Lasik and Refractive Surgery
Laser in-situ keratomileusis (LASIK), which is sometimes termed laser intrastromal keratomileusis (LASIK), is the most advanced procedure utilizing the excimer laser for correction of refractive errors.
LASIK has become the most successful and popular vision correction procedure in the world. LASIK surgery changes the shape of the cornea permanently. It can drastically decrease the need for glasses or contact lenses for most patients.
The surgery is performed using only topical anesthetics (eye drops). The procedure combines the use of the microkeratome (a delicate surgical instrument) to create a thin protective corneal flap followed by application of the excimer laser beam to the bed of the cornea. The excimer laser removes tissue with minimal thermal damage or scarring to adjacent tissue. The computer guided excimer laser beam accurately reshapes the cornea by removing microscopic layers of the cornea (.25 microns per laser pulse). The corneal flap is then placed back in position and allowed to heal without the need for stitches.
Following a LASIK procedure, most patients are able to resume their normal daily activities the next day. The advantage of LASIK is that there are no raw surfaces left to heal after application of the excimer laser. The normal physiologic layers of the cornea are left intact after the treatment, because the treatment is done beneath the corneal flap.
LASIK surgery improves the focusing power of the cornea. Most patients that have undergone LASIK surgery now enjoy excellent vision without the need for glasses or contact lenses.
Most patients that wear contact lenses or glasses are candidates for LASIK surgery. To find out if you are a candidate for LASIK surgery, you can contact us toll free at 215.639.4500 or email: firstname.lastname@example.org The initial consultation is free.
Cosmetic and Med Spa
BOTOX® Cosmetic is a simple, nonsurgical, physician-administered treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 18 to 65 years of age. It is the only treatment of its type approved by the Food and Drug Administration (FDA).
One 10-minute treatment—a few tiny injections—and within days there's a noticeable improvement in moderate to severe frown lines between the brows, which can last up to 4 months. Results may vary.
BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which reduces the activity of the muscles that cause those frown lines between the brows to form over time.
In 2005, almost 3.3 million procedures were performed with FDA-approved BOTOX® Cosmetic.There’s only one BOTOX® Cosmetic. Talk to your doctor to see if BOTOX® Cosmetic is right for you!
Botox Cosmetic may work for you
When it comes to selecting a physician-administered aesthetic treatment, chances are you’ll want proof, not just claims. The proof for BOTOX® Cosmetic is in the numbers.
- In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment. Results vary.
- Results can last for up to 4 months, and may vary
- BOTOX® Cosmetic was approved by the Food and Drug Administration (FDA) in 2002 for the temporary treatment of moderate to severe frown lines between the brows in people ages 18 to 65, and almost 3.3 million procedures were performed in 2005 alone.
- The American Society for Aesthetic Plastic Surgery ranked BOTOX® Cosmetic as the most popular physician-administered aesthetic procedure in the United States for the fourth year in a row (surgical and nonsurgical combined).
So why not ask your doctor if BOTOX® Cosmetic is right for you?
What To Expect at the Doctor’s Office
Before you try and schedule your first BOTOX® Cosmetic treatment consultation, you probably have some questions, such as: How long will it take? How long will the results last? Will it hurt? Will I still be able to make facial expressions?
Here's what you might expect at the doctor's office from the moment you arrive until your procedure is done. (Please note that although this experience is typical, the routine at your doctor's office may be different.)
The day of your appointment. Allow time before your appointment for filling out forms and for consulting with the doctor or a member of his or her staff. If it's your initial visit, you may first meet with your doctor personally or a staff member. Many doctors have on-staff licensed aestheticians or nurses who are trained in skin care and skin care procedures who can answer many of your questions.
You may also be asked about your expectations for treatment and if you have any allergies or any condition that wouldn't make you a good candidate for BOTOX® Cosmetic.
Before the procedure. You'll probably be seated in a reclining chair, much like you find in a dentist's office. No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream.
The procedure. Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The entire BOTOX® Cosmetic injection procedure takes approximately 10 minutes.
After the procedure. There's no recovery time needed. You're ready to get on with your day! The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.
Seeing results. Within days, you may notice an improvement in the moderate to severe frown lines between your brows that can last up to 4 months. Results may vary.
What Does FDA Approval Mean?
You've heard it many times before: A product is advertised as "FDA-approved." But what does that really mean?
In the United States, prescription drugs and biologics are required to undergo rigorous laboratory, animal, and human clinical testing before they can be put on the market. The Food and Drug Administration (FDA) reviews the results of these studies to verify the identity, potency, purity, and stability of the "ingredients"; and demonstrate that the drug is safe and effective for its intended use.
What about BOTOX® Cosmetic?
BOTOX® Cosmetic received FDA approval in 2002 for the temporary treatment of moderate to severe frown lines between the brows in people 18 to 65 years of age. BOTOX® Cosmetic is available by prescription only.
Routine Eye Care
A routine visit is more than just a determination for prescription glasses and contact lenses. Through various eye tests and a review of medical history, our doctors are not only able to provide outstanding eye care services but also evaluate for signs of ocular disease.
Ocular Diseases may include:
- Macular Degeneration
- Refractive Errors
- Diabetic Eye Problems
Neglecting an annual eye exam is harmful to one's overall vision. Being mindful and scheduling regular eye examination could save one's overall health in the long run. Findings of systematic health issues such as heart disease and diabetes could be discovered, which otherwise would have gone undetected.
Emergency Eye Care
Seek emergency eye care if you have any of the following symptoms:
- Sudden vision loss of any type, including but not limited to, transient vision loss, central blurring, or field defects
- Seeing spots/shadows (floaters), flashing lights, a “veil” across the field of vision, or distortion in the visual field
- Pain within and around the eye
Sensitivity to light and excessive tearing
- Bulging eye
- Double vision or a sudden crossing of the eye
- Discharge (crusting) within the eye
- Chemical or traumatic injury
If chemicals are to reach the eye make sure to rinse the area with clean contact lens solution. If contact lens solution is unavailable, you may use clean water. Once this is done for 15 minutes, seek further care.
