Foreman Eye Care

A cataract is a cloudy area in the normally clear lens in the front of the eye. Cataracts are caused by a chemical change of unknown origin in the eye, and cause blurred or distorted vision. They cannot be prevented from forming, but early detection through regular eye exams can help maintain the clearest vision possible. People at risk for developing cataracts are over 55 years old, have had eye injuries or disease, have a family history of cataracts, smoke cigarettes or use certain medications. There is no pain associated with the condition, but there are several symptoms that indicate failing vision due to cataracts. These include: Blurred/ hazy vision Spots in front of the eye(s) Sensitivity to glare A feeling of “film” over the eye(s) A temporary improvement in near vision Vision loss from cataracts can often be temporally corrected with prescription glasses and contact lenses. For people who are significantly affected by cataracts, replacement surgery may be the preferred method of treatment. During cataract replacement, the most common surgical procedure in the country, the lens is removed and replaced with an artificial one called an intraocular lens or IOL.

Refractive Surgery techniques are used to correct vision problems like nearsightedness, farsightedness and astigmatism. These problems occur when the eye is not able to bring images to a proper focus inside the eye. LASIK (laser in situ keratomileusis) is the most common refractive surgery technique used today. LASIK LASIK is a safe, reliable and virtually painless way to improve vision without the need for glasses or contact lenses. LASIK, which stands for laser assisted in-situ keratomileusis, is a form of refractive surgery that changes the way light is bent, or refracted, as it passes through the cornea so that it focuses properly on the retina in the back of the eye and objects can be seen clearly. The procedure is effective for many patients with nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. During the procedure, a device called a microkeratome creates a flap in the outer layers of the cornea. Patients are given topical anesthesia and a mild sedative so they are awake but calm and cannot feel the instruments. The flap is lifted and an excimer laser beam adjusts corneal curvature so objects no longer appear blurry. The cornea is steepened for hyperopic patients, flattened for myopic patients, and made more spherical for patients with astigmatism. The flap is then closed. The entire LASIK procedure usually takes only 10-15 minutes for both eyes, and patients are often ready to leave the laser center within an hour. A common complaint after surgery is sensitivity to light, but this will subside. Antibiotic and anti-inflammatory drops will be prescribed for a week. Full recovery usually takes a couple of weeks. Dr. Foreman uses the ATLAS Corneal Topography with Pathfinder™ software to analyze your cornea and help ensure you don’t have corneal pathology that would disqualify you from LASIK surgery. WAVEFRONT TECHNOLOGY Wavefont technology allows surgeons to perform customized LASIK, LASEK and other refractive surgeries using information gathered from the patient’s own eyes. During a pre-operative examination, light is projected onto the retina and a set of measurements called a wavefront is created. Data obtained from the wavefront exam is converted into a waveprint, a unique profile of the patient’s optical system that is as personal as a fingerprint. Using the results of the wavefront procedure, surgeons can correct the particular refractive errors that obscure the patient’s vision. CUSTOMVUE™ ISX™’s CustomVue procedure combines the technologies of the WaveFront and STAR S4 Excimer Laser systems for high-definition, high-accuracy LASIK vision correction. Benefits of the CustomVue process include faster treatment time, elimination of need for pharmacological pupil dilation, minimal heating of the cornea, capability of ignoring errors arising from torsional eye movements, variability of beam size and depth during spot scanning, and individualized treatment with images based on hundreds of data points gathered from each patient’s pupil.

