About Your Eyes

Stories, Observations, and Recommendations - Dr. Anna B. Miller


1. Myths About Your Eyes

2. Eye Examinations

3. Taking Time to Listen to the Patient

4. "Medical" and "Vision" Insurance -- An Explanation

5. Pink Eye

6. Botox, Juviderm, and Blepharoplasty

7. Fear of Losing Your Driver's License

8. How to Choose a Doctor

9. How to Choose a Cataract Surgeon

10. Check Your Child's Vision

11. Remember Eye Safety on the Fourth of July

12. Ophthalmologists, Optometrists, and Opticians

13. Cataracts and Glasses

14. Glaucoma a Hidden and Growing Threat to Vision

15. Eyeglasses Where and How to Buy

16. The Causes and Cures for Dry Eye



1.Myths About Your Eyes

We all grew up with myths concerning our eyesight what helps our eyes and what damages them. Much of it is untrue. Here are some of these myths, which you may find helpful, and amusing.

Eating carrots will help you maintain healthy vision.

Carrots are high in vitamin A, the nutrient essential for good vision. Eating carrots will provide you with the small amount of vitamin A needed for good vision, but it can also be found in other foods.

Sitting too close to the TV will damage your vision.

Sitting closer than necessary to the television may give you a headache, but it will not damage your vision.

Reading in the dark will weaken your eyesight.

As with sitting too close to the television, you may get a headache from reading in the dark, but it will not weaken your sight.

Using glasses or contacts will weaken my eyesight, and my eyes will eventually become dependent on them.

Your eyes will not grow weaker as a result of using corrective lenses. Your prescription may change over time because of aging or the presence of disease, but it is not because of your current prescription.

Children will outgrow crossed eyes (strabismus).

Children are not able to outgrow strabismus on their own, but it can be more easily corrected at a younger age. That's why it is important for your child to have an eye exam early--first when they are infants, and then again by age two.

There's nothing you can do to prevent vision loss.

At the very first signs of vision loss such as blurred vision or flashes of light, you should see your doctor. If detected early enough, depending on the cause, there are treatments that can correct, stop, or slow down the loss of vision.

Using a nightlight in your child's room will contribute to nearsightedness.

It has been thought that using a nightlight in your child's bedroom may contribute to nearsightedness. There is not enough evidence to support this claim. Keeping a nightlight on in your baby's room may actually help him or her learn to focus and develop important eye coordination skills when he or she is awake.

Looking straight at the sun will damage your sight.

Looking at the sun may cause headache and distort your vision temporarily, but it can also cause permanent eye damage. Any exposure to sunlight adds to the cumulative effects of ultraviolet radiation (UV) on your eyes. UV exposure has been linked to eye disorders such as macular degeneration, solar retinitis, and corneal dystrophies.

Using artificial sweeteners will make your eyes more sensitive to light.

If you use artificial sweeteners, like cyclamates, your eyes may be more sensitive to light. There are other factors that will make your eyes more sensitive to light as well. They include antibiotics, oral contraceptives, hypertension medications, diuretics, and anti-diabetic medications.

Those are the myths. The truth is that if you have any problems, questions, or concerns about your eyesight you should see an Ophthalmologist, an Eye Doctor.

Back to Top


2. Eye Examinations

Periodic eye exams are a key to maintaining healthy vision. Over time you may experience a gradual degradation of vision, and gradual changes may go unnoticed. If you are prone to needing glasses, the eye exam may reveal that a new prescription will restore your sight. We all have a tendency to accept our vision as it is not remembering how good it can be.

People who have diabetic conditions, or who suffer from glaucoma, may be particularly prone to gradual loss of vision. In some cases, losses are irreversible if not treated in their early stages. The best approach is to have a periodic "healthy eye exam". A thorough check of your eyes by a medical eye doctor will reveal the early stages of a disease which can have a devastating effect over time if left untreated.

Of course, any eye injury or sudden change of vision should be treated immediately by your eye doctor. Eye pain is an obvious signal that you need to visit an eye doctor, as are flashes of light, and the appearance of "floaters". It is never safe to assume that sudden changes in your eyes will go away untreated.

