Cincinnati Eye Institute

Cincinnati Eye Institute

• Blepharoplasty

  What Is Blepharoplasty? Blepharoplasty, also known as eyelid surgery, is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid droops because the skin is much thinner than the skin in other parts of the face. The Eyelids are often one of the first facial areas to exhibit signs of aging. Risk Factors Of Droopy Eyelids Eyelid surgery may become necessary when various factors, which include aging, smoking, sun damage, and obesity, cause the muscles and tissue that support the eyelids to weaken. What Issues Can Blepharoplasty Correct? A blepharoplasty is ideal for correction of the following: Loose, sagging and/or folded upper eyelids that may interfere with vision Puffy fat deposits in the eyelids Undereye bags Sagging lower eyelids that may show the whites of the eyes below the irises Excess skin in the lower eyelids Fine wrinkles in the lower eyelids A blepharoplasty cannot raise the eyebrows, or treat deep wrinkles, dark circles under the eyes, or crow’s feet. Candidates For Eyelid Surgery The best candidates for blepharoplasty are patients that are in good overall health, does not smoke, does not have serious eye conditions, and has healthy facial tissue and muscle. A person with eye disease, diabetes, thyroid disorder, cardiovascular disease or high blood pressure may not be a good candidate for a blepharoplasty. Reasons for Eyelid Surgery Eyelids that droop or sag can affect peripheral vision making daily activities such as driving difficult. Blepharoplasty will tighten the eyelid’s muscles and tissue and removes excess fat and skin. Types of Blepharoplasty Functional blepharoplasty will eliminate the drooping of skin into the visual field, improving peripheral vision. Cosmetic blepharoplasty is performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person’s looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance the appearance and improve self-confidence, it does not radically alter the face. Blepharoplasty Procedure Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. Results Of Eyelid Surgery The swelling and bruising around the surgical site will subside on its own, and the eyelids will improve in appearance for up to a year. The scars will be well-concealed and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results. Blepharoplasty Recovery After the blepharoplasty procedure, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize the side effects. Most patients return to work within a few days to a week after surgery. Patients should avoid exercise and strenuous activities for at least 2 weeks. The stitches are usually removed after 3 or 4 days. The swelling and other side effects typically subside within 2 weeks. Patients may not wear contact lenses and eye makeup for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind.

  Link: Blepharoplasty

• BOTOX® Cosmetic for Medical Use

  Botulinum toxin, sold under the brand name BOTOX® Cosmetic, is a synthetic chemical that can be used to block nerve signals for treatment of a wide range of conditions. Although most commonly known for its cosmetic applications, BOTOX Cosmetic injections are an effective treatment for many medical conditions, including muscle spasm disorders such as blepharospasm, which results in forcible closure of the eyelids. BOTOX Cosmetic injections are administered, with no need for anesthesia, directly into the affected muscle. The injection effectively blocks nerve signals sent to the muscle to prevent it from contracting and to reduce pain. Patients may need anywhere from 1 to 10 injections during a single treatment session in order to successfully block nerve signals. The results of treatment are often most effective during the first 2 to 6 weeks after the injection and, according to the manufacturer, will last for up to 4 months. Results can be maintained through routine follow-up injections.

  Link: BOTOX® Cosmetic for Medical Use

• Cataract Surgery

  A cataract is a clouding of the lens of the eye; cataract surgery is performed to improve vision by replacing the clouded lens with an artificial one. Cataracts affect millions of people in the United States each year. Most cataracts are the result of aging, though some form as a result of genetic factors, disease or injury. Cataract surgery is common, and considered safe and effective. Reasons for Cataract Surgery Cataracts can cause blurry vision, and increase the glare from lights. In their early stages, cataracts usually are not troublesome but, as they thicken, surgery to remove them may be required. Typically, surgery is needed because cataracts are interfering with everyday activities, or the treatment of another eye problem. Candidates for Cataract Surgery Cataracts caused by aging develop gradually, and patients may not notice the early vision changes they cause. It is only when their cataracts start interfering with vision that patients may become aware of them. An ophthalmologic examination will detect cataracts, and rule out other causes for vision issues, such as glaucoma or macular degeneration. Patients who become aware of visual difficulties related to cataracts usually experience, especially at night, clouded, blurred or dim vision. Benefits of Cataract Surgery Cataract surgery’s benefits are many, greatly enhancing the quality of life. They include the following: Improved quality of vision (sharper images, brighter colors) Less difficulty with routine tasks (particularly night driving) Decreased dependency on eyeglasses Greater independence, regardless of age or disability Greater safety Research indicates that the improved vision provided by cataract surgery reduces the risk of falls, making exercise, sports and hobbies safer. This, combined with the improved ability to read, recognize faces, and perform everyday activities with greater ease, results in improved physical health, increased sociability and longer life expectancy. The Cataract Surgery Procedure After the pupil is dilated, and the area in and around the eye is numbed with anesthesia, a tiny incision is made to insert an ultrasonic probe. The probe emulsifies (breaks up) the cloudy lens into tiny pieces that are then suctioned out of the eye. Once the cloudy lens has been removed, an artificial lens is implanted. The new lens, known as an intraocular lens (IOL), is often inserted through the original incision. Some varieties of IOLs serve multiple purposes, such as blocking ultraviolet light, or helping to correct astigmatism offering near intermediate and distant vision. Surgery is usually performed on an outpatient basis in an accredited ambulatory surgical center, takes only 20 to 30 minutes, and is relatively painless. A very high percentage of patients demonstrates improved vision after the procedure. Risks of Cataract Surgery Although cataract surgery is a common procedure and considered quite safe, any surgery poses risks. In the case of cataract surgery, there is a slightly increased risk of retinal detachment, a painless but dangerous condition. Other risks of cataract surgery include bleeding and infection. The risk of complications after cataract surgery is greater if the patient has another eye disease or serious medical condition. Danger signs of complications after cataract surgery include increased pain in or redness of the eye, light flashes or floaters, diminished vision, nausea, vomiting or intense coughing. Recovery from Cataract Surgery Immediately after surgery, an eye patch is worn; some doctors advise wearing a protective shield, even when sleeping, for several days. Vision may be blurry at first, but improves within a few days. Some itching and discomfort are also present for a few days, but it is important that a patient not rub or exert pressure on the treated eye. Heavy lifting should be avoided. Eye drops to prevent inflammation and infection, and control eye pressure are prescribed. Even though full healing can take up to 2 months, because cataract surgery is performed on one eye at a time, daily activities can be resumed in a few days. Most patients need to wear eyeglasses, for at least some tasks, after surgery. If the other eye also has a cataract, which is usually the case, the second surgery is scheduled a month or two after the first.