Glaucoma is the leading cause of blindness and visual impairment in the United States. A simple painless eye exam can detect the disease. With early detection and treatment, glaucoma can usually be controlled and blindness prevented. Glaucoma can affect anyone from newborn infants to the elderly. It has been estimated that up to 3 million Americans have glaucoma. At least half of those people do not know they have it because glaucoma usually has no symptoms. People who are at a greater risk for glaucoma usually have the following conditions: At least 45 years old without regular eye exams A family history of glaucoma Abnormally high eye pressure African descent Nearsightedness Diabetes Previous eye injury Regular, long-term use of cortisone / steroid products To detect glaucoma, Dr. Foreman will test your visual acuity, test the pressure in your eye and dilate your pupils. He will also test your peripheral vision with a visual field and analyze your optic nerves. Regular and complete eye exams help to monitor the changes in your eyesight and will help to determine whether you may develop glaucoma. Dr. Foreman uses the Zeiss Stratus OCT™, the Humphrey ® Field Analyzer, and the Optos Fundus Camera to detect and test for glaucoma. In addition, Dr. Foreman uses the new SITA SWAP software on the visual field machine and Diopsys for early detection of glaucoma. Treatment to control glaucoma include medications in the form of either eye drops or pills, SLT laser surgery and ISTENT surgery. DIOPSYS® ERG Diopsys® ERG tests use electroretinography (ERG) technology to help eye care specialists gain objective, functional information about the performance of the inner retinal cells of the eye, especially in the macula. Diopsys offers two ERG modules – Contrast Sensitivity and Concentric Stimulus Fields. Diopsys® VEP tests use a technology called Visual Evoked Potential (VEP) to objectively measure the functional responses of the entire visual pathway from the anterior segment of the eye to the visual cortex. Diopsys offers two VEP modules – Multi-Contrast(LX) and User-Defined. For more information on Diopsys see http://www.diopsys.com/. OPTICAL COHERENCE TOMOGRAPHY The swift and painless OCT ( Optical Coherence Tomography) exam can detect the development of glaucoma and retinal disease years earlier than other available technologies. This is made possible by studying damage to the optic nerve caused by glaucoma and retinal disease before you lose a ny vision. During the exam, you simply lean into the OCT instrument and look at a light. A harmless laser scans the back of your eye and forms an image in under one second. The entire procedure may be over in less than a minute. It is non-intrusive and often does not require pupil dilation. Exam results take the shape of a color-coded “thickness map” of the retinal nerve fiber layer and optic nerve in your eye. In addition your information is tabulated and compared to a normative data bank. This supplies your physician with information about the health of your eyes that cannot be obtained from other exams. SELECTIVE LASER TRABECULOPLASTY Selective Laser Trabeculoplasty, or SLT, is a form of laser surgery that is used to lower intraocular pressure in glaucoma. For more information on SLT Laser see http://www.glaucoma.org/. ISTENT® The iStent® is a tiny medical implant-the smallest known to be implanted in the human body-that is designed to restore your eye’s natural ability to drain fluid out of the eye to reduce glaucoma pressure.

During cataract surgery, a small ultrasonic probe is inserted into the eye which breaks up, or emulsifies, the cloudy lens into tiny pieces and gently sucks, or aspirates, those pieces out of the eye. Phaco surgery requires a small incision of only 2.8 mm or less. To make your procedure as painless as possible, anesthesia is a combination of local and/or topical along with IV sedation. With the recent advance of foldable IOLs, artificial lenses can be implanted through the same small incision that is created in the phaco procedure. These IOLs are made of a flexible material, allowing them to be folded for implantation. Once inside the eye, the lens unfolds and returns to its original shape. LENS IMPLANTS Tecnis™ Lens and Alcon Multi-focal Lenses Cataract surgery, which replaces the eye’s cloudy lens with an artificial clear lens (called an intraocular lens, or IOL), is the most common operation in the U.S. More than half of adults over age 65 have some degree of cataract development. People 65 and older are also more likely to be involved in car crashes than people in their 30s, 40s and 50s. Now an innovative night vision-enhancing IOL can help elderly drivers with cataracts avoid accidents. The Tecnis and Alcon multi-focal IOLs were designed to provide cataract surgery patients with high-quality vision comparable to that of young people. It is meant to improve functional vision – the ability to see objects in varying light conditions – especially at night and twilight and in rain, snow and fog. This means improved night vision and reduction of spherical aberrations, an undesirable scattering of light that is a common side effect of cataract surgery. In tests, drivers 65 and older wearing a acrylic Tecnis ™ lens were able to recognize objects faster, improving their braking response time by half a second and stopping about 60 feet shorter than drivers wearing traditional acrylic lenses. For more information on Tecnis™ Lens and Alcon Multi-focal lenses, click here. MULTIFOCAL PRESBYOPIC CORRECTING LENS IMPLANTS Dr. Foreman has been using flexible Acrysof® IOLs for years to replace the eye’s cloudy lens during cataract surgery and help patients enjoy clear vision again. Technis® Symfony IOL The latest addition to the TECNIS® Family of IOLs offers new optical technology for providing an Extended Range of Vision . Traditional IOL solutions for treating presbyopia include Multifocals and Trifocals, which work on the principle of simultaneous vision by splitting light into multiple distinct foci, and Accommodative IOLs, which change in shape and power when the ciliary muscle contracts. Traditionally with these technologies, the correction of presbyopia is commonly thought of in terms of the distinct distance for which functional vision is provided. For more information on Tecnis Symfony IOL see http://www.tecnisiol.com/eu/. Alcon ReSTOR® Lens Built on the AcrySof® IQ IOL platform ,AcrySof® IQ ReSTOR® presbyopia-correcting IOLs deliver the same BioMaterial, BioMechanics and, BioOptics benefits you’ve come to expect from this industry-leading portfolio of lenses. IPlus they are designed to reduce dependence on spectacles over a range of distances.