Back to Top


3. Taking Time to Listen to the Patient

As an Eye Doctor, my typical day consists of examining patients. Each meeting is individual, separate from the previous examination and the next. Each patient's needs need to be considered separately from the last, with the patience and attention to detail they warrant. It should be as though each patient visit were my only visit of the day. To the patient, it IS the only visit of the day. Anything else that transpires during the day should have absolutely no impact on the time I spend with each patient individually.

Of course, there is much more to do than examine patients. There are the administrative tasks of running an office, guidance of my staff, consultations with other doctors, phone calls, and of course surgeries.

But for each patient who comes to my office, their visit is an isolated experience. That is the way it should be. My involvement with other patients, staff, and other doctors should never impinge on the unique needs of each individual patient.

Some of the time I spend with each patient is in the physical examination itself. Through the patient interview and examination I come to a conclusion concerning the medical issues and treatment alternatives. But that is only a part of what takes place in a typical visit. Communicating my findings with the patient is equally if not more important. The patient needs to understand the nature of his or her medical condition, the treatment alternatives, and ultimately needs to buy into one of the treatment options and commit to following up on it to resolution.

That communication back to the patient is sometimes the most critical part of my job. For example, in many cases the diagnosis of a cataract is quite straightforward. But to any patient, that diagnosis is a unique revelation. It needs to be understood in a very personal way. The options require careful explanation and consideration. The patient needs to participate fully in the decision regarding what has been done and fully accept that decision.

That takes time. It requires my ability to focus exclusively on the patient and his or her comprehension and needs. My skill as a diagnostician comes first. My providing treatment, and possibly my skill as a surgeon comes later. The critical step in-between is communication with the patient.

I can never know in advance how much time that communication process will take. It is possible that my other duties will detract from my accomplishing that critical task. The next patient (or the last), the staff, consultations with other doctors are all waiting to grab my attention. If I ever fall short in that communication process I need to be corrected. I need to hear from the patient that they didn't understand, they don't agree. That's my signal that I need to focus again on the patient. I do my best. When I fall short, I need to hear about it. I take pride on my communication skills being the trait that brings value to my patients.

Back to Top


4. "Medical" and "Vision" Insurance -- An Explanation

There are two general categories of insurance that apply to eye care. "Medical" insurance and "Vision" insurance. Many patients find this situation somewhat confusing, and the terminology is often of little help. I will try to offer some clarification. Before I do, however, I must say that there are many varieties of both Medical and Vision insurance, and it is difficult to generalize. My comments may not exactly correspond to the particular Medical and Vision insurance that you use, but are meant instead as a general guide.

"Medical" insurance is relatively straightforward. Your medical insurance provides coverage for the treatment of injuries and pathologies of your eyes. It covers:

• accidental injuries
• surgery
• medical treatment
• diagnostic tests
• ongoing observation for a variety of medical conditions
• glaucoma
• diabetes
• cataract
• macular degeneration<
• others

In general, your "Medical" insurance covers all medical problems you may have with your eyes, actual and potential. It may be used at any time it is needed. There is no limit to the number of times you can use it during the year. For example, you are not limited to using it only once a year. If you have a medical problem with your eyes you can be treated at any time, without limit or time constraint.

The one thing that Medical insurance does NOT cover is routine correction of vision by the use of glasses or contact lenses. That is what your "Vision" insurance is for.

Each insurance plan is different, but in general it can be said that Vision insurance is limited to once a year or once every two years. Each insurance company rigorously specifies what is covered under their Vision insurance, but in general it covers the examination to determine the prescription for your glasses or contacts and provides some coverage for the purchases of glasses or contacts.

As an eye doctor I have little if any latitude in determining whether your Medical or your Vision insurance applies to any particular visit. It depends on the purpose of your visit and what is discovered in the course of the examination. If you do not request a medical check-up, and you desire only prescription for glasses, it is most likely that your "Vision" insurance will be used. Again, these are general statements and specific rules apply to each insurance plan.

The determination of your benefits under each plan is a complicated process. In many cases, which insurance applies for a particular visit is obvious. In some cases, the expertise of a Medical Biller is needed to make the determination, and there are cases where the final determination can only be made after review by the insurance companies involved and a complex discovery process.

At my Eye Care Center the staff works to assure that you receive the maximum benefit available from both of your insurances. The final determination of your benefits sometimes has to wait until after we file for payment from your insurance company. In all cases, you are entitled to a full explanation of how the determination was made. We invite your questions and we want you to be assured that in each instance we have done everything possible to be sure that you have received the maximum benefit from both your Medical and Vision insurance on each visit.

