Physicians Eye Care & Laser Center

What is a Cataract? In the eye, the natural lens focuses light rays on the retina to produce an image. At birth, the lens is clear. With time, the lens starts to get cloudy and obstruct light. This cloudy lens is known as a cataract and can diminish vision. Cataracts are diagnosed during a complete eye exam by your physician at Physicians Eye Care Center. Common symptoms of cataracts include the following: -Blurry Vision -Difficulty Driving -Glare Symptoms and Haloes Around Lights -Difficulty Reading or Watching Television -Perception that colors are dull or faded -Needing frequent changes in glasses prescription Fortunately, cataract treatments and surgery are available to restore clear vision. The cloudy lens is replaced with a clear intraocular lens that can also reduce or eliminate their need for glasses or contacts following the procedure. When is it time to have cataract surgery? With mild cataracts, there is often a shift in your glasses prescription and vision can be improved with a glasses adjustment. At some point, changes in the glasses prescription will not be sufficient to improve your vision as the cataract becomes more significant. The only effective treatment is to remove the cloudy lens. Fortunately, modern cataract surgery is safe and effective resulting in improved vision and quality of life. Cataract Surgery Our cataract surgeons at Physicians Eye Care Center continue to stay abreast of latest developments in technology in order to provide our patients with the best possible care. We offer both laser-assisted cataract surgery and traditional cataract surgery. The following will give you a general idea of what to expect from the cataract surgery procedure. If you would like more information, or if you would like to schedule a consultation with one of our experienced ophthalmologists, please contact Physicians Eye Care Center today. Pre-Operative Care and Preparation Surgery is done on an outpatient basis, at Snowden River Surgical Center. You will be asked to skip breakfast, but generally should take any medications you normally take in the morning. These may be taken with a small amount of water. When you arrive for surgery, you will be given eye drops and a mild intravenous sedative to help you relax. A local anesthetic will numb your eye. The Procedure The actual surgery time is very brief, and can typically be completed in less than 20 minutes. First, under an operating microscope, a small incision is made in the cornea. The anterior capsule is removed to access the cataract. Then, ultrasound waves are used to break the lens into pieces, and vacuum tubing removes the emulsified cataract. After this is accomplished, an intraocular lens (IOL) can be inserted to correct existing refractive errors such as nearsightedness, farsightedness, or astigmatism. Surgeons at Physicians Eye Care Center now offer laser-assisted cataract surgery as well. In laser-assisted surgery, several portions of the procedure are performed using a laser that enhances precision. (See below section entitled “Laser Cataract Surgery”) Post-Operative Care and Recovery After surgery is completed, your doctor may place a shield over your eye. After a short stay in the outpatient recovery area, you will be ready to go home. During the first four weeks, medicated eye drops will be used to assist in the healing process. You will then have a follow-up appointment to determine if you will require prescription lenses, such as reading glasses. Our cataract surgeon will also monitor your recovery to ensure no complications arise. As with any type of surgery, there are some risks involved in cataract surgery. However, complications occur in far less than 1% of all cataract surgery patients who do not have any pre-existing conditions, and most complications associated with cataract surgery are treatable. Your surgeon will provide you with more detailed information about the risks associated with cataract surgery during the consultation process. YAG Capsulotomy In some eyes, over the course of time after cataract surgery, the lens capsule (the part of the eye that holds the lens in place) sometimes becomes cloudy This can occur several months or years after the original cataract operation. If the cloudy capsule blurs your vision, your ophthalmologist can perform a second surgery using a laser. During the second procedure, called a posterior capsulotomy, a laser is used to make an opening in the cloudy lens capsule, restoring normal vision. Unlike the original cataract surgery, there are no external openings made in the eye, so there is no restriction on your activity and no special eye drops needed after this office procedure.

