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You need and deserve expert and compassionate care. At Pisacano Eye, your vision is our number one priority and we believe you should be treated like family. We take that statement very seriously— after all, Pisacano Eye is a professional, family-owned and family-staffed eye care practice.

Services and Treatments:

  • EYE EXAMS

    The importance of routine eye examinations

    We often seek medical attention if our eyes hurt, or turn red, or if our vision becomes blurry. But we don’t often get our eyes examined regularly if we are not having any problems with them. Routine eye examinations are important even if our eyes and vision are fine—because many blinding eye diseases have few or no warning signs until they have taken away some or all of our vision.
    The most common cause of blindness in the United States is diabetic eye disease. In the early stages, when it is most easily treated, diabetic eye disease has no symptoms. The only way for a diabetic to know if he or she has diabetic eye disease is to get routine eye examinations at least once a year.

    The second most common cause of blindness in the US is glaucoma. Glaucoma is called the silent thief of sight because it has no symptoms at all until the disease is very advanced. And in glaucoma, once vision is lost, it can never be regained, so finding it in the advanced stage is often too late to save the sight. Glaucoma is common in older adults, but can occur at any age. The only way to know if you have glaucoma is to have a comprehensive eye examination on a regular basis.

    The most common cause of blindness among Americans over age 50 is age-related macular degeneration. In the early stages of macular degeneration, treatments can be used to prevent the disease from getting worse. But the early stages of macular degeneration have no symptoms. The only way to know if you have early macular degeneration—and to start treatment to prevent it from getting worse—is to have routine eye examinations even if your eyes seem fine.

    These are just a few of the eye diseases that can blind you without your even knowing you have them. To be safe, you should have a thorough eye examination on a regular basis to be sure your eyes are as healthy as you think they are. Finding eye diseases as early as possible gives you the best chance of saving your sight.

    How often should you have a routine eye examination? Children should have their first examination, including a measurement of vision, before they begin kindergarten. Their vision should be measured at least every few years to make sure that sight is developing normally. It is a good idea for teens to have a full eye examination before beginning to drive, to make sure they will be safe behind the wheel. After that, adults should consider having an eye exam every year or two beginning at age 40, and at least once a year after age 50 when the blinding diseases listed above become more common.

    There are a few exceptions to these guidelines. People with diabetes should have an eye examination every year starting when they are diagnosed with diabetes, no matter how old they are. And people who have relatives with eye diseases, such as glaucoma or macular degeneration, should have examinations once a year beginning as soon as age 30.

    Why are eye exams important in diabetes?

    Diabetes is a common disease in the United States, and diabetic eye disease is the most common cause of blindness in the US. Regular eye examinations are important in diabetes because diabetic eye disease and the vision loss caused by it are completely preventable.

    In diabetes, high sugar levels in the blood damage blood vessels throughout the entire body. Damage to blood vessels in the kidneys can cause kidney failure requiring dialysis. Damage to blood vessels in nerves can cause neuropathy. Your eye also has many blood vessels in it, and diabetes can also damage those blood vessels. In particular, high blood glucose levels cause damage to the blood vessels in the retina of the eye. The retina lines the back of your eye like wallpaper, and is like the film in a camera—it detects the light entering your eye and turns it into pictures for your brain to see. When the retina’s blood vessels are damaged, the retina stops working properly, and sight can be lost.

    After being exposed to high sugar levels for a long time, the blood vessels in the retina develop some weak spots. These weak spots often pooch out like bubbles along the blood vessels, and these are called microaneurysms. Sometimes the microaneurysms rupture, and blood spills into the retina to form small dot hemorrhages. Your retina will eventually clear the blood away, but some debris is often left behind—these clumps of debris are called hard exudates. Altogether, these changes—microaneurysms, dot hemorrhages, and hard exudates—are called background diabetic eye disease. Most people with diabetes get these small changes in their eyes after having diabetes for 10 years or more. Background diabetic eye disease does not usually cause significant vision loss unless the swelling occurs in the very center part of the retina, called the macula. If you have swelling here, it is called diabetic macular swelling, and it is a common cause of vision loss among diabetic patients.

    These are just a few of the eye diseases that can blind you without your even knowing you have them. To be safe, you should have a thorough eye examination on a regular basis to be sure your eyes are as healthy as you think they are. Finding eye diseases as early as possible gives you the best chance of saving your sight.

    Background diabetic retinopathy is a sign that your retina’s blood vessels are sick. If enough of the blood vessels rupture, the retina may not receive enough blood to keep it healthy. In this case, the retina will try to grow new blood vessels to replace the sick ones. Unfortunately, these new blood vessels usually grow in the wrong places. They are fragile, and they break easily, sometimes spilling enough blood to fill up the eye. When these new blood vessels begin to grow, it is called proliferative diabetic eye disease. Proliferative diabetic eye disease is less common than background diabetic eye disease, but is much more likely to take away some or all of your vision.