Back to Top


5. Pink Eye

Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane that lines your eyelid and part of your eyeball. The cause of pink eye is commonly a bacterial or viral infection or an allergic reaction.

Pink eye may make you feel as if you've got something in one or both of your eyes that you just can't remove. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes. The whites of your eyes may begin to have a pink discoloration, and you may not see as clearly as you did before.

Inflammation causes small blood vessels in the conjunctiva to become more prominent, resulting in a pink or red cast to the whites of your eyes. Pink eye and red eye are terms commonly used to refer to all types of conjunctivitis.

Though the inflammation of pink eye makes it an irritating condition, it rarely affects your sight. If you suspect pink eye, you can take steps to ease your discomfort. But because pink eye can be contagious, it should be diagnosed and treated early.

The most common signs and symptoms of pink eye include:

• Redness in one or both eyes
• Itchiness in one or both eyes
• Blurred vision and sensitivity to light
• A gritty feeling in one or both eyes
• A discharge that forms a crust during the night
• Tearing

Most cases of pink eye are caused by viruses.

Pink eye can be an irritating condition, but it's usually harmless to your sight and typically doesn't require extensive or emergency treatment. Yet because pink eye can be highly contagious for as long as two weeks after signs and symptoms begin, it's important to seek diagnosis and treatment early.

Occasionally, conjunctivitis causes corneal complications in both adults and children making early treatment even more important.

The Eye Care Center treats Conjunctivitis and all diseases and injuries of the eyes, as well as providing routine preventive care and eye surgeries for medical and cosmetic purposes. The Center is available for same-day visits when required by a medical condition, or scheduled appointments when urgent care is not medically required.

Back to Top


6. Botox, Juviderm, and Blepharoplasty

Botox and Juvederm are alternative approaches improving your appearance. There are differences between them, but they share the fact that they are minimally invasive, and not permanent. Therefore they minimize risk in two ways: first, they avoid the possible consequences of more radical approaches, and secondly, they do not need to be reversed if you should be dissatisfied with the result. The effects of each recede over time. This of course makes it necessary to repeat the procedures periodically.

Botox and Juvederm each have their place. Botox tends to remove the lines on your face by relaxing muscles. Juvederm acts as a "filler", expanding the tissue beneath areas that exhibit creases. Both tend to minimize some of the affects of aging on your facial skin without permanently removing or altering your skin, bone, or muscle structure.

Your doctor can examine the lines and contours around your eyes, mouth, and other parts of your face to determine the benefits of each procedure and recommend a course of action. In either case treatments are done in the office, without the need for anesthetic.

When administered as appropriate, the effects should be subtle, not radical. They should not fundamentally alter your appearance, but instead allow you to appear more relaxed, rested, and younger.

Botox in particular is typically applied around the eyes and forehead. It is, however, never applied to the eye lids or near the supporting structure and muscles of the eye. It is not recommended for improving the appearance of eye lids upper or lower.

Blepharoplasty, on the other hand, may be an effective means of improving the appearance of your lids. The lids may require surgical alteration if they tend to sag as the result of aging a process which can affect your vision as well as appearance. Simply stated, Blepharoplasty is a surgical procedure, done on an out-patient basis, for removing excess eye lid tissue. It essentially removes excess lid tissue which accumulates as we age, reviving a youthful appearance.

Botox, Juvederm, and Blepharoplasty can each be effective depending on the area of the face and desired result.

I recommend and provide an in-office evaluation to discuss the relative benefits of each, and possibly developing a course of treatment to satisfy your goals. Each approach provides a different benefit. None can be recommended without first understanding first your concerns and goals through a personal consultation.

Back to Top


7.Fear of Losing Your Driver's License

Many of us live with the vague fear that we will lose the ability to drive as we get older. In some cases, it is a physical disability such as poor coordination or diminished reflexes that rob us of the ability to drive. More often, it is poor eyesight.

As an ophthalmologist, I am accountable to the State of Pennsylvania for reporting situations in which poor eyesight disqualifies people from driving. This obligation sometimes puts me in a difficult situation with elderly patients who may deny that they have poor eyesight. In some cases, they may reject the input of an eye doctor, and even express hostility when told that they should not drive. Reporting their condition to the State can cast the doctor in the role as "that person who took away my license".

