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What is a Cataract?
A cataract is the clouding of the crystalline lens in your eye. This opacity obstructs the passage of light resulting in a reduction of clear vision. Normally, light passes through the clear lens and is focused onto the Retina. However, the natural aging process can cause the lens to become cloudy, or milky. The cataract blocks the passage of light through the eye and causes distorted or blurred vision, glare, or difficulty seeing in poor lighting conditions.
There are three types of cataracts:
A nuclear cataract
forms in the lens. Those over 65 are more prone to develop this type of cataract. More than half of all Americans over the age of 65 will develop a cataract.
A cortical cataract
forms in the lens, then grows from the outside to the center of the lens. Diabetics are more prone to develop this type of cataract.
A subcapsular cataract
forms in the back of the lens. Those with diabetes, high hyperopia (Far-sightedness) or retinitis pigmentosa may be at a higher risk to develop this type of cataract.
What are the symptoms of a Cataract?
You may not notice a slight change in your vision, as cataract starts out very tiny, but as it grows from the size of a pin head, you may notice that your vision is becoming blurry, and you may feel you are looking through dirty lenses. Object edges may appear to fade into one another and colors may not appear as bright as they should.
The most common symptoms of a cataract are:
» Cloudy or blurry vision.
» Problems with light, headlights that seem too bright, glare from lamps or very bright sunlight.
» Colors that seem faded.
» Poor night vision.
» Double or multiple vision.
» Frequent changes in glasses or contact lenses.
» Optical aids such as eyeglasses or contact lenses are no longer effective.
How is a Cataract treated?
Cataract surgery is a selective and successful solution to restoring vision when the cataracts seriously impair your vision and affect your daily life. Cataract surgery is the most frequently performed surgery in the United States, with millions of surgeries done each year. Cataract surgery is a routine and relatively painless procedure.
Cataract surgery is generally performed on an out patient basis. You will not need to be hospitalized or put to sleep for your doctor to perform your surgery. The procedure normally takes less than 15 minutes and you can return home shortly after your procedure. Most people will enjoy improved vision by the day after surgery or within a few days following the procedure.
To begin, your surgeon will administer a light sedative which will relax your nerves and keep you comfortable during the procedure. Anesthetic eye drops will be used to completely numb the eye. The entire procedure is performed through an incision that is smaller than 1/8 of an inch and does not require stitches to heal.
Once the cataract is removed, an intra-ocular lens (IOL) is placed where the cataract lens was removed, to restore your sight. Most patients will not require an eye patch and will not have any discomfort.
Most can return to their normal daily routines; including reading, driving, and exercise, the day after surgery.
What causes a Cataract?
It is not known why cataracts occur in all instances but studies on the cause of cataracts will soon teach us how to more successfully treat and prevent them. The most commonly known type of cataract is age related.
Ultraviolet light is a known catalyst for the formation of cataracts, so we recommend wearing 100% UV blocking sunglasses which will lessen your exposure over time. Other studies point to people with diabetes as a higher risk group for cataract development than those who do not suffer from diabetes. Cigarettes, air pollution, heavy drug usage and severe alcohol consumption may also contribute to your chances of developing cataracts.
Can I be too young or old for Cataract surgery?
Any patient who can undergo a thorough eye examination can undergo surgery if the procedure is performed with topical anesthetic-drops alone.
How do I decide whether to have surgery?
Fortunately, cataracts are not life threatening so most people have plenty of time to decide about cataract surgery. However, we cannot make your decision for you, but talking with us can help in your decision. Together, we can ascertain how your cataract affects your vision and your life. If any of the below applies to you, then please contact us for a consultation.
The most obvious symptoms may include:
» I need to drive, but I see too much glare from the sun or headlights.
» I do not see well enough to do my best at work.
» I do not see well enough to do the things I need to do at home.
» I have trouble trying to read, watch TV, sew, play cards, etc.
» I am afraid I will bump into something or fall.
» Because of my cataract, I am not as independent as I desire.
» My glasses do not help me see well enough.
» My eyesight interferes with many of my daily functions.
