Listed below are some eye tests, procedures or surgery that many people commonly undergo. If you are interested in learning more, click on any of the procedures to read information outlining the characteristics of each.
- Cataract surgery
- YAG Posterior Capsulotomy
- Multifocal Implants
- Limbal Relaxing Incisions
- Intraocular Lens Implants
- Blepharoplasty (Eye Lift)
- Botox Injections
- Ptosis Repair
- Thermage Skin Tightening
- Restylane Injections
- Entropion Repair
- Ectropion Repair
- Selective Laser Trabeculoplasty
- Lacrimal Probe
- Punctal Plugs
- Diabetic Retinopathy Laser
- Pterygium Excision
- Chalazion Excision
- Corneal Topography
- OCT (Optical Coherence Tomography)
- Visual Field
Cataract surgery is the removal of the lens of the eye that has developed an opacity, which is referred to as a cataract. Metabolic changes to lens fibers over time lead to the development of loss of transparency. Following surgical removal of the natural lens, an artificial intraocular lens implant is inserted. Cataract surgery is generally performed by an ophthalmologist in an ambulatory (rather than inpatient) setting, in a surgical center or hospital, using local anesthesia (either topical, peribulbar, or retrobulbar). Well over 90% of operations are successful in restoring useful vision, with a low complication rate.
YAG Posterior Capsulotomy
YAG Posterior Capsulotomy is a quick outpatient procedure which utilizes a Nd-[[YAG laser]] (neodymium-yttrium-aluminum-garnet) to clear the central portion of opacified posterior lens capsule. Some people can develop a posterior capsular opacification (also called an after-cataract) weeks to several years after cataract surgery. As a physiological change expected after cataract surgery, the posterior capsular cells undergo hyperplasia, showing up as a thickening, opacification and clouding of the posterior lens capsule (which is left behind when the cataract was removed, for placement of the IOL). The YAG laser makes small holes in the posterior capsule behind the implant. This creates a clear central visual axis for improving visual acuity.
Multifocal Implants are artificial lenses that replace the eye's natural lens that is removed during cataract surgery. The new multifocal implants offer the possibility of seeing well at more than one distance, without glasses or contacts. Traditional IOLs are monofocal, meaning they offer vision at one distance only (far, intermediate, or near). By distributing light through optical zones of differing power, the multifocal implants provide light that is focused for near, intermediate and distance. These implants, therefore, provide the probability of good vision without total dependence on eyeglasses or contacts. It's important to note that there is no guarantee that you will be able to see well at all distances under all circumstances totally without eyeglasses or contact lenses after cataract surgery even if you have a multifocal implant. In most studies, multifocal lenses resulted in total independence from glasses or contacts in about 80% of cases. The other 20% wear glasses or contacts occasionally for some activities.
Limbal Relaxing Incisions
Limbal Relaxing Incisions are a variation of astigmatic keratotomy (AK), which is a procedure to treat astigmatism. Astigmatism is present when the cornea is not spherical, i.e., it is steeper in one meridian than the opposite meridian 180 degrees away. The cornea with astigmatism may be thought of as being more oval shaped rather than round. LRI's are incisions that are placed on the far peripheral aspect of the cornea (the limbus) resulting in a cornea that is more round. The astigmatism is thus reduced and uncorrected vision is improved. LRIs can be performed separately or in conjunction with cataract surgery to reduce pre-existing astigmatism. Additionally, they may be performed to treat surgically induced astigmatism.
LASIK, an acronym for Laser-Assisted in Situ Keratomileusis, is a form of refractive laser eye surgery performed by ophthalmologists intended to correct myopia, hyperopia, and astigmatism. The procedure is usually a preferred alternative to photorefractive keratectomy, PRK, because it requires less time for full recovery and is generally less painful. Many patients choose LASIK as an alternative to wearing corrective glasses or contact lenses.