Objectively, of course, this is not true. A doctor who reports that poor eyesight disqualifies you from driving may ultimately save your life, and the lives of innocent people who may be injured in an accident. A responsible doctor has no choice it is no favor to a patient to ignore an unsafe situation which may cause them to lose their life.

I see three reactions from patients who hear that their poor eyesight makes driving unsafe.

1. Acceptance. In most cases, the news is greeted regretfully, but maturely. Patents most often are disappointed to learn that they can no longer drive, but shortly accept the situation, and go about reordering their lives around the new reality.

2. Initial denial. It sometimes takes a while for a patient to recognize the fact that they can no longer drive. It is understandably hard to loose the mobility and freedom that comes from driving, but must people understand that their safety and the safety of others depends on their accepting the reality that many people have to give up driving at some point in old age.

3. Hostility. Occasionally I meet a patient who brands me the "enemy" who wants to take away their freedom and harm their life. When this happens, I strongly recommend that the patient get a second opinion.

Some elderly people avoid going to an eye doctor when they suspect that their vision may be deteriorating -- specifically to avoid hearing what they most fear. This is understandable, but wrong for multiple reasons. First, avoidance of detection will obviously increase their chances of injury in an accident caused by their poor vision. Secondly, they may be loosing out on a chance to restore their vision. Often a pair of glasses, an adjustment in their prescription, or the removal of a cataract, may restore their vision.

If you suspect that deteriorating vision may jeopardize your ability to drive, call for an appointment. If you know or love somebody in this situation, encourage him or her to see an eye doctor. Whether your vision can be corrected, or you should stop driving, your safety and health depends on being seen by an eye doctor.

Back to Top


8. How to Choose a Doctor

Each of us is in charge of our own medical care. It is the responsibility of each person to be sure that he or she is receiving the care that they require, and doing so in the most effective, efficient and comfortable manner. Once you have made the commitment to seek medical care, your most important decision will be your choice of a doctor.

There are many important considerations. Most obviously, does he or she take your insurance? Is he or she close enough to you to be convenient? Once you get past these obvious considerations, there are several more subjective factors, which are harder to evaluate but even more critical to your health. Out-of-pocket costs and travel time are important, but not as important as the quality of the service you receive.

Will the care you receive from a particular doctor resolve serve your interests? Obviously, you want your medical issues to be resolved. This is the issue of competency. There are also issues of confidence. Will you be able to determine a course of action with your doctor in a way that enables you to be comfortable with the selected course of treatment and the associated risks? Have you been referred to a sub-specialist when it is called for? Have all necessary tests been done, and have you been asked to do tests or procedures that are not necessary? These subjective factors will affect the effectiveness of your treatment.

These are all critical questions. Unfortunately, most of us are not competent to evaluate the capabilities of physicians. It is even harder to determine whether we will feel comfortable and confident in working with a particular physician who we have not yet met. We expect more from a physician than a simple diagnosis and prescription. We need to understand the nature of our medical problem and options for treatment, probability of success, and we need to feel comfortable with the process of treatment.

I have two general recommendations, which I encourage all of my patients to follow, and especially people who are not my patients, even if the medical assistance needed is not related to my medical specialty, Ophthalmology.

1. Seek recommendations from your friends and associates who have experience with the doctors who you might see. Are they comfortable with the treatment they have received or are receiving? Are they treated respectfully, are all of their concerns answered, and are their medical issues resolved. (Anecdotal evidence is not a conclusive indicator of medical competence, but can be a useful indicator for non-professionals.)

2. If you have any doubts that the course of action prescribed by your current physician is best for you, seek a second opinion. Most insurances cover additional doctor visits for the purpose of seeking further input. In any case, cost is an incidental factor when it comes to your being comfortable with your doctor's input. A second opinion can either eliminate your doubt, or lead you to be under the care of a doctor in whom you have confidence.

Most doctors are entirely competent. In this age, most doctors understand the need for the interpersonal skills necessary to develop patient confidence. But each patient is different, and each patient should feel that their needs and concerns are met by their doctor. Finding the right doctor for you is worth your time and effort.

