Select a Topic From the List Below:
  1. Glasses, Contacts - Where'd They Go? 

  2.     The History of Refractive Surgery

  3.     The History of Cataract Surgery

  4. Lessons from the Practice-The Gift of Sight

  5. So What's All This Talk About Laser Vision Correction?

  6. LASIK

  7. Intraocular Lens

  8. Cataract

  9.     Topical Anesthesia

  10.     Clear Corneal Incision

  11.     Phacoemulsification

  12.     Insertion of the Lens

  13.     The Lens in the Capsule

  14. Are You at Risk for Glaucoma?

  15. Computers and Eye Strain

  16. "FLOATERS" A Common Eye Problem

  17. The Eye and How It Works

  18.     When Should You Get Yours Eyes Examined?

  19.     The Eye Examination

  20.     Questions About How Your Eyes Do What They Do

  21.     Why Do We Require Reading Glasses After We Turn Forty?

  22.     Will Wearing Eyeglasses Make My Eyes Dependent Upon Them?

  23.     Do Wearing Contacts Slow Down the Deterioration in My Vision?

  24.     If I Need to Keep Changing Eyeglasses are My Eyes Getting Worse?

  25. What is Amblyopia or "Lazy Eye"?

  26. When Should a Child's Eyes Be Examined?

  27. If My Child's Eyes Are Crossed, Will He Grow Out of It??

  28. If I Need to Wear Eyeglasses Will My Child Need Them Too?

  29. Do Eye Exercises Really Help?

  30. What About Pinhole Eyeglasses, Do They Improve Your Vision?

  31. What About Those Lenses that Block Out Blue-Light?

  32. Can Ophthalmologists Transplant an Eye?

  33. What are Corneal Transplants?

  34. Questions About KeratoRefractive Vision Correction Procedures

  35.     Why Am I Dependent Upon Eyeglasses?

  36.     What is Myopia or Nearsightedness?

  37.     What is Hyperopia or Farsightedness?

  38.     What is Astigmatism?

  39.     How Can I Reduce or Eliminate My Need for Glasses and Contacts?

  40.     Am I A Suitable Candidate?

  41.     Tell Me About The Procedure

  42.     What Can I Expect After Laser Vision Correction?

  43.     How Can I Find Out If I Am A Good Candidate?

  44. The Eye Examination

  45. The History of Modern Cataract Surgery


  47.     The Basics

  48.     Technological Breakthroughs

  49.     Do I Need Cataract Surgery?

  50.     Questions and Answers About MicroIncision Cataract Surgery

  51. Diseases of the Retina

  52. MACULAR DEGENERATION (ARMD) and The Role Of Nutrition

  53.     Determining the Nutritional Content of Vegetables

  54.     Risk Factors For Developing Age-Related Macular Degeneration (AMD)

  55.     What You Can Do to Limit Your Risk of Developing AMD

  56.     What to Do To Maximize Your Vision With AMD

  57.     Who to Call For Low Vision Devices

  58. Diabetic Retinopathy

  59. Retinopathy of Prematurity

  60. The Red Eye

  61. What is a Pterygium or Pinguecula?

  62. DRY EYES

  63.     How Can I Tell If I Have Dry Eye?

  64. Beware of Sun Exposure

  65. Systemic Diseases and Your Eyes

  66. LASERS

  67.     What is a Laser?

  68.     Are Lasers Safe?

  69.     How Long Does the Laser Treatment Take?

  70.     How Does Dr. Kershner Aim the Laser?

  71.     Will The Laser Treatment be Painful?

  72.     What Will I Experience During the Laser Treatment?

  73.     What If I Move My Eyes or Close My Eyelids?

  74.     Will My Vision be Blurred Following the Laser Treatment?

  75.     Do I Take My Regular Medications on the Day of the Laser Treatment?

  76.     Where Will The Laser Procedure Take Place?

  77.     Will I Be Able to Drive Myself Home?




        No.  The eye will be numbed with anesthetic eye drops and although you will be awake for the procedure, you should not feel any pain.


        Yes.  Although no surgical procedure is 100% risk free, millions of individuals have had their eyesight improved with cataract surgery.


        At one time ophthalmologists waited until a cataract was ripe, that is, the individual could no longer see, before proceeding with surgery.  That was because the treatment required a hospital stay, general anesthesia and vision was only possible with very thick eyeglasses.  Today’s improved procedures allow cataracts to be removed when they begin to interfere with your day-to-day activities.  You need not wait until you are blind or the cataracts are ripe.


        With today’s advances in the surgical treatment of cataracts, your vision should improve within twenty-four hours.


        As the eye drops wear off, some people experience a sandy or gritty sensation as if the eye is dry, others feel their eye waters slightly more.  Most people notice no change in the sensation of the eye.


        Refrain from eye rubbing and swimming for the first several weeks following the surgery to avoid injury or introducing infection.  You will normally be given eye drops to use four times a day for the first two weeks.  No bandage is required and you are encouraged to use the eye right away.  If your present prescription eyeglasses need to be changed, you may find a drug store type reading glass with +2.50 diopters correction will be satisfactory for reading.  You may resume all other normal activities.



