Saving Vision - Helping people see clearly
What is Glaucoma?
Medical Treatment of Glaucoma
Laser Treatment of Glaucoma Primary Open Angle Glaucoma, the most common type of glaucoma, is treated with laser to stretch open the collapsed pores in the patient's natural drainage channel. A treatment called Argon Laser Trabeculoplasty may be performed once or twice to achieve the desired pressure lowering effect. The treatment is done in the office. Anesthetic eyedrops are instilled prior to the procedure that only takes a few minutes. There are no restrictions of activity after the treatment. Another kind of laser treatment called Diode Laser Cyclocoagulation may be used in difficult cases of glaucoma as an alternative to, or following surgery. It works by coagulating or cauterizing the glands in the eye that make the eye fluid. Anesthesia is typically achieved by the local injection of anesthetic beneath the eye. A patch is placed on the eye before the patient leaves for home. There are no restrictions of activity after the treatment.
Surgical Treatment of Glaucoma Glaucoma surgery is done in the outpatient surgery center. It is usually not necessary to put the patient to sleep. Sedation is given and anesthesia is typically achieved by the local injection of anesthetic beneath the eye. When the surgery is completed, a patch is placed on the eye. The patient leaves for home after a short stay in the recovery room.
What are Cataracts?
Surgical Treatment of Cataracts The operation, Small Incision Cataract Surgery, is done through a small opening in the cornea with a Phacoemulsification (high-speed ultrasound) instrument. An Intraocular Lens Implant is inserted into the eye. The patient leaves for home after a short stay in the recovery room. AVC surgeons perform state of the art surgery with either a Standard Lens Implant, which is covered by the usual insurance carriers or with various types of Premium Lenses, which require additional cost to the patient.
There are advantages and disadvantages to all types of implantable lenses, standard or premium; please discuss this further with our AVC surgeons.
Laser Treatment of Cataract
Surgical Treatment of Glaucoma with Cataract
What is the Retina?
What is the vitreous?
The most common diseases or symptoms of the retina and vitreous that we regularly evaluate and/or treat.
We offer a full spectrum of in office treatment
Floaters and Flashes The vitreous is a viscous fluid that is slowly moving inside the eye when the eyes move. It sometimes becomes adherent to the retina or optic nerve and causes sensation on light flashes when it gives small tugs on these areas. Floaters occur when there are cells or other particles floating in the vitreous. They may be due to inflammatory diseases, broken blood vessels or just minor strands of vitreous causing shadows on the retina. There is no pain or redness and most floaters are no threat to vision. Serious vision threatening disorders may also be accompanied by a shower of dark spots or cobwebs. There may be a retinal tear or detachment. There could be a vascular disorder or ocular inflammation. These require retinal examination and to prevent serious loss of vision. Diagnosis and Treatment Retinal examination requires careful inspection of the entire eye. Eye drops are needed to dilate the pupils so that we can see the far peripheral areas of the retina with special optical instruments. Various lights, microscopes and even cameras are utilized to diagnose retinal disorders. When the retina is obscured by dense hemorrhage in the vitreous we use ultrasound techniques to detect retinal or choroidal disorders. A surgical technique, Pars Plana Vitrectomy, has been used since the early 70s to correct vitreo-retinal disorders. Posterior Vitreous Detachment The vitreous is a rather rubbery substance that fills the eye in infancy. As we get older the vitreous gradually becomes more watery and actually separates from the retinal surface in older age. Generally this separation causes no problems. Occasionally there is a shower of black spots in the vision when the vitreous separates. The spots generally clear spontaneously. A retinal tear may be caused by vitreous separation in rare cases. Early diagnosis of a retinal tear allows us to prevent a retinal detachment by treating the tear with laser in the office. Age Related Macular Degeneration – dry (non-exudative) & wet (exudative) Macular degeneration is a condition that causes loss of central vision due to retinal deterioration. It most commonly occurs in 60 to 80 year olds but there are several kinds of the disorder and some may even start in the teen-age years. The most common type we see is Age Related