Back to Top


9. How to Choose a Cataract Surgeon

When you develop cataracts, you confront an important decision. You need to choose a Cataract Surgeon. It is important to choose a surgeon who truly listens to your needs and has the experience to deliver quality results. By researching each surgeon carefully, you can find the surgeon who is right for you. There are several factors to keep in mind.

Qualifications and Experience

Your cataract surgeon should have recent experience in the newest technologies. You may want to consider how many years the surgeon has been performing cataract surgeries, paying close attention to how many he or she has performed in the last 12 months. High volume, however, is not necessarily a true indication that a surgeon is right for you.

Previous Patient Testimonials

When you begin your search for a cataract surgeon, you may want to ask friends, co-workers, and relatives about their experiences. Other patients' experiences can give you a better idea of the quality of the surgeon you are considering. A high-quality cataract surgeon is typically one with a solid reputation in the community.

Safety and Results

When you choose a cataract surgeon, you want someone who is concerned for your safety. Choose a surgeon who adheres to effective standards of safety and has a proven track record of success. You may also want to consider how many patients required follow-up procedures to achieve optimal results. All surgery involves risks. Therefore, cataracts should not necessarily be removed as they appear, in some cases removal is never advisable. Your surgeon should demonstrate a sensitivity to your needs and expectations, and recommend the surgery only when it will enhance both your vision and quality of life without exposing you to unnecessary risk.

Personalized Care

Each patient is different, and you should not settle for a surgeon who takes a "cookie-cutter" approach. A good cateract surgeon will create a customized surgical plan to fit the needs of each patient. Choose a surgeon who is willing to listen to all of your concerns and answer your questions fully.

Personalized care and sensitivity to your needs can provide a feeling of comfort during the process of accepting the need for surgery, preparing for it, and undergoing the surgery. More important than that, personalized care, listening, and explaining have a direct impact on your decision to proceed with surgery and the success of the process. Cataract surgery is not an emergency procedure. It is hardly ever the case that the surgery needs to be done when your doctor is ready to do it. You need to reach your own conclusion regarding whether to proceed, the timing, and you need to be comfortable with the competency of your physician.

Back to Top


10. Check Your Child's Vision

When the new school year about to start is the time to have your child's vision checked. Without good vision, a child's ability to learn about the world becomes more difficult. Since many vision problems begin at an early age, it is very important that children receive proper eye care. Untreated eye problems can worsen and lead to other serious problems as well as affect learning ability, personality, and adjustment in school.

I have observed that eye problems in young children can lead to frustration and lowered self-esteem. Children do not necessarily know what to expect of their eyes. Unable to diagnose their problem or communicate it to their parents, they suffer anxiety and humiliation when they cannot perform as well as other children. Poor academic performance goes hand-in-hand with the other social problems that result from their frustration.

I provide a detailed and empathetic examination of your child, taking the time to develop their confidence and encouraging them to communicate their concerns. As a result of a detailed eye exam you can be confident that your child is not frustrated by vision problems that they cannot identify or communicate or have the problem treated.

An appointment now will provide the time for correction before school begins. If your child needs glasses, for example, he or she can have them and adjust to them before beginning school. He or she can avoid the disadvantage of not being able to focus on the teacher.

I have listed here some of the most common eye problems affecting children.

Amblyopia (Lazy Eye)

Lazy eye, or amblyopia, is a loss of vision in an eye that is not corrected by glasses alone. Crossed eyes, eyes that don't line up, or one eye that focuses better than the other can cause amblyopia.

Strabismus (Crossed Eyes)

Strabismus is a word for eyes that are not straight or do not line up with each other. If the problem is not treated, it can cause amblyopia.

Color Deficiency (Color Blindness)

Children with color blindness are not really blind to color. Instead, they have trouble identifying some colors.

Retinopathy of Prematurity

Soon after birth, some premature infants develop changes in the blood vessels of the eye's retina that can permanently impair vision.

Myopia (Nearsightedness)

In myopia, the eyeball is too long for the normal focusing power of the eye. As a result, images of distant objects appear blurred.

Hyperopia (Farsightedness)

In this condition, the eyeball is too short for the normal focusing power of the eye. In children, the lens in the eye accommodates for this error and provides clear vision for distance and usually near viewing, but with considerable effort that often causes fatigue and sometimes crossed eyes (strabismus).