» You may also have other specific problems that we will discuss with you.
Is Cataract surgery right for me?
Most people who have a cataract recover with no problems and improved vision. This type of surgery has a success rate of 98% in patients with otherwise healthy eyes. If you have a cataract in both eyes, we believe it is best to wait until your first eye heals before having surgery on the second eye. If the eye that has a cataract is your only working eye, we will weigh very carefully the benefits and risks of cataract surgery.
You will be able to make the right decision for yourself if you know the facts. We are more than happy to explain anything you do not understand. There is no such thing as a "dumb" question when it comes to your health.
How soon can I drive after the surgery?
We will require that you have someone drive you home following your procedure. However, you may drive when you feel comfortable enough to drive safely, possibly the next day.
Do I have to avoid all activities post-operatively?
We typically demonstrate to our patients that they can bend over immediately after surgery, pick up 20-30 pounds, and shower provided they don't get water into their operative eye.
We do ask that they wear an eye shield at bedtime for the first few weeks after surgery so they do not inadvertently rub the eye during sleep. Typical follow-up evaluations are scheduled at 1 day, 1 week, 3 weeks, and 6 weeks with glasses being prescribed between the 3rd and 6th week visit.
Does Cataract surgery hurt?
The treatment is painless. We will place a numbing drops in your eye(s) to make you more comfortable.
What else should I know about surgery?
We will discuss in the greatest detail your options before choosing the best technique for your surgery. We will also explain how to prepare for surgery and how to take care of yourself after it is over.
Cataract surgery is outpatient. You do not need to stay overnight in a hospital. However, you will need a friend or family member to take you home. You may need someone to stay with you for a day to help you follow your doctor's instructions.
With modern cataract surgery, most patients have fast visual recovery. Some patients are even able to drive themselves to see doctor for follow-up the day after surgery. Remember that the follow-up is very important. We will thoroughly check your progress and make sure you have the care you need until your eye recovers fully.
Will I still need glasses or contact lenses?
You may need glasses or other corrective lenses after the procedure on a temporary or permanent basis. Cataract surgery will not prevent, and may unmask, the need for reading glasses.
Do regular glasses protect my eyes from the sun?
Plastic lenses do not protect your eyes. You need to have UV protection from UV rays, which are not inherent in a plastic lens. You can have a UV protective coating applied to a plastic lens, but polycarbonate lenses have built-in UV protection.
Glass lenses protect your eyes from harmful UVB rays but not from UVA. Some experts think UVA rays might have long-term, damaging effects to your eyes and skin.
DRY EYE FAQs
What is Dry Eye?
In medical terms,
Dry Eye is lovingly known as "KERATOCONJUNCTIVITIS SICCA".
The tear film consists of 3 layers: A superficial lipid (oily) layer which decreases evaporation, a middle aqueous layer which contributes 90% of the tear film, and a deep mucin layer which facilitates spreading of the tears over the cornea.
How do you treat Dry Eye?
(1) Stimulation of tear production. Tear production is best stimulated by the topical administration of drops or ointments to the eye to the eyes. Usually 4-6 weeks (sometimes longer) is required for tear production to improve. Usually treatment must be continued for life to maintain tear production, but it is possible in some cases to reduce usage. This is especially true if KCS is detected early before severe drying is present.
(2) Control of ocular inflammation and infection through the topical application of an antibiotic-steroid preparation. Occasionally antibiotics may be given orally
Can Watery Eyes Be a Symptom of Dry Eye?
Yes. As odd as it sounds, many Dry Eye sufferers experience ‘wet eyes’ due to the tear glands overproducing watery or reflex tears to compensate for a lack of a balanced tear film.
Can reading & TV or computer viewing cause Dry Eye?
During reading and TV or computer viewing, the rate of eyelids blinking reduces significantly. This causes the tear film to evaporate leading to dryness of the eyes. This may happen in some people, especially more when they are tired, or have spent long hours watching TV or computers. Computer Users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22 times/minute).
This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor. Ideally, computer users should take short breaks about every 20 minutes to reduce this factor. Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye’s surface, again to reduce evaporation..