  Link: Cataract Surgery

• Digital Retinal Imaging

  Digital retinal imaging is an advanced diagnostic tool that is used to effectively detect and diagnose a wide range of abnormalities within the retina, the light-sensitive tissue that lines the back of the eye. The highly magnified images can be used to evaluate the health of parts of the eye that include the following: Optic nerve Vitreous Macula Retina Conditions Diagnosed with Digital Retinal Imaging Digital retinal imaging allows for a comparison of the retina over time. Some of the conditions that may be detected with digital retinal imaging include the following: Diabetic retinopathy Macular degeneration Glaucoma Retinal detachment High blood pressure High cholesterol Digital retinal imaging can help track any changes within the retinal tissue that may indicate early signs of disease as well as assess the progression of certain diseases.

  Link: Digital Retinal Imaging

• Endothelial Keratoplasty

  An endothelial keratoplasty is an alternative type of corneal transplant, a surgical procedure that removes the abnormal inner lining of the cornea, known as the endothelium, and replaces it with a donor cornea. The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. If the cornea is not shaped properly or is somehow clouded, whether because of injury, infection or disease, visual acuity is compromised, and a corneal transplant may be recommended. The three surgical methods of an endothelial keratoplasty include the following: Descemet’s stripping and automated endothelial keratoplasty, known as DSAEK Descemet’s stripping endothelial keratoplasty, known as DSEK Descemet’s membrane endothelial keratoplasty, known as DMEK Benefits of an Endothelial Keratoplasty An endothelial keratoplasty requires a much smaller incision than a regular cornea transplantation and results in fewer risks and a shorter recovery time. Recovery of vision is quicker with an endothelial keratoplasty and there is less of a restriction on activities. There is less of an issue with astigmatism with an endothelial keratoplasty and there are minimal or no suture problems. Candidates for Endothelial Keratoplasty Endothelial keratoplasty is commonly performed on patients with Fuchs’ Dystrophy, which is an inherited eye disease that causes the cells of the endothelium to deteriorate, resulting in distorted vision and corneal swelling. As the condition progresses, vision will continue to worsen because damaged cells are unable to grow back. Endothelial keratoplasty has also been performed on patients who have the following conditions: Swelling of the cornea after cataract surgery Clouding of the cornea Graft failure from a previous cornea transplant Keratoconus Trauma The Endothelial Keratoplasty Procedure During the endothelial keratoplasty procedure, the surgeon will make an incision in the sclera, the white part of the eye. This incision allows the surgeon to access the cornea, and remove the damaged endothelial tissue using a microkeratome blade, the same instrument that is used during LASIK surgery. The donor tissue is then folded and implanted inside the eye. After the donor tissue has been placed, it will either unfold on its own or be unfolded by the surgeon. An air bubble is injected to properly position the graft. This procedure is performed with a topical anesthetic to minimize any potential discomfort. The actual procedure takes up to 45 minutes to perform. Recovery from Endothelial Keratoplasty Procedure After the procedure, the patient will be moved to a recovery room and monitored before being allowed to go home. A prescription will be given for antibiotic and steroid eye drops, which are to be taken during the next few days to help with healing. Post-operatively, the patient will be required to lie down, face up, for the next 24 hours. A follow-up appointment will need to be scheduled. Most patients notice improvements to their vision within the first 2 weeks after surgery, with results continuing to develop during the next 4 to 6 months. This is significantly faster than with the traditional corneal transplant procedure, which may take 6 to 12 months before effective results are achieved. Other existing eye conditions may slow or hinder the improvement of vision after the procedure. Risks of the Endothelial Keratoplasty Procedure While the procedure is considered safe for most patients that have cornea damage, there are certain risks involved with any type of surgical procedure, including: Infection Bleeding Transplant rejection Redness of the eyes Sensitivity to light Blurred vision Pain If these or any other symptoms are experienced after the procedure, the patient should immediately contact their doctor to prevent any permanent damage.

  Link: Endothelial Keratoplasty

• Fluorescein Angiography

  Fluorescein angiography is a diagnostic procedure used to evaluate the blood vessels in the following parts of the eye: Retina Choroid Optic disc Iris Reasons for a Fluorescein Angiography The fluorescein angiography provides doctors with information about the retina. It can also be used to provide information as to the status of current treatments. A fluorescein angiography helps to diagnose and track problems such as: Diabetic retinopathy Macular degeneration Abnormal vessel growth Swelling Leaking Retinal detachment Cancer Tumors Retinitis pigmentosa The Fluorescein Angiography Procedure The patient’s pupils are dilated with eye drops A baseline photograph of the inside of the eye is taken with a special ophthalmic camera A contrast dye is injected into the patient’s arm As the contrast dye circulates in the eyes, more photographs will be taken After about 20 minutes, a final set of photographs is taken for comparison. The doctor will be able to determine if the blood vessels are closed, leaking fluid or blocked. After the Fluorescein Angiography Procedure There is a risk of complications with any procedure. Some of the risks that patients may experience include: Nausea Vomiting Urine that is darker than normal or orange in color Dizziness Hives An unusual taste in the mouth Serious allergic reactions are rare.

  Link: Fluorescein Angiography

• Fundus Photography

  A fundus photograph is a specialized form of medical imaging. Using a customized camera with high-powered lenses that are mounted to a microscope, photographs are taken of the back of the eye by focusing light through the cornea, pupil and lens. Fundus photographs are used to identify or monitor a wide variety of ophthalmic conditions. To begin the process, the pupil is dilated with eye drops. The patient will be asked to stare at a fixed device, keeping the eyes focused and still. There will be a series of flashes of light. The process usually takes no more than 10 minutes. Some of the ophthalmic conditions fundus photography is used for include: Glaucoma Diabetic retinopathy Macular edema Microaneurysm Optic nerve Fundus photography has also been used to interpret the results of a fluorescein angiogram.

  Link: Fundus Photography

• Humphrey Visual Field

  The Humphrey visual field is a diagnostic test to measure visual fields, or perimetry. The Humphrey visual field test measures the entire area of peripheral vision that can be seen while the eye is focused on a central point. During this test, lights of varying intensities appear in different parts of the visual field while the patient’s eye is focused on a certain spot. The perception of these lights is charted and then compared to results of a healthy eye at the same age of the patient to determine if any damage has occurred. This procedure is performed in about 20 minutes and is effective in diagnosing and monitoring glaucoma. Patients with glaucoma will undergo this test on a regular basis to determine the progress of the disease. The Humphrey visual field test can also be used to detect conditions within the optic nerve of the eye, and certain neurological conditions as well.

