It
is a surgical procedure that uses a cool
(non-thermal) beam of light to gently reshape the
cornea — the surface of the eye — to improve vision.
The laser removes microscopic bits of tissue to
flatten the cornea (for nearsightedness), steepen
the cornea (for farsightedness), and/or smooth out
corneal irregularities (for astigmatism).
The goal of laser eye surgery is to change the shape
the cornea so it does a better job of focusing
images onto the retina, for sharper vision.
How Common Are LASIK
Complications?
Studies in the late 1990s indicated
that up to 5% of people who underwent LASIK
experienced some type of problem. However,
experienced LASIK surgeons now are reporting that
complication rates can be held below 1% if surgical
candidates are selected carefully. Even when LASIK
complications do occur, they often can be resolved
through laser re-treatments or enhancements of the
eye. It's very rare for LASIK to cause permanent,
significant vision loss such that eyesight with
contact lenses and eyeglasses (best corrected
vision) is actually worse than it was before
surgery.
Can I have both eyes done at
the same time?
Yes, most surgeons perform the procedure on both
eyes at the same time; however, some patients prefer
to wait a week between eyes.
Does
laser vision correction hurt?
You won't feel pain during LASIK, because your
surgeon will place anesthetic drops in your eye
first. Afterward, he or she may prescribe medication
if necessary. Many LASIK patients report no more
than mild discomfort for a day or so — often it's an
itchy feeling, as if sand were in the eye.
How long does LASIK take?
The laser treatment itself usually takes less than a
minute, while the entire procedure takes around 15
minutes per eye.
How do I know if I'm eligible for
laser vision correction?
Your
eyecare
practitioner can help you
decide, but below are some general
guidelines to check out before your
doctor visit:
You must have
healthy eyes — no
glaucoma, infection,
cataracts, severe dry eye,
or any other condition that
would affect postoperative
healing.
You must be an
adult: at least 18 for some
procedures and at least 21 for
others.
Your vision must
be stable for at least a year
before surgery.
If you're
pregnant or nursing, your
hormonal levels can affect the
shape of your eye. You'll need
to wait until hormones are back
to normal levels.
You cannot have a
degenerative or autoimmune
disease, since this would affect
healing.
What happens before laser eye
surgery?
Your eye care practitioner will give you a thorough
eye exam to make sure your eyes are healthy and
you're a suitable laser vision correction candidate.
He or she will test for glaucoma, cataracts and
other disqualifying conditions. He or she will also
use a machine called a corneal topographer to
photograph and electronically map your eye. The
surgeon will use this map to plan your surgery for
the most precise results possible.
What happens on the day of
treatment?
LASIK is an outpatient procedure, which means you'll
spend around an hour at the surgeon's office and
walk out afterwards. Someone else should drive you
home, since your vision might be a little blurry
right after surgery.
You'll lie down in a reclining chair. The surgeon
will place anesthetic drops in your eye, position
your head under the laser and place an eyelid
speculum (retainer) in your eye to hold the lids
open.
In LASIK, the surgeon creates a thin flap in the top
of the cornea, folds it back out of the way, uses
the laser to remove some corneal tissue, then puts
the flap back in place.
What happens afterward?
The surgeon will place drops or ointment in your
eye. You may relax for a little while, then go home
and rest. You'll probably notice clearer vision
immediately, and it may improve even more as the
weeks go by.
When may I resume driving?
You may begin driving as soon as you see well
enough, excluding the day you had LASIK performed.
Can I go back to work right
away?
Some people return to work the next day, but
surgeons usually recommend two or three days of rest
instead.
When may I go back to wearing
makeup?
You may start wearing makeup again in two to three
days. However, throw out your old makeup and buy new
to decrease your risk of infection.
Are there any side effects?
Some people experience dry eye, which usually is
alleviated with drops and disappears over time.
Others may experience starbursts or halos around
lights, especially at night. Usually this effect
lessens or disappears over time, too. In a small
number of people (probably less than 1%), their
vision worsens rather than improves. ]
How many checkups will I need
after LASIK?