        When we hear the word glaucoma, most of us think of blindness.  Although glaucoma is 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 an increase in fluid pressure within the eye causes damage to the optic nerve, and ultimately, vision.  Under normal circumstances, a certain amount of clear aqueous fluid is produced 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 glaucomatous eye through normal channels, and that condition causes an abnormal build-up of pressure.  If untreated, damage to the sensitive optic nerve can result, leading to loss of vision.

        It is very important to know that there are very few symptoms from glaucoma.  In fact, most people with the disease have no symptoms at all.  As the build-up of fluid pressure continues over time, a reduction of peripheral vision occurs gradually.  Usually this can only be detected with a specialized test known as a visual field exam.


        The answer is not simple, and that’s why you need regular eye exams.  Glaucoma is an insidious disease and 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 siblings of people who have glaucoma are at greatest risk.  In addition, individuals who have diabetes, a history of an eye injury, highly nearsighted, or take oral Prednisone medication are most at risk.  Glaucoma is usually a life-long condition, fortunately it is treatable.


        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 (Fundoscopy) to identify signs of damage (Optic Nerve Cupping).  Because glaucoma can be a silent disease and the effects of visual loss irreversible if not diagnosed and treated early, everyone should have a complete examination for glaucoma as part of a regular eye examination.

        There are two major types of glaucoma, open-angle and –closed-angle.  Closed-angle glaucoma is much less common and is usually seen in elderly individuals who are very farsighted or have a family history of angle closure glaucoma.  It is distinguished by the painful sudden buildup of eye pressure by the mechanical apposition of the iris or colored part of the eye blocking the drainage of aqueous fluid through the normal drains.

        The open-angle variety is much more common and is distinguished by the painless buildup of eye pressure gradually over time as the normal drainage system of aqueous fluid within the eye becomes clogged.


        The treatment for these two types of glaucoma are different.  Therapy takes several forms including eye drops to lower the production of fluid or increase its removal from the eye.  When eye drops or oral medications are not effective in lowering eye pressure, then the argon laser may be used.  Many individuals have reduced ocular pressure following a single laser treatment.  This may decrease the need for additional eye medications.

        Many patients require oral medication with a pressure reducing drug known as a carbonic anhydrase inhibitor.  Treatment may be discontinued due to undesirable side effects.  Fortunately recent research has developed new more soluble forms of this compound that can be administered in eye drops without the potential problems that oral medication can cause.

        If eye pressure fails to respond to either medication or laser treatment, surgery may be performed.  This surgery, for which there are presently several methods, creates a new channel for fluid drainage that bypasses the clogged drainage passages inside the eye.



        Not only is this a silent disease without symptoms, it can be devastating as well.  Ten million Americans have elevated intraocular eye pressure associated with glaucoma and one million of them have undiagnosed signs of the disease.  Many individuals are at risk of losing their vision from a disorder that is treatable if identified early.



Age-related macular degeneration (AMD) is a disorder of the back of the eye (retina) that results in a deterioration of central vision.  It is the number one cause of blindness in individuals 65 years of age and older.  Dozens of studies have been undertaken over the past 15 years to better understand this frustrating disorder.  Enthusiasm for new treatments for this disease has diminished as research studies show little progress in a medical or surgical “cure.”  Many approaches to treatment such as interferon, radiation therapy, surgery to relocate the diseased area of the retina, blood plasma filtration treatments and photodynamic therapy have not yielded an improvement in vision.

        AMD is a genetic disorder.  Some day we may understand why it occurs; why it is more common in family members with the disease; and what can be done to prevent its occurrence.

        In this article, I would like to outline what we do know about the benefits of early diagnosis and preventative care, to help slow the progression of AMD.  You do not have to lose vision with AMD.


          When your mother told you to eat your carrots because it was good for your eyes, she was probably right.  In fact, eating your spinach may actually be better.  The role of nutrition in the process of macular degeneration is well known.  Two substances known as carotenoids found in green leafy vegetables may significantly reduce an individual’s risk of developing AMD.  They may also help preserve vision and prevent further deterioration of the retina.  Substances, also known as anti-oxidants, exist in high concentration within the pigment of the central part of the retina in the back of the eye (macula).  We know that a large amount of macular pigment (the substance that filters blue light) reduces the risk of macular degeneration.  Absorbing blue light, acts to protect the retina by preventing oxidation.   People with light colored irises (blue as opposed to dark brown) are at greater risk for developing AMD.  Smoking is a well-established risk factor for this disease as well.

        Two specific carotenoids, lutein and zeaxanthin, have been associated with a decreased risk of AMD.  As you might expect, these two substances also appear in high concentration within the macular pigment. The body cannot manufacture lutein on its own, and that is why an adequate dietary intake is important.  A diet high in fruits and vegetables helps increase the concentration of this substance in the blood.  A study published in 1988 showed that individuals with AMD who consume fruits and vegetables in their diet and increase their intake of beta carotene (vitamin A) had increased protection from AMD compared to those who did not.  Vitamins A, C, and E, as well as the trace mineral zinc, also play an important role.





