Frequently Asked Questions
Also see our Services page for more discussion about Cataract,
Glaucoma, Refractive Surgery, Ocular Plastics, Cornea,
Diabetic Eye Disease, and Eyewear.
What is Glaucoma?
Glaucoma is a disease that causes damage to the nerve tissue
of the eye, which can lead to permanent loss of vision
if not treated soon enough. Several factors affect the
development of glaucoma, not all of which are known.
Some of the contributing factors are:
1. Intraocular pressure: Higher levels of pressure inside
the eye can cause damage. For many years, this was one
of the only factors measured in evaluating glaucoma. However,
we now know that there are also people who have progressive
visual loss even with a low intraocular pressure.
2. Family history: It is more likely that a person will
develop glaucoma if there is a family history of the disease,
but not all glaucoma is inherited.
3. Optic nerve damage: It is critical to examine the optic
nerve for signs of damage as a result of glaucoma. This
helps diagnose glaucoma, and also determines if the condition
is responding adequately to treatment.
4. Other conditions: Some eye diseases are more likely
to be associated with glaucoma, and it is important to
look for this possibility during the exam.
5. Previous eye injury: Occasionally, trauma can lead
to secondary glaucoma, even years after the original injury.
There are several types of glaucoma, but the most common
is a chronic, progressive, painless condition, which will
not be noticed by the person who has it until significant
vision has been lost. This fact makes a regular eye examination
very important.
What Tests are Used for Glaucoma?
A complete eye examination will include intraocular pressure
measurement and evaluation of the optic nerve. Additionally,
if there is suspicion of possible glaucoma, a visual
field test and scan of the nerve cell tissue will provide
more detailed information. Measuring the thickness of
the cornea and the use of a special examining lens are
also utilized, and all these factors are considered in
the diagnosis.
What is the Treatment for Glaucoma?
Many cases of glaucoma can be adequately treated with eyedrops.
One important point is that every medication (including
eyedrops) has side effects. If drops fail to adequately
control the condition, either laser treatment or surgery
may be required. The goal is to get the eye pressure
down to a level where no more damage is being done.
What is a Cataract?
A cataract is any clouding of the natural lens of the eye.
Just as a camera has a lens used to focus the picture
image, our eye has a similar lens. The formation of some
cataract change is very common in any person over about
60 years of age. Often early cataracts do not interfere
significantly with vision.
What Causes a Cataract?
The most common cause of cataract formation is aging, and
this may be related to years of ultraviolet light exposure.
Some types of cataracts are inherited, others are associated
with medical diseases (such as diabetes). Additionally,
there can be cataract formation secondary to previous
injury or medications.
What is the Treatment?
If vision is affected to the point of interfering with
your activities of daily life, cataract surgery should
be considered. The procedure is done on an outpatient
basis under local anesthesia. When the cloudy cataract
is removed, vision is restored by implanting a new lens
called an "intraocular lens implant", or IOL,
through a tiny incision of about 3mm. The Outpatient
Surgery Center is part of our facility for your convenience.
Will I Need Glasses After Surgery?
It is not uncommon to need some glasses correction after
cataract surgery. However, most people find that they
are not as dependent on glasses as they were before surgery,
because the IOL can reduce previous correction.
What is "Dry Eye"?
The surface of the normal eye is lubricated and protected
by tears, which are produced by several glands of the
eyelids. Many people, especially women, have a decreasing
level of tear production as they age. This causes a variety
of symptoms, such as stinging, burning, scratching, and
blurred vision. Sometimes, it can even stimulate the
glands to produce too many tears. Sjogren’s Syndrome
is a condition associated with more severe dry eye and
dry mouth.
Treatment
The treatment of dry eye consists of supplementing the
body’s own tears with some artificial lubrication
in the form of eyedrops or gel. Additionally, a small
plug can be inserted into the duct where tears drain
out of the eye. This will help retain any tears being
produced in the eye. Initially a temporary, dissolvable
plug can be placed. If it successfully relieves the problem,
than a more permanent plug is appropriate and is performed
in the office setting. Recently, a new type of medication
(prescription eyedrop) has been introduced which actually
restores a better level of tear production in some cases.