Depending on your surgeon, you will probably return
the next day, then one week or one month later and
then three months later. Your doctor will let you
know if more visits are necessary after that.
What if time passes and I'm
not seeing better?
A small number of patients see well after surgery
then experience regression, a gradual worsening of
vision. If this happens, you'll want to consult with
your eyecare practitioner to determine the cause and
to see if retreatment (enhancement) is appropriate.
Glaucoma is an eye disease that causes loss of sight by damaging a
part of the eye called the optic nerve. This nerve sends information
from your eyes to your brain. When glaucoma damages your optic
nerve, you begin to lose patches of vision, usually side vision
(peripheral vision). Over time, glaucoma may also damage straight
ahead (central) vision. You may not notice a loss of side vision
until you have lost a great deal of your sight. When checking for
glaucoma, eye doctors usually look for damage to the optic nerve and
any loss of side vision. They may also check your eye pressure.
Who is at Risk for Glaucoma?
These risk factors may increase your chance of having glaucoma:
Age – The older you are, the greater your risk. Race – African-Americans have glaucoma four to five times
more often than others. African-Americans are also likely to have
glaucoma at a younger age. Family history – If you have a parent, brother or sister with
glaucoma, you are more likely to get glaucoma too. If you have
glaucoma, your family members should get complete eye exams. Medical history – Diabetes, previous eye injuries, eye
surgery or long-term steroid use can increase your risk of glaucoma.
Anyone can get glaucoma. Glaucoma affects one in 200 people age 50
and younger. The rate increases to one in 10 over the age of 80.
How Does Glaucoma
Damage My Eyes?
Doctors don't know
exactly how glaucoma damages the optic nerve. For
many people, increased eye pressure seems to play an
important role.
Your eye produces a watery fluid,
which goes into the eye and drains out. When your
eye is healthy, the fluid drains through a mesh-like
pathway and into the bloodstream. Aqueous fluid is
produced by the ciliary body. It flows through the
pupil and behind the clear cornea. Finally, it
drains away through the trabecular meshwork.
For some people, fluid can't drain
properly because of a faulty drainage system.
Drainage that once worked well may gradually slow
down as you get older. A sink that becomes clogged
backs up with water. When there is no place for
excess fluid to go, pressure inside the eye builds
up.
This increased eye pressure may
damage the optic nerve over time. Slowly, the nerve
fibers that are essential for vision die.
For others, glaucoma damages the
optic nerve without increased pressure. These people
may be unusually sensitive even to normal levels of
pressure. Their glaucoma may also be related to
problems with blood flow in the eye. Doctors
continue to study eye pressure and other possible
causes of glaucoma.
Different people experience glaucoma
differently. Usually, glaucoma affects side vision
(peripheral vision) first. Late in the disease,
glaucoma may cause "tunnel vision." In this
condition, the person can only see straight ahead.
That's why someone with glaucoma can have good
straight ahead (central) vision. However, even
central vision can be seriously damaged.
What are the Different Types
of Glaucoma?
There are many types of glaucoma. Often, the cause
of high pressure in the eye can help tell the type
of glaucoma and the best treatment for it. The most
common types include:
Chronic (Open Angle) Glaucoma
This is the most common type. In open
angle glaucoma, aqueous fluid drains too slowly and
pressure inside the eye builds up. It usually
results from aging of the drainage channel, which
doesn't work as well over time. However, younger
people can also get this type of glaucoma.
Normal Tension Glaucoma
This is a form of open angle glaucoma not related to
high pressure. People with normal tension glaucoma
may be unusually sensitive to normal levels of
pressure. Reduced blood supply to the optic nerve
may also play a role in normal tension glaucoma.
Acute (Angle Closure) Glaucoma
Less than 10 percent of Caucasians or
African-Americans have this form, but for those of
Asian and Native American descent, the risks are as
high as for open angle glaucoma. Hispanics are
midway between these groups. It causes a sudden rise
in pressure, requiring immediate, emergency medical
care. The signs are usually serious and may include
blurred vision, severe headaches, eye pain, nausea,
vomiting or seeing rainbow-like halos around lights.