Broccoli, cooked



Brussels sprouts






Sweet potato






Parsley, fresh (not dried)







  • AMD is the leading cause of blindness in people over 65 years of age. 

  • As many as 13 million people in the United States have AMD

  • 1.2 million Americans are visually impaired from AMD. 

  • 30% of people over the age of 75 have AMD. 

  • The number of Americans over age 65 will double by the year 2050.


  • The incidence of AMD is greater in family members of people who have the disease.

  • Women are at greater risk for AMD than men.

  • People with blue eyes are at greater risk than people with brown eyes.

  • Smoking increases the risk of AMD.

  • Alcohol use may also increase the risk of AMD.

  • Sun exposure increases the risk of AMD.

  • Increased fat in the diet increases the risk of AMD.

  • A diet low in anti-oxidants is associated with increased risk of AMD.


  • Stop smoking.

  • Use ultra-violet protecting sunglasses and wear a hat when out of doors to reduce the amount of ultraviolet light entering the eye.

  • Eat generous daily helpings of spinach, kale and vegetables high in lutein and zeaxanthin.

  • Take an anti-oxidant vitamin supplement which includes the following:

Vitamin E

400 units

Vitamin A as beta carotene

5,000 units

Vitamin C

250 mg

Zinc oxide

40 mg


  1. Spectacle correction – Get a good pair of eyeglasses with proper correction which has a large reading bifocal with increased power.

  2. Use a hand magnifier and a very bright reading light to magnify the image.

  3. Use a stand magnifier when reading.

  4. Low vision aids are available through low vision services that can magnify distance and intermediate vision, such as telescopes.

  5. Closed-circuit television cameras and monitors can magnify imaging for reading and can be purchased from several sources.


The Lighthouse Inc. Information and Resource Center

111 East 59th Street, New York, NY 10022

Phone (800) 334-5497   Fax (212) 821-9705 ATTN I&R

Information on eye diseases, low vision resources


The Lighthouse Low Vision Catalog, Optical Products, Non-optical products and Educational Materials

111 East 59th Street, New York, NY

Phone (800) 453-4923   Fax (718) 786-0437


LS&S Group Catalog of products for the visually and hearing impaired

Phone (800) 468-4789   Fax (847) 498-1482   E-mail


Tech-Optics International Catalog, vision care products

59 Hanse Avenue, Freeport, NY  11520

Phone (800) 678-4277   Fax (800) 678-0002


Eschenbach Optik of America Catalog, Low Vision Rehabilitation Program

904 Ethan Allen Highway, Ridgefield, CT  06877

Phone (203) 438-7471   Fax (203) 438-1670


Designs for Vision, Inc., Optical Aids for the Partially Sighted

Custom designed telescopic and microscopic lens systems, special orders

760 Koehler Avenue, Ronkonkoma, NY  11779

Phone (800) 345-4009

Macular Degeneration Help Center

Macular Degeneration Foundation

AMD Alliance

Macular Disease Society



Ongoing Clinical Trials from the National Eye Institute

Photodynamic Therapy


Complications of the Age-Related Macular Prevention Degeneration Laser Trial

Age Related Macular Degeneration Radiotherapy Trial (AMDRT)


Submacular Surgery Trials

Oral Anti-Protease Inhibitor Trial

Anti-VEGF Antibody Fragment Study

Thalidomide Clinical Trials

 Lipid Filtration from the Circulation Rheophoresis Study



        Another, though more severe and inherited disease of the retina is Retinitis Pigmentosa or RP.  Individuals who are diagnosed with one of the many forms of RP can experience severe and devastating loss of vision over time.

        Recent evidence has shown that Vitamin E is not helpful in this disease and because of adverse effects it is not advised.  For patients with RP the use of Vitamin A has been advised.  This should be taken as 15,000 International Units of Vitamin A palmitate.  Beta Carotene was shown to have no prophylactic value.

        The recommended dosage of vitamin A palmitate was shown to be beneficial in reducing the rate of deterioration of the electroretinogram, a measurement of the sensitivity of the retina and therefore the visual field in patients with RP.

        Doses in excess of the recommended amount are potentially toxic and are to be avoided.  Most likely a product will become commercially available in the near future.  Those with RP and their families are encouraged to contact the RP Foundation at 1-800-683-5555 for more information.


        Diabetes is a disorder in the body’s ability to absorb and utilize sugar (glucose).  Some individuals inherit this condition while others develop it for no apparent reason.  Not long ago a diagnosis of diabetes meant that an individual would likely go blind.  Today with early diagnosis and proper treatment, millions of people can live near normal lives without the devastation that visual loss can bring.

        As you recall, the retina is the thin film of tissue and blood vessels in the back of the eye that is responsible for recording the fine details of vision within it’s center, the macula, or it’s side vision, the periphery.  The retinal is fed with millions of tiny vessels that provide oxygen carrying blood and nutrients and remove wastes.  In diabetes these vessels can become fragile and break or leak.  When this occurs, it is known as Background Diabetic Retinopathy.