Because every person’s eyes are unique, like fingerprints, it can be difficult to determine the appropriate specifications of the IOL to be implanted during cataract surgery. The Zeiss IOL Master® now provides Dr. Foreman with information on key ocular measurements such as axial length, corneal curvature and anterior chamber depth, making it possible to choose the right IOL for each patient. Approved by the FDA in 2000, the non-contact IOL Master is the only product in the world that makes these “optical biometry” examinations possible and has proven to be five times more accurate than traditional technologies such as ultrasound.

LIMBAL RELAXING INCISIONS (LRI) Limbal relaxing incisions are a type of surgery used in treating astigmatism at the time of cataract surgery. Limbal relaxing incisions are a form of astigmatic keratotomy (AK). The incisions in LRls are made on the peripheral parts of the cornea (limbus). LRls are made in order to create a more rounded distortion free cornea. These types of incisions are created to improve vision without glasses. Dr. Foreman uses Corneal Topography to determine the exact axis and degree of astigmatism to treat. He also measures the peripheral cornea to determine the exact depth of the incision. Limbal relaxing incisions help with astigmatism and also have been shown to have fewer side effects, such as glare or discomfort, than other incisive astigmatic surgeries. The wounds from limbal relaxing incisions also tend to heal faster than other surgeries. TORIC LENS IMPLANTS Toric IOLs are specially designed for patients with large amounts of astigmatism that are not suitable for LRI. Traditionally, surgical correction of astigmatism requires making a series of small incisions (called LRis) around the cornea to make it more spherical instead of football shaped. Implanting a toric IOL often improves vision due to astigmatism without the need for these extra incisions and also allows patient to enjoy a faster more comfortable recovery.

WHAT IS OPTIC NERVE ANALYSIS? The swift and painless OCT (Optical Coherence Tomography) exam can detect the development of glaucoma years earlier than other available technologies. This is made possible by studying damage to the optic nerve caused by glaucoma before you lose any vision. During the exam, you simply lean into the OCT instrument and look at a light. A harmless laser scans the back of your eye and forms an image in under one second. The entire procedure may be over in less than a minute. It is non-intrusive and often does not require pupil dilation. Exam results take the shape of a color-coded “thickness map” of the retinal nerve fiber layer and optic nerve in your eye. In addition your information is tabulated and compared to a normative data bank. This supplies your physician with information about the health of your eyes that cannot be obtained from other exams.

WHAT IS SELECTIVE LASER TRABECULOPLASTY (SLT)? Selective Laser Trabeculoplasty (SLT) is an advanced laser system that targets specific cells of the eye — those containing melanin, a natural pigment. Using a special wavelength and energy, the SLT targets these specific cells in the trabecular meshwork (outflow barrier inside your eye), leaving the surrounding tissue intact, and improves the flow of fluid in the eye, thereby lowering your eye pressure. Your eye pressure may drop as quickly as a day or more after having the SLT procedure. You may be treated with anti-inflammatory eye drops that will be continued after the procedure. There are no incidences of allergy or systemic side effects with SLT. The SLT treatment does not cause pain. The SLT procedure is reimbursed by Medicare and many other insurance providers, which minimizes your out-of-pocket expenses. For information on Lumenis laser, click here.

RESTASIS® RESTASIS® Ophthalmic Emulsion is a prescription eye drop available to treat chronic dry eye caused by low tear production. Made by Allergan, RESTASIS® drops increase tear production so the eyes are better moisturized and less painful. Two drops a day in each affected eye- one drop in the morning and one at night-is all it takes. According to Allergan, patients who use RESTASIS® report a noticeable increase in tear production. For more information on RESTASIS®, click here https://www.restasis.com/. XIIDRA® XIIDRA® is the first prescription eye drop approved by the FDA for both the signs and symptoms of dry eye disease. Use one drop XIIDRA® in each eye, two times a day, about 12 hours apart. For more information on XIIDRA®, click here https://www.xiidra.com/. PUNCTUAL PLUGS Punctal plugs are a treatment option for patients suffering from dry eye that has not been relieved by drops or ointments. Punctal plugs are placed in the opening of the tear ducts in the eyelids (called “puncta”) to block tear drainage and keep the eyes moist. Implantation should reduce the need for artificial tear drops and increase the patient’s overall comfort. Punctal plugs come in a few different shapes and sizes, and may be placed in the lower or upper eyelid or both eyelids. The most common plugs are umbrella-shaped and made of silicone. They may be placed partially inside the tear duct or embedded entirely within the duct (Herrick plugs). A recently introduced acrylic plug called the SmartPLUG softens at body temperature and expands to custom-fit each patient’s eye. Implantation takes only a few seconds in a professional’s office.