If you are experiencing any of the following problems please call our office immediately and we will work to ensure that you are seen promptly. If you are experiencing these problems outside of normal business hours, over physicians may be available.
Please call any of our three office locations:
821 Huntingdon Pike, Suite 200
Huntingdon Valley, PA 19006
119 York Road
Jenkintown, PA 19046
Rising Sun Office
6609 Rising Sun Ave
Philadelphia, PA 19111
A cataract is a clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window. Clouded vision caused by cataracts can make it more difficult to read, drive a car, especially at night, or see the expression on a friend's face.
Most cataracts develop slowly and don't disturb your eyesight early on. But with time, cataracts will eventually interfere with your vision.
At first, stronger lighting and eyeglasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe, effective procedure.
A cataract is a very slow, clouding of the eye's natural lens. The cataract development interferes with light passing through the eye to the retina. Cataracts are caused by a change in the proteins of the eye, which causes clouding or discoloration of the lens. Over time cataracts typically result in blurred or fuzzy vision and sensitivity to light.
People with progressed cataracts often describe the sensation as looking through a piece of cloudy cellophane. A cataract may make light from the sun or a lamp seem too bright, causing glare. Colors may not appear as bright as they once did, however, most cataracts develop so slowly that people usually don’t realize that their color vision has markedly deteriorated. Oncoming headlights may cause uncomfortable glare at night, making driving more difficult.
What Is The Cornea?
The cornea, the eyes outermost layer, is clear and dome shaped. It covers the front of the eye and has the major task of focusing one’s vision. Because there are no blood vessels in the tissue of the cornea, nourishment comes directly from tears and the aqueous humor. There are five layers to this tissue, with each having important functions.
Epithelium (Outermost Layer)
The epithelium blocks any foreign material such as dust particles and bacteria from entering the eye as well as allowing for the absorption of oxygen and nutrients to the rest of the cornea.
This layer, behind the basement membrane of the epithelium, contains fibers called collagen. If large scars develop from injury to Bowman’s layer in the cornea, vision loss may occur.
Behind Bowman’s layer is the stroma, the thickest layer of the cornea. Much like the previous layer, the stroma contains collagen. Collagen is great for strength and elasticity in the eye as well as producing light-conducting transparency in the cornea.
The next layer of tissue, behind the stroma, is Descemet’s membrane. This tissue protects against infection and injuries for it contains collagen fibers that are unique compared to stroma fibers. This layer, once injured, can repair itself quite well.
Endothelium (Innermost Layer)
Endothelial cells are important in that they keep the cornea clear. Normally, with fluid leakage to the stroma from the inside of the eye, the endothelium pumps excess fluid out. If this did not occur, the stroma would result in over swelling, thus becoming thick and opaque. In a healthy eye, there needs to be homeostasis between fluid moving into the cornea and fluid being pumped out.
Symptoms Of Corneal Conditions
The cornea has the ability to heal quickly after most injuries or diseases, due to its ability to repair naturally. However, with natural repair to the cornea occurring, there may be some major symptoms that call for medical attention:
- Pain in the eye
- Excessive redness and tearing
- Sensitivity to light
- Scarring to the cornea
- Blurred vision
If one is experiencing these symptoms, he or she should seek immediate professional eye care.
Conditions That Affect The Cornea
Dry Eye is a condition in which the eye produces less tears but also ones that are lower in quality. This condition causes an inability for surface lubrication of the eye. Symptoms may include:
- A scratchy feeling in the eye
- A burning or stinging sensation in the eye
- Excess tearing followed by periods of dryness
- Discharge from the eye
- A feeling of heavy eyelids or blurred vision
When the weather is warm and dry, pollen related allergies affect the eye. Symptoms may be minor with no need for medical attention, but they tend to be bothersome. Antihistamine decongestant eye drops will effectively reduce any symptoms. In the event of rain and cooler weather, symptoms may reduce due to the decrease in pollen in the air.
Noninfectious Keratitis, or inflammation in the cornea, can be caused by a minor injury as well as from wearing contact lenses for too long. Viruses or bacteria can cause infectious Keratitis in the cornea, often related to improper cleaning of contact lenses, or the overuse of old contact lenses that should have otherwise been discarded. Antibacterial eye drops may treat minor corneal infections but if the problem is more severe, intensive antibiotic or antifungal treatment may be required.
Corneal diseases affect vision in many different ways. Some diseases cause episodes of pain in the eye, some cause severe visual impairment, while others cause no vision problems, with discovery only occurring during routine eye exam. Some of the most common corneal diseases include keratoconus or thinning of the cornea, Fuchs’ dystrophy or gradually worsening vision, lattice dystrophy or lattice-like patterns of deposits in the stroma, and map-dot- fingerprint dystrophy or abnormal development of the basement membrane in the cornea.
Shingles, or the reactivation of the varicel-lazoster virus, is the same virus that causes chickenpox. The virus may travel through nerve fibers and emerge in the cornea, thus causing decreased sensitivity. Once the shingles have cleared it is important to have the eyes examined several months later, for the symptoms of shingles may still be present.
Ocular Herpes, or herpes of the eye, is a persistent viral infection that is caused by the herpes simplex virus, which is known to cause cold sores. The sexually transmitted herpes simplex virus, also known to cause genital herpes, can also cause ocular herpes. This condition may present itself as sores on the eyelid or surface of the cornea with a deeper spreading into the cornea, causing inflammation. There is no cure for ocular herpes but over time it may be controlled with antiviral medication.
