Strabismus treatments Strabismus Strabismus is a condition in which the eyes are not properly aligned with each other. It is caused by a lack of coordination between the eyes. As a result, the eyes look in different directions and do not focus at the same time on a single point. In most cases of strabismus in children, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth (congenital strabismus). In children, when the two eyes fail to focus on the same image, the brain may learn to ignore the input from one eye. If this is allowed to continue, the eye that the brain ignores will never see well. This loss of vision is called amblyopic, and it is frequently associated with strabismus. Symptoms and Diagnosis Eyes that appear crossed • Eyes that do not align in the same direction • Uncoordinated eye movements (eyes that do not move together) • Double vision • Vision in only one eye, with loss of depth perception (depth perception is our ability to see three dimensions, and recognize the order of objects in the space around us) During eye examinations, ophthalmologists, orthoptists, and optometrists typically use a cover test to aid in the diagnosis of strabismus. The physical examination will include a detailed examination of the eyes. The patient may be asked to look through a series of prisms to determine the differences between the eyes. The eye muscles will be tested to determine the strength of the extra ocular muscles. Tests include: • Standard ophthalmic exam • Visual acuity • Retinal exam • Neurological examination Treatment Initially, strategies to strengthen the weakened muscles and thereby realign the eyes are attempted. Glasses may be prescribed. Eye muscle exercises may be prescribed. If amblyopic is present, patching of the preferred eye may be done to force the child to use the amblyopic eye. Surgery may be required to realign the eye muscles if strengthening techniques are unsuccessful. Patient's Info List 1. CATARACT 2. GLAUCOMA 3. RETINAL DISEASES a. Retinal Detachment b. Diabetic Retinopathy c. Age Macular Degeneration 4. LASIK CATARACT | Definition A cataract is a clouding of the normally clear lens of your eye. Clouded vision can make reading and driving a car difficult. Cataracts commonly affect distance vision and cause problems with glare. They generally do not cause irritation or pain. Most cataracts develop slowly and don't disturb your eyesight early on. But as the clouding progresses, the cataract eventually interferes with your vision. Fortunately, cataract removal is generally a safe, effective procedure. Symptoms A cataract usually develops slowly and causes no pain. At first, the cloudiness may affect only a small part of the lens and you may be unaware of any vision loss. Over time, however, as the cataract grows larger, it clouds more of your lens and distorts the light passing through the lens. Eventually, this impairs your vision because of overall blur or image distortion. Signs and symptoms of cataracts include clouded, blurred or dim vision, increasing difficulty with vision at night, sensitivity to light and glare, halos around lights and double vision in a single eye. Cataracts don't typically cause any change in the appearance of your eye. Pain, redness, itching, irritation, aching in your eye or a discharge from your eye aren't signs or symptoms of a cataract, but may be signs and symptoms of other eye disorders. A cataract isn't dangerous to the physical health of your eye unless the cataract becomes too mature. This can cause glaucoma resulting in inflammation, pain and headache. This type of cataract requires removal as an emergency procedure. Treatment Cataract surgery is the commonest type of eye surgery performed. Surgical techniques and instrument technology have advanced over the years and the risks from cataract surgery are very much lower. Modern day cataract surgery is done through a suture-less micro-incision of 1.2 to 2.5 mm under topical anesthesia. The procedure is generally recommended when cataracts begin to affect your quality of life or interfere with your ability to perform normal daily activities. It's generally done on an outpatient basis. The procedure takes about fifteen minutes to complete. Stitches are not usually needed and the eye need not be bandaged after surgery. Recovery is fast. You can often resume your normal daily activities the next day. Some patients may choose to have surgery done in both eyes on the same day. A new lens is placed inside the eye to replace the cataract which has been removed. This may be a monofocal or multifocal type lens. Monofocal lenses allow good distant vision, and reading glasses are worn for near work when using the computer or reading. Multifocal lens implants give a range of useful vision so the patient is much less dependent on glasses. Some patient can experience glare and halos under dim light condition after multifocal lens implant, though these symptoms generally improve with time. Your surgeon will discuss with you the most suitable type of lens implant for you. Following surgery, antibiotics drops are instilled for up to one month. Follow-up reviews are scheduled by your doctor the next day and usually at one week and one month thereafter. International patient may travel by air after two to three days. Definition GLAUCOMA | Glaucoma is not just one disease, but a group of conditions in which abnormal eyeball pressure results in optic nerve damage, which diminishes sight progressively and irreversibly. Glaucoma is one of the leading causes of blindness. It can damage your vision so gradually you don't notice any loss of vision until the disease is at an advanced stage. In some cases of glaucoma, it usually has no noticeable signs or symptoms except gradual vision loss. Early diagnosis and treatment can minimize or prevent optic nerve damage and limit glaucoma-related vision loss. It's important to get your eyes examined regularly, and make sure your eye doctor measures your intraocular pressure. Symptoms The two most common types of glaucoma, primary open-angle glaucoma and acute angle-closure glaucoma have different symptoms. Primary open-angle glaucoma presents symptoms like gradual loss of peripheral vision in both eyes while symptoms for acute angle-closure glaucoma include severe eye pain, sudden onset of visual disturbance often in low light, blurred vision and reddening of the eye. Treatment Glaucoma treatments reduce intraocular pressure by improving aqueous outflow, reducing the production of aqueous, or both. Glaucoma can't be totally cured, and damage caused by the disease can't be reversed, but treatment and regular checkups can prevent visual loss in people with very early glaucoma. If visual loss has already occurred, treatment can slow or prevent further vision loss. Regular reviews by the ophthalmologist are essential. Your ophthalmologist will perform measurements of the eyeball pressure, visual field tests and ocular CT scan of the optic nerve head regularly to monitor the progress of the disease. You may need surgery to treat glaucoma if you can't tolerate medications or if they are no sufficient to control your eyeball pressure. Sometimes a single surgical procedure may not lower eye pressure enough, in which case you'll need to continue using glaucoma drops or have another operation. RETINAL DISEASES | Definition Retinal diseases vary widely where some are common and easily remedied, while others are rare, more difficult to diagnose and require more complex treatment. A few common retinal diseases and conditions are listed below. 