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Implanted during cataract surgery, iStent inject® W can effectively lower IOP, one of the most important risk factors for glaucoma, and may reduce your reliance on glaucoma medication.

istent inject is one of the smallest medical implants known to be inserted in the human body and can lower the intraocular pressure, one of the most important risk factors in glaucoma.

Once implanted in the eye, iStent inject® W can help restore normal pressure in the eye. It’s designed to restore your eye’s natural ability to drain the fluid that causes the increased pressure inside your eye. This may allow your doctor to reduce or eliminate your glaucoma medications.
SYMPTOMS

Cataract Symptom: Blurry Vision

The most common symptom of cataracts is seeing blurry images at any distance. People may describe their vision as foggy, cloudy, or filmy.

Cataract Symptom: Glare

Glare, or sensitivity to light, is another symptom of cataracts. It can be difficult for a person with cataracts to see in bright sunlight. Indoor lights may begin to seem too bright, or they may appear to have halos around them. Glare from oncoming headlights cause problems with driving at night.

Cataract Symptom: Double Vision

Diplopia, or double vision, when looking with one eye can be another symptom of cataracts.

Cataract Symptom: Color Changes

Cataracts also affect color vision. Some colors may appear faded, and things may acquire a yellowish or brownish tint.

Cataract Symptom: Second Sight

The cataract acts as a stronger lens, temporarily improving the ability to see things at a close distance. Unfortunately this decreases as the cataract progresses.

Cataract Symptom: New Prescription

People with cataracts often need frequent changes in their eyeglasses or contact lenses because their vision deteriorates over time.
WHAT ARE THE CAUSES OF CATARACTS?

• Smoking
• Excessive use of alcohol
• Diabetes
• Trauma to the eyes
• Extended use of corticosteroids
• Prolonged radiation or sun exposure
• Aging

HOW ARE CATARACTS DIAGNOSED?

Cataracts can be diagnosed with an eye exam. The eye exam contains a vision test and an examination of your eyes using a slit lamp microscope. The pupils are dilated to rule out other pathology.
CATARACT SURGERY

Surgery to remove cataracts may be required if the related vision loss cannot be corrected with glasses or contact lenses. Cataract surgery involves removing the cloudy natural lens and replacing it with an artificial lens.
INTRA-OCULAR LENS CHOICES

New developments in cataract surgery allow for IOL s that correct both near and distance vision, reducing or even eliminating the need for glasses after the operation. Conventional “monofocal” lenses only correct one focal distance, so people still need reading or driving glasses after surgery. So-called “toric” implants are available to correct astigmatism. Multifocal and or Extended depth of focus lens “ Symfony”correct distance and near and some also astigmatism, to reduce dependence on glasses.

ANATOMY OF THE EYE

• Cornea: clear tissue in the very front of the eye • Conjunctiva: tissue covering the eye and inner lid • Iris: colored part of the eye surrounding the pupil • Pupil: dark hole in the iris that regulates the amount of light going into the eye • Lens: small clear disk inside the eye that focuses light rays onto the retina • Retina: layer that senses light, and creates electrical impulses • Macula: small central area in the retina • Optic nerve: connects the eye to the brain • Vitreous: clear, jelly-like substance that fills the middle of the eye

CATARACTS

One of the most common eye problems among seniors, the development of cataracts can cause vision problems and vision loss. A cataract is a painless clouding of the lens in the eye that causes blurry vision.

It progresses slowly as we age. Causes of cataracts include aging, diabetes, trauma, some medications, and excessive UV light exposure.

Your doctor can see a cataract while doing a routine eye exam. Surgery is curative as the cloudy lens is removed and replaced with an artificial one, called an IOL or intraocular lens. There are many types of Intraocular lens and will determine where the eye is in focus following surgery.

AGE-RELATED MACULAR DEGENERATION (AMD)

Age-related macular degeneration is an eye disease that can begin at any age, but usually develops after age 60. This eye condition progressively destroys your macula, which is the central portion of the retina.

There are two types: wet and dry. In wet macular degeneration, abnormal blood vessels behind the retina start to grow, leaking blood and fluid, causing loss of central vision. Treatment consists of injections to stop or slow the leakage. In dry macular degeneration, the light-sensitive cells in the macula slowly break down causing central vision to diminish over time. Treatment consists of special vitamins to slow the process.

CONJUNCTIVITIS (PINK EYE)

Conjunctivitis, or pinkeye, is an eye disease that causes redness and inflammation of the clear tissue covering the eye and the inside of the eyelids. It is caused by bacterial or viral infections and irritants such as chemicals, pollutants, or allergens.

Most infections do not need antibiotics. Bacterial conjunctivitis can be treated with antibiotic drops or ointments. A crusty discharge makes opening the eyelids difficult.