What is Blepharoplasty?
Blepharoplasty is the medical term to describe the removal
of excess skin from the eyelids. In many cases, some
fatty tissue is also removed to give a better, more youthful
appearance to the eyelids. Everyone normally has loosening
of the skin around the lids with age. In some people,
there is also a family tendency to have excess skin or "heavy" eyelids.
When the excess skin becomes bothersome, many people
decide to have it removed. This can be done for either
cosmetic or visual reasons (if the skin is interfering
with the area of sight.) Special tests are required to
determine if that is the case.
Does Insurance Pay for Blepharoplasty?
If the procedure is elective, or cosmetic, most policies
will not cover the surgery. If the reason for the procedure
is visual, the surgery will likely be covered.
How is the Surgery Performed?
Blepharoplasty is conveniently performed here at the Outpatient
Surgery Center, on an outpatient basis. Mild sedation
and local anesthesia is used. Our staff will be happy
to answer your questions about this procedure.
What is Conjunctivitis?
Conjunctivitis is an inflammation of the tissue that covers
the eye and the inside of the eyelids. This tissue is
called the conjunctiva. Some such inflammation can be
from a toxic substance (such as a chemical), from an
allergy (such as pollen or medication), or from an infection
(bacteria or virus). Bacterial infections are treated
with antibiotic drops. Viral infections do not respond
to antibiotics, but the body has to build up antibodies
internally to fight the virus. When a person has conjunctivitis,
there is redness, discharge and swelling of the conjunctiva.
Occasionally, the clear front part of the eye (the cornea)
will also be affected. This can be a much more serious
situation, and may lead to scarring and decreased vision.
No matter what the cause of conjunctivitis, the safest
action is to assume that it is due to an infection. Therefore,
it is especially important to use frequent hand washing
to avoid spreading the infection to the other eye or
to someone else.
What is Macular Degeneration?
The macula is the central area of the retina - the visual
nerve tissue. It is the area with which a person reads
or sees detail when looking directly at any object, so
it is the most critical area of the retina. Macular degeneration
refers to any condition which causes progressive scarring
of this retinal tissue. The most common form of macular
degeneration is the one associated with aging. A number
of factors appear to play a part in the development of
this condition. Among those factors are family history,
race and cigarette smoking, in addition to one’s
age. Other possible influences are nutritional deficiencies
and cumulative light exposure.
It is fairly common to see some mild changes of degeneration
in many people as they age. This does not affect the vision
to any great degree. However, the incidence of progressive
macular degeneration is growing, due in part to our longer
lifespan.
How Do
I Find Out if I Have Macular Degeneration?
One of the first signs a person may exhibit is distortion
or irregularity of vision. A thorough eye examination
will reveal whether changes of macular degeneration are
present. Special tests can help determine how much of
the retina appears to be affected.
Can this
Condition be Prevented?
There is no way known to prevent the problem, but a well-rounded
diet (especially dark, leafy vegetables and fruit), using
glasses or sunglasses with an ultraviolet filter, and
above all, not smoking are beneficial. In addition, within
the past few years, it has been shown that taking a multivitamin
with zinc is a practice that can reduce the severity
of disease progression. Medical conditions such as hypertension
and diabetes should also be kept under control. These
conditions cause damage to the small blood vessels of
the retina, which is part of the problem with macular
degeneration. Very recently, there is evidence that control
of high cholesterol with statin drugs may be beneficial.
What are "Wet" and "Dry" Macular
Degeneration?
Most cases of Macular Degeneration are the "dry" type,
because they have no fluid or blood leakage. The “wet” type
involves abnormal blood vessels, which can leak fluid and
blood. This type can sometimes be slowed by laser treatments.