Diabetic retinopathy is a complication of diabetes that weakens the blood vessels that supply nourishment to the retina (the light-sensitive lining in the back of the eye where vision is focused). When these weak vessels leak, swell or develop thin abnormal branches that bleed, vision loss occurs. Currently, the most common and effective clinical treatment for clinically significant macular edema (CSME)-swelling of the central retina, called the macula, is anti-VEGF therapy – which is periodic intravitreal (into the eye) injection of a chemical called an “anti-VEGF”. Eylea (is one form of anti­ VEGF therapy, and recently approved by the Food and Drug Administration. Other variants of anti-VEGF injections include ranibizumab (Lucentis, made by Genentech/Novartis ), and bevacizumab (off label Avastin from Genentech). Each of these chemicals works in a similar way to inhibit blood vessel growth. Focal laser coagulation may also be recommended for patients with clinically significant macular edema. The laser coagulates leaking blood vessels to dry up the fluid that is causing the swelling. Peri or intraocular steroids can also be used to reduce swelling. Optical Coherence Tomography (OCT) is a non-invasive test that uses light waves to measure the retinal thickness, and is used to analyze and guide the treatment of diabetic retinopathy. A similar procedure called scatter laser photocoagulation (also known as pan-retinal photocoagulation or PRP) destroys abnormal blood vessel growth in patients with proliferative diabetic retinopathy (PDR). New studies show that frequent anti-VEGF injections may safely control PDR and thus avoid the laser treatment. If there is blood in the eye obscuring the laser, a vitrectomy may be performed to drain the blood in preparation for photocoagulation.

The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Age-related macular degeneration (AMO) occurs when the arteries that nourish the retina harden. Deprived of nutrients, the retinal tissues begin to weaken and die, causing vision loss. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of vision. Dry AMO treatment includes AREDSII vitamins, fish oil and sun protection. There is also new research with stem cells. Wet AMO (neovascular/exudative) occurs when new blood vessels grow into the retina as the eye attempts to compensate for the blocked arteries. These new vessels are very fragile, and often leak blood and fluid between the layers of the retina. Not only does this leakage distort vision, but when the blood dries, scar tissue forms on the retina as well. This creates a dark spot in the patient’s vision. Avastin TM, Eylea® and Lucentis® are medications that can reduce swelling in the macula, prevent further vision loss and even improve vision for some patients with age-related macular degeneration or AMO. They work by stopping the body from producing VEGF (vascular endothelial growth factor), a chemical that makes abnormal blood vessels grow. These medications are given in a series of injections about 4-6 weeks apart. When stable the treatments are extended to longer intervals. lntraocular steroids and PDT (Photo dynamic Therapy) laser treatments can also be used for resistant cases of wet AMO. There are other medicines going through FDA trials currently. Optical Coherence Tomography (OCT) is a non-invasive test that uses light waves to take pictures of the retina. This is used to analyze and guide the treatment of wet AMO.

Blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes by removing excess fat, skin and muscle from the upper and lower eyelids. It may be performed for cosmetic reasons or to improve sight by lifting droopy eyelids out of the patient’s field of vision. Blepharoplasty can be combined with BOTOX® treatments to raise the eyebrows or reduce the appearance of wrinkles, crow’s feet or dark circles under the eyes. The procedure is performed with local anesthesia and lasts 45 minutes to a few hours depending on how much work is done. Incisions are made along the eyelids in inconspicuous places (in the creases of the upper lids, and just below the lashes on the lower lids). The surgeon removes excess tissue through these incisions and then stitches them closed with fine sutures. Stitches are removed after 5-7 days and most people return to work in ten. Contact lenses may not be worn for two weeks. The effects of blepharoplasty can last for a long time and are sometimes even permanent.