  Link: Humphrey Visual Field

• iLASIK

  To learn more about LASIK at CEI, call us directly at (513) 936-1000. Many improvements have been made in LASIK procedures, among the newest and most advanced is iLASIK, which is the exclusive combination of IntraLase and CustomVue technologies to produce the best possible vision enhancement for patients. Uses wavefront diagnostic technology Creates custom-designed corneal flaps Provides an accuracy for ablation IntraLase® has redefined the world of LASIK vision correction. Also known as blade-free LASIK, the IntraLase® all-laser procedure eliminates the need for a metal blade during surgery, helping bring clear vision to many people who feel uneasy about going “under the knife” during LASIK. The state-of-the-art IntraLase® laser technology replaces the microkeratome blade that has traditionally been used to create the corneal flap needed for the LASIK procedure. The IntraLase laser applies rapid pulses of laser energy to the top outer layers of the cornea. The IntraLase laser moves back and forth across the cornea creating microscopic bubbles at a specified depth and position just below the corneal surface. The bubbles under the cornea eventually create a perforation which is then lifted aside by the surgeon. The surgeon is then able to continue with the next step of the laser vision correction procedure. The Advanced CustomVue laser combines the technologies of the WaveScan WaveFront with the STAR S4 Excimer Laser system to provide patients with a high-definition, high-accuracy LASIK vision correction. Advanced CustomVue technology makes it possible to perform customized refractive surgeries using information gathered from the patients eyes. This allows for the correction of the very specific refractive errors so patients can enjoy the best post-operative vision quality possible. The FDA has approved both the STAR S4 Excimer Laser and the WaveScan WaveFront for the following refractive errors: Myopia – up to -11.0 diopters, with or without astigmatism, up to -3.0 diopters Hyperopia – up to 3.00 diopters, with or without astigmatism, up to 2.0 diopters Mixed astigmatism – up to 5.0 diopters The Benefits of iLASIK Because of the low risk of complications and high level of precision it provides, blade-free LASIK treatment has become the standard of care among leading LASIK surgeons and ophthalmic teaching institutions worldwide. Compared to methods that use a microkeratome blade, this minimally invasive and incredibly precise procedure decreases the occurrence of partial flaps, holes in the flap, and other traumatic flap complications. Other benefits of the iLASIK procedure also include a faster treatment time and no need to dilate the pupils. Candidates Eligible for iLASIK A thorough medical eye examination is required to determine if you are a candidate for laser vision correction. Candidates must be at least 18 years old to ensure that their eyes have matured. Also, vision must have remained stable without an infection or injury for one year prior to the surgery. Patients not eligible for iLASIK include those with the following conditions: Dry eye syndrome Autoimmune disorder such as lupus or Sjogren’s syndrome Corneal edema or lesions Glaucoma Corneal implant Keratoconus The iLASIK Procedure The laser uses quick pulses of laser energy to create a flap in the cornea that is needed for the second step of the procedure. The computer-guided laser pulses travel through the outer layers of the cornea, moving back and forth across the eye to create microscopic bubbles at a specified depth. The bubbles under the cornea eventually create a perforation which is then lifted aside by the surgeon. With computer guidance, the laser procedure is carried out with extreme precision to create the optimal depth, position, and diameter for the flap specific to each patient. The entire process of creating the corneal flap takes about 15 seconds for each eye. After the iLASIK Procedure Discomfort is usually minimal following iLASIK. You can expect to notice a significant improvement in vision the very next day. Most patients are able to resume normal daily activities, including driving and returning to work, at this time. You should, however, avoid using any eye makeup following the procedure and avoid swimming and rubbing your eyes for two weeks. Some patients experience increased sensitivity to bright light in the weeks following iLASIK. Patients sometimes also report seeing halos around lights at night. On occasion, patients may experience dry eyes and require eye drops to increase moisture. These symptoms typically decrease shortly after the surgery. Follow-up visits are required to make sure that the procedure went well and your vision remains crisp and clear.

  Link: iLASIK

• JUVÉDERM® XC Injectable Gel

  JUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to “temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds” in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable. JUVÉDERM XC is a smooth-consistency gel that restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. It is made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA’s role is to deliver nutrients and hydration, and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing skin to lose structure and volume. JUVÉDERM XC is most effective in improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face. JUVÉDERM XC Injectable Gel Procedure JUVÉDERM XC injections take about 15 minutes to administer in a doctor’s office. A fine needle is used for the injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because JUVÉDERM XC contains lidocaine to improve comfort, an anesthetic may not be needed. However, a doctor may still elect to use a topical anesthetic on the area to be treated before giving the injection. Afterword, the doctor may gently massage the treated area(s). Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption. Results of JUVÉDERM XC Injectable Gel The results of JUVÉDERM XC are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to year. However, according to its manufacturer, “Results from injectable dermal filler vary and correction is temporary. Supplemental ‘touch up’ treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds. Risks of JUVÉDERM XC Injectable Gel Although JUVÉDERM XC is considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following: Redness Pain or tenderness Firmness Swelling Lumps or bumps Bruising Itching Discoloration Infection For customized treatment, Allergan, Inc., offers two types of JUVÉDERM XC: JUVÉDERM Ultra XC, which is suitable for superficial facial lines and folds, and JUVÉDERM Ultra Plus XC, a stronger formulation that is used for deeper facial folds and lines. JUVÉDERM XC is the first HA filler that is FDA-approved for use on people of color.