Generally, "wet" macular degeneration progresses
more suddenly than the “dry” type.
Do Glasses
Correct the Vision in Macular Degeneration?
Although a change in eyeglass prescription may give some
help, glasses do not restore the areas of sight which
have been lost to the degenerative condition. Good lighting
and magnification will help with close tasks, unless
the degeneration is quite advanced.
What is
Recommended as a Nutritional Supplement?
There is no certainty of the nutritional dosages best for
slowing this condition. We recommend the formulation
Macula Complete, produced by Biosyntrx.
Persons who are smokers should avoid beta-carotene supplement.
What is Herpes?
Herpes is the name of a common family of viruses. What
is unusual about the Herpes group is that once infected,
the virus can live in the nerve tissue of the body for
the rest of a person’s lifetime, and can become
active many years later.
Herpes Zoster
One type of Herpes virus, called Herpes Zoster, causes
Chicken Pox. When this virus becomes active later in
life, a person develops what is called "shingles." A
painful or unusual feeling along an area of the body
such as the face or chest is often the first sign. This
is followed by a rash in the same area. If the area of
the eyelids and nose are involved, there may be inflammation
of the eye itself. Treatment is by oral medication, and
it is important to begin this medication as soon as possible
to lessen the severity of the outbreak.
Herpes Simplex
A second type of Herpes virus, called Herpes Simplex causes
ulcers of the lip, mouth and cornea of the eye. At least
80% of people have had this virus by the time they become
adults - usually in childhood. Later in life the virus
can become reactivated by some event such as a cold or
sunburn (hence the name “cold sore” and "fever
blister"). Most often, these sores resolve over
about 7-10 days - even without treatment. However, on
the cornea of the eye, the ulcers can leave scarring
and reduces sight. Treatment is by medicated eyedrops,
and sometimes with oral medication.
Herpes Simplex I and II
Many people have heard of the Herpes virus because it can
also cause a recurring venereal disease. This is usually
caused by the type II virus, while the mouth and eye
problems are caused by the type I virus. People who have
repeated outbreaks of either type may benefit from long-term
oral medication. When someone has active blisters of
Herpes, they should avoid contact with infants and young
children, very elderly people and persons with decreased
immunity (such as someone on chemotherapy).
What is Blepharitis?
Blepharitis is an inflammation of the eyelids, especially
along the area of the lashes. The two most common forms
are secondary to either infection or a skin disorder,
such as rosacea or seborrhea. When this type of inflammation
is present, the lids can be very irritated, with scaling,
itching or chronic redness. It is often associated with
tear deficiency ("dry eyes"). The surface of
the eye itself can sometimes be affected by this inflammation,
even to the point of permanent scarring.
Blepharitis is frequently a chronic problem, and requires
long-term treatment. In both types of blepharitis, regular
cleaning of the eyelids is very important. This is best
done with warm compresses followed by gently cleaning.
In more severe cases, antibiotic ointment or anti-inflammatory
ointment is then applied on the skin. It may be necessary
to treat on a frequent basis initially, but treatment can
usually be reduced after the condition is under control.
In some situation, oral antibiotics may be required in
addition to the skin treatment. If decreased tearing is
also present, artificial tears will help relieve irritation.
What is a Migraine?
The term migraine is commonly used to describe a type of
headache which can be quite severe. In fact, there are
several variations of migraine episodes - some occurring
without any headache at all. Migraines are associated
with a strong family history and are more frequent in
women than in men. They generally begin in adolescence
or early adult life, and are actually quite common.
One of the typical migraine features
is called an "aura." This
is a visual episode which precedes the headache, and lasts
from 15 to 45 minutes. The experience is of a shimmering
visual disturbance which is described as an oval or crescent.
The area of involved vision is quite blurry, but is not
completely dark or missing. It gradually grows larger and
then becomes smaller until it disappears. Frequently, a
headache will follow this aura, but some people experience
the visual symptoms without any headaches.