Occasionally, the condition may be without symptoms;
similar to open angle.
Secondary Glaucoma
Another 10 percent of glaucoma cases come from
certain diseases and conditions that damage the
eye's drainage system. These include diabetes,
leukemia, sickle-cell anemia, some forms of
arthritis, cataracts, eye injuries or inflammation
of the eye, steroid drug use and growth of unhealthy
blood vessels. For information about uveitis, a kind
of inflammation that can cause glaucoma, visit our
Uveitis Learning Center.
Post-Surgical Glaucoma
Some surgeries, such as retinal reattachments,
increase the chance of getting glaucoma.
How Do Eye Doctors Treat
Glaucoma?
Glaucoma can usually be treated and controlled using
medicine(s), laser surgery, glaucoma surgery or a
combination of these treatments. Medicines (eye
drops) are typically the first step in treatment,
but laser surgery may be just as effective as a
first choice.
A cataract is a clouding of the eye's lens, which blocks or changes
the passage of light into the eye. The lens of the eye is located
behind the pupil and the colored iris, and is normally transparent.
The lens helps to focus images onto the retina - which transmits the
images to the brain.
Your vision may become blurry or dim because the cataract stops
light from properly passing through to your retina.
How
common are cataracts?
Cataracts are a leading cause of blindness among older adults in the
United States. More than 20 million Americans age 40 and older have
cataracts. More than half of all Americans have cataracts by the
time they are 80 years old. Cataracts can also sometimes be found in
young people or even newborn babies.
Am
I at risk for developing cataracts?
The exact cause of a cataract is unknown. Most often, a cataract is
part of getting older. As you age, you are at greater risk of
developing a cataract. There are also several possible risk factors
for cataracts, such as:
-Intense heat or long-term exposure to UV rays from the sun
-Certain diseases, such as diabetes
-Inflammation in the eye
-Hereditary influences
-Events before birth, such as German measles in the mother
-Long-term steroid use
-Eye injuries
-Eye diseases
-Smoking
What are the symptoms of a cataract?
Generally, a cataract does not cause pain, redness or tears. The
following problems may indicate that you have a cataract:
You have blurred vision, double vision, ghost images, or the sense
of a "film" over your eyes.
Lights seem too dim for reading or close-up work, or you are
"dazzled" by strong light.
You change eyeglass prescriptions often and the change does not seem
to help your vision. You may also be able to see the cataract in
your eye. It may look like a milky or yellowish spot in your pupil.
What treatments are available for cataracts?
The key to preventing vision loss is regular eye exams. If you are
65 or older, you should get a complete eye exam every one or two
years, even if you have no problem seeing well. Be sure to ask your
eye doctor for a dilated eye exam.
BOTOX® ® is a formulation of botulinum toxin type A. It is derived
from the bacterium Clostridium botulinum. This bacterium produces a
protein that blocks the release of acetylcholine and relaxes
muscles. Type A is just one of seven different types of botulinum
toxin (A, B, C1, D, E, F, and G), and each has different properties
and actions. No two of these botulinum toxins are alike.
More than 100 years of research have expanded our knowledge of
botulinum toxin type A from the identification of the bacterium
Clostridium botulinum to the commercialization of botulinum toxin
type A as BOTOX® ®.
In the 1960s, the muscle-relaxing properties of botulinum toxin type
A were tapped for investigational use in realigning crossed eyes.
These early studies paved the way for treating other conditions
caused by overactive muscles with botulinum toxin type A.
How does BOTOX® Work?
BOTOX® ® is indicated for the treatment of cervical dystonia in adults
to decrease the severity of abnormal head position and neck pain
associated with cervical dystonia. BOTOX® ® is indicated for the
treatment of strabismus and blepharospasm associated with dystonia,
including benign essential blepharospasm or VII nerve disorders in
patients 12 years of age and above.