  Link: JUVÉDERM® XC Injectable Gel

• Keratoplasty

  Keratoplasty, or corneal transplantation, is performed when the curvature of the cornea (the transparent covering on the eye’s anterior wall) is too steep or too flat to be treated with other methods, when extensive damage has occurred due to injury or disease, or when a tumor is present. Traditional keratoplasty is a procedure that removes and replaces the cornea with donor tissue. In recent years, less invasive procedures, which remove only selected portions of corneal tissue, have also been perfected. Reasons for Keratoplasty Conditions that may require a corneal transplantation include: Corneal scarring Keratoconus Inherited corneal disorders, like Fuchs’ dystrophy Infections of the eye External tumor or pterygia Irreversible cornea edema Corneal ulceration or erosion Corneal thinning or perforation The most common reason for performing a keratoplasty is to improve diminished vision. More rarely, the surgery is performed to treat a chronic corneal infection. In extremely rare cases, the operation is performed for cosmetic reasons, when corneal scars have affected the appearance of the eye. Types of Keratoplasty Procedures Keratoplasty is a relatively low-risk surgical procedure. It is the most common type of transplant surgery currently performed and has the highest rate of success. There are several different corneal transplant methods available to help restore vision in patients with corneal problems. Penetrating Keratoplasty Penetrating keratoplasty is the traditional method used for corneal transplantation where the central two-thirds of the damaged cornea is surgically removed and replaced with a healthy cornea from a human donor. Deep Anterior Lamellar Keratoplasty Deep anterior lamellar keratoplasty, also known as DALK, removes only the outermost layers of the cornea, while preserving the healthy, well-functioning inner layers, known as Descemet’s membrane and the endothelium. New laser technology used in a DALK procedure reduces the likelihood of scarring or irregularities in shape that might impair vision. Endothelial Keratoplasty Endothelial keratoplasty, of which there are several types (DSAEK, DSEK and DMEK), is a surgical procedure that removes the abnormal inner lining of the cornea, known as the endothelium. Endothelial keratoplasty requires much smaller incisions than a penetrating keratoplasty, resulting in fewer risks and a shorter recovery time. Corneal transplants are usually performed with patients under local anesthesia. While there is some chance of graft rejection or the failure of donor tissue to attach properly to the patient’s own tissue, in the less invasive procedures, this risk is greatly reduced. In these less invasive, shorter surgeries, there is also less scarring and and a shorter recovery period. Reasons for Keratoplasty Conditions that may require a corneal transplantation include the following: Corneal scarring Keratoconus Inherited corneal disorders, like Fuchs’ dystrophy Infections of the eye External tumors or pterygia Irreversible cornea edema Corneal ulceration, erosion, thinning, or perforation The most common reason for performing a keratoplasty is to improve diminished vision. More rarely, the surgery is performed to treat a chronic corneal infection. In extremely rare cases, the operation is performed for cosmetic reasons, when corneal scars have affected the appearance of the eye. Types of Keratoplasty Procedures Keratoplasty is a relatively low-risk surgical procedure. It is the most common type of transplant surgery currently performed and has the highest rate of success. There are several different corneal transplant methods available to help restore vision in patients with corneal problems, all of which are usually performed under local anesthesia. Penetrating Keratoplasty Penetrating keratoplasty is the traditional method used for corneal transplantation in which the central portion of the damaged cornea is surgically removed and replaced with a healthy cornea from a human donor. While a very effective surgery for vision correction, this procedure carries greater risks of graft rejection than the partial corneal transplantations. Deep Anterior Lamellar Keratoplasty Deep anterior lamellar keratoplasty, also known as DALK, removes only the outermost layers of the cornea, while preserving the healthy, well-functioning inner layers, known as Descemet’s membrane and the endothelium. Endothelial Keratoplasty Endothelial keratoplasty, of which there are several types (DSAEK, DSEK and DMEK) is a surgical procedure that removes the abnormal inner lining of the cornea, known as the endothelium. Endothelial keratoplasty requires much smaller incisions than a penetrating keratoplasty, resulting in fewer risks and a shorter recovery time.

  Link: Keratoplasty

• Laser Peripheral Iridotomy

  Laser peripheral iridotomy, also known as LPI, is a laser procedure used to lower eye pressure in patients with narrow-angle glaucoma. Narrow-angle glaucoma is a condition that occurs when the angle between the iris and the cornea in the eye is too small, resulting in a blockage of fluid in the drainage channel of the eye. Using a laser, a small hole is made in the iris to increase the angle between the iris and cornea allowing fluid to drain from the eye. Laser peripheral iridotomy is an outpatient procedure. Patients are given eye drops to constrict the pupils. Once these have taken effect, an anesthetic is applied to the eye and the laser treatment can begin. The doctor precisely targets a spot in the periphery of the iris and uses laser pulses to create a tiny hole. The procedure is completed in a few minutes and most patients experience little to no discomfort. After the laser treatment, the patient’s intraocular pressure will be monitored several times to ensure the LPI was successful. Patients may experience irritation and blurry vision after the procedure which should disappear within a few days. Topical corticosteroids will need to be applied to the eye for approximately one week to prevent swelling and promote healing.

  Link: Laser Peripheral Iridotomy

• Limbal Relaxing Incisions

  Limbal relaxing incisions (LRIs) are a minimally invasive corneal surgical procedure that is used to treat low to moderate degrees of astigmatism. LRIs are often performed during cataract surgery to reduce the effects of astigmatism, providing cataract patients with clearer vision and a reduced or eliminated need for glasses or contact lenses. LRIs are tiny incisions made around the edge of the cornea, called the limbus. When the limbus is cut or relaxed, the steep curvature of the cornea becomes more rounded, improving the way the eye focuses light. Compared to other procedures performed to correct astigmatism, such as astigmatic keratotomy, LRIs heal faster and cause fewer side effects. Candidates for Limbal Relaxing Incisions This procedure is ideal for patients with the following concerns: Astigmatism Reducing the need for glasses or contact lenses Cataracts It is important for patients to be in good overall health and to have realistic expectations for the surgery before undergoing the procedure. While most patients experience significant improvements to their vision after a LRI, some may still require vision correction in the form of glasses or contacts. The Limbal Relaxing Incision Procedure During the LRI procedure, the eyes are first cleaned and anesthetic drops are applied to numb the area. An eyelid holder is placed to prevent patients from blinking and to ensure precise placement of the incisions during the procedure. The surgeon will mark the locations on the limbus for incision based on the patient’s prescription, age and amount of vision correction needed. The tiny, arc-shaped incisions are then made into the limbus where marked. Antibiotic drops are administered to the area and the eye holder will be removed. The LRI procedure takes about five minutes to perform, although patients can expect to be in the recovery room for about an hour. Recovery from Limbal Relaxing Incisions After the LRI procedure, you will receive additional eye drops and shields to protect the eyes. Any post-operative discomfort can be managed with over-the-counter pain medication. Some patients may also experience the following post-operative symptoms for a few days after the procedure: Sensitivity to light Tearing of the eyes Swelling in the eyes Most patients will be able to return to work and other regular activities the next day after surgery. Vision will likely improve significantly within the first day, although some patients may experience blurry vision for several weeks after the procedure. Risks of Limbal Relaxing Incisions The LRI procedure is considered safe for most patients with little to no risk of major complications. Some patients may not achieve their desired results from this procedure and may require additional surgery. It is important to discuss the details, benefits and risks of this procedure with the surgeon before undergoing surgery. The surgeon will address any questions or concerns the patient may have to ensure that limbal relaxing incisions are the right choice for them.