1. Retinal Detachment A serious eye disease that requires prompt treatment, retinal detachment occurs when the gel-like substance that fills the eye cavity (vitreous) begins to sag and shrink with age. While this shifting occurs in most peoples' eyes as they age, it becomes dangerous quickly if the retina tears. When fluid from the vitreous begins to leak through the tear under the retina, the retina may begin to peel away from the back of the eye. The patient begins to lose vision in the areas where the retina is detached; if left untreated, this condition can lead to permanent and severe vision loss. Floaters and flashes are common symptoms of degeneration in the eyeball and almost everyone begin to see some of these at forty years old and beyond. However, a sudden and dramatic increase in these symptoms may indicate a retinal tear and an examination by the ophthalmologist are needed. Untreated, these may progress to a retinal detachment, when the patient will notice a black shadow extending across the field of vision, like a curtain drawn across the window. Retinal holes and tears can be treated with laser surgery. This is done as an outpatient procedure and takes a few minutes to complete. It is safe and non-invasive, and the patient can resume normal activity almost immediately. By the time the retina detaches, surgery is necessary. The success rate of surgery is more than 90%, though some patients may still experience some degree of visual loss despite successful reattachment of the retina. More than one surgery may be needed to reattach the retina if it detaches again after the initial operation. The surgery is usually performed under general anaesthesia. The eye will appear red and puffy after surgery. Visual recovery can take a few months, though the patient may move about in his daily activity by the next day. International patients should discuss travel plans with their ophthalmologist, as a gas bubble is sometime injected into the eye as part of the surgery, and after that the patient may not be able to travel by air for three to four weeks. 2. Diabetic Retinopathy Diabetic retinopathy refers to damage to the tiny blood vessels that nourish the retina. These blood vessels are often affected by the high blood sugar levels associated with diabetes. For those on oral diabetic medication, nearly 60% will develop some form of blood and fat leakage at the back of the eye after 20 years of diabetes, while up to 99% of those requiring insulin injection for their diabetes will develop these damages over twenty years. Early diagnosis and laser treatment is required to control the progression of the disease in the eye. Laser treatment is safe and non-invasive. It is done as an outpatient procedure and patients can resume normal daily activities on the same day. Further sessions of laser treatment may be scheduled by your ophthalmologist if necessary. Laser treatment can effectively prevent worsening of diabetic retinal disease in the early stages. Despite llser treatment, some patients, especially those with poorly controlled diabetes, experiences progressively worsening eye disease and other treatment may be needed. Injections may be given into the eyeball to arrest the bleeding. In late stages of diabetic eye disease, advanced vitrectomy surgery can help to clear blood and scar tissue from the back of the eye to save vision. Good general diabetic control with medication and regular review by your ophthalmologist are keys to maintaining healthy vision in those with diabetes disease. 3. Age Macular Degeneration Age-related macular degeneration (AMD) is a chronic eye condition that affects age 50 and older. When a person has macular degeneration, the macula begins to deteriorate, causing anything from blurred or slightly distorted central vision to a blind spot in the center of the visual field. Symptoms Usually the symptoms of retinal diseases are painless, and some may be slight and difficult to notice. When the disease is present in only one eye, the healthy eye will compensate for the other; many people live with a disease for years without knowing. Signs and symptoms of a retinal disease may include: • Tiny specks and spots that appear to float in the field of vision • A sensation of flashing lights in one or both eyes • Blurred vision or vision loss • A shadow over a portion of the visual field • Poor night vision • Difficulty adjusting from bright to dim light Treatment The goal of many treatments is to stop further progression of the disease. In most cases, the damage that has already occurred cannot be reversed, making early detection very important for vision preservation. Treatment options include laser, injections of anti- angiogenic medication into the eye and vitreoretinal surgery. Treatment can limit or slow down the progression of the disease, but a complete cure is not available. Long term regular reviews by your ophthalmologist are necessary. LASIK / Epi-LASIK | LASIK (Laser Assisted In Situ Keratomileusis) is a procedure which uses laser to change the curvature of the cornea for correction of presbyopia, myopia, hypreopia and astigmatism. LASIK removes tissue within the cornea to treat common ophthalmic conditions like nearsightedness, farsightedness and astigmatism. It is a highly successful operation with very low risk to patients who are suited to the procedure. Wavefront customized lasik is the most popular treatment option with our patients. The older standard lasik treatment is also available at our clinic. Before the Lasik treatment, a thin flap is raised off the surface of the cornea. This can be done with a standard bladed keratome, though in recent years most of our patients choose the blade-free femtosecond laser (e.g. IntraLase) to create the flap. LASIK is suitable for the following: • People who want to reduce or eliminate their dependence on glasses or contact lenses • Are at least 18 years of age • Have stable eye prescription for at least one year • Have no eye diseases such as cataract, glaucoma or retinal diseases It is an important decision to have LASIK and the patient should make a careful deliberation. The patient will need to consult a certified ophthalmologist for an eye examination. Both patient and the eye doctor will then determine if LASIK is an option. If you are a suitable candidate for LASIK, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. General Interest Topic 1. Allergies and the Eyes 2. Anesthesia - General 3. Anesthesia - Topical 4. Color Vision 5. Complete Eye Examination 6. Computer Screens 7. Conjunctivitis 8. Dry Eye 9. Erectile Dysfunction Drugs 10. Eye Care Facts and Myths 11. Herpes Zoster 12. How Are Ophthalmologists, Optometrists, and Opticians Different? 