Ophthalmic Partners

Ophthalmic Partners provide eye care services for patients in Philadelphia, Pennsylvania and the surrounding communities. Our board-certified ophthalmologists provide advanced eye care in the areas of cataract and refractive surgery, cornea and external disease, anterior segment, glaucoma and related disorders, and pediatric ophthalmology. Whether you are seeking a routine eye exam for your child or the latest advancement in corneal transplants and glaucoma surgeries, the physicians at OPP are prepared to meet your needs. Early detection of eye disease is the best defense against vision loss. Call our offices to schedule an appointment with one of our outstanding physicians. At Ophthalmic Partners, we offer the following eye care services: Cataract Evaluation and Surgery Cornea Surgery Diabetic Eye Care Glaucoma Treatments Laser Refractive Surgery Laser Vision Correction Tear Care Pediatric Ophthalmology and Strabismus Surgery Routine Eye Care Additional information is available from the American Academy of Ophthalmology, the world’s most trusted source of eye health information. Visit the Academy’s patient education website at www.GetEyeSmart.org.

Ophthalmic Partners provides cataract surgery for patients in Philadelphia, Pennsylvania and the surrounding communities. Rapid changes in surgical technology leave us with too many choices and insufficient information to make the right decision. Ophthalmic Partners is committed to working with each patient and individual. We will identify the significant issues, educate you about options, and help you choose the best. The physicians of Ophthalmic Partners perform an average of 3,000 cataract surgeries each year. In addition, Dr. Richard Tipperman focuses predominantly on cataract surgery, emphasizing higher-risk eyes and managing complications. WHEN IS CATARACT SURGERY INDICATED? The impact of a cataract can be subjectively assessed by how it affects your activities of daily living. In addition to progressive blurred vision and glare, cataracts can also cause impaired color vision and even double vision. A major concern is the loss of depth perception. Often cataract progression occurs so slowly (especially if both eyes are changing at the same rate) that patients adapt to their visual impairment and fail to notice. Testing can measure your compromised vision and the impact of glare, and in the early stages, changing your glasses may provide some improvement. Cataract surgery is most often indicated when your visual function no longer meets your needs, and your eye exam, combined with the results of diagnostic testing, suggests the likelihood of improved vision if the cataract is removed. In a small percentage of patients, surgery is indicated for the health of the eye or to facilitate the diagnosis and management of another ocular problem. WHAT IS THE IMPACT OF CATARACT SURGERY? The loss of visual function in the elderly is associated with a decline in physical and mental functioning, as well as independence in activities of daily living such as driving, reading, social and community activities, and household tasks. Visual function plays an important role in terms of mobility and is a significant factor in falls and hip fractures, which often lead to nursing home placement. Up to 90% of patients undergoing cataract surgery note improvement in functional status and satisfaction with vision after surgery in the first eye, with a significant reduction in the rate of falling and hip fracture. Similar improvement following surgery in the second eye has also been confirmed. Drivers with visually significant cataracts are also two to three times more likely to have an at-fault motor vehicle crash. Numerous studies show that physical function, mental health, emotional well-being, safety, and overall quality of life can be enhanced when visual function is restored by cataract extraction. Most people who choose cataract surgery are extremely pleased with the results. WHAT DOES CATARACT SURGERY DO? Cataract surgery removes the cloudy focusing lens from the eye and replaces it with an implant. Virtually every operation is combined with the placement of a new focusing lens called an intraocular lens implant or IOL, which is designed to remain in the eye forever. Many traditional implants improve vision at one focal point, so patients often continue to need glasses. Advanced Technology Intraocular lenses can decrease the dependency on glasses after surgery and correct astigmatism and presbyopia. Surgeons at Ophthalmic Partners choose from a wide variety of IOLs to address individual patient needs and desires. The strength or power of the IOL is calculated from measurements obtained at the time of your evaluation. If you are having cataract surgery, you have a number of intraocular lens focusing technology options: Monofocal IOLs are calculated to focus light at one distance. You and your surgeon can decide to aim for good distance vision, good intermediate vision, or good near vision without glasses. In addition to the patient’s desires, the most important issue is to choose an IOL so that both eyes work together without too much of an imbalance. Glasses are usually necessary after surgery to provide a full range of vision since the mono-focal corrects only one range. Blended vision/Monovision is a condition in which one eye is corrected for distance, and the other eye is corrected for intermediate or near vision. This requires the brain to shift into the clearer-focused eye while suppressing the blurred image in the fellow eye. Many patients tolerate this well and are able to function uncorrected for most activities. Toric IOLs are a type of mono-focal designed to maximize uncorrected vision quantity and quality by neutralizing pre-existing astigmatism, which is present in more than 30% of patients.