  Link: Limbal Relaxing Incisions

• Lower Eyelid Blepharoplasty

  Blepharoplasty, also known as eyelid surgery, is a surgical procedure that improves the appearance of the eyelids by tightening muscles and tissue or removing excess fat and skin. A lower eyelid blepharoplasty is used to treat the following: Under-eye bags Drooping lower eyelids Excess skin Fine wrinkles Circles under the eye A lower eyelid blepharoplasty can be performed on adult men and women alike and offers a younger, more refreshed look that reflects across the whole face. Blepharoplasty is one of the most commonly performed facial plastic surgery procedures. The popularity of this procedure reflects the importance of the eyes in perfecting overall appearance. If the appearance of the eyes causes a patient to be unhappy, they may want to consider lower eyelid blepharoplasty to improve their look and boost their confidence through a safe procedure with minimal downtime. Candidates for a Lower Eyelid Blepharoplasty The best candidates for lower eyelid blepharoplasty are those individuals who meet the following conditions: Are in good overall health Do not smoke Do not have any serious eye conditions Have healthy facial tissue and muscle If a patient has loose, sagging skin or puffy bags beneath their eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh. It is important for patients to have realistic expectations before undergoing a lower eyelid blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance their appearance and may improve self-confidence as a result, it cannot alter a patient’s entire appearance or change the structure of their face. The Lower Eyelid Blepharoplasty Procedure The lower eyelid blepharoplasty procedure is performed with either local or general anesthesia. The method or procedure to be used will be determined by the amount of fat that needs to be removed, the location of the fat and how tight to make the eyelid. The procedure typically takes from 45 minutes to an hour. There are several different surgical approaches that can be used in a lower eyelid blepharoplasty. They are as follows: Transconjunctival Lower Lid Blepharoplasty Often chosen when no skin needs to be removed, a transconjunctival lower lid blepharoplasty creates an incision on the inside of the lower eyelid, leaving no visible scar or other evidence of the surgery. Transcutaneous Lower Lid Blepharoplasty A transcutaneous lower lid blepharoplasty is performed with a subciliary incision, also known as a pinch technique, to remove protruding fat and excess skin. Transconjunctival Arcus Marginalis Release A transconjunctival arcus marginalis release moves the fat within the lid to maintain some volume in the soft tissue. It prevents the ridge of orbital bone from becoming too prominent, which causes the eyes to look hollow and the face to appear older. After the lower eyelid blepharoplasty procedure is performed, the incisions are closed with sutures and usually wrapped in gauze to allow the area to heal. Recovery After a Lower Eyelid Blepharoplasty After the lower eyelid blepharoplasty procedure, the surgeon may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as: Swelling Bruising Irritation Dry eyes The eyes may be wrapped in gauze after the procedure as well. Patients can usually return to work within a few days, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed three or four days after the procedure. Swelling and other side effects usually subside within two weeks after surgery. Contact lenses and eyelid make-up may not be worn for two weeks after surgery. The surgeon will give specific instructions on how to care for the eyes post-procedure. Results of a Lower Eyelid Blepharoplasty Procedure The results of a lower eyelid blepharoplasty procedure are visible as swelling and bruising subside and will continue to improve for up to a year after surgery. The lower eyelid blepharoplasty procedure is designed to produce long-lasting results. While surgery cannot prevent the eyes from aging, most patients are satisfied with their results and do not seek a repeat procedure.

  Link: Lower Eyelid Blepharoplasty

• Optical Coherence Tomography

  Optical coherence tomography, also known as OCT, is an imaging system that uses light waves to produce a high-resolution view of the cross-section of the retina and other structures in the interior of the eye. Conditions Detected With an OCT The images can help with the detection and treatment of serious eye conditions such as: Macular hole Macular swelling Optic nerve damage Age-related macular degeneration Macular pucker Glaucoma Cataracts Diabetic eye disease Vitreous hemorrhage OCT uses technology that is similar to that of a CT scan of internal organs. With the scattering of light it can rapidly scan the eye to create an accurate cross-section. Each layer of the retina can be evaluated and measured and compared to normal, healthy images of the retina. The OCT exam takes about 10 to 20 minutes to perform in your doctor’s office, and usually requires dilation of the pupils for the best results.

  Link: Optical Coherence Tomography

• Penetrating Keratoplasty

  Penetrating keratoplasty (PKP), also referred to as a corneal transplant or corneal graft, is the surgical removal of a damaged or diseased portion of the cornea, followed by the implantation of healthy tissue from a donated human cornea, which is usually obtained from an eye bank. The cornea is the clear covering of the front of the eye that refracts (bends) light rays as they enter the eye. If visual acuity is compromised because the cornea is not shaped properly or is clouded from injury, infection or disease, PKP may be recommended. The cornea has five layers; during PKP, all five layers are replaced with donor tissue. Candidates for Penetrating Keratoplasty An improperly curved cornea may be corrected surgically for patients whose curvature is too steep or too flat to be treated with other methods, or when there is extensive damage from disease, trauma, infection or previous surgery. PKP may be performed on patients with one of the following conditions: Corneal edema, ulceration or dystrophy Fuch’s dystrophy, a hereditary condition Keratoconus Keratitis or trichiasis Pterygia, a benign growth Traumatic injury Bacterial, fungal, viral, or protozoan infection Rejection of a previous graft A patient whose impaired vision is not treatable with corrective lenses alone may be considered a candidate for PKP, and put on a corneal-transplant waiting list at a local eye bank. It usually takes up to several weeks for appropriate transplant tissue to become available. The donor cornea is screened for any possible diseases, such as AIDS or hepatitis, according to strict U.S. Food and Drug Administration regulations. The Penetrating Keratoplasty Procedure The PKP procedure is performed, depending on the patient’s age, condition and preference, under local or general anesthesia. Once the patient is anesthetized, a speculum is used to keep the eyelids open, and measurements are taken to assess how much donor tissue is needed. The damaged tissue is removed, and a matching portion of donor tissue is inserted in its place. The new tissue is stitched into place; stitches usually remain in place for many months up to a year. The surgery takes 1 to 2 hours, and is performed on an outpatient basis. Risks of Penetrating Keratoplasty As with any type of surgical procedure, there are certain risks, including the following, associated with PKP: Scarring Postsurgical infection Leakage from the incision site Glaucoma or cataract formation Astigmatism, nearsightedness or farsightedness Vision problems, such as astigmatism, that occur after surgery can be addressed with corrective eyeglass or contact lenses. Graft rejection occurs in a certain percentage of cases. Medications are available, however, to prevent or treat corneal rejection. Excessive bleeding can also occur, but it is rare. Recovery from Penetrating Keratoplasty Patients should anticipate a slow improvement in vision after PKP. It may take up to a year for vision to be restored to satisfactory levels. Most patients wear corrective glasses or contact lenses during this period. During recovery, the patient self-administers eye drops, and should avoid any possible injury to the eye. This means refraining from sports or other high-risk activities. Removal of sutures is a simple in-office procedure. A patient should report any eye irritation and vision issues to the ophthalmologist immediately; they may indicate that the body is rejecting the donated cornea. Unfortunately, rejection can occur even years after surgery, so patient and doctor must be vigilant. For undetermined reasons, African-Americans are five times more likely to experience a graft rejection. Approximately 45,000 PKPs are performed annually in the United States, and most are successful in restoring vision. Nearly three-quarters of PKPs result in grafts that are effective for at least 10 years.

