Conditions We Treat
Glaucoma
Glaucoma is a group of related diseases that damage the optic nerve, resulting in vision loss and possible blindness. Glaucoma, a leading cause of blindness and visual impairment in the United States, can affect patients of all ages. Many people affected with glaucoma do not experience any symptoms and may not be aware that they have the disease until they have lost a significant amount of vision. With early detection and treatment, however, eyes can be protected against the serious loss of vision or blindness. Catching glaucoma at an early, treatable stage is one important reason to have thorough eye examinations regularly.
Treatment of Glaucoma
There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage. Some of the treatment methods for glaucoma are as follows:
- Medication
Eye drops or oral medication may be used to either reduce fluid production in the front of the eye or to help drain excess fluid. Side effects of the medication may result in redness, stinging, irritation or blurred vision. Regular use of the medication is needed to keep the eye pressure under control. - Laser Surgery
Trabeculoplasty, iridotomy or cyclophotocoagulation are laser procedures that aim to increase the outflow of fluid from the eye or eliminate fluid blockages. - Other Surgery
A trabeculectomy may be used to create a new channel to drain fluid from the eye and reduce the pressure that causes glaucoma. Surgery is performed only after medication and laser procedures have been unsuccessful.
While patients with early stage glaucoma may not experience any symptoms, prompt treatment is required to preserve their vision.
Hyperopia
Hyperopia, also known as farsightedness, is a condition of the eyes in which distant objects appear in clearer focus than do objects closer to the eye. As a result, nearby objects appear blurry. The eye is designed to focus images directly on the surface of the retina; with hyperopia, light rays focus behind the surface of the retina, producing a blurred image. Hyperopia occurs if the eyeball is abnormally short, the cornea has too little curvature, or the lens is situated too far back in the eye.
In addition to the anatomical causes mentioned, farsightedness may be hereditary or may be the result of certain eye diseases, such as retinopathy or eye tumors. It may also be caused by weakened focusing power.
Treatment of Hyperopia
For a great many people who are farsighted, the condition does not present any real problem since they are able to adjust their focus well enough to function without difficulty. In more severe cases, however, prescribed corrective lenses, worn as eyeglasses or contact lenses, may be necessary. For farsighted individuals, prescribed corrective eyeglasses are normally worn only for reading or other close work. Most people with the condition require prescription lenses as they get older, since hyperopia worsens during the aging process.
Surgery is also a treatment option for patients with hyperopia. In mild cases, surgical procedures to reshape the cornea may be performed. Two common ones are LASIK (laser-assisted in situ keratomileusis) and PRK (photorefractive keratectomy). When the farsightedness is severe, the lens of the eye can be replaced with an implanted lens.
Myopia
Myopia, or nearsightedness, is a vision condition affecting nearly a third of people in the United States. The eye focuses properly on nearby objects, while distant objects appear blurry. This imbalance typically occurs either because the eye has an oblong shape (astigmatism) or the cornea is excessively curved, so that only some of the light entering the eye focuses on the retina.
Nearsightedness may be hereditary, and it may also be caused or exacerbated by frequent close-vision work such as reading. The most telling symptom is difficulty seeing objects in the distance, for example a chalkboard or television screen. Nearsightedness usually develops before the age of 20.
Eye exams test the degree of nearsightedness so your optometrist can prescribe glasses or contact lenses, which help to properly bend light entering the eye. Other procedures – refractive or laser surgery, or orthokeratology (non-invasive corrective contact lenses) – may also be helpful.
Treatment of Myopia
Myopia is typically a common and easily treated visual disturbance. Patients are prescribed corrective lenses, eyeglasses or contact lenses, either of which shift the focus of light directly onto the retina so that a clearer image is perceived. Depending on the patient’s vision, corrective lenses will have to be worn during all waking hours, or only for certain activities, such as driving.
It is also possible to have surgery to correct myopia, which, in many cases, negates the need for corrective lenses. The most common surgical procedure performed to correct myopia is LASIK, during which an excimer laser is used to reshape the cornea.
Keratoconus
Keratoconus is the gradual thinning and outward bulging of the cornea into a cone shape. This progressive eye condition usually affects both eyes by thinning the corneas from that of a normal rounded dome-shape into one that has a cone-shaped bulge. The cornea is the clear, central part of the surface of the eye. In those patients with keratoconus, the cone-shaped cornea deflects light and causes distorted vision.
Treatment for Keratoconus
In the early stages of keratoconus, glasses or soft contact lenses may help to correct the nearsightedness and associated astigmatism. As the condition progresses and the cornea becomes thinner, more advanced treatment is required.