Iridocorneal Endothelial Syndrome (ICE)
Iridocorneal Endothelial Syndrome usually presents itself in only one eye, for any given case, with three main symptoms:
- Swelling in the cornea
- Changes in the iris, visible change in the colored part of the eye
The symptoms listed above are caused by the movement of endothelial cells from the cornea to the iris. This movement of cells also blocks fluid outflow channels of the eye, causing glaucoma. Glaucoma is treatable but the progression of ICE is unpreventable. If swelling in the cornea becomes too severe, a transplant of the cornea may be necessary for ultimate relief.
Pterygium is a tissue growth on the cornea. Some Pterygia grow slowly over a lifetime, with other Pterygia stop growing early in their development. A Pterygium rarely grows so large that it covers the eye’s pupil. Researchers believe that chronic exposure to UV light from the sun may be a determining factor for developing a Pterygium. Simple fixes like wearing protective sunglasses and hats while in the sun could drastically decrease the development of a Pterygium. Unless a Pterygium affects vision, it is recommended that one does not get it surgically removed for it may grow back over time.
If surgery for a Pterygium is the best option for a patient, our doctors will reconstruct the outer surface of the cornea with an amniotic membrane graft to correct the cornea. This technique prevents reoccurrence and additionally promotes good cosmetic appearance.
Stevens-Johnson Syndrome (SJS)
Stevens-Johnson Syndrome, called erythema multiforme major, is a disorder of the skin that affects the eyes. Symptoms include:
- Painful blisters on the skin and in the mouth, throat, genitals, and eyelids
- Flu-like symptoms
- A rash of blisters that spreads
SJS can cause severe conjunctivitis, inflammation inside the eye (iritis), corneal blisters and holes, with a possibility for significant vision loss.
Treatment For Corneal Conditions and Disease
Phototherapeutic keratectomy (PTK) is a surgical technique that uses laser technology and UV light to restore the cornea. This technique helps to postpone the need for corneal grafting and/or replacement.
Corneal Transplant Surgery
This type of surgery removes portion of the cornea that is damaged and needs to be replace. The replacement procedure uses healthy donor tissue. Penetrating keratoplasty, in the past, was the standard procedure for corneal transplant with replacing the entire cornea with donor tissue. This procedure may be the only option for advanced keratoconus and corneal scarring.
A newer procedure, called lamellar keratoplasty, is a partial thickness transplant that may be helpful for less severe corneal injury. In this type of transplant, the surgeon moves and replaces the layer(s) of the cornea that are diseased with healthy tissue. This will leave the cornea more structurally intact and prevents complications in the future.
Descemet’s Stripping with Endothelial Keratoplasty (DSEK) is also a newer cornea transplant technique that replaces damaged cell layers of the cornea instead of the entire thickness of the cornea. This technique allows for a speedy recovery and healing that is much stronger. Because this technique improves visual results with a smoother interface, it has become the preferred treatment method for Fuchs’ dystrophy.
The FDA recently approved cross-linking of the cornea. During this procedure, riboflavin drops saturate the cornea. Research has shown that increasing the amount of collagen cross-linking will increase the strength of the cornea. Although this is not a cure for keratoconus (thinning of the cornea), it will slow down the progression of keratoconus and need for a corneal transplant.
Intacs are thin plastic, semi-circular rings that are inserted into the middle layer of the cornea. When they are inserted in the keratoconus cornea they change the shape and location of the cone, flattening the cornea. The placement of Intacs reinforces the cornea and eliminates some or all of the irregularities caused by keratoconus.
A keratoprosthesis is an artificial cornea called KPro. This procedure may be the only option for those who have not had successful corneal tissues implants or have had some type of tissue rejection. The Boston type-1 KPro is made of clear plastic, consists of three parts, and is the most used keratoprosthesis. This procedure is achieved by taking donor tissue and clamping that tissue between the front and back plates of the artificial cornea.
Glaucoma is not just one eye disease, but a group of eye conditions resulting in optic nerve damage, which causes loss of vision. Abnormally high pressure inside your eye (intraocular pressure) usually, but not always, causes this damage.
Glaucoma is the second leading cause of blindness. Sometimes called the silent thief of sight, glaucoma can damage your vision so gradually you may not notice any loss of vision until the disease is at an advanced stage. The most common type of glaucoma, primary open-angle glaucoma, often has no noticeable signs or symptoms.
Early diagnosis and treatment can minimize or prevent optic nerve damage and limit glaucoma-related vision loss. It's important to get your eyes examined regularly, and make sure your eye doctor measures your intraocular pressure.
Glaucoma treatment is aimed at controlling the eye's fluid pressure, as a means of slowing the disease's progression. Such treatment does not cure the disease. Most doctors use medications for newly diagnosed glaucoma; however, new research findings show that laser surgery is a safe and effective alternative.
- Medications: Several medications, in the form of eyedrops or pills, are available either to enhance fluid drainage or decrease the eye's production of aqueous humor. Unfortunately, because anti-glaucoma drugs enter the blood system, they can cause various side effects such as headaches and respiratory problems. When such side effects occur, patients should consult with their eye care professional about alternative treatment regimens.
- Laser Surgery: Glaucoma treatment using an argon laser has proved beneficial in preliminary studies. In this form of treatment, a high-energy beam of light is directed onto the trabecular meshwork--part of the anterior chamber's drainage system--and approximately 100 tiny burns are made on its surface. The burns stretch the existing holes in the meshwork for better fluid drainage. Laser surgery, however, may be effective for only a short time and usually is used in conjunction with drops or pills.
- Surgery: Several procedures may be performed to improve drainage flow, such as a trabeculotomy, goniotomy, and trabeculectomy. All of these involve making a small hole in the anterior chamber through which fluid can leave the eye. Although these procedures have a fairly high success rate, they are generally reserved until medical therapy is no longer effective.
Pediatric Eye Care
Pediatric Eye Care Is Different From Adult Eye Care
Brain cells in the early stages of adolescent development are very sensitive. Because these brain cells develop throughout the first decade of life, disorders to the eyes that have little effect on adults have a tremendous and life-long effect on younger eyes. Poor vision due to inadequate stimulation of brain cells, called amblyopia or “lazy eye”, is a common cause of vision loss in young children.