Rather than being a problem primarily of the eye, migraines
are inflammatory in origin, and affect some vessels of
the brain, including the visual area. For some people,
they are triggered by certain foods (such as cheese or
chocolate), drinks (such as caffeine or alcohol), bright
lights, or stress. There are medications which relieve
the severe headaches that may occur. Additionally, avoiding
known triggers as mentioned above and discontinuing smoking
may decrease the frequency of episodes. There are also
medications which can be prescribed for people having recurring
migraines which do not respond to other methods of control
It is important to notify your physician if there is a
change in pattern or frequency of migraine-type episodes.
Why Do I Need to Have My Eyes Dilated?
People often ask why it is necessary to dilate the pupils
for a complete eye examination. This allows a full view
of the back portion of the eye, including the lens (where
cataracts form), the blood vessels, the optic nerve,
and the retina. It is especially critical to perform
this evaluation on anyone having visual problems. However,
even in those cases where there is no special complaint,
it is important to examine these parts of the eye carefully
and completely.
When the pupils are dilated, the vision
becomes blurry, so that it may not be safe for driving.
We request that you have someone with you to drive when
you come in for a complete examination for this reason.
What is Diabetic Eye Disease?
Diabetes mellitus can affect eyesight in several different
ways. For example, persons with diabetes are more likely
to have cataract formation. The most serious eye problem
secondary to diabetes is diabetic retinopathy. This condition
occurs because of damage to the blood vessels in the
retina, which is the innermost tissue lining the eye.
There are two types of diabetic retinopathy: nonproliferative
and proliferative. Nonproliferative, or background retinopathy,
is the most common type of blood vessel damage. In some
cases, vision is not affected. However, hemorrhage or swelling
of the macula - the retinal area of central vision - may
occur. This problem may require treatment either with injection
of medication or with laser surgery to the retina.
Proliferative retinopathy is a more serious disease, in
which new, abnormal vessels form in the retina. These fragile
vessels are very prone to hemorrhage, and often require
laser therapy to prevent progression and profound vision
loss.
How is Diabetes Treated?
Medical treatment of diabetes mellitus is determined by
control of the blood hemoglobin A-1c level-either by
oral medication or by insulin injection. It is extremely
important for persons with diabetes (both Type I and
Type II) to have an annual eye examination with pupil
dilation and detailed retinal evaluation. If diabetic
retinopathy is detected, laser treatment to the retina
may be necessary. This is performed as an outpatient
in our adjoining Outpatient Surgery Center.
In the U.S., more people are being diagnosed with diabetes
mellitus than ever before. Diabetic retinopathy is now
one of the leading causes of visual loss. Control of blood
sugar and regular eye examinations are the most crucial
steps a person can take to lessen the risk of severe vision
damage from this disease.
What is a Presbyopic Lens Implant?
Intraocular lens implants (IOL) have been used surgically
since the 1970's, and have proven to be extraordinarily
safe and effective in visual correction after cataract
surgery. However, these implants only correct vision
at one primary focal point (usually distance) and patients
require glasses correction for other distances. Recently,
an exciting new lens technology has been approved, which
is designed to correct vision for more than one distance.
These IOLs are called “Presbyopic Lens Implants”.
While not all persons are candidates for this lens implant,
it can be used for both patients undergoing cataract
surgery, and also for those people simply wishing to
have surgery to attain good visual correction. This is
considered a type of “refractive” surgery,
and is generally classified as an elective procedure.
More information about these implants is available on
our website in the SERVICES-Cataract section.
Can the
New Lens Implants (ReSTOR, ReZoom, Crystalens) Eliminate
My Need for Glasses?
These implants do have the potential to decrease your dependence
on glasses. Most patients are able to see well at distance
and near without glasses. There are many variables that
come into play for each individual patient, and no guarantees
can be made. Depending upon which lens is used, the studies
have shown that 30% to 80% of patients never wear glasses
after surgery. In-depth testing can improve the likelihood
of success with this procedure.