Ophthalmic Partners provides corneal disease treatment for patients in Philadelphia, Pennsylvania and the surrounding communities. WHAT IS CORNEAL DISEASE? The cornea is the clear, front part of the eye. It is the first structure that light must pass through to enter the eye and be focused on the retina, allowing clear vision. Because the cornea is responsible for about two-thirds of the light-focusing power of the eye, a problem with the cornea often leads to problems in vision. Corneal disease and conditions that damage the cornea include: Corneal neovascularization Corneal abrasion Infections Dry Eye Fuch’s Dystrophy Keratoconus Conjunctivitis And a number of other disorders. Many corneal conditions can be treated with medications while others may need surgery. WHAT DOES CORNEA SURGERY INVOLVE? Ophthalmic Partners offers several cornea surgery options: Full-thickness corneal transplant (Penetrating Keratoplasty): A full-thickness corneal transplant can be used to treat a wide variety of corneal conditions. In this procedure, a central, full-thickness button of the cornea is removed and replaced by a donor cornea of similar size. The transplanted tissue is typically sutured into position. The full-thickness corneal transplant is an excellent tool to restore vision, but recovery of the best vision can take as long as 12 to 18 months. Intralase Enabled Keratoplasty (IEK): This is very similar to a traditional corneal transplant. The major difference is that with IEK, both the diseased cornea and donor cornea are trephined (or cut) with a laser. The use of the laser allows for greater precision for transplant size and wound construction. This custom design may allow for faster healing and less post-operative irregularity in the cornea and does allow for greater wound strength. IEK is not for everybody, and only a detailed exam with special imaging studies of the cornea can determine if a patient is a good candidate for a laser-guided corneal transplant. Deep Anterior Lamellar Keratoplasty (DALK): DALK is an advanced technique allowing a partial thickness corneal transplant. In this procedure, the stroma and epithelium are selectively removed, leaving the very thin Descemet’s membrane and endothelium intact. Only donor stroma and epithelium are transplanted during this surgery. Visual rehabilitation with a DALK is similar to a full-thickness corneal transplant at 12 to 18 months. The major advantage of a DALK is the lower rate of rejection as compared to a full-thickness transplant. This procedure is an option only in conditions where the corneal stroma is diseased, but the endothelium is healthy, such as keratoconus, lattice dystrophy, and anterior corneal scarring. Descemet’s Stripping Endothelial Keratoplasty (DSEK): This is one of the more recently developed techniques in partial-thickness corneal transplantation. DSEK has been a revolutionary treatment for patients with endothelial conditions such as Fuch’s dystrophy and pseudophakic bullous keratopathy. In this procedure, a small incision is made in the patient’s cornea, and only the endothelium is removed. A thin slice of donor cornea consisting of stroma and healthy endothelium is then inserted into the eye and attached with an air bubble. Because of the small incision technique, recovery is greatly accelerated with DSEK. Patients rarely complain of discomfort after DSEK and vision is restored as quickly as 2 to 3 months. Keratoprosthesis (K-Pro): K-Pro surgery is for patients with severe corneal disease where multiple traditional corneal transplants have already failed, or there is no chance for transplant success. In this procedure, a synthetic cornea made of a special polymer is transplanted in place of a traditional cornea. This type of corneal transplant can give excellent vision to those previously with no hope of sight. However, medications and antibiotics are necessary for a lifetime Anterior Segment Surgery: Implantable Corneal Ring Segments (Intacs) are small rings that can be implanted in the corneal stroma and are used to reshape the cornea. Intacs have been shown to be beneficial for patients with keratoconus, both in restoring vision and allowing better contact lens fitting. Intacs are implanted through a tiny partial thickness incision in the cornea, allowing for more rapid recovery. Anterior Segment Reconstruction: Our surgeons at Ophthalmic Partners specialize in the repair of eye injuries from trauma or surgically induced damage. This repair includes the removal of traumatic cataracts, intraocular lens exchange or repair, and repair of iris defects due to injury. Cataract Surgery: We have doctors who also specialize in cataract surgery in those patients with corneal disease as well as repair of cataract-related complications. This includes implanted lenses for the correction of astigmatism and presbyopia-correcting lenses.