13. How to Instill Eye drops 14. Living With Vision Loss in One Eye 15. Recycling Eyeglasses 16. Refractive Errors 17. Smoking and Eye Disease 18. Tanning Beds Allergies and the Eyes Allergies and the Eyes Approximately 22 million people in the United States suffer from seasonal itchy, swollen, red eyes. Airborne allergens, such as house dust, animal dander, and mold, constantly bombard the eyes and can cause ocular allergies at any time. But when spring rolls around and the plant pollen starts flying, it seems as if almost everyone starts crying. Seasonal allergic conjunctivitis, or hay fever, is the most common allergic eye problem. Various antihistamine and decongestant eyedrops and sprays can soothe your irritated eyes and nose. Make every effort to avoid allergens. An allergist can help determine what you are allergic to so you can stay away from it. Staying away from outdoor pollen may be impossible, but remaining indoors in the morning when the outdoor pollen levels are highest may help control symptoms. If you are allergic to house dust, open the windows and keep household filters clean. Applying cool compresses to the eyes helps decrease swelling and itching. Artificial tears dilute the allergens and form a protective barrier over the surface of the eye. Avoid rubbing the eyes, which makes symptoms worse. If seasonal allergic conjunctivitis is a problem, see an ophthalmologist (Eye M.D.). Your ophthalmologist can prescribe several safe and effective anti-allergy drops. In some cases, oral medications are needed. Your ophthalmologist can also make sure that your symptoms are not being caused by a more serious problem. Anesthesia - General Anesthesia - General During surgery, an anesthesiologist will put you to sleep so that you do not experience any pain. The combination of drugs and/or gases that puts you to sleep and prevents pain is called general anesthesia. Anesthetic medications are usually delivered through an IV in your arm or hand. Once you fall asleep, you will not be aware of anything until you wake up after surgery. Once asleep, your anesthesiologist may put a tube in your airway and put you on a respirator to help you breathe and to deliver additional anesthetics. Monitors will record your blood pressure, heart rate, and oxygen concentration, and your anesthesiologist will make sure your lungs, kidneys and heart are functioning well. When you awaken after surgery, the tube in your throat will be removed and you will be watched in the recovery room until you are fully alert. General anesthesia is very safe, but there are some risks. You could have an allergic reaction to the anesthesia, and you may experience nausea and vomiting following surgery. There are also small risks of lung infection, heart attack, and stroke. You can help prevent these risks by telling your doctor about any allergies you have, about all the medications you take, and about all your medical conditions. Also, be sure to tell your doctor if you or anyone in your family has ever experienced problems with anesthesia in the past. Anesthesia - Topical Anesthesia - Topical A topical anesthetic is one that is applied directly to the surface of your eye and affects only the area to which it is applied. Topical anesthesia is usually given in the form of eyedrops or gels, or applied with sponges to the surface of the eye. In some cases, if surgery time will be relatively short, you may only require topical anesthesia. If this is the case, anesthetic drops or gel will be applied to your eye and you will need to follow your ophthalmologist's (Eye M.D.'s) instructions during the surgery to keep eye movement to a minimum. If you need to sneeze or shift position, you will simply need to alert your ophthalmologist beforehand. Often, if surgery is longer or more involved, the topical anesthetic will be supplemented with other forms of anesthesia to make you more comfortable and perhaps to immobilize your eye. By using topical anesthesia, your ophthalmologist ensures that you are as comfortable as possible during and following surgery. Since you will not be put to sleep using general anesthesia, your recovery time after surgery will be much quicker, and you will be able to go home the same day. There are usually few side effects or complications due to topical anesthesia. Color Vision Color Vision Color blindness (color vision deficiency) is a condition in which certain colors cannot be detected. There are two types of color vision difficulties: congenital (inherited) problems that you have at birth, and problems that develop later in life. People born with color vision problems are unaware that what they see is different from what others see unless it is pointed out to them. People with acquired color vision problems are aware that something has gone wrong with their color perception. Congenital color vision defects usually pass from mother to son. These defects are due to partial or complete lack of the light-sensitive photoreceptors (cones) in the retina, the layer of light-sensitive nerve cells lining the back of the eye. Cones distinguish the colors red, green, and blue through visual pigment present in the normal human eye. Problems with color vision occur when the amount of pigment per cone is reduced, or one or more of the three cone systems are absent. This limits the ability to distinguish between greens and reds, and occasionally blues. It involves both eyes equally and remains stable throughout life. There are different degrees of color blindness. Some people with mild color deficiencies can see colors normally in good light but have difficulty in dim light. Others cannot distinguish certain colors in any light. In the most severe form of color blindness, everything is seen in shades of gray. Except in the most severe form, color blindness does not affect the sharpness of vision at all. It does not correlate with low intelligence or learning disabilities. Most color vision problems that occur later in life are a result of disease, trauma, toxic effects from drugs, metabolic disease, or vascular disease. Color vision defects from disease are less understood than congenital color vision problems. There is often uneven involvement of the eyes and the color vision defect will usually be progressive. Acquired color vision loss can be the result of damage to the retina or optic nerve. There is no treatment for color blindness. It usually does not cause any significant disability. However, it can prevent employment in an increasing number of occupations. Change in color vision can signify a more serious condition. Anyone who experiences a significant change in color perception should see an ophthalmologist (Eye M.D.). Complete Eye Examination Complete Eye Examination A complete eye examination does more than determine how clearly you see from a distance and which lens prescription, if necessary, will give you the best possible vision. Your ophthalmologist (Eye M.D.) will also run a number of tests to check the health and function of your entire eye. If you have never had an eye examination or are seeing a new ophthalmologist, your doctor or a technician will begin by asking you questions about your medical history, your