Our Pediatric Eye Team
Our doctors are not only trained to handle the most advanced macular dystrophies in adults, but they are also a dedicated team, trained in understanding and treating children of all ages. Our multidisciplinary team provides safe, and highly effective care at all of our locations. Our ophthalmic imaging and diagnostic testing are attempting to improve outcomes for the following conditions in children:
- Amblyopia (Lazy Eye)
- Childhood Glaucoma
- Corneal Abrasions
- Dacryostenosis (Blocked Tear Duct)
- Hordeolum (Stye)
- Myasthenia Gravis
- Optic Neuritis
- Refractive Errors in Children
- Retinopathy of Prematurity
- Strabismus (Crossed-Eyes)
- Syndromic Craniosynostosis
Eye and Orbital Plastic Surgery
Our world-class surgeons are able to correct impaired vision and functions within the eye by addressing many underlying problems. The focus is to resolve disorders of the eyelids, orbits, and lacrimal system. Besides resolving impaired vision and functions to the eye and surrounding structures, our surgeons leave the eye looking cosmetically appealing and youthful.
Used for cosmetic procedures, reduces and/or eliminates the appearance of wrinkles in the face. This is achieved through minimally invasive injections. Created from an FDA approved substance, botulinum A, once injected into the face will block the nerves and muscles that are responsible for causing lines and wrinkles in the face.
An injectable, used for temporarily lessoning and/or eliminating moderate-to-severe frown lines between the eyebrows, is placed directly underneath a furrow. It weakens the muscle to where contraction cannot be achieved.
This medication is used to treat involuntary closing of the eyelid. It is injected into the affected muscles to reduce the activity. A chemical in the body, called acetylcholine, is inhibited from signaling the nerves in that muscle to contract.
Aid in the smoothing of the skin through removal of damaged outer layers, also reducing scarring while removing blemishes. The three types of chemical peels are alphahydroxy acid (AHA), triachloroacetic acid (TCA) and phenol, ranging from mild to strong in toleration. Chemical peels reverse the effects of aging, damaged skin and other skin conditions. The overall appearance of the skin will be improved through the removal of dead skin cells while promoting growth of new ones.
During the aging process, subcutaneous fat is lost. Muscles in the face are then working closer to the surface of the skin, causing lines and creases in the face to be visible. Dermal fillers help to diminish those lines and restore fullness back into the face.
This FDA approved procedure uses fractional laser technology to help restore skin to its original texture, leaving the skin feeling smoother with a fresh feeling of youthfulness. This laser technology improves tone, as well as improvement to the pores, acne scars, unwanted brown spots, as well as a reduction in fine lines in the face.
Typically a cosmetic procedure, eyelid surgery can also improve vision by lifting a droopy eyelid from one’s field of vision. This procedure can rejuvenate tired looking eyes through removing excess fat, skin and muscle from the eyelids.
A condition, in which a patient blinks abnormally, is a form of focal dystonia. Although individuals with this condition may have normal vision, this disturbance interferes with visual perception. In the most severe cases, this disturbance may result in functional blindness. There is no cure for blepharospasm but there are treatments to combat the condition, such as oral medications, injections, surgeries, and brain stimulation.
This is a procedure in which the eyebrow is returned to an aesthetically pleasing location on the upper face by lifting the eyebrow through incisions in the upper-eyelid. An internal browpexy technique is achieved when brow fat is reattached to the forehead through an incision in the upper eyelid. A direct browpexy, another technique, is achieved when direct incisions are made above the brow with small amounts of brow ptosis. The pretrichial browpexy technique is performed through a longer incision, raising the brows and smoothing out the forehead, hidden along the hairline. Each procedure is done according to the needs of the patient.
Canthopexy And Canthoplasty
Canthopexy is a surgical procedure that lifts the corners of the eye, eliminating a tired appearance, and restores the look around the eye to a much more youthful expression. Moreover, canthoplasty, another surgical procedure, is used to create an upward slant in the corner of the eyelid. This procedure can also be used to correct a dystrophic appearance in that area of the eyelid.
Ectropion And Entropion
Ectropion is a condition in which the eyelid turns slightly outward. When this occurs the inner lid of the eyelid in either one section of the eye or across the entire lid, is exposed. Ectropion can be caused for any number of reasons (aging, paralysis of the face, scar tissue, or a birth defect). Whatever the case, corrections to this condition are done through surgery of eyelid repositioning. Entropion is a condition in which the eyelid turns slightly inward. Entropion, much like ectropion, can have many causes (aging, congenital defect, spasms, inflammation, or scarring). Irritation in the eye can cause damage to the cornea, if not corrected. Treatment for this condition is surgery with a local anesthesia.
Eyelid Crease Fixation and Formation
Creases in the eyelid change due to the aging process, injuries, and inflammation. This change occurs because the skin around the eyelids are much thinner than other parts of the face and body. Fixation and formation of eyelid creases is done for both cosmetic and functional purposes.
Lesions on and around the eyelids may be malignant or benign. If the case is a benign lesion, individuals usually prefer to eliminate the growth as a whole, called an excision or excisional biopsy.
Floppy Eyelid Syndrome Treatment
FES is an ocular condition that occurs when the upper eyelids are loose and may become turned inside out. Lubrication to treat this condition usually turns out unsuccessful because there may be additional problems that can only be resolved through surgery. In surgery, a segment of the eyelid is removed, tightening the eyelid and turning it to a correct position.
Usually the result of aging, ptosis or the drooping of the eyelid is mostly seen in the older adult population. Some may develop this condition after an injury or eye surgery with some extreme cases found in children born with drooping eyelids.
This procedure is achieved when the eyelids are partially sewn together to create a narrowing of the palpebral opening. If the eyelids become weak and can no longer blink effectively, the cornea and the rest of the eye may develop problems. This procedure helps protect the eye until a more permanent action can be taken.