Ophthalmic Partners provides diabetic eye care treatment for patients in Philadelphia, Pennsylvania and the surrounding communities. WHAT IS DIABETIC EYE DISEASE? The most common diabetic eye disease is diabetic retinopathy. This is a disease of the retina in which blood vessels swell and leak. Soon they can no longer supply sufficient oxygen to the retina, and the body responds by creating new blood vessels that are abnormal and fragile. These begin to leak, causing loss of vision. In the early stages, symptoms are mild, but the disease can progress quickly into more severe stages of macular edema and complete vision loss. HOW DOES DIABETES HARM THE EYE? One of the main ways diabetes harms the eye is through a condition called diabetic retinopathy, but diabetes also increases risk factors for developing glaucoma, cataracts, and other issues. Everyone with diabetes, both type 1 and type 2, has an increased risk of eye disease. Pregnant women may also experience vision problems caused by gestational diabetes. WHAT SYMPTOMS SHOULD I NOTICE? If you begin to experience any indicators of eye problems, see a doctor immediately. These could include the following symptoms: Blind spots or shadows Floating spots in your eyes Double vision Blurry vision and difficulty focusing Pain in the eyes Loss of peripheral (side) vision Unexplained headaches WHAT IS INVOLVED IN DIABETIC EYE CARE? Because eye disease can be present among diabetics even when no symptoms are present, the most important preventative factor involved in diabetic eye care is a regular eye exam. If you have diabetes, a yearly exam (or more often in some cases) can identify potential risk factors and expose early evidence of eye disease development. A comprehensive eye exam includes a visual acuity test and a pupil dilation test so the eye doctor can observe the entire retina. Sometimes a fluorescein angiogram is performed to take photographs of the back of the eye. Diabetic eye care also means keeping a close watch on blood sugar levels and keeping blood pressure under control. Maintaining a good diet, along with taking certain supplements known to have beneficial effects on diabetic eye disease, is also important. If an eye disease is present, a number of treatment options are available depending on the disease and the stage reached. The best treatment for diabetic eye disease is prevention. If you have diabetes, Ophthalmic Partners can help you understand how diabetic eye care treatment can be effective in preventing vision problems and blindness.

Patients in Philadelphia, Pennsylvania and the surrounding communities can receive a range of glaucoma treatments from Ophthalmic Partners. HOW IS GLAUCOMA TREATED? Treatment for glaucoma is dependent on the type of glaucoma. For open-angle glaucoma, treatment usually entails lowering the intraocular pressure, typically with glaucoma drops or a laser procedure. Treatment is specific for each person so a laser may be appropriate for one individual while drops may be used for another. For patients with narrow angles, a laser can be used to open up the angle and prevent an attack of angle closure. This procedure is called a laser iridotomy and is performed in an office or outpatient facility. A small hole is made in the peripheral iris, which is able to be seen only at a slit lamp exam. WHY IS GLAUCOMA SURGERY NECESSARY? For some patients, drops or laser procedures are not effective in controlling the intraocular pressure or the glaucoma continues to worsen. In these cases, glaucoma surgery may be recommended. Although different operations and devices are available, most glaucoma surgeries attempt to allow drainage of aqueous fluid from the eye to a space outside of the eye-wall and under the conjunctiva. WHAT ABOUT ON-GOING MANAGEMENT FOR GLAUCOMA? Patients with glaucoma should be examined regularly and may require periodic glaucoma testing, such as visual fields or imaging of the optic nerve.