What else can cause Dry Eye?
can often cause Dry Eye symptoms due to inflammation of the eye lid margins, which is caused by a bacterial infection (Staphylococci). This condition can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material that can cause a mild toxic reaction leading to chronic red, irritated eyes. Click Blepharitis for treatment.
surgery temporarily disrupts the ocular surface/lacrimal gland unit. This condition usually eventually clears up.
Diseases that may be associated with Dry Eyes include Rheumatoid Arthritis, Diabetes (especially when the blood sugar is up), Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.
Tear volume decreases as much as 60% by age 65 from that at age 18. Dry Eye Syndrome affects 75% of people over age 65.
for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.
Dust, Pollen, and Tobacco -
When tear production decreases, dust and pollen stay in the eye longer and are more likely to stimulate an allergic response. In addition, anything that makes an eye more irritated, including Dry Eye, will make an eye more sensitive to environmental irritants such as tobacco smoke.
Too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat.
What are the warning signs and how is it detected?
People with Dry Eye have sandy-gritty irritation or burning in their eyes. Initially people may have symptoms only after particularly long days, or when driving, or with contact lens wear, or when exposed to extremely dry environments such as that seen in airplane cabins.
Eventually symptoms become more consistent, and if someone has sandy-gritty irritation or burning that gets worse as the day goes on, and if they have had these symptoms for more than a few days, Dry Eye should be ruled out by an eye doctor.
We will review your history and examine your eyes to make sure you do not have any other problems, and determine the cause for your Dry Eyes.
Can Dry Eye syndrome come and go?
Dry Eye syndrome does not truly come and go, but in the early stages of the condition, or with mild Dry Eye, you may only have symptoms after long days, or with environmental conditions that decrease your blink rate (i.e. computer use) or under conditions that increase evaporation from your tear film (i.e. wind, dry air, etc.).
Some patients may notice discomfort only when they wear their contact lenses. Some people may develop symptoms only when they are dehydrated--just like your mouth becomes dry, your eyes can become dry in this way.
What if I don't treat Dry Eye. Can I lose sight?
If untreated, Dry Eye can progress to a more irritable, troublesome condition called chronic conjunctivitis. It can cause considerable trouble, and Dry Eye can lead to loss of sight due to corneal scarring, so delaying treatment is not recommended.
Is there treatment for corneal scarring caused by Dry Eye
When patients experience corneal scarring from Dry Eye, sight may be restored by corneal transplants. However, the original cause of the scarring should be addressed to prevent a recurrence of vision loss.
What can I do to prevent or control Dry Eye syndrome?
Have annual eye exams.
See us immediately if you notice Dry Eye symptoms or any decline in your vision..
EYE EXAM FAQs
What is a routine eye exam?
A routine eye examination is much like a routine physical, but for the eyes. Typically, there is no specific problem with the eyes other than the need for lenses to correct your vision. The insurance companies consider the need for corrective lenses to be routine.
A complete examination includes a glaucoma pressure check, a muscle evaluation, observation for external eye disease, examination of the retina and refraction..
What's the difference between a routine and medical exam?
These two terms refer to the way an examination is billed out by the office. Both examinations are performed the same way by the doctor. The diagnosis, which is billed out by the office, depends on the chief complaint of the patient, as related to the doctor or technician.
The patient comes to the office with a history of diabetes. He/she is healthy and has no eye problems, but wants his/her eyes examined. This is considered a medical examination because the patient has a disease which can affect the eyes and the physician needs to evaluate the patient's eyes in light of this disease.
The patient comes to the office with a complaint of difficulty seeing the newspaper, but no problem with distance vision. This would be considered routine in nature because there are no medically related problems.
The patient comes to the office with pain in the eye and tearing. These complaints are considered medical symptoms and the eye examination would be billed as a medical exam.
What should i bring with me for my appointment?
Please bring the following on the day of your visit to our office:
• Photo ID
• Current insurance cards
• Current medication list
• All recent glasses and contact lenses (both distance and near)
• An insurance referral if your plan requires one
Should I wear my contacts to the office and bring my glasses too for my exam?
