Conditions & Treatments

Cataracts

As you age, the lens of your eye can become cloudy, preventing light from passing through. This loss of transparency may be so mild that vision is barely affected or so severe that you see only light or dark. When the lens obstructs vision to a significant degree, it’s called a cataract. Trauma can also cause cataracts as well as medications like steroids, systemic diseases like diabetes, or prolonged exposure to ultraviolet light.

Glasses or contact lenses correct slight errors but can’t sharpen your vision if the situation is severe.

I can remove your cloudy, natural lens in a routine outpatient visit. There is minimal risk and more than a million people have this same procedure done annually.

Under topical or local anesthesia, I’ll make either a small incision (phacoemulsification) or a larger one (extracapsular extraction). Then, a small ultrasound instrument breaks up the faulty lens so I can vacuum it out of your eye. There is little or no pain and the incisions usually heal by themselves so there is no need for stitches. A synthetic intraocular lens (IOL) will be inserted at the same time to replace the focusing power of your natural lens. This takes just 20 minutes. Your IOL can be monovision, fixed focus for a preset distance; multifocal, for vision at many distances; or accommodative, where a hinge works with the eye muscle so the lens can move forward as the eye focuses on near objects or backward for distance

Blepharitis

Also known as lid margin disease, blepharitis is chronic inflammation of the eyelids and quite common, especially in people who have oily skin, dandruff or dry eyes. Symptoms can include irritation, itching, stinging and red eyes. Sometimes, the bacteria that reside normally on skin grow at the base of eyelashes making the oil glands nearby overreact and causing dandruff-like scaling along the lashes and eyelids.

You can control blepharitis with simple, at-home steps. Twice a day, place a warm, wet washcloth over your closed eyes to loosen scales or debris. Softening the glands and the oil secretions also helps prevent the formation of chalazions, inflamed lumps in eyelid oil glands or styes, red tender bumps caused by infections. Then, take your finger and a thin wet washcloth, cotton swab or lint-free cloth and gently scrub the base of your eyelashes for a few seconds. This daily cleansing is key..

I also recommend artificial tears to relieve dry eye symptoms, antibiotics (oral or topical) to decrease the eyelid bacteria, or steroids (short term) to decrease inflammation

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Glaucoma

The eye’s drainage system, called the trabecular meshwork, is a cluster of canals that allow the continuous flow of clear fluid into and out of the eye nourishing nearby tissues. In a healthy eye, this fluid exits and enters the eye where the cornea and iris meet. If the fluid can’t do this for some reason, pressure builds up and the optic nerve can be damaged. This is called glaucoma but there are several types including open angle, angle closure, acute angle, low tension, and congenital, to name just a few. Acute angle closure glaucoma is a condition that produces many symptoms including eye pain, nausea, blurred vision, reddening of the eye and halos around lights.

Because some types of glaucoma (open angle) have no symptoms or pain, regular comprehensive eye exams when your eyes have been dilated are critical for detection. Untreated, glaucoma will result in vision loss, especially peripheral, or complete blindness. It is also important to have your body’s blood pressure checked regularly and kept under control because high blood pressure in general can damage your optic nerves.

Although glaucoma is more common in senior citizens, anyone and everyone is at risk. Approximately 1 in every 10,000 babies in the United States is born with glaucoma..

Daily prescription eyedrops can control glaucoma by lowering the intraocular pressure (IOP). Selective laser trabeculoplasty (SLT) is also a surgical procedure I use to lower IOP in patients with open-angle glaucoma. I can treat tiny specific areas of damaged cells within the meshwork with no effect to the surrounding system and the procedure takes only a few minutes. The laser itself looks similar to the microscope I use to look at your eyes during an ordinary office visit. You’ll see a flash of light during each laser application, feel a bit of pressure perhaps but you won’t experience pain. Afterward, your vision might be blurry for a few hours. Following the procedure, most patients continue to take medicine to reduce IOP but need far less to keep that pressure under control

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Diabetic Retinopathy

Diabetes can damage blood vessels in the retina, the layer of nerves at the back of your eye that sense light and send images to the brain. Nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is the early stage where tiny blood vessels leak blood or fluid making the retina swell or form deposits called exudates. Mild NPDR doesn’t always affect vision.

Macular edema is swelling or thickening of the macula, the small area in the center of the retina that allows you to see fine details. Fluid leaking from the retinal blood vessels is the most common cause of visual loss in people with uncontrolled diabetes. This loss can be mild to severe but even in the worst cases I’ve seen, peripheral, or side, vision still functions. Macular ischemia occurs when small blood vessels close. Your vision is blurry because the macula isn’t receiving enough blood supply.

To look for signs of diabetic eye disease, I rely on a test called fluorescien angiography or optical coherence tomography (OCT).

First of all, follow doctor’s orders to control your diabetes and schedule regular eye checkups. Early detection is the best way to save your eyesight when you have diabetes. This is a systemic disease that can affect your entire body. Laser surgery (photocoagulation) can be used to help control visual loss from macular edema and newer treatments are also under investigation but at this point, there are no effective ways to control macular ischemia.

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Dry Eye

To stay moist and comfortable, your eyes produce tears constantly at a steady rate. Symptoms of dry eye include a scratchy, stinging sensation, stringy mucus, blurry vision, or excessive tearing because the tear glands are producing too much and overwhelming the drainage system

Tear production slows down with age and for women, this is especially true after menopause. Certain medical conditions can also cause dry eye as well as smoking and spending too much time in dry overheated rooms. Staring at computer screens for long periods of time can also be a factor.

The Schirmer test measures tear production using a filter paper strip placed along the inside of your lower lid next to the eyeball. Diagnostic drops can also check for patterns of dryness on your eye’s surface. Eyedrops (artificial tears), warm compresses, lid scrubs can help maintain moisture temporarily but Quadra Q4 Intense Pulse Light Treatment or IPL, a novel painless procedure offered at Bucks Eye can provide longer lasting relief. A small handheld device delivers pulses of light to the eyelids and surrounding area to improve function of the glands. I was the first in the Philadelphia and Bucks County area to offer IPL and some patients call it “a miracle.”

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Ptosis

When the delicate skin around the eye stretches and the muscles weaken, your eyelids – both upper and lower – can sag or droop so much that vision is blocked or restricted. Normal protective deposits of fat around the eye are sagging, weighing down the eyelids. Ptosis can also involve the levator muscle that lifts the eyelid. In children, uncorrected congenital ptosis or drooping eyelids can cause amblyopia or “lazy eye.”

Blepharoplasty or eyelid surgery can be done for functional or cosmetic reasons on an outpatient basis. I’ll make incisions in the natural creases of the upper lid and under the lash line below your eye. Surgery will last from one to three hours and swelling, bruising or blurry vision are common for several days afterward.

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