Simon Eyes

Age-related macular degeneration (AMD) is the most common cause of vision loss in individuals over the age of 50. The name of the condition derives from its cause: damage to the macula, the most sensitive spot on the retina, required for clarity in the center of the visual field. The macula transmits electrical signals through the optic nerve to the brain. Damage to the macula results in retinal tissue degeneration that gradually worsens, diminishing or destroying central vision. The speed at which AMD advances is variable. In some patients, the condition progresses slowly and the changes in vision are imperceptible for some time. In others, the disease moves at an accelerated pace, leading relatively quickly to loss of central vision in one or both eyes. While AMD does not result in complete blindness because some peripheral vision always remains, it does make ordinary activities, particularly those that require close visual acuity, increasingly difficult. Stages and Types of AMD There are three stages of AMD. These stages are designated both by signs detected by the ophthalmologist and symptoms experienced by the patient. Early Stage AMD During early AMD, the physician can diagnose the illness by the presence of more than the usual number of drusen, yellow deposits under the retina, These drusen of medium size. Typically, patients with early AMD are not yet experiencing any loss of vision. Intermediate Stage AMD When a patient is in the intermediate stage of AMD, the doctor observes large drusen as well as possible changes in retinal pigment. While some patients at this stage may experience small gaps in vision, most patients with intermediate AMD do not experience any significant vision loss. Late Stage AMD During late stage AMD, patients have enough damage to the macula to experience significant vision loss. The two types of late AMD are: Dry, or geographic, in which macula tissue degenerates Wet, or neovascular, in which abnormal blood vessels grow In the wet type of AMD, which progresses more rapidly than the dry, the newly developed blood vessels may leak blood and fluid. Visual loss in dry AMD usually occurs more gradually. Ninety percent of patients diagnosed with AMD have the dry variety, but approximately 10 percent of these patients later develop the wet variety of the disorder. Although patients with either type may experience vision loss, wet AMD not only progresses more rapidly, but usually results in greater visual damage. Risk Factors for AMD Individuals over the age of 50 with a family history of the disease are at increased risk of developing AMD. Environmental factors may also increase risk. These include: Poor diet Lack of exercise Smoking Excessive exposure to sunlight Elevated blood pressure Elevated cholesterol levels Females and people with light skin or eyes are at greater risk of developing this condition. Symptoms of AMD Just as there are a number of signs that indicate the presence of AMD to the ophthalmologist, there are a number of symptoms experienced by the patient. Visual symptoms of macular degeneration may include: Wavy lines Gradual lessening of color perception Distorted or blurry vision Dimmed vision, especially when reading Dark spots in the center of the visual field In a great many cases of AMD, even when the central field of vision has been lost, patients retain enough visual acuity to navigate their daily lives. Diagnosis of AMD In order to definitively diagnose AMD, any or all of the following are necessary: Visual acuity test Physical examination of the back of the eye after dilation Amsler grid test for central vision Fluorescein angiogram, in which dye highlights the blood vessels Optical coherence tomography (OCT) During the physical examination of the eye, the ophthalmologist takes particular care to look for pigment changes under the retina, as well as for drusen. Treatment of AMD While there is not yet a cure for AMD, many patients have been helped greatly by recent innovations in treatment. Regular eye examinations to facilitate early detection of AMD are essential, since most therapies work best when started at an early stage of either type of the disorder. Even though treatments cannot reverse the disease process, they are often able to stop the progression of symptoms so the patient can maintain as much vision as possible. Recommended treatments for AMD may include one or more of the following, each of which approaches controlling AMD in a somewhat different way: Vitamin and mineral supplementation known as AREDS Injections of anti-VEGF (vascular endothelial growth factor) Laser therapy Laser submacular surgery Use of low vision aids An innovative device, known as an implantable miniature telescope (IMT) has been designed to be implanted in place of the patient's natural lens. While not a cure for AMD, it offers hope for much improved vision for those with the disorder.