Yes, especially if you want the doctor to evaluate the fit and vision of the contact lenses in your eyes. You may be asked to take the contact lenses out of your eyes during the examination, so please bring all recent glasses (reading and distance) with you to your exam.
How long does a thorough exam take?
Your stay for a complete eye examination generally takes from 45 minutes to an hour.
If my eyes are to be dilated, how long will my eyes stay blurry after the exam?
After your eyes have been dilated, the blurriness may last from 2 - 4 hours, with vision improving every hour. This blurriness is for close-up vision, but you will be light sensitive for distance as well. Please bring your sunglasses with you to the office.
You may want to consider bringing someone with you to drive you or help you navigate to where you want to go when you leave our office.
Will my insurance cover my eye exam?
It is the responsibility of the patient to know his/her benefits. Most insurance plans will differentiate between a routine eye exam and a medical eye exam. You must decide if the reason you need an eye exam is because you have a specific complaint or just because you would like your eyes examined.
Any examination that takes place as a result of a patient's complaint or symptoms (ie: dry eyes, headaches, eye infection, etc.) would be considered medical in nature and should be covered under your medical insurance. Any eye exam conducted at the patient's request without a specific complaint would be considered routine. This type of exam would only be covered if your insurance contact specifically states routine eye coverage is a benefit.
Vision Plans - What's the difference?
It is important that you understand that your Vision Plan covers ROUTINE eye care only (nearsightedness, farsightedness, and normal astigmatism). You will be receiving a comprehensive medical eye exam from one of our fine doctors who are committed to giving you the highest quality eye care. We will examine you for many conditions such as glaucoma, dry eyes, cataracts, retinal holes or tears, diabetic and hypertensive eye disease among many others. If your eye exam involves a medical condition related to your eye that requires specific counseling, documentation, follow-up care, regular monitoring or referral to a surgeon, then your visit is often NOT COVERED by your Vision Plan. Unfortunately, the doctor cannot tell if medical eye conditions exist before you are thoroughly examined.
The good news
is that your Medical Insurance can be used with an eye-related medical problem, such as cataracts, dry eyes, complicated from diabetes or high blood pressure (among many others) if found during the course of the eye examination. You do not need a vision benefits rider on your medical insurance to be covered for a medical eye condition. In these cases, your Medical Insurance will be billed for the eye exam even though a Vision Plan may also be in effect. Your Medical Insurance co-pays and deductibles must be paid at the time of your exam.
More good news!
If we do file the exam with your medical insurance, you can still use your Vision Plan benefits towards the purchase of glasses or contact lenses based on your plan’s allowances. If you elect to have refractive services done to establish what prescription you need for glasses, please be aware this will NOT be covered by your medical insurance and a $40 fee will be due at the time of the visit.
What is Glaucoma?
Glaucoma is the term for a diverse group of eye diseases, all which involve progressive damage to the optic nerve. Glaucoma is usually, accompanied by high intraocular (internal) fluid pressure. Optic nerve damage produces certain characteristic defects in the individual’s peripheral (side) vision, or visual field.
Are there different types of Glaucoma?
There are three basic types: Primary, Secondary, and Congenital Glaucoma.
is the most common type and can be divided into open angle and closed angle Glaucoma.
Open angle Glaucoma
is the type seen most frequently in the United States. It is usually detected in its early stages during routine eye examinations.
Closed angle Glaucoma
, also called acute Glaucoma, usually has a sudden onset. It is characterized by eye pain and blurred vision.
occurs as a complication of a variety of other conditions, such as injury, inflammation, vascular disease and diabetes.
is due to a developmental defect in the eye’s drainage mechanism.
How is Glaucoma detected?
Early detection of open angle Glaucoma is extremely important, because there are no early symptoms. Fortunately, routine eye exams are a major factor in early detection. People with a family history of Glaucoma should be checked at intervals in their 30s to establish a baseline.
Initially, detection is based often on intraocular pressure readings, but also includes observation of the optic nerve as well as evaluation of optic nerve function using visual field tests.
Is surgery necessary to treat Glaucoma?
