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So what's all this talk about laser vision correction?
When we hear the term glaucoma, most of us think of blindness.
Although glaucoma used to be one of the leading causes of preventable blindness, today, with advances in glaucoma treatment, most people can lead normal lives without fear of losing their vision.
The term glaucoma describes a medical condition in which a build up of fluid pressure within the eye causes damage to the optic nerve and ultimately to a person’s vision. Under normal circumstances, a certain amount of clear aqueous fluid is produced throughout the day by a structure known as the cilliary body within the eye. This fluid bathes the inner structures of the eye assuring clear vision. However, in circumstances that are not clearly understood, this fluid fails to escape from the eye through normal channels causing an abnormal build-up of pressure. If left untreated, damage to the sensitive optic nerve can result, leading to loss of vision.
There are very few symptoms from glaucoma. In fact, most people with it have no symptoms at all. As the buildup of fluid pressure continues over a period of time, a reduction of side vision occurs gradually. Usually this can only be detected with a specialized test known as a visual field.
How can you tell if you are at risk for developing glaucoma? Glaucoma can develop in any individual at any age. It is, however, more common in individuals over forty years of age. The single greatest risk factor in developing glaucoma is a family history of glaucoma. Children, and brothers and sisters of people who have glaucoma are at greatest risk.
In addition, individuals who have diabetes, have a history of eye injury, are markedly nearsighted, or take regular treatment with Prednisone are most at risk. Once glaucoma develops, it is usually a life-long condition. It is however, a treatable condition.
There are two major types of glaucoma, the open-angle variety and the closed-angle type. Closed angle glaucoma is distinguished by the sudden build up of pressure with the eye by the mechanical position of the iris or colored part of the eye. The open angle variety is the most common and refers to the gradual build-up of pressure as fluid fails to drain from the eye through normal channels. The treatment for these two types of glaucoma are different. Treatment takes several forms including the use of eye drops to lower the production of fluid or increase its removal from the eye. When eye drops or medications by mouth are not effective in lowering eye pressure, then the Argon laser may be used. Many individuals can reduce the pressure within the eye with a single laser treatment and may decrease the need for additional eye medications. Finally, if eye pressure fails to respond to either medication or laser treatment, surgery which is directed towards creating a new channel for drainage of fluid from the eye, may be necessary. With the advent of more effective glaucoma medication and the use of laser treatment for glaucoma, surgery is required far less often today than it used to be. New techniques of glaucoma surgery include the procedure known as "non-penetrating trabeculectomy". This technique creates a new channel of fluid drainage without the need for surgical penetration into the eye.
The diagnosis of glaucoma can only be made by a thorough examination of the eye which includes a test for intraocular pressure (tonometry), a measurement of the entire field of vision (perimetry), and a direct examination of the optic nerve to look for signs of damage (fundoscopy). Everyone should be examined for glaucoma as part of a regular eye examination.
The use of computer and its visual display terminals (VDTs) in both the home and the work place is becoming more and more common.
Today few homes and offices are without at least one VDT. Because of the widespread use of VDTs, questions concerning safety and the potential problems they create in the work place are being raised.
What exactly is a VDT? Computer screens are like TV screens. They are basically a glass tube with a phosphorescent coating on the front inside face of the tube.
The back of the tube emits electrons that strike the inside face of the tube creating the image we see.
As a result, electrical reactions create several forms of radiation. Extensive testing of VDTs in both government and private laboratories have led to the development of strict standards in manufacturing.
These tubes are prevented from emitting any harmful ionizing radiation such as X-ray and non-ionizing radiation in such forms as ratio frequencies, ultra-violet, visible of infrared radiation.
In fact, fluorescent lighting produces far greater levels of ultraviolet radiation than that produced by VDTs. Numerous studies have shown that continuous use of VDTs will expose an individual to levels of radiation far below that required to produce cataracts or other eye damage even after a lifetime of exposure.
Why then is there so much concern about working with VDTs? Those who work with a VDT on a daily basis, especially for long periods of time, are most at risk for developing symptoms of eyestrain and irritation. Aching or tiredness of the eyes, difficulty focusing, headaches, red eyes or muscle spasms of the neck or shoulders are among the common irritations.
One of the factors causing this is glare and distorted images on the screen. The contrast of the screen, the difference in brightness of the letters from the background and its color is often far less than is commonly seen with the printed page.