        When circulation to the retina is impaired by progression of this process then these vessels can close and permanently impede the flow of nutrients and oxygen.  The retina responds by creating new vessels in a process known as Proliferative Diabetic Retinopathy.  Unfortunately, these new vessels are abnormal and re more likely to bleed and leak making the condition worse.  A procedure known as Intravenous Fluorescein Angiography can be performed to photograph and study the leaking areas of the retina.

        There is a treatment for diabetic retinopathy using a high energy light beam known as a laser.  Using this treatment, abnormal areas of the retina can be obliterated before the leaking and hemorrhage leads to permanent damage.  The key to saving vision is early diagnosis and treatment.

        Diabetics are also at increased risk for the development of cataracts and glaucoma.  In diabetic eye disease, warning signs and symptoms may not be apparent.  That is why it is crucial that any individual with diabetes be examined by an ophthalmologist at least once a year or more frequently if any evidence of retinopathy is present on examination.  The ophthalmologist will then decide if treatment is required and how often to be reexamined.

        The longer one has diabetes, the greater is the likelihood that complications from the disease will affect the eyes.  Naturally, following the advice of your doctor and controlling blood sugar is the most important thing that can be done to prevent the complications of diabetes.


        Previously called retrolental fibroplasia, this disorder of the retina is commonly seen in infants born prematurely.  The eyes are not fully developed until almost a year after an infant is born.  If the child is born too soon, the eyes and particularly the retina is not fully formed.  Because of its immaturity, the retina is particularly susceptible to the influence of excess oxygen.  Premature infants have breathing problems due to the immaturity of their lungs and often they require added oxygen for prolonged periods of time.  This can lead to the development of abnormal vessels in the retina (ROP).

        Left undiagnosed and untreated this condition can lead to blindness.  That is why all premature infants or children who required oxygen shortly after birth, should have their retinas examined by an ophthalmologist.


        At one time or another, everyone has experienced the symptoms of red eye.  Red eye refers to the inflammation of the outer coating of the eyeball, the conjunctiva, which is why it is also called conjunctivitis.

        The four most common causes of red eye are dry eye, allergy, bacterial and viral infection (so-called pinkeye).  When the eye gets irritated from dryness or exposure to irritants such as cigarette smoke, hairspray, exhaust fumes and the like, its outer covering will swell and the microscopic blood vessels on its surface will dilate causing the eye to look red.

        In dry eye, the eyes may feel gritty or sandy and may tear profusely.  Treatment usually takes the form of eye drops made of artificial tears, and the use of a humidifier.  Untreated dry eye can lead to secondary infections with bacteria or viruses.

        In allergic conjunctivitis, a pollen, mold or allergen causes the eye to release histamine, the surface of the eye to swell and a whitish mucus to be produced as the body’s way of trying to rid itself of the antigen.  Avoidance of known allergens that usually also make your nose run or cause you to sneeze or itch can help.  The use of over-the-counter decongestant eye drops (with an ingredient such as naphazoline) can provide some symptomatic relief.  Also cool compresses, a washcloth placed on the closed eyelids, may be comforting.  Sometimes oral antihistamines are required.

        If the red eye produces a colored discharge that is yellow or green it is probably a bacterial infection of the eye. These infections are quite common and are easily passed between children at school, or between children and adults.  They are best diagnosed and treated by an ophthalmologist with the appropriate antibiotic eye drops that are available by prescription only.

        Watery discharge from a red eye, sometimes associated with the common cold, sore throat, earache, or swollen lymph nodes is most commonly viral in origin.  Viral infection can sometimes lead to secondary bacterial infections and that is why careful examination by an ophthalmologist is advised.  Viral conjunctivitis is very contagious (the so-called infectious pinkeye) and is easily passes from person to person by casual contact, water droplets such as a sneeze and hand to eye contact such as sharing towels.  For these reasons it is important to isolate anyone who has a viral conjunctivitis from contact with others until the infection has cleared.

        Other causes of red eye include, subconjunctival hemorrhage, foreign bodies, abrasions, herpes keratitis and iritis. 

A subconjunctival hemorrhage commonly occurs during sleep when a small blood vessel breaks and bleeds.  It appears as a red velvety collection of blood under the conjunctiva of the white part of the eye.  It is harmless.  Foreign bodies are common after grinding or hammering metal with some entering the eye.  They should always be removed.  Abrasions occur when the skin covering the cornea is scraped off.  This can happen following direct trauma with a fingernail or something striking the eye and is common with contact lens wearers.  It should be treated by cleansing, applying an antibiotic ointment and bandaging until healed.  When an infection of the cornea occurs with the herpes virus, a characteristic foreign body sensation, light sensitivity and discomfort occurs.  Much like a cold sore on the lips, herpes infection of the eye is recurrent and because of its location on the eye, can permanently affect vision.  When the possibility of a herpes infection is present, prompt evaluation and treatment by an ophthalmologist is indicated.  Fortunately, there are antiviral medications to shorten the duration of the attacks.