Astigmatism

Astigmatism results primarily from an irregular shape of the front surface of the cornea, the transparent "window" at the front of the eye. Persons with astigmatism typically see vertical lines more clearly than horizontal ones, and sometimes the reverse.

Back to Top


11. Remember Eye Safety on the Fourth of July

Enjoy the 4th, but do not risk your eyesight by using fireworks.

One of the most recognizable symbols of an Independence Day celebration is the fireworks display. It is a time-honored holiday tradition that unfortunately carries with it the risk of causing serious damage to the eyes. Despite many of the advances made in eye surgery, repair of the severely injured eye remains a challenge.

An eye injury can be a life-altering event - especially for young children, who appear to account for a majority of firework injuries. Losing your sight is a devastating price to pay for a few minutes of fun with fireworks. According to the United States Eye Injury Registry, approximately 12,000 Americans are treated in emergency departments annually for firework-related injuries, and approximately 2,000 of those injuries involve the eye. Almost half of those injured are simply bystanders.

About two-thirds of fireworks-related eye injuries result from bottle rocket use. These small devices consist of a firework attached to the end of a thin stick approximately one foot long. Participants insert the rocket into a bottle acting as a base and then light the fuse. After ignition, the bottle rocket launches from the bottle into the air with little or no control from the participant.

To keep the July 4 holiday from turning into a personal tragedy, it's best to leave fireworks to the professionals, who take extensive safety precautions when producing the spectacular displays.

My recommendation: 'just say no' when it comes to recreational fireworks use. At the very least, all participants and bystanders should wear protective safety eyewear. In case of an eye injury, do not touch, rub or press the injured eye. Seek immediate care from an ophthalmologist or hospital emergency room.

Important Facts about Fireworks Eye Safety

• Attend only professional fireworks displays. Don't ever let your children play with fireworks of any kind.
• All fireworks are dangerous. Firecrackers, bottle rockets, sparklers and Roman candles account for most firework injuries.
• Protect children. Don't entertain the family with fireworks. Forty percent of those injured last year were under the age of 14, and many of them were bystanders.
• 30% of the injuries that occurred last year involved burns to hands, wrists and arms, and 20% of injuries were to the eyes.
• 10% of children injured by fireworks suffer permanent damage, such as the loss of an eye, a finger or a hand.
• Sparklers burn as hot as 2,000 degrees, hot enough to melt gold. For children under the age of five, sparklers account for three-quarters of all fireworks injuries.
• Legal fireworks carry the name of the manufacturer, the words "Class C Common Fireworks," and a warning label. If these are missing, you should consider them illegal and extremely unsafe.
• If you find unexploded fireworks, don't touch them. Contact your local fire or police department immediately.

Back to Top


12. Ophthalmologists, Optometrists, and Opticians

When I meet people in a social setting, I am sometimes asked about my profession. My answer: "I'm an Ophthalmologist." The next question is always the same: "What kind of eye doctor is that?" There are basically three kinds of eye care professionals, and they all begin with "Op". I came across the following descriptions by the Cleveland Clinic, which may be helpful:

What is an Ophthalmologist?

Ophthalmologists are doctors that specialize in the medical and surgical care of the eyes and visual system, and also in the prevention of eye disease and injury. They can be either doctors of medicine (M.D.) or doctors of osteopathy (D.O.). While medical doctors focus on disease-specific diagnosis and treatment, osteopaths concentrate on the loss of structure and function in different parts of the body caused by disease.

An ophthalmologist has completed four years of pre-medical undergraduate education, four years of medical school, one year of internship, and three or more years of specialized medical and surgical training in eye care. As a qualified specialist, an ophthalmologist is licensed by a state regulatory board to diagnose, treat, and manage conditions affecting the eye and visual system. An ophthalmologist is qualified to deliver total eye care, meaning vision services, eye examinations, medical and surgical eye care, and diagnosis and treatment of disease and visual complications that are caused by other conditions, like diabetes.

What is an Optometrist?

Optometrists are doctors of optometry (O.D.). They are trained to examine, diagnose, treat, and manage some diseases and disorders of the visual system. The optometrist has years of professional education at an accredited college of optometry. (Optometrists do not attend medical school.) In addition, some optometrists may have completed a one-year optional residency in a specialized area.