Laser vision correction is performed by Ophthalmic Partners for many types of vision problems experienced by patients in Philadelphia, Pennsylvania and the surrounding communities. WHAT IS LASIK? LASIK surgery is the most common solution used to correct refractive errors. Custom PRK (Surface Ablation) is similar to LASIK but uses some modifications for how the laser is applied to the corneal surface. Patients who are not good candidates for laser vision correction have other options, such as the phakic intraocular lens, to treat vision problems with implants. Refractive Lens Exchange (RLE) is effective for older individuals with presbyopia. Corneal inlay surgery may also be used to improve vision. These safe and effective technologies have been used for many years, and the procedures are fast and virtually painless. Laser vision correction continues to be the most common elective vision procedure performed. The surgery is done on an outpatient basis and takes about 15 minutes per eye. Vision improvements can be seen within 24 hours. Laser vision correction technology continues to advance, with new developments and improvements added regularly. Contact Ophthalmic Partners to book a consultation and learn how laser vision correction can improve your eyesight. A thorough eye exam will be performed to evaluate eye health, and the curvature of your cornea will be mapped. If you are a suitable candidate for laser surgery, the eye doctor will explain the procedure, including any preparations needed. Laser vision correction can dramatically improve your quality of life, with most people achieving 20/20 vision after surgery.

Ophthalmic Partners provides pediatric ophthalmology services to patients in Philadelphia, Pennsylvania and the surrounding communities. Keeping eyes healthy from an early age is the best way to prevent the development of eye disease, and ensure that vision problems do not interfere with normal physical development and education. A number of pediatric ophthalmology conditions are treated by Ophthalmic Partners including: Strabismus Amblyopia (Lazy Eye) Retinopathy of Prematurity Symptoms of Eye Problems in Children Symptoms of Eye Problems in Infants STRABISMUS (MISALIGNED) What is strabismus? Strabismus is the medical term used when the eyes are out of alignment. One eye may be drifting in, out, up, or down with respect to the other. This may occur at any age for many different reasons. What causes strabismus? In most cases, the cause is unknown. Muscle control is involved rather than muscle strength. In many cases, the condition is already present at birth or shortly after. How is strabismus diagnosed and treated? All children who have strabismus (except for the intermittent horizontal strabismus in the first 3 months of life) should have a complete eye examination performed. Usually, the strabismus is an isolated problem, but occasionally it may be a sign of more serious eye conditions or neurological disease. Even isolated strabismus can cause permanent vision loss if untreated in a child with amblyopia (lazy eye). Treatment of strabismus depends on a number of factors but may include eyeglasses or surgery. AMBLYOPIA (LAZY EYE) What is amblyopia? Sometimes referred to as “lazy eye,” amblyopia is poor vision in an eye compared to the other eye during early childhood. When one eye develops good vision while the other does not, the eye with the poorer vision is called amblyopic. It is a relatively common condition, affecting two to three percent of the population in the United States. What causes amblyopia? The three major causes of amblyopia are as follows: Strabismus or misaligned eyes is the most common cause. The misaligned eye “turns off” to avoid double vision, and the child uses only the better eye. Uncorrected refractive errors, where one eye is out of focus because it is more nearsighted, farsighted, or astigmatic than the other is another cause. The blurred eye essentially “turns off.” Amblyopia can also occur in both eyes if they are both blurred by a significant refractive error. An eye disease that causes clouding of an eye such as a cataract interferes with the ability of light to be focused which can also cause amblyopia. How is amblyopia diagnosed and treated? Early diagnosis and treatment are critical to preventing vision loss due to amblyopia. The earlier the treatment is started, the better the prognosis is for reversing vision loss. The best time to correct amblyopia is during infancy or early childhood. Sometimes amblyopia treatment is started and/or continued into the teenage years. Before treating amblyopia, it is often necessary to first treat the underlying cause. Glasses may be prescribed to correct focusing errors. Often glasses alone do not improve the child’s vision, and patching is necessary. This involves covering the good eye to force the child to use and strengthen the amblyopic eye. Left untreated, an amblyopic eye may never develop good vision and may even become functionally blind. Blocked tear ducts (nasolacrimal duct obstruction) Newborns may be born with blocked tear ducts. Typically this will cause excess tearing and frequent infections. This is a common condition affecting up to 10 percent