        Iritis is an inflammation of the inside of the eye which causes pain, light sensitivity and decreased vision.  It needs prompt treatment with anti-inflammatory medications and like the herpes infection, it is often recurrent.

        Any red eye that fails to improve within three days of treatment should alert the individual to the possibility of a more serious cause that requires medical evaluation and treatment.  Red eyes although uncomfortable, generally do not affect vision and are NOT painful; therefore if a red eye is associated with a change in vision or eye pain prompt evaluation and treatment is advised.


        Everyone experiences symptoms of dry eyes at one time or another.  Conditions that speed up the evaporation of tears from the surface of the eye such as dry, arid climates, wind, a fan blowing, running and air conditioner or heater in your car, or sitting in front of a fireplace, can all bring on the symptoms of dry eye.

        In addition, certain diseases such as thyroid problems, diabetes, or rheumatoid arthritis can increase the likelihood that dry eyes will develop.  Women are more symptomatic than men, and those who are menopausal are most likely to be affected.  Also, environment plays an important role whether or not a dry eye problem will affect you.  Those who live in cold or hot arid climates are more susceptible to symptoms, for example, than those who live in moist, tropical environments with high levels of humidity.

        The surface of the eye requires an endless supply of moisture.  Producing tears fast enough to keep up with evaporation is difficult, making dry eyes extremely common. 

        The symptoms are made worse when an individual is using oxygen or taking medications such as, diuretics, antihistamines and bronchodilators, which dry out the mucous membranes.


        The symptoms of dry eye include a feeling of something in the eye often described as “like someone threw sand in my eyes,” a burning sensation, and blurry vision.  These symptoms can lead to excessive tearing and redness.  Symptoms may be greatest upon awakening if the eyes have dried out during sleep or may worsen as the eye continue to dry out during the day.


        The treatment of dry eye eliminates the factors which promote drying and supplements the normal tear production.  Eliminating drafts on the face, such as rolling up the windows when driving often may be all that is needed.  Using sunglasses or eye protection out of doors, especially on windy days, and using a room humidifier during sleep may provide marked improvement in symptoms.

        There are a wide range of artificial tear supplements available without prescription from a pharmacist.  Choose preservative-free eye-drops as they are less likely to cause allergic reactions.  Avoid decongestants, (the so-called “whitening” additives, such as tetrahydralazine) they may get the red out but they do so by drying the eye out and can make the problem worse.

        Tear supplements are most effective it used frequently throughout the day before symptoms develop.  They are less effective when used intermittently or after symptoms occur.

        If dry eye bothers you upon awakening, the use of a bland ophthalmic ointment at bedtime applied to the crease between the eyelid and the eye may prevent drying out of the eyes during sleep.


        Severe and frequent dry eye symptoms can lead to the breakdown of the outer surface of the eye and to the development of serious eye infections that may require more extensive treatment by a physician.  You should see an ophthalmologist or optometrist as soon as possible if you are having dry eye symptoms.

        In addition, those who have other symptoms of dryness such as dry mouth may have a specific entity known as keratoconjunctivitis sicca.  The treatment of this problem may include bandaging of the eye, closure of the tear ducts to prevent evaporation of moisture, and the use of goggles to reduce tear evaporation.


        The sun can be an enemy to your eyes as well as your skin.

        Eyelid skin is the most delicate and thinnest of all skin, and yet people rarely think to protect it from the sun’s damaging rays.  Fortunately many commercial products are available, some of which are specially prepared for the eyelid area.

        The structures within the eye can be harmed by excess sun exposure just like the outer structures of the eye.  The use of a brimmed hat and ultraviolet protecting sunglasses is a must during sunlight hours.

        Avoid the common mistake of reading out of doors in the direct sunlight without eye protection.  The reflective rays of sunlight can be damaging to the outer surface of the eye leading to burns to the clear portion, the cornea, and redness and swelling of the white portion of the eye, the conjunctiva and sclera.  This may be felt several hours later as a sensation of gravel in the eye or foreign body sensation under the eyelid and can lead to actual pain, depending upon the extent of the injury.  All structures of the eye are susceptible to sun damage, both from ultraviolet radiation, as well as the intensity of the full visual spectrum of light.

        The best protection can be provided through the use of oversized sunglasses incorporating a dark tint and ultraviolet (UV400) filter.  If the eyeglasses does not specifically state that is an ultraviolet protecting lens, then assume it is not.

        Ask your local optician about the availability of ultraviolet protection incorporated into your daily eye wear.


        It is unfair, but chances are if you suffer from a respiratory disease, thyroid disease, or rheumatoid arthritis, you may be at added risk for ocular disease as well.  Many medications which are quite effective for improving breathing, also have a drying effect on the eyes (such as decongestants and antihistamines).  Other medications such as prednisone, can lead to the development of cataracts or glaucoma.