UVEITIS

Uveitis is inflammation to the middle layers of the eye called the uvea. The uvea consists of the iris, the ciliary body and the choroid and contains the arteries and veins. Causes of uveitis include trauma or injury to the eye, infections, or rheumatologic or inflammatory diseases that affect other parts of the body. The main symptom of uveitis is pain in the eyeball. The eye will look red and you may notice blurred vision, light sensitivity, and spots in your vision.

Treatment for uveitis depends on the cause. Anti-inflammatory or antibiotic drops will be prescribed.

EYE ALLERGIES

Causes of eye allergies are usually due to seasonal allergies, sensitivities to cosmetics or medications, or dust. Over-the-counter eye drops that contain antihistamines or decongestants are usually helpful. Make an appointment if these do not work, or if you experience pain, discharge, or extreme eye redness.

STYE

A stye is an infection of the oil gland at the base of an eyelash. It appears as a red, raised pimple on the edge of the eyelid. Symptoms are pain, tenderness, redness, and swelling with a small pustule. The eyeball itself may feel irritated or as if something is scratching it due to the swelling of the eyelid. If the stye comes to a head and releases pus this usually leads to resolution, if not, an appointment is indicated.

KERATOCONUS

The cornea is the clear surface covering the front of the eye. It is normally smooth and round. Weakness in the structure of the cornea can lead to a cone-shaped abnormal bulge to the front of the eye in a condition called keratoconus. Changes in the shape of the cornea make it difficult for the eye to focus even with the help of glasses or contact lenses. This is diagnosed by corneal topography in the office.

BLEPHARITIS

Blepharitis is inflammation of the eyelids. The inflammation can be found on the outer (anterior) or inner (posterior) eyelid. Symptoms include burning, itching, swelling, flaky material at the base of the lashes, crusting of the eyelids, tearing, or blurred vision. Common causes of blepharitis are problems with oil glands at the base of the eyelids, infections, or other skin conditions. Treatment includes frequent cleaning, light scrubbing. Severe cases of blepharitis may require antibiotics or steroids or treatment with lipiflow to unblock oil glands.

CHALAZION (EYELID CYST)

A chalazion is the inflammation of a small cystic gland in the eyelid. The gland becomes clogged and the gland swells. Chalazions are treated with warm compresses, they may require antibiotics. If the chalazion becomes severe, causes changes in vision, or is persistent, it may be removed surgically in the office. And is covered by insurance.
CORNEAL ULCER

 A corneal ulcer is a small crater (ulcer) on the front part of the eye, usually following an infection. Bacteria, viruses, or fungus can be the cause.

People who wear contact lenses are at higher risk for corneal ulcers.

Symptoms of a corneal ulcer include:

• pain,
• intense redness,
• feeling as if something is in the eye,
• sensitivity to light
• blurry vision.

If you suspect a corneal ulcer or have the symptoms of a corneal ulcer and wear contact lenses, make an appointment immediately. High potency antibiotics will be prescribed.
DIABETIC RETINOPATHY

 There are two types of diabetic retinopathy:

• Nonproliferative retinopathy, the less severe type in which there may be bleeding in the retina and leakage of blood or lipid causing a swelling in the center of the eye requiring treatment.
• Proliferative retinopathy, a more severe type where new abnormal blood vessels grow abnormally on the retina. These vessels may bleed into the vitreous.

Treatment involves laser surgery and intraocular injections and surgery. Strict glucose control and a healthy lifestyle with weight loss, dietary restrictions, and exercise can reduce the risk.
CROSSED EYES OR DOUBLE VISION

Crossed eyes is an eye problem involving a misalignment of your eyes. This may be congenital or acquired.

Young children born with this disorder may develop decreased vision in one eye (amblyopia, also known as “lazy eye.”). Treatment for strabismus involves using an eye patch on the stronger eye, eye exercises, and possibly surgery.

Acquired or new onset diplopia needs evaluated to determine the cause, as some causes require immediate treatment.
FLOATERS

Floaters are caused by aging changes in the vitreous jelly of the eye. They are a common consequence of aging. If you develop multiple floaters, or floaters associated with pain make an appointment. In general floaters do not cause blindness and are mostly harmless, but can be a sign of a retinal detachment, bleeding, inflammation or infection.

Why is eyelid surgery performed?

Excess skin and fat can create a heavy looking eyelid, aged appearance, puffiness, and sometimes block the upper field of vision. Upper blepharoplasty can improve the field of vision.

How much does eyelid surgery cost? Does insurance cover the cost of blepharoplasty?

Insurance carriers will only cover the cost of upper eyelid surgery if the patient has obstruction of their visual field. This must be documented with formal visual field testing and photographs. Some insurance carriers require submission of the visual fields and photographs before approving the blepharoplasty as a medically indicated procedure.

Entropion

Entropion is a condition in which your eyelid turns inward so that your eyelashes and skin rub against the eye surface. This causes irritation and discomfort. Your eyelid may be turned in all the time or only when you blink or look down. Entropion is more common in older adults, and it generally affects only the lower eyelid.