This condition occurs when the eyelashes turn inward and irritate the cornea. Treatment includes removing and correctly positioning the lashes. If recurrence is the case, epilation with electrosurgery may be more suitable. During epilation with electrosurgery a radiofrequency device is employed to permanently remove the follicles of the affected eyelashes. An electrode wire is inserted into the eyelash follicle and an electrical current destroys those follicles, ending hair growth.
This procedure is the removal of the eye due to severe pain, injury and trauma, blindness, and disease. In most cases the enucleated eye is replaced with an orbital implant and an artificial eye. An evisceration is a similar procedure that only removes the contents of the eye but leaves the shell of the eye. The doctor will best understand which procedure should be attempted, based on a number of indications.
This surgery creates space within the orbit, allowing the eye to return to its natural position. Patients who have eye proptosis will undergo this surgery. The focus for the surgery is removing the bone from one or more walls of the orbit as well as removing orbital fat. Removing bone and fat from the orbit will help maintain symmetry in the tissues of the orbit, reduce proptosis, and release any compression on the eye.
This fracture is a break or crack in one or more of the bones of the eye socket. An orbital fracture can cause double vision depending on whether eye muscles are injured or trapped in the fracture. Once the swelling recedes from this injury, the eye may appear more recessed compared to a normal eye. This treatment is necessary for both cosmetic and functional purposes. If surgery is a must, the incisions are small, and placed inside the eyelid or in creases in the skin.
Implants are attached to the muscles and structures in the eye socket during surgery. This allows for an ability to retain movement in the artificial eye. Ocularists are specialized in creating prosthetic eyes out of non-toxic, and non-allergenic materials that look and feel natural. A patient who undergoes this surgery will obtain custom-fitted prosthesis to match their other eye.
These are lesions behind and around the eye, which impact nerves, muscles, and blood vessels in the eye. Double vision, vision loss, and severe pain are common symptoms of orbital masses. Imaging tests are key for diagnosing whether these tumors are benign or malignant. If the tumor causes visual problems, surgical excision may be necessary. A biopsy may be conducted to provide a more definitive diagnosis.
This is a procedure that repairs deformities and complications of the orbit, which include orbital dystrophy, exorbitism, and fractures. Orbital reconstruction will help correct deformities through a number of various techniques.
Thyroid Strabismus Surgery
Common symptoms of thyroid eye disease are swollen eyelids, as well as bulging and red eyes. If glasses and prisms are not an effective measure of treatment, thyroid muscle strabismus surgery may be recommended. This surgery repositions fibrotic eye muscles to better align the eyes, thus correcting double vision that may be associated with thyroid eye disease.
This is a surgical procedure, known as balloon dacryocystoplasty that opens a tear duct once it is blocked. The incision for the surgery is made in the nose or the face. During the procedure, a very thin wire is inserted through a hole in the corner of the eye. In doing so, tears will drain. A deflated balloon, attached to the wire being inserted, is inflated with a liquid. The pressure from doing so will open and expand the blocked duct. Once the balloon deflates, it will be removed along with the wire. To prevent infection, antibiotics will be taken several days after the surgery to prevent any type of infection.
When there are breaks in the normal tear duct drainage system it is called canalicular lacerations. This type of injury is usually the result of blunt or sharp trauma. Surgery will be most effective within the first 48 hours of the blunt injury. The severity of the patient’s injury will dictate which techniques will be performed.
Dacryocystorhynostomy or dacryocystorhinostomy (DCR) is a procedure that is performed if tear blockage cannot be effectively treated. DCR is a surgical procedure to construct a new tear drain after blockage occurs. During the surgical procedure the doctor makes an incision in the side of the nose to create an opening between the tear drainage system and the nose. With the endoscopic approach to the procedure, a lighted tube with a microscopic camera is guided through the nasal opening to access the tear duct area. Once a new tear drain opening is created between the eye and the nose, a stent is placed in the new tear drain and kept in place for several months to ensure the duct will continue to remain open. In cases where the tear drain blockage cannot be cleared, a small drain is inserted to offer a more permanent solution to a clear tear duct.
Lacrimal Gland Biopsy
This procedure is performed if a lacrimal gland growth or enlargement is present. Lacrimal gland tumors may include eyelid swelling that lasts for several months. A biopsy is typically conducted based on the size of the tumor in the area. If it cannot be determined if the tumor is benign or malignant, an incision biopsy will be performed to remove a sample of the growth. Once the tumor can be categorized as malignant the entire gland will be removed.
Lacrimal Gland Plication
The lacrimal gland produces tears as well as helping to keep the surface of the eye lubricated. If the lacrimal gland protrudes, sarcoidosis may be the culprit, an inflammatory disease. Dry eye syndrome is a strong indication that there may be an issue with the lacrimal gland. Plication is a surgery, which takes the lacrimal gland and repositions it so the tears can be produced with limitations on swelling and protrusion.
Also known as punctal plugs, punctum plugs, or occluders, lacrimal plugs are the choice method for treating dry eyes. When eye drops or ointments fail, lacrimal plugs can relieve dry eye symptoms. They are placed on the opening of the tear duct, reducing the drainage of tears, and increasing moisture in the eyes. Temporary plugs may be useful for days to several months, whereas a permanent plug may be implanted if there was a successful response to the temporary plugs. The implanting of the plugs only takes a few seconds by a skilled doctor.
Tear Duct Obstruction
While many cases of tear duct obstructions clear after the first year of life for children, the pathology for adults is a lot different. In adults when an obstruction exists, tears cannot properly drain from the eyes, causing an overflow to the surface of the eye on the eyelashes and eyelids. The eyelids may become swollen with a yellow or greenish discharge. Tear duct massages as well as antibiotic eye drops may relieve the discharge, but if the obstruction does not clear, a minimally invasive procedure may help. A probe passed through the tear duct and into the nose may open any obstructions. In some cases however, surgery may be needed to clear the tear duct obstruction.