PRK is a laser eye surgery procedure intended to correct a person's vision and reduce their dependency on glasses or contact lenses. The procedure permanently changes the shape of the anterior central cornea using an excimer laser to ablate (burn off) a small amount of tissue from the corneal stroma at the front of the eye, just under the corneal epithelium. The outer layer of the cornea is removed prior to the ablation. Because PRK does not involve a permanent flap in the deeper corneal layers, the cornea's structural integrity is less altered by PRK, but PRK can be more painful and visual recovery is slower. In the majority of patients, PRK has proven to be a safe and effective procedure for the correction of myopia.
Wavescan technology allows the possibility to custom tailor a laser vision correction for the unique characteristics of each individual's vision. WaveScan technology was originally developed for use in high-powered telescopes to reduce distortions in space, This technology has now been applied to laser vision correction, measuring imperfections in the eye never before measured using standard methods for glasses and contact lenses. WaveScan based digital technology identifies and measures imperfections in an individual's eye 25 times more precisely than standard methods. A single beam of infrared laser light is passed into the eye and focused on the retina. The light is then reflected off the retina, passed back through the eye, through a lenslet array to a sensor, and then analyzed from 200 different aspects to create a map of the eye - or fingerprint of vision.Surgeons use this information to treat individuals with the CustomVue Procedure.
Intraocular Lens Implants
Intraocular Lens Implants are implanted lenses in the eye, usually replacing the existing crystalline lenses because they have clouded over with a cataract, or they have been removed as a form of refractive surgery to change the eye's optical power. They usually consist of acrylic or silicone with plastic side struts, called haptics, to hold the lens in place within the capsular bag. The procedure can be done under local anesthesia with the patient awake throughout the operation. The procedure usually takes less than 30 minutes in the hands of an experienced ophthalmologist. The recovery period is about 2-3 weeks. After surgery, patients should avoid strenuous exercise or anything else that significantly increases blood pressure. They should also visit their surgeons regularly for several months so as to monitor the implants.
Blepharoplasty (Eye Lift)
Blepharoplasty (Eye Lift) can be either a functional or cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an excessive amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause of loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.
Botox Injections involve the use of Botulinum toxin, a neurotoxin protein produced by the bacterium Clostridium botulinum. Botox has been used extensively for a variety of conditions, including facial wrinkles, eyelid spasm (blepharospasm), hemifacial spasm, spastic entropion (inward turning of the lower eyelid) and even certain types of strabismus (crooked eyes). Botox blocks nerve impulses to muscles by blocking the receptor site for the appropriate neurotransmitter, thereby producing relaxation of the muscle and smoothing of facial lines caused by contraction of the muscle. Botox has been FDA approved and has been shown to be extraordinarily safe and effective for these treatments.
Ptosis Repair, usually completed under general anesthesia in infants and young children and under local anesthesia in adults, is performed by making an incision in the drooping eyelid, and carefully advancing and tightening the levator muscle, which elevates the upper eyelid. Once the lid height is secured in the desired location, the eyelid incision is closed with tiny sutures. One or both eyes may need to be treated.
Thermage Skin Tightening
Thermage Skin Tightening, also referred to as ThermaCool, is a technology that allows non-surgical lifts. Thermage is a noninvasive, non-ablative and non-laser treatment that tightens skin by inducing the production of new collagen in the skin. With Thermage, patients are able to improve their appearance and reduce wrinkles and sagging skin. Thermage is used for the face, eyelids, neck, arms, hands, abdomen, buttocks, hips and knees. Thermage is FDA approved as of 2001, and works well with all skin types and ages. Click here for more information.
Restylane Injections improve the resilience and youthful contours of your skin and its ability to counter the effects of gravity, time, wind and weather. Restylane, composed of hyaluronic acid, is found naturally in your skin and other tissues. Hyaluronic acid has a chemical structure similar in many ways to sugar and is identical in all species and in all tissue types, making Restylane a very safe product for you. Smoothing out folds and wrinkles or enhancing lips with Restylane injections by adding volume can make an enormous difference in one's appearance.
Entropion Repair involves surgical correction of an inwardly turned (inverted) eyelid. This condition causes the eyelid and its lashes to constantly rub against the cornea (the front part of the eye) and conjunctiva (the mucous membrane that protects the eye). Entropion is usually caused by the relaxation of the eyelid tissues often accompanied with aging. The most effective treatment for entropion is surgery where the eyelid and its attachments are tightened to restore normal positioning.