Like ophthalmologists, optometrists are trained to examine the internal and external structure of the eyes to detect diseases like glaucoma, retinal diseases, and cataracts. Optometrists do not perform surgery and are not trained to care for and manage all diseases and disorders of the eyes. The optometrist is trained to diagnose and treat vision conditions like nearsightedness, farsightedness, astigmatism, and presbyopia. They may also test a person's ability to focus and coordinate the eyes and see depth and colors accurately. Optometrists are licensed by the state to examine the eyes to determine the presence of vision problems and visual acuity. They also prescribe eyeglasses, contact lenses, eye exercises, low vision aids, vision therapy, and medications to treat eye diseases.

What is an Optician?

Opticians are eye healthcare professionals who work with ophthalmologists and optometrists to provide vision services. They assist optometrists and ophthalmologists in providing complete patient care before, during, and after exams, procedures, and surgeries. With a two-year technical degree, opticians analyze and interpret eye prescriptions; determine the lenses that best meet a person's needs; oversee ordering and verification of eye-related products from start to finish; and dispense, replace, adjust, repair, and reproduce contacts, eyeglasses, and frames.

I am an Ophthalmologist. I am a MD and a PhD. I perform all of the services listed in the above description. I perform no-stitch cataract surgeries at local hospitals, lid surgeries, including Blepharoplasty, and cosmetic injection treatments such as Botox and Juviderm.

Back to Top


13. Cataracts and Glasses

When cataracts first form in your eyes, you may be able to improve your vision for a while by using new glasses, strong bifocals, magnification, intense lighting or other visual aids. These aids may be useful for a time, but the progress of cataract formation tends to be progressive and irreversible, and these aids cannot provide the ultimate remedy.

Interestingly, cataract surgery tends typically results in the elimination of the need for eyeglasses at least for distance vision, whereas delaying a needed cataract operation may require successively stronger glasses. The reason is that the cataract operation involves the removal of the clouded lens which restricts vision, and its replacement by an artificial lens which is designed to compliment your eye so as to improve your vision to the point at which glasses are often not necessary for distance sight.

Think about cataract surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. If you tend to require increasingly strong lenses, it may be time to consider cataract surgery. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with over 1.5 million cataract surgeries done each year. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic IntraOcular Lens (IOL). Many people are literally startled with the results of their cataract surgery. It is an out-patient process involving little inconvenience and typically a very rapid recovery.

After improved clarity, more vivid perception of colors, decreased reliance on glasses is an additional benefit.

Back to Top


14. Glaucoma a Hidden and Growing Threat to Vision

Glaucoma is a disease of the optic nerve the part of the eye that carries the images that we see to the brain. The optic nerve is made up of many nerve fibers, like an electronic cable containing numerous wires. When damage to the optic nerve fibers occurs, blind spots develop. These blind spots usually go undetected until the optic nerve is significantly damaged. If the entire nerve is destroyed, blindness results.

A clear liquid called Aqueous Humor circulates within the globe of the eye. To maintain a healthy level of pressure within the eye, a small amount of this fluid is produced continually while an equal amount flows out of the eye through a microscopic drainage system. If drainage is blocked, the excess fluid cannot flow out of the eye, and pressure increases. The increased pressure is what can cause damage to the optic nerve.

Glaucoma is the leading cause of blindness in the United States especially among the older population. Early detection through routine eye exams is key.

Risk factors for glaucoma include age, a family history of glaucoma, and systematic health problems -- specifically diabetes, migraine headaches, and poor circulation. A variety of treatments are available, depending on the specific type of glaucoma detected and the severity of the case. These treatments include several eye drops, Laser treatment, and surgeries.

You should see an eye doctor on a periodic basis to have a routine pressure check and examination. Damage to the optic nerve caused by glaucoma is generally irreversible, but it is largely preventable if glaucoma is detected early.

My office is equipped with the latest in equipment for the diagnosis and treatment of glaucoma, including the recently-developed HRT imaging computer and a SLT laser. HRT provides a detailed picture of the geometry of the retina and optic nerve. Period re-imaging is an excellent way to monitor changes to the retina resulting from glaucoma. The SLT laser is an excellent tool for the treatment of glaucoma in many cases. Diagnosis and treatment is typically done on-site, and treatment is therefore immediately available without requiring travel and delays.

