Lakeland Ophthalmology

Thanks to advances in contact lens technology, almost everyone can now see clearly with contact lenses, regardless of the type or severity of their vision problems. At Lakeland Ophthalmology, with our comprehensive array of contact lens options, we can successfully fit patients in contact lenses who have myopia (nearsightedness), hyperopia (farsightedness), and astigmatism as well as those who need bifocal (multifocal) contact lenses. We also have contacts specifically designed for patients with dry eye. Dr. Hirschfeld and Dr. Bruther can help patients find and order contact lenses to address each patient’s specific needs. Please contact Jim in our Optical Shop for information regarding rebates and discounts. Daily Disposable Contact Lenses Daily disposable contact lenses are the most popular contacts at Lakeland Ophthalmology. These lenses are intended to be discarded and replaced after they have been worn each day. These lenses are easier to maintain than regular soft contacts because they require no cleaning or disinfecting. Daily disposable lenses have a lower rate of infection and allergy because patients start each day with a fresh, clean pair of lenses. Astigmatism Contact Lenses Astigmatism-correcting (toric) contact lenses, in both daily- disposable and monthly- replacement varieties are utilized by patients with astigmatism. These patients have corneas that are oval (like a football) instead of round (like a basketball). Astigmatism contact lenses compensate for this irregular shape — allowing patients to achieve clear vision. Bifocal (Multifocal) Contact Lenses Multifocal daily-disposable or monthly-replacement contact lenses allow patients who might otherwise need reading glasses to see clearly for both near (reading/computer) and far (driving) distances simultaneously. This allows patients in the 40+ age range to see their phones, computers and reading materials without the need for reading glasses. Brands We Carry ACUVUE® Products: 1-DAY ACUVUE® MOIST Brand MULTIFOCAL 1-DAY ACUVUE® MOIST Contact Lenses 1-DAY ACUVUE® MOIST Contact Lenses for ASTIGMATISM 1-DAY ACUVUE® TruEye® ACUVUE® OASYS 1-Day with HydraLuxe® Technology ACUVUE® OASYS 1-Day with HydraLuxe® Technology for ASTIGMATISM ACUVUE® 2 ACUVUE OASYS® 2-WEEK Contacts for ASTIGMATISM ACUVUE OASYS® for PRESBYOPIA ACUVUE OASYS® with HYDRACLEAR® PLUS Technology ACUVUE® OASYS with Transitions™ Light Intelligent Technology™ ACUVUE® VITA® ACUVUE® VITA® for ASTIGMATISM Alcon Contact Lenses: AIR OPTIX® COLORS AIR OPTIX® NIGHT & DAY® AQUA AIR OPTIX® PLUS HYDRAGLYDE® FOR ASTIGMATISM AIR OPTIX® PLUS HYDRAGLYDE® MULTIFOCAL DAILIES® AQUACOMFORT PLUS® DAILIES® AQUACOMFORT PLUS® MULTIFOCAL DAILIES® AQUACOMFORT PLUS® TORIC DAILIES® COLORS DAILIES TOTAL1® DAILIES TOTAL1® MULTIFOCAL PRECISION1® Bausch + Lomb Products: Biotrue ONEday lenses Biotrue ONEday for Astigmatism Contact Lenses Biotrue ONEday for Presbyopia Contact Lenses Bausch + Lomb ULTRA contact lenses with MoistureSeal technology Bausch + Lomb ULTRA for Astigmatism contact lenses Bausch + Lomb ULTRA for Presbyopia contact lenses SpecialEyes Custom Contacts Gas-Permeable Lenses Rigid, gas-permeable contacts are available for patients who require this specialty product. Color Contact Lenses Stunning daily-disposable and monthly-replacement color contact lenses are available to enhance eye definition and make eyes appear bigger and brighter. Advanced color technology allows patients to blend eye color for a beautiful, natural appearance. Lakeland Ophthalmology is fully stocked — so have fun sampling the wide range of colors! To learn more about Contact Lenses or to make an appointment, call us at 973-331-0300.

Patients with diabetes are at risk for developing retinal disease. Diabetic retinopathy can occur in patients with both type 1 and type 2 diabetes. Retinopathy progresses through two main stages, nonproliferative and proliferative. In the proliferative form, there is a growth of “new” blood vessels which can significantly increase the risk of sudden vision loss from bleeding. Retinal swelling (“macular edema”) can occur at any stage of diabetic retinopathy and is the most common cause of vision loss. It is important to detect diabetic retinopathy as early as possible so that treatment can be initiated. Diabetic eye disease is most commonly treated with stricter hemoglobin A1C control, injections (intravitreal anti-VEGF injections and intravitreal steroid injections) or with thermal (heat) laser. Hypertension, hyperlipidemia, and pregnancy can result in cases of retinopathy that are more severe and can further increase the risk of visual loss. It is important for patients with diabetes to have comprehensive dilated eye exams annually to detect any signs of diabetic eye disease. Early treatment is critical to prevent loss of vision. To learn more about Diabetic Eye Exams or to make an appointment, call us at, call us at 973-331-0300.