In addition, the VDT screen is often placed too far from the individual to be comfortable. Fluorescent lighting, glare from windows, desk lamps or other sources of light also can create an uncomfortable reading environment.
To minimize the symptoms of VDT eyestrain I suggest you follow these simple rules:
1. Examine the lighting in the room. Position the screen to reduce glare from existing lighting and reduce overall lighting level to allow comfortable viewing of the screen. Eliminate glare with a diffusing screen and adjust brightness and contrast of the letters for maximum visibility.
2. Position the height of the screen and its distance from your eyes as comfortably as possible for maximum viewing.
3. Adjust your chair to allow an easy viewing level without leaning, bending or straining.
4. Take breaks. Even brief periods of looking away from the screen to allow your eyes to relax their focus is important.
5. The use of special spectacles that allow the computer screen to be in focus can be very helpful for many individuals, in particular those who normally wear bifocals. In addition, the use of an anti-reflective coating and special tinting in the lenses can help reduce glare and minimize eyestrain.
6. When looking at the computer screen for long periods of time, many individuals will inadvertently stop blinking. Staring at the screen can easily lead to symptoms of "dry Eye". The itching, burning and watering of the eyes can be alleviated by using non-preserved artificial tear drops frequently while working on the computer. These are available without a prescription from your local pharmacy.
By paying particular attention to each of these points, eyestrain can be reduced or eliminated.
One of the most common symptoms I hear in the practice of ophthalmology is that of spots or floaters in front of the eyes. Everyone experiences these floating spots or specks, which resemble threads or cobwebs. The first impulse is to clean your eyeglasses or rinse your eye; these floaters, however, are not on the surface of the eye, but rather within the eye itself.
The eye is a hollow sphere that is filled with a clear, jello-like material known as the vitreous. We were all born with fine, thread-like floaters within this gelatin; the floaters are remnants of the early development of vessels within the eye.
Each year of our lives, these floaters move, and the gel-like substance within the eye becomes more liquid. As these floaters move behind the natural lens of the eye, light casts a shadow upon the retina, which creates the image of the fleck or spot that floats in front of the vision.
These can be seen more easily when one looks at a bright sky, a white or light background such as a wall or brightly illuminated page. As the eye moves, the floaters may move also, dancing or darting about the page.
Most floaters of this variety are not associated with eye disease and are, in fact, present in each individual and are considered normal. There is no surgical procedure or indication for the removal of these floaters. Usually, they disappear in time and, eventually float out of view.
The appearance of an increased number of floaters, above that which you have normally experienced, may, however, signal the onset of a problem within the eye. The rapid onset of this, in association with flashes of light, usually, suggest that the clear vitreous has separated or detached from the inside wall of the eye.
In a very small percentage of cases, this detachment of the vitreous gel can be associated with a tear or break in the retina leading to bleeding within the eye or retinal detachment. There are other eye diseases, such as infections and inflammatory conditions, where collections of cells accumulate within the vitreous that can create the appearance of floaters.
Again, the important feature that distinguishes these from normal, vitreous floaters are a change in their number or appearance or an association with flashes of light or blurry vision. These situations may require prompt evaluation and treatment to prevent eye damage and visual loss.
Only a thorough examination by an eye specialist can determine if spots or floaters are of the harmless variety or are the beginning of a more serious problem. Symptoms that persist or worsen should always be evaluated.
Most everything that we have ever learning has come to use through our eyes. Because the eyes are such an important part of our life, the loss of vision can be devastating. The brain has therefore attributed a very important role for the eyes. In fact, the eyes are actually part of the brain, connective to it by a network of millions of delicate nerves and blood vessels. And during embryological development, when the human body is forming as an embryo, a tremendous amount of time and energy is devoted to the normal development of the eyes. This process is not completed until after a baby is born.
The human eye is a complex and fascinating system. The eyelids and eyelashes protect the eye from drying out and from foreign material entering the eye. The lacrimal or tear gland, which is located under the upper, outer portion of the eyelid, produces the tears which continuously bathe the eyes with moisture and nutrients. These tears then drain through two small ducts located on the inside corner of the upper and lower eyelids near the nose. With each blink the tears wash away debris and potentially harmful bacteria in the nose. That is why when you cry, or when the wind blows, your nose will run.