    If it is caught early—before your vision is damaged—proliferative diabetic eye disease can be treated with laser therapy to save your vision. Once the vision is lost, it is very hard to get it back.

    Background and early proliferative diabetic retinopathy have no symptoms. The only way to know if you have these changes—and need laser therapy to save your sight—is to visit your eye doctor regularly. People with diabetes should have their eyes examined at least once a year.

  • GLAUCOMA

    What to expect if you have glaucoma

    Glaucoma is an eye disease that can lead to blindness if not treated. While there is no cure for glaucoma, there are effective treatments that can save your sight. If you have glaucoma, it is necessary to have regular follow up visits to your eye doctor. The purpose of these visits is to make sure that your glaucoma is well controlled and not getting worse. Glaucoma gets worse very slowly, and because there are no symptoms that you can detect to tell if your glaucoma is getting worse. So regular visits—at least 2-3 every year—are very important to make you’re your glaucoma is not getting worse. During these visits, you will likely undergo a number of tests evaluating the status of your glaucoma.

    At every visit, your eye pressure will be measured. High eye pressure is thought to play a role in the damage that destroys vision. The goal of glaucoma treatment is to lower eye pressure. This is usually achieved with eye drop medications. Checking your eye pressure at each visit lets your doctor know if your drugs are still working effectively. There are several ways to measure eye pressure, including an air puff or a blue light.

    Your doctor may also measure the thickness of your cornea. The cornea is the clear window covering the front of the eye. The thickness of your cornea may affect the accuracy of your eye pressure measurements. Knowing your corneal thickness may help your doctor to determine your risk of getting worse from glaucoma, and to adjust your treatment to better control your glaucoma.

    Occasionally, your doctor will dilate your pupils to carefully examine your optic nerves. The optic nerve connects the eye to the brain, and is the structure that is damaged in glaucoma. When the optic nerve is damaged by glaucoma, you gradually lose your peripheral vision. You may also have a computerized optic nerve scan. The purpose of these evaluations is to measure the amount of glaucoma damage you have, and to determine if your glaucoma is stable or is getting worse. If it is getting worse, your doctor will change your treatment to further lower your eye pressure.

    Since optic nerve damage destroys your peripheral vision, you will periodically take a visual field test to measure your peripheral vision. During this test, you will push a button when you see a small light appear in different parts of your peripheral vision. The visual field test provides your doctor with a map of your remaining peripheral vision. If your glaucoma is continuing to steal your peripheral vision over time, your doctor will change your treatment to further lower your eye pressure.

    These various tests are all necessary to make sure that your eye pressure has been lowered enough to stop glaucoma from stealing your sight. Keeping your appointments faithfully, and using your eye drop medications regularly as prescribed, are important in keeping your glaucoma under control and saving your sight.

    Optic nerve scans for glaucoma

    Glaucoma is an eye disease that can lead to blindness if not treated. While there is no cure for glaucoma, there are effective treatments that can save your sight. If you have glaucoma, it is necessary to have regular follow up visits to your eye doctor. The purpose of these visits is to make sure that your glaucoma is well controlled and not getting worse. Glaucoma gets worse very slowly, and because there are no symptoms that you can detect to tell if your glaucoma is getting worse. So regular visits—at least 2-3 every year—are very important to make you’re your glaucoma is not getting worse. During these visits, you will likely undergo a number of tests evaluating the status of your glaucoma.

    At every visit, your eye pressure will be measured. High eye pressure is thought to play a role in the damage that destroys vision. The goal of glaucoma treatment is to lower eye pressure. This is usually achieved with eye drop medications. Checking your eye pressure at each visit lets your doctor know if your drugs are still working effectively. There are several ways to measure eye pressure, including an air puff or a blue light.

    Your doctor may also measure the thickness of your cornea. The cornea is the clear window covering the front of the eye. The thickness of your cornea may affect the accuracy of your eye pressure measurements. Knowing your corneal thickness may help your doctor to determine your risk of getting worse from glaucoma, and to adjust your treatment to better control your glaucoma.

    Occasionally, your doctor will dilate your pupils to carefully examine your optic nerves. The optic nerve connects the eye to the brain, and is the structure that is damaged in glaucoma. When the optic nerve is damaged by glaucoma, you gradually lose your peripheral vision. You may also have a computerized optic nerve scan. The purpose of these evaluations is to measure the amount of glaucoma damage you have, and to determine if your glaucoma is stable or is getting worse. If it is getting worse, your doctor will change your treatment to further lower your eye pressure.

    Since optic nerve damage destroys your peripheral vision, you will periodically take a visual field test to measure your peripheral vision. During this test, you will push a button when you see a small light appear in different parts of your peripheral vision. The visual field test provides your doctor with a map of your remaining peripheral vision. If your glaucoma is continuing to steal your peripheral vision over time, your doctor will change your treatment to further lower your eye pressure.