Tears function to protect the eyes and to keep them lubricated and comfortable. Dry eye is a disease of the tears and the surface of the eye that results in symptoms of discomfort and blurry vision. It occurs when the eyes are not sufficiently moisturized, leading to itching, redness and pain from dry spots on the surface of the eye. This may occur because the tear ducts do not produce enough tears, or because the tears themselves have a chemical imbalance. Severe dry eye can even cause damage to the surface of the eye. Dry eye is one of the most under-diagnosed ocular diseases, and yet it is the most common reason why patients go see their eye doctor. There are estimated to be 55 million Americans with dry eye disease. Osmolarity Dry eye disease occurs when eyes do not produce enough tears or when they produce poor quality tears. At Lakeland Ophthalmology, tear osmolarity will be assessed to properly diagnose dry eye and treat it appropriately. To measure tear osmolarity, a small sample of tears is taken from each eye. The TearLab unit measures osmolarity (the saltiness of the tears). As osmolarity in tears increase, ocular surface cells become damaged. Symptoms Of Dry Eye Many people mistake dry eye symptoms for allergies, climatic conditions or just “eyestrain.” While all of these may aggravate dry eye symptoms, they are not the cause. Dry eye symptoms may include: Blurred Vision Stinging Difficulty Wearing Contact Lenses Burning Tired Eyes Scratchy Sensation Tearing Sensitivity to Light Causes Of Dry Eye ENVIRONMENTAL CAUSES: Hot, dry, cold and/or windy climates High altitudes Excessive sun exposure Central heating Air conditioning Hair dryers Cigarette smoke Air pollution Air travel MEDICATIONS Allergy medications, especially antihistamines Antidepressants (e.g. amitriptyline, diazepam) Some blood pressure medications Parkinson’s medications Birth control pills Diuretics Beta blockers Sleeping pills Many pain medications Certain medications which regulate heart rhythm irregularities Decongestants CONTACT LENS WEAR Contact lens wear can dramatically increase tear evaporation, causing discomfort, infection, and protein deposits. Dry eye syndrome is the primary reason that patients are unable to tolerate contact lenses. DISEASES Sjögren’s syndrome – An immune disorder associated with dryness of the mouth, eyes and mucous membranes. The tear-producing lacrimal glands are damaged and tear production is affected. Meibomian gland dysfunction and blepharitis (treated with warm compresses and other medications) Lacrimal gland deficiency (can be treated with punctum plugs) “The Aging Process” – Tear flow normally decreases with age. Stevens-Johnson syndrome Parkinson’s disease Rheumatoid arthritis Lupus Diabetes Sarcoidosis Rosacea REFRACTIVE EYE SURGERIES Dry eye is the most common complaint or adverse event following LASIK. HORMONAL DEFICIENCIES OR CHANGES Thyroid conditions Hormonal changes in women Changes associated with pregnancy, oral contraceptives and menopause Decreased production of androgen Estrogen supplementation LOW BLINK RATE Blinking is critical in spreading tears over the surface of the eye and stimulating tear production. A chronic low blink rate is associated with dry eye symptoms. Computer use, reading, and watching TV are the three activities most commonly associated with a low blink rate. People usually begin experiencing dry eye symptoms as they age. Dry eye is not only painful, but it can also damage the eye’s tissues and impair vision. Fortunately, many treatment options are available. Non-surgical treatments for dry eye include: increasing humidity at home or work artificial tears and gel drops moisturizing ointment warm compresses (used to treat blepharitis) prescription drops such as Restasis, Xiidra and Cequa oral antibiotics such as doxycycline eyelid cleansing wipes topical steroid drops and ointments At Lakeland Ophthalmology, dry eye is often treated with punctal plugs (occluders). These tiny plugs, which can be dissolvable or made of silicone, block the tear duct, which is the drainage duct that carries tears away from the surface of the eye. Blocking these drainage ducts prevents tears from draining away too quickly. Just like putting a stopper in a sink drain, punctal plugs keep the tears on the eye’s surface for longer periods. This widely performed procedure is safe, quick and painless. The dissolvable occluders are completely invisible. can be inserted in the tear drainage ducts. Punctal plugs limit the egress of tears from the eye, allowing more of the tears to be available to moisten and protect the eyes. To learn more about Dry Eye Treatment or to make an appointment, call us at 973-331-0300.