Retinal Diagnostic Testing
What Is Eye Angiography?
Fluorescein and indocyanine green (ICG) angiography are diagnostic tests which use special cameras to photograph the structures in the back of the eye. These tests are very useful for finding leakage or damage to the blood vessels which nourish the retina (light-sensitive tissue). In both tests, a colored dye is injected into a vein in the arm of the patient. The dye travels through the circulatory system and reaches the vessels in the retina and those of a deeper tissue layer called the choroid (see Fig. 1 below). Neither test involves the use of X-rays or harmful forms of radiation.
Fluorescein is a yellow dye which glows in visible light. Indocyanine is a green dye which fluoresces with invisible infrared light; it requires a special digital camera sensitive to these light rays.
Why Is Eye Angiography Performed?
Both tests can help retina specialists diagnose and evaluate specific eye diseases. Fluorescein dye is best for studying the retinal circulation (below) while indocyanine green is often better for studying the deeper choroidal blood vessel layer (below). Certain eye disorders, such as diabetic retinopathy and retinal vascular occlusive disease affect primarily the retinal circulation and are usually imaged with fluorescein dye. In other disorders, such as age-related macular degeneration, where leakage is from the deeper choroidal vessels, both tests may be useful. Indocyanine green angiography is especially helpful when there is leakage of blood, which may make interpretation of fluorescein studies difficult.
When abnormal vessels or leakage is identified with an angiogram, laser treatment or pharmacological therapies may be indicated to prevent vision loss. The tests can also be useful for following the course of disease or response to treatment.
Fluorescein and ICG angiography are universally employed throughout the world as diagnostic tests. The doctors of Vitreous-Retina-Macula consultants contributed extensively to the development and understanding of these techniques. They have published numerous peer–reviewed papers on the subject, a major textbook, and a CD–ROM.
What Are The Risks Of Eye Angiography?
Both fluorescein angiography and indocyanine green angiography are considered very safe and serious side-effects from these tests are uncommon. However, there is the possibility that a patient may have a reaction to the dyes. While fluorescein contains no iodine and is safe in patients known to be allergic, indocyanine green is currently formulated with iodine and should not be used in these individuals. Some people may experience slight nausea after dye injection that usually passes quickly. Patients who are allergic to the dye can develop itching and a skin rash. These symptoms generally respond quickly to oral medications such as anti–histamines or steroids. Very rarely, a sudden life-threatening allergic reaction called anaphylaxis can occur. This condition requires medical treatment. There is also a possibility of an infiltrate of the dye into the skin at the injection site; this would cause some discomfort or discoloring of the skin for several days. Fluorescein dye will also turn a patient’s urine orange and may slightly discolor the skin as well for a brief period. For special patient populations there may be individual risks of these procedures which your physician will specify for you.
Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT) is a diagnostic test that allows for the imaging and measurement of retinal thickness. OCT is very useful in detecting retinal swelling or fluid accumulation secondary to a variety of retinal conditions. It provides very valuable information and is also useful for following the response to a treatment. OCT testing has become a standard of care for the assessment and treatment of most retinal conditions. OCT uses rays of light to measure retinal thickness and can be performed in a few minutes. No radiation or x-rays are used in this test.
Ultrasound is a test that uses sound waves to assess ocular and retinal conditions. If your doctor cannot view the retina because of some opacity that blocks the view, they may use an ultrasound to determine the general status of the retina. Ultrasound is commonly used to assess the retina in patients with a dense cataract or vitreous hemorrhage. Ultrasound is simple to perform, painless, and does not involve any radiation.
Visian ICL, known as the Implantable Collamer Lens, is FDA approved, a fairly new procedure in vision correction, and works to benefit those who suffer from nearsightedness. The lens gently unfolds in the eye, resting behind the iris, and is biocompatible with the body. The materials that make up the Visian ICL are certainly unique; a barrier protecting from UV rays is created while allowing natural light to pass through unaltered. Unlike other procedures for the cornea, Visian ICL does not remove corneal tissue, which works well with the natural eye.
The procedure itself is painless due to the numbing medication, as well as being minimally invasive. By using only a 3.5 mm insert, recovery time is optimized. With an expecting procedure time of 20 to 30 minutes or less, most people are able to resume their daily activities in just a few days with overall clearer vision.
If a major prescription change occurs or new vision correction options become available, the Visian ICL can be completely removed. Working with the patient and doctor, changes will be made in accordance to the continuous improvement of technology for vision correction.
Older Adults With Presbyopia
Corneal inlays and corneal onlays are tiny lenses or other devices inserted into the cornea improving overall reading vision. The primary purpose of these inlays and onlays are to improve near vision and reduce the need for reading glasses for older adults with presbyopia. Their names suggest where on the surface of the cornea they are being inserted. Additionally corneal inlay surgery can sometimes be combined with LASIK surgery to correct presbyopia, as well as nearsightedness, farsightedness, and/or astigmatism.
Kamra Corneal Inlay
The Kamra Corneal Inlay reduces and or eliminates the need for reading glasses for adults between the ages of 45 and 60 who have good distance with their vision without glasses. Those same people have issues seeing up close, due to their presbyopia. The Kamra Inlay is very thin, only 3.8 mm in diameter with an opaque outer ring and a central opening of 1.6 mm.
When implanted, the inlay is positioned so the central opening is directly in front of the pupil of the eye. A “pinhole camera effect” is created to where the range of clear vision is expanded to bring near objects into focus while also maintaining vision that is clear for distance. The non-dominant eye typically receives the inlay, allowing for both eyes to see for distance while having near vision improvement from the implanted inlay.