    These various tests are all necessary to make sure that your eye pressure has been lowered enough to stop glaucoma from stealing your sight. Keeping your appointments faithfully, and using your eye drop medications regularly as prescribed, are important in keeping your glaucoma under control and saving your sight.

    Selective laser trabeculoplasty:
    are you a candidate?

    Glaucoma is an eye disease that, if left untreated, can lead to blindness. In eyes with glaucoma, the eye pressure is usually higher than normal. The eye is filled with clear fluid that flows in through a spigot and flows out through a drain. In glaucoma, the drain of the eye gets plugged, and fluid coming into the eye cannot get out, raising the eye pressure. This high eye pressure causes nerve damage, which leads to loss of sight.

    Glaucoma is treated by lowering the eye pressure to prevent further damage. Eye pressure can be lowered in several ways. One common way to lower eye pressure is to use eye drop medication. There are many different glaucoma eye drop medications, and they lower eye pressure by either turning down the spigot or opening up the drain of the eye. Most people with glaucoma use at least one eye drop medication to lower their eye pressure.

    Another way to lower eye pressure is with laser therapy. A common laser treatment for glaucoma is called selective laser trabeculoplasty, or SLT. In SLT, laser treatment is applied to the drain of your eye in order to open it up and let fluid out, lowering the eye pressure and saving your sight. SLT treatment takes only a few minutes, is performed in the office (not the operating room), is safe, and effectively lowers eye pressure in most people. The treatment is approved by the Food and Drug Administration (FDA) for treating glaucoma, and is covered by essentially all insurance plans.

    Are you a candidate for SLT?

    People who might benefit from SLT are described below. If any of these descriptions apply to you, ask your doctor if SLT is right for you.

    • Eye pressure not controlled despite using one or more eye drop medications—if you have tried several medications and your eye pressure is still not under control, SLT may be the next step.

    • Inability to tolerate eye drop medications—some people have medical problems that make using eye drop medications unsafe, and others may be allergic to the preservatives in bottles of eye drop medications.

    • Inability to put eye drop medications in your eyes—if you have arthritis, or a tremor, or very poor vision, you might not be able to put the drops in your eye.

    • Frequently forgetting to use your eye drop medications—if you often forget to put your drops in, your eye pressure may be going up and down a lot; these fluctuations in eye pressure can make glaucoma worse.

    • Inability to afford your eye drop medications—many people have insurance that will cover SLT but will not cover medications. If you cannot afford your medications, SLT might be a more cost-effective way to control your glaucoma.

    • Desire to reduce the number of eye drop medications you are using—if your eye pressure is controlled but you require several eye drop medications to keep it controlled, SLT might allow you to reduce the number of medications you are using for eye pressure.

    • Desire to avoid starting eye drop medication therapy—if you have just been diagnosed with glaucoma, you may prefer to avoid eye drop medications entirely. SLT may help you accomplish this.

  • CATARACT

    All about cataracts

    Modern cataract surgery makes use of an amazing array of high-tech equipment and techniques. Gone are the days when cataract surgery required a two-week stay in the hospital, with your head immobilized with sandbags until you healed. Today’s cataract surgery is an out-patient procedure that takes a half-hour or less and lets you get back to your normal activity level within a few days.

    One of the most dramatic advances in cataract surgery involves anesthesia for the procedure. Long ago, patients were put to sleep for cataract surgery. More recently, patients were given a shot behind the eye before surgery to numb it. But now, the vast majority of cataract surgeries are performed under topical anesthesia, with only a few numbing drops placed on your eye before the start of the procedure. This eliminates both the risks and discomforts of the shot. Also, the shot made the vision blurry for several hours after surgery—with just the numbing drops, some patients notice improved vision within minutes after the surgery is completed.

    The technique of cataract removal has also undergone major improvements. Once upon a time, the cataract was removed whole through an incision over a half-inch long. Modern cataract surgery is performed through an incision less than an eighth of an inch long. A small instrument is inserted through this tiny incision, and is used to break the cataract into many small pieces that are removed without the need for a large incision. There are many advantages to a smaller incision, including a faster recovery time, less need for glasses after surgery, and a smaller risk of infections after surgery. In addition, while the old incisions required many stitches to close up, modern cataract surgery can often be performed without any stitches, or with one stitch at most.

    During cataract surgery, the cloudy lens of your eye is removed and replaced with a clear lens implant. In the old days, there were no implants, and patients had to wear thick glasses (“Coke-bottle glasses”) after surgery to see well. Now there are implants that are placed directly into the eye, reducing or eliminating the need for any glasses after surgery. The newest implants (called multifocal implants, or presbyopia-correcting implants) can even provide sharp vision at both distance and up close, reducing or eliminating the need for any kind of glasses, including reading glasses, after surgery.

    Antibiotic advancements also benefit patients undergoing cataract surgery. Cataract surgery is among the most successful operations in all of medicine, but complications can occasionally occur. One of the most severe complications is an infection in the eye called endophthalmitis. To reduce your risk of getting endophthalmitis, your doctor will prescribe antibiotic eye drops to use around the time of your surgery. New antibiotics developed in the past few years are more effective than ever at preventing eye infections during cataract surgery.