The eye is covered with a mucus membrane called the conjunctiva, which covers the inner part of the eyelids and the surface or white of the eye. It is this tissue which becomes red when the eye is inflamed, leaving to the so-called red eye. The outer coating of the eyeball under this membrane is a tough tissue called the sclera.
There are six delicate eye muscles which are connected to the eyeball which in turn allow the eye to move in every direction within the orbit or bony socket in the skull. Central controlling stations in the brain send signals along the nerves to coordinate the movement of the eyes together to allow for rapid eye movement from watching a tennis match to reading a book. Abnormalities in the ability of the eye muscles to keep the eyes straight result in a condition known as strabismus.
The clear, covering of the front of the eye is known as the cornea which is the eye’s window into the world. Eighty-five percent of the focusing power of the eye occurs through this tough, transparent covering. Because the cornea is important in the focusing of light, abnormalities or irregularities in the corneal shape affect the clarity of vision, known as refractive errors. This is the reason people need to wear glasses or contacts. The light then passes through the pupil or opening in the colored part of the eye, the iris.
The color of the iris is determined by the genes inherited from your parents. The more brown pigment or melanin that is formed on it’s surface the darker will be your eye color. Blue-eyed individuals have very little brown pigment on their iris. The iris regulates the amount of light that enters your eye, the pupil getting larger in the dark and smaller in the light.
The light then passes through the crystalline lens within the eye which focuses the image. It is here where a clouding of the crystalline lens, a cataract, can interfere with vision.
The clear vitreous fills the void within the eye’s inner cavity maintaining the eye’s shape and plays a passive role in focusing light onto the retina. Imperfections in the clarity of the vitreous leads to perception of floaters or spots. The retina, acts like the film in a camera recording the image. The central part of the retina, known as the macula, is responsible for detailed vision. Disease or irregularities of the macula, such as macular degeneration an aging process of the retina, can adversely affect vision. Once focused onto the retina, the image is transformed into a message which passes along the optic nerve to the back of the brain where the image is interpreted as what we see. A blockage of blood flow to the brain, known as a stroke, can result in a loss of vision by blocking the transmission of this message.
Over the past several years, there have been remarkable advances in the diagnosis and treatment of eye diseases. Many people, who otherwise would have had to look forward to a lifetime of blindness, can now have their vision restored. Those who wore eyeglasses and contact lenses can now enjoy a lifetime of visual freedom without the hassle of lenses.
The definition of blindness varies from region to region and throughout the world. The World Health Organization describes 65 different definitions of blindness. In the United States, legal blindness is represented by corrected visual acuity of 20/200 or worse in the better eye or less than 20 degrees of visual field remaining in the better seeing eye.
With the creation of the Federal Interstate Highway System, many states adopted a legal standard of 20/40 as a requirement to operate a motor vehicle at highway speeds and be able to read road signs. Visual acuity of 20/50 or worse in the better seeing eye may prevent an individual from obtaining a valid driver’s license.
The four major causes of blindness in this country in order of frequency are: macular degeneration, cataract, glaucoma and diabetic retinopathy. Blindness caused by other diseases occurs much less commonly.
These four major causes of blindness increase with the age of an individual. The average age of individuals with macular degeneration is 70 years; for glaucoma 72 years; for cataracts 69 years; and for diabetic retinopathy, 61 years of age is the average.
In 1972, the National Eye Institute estimated the economic impact of visual disability at $5 billion. The increase in aging of the United States population will certainly create an increased incidence of eye diseases.
In addition to eye diseases seen with increasing frequency in seniors, the need for eyeglasses is quite common. Approximately 40% of the population between the ages of 5 and 20 years require the use of eyeglass correction. Past the age of 40, there is almost a doubling in the need for eyeglasses and by age 65, almost 100% of the population require eyeglasses to see clearly. The cost to society for eyeglasses and contacts alone exceeds 3 billion dollars a year!
The increased incidence of eye disease as aging occurs sets the stage for added risk. So when should you have your eyes examined? Comprehensive medical eye examinations to check for early signs of eye disease and to provide corrective lenses are advised for all individuals when they start school or earlier, if there is a family history of eye disease or if there is difficulty seeing.
All individuals should have eye examinations before the age of 40. By retirement age, yearly exams are indicated. Individuals with eye diseases, visual difficulties or systemic illness such as diabetes, thyroid disease or those who take medication that may affect the eyes, should be examined more frequently. With early diagnosis and treatment, visual loss can now be prevented in many eye diseases which were once considered incurable.