Raindrop Near Vision Inlay
The Raindrop Near Vision Inlay, much like the Kamra Corneal Inlay, was also developed to treat those with presbyopia. The clear inlay of 2.0 mm in diameter is made of materials similar to those used for soft contact lenses. The characteristics of the inlay are almost identical to the human cornea. This inlay is implanted in the patient’s non-dominant eye through a laser-cut flap in the cornea. When in position, the inlay will change the curvature of the cornea so the front of the eye acts much like a multifocal contact lens.
Presbia Flexivue Microlens
Another inventive corneal inlay designed for correcting presbyopia is the Presbia Flexivue Microlens. This inlay resembles a small intraocular lens like the ones used in cataract surgery. With only a 3.2 mm diameter, the Presbia Flexivue Microlens is available in a range of different powers. When implanted, a small pocket is created in the stroma of the cornea with a femtosecond laser. The inlay is placed into the pocket and self sealed. The Presbia Flexivue Microlens can be removed and replaced with a higher or lower power lens if that is the case.
With much similarity to corneal inlays, corneal onlays are different in that they are placed closer to the surface of the cornea, under the epithelium. The epithelium of the cornea acts as a protective barrier keeping bacteria, dust, and foreign substances from penetration into the eye. Through research, corneal inlays have become the preferred technology for corneal implants regarding vision correction.
Ophthalmic Imaging and Testing
Content coming soon…
INTACS is a new and novel treatment for Keratoconus. It is a minimally invasive office procedure which can greatly improve vision without much risk. INTACS work by flattening the cornea.
Diabetes and The Eye
If you are a diabetic patient you are most likely aware of many dangers related to your health but have you discussed the implications of this disease with an eye care professional. The doctors at IC Laser have extensive training for diagnosing and treating patients that may suffer from degenerative symptoms related to diabetes. We suggest regular eye examinations to determine actual health of your eye. We hope to detect any early developments of diabetic retinopathy, retinal tears, or even macular degeneration in order to ensure quick and effective treatment. Keeping blood sugars relatively normal is the best known way to keep your eyes healthy and safe from the possible dangers of retinal problems.
If you have been diagnosed with diabetes, you may be at risk of losing your vision since your body does not utilize sugar properly and, when the sugar levels rise, damage to the retinal blood vessels may occur. This injury to the retinal vessels is known as Diabetic Retinopathy. Diabetic Retinopathy is the leading cause of blindness in working-age adults.
What are the symptoms of diabetic retinopathy?
Often, one may not be aware of any symptoms even when significant diabetic retinopathy is present. When macular edema occurs, vision often becomes blurry and may fluctuate. If abnormal new blood vessels form, as in proliferative diabetic retinopathy, they may bleed and result in small specks or large floaters obscuring the vision. If a large hemorrhage occurs, vision often becomes very blurry.
How is diabetic retinopathy diagnosed?
A comprehensive eye examination by an optometrist or retina specialist is the only reliable means of detecting diabetic retinopathy. After the pupil is dilated, a device called an ophthalmoscope is used to view the retina and determine the extent of the retinopathy. If diabetic retinopathy is discovered, a fluorescein dye test and/or optical coherence tomogram (OCT) may be recommended. A fluorescein angiogram involves the injection of a dye into a vein in the arm followed by several minutes of intermittent photos with a special digital camera focused on the retina. An OCT is a non-invasive photo that creates a detailed cross-sectional image of the macula.
What is the treatment for diabetic retinopathy?
The best therapy for diabetic retinopathy is prevention. Studies show that strict control of blood sugar levels can significantly lower the risk of vision loss from diabetic retinopathy. High blood pressure and kidney problems should also be treated to minimize their effect on the retinopathy. Laser surgery is often the first line of treatment if macular edema or proliferative retinopathy is present. For macular edema, the laser is focused on leaky areas of the retina to aid in reabsorbing the excess fluid. The primary goal of this treatment is to prevent further vision loss. It is uncommon for people to recover significant vision following treatment but some do experience partial restoration. Laser surgery is not a cure for diabetic retinopathy and is not guaranteed to prevent further loss of vision. Other treatments for diabetic retinopathy include medications like steroids or a novel class of medication called anti-VEGF.
Imagine being able to see your world as well as you did when you were younger, without the help of glasses or contact lenses. Being seen the way you want people to see you. Youthful. Energetic. Vibrant.
Imagine being able to see the way you want to see. Near, far and all distances in between. Seamlessly. Effortlessly. Naturally. Never missing a child's smile, the sparkle of a diamond, a cloud that looks like a face, an important plot twist in a mystery novel. Imagine a way to do it. Through your own eyes. Imagine all the possibilities. Imagine crystalens™.
What is Crystalens?
Crystalens, a single-focus lens, is a cataract replacement lens that works naturally with your eyes' muscles to give you the quality of vision you enjoyed when you were younger.
The revolutionary design element that makes crystalens the state-of-the-art replacement lens are chinges which are designed to allow the lens to move, or accommodate to focus on objects near, far and all distances in-between seamlessly.
Unlike old-style fixed focal lenses, which didn't move, crystalens has the ability to move, thus focusing as your eye's natural lens does. Dr. Iftikhar Chaudhry will take precise measurements to insure the correct power selection.
The Crystalens Procedure
The medical procedure to implant the crystalens is the same safe, proven cataract surgery performed annually on over 7 million eyes globally. Over 65 million procedures have been done in the US in the last 25 years.
Typically performed in an outpatient surgical facility, the actual surgery takes less than twenty minutes. In a pain free procedure, Dr. Iftikhar Chaudhry will place a few drops in your eye, then use an ultrasonic probe to remove the cloudy lens from your eye. The crystalens is then gently placed where your original lens used to be. Once surgery is complete, Dr. Iftikhar Chaudhry will place additional drops in your eye to prevent infection and decrease inflammation.
Because the opening into the eye is so small, it heals quickly on its own, without any need for stitches.
With Crystalens,the Advantages are Clear
The crystalens offers significant advantages over other kinds of lens implants and corrective lenses. Standard (single vision) lens implants don't have the ability to provide a full range of vision. Most people who have single vision lens implants MUST wear glasses for middle and near vision.