    Routine cataract surgery is so well tolerated that it has become the most common surgery performed on adults in the United States. As a result of these many high-tech developments in all aspects of cataract surgery, the operation is more successful—and has a faster recovery time—than ever before.

    Advances in cataract surgery

    Glaucoma is an eye disease that can lead to blindness if not treated. While there is no cure for glaucoma, there are effective treatments that can save your sight. If you have glaucoma, it is necessary to have regular follow up visits to your eye doctor. The purpose of these visits is to make sure that your glaucoma is well controlled and not getting worse. Glaucoma gets worse very slowly, and because there are no symptoms that you can detect to tell if your glaucoma is getting worse. So regular visits—at least 2-3 every year—are very important to make you’re your glaucoma is not getting worse. During these visits, you will likely undergo a number of tests evaluating the status of your glaucoma.

    At every visit, your eye pressure will be measured. High eye pressure is thought to play a role in the damage that destroys vision. The goal of glaucoma treatment is to lower eye pressure. This is usually achieved with eye drop medications. Checking your eye pressure at each visit lets your doctor know if your drugs are still working effectively. There are several ways to measure eye pressure, including an air puff or a blue light.

    Your doctor may also measure the thickness of your cornea. The cornea is the clear window covering the front of the eye. The thickness of your cornea may affect the accuracy of your eye pressure measurements. Knowing your corneal thickness may help your doctor to determine your risk of getting worse from glaucoma, and to adjust your treatment to better control your glaucoma.

    Occasionally, your doctor will dilate your pupils to carefully examine your optic nerves. The optic nerve connects the eye to the brain, and is the structure that is damaged in glaucoma. When the optic nerve is damaged by glaucoma, you gradually lose your peripheral vision. You may also have a computerized optic nerve scan. The purpose of these evaluations is to measure the amount of glaucoma damage you have, and to determine if your glaucoma is stable or is getting worse. If it is getting worse, your doctor will change your treatment to further lower your eye pressure.

    Since optic nerve damage destroys your peripheral vision, you will periodically take a visual field test to measure your peripheral vision. During this test, you will push a button when you see a small light appear in different parts of your peripheral vision. The visual field test provides your doctor with a map of your remaining peripheral vision. If your glaucoma is continuing to steal your peripheral vision over time, your doctor will change your treatment to further lower your eye pressure.

    These various tests are all necessary to make sure that your eye pressure has been lowered enough to stop glaucoma from stealing your sight. Keeping your appointments faithfully, and using your eye drop medications regularly as prescribed, are important in keeping your glaucoma under control and saving your sight.

    Choosing a Lens after cataract surgery

    The lens of your eye is an important structure. In order to see clearly at all distances (from up close to far away), your eye must be able to change its focus power. The lens of your eye is responsible for this change in focus—it changes its shape to bring whatever you’re looking at into clear focus. In your early 40’s you lost the ability to see up close, and required either bifocals, or at least reading glasses. This was because as we age, the lens hardens and cannot change its shape anymore, and in order to focus at different distances, more than one glasses prescription was required.

    As we age even more, the lens becomes cloudy. This cloudiness of the lens is called a cataract. Cataract is a common problem among aging Americans, and cataract surgery is the most common surgery performed on adults in the United States. In cataract surgery, the cloudy lens is removed. In order for you to see clearly afterward, a new lens (called an intraocular lens implant, or IOL) must be inserted at the time of surgery.

    Selecting the right implant for your eye is very important for your vision after surgery. Your doctor will take measurements before your surgery to determine how strong your lens is, so an implant with the same strength can be put in during the surgery. If you wear glasses, the implant strength can be adjusted to replace both your lens and your glasses.

    Like your aging lens, the implant cannot change its shape to help you see both up close and off at a distance. But several options are available to help you minimize—or even eliminate—your need for any type of glasses after cataract surgery.

    For instance, your doctor may place implants in your eyes with the appropriate strength for you to see well at a distance, and you can wear reading glasses when you want to see up close, such as for reading.

    Another option is for your doctor to select the implant strength for you to see clearly off at a distance for one eye, and a different strength—the one for up close—for your other eye, so that you can see clearly at all distances without glasses after surgery. This works well for most people, but some people have trouble with depth perception when their two eyes are focused at different distances.

    In recent years, several types of bifocal and/or multifocal implants have been developed. These lenses allow you to see clearly at a variety of distances, effectively eliminating the need for glasses. Several manufacturers, including Alcon, Advanced Medical Optics, and Eyeonics, have recently received approval from the FDA for new technology multi-focal lenses following cataract surgery. It should be noted, however, that multi-focal lens technology is evolving rapidly and patients are encouraged to consult with their doctor about these offerings. Also, this technology is relatively expensive and is considered elective by Medicare and most payers, thus the difference in price between a standard cataract IOL and the new technology must be paid by the patient.

