Eye Care
Laser iridotomy is a surgical procedure used to treat closed-angle glaucoma. This procedure is also performed on patients who are "at risk" for closed-angle glaucoma. As with many medical conditions, it is preferable to treat patients at risk and thereby avoid vision loss. WHAT IS CLOSED-ANGLE GLAUCOMA? Like other forms of glaucoma, closed-angle glaucoma has to do with pressure inside the eye. A normal eye constantly produces a certain amount of clear liquid called aqueous humor, which circulates inside the front portion of the eye. An equal amount of this fluid flows out of the eye through a very tiny drainage system (called the drainage angle), thus maintaining a constant level of pressure within the eye. There are two main types of glaucoma. The most common type is open-angle glaucoma in which fluid drains too slowly from the eye and causes a chronic rise in eye pressure. In contrast, closed-angle glaucoma causes a more sudden rise in eye pressure. In closed-angle glaucoma, the drainage angle may become partially or completely blocked when the iris (the colored part of the eye) drops over this area. The iris may push forward and completely block the aqueous fluid from leaving the eye, much like a stopper in a sink. In this situation, the pressure inside the eyecan rise very quickly and cause an acute closed-angle glaucoma attack. Symptoms of an acute closed-angle glaucoma attack include: - severe ocular pain and redness; - decreased vision; - colored halos; - headache; - nausea; - vomiting. Because raised eye pressure can damage the optic nerve and lead to vision loss, a closed-angle glaucoma attack must be treated immediately. Unfortunately, individuals at risk of developing closed-angle glaucoma often have few or no symptoms prior to the attack. Some early symptoms in people at risk for closed-angle glaucoma include blurred vision, halos in their vision, headache, mild eye pain or redness. People who are at risk for developing closed-angle glaucoma should have a laser iridotomy. Many common medications, including over-the-counter cold medications and sleeping pills (and any other medication that can dilate the pupil), should be avoided until after the laser procedure is completed. WHAT HAPPENS DURING LASER IRIDOTOMY? Using a laser, a small hole is made in the iris to create a new pathway for the aqueous fluid to drain from the eye. The new drainage hole restores the balance between fluid entering and leaving your eye, lowering eye pressure. The surgery is performed by your ophthalmologist (Eye M.D.) on an outpatient basis, usually in his or her office. Your eye will be numbed with eyedrops. A contact lens is placed on your eye to serve as a precise guide for the laser. A hole about the size of a pinhead is made in your iris, and will be concealed from view by your upper eyelid. The actual procedure will only take a few minutes. You should plan to have someone drive you home afterwards. ARE THERE ANY RISKS INVOLVED? Complications following laser iridotomy are uncommon; however, some patients may experience some side effects, including: - blurred vision; - minor bleeding; - need for re-treatment or a different type of treatment; - double vision (rarely). The risks and side effects of glaucoma treatment are always balanced with the greater risk of leaving glaucoma untreated. What is a retinal vein occlusion? A retinal vein occlusion means that a vein in the retina of the eye has become blocked. The retina is the light sensing tissue at the back of our eye. The veins drain blood out of the retina and return it to the heart. Blockage or occlusion in the vein prevents adequate blood flow in the affected area. The walls of the vein leak blood and excess fluid into the retina. What are the types of retinal vein occlusion? There are two types of retinal vein occlusion: - Central retinal vein occlusion (CRVO) - Branch retinal vein occlussion (BRVO) Central retinal vein occlusion: The main retinal vein is blocked. Blood flow is poor throughout the entire retina. The amount of visual loss varies but is often sever in older people. Branch retinal vein occlusion: A smaller branch of the main retinal vein is blocked. Only the part of the retina drained by this branch vein is damaged. Vision loss varies but is not as severe as in CRVO. Who is at risk for a retinal vein occlusion? Retinal vein occlusions are more common in people who have : - Glaucoma (abnormal eye pressure); - Diabetes; - Age-related vascular (blood vessel)disease; - High blood pressure; - Blood disorders. What are the symptoms of retinal vein occlusion? Blurred vision is the main symptom of retinal