Back to Top


15. Eyeglasses Where and How to Buy

Eyeglasses are available from many sources. You can buy simple "readers" in drug stores. There are quick-service and discount stores, some offering packages that offer specials that include examinations. There are high-fashion outlets. And eyeglasses are sold in Ophthalmology medical practices, such as my own.

After selecting a source and your eyeglass frames, there are many lens options to choose from. There are options for coatings and tinting, "Transitions" that provide varying degrees of shading in re action to different lighting conditions, and "Progressives" that allow you to focus at a variety of distances without the "bi-focal line". And there are simple single focus lenses, as well as bi-focals and tri-focals. Anti-reflective coatings and special high-refraction plastics are also options. All of these variables can be mixed in an almost unlimited number of combinations to suit a particular eyeglass prescription. In other words, the prescription your doctor provides can be filled in a variety of ways, all of which provide the optical correction prescribed for you. It is often the options, as much as the prescription, that determine the suitability of the glasses to your particular needs.

Furthermore, many of the options available to you can be provided in different ways and in different qualities. Progressives, for example, are manufactured by a large variety of suppliers. They differ widely in the degree to which they are comfortable to use and adjust to, and there is no "best". What is best for you will depend on how you intend to use them, your age, line of work, etc. The same is true for the various anti-scratch and anti-reflective coatings.

The options are almost endless, all of which can all satisfy the prescription written by your doctor. There is no answer I can provide other than that you should rely on an experienced optician working in conjunction with your eye doctor. The person who knows the options is your optician. The person who knows your medical requirements is your eye doctor.

In my own practice I can sometimes tell a patient that an inexpensive pair of reading glasses purchased at a discount store will satisfy his or her needs. In some cases I consult with my optician to select a particular eyeglass option which will meet a patient's unusual requirements. I often can tell a patient that a new prescription is not needed. Sometimes a new prescription will be so close to the previous one that a new pair of glasses will not provide an observable benefit.

For all of these reasons, your eye doctor, working with an optician, is the best way to get your glasses. As an Ophthalmologist, my goal is not to have you purchase a new pair of glasses, but to be sure that you have the best vision possible while avoiding unnecessary expense. My practice supplies a wide variety of fashionable frames, and all of the available options for filling each prescription, and I am happy to work with my opticians to provide the best glasses to each patient.

Back to Top


16. The Causes and Cures for Dry Eye

There are many causes of Dry Eye. As we age, tear production decreases. Wearing contact lenses often increases tear evaporation. A variety of common medications reduce tear secretion. These include decongestants, antihistamines, diuretics, beta-blockers, sleeping pills, antidepressants, and pain relievers. Also, various environmental factors can cause eyes to dry: sunny , dry, or windy conditions, dehumidifiers, fans, or air conditions, hair dryers, high altitudes, smoke or air pollution are among the many causes.

The human eye is lubricated by two kinds of tears produced by glands in the upper and lower eyelid. There are Constant Tears, which are continually formed to lubricate the eye and contain natural antibiotics to help fight infections. There are also Reflex tears, produced only in response to irritation, injury, or emotion. These help to rinse the surface of the eye. A balance is necessary between the two types of tears to ensure that your eyes a re comfortable and protected. When constant tear flow is reduced, there is irritation that can cause excessive reflex tearing ("watery eyes"). These excess tears lack the oil needed to keep from evaporating and do not lubricate the eye.

A lack of tears, improper lubrication, or tears draining too quickly from the eye result in a condition known as Dry Eye.

Tears can be reproduced by using eye drops called Artificial Tears. They replace the moisture that is missing and lubricate the eyes. They temporarily soothe dry eye symptoms. However, they can also wash away the natural, infection-fighting tear film. For many people, artificial tears to not offer relief and are impractical.

Tear duct closure, which allows you to retain your own natural tears, may be the best solution. Temporary closure of the tear duct (punctal canal) is accomplished by inserting a tiny plug (like a sink stopper) to prevent tear drainage. This allows your own tears to bathe you eye for a longer period of time. In about one or two weeks this plug will dissolve and wash away with your tears.

Long-term closure of the tear drainage ducts involves the use of a non-dissolvable, yet removable, plug to seal the tear duct. This non-surgical procedure is painless and takes only a few minutes.

With punctal plugs relief from the discomfort of dry eyes may be immediate for some patients, while for other s relief may be more gradual. Most patients find the reduction in artificial tear use and related costs very beneficial.

Back to Top