family's medical history, and any vision problems you may have. If you wear contact lenses, be sure to bring them with you to your appointment. Your ophthalmologist will check them to make sure that they are the correct prescription, fit, and kind of lens for your eyes. A complete eye examination will include many or all of these painless tests: A visual acuity test measures how well you can see from a distance. Covering one eye at a time, you will look at an eye chart and be asked to identify letters that get smaller as you read farther down the chart. If your visual acuity test indicates that you need corrective lenses, you will be given a refraction test to determine the correct prescription. Your ophthalmologist may use retinoscopy to estimate your prescription by shining a light into your eyes to see the movement of the light reflected by your retina. Your ophthalmologist will finalize your prescription by asking you to look through a device called a phoroptor that has many different lenses in it. You will be asked to compare a series of two lens choices and evaluate which lens combination provides you with your best possible vision correction. To test the function of your eye muscles, your ophthalmologist will have you follow the movement of an object in many directions, looking for weak muscles or poor control of the muscles that move your eyes. To test your peripheral vision, which is what you are able to see to the sides of your visual field when you look straight ahead, your ophthalmologist uses a visual field test. You may be asked to cover one eye at a time and, while looking straight ahead, tell your ophthalmologist when you can see his or her hand or other object as it moves inward from outside your visual field. Or a computer program may be used to test your visual field. If so, you will look straight ahead into a special device, often a lighted bowl-shaped instrument, and press a button each time you see a flash of light. Your ophthalmologist can use your responses to see if there are any blind spots in your visual field. Your ophthalmologist will use a slit-lamp microscope to examine the front part of your eye, including the cornea, iris, and lens. You will sit at the slit lamp, which greatly magnifies your eye and shines a bright line of light into it, allowing your ophthalmologist to examine your eye closely. Before the test, you may be given eyedrops with fluorescein, an orange dye, to make your cornea easier to see. This dye will wash away naturally. To test for glaucoma, a disease that can cause blindness when too much pressure in your eye damages the optic nerve, your ophthalmologist will use a tonometer to measure your intraocular pressure. Using one method, noncontact tonometry, you will sit with your chin and forehead resting comfortably on the guides of a device that will blow a puff of air into your eye and thereby measure your eye pressure. Applanation tonometry is another option. Your ophthalmologist will give you eyedrops containing an anesthetic and fluorescein dye to numb the front surface of your eye and will then use a manual tonometer to gently touch your cornea and measure the force required to flatten it. This procedure is quick and painless, and the anesthetic will wear off in 15 or 20 minutes. Your ophthalmologist may also use pachymetry to measure the thickness of your cornea, which helps evaluate the accuracy of your intraocular pressure measurement. After applying numbing eyedrops, your ophthalmologist will use ultrasonic waves to measure your corneal thickness. This test is also a critical component of evaluating a patient's candidacy for LASIK surgery. A retinal examination explores the back of your eye including the retina and optic nerve. First, depending on the type of retinal examination your ophthalmologist chooses, your pupils will be dilated with eyedrops, which may sting briefly. If your ophthalmologist chooses to use direct examination, he or she will shine a light in your eye and use a device called an ophthalmoscope to look at the back of your eye. Alternatively, using a method called indirect examination, your ophthalmologist may use a much brighter light mounted on his or her forehead to examine your eye while holding it open. Finally, to get the best look at the back of the eye, your ophthalmologist may choose to perform a slit- lamp examination, which combines the use of the slit lamp and special lenses. Retinal examinations usually take about five minutes, but the eyedrops will continue to blur your vision for several hours. You may not be able to drive and will be sensitive to bright light, but this is temporary and should resolve in several hours. Computer Screens Computer Screens Complaints of eye discomfort and fatigue are becoming more common as the use of computer screens increases. While it is true that computer screens can cause eyestrain, there is no convincing evidence that they can harm the eyes. Some people fear that computer screens emit damaging ultraviolet (UV) light or radiation. The amount of UV light emitted by computer screens is a fraction of what is emitted from a fluorescent light. Radiation levels from computer screens are so low that a lifetime of exposure will not damage the eyes. After prolonged use of a computer screen, black and white objects may appear colored, but this is not a sign of eye damage. Symptoms of eyestrain are eye irritation (red, watery, or dry eyes), eye fatigue (tired, aching heaviness of the eyelids or forehead), difficulty in focusing, and headaches. However, eyestrain does not result in permanent eye damage. Eyestrain, backache, and muscle spasms may improve with proper arrangement of the computer screen and seating area. The Occupational Safety and Health Administration (OSHA) provides helpful suggestions on workstation arrangement. It is important to wear appropriate eyeglasses adjusted for the distance between the eyes and the computer screen. Most computer users prefer to position the screen farther from where they normally read. Prescription eyeglasses should be adjusted accordingly. Take periodic rest breaks. Using a computer requires unchanging body, head, and eye positions that can be fatiguing. Lubricate the eyes by blinking frequently or using artificial tears (lubricating eyedrops). Keep workstations clean to minimize eye irritation from dust. Minimize light glare by adjusting office lights or using hoods or filters on the video screen. Standard office lighting is too bright for comfortable computer screen viewing. Conjunctivitis Conjunctivitis “Pink eye,” the common name for conjunctivitis, is an inflammation or infection of the conjunctiva. The conjunctiva is the outer, normally clear covering of the sclera (the white part of the eye). The eye appears pink when you have conjunctivitis because the blood vessels of the conjunctiva are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal and discomfort is mild. Either a bacterial or a viral infection may cause conjunctivitis. Viral conjunctivitis is much more common. It may last several weeks and is frequently accompanied by a respiratory infection (or cold). Antibiotic drops or ointments usually do not help, but symptomatic treatment such as cool compresses or over-the-counter decongestant eyedrops can be used while the infection runs it course. Unlike viral conjunctivitis, bacterial conjunctivitis can be treated with a variety of antibiotic eyedrops or ointments, which usually cure the infection in a day or two. Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work, and they should stay out of swimming pools. Not all cases of conjunctivitis are caused by an infection. Allergies can cause conjunctivitis, too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (names of steroids usually end in “-one” or “-dex”) unless prescribed by an ophthalmologist (Eye M.D.). Finally, not all cases of pink eye are caused by conjunctivitis. Sometimes more serious conditions, such as infections, damage to the cornea, very severe glaucoma, or inflammation inside the eye will cause the conjunctiva to become inflamed and pink. Vision is usually normal when pink eye is caused by conjunctivitis. If your vision is affected or you experience eye pain, it is recommended that you see an ophthalmologist. Dry Eye Dry Eye Your eyes constantly produce tears at a slow and steady rate so that they stay moist and comfortable. Some people are not able to produce enough tears or the appropriate quality of tears to keep their eyes healthy or comfortable. This condition is known as dry eye. Symptoms of dry eye include scratchiness, stinging, stringy mucus in or around the eyes, and blurry vision. Sometimes people with dry eye will experience excess tearing. This is the eye's response to the discomfort from dry eye. When the eyes get irritated, the gland that makes tears releases a larger than usual volume of tears, which overwhelm the tear drainage system. These excess tears then overflow from your eyes. Dry eye often increases with age as tear production slows. For women, this is especially true after menopause. Dry eye can be associated with other problems like Sjögren's syndrome, which can cause dry eyes along with dry mouth and arthritis. Your ophthalmologist (Eye M.D.) can usually diagnose dry eye by examining your eyes. Sometimes tests that measure tear production are necessary. The Schirmer tear test measures tear production by placing filter-paper strips between your eyeball and your lower lid. Your ophthalmologist might also test you for dry eye using diagnostic drops to check for patterns of dryness on the eye's surface. Treatments for dry eye include eyedrops called artificial tears to lubricate the eyes and help maintain moisture. Your ophthalmologist may conserve your tears by closing the channels through which your tears drain. You can also try to prevent tears from evaporating by avoiding wind and dry air from overheated rooms and hair dryers. Smoking irritates dry eyes and should be avoided. In less developed countries, dry eye due to a lack of vitamin A in the diet is not uncommon. Ointments with vitamin A can help dry eye caused by unusual conditions like Stevens-Johnson syndrome or pemphigoid. Eye Care Facts and Myths Eye Care Facts and Myths Myth: Reading in dim light is harmful to your eyes. Fact: Although reading in dim light can make your eyes feel tired, it is not harmful. Myth: It is not harmful to watch a welder or look at the sun if you squint or look through narrowed eyelids. Fact: Even if you squint, ultraviolet light still reaches your eyes, damaging the cornea, lens, and retina. Never watch welding without wearing the proper eye protection. Never look directly at a solar eclipse. Myth: Using a computer screen is harmful to the eyes. Fact: Although using a computer screen is associated with eyestrain or fatigue, it is not harmful to the eyes. Myth: If you use your eyes too much, you will “wear them out.” Fact: You can use your eyes as much as you want—you will not wear them out. Myth: Wearing poorly fitting eyeglasses damages your eyes. Fact: Although a good fit is required for good vision, a poor fit does not damage your eyes. Myth: Wearing poorly fitting contact lenses does not harm your eyes. Fact: Poorly fitting contact lenses can be harmful to your cornea, the clear front window of your eye. Make certain your ophthalmologist (Eye M.D.) checks your eyes regularly if you wear contact lenses. Myth: You do not need to have your eyes checked until you are in your 40s or 50s. Fact: Several asymptomatic yet treatable eye diseases (most notably glaucoma) can begin prior to your 40s. Myth: Safety goggles are more trouble than they are worth. Fact: Safety goggles prevent many potentially blinding injuries every year. Keep your goggles handy and use them! Myth: It is okay to swim while wearing soft contact lenses. Fact: Potentially blinding eye infections can result from swimming or using a hot tub while wearing contact lenses. Myth: Children will outgrow “crossed” eyes. Fact: Children do not outgrow truly crossed eyes. A child whose eyes are misaligned has strabismus and can develop poor vision in one eye (a condition known as amblyopia), because the brain “turns off” the misaligned or “lazy” eye. The sooner crossed or misaligned eyes are treated, the less likely the child will have permanently impaired vision. Myth: A cataract must be “ripe” before it can be removed. Fact: With modern cataract surgery, a cataract does not have to mature before it is removed. When a cataract interferes with your regular daily activities, you can talk with your ophthalmologist about having it removed. Myth: Cataracts can be removed with lasers. Fact: Cataracts cannot be removed with a laser. The cloudy lens must be removed through a surgical incision. However, after cataract surgery, a membrane within the eye may become cloudy. This membrane can be opened with laser surgery. Myth: Eyes can be transplanted. Fact: The eye cannot be transplanted. It is connected to the brain by the optic nerve, which cannot be reconnected once it has been severed. However, the cornea can be transplanted. Myth: All eye-care providers are the same. Fact: An ophthalmologist is a medical doctor (M.D.) or doctor of osteopathy (D.O.), uniquely trained to diagnose and treat all disorders of the eye. An ophthalmologist is qualified to perform surgery, prescribe and adjust eyeglasses and contact lenses, and prescribe medication. An optometrist (O.D.) is not a medical doctor but is specially trained to diagnose eye abnormalities and prescribe, supply, and adjust eyeglasses and contact lenses. In most states, optometrists can use drugs to treat certain eye disorders. An optician fits, supplies, and adjusts eyeglasses and contact lenses. An optician cannot exHerpes Zoster Herpes Zoster Herpes Zoster One's first encounter with the herpes zoster virus is usually childhood chicken pox. Later in life, the virus may reactivate, causing a characteristic rash of small blisters, frequently on the chest or forehead, which form crusts and may leave scars. This second encounter with the virus is commonly known as shingles. Unlike chicken pox, shingles is usually quite painful. Although this disease often occurs in normal, healthy people, it occurs more frequently in elderly or immune-compromised individuals. It is important