of children. In most cases, it will resolve with time. Massaging the tear duct may help. If symptoms persist, the tear duct may be opened by an ophthalmologist when the child is six to 12 months of age. RETINOPATHY OF PREMATURITY What is retinopathy of prematurity (ROP)? ROP is a potentially blinding eye disease that occurs in a small percentage of premature babies. With ROP, abnormal blood vessels grow and spread on the retina, the light-sensitive tissue that lines the back of the eye and allows us to see. What causes retinopathy of prematurity (ROP)? Several factors can lead to ROP. The eye’s blood vessels do not typically finish developing until the final weeks before birth. As a result, the eyes of babies born pre-term may not be fully developed. In addition, premature infants are exposed to high levels of light, oxygen, and temperature changes which could further impact normal eye development. How is retinopathy of prematurity (ROP) treated? Sometimes these abnormal vessels shrink and go away without treatment. In other cases, they can lead to the following: Retinal detachment Myopia (nearsightedness) Amblyopia (lazy eye) Strabismus (misaligned eyes) Glaucoma (increased eye pressure) Vision loss or blindness

Ophthalmic Partners is pleased to provide the very best in routine eye care for patients in Philadelphia, Pennsylvania and the surrounding communities. Protecting the health of your eyes is extremely important and needs to begin at an early age. Vision impairment or vision loss can have a devastating impact on one’s lifestyle and can negatively affect normal child development. At an older age, diminished vision can hamper mobility, impair physical and financial independence and have profound psychological and emotional consequences on an individual’s quality of life. Vision loss is increasing and becoming a significant public health problem in the U.S., ranking among the top ten causes of disability. In many cases, however, early detection and treatment and good routine eye care can prevent or limit the progress of vision impairment and blindness among residents of Pennsylvania and New Jersey. HOW CAN ROUTINE EYE CARE KEEP MY EYES HEALTHY? You can ensure good eye health and avoid vision loss as you age in a number of ways: Eat a healthy diet that is rich in nutrients and vitamins known to promote eye health and good eyesight. Maintain a healthy weight to reduce risk factors. Quit smoking. Tobacco smoke has been linked to an increased risk of several eye conditions leading to blindness. Wear protective eyewear. Many workplace activities, sports, or home activities can increase your risk of eye injury. Know your family history, since many eye conditions are hereditary. Premature birth, exposure to infection in utero, and certain genetic conditions can also increase the risk of developing vision problems. Start having a routine eye exam at an early age. Vision is linked closely with learning, and children with vision problems often have trouble in school. They don’t know what constitutes normal vision and may not be able to explain the problem. If your child is having difficulties, a routine eye exam can help ensure normal vision development and academic progress. Adults who use corrective lenses should also have regular eye tests to keep prescriptions current and monitor for eye disease. Have a comprehensive dilated eye exam. A comprehensive exam will test all aspects of your vision, identify risk factors for developing an eye disease, or diagnose the presence of an eye condition. Eye doctors are often the first to detect the presence of diseases such as high cholesterol, diabetes, or hypertension through a comprehensive eye exam. WHAT DOES AN EYE EXAM ENTAIL? An eye exam will explore the patient’s history, including a family history of eye disease, medications used, and environmental or occupational hazards that may impact vision. A vision acuity test is performed to determine how clearly you can see at a distance of 20 feet, measured against the normal acuity of 20/20. Tests are taken to measure depth perception, color vision, the strength of eye muscles, pupil response to light, and peripheral vision. Refraction is done to measure whether your eyes need corrective lenses to improve nearsightedness, farsightedness, or astigmatism. Other tests measure eye shape and determine whether the eyes are focusing and moving properly. Finally, an eye health evaluation will assess the complete eye, looking for evidence of any disease. In a comprehensive dilated eye exam, the eye doctor dilates the pupil so that the back of the eye can be thoroughly examined. A pressure test is also done to determine glaucoma risk. AT WHAT AGE SHOULD AN EYE EXAM BE PERFORMED? If you’ve never had a routine eye exam, it’s important to do a benchmark comprehensive exam by about age 40, followed by regular exams every few years. If you wear corrective lenses, comprehensive eye exams are recommended more often. Children should have routine vision testing by the time they reach school age, particularly if they are experiencing learning difficulties or show evidence of vision impairment. Children at risk for visual impairment should be tested as early as six months of age.