Artificial tears and lubricating ointments can help relieve symptoms of entropion. But usually surgery is needed to fully correct the condition.

Symptoms

The signs and symptoms of entropion result from the friction of your eyelashes and outer eyelid against the surface of your eye. You may experience:

• The feeling that something is in your eye
• Eye redness
• Eye irritation or pain
• Sensitivity to light and wind
• Watery eyes
• Mucous discharge and eyelid crusting

CausesEntropion can be caused by:

• Muscle weakness. As you age, the muscles under your eyes tend to weaken, and the tendons stretch out. This is the most common cause of entropion.
• Previous trauma or burns

• Age. The older you are, the greater your chances of developing the condition

Surgical TreatmentQuickert Sutures- performed in the office. Sutures are placed in the lower lid to create a scar and redirect the lid into its normal position.Incisional Surgery-Performed in an outpatient surgery center. The lid is cut and the muscles are shortened to make them stronger and redirect the lid into its normal position.

Ectropion

Ectropion is a condition in which your eyelid turns outward. This leaves the inner eyelid surface exposed and prone to irritation.

Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye.

Artificial tears and lubricating ointments can help relieve symptoms of ectropion. But usually surgery is needed to fully correct the condition.

Symptoms

Normally when you blink, your eyelids distribute tears evenly across your eyes.

If you have ectropion, your lower lid pulls away from your eye and tears don’t drain properly into the puncta. The resulting signs and symptoms can include:

• Watery eyes (excessive tearing). Without proper drainage, your tears may pool and constantly flow over your eyelids.
• Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
• Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
• Sensitivity to light. Stagnant tears or dry eyes can irritate the surface of the cornea, making you sensitive to light.

Ectropion can be caused by:

• Muscle weakness. As you age, the muscles under your eyes tend to weaken, and tendons stretch out.
• Facial paralysis. Bell’s palsy, and certain types of tumors can paralyze facial nerves and muscles.
• Scars or previous surgeries. Skin that has been damaged by burns or trauma. Previous eyelid surgery.
• Eyelid growths. Benign or cancerous growths on your eyelid.

Treatment

Ointments and Artificial tears provide some temporary relief, as well as taping of the lid.

Surgical Repair is done in an outpatient surgical center to correct the ectropion.

PTOSIS

Ptosis is when the upper eyelid droops over the eye.Ptosis can limit or even completely block normal upper field of vision.

Children and adults can have ptosis. Fortunately, this condition can be treated to improve vision as well as appearance.

Adults get ptosis when the levator muscle stretches or separates away from their eyelid. This can be caused by aging or injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.

The cause must be found before treatment is recommended.

There is a new prescription eye drop for some adults with acquired ptosis. The medication Upneeq activates the muscle that raises the eyelid. It needs to be used daily to keep working.

Ptosis surgery is done in an out- patient surgical center. A local anesthesia will be used to numb your eye and lid skin.

The muscle is repositioned on the lid to raise it to a higher position.

Before eyelid surgery blood thinners will be stopped and recovery is about a week.

Dermatochalasis refers to redundancy of eyelid skin and is often associated with orbital fat protrusion or prolapse. Significant dermatochalasis of the upper lids leads to complaints of a heavy feeling around the eyes, brow ache, eyelashes in the visual axis, and, eventually, reduction in the superior visual field

Indications for upper eyelid blepharoplasty

Indications for upper eyelid blepharoplasty include redundant and lax skin and fat herniation that result in either functional visual symptoms. Dermatitis of the redundant skin can also be an indication for surgery.

Risk Factors

• Aging
• Inflammatory diseases affecting the eyelids
• Chronic lid swelling/edema associated with systemic disease or allergy
• Family history

Diagnosis

History

Patients often report drooping, sagging, tired appearing eyelids that interfere with various activities of daily living. In severe cases, patients may have to manually lift the skin upward to improve their visual field. A complete medical and ophthalmic history should be obtained that includes:

• Impact of upper eyelid changes on activities of daily living
• Previous ocular conditions and surgeries
• Systemic disease which will influence the outcome of the surgery such as rheumatologic conditions, collagen vascular diseases and diabetes
• Prior cosmetic procedures
• Dry eye symptoms and treatments
• Complete list of medications including blood thinners and herbal supplements

Physical examination

Eyelid examination

• Quality, quantity and relative symmetry of redundant skin
• Eyelid crease height and symmetry
• Fat pad herniation
• Evaluation for presence of concurrent ptosis
• Assessment of brow position

Ocular vital signs Visual acuity, pupillary examination, extraocular motility, intraocular pressure, corneal exam, and tear evaluation.

Diagnostic procedures

Visual field testing with the eyelids untaped and taped can be used to quantify the degrees of visual field obstruction present in patients with severe dermatochalasis and preaponeurotic fat herniation.