to see an ophthalmologist (Eye M.D.) when herpes zoster occurs on the face, because the virus can invade the eye. An ophthalmologist looks for elevated pressure in the eye, inflammation inside the eye, and herpes zoster lesions on the surface of the eye. All of these problems can be treated, but they are sometimes difficult to manage. Careful treatment and follow up are required. Today, new oral antiviral medications are providing shingles patients with a quicker, more complete recovery. How Are Ophthalmologists, Optometrists, and Opticians Different? How to Instill Eye drops How to Instill Eye drops Infections, inflammation, glaucoma, and many other eye disorders often are treated with medicated eye drops. It is important to remember that all medicines can have side effects. Surprisingly, even the small amount of medication in an eye drop can create significant side effects in other parts of the body. There are ways to decrease the absorption rate of the eye drop into the system and to increase the time the eye drop is on the eye, making the medicine safer and more effective. Instilling eyedrops may seem difficult at first but becomes easier with practice. To place an eyedrop in your eye, first tilt back your head. Then create a “pocket” in front of the eye by pulling down on the lower with an index finger or by gently pinching the lower lid outward with the thumb and index finger. Let the drop fall into the pocket without touching the dropper tip to your eye, eyelid, or fingers, so as to prevent contaminating the bottle. Immediately after instilling the drop, press on the inside corner of the eyelids next to the bridge of your nose for two to three minutes with your thumb and forefinger. This prevents most of the drop from traveling down the tear duct to the back of the throat, where it then is absorbed by the rest of the body. Keep your eyes closed for three to five minutes after instilling eye drops. Before opening your eyes, dab unabsorbed drops and tears from the closed lids with a tissue. If you are taking two different types of eye drops, wait at least five minutes before instilling the second drop. Because the volume of a single drop exceeds the capacity of the surface of the eye, it serves no purpose to use two drops at the same time. Living With Vision Loss in One Eye Living With Vision Loss in One Eye People who lose vision in one eye because of an injury or a medical condition must adapt to a narrower field of vision and loss of depth perception. They may still see small objects as well as before, assuming the other eye is normal. At first, adults who lose vision in one eye may have a few fender-benders, and they may have difficulty reaching out accurately to shake hands. This is due to the lack of depth perception as well as a narrower field of vision. The patient will soon learn to turn his or her head more when driving, reading, or doing other activities in order to compensate for the lack of depth perception and smaller field of view. With patience and time, they learn to use other clues to help them navigate the world around them and to function normally. Assuming that the unaffected eye is normal, a person with vision loss in one eye is not considered legally blind. In addition, the patient is also eligible for a driver's license and is able to work in almost any occupation. There may be some jobs that a person with vision loss in one eye cannot safely perform, but they are few. Your ophthalmologist ( Patient Education Patient Education >General Interest >Recycling Eyeglasses Refractive Errors Refractive Errors Refractive errors occur when light does not focus properly on the retina because of the shape of the eye. The resulting image is blurred. Common refractive errors are myopia (nearsightedness), hyperopia (farsightedness), astigmatism (distorted vision), and presbyopia (aging eyes). Myopia A myopic eye is longer than a normal eye or has a cornea that is too steep, causing light rays to focus in front of the retina instead of on it. With myopia, close objects appear clear, but distant ones appear blurred. Hyperopia A hyperopic eye is shorter than normal or has a cornea that is too flat. The light rays focus beyond the retina instead of on it. Distant objects appear clear, but close ones appear blurred. Astigmatism The cornea of an astigmatic eye is curved unevenly. Images focus in front of and beyond the retina, causing both close and distant objects to appear blurry. Presbyopia Presbyopia refers to the hardening of the lens that occurs with age. After the age of 40, the lens becomes more rigid and cannot change shape as easily to accommodate near objects. This makes reading and other tasks performed at close range difficult. Presbyopia can occur in combination with any of the other three refractive errors. Refractive errors are usually corrected with eyeglasses or contact lenses. Sometimes surgery is needed or desirable. Some common surgical procedures include the following: LASIK This popular procedure uses an instrument called a microkeratome to create a flap in the cornea so that the underlying corneal tissue can be reshaped with a laser. Epi-LASIK This procedure is similar to LASIK in that it also uses a laser to reshape the cornea, but it uses a different device to create the corneal flap. Photorefractive Keratectomy Photorefractive keratectomy (PRK) sculpts the surface of the cornea using a laser. A “bandage” contact lens is then applied for about three days to allow it to heal. Intrastromal Corneal Rings Intrastromal corneal rings are crescent-shaped plastic segments implanted in the cornea to flatten the cornea and correct mild nearsightedness. If you are considering any of these surgical procedures, it is important to discuss them with your ophthalmologist (Eye M.D.) so as to make an informed decision about whether refractive surgery is right for you. Sometimes the best option is to choose eyeglasses or contact lenses instead of surgery to correct a refractive error. Side effects of any of these refractive surgery techniques include blurring, glare, poor night vision, corneal scarring, or permanent vision loss. No one method is known to be better than another. The most appropriate method depends on the specific condition and liSmoking and Eye Disease Smoking and Eye Disease Tobacco smoking is directly linked to many adverse health effects, including high blood pressure, heart disease, and cancer. Smoking is also linked to eye disease. How does smoking affect the eyes? People who smoke cigarettes are at increased risk for developing cataracts, a clouding of the naturally clear lens of the eye. Cataracts cause a variety of vision problems, including blurry distance vision, sensitivity to glare, a loss of contrast sensitivity, and difficulty seeing colors. When eyeglasses or magnifiers are no longer helpful for someone with cataracts, or when cataracts develop in both eyes, surgery is the only option. Tobacco smoking is also one of the preventable risk factors for age-related macular degeneration (AMD). Studies have shown that current smokers and ex-smokers are more likely to develop AMD than people who have never smoked. AMD has