Screening or routine eye health examinations serve to diagnose previously undetected vision disorders that can potentially threaten one’s vision. As part of a routine eye health exam, our doctors examine your eyes to assess your vision, determine the need for glasses as well the general health of your eye. A comprehensive eye exam consists of the following elements: -Review of patient’s overall health and medical history, family history and ocular history -Visual acuity and refraction to determine eyeglass prescription -Basic eye tests such as ocular motility, pupil reactivity and peripheral vision -Intraocular pressure to screen for glaucoma -Examination of the eye itself, including dilation of the pupils to examine the retina -Common eye conditions that we screen for in a routine eye exam include cataracts, glaucoma, macular degeneration, diabetic retinopathy and dry eye syndrome -Because the eye exam consists of several components, as well as pupil dilation, please allow for 60 to 90 minutes. -If you are a contact lens wearer looking for a contact lens fitting, please note that this will be a separate appointment from your routine eye health appointment. A contact lens appointment will ensure proper fit of your lenses as well as lens care. Everyone needs routine eye health exams. To schedule an exam with an eye doctor at Physicians Eye Care please call 410-964-8285 or 410-644-9515.

Laser Vision Correction (LVC) is one of the most exciting technological advances in the history of eye care. It is performed with an excimer laser, which produces a “cool” ultraviolet laser light that gently reshapes the cornea. Both LASIK and PRK utilize an excimer laser to perform Laser Vision Correction. During PRK (Photo Refractive Keratectomy), Physicians Eye Care and Laser Center surgeons gently alter the cornea’s outer layer through a series of ultra precise pulses, which changes the way you see. The treatment takes only a few minutes and anesthetic drops are used to ensure that the treatment is completely painless. PRK is performed for nearsightedness, farsightedness, and astigmatism. During LASIK (Laser Assisted In-Situ Keratomileusis) Physicians Eye Care and Laser Center surgeons lift a flap of the cornea with a special instrument called a keratome. Then the laser beam is directed with precision control to reshape the cornea. The flap is then returned for more controlled healing and more rapid vision stabilization, with little or no discomfort. LASIK is performed for nearsightedness, farsightedness, and astigmatism. Determining whether PRK or LASIK, or any other procedure such as RK (Radial Keratotomy), ICL (Intraocular Contact Lens), Corneal Ring, or clear lens extraction, is right for you is a decision best made by you in consultation with one of our surgeons. There is no cost for the initial consultation and there is absolutely no obligation. Physicians Eye Care and Laser Center is always looking for the newest innovative technology while making sure the patients’ safety and best interests come first. In this respect, Dr. Wexler continues to evaluate new laser technology (wavefront analysis and custom ablation) in order to provide quality service you can clearly see. With CusomVue corneal ablation, your vision becomes unique as WaveScan technology provides a “fingerprint” map of your eye. At Physicians Eye Care and Laser Center there are always ongoing laser and CustomVue updates. At Physicians Eye Care and Laser Center we use the VISX StarS4 with ActiveTrak and iris registration. This is a 7-beam variable spot laser with eye tracking. The VISX Star53 is FDA approved for the correction of nearsightedness, farsightedness, astigmatism, and mixed astigmatism. By coupling the StarS4 excimer laser and WaveScan Wavefront system, CustomVue treatments are performed. This allows a tailored procedure for each eye. This technique of measuring is 25 times more precise, which translates to a higher level of precision and accuracy, allowing patients to achieve the full potential of their vision. For more information about Laser vision correction, try these helpful links: Potential Risk Since 1982, more than two million Laser Vision Correction treatments have been performed. From all of the data available to date, there have been no significant long term problems. Laser Vision Correction is considered to be very safe. Though extremely rare, as in any medical procedure, there may be some side effects associated with excimer laser treatment. During a consultation, these will be explained by a Physicians Eye Care and Laser Center