Frequently Asked Questions
I have a question for my doctor, how can I get all of my concerns to him/her?
You should bring your glasses and your medications at each visit. Previous reports, examinations and imaging studies done elsewhere are very helpful and we recommend you bring them too.
You should prepare yourself for eye dilatation at any visit, and this will cause blurring in your vision for 4-6 hours. We strongly recommend bringing someone with you as driving becomes dangerous after dilatation.
There are several tests which must be done by the technician so that your doctor will have necessary information to evaluate your eyes. You may also be dilated, which takes 30 minutes.
Vision can change for many reasons, just as pulse rate and blood pressure can change.
Although reading in dim light can make your eyes feel tired, it is not harmful.
Although using a computer is associated with eye strain and dryness, it is not harmful to the eyes.
At any time if there is suspected problem. Otherwise a guideline is a general exam at 3 years of age.
Yes, every patient with Diabetes should have regular eye examinations. How often you need to come depends on the stage of damage in your eyes, your doctor’s judgment and your compliance. This ranges from a visit every one month to a visit every six or nine months.
We recommend that you undergo an eye examination by an ophthalmologist. If the eye is normal, this condition is called presbyopia. Presbyopia is a normal aging process, where there is decreased elasticity in the eye’s lens, leading to variable inability to focus when looking at near objects. This condition is commonly managed by prescribing glasses for near work. Other options may be available and can be discussed with your physician.
The cornea is the transparent, dome-shaped surface at the front of the eye. The cornea helps protect the rest of the eye from germs, dust, and other harmful matter. The cornea bends, or refracts, light entering the eye, and accounts for most of the eye’s total focusing power. It also serves as a filter to screen out most of the damaging ultraviolet (UV) wavelengths in sunlight.
Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.
In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.
Dry eye symptoms may include any of the following:
- Stinging or burning of the eye;
- A sandy or gritty feeling as if something is in the eye;
- Episodes of excess tears following very dry eye periods;
- A stringy discharge from the eye;
- Pain and redness of the eye;
- Episodes of blurred vision;
- Uncomfortable contact lenses;
- Decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention.
Use artificial tears, gels and ointments - available over the counter - as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency.
Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces.
Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.
If dryness is severe, there are other options that your ophthalmologist may discuss with you, that include using other types of eye drops and surgical options.
It is a surgical procedure that uses a cool (non-thermal) beam of light to gently reshape the cornea to improve vision. The laser removes microscopic bits of tissue to flatten the cornea (to correct nearsightedness), steepen the cornea (to correct farsightedness) and/or smooth out corneal irregularities (to correct astigmatism).
The goal of laser eye surgery is to change the shape the cornea so it does a better job of focusing images onto the retina for sharper vision. LASIK and PRK are two types of laser vision correction.
LASIK and PRK are proven, safe and effective. The surgeon turns the laser on and is able to turn it off at any moment. Many safeguards are in place to reduce the risk of error. However, risks are associated with any surgical procedure.
Studies suggest that the incidence of minor difficulties such as dry eyes and nighttime glare is around 3 percent to 5 percent, while the risk of serious incidents such as lost vision is thought to be less than 1 percent. There are no known cases of blindness from LASIK or PRK. Again, outcomes generally are excellent.
You won't feel pain during LASIK or PRK, because your surgeon will place anesthetic eye drops in your eye first. Afterward, he or she may prescribe pain medication if necessary. Many LASIK patients report no more than mild discomfort for a day or so after surgery. There is more discomfort after PRK because the procedure exposes the deeper layers of the cornea. For clear and comfortable vision after PRK, protective surface cells have to grow back over the treated area. This process can takes usually a week.
The laser treatment itself usually takes less than a minute, while the entire procedure takes approximately 15 minutes per eye.
Your ophthalmologist will give you a thorough eye exam to make sure your eyes are healthy and you're a suitable candidate for laser vision correction. He or she will test for glaucoma, cataracts and other disqualifying conditions. He or she also will use a machine called a corneal topographer to photograph and electronically map your eye. The surgeon will use this map to plan your surgery for the most precise results possible.
LASIK and PRK are outpatient procedures, which mean you'll spend around an hour at the center and walk out afterward. Someone else must drive you home, because your vision will be a little blurry right after surgery.
You'll lie down in a reclining chair. The surgeon will place anesthetic drops in your eye, position your head under the laser and place an eyelid speculum (retainer) under your lids to hold your eye wide open. The laser is then applied.The surgeon will place eye drops or ointment in your eye. You may relax for a little while then go home and rest.
You may begin driving as soon as you see well enough, excluding the day you had LASIK or PRK performed.
Most people who have LASIK return to work the next day. With PRK, many surgeons recommend two or three days of rest instead.
You may resume wearing makeup about one week after your surgery. However, throw out your old makeup and buy new to decrease your risk of infection.
Some people experience dry eye after LASIK, which usually is relieved with eye drops and disappears over time. Others may experience starbursts or halos around lights, especially at night. Usually this effect lessens or disappears over time, too. In a small number of people (probably less than 1 percent), their vision worsens rather than improves.