Each year, cataracts affect millions of people, including more than half of all Americans aged 60 and older. A cataract is a painless clouding of the eye's natural lens that is caused by a buildup of protein. A cataract can form in one or both eyes. If left untreated, cataracts worsen over time and interfere with everyday activities such as reading or driving. Night vision is usually most affected. When cataracts are in their early stages, people are helped by brighter lighting. As cataracts get worse, however, most people require surgery. Risk Factors for Cataracts In addition to aging, other factors, including the following, can increase the risk of developing cataracts: Diabetes Smoking Obesity Excessive alcohol use Excessive exposure to sunlight Exposure to radiation Family history of cataracts High blood pressure Previous eye injury or surgery Prolonged use of corticosteroid medications In rare instances, infants are born with cataracts, which may be the result of an infection, such as rubella, contracted by the mother during pregnancy. They may also occur in combination with some other birth defect. Occasionally, infants develop cataracts shortly after birth. Diagnosis of Cataracts Several tests, including the following, are performed to diagnose cataracts: Retinal examination under pupil dilation Visual acuity test Slit-lamp examination Tonometry to test intraocular pressure (IOP) In combination, such tests help determine whether a patient has cataracts, or whether her or his vision problems have some other cause. They also assist in evaluating the degree of visual impairment, and whether surgery should be performed. Symptoms of Cataracts People with cataracts often do not realize they have them until vision is affected. Cataract symptoms include the following: Blurred, hazy or double vision in one eye Decreased color perception Sensitivity to bright light Poor night vision Perception of halos around lights Frequent changes in corrective-lens prescriptions Yellow-tinged vision is also an indicator of cataracts. Treatment of Cataracts Early cataracts can sometimes be treated with nonsurgical methods, including the following: New corrective-lens prescriptions Anti-glare sunglasses Magnifying lenses Brighter lighting If cataracts begin to interfere with reading ability, work, night driving or other daily activities, cataract surgery may be recommended. If cataracts are in both eyes, surgery is performed, usually 4 to 8 weeks apart, on one eye at a time. Cataract surgery is the most common surgical procedure in the United States. Prevention of Cataracts Although cataracts cannot be prevented, their development can sometimes be delayed by the following: Wearing wide-brimmed hats to block sunlight Wearing sunglasses that block ultraviolet rays Not smoking; not drinking excessively Eating a diet high in antioxidants Left untreated, cataracts cause serious visual impairment. In most cases, however, they can be effectively treated with surgery once they become intrusive in everyday life.

Patients with diabetes are at a higher risk of developing eye conditions as a complication of their disease. These conditions can lead to vision loss and blindness and include diabetic retinopathy, cataracts and glaucoma. Diabetic retinopathy is actually the leading cause of blindness in the United States. Diabetic eye conditions often develop without any noticeable loss of vision or pain, so significant damage may have occurred by the time patients notice any symptoms. For this reason, it is important for diabetic patients to have their eyes examined at least once a year. Early detection of eye disease can help prevent permanent damage. Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the eye. Over 40 percent of patients diagnosed with diabetes develop some form of eye disease as a result of their disease. The risk of developing eye problems can be reduced with regular eye exams and by controlling blood sugar levels with a healthy diet and regular exercise. Causes of Diabetic Eye Conditions Diabetic eye conditions develop in the retina as a result of microvascular abnormalities. The tiny blood vessels within the retina develop microaneurysms that, over time, leak blood. As new blood vessels develop to replace the blood vessels that are no longer viable, they also leak blood causing hemorrhages and permanent damage to the retina. While diabetics struggle with a high sugar count in the blood along with insufficient insulin production, it is actually the lack of oxygen in the blood that leads to loss of vision. Diagnosis of Diabetic Eye Conditions Diabetic eye conditions can be detected through a comprehensive eye exam. A comprehensive eye exam involves a visual acuity test to measure vision at various distances, and a dilated eye exam to examine the structures of the eye for any signs of disease. During this test, your doctor can examine the retina and optic nerve with a special magnifying lens. Tonometry may also be performed during a comprehensive eye exam to measure the pressure inside the eye with a special instrument. Eye exams should be performed at least once a year or as soon as any potential problems are detected in order to ensure early detection of any serious conditions. Early detection is the strongest protection against diabetic eye diseases. Treatment of Diabetic Eye Conditions Other than controlling blood pressure, blood cholesterol and the levels of blood sugar, treatment is not needed during the first three stages of diabetic retinopathy. The fourth stage, proliferative retinopathy is treated with a laser surgery procedure known as scatter laser treatment. During the procedure the abnormal blood vessels are ablated causing them to shrink. This procedure works best once the blood vessels begin to bleed. Severe blood vessel bleeding may need to surgically corrected with a vitrectomy procedure to remove the blood from the eye. Treatment for macular edema usually includes a laser procedure called focal laser treatment. During this procedure, several hundred small laser burns are placed in the areas of retinal leakage around the macula to prevent leakage from occurring and reduce the amount of fluid in the retina. This helps reduce the risk of vision loss and may improve lost vision in a small number of cases. Focal laser treatment is performed in your doctor's office and can usually be completed in just one session.