When medication and laser surgery fail to control Glaucoma, a surgical procedure called 'filtering operation' is recommended to create an artificial outlet for fluid from the eye, thus lowering intraocular pressure.
Requiring use of an operating microscope and a local anesthetic, this procedure is performed in the hospital. If such a procedure is not feasible or has failed, production of aqueous fluid may be reduced by freezing (cryoprobe) or laser energy directly applied to the eyeball over the area where the fluid is produced.
The most helpful advice concerning Glaucoma is to keep in mind the importance of early detection through routine eye examination, faithful use of prescribed medications, and close monitoring by an eye doctor of the optic nerve, visual fields and pressures.
Can Glaucoma cause blindness if left untreated?
Between 89,000 and 120,000 people are blind from Glaucoma yearly. It is a leading cause of blindness, accounting for between nine and 12 percent of all cases of blindness. The rate of blindness from Glaucoma is between 93 and 126 per 100,000 population over 40.
Between two million and three million Americans age 40 and over, or about one in every 30 people in that age group have Glaucoma. This includes at least one half of all those who have Glaucoma are unaware of it.
What are the signs and symptoms?
In the vast majority of cases, especially in early stages, there are few signs or symptoms. In the later stages of the disease, symptoms can occur that include:
» Loss of side vision.
» An inability to adjust the eye to darkened rooms
» Difficulty focusing on close work
» Rainbow colored rings or halos around lights
» Frequent need to change eyeglass prescriptions
Can Glaucoma be cured?
Not yet. Any sight that has been destroyed cannot be restored, but medical and surgical treatment can help stop the disease from progressing.
Can Glaucoma be prevented?
Not yet, but blindness from Glaucoma can be prevented through early detection and appropriate treatment.
How can I know if I am a high risk for Glaucoma?
A number of risk factors for the development of Glaucoma exist. The most important of these include high pressure inside the eye, advanced age, extreme near-sightedness, or a family history of Glaucoma.
The best and safest way to learn if you have Glaucoma, and to have a chance to avoid blindness, do NOT delay;
Get an eye examination!
What is the best defense against Glaucoma?
Have annual eye exams!
See us immediately if you notice any symptoms or any decline in your vision.
MACULAR DEGENERATION FAQs
what is Age-related Macular Degeneration (AMD)?
Age-related Macular Degeneration (AMD) is an eye disease causing clear vision to fail in millions of older People.
When electrical signals from the retina (the inner layer of the eye that captures light and turns it into electrical signal) are received by the brain through the optic nerve, they are translated into images.
Age related Macular Degeneration is traditionally described as a form of the disease which affects individuals over the age of 55 years. However, we have recently discovered that a significant number of these individuals may have a major genetic component that contributes to the disease.
How many types of Macular Degeneration are there?
There are two types of Macula Degeneration
Dry Macular Degeneration,
in which the cells of the macula slowly begin to break down, is diagnosed in 90 percent of the cases. Yellow deposits called "drusen" form under the retina between the retinal pigmented epithelium (RPE) and Bruch’s membrane, which supports the retina. Drusen deposits are "debris" associated with compromised cell metabolism in the RPE and are often the first sign of Macular Degeneration. Eventually, there is a deterioration of the macular regions associated with the drusen deposits resulting in a spotty loss of "straight ahead" vision.
Wet Macular Degeneration
occurs when abnormal blood vessels grow behind the macula, then bleed. There is a breakdown in Bruch’s membrane, which usually occurs near drusen deposits. This is where the new blood vessel growth occurs (neovascularization). These vessels are very fragile and leak fluid and blood (hence ‘wet’), resulting in scarring of the macula and the potential for rapid, severe damage. "Straight ahead" vision can become distorted or lost entirely in a short period of time, sometimes within days. Wet macular degeneration accounts for approximately 10% of the cases, however it results in 90% of the legal blindness.
What does Macular Degeneration do to your vision?
Macular degeneration is the imprecise historical name given to that group of diseases that causes sight-sensing cells in the macular zone of the retina to malfunction or lose function and results in debilitating loss of vital central or detail vision.