Macular Degeneration (ARMD). This is divided into the "Dry" type and "Wet" or exudative ARMD. There is a lot of research in progress but currently we are only able to treat the "Wet" type. Vitamins and Zinc seem to help to delay the onset of ARMD but they do not correct the visual loss in those already affected. Luckily, the peripheral vision is not lost in ARMD and so many patients utilize magnifiers and other devices to improve the partial vision that always remains. Many of our ARMD patients have been helped with new intravitreal injections of medications that slow or stop the deterioration of central vision. The list of treatments now includes Visudyne laser, Macugen, Kenalog, Lucentis and Avastin as well as several adjuncts and combinations of treatment regimens. Diagnosis and Treatment Evaluation for macular degeneration requires a thorough eye exam with dilated pupils in order to see the entire retina. Optical instruments, various cameras and digital imaging devices help to determine if there is any sign of macular degeneration. These also help to determine the type and treatment possibilities. Several treatment methods have been approved for use by the FDA and other experimental methods may also be available. At first (in the 60s) we had no treatment modalities. Then we started to use Xenon arc, Argon and Krypton lasers. Later we worked with Tunable Dye lasers and the Visudyne Laser. Intravitreal injections with Macugen, Avastin, Kenalog or Lucentis are currently the most common method of treatment for the Wet type of macular degeneration. We feel that anti oxidant vitamins and ultraviolet blocking sunglasses are also preventive. Diabetic Retinopathy – Diabetic Macular Edema, Background Diabetic Retinopathy, and Proliferative Diabetic Retinopathy Diabetic retinopathy is a vascular disorder of the retina that develops in diabetic patients. It seems to occur after 5 to 10 years of reasonable but not "perfect" blood sugar control. The first abnormality to become apparent in diabetics is background disease. We see dots and blots of blood in the retinas and microaneurysms. This may progress without treatment over the years and result in diabetic macular edema. Central vision is compromised and laser treatment may be needed. Laser has been shown to be 90% effective in preventing severe visual loss. Without appropriate laser treatment we may begin to see proliferative diabetic retinopathy with the growth of abnormal retinal vessels and fibrous membranes. These go on to major visual loss by causing traction retinal detachments and vitreous hemorrhage. Laser treatment must be applied before these defects develop in order to protect vision. Vitreous surgery is done when hemorrhage fails to clear spontaneously or when retinal detachment is present. Diagnosis and Treatment Diabetic retinopathy is picked up with a careful dilated retinal examination. Special retinal photographs also help to show these abnormalities but hands on examination is needed to really see all of the retinal pathology. Argon laser treatment has been the best method of prevention of visual loss since the early 70s. These 10 minute office treatments may need to be repeated several times over the years but the results are quite successful. Retinal Vascular Disease – Hypertensive Retinopathy, Retinal Artery Occlusion, and Retinal Vein Occlusion The retina is unique since each one is supplied by a single artery and single vein. There are major and minor branches of these vessels on the retinal surface. If the artery becomes occluded all vision is lost on that side. If only the vein becomes closed there is still a possibility of reopening the venous circulation with treatment. Sometimes a small branch of a vessel closes and there is a small visual field defect but normal vision elsewhere. General medical disorders such as high blood pressure, diabetes, blood clotting defects and Arteriosclerosis may cause vascular occlusions in the retina. Diagnosis and Treatment Vascular disorders of the retina are easily diagnosed by examining the retinas through dilated pupils. The retinal vessels are all in full view on the retinal surface. Optical instruments and specialized camera equipment can readily detect these obstructions. Treatment generally consists of laser treatment or intravitreal injection. Sometimes systemic medications are also used to help improve the circulation. Retinal Tears and Retinal Detachment Retinal tears are usually occur at locations where the vitreous is adherent to the retina. This may be accompanied by a shower of floaters and flashes. If the tear is left untreated there is a possibility that the retina may start to detach. This results in