Dry eye is a common condition in which the eyes are insufficiently lubricated, leading to itching, redness and pain. The eyes can become dry and irritated because the tear ducts are not producing a sufficient number of tears, or because there is a chemical imbalance in the tears themselves. Natural tears require a particular chemical balance to lubricate the eyes efficiently. Alleviating the symptoms of dry eye is important. Left untreated, they have the potential to damage vision. Dry eye can be diagnosed after a thorough examination of the eyes, and a Schirmer tear test to evaluate tear production. Causes of Dry Eye People usually begin experiencing dry-eye symptoms as they age (they are more common in people older than 50), but they can also result from certain medications, medical conditions or injuries. Dry eye tends to affect women more than men because of the hormonal changes that take place during pregnancy and menopause. Oral contraceptives can also affect the consistency of tears. Other causes of dry eye include the following: Antihistamines, decongestants and blood-pressure medications Rheumatoid arthritis, diabetes, Sjögren's syndrome and thyroid disease Environmental conditions such as smoke, wind or excessive sun Long-term contact lens use Eye injury Eye or eyelid surgery Inflammation of the eye (conjunctivitis or keratitis) Any of these factors, alone or in combination, can affect the frequency or consistency of tears, either of which can lead to dry eye. Symptoms of Dry Eye The symptoms of dry eye typically occur in both eyes, and include the following: Stinging, burning or scratchiness Eye fatigue Sensitivity to light Difficulty wearing contact lenses Excessive tearing Blurry vision Dry eye can damage eye tissues, leaving tiny abrasions on the surface that can impair vision. There are, however, many treatments for relieving dry-eye symptoms, restoring eye health and protecting vision. Treatment of Dry Eye Treatment for dry eye depends on its cause and severity, as well as the patient's overall health and personal preference. Nonsurgical Treatments Nonsurgical treatments, which include the following, are often effective: Deliberately blinking Increasing humidity levels at home or work Using artificial tears or a lubricating ointment Avoiding environmental irritants Eliminating medications that may be responsible Adding Omega-3 fatty acids to the diet or taking them as supplements In many cases, simple lifestyle changes can alleviate dry-eye symptoms. Surgical Treatments If less invasive methods are unsuccessful, surgical treatments, which include the following, may be an option: Insertion of punctal plugs to limit tear drainage Punctal cautery to permanently close the drainage holes Treatment of an underlying disease If an eyelid condition is causing dry eye, eyelid surgery may be recommended. If dry eye is left untreated, it can lead to complications that include pain, corneal ulcers/scars or vision loss. Preventing Dry Eye There are steps that can be taken to prevent dry-eye symptoms. Simple lifestyle modifications such as wearing protective glasses on windy days, and giving the eyes a break during reading or other tasks that require intense focus, can effectively reduce the frequency and severity of symptoms.