Glaucoma is a leading cause of blindness in the U.S. It typically occurs when the pressure inside the eye rises, resulting in damage to the optic nerve and vision loss in severe cases. Open angle glaucoma often develops over many years without causing pain or symptoms. Patients may not experience any signs of vision loss until the disease has progressed to a severe stage. Some symptoms of glaucoma that may occur can include: Dry Eye Treatment | Diabetic Eye Diseases Blurred vision Loss of peripheral vision Halos around lights Painful or reddened eyes Risk factors for glaucoma include: Dry Eye Treatment | Diabetic Eye Diseases Age > 40 Diabetes Near-sightedness Far-sightedness African-American race A family history of glaucoma Those at risk for a closed angle glaucoma attack will be assessed with gonioscopy and anterior segment scanning laser imaging (OCT). To prevent an attack of narrow angle glaucoma, prophylactic laser peripheral iridotomy is performed. To detect and monitor glaucoma, Dr. Hirschfeld will check visual acuity, perform visual field testing, measure the pressure in the eyes, utilize gonioscopy to check the drainage outflow channels, monitor serial optic nerve photography, as well as utilize sophisticated scanning laser technology imaging and analysis (OCT) of the optic nerve and macular ganglion cell layer. Regular eye exams are critical to monitor the health of the optic nerve to continually assess whether glaucoma is present and if there is evidence of progression. Dry Eye Treatment | Diabetic Eye DiseasesOnce diagnosed, glaucoma can be treated, and further vision loss can be prevented. Treatments to lower the pressure in the eye include non-surgical methods such as prescription eye drops and medications, laser treatments, and surgery. To learn more about glaucoma or to make an appointment, call us at 973-331-0300.

A cataract is a common condition that causes a clouding of the eye’s natural lens, and affects millions of people each year, including more than half of all Americans over the age of 65. Cloudiness develops as a result of a buildup of protein in the lens. Cataracts cause a progressive, painless loss of vision. The lens clouds naturally as people age, causing them to see a gradual reduction of vision. Cataracts are typically considered part of the natural aging process. Other causes of cataracts include injury, certain medications (such as steroids), illnesses (such as diabetes), prolonged exposure to ultraviolet light, and smoking. Diagnosing Cataracts The doctor may perform a series of tests, including a brightness acuity test (BAT), in order to diagnose a cataract. Vision will be tested, and a dilated eye exam will be performed to examine the condition of the lens and other parts of the eye. The doctor may also perform tonometry, a procedure that measures the pressure in the eye. Symptoms Of Cataracts Patients with cataracts often do not experience any symptoms at first. As cataracts progress, patients may experience: Double vision Poor vision in bright light Seeing halos around lights Poor vision at night Yellowish tinged vision Frequent changes in eyeglasses or contact lens prescriptions Patients often complain of difficulty with the following: Night driving – especially with oncoming headlights Using a computer (especially spreadsheets) or tablet Reading a newspaper Seeing small print on a phone – checking texts and emails Reading print on the TV – sports scores and subtitles Seeing the cable box – trouble seeing the time and channel Reading fine print – expiration dates and medication labels Treatment Of Cataracts Laser cataract surgery is a minimally invasive procedure. No injections or needles are used. Numbing drops and mild intravenous sedation are used. LenSx Laser First, the laser is used to soften the cataract. Centurion Cataract Ultrasound After this step, the cataract is broken up by a tiny ultrasound that is placed in the eye through a microscopic incision. Next, the cataract is vacuumed out of the eye through a tiny tube. ORA System Once the cloudy lens has been removed, the ORA System is used to optimize lens implant selection. PanOptix IOL Next, the new arcylic lens (IOL) is folded up like a taco, and placed into the eye through another tiny tube. Once the new IOL is inside the eye it is unfolded and placed in the precise correct position. Surgery usually takes only a few minutes to perform and is painless for most patients. After the procedure, a clear plastic shield is placed over the eye. Patients return home shortly after the procedure. The eye can feel scratchy immediately after the procedure, and it is normal to be a bit light sensitive in the initial post-operative period. Dr. Hirschfeld will prescribe eye drops to help the healing process and to reduce the risk of infection. CATARACTS CloudyMONOFOCAL LENS Distance OnlyPANOPTIX LENS Distance and Details A variety of IOLS are available to help patients achieve the best possible results from their laser cataract surgery. Multifocal IOLs allow for full vision correction at near, intermediate and far distances, often completely eliminating the need for eyeglasses or contact lenses. Some IOLs correct astigmatism, allowing patients with astigmatism to be free from the glasses they have had to use for a lifetime. In short, laser cataract surgery is a modern miracle, curing patients of their cataracts while simultaneously being freed from their glasses. After cataract surgery, many patients are able to drive, attend sporting events and watch movies, as well as perform near tasks such as reading, computer work or crafts, without ever needing to pick up a pair of glasses again. To learn more about Laser Cataract Surgery or to make an appointment, call us at 973-331-0300.