    Talk with your doctor about the various types of implants available, and their effects on your vision after surgery. You and your doctor will develop a plan that pairs you with the best type of implants for your eyes and your vision needs.

  • LASIK

    Advances in refractive surgery

    New advances in refractive surgery technology have greatly improved the success of these popular procedures designed to reduce or eliminate your need for glasses or contact lenses. Nearsightedness (myopia), farsightedness (hyperopia) and astigmatism can all be corrected by refractive surgery techniques. These vision problems arise when your eye’s focusing system is either too weak or too strong; refractive surgery corrects your eye’s focusing power system so you can see clearly without glasses or contacts.

    The most commonly performed refractive surgery is LASIK. In LASIK, a corneal flap is cut from the front surface of your eye and gently folded out of the way while the excimer laser sculpts your corneal shape to correct your nearsightedness, after which the flap is repositioned and the procedure is complete. Traditionally, the flap is cut with a special blade instrument called a microkeratome. A new laser system—called a femtolaser—has been developed to create the corneal flap without using a blade at all. The femtolaser approach allows your doctor to create a more precise flap, giving him or her more control over the size, shape and thickness of the flap, all of which ultimately improve the quality of your vision after surgery.

    Once the LASIK flap is made and folded out of the way, the excimer laser is used to reshape your cornea to do away with your refractive error. LASIK is highly successful, but some patients experience unwanted visual effects such as glare, halos, and reduced contrast sensitivity after surgery. These effects arise from higher order aberrations, which are complex and irregular refractive errors arising from your eye’s focusing system. These higher order aberrations can now be measured using a technique called wavefront analysis. More importantly, when wavefront analysis is combined with the excimer laser, these higher order aberrations—and the visual problems that arise from them—can be corrected with LASIK. In this way, you can enjoy excellent vision after LASIK without the problems of glare, halos, and reduced contrast sensitivity.

    Another refractive procedure growing in popularity is called refractive lens exchange (RLE). Both your cornea and your lens provide focusing power to your eye, and changing the focusing power of either one can change your eye’s refractive state. In RLE, your natural lens is removed and replaced with a lens implant that has the right amount of focusing power to provide you with excellent vision without glasses or contact lenses. This is similar to cataract surgery, except that RLE is performed before cataracts develop in your lenses. One drawback to RLE is that traditional lens implants only have a single focusing power, and after RLE in both eyes, you can see well off at a distance but still require reading glasses to see up close. New multifocal lens implants have been developed that, once implanted, allow you to see clearly both at distance and near without the need for any glasses at all.

    New technology is constantly providing improvements in refractive surgery techniques and outcomes. If you are considering refractive surgery, ask your doctor about these advanced refractive techniques.

    Refractive Surgery Basics

    Refractive surgery is a group of surgical procedures designed to help you reduce or even eliminate your need for glasses or contact lenses. Various procedures are available to help correct the various types of refractive errors: myopia, hyperopia, and astigmatism.

    Myopia is also called nearsightedness—you can see well up close without glasses but need glasses to see well at a distance. Myopia arises when the front surface of your eye—called the cornea—is steeper than usual. Hyperopia is far-sightedness—you cannot see well up close and usually cannot see well at a distance either. People with hyperopia often have flatter than usual corneas. Astigmatism is a mixture of myopia and hyperopia—your cornea is warped like the shape of a saddle.

    Refractive surgery improves your vision by changing the focus power of your eye. This is accomplished by altering either of the two focusing structures of the eye—the cornea and the lens. The cornea or lens can be altered by various surgical techniques.

    The most common refractive surgery procedure of the cornea is LASIK (laser-assisted in situ keratomileusis). In LASIK, laser energy is used to reshape your cornea, essentially sculpting your prescription into your eye. If the laser energy were applied directly to the surface of your eye, the treated area would be sore for several days during the healing process. To avoid this discomfort, a thin flap is cut on the surface of your cornea, then folded out of the way. Laser energy is then used to sculpt your exposed cornea to correct your nearsightedness, then the flap is put back into its normal position, covering the treated area. LASIK is nearly painless, highly successful, and you can see the improvement in your vision immediately after surgery. A slightly different procedure, called LASEK (laser epithelial keratomileusis), uses a thinner flap, and is typically performed in people whose cornea is too thin or too flat for LASIK. A third type of corneal refractive surgery is called PRK (photorefractive keratectomy), which differs from LASIK and LASEK in that no flap is made–the laser directly sculpts the front surface of your cornea to flatten it.

    There are two common refractive surgery procedures of the lens. One is implantation of an ICL (intraocular contact lens). An ICL is essentially a contact lens, but instead of being placed on the surface of your eye, it is permanently placed inside your eye. The implant rests on the surface of your natural lens, behind your iris. The strength of the implant is specifically selected to work with your cornea and lens to correct your refractive error. The second procedure is called RLE (refractive lens exchange). Refractive lens exchange involves removing your lens and replacing it with a lens implant that works with your cornea to correct your refractive error.

