Patient Education

Cataracts

A cataract develops when the natural lens of the eye becomes cloudy, and is mostly due to exposure of the eye to ultraviolet radiation throughout life. Typically, cataracts affect people over the age of 50. However a cataract can occur at any age, and can also be inherited (genetic). A congenital cataract occurs when a baby is born with a cataract because of an inherited defect or infection within the womb.

Cataract surgery is performed when eyesight is impaired to the point where the patient has some difficulty doing daily tasks, like driving or reading. In children, it is important that surgery is performed as soon as possible to prevent permanent loss of vision. It is best to perform the surgery before the cataract is too dense, or this makes the procedure more difficult and lengthy. A special type of ultrasound known as phacoemulsification is used to break up the cataract into smaller pieces that are easily removed from the eye. The cataract is replaced with an artificial intraocular lens implant made out of silicone or acrylic.

The entire cataract and implant procedure is done through a small incision in the outer surface of the eye within minutes, often without the need for sutures. The patient is given mild intravenous sedation during the surgery and it only takes a few anesthetic drops to numb the eye. The surgery is painless and the eye does not have to be patched after the procedure. If the other eye has a cataract, then it is prudent to wait several weeks to consider surgery on the second eye.

In addition to the benefit of improved vision, the patient will also be less dependent on their glasses following cataract surgery. The intraocular lens implant is calculated prior to the procedure, therefore reducing the need for a distance vision prescription in the new glasses. Most postoperative patients rely on their new glasses mostly for near reading vision. For patients with astigmatism (irregular curvature of the corneal surface) the surgeon can correct this at the time of the procedure with a Limbal Relaxing Incision or a Toric intraocular implant lens.

Cataract surgery has undergone many advances over the last 20 years. It is a much faster and safer procedure than it was before, and visual recovery is rapid. Most patients see an improvement in their eyesight within a few hours after surgery. Eye drops that reduce inflammation and prevent infection are prescribed to be taken a few times a day for 4-5 weeks postoperatively. The new, clear artificial lens implant is permanent, and will never turn into a cataract. In about 80% of all patients that have cataract surgery, a simple laser procedure is required if a scar tissue film develops behind the lens implant. The scar tissue (also known as a secondary cataract) can occur almost immediately after the surgery, or months to years later. The buildup of this scar tissue is part of the normal healing response of the eye, and once cleared away with the laser, it will never return.

New 'Multi-Focal' implant lenses are now available that have significantly decreased the individual's need for reading glasses after cataract surgery. Many patients relied heavily on reading glasses after cataract removal in the past, but are now enjoying the freedom of being glasses free. Our patients have enjoyed great success with the Restor® and Rezoom™ and Crystalens® multi-focal implant lenses. For more information on these new lenses, click below: (Link to multifocals)

Glaucoma and Treatment

Glaucoma is a disease of the eye characterized by damage to the optic nerve due to an elevated intraocular pressure. It is traditionally diagnosed by the combination of three major tests: intraocular pressure measurement (tonometry), evaluation of the appearance of the optic nerve during the dilated eye exam, and visual field testing (perimetry). In the primary form of glaucoma, open angle glaucoma, there is a higher than normal intraocular pressure. This elevation leads to damage of the nerve fiber layer of the retina that collects to form the optic nerve. An optic nerve affected by glaucoma will show "cupping" or extreme loss of nerve fiber tissue. A visual field test would then reveal some loss of peripheral or side vision. Fortunately, there are several medical and surgical therapies for glaucoma that successfully lower intraocular pressure and ultimately save vision in affected patients. The key to effective glaucoma treatment is early diagnosis.

In addition to the measurement of corneal thickness and the use of a Humphrey Visual Field machine, we are now proud to add Optical Coherence Tomography (OCT) to the list of testing machines in our practice. The OCT is the latest diagnostic technique available to monitor the nerve fiber layer of the retina and the optic nerve. Using a scanning laser, the OCT is able to give our doctors both quantitative and qualitative data about the possible loss of nerve tissue and optic nerve damage. Studies have shown that up to 50% of nerve fiber must be lost before a visual field defect is noted on a visual field test. By utilizing baseline and yearly scans with the OCT, we are now able to monitor for and address any small changes to the eye before further damage transpires.