The best way to determine your visual acuity and the health of your eyes is to have a comprehensive eye examination. The three professionals responsible for the health of your eyes are the ophthalmologist, the optometrist and the optician.
The ophthalmologist is a medical doctor (M.D.) who is a graduate of an accredited college of Medicine, having completed at least four years of college and an additional four years of medical education. He or she then completes an internship in a hospital for one year and at least three additional years of specialty medical residency in ophthalmology studying surgery and diseases of the eye and their treatment. An ophthalmologist can examine your eyes, diagnose eye diseases, prescribe drugs, initiate treatment and perform surgery on the eyes.
An optometrist is a doctor of optometry 9O.D.) who has completed college and additional three or four years of training in an accredited college of Optometry. He or she can examine the eyes, prescribe glasses or contacts and can diagnose eye diseases and use eye drops to treat these conditions. They do not perform surgery.
The optician has taken several courses of study in the manufacture, grinding and fitting of eyeglasses. He or she can fit your eyeglasses, but cannot examine the health of the eyes or prescribe treatment for eye diseases.
Together these three "Os" of eye care professionals work to provide you with the best methods of ensuring healthy eyes and clear vision.
The comprehensive eye examination usually takes about one hour. Eye drops will be placed in the eyes for glaucoma testing and to dilate the pupils to allow a more thorough examination of the inner aspect of the eye. It may be helpful during your examination to have a friend or family member with you to drive as your vision may be blurred temporarily after the testing. Bring your present eyeglasses, contacts or your last prescription with you.
The comprehensive eye examination has two parts. The first part is used to gain information from your history as to the health of your eyes, and any preexisting medical conditions.
Bring a list of any medications you may be taking, any allergies you may have and any surgical procedures you may have undergone. A knowledge of your family’s medical history of important especially if there is any predispositions to eye ailments within your family as many conditions can be inherited.
During the first part of your examination your vision will be measured and the proper prescription for your eyewear will be determined (refraction). The prescription will be written in a manner that will allow your optician to properly manufacture the correct lenses for you. The right eye will be designated with the Latin abbreviation O.D. and the left eye as O.S. The power is measured in diopters which is the focal length of the lens represented in meters. The notation will designate the sphere in plus or minus depending upon the power required for each eye. Next, the cylinder will be noted in plus or minus power as the correction for any astigmatism and finally the axis will be designated to tell the optician where to apply the cylinder correction.
For example, an individual with myopia or nearsightedness will require a prescription for a minus power lend, and an individual with hyperopia or farsightedness a plus power lens. The prescription may look like: -3.50 +2.50 X 180, which would represent a myopic correction of three and a half diopters with two diopters of correction for hyperopic astigmatism at one-hundred and eighty degrees.
Next, the action of the pupils will be tested, the eye muscle balance and actions, and an assessment of the side or peripheral vision for each eye. Eye drops will be instilled to allow a special measurement of the eye pressure to test for glaucoma.
In the second part of the examination, eye drops will be used to dilate the pupils to allow a more thorough examination of the interior of the eye. A slit lamp, a powerful microscope with a slight beam of light will be focused by the doctor examining the surface structures and interior of the eye. Additional instruments such as the hand held direct ophthalmoscope or a headlight indirect ophthalmoscope will be utilized to more carefully examine the delicate structures within the eye.
When the doctor has completed the examination, the findings should be explained to you in words that you can understand, especially if any abnormality is uncovered that may require further evaluation and treatment. You should be confident that you have received a thorough eye examination and that all of your questions and concerns have been adequately addressed. At the conclusion of the examination you will receive your eyeglass prescription and any written instructions that you will require. It is best to wear sunglasses when leaving the office and to avoid bright light and reading for several hours until you feel your eyesight has recovered from the temporary effects of the eye drops.
It is said that a lot can be learned by simply looking into someone’s eyes. This is no less true when a medical doctor examines the health of your eyes. This examination can sometimes locate diseases elsewhere in the body such as hypertension or high blood pressure, diabetes, and thyroid disease to mention a few. It is for this reason, that everyone should have a thorough eye examination.
VISUAL ACUITY – WHAT IS 20/20?