Normally, your brain sends electrochemical messages to your muscles
to make them contract and move. These messages are transmitted from
a nerve to the muscle by a substance called acetylcholine. When too
much acetylcholine is released, muscles become overly active and
spasm or tense up.
BOTOX® ® blocks the nerve from releasing acetylcholine. As a result,
the muscle spasms stop or are greatly reduced, providing relief from
symptoms. Your healthcare provider will know how much BOTOX® ® is
needed to treat you effectively.
It's important to remember that botulinum toxin treatment is not a
cure. For many people, however, its effects have been dramatic. With
BOTOX® ®, the nerve will take about 3 months to recover and begin to
release acetylcholine, and the muscles may become overactive again.
At that point, another injection will be needed to provide relief,
as long as no allergic reactions or other significant side effects
occurred and clinical response was obtained.
How
is BOTOX® Given?
BOTOX® ® is injected into the affected muscle(s). Your doctor will
determine which muscles need to be treated.
Does the injection hurt?
Some people report minor, temporary discomfort from the injection.
BOTOX® ® is reconstituted with sterile, preservative-free, normal
saline for injection. The neutral pH of the injected solution, in
combination with the fine-gauge needle your doctor will use, can
help to minimize any injection-related pain.
BOTOX® ® should only be diluted with 0.9 % nonpreserved sodium
chloride. Other diluents, including lidocaine, should not be used
for reconstitution.
When will the BOTOX® start to work?
If you're receiving BOTOX® ® for cervical dystonia, you'll usually see
the effects within 2 weeks of the injection. If you're receiving
BOTOX® ® for blepharospasm, you'll usually see effects within 3 days.
How
long will the effect last?
BOTOX® ® offers sustained relief, dose after dose. The relief you'll
feel from one treatment of BOTOX® ® will normally last for up to 3
months. Treatments can be continued as long as your condition
responds to BOTOX® ®, and you do not have any serious allergic
reactions or other significant side effects. When the relief begins
to fade, you'll return to your doctor for your next treatment.
Usually, BOTOX® ® treatment is required approximately 4 times per
year. Because symptoms can change over time, the amount and duration
of relief you'll experience can vary. Consult your doctor, who can
determine how to achieve the best possible results with BOTOX® ®.
What side effects has been seen with BOTOX® ?
The most frequently reported adverse reactions in patients receiving
BOTOX® ® for the treatment of cervical dystonia are dysphagia
(difficulty swallowing, 19%), upper respiratory infection (such as a
cold or flu,12%), neck pain (11%), and headache (11%). Dysphagia is
a commonly reported adverse event following treatment of cervical
dystonia patients. In these patients, there are reports of rare
cases of dysphagia serious enough to require the insertion of a
gastric feeding tube (a tube for introducing nutritious,
high-calorie fluids into the stomach).
The most frequently reported treatment-related adverse reactions in
patients receiving BOTOX® ® for the treatment of blepharospasm are
ptosis (droopy eyelids, 20.8%), superficial punctuate keratitis
(inflammation of the cornea characterized by small erosions of the
tissue covering the cornea, 6.3%), and eye dryness (6.3%). Reduced
blinking from BOTOX® ® injection of the orbicularis muscle can lead to
corneal exposure, persistent epithelial defect (a defect in the
corneal covering), and corneal ulceration (a hollowed-out cavity in
the cornea), especially in patients with VII nerve disorders.
Macular degeneration is a broad term describing diseases that lead
to a loss of central vision. Some of these diseases affect the
macula directly, while age related macular degeneration (AMD)
affects the layer under the macula known as the retinal pigment
epithelium, or RPE. Note that the conditions called macular hole and
epimacular membrane (also called "macular pucker", "wrinkling", or
"cellophane") are not macular degeneration.
Can
macular degeneration cause blindness?
It cannot cause total blindness. It can only cause loss of central
vision. The amount of vision loss from macular degeneration varies
quite a bit from patient to patient, and is not predictable. It can
cause legal blindness, defined as 20/200 or worse best corrected
visual acuity.