        Individuals with thyroid disease are also at risk for severe dry eye.  And those with rheumatoid arthritis are at risk for dry eye as well as the complications of Prednisone usage.  Patients who take Plaquenil should be examined by an ophthalmologist while on therapy, which should include serial visual field testing to screen for retinal damage from accumulation of the drug.  Those who take Amiodarone for their heart can develop deposits on the cornea from the drug.  Patients who take Mevacor for cholesterol can develop cataracts while on therapy.  Viagra is associated with alterations in vision and should be avoided in some individuals.

        It is always important to tell your doctor what medications you may be taking as the potential for side effects from the drugs on the eye and systemic drugs can occur.


        I am often asked, “Will you be using a laser for my eye surgery?”  Ophthalmologists have employed the use of lasers for several decades successfully in the treatment of eye diseases.  In fact, ophthalmology was one of the first fields of medicine to recognize the importance and benefits of laser surgery.  However, laser surgery is not applicable to every individual or every eye disease.


        Laser is actually an abbreviation for Light Amplification of Stimulated Emission of Radiation.  It refers to a series of specialized optical devices that take a specific wavelength of light and amplify it in such a way that the beam that is produced is extremely concentrated.  Lasers emit a narrow, finely focused beam of light energy. That is why even though a very lower energy laser beam, such one one-thousandth of a watt, can be far more powerful than an ordinary sixty watt light bulb.  Lasers can be used to treat a variety of medical conditions within the eye.

        Because the eye is optically clear, laser beams can pass into the eye without being absorbed and can therefore be directed specifically at a target tissue to be treated.  Depending upon the source or wavelength of light, the color and intensity of each individual laser is correspondingly created.  Each individual laser wavelength has a particular use in ophthalmic surgery.  Some lasers focus their energy to burn or coagulate and seal vessels in tissue, some cut and some vaporize or ablate tissue.


Lasers have been used in Ophthalmology to treat the eye since the early 1970s.  The lasers are safe and clinically effective.


Most laser treatment sessions are completed in a matter of minutes. Eyedrops are often used to dilate the pupil.


          The laser is connected to a slit lamp.  This is a microscope that is similar to the one your doctor uses to examine your eyes.  The microscope is focused on the precise part of your eye that needs to be treated.  The laser beam is so finely concentrated that no damage occurs to other parts of your eye.


No.  There is little, if any, discomfort associated with the laser treatment. 


You will see the light of the slit lamp microscope.  You may notice two small red laser beams that are used to focus the laser, and hear the clicking of the shutter of the laser.


The doctor is in control of the laser during the treatment.  You will need to stay focused with your head still while the treatment is in progress.


The bright light may blur your vision as if you stared into a camera's flash.  You may see some floating specks for a period following the treatment-this is normal.


Yes.  Unless specifically told otherwise, you should take all your medications as you normally would.


The laser is located within Dr. Kershner's offices.


Although your vision will be close to normal by the time you leave, most people undergoing laser surgery are a little nervous.  It might be best for you to leave the driving to someone else.


        Argon lasers consist of a laser beam delivered through an optical microscope system and focused by the surgeon into the eye.

        Argon lasers are in the blue/green spectrum and, therefore, are best absorbed by the pigment within the eye.  Their use includes treatment of the drainage system of aqueous fluid for glaucoma, known as Argon laser trabeculoplasty.  By placing a series of microscopic dots into the trabecular meshwork drainage system in front of the iris, the surgeon can open up the drains and increase the flow of fluid from the eye.  This can reduce eye pressure and its potential damage to the eye in glaucoma.

        Argon lasers are also used in diabetic retinopathy to coagulate tissue and vessels to prevent leakage of blood and fluid.


        The krypton laser is another particular wavelength of laser absorbed within the macula or central region of the retina where central vision occurs.  This particular laser is utilized by retinal surgeons to treat areas within the macula that may be leaking fluid and to promote sealing of vessels.


        This most unusual laser was first developed by the Swiss watch industry to drill microscopic gems.  Ophthalmologists in Europe recognized the potential use in eye surgery.  This wavelength of laser is entirely invisible and can pass through the clear tissues of the eye without causing damage.

        The YAG laser is used predominantly for removing scar tissue, capsular fibrosis, which commonly occurs after cataract surgery.  This laser is also being adapted to remove a cataract from the eye.


        The excimer is a laser of ultraviolet wavelength which has the unique property of ablating or removing tissue which it strikes.  The excimer laser has been approved by the United States Food and Drug Administration to reshape the corneal surface to correct refractive errors such as nearsightedness, farsightedness and astigmatism.  It is commonly used along with the microkeratome in a laser vision correction procedure known as LASIK.


        The holmium laser generates heat that creates scar tissue which may facilitate drainage of excess ocular fluid such as in glaucoma.  The device may have some use in altering nearsightedness and astigmatism.  Its investigation in these areas has just begun.


The erbium laser is being developed to perform intraocular surgery for cataract and refractive uses.  It uses a red wavelength of light to obliterate tissue.


        Undoubtedly new lasers will be invented over the next several years.  The benefits of laser surgery have enabled patients to have same day treatment without the need for anesthetic and without the associated risks of conventional surgery.