a shadow blocking a portion of the peripheral vision. If this is left to progress, the entire retina may detach resulting in total loss of visual field. Treatment Retinal holes are treated in the office with cryo or laser. These procedures each work to seal the retinal hole and prevent detachment. The procedure is done with eye drop anesthesia and takes only a few minutes. This is a preventive procedure designed to avoid more major surgery to repair a retinal detachment. Macular Holes The very center of the retina is called the macula. It is responsible for clear, sharp central vision. In very rare instances a thinning of the retina develops in this area and results in a Macular Hole. This causes a loss of the center of vision. There is no pain or redness. The central area of vision becomes distorted and may have a missing spot resulting in poor reading vision. Diagnosis and Treatment Macular holes are discovered with a dilated retinal exam. The pattern is easily detected with optical instruments and confirmed with specialized testing such as OCT. Treatment was impossible until several years ago when it was discovered that pars plana vitrectomy surgery and the use of an intravitreal gas bubble could repair almost all of these holes. This process requires face down positioning post operatively but the results are gratifying. Other inherited or acquired disorders There are hereditary retinal abnormalities that are detected with retinal examination. Several types of macular degeneration and types of color blindness may be present in the first 20 years of life. Angioid streaks, colobomas, optic nerve disorders and certain inflammatory diseases are first detected on a retinal exam. Diagnosis As with most retinal disorders, a careful complete ophthalmic exam with dilated pupils is needed to pick up esoteric diseases that have retinal findings. The use of optical and electronic apparatus assists in making the diagnosis. |
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Glaucoma is the term given to a variety of diseases that cause weakening of the optic nerve. In most cases the damage is related to an abnormally high fluid pressure in the eye. Glaucoma is actually a number of disorders categorized by whether the drainage channel (angle) in the eye is obstructed (Primary or Secondary Angle Closure Glaucoma) or is not obstructed (Primary or Secondary Open Angle Glaucoma). Treatment with medication, laser or surgery is designed to save vision by reducing the eye pressure.
In most senior adults, cataract (a clouding of the transparent lens of the eye) is a result of the natural aging process and is not an acquired disease. Symptoms of cataract include blurred or distorted vision, dim vision, loss of contrast, decreased color perception and glare. As other eye diseases may cause some of the same symptoms, a careful eye exam must be done to look for other problems. Cataract formation may be increased or caused by exposure to ultraviolet light, some medications, other medical or eye diseases, or injuries. Wearing sunglasses outdoors is helpful in slowing absorption of ultraviolet light. Currently, there is no non-surgical medical treatment to remove cataracts. Surgery is usually only recommended when the disturbance in vision is causing difficulty in the patient's daily activities. Many patients elect to have surgery when they have trouble reading, driving (particularly at night), performing their jobs or engaging in sports or hobbies.
The Retina is the innermost lining of the eye. It is the light sensitive structure that is responsible for vision. The Retina receives images from the outside world and sends them to the brain. The Retina is composed of specialized cells and nerves that detect color as well as shades of gray. The Retina is supplied with blood vessels and is supported by other layers of the eye such as the choroid and sclera. All elements of the Retina must work properly to produce normal visual acuity.
Just adjacent to the retina inside the eye is a viscous substance called the Vitreous. It fills the entire space from the retina to the lens. It is normally crystal clear and is usually innocuous. There are, however, conditions which may lead to loss of vision and Vitreous surgery may be needed. It can be removed with surgery to clear Vitreous Hemorrhage due to Diabetic Retinopathy or to repair Retinal Detachments. Once removed, the Vitreous never reforms. The interior of the eye has another fluid, the Aqueous, which is constantly forming to maintain normal intraocular pressure. This watery fluid fills the Vitreous space and the eye continues to have good vision.
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