two forms: dry (called atrophic) AMD and wet (called exudative) AMD. In dry AMD, your retina gradually thins. There is no proven cure for this type of degenerative disease. In wet AMD, new blood vessels grow in the retina, leaking blood or fluid and damaging the macula, the part of the retina responsible for your central vision. Permanent vision loss may occur with both types of AMD, so an attempt at prevention is of utmost importance. Some studies suggest that in people with high blood sugar levels, smoking may be linked to diabetic retinopathy, or damage to the blood vessels in the retina. The optic nerve is also susceptible to damage from smoking. People with poor diets who smoke heavily and drink excessive amounts of alcohol run the risk of developing optic nerve–related vision loss (called tobacco–alcohol amblyopia). Certain optic nerve problems, like Leber's hereditary optic neuropathy, can run in families. People with this condition who smoke have increased risk of vision loss. Some patients with thyroid disease (called Graves' disease) may also have eye involvement; smoking may cause their eyes to become worse, and vision loss is also possible. People who do not produce enough tears to keep their eyes comfortably lubricated have a condition called dry eye. For these people, smoking is a significant irritant, worsening the symptoms of scratchiness, stinging or burning of the eyes, and excess tearing from irritation. How does smoking affect fetal and infant eye health? Studies have also shown a strong association between smoking during pregnancy and the risk of invasive meningitis during early childhood. The risk of bacterial meningitis is five times higher among children whose mothers smoked during pregnancy. In addition to other severe health problems, childhood meningitis can cause inflammation of the cornea and pink eye. Smoking during pregnancy is also associated with low birth weight and premature birth. Finally, oxygen therapy given to sustain the lives of premature infants can cause retinopathy of prematurity, causing permanent vision loss or blindness in the infant. festyle of the patient. Services With very few exceptions, the physicians at The Eye Clinic can provide diagnostic and treatment capabilities for any type of eye or vision disorder. Learn More The Eye Clinic is committed to providing our patients with the latest Diagnostic advances in diagnostic capabilities. An accurate diagnosis is the most Services critical element in successful treatment outcomes for our patients. Our staff of diagnostic technicians receives intensive and ongoing training for each type of testing equipment we use. Vision Clear vision plays a critical role in every aspect of your life. Correction Fortunately today, there are vision correction options to bring life back into focus for nearly every vision problem. Whether your choice for clear vision is glasses, contact lenses or LASIK, The Eye Clinic can help improve your point of view with the area’s largest variety of vision correction options. Specialized Eye diseases pose the biggest threat to your eyesight if left untreated. Treatment Early detection and treatment are the best way to help ensure good Capabilities vision for a lifetime. The Eye Clinic offers the region’s most comprehensive treatment services for a wide range of eye health conditions. Over 95% of eye health conditions can be treated here by our experienced eye care specialists. Before You Begin Skin provides the earliest and clearest indications of aging. Treating and maintaining healthy skin is key to reversing the clock. During a consultation with one of our skilled skin care specialists, we will conduct a thorough analysis of your skin and the problems you would like to address. Your skin type and its overall condition will be evaluated. Based on this analysis, we will recommend any needed facial treatments as well as a home care regimen. If you are interested in cosmetic surgery, your expectations and treatment options will be discussed in great detail. Additional tests and further exams may be required before the actual date of the surgery. We offer an array of skin treatment options, including facials, chemical peels, Derma Sweep microdermabrasion, FotoFacial and laser applications. Facials A professional skin care facial helps to nourish the skin and all its structures by stimulating blood circulation. Blood brings oxygen, which is essential to cell growth, and also removes waste products, helping to rid the skin of impurities. Other benefits of facials include strengthening, nourishing, and toning of muscle fibers. By toning the facial muscles the skin will experience a slowing of the aging process. The facial begins with analysis of the skin to determine which procedures will best benefit the skin type of the client. The face will be cleaned thoroughly, then steamed to open skin follicles, allowing a deep cleaning of dirt and other debris from the follicles. Massage will depend upon the client's skin type. A treatment mask is applied. The type of mask will also depend upon skin type and condition. The treatment will end with a protective lotion that is applied to the entire facial area. Specific skin care products and home care regimen may be recommended at this time to insure the products best suited to their particular skin type and condition are being used. Chemical Peels Chemical peels have been used for over 100 years to create an even and controlled shedding of damaged skin cells. Every day thousands of skin cells die, flake off and are replaced by new cells. As we age, this process slows down and skin can become dull, uneven and discolored. Fine lines, sun damage and other signs of aging begin to be noticeable. During a chemical peel a solution is applied to the skin to remove dead skin cells and stimulate the production of new ones. These treatments tighten the skin, reduces wrinkling and leaves you with healthier, younger-looking skin. Chemical peels are not a substitute for a facelift, but they can produce very satisfactory results for many different types of skin conditions, including: • Sun damage • Mild scarring • Wrinkles and lines • Skin discolorations - age spots, freckling, uneven pigmentation • Oily skin • Rough, dry skin • Acne • Loose, sagging skin There are many different types of chemical peels. The chemical solutions used vary depending on the type of skin condition being treated and the desired depth of the chemical peel. If the skin problem is primarily superficial, then a milder, less caustic ingredient is used. If the problem is deeper, involving multiple layers of skin, then far stronger products are required. Dermasweep Microdermabrasion Microdermabrasion is a safe and effective way to combat the signs of aging by removing dead and flaking cells, creating an immediate improvement in your skin's appearance. At the Aesthetic Center, we use the DermaSweep microdermabrasion technique. This "clean” treatment provides particle-free skin exfoliation. Instead of crystals, our system uses variable vacuum action and patented treatment tips to exfoliate and rejuvenate the skin. The vacuum action of the wand stimulates