  Link: Penetrating Keratoplasty

• Posterior Capsular Opacification

  Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. This condition affects 1 out of 4 patients within 5 years of undergoing cataract surgery. A posterior capsular opacification is also known as a secondary cataract. During cataract surgery, the clouded lens in the eye is removed from the lens capsule and replaced with a clear, artificial lens called an IOL. Weeks, months or years after the surgery, some patients experience a loss of vision. This sometimes happens because the lens capsule becomes cloudy or wrinkled, blurring the patient’s vision once again. Symptoms of a Posterior Capsular Opacification Symptoms of a PCO are similar to the symptoms experienced with a cataract. They include: A gradual decrease of vision Vision that is blurry Glare around lights Sensitivity to sunlight Halos around lights Diagnosis of a Posterior Capsular Opacification After a thorough medical examination of the eyes, the following tests may be conducted to confirm diagnosis: Dilated eye examination Slit-lamp Visual acuity exam Treatment of a Posterior Capsular Opacification If an examination confirms that this is the case, and if the clouded capsule prevents the patient from functioning, then a posterior capsulotomy may be recommended. This procedure uses a YAG laser to open a window in the back of the lens capsule to restore clear vision. Posterior capsulotomy is a painless outpatient procedure that takes less than 15 minutes. Clearer vision is restored quickly. The improvement of vision depends upon the extent of the clouding experienced and the patients eye health. The patient should be able to resume normal activities almost immediately.

  Link: Posterior Capsular Opacification

• RADIESSE® Volumizing Filler

  RADIESSE® volumizing filler is a synthetic injectable filler that has been U.S. Food and Drug Administration (FDA)-approved for reducing moderate-to-severe wrinkles, folds and creases around the nose and mouth by augmenting the skin’s natural collagen supply. It is a safe, effective and long-lasting alternative to injectable collagen and other dermal fillers for smoothing wrinkles and adding facial volume and contour. RADIESSE filler is composed of microspheres in a water-based gel; the microspheres are made of a substance called calcium hydroxylapatite, which stimulates the production of collagen. When injected into lines and wrinkles, the additional collagen that is produced smooths out the lines and wrinkles, and adds volume to the skin. RADIESSE Volumizing Filler Applications RADIESSE volumizing filler can be used on various areas of the face and body. In addition to correcting scars that leave depressions, it is effective in improving the look of the following: Nasolabial folds (run from corners of nose to corners of mouth) Marionette lines (run downward from corners of mouth) Downturned corners of the mouth Jowl pre-sagging Chin wrinkles RADIESSE filler has also been approved by the FDA to restore and correct the signs of lipoatrophy (loss of fat beneath the skin) in patients with the human immunodeficiency virus (HIV). RADIESSE Volumizing Filler Procedure Before a patient is given RADIESSE filler, the treatment area is cleaned. RADIESSE injections are then made with a fine needle, and typically take only 15 minutes to perform. There is little-to-no downtime; many patients return to their normal activities right away. RADIESSE volumizing filler is also FDA-approved for mixing with the anesthetic lidocaine, which makes the injections less painful. Typically, only 1 or 2 treatments are needed to achieve the full benefits of RADIESSE volumizing filler. RADIESSE Volumizing Filler Results Results are visible immediately after injection, and sometimes last up to a year. Because results are temporary, treatments must be repeated to sustain them. Touch-up treatments may prolong the effects of RADIESSE filler. RADIESSE Volumizing Filler Side Effects Side effects of RADIESSE filler are usually not serious, and go away on their own. They occur at the injection site, and include the following: Mild irritation Swelling Itching Redness Bruising Tenderness Allergy testing is not necessary before treatment because the calcium hydroxylapatite microspheres in RADIESSE filler are similar to minerals that occur naturally in the body.

  Link: RADIESSE® Volumizing Filler

• Restylane® Injectable Gel

  U.S. Food and Drug Administration (FDA)-approved Restylane® injectable gel is a cosmetic “filler” that contains hyaluronic acid (HA), a natural substance that is found in the body. HA gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane gel is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable. The most common areas for Restylane treatment are the glabellar lines (which run between the eyebrows) and the nasolabial folds (which run from the sides of the nose to the corners of the mouth). Restylane injectable gel is also FDA-approved, for those 21 and older, for enhancing the lips. According to manufacturer Medicis, results can last for up to 6 months, at which point the hyaluronic acid is reabsorbed by the body. Benefits of Restylane Injectable Gel When injected, Restylane gel plumps up glabellar lines and nasolabial folds, making skin appear younger and look smoother. When used for lip enhancement, it makes the lips fuller and gives them more definition. Advantages of Restylane Injectable Gel One significant advantage that Restylane injectable gel has over other facial fillers made with hyaluronic acid is that it contains nothing of animal origin. As a result, it does not require a potential user to undergo allergy testing, which can sometimes take weeks. Another advantage is that Restylane injections are performed in-office, usually by a dermatologist, in less than half an hour, and require little-to-no downtime for the patient. Side Effects of Restylane Injectable Gel The most common side effects of Restylane injectable gel are swelling, redness, pain, bruising and tenderness in and around the injection sites. They typically go away within a week. Although considered safe for most patients, Restylane injections carry a risk of infection, bleeding or allergic reaction.