Ectropion Repair involves surgical correction of an outwardly turned (everted) eyelid. The condition most often is associated with aging, though it may also occur congenitally, as a result of scarring or other surgeries, or secondary to facial nerve paralysis (Bell's palsy). If not repaired, the condition may lead to thickening of the mucosal surface on the inside of the eyelid (conjunctiva) with consequent inflammation of and danger to the health of the eye itself. This typically is completed with an incision of the skin at the lateral corner of the eye. The surgeon then excises a small segment of the lateral aspect of the lower eyelid, and subsequently reconnects the eyelid to underlying tissues and the upper eyelid. Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition.
Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty is a laser procedure used to treat glaucoma by reducing the pressure in the eye. SLT is not associated with systemic side effects or the compliance and cost issues of medications. SLT utilizes selective photothermolysis to target only specific cells, leaving the surrounding tissue intact. SLT works by using laser light to stimulate the body's own healing response to lower your eye pressure. Using a special wavelength and energy, the laser affects only pigmented (melanin containing) cells of your eye. SLT improves the flow of fluid in the eye, which in turn lowers your eye pressure.
Trabeculectomy is a surgical procedure to treat glaucoma by lowering eye pressure. In this procedure, a tiny piece of the wall of the eye, which may include the trabecular meshwork (the natural drain), is removed by the surgeon. This opens a new drain which creates a bypass for the trabecular meshwork to reduce eye pressure. The eye pressure is reduced because fluid can now drain with relative ease through the new opening into a reservoir (bleb) underneath the conjunctiva (which comprises the surface of the eye). The fluid is then absorbed by the body. Although the results of the trabeculectomy depend on numerous factors and can vary greatly, as a general rule approximately 70% of operated eyes will have satisfactory eye pressure and no need for medication one year after surgery. If eye drops are added, over 90% of eyes will have a satisfactory lowering of eye pressure.
Lacrimal Probe of the nasolacrimal duct is a surgical procedure performed to relieve the obstruction for any of the following reasons: excessive tearing due to poor tear flow away from eye, pus-like discharge that persists despite use of the antibiotic eye drops and massage, a more serious infection of the tear duct ("dacryocystitis") or infection of the skin over the tear duct occurs as a result of the obstruction. The probing procedure is relatively simple and quick. A small smooth wire probe is passed through the tear duct and into the nose. The surgeon confirms an open tear drainage system at the end of this procedure. There are no incisions or scarring from this operation. There is no significant post-operative discomfort.
Punctal Plugs are one way to alleviate dry eye by helping the eyes to make better and longer use of the small amount of lubricating tears they do produce. This is accomplished by closing off the small funnel-like drain hole found in the inner corner of the upper and lower eyelids. The drain hole, called a punctum, can be closed with a tiny plug called a punctal plug. The plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts.Punctal plugs can be temporary or permanent. Temporary plugs dissolve a few days after insertion. If your dry eye symptoms disappear when the temporary plugs are inserted, your doctor may consider permanent punctal occlusion.
Diabetic Retinopathy Laser
Diabetic Retinopathy Laser is primarily done in order to reduce the risk of vision loss that would otherwise occur in the absence of treatment. In general, prompt treatment is advised for patients with high-risk proliferative diabetic retinopathy and clinically significant diabetic macular edema. The current standard treatment for proliferative diabetic retinopathy is panretinal photo-coagulation (PRP). Two or three treatment sessions are usually required for approximately 1,500 laser spots to be placed throughout the retinal periphery outside of the macula. It is important to note that some patients still progress to significant vision loss. PRP treatment may be associated with side effects such as the loss of peripheral vision and night vision. The current standard treatment for diabetic macular edema is focal laser photocoagulation. This is used at later stages of the disease to preserve central vision (visual acuity). Macular laser treatment is performed in a focal fashion in which the individual leaking microaneurysms are lasered, or in a grid fashion in which areas of diffuse swelling or leakage are treated in a grid-like pattern. Focal/grid photocoagulation provides a 50% risk reduction in moderate vision loss from diabetic macular edema and less severe retinopathy after 3 years. The procedure may be associated with significant temporary or permanent vision loss and may be associated with subretinal scar. It may also lead to decreased vision in central visual fields.