    Each of these procedures has different risks and benefits, and each is designed for a different group of people based on the type and severity of their refractive error. If you are considering having refractive surgery, talk with your doctor about which procedure is best for your eyes.

  • DRY EYE

    Dry Eye: Why Is It A Disease And Not Just A Nuisance?

    Do you have dry eyes? Up to 12 million Americans suffer from a disease called dry eye syndrome. People with dry eyes frequently experience burning and stinging of their eyes, their eyes often feel sticky, and their eyes are often red. Some people with dry eyes also have periods when their eyes get so watery that tears spill over their eyelids and run down their cheeks.

    Your eyes normally make small amounts of tears all day long. Tears play several important roles in keeping your eyes healthy and your vision clear. Tears lubricate the eye’s surface, wash away debris, provide a smooth surface to help keep your vision clear, and also contain natural antibiotics that keep your eyes safe from germs that might cause infections.

    Tears coat the eye in a smooth film made up of three separate layers. The layer of tears closest to the front surface of the eye is called the mucin layer. Its job is to smooth out the uneven spots on the eye surface. Next, a layer of aqueous tears covers the mucin layer. The aqueous layer is watery, and makes up the majority of the tear film. Its job is to lubricate the eye and keep it moist. The final layer of the tear film is an oily layer called the lipid layer. This is the outermost layer, and its job is to cover the aqueous layer and prevent it from evaporating.

    Each layer of the tear film is made by a different part of the eye. The mucin layer is made by the eye surface itself. The aqueous layer is made by a tear gland tucked under the upper eyelid. And the lipid layer is made by small glands in the eyelids. For the tear film to do its job, all three layers have to be in their proper places in the correct amounts, like a recipe. If any layer is missing or abnormal—which can happen for a number of reasons—the tear film becomes disorganized and no longer soothes the eye like it should.

    When that happens, the symptoms of dry eye syndrome occur. The front surface of the eye gets dried out (causing stickiness) and gets inflamed (causing stinging and burning). Once it gets inflamed, the eye ignores the proper tear film recipe and starts making large quantities of the aqueous layer in an effort to soothe itself. These bad tears don’t soothe the eye at all—they just run down your face, washing away the mucin and lipid layers as well. This makes the eye even more irritated, so it makes even more bad tears, and the cycle continues.

    For some people, the stinging and burning and redness and watering may seem like little more than a nuisance, but in fact, if left untreated, dry eye syndrome can lead to serious eye problems, including blindness. Dry eyes are inflamed eyes. Inflammation of the front surface of the eye increases the risk of some infections, and can also lead to scarring. Once scarring occurs, permanent loss of sight can occur. If you have symptoms of dry eye syndrome, ask your doctor for a dry eye evaluation. Treatments are available to halt the disease and save your sight.

    What Can I Do For My Dry Eyes?

    Dry eye syndrome is a common condition that affects as many as 10 million people in the United States. Symptoms of dry eye syndrome include burning and an itchy or scratchy sensation, like having sand or grit in your eyes. Many people with dry eye syndrome have intermittent blurry vision that temporarily improves with rapid blinking. There are many causes of dry eye syndrome, but in general, the condition occurs because your tears are either abnormal or they are evaporating from your eye’s surface too quickly.

    Dry eye syndrome is often a nuisance, and in some cases, can lead to scaring of the eye’s surface with loss of vision. There are several treatments available. These range from simple lifestyle modifications to prescription medications, depending on the severity of the condition.

    If you have mild dry eyes, you may be able to improve your symptoms just by changing your environment. Sitting too close to a heating or air conditioning vent exposes the eye to a constant flow of forced air, which can make tears evaporate too quickly. Most heating systems dry out your home’s air even if you don’t sit too close to the vent; a humidifier can help put moisture back into the air. Cigarette smoke can irritate and dry out the eye surface as well, and quitting smoking often improves symptoms of dry eye syndrome.

    If your eyes don’t produce enough tears or don’t produce healthy tears, there are tear replacements available. These artificial tears are sold over the counter in most drugstores and grocery stores. If your symptoms are mild to moderate, putting artificial tears into your eyes two to four times daily often helps relieve your symptoms. Artificial tears are available in multi-dose bottles and single-dose vials. The multi-dose bottles are less expensive but contain preservatives that some people cannot tolerate more than four times daily. The single-dose vials contain no preservatives, and can be used more than four times daily, but they are generally more expensive.

    If you require artificial tears more than four times daily, you may benefit from punctual plugs. The punctum is the opening in the lower eyelid through which your tears drain away. Plugging the punctum makes your tears—or artificial tears—stay on your eye surface longer, which improves your dry eye symptoms. Punctal plugs are quickly, easily, and painlessly inserted during an office visit, and provide significant relief for many dry eye sufferers. If for any reason you are unsatisfied with them, they can be removed as easily as they are inserted.