Ophthalmic Partners provides laser refractive surgery for patients in Philadelphia, Pennsylvania and surrounding communities. A number of laser refractive surgery options are available, but laser vision correction (LASIK and/or Advanced Surface Ablation) is the most common surgical procedure used to achieve this goal. These procedures utilize the excimer laser to painlessly reshape the cornea, correcting nearsightedness (myopia), farsightedness (hyperopia), and many forms of astigmatism. The Intralase laser can also be used to create a laser-guided LASIK flap so that no metal cutting blade is necessary. This “all laser LASIK” affords our patients an added layer of precision and safety during their laser procedures. Astigmatism may also be corrected with astigmatic keratotomy (AK), which is sometimes used in conjunction with LASIK. WHAT IS LASIK SURGERY? LASIK stands for Laser-Assisted In Situ Keratomileusis. The surgeon begins by creating a hinged corneal flap, which is precisely cut to 110 microns, approximately the thickness of a hair. The flap is lifted to expose the corneal tissue underneath, and the laser is applied, usually for less than one minute. The flap is then repositioned over the cornea. The surgical procedure takes about 15 to 20 minutes for both eyes. Photorefractive keratectomy (PRK) is another refractive laser surgery that reshapes the cornea. WHAT IS THE PHAKIC INTRAOCULAR LENS? Some patients are not good candidates for laser refractive surgery, either due to corneal shape, thickness, or level of near-sightedness. In many cases, these patients can be treated with the placement of a phakic intraocular lens. In this procedure, a small implantable lens, similar to a contact lens, is placed in the eye without the removal of the natural human lens. Once implanted, it cannot be seen or felt by the patient. Phakic lenses can take care of a wide range of refractive errors, even beyond what LASIK can treat. Our physicians at Ophthalmic Partners have performed countless laser refractive surgery procedures, and have advanced training in laser refractive surgery as well as the repair of refractive surgical problems.

What is Dry Eye Disease? Our eyes need tears to stay healthy and comfortable. If your eyes do not produce enough tears, it is called dry eye. Dry eye is also when your eyes do not make the right type of tears or tear film. How do Tears Work? When you blink, a film of tears spreads over the eye. This keeps the eye’s surface smooth and clear. The tear film is important for good vision. The tear film is made of three layers: An oily layer A watery layer A mucus layer Each layer of the tear film serves a purpose. The oily layer is the outside of the tear film. It makes the tear surface smooth and keeps tears from drying up too quickly. This layer is made in the eye’s meibomian glands. The watery layer is the middle of the tear film. It makes up most of what we see as tears. This layer cleans the eye, washing away particles that do not belong in the eye. This layer comes from the lacrimal glands in the eyelids. The mucus layer is the inner layer of the tear film. This helps spread the watery layer over the eye’s surface, keeping it moist. Without mucus, tears would not stick to the eye. Mucus is made in the conjunctiva. This is the clear tissue covering the white of your eye and inside your eyelids. Normally, our eyes constantly make tears to stay moist. If our eyes are irritated, or we cry, our eyes make a lot of tears. But sometimes the eyes don’t make enough tears or something affects one or more layers of the tear film. In those cases, we end up with dry eyes. What is Tear Care? TearCare® is a 15-minute in-office procedure used to treat meibomian gland disorders. The sterile single-use flexible eyelid devices gently adhere to the contours of the patient’s eyelids and apply low heat. SmartLidTM technology works in conjunction with the blinking eye to facilitate natural meibum expression as the meibum melts. The TearCare® procedure is usually repeated every two years or every year. After TearCare®, we may prescribe a corticosteroid such as Inveltys or Lotemax SM for use twice per day.