  Link: Restylane® Injectable Gel

• Retinal Laser Photocoagulation

  During laser photocoagulation, a laser beam is directed to the blood vessels that are leaking on the retina. The laser creates scar tissue around the area that slows the growth of any new or abnormal blood vessels. While it is unable to restore vision that has already been lost, laser photocoagulation can reduce the risk of vision loss, a major complication of retinal diseases. Retinal laser photocoagulation is a minimally invasive procedure used to seal or destroy leaking blood vessels in the retina that leads to serious retinal conditions such as: Diabetic retinopathy Macular edema Retinal detachment Retinal tear Macular degeneration The laser photocoagulation procedure is usually performed on an outpatient basis with a local or topical anesthetic. Patients will need someone to drive them home after the procedure, since the pupils will be dilated for several hours. After the laser photocoagulation procedure, patients may experience blurry vision and mild pain for a day or two after the procedure. Normal activities may be resumed with the surgeon’s approval. Risks and Complications of the Retinal Laser Photocoagulation Procedure Laser photocoagulation carries certain risks, since it involves the retina. Patients may experience the following symptoms: A mild loss of central vision Reduced night vision A decreased ability to focus The potential loss of vision caused by this procedure is far less than the severe vision loss that may occur as a result of retinal conditions like diabetic retinopathy. Benefits and risks of a retinal laser photocoagulation procedure will be discussed with the patient to determine if this procedure would be in their best interests.

  Link: Retinal Laser Photocoagulation

• Sculptra® Aesthetic Facial Injectable

  Sculptra® Aesthetic injectable is used to reverse the signs of facial fat loss that occur with aging. By restoring collagen, which decreases as the body ages, it fills out shallow-to-deep wrinkles and folds that run from the sides of the nose to the corners of the mouth (nasolabial folds). It is not appropriate for use in the eye and lip areas. Sculptra Aesthetic’s main component is an alpha hydroxy acid called poly-L-lactic acid (PLLA), which is a safe and long-lasting synthetic (artificially created), biocompatible (can be used harmlessly in the body), biodegradable (able to be broken down by the body) substance. PLLA has been used for more than 20 years in many surgical products, including dissolvable sutures and soft-tissue implants. Benefits of Sculptra Aesthetic Facial Injectable U.S. Food and Drug Administration-approved for the treatment of nasolabial folds, Sculptra Aesthetic is considered safe and effective for most patients. Because it works gradually, patients achieve a more youthful, natural-looking appearance with subtle, yet noticeable, results. Although not FDA-approved to treat them, according to manufacturer Valeant Aesthetics, Sculptra Aesthetic can be used on marionette lines (at the corners of the mouth) and chin wrinkles. Because it contains no animal, human or bacterial components, allergy testing is not necessary prior to treatment. There is little-to-no downtime after receiving Sculptra injections; most patients return to their normal activities immediately. Treatment and Results of Sculptra Aesthetic Facial Injectable Sculptra Aesthetic injections are designed to be a one-time treatment. A patient can have up to 4 injection sessions, which are spread 3 weeks apart. When injected into shallow-to-deep folds and lines, the additional collagen that is produced smooths them out, and adds volume to the skin. Results of Sculptra injections vary but, in a clinical study, their effects were shown to last for up to 2 years in most patients. Side Effects of Sculptra Aesthetic Facial Injectable Possible side effects of Sculptra injections include localized bleeding, tenderness, discomfort, redness, bruising and swelling. Side effects usually fade within a few days, although can last longer. According to Valeant Aesthetics, “Other side effects may include small lumps under the skin that are sometimes noticeable when pressing on the treated area. Larger lumps, some with delayed onset with or without inflammation or skin discoloration, have also been reported.”

  Link: Sculptra® Aesthetic Facial Injectable

• Selective Laser Trabeculoplasty

  Selective laser trabeculoplasty, or SLT, is an FDA-approved laser procedure for the treatment of open-angle glaucoma. SLT is an advanced treatment option that lowers eye pressure and increases fluid drainage. It is minimally-invasive and uses low levels of energy to selectively pinpoint the areas of the trabecular meshwork, relieving the symptoms of glaucoma. If needed, the procedure can be repeated several times without causing damage to surrounding tissue. Advantages of SLT for Glaucoma Performed as an in-office procedure, SLT takes just a few minutes yet provides long-term results. Other advantages of the SLT procedure include: Selective targeting of areas within the trabecular meshwork Minimal damage to surrounding tissue Reduction of intraocular pressure (IOP) by about 30 percent Minimal side effects Procedure can be repeated SLT controls glaucoma symptoms for up to 5 years with no need for additional medication, and relieves symptoms by promoting the body’s natural healing response. There are no major risks or complications associated with SLT and the procedure is covered by most major insurance companies.

  Link: Selective Laser Trabeculoplasty

• Trabeculectomy

  Trabeculectomy, also known as glaucoma filter surgery, is a surgical procedure that removes part of the trabecular meshwork of the eye in order to increase the drainage of fluid. A trabeculectomy is one of the most common surgical procedures used to treat open-angle and chronic closed-angle glaucoma. A new drainage passage is created during the procedure by cutting a small hole in the sclera (the white part of the eye) and creating a collection pouch between the sclera and conjunctiva (the outer covering of the eye). This serves to create a system for bypassing the blocked drainage channels and encourages fluid drainage and reduces eye pressure. The Trabeculectomy Procedure Glaucoma filter surgery is usually performed as an outpatient procedure and does not require a hospital stay. Most patients experience only mild pain post-surgically. The treated eye must remain covered at night for several weeks after the procedure. In addition, patients will need to regularly apply corticosteroid eye drops to the eye to reduce swelling. Activity will be somewhat limited for the first few weeks after glaucoma filter surgery, and specific restrictions will be discussed with the patient. Complications of Glaucoma Filter Surgery Every surgery has some form of risk or complication. While rare, complications may include: Eye pressure that is lower than normal Formation of a cataract Hemorrhage Scarring Infection Inflammation