What do the numbers that describe your visual acuity actually mean? To enable eye doctors to compare visual acuity between one person and another, a classification had to be established. Vision is measured at a distance of twenty feet from an eye chart. The first number indicates the distance in feet at which your vision is measured, in this case 20. The second number represents the size of the letter which you can clearly identify, measured in feet.
Therefore if your vision is 20/20, you see at 20 feet what the majority of individuals with normal vision see at 20 feet. Poorer vision is indicated by larger second numbers. For example, if your vision is 20/40, you see at twenty feet what an individual with normal vision could clearly identify at 40 feet. This is the minimum requirement for seeing clearly to safely drive a motor vehicle. An individual with 20/200 vision sees a letter at 20 feet which could be identified by an individual with normal vision from 200 feet away. As you can imagine, 20/200 is very poor distance vision and is considered legal blindness. Interestingly, those of us who are nearsighted usually can’t see 20/200 or better without our glasses and therefore are legally blind without glasses for distance!
Many people believe, incorrectly, that poor vision is a natural part of aging. This misconception is fostered by the common observation that reading glasses or bifocals are more likely to be required by those over forty. Millions of us require eyeglasses to see clearly. Those of us who are nearsighted (myopic) require glasses for distance tasks but do not require them for close work such as reading. Farsighted or hyperopic individuals however find that eyeglasses are required when the eye loses its ability to change its focusing power from near to far (presbyopia). This natural process of sclerosis or hardening of the natural lens and an increase in it's size, occurs throughout life so that by the age of forty enough focusing power is lost to require additional help in the form of reading glasses.
Wearing glasses is simply utilizing an appliance to focus an image when our eyes are not capable of doing it on their own. Not wearing glasses does not make the eyes worse, though it may lead to symptoms of eyestrain, such as fatigue when reading, or headaches. Many people consider wearing eyeglasses a handicap or an admission of old age and are resistant to using them.
Although contact lenses are a desirable alternative for many to having to wear eyeglasses, they ultimately do not permanently alter the shape of the cornea or the focusing power of the eye and therefore they neither slow the progression or permanently improve the visual acuity.
When we first start wearing eyeglasses as children, we may need multiple prescription changes. This is because as we grow, so do our eyes, and as our eyes get larger our prescription for lens power will also change. This usually will stabilize when we attain our adult growth. If multiple changes in prescription persist, then most likely an abnormal situation such as progressive high myopia, an abnormal thinning of the eye wall or keratoconus an abnormally steep cornea may exist.
Adult eyeglass prescription changes after years of stability may represent the early signs of cataract or diabetes.
Amblyopia is the inability of an otherwise normal eye to see clearly. The more common causes are eyes not working together as in a crossed eye at birth (strabismus), or one eye having an unequal ability to focus creating a blurred image in that eye that prevents normal visual development. Individuals with amblyopia can usually be treated and the vision of the affected eye improved if the underlying cause is diagnosed early enough in life. The treatment instituted may take the form of eye patching, eyeglasses or surgery to prevent permanent loss of vision. Once permanently affected and left untreated, the amblyopic eye will never see clearly and no surgical treatment to reverse the damage will be possible.
A child is never too young for an eye examination. If there is a family history of eye disease or refractive disorder such as the need to wear glasses, an eye examination by an ophthalmologist or optometrist should be performed before the child starts school and periodically thereafter depending upon the results of the examination. Children’s eyes can be examined at the moment of birth of there is any concern about an eye abnormality.
Absolutely not. All types of misalignments of the eyes must be properly diagnosed and corrected as soon as they are noticed. It is not normal past three months of age, for the eyes to be crossed or for the child to squint to see.
If either parent wears glasses or contact lenses then there is a greater likelihood that their child will also need corrective lenses. Refractive disorders are inherited just like hair color and the color of the iris.
The muscles of the eye are not like muscles elsewhere in the body. The eye muscles do not get stronger or the eye’s ability to see, improve, with eye exercises.
The eye with imperfect focus can see more clearly when the unfocused rays of light are blocked. That is why squinting or looking through a pinhole in a card or using a specially designed lens with holes in it, can allow you to see without eyeglasses. It will not however improve your vision and the use of these lenses for reading or every day activities is not only uncomfortable but quite impractical.
Eyeglass lenses can be tinted in any color. Some tints filter out specific wavelengths of light. Filtering blue light, because so much of our light out of doors is reflected blue from the sky, can seem to increase contrast. It has no special advantages, however, and it is not a good substitute for strong filtering sunglasses with a dark tint and an ultraviolet absorber.
