripheral vision, before being gradually moved inwards to determine their field of vision.
Visual field testing is non-invasive, painless and doesn’t require patients to have their eyes dilated. The results, which are usually presented in a series of charts, are digital and sent directly to your eye doctor for interpretation. Depending on the outcome of your results, you may be recommended for further diagnostic testing which could include blood tests. If you have been diagnosed with glaucoma, you will probably be recommended to have several visual field tests each year, which will help your eye doctor to monitor the progression of your condition and recommend treatments to slow it.
If you would like more information about visual field testing, or if you have concerns about your peripheral vision, please don’t hesitate to schedule an appointment with our experienced and knowledgeable eyecare team today.