The crystalens has the unique ability to focus on objects at varying distances using the eye's natural muscle. This means the crystalens can provide sharper vision, without corrective lenses, throughout a full range of vision from near to far and everything in between.
The crystalens FDA one-year clinical study results indicate that 92% of the people enrolled in the study (implanted bilaterally) could see 20/25 or better at distance, 96% could see 20/20 at arm's length and 73% could see 20/25 at near without glasses or contact lenses.
What is more exciting is that 98% of these people could pass their drivers test, 100% could see their computer or put on their makeup, and 98% could read a magazine, all without glasses or contact lenses. Also, your ability to see at approximately arm's length (middle vision) will be greatly enhanced with the crystalens.
In addition, the quality of vision compared to wearing bifocals and/or trifocals is significantly improved. You'll have a full range of vision, without having to tilt your head to find that portion of your glasses that allows you to see clearly. You simply look at something and the crystalens, mimicking the natural focusing ability of your eye, will automatically focus your eye at near, arm's length, or distance. Dr. Iftikhar Chaudhry will be glad to answer any questions you have about the crystalens™.
New Intraocular Lens Technology
Helps Patients See at Far, Near and Intermediate Distances. The NEW Multifocal IOLs are available at IC Laser. Cataract surgery has undergone tremendous technological improvements in the last five years. These technological improvements have resulted in better vision and a better overall lifestyle for our patients. Imagine being able to see a golf ball in the trees on a great drive and watch where it lands or imagine not needing corrective glasses for reading the newspaper. These are some of the advantages that our patients are now experiencing. Some patients have even stated that, “I have not had vision like this since I was 20 years old”. IC laser is providing better technology and better vision for all of our patients. These improvements have clearly lead to better overall patient satisfaction. Please feel free to review the following lens options that your doctor will discuss with you at the time of your pre-operative examination.
ReZoom ™ Multifocal Intraocular Lens
As previously mentioned, modern day cataract surgery has some very NEW and exciting intraocular lens technologies. If you are experiencing cataracts or have presbyopia, the ReZoom ™ Multifocal Intraocular Lens may be a great option. This intraocular lens is designed for very flexible and multifunctional vision. The ReZoom™ intraocular lens is a second-generation refractive multifocal IOL that provides cataract patients with greater independence from glasses than monofocal IOLs. The ReZoom™ proprietary multifocal design provides a range of vision that monofocal lenses cannot match.
The ReZoom™ Balanced View Optics™ technology distributes light over five optic zones so that each lens has a distance-dominant central zone for distance vision in bright light conditions when the pupil is constricted.
If you have been told by your eye doctor that you have cataracts and are experiencing one or more of the following vision problems, you may be a candidate for the ReZoom ™ Multifocal lens:
- If you have trouble reading and may require bifocals.
- If your vision is getting increasingly blurred
In a clinical study 92 percent of ReZoom™ IOL patients reported never or only occasionally having to wear glasses.
Restor Lens - AcrySof® ReSTOR® IOL
IC laser of the Philadelphia area is now offering a new treatment for refractive lens exchange or as an option after cataract surgery. The ALL-NEW restor lens can now allow patients to see at both far distances and near distances with the dependence on glasses or contact lenses. In a recent FDA clinical study, 80% of patients receiving the ReSTOR lens reported that they no longer required glasses for daily activities. This intraocular lens insertion process is the exact same surgical technique used in cataract surgery and does not even require any type of stitches.
From Alcon (FDA clinical trial data)
During the AcrySof® ReSTOR® IOL clinical studies, patients experienced lifestyle enhancement through quality vision, and greater freedom from reading glasses and bifocals. According to the AcrySof® ReSTOR® clinical studies, four out of five patients with the AcrySof® ReSTOR® IOL reported never wearing glasses following cataract surgery in both eyes, compared to only 1 out of 10 patients with monofocal lenses. This is the highest level of freedom from glasses ever demonstrated in an IOL clinical trial.
Additionally, the AcrySof® ReSTOR® clinical studies indicated that nearly 94% of the study subjects were so satisfied with their new quality vision that they would have the AcrySof® ReSTOR® IOL implanted again.
ICL (Implantable Collamer Lens)
Introducing a solution for patients with high amounts of nearsightedness. The ICL is a revolutionary refractive lens that corrects myopia from -3 to -15 diopters, and reduces myopia from -16 to -20 diopters. The ICL procedure has been repeatedly improved through years of studies and continued refinement. This lens is a posterior chamber implant that is situated behind the iris and in front of the natural crystalline lens. It is also know as a Phakic IOL. The surgery is performed on an outpatient basis, which means that a patient has surgery and leaves the same day.
Prior to the surgery a surgeon will make two microscopic holes in the iris. Your eye will be numbed with a light, topical or local anesthetic. Once the eye is numbed the surgeon will make 2 side port incisions and one main temporal incision that is critical to the insertion process. Next the surgeon will insert the ICL through the main temporal incision and place the lens behind the iris and in front of the crystalline lens. This insertion procedure is typically performed one eye at a time. There is very little discomfort and normally no pain associated with the procedure. Some drops or perhaps oral medication may be prescribed and a visit is usually scheduled the day after surgery. Patients will be advised to arrange for someone to drive them to and from surgery.
Are You a Candidate?
Individuals who suffer from extreme nearsightedness will have a solution for their poor vision. The ICL provides an opportunity to those individuals who are not candidates for LASIK eye surgery. Some people cannot have LASIK for reasons ranging from high prescriptions to thin corneas. The ICL will now give these patients the opportunity to experience the same lifestyle change that lasik has brought to millions.
You're likely a good candidate for ICL if:
- You have extreme to moderate nearsightedness
- You have thin corneas and are not a LASIK candidate
- You have a history of dry eye
- You have large pupils