        The eyelids provide an important function in protecting the eye, distributing tears, and are an important part of our appearance.  The eyes reflect our emotions and well-being.  Sagging eyelids or red eyes inadvertently project an image of aging or fatigue.

        Many people are susceptible to thinning and loosening of the upper eyelid skin as part of the aging process.  In addition to adversely affecting an individual’s appearance, this sagging of the eyelids can interfere with the ability of the eyes to open and close normally, and can block peripheral or side vision.

        Symptoms of drooping eyelids are a heavy or tired feeling to the eyes, puffiness around the eyes, headaches or brow aches, prominence of forehead wrinkles and limited field of vision.  When the sagging of eyelid skin interferes with daily activities then surgical correction can be considered.  The surgical procedure is known as blepharoplasty.  It is a very common procedure that is performed with a local anesthetic and takes about twenty minutes.  The excess skin is marked and removed and the skin edges closed with an absorbable suture.  There usually is some bruising around the eyelids and healing takes several weeks.  The result however can be dramatic, with patients experiencing improved appearance as well as function.  For many, it is as if someone has opened the curtains, and expanded their field of view.  The world is brighter, side vision, especially when driving, is improved.  Women can also return to applying eyelid makeup, such as eyeliner or eye shadow, when unable to previously due to drooping eyelid skin.


        Abnormal positions of the eyelid occur due to aging or injury.  These include the eyelids turning inward, entropion, or outward, ectropion.  In either case, surgical correction can prevent the irritation and chronic drying of the eye that can occur if left untreated.

        Droopiness of the eyelids, ptosis, occurs when excessive looseness of the eyelid skin hangs down in front of the eyes.

        Fortunately, most malpositions of the eyelids are correctable with surgery.  Left untreated, these conditions can lead to excessive drying of the eye, poor blinking, and infections of the eye itself.


        Blepharitis exists when the skin edge of the eyelid becomes scaly.  Most commonly, blepharitis is caused by excessive seborrhea or bacterial infection of the eyelids.  The condition looks much the same as dandruff which affects the scalp and appears on the eyelashes.  Symptoms include redness of the edge of the eyelids, itchiness, scaling, and awakening with the eyelids “glued shut.”

        Infections of the oil glands at the root of the eyelashes is the culprit.  This leads to the development of the common stye.  The stye is a localized swelling or red spot which can be quite painful.  It may swell, cause pain and rupture with drainage of mucous material.


        Treatment of eyelid problems includes cleansing of the eyelids and lashes at bedtime.  A wet washcloth and baby shampoo can gently wash away the collections that accumulate on the lids during the day.  Following a cleansing, rinse the eyelids with clean, warm water.  Apply a thin film of antibiotic or boric acid ointment, available from your doctor, to the edge of the upper and lower eyelids, at the base of the eyelashes.  By cleansing and treating the eyelids nightly, your eyes will be refreshed and clean upon wakening without the annoying granulation, stickiness or redness.


        There is nothing wrong with wearing cosmetic eye makeup.  I recommend using the hypoallergenic products, such as Clinique or Almay, as these products are specially formulated to prevent the irritation that makeup can sometimes cause.  It is very important to totally remove all of the makeup each night to prevent clogging of the pores of the eyelid skin and oil glands.


        The skin of the eyelid is the thinnest skin in the human body.  Because of this, it is often the first area to be affected by exposure to the elements of drying, sun exposure, irritants, and allergens.  One of the most common offenders I see in the practice of ophthalmology, is allergy to fabric softener, perfumes, soaps and detergents.

        If you experience redness, swelling or scaling of the eyelid skin, consider stopping use of fabric softener, and switching to non-perfumed soaps such as Ivory or Dreft detergent.  Treat your eyelid skin like you would a baby’s and the symptoms will probably disappear.

        Don’t forget to use a hypoallergenic moisturizer specially formulated for the eyelid skin and sun block to prevent drying out and sunburn.


        It’s certainly an annoying experience.  You’re reading or enjoying a sunshiny view, and suddenly spots drift in front of your vision.  You’re experiencing the phenomenon of floaters.

        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 eyes.  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 jellylike material known as the vitreous.  Everyone is born with fine, thready floaters within this gelatin which are remnants of the early development of vessels within the eye.

        Every day, 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 sport that floats in front of the vision.

        These spots 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 considered normal.  There is no surgical procedure or indication for the removal of these floaters, though refraining from rubbing the eye may help.  Although a nuisance, they disappear in time and eventually, drift out of view.


        The appearance of an increased number of new spots or floaters, however, may signal a problem within the eye.  The rapid onset of symptoms associated with flashes of light, usually suggests that the clear vitreous has separated or detached from the inside wall of the eye.

        In a small percentage, this detachment of the vitreous gel results in a tear or break in the retina leading to bleeding within the eye or retinal detachment.

        There are other eye diseases, such as infections, inflammatory conditions and diabetes where collections of cells accumulate within the vitreous that can also create the appearance of floaters.