surgeon who will be performing your procedure. Risks of PRK And Lasik Include Overcorrection and Undercorrection: This is a normal part of healing; however, in rare instances if it persists, a follow-up procedure can be performed to remedy this problem at no charge to you. This is called an “enhancement.” At Physicians Eye Care and Laser Center, our enhancement rate is less than 3 percent, far less than the national average. Regression: Over time, if undercorrection occurs, it too can be corrected with an additional procedure. The overwhelming majority of individuals require only one procedure. Night Glare: The most common problem, which usually improves within the first few months. Infection: Although very rare, corneal scarring can occur from a severe infection. All patients receive antibiotic eye drops both before and after surgery. Corneal Haze: A scar or cloudy cornea that may affect vision. Loss of best corrected vision. Although rare, this may be permanent. Contrast Sensitivity Loss: Can occur but is usually well tolerated

Dry eye syndrome is one of the most common ailments in the world. Dry eye usually involves inadequate tear production and or inflammation on the surface of the eye or eyelids. Patients with dry eye may have the following symptoms: fluctuating/decreased vision, irritation, redness, eye pain and tearing. Risk factors for dry eye include hormonal factors, contact lens usage, certain medical conditions, prior eye surgeries and environmental factors. Our ophthalmologists at Physicians Eye Care Center are very experienced in diagnosing and treating dry eye syndrome. At our accredited dry eye center of excellence we use advanced diagnostics made available by the new TearLab Osmolarity system. This technology assists us in quantitatively measuring the extent of ocular dryness as well as it helps in monitoring treatment response. The mainstay of traditional dry eye treatment was artificial tear supplementation. At Physicians Eye Care we are utilizing a whole host of modern treatment modalities to help tailor dry eye treatment to each individual patient. Below are some of the advanced treatments commonly used at our dry eye center: Anti-inflammatory Medications Topical steroids, Restasis and Xiidra are all medications that are used to control inflammation on the surface of the eye and improve tear film. Omega-3 Supplementation Omega-3 fatty acids have been shown in numerous recent studies to improve tear film quality and provide symptomatic relief to dry eye sufferers. Eyelid Heat Eyelid heat is helpful in the treatment of blepharitis which is a significant cause of ocular dryness. Eyelid heat is best applied using a heat mask that is able to stay warm for at least several minutes at a time. The EyeEco Dry Eye Relief Mask (DERM) is available for purchase at Physicians Eye Care Center. Punctal Plugs Punctal plugs are microscopic inserts placed in the tear drainage duct that allow more tear coverage on the surface of the eye. Punctal plug placement is performed in the office and takes only a few minutes. Meibomian Gland Expression Blepharitis is a condition involving clogged meibomian glands (which are essentially oil glands) along the eyelid margin. When these glands get clogged, there is inflammation on the surface of the eye resulting in dry eye syndrome. When eyelid heat at home is not enough to unclog your oil glands, we can perform a brief in-office procedure called meibomian gland expression. The procedure consists of heating the eyelids for about 10 minutes. This is followed by your physician using a small handheld device to gently unclog and rejuvenate your oil glands. This procedure has improved quality of life for many of our dry eye sufferers. Amniotic Membrane Placement An amniotic membrane is a biologic treatment that has potent regenerative powers. Physicians Eye Care has several different types of amniotic membranes and we utilize these to reduce inflammation and promote a healthy ocular surface. Autologous Serum Tears In certain situations your ophthalmologist at Physicians Eye Care Center may prescribe autologous serum tears. Because these tears are derived from your own blood they contain restorative growth factors that are not available in other eye drops that allow your ocular surface to function in a physiologic manner. Our dry eye center partners with the Hunt Valley Compounding Pharmacy to deliver our patients this innovative therapy. To schedule an appointment at our at the Physicians Eye Care Dry Eye Center of Excellence please call 410-964-8285 or 410-644-9515.