  Link: Trabeculectomy

• Types of IOLs

  A wide range of replacement lenses are available to cataract patients, each offering different advantages for post-surgery vision. The most effective lens to use depends on the patient’s individual preferences and goals for their vision. The lenses eliminate the need for glasses or contacts after cataract surgery, providing most patients with convenient, effective results for their specific vision conditions. Multifocal IOLs Multifocal IOLs allow for full vision correction at near, intermediate and far distances, completely eliminating the need for eyeglasses or contact lenses for most patients. Some IOLs can also correct astigmatism. The procedure to implant a multifocal IOL is performed at the conclusion of cataract surgery. These choices were not always available for cataract patients. In the past, cataract surgery only involved monofocal lenses, which could only focus on objects near or far, but could not adjust to accommodate varying distances. These patients still had to rely on glasses or contact lenses after surgery in order to see clearly at all distances, especially for those older patients suffering from presbyopia. Crystalens is the only FDA-approved presbyopia correcting intraocular lens (IOL) that corrects vision through accommodation. The Crystalens IOL is made with flexible silicone that has hinges on each side allowing it to move with the eye muscle, flexing and accommodating seamlessly so you can focus on the objects around you at any distance. In other words, it dynamically adjusts to your visual needs. Accommodation is the ability to shift focus between nearby and distant objects, providing sharper vision at multiple distances in order to minimize the use of glasses. Other IOLs are unable to accommodate and those patients may require additional vision correction with glasses or contact lenses. Toric IOLs Intraocular lenses are used during cataract surgery to replace the damaged lens of the eye with an implant that clears up and corrects vision, oftentimes leaving patients with little to no dependence on glasses. Up until now, patients with astigmatism did not have the same opportunities that other cataract patients have had in correcting their condition with the types of IOL lenses that were available. Typically, the astigmatic patient would need an additional surgical procedure, such as refractive surgery or LASIK, to correct their vision after the procedure. If the patient did not want to undergo another surgical procedure, the only option for correction would be the use of either contact lenses or glasses to address their astigmatism. Toric IOLs are able to accommodate for the condition of astigmatism. Toric IOLs are specially designed to correct astigmatism along with overall vision during cataract surgery, offering complete vision correction.

  Link: Types of IOLs

• Visian ICL™

  The Visian ICL by STAAR Surgical is an Implantable Collamer Lens (ICL), also known as an Implantable Contact Lens. The Visian ICL is implanted in the eye behind the iris and in front of the natural lens to correct nearsightedness that ranges from -3.00 diopters to -20.00 diopters. Vision correction with the Visian ICL is classified as high definition vision due to the sharpness and clearness of the vision achieved. Composed of Collamer®, a collagen copolymer, the Visian ICL is compatible with the natural chemistry of the body so there are minimal risks of lens rejection. Additionally, the Visian ICL has anti-reflective properties and provides ultraviolet protection. The Benefits of Visian ICL Quality of vision obtained Compatibility of the implant with the body’s immune system The broader treatment range for patients with myopia exceeds that of LASIK or PRK No additional maintenance Safe Lens placement is not visible to patient Removable and replaceable Ultraviolet protection Candidates for the Visian ICL Procedure For optimal safety and best results, patients should not have a history of ophthalmic surgery or diseases such as iritis, glaucoma or diabetic retinopathy. After a thorough medical examination of the eyes and an evaluation of the patients vision history the doctor will determine whether or not this treatment is appropriate. Patients must meet the following requirements for the procedure: Must be adults between the ages of 21 years to 45 years of age The anterior chamber depth must be 3.00 mm or greater Had stable vision for at least a year prior to implantation Nearsighted Patients not eligible for the Visian ICL are those with the following: Anterior chamber depth is less than 3.00 mm Pregnant or nursing Did not meet the requirements for endothelial cell density Angle of the anterior chamber is less than Grade II Patients with thin corneas or dry eyes, who are not candidates for LASIK or PRK, may be eligible for Visian ICL vision correction. The Visian ICL Procedure The Visian ICL treatment begins one to two weeks before the actual procedure. Using a YAG laser, the surgeon will perform a laser iridotomy. This preliminary procedure will create two small openings near the edge of the iris. This allows fluid to circulate around the eye preventing an increase of intraocular pressure during the procedure. Prescription eye drops will need to be administered for the next few weeks to prevent infection. On the day of the Visian ICL implantation, the surgeon will numb the eyes with a topical anesthetic before making an opening at the base of the cornea to insert and position the lens. A gel-like solution will be used during the procedure to cushion and protect the eye while the lens is being placed behind the iris of the eye. In most cases, sutures are not needed because the incision is a smaller size. Eye drops will be administered to prevent infection or inflammation during both the procedure and recovery periods. An eye patch or shield may be used for further protection and comfort after the procedure. Patients should arrange to have someone provide transportation after the procedure. In total, the entire procedure takes 15 to 30 minutes to complete. Results and Recovery After the Visian ICL Procedure After the Visian ICL is implanted, patients will likely only need a day or two for recovery, with little to no side effects. Noticeable vision improvement will occur almost right away. The lens remains invisible to others due to its position behind the iris. The patient will need to return to the surgeon’s office the next day so that the results of the procedure can be evaluated. While the lens is meant to be kept in place for permanent vision correction, it can be removed if necessary. It can also be replaced with an updated lens if significant vision changes occur after the implantation. Patients will still be able to wear reading glasses for presbyopia after this procedure as well. Safety of the Visian ICL Implantation The Visian ICL procedure is not typically associated with the same complications found with either LASIK or PRK. The Visian ICL procedure is considered safer and less invasive than these other procedures, while still achieving a clear distance vision. When complications do occur, they are usually mild and can be corrected by the doctor. Patients experiencing severe eye pain or a decrease in vision should contact their surgeon immediately.

  Link: Visian ICL™

• Vitrectomy

  The center of the eye is composed of a clear, gel-like substance known as the vitreous. The vitreous is more than 30 percent of the eye’s volume, providing the eye with its shape. Due to the size and consistency of the vitreous it is prone to diseases that cause the vitreous to: Cloud Fill with blood Harden Prevent light from reaching the retina These diseases may lead to blurred vision, tears or other serious conditions. Conditions Treated With a Vitrectomy Patients with a disease or injury to the vitreous may require a vitrectomy to address their condition. Some of these conditions include: Vitreous floaters Retinal detachment Macular pucker Macular hole Diabetic retinopathy Vitreous hemorrhage Vitreous injury or infection The Vitrectomy Procedure A vitrectomy removes the vitreous by suctioning it out with tiny instruments inserted into the eye. Upon removal, the retina may be treated with a laser to: Cut or remove scar tissue Flatten detached areas of the retina Repair holes or tears in the retina Patients may experience mild discomfort and redness for several days after this procedure, and may wear an eye patch for a few days. While results vary, depending on the individual condition treated, most patients experience an improved visual acuity after the procedure. Complications of a Vitrectomy There are certain risks associated with any surgical procedure. Some of these risks include retinal detachment, fluid buildup, growth of new blood vessels, infection and further bleeding into the vitreous gel.

  Link: Vitrectomy