        The important feature that distinguishes these from normal vitreous floaters is a change in their number or appearance, flashes of light or a change in vision.  These situations require prompt evaluation and treatment to prevent eye damage and visual loss.

        Only a thorough examination by an ophthalmologist or optometrist can determine if spots or floaters are harmless or are the beginning of a more serious problem.  Symptoms that persist or worsen should always be carefully evaluated.


        The age of video games and computerization is upon us.  Virtually every home, workplace, and recreational facility harbors at least one video screen.  The appearance of these visual display terminals (VDTs) in both the home and work place is becoming more and more common.  In fact, few offices are without at least one VDT.  Their widespread use is raising questions concerning safety and potential problems with daily use.

        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 that we see.  The result of these electrical reactions is the creation of 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-rays and non-ionizing radiation such as radio frequencies, ultraviolet, visible or 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 exposure an individual to levels of radiation far below that required to produce cataracts or other eye damage even after a lifetime of exposure.  After years of testing, the safety of VDTs in terms of exposure hazard has been well established.

        So why so much concern about working with VDTs? 

People who use a VDT daily, especially for long periods, can develop symptoms of eyestrain.  These include tiredness of the eyes and hands, difficulty focusing, red eyes, headaches, or muscle spasms of the neck or shoulders.

        Why do people experience these discomforts?  There are a variety of reasons.  Mostly they are caused by the screen due to glare, distorted images and unwanted reflections, lack of contrast (the difference in brightness of the letters from the background) and color.  Often, the VDT screen is 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 follow these simple rules:

1.    Examine the lighting in the room.  Position the screen to reduce glare from existing lighting and reduce the 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 comfortable 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 artificial tear supplements to moisturize the eyes and a trip away from the desk can be quite helpful in relieving the focusing spasm that can be caused by prolonged periods of viewing the computer screen.

6.    Use special spectacles that place your focus on the computer screen.  This is very helpful for those who normally wear bifocals.  In addition, the use of an artificial coating and special tinting in the lenses can help reduce glare and minimize eyestrain.

The widespread use of VDTs in both the home and the work place has created a whole new set of demands on our vision.  By paying particular attention to each of these points, eyestrain can be reduced or eliminated.


        America is aging.  The number of Americans over 85 will more than double and those over 65 years of age will form more than 17 percent of the population of the United States within the next thirty years.

        In Arizona, for example, there were more than 470,000 persons age 65 and older in 1986, and it is predicted that by the year 2000, the population of our state’s elderly will increase by 59%.

        Eye diseases such as cataracts, macular degeneration, diabetic retinopathy, and glaucoma are highest among seniors.  Sadly, the risk of blindness is ten times as great for those over 65 years of age than for younger individuals.

        Many people believe, incorrectly, that poor vision is a part of getting older.  More often than not, poor vision can be corrected with proper diagnosis and treatment.

        So don’t put off getting an eye examination from your local ophthalmologist or optometrist.  He or she just may have some good news for you!


Lessons from the Practice-The Gift of Sight

It was nearing the end of a long, hot dusty day in the Navajo reservation in northeastern Arizona when a young man stood shyly in the doorway of our makeshift eye clinic just as we were about to close our doors for the night. The young man explained that his great-grandmother wanted her eyes examined although she had never been to a doctor in her life. As a volunteer at the Arizona Medical Eye Unit, a project started in 1979 to provide ophthalmic examinations to the Indians of the Navajo reservation, I was aware that many Indians did not receive specialist medical care if they did not travel off the reservation.
He explained that she lived as many Navajo elderly did, with her family in a "hogan" or hut. For the past 27 years he had known her, they had cared for her, clothed her, and fed her because she was blind. He walked to his truck and returned leading an elderly woman by the arm.
For me, in 1985, a young doctor from the city, she was a magnificent sight. Dressed in the traditional long black dress of the Navajo, she was wearing elaborate pieces of turquoise and silver jewelry, collected through years of trading between various Indian groups of the region. One look in her eyes revealed that both of her pupils were as opaque as the turquoise jewelry that she wore. She had advanced cataracts. I told her great-grandson that her sight might be restored by surgery, which could be done in Tucson, several hundred miles to the south.
A preoperative physical examination showed this 103 year old woman to be in remarkably good health. With local anesthesia and with her great-grandson interpreting my instructions for her, a cataract was removed and an intraocular lens implanted.
The next morning, as the bandage was carefully removed, she looked at me and spoke a few pleasant-sounding words in Navajo. Her great-grandson translated that she "liked my beard." Hearing his voice, she turned to her great-grandson and smiled. She knew who he was from the sound of his voice, but she had never before seen his face.
That evening, on my drive home, I took the long way through the foothills surrounding the city. As the sunlight reflected its colors on the mountains, I imagined seeing it all for the first time.

These (FAQs) are excerpted from the book "Lessons from the Practice-The Gift of Sight" written by Robert M. Kershner, M.D., F.A.C.S. 

Copyright 1994-2004.  All Rights Reserved.  Not to be copied by any means, mechanical or electronic without the written permission of the author.


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