What are the Symptoms of Macular Degeneration?
Macular Degeneration can cause different symptoms in different people. Sometimes only one eye loses vision while the other eye continues to see well for many years. The condition may be hardly noticeable in its early stages. But when both eyes are affected, reading and close up work can become difficult.
One of the easiest ways to screen for age-related macular degeneration (AMD) is to use an Amsler grid. An Amsler grid is a chart with lines and a dot at the center.
In many cases most dehabilitation diseases can be treated or managed with early detection, so regulalary scheduled eye exams are imperative to catching many issue early, before they get unmanagable.
Is there treatment for Macular Degeneration?
There is no treatment for early dry AMD, although a special combination of supplements (zinc and antioxidant vitamins) may slow progression in some people with more advanced disease. Early intervention for wet AMD can delay progression.
What if am post-menopausal?
If you are post-menopausal, you should consult with your physician concerning estrogen replacement therapy. This may have a favorable impact upon cholesterol lipid levels that play a role in worsening the disease.
What can I do to delay getting Macular degeneration?
While is is no cure for Macular degeneration you may be able to slow down the progression of the disease. Develop healthy habits! If you smoke, QUIT SMOKING! Exercising, maintaining normal blood pressure, cholesterol levels and eating a healthy diet is a step in the right direction. Eat food and-or supplements rich in vitamin E,C and Lutein. Lutein is a plant antioxidant found in high quantities in spinach, kale and other dark green, leafy vegetables.
People who eat fish and green leafy vegetables may be at lower risk of AMD. There is no treatment for early dry AMD, although a special combination of supplements (zinc and antioxidant vitamins) may slow progression in some people with more advanced disease. Early intervention for wet AMD can delay progression.
CHILDREN'S EXAM FAQs
Is a school vision screening just as effective as a full eye examination by a doctor?
Vision screenings at your pediatrician or school are useful to pick up gross problems, but they do not take the place of full eye exams. A study that was funded by the National Eye Institute and was published in the April 2004 issue of Ophthalmology found that 36-39% of preschool children with one of the targeted vision disorders was missed.
The requirements for grade school vision screenings consist of testing the distance visual acuity. Even near vision, which is a critical component in learning, is sometimes not tested. Farsightedness can easily be missed. Many other important tests especially for the at-risk students are left out. Thus it is very important to have a full eye examination at least before kindergarten.
How do you test an infant or toddler that can not talk?
We have many tests that look at their prescription, eye alignment, basic visual acuity, eye health, focusing and tracking. One test for infants involves two cards. There are black and white stripes on one card and only a gray color on the other. Babies tend to look at the more interesting target (the stripes) and will do so if they can see them. The size of the stripe-pattern is varied to help determine how well they can see with each eye.
Another example is a test for a two year old. We use the Lea chart, which has simple pictures of a house, heart, square and circle. When they are presented, the child points to a card that matches the shape they see.
My child is struggling in school but his last eye doctor said his eyes are fine. Was something missed?
Unfortunately all examinations are not created equal. Most exams include eye clarity, eye health and gross eye alignment. Other tests that are equally important will look at fine eye alignment, depth perception, color vision, eye tracking and focusing.
These additional tests can help determine if vision is a component in a child’s learning struggles. If these tests are not performed, visual problems can be overlooked leading to frustration for the child and the teacher.
My child can see airplanes and street signs that I can't see. Does he still need an examination?
This shows that the child can see well at a distance out of at least one eye. The other eye may be very blurred and the child will not complain because they are unaware. Children can have double or blurred vision with reading and not complain because it has always been that way. They believe that everyone sees the way they do and that their vision is normal, even when it is not.
Nicholas & Meland
1 Coliseum Crossing Dr.
Hampton, VA 2366
Nicholas & Meland Family Eyecare
1 Coliseum Crossing Dr.
Eye to Eye Optical, Ltd. proudly serves Hampton, VA and the surrounding areas of Newport News, Yorktown, Poquoson, Smithfield, Norfolk, Virginia Beach, Portsmouth, Chesapeake, Gloucester, Williamsburg, and Carrollton.
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