blood flow, cleans the pores, and firms and tones the epidermis. Another unique feature available with DermaSweep is epi-infusion, which allows the same system, using gentle ultrasound, to deliver specific treatment solutions deep into the skin. This combination quickly rejuvenates damaged skin, as well as stimulates collagen production for long-lasting effects. The results are a deeper polish and more rapid improvement to the skin's appearance. In addition to improving overall skin health, DermaSweep microdermabrasion is an ideal, convenient treatment for treating: • early aging lines • acne • hyper pigmentation • sun damage • surgical scars Derma Sweep treatments are tailored for each client, with treatment tips, vacuum action and treatment solutions adjusted to precisely address their skin's condition at that time. General Pages: Tired of looking tired with those dark under eye circles? Did you know that this is one of the most common cosmetic complaints? According to cosmologists, nine out of ten people have dark circles under their eyes at one time or another. There are some things you can definitely do to minimize the darkness and bring out the brightness in your eyes. Why the darkness? In some cases, darkness around the eyes is hereditary. And many people with allergies seem to have dark circles. There are other culprits - something you can do something about. Smoking, drinking a lot of coffee, soda or caffeine beverages will usually make dark circles worse. So does generally not eating right. Also pulling all-nighters - whether for school or fun - also contribute to the dark-eyes problem. The various causes are: 1. People who were born with sharp nose (high nose bridge) and deep-set eyes will naturally have there eye circles appearing dark. 2. People who were born to have genuine dark circles. 3. People who suffer from long period of insomnia - lack of adequate rest and sleep. 4. People who need to light midnight candles - overstressing their eye muscles. 5. Pigmentation after childbirth or due to side effects of some drugs - these hyper- pigmentation around the eye area will appear like dark circles. Eye Puffiness? Generally, you can trace early-morning puffiness to your activities of the previous day: You drank fluids at bedtime, ate salty foods, spent all day with your head bent over a garden or stayed up half the night. The worst of the swelling subsides a few hours after rising as the fluid is re-absorbed by your body. You may also have puffy eyes as part of an allergic reactionfrom eating strawberries, for example, or from sleeping on feather pillows. Hormonal changes during menstruation can puff up eyes, too. A more permanent kind of puffiness can occur from saggy skin caused by normal aging. The skin around the eyes becomes thinner and less elastic with age. Then underlying fat causes the skin to bulge out. Here's how to avoid puffiness tomorrow. Raise the head of the bed. Six-inch wooden blocks placed under the headboard will elevate your head and help keep fluid from pooling around your eyes. Skip the water at bedtime. Or restrict yourself to a few sips. Cut out overly salty foods. And if you have Chinese food for dinner, tell the waiter to hold the monosodium glutamate (MSG). "Eating sodium-loaded Chinese food at dinner always gives me puffy eyes the next day," says Dr. Stefanyszyn. Skip wrinkle removers at night. An eye cream designed for plumping up wrinkles may be doing its job too well. These products can backfire and give you bags by puffing up the surrounding eye area. Switch to gel-type makeup. Water-based makeup and gels are lighter than oil-based and less likely to irritate delicate under-eye skin. DIABETES AND YOUR EYES Abnormal cell growth in the eye (the red spots and clusters) Diabetic Eye Disease Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or blindness. Diabetic eye disease may include: •Diabetic retinopathydamage to the blood vessels in retina. •Cataractclouding of the eye’s lens. Cataracts may develop at an earlier age in people with diabetes. •Glaucomaincrease in fluid pressure inside the eye that leads to optic nerve damage & loss of vision. What is Diabetic Retinopathy? Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. The retina is the lightsensitive tissue at the back of the eye. A healthy retina is necessary for good vision. If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. Causes & Risk Factors Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways: 1. Fragile, abnormal blood vessels can develop & leak blood into the center of the eye, blurring vision. 2. Fluid can leak into the center of the macula (part of eye where sharp vision occurs). The fluid makes the macula swell, blurring vision. This condition is called macular edema & can occur at any stage of diabetic retinopathy. Who is at risk for diabetic retinopathy? All people with diabetes, type 1 & type 2, are at risk. That’s why everyone with diabetes should get an annual comprehensive dilated eye exam. The longer someone has diabetes, the more likely he will get diabetic retinopathy. Between 4045% of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression. During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend more exams during your pregnancy. What can I do to protect my vision? If you have diabetes, schedule a comprehensive dilated eye exam at least once a year and remember: better control of blood sugar levels slows the onset and progression of retinopathy. Diabetics who kept their blood sugar levels as close to normal as possible also had less kidney and nerve disease. Better control reduces the need for sightsaving surgery. Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these factors will help your overall health as well as help protect your vision. Symptoms and Detection Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year. Blurred vision may occur when the macula the part of the retina that provides sharp central vision swells from leaking fluid. This condition is called macular edema. If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision. Treatment During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Focal laser treatment stabilizes vision. In fact, focal laser treatment may reduce the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss. Both focal and scatter laser treatment are performed in your doctor’s office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort. The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that may be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses. For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment. Laser surgery & appropriate followup care can reduce the risk of blindness by 90%. However laser surgery often cannot restore vision already lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss. Low Vision Services If you have lost some sight from diabetic retinopathy, ask your eye doctor about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services. Eye Clinic provides comprehensive eye care services and complete ophthalmic care including cataract, laser, refractive, lid and minor eye surgeries.
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