- Rigid Gas Permeable (RGP) Contact Lenses
If eyeglasses or regular soft contact lenses cannot control keratoconus, rigid gas-permeable contact lenses are usually the preferred treatment. The rigid lens covers the cornea, replacing the cornea’s irregular shape with a smooth, uniform refracting surface, improving vision. RGP lenses can be less comfortable to wear than soft lenses and fitting contact lenses on a cornea with keratoconus can be a challenge. Frequent doctor visits may be necessary to fine-tune the fit and prescription of RGP lenses, especially if keratoconus continues to progress. - Intacs® Corneal Implants
Intacs are small implantable rings inserted into the mid-layer of the cornea to flatten it, changing the shape and location of the cone. Intacs may be needed when the distorted vision from keratoconus can no longer be corrected with contact lenses or eyeglasses. The implants are able to be removed and exchanged as needed. Intacs can only delay the need for a corneal transplant, not prevent it, if the keratoconus continues to progress. - Collagen Cross-Linking
Collagen cross-linking is a relatively new method for treating keratoconus. It works by strengthening the corneal tissue to stop it from bulging. In this procedure, eye drops containing riboflavin (vitamin B2) are applied to the cornea and then activated by ultraviolet light. This strengthens the collagen fibers within the cornea. - Corneal Transplant Surgery
A corneal transplant may be recommended for patients with advanced keratoconus, when other treatment methods fail to provide clear vision. This occurs in 10-20% of patients with keratoconus. In corneal transplant surgery, the diseased cornea is removed and replaced with a donor cornea. Healing can take up to a year with a low rate of rejection.
Presbyopia
Presbyopia is a visual problem of middle age, a normal part of the aging process, during which the eyes gradually lose the ability to focus at a close range. It occurs when the lens of the eye loses its flexibility, causing objects that are near to appear blurry. Symptoms take years to develop and most patients begin to show signs of presbyopia in their early-to-mid 40s. Typically, the condition worsens until about age 65. Presbyopia is diagnosed with a routine eye examination and can be treated with corrective lenses or surgery.
Treatment of Presbyopia
Treatment of presbyopia is designed to help patients focus clearly on nearby objects. This can be accomplished nonsurgically or with a surgical procedure.
Nonsurgical Correction of Presbyopia
Presbyopia can be easily addressed by getting one of the following types of corrective lenses:
- Reading glasses
- Bifocal or trifocal eyeglasses
- Progressive eyeglasses
- Multifocal contact lenses
- Monovision contact lenses
Corrective eyeglasses are available over-the-counter for simple, more minor corrections: from 1.00 diopter to 3.00 diopter. Patients who require greater correction for near vision, or who also have farsightedness or astigmatism, will require prescription lenses. Monovision contact lenses, to which most, but not all, patients can adjust, correct for distance vision in one eye and close vision in the other.
Surgical Correction of Presbyopia
There are several methods to treat presbyopia with surgery. These include:
- Refractive surgery, such as keratoplasty (CK) or laser surgery
- Intraocular lens implants or IOLs
- Corneal inlays
Patients should be aware that any surgical procedure carries some risk and that most eye surgeries are not reversible.
Presbyopia is part of the normal aging process and, though at times troublesome and annoying, can fortunately be effectively treated in a number of ways.
Pterygium
A pterygium is a painless, non-cancerous growth of the conjunctiva, the lining that covers the white part of the eye. The pterygium may grow on the cornea, which covers the iris, the colored part of the eye. A pterygium usually begins at the nasal side of the eye and can be different colors, including red, pink, white, yellow or gray.
Patients with pterygium often first notice the condition because of the appearance of a lesion on their eye or because of dry, itchy irritation, tearing or redness. Pterygium is initially noticed when it is confined only to the conjunctiva. At this stage of development it is called a pinguecula. As it extends to the cornea it is termed a pterygium and can eventually lead to impaired vision.
Pterygium is diagnosed after a thorough medical examination of the eyes. A slit-lamp examination will allow the physician to examine the cornea, iris and lens to confirm diagnosis.
Surgical Treatment of Pterygium
In most mild cases of pterygium, artificial tears can be used to reduce dryness and irritation. For those patients with severe cases of pterygium and whose vision has been affected, different types of surgery are available. Surgery is the only way to definitively remove a pterygium, but it is not a perfect solution; it requires long-term follow-up, and the recurrence rate is between 30 to 40 percent.
- Autologous Conjunctival Auto-Grafting
A safe and effective technique to surgically remove a pterygium is autologous conjunctival auto-grafting. The pterygium is removed as well as the tissue covering the conjunctiva. The tissue that is removed from the sclera is replaced by tissue that has been removed from the inside of the patient’s upper eyelid. - Amniotic Membrane Transplantation
Amniotic membrane transplantation is another safe and effective procedure to remove a pterygium. Donor tissue from an inner layer of the human placenta is used to reconstruct the surface of the eye. This type of graft encourages healing and reduces swelling.