The macula is the central part of the retina in the back of the eye that ensures that our vision is clear and sharp. Age related macular degeneration (AMD) is the leading cause of visual loss in the senior population of the United States. This condition causes deterioration—and possibly the eventual loss—of central vision. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of their vision. Macular degeneration does not cause total blindness because it does not affect peripheral vision. Risk factors include: Genetics Age Diet Smoking Sunlight exposure Symptoms of macular degeneration include:: A gradual loss of ability to see objects clearly A gradual loss of color vision Distorted or blurry vision A dark or empty area appearing in the center of vision There are two types of AMD, dry and wet. Assessing risk factors and evaluating the macula, via careful retinal examination and sophisticated diagnostic testing can help classify AMD into these categories. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss. To learn more about Macular Degeneration or to make an appointment, call us at 973-331-0300.

During cataract surgery, high-tech acrylic intraocular lenses (IOLs) are implanted in the eye to replace the cataract – the natural lens that has become yellow and cloudy over time. At one time, these IOL implants were unable to correct astigmatism and were only able to correct for distance vision, leaving patients dependent on reading glasses for any near tasks such as reading, using a cell phone or working on a computer. Thus, early lens implants could not correct astigmatism and were “monofocal,” meaning that they had only one focal point and could not adjust to varying distances. New advances in IOL technology have allowed for the development of the AcrySof Toric IOL, which corrects astigmatism, the AcrySof PanOptix multifocal IOL, which lets patients see clearly at all distances, and the extended depth of focus (EDOF) AcrySof Vivity IOL, which improves intermediate and near vision. The multifocal AcrySof PanOptix IOL and extended depth of focus AcrySof Vivity IOL can also correct astigmatism when it is present. Premium high-tech IOL implants are ideal for cataract patients who want to minimize their dependence on eyeglasses – patients who want to participate in leisure activities and sports without the hassle and inconvenience of eyeglasses. When undergoing laser cataract surgery, Dr. Hirschfeld and his team will work with each patient to determine which lens is best to reduce each patient’s reliance on eyeglasses so that they can enjoy long-lasting, clear vision.

Medical History. A comprehensive eye exam starts with an assessment of each patient’s medical history, including an understanding of prior ophthalmic diseases and procedures. Allergies and systemic medical conditions are reviewed. Conditions such as hypertension, diabetes, and autoimmune disease can affect the eyes. Similarly, eye exams can help patients and their physicians understand whether systemic conditions are adequately controlled or whether they are adversely affecting the eyes and other organs in the body. Visual acuity is measured (the ability to read an eye chart), is measured. Intraocular pressure of the eyes is assessed. Color vision test. A color vision test may be used to assess your ability to distinguish between different colors. Refraction is a subjective assessment which helps to determine the appropriate lens power needed for each individual patient, whether they are nearsighted, farsighted, or have astigmatism or presbyopia. After refraction, an eyeglasses prescription is made available to each patient. Contact lenses may be fitted. A variety of contact lenses are utilized, depending on whether astigmatism or presbyopia is present. Pupillary function is observed, as is the functioning of the extraocular muscles which move the eyes. Tonometry is a test to measure the pressure inside your eyes. This test is used to screen for and manage glaucoma. Slit-lamp exam. This allows Dr. Hirschfeld to evaluate the structures in the front of the eye such as the eyelids, conjunctiva, sclera, cornea, and lens. Dilation. Drops may be placed in the eyes to dilate, or widen, the pupils. Dr. Hirschfeld will then utilize a magnifying lens to examine the eyes. Vision may remain blurred for 1-2 hours after the drops are placed. It is suggested to bring a driver, if necessary. After pupillary dilation, high-powered lenses are utilized to visualize the tiny structures inside of the eyes such as the retina and optic nerve. Visual field test. This test measures your side (peripheral) vision. It helps our doctors find out if you have lost peripheral vision. Additional testing may be needed based on the results of initial testing. This further evaluation may confirm pathology, clarify uncertain findings, or provide a more in-depth assessment. A comprehensive eye exam can take an hour or more, depending on the number and complexity of tests required to fully evaluate each patient’s vision and eye health.