In the treatment options for glaucoma, most first line therapies involve the use of eye drops to lower the intraocular pressure in the eyes. If drops have proven over time not to be adequate in the maintenance of a low pressure, we offer many state-of-the-art laser and surgical options to treat glaucoma. In consultation with our doctors, if a procedure is decided upon, you may be offered one of the following techniques:

• Selective Laser Trabeculoplasty (SLT): For uncontrolled pressures in open-angle glaucoma; a laser technique that works on the drainage filter in the eye to reduce fluid outflow resistance and lower intraocular pressure.
  
• Laser Peripheral Iridotomy (LPI): For narrow-angle glaucoma; a small opening in the iris is created with a laser to prevent a sudden increase in pressure in the eye (acute closed angle glaucoma).
  
• Endoscopic Cyclophotocoagulation (ECP): For both open and narrow angle glaucoma; an intraocular laser procedure that focuses on the part of the eye that creates the fluid. Treatment reduces fluid production that in turn, reduces intraocular pressure.
  
• Mini-Express Tube Shunt Implantation: The implantation of a small drainage tube to increase the outflow of the eye fluid and maintain a low intraocular pressure.

Macular Degeneration

For patients over 65, macular degeneration is the single greatest cause of vision loss and blindness in the U.S. The disease process attacks the retina in a specific location known as the macula, where your sharpest central vision is located. There are two forms of macular degeneration, a dry and a wet form.

In the dry form of macular degeneration, the pigmented cells beneath the retina accumulate waste products, clump together, and lose the ability to support the cells on the surface of the retina. The retina overlying the damaged pigmented cells then dies off. Patients with mild, or 'dry' macular degeneration sometimes describe a fuzzy spot in the center of their vision. In advanced macular degeneration however, there may be a central blind spot and distortion of the central vision, though peripheral vision typically is unaffected. Treatment of dry macular degeneration often involves high dose antioxidant vitamins, which have been proven to slow the progression of the dry form to the wet form.

In some cases, small blood vessels can grow in the clumping pigmented cells beneath the retina. These blood vessels are weaker than normal vessels and can easily break or leak fluid resulting in sometimes devastating vision loss. This is the 'wet form' of macular degeneration. Wet macular degeneration may be treated with state-of-the-art photodynamic therapy (PDT) laser or the latest proven medications, Avastin and Lucentis. Avastin and Lucentis work within the eye to specifically target the chemical messengers that create the weak and leaky blood vessels. By blocking the messengers, the leakage of the damaged vessels is decreased and vision can be increased.

Diabetes and the Eye

Any patient being treated for diabetes by a primary care physician should be seen on a yearly basis for a dilated ocular health exam. Diabetes and fluctuating blood sugars can negatively effect the front and back of your eye, causing prescription changes, cataracts, and retinal disease.

In diabetic eye disease, the normally stable retinal blood vessels develop leaks, allowing fluid or blood to accumulate in the retina. Bleeding or leaking of fluid may cause retinal swelling, keeping the retina from working properly. Patients describe blurry and distorted vision when fluid begins to leak. This macular edema often responds dramatically to steroid injections, medicines Avastin or Lucentis, or even 'focal' laser treatments by our retina specialist. Diabetes can also cause the small blood vessels to become obstructed. Blockage of blood vessels leaves areas of the retina starving for blood, which is carrying oxygen and nutrients. The impaired retina sends out chemical signals to promote new blood vessel growth. These new blood vessels are much weaker than normal vessels and frequently leak or bleed.

At Total Eye Care & Cosmetic Laser Centers, we use the latest in technology to treat all degrees of diabetic retinal disease. Using specialized lasers or medications we can decrease inflammation and fluid accumulation and can decrease or eliminate the new vessel growth.

'Flashes and Floaters': Vitreous/Retinal Detachment

The eye is filled with a jelly-like material called vitreous that shrinks and condenses over our lifetime and can pull away from its attachment at the retina. Once free, the jelly can float freely in our vision (noted by many as 'floating spots'). This is a normal occurrence that happens with advancing age and usually has no adverse consequences. The vitreous, while pulling away from the retina, is sometimes noticed by the patient as 'flashing lights' in the vision.

In some cases, as the jelly pulls away from the retina, a small tear can develop. This tear (not noticed/known by the patient) can begin to spread and separate from the retina and turn into a visually devastating retinal detachment.

Retinal Detachments are serious occurrences that can happen to an eye for various reasons. They can be caused by trauma, high nearsightedness, vitreous detachments, and other retinal pathology. Retinal detachments can begin as dramatic as a loss of vision, resembling a curtain moving over the eye, or as subtle as flashing lights and/or floating spots. Because retinal detachments often lead to blindness if not treated, it is imperative with the onset of any new flashing lights or floating spots, to be seen immediately in our office to make sure the simple vitreous detachment did not tear the retina.