    Moderate to severe dry eye may require medical therapy. Prescription eye drops are available that stimulate your tear glands to produce more of your own natural tears. All medications have side effects, and prescription medications can be costly, so this solution may not be for everyone. If you have dry eye symptoms, talk to your eye doctor. Based on your lifestyle and the severity of your symptoms, your doctor will work with you to design a treatment plan to make your eyes comfortable.

    Your Eyes Should Not Itch
    And Burn As You Age

    Aging is unavoidable, and as you age, your body undergoes many important changes. Your eyes are no exception. One of the most common problems associated with aging eyes is dry eye syndrome. If your eyes frequently burn or feel itchy or scratchy, you may have dry eye syndrome.

    As its name suggests, dry eye syndrome is caused by inadequate moisture to the eye. The front surface of the eye must be kept moist at all times in order to work properly. This is why your body produces tears—to keep the eye moist and healthy so that your vision will be crisp and clear. Tears have three main ingredients: a mucin layer that coats the outer surface of the eye, an aqueous or watery layer that provides moisture to the eye surface, and a lipid or oil layer on the outside to slow down evaporation so that your tears will last longer on your eye. Each of these three key ingredients is made by a different set of tear glands in your eyelid. If any of the three ingredients is missing, or if your tears evaporate too quickly, you will develop dry eye syndrome.

    The symptoms of dry eye syndrome include burning, itching or scratching, and a sensation of grittiness like sand in your eyes. Your vision may be blurred. Often these symptoms worsen throughout the day, becoming worse in the late afternoon or evening. Although this sounds backwards, some dry eyes water excessively. This is because a dry eye is often irritated, and eye irritation often triggers tearing to help soothe the eye. If your eye becomes dry and irritated because your tears are defective, then making lots more defective tears is no solution: instead you just end up with irritated, wet eyes.

    Like your aging lens, the implant cannot change its shape to help you see both up close and off at a distance. But several options are available to help you minimize—or even eliminate—your need for any type of glasses after cataract surgery.

    There are many causes of dry eyes, but the most common cause is simply getting older. As you age, your body produces less oil. This results in dry, irritated skin, and also dry eyes. The eyes get dry because the oil layer of your tears is deficient, and the water in your tears evaporates too fast. Women are particularly vulnerable to dry eyes as they age, because the hormonal changes that accompany aging often reduce tear production.

    Dry eye syndrome can be treated in a variety of ways. Environmental and lifestyle changes may be all that is needed. Perhaps you sit too close to a heating or air conditioning duct that is drying out your eyes, or perhaps cigarette smoke is irritating your eyes. Tear replacement therapy can effectively moisten your eyes. Placing small plugs in your tear ducts can reduce tear drainage, making your tears last longer. And new prescription medications can help stimulate your tear glands to produce more of your natural tears.

    Itching and burning is not a normal sign of aging. If your eyes itch and burn, tell your doctor. Your doctor will help you identify possible reasons for your dry eyes, and will design a treatment plan to relieve your symptoms.

    Talk with your doctor about the various types of implants available, and their effects on your vision after surgery. You and your doctor will develop a plan that pairs you with the best type of implants for your eyes and your vision needs.

  • FLASHES AND FLOATERS

    Flashes And Floaters: What You Need To Know

    The eye is filled with a clear jelly called the vitreous gel. The vitreous gel inflates the back part of the eye in the way that water inflates a water balloon. As we age, the vitreous gel begins to dissolve into a more watery form. Once enough of the vitreous gel has dissolved – usually when we are in our late 50’s or early 60’s – the gel pulls free of its attachments to the back of the eye. This sudden and often dramatic event – called a posterior vitreous detachment – often causes a number of symptoms that can be alarming.
    One common symptom of a posterior vitreous detachment is the appearance of floaters. Floaters are exactly what they sound like – tiny bits of debris that appear when the vitreous gel separated from the back of the eye. These bits of cloudy debris float in the liquefied vitreous like snow in a snow globe. If you have a single small floater, you may have the sensation that a bug is flying in your face. Often in eyes with posterior vitreous detachments, the floaters are bigger and somewhat stringy, and you may describe it as a spider web or cobweb in your vision. Typically, these floaters will move around in your vision, especially when you move your eyes around. Floaters usually do not stay in exactly the same spot in your vision.

    Another common symptom of a posterior vitreous detachment is seeing flashing lights in the very periphery of your vision. As the vitreous gel pulls loose from the back of the eye, it tugs on the wallpaper lining the back of the eye. This wallpaper is called the retina. The retina is a thin layer and is like the film of a camera—it is the light-sensing part of the eye. When the retina is tugged on, it generates the sensation of flashing lights in the periphery of your vision.
    Floaters are often annoying but not usually a threat to vision. But flashing lights can be a more worrisome sign. Sometimes when the vitreous tugs on the retina as it is pulling loose, it can pull so hard that it makes small rips or tears in the retina. The liquefied vitreous can then pass through the hole and cause the retina to come loose from the back of the eye as well. This is called a retinal detachment. If you have a retinal detachment, you may notice sections of your vision disappearing, as if a curtain or veil is covering parts of your vision. A retinal detachment is an emergency and often requires surgery to repair.
    If you have the sudden onset of new floaters in your vision and/or flashing lights in the periphery of your vision, call your eye doctor immediately to arrange a prompt examination. During this examination, your pupils will be dilated to examine your retina to make sure there is no retinal detachment. While they are uncommon, retinal detachments can cause vision loss, and repairing them quickly is the best way to save your vision.