At Physicians Eye Care Center, Dr. Jonathan Etter is a fellowship trained specialist in cornea and external disease. He treats a wide variety of ocular surface conditions with both medical and surgical treatments. Some of his specialty areas include: -Dry Eye Syndrome and Sjogrens Syndrome -Blepharitis -Corneal Ulcers and Abrasions -Fuchs Dystrophy and Corneal Edema -Keratoconus -Corneal Scarring -Pterygium -Ocular Surface Tumors, Neoplasia and Melanosis -Recurrent Erosion Syndrome -Band Keratopathy -Salzmans Nodules -Herpetic Eye Infections -Shingles Eye Infections -Conjunctivitis -Ocular Allergy For diseases that can not be cured medically, Dr. Etter has extensive experience in corneal and ocular surface surgery. He performs full-thickness corneal transplants (penetrating keratoplasty) as well advanced partial thickness transplants (endothelial keratoplasty). He also performs pterygium excision and ocular surface tumor removal. In addition, he performs in-office corneal polishing (superficial keratectomy) for corneal scarring, band keratopathy and recurrent erosion syndrome. Dr. Etter sees patients at all 3 of our offices. To schedule an appointment please call 410-964-8285 or 410-644-9515.

Diabetics are at increased risk of developing eye disease, including diabetic retinopathy, cataracts and glaucoma. The most common of these is diabetic retinopathy, the leading cause of new cases of blindness among working-age people in the United States. If you have diabetes, you are likely to get cataracts at a younger age and your chances of developing glaucoma are doubled. Diabetic retinopathy is a potentially vision threatening condition in which the blood vessels inside the retina become damaged from the high blood sugar levels associated with diabetes. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The longer you have diabetes, the greater your chance of developing diabetic retinopathy. The risk increases if blood sugar levels and blood pressure are poorly controlled. Once diagnosed with diabetes, schedule a comprehensive dilated eye evaluation at least once a year. Your eye doctor will recommend more frequent examinations if abnormalities are detected. Diabetic eye disease is most successfully treated if it is diagnosed early, before vision is significantly affected. Because there are often no symptoms in the early stages of diabetic retinopathy, your vision may not be affected until the disease becomes severe. You should also see your ophthalmologist promptly if you experience: Blurred vision that last more than a few days Blurred vision that is not associated with a change in blood sugar Floaters Women with diabetes should also be examined if considering pregnancy, early in the first trimester and every 1 to 3 months during pregnancy because diabetic retinopathy can progress much more rapidly during pregnancy. An effective partnership between you, your primary care physician and your Eye M.D. is essential to assure proper eye care and treatment. The current primary treatment option for diabetic retinopathy is an office treatment called laser photocoagulation. With the “pan retinal” laser, the ophthalmologist makes tiny burns on the retina surface removing damaged retinal tissue. This helps to stop or prevent growth of abnormal blood vessels that cause vitreous hemorrhage and retinal detachment. The “focal” laser helps to close leaking blood vessels, which lead to macular edema. When performed promptly, laser photocoagulation helps reduce the risk of severe vision loss by up to 90 percent. Recent studies show that intensive control of diabetes with self-monitoring of blood sugar levels can significantly slow the development of diabetic retinopathy and other complications from diabetes. As always, early diagnosis of diabetes and the effective control of blood sugar levels and hypertension through diet, exercise, and medication can help control eye diseases associated with diabetes. Macular Degeneration Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. The most common symptom of dry AMD is slightly blurred central vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision loss may be more severe in one eye than the other. During your comprehensive dilated eye exam, your ophthalmologist examines the macula for signs of AMD. In mild cases this may be seen as a mild disturbance in the normal pigment layer which is underneath the macula. In some cases, drusen develop. Drusen are yellow deposits under the retina. They often are found in people over age 60. Drusen alone do not usually cause vision loss. In fact, scientists are unclear about the connection between drusen and AMD. They do know that an increase in the size or number of drusen raises a person’s risk of developing either advanced dry AMD or wet AMD. These changes can cause serious vision loss. Dry AMD has three stages, all of which may occur in one or both eyes: Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are no symptoms and no vision loss. Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks. Advanced Dry AMD. In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This breakdown can cause a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or recognizing faces until they are very close to you.