vein occlusion. It occurs when the excess fluid leaking from the vein collects in the macula. The macula is the central area of the retina which is responsible for our central, detailed vision. If the macula swells with excess fluid (macular edema), vision blurs. Floaters can appear as spots which interfere with vision. When retinal blood vessels are not working properly, the retina may grow abnormal blood vessels (neovascularization) which are fragile. They can bleed or leak fluid into the vitreous (the gel like fluid that fills the center of the eye) causing the floaters. Pain in the eye sometimes occurs as a complication of severe CRVO. It is caused by excessive eye pressure called neovascular glaucoma. What tests might the doctor order? After a complete eye examination, your ophthalmologist (Eye M.D.) may order blood tests and/or a test of the retinal circulation called fluorescein angiography, A dye (fluorescein) is injected into your arm and then special photos are taken of the inside of your eye when the dye passes through the blood vessels. Your Eye M.D. may also suggest a visit to your family physician to discover and manage any associated medical problems. What treatment is available? There is no cure for retinal vein occlusion. Your ophthalmologist may recommend a period of observation, since hemorrhages and excess fluid may subside on their own. Laser surgery improves sight in some patients with BRVO and macula edema, but vision does not return to normal. Laser surgery is not as helpful in CRVO, but new types of laser surgery are being evaluated. Laser surgery is very effective in preventing vitreous hemorrhage and neovascular glaucoma. However, it does not remove hemorrhage or cure neovascular glaucoma once they are already present. It is best to treat people at risk for these complications before they occur. Your Eye M.D. will decide whether laser surgery is appropriate for you. Frequent follow-up examinations are essential. You should make sure that any associated medical condition is treated by your regular physician. Why are regular medical eye examinations important for everyone? Eye disease can occur at any age. Many eye diseases do not cause symptoms until the disease has done damage. Since most blindness is preventable if diagnosed and treated early, regular medical examinations by an Eye M.D. are very important. 1. The National Eye Institute has found that antioxidant vitamins and Zinc help to lower the risk of developing the wet form of Age-Related Macular Degeneration. 2. According to the Age-Related Eye Disease Study (AREDS), the daily dosage of nutrients are as follows: (a) Vitamin C 500mg (b) Vitamin E 400IU (c) Beta Carotene 15mg (d) Zinc 80mg (with 2mg as Copper) Please Note: Smokers should not take Beta Carotene. The study also found that taking these antioxidants plus Zinc did not reduce the progression of Cataracts.  The Basic Eye Examination consists of a check of your vision (both near and distance vision), a review of your medical, family and social history, a reading of your current eyeglasses (as applicable), a measurement for new eyeglasses called a refraction, an intraocular pressure check (this screens you for Glaucoma), and a dilated fundus exam which enables the doctor to look into the back of the eye and examine for cataracts, glaucoma, retinal problems, diabetes and high blood pressure. If, through an eye exam, you are found to have any eye disease(s), you may be referred to a specialist or an ophthalmologist for treatment. An estimated 35,000 sports-related eye injuries are treated in hospital emergency rooms annually. Many experts believe that this number represents only part of the total sports eye injury problem. Some injuries are seen and treated in physicians’ offices, while others may require admission directly into a hospital. More than two-thirds of sports-related injuries are identified with the following sports – baseball; basketball; racquet sports (squash, racquetball, paddleball, badminton and tennis); football; swimming; soccer; hockey; boxing; and volleyball. For all age groups, sports-related eye injuries occur most frequently in baseball, basketball and racquet sports. Although most of the eye injuries are classified as mild to moderate, too frequently other injuries that occur are severe and may result in permanent vision loss. Any traumatic eye injury may also increase the risk of other eye health problems (i.e. glaucoma, cataracts, retinal detachment). The saddest fact of all…almost all sports-related eye injuries can be prevented. Whatever your game, whatever your age, you need to protect your