Conditions

Cataracts


Your eye has a clear lens through which the image passes allowing you to see. When this lens becomes cloudy it is called a cataract.

Cataracts cause progressive painless loss of vision. The lens clouds naturally with age so that, in general, people over the age of 65 usually a gradual reduction in their vision. In younger people, cataracts can come from injury, certain medications or illnesses such as diabetes. Ultraviolet light may play a role in cataract formation. Smoking cigarettes has also been linked to cataract formation.

 

If vision drops to a level that interferes with your ability to read, work, or do your normal activities, then cataract surgery should be considered. Surgery is the only effective way to deal with cataracts. The procedure is generally painless. It is one of the most frequently performed procedures. Cataract surgery also has a very high success rate.

Treatments and Additional Information





Cataracts can cause:

We perform no-stitch cataract surgery through a very small incision. After the eye is numbed with anesthesia: Step 1 –  A phacoemulcification (ultrasound) probe is inserted into the eye and the cataract is broken up or emulsified. It is then gently removed from the eye. Step 2 – Placement of a new artificial lens called an IOL. The IOL will correct for the majority of your distance vision. Fine tuning is done with prescription glasses. Some patients will only need glasses for reading.
For patients who are having cataract surgery and have glaucoma as well. This laser is applied to the ciliary processes (the area where the fluid is made in the eye) so that fluid production is decreased. This in turn, lowers the pressure inside the eye.

Glaucoma


Glaucoma is a disease of the optic nerve. That is the Optic nerve carries the images from the eye to the brain. There is a high prevalance of Glaucoma in the African American and Latino population. It is the leading cause of blindness for African-Americans. Glaucoma has been called the “Sneak Thief of Sight” because; in its most common form it has no symptoms; no blurred vision, no pain, no redness or swelling. People with glaucoma can go a long time with the disease and not know that anything is wrong until it is very late in the disease process.

Elevated pressure in the eye is the hallmark of glaucoma. There is fluid that is made in the eye that builds up because it can not get out through the internal drainage channels of the eye. Therefore, the pressure becomes elevated. This pressure slowly causes the death of nerve cells in the optic nerve, leading to loss of vision. Early diagnosis and treatment are essential in the prevention of visual loss due to glaucoma.





There are different categories of glaucoma:

  • Open Angle – This is the most common form of glaucoma which does damage slowly and silently.
  • Narrow Angle – This can also be a silent type of glaucoma or it can present as an acute closed angle attack which is characterized by blurred vision, pain, redness, and headache and even vomiting.
  • Secondary Glaucoma – This can develop following an eye injury, from disease and even from some medications such as Prednisone.
  • Congenital Glaucoma – This occurs when there is high pressure in the eye even at birth, causing visual loss.

The treatment of glaucoma involves drop therapy, laser (SLT, LPI, ECP, YAG CP), and filtering surgery.

Treatments and Additional Information

For patients who have open angle glaucoma, Selective Laser Trabeculoplasty (SLT) is used to open the drainage system in these patients so that the internal drainage system of the eye functions better. In that way, the pressure is then lowered in the eye. This procedure is effective in 75% of patients.
For patients with narrow angle glaucoma, a small hole is placed in the iris to open up the angle between the iris and the cornea to facilitate fluid drainage.
Neodymium:YAG Laser Cyclophotocoagulation (YAG CP) is for patients with very severe glaucoma damage where all other procedures have failed.  The ciliary body that produces the fluid inside the eye is destroyed.
For patients who are having cataract surgery and have glaucoma as well. This laser is applied to the ciliary processes (the area where the fluid is made in the eye) so that fluid production is slowed down. This in turn, lowers the pressure inside the eye.

Diabetic Retinopathy


Diabetes is a disease that occurs when an organ called the pancreas does not secret enough insulin. Insulin is the hormone that regulated the blood sugar (Glucose) level. Diabetes most commonly occurs in adults, although it can affect children as well.

Both cataracts and glaucoma are associated with diabetes. The main area to be affected in the eye is the retina. This is called diabetic retinopathy. It most commonly occurs in individuals who have had diabetes for more than 20 years.

Over time, diabetes affects the circulatory system of the retina. There are two major stages of DR. The earliest stage is called background diabetic retinopathy. In this stage the small blood vessels of the retina become weak and they have a tendency to bleed and to leak fluid as well as fat (lipid) out of the bloodstream and into the retina. This can cause blurred vision.

The next stage is known as proliferative diabetic retinopathy. In this stage abnormal, fragile blood vessels grow erratically from the retina. This is called neovascularization. These very fragile vessels hemorrhage easily. Blood can leak into the retina and the vitreous. If it leaks into the vitreous it can cause spots or floaters as well as blurred vision.

In the later stages of the disease, continued growth of these abnormal vessels and cause tugging on the retina and scarring. This may lead to serious problems like retinal detachment and glaucoma.





Some of the sign and symptoms of diabetic retinopathy are

  • Blurred vision
  • Floaters and spots
  • Sudden loss of vision

Diabetic patients require routine examination of the eye to detect any diabetic eye changes. The earlier diabetic retinopathy is caught, the better the prognosis. Diabetic retinopathy is monitored by testing such as flourescein angiography, retinal photography and ocular tomography.

The methods of treatment for diabetic eye disease include laser surgery and vitrectomy (blood is removed along with the vitreous gel of the eye). If retinal detachment occurs, that is repaired surgically.

There are 4 mainstays of prevention for diabetic eye disease:

  • Good control of the blood glucose (sugar) levels
  • Good control of blood pressure
  • Good control of cholesterol levels
  • Management of any kidney disease.

Treatments and Additional Information

A laser treatment for proliferative diabetic retinopathy. The laser is applied to the peripheral retina. This shrinks the blood vessels, often prevents them from regrowing, and decreases the chances of the blood vessels bleeding into the vitreous or causing a retinal detachment.
Focal treatment is used to seal specific leaking blood vessels in a small area of the retina, usually near the macula. The ophthalmologist identifies individual blood vessels for treatment and makes a limited number of laser applications to seal them off.
Avastin is an Anti-Vegf agent that is used to treat diabetic macular edema, neovascular glaucoma  and proliferative diabetic retinopathy.