Glaucoma is a disease of the optic nerve that can diminish vision if left untreated. The condition is common, especially in patients with a family history of glaucoma. How is glaucoma diagnosed? During a routine eye exam your doctors at Physicians Eye Care will screen for glaucoma by assessing your ocular and family history, checking your eye pressure as well as examining your optic nerve after pupil dilation. The image below shows optic nerve cupping over time which is a sign of optic nerve damage. Additional tests to assess one’s risk for glaucoma may be performed if your physician feels you are at risk. These tests may include the following: -Corneal Thickness Testing -Gonioscopy (a lens to assess the fluid drainage portion of the eye) -Optic Nerve Scanning (This is a scan called OCT – Optical Coherence Tomography that measures your nerve fiber thickness and health.) -Visual Field Testing (This is a test that will assess your peripheral vision to determine if you have damage from glaucoma.) How is glaucoma treated? Doctors at Physicians Eye Care Center utilize the most advanced techniques to treat glaucoma. Treatment involves lowering one’s eye pressure and is tailored to each individual patient. In most cases of glaucoma, surgery can be avoided if detected and treated early enough. Routine glaucoma screening and early detection is key. The following are some of the modalities utilized to treat glaucoma: Eye Drops – Your physician may prescribe you eye drops to lower your eye pressure. There are several eye drops available and each has its dosing schedule and profile. Laser – Depending on what type of glaucoma you have, it may be amenable to laser treatment. Selective laser trabeculopasty (SLT) is a quick and painless laser that facilitates more efficient fluid drainage from the eye, which lowers eye pressure. SLT can often decrease or eliminate the need for eye drops. Alternatively, it can be used as a therapy to help lower eye pressure in more advanced cases of glaucoma and put off the need for glaucoma surgery. Laser peripheral iridotomy (LPI) is a laser used in narrow angle glaucoma to help prevent damage from angle closure which can cause pain and vision loss. Both SLT and LPI are performed in the office and do not require any post-procedure restrictions. Glaucoma Treatment with Cataracts With the newest advancements in glaucoma technology, our eye surgeons can help slow the progression of glaucoma for cataract surgery patients. There are several additional procedures that our eye surgeons can perform along with your cataract surgery to lower your eye pressure and help treat mild to moderate glaucoma. These procedures are collectively referred to as Micro-Incisional Glaucoma Surgery (MIGS). There can be several advantages of MIGS procedures, including the following: Lower intraocular pressure (IOP) Less risk compared to other traditional surgical glaucoma procedures Reduction in, if not complete elimination of, the use of expensive medication Below is a list and brief description of MIGS procedures commonly performed by surgeons at Physicians Eye Care Center. Your eye surgeon will discuss the risks and benefits of these procedures as well as which MIGS procedure would be best for you. Endoscopic Cyclophotocoagulation (ECP) Endocscopic Cyclophotocoagulation (ECP) is a technology that involves using a laser to treat the fluid producing organ of the eye (the ciliary body) so that the fluid production is more appropriate for your eye and your eye pressure is lower. CyPass Micro-Stent The CyPass shunt is a minimally invasive shunt device designed to reduce IOP in adults with mild-to-moderate glaucoma. It’s inserted through the angle (the fluid drainage area of the eye) in conjunction with cataract surgery. The CyPass allows the eye to more effectively drain its fluid so that the eye pressure is lower, thereby decreasing the chances of glaucoma progression. Kahook Dual Blade The Kahook Dual Blade is a device used to create a goniotomy – which is an opening in the trabecular meshwork, creating a path through which excess fluid can drain from the eye, which results in an overall decrease in eye pressure. Although glaucoma cannot be reversed, MIGS procedures can slow the rate at which the condition advances by lowering intraocular pressure. Patients may be unaware of their glaucoma until it gets worse and starts to impair their vision, which is why routine eye examinations are crucial for early detection and treatment of this common eye condition. During any pre-operative evaluation for a MIGS procedure, your surgeon at Physicians Eye Care will discuss the risks and benefits to each option and will help determine which will be most appropriate for the health of your eyes.