eyes! · Visually Impaired Athlete - Sports participants with only one good eye are at particular risk since a serious injury to the good eye could leave them with a severe visual handicap or permanently blind. Any person with good vision in only one eye should consult with an eye care specialist on whether or not to participate in a particular sport. If a decision is made to participate, then the person should wear maximum protection such as protective glasses and helmets with face guards. Most eye injuries could be prevented, or at least the effects of such injuries minimize, by using protective eyewear. WARNING: Glass lenses, ordinary plastic lenses and open (lensless) eyeguards do not provide adequate protection for those involved in active sports. Contact lenses should only be worn in combination with other recommended sport eye protectors. It is recommended that everyone follow the advice of his or her eye care specialist and have his or her vision tested and eyes examined on a regular basis. Vision or eye problems are best corrected when detected early. An examination also offers an opportunity to discuss any sports vision needs with an eye care specialist who can assist in selecting the most appropriate type of protective eyewear. Eye protection devices are available from eye care specialists or sporting goods stores.  The eye produces a fluid that helps maintain the eye’s shape and function. In Glaucoma patients, the optic nerve is damaged and loss of vision occurs, due to elevated eye pressure. This can be due to problems in the drainage system within the eye, and the eye does not drain the fluid well and the fluid causes pressure on the nerve. Diagnosing Glaucoma: (1) Measuring eye pressure at regular eye exams. (2) Having a dilated fundus exam, which involves the use of drops to enlarge the pupils, allowing the doctor to view the back of the eye and nerve to observe for damage. (3) Looking at the drainage angles in the eye to ensure they are working properly. (4) Obtaining a visual field test, which checks your peripheral vision (which is usually where glaucoma starts to effect vision). (5) Obtaining a GDx Nerve Fiber Layer Analysis, which measures the thickness of the nerve fiber layer which if thinned, can indicate glaucoma damage. If left undetected/untreated, permanent vision loss may result. Eye Center Northeast is pleased to be one of only a few practices in Maine offering this specialized test. Some people are more at risk for glaucoma than others. Some of the more common risk factors are: (1) Increasing Age (2) African-American Heritage (3) High Blood Pressure (4) Previous Eye Injuries (5) Nearsightedness (6) Long-term Steroid Treatment (7) Family History (8) Diabetes If you are diagnosed with glaucoma, you may be treated with drops, surgery, or both. You and your eye specialist can make these decisions based on what type of glaucoma you have. Eye Drops: (1) Make sure the person administering the eye drops has clean hands. (2) It is very important that the dropper is kept clean, so do not touch it to any foreign object, including the face and eye. (3) Pull down the bottom eyelid to form a pouch. (4) Holding the dropper in your hand, place it as close to the eye as possible above the pouch. (5) Place the prescribed number of drops into the pouch. (6) Close the affected eye and do not rub or put any pressure on the closed eye. (7) Dab the excess medication around the eye with a facial tissue. Eye Ointments: (1) Make sure the person administering the eye ointment has clean hands. (2) It is very important that the ointment is kept clean, so do not touch it to any foreign object, including the face and eye. (3) Pull down the bottom eyelid to form a pouch. (4) Holding the tube in your hand, place it as close to the eye as possible above the pouch. (5) Squeeze out the prescribed amount of medication in a fine ribbon, approximately ½ inch along the pouch. (6) Close the affected eye and do not rub or put any pressure on the closed eye. (7) Dab off the excess ointment around the eye with a facial tissue.  