Pterygium Excision is the surgical removal of a fibrous, fleshy growth on the surface of the clear cornea, usually beginning on the inner aspect of the eye. Dryness and exposure to ultraviolet light seem to be important factors in their development. They tend to be slowly progressive, but in many patients, pterygia stabilize and don't seem to cause problems. If clear vision is threatened by the presence of a pterygium, surgical excision is indicated. Other indications for surgery are increasing astigmatism or the desire for removal for cosmetic reasons. Surgery for excision of pterygia usually is performed in an outpatient setting under local or topical anesthesia with the patient returning home the same day. The pterygium is carefully dissected away. Postoperatively, the eye generally is patched overnight and healing typically takes many weeks with patients applying prescribed topical eye-drops or ointments several times a day. In the early phase of healing, the eye may be slightly swollen and bloodshot in appearance. Eventually the surgical site improves in comfort and appearance. Pterygia often recur, sometimes quite rapidly after removal. Certain forms of radiation therapy and drops are available to reduce this risk. Nevertheless, recurrence is a difficult problem especially in high risk climate areas.
Chalazion Excision is performed if a chalazion persists for more than 6 weeks. It is a quick and easy surgery that can be performed in a doctor's office. It involves lancing the cyst, draining the contents, and removing the cyst lining with a curette. A chalazion (kuh-LAY-zee-on) is a cyst that forms in the eyelids as a result of a blockage in one or more of the meibomian glands that produce oil that forms the outer layer of tears. It initially may resemble a stye - being red, tender and swollen. But after a few days, a chalazion typically becomes a painless, slow-growing bump that, unlike a stye, does not contain live bacteria. However, it may attract bacteria and lead to an infection or occur as an after-effect of a stye. In most cases, chalazia are gone within a few months, although one chalazion cyst may be followed by other, possibly larger cysts over several years.
Corneal Topography provides the most detailed information about the curvature of the cornea. Using a very sophisticated computer and software, thousands of measurements are taken and analyzed in just seconds. The computer generates a color map from the data. This information is useful to evaluate and correct astigmatism, monitor corneal disease, and detect irregularities in the corneal shape. The map is interpreted much like other topography maps. The cool shades of blue and green represent flatter areas of the cornea, while the warmer shades of orange and red and represent steeper areas. This corneal map allows the physician to formulate a "3-D" perspective of the cornea's shape. Measuring astigmatism is important for planning refractive surgery, fitting contact lenses, and calculating intraocular lens power.
OCT (Optical Coherence Tomography)
OCT (Optical Coherence Tomography) is a promising new class of diagnostic medical imaging technology that utilizes advanced photonics and fiber optics to obtain images and tissue characterization on a scale never before possible within the human body. OCT uses infrared light waves that reflect off the internal microstructure within the biological tissues. Ocular optical coherence tomography is a new, non-invasive, non-contact, transpupillary imaging technology which can image optic nerve and retinal structures to a very high degree of resolution. The anatomic layers within the retina can be differentiated and retinal thickness can be measured. The appearance of a variety of posterior segment pathologies using OCT has been described. These include glaucoma retinal nerve fiber changes, diabetic retinopathy, macular holes, epiretinal membranes, cystoid macular edema, central serous choroidopathy and optic disc pits.
Visual Field is used to test and monitor peripheral vision. It gives the doctor very important information about the neurological function of the retina, optic nerve, and brain. This test is usually ordered to monitor certain eye diseases such as glaucoma, and also as a screening test prior to surgery. Visual field tests come in different forms, but most have a white bowl with a small fixation light in the center. The most sophisticated ones are computerized. After your pupils have been dilated, you will be comfortably seated in front of the instrument. The trick to the test is to stare straight ahead as lights flash in the periphery. A button is available to press each time a light appears. A technician is available throughout the test should you have a question or need to pause for a break. Afterward, the computer analyzes the data and prints a chart of the results. Your visual field results are organized in your record so that your doctor can monitor your progress.