A pterygium is a growth on the outside of the eye. When the growth is small, it is sometimes called a pinguecula. It is not a tumor or malignancy, but rather a response from the eye to an injury to the surface of the cornea (or clear part of the eye through which we see). Most commonly pterygia grow as a result of sun damage to the cornea and the delicate membrane, the conjunctiva, covering the eye. Dry, dusty conditions and outdoors exposure are associated with pterygia. There also is a family tendency for these growths to occur. Commonly called "cowboy cataracts", these growths are not cataracts at all, but are more like a "callous" that covers the inside corner of the eye when exposure to sunlight and dryness result in inflammation and irritation.
Treatment of Pterygia consists of the wearing of sunglasses, particularly with ultraviolet absorber, and the use of artificial tear drops to increase moisture and prevent the irritaion that leads to the development of pterygia. Occasionally the growths can get large enough or grow onto the surface of the cornea interfering with vision. When this occurs, surgical removal of the growth (done with eyedrops by Dr. Kershner under the microscope), can provide relief.
Ophthalmologists have not been able to transplant an entire human eye for obvious reasons. The eye is connected to the brain with millions of delicate nerves and vessels. Unlike the transplantation of the heart, the eye is made up of hundreds of different types of tissues instead of just one, making rejection all but impossible to avoid.
Surgeons are however, able to transplant the clear cornea on the surface of the eye, or the white part of the eye, the sclera. These are single types of tissue and rejection is much easier to prevent. There are also no nerves or vessels to reconnect.
Keratorefractive surgery alters the shape of the cornea to change its ability to focus light. Recent advances in keratorefractive procedures, such as Excimer Laser Photokeratectomy or LASIK, have allowed eye surgeons to correct most forms of nearsightedness, farsightedness and astigmatism with a high probability of success.
Patients often have many questions concerning their type of visual deficit and how these procedures can help them. The following are some of the most commonly asked questions regarding laser vision correction procedures.
You depend on glasses or contacts because light rays entering the eye are focused in front of or behind the retina instead of directly on it, as in a normal eye. The resulting image is blurred.
A normal eye does not require glasses or contacts to see clearly. The nearsighted and farsighted eye is not functionally normal. Consequently, glasses or contacts are necessary for everyday activities such as driving, working, recreation or simply enjoying a view.
Myopia is a medical term which means your eyes focus on close objects, but cannot see more distant objects without the aid of glasses or contacts.
WHAT IS HYPEROPIA OR FARSIGHTEDNESS?
Farsightedness refers to eyes which cannot focus clearly on objects up close but may or may not need glasses or contacts for distance.
In astigmatism, the curvature of the cornea, or the clear part of the eye through which we see, is uneven (not entirely spherical in shape), and light rays are not focused equally in all directions. As a result, a single focus point on the retina is not achieved and distorted vision occurs.
In the myopic eye, the curvature of the cornea (the clear part of the eye where a contact lens would rest) is too steep. In the hyperopic eye, the curvature of the cornea is too flat. This condition causes light rays to focus in front of or behind the retina. If the cornea could be “flattened,” for myopia or "steepened" for hyperopia light rays would focus closer to or directly on the retina. This reduces or eliminates the focussing problem.
Advances in instrumentation and surgical technique now allow surgeons to perform keratorefractive procedures with improved accuracy and predictability. Recent studies have shown that following the procedure, the majority of suitable keratorefractive surgery candidates enjoy 20/40 vision (required to pass a standard driver’s exam) or better without glasses or contact lenses.
A series of painless tests must be performed to determine whether this is an option for you. You should be 21 years of age or older and have:
--Problems with glasses interfering with your occupation or lifestyle.
--An intolerance to contact lenses.
--Have nearsightedness, farsightedness or astigmatism.
--A stable prescription.
--A healthy, disease-free cornea.
You are the only one who decides whether this is right for you. As with any surgical procedure, certain risks are involved of which you must be aware. You must fully understand the procedure, its risks, potential complications and benefits, in order to make an informed decision. That information will be provided to you during your examination.