Small number of patients see well after surgery then experience regression, a gradual worsening of vision. If this happens, consult with your ophthalmologist to determine the cause and to see if retreatment (enhancement) is appropriate.
Hormonal changes women experience during and after pregnancy can have effects on the eyes that can make LASIK outcomes less predictable.Also, during and after LASIK surgery, several prescription and non-prescription medications typically are used by LASIK patients, and some of these might pose risks to a developing baby.
For these reasons, most refractive surgeons advise their female patients to avoid having LASIK surgery during pregnancy and to wait a few months after they are done nursing their infant to have a vision correction procedure performed.
Yes, in most cases, and the effect is permanent.
Astigmatism is a very common vision problem. Despite having a somewhat scary-sounding name, astigmatism is not an eye disease — it's simply a refractive error like nearsightedness and farsightedness.
Yes, you definitely still need eye exams after LASIK surgery.
In addition to making sure your vision remains stable, routine comprehensive eye exams are needed to check and safeguard the health of your eyes.
Unless your ophthalmologist recommends more frequent exams, you should have your eyes checked yearly after LASIK to keep them in top shape.
The short answer: You need to be at least 18 years of age to have this surgery. And sometimes it's better to wait longer.
Primarily, the reason there's a minimum age requirement for LASIK is to increase the likelihood that your eyes are stable and your refractive error — the amount of nearsightedness, farsightedness and/or astigmatism you have — is unlikely to worsen after you have your Laser refractive surgery.
In most cases the improved vision the surgery provides is permanent.
But in a limited number of cases - usually due to changes that can occur in the lens inside the eye, with or without this surgery - some nearsightedness, farsightedness and/or astigmatism can return over time, causing blurry vision. If a regression of this sort occurs and becomes bothersome, a follow-up procedure called enhancement usually can be performed to restore clear vision.
In many cases, people who experience minor refractive changes after LASIK or PRK aren't bothered by the change and don't feel a need for additional vision correction. Others choose to wear prescription eyeglasses only for specific activities (driving at night, for example), and some choose to have an enhancement surgery performed.
This is a common concern, but rest assured that blinking and moving during LASIK surgery usually is not a problem.
Numbing drops are applied to your eyes prior to surgery to make your LASIK procedure comfortable and decrease your natural urge to blink. Also, a small device will hold your eyelids open during the procedure so you can't accidentally blink and your eyelids cannot interfere with any step of the surgery.
Movement of your head and body also is not a significant concern. You will be lying down on a comfortable, flat, cushioned surface during the relatively brief surgery (approximately 20 minutes for both eyes).
Individual surgeons may have different preferences regarding when you should discontinue contact lens wear prior to LASIK surgery. But generally, most surgeons say you should stop wearing soft contact lenses at least one week prior to surgery.
If you wear rigid gas permeable contact lenses, you should stop wearing these lenses for a longer period of time prior to LASIK — generally a month or longer.
The Lens and Cataract
This could be due to cataract, or less commonly, astigmatism. You are advised to be seen and examined by an ophthalmologist so as to be diagnosed and offered the appropriate management.
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all people either have a cataract or have had cataract surgery.
A cataract can occur in either one or both eyes, though one eye may advance faster than the other. It cannot spread from one eye to the other.
Age-related cataracts develop when the lens, which consists mostly of water and protein, clumps together. This produces clouding of the lens and reduces the amount of light that reaches the retina and results in glare and seeing halos at night. The clouding may become severe enough to cause blurred vision.
Cataracts can also develop from exposure to ultraviolet radiation, eye injuries, eye diseases, certain medications, or diabetes.
The most common symptoms of a cataract are:
Cloudy or blurry vision.
Colors seem faded.
Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
Poor night vision.
Frequent prescription changes in your eyeglasses or contact lenses.
These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your ophthalmologist.
A cataract is detected through a comprehensive eye exam that includes:
Visual acuity test. This eye chart test measures how well you see at various distances.
Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your ophthalmologist uses a special magnifying lens to examine the front part of the eye, retina and optic nerve for signs of damage and other eye problems.
The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, or anti-glare sunglasses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
Cataract needs to be removed only when vision loss interferes with your everyday activities. Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.
If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times.
With modern cataract surgery, a cataract does not have to ripen before it is removed. When a cataract keeps you from doing the things you like or need to do, consider having it removed.
Cataracts cannot be removed with a laser. The cloudy lens must be removed through a surgical incision. However, after cataract surgery, the capsule behind the artificial lens may become cloudy. This membrane can be easily opened with laser surgery.
You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract.
If you received an intraocular lens (IOL), you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also, when your eye heals, you may need new glasses.
Glaucoma is a group of diseases in which the pressure inside the eye is raised to the extent that it can damage the eye's optic nerve and result in vision loss and blindness. However, with early detection and treatment, you can often protect your eyes against serious vision loss.
The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.
In the front of the eye there is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues.
In glaucoma, there is an impairment of the drainage of this fluid. As the fluid backs up, the pressure inside the eye raises, much like an over-inflated ball, to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, vision loss results. That's why controlling pressure inside the eye is important.