  • PERIPHERAL VISION

    Performing The Visual Field Test

    The visual field test measures your peripheral vision, also called your side vision. Many diseases can reduce your peripheral vision. To diagnose and treat these conditions, we must carefully measure the peripheral vision. Your peripheral vision is measured with a special test called a visual field test.

    Taking a visual field test can be challenging, and the results are only useful if you can perform the test well. Each eye will be tested separately, and the eye not being tested will be covered with an eye patch. To get started, your head will be comfortably positioned in the visual field machine. The test takes 5-10 minutes per eye, and if you are uncomfortable, you will not be able to do a good job taking the test. If you are not comfortable, tell your technician so you can be adjusted until you’re comfortable.

    Once you are comfortably positioned, you will be looking into a dimly-lit bowl. Your technician will ask you to stare at a small target light in the middle of the bowl. Your job is to keep staring at that spot throughout the whole test. You may blink your eyes whenever you need to—this will not affect the test.

    Before the test begins, you will be handed a small device with a button on it. Try pushing the button a few times before starting the test. If you have arthritis or any other health problem that makes it hard for you to push the button in your hand, now is the time to tell your technician.

    During the test, small lights will appear throughout the bowl. Your job is to push the button every time you see one of the lights. Pushing the button is how the machine knows you saw that light. If you see a light but don’t push the button, the machine will think you did not see that light. Don’t worry about missing lights when you blink—the machine will come back to each spot you missed and check it again.

    You should keep looking straight at your small target even when you see the test lights in your peripheral vision—if you move your eyes to look at them, the test is no longer measuring your peripheral vision. The machine keeps track of whether you look around or not, and if you look around too much, your doctor may not be able to use your test results and you may have to repeat the entire test.

    You may hear some sounds during the test. The machine makes noises while the test is performed. If you hear noises but do not see lights, don’t worry—sometimes the machine shines lights too small or too dim to be seen, or doesn’t shine any lights at all, just to make sure you aren’t hitting the button every time you hear the noise. If you hit the button even when you don’t see the light, your test results may not be useful and you may need to repeat the test.

    When the test is complete, the machine will print out a map of your peripheral vision. The pattern of this map tells your doctor where you can see and where you can’t see.

  • READING ISSUES

    Welcome To Presbyopia

    As we age, our bodies undergo many significant changes. One such change that often causes concern for people is the gradual loss of near vision that occurs when we reach our 40’s. This normal and unavoidable effect of aging is called presbyopia, or “old eyes.”

    The symptoms for presbyopia are familiar to anyone over age 45. At first, you will notice that after you’ve been reading for a short time, the words seem to run together. After a brief rest, you can again read for a short time before it happens again. Over time, reading small print – such as numbers in the phone book, the box scores in the newspaper, or items on a menu – becomes harder and then impossible. You may notice that if you hold reading material farther away than normal, the words come into sharper focus. As presbyopia continues to develop, you may find yourself hold your newspaper farther and farther away until at last your arms aren’t long enough to compensate.

    Presbyopia arises due to changes in the lens of the eye. Like in a camera, the lens of the eye is responsible for adjusting focus. When we are young, we can easily change focus to look at objects that are nearby or far away. This is because our lens is young and soft and can quickly and easily change its shape to accommodate between distance and near focus. But as we age, the lens becomes stiff and can no longer easily change its shape. As a result, we can no longer adjust our focus to see up close without some help. This most commonly starts around age 42, but can come on a few years earlier in some people, and show up later in others.

    Help for presbyopia comes in the form of glasses. If you do not use glasses for distance vision, then a pair of reading glasses is the easiest solution. Reading glasses are necessary only for up-close tasks such as reading or sewing, and must be removed to see clearly off at a distance. Reading glasses come in different strengths. Usually weak reading glasses (in the range of +1.25 to +1.50 diopters, or focusing units) will work well when presbyopia symptoms are just beginning, and stronger glasses will be needed every few years until presbyopia stops getting worse, usually in your late 50’s to early 60’s. Once presbyopia stops progressing, most people end up with reading glasses in the range of +2.50 to +2.75 diopters. If you do use glasses for distance vision even before presbyopia starts, the solution for you will involve bifocals. Bifocals are glasses that have your distance prescription in the top of the lens and your presbyopic reading prescriptions in the bottom of the lens. The strength of the bifocal part of the lens will have to be increased over the years as presbyopia progresses, just as with reading glasses.