Treatment of retinal detachments may involve a laser, gas bubble in the eye, a band around the eye, and/or removal of the vitreous gel that fills the back of the eye.

Dry Eyes and Tearing

One of the most common conditions seen in our office is dry eyes and tearing. Gritty, burning, red, watery eyes, sometimes with eye pain, are some of the symptoms that our patients experience. These symptoms represent the imbalance in both the quantity and quality of tears. Even though many patients feel their eyes are excessively 'watery' or producing extra tears, this is in fact one of the primary indicators of dry eyes. The level of moisture in our eyes and the stability of the tear film is essential in good ocular health and in the quality of vision. If any part of the tear film is disrupted or lacking, vision can be mildly to severely affected. The causes of dry eye are numerous but may include aging, systemic disease, medications, environmental conditions, computer use, and contact lens wear.

The treatments for dry eye include replacing and replenishing the tear film, decreasing the drainage of the tears so that they can bathe the eye longer, and decreasing any causes of inflammation that can aggravate the condition. Our doctors may suggest artificial tear replacement, small plugs that can be placed (without any pain) in the drainage channels to keep tears around longer, and/or Restasis and other newer medications to treat the underlying inflammation and create more tears.

'Pink Eye'

The term 'Pink Eye' is used to describe a type of conjunctivitis. The conjunctiva is the outermost layer of the eye and is inflamed in this condition. There are many types of conjunctivitis but the most common causes are allergic, viral, and bacterial. The different forms of conjunctivitis require different approaches to treat them.

Allergic conjunctivitis is typified by an, 'itchy' feeling and is prevalent in our patient population with allergies. Symptoms may be seasonal with fluctuations in their severity over certain months.

Viral conjunctivitis is very common, especially in children. Viral conjunctivitis is usually associated with a recent cold or flu or sore throat. Supportive therapy and artificial tears are a common treatment.

Bacterial conjunctivitis is caused by various bacteria strains such as staphylococcus and streptococcus. The severity of the infection depends on the type of bacteria involved, and the treatment will vary accordingly.

For the latter two types of conjunctivitis, it is important to note that they are very contagious and caution of transmission should be taken. Washing hands, disinfecting surfaces, keeping your hands away from your eyes and face, and not sharing items such as towels, hats or, glasses, are all ways to decrease the chance of spreading the infection.

Pediatric Eye Care

At Total Eye Care & Cosmetic Laser Centers, our lifelong commitment to healthy vision starts at a young age with your child's eyes. The importance of yearly ocular health exams should begin early to insure your child's every opportunity to learn and grow normally with no visual limitations.

Between the ages of 2 or 3, toddlers should be seen by one of our experienced physicians for his or her first thorough eye examination. If your child shows signs of a problem earlier than age two, our pediatric ophthalmologist Dr. Judith B. Lavrich, specializes and treats all eye conditions in infants and children. During an exam your child will be checked for eye muscle imbalance, eye health, neurological health, and also unequal or high amounts of nearsighted, farsighted, and/or astigmatism. It is important to identify these children at a young age, as vision development and eye health problems can be more easily corrected if treatment is begun early.

With an estimated 80% of learning accomplished through vision, all children should have their visual system assessed before the first day of school. There are many signs that may indicate a vision problem including a short attention span for the child's age, difficulty with hand-eye coordination, avoidance of coloring and puzzles and other detailed activities. The ability to read can be affected by a variety of vision disorders including the need for glasses, muscle imbalances and focusing abnormalities. At your child's eye exam, all of these conditions will be evaluated. Early detection and treatment of these problems can prevent learning disorders and delays.

Strabismus, or misalignment of the eyes, is a common condition encountered in the pediatric population, affecting approximately 4% of children younger than 6 years of age. It is an important ocular disorder that can disable sight in one eye and have significant ocular effects. Early detection and treatment of strabismus is essential to prevent permanent visual impairment. Of children with strabismus, 30% to 50% will develop secondary visual loss, or amblyopia. Restoration of proper alignment of the visual axis must occur at an early stage of visual development to allow these children a chance to develop normal binocular vision.