Glaucoma is a group of related diseases that damage the optic nerve, resulting in vision loss and possible blindness. Glaucoma, a leading cause of blindness and visual impairment in the United States, can affect patients of all ages. Many people affected with glaucoma do not experience any symptoms and may not be aware that they have the disease until they have lost a significant amount of vision. With early detection and treatment, however, eyes can be protected against the serious loss of vision or blindness. Catching glaucoma at an early, treatable stage is one important reason to have thorough eye examinations regularly. Risk Factors for Glaucoma There are several factors that increase the risk of developing glaucoma, including: Being over 60 Being of particular descent, such as African-American or Asian Having a family history of glaucoma Having elevated intraocular pressure Having poor vision or other eye disorders or injuries Having certain medical conditions, like diabetes Taking certain medications, such as corticosteroids for prolonged periods Patients with risk factors for the disorder should be especially vigilant about having regular eye examinations. Causes of Glaucoma Certain diseases or conditions can contribute to the development of glaucoma. These include: Increased pressure within the eye Severe eye infection Injury to the eye Blocked blood vessels Inflammatory conditions of the eye Glaucoma is considered primary if its origin is unknown and secondary if it results from another medical condition. Types of Glaucoma There are several types of glaucoma. The two major types are primary open-angle glaucoma, in which fluid drains too slowly from the drainage channels (trabecula) of the eye, and angle-closure (narrow-angle) glaucoma, which occurs when the trabecula become blocked. Approximately 95 percent of glaucoma patients suffer from primary open-angle glaucoma. Other types of glaucoma, which occur much more rarely, include: Low Tension Glaucoma Congenital Glaucoma Secondary Glaucoma Pigmentary Glaucoma Pseudoexfoliation Glaucoma Symptoms of Glaucoma It is important to remember that patients with early stage glaucoma are most often asymptomatic. When symptoms occur, they vary depending on the type of glaucoma and can occur in one eye or both eyes. The symptoms of open-angle glaucoma include: Dim or blurred vision Gradual loss of peripheral vision Tunnel vision (at advanced stages) The symptoms of angle-closure glaucoma encompass systemic, as well as eye symptoms, including: Severe eye pain Nausea and vomiting Sudden visual disturbance Blurred vision Halos around lights Red eyes Headache Either type of glaucoma may be a primary or secondary disorder. Diagnosis of Glaucoma The diagnosis of glaucoma is made after a comprehensive medical examination of the eye and a review of the patient's medical history. Tests are conducted to confirm the diagnosis. Testing may include some of the following: Tonometry Dilated eye examination Visual field test (perimetry) Retinal evaluation Pachymetry Gonioscopy Visual acuity test Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. Treatment of Glaucoma There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage. Some of the treatment methods for glaucoma are as follows: Medication Eye drops or oral medication may be used to either reduce fluid production in the front of the eye or to help drain excess fluid. Side effects of the medication may result in redness, stinging, irritation or blurred vision. Regular use of the medication is needed to keep the eye pressure under control. Laser Surgery Trabeculoplasty, iridotomy or cyclophotocoagulation are laser procedures that aim to increase the outflow of fluid from the eye or eliminate fluid blockages. Other Surgery A trabeculectomy may be used to create a new channel to drain fluid from the eye and reduce the pressure that causes glaucoma. Surgery is performed only after medication and laser procedures have been unsuccessful. While patients with early stage glaucoma may not experience any symptoms, prompt treatment is required to preserve their vision.

Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. Reasons for Blepharoplasty Blepharoplasty tightens the eyelid's muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also 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 appearance and improve self-confidence, it does not radically alter the face. Candidates for Blepharoplasty The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. The 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. Recovery After Blepharoplasty After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn 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. Risks of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are 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.

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 working as bifocals. Depending on the type of IOL used, sutures may or may not be needed. Surgery is usually performed on an outpatient basis in a doctor's office, takes only 20 to 30 minutes, and is relatively painless. A very high percentage of patients demonstrates improved vision after the procedure. 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.

Regular eye examinations are important in maintaining eye health. During a comprehensive eye examination, eye diseases or other abnormalities that are not yet causing symptoms can be detected. Early intervention is crucial in preventing vision loss from a disease such as glaucoma, which may not cause symptoms until significant and irreversible damage has taken place. Early detection of eye problems gives a patient a choice of treatment options, and reduces the risk of permanent damage. Benefits of a Comprehensive Eye Examination A comprehensive eye exam should be performed once every year. Children should have regular tests to ensure that their vision is normal so that their schoolwork does not suffer. Older adults are at higher risk for eye conditions such as glaucoma, macular degeneration and cataracts. During a comprehensive eye examination, simple refractive errors are detected, and serious eye problems or diseases, including the following, are diagnosed: Amblyopia (lazy eye) Strabismus Eye-tracking difficulty Glaucoma Diabetic retinopathy Even in younger, healthy adults who are asymptomatic, a regular eye examination is essential. Serious medical conditions, such as high cholesterol, diabetes and high blood pressure, can be detected, allowing patients to seek treatment early. The Comprehensive Eye Examination Procedure A comprehensive eye examination differs from a vision screening. The latter only tests visual acuity, and is commonly performed by a school nurse, optician, pediatrician or other healthcare provider. In order to evaluate the eyes thoroughly and detect any problems, the following tests are performed: Visual acuity Visual field Retinal examination under pupil dilation Slit-lamp Tonometry (tests intraocular pressure (IOP)) Keratometry (measures the curvature of the cornea) Refraction Tonometry checks for the presence of glaucoma, and keratometry for astigmatism. All of the above tests are safe for all patients. Possible Treatments Based on the diagnostic findings of the examination, eyeglasses or contact lenses, medication for infection or inflammation, vision therapy, and vitamins or other supplements may be recommended. In some cases, eye surgery may be necessary. Common Refractive Errors The most common eye conditions diagnosed during a comprehensive eye exam involve refractive errors that cause blurry vision. These conditions affect millions of people in the United States, and often get progressively worse as patients age. Refractive errors are easily treated. Myopia Also known as nearsightedness or shortsightedness, myopia is a condition of the eyes in which nearby objects are clear, and distant objects are blurry. Almost a third of people in the United States have some degree of nearsightedness. Hyperopia Also known as farsightedness, hyperopia is a condition of the eyes in which the focus on distant objects is better than the focus on objects closer to the eye, making nearby objects appear blurry. The eye is designed to focus images directly on the surface of the retina; with hyperopia, light rays focus behind the surface of the retina, producing a blurry image. Astigmatism Astigmatism occurs when curvature of the eye is irregular. There are two types of astigmatism: corneal, in which the shape of the cornea (the clear covering of the eye) is irregular, and lenticular, in which the lens is imperfectly shaped. Corneal astigmatism is more common. Astigmatism can result in blurred vision at any distance. Presbyopia Presbyopia, meaning "old eye," is a condition in which the eyes lose their ability to focus on close objects. It is considered a normal part of the aging process. Symptoms typically begin when patients are between 40 and 45 years old. All of these vision conditions can be effectively treated with either eyeglasses or contact lenses. Corrective lenses may need to be used only during certain activities, such as reading, watching television or driving, or may be needed at all times. Comprehensive eye examinations are essential in checking for vision problems, eye diseases, refractive errors and overall health. How frequently the eyes should be examined is based on the patient's age and specific circumstances.