Laser surgery in ophthalmology can successfully treat many types of eye diseases. What is a laser? - The word laser stands for “Light Amplification by Stimulated Emission of Radiation.” A laser is a concentrated beam of light, created when an electric current passes through a special material. How does the laser work? - There are two different ways that lasers are used to treat eye diseases. Thermal lasers: The light is converted to heat when it reaches the eye. The heat is used to: · Seal blood vessels (veins and arteries) that are bleeding or leaking fluids; · Destroy abnormal tissue such as a tumor; · Bond the retina to the back of the eye; · Open the eye’s filtration system for glaucoma treatment; · Create an opening in the iris for treatment of narrow angle glaucoma. Photodisruptive lasers:The light cuts or sculpts the tissue, similar to a knife. The beam of light is used to: · Cut thin membranes inside the eye that are blocking vision; · Change the shape of the eye’s surface. Presently, Eye Center Northeast is pleased to be one of the only eyecare practices in Maine offering in-office Selective Laser Trabeculoplasty (SLT) treatments. Selective Laser Trabeculoplasty is an advanced type of laser treatment to manage patients with open-angle glaucoma. Instead of generally burning tissue as in Argon Laser Trabeculoplasty (ALT), SLT selectively stimulates or changes only specific pigmented cells to activate increased fluid drainage. Both SLT and ALT produce equivalent drops in IOP, however the more gentler SLT procedure does not have any associated damage to other tissues and adverse scarring effects. For this reason, where ALT is limited, SLT may potentially be repeated. SLT has also been found to be effective when ALT and other forms of medical treatment have failed. What are the advantages of using ophthalmic lasers? - Laser surgery of the eye has several advantages: · There is no risk of infection from the laser light; · Laser surgery can be performed in an outpatient setting, allowing you to go home shortly after the procedure is finished; · The surgeon has great precision and control. Which eye diseases can be treated with laser surgery? Diseases of the Retina Retinal tears or holes: The retina is the inner layer of the eye that senses light and helps you to see. If the retina tears, it can separate from the back wall of the eye. This is called a detached retina, and it can cause you to lose sight. Symptoms of retinal tears include: · Sudden flashes of light; · “Floaters” or specks in your vision. Diabetic retinopathy: Eye disease from diabetes is a major cause of vision loss. Diabetes can cause blood vessels in the retina to grow abnormally. The vessels can leak fluid (macular edema) or bleed inside the eye. After cataract surgery: After a cataract has been removed, the capsule of the lens sometimes becomes cloudy. The neodymium-YAG laser can open up this cloudy membrane and restore clear vision. The laser is not used to remove cataracts. Laser surgery has been one of the great advances in treating eye diseases. The success of the laser depends on the type of eye disorder. In most situations, laser surgery helps prevent further loss of sight, but will not provide great improvement in vision. Your ophthalmologist (EYE M.D.) will discuss the risks and benefits that laser treatment can offer you. Our contact lens fees reflect our commitment to providing comprehensive, quality lens fits that take into account your unique vision requirements. The package price includes the comprehensive contact lens fitting, all instructions and follow-up care for the first three months, as well as the lenses and the appropriate care kit. We offer many different types of contact lenses and package prices. This is due to the differences in lens costs as well as more extensive follow-up care for certain lenses. Below are brief descriptions of each component of the basic contact lens package. Diagnostic: Includes careful measurement of your eyes, consultation regarding which type of lens would be appropriate for your eyes and lifestyle, and evaluation of trial lenses on your eyes. Dispensing and Instruction Session: Inspection of new lenses on your eyes, supervised instruction in proper care and handling of your lenses, and dispensing of appropriate solutions and care kit. Follow-Up Care: Follow-up visits are very important to ensure your eyes are healthy after wearing contact lenses all day, and to see if there are any changes necessary in lens type or power. The number of follow-up visits can vary considerably depending on the complexity of the case. However, you can usually expect up to two follow-up visits in most cases, and up to five in complex cases. The initial fee covers the original supply of contact lenses and any modifications in lens size or power during the follow-up period. If there is a change to a significantly different and more expensive type of lens, there will be a charge for the difference in lens type only. Please contact us at (207) 947-1291, and speak with one of our contact lens specialists, who will be happy to address and answer all of your questions.
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