Not necessarily. Increased eye pressure means you are at risk for glaucoma, but does not mean you have the disease. A person has glaucoma only if the optic nerve is damaged. If you have increased eye pressure but no damage to the optic nerve has been found, you may not have glaucoma. However, you are at risk. Follow the advice of your ophthalmologist.
Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as open-angle glaucoma.
Anyone can develop glaucoma. Some people are at higher risk than others. They include:
Everyone over age 40 is at potential risk , this risk increases with aging
People with a family history of glaucoma
People with a history of direct trauma to the eye
Family history of glaucoma in first degree relatives increases the risk of glaucoma. We recommend screening in these cases, and we advise you to do an eye examination (especially if you are above 40 years old).
At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. As glaucoma remains untreated, people miss objects to the side and out of the corner of their eye. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.
Yes. Immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That's why early diagnosis is very important.
Glaucoma treatments include medication, laser, conventional surgery, shunt tubes or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.
The Retina and Vitreous
The retina is a light-sensitive tissue that covers the interior wall of the eye. It receives images projected through the lens of the eye; the retina then sends these images to the brain through the optic nerve. When the retina is damaged, vision may become impaired.
The vitreous is a gel-like substance that fills the posterior cavity of the eye and is loosely attached to the retina.
As people age, the vitreous liquefies and tends to shrink. Shrinkage can then cause some traction or pulling of the vitreous on the retina. When this happens, most of the time the vitreous will separate from the retina and optic nerve cleanly. This separation is called a posterior vitreous detachment, or PVD.
As the vitreous ages and liquefies, it also changes in consistency and becomes stringy and forms strands. These strands float in the vitreous and cast shadows on the retina. They are seen by the patient as cobwebs, spiders, or as a series of irregular fine lines in the vision. Since these particles appear to move or "float" in the field of vision, they are referred to, as floaters.
Diabetic Retinopathy occurs when diabetes affects small blood vessels of the retina. It can cause the blood vessels to leak or become blocked. This may affect sight most frequently due to macular edema or ischemia. Bleeding inside the eye and retinal detachment involving the macula are other causes of vision loss due to diabetic retinopathy.
Anyone with Diabetes Mellitus is at risk. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Those who have poor diabetic control, hypertension, hyperlipidemia and nephropathy are also more likely to develop diabetic retinopathy.
Seeing black spots, floaters and cobwebs or sudden loss of vision are the main indicators.
Research found that prompt treatment of macular edema with intraocular injections of anti-VEGF drugs, with or without laser treatment, resulted in better vision than laser treatment alone or steroid injections. When injected into the eye, these drugs reduce fluid leakage and interfere with the growth of new blood vessels in the retina.
In some cases, focal laser treatment is used along with the eye injections. Focal laser treatment slows the leakage of fluid and reduces the amount of fluid in the retina. Focal laser treatment is usually completed in one session. Further treatment may be needed.
These are injections given into the eye to reduce retinal thickening due to fluid collection as well as to control bleeding in advanced retinopathy. After the injection, you will be monitored for any increase in eye pressure or infection. Depending on your eye condition, you may require repeated injections.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Between 1,500 and 3,000 laser burns in the areas of the retina, away from the macula, are applied using a special laser machine. This type of laser causes the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color and night vision.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
Vitreoretinal surgery or pars plana vitrectomy may be the only option in advanced diabetic eye disease, when there is persistent bleeding inside the eye (vitreous hemorrhage) or when the retina is detached.
Vitrectomy is performed under either local or general anesthesia. The procedure involves making three tiny incisions in the anterior portion of the eye. Next, a small instrument is used to remove the vitreous gel, the bleeding and the fibrous proliferation and to repair any retinal detachment. The vitreous gel is replaced with silicon oil or intraocular gas bubble which is gradually replaced by aqueous secretions.
AMD is a condition that causes deterioration or breakdown of the eye’s macula. The macula is a small area of the retina that is responsible for central vision. There are more than one form of AMD and multiple presentations. Any patient with AMD should undergo regular eye examinations and follow ups, even if the condition looks stable. Your ophthalmologist will discuss your case with you and offer you the appropriate treatment.
Retinal detachment is separation of neural layer of the retina from the underlying pigmented layer.
Some people are at increased risk of developing retinal detachments. The high risk group includes those with a high degree of myopia (nearsightedness), a family history of retinal detachment, or those who have previously experienced a retinal detachment. Patients who have had cataract surgery also experience an increased risk of developing a retinal detachment.
Treatment options include external and internal procedures depending on the extent of retinal detachment and break localization. External approaches include scleral buckle and retinal pneumopexy. Internal approach is by pars plana vitrectomy.
Vitrectomy is typically reserved for more severe and complicated retinal detachments and consists of the removal of the liquid, gelatinous mass that fills the rear two-thirds of the eye between the lens and the retina. The vitreous is replaced with either clear fluid or a gas that completely fills the eye. Each type of surgery has varying success rates.
This depends on the extent of macular involvement (the macula is the center of the retina); if the macula is not involved pre-operative vision may be maintained. If the macula is involved the prognosis depends on the duration of detachment; however the prognosis is generally guarded.