The actual laser procedure, once underway, takes only five to ten minutes to perform. It is not considered an invasive procedure and no injections are necessary. Drops are placed on the eye and pain is not felt during the procedure. The doctor will then ask you to look into the light of a powerful microscope and small flap of corneal tissue will be created with the microkeratome on the surface of the cornea. No injections, bandages or patches are necessary. After the procedure, have a friend drive you home and rest. Usually, you will be reexamined by the doctor the day following the procedure.
Results depend on several factors such as the degree of refractive error and the healing of the cornea. Most people achieve near-normal or excellent vision without glasses or contacts. Many notice an improvement in vision within twenty-four hours after the treatment.
There have been many advances in the surgical technique and instrumentation used for refractive vision correction. This has resulted in an improved outcome for many patients. The results of these techniques have shown:
--100% of patients will experience a decrease in myopia, hyperopia or astigmatism.
--97% of patients achieve 20/40 vision or better after the procedure.
There are normal post-treatment side-effects. The most common ones include blurred vision, increased sensitivity to light and eye discomfort. These symptoms diminish over the first twenty-four hours.
Freedom from or a reduced need for glasses or contacts can significantly improve the quality of life. Contact us now to proceed.
Visit your ophthalmologist or optometrist for a screening examination to determine if you are a good candidate. Bring your glasses or prescription to the screening. This information will determine if you are nearsighted, farsighted or if you have astigmatism. You can learn more about the procedure, and have the opportunity to talk to people who have had the procedure done.
The exam takes approximately 1-1 ½ hours.
As part of your comprehensive eye examination prior to undergoing this procedure, your correct refraction will be measured, the health of your eyes examined, and a computerized analysis of your cornea performed (topography). This state-of-the-art information provides the doctor with the most accurate measurement of the individual correction needed for each of your eyes. The results of these tests will be discussed with you by the doctor prior to the procedure.
Cataract surgery is one of the oldest known surgical procedures. Writings concerning the treatment of cataracts date back to the Bible, ancient Egyptian papyruses and the writing of Hippocrates. Surprisingly, the actual procedure had changed very little over thousands of years.
Cataracts were once believed to be a film or growth in the eye. The treatment for correction of this growth was to get the obstruction out of the way. This procedure was known as couching. The surgeon, who could be anyone from the local medicine man to the barber would insert a sharp object into the eye and push the clouded lens out of the way. Many famous people throughout history underwent this procedure including the artists Michelangelo, Rembrandt and Renoir.
Fortunately, in the twentieth century modern surgical techniques began to change the nature of cataract surgery. It became a major surgical procedure requiring general anesthesia and a hospital stay. A large incision was placed into the eye with the patient asleep, the cataract surgically removed from the eye, the eye stitched closed and heavily bandaged. Patients were kept at bed rest with their heads sandbagged into position to prevent movement for days at a time. Then when the eye was healed, a very thick pair of eyeglasses were fitted to allow the patient to see once again. The glasses were cumbersome and caused excessive magnification and distortion. Still it was better than going blind from cataracts. This procedure was utilized until the early 1980s.
In 1949, a physician in the British Royal College of Surgeons, Mr. Harold Ridley, was experimenting with the correction of aphakia (the loss of the human lens from cataract surgery) by implanting artificial lenses into animals. As World War II broke out, he treated many fighter pilots whose eyes were injured by shattering plastic from the windshields of their fighter jets damaged during air combat. He discovered that if the tiny pieces of plastic were left in the eye, they were very well tolerated. A medical student suggested to Dr. Ridley that he use this plastic known by the chemical name, polymethylmethacrylate or Perspex CQ, as the material for a human intraocular lens implant. Thus became the beginnings of the artificial lens implant to replace the cataractous lens removed at the time of cataract surgery.
Intraocular lens implants or IOLs gained in popularity in this country in the late seventies and early 1980s and is one of the most important advances in the field of modern eye surgery. In fact, Robert Young, the actor who played Dr. Marcus Welby in the TV series, credited the procedure with saving his career.
Recent advances in the techniques of cataract surgery continue to make this one of the fastest evolving surgical procedures known in medicine. Today cataracts are removed using a process known as phacoemulsification. A tiny hollow titanium needle is introduced through an incision of about one millimeter and the entire cataract is liquefied and vacuumed out through the tube in a matter of minutes.
Because the incision size is so much smaller than conventional surgery, hospitalization, general anesthesia, sutures and bandages have all been eliminated.