Amblyopia occurs in 1 of every 50 children. This disorder, commonly known as 'lazy eye,' is loss of vision due the child's brain turning off visual development. Amblyopia can result from misalignment of the eyes, the need for glasses, or cataracts which block light rays from entering the eye. Depending on the type and cause of amblyopia, vision can be improved with early treatment. Patching of the good eye, to force the brain to use the bad eye, and glasses are the most common treatments for this condition.

Tearing disorders are a common occurrence in children. Approximately 5% of all infants suffer from a tear duct blockage, which can present with the tears welling up in the eyelid margins and pouring down over the cheeks. Frequent eye infections with yellow or greenish discharge are also common. Properly diagnosed, Dr. Lavrich can institute a plan to treat the infection, increase tear drainage, and unblock any obstructions with simple massages or a gentle probing technique may be performed if necessary.

Vision Therapy

Does your child suffer from eyestrain, headaches, or double vision? Does he/she avoid near work or seem to have difficulty with learning and reading? You or your child's vision problems may not be solved with just a pair of glasses. The problem may lie in the relationship of how your eyes work together and if so, vision therapy may be the answer you've been looking for!

Vision therapy is most successful in correcting convergence insufficiency, a condition in which the eyes have difficulty “crossing” to see a near target. Many children with convergence insufficiency are misdiagnosed by teachers or pediatricians and are labeled with reading and/or attention deficit disorders. By correcting this condition with vision therapy, many children will improve reading ability and attention span. Vision therapy is also useful in correcting many cases of intermittent strabismus, a disorder in which one or both eyes occasionally turns either out or in. In addition, some accommodative (focusing) problems can also be treated with vision therapy.

These conditions can be diagnosed during a full routine eye exam with one of our doctors. At Total Eye Care & Cosmetic Laser Centers, our doctors will assess the need for glasses and the overall health of the eyes as well as the alignment and focusing ability of you or your child's eyes. If the doctor feels your symptoms are related to an eye muscle or focusing problem, vision therapy may be recommended.

Vision therapy involves teaching various exercises to improve the brain's ability to align the eyes, while increasing the brain's ability to focus the eyes. The exercises stimulate the binocular and accommodative systems of our visual pathway to work harder together and overcome the focusing issues that can cause discomfort. By using the natural reflexes in the brain, vision therapy is similar to physical therapy and strengthens the coordination between the brain and eyes allowing them to function better together.

Vision therapy and eye muscle exercises can be very effective at treating symptoms. The exercises our doctors create for your specific plan are completed over a few months time. Many patients notice a decrease in symptoms in less than three months and are able to enjoy a more comfortable lifestyle after only a few training sessions.

Blepharitis

Blepharitis is a common inflammation of the eyelid caused by a chronic bacterial infection of the skin at the base of the eyelashes and lash glands. We all normally have bacteria on our skin and lids, but an excessive collection on the lids can cause blepharitis. The main symptoms you may have with blepharitis are irritation, burning, and itching of the eyelid margins. Scales or 'granulations' can often be seen on the eyelashes, especially around the bases of the lashes. Styes or lumps on the eyelid are common and the eyelids may be sticky and crust together in the morning. Sometimes the eyes become 'red-rimmed' from blepharitis. Vision is usually not affected.

While blepharitis is usually hard to ever completely cure, with regular, diligent care, your blepharitis can be very well controlled. Our doctors may use a regimen of lid scrubs and warm soaks to clean the lids, as well as antibiotic ointment to decrease the bacteria. In severe cases an oral antibiotic may be needed to clear the bacteria from the eyelids and glands.

Keratoconus

Keratoconus is an inherited condition that affects the cornea, or clear front surface of the eye. Over a period of time, the normally round shape of the cornea begins to progressively thin and bulge in a cone-like manner. The result of keratoconus on the eye is a blurring of vision, which is not easily corrected with a glasses prescription.

As the condition progresses, many patients are fit with rigid, or specialty, contact lenses by our contact lens specialist, Dr. Paul Pascarella. These specialty lenses provide many patients with clearer vision than is possible with glasses or regular contacts. The process of fitting specialty lenses on the keratoconic patient can be a difficult one and may require many return visits to fine tune the prescription.

Dr. Pascarella has extensive experience successfully fitting contact lenses on patients with keratoconus.  Using corneal topography and ultrasound pachymetry, an educated correct diagnosis can be made. Dr. Pascarella carries the state-of-the-art technology right into the treatment of keratoconus using the latest lenses and materials available for patients with this condition. He will work with you to achieve your best optical correction to maximize your vision.