LASIK, an acronym for Laser-Assisted In Situ Keratomileusis, is a refractive procedure that reshapes the cornea to correct nearsightedness, farsightedness and astigmatism. It is the most common type of refractive surgery. Using targeted laser beam energy, the LASIK procedure reshapes the cornea so that light rays are focused more precisely on the retina, producing clear, sharp vision. Candidates Eligible for LASIK LASIK is considered a safe procedure, yet it is not ideal for everyone. A thorough medical evaluation of the patient's eyes must be performed to determine whether the LASIK procedure is appropriate. Good candidates for LASIK are patients who: Are over 18 years old Not pregnant or nursing In general good health Have had stable vision for at least 6 months Have healthy corneal tissue, thick enough for a flap Have refractive errors that fall within the treatable range It is also important for patients to fully understand the details and risks of the procedure, and to maintain realistic expectations for the outcome. Benefits of LASIK One of the primary benefits of LASIK is that patients immediately experience improved vision after surgery. For many people, laser eye surgery can correct their vision sufficiently to permit them to perform all, or most, of their daily activities without eyeglasses or contact lenses. Approximately 90 percent of patients who have undergone LASIK achieve 20/20 to 20/40 vision as a result of the procedure. LASIK has the advantage of being a short procedure that results in permanent vision improvement. Most patients who choose to undergo LASIK achieve clear vision without corrective lenses while also benefiting from minimal downtime and only mild post-operative discomfort. The LASIK Procedure LASIK is performed on an outpatient basis using only numbing eye drops to reduce any potential discomfort. The entire surgery takes less than 5 minutes to perform, although patients can expect to spend a few hours at the doctor's office. If requested, patients can receive an oral sedative prior to surgery to reduce any anxieties about the procedure. During the LASIK procedure, the patient lies down in a reclining chair as the doctor positions the laser precisely over the eye. A speculum is used to keep the eye open while the eye is cleaned and anesthetic eye drops are administered. A corneal flap is created with either a blade or a laser. The surgeon gently lifts the surface of the cornea aside, enabling the excimer laser to reshape the curvature of the cornea. The excimer laser delivers customized pulses of light energy based on each patient's prescription. The measurements for customization are determined prior to surgery, with the precise positioning confirmed prior to the start of the procedure. The second eye is treated immediately after the first. Following the surgery, the patient is provided with a protective shield to protect the eyes from bright lights. Risks of LASIK Any surgical procedure carries some risks, and patients should be aware that changes to the cornea made during LASIK cannot be reversed. Nonetheless, LASIK is considered safe for most eligible patients. While rare, complications may occur after the procedure, including: Undercorrection or overcorrection of vision Astigmatism Dry eyes Flap complications Postsurgical infection Increased sensitivity to light Visual problems, such as halos or night glare Fluctuating vision Only 1 percent of patients undergoing LASIK experience complications. Recovery After the LASIK Procedure After LASIK, patients rest in the ophthalmologist's office for a short time before having someone else escort them home. Medication may be prescribed to relieve any discomfort experienced during the first 24 to 48 hours after surgery, but most patients tolerate this procedure well. The doctor will likely recommend a few hours of rest after treatment. Most patients are able to return to work and other regular activities the very next day. Patients who have undergone LASIK are instructed to avoid strenuous activities for at least a week. Typically, patients experience a significant improvement in their vision immediately after the procedure, but the full benefits of LASIK may not be apparent for several months. While patients can achieve clear vision from LASIK, this procedure does not prevent the development of presbyopia, the age-related vision changes that occur after the age of 40. Many patients will need reading glasses for this condition, but their distance vision will remain clear.