Quality eyewear at a competitive price. Our friendly, professional eyeglass dispensary staff will help you choose the perfect pair of glasses at a very competitive price. We participate in a variety of insurance plans, and offer our own specials and discounts.. Your new glasses will be expertly fitted to not only help you see better but also to protect your eyes from dangerous ultraviolet rays of the sun. Our Practice only uses top quality lenses. We use Varilux Physio Enhanced Progressive lenses. Polycarbonate lens material, which is the safest material as it is impact resistant. High Index 1.74 lens material is the lightest and thinnest on the market. Polarized Lenses are a must for eliminating glare in your sunglassses. Any surface can create glare in sunlight including water, snow, windows, vehicles, and buildings. Drivers, boaters and fisherman are some who benefit for the glare cutting properties of polarized lenses. Transition Lenses Lenses that darken and lighten according to sun exposure. We use Crizal Avance with Scotch Guard Anti Glare (AR) treatment for our lenses. Say goodbye to tired eyes! These lenses fight reflections and eye fatigue from computers and overhead lights and reduce glare from headlights/streetlights for safer nighttime driving. All of our lenses are UV (ultra-violet) protected and scratch resistant. All our locations are authorized Maui Jim Sunglass Dealers. All of our locations are authorized Callaway Golf SOLFX Sunglass Dealers. We carry a large assortment in frames. We carry designer frames such as Gucci, Kenneth Cole, BCBG, Cole Haan, Banana Republic, Hugo Boss, Giorgio Armani, Valentino, Nine West, Ellen Tracey, Callaway, Kate Spade, and hundreds more styles to choose from. We carry plastic frames and metal frames. Titanium to flex frames. Children’s frames and Sunglasses. Whether its a trendy new look or something more conservative our Optician will be able to help you choose a frame that will perfect your vision and enhance your appearance.All our frames and lenses have warranty’s that may vary by your vision insurance policy. Our optical shops take many insurance plans, including VSP, Davis Vision, Eye Med, Optumhealth, and State of Maryland . Did you know that we are one of only 3 practices in Maryland that offer the Visioffice!? It allows precision optical measuring of each patient’s unique facial features and eye movements to give a custom fit of your eye glass. Digital photos allow you to see up to 4 frames on your face, side by side. You can even send “your new look” to someone’s phone! Learn more about our Visioffice! Contact Lenses The contact lens department at Physicians Eye Care Center is ready to meet all of your contact lens needs. Our staff includes professionals with decades of experience who can fit everyone from new wearers to experienced ones who might like to try something new or continue with their current lenses. We can order the lenses for you and handle your insurance coverage, or give you a contact lens prescription (as long as you have been adequately evaluated) so that you may order them yourself. he developments in contact lenses continuously change and we offer the newest lenses and can advise you as to whether you may benefit from these new changes. When you come in for evaluation, please bring your current contact lenses, the packages they come in, or any previous contact lens prescriptions if you have them. In general contact lens wear is not recommended before age 12 but there is no upper age limit. Children age 12 and above need to have a certain level of maturity to comply with adequate care of the lenses and to understand the potential problems if they do not care for them properly. The doctors, contact lens staff, and technical staff are happy to discuss these issues with patients and their parents. We offer a wide variety of contact lens types, including: Many vision insurance plans will contribute towards contact lens fittings and/or the lenses. Please check with your plan to find out this information so that you are aware prior to the visit whether there will be a charge. Remember to tell the office personnel when you schedule your appointment that you need contact lens services. And again, remember to bring your lenses, their packaging, and any past written prescriptions with you to your visit. It is also very helpful to bring your eyeglasses, even if you rarely wear them. For more information about glasses and contact lens options at Physicians Eye Care Center please contact us today at 410-644-9515 or 410-964-8285.