Someday we may understand why cataracts develop and prevent them from occurring. Until then, todays' advanced technology can make the daily modern miracle of cataract surgery a reality of clear vision for millions the world over.
The most commonly performed refractive procedure in the United States today is cataract surgery. For the past several years, nearsightedness, farsightedness and astigmatism have also been reduced or eliminated at the time of cataract surgery. This has enabled people to not only improve their eyesight following the removal of their cataracts, but in many cases to see clearly without dependence on eyeglasses or contacts following the procedure.
More than 50% of the world’s blindness is due to cataracts, making it the number one cause of poor vision that can be corrected.
Behind the pupil and iris, or colored part of the eye, is a clear lens that focuses light onto the retina. A cataract develops when this lens becomes cloudy, either through aging or injury. Cataracts reduce vision and cause glare from lights, haziness of images, and difficulty in reading street signs.
In the early stages, cataracts may be treated with a change in eyeglass prescription. Later, when vision cannot be improved with glasses, surgery with intraocular lens implantation may be required. And while we don’t understand exactly why cataracts occur, today, small incision cataract surgery is restoring excellent vision to many seniors who develop cataracts.
There has been an explosion of technology in the field of modern cataract surgery in the past several years. Today, cataract surgery can be performed without painful injections, without sutures, without bandages, and with more rapid recovery of normal vision. This has been made possible by ultra fine microscopic instruments and new techniques.
One of these new techniques is called phacoemulsification. This instrument vibrates a small titanium needle 45,000 times a second, faster than the speed of sound, (hence the term ultrasonic) to breakup and remove the cataract through an incision of 3 mm or less. Because of the small incision required for this procedure, no sutures are required to close it. And the eye need only be numbed with eyedrops instead of an injection behind the eye, as is commonly performed. New soft, foldable implants can now pass through an incision so small (something that was not even dreamt possible several years ago)that you cannot see it or feel it. The eye is no longer bandaged shut, which allows more rapid recovery of vision with less restriction on activities following surgery.
Cataract surgery is an outpatient procedure usually done at the hospital or ambulatory surgical center (ASC) that, once underway, takes approximately 10 to 15 minutes. The procedure uses local anesthesia in the form of eyedrops to ensure comfort. Patients are awake during the surgery. Eye patches are not required after surgery, and restrictions are minimal.
A successful cataract surgery can greatly improve the quality of life by giving people the freedom to see clearly to once again enjoy day and night time activities. Driving, reading, shopping and recreation can again become pleasurable activities.
To decide whether or not you need cataract surgery, you must first have a complete eye examination. There are several indications for cataract surgery, rarely will a cataract need to be removed immediately or as an emergency. Because the procedure is elective, most cataract surgery can be scheduled at the individual’s convenience. Some of the more common reasons an individual chooses cataract surgery are:
--Decreased vision – such as difficulty seeing the street signs, or problems reading fine print.
--Foggy vision – some people report that their vision appears to have a fog or film over it.
--Halos around lights – some people have difficulty in particular with night driving due to glare from oncoming automobile headlights.
--Glare – problems with light sensitivity going from a darkened room to bright light.
--Decreased ability to perform daily tasks – such problems as reading medication instructions, failure to pass a driver’s visual examination, problems seeing to play cards, bowl or play golf are common.
After consultation with your ophthalmologist, you may decide that you wish to have cataract surgery. Before your make this decision, however, you need to be informed about the health of your eyes, the risks and complications of surgery, and the alternatives as well as the potential benefits for you. You also need to know what you can reasonably expect for visual improvement following the procedure. Although millions of people have undergone safe and successful cataract surgery, complications, though rare, can and do occur. The most serious complication of eye surgery is blindness, due to infection, retinal detachment or technical problems with the surgery and your eye. You must be fully informed about the surgery and its attendant risks before making an informed decision to proceed.
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*Individual results may vary. Persons over the age of forty are more likely to require glasses for reading. Sunglasses may be necessary when out of doors. As with all surgical procedures, there is no assurance or guarantee as to the outcome of the procedure.
This website is intended for educational purposes only. It is not a substitute for medical advice from a physician. Use of this site constitutes an agreement with the user that releases the Eye Laser Center, Eye Laser Consulting and Robert M. Kershner, MD, MS, FACS from any and all liability.
Robert M. Kershner, M.D., M.S., F.A.C.S.
Boston, Massachusetts, USA
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