Photorefractive keratectomy, or PRK, is a laser vision correction procedure that reshapes the cornea to correct mild to moderate conditions of myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. It is the second most common type of laser eye surgery after LASIK. While during LASIK a flap is created to access the cornea, during PRK the entire epithelial layer of the cornea is removed and later allowed to grow back. During both processes, the cornea is reshaped to provide vision correction. Advantages of PRK Compared to LASIK, PRK provides the surgeon with greater control over the location and amount of tissue being removed, which permits more precise results. PRK gently sculpts the cornea rather than cuts, maintaining corneal strength while providing impressive vision correction. Other advantages of the PRK procedure include: Less depth of laser treatment No corneal flap complications Ability to be performed on thin corneas The PRK procedure offers distinct benefits to individuals whose activities put them at elevated risk of eye injury (boxers, for example) and for patients whose corneas are too thin, or whose pupils are too large, to permit LASIK. PRK also avoids not only the complications from corneal flaps, but a serious complication of LASIK known as corneal ectasia, which can result in distorted vision and even permanent vision loss. Disadvantages of PRK While PRK may be a preferable to LASIK surgery for some patients, there may be disadvantages to the procedure as well, including: More discomfort for the first few days after surgery Longer recovery period Greater risk of postsurgical eye infection Greater risk of temporary or permanent haziness of the cornea Both LASIK and PRK have comparable rates of vision improvement and carry some of the same risks, so a serious consultation with the ophthalmologist is necessary to determine which surgery will be most beneficial to the individual patient. The PRK Procedure Before the PRK procedure begins, the eyes are numbed with anesthetic eye drops. The surgeon then uses an excimer laser, with targeted laser energy, to reshape the cornea. The surgeon has complete control over the laser throughout the procedure, for a highly precise and customized result, designed to give each patient the best vision possible. The entire procedure takes only a few minutes to perform. Because of the potential for blurred vision for a time after PRK, the surgery is often performed on only one eye at a time, with the surgeon waiting to schedule the second eye until the vision in the first has adequately cleared. After the procedure, the eyes are bandaged with a soft contact lens to protect the cornea. New cells will grow back over the next few days to replace the cells that were removed. The contact lens will be removed by the surgeon in a follow-up examination. Recovery After the PRK Procedure After the PRK procedure is completed, patients are instructed to rest before returning home. They may required to wear eyeglasses after the procedure until their vision has stabilized. The surgeon prescribes eye drops to prevent infection and keep the eyes moistened. While vision may improve immediately after the PRK procedure, full results may take several days or weeks to become apparent. Strenuous exercise should be avoided for at least a week because this can interfere with the healing process. Patients will likely be able to see well enough to drive a car after 2 to 3 weeks. Results After the PRK Procedure The results of PRK are considered comparable to those of LASIK. Some patients may experience only 20/40 vision and may still need glasses or contact lenses after their procedure. PRK does not correct presbyopia, a natural change in the eyes that affects people over the age of 40. Patients who require glasses for reading will continue to need them after surgery. It is important for patients to maintain realistic expectations of the results of any laser surgery if they are to be satisfied with the results. Risks of PRK As with any type of surgery, there are certain risks associated with the PRK procedure, including: Postsurgical infection Adverse reaction to anesthesia Inaccurate vision correction Sensitivity to light Problems with night vision, such as halos Hazy vision Dry eyes Many of the complications that may arise after PRK are similar to those that may occur after any type of refractive surgery.

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. Accommodative IOLs 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.

BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Applications for BOTOX Cosmetic Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following: Forehead furrows Frown lines Crow's feet Skin bands on the neck According to Allergan, BOTOX Cosmetic has been "extensively researched, with approximately 2500 studies." BOTOX Cosmetic Procedure and Results Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. Side Effects of BOTOX Cosmetic Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

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.