What can this loss of central vision mean in terms of quality of
life?
With loss of central vision, reading, recognizing faces, and seeing
straight ahead can be difficult to impossible. Many patients
describe their vision as having a dark spot in the center where they
cannot see anything. The side, or peripheral, vision, however, is
not affected. Therefore, these patients are still able to walk
around; recognize their surroundings; and even, with the help of low
vision devices, do some limited reading in many cases.
What are the types of macular degeneration?
Some of them are:
Age related macular degeneration (AMD)
Numerous other hereditary types:
Vitelliform (Bests)
Fundus flavimaculatus (Stargardts)
Central areolar choroidal atrophy
Cone degeneration
Toxic, caused by the following drugs:
Plaquenil (prescribed for lupus and rheumatoid arthritis)
Certain major tranquilizers when used over a long term in high
dosages
How
common is AMD?
It is the most common cause of irreversible central vision loss in
people age 65 and older. In the United States, 5% of people in this
age group are affected by AMD.
What is the underlying cause of AMD?
More than 35% of cases of AMD are hereditary. Probably, multiple
genes are involved. We do know these facts:
AMD is twice as common in blue eyes
Whites have much more AMD than blacks
Certainly, there is more to the story than aging, since "age
related" macular degeneration occurs in some 40 year old patients.
No single mechanism of aging seems to be responsible. Probably,
singlet oxygen (and thus antioxidants) plays some role in some aging
processes, but it is not the whole story.
Does nutrition play any role in the development of AMD?
The Beaver Dam Eye Study examined the dietary history of people with
and without AMD. The study showed that there was slightly less AMD
in patients who had diets high in green, leafy vegetables. Spinach
consumption had a statistical correlation with less AMD. Kale,
turnip greens, mustard greens, and collard greens had a significant
but lesser correlation with less AMD. Note that this was not a study
of treatment or progression of the disease, but only diet for many
years before developing AMD. There is also evidence that eating nuts
and so-called oily fish such as salmon reduce progression rates in
AMD patients. It is probable but not proven that eating fruits and
vegetables high in anti-oxidants such as blueberries, strawberries,
blackberries, broccoli, peaches, green and red peppers, and other
intensely colored fruits and vegetables.
Does smoking play any role in AMD?
Yes. In the Beaver Dam Eye Study and Blue Mountain Eye Study,
smokers were shown to have 300-500% risk of AMD.
Why
should I be concerned about using beta carotene supplements to
prevent AMD?
Beta carotene supplements have been shown to increase the risk of
lung cancer deaths in smokers by 30%, so if you smoke, you should
not take beta carotene.
What measures can I take against AMD?
The following:Stop smoking, eat leafy green vegetables, especially
spinach, if you have drusen, early AMD, or parents or grandparents
with AMD. Take ICAPS or another AREDS formula anti-oxidant
formulation Intravitreal injection of Avastin is highly effective in
wet AMD.
Amblyopia, commonly known as lazy eye, is the eye condition noted by
reduced vision not correctable by glasses or contact lenses and is
not due to any eye disease. The brain, for some reason, does not
fully acknowledge the images seen by the amblyopic eye. This almost
always affects only one eye but may manifest with reduction of
vision in both eyes. It is estimated that three percent of children
under six have some form of amblyopia.
What are the causes of Lazy Eye?
Anything that interferes with clear vision in either eye during the
critical period (birth to 6 years of age) can cause amblyopia. The
most common causes of amblyopia are constant strabismus (constant
turn of one eye), anisometropia (different vision/prescriptions in
each eye), and/or blockage of an eye due to cataract, trauma, lid
droop, etc.
Amblyopia is a neurologically active process. In other words, the
loss of vision takes place in the brain. If one eye sees clearly and
the other sees a blur, the brain can inhibit (block, ignore,
suppress) the eye with the blur. The brain can also suppress one eye
to avoid double vision. The inhibition process (suppression) can
result in a permanent decrease in the vision in the blurry eye that
can not be corrected with glasses, lenses, or lasik surgery.
